Patient Care First

​The aroma of the clinic was not one that was familiar to me. It was odd, and was the first thing I noticed upon entering the treatment floor to tour the clinic after my interview. The patients were consistent throughout the clinic; eyes closed, bodies covered with thick blankets. I proceeded into the reuse and water room where I was immediately intimidated by the components. The clinic manager was kind in reassuring me that eventually all of what I was seeing would be understood in time and I’d master each task as time progressed. Despite my fears and uncertainty, I accepted the offer to begin my career as a Hemodialysis Patient Care Technician. Several years later, I transitioned into a regulatory role and worked for the Department of Health as a Federal and State Licensing Surveyor.

Understanding the rules and regulations that govern the many types of healthcare facilities throughout the state intrigued me. The Centers for Disease Control and Prevention (CDC) defines infection control as “infrastructure and routine practices for occupational infection prevention and control services” (2019). Adherence to infection control practices can reduce patient hospitalizations in outpatient settings. We as healthcare providers have a responsibility to abide by exceptional infection control practices. Dialysis policies and procedures are in place to protect the health and safety of patients. Continuous education and training related to infection control is key to decreasing the risk of infection to our dialysis patients.

​In addition to state rules, dialysis clinics must also adhere to the Centers for Medicare and Medicaid (CMS) regulations. Most of the population of dialysis patients have Medicare as their primary payer for dialysis services. For this reason, CMS has many regulations that dialysis clinics use as a support to comply with Federal regulations. Our clinics are surveyed every two to three years by CMS to ensure that they are in compliance with the basic requirements for continued certification, or Conditions for Coverage (CfCs). The CfCs vary depending on the provider type such as Hospice, End-Stage Renal Disease, Ambulatory Surgery Center, Rural Health Clinics and many more.

Dialysis providers have strict guidelines that must be practiced in order to ensure that patient safety is paramount in the patient’s daily care. Every patient must keep their access site uncovered during treatment. This may be uncomfortable for some patients because they are usually cold and like to be completely covered. Access sites must be visible so that the dialysis care team can see that the needles and lines are not dislodged, which can cause serious complications. Safety checks are also a guideline mandated by CMS under the CfCs. Every thirty minutes, staff must visually check and document the patient’s status during treatment. Some of these checks include ensuring that the access site is visible and intact, what the patient is doing (resting, reading, watching tv), bloodlines are secure and also reviewing the patient’s blood pressure and heart rate. Dialysis treatment documentation should tell the story of what happened during the treatment and how the patient responded to treatment. Documentation should never be left to interpretation.

Over the years, dialysis has changed and will continue to change as research evolves and new treatment options become available to patients. We as healthcare providers endeavor to move with the times, continuing to excel and advance in our respective disciplines. We have a responsibility to be in compliance with our local, federal and state organizations. Our patients deserve the very best patient care delivered in excellence and compassion, never compromising quality and value-based care. Our commitment to our dialysis patients can ultimately help provide a meaningful lifestyle that extends beyond the walls of the dialysis clinic. When our patients feel better, they show up as better people for their families and loved ones. Let us never compromise our integrity and work ethic for company metrics. Value-based, quality patient care should always be our motivation to continue in the wonderful work that we do for our patients every day.

Twana Staley

Facility Administrator

Fresenius Medical Care North America

“ I Don’t Know About This!”(A Patients Initial Dialysis Treatment) Pt. 5

“Well this is a great lesson for you to learn as a Renal Patient, I mean as a Dialysis Patient”.,” I first want you to visualize this thing we call dialysis is like a Tune Up / Oil Change to your body like a car. It’s just that instead of maintenance for your car every few months, this is daily maintenance for your body. So let’s begin. As you notice with your cannulation sites…. Venous which is at the top or closest to you pointing towards your heart or towards you . In which it should at all times, and your Arterial  which is also pointed towards your you or your heart 1 1/2 to 2 inches apart from your venous needle in which it can also be pointed downward or facing your wrist or hand……. So let’s do a quick run down. The patient’s blood,( your blood) exits your body through these well insulated tubes or as you would say my lines in which is synonymous to your veins, goes through the blood pump segment which is right here…” That thing turning there Dwelyn?”, ..” Yes , that’s the blood pump which is at a speed of 400. Next while the pump is spinning or turning , a dialysis solution is already in progress so once your blood is returned to you it has already been processed for you to have a safe and successful treatment. Within this solution are numerous components that make this thing work. These components consist of Compressed air and CO2( Carbon), fresh dialysis solution, constant temperature bath, expended dialysis solution, in addition to your Semipermeable membrane which is your dialyzer which also can be considered as your Kidney which has two compartments . A blood side and a dialysate side. Within these compartments are Red Blood Cells, Blood Proteins, Salt ,and Waste Products …… “ Wait a minute, or two..!”” ,” I’m so lost that this is unreal. “ You lost me after the blood pump. All I see is my blood leaving my body from this part of my arm and coming back to me on this part of my arm.!” Sheesh man this is craaaaaazzzzeeeeee! “ I hate that I ever got sick. This is depressing let alone confusing.” “ Okay I apologize Mrs.AW, let me just try to explain inire of a simple term. This is only what YOU as a Renal Patient sees. Simple , your dirty blood is taken away from you through this human washing machine and given back to you clean. Three  times a week, for three and half hours to four hours a day, until…… ” Dwelyn , until what?” “ The until means either you may not need to come anymore or you decide not to come anymore. ,” AW replies ,” If I come for a week or two I may not have to come anymore?”. I reply,” Not exactly”. You see let’s take me for example. At this point in time in my life I don’t need dialysis , so my kidneys work twenty four hours a day for seven days a week . Yours is only working mainly three days a week due to the lack of function you have. For example, do you still urinate? AW replies,” Yes but just a weee bit.” , I reply,” So therefore the machine is helping you peee a weeee bit more. Kinda ! ( AW with a confused look on her face looks down in between her legs in hopes or hopes not to see urine down below ) As I laughed, “ Not only AW that the dialysis machine helps you urinate. It also helps you get rid of the toxins in your body. So we actually have patients here who urinate a lot , some do a little, some do frequently , some mildly , and some that do not urinate at all. ….” Wait Dwelyn, I know we are talking about a lot of  things here , and I’ll let you get back to this pump , and washing machine thing , but…… You Mean  ……. To Tell Me……There  are people in here who don’t pee???””” ( as she looks around the treatment floor), “ Huh, no way!” Yes Mrs AW. This is all true. That’s the sole purpose of HemoDialysis. To help patients remove fluid and remove toxins from their body.” ….. Okay so Dwelyn as we are talking I noticed that one of my lines was red and the other one was clear with nothing in it. So is it safe to safe that you’re taking ALL my blood , cleaning it and giving it back to me clean?” Not quite!  The process of Hemodialysis is to like I said before , remove fluid and waste products. However the process is only for a limited time at a gradual pace. In addition that takes precision of a Physician’s order. To piggyback off of what you said as far as removing ALL of your blood and cleaning it…. If that were the case you would not survive this process. “, “ Huh?? “ I’m very confused!”, Enlighten please.!”  Let me Break it Down to you AW. The process of Hemodialysis as far as blood cleaning we are only acquired to take one to one and half pints of blood out of your body during a specific time at a designed flow rate. Can you imagine if I took all of the blood from your body ( 1.2-1.5 gallons or 10 units ) , clean and give it back to you? Will you be patiently waiting ?” AW replies sort of loudly “ Boxcova!!!!

Disclaimer: ( Remember ladies and gentlemen, AW has Jamaican roots. Her using the term “ Boxcova!” Means she is surprised / overwhelmed/ in shock , or you may hear most Jamaicans say “ Bumboclaat)

Dwelyn I think this makes a little sense. So this machine here can only clean or wash me or my blood or whatever you say, a certain amount of time I come here?” And only a certain amount of my blood as well?” Egggggzaaaackllleee !” I replied….. 

“ So is that why we have to come here three times a week ? For these long hours…. Wait a minute…. That’s only three days a week and there’s seven days in a week. Only three to four hours a day when it’s in reality twenty four hours in a day… So what do I do when my body isn’t on dialysis? “ “ Do I just sit around and wait for my next visit? Should I drink a lot of water? Should I eat more healthy? “ AW I see you’re highly interested in this process. Well I can tell you that just sitting around hasn’t got anyone anywhere in life. As far as drinking a lot of water, that’s kind of tricky. As a Renal Patient you’re on a fluid restriction. Your diet is the most important key factor to your treatment as well as your health to progress.” AW replies,” I’m on a Fluid Restriction? I thought that the dialysis machine would take away all my fluids , remove my toxins, clean my blood and give it back??” “ You did say that right?” No, remember as we discussed earlier, only a certain amount of blood and fluid removal will be processed during your time here. “ Okay Dwelyn, so what if I came everyday ?” Oh yeah also , explain to me this dialysis solution stuff. And where is it ? 

To Be Continued……….

Kidney Friendly Sloppy Joe’s

When I was in elementary school we were served “sloppy joe” sandwiches.  They were just that…sloppy.  They were also salty.   As a kid, I didn’t even pay attention to the nutrient content of foods, but now I do.  There is a food product in stores that some folks use to make sloppy joe type meals, but the mix can be high in sodium.

This recipe is a lower sodium version with more flavor and freshness for a healthier choice.  This recipe is a good source of protein to add variety to your diet.   You can even make a larger batch and freeze in individual containers to bring out on days that you do not feel like cooking.

**This is a medium to high potassium food, so if your potassium is restricted, check with your dietitian before trying this.

“Sloppy Joe with Sodium Low”

Serves 6

2 lbs ground beef (85% lean or greater)

1 large onion, chopped

1 med. green pepper, diced

3 cloves garlic, minced

5 medium fresh tomatoes, peeled and chopped (or 1 can no salt added petite diced tomatoes)

1/3 c. regular ketchup

1/3 c. BBQ sauce (such as Sweet Baby Ray’s)

1 Tbsp. Toasted Onion and Garlic Chef Paul Prudhomme’s Magic seasoning (no sodium or potassium)

1 Tbsp. Sweet & Spicy Chef Paul Prudhomme’s Magic seasoning (no sodium or potassium)

1 tsp.  LS taco seasoning (from a low sodium taco mix pkt)

1 c. water

Add ingredients to the pan in order listed.  Let simmer for 25-30 minutes, stirring often.  Serve on a hamburger bun (like a Sloppy Joe) or by itself with other sides.

Carol Jones

M,RDN,CSR,CDO

Registered Dietitian

Certified Specialist in Renal Nutrition

Trying to Get Back to My Life

Many times when diagnosed with something such as Kidney Disease it seems that your life stops. There comes a time that you need to get back to life or you will lose the life that you have.

Anthony E Reed

There is a song that says “there goes my life.” This song summed up how I felt when I started on the journey of dialysis. It seemed that my world had crashed but now I felt more settled and it was time to get back to life. Getting back to life was a little more difficult than expected but here is what I learned about getting back to life

1. Appreciate the small things in life. The quote that is said so often “Stop and smell the roses” was more than a quote for me. It became reality and something that I started to live by and still live by this today.

2. Life is short and it is filled with all kind of experiences. I had good days and bad days but I have experienced more good than bad.

3. You are not guaranteed tomorrow-Enjoy today to its fullest.

4. Go for adventure. It’s much better than sitting at home and doing nothing.

One thing I needed to do is to get back to work. The reason for this is work gave me a purpose to wake up everyday. When I started asking when I could go back to work my medical team was in agreement but all options were giving to me. One of these was claiming disability. Disability instead going back to work. One of the big draws to this was that I could receive more money with disability than I could working but then what would the consequences be for me not going back to work? After weighing my options I decide that my mental health was a more value than money. Now for some this may not be an option and I would encourage those to find something to keep busy such as getting involved in your community or volunteering for a project or visiting family whether that be in person or in these times perhaps a weekly phone or video call. I also recommend getting involved with organizations such as NKF, AAKP or your local dialysis center. Finding a purpose in your life can help you a great deal.

It was good to go back to work even though my schedule was a little crazy. I started out with 4 hours shift and then worked up to 8 hours shift. Also put myself on the list to change my shift at dialysis. I had started out with a mid morning spot but was able to change to third shift which meant my treatment started around 5:00-9:00pm by having this time it meant that Monday, Wednesday and Friday night was off limits to work or any other activity but I would have somewhat of a steady schedule. I worked in retail at the time and my schedule was mediocre at best so that was a positive about dialysis is it steady my schedule to a degree.

While it was great to get back to work there were other things to get back to. Hanging out with friends and going to events that did not interfere with my dialysis treatment. Yes, it was great to get back to life but the realization hit me. It was not the life that I was used to, in fact, it was a new chapter one that was unknown yet had many adventures along the way.

Tune in next week as what started out as a innocent fishing trip ended up with a one week stay in the hospital, and don’t forget to subscribe so you don’t miss any new and exciting content especially the new Kidney Trails Comic Series that is just right around the corner.

My Why…..

Being a nurse is not for everyone, we often spend more time with our patients and their families than we spend with our own.  We miss holidays, birthdays and anniversaries because we are taking care of our patients and THEIR families.  We work long hours.  We work hours during the day, hours during the night and sometimes, we work hours during the day that become hours during the night and then again hours during the day. Twelve hours often becomes 18 hours and then 24 hours and even 48 hour shifts.  We are yelled at, hit at, spit on, bitten, bled on, peed on, pooped on and vomited on, and yet, we continue to be nurses.  We come back to work after the longest, hardest, most unbearable days.  We continue to come back when we are missing our families and haven’t seen them for days.  We come back after having to tell a family, their parent has died or telling a mother, her child is GOING to die.  We laugh and cry with the families of our patients, we hold their hands as they weep for their dying loved one.  And we sit at our patients bedside and silently shed tears as they take their last breath.  Why do we continue to do such a trying, emotional and many times heart wrenching job?  We each have our own reasons WHY we became a nurse, continue to be a nurse and LOVE being a nurse.  We have our own reason, our own inspiration and our own WHY.  

I have MY WHY.  My inspiration, my motivation, my drive and dedication and my PASSION for being a nurse.  A DIALYSIS nurse.  My DAD!  I had been an ICU nurse for 10 years and knew I was ready to make the move to the area of nursing I really longed to be a part of; DIALYSIS.  My interest in dialysis was for many reasons.  I knew I wanted to continue to care for critically ill patients. I had cared for many patients with varying degrees of kidney failure during my years in the ICU but my real interest was in learning to care for the patient in complete renal failure requiring the lifesaving treatments of dialysis.  My interests in this area stemmed from growing up with a dad who had been a dialysis patient for 9 years and then was one of the very fortunate ones’ to receive a kidney transplant. 

When my dad was a young child, he suffered a severe infection that destroyed a large portion of his kidney function and he was told, someday, he would require dialysis. Then in his early 30’s he contracted a bad Strep infection that knocked out his remaining kidney function making it emergent he started dialysis for survival.  Although he had been warned this would happen someday, nothing quite hits you until you are faced with needing an invasive procedure that will become the center of your life, with everything you do, revolving around that one, lifesaving procedure.  The first time my dad saw a dialysis machine, the tubing, the needles and the blood, he fainted!!  And when he woke, he said “I CAN’T do that!”.  But, not only did he do ‘that’, he fought to be ABLE to do that.  He literally had to FIGHT for his life and be GRANTED dialysis. This time in my dad’s life was in the 1960’s when Healthcare was very different from what we know today. Today, you need a procedure, a surgery, a special doctor, a hospital stay, you have it.  It’s not something most of us think about, the care is there if or when we ever need it.  This is not how healthcare has always been.  In the 1960’s, my dad lived in Seattle, WA and there was a very short supply of dialysis machines and beds to take care of the growing amount of patients who needed this life saving treatment.  The demand for this specialized procedure was grand, for although kidney machines were not new, the first one was built in 1912, they were suited for only short-term use.  So my dad found himself among the more than 100,000 chronic kidney patients in the United States who required dialysis three times a week.   How could so many patients in need of dialysis receive the treatments with so few machines available?  How would it be decided who would get the use of a machine?  And what would happen to the patients that couldn’t be given dialysis? 

Seattle Artificial Kidney Center, later named Northwest Kidney Center opened in Seattle, WA in January of 1962 and was the world’s first dialysis center.  A committee, The Admissions and Policy Committee, later known as “The Death Committee” was formed.  A committee of 7 “ordinary” citizens.  The committee consisted of 6 men and 1 woman.  A lawyer, minister, labor leader, surgeon, banker, state government official and housewife.   The committee was formed to decide who would receive the life sustaining treatments of dialysis.  They were faced with the wrenching ordeal of deciding who would live and who would die.  The committee looked at all aspects of a patient’s life.  It helped if you went to church, had a steady job, small children and a good, loving wife.  It did not help to be the loving wife or a person of color, or unmarried, or too old or too young.  The committee made the decision to narrow the field of dialysis candidates to Washington residents under age 45.  My dad fit!!  And so my dad went before this committee.  He went and fought for his life.  He fought to be deemed “worthy” of dialysis, worthy of living.  The Committee found his life was worthy and he was granted dialysis!!  He received dialysis for more than 9 years before he was given a kidney by his sister.  

I have always found it amazing, shocking and more than a little scary that this is what healthcare used to be.  A person’s life was judged worthy of receiving a treatment that would allow them to live or die.  Of the first 17 people who appeared to the “The Death Committee” in Seattle, 10 were granted dialysis and 7 were SENT HOME TO DIE.  I often pray and thank God my dad was not one of those 7.  When I was 18, my dad died from an accident at work.  He is one of the people in my life who has meant the most, had the biggest influence and helped me become the person I am today. He was an incredible, loving, caring, giving person.  He loved me and my brothers and sister as we were his own kids.   When I think about what it must have been like, what my dad must have felt, to go before the committee and wait, wait to be told if his life was WORTH being saved, wait to hear if his life would be deemed WORTHY of continuing to live.  I know WHY I became a nurse.  I know WHY my passion is with dialysis and WHY I care for my patients with the dedication, desire and LOVE I do.  I know WHY, when I have put in a 60-hour week and my scheduler calls and desperately needs someone to do ‘just one more run’, I do it.   Or, WHY when my phone rings at 3am, it’s the Answering Service, a patient needs treatment emergently, I force myself out of bed and I go.  Or, WHY I spend more Holidays with strangers, my patients, than I do my own children.  I know WHY I do what I do.   I know WHY because if my dad had the strength and courage to face what he had to, to face being told whether his life was WORTHY of living, I know I have the strength to do “just one more run”, I have the strength to get out of bed at 3am for a complete stranger, and I have the strength to spend Holidays without my family.  I know I can give just a little bit more of myself to help someone who is facing and doing something a lot harder, a lot more time consuming and a lot scarier than what I am doing.  I know if my dad, if my PATIENTS can have the strength and courage they carry each day, I too, can do a LITTLE MORE!  And I will continue to give and do just a little more so that someone else’s dad will be there for them and have the same impact and BLESSING on their life that my dad had on mine.

Brooke Shepherd

RN

Fresenius Medical Care North America

Singing on the Kidney Trail

There is an ancient story that says two men were in prison and though they were not in the most desirable place, instead of getting down in the dumps they started to sing. Soon after they started singing their feet were loosed in the stocks and not long after that they were released from the prison. What a wonderful story this is! Imagine being in a difficult situation and all you can do is sing even if no one else hears you it may help you on your journey.

So what does have to do with my story? Ever since I was little music, was a big part of my life from singing to playing musical instruments. At age 16, I started to learn the piano and took voice lessons. These music lessons not only helped me to enjoy music more but it would be a significant part in battling dialysis and kidney disease. Many times when I am hiking or on a trip, one way I pass the time is to sing. So it was on this journey singing and playing seemed to pass the time.

When I was sitting in the chair, it was a long four hours and many times encouragement was needed. So what would I do? SING of course, quietly at first. In fact, the first few treatments I sang quietly to myself but over time the singing would get a little louder until the staff and patient could hear me. Now lets say you walked in my dialysis clinic, at the time what kind of songs would you hear. Songs of encouragement ones that can uplift the spirt and give hope to the hopeless strength to the weak. Then there was Disney, sigh, yes I am a Disney song buff. I can still hear “A Spoonful of Sugar”, filling the room or “There’s a Great Beautiful Tomorrow” pouring out in my audience of the other patients and staff.

There are two stories about me singing come to mind. The first one happened on 3rd shift which I started treatment around 4:30-5:00pm. Now in this clinic we had a morning shift and evening shift staff and sometimes they would work the opposite shift. This particular afternoon one of the morning shift was taking care of me was not used to me singing. Not long after the treatment started I started up and my first selection that I wanted serenade my audience with was the Josh Groban Song “when you say you love me” and things were going great until part where he belts it out so what did I do I belted it out too. With in a few seconds the nurse came running in the room and asking was if I was “Ok”? Was I dying? Now keep in mind, she had never heard me sing and was not expecting it and knew nothing about me except what she read in the chart, and I am sure that no one ever put in the chart “Caution He Sings”.

The next story was similar but it happed early in the morning I had switched shift that day and and went in at 5:45am to start my treatment and around 9:00 I started up and must have gotten a little too loud because the nurse came over and asked me to sing more quietly. I asked her was it a bother she said no but the other patients were trying to sleep and she did not want them disturbed. Yup with that kind of answer I had bothered her and probably gave her a headache in the process. Ooops

There were other story’s to such as some of the staff and I would play the game name that tune or request song for me to sing. Music whether it was singing in the clinic or playing the piano in the middle of the night when the mind battle was severe, music gave me strength and hope to travel on.

What about now you may ask? Yes I still sing and play and it still does the same thing for me now that it did back then, in fact, even more for I understand that music that can heal the soul. Now what are you during a challenging time? Do you get under it or do you sing over it so to speak? I know that me choosing to sing even when I did not feel like it made a big difference in my outcome and it might for you.

Music can heal a broken spirt and uplift the down trodden to heights that you never knew existed.

Anthony E Reed

I am grateful not only for music but the ones that taught me about it for they truly made a positive impact on my life. Tune in next week as I would have to learn how to get back to life and not only get back but to go farther than where I had been, and don’t forget to subscribe so you don’t miss any new and exciting content especially the new Kidney Trails comic series that is coming very soon.

Anthony E Reed

CEO/Master Kidney Coach/Blogger

“ I Don’t Know About This !”( A Patients Initial Dialysis Treatment , Pt.4

Happy National Dialysis Technician Recognition Week 

Follow us on the Kidney Trails where the protein of knowledge never ends!!!

YEEEOOOOOWW!!!! “ ,” Oh my that kinda stung a bit!” ……….Ouch!!!””. Woooooo Weeeee….. This is madness!” (as she breathes heavily with eyes of disbelief) After I cannulated Mrs. AW with her fistula needles, flushed both of her access sites with heparin and normal saline, I had to give her a moment. “So Dwelyn , can I ask you something?”, “I understand it’s a needle, but why not just one? Why two? And will this be for every treatment I have? That’s 2 needles a day, 3 times a week, a total of 6 needles a week!!! “ I don’t even wanna think about it. I replied to Mrs.AW, “So sorry, but yes this procedure will require two needles each time, sometimes three Cannulation techniques and yes your mathematical calculations are correct with the numbers of needles and days and per week, give or take……” Wait , what do you mean sometimes three???? And give or take ??? “, “ Well what I mean by a possibility of three needle Cannulations instead of just two, simply because if myself or another staff member is unsuccessful with your Cannulation, we may have to insert another needle into your arm. “ No Maan!” “, I can’t beer eit( I can’t bare it was the phrase she used. Her Jamaican accent came into play. Like I said previously, Mrs.AW is very animated with her facial expressions)…. “ Well Mrs. AW, do you remember when months ago when you had your surgery for your access placement, your surgeon, or nurse, or anyone from the medical team explaining to you how important it is that once you have a fistula access, that exercising your vein is important for strengthening? When you do this throughout the day on a daily basis, it increases or as we like to say enhance the blood flow and improve arm vein tone. In this case it makes it easier for yourself and me or anyone of us here on the clinical floor to cannulate during your Hemodialysis treatment. Did you ever receive a squeeze ball in the shape of a ball or kidney? “ Mrs.AW replies , “ I remember vaguely, but a lot of things have happened the past couple of months. Ya know, when this Dialysis thing became a reality to me, or I guess once I’ve accepted it and left the stage of denial slowly, there’s too much to process in the moment and throughout. It’s a life change I’ve never could’ve imagined. So to answer your question, they may have told me but I forgot. “ Point Taken Mrs. AW, that’s why we are here to remind you and all of our patients about their care. We are family. “ Thank you Dwelyn. That helps because I have a lot going on.”, Understood, now let’s start your treatment and get this show on the road.!” ,” Wait, Dwelyn before you start, what was in those syringes you pushed inside of me?” , I think I could taste a funny taste in my mouth. Maybe I’m exaggerating( shaking her head) ………….( “ As I snickered with my reply. It’s amazing how all the years I’ve been a Nephrology Clinical Technician, the questions that are asked by our patients. I tell you , you never stop learning. I mean when you’re on this end of spectrum, and I mean when you’re the person giving the care, or providing the treatment. It sometimes never occurs to you the What If’s? Or you say to yourself,” I’ve never thought of that, hmm!” . Everyday is a learning experience)…….. “ Mrs. AW you’re definitely not exaggerating. Well in one of the syringes there was a medication of heparin. You have an order for three thousand bolus of heparin . The other two syringes were normal saline flushes. The heparin was prescribed for you to prevent from your blood clotting during your treatment and the normal saline flushes were used to test patency in both of your needle Cannulation sites. “ Dwelyn is my body of blood clotted? “ , “ Oh no I didn’t know!” And who is Payton!” “ LOL, no Mrs. AW, the heparin is only used for and during your dialysis treatment so not you as an individual’s body of blood clots off, but primarily for the system setup I have here in place for you. So once I initiate treatment for you, I will explain this process from beginning to end.” Now this Payton person you’re speaking of is pronounced “ Patency”. Which means we are testing for openness to your access, to detect any blockage, for myself to make sure my needle is tunneled properly, and most importantly to reduce the pain level for you and our patients while giving care. If the Cannulation isn’t tunneled properly, it’s a possible chance you could experience an arm infiltration. “ A what?” ,” Oh boy, there’s a lot words you saying I don’t have a clue about!” “ This is a lot !” ,” Don’t be alarmed. Remember I said we are family and we are here to remind and guide. “ An infiltration is like swelling of your arm access that can be very painful and traumatic. If the cannulation technique isn’t done properly and taken the proper time, we could have an issue. So it’s very important for us as staff members to follow the proper procedure to clean the whole arm access for both fistula and grafts for Cannulation, for everyone with a fistula to use a tourniquet, listen for the bruit with our stethoscope, and feel for the thrill. Everyone doesn’t have an order or prescription for heparin , but we must always test for patency. This process makes the treatment a little bit easier or more sustainable for our patients. And most of all it’s safe and clean….. ” Dwelyn I think I get it kinda. It makes sense once you explained it to me. I thank you. “, But I wanna ask , if you don’t mind… So this squeeze ball thingy is supposed to help my arm by me squeezing it all day everyday?”….. Indeed it does to help strengthen your arm vein.” So what if I get tired of squeezing?,” Well Mrs. AW , you don’t have to squeeze it all day, just maybe five minutes a day , each day. Or you could just make a repeated fist back and forth throughout your day when you’re just sitting around watching television, listening to the radio, taking a walk , shopping or etc….”. “ Makes sense Dwelyn. But I do have a bit of a circulation problem in my hands. Especially this hand where my fistula is. What if I can’t squeeze a ball anymore or lose strength in it?” Will my access give up, stop working or die?”…… Well I can recommend a device you could purchase online if you’re a online shopper.” …. “ Oh my! Yes I am an online shopper. I have nothing else to do with my life but go home and shop. I brought my iPad with me today because I didn’t know how long I was going to be here. If that’s okay.” ….. “ It’s definitely okay. Well I recommend a device, if you choose to purchase on Amazon to be exact. I myself know during this time of the COVID-19/ Coronavirus, a lot of people are shopping more online than ever before due to being safe. And all of our patients are at more risk with effects to their immunity. So I definitely get it with the precautions of social distancing. In your case as a kidney patient access care is highly important. The device is specifically for arm vein fitness, arm vein exercise, improve or endurance of the flow, increase the energy and strength of the arm vein for wellness, improve muscle size and tone………. it’s called Fist Assist!”……… Dwelyn this sounds amazing for someone like me who just simply can’t just squeeze a ball. But will I have to squeeze this Fist Assist thingy?” ….. No it’s fully automatic with the touch of a button once it’s wrapped around your arm. The comfortability of the device is manufactured with a Velcro strap to hold in place. It’s like it’s soft vibrations to your arm. Think of it as being Automatic For The People. All People…….. I love it. With this talk of improving my access and getting through this procedure has really helped. It makes it easier for me. I will definitely check into this Fist Assist Device later on.” , “ Okay great Mrs.AW, I will connect your lines from your machine to your access and we will start treatment.”…… ( After our brief conversation about access, I stop my blood pump, prime both my arterial by gravity and venous lines in the priming bucket with the pump on, stopped my pump, marry my lines together, clamp both venous and arterial, three clamps for my saline line, manage my pump segment to ensure it’s secured and locked, no transducers are wet, chambers full both arterial and venous, check my orders for Mrs.AW’s Treatment…..goal,time,dialysate flow,blood flow,profile ,sodium variation,acid and bicarbonate bath,….. I use a hemostat clamp one to her upper shoulder, applied tape around her upper arm, and once again checked my Dialyzer headers to make sure they’re tight and secure. We don’t want any leaks of water and most definitely no leaks of blood, I unclamped her lines and turn my blood pump up to 150 speed and then 200 speed slowly )…..Mrs. AW replies with eyes as big as the movie Roger Rabbit when he was excited or one of those keychain toys you squeeze and the head inflates…. …” Dwelyn, I have more questions.” “Where is my blood going and coming from my body????

Sign Me Up for a Kidney Transplant

Not long after being deemed officially ESRD, I started to consider what would be the best option for me and the answer came to me a kidney transplant. The reason I felt this was the best option was my age. I just could not see myself all through my 20s and beyond in the dialysis chair and I am sure that many young people would feel the same way. What young person, who have their whole life ahead of them, would want to go to dialysis three days a week at four hours a treatment, not many I can assure you.

As I woke up to get ready for the day, there was much anticipation for that day. My mother had decided to go with me not only as a support but it was recommended and necessary that a care partner attend. The reason for this is you will need a care partner after the transplant to help you as you recover. By going to this appointment, my mom was able to learn about the process and also take notes as well, which would benefit us both in the future. Once I arrived and checked in, we were taken to a class room to learn the basic about transplant and also what to expect for the day. As we entered class there was others there and each were learning about transplant, now this was not just kidney transplant center they do many other transplants as well such as lung, heart, pancreas and kidney. After the class was over I came out feeling more informed but also overwhelmed about the day ahead.

Not really knowing what to expect the appointments started, I met with the the whole transplant team. From the surgeon, to the nephrologist, to the social worker, to the financial coordinator, to the dietician and so on. Not only did I meet the team but also needed to do some test such as a chest X ray and blood work. The whole day felt like we were rushing around from test to appointment and from appointment to test. What a busy day and it just keep going on and on.

At the appointments, there were many words that were spoken that I did not completely understand. Such as active vs inactive what did that mean? What is the difference between deceased and living donation? Why do I need to do so many test are they really that Important? Can’t you just sign me up for a kidney transplant and I receive it now or will it take a few days, weeks, months or is it going to take years? So many questions and so many answers were given that day. This is one reason to have someone with you that can take notes.

During the appointment I still wrestled with that dialysis was my life and the only way to change it would not only to pursue a transplant but to receive a transplant. So how long did i have to wait before I was active on transplant list and receive a kidney. The first step is to get the testing completed and then the transplant team would evaluate me to ensure that I was a good candidate for transplant. Also the wait time is generally 4-8 years though it could be shorten if I was able to get a live donor.

Let me just stop here and elaborate a little bit on this. When it comes to receiving a kidney transplant there are a few options. There is deceased donation and living donation. A Deceased donor is someone that has passed and decided before they passed they wanted to be a donor. The next option is a living donor if you have or have found someone that would be willing to donate this can potently decrease your wait time.

At the end of the appointment there was still more test that needed done before I became active on the list but they were scheduled for another day so we headed home and would try to digest the information that had been given. No it was not as easy as going in and signing paper work and then I would get a kidney and it would be work to be able to reach that goal. At the end of the day, I started to learn that the journey is not about how fast you finish but if you had the endurance you can reach the top. Tune in next week to read how one of the nurses that took care of me learned very quickly that I was not as quite as they had originally thought and don’t forget to subscribe so you don’t miss any new and exciting content.

“ I Don’t Know About This!” ( A Patients Initial Dialysis Treatment)

“Follow us on the Kidney Trails where the Protein of knowledge never ends!”

…..Let’s step away from AW’s treatment for a few minutes. I want you to know and fully understand her. As a Nephrology Clinical Technician or as most would say Hemodialysis Technician, we sometimes forget that the individuals that we help take care of have other struggles besides experiencing Renal Failure. So what we don’t know about AW is that exactly year ago from this date of her first initial dialysis treatment, she made a visit to her Nephrologist . This was a visit that felt like lightning stuck. She was informed that she was in Stage 4 Renal Failure. In further detail of what I mean by Stage 4, is that their are five stages of CKD ( Chronic Kidney Disease) that unfortunately leads to an individual possibly needing dialysis to sustain and continue their lives. AW was in Stage 4 when she was notified by her Physician , meaning that she was at a severe and critical point in her life and she had to make a decision. The decision was to either to move forward with the process of starting Hemodialysis or let nature take its course…… Man I tell you when someone says to you ,” Let Nature Take It’s Course!”…… , the darkest of clouds move upon you, and you grow numb. It’s like the world comes to a complete stop. Like the iconic movie The Day The Earth Stood Still. So many thoughts run through your head. All the things you should’ve done. All the things you have done……All the things you could’ve avoided……All the things that were said…….All the things that could’ve been said……All the things you shouldn’t have said…….The people you lost…… The people you found……The people you never found….. The people you never will find……All of the places you’ve never been…… Possibly all the places you never will go….. ”Why is this happening to me?”…….. This last question was literally said by AW when she was admitted to the hospital three years ago with a minor stroke she suffered from. She said she remembers laying in her hospital bed shortly after her youngest son visited her and after he left. She felt alone , cold and in despair. Staring at the ceiling , she said to herself ,” God why is this happening to me? What did I do? I’m a good person!” ……..She told this to me in one of our conversations at the clinic. She said that she learned then from that point in her life that their is no answer to the question Why! Indeed we all have a story to tell. When we look into each other’s eyes. There’s so much mystery behind us. The saying that goes ,” The eyes are the windows to the soul “, couldn’t be more detailed than as it is stated. Especially since we all are wearing mask now, LOL. AW definitely has a story to tell. She has such Devine demeanor. AW wanted to pursue a career in law enforcement prior to her becoming ill. Growing up in Patterson, New Jersey at the age of 15, prior to that , born and raised in Spanish Town, Jamaica and Toronto, Canada, AW experienced many aspects of life at a young age. She was athletic and loved to run. Remembering one of her childhood events playing with friends the game of Catch A Thief , is where she was ignited with a spark to become a police officer. She was a very fast runner . As she always played the cop and wanted to protect others or in other words be the Savior, it was her calling . I failed to mention that at the age of seven , AW’s father was found mysteriously dead in Spanish Town,Jamaica…… Her father dying crushed her tremendously. A woman’s father is the first man in her life. One of the fond memories she had of her father was that every day when he arrived home from work , he would bring her and her sister a single white rose and a Almond Joy candy bar. Almond Joy was her favorite. Coconut and Chocolate was a combination to her palate that she dreamed of. Her father knew her all so well. Losing him was an unfulfilled empty space in her heart and soul. When the lost of a Father is taking away from a young lady , she could be in a complete dark place in her life with no sight of light. AW’s father was born and raised in Cuba and later moved to Jamaica prior to AW’s existence, where there he met her mother who was of Jamaican descent. So with that being said, I felt as though deep down within the debts of her soul, AW wanted to become a cop and made a vow to herself that she will honor her fathers death by catching the individual who murdered him. So now you know just a portion of AW’s story and what led her here to our clinic. Her seeing the Jamaican flag hung over her chair along with the number 7 at her station. Clearly explains why she stopped and stared and felt like this was home. And she no longer can run like she used to as a child growing up.

To Be Continued…….

The Battle Scar

This battle scar will be with me the rest of my life. It reminds me of the journey, the good times and bad times and from whence I came.

Anthony E Reed

Battle scars that is a strange title you may say. Why title? The next part of your story battle scars? After I was officially deemed ESRD I had to accept that a catheter was no longer my best option. It did well in the emergency but now I needed something more permanent, and also that was not prone to infection. A chest catheter has a higher infection rate and if at all possible, it is best to get it out.

Thankfully there was a better option. It was called a fistula. This was the best option for me and yes I wanted to get the catheter out of my chest. It was annoying to say the least. Let me try explain what it was like having a catheter. The first thing it would hang out of my chest and it was annoying trying to do my day to day activity and it would get in my way. Not to mention it made me a little self conscience because it looked as though one side of my chest was bigger then the other. Also I could not take a shower or a bath. If it got wet it was more than likely to get infected and I would get sick and then end up in the hospital for a one week vacation which I think many will pass on the hospital vacation.

So after talking to the nephrologist, I was referred to the vein clinic to be have something called vein mapping done. Basically a surgeon would look at my veins in my arm to determined which side would be the best to put it in. After this was completed it was decided that the fistula would go in my lower right arm. This was exciting for me, for my left arm was more dominant and I could use it with no hindrances. After the appointment and determining where the fistula would be placed my surgery date was set.

The day of surgery came and there was no doubt about it, I was nervous and not to excited either for this was the second surgery that I had faced in just a few months. My mom had decided that she would come and be a support. As we were sitting in the prep area the surgeon came and went over the the procedure. During the conversation, my Mom mentioned that I did not sleep much the night before, before the surgeon left she said that he would let the anesthesiologist (A doctor that helps with pain meds or sleeps meds during surgery) know so they would not have to wait so long for me to wake up post surgery. This seemed to be a great idea at the time but during the surgery I started to wake up, and happened to look down and saw my arm open where they were doing the surgery. Some may have found this terrifying but I thought it was interesting. They said he is waking up give him a little bit more meds. The next thing I remember is waking up in the recovery area. By the end of the my fistula was in but was worn out and went home and rested.

This was a unique experience. One that many dialysis patients have or may have to experience. There are two ways that people may look at a fistula. One is that my arm looks funny and deformed and it is a real bother or I have a battle scar and have a story to tell of what I have experienced and maybe can help someone else. There are many other things that I can share about my fistula and will do so in a later blog posts. Don’t forget to tune in next week for the next part of this amazing journey. Signing up for transplant. What a unique experience this was, and one you won’t want to miss. Don’t forget to subscribe so you don’t miss any new and exciting content that is coming up.