Thursday, August 12, 2010

Dialysis extending life for many



Four years ago life was pretty normal for one senior Kingsport resident. Charmie Horton worked with children, attended services at First Baptist Church, Kingsport, and enjoyed time with friends and family.

On a day that began like any other, she was feeling fine and taking care of chores. By afternoon, she began to having breathing difficulties. “I don’t know what happened to me,” she said, still bewildered.
Unable to get enough air to call for help, she motioned for a neighbor who contacted 911. She gazed back at her home as they loaded her into an ambulance. “When I looked back at my gate, I thought I’d never be back,” Horton recalled.
When she did finally see her gate again, it was three weeks later. She returned home from the hospital with two new diagnoses –– diabetes and chronic kidney failure. Without a kidney transplant, dialysis was her only hope.
“I was in Indian Path for three weeks. When I got ready to go home, Dr. (Abrar) Ahmad told me, ‘When you go to dialysis, you treat it as if you’re going to a job every day.’ I’ve learned that is the truth.
“There are days you don’t feel like getting up at five o’clock to get ready to come here. Something says you’ve got to go and you do. You don’t lay out. You don’t miss your treatment. This is your lifeline. You either get your priorities right, you either come, or you die.”
Dr. Steven Butler, a nephrologist with Regional Kidney Care, founded a Kingsport dialysis clinic in 1993 with 30 patients. Today, Horton is one of 152. The majority of these patients have chronic kidney disease, which currently affects 26 million American adults according to the National Kidney Foundation. When the disease limits the function of both kidneys to 10 or 15 percent, dialysis is needed.
There are two forms of dialysis. Peritoneal uses the stomach lining and peritoneal fluid, allowing patients to remain at home. The most common, hemodialysis, directly accesses the bloodstream and is usually done at a professional center.
Although it is not as effective as the kidneys, dialysis helps to replace three important kidney functions: removal of waste from the blood, removal of excess fluid, and keeping electrolytes in balance.
While there is the rare patient who is able to recover kidney function, most will need a kidney transplant or remain on dialysis for the rest of their lives, Butler said. “One of the perceptions out there is that dialysis is a death sentence or that it’s associated with a universally poor quality of life and that you’re there and you’re miserable for a few months and then you die,” he said.
Unfortunately, dialysis does have a high mortality rate. “Nationally, the mortality rate is about 20 percent. A lot of it really does depend on the patient. If you just look statistically, the one-year survival is about 80 percent. ... Out 10 years, there are only about 10 percent still alive,” Butler said.
Nonetheless, these patients are not without hope.
Nurse Practitioner Cindy Butler sees life expectancy misperceptions all too often. That, she said, is when she introduces those with misperceptions to a patient who has been on dialysis for more than 20 years.
“As a rule, when patients first come, they will feel as bad as they have ever felt in their entire lives,” she said, explaining that some do not even want to try dialysis. Once they do, however, things quickly turn around. “Over about a month ... they feel like themselves again.”
“(It is) a miraculous therapy in a lot of ways because when you walk into a dialysis center you’re seeing on that shift of 16 patients, people that would otherwise not be here,” Dr. Butler said.
For three days a week, four hours a day, Charmie Horton is one of the 16 patients who must sit patiently while their blood cycles from an access, into the machine for cleaning, and then back.
“I think about dialysis a lot,” she said.
It is certainly not without its challenges. The process is time-consuming, maintaining proper health difficult and the diet tedious.
“They take everything,” Horton said, voicing a rare complaint. “You have to sneak your cake ... and your lemon pie.”
A dietitian works to create individualized plans for each of the patients, balancing diabetes, kidney failure and economic concerns. “The foods that really they need to minimize or avoid are going to be the less expensive foods,” Cindy Butler said. “When you start telling them what they need to eat, a lot of times they’re people that are just barely making it economically and you’re putting more stress on them.”
Outside of her dietary complaints, Horton remains highly optimistic about her new life, prompting the staff to describe her as “delightful” and “a sweetheart.”
She, in turn, claims the staff as her own children. “We have wonderful doctors that care about you,” she said. “If you ever have to come, you won’t want to come. But once you come, you won’t want to miss. It’s like a social club! I’ve made so many friends here.”
Her optimism endears her to the staff, but they are all aware of how difficult the patients’ lives can be, Cindy Butler said. “Every once in a while, they’ll say something like, ‘You don’t know how hard this is,’ and we have to say, ‘You’re right, we don’t.’ ”
Yet Horton remains as optimistic as ever.
“Nobody told us this would be a rose garden. Just be thankful we have this place to come to and these people to take care of you.”