tag:blogger.com,1999:blog-42563775419902209172024-03-06T12:02:35.535-08:00LindaGromkoMDkidneycareLinda Gromko, MD is a family physician whose husband, Steve Williams, received five Home Hemodialysis treatments per week beginning in 1/08. He switched to Home Peritoneal Dialysis in 1/11. Sadly, Steve died in April 2011 - one week after a leg amputation. Dr. Gromko's blog explores issues of treating Renal Failure at home, making the treatments more user-friendly, and supporting the all-important caregiver in the family on Home Dialysis.LindaGromkoMDTransgenderBooks.blogspothttp://www.blogger.com/profile/18075274561545354491noreply@blogger.comBlogger173125tag:blogger.com,1999:blog-4256377541990220917.post-13128573075708734522016-01-30T16:00:00.002-08:002016-01-30T16:00:44.470-08:00Moving Over to a New Blog: From Kidneys to Gender Issues<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi8pq7tG9nUi-A21v5MOFqxjFNrYF71tEJKuOyk2OLOLI-Wb1r5rMBQnCXM2Ln66vOL4XJuN060UEq1PM1T_lXTW8kn5-N9wVaz0m6kJDhqzsQ5_n3aHNNOod9AiXsd8zoABL-O7tMUstU/s1600/Hands_2MB.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi8pq7tG9nUi-A21v5MOFqxjFNrYF71tEJKuOyk2OLOLI-Wb1r5rMBQnCXM2Ln66vOL4XJuN060UEq1PM1T_lXTW8kn5-N9wVaz0m6kJDhqzsQ5_n3aHNNOod9AiXsd8zoABL-O7tMUstU/s320/Hands_2MB.jpg" width="233" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><span style="font-family: Arial, Helvetica, sans-serif;">Jacqui Beck's "Hands" is one of many paintings featured</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">in <strong>Where's <em>MY</em> Book? A Guide for Transgender and Gender Non-Conforming Youth, Their Parents, & Everyone Else</strong> (</span><a href="http://www.jacquibeck.com/"><span style="font-family: Arial, Helvetica, sans-serif;">www.JacquiBeck.com</span></a><span style="font-family: Arial, Helvetica, sans-serif;">).</span><br />
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<span style="font-family: Arial;">Well, I'm taking a break from Kidney World; I may be back. I have written a new book dealing with Transgender Medicine, and am focusing on this fascinating aspect of health care. Seattle has the third largest population of trans folks in the US - and I have been doing trans medicine for eighteen years.</span></div>
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<span style="font-family: Arial;">I love the new book. Thanks to the paintings of Jacqui Beck, it's gorgeous. But it's also packed with practical information needed by transgender youth, health care providers, educators, social workers, etc. </span></div>
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<span style="font-family: Arial;">After three books dealing with kidney disease and dialysis, I'm pretty much out of the closet as a writer! Check the new book out on Amazon.com. I love to speak for groups, so please let me know if I can be of help.</span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;">Thank you for your support of the Kidney Blog. I so wish Steve were here to welcome the new book - he'd absolutely love it!</span></div>
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<span style="font-family: Arial;">Take care,</span></div>
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<span style="font-family: Arial;">Linda</span> <span style="font-family: Arial, Helvetica, sans-serif;">Gromko, MD</span></div>
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<span style="font-family: Arial;"><a href="http://www.lindagromkomd.com/">www.LindaGromkoMD.com</a></span></div>
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<br />LindaGromkoMDTransgenderBooks.blogspothttp://www.blogger.com/profile/18075274561545354491noreply@blogger.com3tag:blogger.com,1999:blog-4256377541990220917.post-80801082098606662015-11-05T11:35:00.001-08:002015-11-07T14:15:14.930-08:00The New Transgender Book is Here!<span style="font-family: "arial" , "helvetica" , sans-serif;"><strong><em>Where's MY Book? A Guide for Transgender and Gender Non-Conforming Youth, Their Parents, & Everyone Else </em></strong>is now available in paperback on Amazon.com. The e-book version will follow along later this month. </span><br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjSI105f5JJHvL2fqtrAjoOR-0XqDfHaHlA4rMFkIjSmG8LuEguOQ3HC-H08L8nbrFNPrt-Z8Uz2xDHuga6UbUtJmxcsoxdIo_kkXoKNmDGHglqK9RtIzv0ZYwtalLkj3Kx5xUirrD7IZk/s1600/Gromko_BookCover_Rev1.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjSI105f5JJHvL2fqtrAjoOR-0XqDfHaHlA4rMFkIjSmG8LuEguOQ3HC-H08L8nbrFNPrt-Z8Uz2xDHuga6UbUtJmxcsoxdIo_kkXoKNmDGHglqK9RtIzv0ZYwtalLkj3Kx5xUirrD7IZk/s320/Gromko_BookCover_Rev1.jpg" width="218" /></a></div>
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<span style="font-family: "arial";"></span><br />
<span style="font-family: "arial";">How Steve would have loved this book! He met a number of my transgender patients - always befriending them and wanting to hear their stories. Many of them mourned his death at only 61.</span><br />
<span style="font-family: "arial";"></span><br />
<span style="font-family: "arial";">How does this relate to kidney disease? </span><br />
<span style="font-family: "arial";"></span><br />
<span style="font-family: "arial";">My earlier books were prompted by a need to chronicle my husband's experiences with end stage renal failure and home dialysis, using that ferry commute time from Seattle to Bainbridge Island to "process" what was going on in our complicated lives - and to educate others.</span><br />
<span style="font-family: "arial";"></span><br />
<span style="font-family: "arial";">I always thought that dialysis - particularly in-Center hemodialysis - represented a state of singular vulnerability. For transgender clients, that vulnerability is increased. Many trans clients are forced to educate their health care providers about the delivery of "trans competent" care. </span><br />
<span style="font-family: "arial";"></span><br />
<span style="font-family: "arial";">So, check it out. It's not boring, and it's rated "R for Realistic!"</span><br />
<span style="font-family: "arial";">Take care,</span><br />
<span style="font-family: "arial";">Linda Gromko, MD</span>LindaGromkoMDTransgenderBooks.blogspothttp://www.blogger.com/profile/18075274561545354491noreply@blogger.com3tag:blogger.com,1999:blog-4256377541990220917.post-83222896156701700712015-09-20T12:09:00.001-07:002015-09-20T12:13:15.574-07:00Single Needle Dialysis: Something I Learned at the University of Indiana Home Dialysis Conference<span style="font-family: Arial, Helvetica, sans-serif;">I attended the University of Indiana's conference September 17-18, <strong>"Building a Comprehensive Home Dialysis Program: 'The Road Home.'" </strong>I gave a presentation entitled "Caring for the Partner."</span><br />
<span style="font-family: Arial;"></span><br />
<span style="font-family: Arial;">During the patient panel, I learned about the Medisystems double-lumen needle. The exterior lumen is 14 French, and it houses a more narrow needle inside. It is FDA-cleared for use in the US, and is currently undergoing pilot testing in 5-6 centers. It is hoped the double-lumen needle will be more generally available in January 2016. </span><br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjY0Jc8S9CYYh3XKT-a8j7r55IYlFB2YL-i0HMinMWc2fG1BRwYY-lY1NRUnyr7eC1jaoAxngD5NMVeLuNpLF37NZKzsUXF2E1WXnIiG8UEAbZx4sTa-RW4qbj2nnBqazen3h5TvJpOO5o/s1600/Kidney+patient+UofIndiana.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjY0Jc8S9CYYh3XKT-a8j7r55IYlFB2YL-i0HMinMWc2fG1BRwYY-lY1NRUnyr7eC1jaoAxngD5NMVeLuNpLF37NZKzsUXF2E1WXnIiG8UEAbZx4sTa-RW4qbj2nnBqazen3h5TvJpOO5o/s320/Kidney+patient+UofIndiana.JPG" width="240" /></a></div>
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<span style="font-family: Arial, Helvetica, sans-serif;">Panelist Sharon Bradley holds the double-lumen needle in the photo above. She says it's "the best thing since sliced bread." Sharon had a very calm way about describing her home dialysis experiences. She seemed to take everything in stride - and was very clear about how home hemodialysis had improved her quality of life. NxStage should be hiring her as a spokesperson. </span><br />
<span style="font-family: Arial;"></span><br />
<span style="font-family: Arial;">No doubt, a single needle-stick would improve the experience for many!</span><br />
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<span style="font-family: Arial;">Many thanks to University of Indiana's Mike Kraus MD for coordinating a great conference.</span><br />
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<span style="font-family: Arial;">Take care,</span><br />
<span style="font-family: Arial;">Linda Gromko MD</span>LindaGromkoMDTransgenderBooks.blogspothttp://www.blogger.com/profile/18075274561545354491noreply@blogger.com0tag:blogger.com,1999:blog-4256377541990220917.post-83501896430301222152015-07-25T22:11:00.002-07:002015-07-25T22:11:35.610-07:00Shifting Focus to a New Book...<span style="font-family: Arial, Helvetica, sans-serif;">As a family physician, I've had an amazing range of experiences. I've seen so many different people, with so many life circumstances.</span><br />
<span style="font-family: Arial;"></span><br />
<span style="font-family: Arial;">For the past 17 years, I have been honored to serve the transgender community - with my patients ranging in age from 8 to 80! </span><br />
<span style="font-family: Arial;"></span><br />
<span style="font-family: Arial;">I am currently writing, <strong><em>"Where's MY Book?" A Guide for Transgender and Gender Non-Conforming Youth, Their Parents, & Everyone Else. </em></strong></span><br />
<strong><em><span style="font-family: Arial;"></span></em></strong><br />
<span style="font-family: Arial;">Look for it around Halloween! I guarantee you, it won't be boring!</span><br />
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<span style="font-family: Arial;">Take care,</span><br />
<span style="font-family: Arial;">Linda Gromko, MD</span><br />
<span style="font-family: Arial;"><a href="http://www.queenannemedicalassociates.com/">www.QueenAnneMedicalAssociates.com</a></span><br />
LindaGromkoMDTransgenderBooks.blogspothttp://www.blogger.com/profile/18075274561545354491noreply@blogger.com1tag:blogger.com,1999:blog-4256377541990220917.post-62782905742831099662015-02-22T10:18:00.001-08:002015-02-22T10:18:13.952-08:00Dori Schatell Introduces Practical New Tool for Dialysis Choices at 2015 ADC Conference<span style="font-family: Arial, Helvetica, sans-serif;">When my husband Steve was first diagnosed with End Stage Renal Failure, we attended the "Choices Class" at the NW Kidney Centers.</span><br />
<span style="font-family: Arial;"></span><br />
<span style="font-family: Arial;">It was an honest representation of the options available, but Steve and I quickly labeled it the <em><strong>No Good Choices Class</strong></em>. Simply, the choices were 1) Kidney transplant (not an option in the short run), 2) Dialysis (in-Center Hemodialysis, Home Hemodialysis, and Home Peritoneal Dialysis), and 3) No treatment. </span><br />
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<span style="font-family: Arial;">Steve quickly dubbed the last option as "Door Number Three," i.e., certain death in about two weeks with no treatment at all.</span><br />
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgY-wlGyNQM3d2k9MHBlVHxWz0NJngzv8I4wo1ZZr7sjQpUWakwcEq0Gyb6HM5nXNc-Kg-lHrSOR3CNepUnHiNW5JNaO9UPkP_r-m8kL7PWwkkqAVTTvyrrQD1dijigxhyUFhwDcg_YuzI/s1600/Dori+Dialysis+Show+1.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgY-wlGyNQM3d2k9MHBlVHxWz0NJngzv8I4wo1ZZr7sjQpUWakwcEq0Gyb6HM5nXNc-Kg-lHrSOR3CNepUnHiNW5JNaO9UPkP_r-m8kL7PWwkkqAVTTvyrrQD1dijigxhyUFhwDcg_YuzI/s1600/Dori+Dialysis+Show+1.jpg" height="320" width="240" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><span style="font-family: Arial, Helvetica, sans-serif;">Medical Education Institute Staff at the Annual Dialysis Conference</span><br />
<span style="font-family: Arial;">in New Orleans, February 2015</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;">Dori Schatell, Director of the Medical Education Institute and co-author of "Help! I Need Dialysis," introduced a new model for presenting dialysis choices at the ADC Conference. I think it has great merit.</span><br />
<span style="font-family: Arial;"></span><br />
<span style="font-family: Arial;"><strong>As all dialysis choices can sound overwhelming at first, Dori devised a tool that helps kidney patients identify what's important to <em>them,</em> i.e., flexibility, NOT having medical responsibility, dietary freedom, etc.</strong></span><br />
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<span style="font-family: Arial;">Then, after completing an on-line personal survey - with immediate personal results, an individual is better able to identify what method of dialysis would best fit with their own priorities and lifestyle. </span><br />
<span style="font-family: Arial;"></span><br />
<span style="font-family: Arial;">It focuses on a patient's life, rather than on a mix of choices that all sound burdensome at the outset.</span><br />
<span style="font-family: Arial;"></span><br />
<span style="font-family: Arial;">I like the fact that this tool feels empowering. When a patient is feeling overwhelmed and out of control, this tool brings a bit of control back to the patient. Win/win!</span><br />
<span style="font-family: Arial;"></span><br />
<span style="font-family: Arial;">Check this out at <a href="http://www.homedialysiscentral.org/">www.HomeDialysisCentral.org</a>.</span><br />
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<span style="font-family: Arial;">Linda Gromko, MD</span>LindaGromkoMDTransgenderBooks.blogspothttp://www.blogger.com/profile/18075274561545354491noreply@blogger.com0tag:blogger.com,1999:blog-4256377541990220917.post-85543569046789481572015-01-31T22:48:00.003-08:002015-01-31T22:56:14.682-08:00Learning from my Japan Visit: Part 2<span style="font-family: Arial, Helvetica, sans-serif;">It's amazing that I had the opportunity to go to Japan to talk about home dialysis. And it's particularly poignant because Steve spent years working in Japan - and had his health permitted, we would likely have traveled there together. I guess he really did take me there, at least indirectly!</span><br />
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhmjzMjuDZ6zcl7o61yNkFNSjP-dB4ezMjlu_dvlWUyrtav8RsnMrDkehVRRhiWh9N7_3K83yl0qiK_ZIBDTWfLOYYvkB6fF4np1CI4EWqIGZRMIG9a6N3UN7cVuRp22JsQergW27IgUr8/s1600/IMG_3480a.jpg" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhmjzMjuDZ6zcl7o61yNkFNSjP-dB4ezMjlu_dvlWUyrtav8RsnMrDkehVRRhiWh9N7_3K83yl0qiK_ZIBDTWfLOYYvkB6fF4np1CI4EWqIGZRMIG9a6N3UN7cVuRp22JsQergW27IgUr8/s1600/IMG_3480a.jpg" height="239" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><span style="font-family: Arial, Helvetica, sans-serif;">Linda giving a bookstore talk, with </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Steve's image on t</span>he PowerPoint slide</td></tr>
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<span style="font-family: Arial;">After speaking at Shizuoka, I traveled to Kyoto on the Shinkansen - the "Bullet Train." I saw the manicured Japanese countryside on my way to the University of Kyoto, where I was to speak to a group of medical students, residents, and nephrology fellows. They were impressed by the small size of the NxStage dialysis machine we used. They wanted to know how we kept Steve's spirits up. The answer? Weekly movies and a dinner out, courtesy of Access Bus!</span><br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjuPVGm7AzMbykXEnaX4_sPYDI5w9V6hptM-3QUxZfDeZz-M2qNkqqt-FGv7L7EUAFIsLt3-2RVtzjTpi5MhlTV9ajhNiq6hR9ZfqGpVcjlOsP879puqIiVOtdVLMtTl6TB3qmJT3ZOfPo/s1600/LG+with+Nephrology+Tour+Guides+at+Kinkajui+Temple+(1).jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjuPVGm7AzMbykXEnaX4_sPYDI5w9V6hptM-3QUxZfDeZz-M2qNkqqt-FGv7L7EUAFIsLt3-2RVtzjTpi5MhlTV9ajhNiq6hR9ZfqGpVcjlOsP879puqIiVOtdVLMtTl6TB3qmJT3ZOfPo/s1600/LG+with+Nephrology+Tour+Guides+at+Kinkajui+Temple+(1).jpg" height="240" width="320" /></a></div>
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<span style="font-family: Arial;">After my talk, the four nephrology fellows (specialists-in-training) shown at left took me to the golden Kinkajui Temple shown behind us. We had a remarkable dinner - with me eating my first-ever raw fish.</span><br />
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<span style="font-family: Arial;">Later, I was to have a most informative visit to the Sakai Rumi Clinic in Kobe. Dr. Rumi Sakai is passionate about dialysis; her daughter, Dr. Aya Kita jokes that "more dialysis" is her Mother's religion! </span></div>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgo6SW-c_RO4QwkFzfNPJno3gCbB4xDQn9SOJNUmV-YgRahuDz2Y-YHfZtvUm-UA-imUimdSRRDAhHBef2Sa1QeSJk-F7weLkQB6BnBU-Hpl8IjQCR-AmpK8ZjelCyE3Ce0Hwnzb4hisvU/s1600/Dr.+Rumi+Sakai+and+Linda.JPG" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgo6SW-c_RO4QwkFzfNPJno3gCbB4xDQn9SOJNUmV-YgRahuDz2Y-YHfZtvUm-UA-imUimdSRRDAhHBef2Sa1QeSJk-F7weLkQB6BnBU-Hpl8IjQCR-AmpK8ZjelCyE3Ce0Hwnzb4hisvU/s1600/Dr.+Rumi+Sakai+and+Linda.JPG" height="320" width="240" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><span style="font-family: Arial, Helvetica, sans-serif;">Dr. Sakai tells of having a patient</span><br />
<span style="font-family: Arial;">on dialysis for 40 years!</span></td></tr>
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<span style="font-family: Arial, Helvetica, sans-serif;">I mentioned in the previous blogpost that cadaver transplants are not accepted in Japan because of the Japanese observation that brain death occurs when the heart stops. Therefore, harvesting donor kidneys isn't done, except for a small number of living donors.</span><br />
<span style="font-family: Arial;"></span><br />
<span style="font-family: Arial;">My observation is that when dialysis is <u>what you do for ESRD, you have to do it very, very well!</u></span><br />
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For example, the blood flow rate in Japanese hemodialysis is much slower than in the United States. Surely, this must be more gentle on the dialysis access fistula! <br />
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In Dr. Sakai's clinic, patients have the option to do hemodialysis <u>every other day:</u> not the Monday, Wednesday, Friday regimen we do in in-Center dialysis. The three-day U.S. routine leaves patients with a long weekend to allow a patient to become volume overloaded, thereby increasing their risk of cardiac events during the break!<br />
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<span style="font-family: Arial, Helvetica, sans-serif;">Above, Dr. Aya Kita explains another feature of the Sakai Rumi Clinic. Each numbered cubicle allows a patient to dialyze in private overnight! They are monitored by video cameras, blood pressure recordings, and moisture detectors - in the event of an accidental disconnection. Patients are able to shower after their dialysis and go right on to work. To me, this seems like a great solution for people who do NOT wish to dialyze at home. Plus, it would allow for maximal facility utilization!<br />
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I am a staunch advocate for the use of home dialysis. But the more options we have, the better!<br />
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We're in this together, and we can make it better!<br />
Linda Gromko, MD</span>LindaGromkoMDTransgenderBooks.blogspothttp://www.blogger.com/profile/18075274561545354491noreply@blogger.com0tag:blogger.com,1999:blog-4256377541990220917.post-60843879781150301242015-01-31T20:45:00.003-08:002015-01-31T20:56:35.260-08:00Visiting the Japanese Society of HHD Conference, Part 1<span style="font-family: Arial, Helvetica, sans-serif;">In February 2013, I gave two presentations at the Annual Dialysis Conference in Seattle, and sponsored by the University of Missouri.</span><br />
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<span style="font-family: Arial;">After hearing my presentation on supporting the caregiver (care partner) in Home Hemodialysis, Dr. Ituko Masakane from Yamagata University asked me if I'd like to come to Japan. </span><br />
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<span style="font-family: Arial;">Japan! A lifelong dream. With an invitation formalized by Dr. Noriko Mori of the Department of Nephrology of Shizuoka General Hospital, I left Seattle on April 17, 2014. My topic: "Home Hemodialysis: The Best Gift I Could Give My Husband."</span><br />
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<tr><td class="tr-caption" style="text-align: center;"><span style="font-family: Arial, Helvetica, sans-serif;">Dr. Masakane, Dr. Gromko, and Dr. Mori after Linda's Talk</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;">What's it like to give a talk in Japan? Considering I speak about three phrases in Japanese - and we weren't planning on formal translation, it could have been rugged! But Dr. Mori was kind enough to translate my slides into Japanese. My audience was very kind and respectful.</span><br />
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<tr><td class="tr-caption" style="text-align: center;"><span style="font-family: Arial, Helvetica, sans-serif;">Here's the poster that advertised the conference I attended in Shizuoka.</span></td></tr>
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<span style="font-family: Arial;">We agreed that my late husband Steve, with his Metabolic Syndrome and Diabetic Renal Failure, would have been nicknamed, "Mr. Metabolic Syndrome." In Japanese, of course, that would have been "Metabol-San."</span><br />
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<tr><td class="tr-caption" style="text-align: center;"><span style="font-family: Arial, Helvetica, sans-serif;">My guides, Keiko and Masaki</span></td></tr>
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<span style="font-family: Arial;">Japan's ESRD culture is quite different from what I know in the US. For example, kidney transplantation is extremely rare. With a philosophical stance that does not allow for brain death as a criterion for organ harvesting, transplants are essentially limited to related living donors, not cadaver donors. </span><br />
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<span style="font-family: Arial;">For this reason, Japan leads the world in its proportion of hemodialysis. <em><u>Home</u></em> hemodialysis, however, occurs much less commonly than in America. There are approximately 400 patients on HHD in the entire country. This is where personal stories - like the story of helping Steve with dialysis at home - may be of help.</span><br />
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhz43yAKKMmEPieJt8u7KGUqXmH5nUP77HiKumQ4bBMT8O1JhCokns8skOkjKknTEOBgpW-lRRprzd6_WjWgNlbMCLu1wc3KY_Dy3H0N4QPsgk0xESS7vqzk6PENC3icI5hnMDH7SJTxd0/s1600/Dialysis+needles+sharp+and+dull+in+Shizuoka.jpg" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhz43yAKKMmEPieJt8u7KGUqXmH5nUP77HiKumQ4bBMT8O1JhCokns8skOkjKknTEOBgpW-lRRprzd6_WjWgNlbMCLu1wc3KY_Dy3H0N4QPsgk0xESS7vqzk6PENC3icI5hnMDH7SJTxd0/s1600/Dialysis+needles+sharp+and+dull+in+Shizuoka.jpg" height="320" width="290" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><span style="font-family: Arial, Helvetica, sans-serif;">Models of sharp and </span><span style="font-family: Arial, Helvetica, sans-serif;">blunt needles - </span><br />
<span style="font-family: Arial;">larger than life, but pretty much how Steve saw them!</span></td></tr>
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<span style="font-family: Arial;">It occurred to me that Steve had been told by a nephrologist, <u>"Dialysis is what you do until you get a kidney."</u> </span><br />
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<span style="font-family: Arial;">In Japan, dialysis is most likely what you do with End Stage Real Failure, period. From what I saw, though, there are some innovative approaches with tremendous merit.</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;">Check out the next blog post for my experience at the University of Kyoto, and - best of all - my visit to the Sakai Rumi Clinic in Kobe.</span><br />
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<span style="font-family: Arial;">We're in this together - and we can make it better!</span><br />
<span style="font-family: Arial;">Linda Gromko, MD</span>LindaGromkoMDTransgenderBooks.blogspothttp://www.blogger.com/profile/18075274561545354491noreply@blogger.com0tag:blogger.com,1999:blog-4256377541990220917.post-45912605174751690262014-09-30T20:40:00.002-07:002014-10-01T20:14:20.684-07:00Supporting Mom through the Night of her Death had Similarities to Assisting Mothers in Labor<span style="font-family: Arial, Helvetica, sans-serif;">My little Mom died this morning at 5:58 a.m. The night reminded me of my years of attending women in labor. Intense and personal, I think her death "went" as well as it could have gone.</span><br />
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<tr><td class="tr-caption" style="text-align: center;"><span style="font-family: Arial, Helvetica, sans-serif;">Mom and Dad - married for 50 years.</span><br />
<span style="font-family: Arial;">He died over 20 years ago.</span></td></tr>
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<span style="font-family: Arial;">My mother was nearly 97 - healthy up until April when she had two falls resulting in three fractures, and the need for a change in care from Assisted Living to an Adult Family Home. She was hospitalized a couple of months ago with a urinary tract infection - which highlighted the degree of her declining kidney function. (She was admitted with an eGFR of only 11, improving to the high 20's by the time of her discharge - and after considerable rehydration.) We all knew that Mom couldn't sustain this degree of hydration. She hated being in the hospital, pulling out her IV and begging to know, "Why are these women trying to hurt me?"</span><br />
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<span style="font-family: Arial;">My sister and I decided to involve the Palliative Care/Hospice Team. They'd provide the care that <u>could</u> be provided in the Adult Family Home, with the intention of delivering comfort - not cure.</span><br />
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<tr><td class="tr-caption" style="text-align: center;"><span style="font-family: Arial, Helvetica, sans-serif;">Mom holding me in 1951, with sister Bonnie looking</span><br />
<span style="font-family: Arial;">"delighted" about my very existence!</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;">Mom was treated as an outpaient for another UTI. Then, about 10 days ago, she began to show more confusion - and an ominous loose cough. This was pneumonia. Strong antibiotics, adjusted for her decreased renal capacity, didn't work.</span><br />
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<span style="font-family: Arial;">The cough grew more tenacious, and Mom grew weaker. She pushed away the oxygen that was offered, and pursed her lips together when food and fluids were attempted. </span><br />
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<span style="font-family: Arial;">On Sunday morning, my mother told me I looked pretty (something she wouldn't typically say). She had sweet visits with my sister, her granddaughter Michelle and great grandson Mason - and, of course, with my son Tim.</span><br />
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<tr><td class="tr-caption" style="text-align: center;"><span style="font-family: Arial, Helvetica, sans-serif;">Great Grandma Florence gets a visit</span><br />
<span style="font-family: Arial;">from Mason</span></td></tr>
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<span style="font-family: Arial;">But early Monday morning, Mom had no more words for me - just a sad straight-ahead gaze. Her focus was locked on the work of breathing. </span><br />
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<span style="font-family: Arial;">I moved through my clinic day, seeing patients and checking in with my sister by phone. I arrived at the Adult Family Home at 8 p.m. Mom looked more "serious" than she had that morning: still no eye contact. Everything she had was invested in breathing. I settled in for the night - just as I often did when I was delivering babies.</span><br />
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<span style="font-family: Arial;">I delivered hundreds and hundreds of babies over a period of 18 years - and I had been an OB nurse before that. There are observtions I made in those days that seemed to fit last night's process. For example,</span><br />
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<li><span style="font-family: Arial, Helvetica, sans-serif;">Birth has its own timetable; there are visual, verbal, and kinetic clues you learn that go beyond knowing the degree of cervical dilation.</span></li>
<li><span style="font-family: Arial;">There is a single-mindedness you see in a laboring woman; there is little attention directed externally.</span></li>
<li><span style="font-family: Arial;">Birth has a rhythm, a pace of its own; except when intentionally stopped, labor pushes ahead.</span></li>
<li><span style="font-family: Arial;">Labor and delivery can be approached by helpers with love and kindness, but it can also be a time of supreme vulnerability.</span></li>
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<span style="font-family: Arial;">Last night, I could see and feel the clues; my Mom was in a different type of labor. Her body changed as the process chugged relentlessly on. Her skin became more transparent. There was no external focus. The sounds of her labored breathing reminded me that there was no turning back. We were on the timetable of dying now.</span><br />
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<span style="font-family: Arial;"><em>I remember one woman in labor who stood up and announced at five centimeters, "I'm going home, right now. I don't want to do this anymore."</em></span><br />
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<span style="font-family: Arial;"><strong>But just as in that situation, turning back wasn't an option.</strong> <strong>The only way out of this was through it.</strong> </span><br />
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<span style="font-family: Arial;">The small doses of morphine deposited under Mom's tongue helped settle her breathing. Stroking her fine hair seemed to help, too.</span><br />
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<span style="font-family: Arial;">Then I sang some songs: "On Christmas Morn" written by my friend Bob Bost, and "The Moon Keeps Me" (Through the Night)" written by my friend Rebecca Cohen. Finally, an old hymn I remembered from my childhood church choir:</span><br />
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<em><span style="font-family: Arial;">"High o'er the lonely hill, black turns to gray.</span></em><br />
<em><span style="font-family: Arial;">Birdsong the valley fills, mist folds away.</span></em><br />
<em><span style="font-family: Arial;">Gray wakes to green again. </span></em><br />
<em><span style="font-family: Arial;">Beauty is seen again.</span></em><br />
<em><span style="font-family: Arial;">Gold and serene again, dawneth the day." (or something like that)</span></em><br />
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<span style="font-family: Arial;">Another half dose of the blessed morphine, and Mom's face relaxed into calm - maybe even a tiny smile. Her breathing shifted again - now soft; not the exhausting, pulling breaths that had forced her tiny upper body into spasmodic contortions.</span><br />
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<span style="font-family: Arial;">And then, at 5:58 a.m., it was quiet in the home. </span><br />
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<span style="font-family: Arial;">She was beautiful; she was strong. She had gotten through her labor, to some other side. I think we made good choices in advocacy and love.</span><br />
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<span style="font-family: Arial;">Take care,</span><br />
<span style="font-family: Arial;">Linda Gromko, MD</span>LindaGromkoMDTransgenderBooks.blogspothttp://www.blogger.com/profile/18075274561545354491noreply@blogger.com2tag:blogger.com,1999:blog-4256377541990220917.post-58700084485498042552014-09-19T23:03:00.001-07:002014-09-30T18:50:31.247-07:00Fargo Trip Brings Important Information: Fatal Vascular Access Hemorrhages<span style="font-family: Arial, Helvetica, sans-serif;">I was invited to speak at the 13th Annual Sanford Kidney Services Nephrology, Dialysis & Transplant Symposium September 17. My topic - one of my favorites - was "What My Husband's Kidney Failure Taught Me About My Own Profession."</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;">But I also had a chance to listen to several speakers before returning to Seattle. One was Lynda Ball, MSN, RN, CNN - who spoke about the alarming topic of "Fatal Vascular Access Hemorrhage." Can you imagine?</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;">Here are some important take-home points from Lynda's talk:</span><br />
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<li><span style="font-family: Arial, Helvetica, sans-serif;">Fatal vascular access hemorrhage accounts for 0.4 to 1.6 percent of all ESRD patient deaths annually (230 episodes annually in US)</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">75% had access complications within 6 months (meaning there were some warning clues)!</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">The majority of these events occur away from a dialysis facility, e.g. SNF, home, jail.</span></li>
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<span style="font-family: Arial;"><strong>Lynda stressed the importance of evaluating the patient for access complications such as stenosis, ulceration, infection, and non-fatal hemorrage. She reminded us that it's important to ask the patient, "Have you had <u>any</u> bleeding at your access site since your last dialysis?"</strong></span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;">Aneurysms in a fistula can occur from repeated punctures in the same location. The skin can become shiny and smooth, but it is also stretched. The patient is likely to request a puncture at this site because it hurts less - but the skin can become thinned, and can rupture like an inflated balloon!</span><br />
<span style="font-family: Arial;"></span><br />
<span style="font-family: Arial;">Any skin breakdown, ulceration, infection, or prolonged scabbing at the puncture site should prompt further evaluation. </span><br />
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<strong><span style="font-family: Arial;">Emergency measures in the case of spontaneous access hemorrhage include:</span></strong><br />
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<li><strong><span style="font-family: Arial, Helvetica, sans-serif;">Direct pressure</span></strong></li>
<li><strong><span style="font-family: Arial;">Elevation about heart level</span></strong></li>
<li><strong><span style="font-family: Arial;">Calling 911.</span></strong></li>
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<span style="font-family: Arial, Helvetica, sans-serif;">Good to know. </span><br />
<span style="font-family: Arial;"></span><br />
<span style="font-family: Arial;">When I speak in various locations, I'm impressed with the hard work and sincerity of the people who work in the area of dialysis: people who are clearly trying to make things better for people traveling this tough road of CKD.</span><br />
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<span style="font-family: Arial;">Take care,</span><br />
<span style="font-family: Arial;">Linda Gromko MD</span><br />
<span style="font-family: Arial;">PS - Please take a moment to look at my medical practice's updated website: <a href="http://www.queenannemedicalassociates.com/">www.QueenAnneMedicalAssociates.com</a>.</span>LindaGromkoMDTransgenderBooks.blogspothttp://www.blogger.com/profile/18075274561545354491noreply@blogger.com3tag:blogger.com,1999:blog-4256377541990220917.post-6026512022774059082014-08-20T02:41:00.001-07:002014-08-20T02:41:30.574-07:00Acute-on-Chronic Renal Failure Brings Different Questions in a 96-year-old Mom<span style="font-family: Arial, Helvetica, sans-serif;">My little Mom had been blessed with excellent health until age 94 when she began to show some signs of cognitive decline. She was still witty - really delightful. She had only one health problem: hypertension - and that was well-controlled with small doses of beta-blocker and a mild diuretic. She'd never had a surgery, and except for a brief admission for Atrial Fibrillation, she'd been in the hospital only to deliver my sister and me!</span><br />
<span style="font-family: Arial;"></span><br />
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiY_CB1FgVqdlHlwJ4lh84ezqwe1BMykRFJ7OplLy3XHbFqXmEgObZL_J1tPzkXdunUcFI75LOtdnGCXDWW7jYdLgKfDeUMHW4eXqoUX1MNm3nYzfUJG_3-kK0idalPEd8ywRjd_TJGbUQ/s1600/Gromko+ladies.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiY_CB1FgVqdlHlwJ4lh84ezqwe1BMykRFJ7OplLy3XHbFqXmEgObZL_J1tPzkXdunUcFI75LOtdnGCXDWW7jYdLgKfDeUMHW4eXqoUX1MNm3nYzfUJG_3-kK0idalPEd8ywRjd_TJGbUQ/s1600/Gromko+ladies.jpg" height="259" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><span style="font-family: Arial, Helvetica, sans-serif;">Florence Gromko, at left, with daughters Linda Gromko</span><br />
<span style="font-family: Arial;">and Bonnie Gromko Mearns in December 2013</span></td></tr>
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<br />
<span style="font-family: Arial;">At 94, she moved into an Assisted Living Community, and did reasonably well until she had a fall in April 2014 - sustaining a distal tib-fib (ankle) fracture. About a week later, she fell again, fracturing her pubic ramus. This required hospitalization and about a month in a rehabilitation facility. She then moved to an Adult Family Home with only six residents and more one-on-one care.</span><br />
<span style="font-family: Arial;"></span><br />
<span style="font-family: Arial;">Like so many elderly folks, Mom had diminished kidney function, CKD Stage 3. This was likely due to hypertension - or more likely, to being 96-1/2.</span><br />
<span style="font-family: Arial;"></span><br />
<span style="font-family: Arial;">A urinary tract infection took her into the hospital in August. She was very dehydrated from vomiting and diarrhea, and on admission, her creatinine had risen to over 3, and her eGFR was only 12. (You start thinking about dialysis with this eGFR - and with an eGFR of 15 in a diabetic.) Of course, this was an <em>acute</em> situation; vigorous volume repletion got her tuned up to an eGFR in the 20s by the time she was ready to return to the Adult Family Home.</span><br />
<span style="font-family: Arial;"></span><br />
<span style="font-family: Arial;">But she hated the whole ordeal: pulling out her IV, and begging me to answer, "Why is this woman trying to hurt me?" - as a very sweet nurse tried to start another IV.</span><br />
<span style="font-family: Arial;"></span><br />
<span style="font-family: Arial;">The amount of fluid my Mom received by IV was appropriate, but we could see there was no way on earth she'd be able to keep up with it on her own. Another bout of diarrhea, another few episodes of vomiting, and she'd be sliding down again. I figured she'd be in trouble within a month or so.</span><br />
<span style="font-family: Arial;"></span><br />
<span style="font-family: Arial;"><strong>When my husband's eGFR was 5, and he was started on emergent dialysis via central line in the setting of Acute-on-Chronic Renal Failure, it made so much sense to initiate the "full court press." With a twelve-year-old daughter, he was hopeful for a successful transplant - and willing to pursue home hemodialysis in the interim.</strong></span><br />
<span style="font-family: Arial;"><strong></strong></span><br />
<span style="font-family: Arial;">But with a woman as elderly as my Mom - voting with her behavior by removing her IV lines, and declining the amount of fluid that would protect her volume status, it seemed time for palliative care.</span><br />
<span style="font-family: Arial;"></span><br />
<span style="font-family: Arial;">She's still happy and glad to see us. Last week, she was saying, "You've got to have goals. I've got to get things done."</span><br />
<span style="font-family: Arial;"></span><br />
<span style="font-family: Arial;">I asked her what goals <em>other </em>96-year-olds had, and she replied instantly, "Oh, they're all dead!"</span><br />
<span style="font-family: Arial;"></span><br />
<span style="font-family: Arial;">Different circumstances clearly call for different interventions.</span><br />
<span style="font-family: Arial;"></span><br />
<span style="font-family: Arial;">Linda Gromko, MD</span>LindaGromkoMDTransgenderBooks.blogspothttp://www.blogger.com/profile/18075274561545354491noreply@blogger.com0tag:blogger.com,1999:blog-4256377541990220917.post-24561778443527753902014-05-11T04:37:00.002-07:002014-05-11T05:46:30.076-07:00Social Workers Talk About Sex at the Council of Nephrology Social Workers' Chapter Conference in Portland <table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: right; margin-left: 1em; text-align: right;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjglz1xpdO1giHsj4ZFgvI4rEMRQwA3GIjPGi98s3cuxhmoiU0EH9xZpRCnzbUb1BODrB-K3eoZAIps0LL0v9ege3d2H0MU7n19Bpf-9JXHPgx5XcaM1TcYiMRB4cGxKaFnTDPDG81eMqk/s1600/Yasuyo+and+Linda+1014.jpg" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjglz1xpdO1giHsj4ZFgvI4rEMRQwA3GIjPGi98s3cuxhmoiU0EH9xZpRCnzbUb1BODrB-K3eoZAIps0LL0v9ege3d2H0MU7n19Bpf-9JXHPgx5XcaM1TcYiMRB4cGxKaFnTDPDG81eMqk/s1600/Yasuyo+and+Linda+1014.jpg" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-family: Arial, Helvetica, sans-serif;">Linda wih Yasuyo Tsunamine, MSW</span></span></td></tr>
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<span style="font-family: Arial, Helvetica, sans-serif;">Kidney failure impacts sexual function, and social workers talk with dialysis patients about the most personal aspects of their lives! I had the chance to speak with a group of very committed social workers at the Chapter Conference of the Council of Nephrology Social Workers in Portland, Oregon last week. (If you look closely at the picture above, you'll see Dori Schatell and John Agar's book cover ("Help! I Need Dialysis!") on the screen in the background.</span><br />
<span style="font-family: Arial;"></span><br />
<strong><em><span style="font-family: Arial;">So, how does renal failure impact sexual function - and what can be done to help our clients?</span></em></strong><br />
<ul>
<li><span style="font-family: Arial, Helvetica, sans-serif;">The two most common causes of renal failure are diabetes and high blood pressure - both of which can impact sexual function.</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Medications commonly used (e.g., beta blockers for hypertension, SSRIs for depression) may adversely impact sexual function.</span></li>
<li><span style="font-family: Arial;">One study indicated that 85% of hemodialysis patients have <em><strong>some degree</strong></em> of erectile dysfunction!</span></li>
<li><span style="font-family: Arial;">Kidney failure doesn't affect men only; information on sexual response in women is more difficult to find.</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">A variety of medications may be useful in sexual dysfunction (always check with kidney center pharmacy or nephrologist).</span></li>
<li><span style="font-family: Arial;">Intimacy, of course, doesn't have to be sexual.</span></li>
<li><span style="font-family: Arial;">Don't forget the importance of "dates," and making time for a relationship in an already busy schedule.</span></li>
<li><span style="font-family: Arial;">Social workers and other health care providers are encouraged to consult with sex therapists, or contact the helpful staff of Babeland in Seattle for detailed (sometimes X-rated) suggestions (<a href="http://www.babeland.com/">www.Babeland.com</a>). They can answer specifc questions - or suggest a product that may help your client immensely!</span></li>
</ul>
<span style="font-family: Arial;"></span><br />
<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: right;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiRQ_QrCP6zLaJyonHPiArU1yMHzcWv6U1musrUVkzHZMlwdCbzkjungSaDSJyupdNlWgXPRbJjzG8aHWFl2MQ1al4qnwgj5v7wisYOtyMkuwTNmdmaLjhBLRBf9JLxKsUZV3M0NUQZaD4/s1600/Babeland+bunnies.jpg" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiRQ_QrCP6zLaJyonHPiArU1yMHzcWv6U1musrUVkzHZMlwdCbzkjungSaDSJyupdNlWgXPRbJjzG8aHWFl2MQ1al4qnwgj5v7wisYOtyMkuwTNmdmaLjhBLRBf9JLxKsUZV3M0NUQZaD4/s1600/Babeland+bunnies.jpg" height="200" width="200" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><span style="font-family: Arial, Helvetica, sans-serif;">Happy Bunnies from Babeland</span></td></tr>
</tbody></table>
<span style="font-family: Arial, Helvetica, sans-serif;">Two excellent books may provide further guidance for providers and their clients. These are:</span><br />
<ul>
<li><strong><span style="font-family: Arial;"><em><u>"The Ultimate Guide to Sex and Disability: For All of Us Who Live with Disabilities, Chronic Pain, and Illness" </u>by Miriam Kaufman, MD, </em></span><span style="font-family: Arial;"><em>Cory Silverberg, and Fran Odette </em></span></strong></li>
</ul>
<strong><em><span style="font-family: Arial;"></span></em></strong><br />
<ul>
<strong>
</strong>
<li><em><span style="font-family: Arial;"><strong>"<u>Help! I Need Dialysis"</u> by Dori Schatell and John Agar, MD.</strong></span></em></li>
</ul>
<span style="font-family: Arial;">Both books are particularly candid, and user-friendly. And, it's about time! Find them both on Amazon.com.</span><br />
<span style="font-family: Arial;"></span><br />
<span style="font-family: Arial;">We also discussed how to talk to a patient about sex, and the importance of breaking through our own discomfort, should any exist. </span><br />
<ul>
<li><span style="font-family: Arial;">Starting a discussion with euphemisms may help, e.g., "How have you find ways to enjoy yourselves as a couple?" or "How has dialysis impacted your relationship?" (That way, your patient isn't cornered into talking about sex if that's not where they want to go!)</span></li>
<li><span style="font-family: Arial;">Normalizing the experience helps, e.g., "Many people find that kidney trouble decreases their sexual appetite."</span></li>
<li><span style="font-family: Arial;">Recognizing any discomfort you have is okay, e.g., "This is a little awkward for me, but I wanted to ask you some more personal questions. Is that okay with you?"</span></li>
</ul>
<span style="font-family: Arial;">Remember, intimacy and sex aren't frills. They are critical to a healthy relationship. By having open discussions - and good resources, we can prevent intimacy from becoming yet another loss that kidney failure brings!</span><br />
<span style="font-family: Arial;"></span><br />
<span style="font-family: Arial;">Take care,</span><br />
<span style="font-family: Arial;">Linda Gromko, MD</span><br />
<span style="font-family: Arial;"></span><br />
<strong><em><span style="font-family: Arial;">Future Blogs: Linda's trip to Japan!</span></em></strong>LindaGromkoMDTransgenderBooks.blogspothttp://www.blogger.com/profile/18075274561545354491noreply@blogger.com1tag:blogger.com,1999:blog-4256377541990220917.post-181211151794890482014-04-06T23:07:00.002-07:002014-04-06T23:13:05.934-07:00Northwest Kidney Centers' Ceremony of Remembrance Helps<span style="font-family: Arial, Helvetica, sans-serif;">It's an annual event: the Northwest Kidney Centers' Ceremony of Remembrance. This is the third one I've attended - and it's clear I'm not ready to stop attending. </span><br />
<span style="font-family: Arial;"></span><br />
<span style="font-family: Arial;">It's a simple, meaningful, event. Joyce Jackson, NKC CEO, leads off with a respectful introduction. There's a responsive reading led by the NKC Chaplain and a number of people who occupy various positions in Kidney World. </span><br />
<span style="font-family: Arial;"></span><br />
<span style="font-family: Arial;">Then, there was a thoughtful address done by Dr. Andrew Brockenbrough, the Medical Director of the NKC in Kent. Kind, sensitive in his remarks, it was clear that he appreciates the profound impact kidney disease has on patients and families. And he passed on to us the impact that we as family have. As he said, "we're often the reasons why our loved ones went on dialysis in the first place."</span><br />
<span style="font-family: Arial;"></span><br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgfRaK8Shi4Nx2aFbBCytHqkgUYjqDSBayvguHDtxVlzRRgpwPDwOnGJSbmA-hzzZ1Mus4SbhxdKg7KQ3yFgNcEvKrMmYvi78oJb4FkUTjni8sfxGZLRDiUfziZmMenm3WDM_HlQCOp9IY/s1600/ceremony+of+remembrance.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgfRaK8Shi4Nx2aFbBCytHqkgUYjqDSBayvguHDtxVlzRRgpwPDwOnGJSbmA-hzzZ1Mus4SbhxdKg7KQ3yFgNcEvKrMmYvi78oJb4FkUTjni8sfxGZLRDiUfziZmMenm3WDM_HlQCOp9IY/s1600/ceremony+of+remembrance.JPG" height="320" width="240" /></a></div>
<br />
<span style="font-family: Arial, Helvetica, sans-serif;">After this, there's a ritual. We have the opportunity to come forth, pick up a shiny glass stone, place it into a container of water and say, as I did, <strong><em>"for my husband, Steve Williams."</em></strong> We take another stone as a memento. I now have three.</span><br />
<span style="font-family: Arial;"></span><br />
<span style="font-family: Arial;">But there were sons and daughters, other wives, husbands, mothers and fathers, and even tearful staff and volunteers of the Northwest Kidney Centers. </span><br />
<span style="font-family: Arial;"></span><br />
<span style="font-family: Arial;">This means something unique to each of us: everyone in that room has a deep and different understanding of the impact of kidney disease. And we didn't have to say a word. </span><br />
<span style="font-family: Arial;"></span><br />
<span style="font-family: Arial;">There were happy contacts, too. I reconnected with Gloria Lomax, my dialysis "penpal," whose husband Ted died less than two months before Steve. There were the wonderful nurses and social workers who got us through the really tough times. </span><br />
<span style="font-family: Arial;"></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Maybe there'll be a day when I won't attend the Ceremony of Remembrance. But it isn't time yet.</span><br />
<span style="font-family: Arial;"></span><br />
<span style="font-family: Arial;">Take care,</span><br />
<span style="font-family: Arial;">Linda Gromko, MD</span><br />
<span style="font-family: Arial;"><a href="http://www.lindagromkomd.com/">www.LindaGromkoMD.com</a></span>LindaGromkoMDTransgenderBooks.blogspothttp://www.blogger.com/profile/18075274561545354491noreply@blogger.com0tag:blogger.com,1999:blog-4256377541990220917.post-23541280805722611172014-03-16T11:49:00.000-07:002014-03-16T11:51:58.512-07:00What was Sidney the Kidney Doing at the Rat City Roller Girls' 10th-Year Anniversary Bout?<span style="font-family: Arial, Helvetica, sans-serif;">Hey, I know that blue kidney-shaped figure standing in the distance! It was Sidney the Kidney in the stands of the Rat City Roller Girls' 10th-Year Anniversary Bout held in Seattle's Key Arena March 15. </span><br />
<span style="font-family: Arial;"></span><br />
<span style="font-family: Arial;">Don't know Sidney? Here's a picture Sid with Steve, Dr. Thakur, and me at a Northwest Kidney Centers Breakfast of Hope a lifetime ago:</span><br />
<span style="font-family: Arial;"></span><br />
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi3ftcK5VccO9WO5BSHE8lH8kN31Sc3NS_BeqHr7hwXSq9tUYnHN6DiKtYnMXVLiwd_u507vEOaUtqZ04DGtxuG9KO8_y3sxvQwB35zxCtlciL72kxGUHat-l3UxA1bYYVhBhnkxQVK3ic/s1600/Sydney+the+Kidney.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi3ftcK5VccO9WO5BSHE8lH8kN31Sc3NS_BeqHr7hwXSq9tUYnHN6DiKtYnMXVLiwd_u507vEOaUtqZ04DGtxuG9KO8_y3sxvQwB35zxCtlciL72kxGUHat-l3UxA1bYYVhBhnkxQVK3ic/s1600/Sydney+the+Kidney.jpg" height="320" width="305" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><span style="font-family: Arial, Helvetica, sans-serif;">Dr. Smiley Thakur, at left, with Sidney, Steve and me. </span><br />
<span style="font-family: Arial;"></span><br />
<div align="left">
</div>
</td></tr>
</tbody></table>
<span style="font-family: Arial, Helvetica, sans-serif;">Sidney was visiting the Rat City Roller Girls crowd to remind us all that March is International Kidney Month. And to remind us that 1 in 9 people have kidney disease, though most don't know it. Sidney recommended that we all check with our health care provders about our own risk factors and kidney status.</span><br />
<span style="font-family: Arial;"></span><br />
<span style="font-family: Arial;">Thanks, Sidney, for reaching out!</span><br />
<span style="font-family: Arial;"></span><br />
<span style="font-family: Arial;">Take care,</span><br />
<span style="font-family: Arial;">Linda Gromko, MD</span>LindaGromkoMDTransgenderBooks.blogspothttp://www.blogger.com/profile/18075274561545354491noreply@blogger.com0tag:blogger.com,1999:blog-4256377541990220917.post-47879759285810802652014-03-10T00:45:00.002-07:002014-03-10T01:46:48.998-07:00My Recent Visit to Bangkok Kidney Center: Travel if you Can!<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEggxvcnRh0ufi3QM9Te2yLhFausLvxFrEz4PZJwXMJaqvFsluKfeTx4_2g2EeK7qCy-zj9P3NXvoF9Z7mRtXiUofUNKvbmiP5RHp3Fn_D2Q_NyOtb2lRRbL82F368ul43E8N2aPc9jyhq0/s1600/Thai+temple+stairs.JPG" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEggxvcnRh0ufi3QM9Te2yLhFausLvxFrEz4PZJwXMJaqvFsluKfeTx4_2g2EeK7qCy-zj9P3NXvoF9Z7mRtXiUofUNKvbmiP5RHp3Fn_D2Q_NyOtb2lRRbL82F368ul43E8N2aPc9jyhq0/s1600/Thai+temple+stairs.JPG" height="320" width="240" /></a><span style="font-family: Arial, Helvetica, sans-serif;">I recently had an opportunity to attend a medical conference in Bangkok, Thailand - the trip of a lifetime. Bangkok is enormous - a bustling mix of eight million people, hundreds of glorious temples, and an abundance of tropical sun. The trip from Seattle took </span><span style="font-family: Arial, Helvetica, sans-serif;">twenty hours each way - and it was worth every minute of the journey.</span><br />
<span style="font-family: Arial;"></span><br />
<span style="font-family: Arial;">It's sad to recognize that I am more mobile since Steve died, and it made me think, "What would <em><u>we</u></em> have done to make such a trip?" Granted, we did travel with our NxStage machine and Steve dialyzed in our hotel during domestic travel. But international travel is more of a challenge. My curiosity led me to consult the concierge at the Anantara Resort where the medical conference was held. He directed me to Samitivej Sukhumvit Hospital (<a href="http://www.samitivejhospitals.com/">www.samitivejhospitals.com</a>) and to Nisarat Jaidee, MD. A visit to the center was arranged.</span><br />
<span style="font-family: Arial;"></span><br />
<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: left; margin-right: 1em; text-align: left;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEixhoPGbfjPacDRwcZ-9VJMbu3xBC06Ml9LlIxw8_nwa0oq4e_nC3KLzM1lKR297AdrtSlBGvCRznWOTycoBChh7h0DW5-e1-4IPXu4xFuhFnp2lW_xxz_ZuIghjv6fWw5pEZkcdU84Dnk/s1600/Thai+dialysis+doctor.JPG" imageanchor="1" style="clear: left; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEixhoPGbfjPacDRwcZ-9VJMbu3xBC06Ml9LlIxw8_nwa0oq4e_nC3KLzM1lKR297AdrtSlBGvCRznWOTycoBChh7h0DW5-e1-4IPXu4xFuhFnp2lW_xxz_ZuIghjv6fWw5pEZkcdU84Dnk/s1600/Thai+dialysis+doctor.JPG" height="320" width="240" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><span style="font-family: Arial, Helvetica, sans-serif;">With Sirinapa Cheethanaghai at </span><br />
<span style="font-family: Arial;">left, and Dr. Nisarat at right</span></td></tr>
</tbody></table>
<span style="font-family: Arial, Helvetica, sans-serif;">Dr. Nisarat and the staff welcomed me graciously. They guided me through the </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">dialysis center: a spotless, airy unit consisting of fifteen dialysis stations. The beds were separated by permanent partitians, not curtains. I recognized the Fresenius dialysis machines - the same type used in Seattle. I imagine that such familiar equipment would be comforting to traveling patents. And clearly, there is an atmosphere of professionalism and respect among the staff. </span><br />
<span style="font-family: Arial;"></span><br />
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi_cauY2bqn4cjnmt1NPnhjsOvc5Ot-YA-k4V0wB_1AwNj0ObkFFdZ89C4EmiMqVFSgrZYGfmdFYPq7u2zU_qDMVy3lEN3F6cDIfZeDex860zMdPAzKfG3qreeVhyFkqUp3JqPlfWXfZZc/s1600/dialysis+unit+in+Bangkok.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi_cauY2bqn4cjnmt1NPnhjsOvc5Ot-YA-k4V0wB_1AwNj0ObkFFdZ89C4EmiMqVFSgrZYGfmdFYPq7u2zU_qDMVy3lEN3F6cDIfZeDex860zMdPAzKfG3qreeVhyFkqUp3JqPlfWXfZZc/s1600/dialysis+unit+in+Bangkok.jpg" /></a><span style="font-family: Arial;"></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">The staff consists primarily of RNs, </span><br />
<span style="font-family: Arial;">mostly medical-surgical nurses who</span><br />
<span style="font-family: Arial;">have received advanced training in hemodalysis. Central line access and fistula punctures </span><span style="font-family: Arial;">are performed by Registered Nurses at this center. Line infections are rare.</span><br />
<span style="font-family: Arial;"></span><br />
<span style="font-family: Arial;">Dialysis patients traveling in Thailand may make advance arrangements for treatment in Sumitivej Sukhumvit Hospital. Treatments are available six days a week, Sundays excluded. As in the US, most in-center patients dialyze three times a week, with treatments lasting four hours. Thailand hosts many patients for surgeries and treatments of all types. </span><br />
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<a href="https://www.blogger.com/editor/static_files/" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" src="" /></a><a href="https://www.blogger.com/editor/static_files/" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" src="" /></a><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhC5wUMbZqwGgnZF8-ujZeZ23GbgA61Zw3s9dMU-4OYNNCKXmxuGF7dMdXtu7UF0_CekTQ6x1jFEKzCqDqMg7GTumA_73tAiGcTwoe61TeZmV0q2JNF-kN2n4iLMeUasA6zmom4dbGnB9c/s1600/thai+dialysis+nursing.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhC5wUMbZqwGgnZF8-ujZeZ23GbgA61Zw3s9dMU-4OYNNCKXmxuGF7dMdXtu7UF0_CekTQ6x1jFEKzCqDqMg7GTumA_73tAiGcTwoe61TeZmV0q2JNF-kN2n4iLMeUasA6zmom4dbGnB9c/s1600/thai+dialysis+nursing.JPG" height="320" width="320" /></a></div>
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<span style="font-family: Arial;">Dr. Nisarat and the kind group of nurses explained that kidney disease is a growing problem in Thailand - usually the result of diabetes or hypertension, as in the US. Kidney transplants are encouraged. Home dialysis is generally peritoneal dialysis and is performed by RNs. I also learned that patients rarely ask to stop dialysis.</span><br />
<span style="font-family: Arial;"></span><br />
<span style="font-family: Arial;">Near the entrance of the dialysis center was a lovely photo of patient celebrations, i.e., birthdays and such. Clearly, these nurses care deeply about their patients - just as the dialysis nurses in Seattle do! </span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;">I valued my visit with the dialysis staff in Bangkok, and I wouldn't hesitate to have a patient or family member dialyze at the Samitivej Sukhumvit Hospital while traveling in Thailand! How unfortunate it would be to miss a visit to Thailand - truly the "Land of Smiles!"</span><br />
<span style="font-family: Arial;"></span><br />
<span style="font-family: Arial;">Take care,</span><br />
<span style="font-family: Arial;">Linda Gromko, MD</span>LindaGromkoMDTransgenderBooks.blogspothttp://www.blogger.com/profile/18075274561545354491noreply@blogger.com10tag:blogger.com,1999:blog-4256377541990220917.post-71665015477611333242014-01-07T18:58:00.001-08:002014-01-07T18:58:08.853-08:00Check out the Series from Jane McClure and me on Home Dialysis!<span style="font-family: Arial, Helvetica, sans-serif;">Check out the series Jane McClure and I have written for Dialysis Patient Citizens. This is Part II of our four-part post on "How to Set Up Your Home Dialysis Unit Without Feeling Like You're Living in an ICU!" <span style="font-family: Times New Roman;"> </span><a class="link customisable" data-expanded-url="http://ow.ly/slBbF" data-scribe="element:url" dir="ltr" href="http://ow.ly/slBbF" rel="nofollow" target="_blank" title="http://ow.ly/slBbF"><span style="font-family: Times New Roman;"><span class="tco-hidden">http://</span><span class="tco-display">ow.ly/slBbF</span></span></a></span><br />
<span style="font-family: Arial;"></span><br />
<span style="font-family: Arial;">It's good, practical information to help you make your home dialysis as easy and as comfortable as possible. </span><br />
<span style="font-family: Arial;"></span><br />
<span style="font-family: Arial;">Take care, </span><br />
<span style="font-family: Arial;">Linda Gromko, MD</span>LindaGromkoMDTransgenderBooks.blogspothttp://www.blogger.com/profile/18075274561545354491noreply@blogger.com1tag:blogger.com,1999:blog-4256377541990220917.post-45679429380569176882013-11-07T18:44:00.001-08:002013-11-07T18:49:52.571-08:00Home Dialysis was the Best Gift I Could Have Given to My Husband!<span style="font-family: Arial, Helvetica, sans-serif;">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 <strong><em>quality of life</em></strong> was the thing that ultimately mattered most.</span><br />
<span style="font-family: Arial;"></span><br />
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh5fGcNiD_iuAk5WxwXZ3bRPzBqt6cN4GmBdU9Ve58XzMysEYWPaLYxBJsJhtAsJAn4MIoBMCh5qO69mIY4MGIMky4NK-uGYcTqG661_AVR3ibb_wuaZmmDt5HJoQ4jFHMuu3Fh6aPP48E/s1600/Steve.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh5fGcNiD_iuAk5WxwXZ3bRPzBqt6cN4GmBdU9Ve58XzMysEYWPaLYxBJsJhtAsJAn4MIoBMCh5qO69mIY4MGIMky4NK-uGYcTqG661_AVR3ibb_wuaZmmDt5HJoQ4jFHMuu3Fh6aPP48E/s320/Steve.jpg" width="246" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><span style="font-family: Arial, Helvetica, sans-serif;">Steve Williams in 2009, on home </span><br />
<span style="font-family: Arial;">hemodialysis at the time</span></td></tr>
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<span style="font-family: Arial;">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.</span><br />
<br />
<a href="http://www.blogger.com/" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" src="" /></a><span style="font-family: Arial;">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: <a href="http://bit.ly/1gv3Uuo">http://bit.ly/1gv3Uuo</a></span><br />
<span style="font-family: Arial;"></span><br />
<span style="font-family: Arial;">Remember, home dialysis can be an enormous gift. Learn to do it!</span><br />
<span style="font-family: Arial;"></span><br />
<span style="font-family: Arial;">Linda Gromko, MD</span>LindaGromkoMDTransgenderBooks.blogspothttp://www.blogger.com/profile/18075274561545354491noreply@blogger.com0tag:blogger.com,1999:blog-4256377541990220917.post-11646156461356248912013-10-21T19:30:00.001-07:002013-10-21T19:34:35.355-07:00Mid-Columbia Nephrology Seminar: Plenty of Content, an Abundance of Heart <span style="font-family: Arial, Helvetica, sans-serif;">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. </span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;">Held in Richland, Washington on October 20, 2013, issues covered included: </span><br />
<ul>
<li><span style="font-family: Arial, Helvetica, sans-serif;">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?</span></li>
</ul>
<span style="font-family: Arial;">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 <em><u>is</u></em> 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?</span><br />
<span style="font-family: Arial;"></span><br />
<span style="font-family: Arial;">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!</span><br />
<span style="font-family: Arial;"></span><br />
<span style="font-family: Arial;">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.</span><br />
<span style="font-family: Arial;"></span><br />
<span style="font-family: Arial;">It was a full and varied conference - plenty of content, and an abundance<strike> </strike>of heart.</span><br />
<span style="font-family: Arial;"></span><br />
<span style="font-family: Arial;">Take care,</span><br />
<span style="font-family: Arial;">Linda Gromko MD</span>LindaGromkoMDTransgenderBooks.blogspothttp://www.blogger.com/profile/18075274561545354491noreply@blogger.com0tag:blogger.com,1999:blog-4256377541990220917.post-38775493529037721552013-09-07T12:56:00.000-07:002013-09-07T13:04:34.979-07:00Medical Writing Seminar Participants to Get a Glimpse of Home Dialysis<span style="font-family: Arial, Helvetica, sans-serif;">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.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">We'll have a number of writing exercises, of course. Like this one: </span><br />
<span style="font-family: Arial;"></span><br />
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<strong><span style="font-family: Arial;">"<em>Compare and/or contrast the following photos of individuals undergoing kidney dialysis treatments."</em></span></strong></div>
<span style="font-family: Arial;"></span><br />
<span style="font-family: Arial;">This photo of Bill Peckham dialyzing on a rafting trip - while <strong><em>drinking champagne from a can(!) - </em></strong>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.</span><br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgHZ2s-NRslCJ_BOFcyrD_Aq3keLjGxvLrKcYUgmOETTEV95wTKAqAPbTwFC8e0t5llKTjl_Vc_a_40NbsNQ-143-ay-il2196poPy60aZNCOnHZjBV0tDPO64aprS_6cZGUyCfoc-WuLo/s1600/Bill+Peckham+July+2013.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="239" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgHZ2s-NRslCJ_BOFcyrD_Aq3keLjGxvLrKcYUgmOETTEV95wTKAqAPbTwFC8e0t5llKTjl_Vc_a_40NbsNQ-143-ay-il2196poPy60aZNCOnHZjBV0tDPO64aprS_6cZGUyCfoc-WuLo/s320/Bill+Peckham+July+2013.jpg" width="320" /></a> </div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh0YPBqqVFTVci0xiJtRopxgVx9TXFOOPWiOLX_MQ2BSEbcY9it53Tp3bbwJYEpZ5WMnikWenHYLyBShOIux-1JBGoWJ_J0VzWBr-e7QcZpeABL8euXf-DsOXcQ1R9a9EXJ-Ey2_cG91ro/s1600/during+dialysis+in-center.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh0YPBqqVFTVci0xiJtRopxgVx9TXFOOPWiOLX_MQ2BSEbcY9it53Tp3bbwJYEpZ5WMnikWenHYLyBShOIux-1JBGoWJ_J0VzWBr-e7QcZpeABL8euXf-DsOXcQ1R9a9EXJ-Ey2_cG91ro/s1600/during+dialysis+in-center.jpg" /></a></div>
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<span style="font-family: Arial, Helvetica, sans-serif;"><strong><em>What a difference!</em></strong></span></div>
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<span style="font-family: Arial;">A photo contrast like this reaffirms my confidence in the superiority of Home Dialysis!</span></div>
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<span style="font-family: Arial;"></span> </div>
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<span style="font-family: Arial;">For more information on the Writing Seminar, visit <a href="http://www.fieldsend.org/">www.FieldsEnd.org</a>.</span></div>
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<span style="font-family: Arial;"></span> </div>
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<span style="font-family: Arial;">Take care,</span></div>
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<span style="font-family: Arial;">Linda Gromko, MD</span></div>
LindaGromkoMDTransgenderBooks.blogspothttp://www.blogger.com/profile/18075274561545354491noreply@blogger.com0tag:blogger.com,1999:blog-4256377541990220917.post-55567243609408401192013-08-08T18:54:00.002-07:002013-08-08T18:54:47.955-07:00Field's End Medical Writing Workshop September 22, 2013<strong><em><span style="font-family: Arial, Helvetica, sans-serif;">Join me for a Sunday writing workshop on Bainbridge Island: </span></em></strong><br />
<em><span style="font-family: Arial;"><strong>Sunday, September 22nd, 1-4 pm, Bainbridge Island Library!</strong></span></em><br />
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<em>This workshop is intended to help participants incorporate <u>credible medical content</u> into their fiction and non-fiction writing.</em></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgntVfmzmU0clK72HksnfbNCfpqV7Xxpel7G1-kme-X2Zb1cy1Epi7yVTNF4OvEx-SxQqWfWTdlkwUuTHcqh4UjohXnk5r6gQm0pVGlBqVjTaun4LDnEXZTsXdD_zsRxfXncbImxFXvM_E/s1600/FieldsEnd_Gromko_class.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><em><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgntVfmzmU0clK72HksnfbNCfpqV7Xxpel7G1-kme-X2Zb1cy1Epi7yVTNF4OvEx-SxQqWfWTdlkwUuTHcqh4UjohXnk5r6gQm0pVGlBqVjTaun4LDnEXZTsXdD_zsRxfXncbImxFXvM_E/s320/FieldsEnd_Gromko_class.png" width="251" /></em></a></div>
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<em>Through writing exercises and discussion,we'll review</em></div>
<ul>
<li><div class="separator" style="clear: both; text-align: left;">
<em>Important medical terminology</em></div>
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<em>Who's who on the medical "food chain?"</em></div>
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<em>Medical dialogue and idioms</em></div>
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<em>The "flow" of an ER visit, delivery, surgery</em></div>
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<em>Basic disease processes</em></div>
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<em>Resources that can help you fact-check your own information.</em></div>
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<strong><em>Bring your questions and writing projects for a painless afternoon of medical attention. For further info, go to <a href="http://www.fieldsend.org/">www.FieldsEnd.org</a>.</em></strong></div>
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<strong><em>Linda Gromko MD</em></strong></div>
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LindaGromkoMDTransgenderBooks.blogspothttp://www.blogger.com/profile/18075274561545354491noreply@blogger.com2tag:blogger.com,1999:blog-4256377541990220917.post-10739148939228954142013-07-04T07:13:00.000-07:002013-07-04T07:18:54.237-07:00New CDC Recommendations Show Reduction in Bloodstream Infections by Half!<span style="font-family: Arial, Helvetica, sans-serif;">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. <a href="http://dialysispatients.wordpress.com/2013/07/02/fistula-first-keeps-life-saving-options-open/">http://dialysispatients.wordpress.com/2013/07/02/fistula-first-keeps-life-saving-options-open/</a></span><br />
<span style="font-family: Arial;"></span><br />
<strong><em><span style="font-family: Arial; font-size: large;">Many of the CDC protocol recommendations were simple: just common sense. How often we appreciate just how rare "common" sense really is!</span></em></strong><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Here are some of the main points:</span><br />
<ul>
<li><span style="font-family: Arial, Helvetica, sans-serif;">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). </span></li>
<li><span style="font-family: Arial;">Follow a checklist for dialysis procedures. The CDC gives examples of these tools.</span></li>
<li><span style="font-family: Arial;">Wash your hands (!).</span></li>
<li><span style="font-family: Arial;">Use clean gloves.</span></li>
<li><span style="font-family: Arial;">Use an appropriate antiseptic for cleansing the access site, e.g., chlorhexidine.</span></li>
<li><span style="font-family: Arial;">Apply a recommended anntimicrobial ointment to dialysis access sites.</span></li>
</ul>
<strong><em><span style="font-family: Arial; font-size: large;">The first point, i.e., "Fistula First!" is probably the most important.</span></em></strong><br />
<strong><em><span style="font-family: Arial; font-size: large;"></span></em></strong><br />
<span style="font-family: Arial;">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).</span><br />
<span style="font-family: Arial;"></span><br />
<span style="font-family: Arial;">And nobody needs such complications less than a dialysis patient!</span><br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhadl2mErYnFarkohnOlj1AL4mbOPEeWLnMvwoC6xq1RdmlSCxS-3rlUaR8vUE_AM-vF-ZrfcucKtJvEDVpAoDijxLhRbW8RctdJHK_MEiw5pMWBOPkZO1B8Ij9KVW4hLA3q4a-IaZX2zY/s160/fistula+and+hemo.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhadl2mErYnFarkohnOlj1AL4mbOPEeWLnMvwoC6xq1RdmlSCxS-3rlUaR8vUE_AM-vF-ZrfcucKtJvEDVpAoDijxLhRbW8RctdJHK_MEiw5pMWBOPkZO1B8Ij9KVW4hLA3q4a-IaZX2zY/s160/fistula+and+hemo.jpg" /></a></div>
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<strong><em><span style="font-family: Arial; font-size: large;">Yet, roughly 80% of dialysis patients begin their initial treatments via a central line!</span></em></strong><br />
<strong><em><span style="font-family: Arial; font-size: large;"></span></em></strong><br />
<span style="font-family: Arial;">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.</span><br />
<span style="font-family: Arial;"></span><br />
<span style="font-family: Arial;">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. </span><br />
<span style="font-family: Arial;"></span><br />
<strong><span style="font-family: Arial; font-size: large;"><em>But most patients don't fall into "kidney hell" as quickly as Steve did; there really can be time to plan ahead!</em></span></strong><br />
<strong><em><span style="font-family: Arial; font-size: large;"></span></em></strong><br />
<span style="font-family: Arial;">Please take a look at my Dialysis Patient Citizens blog, "The Patient's Voice," for more information.</span><br />
<span style="font-family: Arial;"></span><br />
<span style="font-family: Arial;">If you're heading towards dialysis, give yourself <strong><em>every</em></strong> advantage. And make sure you and your dialysis center are following the CDC guidelines.</span><br />
<span style="font-family: Arial;"></span><br />
<span style="font-family: Arial;">Take care,</span><br />
<span style="font-family: Arial;">Linda Gromko MD</span>LindaGromkoMDTransgenderBooks.blogspothttp://www.blogger.com/profile/18075274561545354491noreply@blogger.com0tag:blogger.com,1999:blog-4256377541990220917.post-76588701778228680992013-05-19T18:03:00.002-07:002013-05-19T18:08:12.920-07:00Mark Bittman Offers a Rational "Part-time Vegan" Solution at the Northwest Kidney Centers 2013 Breakfast of Hope<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;"><strong><em>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!</em></strong></span><br />
<strong><em><span style="font-family: Arial; font-size: large;"></span></em></strong><br />
<span style="font-family: Arial;">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.</span><br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj2BdGlmjFUwT6frGG9wcVJCxaxbBS9sxFa079AV5dfQQmlE82bashLCvZsCxJRcCDIhdFPw2s-fFQMTEQ3DjqgigNPr5VeT6mfEP4-dWtIPZE19D20Rqdt7k9IRayni0oUL3J7MWFDVv4/s1600/Mark+Bittman+at+NKC+Breakfast+of+Hope.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="213" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj2BdGlmjFUwT6frGG9wcVJCxaxbBS9sxFa079AV5dfQQmlE82bashLCvZsCxJRcCDIhdFPw2s-fFQMTEQ3DjqgigNPr5VeT6mfEP4-dWtIPZE19D20Rqdt7k9IRayni0oUL3J7MWFDVv4/s320/Mark+Bittman+at+NKC+Breakfast+of+Hope.jpg" width="320" /></a></div>
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<strong><em><span style="font-family: Arial; font-size: large;">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.</span></em></strong><br />
<strong><em><span style="font-family: Arial; font-size: large;"></span></em></strong><br />
<span style="font-family: Arial;">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.</span><br />
<span style="font-family: Arial;"></span><br />
<span style="font-family: Arial;">Taken aback, Bittman came up with an alternative: become a part-time vegan - or more specifically, "Be Vegan Until Six." </span><br />
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<strong><em><span style="font-family: Arial; font-size: large;">VB6 means that you eat vegan until 6:00 pm everyday - and then relax a bit.</span></em></strong><br />
<strong><em><span style="font-family: Arial; font-size: large;"></span></em></strong><br />
<span style="font-family: Arial;">It worked for Mark Bittman, as he watched his weight normalize and his laboratory values improve. </span><br />
<span style="font-family: Arial;"></span><br />
<span style="font-family: Arial;">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.</span><br />
<span style="font-family: Arial;"></span><br />
<span style="font-family: Arial;">There are many ways to lose weight, but keeping it off is trickier. Google up the <em>National Weight Control Registry,</em> or read Ann Fletcher's masterful <em>"Thin for Life"</em> for more advice.</span><br />
<span style="font-family: Arial;"></span><br />
<strong><em><span style="font-family: Arial; font-size: large;">Remember, this is a marathon - not a sprint. </span></em></strong><br />
<strong><em><span style="font-family: Arial; font-size: large;"></span></em></strong><br />
<span style="font-family: Arial;">Thanks to Mark Bittman for his outstanding presentation and contribution to the Northwest Kidney Centers Breakfast of Hope.</span><br />
<span style="font-family: Arial;"></span><br />
<span style="font-family: Arial;">Take care,</span><br />
<span style="font-family: Arial;">Linda Gromko MD</span><br />
<span style="font-family: Arial;"><a href="http://www.lindagromkomd.com/">www.LindaGromkoMD.com</a></span><br />
LindaGromkoMDTransgenderBooks.blogspothttp://www.blogger.com/profile/18075274561545354491noreply@blogger.com0tag:blogger.com,1999:blog-4256377541990220917.post-346088954550263752013-04-27T20:15:00.003-07:002013-04-27T20:15:44.324-07:00Sexuality and Renal Failure? Nephrology Social Workers Talk About It!<span style="font-family: Arial, Helvetica, sans-serif;">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. </span><br />
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<strong><em><span style="font-family: Arial; font-size: large;">These Social Workers are deeply invested in their clients' wellbeing, and they know what they're doing.</span></em></strong><br />
<strong><em><span style="font-family: Arial; font-size: large;"></span></em></strong><br />
<span style="font-family: Arial;">Here are some important take-home messages:</span><br />
<ul>
<li><span style="font-family: Arial;">Sexual function is like the "canary in the coal mine." When the body isn't working well, sexual function suffers.</span></li>
<li><span style="font-family: Arial;">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.</span></li>
<li><span style="font-family: Arial;">Many medications - including those used to treat high blood pressure and depression - may impair sexual function. But there may be alternative medications available.</span></li>
<li><span style="font-family: Arial;">Kidney transplant is the Renal Replacement Therapy that is associated with the best sexual function.</span></li>
</ul>
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<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiTqr6ETJkr1c5t7fn6K70K-FV1JFoM1gOs4SziQUR9rS8mMOWJ9eL8HnnHhkDgt4YNL7udxpCDO47GMprArXYT0HkLMmMTEh-JhUaghqAZ3qqn4W4TMIg3snhhjQJNBvjl8FtrBAA5PDw/s1600/TeresaSteve+%2528Small%2529+copy+%25281%2529.jpg" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="213" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiTqr6ETJkr1c5t7fn6K70K-FV1JFoM1gOs4SziQUR9rS8mMOWJ9eL8HnnHhkDgt4YNL7udxpCDO47GMprArXYT0HkLMmMTEh-JhUaghqAZ3qqn4W4TMIg3snhhjQJNBvjl8FtrBAA5PDw/s320/TeresaSteve+%2528Small%2529+copy+%25281%2529.jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><span style="font-family: Arial, Helvetica, sans-serif;">Steve with his niece and kidney donor, Teresa</span></td></tr>
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<ul>
<li><span style="font-family: Arial;">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. </span></li>
<li> <span style="font-family: Arial, Helvetica, sans-serif;">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!</span></li>
<li><span style="font-family: Arial;">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.</span></li>
</ul>
<strong><em><span style="font-family: Arial, Helvetica, sans-serif;"></span></em></strong><br />
<strong><em><span style="font-family: Arial; font-size: large;">Helpful tips for talking about sexual issues include the following:</span></em></strong><br />
<ul>
<li><strong><span style="font-family: Arial;">Rehearse if you're uncomfortable talking about sex</span></strong></li>
<li><strong><span style="font-family: Arial;">Start with euphemisms ("How has your kidney disease impacted your marriage?")</span></strong></li>
<li><strong><span style="font-family: Arial;">Normalize the situation ("Many people with kidney disease find that they are less interested in sex. What has your experience been?")</span></strong></li>
</ul>
<span style="font-family: Arial;">This group of excellent Nephrology Social Workers "got it" that sexuality isn't a "frill!" It's part of living a normal healthy life. </span><br />
<span style="font-family: Arial;"></span><br />
<span style="font-family: Arial;">Take care,</span><br />
<span style="font-family: Arial;">Linda Gromko, MD</span>LindaGromkoMDTransgenderBooks.blogspothttp://www.blogger.com/profile/18075274561545354491noreply@blogger.com2tag:blogger.com,1999:blog-4256377541990220917.post-61223808271808911532013-04-15T09:52:00.002-07:002013-04-15T09:53:58.766-07:00Is Home Dialysis for Everyone?<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">There's no question about it: Home Dialysis isn't everyone's cup of tea!</span><br />
<span style="font-family: Arial; font-size: large;"></span><br />
<span style="font-family: Arial;">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!</span><br />
<span style="font-family: Arial;"></span><br />
<span style="font-family: Arial; font-size: large;">But how do you know it's for you?</span><br />
<span style="font-family: Arial; font-size: large;"></span><br />
<span style="font-family: Arial; font-size: small;">Please refer to the following link at "The Patient's Voice" blog: <span style="font-family: Times New Roman;">
</span><a data-li-track-url="http://www.linkedin.com/nhome/nus-redirect?url=http%3A%2F%2Fbit%2Ely%2F17nddGP&urlhash=xHat&trkToken=action%3Dcommentary-share-link%26pageKey%3Dmember-home%26contextId%3D146006fb-0fe1-417a-9e60-5098ce1335db%26isNested%3Dfalse%26distanceFromViewer%3D0%26aggregationType%3Dnone%26isPublic%3Dtrue%26verbType%3Dlinkedin%3Ashare%26activityId%3Dactivity%3A5729600861231931392%26isDigested%3Dfalse%26isFolloweeOfPoster%3Dfalse%26actorType%3Dlinkedin%3Amember%26feedPosition%3D1%26actorId%3Dmember%3A72080674%26objectId%3Darticle%3A5729600910162677822%26rowPosition%3D1%26objectType%3Dlinkedin%3Aarticle" href="http://www.linkedin.com/redirect?url=http%3A%2F%2Fbit%2Ely%2F17nddGP&urlhash=xHat&_t=commentary-share-link&trk=commentary-share-link" target="_blank"><span style="font-family: Times New Roman;">http://bit.ly/17nddGP</span></a>.</span><br />
<span style="font-family: Arial;"></span><br />
<span style="font-family: Arial;">There's plenty of help available. And the </span><span style="font-family: Arial;">home dialysis programs don't just "turn you loose." You do need:</span><br />
<ul>
<li><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjp9Gv_g_Bqy0SP7fFdDWmef8bOoLO6ATE0d-oHA1FUHwDtdQ0BDH0bwOXTv9o_zPwXLdYpgY8WU3wHINbYJ6ogcjRsi2CyJ7Hm6UG8RyfPoPhy5piTUWQXtRQV_LF3HkWmiu06HobX6Io/s1600/ArrangingCover.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjp9Gv_g_Bqy0SP7fFdDWmef8bOoLO6ATE0d-oHA1FUHwDtdQ0BDH0bwOXTv9o_zPwXLdYpgY8WU3wHINbYJ6ogcjRsi2CyJ7Hm6UG8RyfPoPhy5piTUWQXtRQV_LF3HkWmiu06HobX6Io/s200/ArrangingCover.jpg" width="133" /><div style="text-align: left;" unselectable="on">
</div>
</a><span style="font-family: Arial;">A shared commitment</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">The ability to read and follow directions</span></li>
<li><span style="font-family: Arial;">Manual dexterity and task-focused strength</span></li>
<li><span style="font-family: Arial;">Ability to function under pressure - with help!</span></li>
</ul>
<span style="font-family: Arial; font-size: large;">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 the</span><span style="font-family: Arial; font-size: large;">1-800 lines available 24 hours a day.</span><br />
<span style="font-family: Arial;"></span><br />
<span style="font-family: Arial;">Take care,</span><br />
<span style="font-family: Arial;">Linda Gromko, MD</span>LindaGromkoMDTransgenderBooks.blogspothttp://www.blogger.com/profile/18075274561545354491noreply@blogger.com0tag:blogger.com,1999:blog-4256377541990220917.post-14372707581311045822013-03-11T10:15:00.002-07:002013-03-11T10:18:00.307-07:0033rd Annual Dialysis Conference Brings a Reunion with Steve's Home Dialysis Instructors<br />
<span style="font-family: Arial, Helvetica, sans-serif;">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.</span><br />
<br />
<strong><em><span style="font-family: Arial;">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.</span></em></strong><br />
<strong><em><span style="font-family: Arial;"></span></em></strong><br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh7lX9BdYctttpD0qDQJLo2xStKqdLj8LNkrNKlMVeubhn1drHYu3WjuB0iCLCqEDJ9haCpu2j3DlqSFKwufXg_rntrDzst-d9Rl5oduenTdgPFb8C4CjcjwgDdcFY2dKx75Gx1o8M4DIM/s1600/LetMeGo61stBdayGroup.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh7lX9BdYctttpD0qDQJLo2xStKqdLj8LNkrNKlMVeubhn1drHYu3WjuB0iCLCqEDJ9haCpu2j3DlqSFKwufXg_rntrDzst-d9Rl5oduenTdgPFb8C4CjcjwgDdcFY2dKx75Gx1o8M4DIM/s320/LetMeGo61stBdayGroup.jpg" width="320" /></a></div>
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<span style="font-family: Arial;">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."</span><br />
<span style="font-family: Arial;"></span><br />
<strong><span style="font-family: Arial;"><em>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 <u>your</u> debt.</em></span></strong><br />
<strong><em><span style="font-family: Arial;"></span></em></strong><br />
<span style="font-family: Arial;">Take care,</span><br />
<span style="font-family: Arial;">Linda Gromko, MD</span>LindaGromkoMDTransgenderBooks.blogspothttp://www.blogger.com/profile/18075274561545354491noreply@blogger.com0tag:blogger.com,1999:blog-4256377541990220917.post-60809955998528317212013-03-05T09:17:00.000-08:002013-03-05T09:19:22.404-08:00Here's a blog you might find interesting...<span style="font-family: Arial, Helvetica, sans-serif;">Dialysis Patient Citizens has a new Education Center, and I wanted to direct readers to the following site: <a href="http://www.dpcedcenter.org/">www.dpcedcenter.org</a>.</span><br />
<span style="font-family: Arial;"></span><br />
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgKWa-PBuDyrCHAGFkN9O5bhz4buTfCbtjef8ApN_QyIeBqCj0E2ZXQI1_T7OrihtG3K6QOYVjRUKnkLa4Vlb5sUrxKgTbUBsGZgP7ji1hlNcoJgTRfuHhiNbwKPQCAZZZEgB6Ux_TmW-w/s1600/DialysisMachineCloseUp.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgKWa-PBuDyrCHAGFkN9O5bhz4buTfCbtjef8ApN_QyIeBqCj0E2ZXQI1_T7OrihtG3K6QOYVjRUKnkLa4Vlb5sUrxKgTbUBsGZgP7ji1hlNcoJgTRfuHhiNbwKPQCAZZZEgB6Ux_TmW-w/s320/DialysisMachineCloseUp.jpg" width="240" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><span style="font-family: Arial, Helvetica, sans-serif;">All primed and ready to run, this NxStage machine is</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> the </span><span style="font-family: Arial, Helvetica, sans-serif;">size of </span><span style="font-family: Arial;">a small office copier. And it travels well!</span></td></tr>
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<span style="font-family: Arial;"></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">I'll be writing a quarterly blogpost featured in the Patient Voice section. My first entry, posted last week discusses benefits of Home Dialysis.</span><br />
<span style="font-family: Arial;"></span><br />
<span style="font-family: Arial;">My next post will discuss, "Are You Cut Out for Home Dialysis?"</span><br />
<span style="font-family: Arial;">Please join me and the other bloggers as we explore various topics pertinent to CKD.</span><br />
<span style="font-family: Arial;"></span><br />
<span style="font-family: Arial;">Take care,</span><br />
<span style="font-family: Arial;">Linda Gromko, MD</span>LindaGromkoMDTransgenderBooks.blogspothttp://www.blogger.com/profile/18075274561545354491noreply@blogger.com1