Saturday, April 27, 2013

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

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

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

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

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

Helpful tips for talking about sexual issues include the following:
  • Rehearse if you're uncomfortable talking about sex
  • Start with euphemisms ("How has your kidney disease impacted your marriage?")
  • Normalize the situation ("Many people with kidney disease find that they are less interested in sex. What has your experience been?")
This group of excellent Nephrology Social Workers "got it" that sexuality isn't a "frill!" It's part of living a normal healthy life.

Take care,
Linda Gromko, MD

Monday, April 15, 2013

Is Home Dialysis for Everyone?

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

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

But how do you know it's for you?

Please refer to the following link at "The Patient's Voice" blog:

There's plenty of help available. And the home dialysis programs don't just "turn you loose." You do need:
    A shared commitment
  • The ability to read and follow directions
  • Manual dexterity and task-focused strength
  • Ability to function under pressure - with help!
It's important to remember that if you do elect this route, the help that's available is extraordinary: from the training nurses at your center, to the1-800 lines available 24 hours a day.

Take care,
Linda Gromko, MD