Home Dialysis was the Best Gift I Could Have Given to My Husband!

In looking back over my late husband's multiple health problems, e.g., diabetes, cardiovascular disease, renal failure, peripheral vascular disease, etc., it's clear that quality of life was the thing that ultimately mattered most.

Steve Williams in 2009, on home
hemodialysis at the time

Home dialysis - first hemodialysis, and later peritoneal - offered Steve the best possible mobility, flexibility, and access to some semblance of normalcy. It gave him more time with his daughter, Brita, and more time with his many friends.

As strong advocates for home dialysis, Interior Designer Jane C. McClure and I have written the first of a four-part series on "Setting Up Your Home Dialysis Unit - Without Feeling Like You're Living in an ICU!" Check it out in the Patient's Voice Blog: http://bit.ly/1gv3Uuo

Remember, home dialysis can be an enormous gift. Learn to do it!

Linda Gromko, MD

Mid-Columbia Nephrology Seminar: Plenty of Content, an Abundance of Heart

In a well-orchestrated program led by Lyle Smith, MN, nephrology nurses and dialysis technicians from all over Washington and Oregon shared common - but challenging - concerns.

Held in Richland, Washington on October 20, 2013, issues covered included:

• What's the most effective way to dialyze? How do you discharge an in-Center patient who is violent or otherwise inappropriate? What do the lab reports mean to our patients?

Dori Schatell, Director of the Medical Education Institute and co-author of the exceptional resource, "Help! I Need Dialysis!" spoke on issues of sexuality and fertility in the kidney patient. How much dialysis is necessary for a pregnant patient? How can we help our patients talk about sexuality concerns? How can we address self-image matters that impact relationships in all areas of life?

Jane McClure and I spoke about "How to Set Up Your Home Dialysis Center (Without Feeling Like You're Living in an ICU)." As the advantages of Home Dialysis become ever more clear, our patients need help in setting up their Home Centers in ways that are life-affirming!

Nancy Spaeth, RN - always inspiring after four kidney transplants - spoke about her experiences as one of the first Home Dialysis patients. She focused on the very real need for post-transplant patients to receive Physical Therapy and Physical Medicine care as part of their recovery.

It was a full and varied conference - plenty of content, and an abundance of heart.

Take care,
Linda Gromko MD

Medical Writing Seminar Participants to Get a Glimpse of Home Dialysis

At my September 22nd Field's End Writing Seminar "Just What the Doctor Ordered," participants will get an upfront look at many things medical.  We'll cover medical terminology, basic disease processes, medical slang, "who's who on the medical food chain," and a range of other topics.

We'll have a number of writing exercises, of course. Like this one:

"Compare and/or contrast the following photos of individuals undergoing kidney dialysis treatments."

This photo of Bill Peckham dialyzing on a rafting trip - while drinking champagne from a can(!) - begs for comment, in contrast with the photo below it! The lower photo was lifted from the Internet: some unidentified woman tolerating her in-center treatment.

 

 

 

 What a difference!

 

A photo contrast like this reaffirms my confidence in the superiority of Home Dialysis!

 

For more information on the Writing Seminar, visit www.FieldsEnd.org.

 

Take care,

Linda Gromko, MD

Field's End Medical Writing Workshop September 22, 2013

Join me for a Sunday writing workshop on Bainbridge Island:
Sunday, September 22nd, 1-4 pm, Bainbridge Island Library!

 



This workshop is intended to help participants incorporate credible medical content into their fiction and non-fiction writing.

 

 

Through writing exercises and discussion,we'll review

• Important medical terminology
• Who's who on the medical "food chain?"
• Medical dialogue and idioms
• The "flow" of an ER visit, delivery, surgery
• Basic disease processes
• Resources that can help you fact-check your own information.

Bring your questions and writing projects for a painless afternoon of medical attention. For further info, go to www.FieldsEnd.org.

 

Linda Gromko MD

New CDC Recommendations Show Reduction in Bloodstream Infections by Half!

Bloodstream infections are among the most common - and most deadly - complications for dialysis patients. A recent CDC report discusses dialysis protocols that were shown to reduce infections by about half. http://dialysispatients.wordpress.com/2013/07/02/fistula-first-keeps-life-saving-options-open/

Many of the CDC protocol recommendations were simple: just common sense. How often we appreciate just how rare "common" sense really is!
Here are some of the main points:

• When possible, start initial dialysis treatments via a fistula or graft - rather than a central IV line in the internal jugular vein (neck) or subclavian vein (chest).
• Follow a checklist for dialysis procedures. The CDC gives examples of these tools.
• Wash your hands (!).
• Use clean gloves.
• Use an appropriate antiseptic for cleansing the access site, e.g., chlorhexidine.
• Apply a recommended anntimicrobial ointment to dialysis access sites.

The first point, i.e., "Fistula First!" is probably the most important.

This is because central line infections are more serious - often involving resistant bacteria such as MRSA. Central line infections are costly - and potentially deadly. Plus, they can lead to complications like infections of the heart valves (endocarditis) or the bones (osteomyelitis).

And nobody needs such complications less than a dialysis patient!

Yet, roughly 80% of dialysis patients begin their initial treatments via a central line!

In the case of my late husband, Steve, there was no other option. When first diagnosed with Chronic Kidney Disease Stage 4 (CKD-4), we thought dialysis would be years to at least months down the road.

Then a perfect storm of three calamities (dental abscess, sinus infection, and bronchitis) precipitated a free-fall into CKD-5 - over a period of only two weeks. This was way too fast for a fistula or peritoneal dialysis catheter.

But most patients don't fall into "kidney hell" as quickly as Steve did; there really can be time to plan ahead!

Please take a look at my Dialysis Patient Citizens blog, "The Patient's Voice," for more information.

If you're heading towards dialysis, give yourself every advantage. And make sure you and your dialysis center are following the CDC guidelines.

Take care,
Linda Gromko MD

Mark Bittman Offers a Rational "Part-time Vegan" Solution at the Northwest Kidney Centers 2013 Breakfast of Hope

If eating healthfully and maintaining a normal weight were, well, a piece of cake, we'd see less End Stage Renal Failure - fewer people on dialysis!

Why? Because the two leading causes of CKD-Stage 5 (End Stage Renal Failure) are Type 2 Diabetes and Hypertension (high blood pressure). And there's no question that both of these conditions are linked to overweight and obesity.

Mark Bittman, well-known author of many cookbooks and a NY Times columnist, presented his practical solutions at the NW Kidney Centers Breakfast of Hope on May 14, 2013.

Bittman, author of "How to Cook Everything," faced his own dilemma several years ago when his doctor pointed out that his weight was climbing and his cholesterol numbers needed improvement. His doctor suggested, "Become a vegan." (Vegans are a strict group of vegetarians who won't eat "anything with a face.") There go Ben & Jerry.

Taken aback, Bittman came up with an alternative: become a part-time vegan - or more specifically, "Be Vegan Until Six."

VB6 means that you eat vegan until 6:00 pm everyday - and then relax a bit.

It worked for Mark Bittman, as he watched his weight normalize and his laboratory values improve.

Is it the only way? Of course not! But Bittman presents a reasonable view: it's not "all or none." It is likely sustainable over the long term.

There are many ways to lose weight, but keeping it off is trickier. Google up the National Weight Control Registry, or read Ann Fletcher's masterful "Thin for Life" for more advice.

Remember, this is a marathon - not a sprint.

Thanks to Mark Bittman for his outstanding presentation and contribution to the Northwest Kidney Centers Breakfast of Hope.

Take care,
Linda Gromko MD
www.LindaGromkoMD.com

Sexuality and Renal Failure? Nephrology Social Workers Talk About It!

I was honored to present a discussion on "Sexuality and the Dialysis Patient" for the Conference of the Northwest Chapter of Nephrology Social Workers on April 25, 2013.

These Social Workers are deeply invested in their clients' wellbeing, and they know what they're doing.

Here are some important take-home messages:

• Sexual function is like the "canary in the coal mine." When the body isn't working well, sexual function suffers.
• The majority of End Stage Renal Disease is caused by Type II Diabetes and/or Hypertension (high blood pressure). Both of these conditions impact a person's over-all health.
• Many medications - including those used to treat high blood pressure and depression - may impair sexual function. But there may be alternative medications available.
• Kidney transplant is the Renal Replacement Therapy that is associated with the best sexual function.



Steve with his niece and kidney donor, Teresa

• The frequency and quality of dialysis both impact sexual function. Peritoneal dialysis and home hemodialysis may be superior to in-Center dialysis for greater normalcy of life in general - including sexual interest and functioning. 
•  Body image is critical to a healthy sex life, and there are some tricks for concealing and protecting a PD catheter or a precious fistula!
• Medications for erectile dysfunction can often be used in kidney patients, with two important caveats: they are contraindicated with certain BP medications (nitrates), and they must be dosed appropriately with impaired kidney function in mind.

Helpful tips for talking about sexual issues include the following:

• Rehearse if you're uncomfortable talking about sex
• Start with euphemisms ("How has your kidney disease impacted your marriage?")
• Normalize the situation ("Many people with kidney disease find that they are less interested in sex. What has your experience been?")

This group of excellent Nephrology Social Workers "got it" that sexuality isn't a "frill!" It's part of living a normal healthy life.

Take care,
Linda Gromko, MD

Is Home Dialysis for Everyone?

There's no question about it: Home Dialysis isn't everyone's cup of tea!

But if it IS for you, there are many advantages: flexibility, infection control, consistency in fistula access, comfort, the ability to travel, and most importantly - the ability to feel more in control of a life that feels as though it's spinning out of control!

But how do you know it's for you?

Please refer to the following link at "The Patient's Voice" blog: http://bit.ly/17nddGP.

There's plenty of help available. And the home dialysis programs don't just "turn you loose." You do need:

• 
   
  A shared commitment
• The ability to read and follow directions
• Manual dexterity and task-focused strength
• Ability to function under pressure - with help!

It's important to remember that if you do elect this route, the help that's available is extraordinary: from the training nurses at your center, to the1-800 lines available 24 hours a day.

Take care,
Linda Gromko, MD

33rd Annual Dialysis Conference Brings a Reunion with Steve's Home Dialysis Instructors

I had just given a presentation entitled "Caregiver Burden in Home Hemodialysis" at the University of Missouri's 33rd Annual Dialysis Conference, when Melinda Archide RN walked up to say hello. Later, a whole group of nurses from the Northwest Kidney Centers Home Dialysis Training Unit stopped by: Sarah Rassa RN, Theresa, and several others.

What a wonderful flashback to these dedicated nurses who held our hands and walked us through those first tenuous weeks of Home Dialysis Training! Melinda and Sarah were the nurses who trained Steve and me in doing our own Home Dialysis. For me, they were our lifelines. Patient, careful, complete: there was no question too ridiculous, never a fear too petty. All of our concerns were addressed with full consideration.

Several nurses involved in home dialysis came foreward after hearing Steve's story in my presentation to say, "This is why we do what we do."

Thank you to all the Home Dialysis nurses for doing what you do! Home Dialysis - and your consistent reassurance and support - makes it possible! You improve the length and quality of life for people on dialysis. I will be forever in your debt.

Take care,
Linda Gromko, MD

Here's a blog you might find interesting...

Dialysis Patient Citizens has a new Education Center, and I wanted to direct readers to the following site: www.dpcedcenter.org.

All primed and ready to run, this NxStage machine is
 the size of a small office copier. And it travels well!

I'll be writing a quarterly blogpost featured in the Patient Voice section. My first entry, posted last week discusses benefits of Home Dialysis.

My next post will discuss, "Are You Cut Out for Home Dialysis?"
Please join me and the other bloggers as we explore various topics pertinent to CKD.

Take care,
Linda Gromko, MD

UW Pre-Health Conference Gives Students a Look at Home Dialysis

UW and area high school students had the opportunity to look at a range of pertinent health topics, including kidney failure and home dialysis at the 12th Annual Pre-Health Conference held on 3/2/13. The Conference was sponsored by the American Medical Student Association (AMSA), the Minority Association of Pre-Health Students, the Undergraduate Students of Public Health Association and the Student Health Consortium.

 

Broad menu offerings included a suture workshop (bananas and pigs' ears), mock interviews, and a host of exhibits. "Give a Gift of Life" (bone marrow donation) was represented, as were Youthcare, "Save Your Boobies," Planned Parenthood, and the US Navy.

 

I conducted a workshop entitled, "Let Me Go When the Banter Stops: An Experiential Crash Course on Renal Failure."

 

I asked participants why they wanted to learn about kidney disease after lunch on a Saturday afternoon. One student had kidney disease in her family. Another was concerned because of its life-threatening implications. One was the son of a nephrologist, and wanted to hear more; one simply wanted to hear about something other than the OB-Gyn interests that seemed to occupy her mindshare.

 

I think they all learned that diabetes, metabolic syndrome, and chronic kidney disease are what they'll be treating in their careers down the road. And they all learned that home dialysis is a viable option to offer to patients.

 

It was energizing to interact with these bright young students; healthcare is in good hands!

 

Take care,

Linda Gromko, MD



Arrange2Live Introduces New Blog: Arrange2LiveWhenEverythingGoes2Health

When Interior Designer Jane C. McClure and I wrote Arranging Your Life When Dialysis Comes Home: The Underwear Factor, we could envision broadening our scope to other issues in addition to kidney disease.

Certainly, Arrange2Live grew out of a critical need: Steve and my need to have some peace and order in the midst of our Home Dialysis experience. While Steve and I eagerly embraced the technology of Home Dialysis, nothing could have prepared us for the onslaught of medical equipment and supplies that landed on our doorstep!

The NxStage Machine (upper left) was nearly swallowed up by
boxes of supplies, and those ubiquitous blue underpads changed the ambience!
 

Steve, Jane, and I made some important observations about bringing health care into the home. It was clearly needed and welcomed - and no doubt, it improved the quality of our lives immensely.

But just as when we welcome a new baby into a home, planning helps! Why don't we have Dialysis Showers?

Thus far, Jane and I have adapted our concepts to provide:

• Hemo and/or Peritoneal Dialysis for Steve in 5 different living spaces
• A functional "dorm" environment for Steve and me when Steve was completely disabled before he died in April 2011
• A welcoming bedroom for a couple after one of them developed a terminal brain tumor
• A move to Assisted Living for my 95-year-old Mom, using the furniture and furnishings from her home of 50 years.

Now, granted, it's been a mixed blessing to have provided the "lab" for many of these experiences. But Jane and I have gathered hundreds of tricks from our combined medical and design experience.

We welcome opportunities to speak to groups - particularly the Dialysis Community, and other health care providers - about bringing health care home. We are also pleased to provide consultation to those on the front lines of home care.

Follow us on our new blog:
www.Arrange2LiveWhenEverythingGoes2Health.blogspot.com.

Take care,
Linda Gromko, MD

ANNA Conference Felt Like Preaching to the Choir!

If anyone would have predicted ten years ago that I'd be talking to the Pacific Northwest Chapter of the American Nephrology Nurses' Association, I'd have thought them completely mad!

For me, nephrology was something I would learn "later." It seemed overwhelming in medical school. And when I would cover the Swedish ICU/CCU as a resident physician, I'd pray we didn't get called to a CODE in the NW Kidney Centers - those people were sick!

But, now, having traveled with my late husband Steve Williams through the precipitous tumble into Acute-on-Chronic Renal Failure, the home hemodialysis, peritoneal dialysis, and his litany of other medical adventures, I feel oddly at home. The kidney nurses are my colleagues, and I will be forever grateful for the hours of assistance they gave me and my husband.

A home dialysis treatment comes to a close.

Linda responds to a dialysis machine alarm - while
Steve watches cooking shows on TV.



Should you be attending the International Dialysis Conference in Seattle in March 2013, join me for my remarks on 1) Caring for the Home Dialysis CarePartner, and 2) "What My Husband's Kidney Failure Taught Me About My Own Profession."

Take care,
Linda Gromko, MD

You are invited....


Please join me for a reading

 

from

 

"Let Me Go When the Banter Stops:

A Doctor's Fight for the Love of Her Life"

 

 

Eagle Harbor Books

 

Winslow Way

 

Bainbridge Island, WA

 

Sunday, February 3, 2013

 

3-4 pm

 

Celebrate Valentine's Day with a True Love Story!