Well, we had a nasty storm the other night, and things look grim for the birdies.

The “West Wing” has we have begun to call it is vacated, and there are broken eggs on the ground. It’s unclear to us whether the storm caused this, or a predator finding its way into the nest after our addition of a chair to the front stoop.

Mama bird appears to have left for good though - I haven’t seen her in two days, and feel like maybe I should leave all this lovey-dovey bird stuff behind, and begin the task of throwing away their home, and cleaning all of their fecal matter off of our siding.

No.
The health care they receive is very very expensive, and you and I are paying for it.

Forgive me to not referring to these people as “undocumented workers” - they clearly are, but they’re also here against the law, making them illegal.

This issue seems so multi-faceted, it’s hard to find a “side” that makes sense isn’t it?

No, it isn’t.

I do however understand the people arguing for immigrant’s rights and such. Lots of great points are made about denying children vaccines and the helpless people affected by such actions. Throw in the fact that the country they’re coming from is doing nothing for them, and it seems so clear that they should be welcome here.

They ARE welcome here!
Nobody is arguing that Mexicans shouldn’t be allowed into the country. We’re saying that they should commit to becoming U.S. Citizens, and come in legally.
Almost all of us come from an immigrant family - my family arrived here only 60 years ago.

I’m PRO-Immigrant.
I’m also of the mindset that some sort of rules need apply to who comes into the country, and how.
People speak of the economic burden we will all incur if we no longer have such cheap labor. I’m sorry - more of an economic burden than we are currently carrying due to increased education and medical costs?

The medical part of this really gets me.
Should I be blessed with children, I will have to vaccinate them. I will also have to pay for it. As a dialysis patient dealing with chronic illness, I’m all to familiar with health care costs and the rate at which they can destroy someone.
Being chronically ill makes me uninsurable. Thankfully Medicare picks up a part of the tab, and with help from some other organizations, the rest of the tab gets picked up — for dialysis costs anyway.
I qualified for Medicare though, because I had already paid into Social Security for a predetermined amount of time. Otherwise I would most likely have Medicaid, and would still be “taken care of”.
As it is, I pay out of pocket for everything not dialysis related. If my wife becomes pregnant, or if I break my leg, we will have to pay for the care we receive.
Before someone yells “but you can afford it!” - no, we can’t.
It’s not really about who can afford it though. If American citizens regardless of their economic status aren’t privy to socialistic health care, why should illegal immigrants living here receive such treatment? Are we that enamored with cheap Big Mac’s and cheap produce that we’re willing to make such obvious, and glaring sacrifices?

Speaking economically, wouldn’t Mexico’s economy greatly improve if all their workers weren’t being encouraged by their government to leave? If their government were more proactive in encouraging people to stay and work, wouldn’t it give opportunity for economic growth?

Come here
Come here if you’re willing to be an American, and help to make America a better place, rather than taking advantage of it.
Otherwise you are insulting every single person who read The New Colossus on the base of the Statue of Liberty as they first arrived in this country.

I once wrote about why I’m awesome as a dialysis patient. It was meant tongue in cheek of course (I would never admit to being so awesome).
I’ve been thinking recently though - there are a lot of real “awesome dialysis patients” (or ADP’s as I will begin calling them).
I think I’m going to start keeping track. To be clear, people might be an ADP for various reasons, not just because of their fortitude or ability to tell a dialysis joke, but for any reason I deem “awesome”.

Bill Peckham
I’ve mentioned this man’s name before - and will again in the future I’m certain. This is a true ADP. Bill’s ambitious goal is to visit 50 different countries - wait for it -
…
while on dialysis.

Wow

Nor is this ambitious goal overly ardent; Bill has already visited 5 different continents, and has kept track of many of his adventures via pictures and writing in his blog.

Bill blogs at Global Dialysis, and has recently been featured in an educational dialysis video.
a great video for any patients interested in home modalities

Bill has done an amazing job of keeping his head up, and remaining active in the “kidney community”. He is an amazing support to people through his contributions to the dialysis_support list, and is inspiring and educating people daily through his willingness to share his knowledge and experience selflessly.

Kudos to you Bill - you are truly a role model for many of us.

Keep smilin!

Did you know that you can dialyze at home?
I realize that as a dialysis patient, the odds are that you know there people who dialyze at home. I’m even sure that most of you know you can do Hemodialysis at home.

In the last year or two a couple of very portable, very usable dialysis machines have hit the market for home patients.
It has been mentioned more than once on the dialysis_support list that there are numerable benefits to home dialysis modalities. Several patients there are utilizing the NxStage machine, and are enjoying the results.

The point of this post isn’t to explain these home modalities, or to get into the specifics of the machines (though I may try to do that in the near future).

The meat is thus:
I started looking at HomeDialysisCentral for information on home modalities, and ended up finding a national coverage map telling me exactly where which of the different home modalities was available.
Perhaps I’m being naive, but I figured such options must not exist here in Colorado, or I would have heard about them. I mean, why would a company such as DaVita who claims to lose money on Medicare dialysis patients, not embrace a modality which would significantly lower their cost of doing business?
I mean, they must not be in favor of such a thing or they would be making me aware of it right?

…

I mean … right?

____________________

So…..
after poking around a bit more I found that Colorado’s home-hemo coverage is provided by DaVita AtHome, the department of DaVita specializing in home modalities.
That’s weird, I would think they’d be trying to recruit me as a home patient. You’d think they’d at least be educating their patients to the options available to them!

How many patients out there are beginning and enduring dialysis treatments in-center simply because they’ve been told to?

I’m constantly encouraging patients to learn as much as they can about their condition and treatment. The reason is to avoid the negatives that come with any chronic illness, typically brought on by over-zealous physicians seeking to better you.
I wrote earlier this week about one such episode. While this particular procedure was recommended, I as the patient had the right to say “no” at any time.

We as patients can not afford to forget this.

After doing some research on the benefits of home dialysis especially for long-term dialysis patients, I’m amazed and appalled that we as patients have to find these modalities for ourselves. Why aren’t our physicians recommending this obviously superior alternative? I understand that perhaps people would still choose in-center dialysis due to comfort-level (I have been doing in-center for nearly 4 years now). Why though, are these people not even being made aware of these simple, superior home modalities such as the daily home-hemo done with the NxStage machine?

This is not a rhetorical question - I’d love to hear the reasoning behind it.

As I sit here listening to Young MC’s Roll With The Punches - I wonder how it is that a DaVita patient who has been proactive, interested, and prone to self care has not been made aware that DaVita itself offers some very new home-dialysis options?(!)

My guess is that it has something to do with the doctors themselves, and their relationship with the dialysis providers. The only thing that would change with me moving to home care (assuming it was the best option) would be the physician in charge of me. The provider (and recipient of my Medicare $$) would still be DaVita.

I can’t be so cynical - it can’t be so… There has to be another obvious solution that I am foolishly blind to at the moment.

Someone please fill me in.

Ahhh… the fistulagram.

No, this is not when a large blood-vessel shows up at your doorstep to deliver some candy and a friendly message from a friend.
Instead, it is a procedure in which your fistula is “checked out” from the inside.

Why Do One?

Normally this test is done to see if there are any problems inside the fistula, affecting its flow. For example, perhaps there is a stenosis (narrowing) of the vessel constricting the flow. Normally this happens further up the arm, as the blood is on its way back to the heart.

So What Do They Do?

Don’t let them fool you, it’s a surgical procedure.
Not very painful, but because of the surgical surroundings, it is a tad uncomfortable. You change into the hospital gown, sign the papers (the normal ‘I/my family will not sue you if I die right now’) and head into the room. In front of you is a large table with all sorts of goodies spread out on it.
I kept thinking to myself “wait, they said this was just going to be some X-Rays of my arm with die in it!” It was - it’s just that they like to freak you out a bit with tools, assistants, blue-paper wrapping everything, and oxygen pumped into your nose. “Why are they trying to calm me down with O2″ I thought to myself. “Is this going to be more invasive than I thought?”

Well, yes, and no. It was a surgical procedure, but I would have no problem doing it again (if I absolutely had to).
The reason they set it up this way is so that they can take care of any problems they may run into right then and there (narrowing, clotting, etc.).

So basically they thread a catheter into the fistula. The needle used isn’t any bigger than what’s used during dialysis procedure - so no real discomfort there. This catheter then dispenses iodine into the vessel, which is then bombarded with x-rays. I don’t know what sort of FPS this machine was capable of, but it seemed like it was probably taking at least 5 pictures a second. So you’re sort of watching x-ray video of the inside of your arm - followed by a rush of dark liquid which you see flow through your vessels, and through the fistula.

Awesome!

Well, yeah, but it would’ve been much more intriguing if I were watching someone else’s fistulagram take place. As it was there were a lot of Our Father’s going on.

What Did They Find?

Awww - the meat of this post.

My basic beef with much of the medical community for the last nine years has been their lack of sensitivity regarding almost everything they do. Doctors have become so preoccupied with quantity of life, that they have forgotten that their goal is quality of life. So it’s not uncommon to have an entire team of physicians chasing something in you that doesn’t exist - or is posing no real problem.

This test was ordered because my KT/V value was a bit low, and my potassium was a bit high. Both out of the acceptable range, but not by a large margin. Rather than re-draw the tests, an invasive procedure seemed the logical answer. When I questioned this the answer was essentially “well, you’ve never had a fistulagram.” As in, it almost felt like “why not?”
Yes, it was explained to me that low KT/V and high potassium were definite indications of lowered blood flow through the fistula - but rather than re-draw these two simple tests, it was decided that there was no reason not to do one.

The best was being told beforehand that they didn’t think they would find anything wrong. Was that said solely to comfort me? Why the lies? Obviously you think there’s something wrong or why am I going through this in the first place?

For the most part the test went alright, until they decided to take a look at the arterial side of the fistula. The Dr. inserted a new catheter in a new site going in the opposite direction towards the arterial anastomosis. Explaining what buttonhole technique was and why they should avoid these two particular sites was hilarious.
Nurse to surgical assistant after I requested that I be able to show the Dr. where to stick:

“He needs to show the Dr. his buttons, they’re a great access.”

*me rolling eyes*

“Uh - no … ‘buttonhole technique’ is the method I use to cannulate, it’s also called constant-site tech…. you know what? never mind - the point is, he needs to be at least one inch AWAY from these sites either proximally or distally, they are NOT accesses for him to use!”

So with the new catheter threaded in and going towards my wrist, they tried to create some back flow into the artery by partially occluding the fistula and squirting in some iodine. The thinking was that without the blood pulsing through the fistula, it would back flow into the artery, at which point they would see it entering the fistula, and check for blockage.
It didn’t work.
For the next hour, they tried over and over to occlude the fistula and squirt in more iodine. For some reason they couldn’t see the radial artery, or my arterial anastomosis (point of connection between the vein and artery).

After a bit of confusion as to how my fistula must have been created, they spoke with the surgeon who created it. His first question to me: “Why are you here?”
“Good question” was my reply.

So after a couple hours of poking and prodding, two very educated doctors decided that there was really nothing to be seen on this day. Both seemed to think - “Leave well enough alone”.

The trick will be convincing my doctors that this is the best course of action. I can practically hearing them now telling me why I need an arteriogram to assure them that there’s no problem with my fistula’s in-flow.
For those non-medical types, the arteriogram is much like my fistula gram, only they feed the die in from the arterial side. Meaning that they must thread a catheter from my femoral artery (in the groin) aaaaaalll the way to my arm.

Needless to say I’m not going to be advocating for that particular test - nor will I be doing it unless there is some other evidence that it is needed.
I understand the need to catch things before they get out of hand. But are we perhaps being a bit over sensitive here?
Every time my KT/V has been lower they have wanted to do a fistulagram. For four years, I have said “No. Re-draw the lab.” And every time, the new KT/V value has been better.

Why would you use this one test if it varies so much? And why does it vary so much?
For one, time is factored into it - time dialyzed. So having a picky machine alarm all night greatly affects the accuracy of the KT/V. Or how long the tube sits in the back of the nurses station before being spun down. There are tons of factors - all of which can affect the accuracy of KT/V. Why then would you rely solely on this value?
“But your potassium was also high.”

Great, potassium - another test that’s very picky. Perhaps my potassium was high due to the extra helping of potato salad I had the night before you drew that lab? Potassium can build up VERY quickly in the blood stream, so having a slightly higher than normal potassium reading could be due to just having eaten something containing some potassium.

I should make it clear that there may indeed be a problem. I might be writing in two weeks time about my arteriogram, how painless it was, and how thankful I am we caught this so quickly.
I’m not always right (pretty much always though).
If these tests and procedures are really indicated, I have no problem going through with it.
I just can’t help but feel used on this one though. I felt it wasn’t necessary in the beginning, and now after a very uncomfortable day for my wife and I, we have no more information than we did before, and two doctors asking us why we even came in.

Forgive me if this is more venting than educational - I hope this information can help someone to ask “do I really need to do this-or-that test?”
As patients we have the right to do (or not do) whatever we feel is necessary. It is very important for you to fully understand what you’re going through, and not just follow along blindly.
Otherwise, at the end of it all you look back and realize there were many things you went through that you did not need to.
I know.