I Hate Dialysis Message Board

Dialysis Discussion => Dialysis: General Discussion => Topic started by: plugger on March 02, 2008, 12:01:37 AM

Title: Barriers to home dialysis
Post by: plugger on March 02, 2008, 12:01:37 AM
I was talking to my state rep and he was wondering what might help people get on home dialysis. What kind of things are stopping people from this treatment besides health? The first thing I thought might be helpful is more education - maybe a roadshow with doctors and nurses?  I'm also hearing there might be a lot of doctors and staff who might need educating.
Title: Re: Barriers to home dialysis
Post by: Joe Paul on March 02, 2008, 03:10:28 AM
What type of home dialysis are you asking about?
Title: Re: Barriers to home dialysis
Post by: plugger on March 02, 2008, 03:53:05 AM
Ok, get technical on me! (just kidding) Actually I'm more interested in the home hemo - nxstage, fresenius machines, baxters etc...
Title: Re: Barriers to home dialysis
Post by: petey on March 02, 2008, 06:01:55 AM
Our experience with home hemo and the lack of people on it in our area hinges mostly on education and awareness.  Few people know it's available and an option around here (southeastern NC).  Hey, we even have to explain it to a lot of health care providers (doctors and nurses) who don't know it's do-able.  (When my Marvin says he's on "home hemo," we've had doctors and nurses say, "So, where's your abdominal catheter?  How many exchanges have you done today?"  When we say, "No, it's home HEMO,"  they say, "You can do that at home now?  Who comes and puts the needles in for you?"   :banghead;  DUH !!)

Also, we think that home hemo requires a good deal of intelligence (it's not a hard process, but you've got to have some sense to make it work), strength (moving those boxes!), and commitment (it is a serious commitment and you have to be vigilant, dedicated, and conscientious to good care, clean areas, ordering supplies, taking care of your machine, being compliant with your treatments, etc.).

Some of the other in-center dialysis folks we know are simply scared.  They're scared to be at home (with no nurse or tech) doing a treatment.  They're scared something will happen.  They're scared they can't do it.  They're scared to take the responsibility of their own care (it's easier to "plop" down in that chair in the clinic, stick out your arm, and let the nurse/tech do it all).

A lot of the in-center dialysis folks around our area are older and frail.  Many of them live in nursing homes and come to the clinic on a rescue squad stretcher.  Obviously, these folks couldn't do home hemo even if they wanted to.

I think if more people knew it was an option, they might be interested.  If more people knew how much better you feel when you're getting more treatments, they would definitely want to check it out.

But, home hemo is NOT for everyone.  I'm just glad it works for my Marvin and me.
Title: Re: Barriers to home dialysis
Post by: Joe Paul on March 02, 2008, 06:40:28 AM
At my center, it is a matter of money. Our Director says the investment in Nxstage is too great and that there aren't enough younger people at his centers who would be interested in doing Nxstage at home to justify the cost. Not that he wasn't informed, I had contacted Nxstage for information and gave it to the Director, then their local Rep called and talked with the Director, end of story.
Title: Re: Barriers to home dialysis
Post by: livecam on March 02, 2008, 07:09:14 AM
I would think any rational person would jump at the chance to do home hemo.  Anyone who has had a taste of the in-unit kind certainly would.  Its a winning situation for everyone.  Dialysis without having to go to a unit is certainly a far better choice for many reasons that would include the mental well being of the patient, quality of treatment, cost effectiveness, superior personal time management, elimination of transportation issues etc.  How do you educate people?  Side by side comparisons might work.  Show them a picture of people and machines lined up in a unit and then a few more of people dialyzing comfortably in their own homes.  That would do it for me.
Title: Re: Barriers to home dialysis
Post by: stauffenberg on March 02, 2008, 07:50:00 AM
No doubt the main bottleneck is the extremely limited number of machines available for home hemodialysis.  Another problem for some people is that they have to have the water pipes leading into their house modernized to allow for safe hemodialysis, and this can be too expensive for some people.  I had to pay $3400 to have the old pipes leading from the water mains to my house replaced before I could start home hemodialysis.

There are further subjective factors that make people not want this option.  They are forced to deal with dialysis constantly, rather than just three days a week, since they endure treatments for six nights and then have to clean the machine on the seventh day, so the well-known phenomenon of 'dialysis fatigue,' usually found in PD patients, begins to set in.  Some patients are afraid of the danger of lines coming loose or some other emergency occurring outside of a hospital setting where it could be corrected in time to prevent death.  There is also the problem of space, since one room is taken up as a sterile area for the machine, while another room is wasted for storage of supplies.  The need to be in charge of the logistics of getting the dialysis supplies ordered, checked, and stored can also be draining.  Even with all this effort at home, the patient still has to go to the hospital or clinic periodically for certain types of blood tests and for medical appointments, both of which would otherwise have been much more conveniently handled during the in-center hemodialysis sessions.  Finally there is the psychological stress of being a condemned man having to build his own scaffold, and the patient has to be prepared to have his face rubbed every day in the fact of the disease and the machine which have ruined his life, since he is much more intimately involved in the details of his medical tragedy when he has to do his own dialysis.  The difference for some people between home dialysis and in-center is like that between doing your own housework and having a professional maid do it for you: why would you want to do your own dialysis if professionals are available to take care of it for you, while all you have to do is show up at the dialysis center, sit down, and read for four hours?  There is also the added psychological stress of having the machine come into your own home, rather than being able to confine that horror at some place away from where you live.  The feeling that your life has been invaded and taken over by the disease discourages many people from this treatment, despite its better medical outcome.
Title: Re: Barriers to home dialysis
Post by: BobT1939 on March 02, 2008, 08:20:55 AM
For a non-intellectual discussion of how people feel about home dialysis go to the NxStage forum here on IHD. You will be spared the "horrors" of a Stauffenberg posting. The man's knowledge of our disease is amazing, and when he doesn't editorialize his posts are entirely worthwhile. Too often, however, he chooses to sink into his own personal memories of how hemodialysis was for him, when he was on it./bobt
Title: Re: Barriers to home dialysis
Post by: Psim on March 02, 2008, 08:46:21 AM
I had to pay $3400 to have the old pipes leading from the water mains to my house replaced before I could start home hemodialysis.

In Canada, basic medical insurance will pay to have this done. Whew!
Title: Re: Barriers to home dialysis
Post by: petey on March 02, 2008, 08:52:48 AM
Oh, stauffenberg -- I see you're your usual self today.  I hadn't seen any of your posts in the last couple of days, and I was missing you!

Another problem for some people is that they have to have the water pipes leading into their house modernized to allow for safe hemodialysis, and this can be too expensive for some people. I had to pay $3400 to have the old pipes leading from the water mains to my house replaced before I could start home hemodialysis.

With the current NxStage system, we didn't have to have ANY modifications made to our house (and our house was built in 1977).  It easily connects to any spigot (sink or washing machine), but my Marvin put (by his choice -- not a requirement) a small sink in his "clinic" (was a bedroom) and attached to the water supply line and the drain line under the sink (the attachment came with the PureFlow system).  With no costs and less than an hour's time, Marvin had connected everything that needed to be connect to get his NxStage and PureFlow system in place and working.  There was no modification needed for electricity, either -- it plugs into a regular wall outlet.   Easy, isn't it, stauffenberg?


There are further subjective factors that make people not want this option. They are forced to deal with dialysis constantly, rather than just three days a week, since they endure treatments for six nights and then have to clean the machine on the seventh day, so the well-known phenomenon of 'dialysis fatigue,' usually found in PD patients, begins to set in.  

Oh, no!  There is no "dialysis fatigue" in our house.  Marvin's treatments take about 2 1/2 hours every day (and we pick the time for the treatments and the one day he gets "off" every week).  After I pull his needles and while he's holding his site to get it to stop bleeding, I clean his machine.  The cartridge is a closed circuit and contains his filter and all of his lines.  I simply open the front of his machine, pull out the cartridge, and throw it away.  Then, I throw away the saline bag that I had hanging.  Then, I shut the door on the front of his machine and wipe down the whole thing (and it's a small machine) with a clorox wipe.  Done!  Takes me about 5 minutes.


There is also the problem of space, since one room is taken up as a sterile area for the machine, while another room is wasted for storage of supplies. The need to be in charge of the logistics of getting the dialysis supplies ordered, checked, and stored can also be draining. Even with all this effort at home, the patient still has to go to the hospital or clinic periodically for certain types of blood tests and for medical appointments, both of which would otherwise have been much more conveniently handled during the in-center hemodialysis sessions.

We emptied ONE small bedroom and made it a "clinic" for Marvin's home hemo treatments.  Marvin built shelves and cabinets to hold supplies and the closet in that room holds all the big boxes.  If you plan it right, it's not that bad.  We did give up a bedroom (and only one, not two), but we weren't using it anyway.

On home hemo, Marvin and I draw his labs every two weeks.  We get a box from the lab a few days before "lab day."  I draw the required tubes before and after treatment (using his arterial line -- so no extra stick).  We have a centrifuge (supplied by DaVita) to spin the necessary tubes.  I refrigerate the labs (Marvin put a small fridge in his "clinic" -- again not mandatory but his choice) and Marvin calls FedEx.  FedEx picks up the box the next morning.  Can't get much easier than that, can it?

Finally there is the psychological stress of being a condemned man having to build his own scaffold, and the patient has to be prepared to have his face rubbed every day in the fact of the disease and the machine which have ruined his life, since he is much more intimately involved in the details of his medical tragedy when he has to do his own dialysis.

There is also the added psychological stress of having the machine come into your own home, rather than being able to confine that horror at some place away from where you live. The feeling that your life has been invaded and taken over by the disease discourages many people from this treatment, despite its better medical outcome.

Fact -- your life has been taken over by this disease whether the machine is in your home or not.  Just because you only see your machine three times a week at clinic doesn't mean you're not a dialysis patient the other four days a week.   Your way of thinking seems to be, "If I don't acknowledge it, it doesn't exist."  Well, stauffenberg, it does exist whether you acknowledge it or not.  Marvin is a dialysis patient 24 hours a day, seven days a week.  We choose to embrace it and control it -- instead of letting it control us.

To Marvin and me, dialysis is not a "horror" -- think of the alternative.  To us, dialysis saves and extends Marvin's life each day.  Something (like dialysis) that does that for Marvin can't be bad.

Marvin has a lot more confidence in having his treatments at home with the same person sticking him every day than having multiple people do it at the clinic.  Marvin likes to make sure that his machine is cleaned, set up, and maintained properly -- we know we're doing that, but we don't know what's being done at the clinic.

To us, it's all a matter of attitude.  Dialysis is what you make of it.  If you make it a "horror," it will become one.  If you make it a part of your everyday life and treat it as a necessary process, that's what it will become.  We choose the latter.

Is home hemo inconvenient?  Yes.  Does it take about four hours out of every day for us?  Yes.  Do we have a lot responsibility to conduct Marvin's treatments?  Yes.  (It takes about 5 minutes every month to order Marvin's supplies.)  But, the advantages far outweigh the disadvantages.  Since we started home hemo, Marvin's labs have been near PERFECT.  His energy level has increased by 300 percent.  He's come off all BP meds and a lot of other meds (he's down to four pills a day !!! -- and he had gotten up to about 16).

Stauffenberg -- where did you get your information?  Some of your statements about home hemo are simply inaccurate.  You obviously have not tried home hemo, for if you had, you would know that it's not as bad as you make it sound.

We don't think that home hemo makes Marvin a "condemned man building his own scaffold."  We think it makes Marvin a man who actively participates in the continuation of his life and who every day improves the quality of his own life.
Title: Re: Barriers to home dialysis
Post by: BobT1939 on March 02, 2008, 09:02:02 AM
Ah, the sweet sound of reason. Bless your heart, Petey./bobt
Title: Re: Barriers to home dialysis
Post by: willieandwinnie on March 02, 2008, 09:18:08 AM
:thumbup; Well said petey. We didn't have NxStage, we had the old Fresenius 2008H and an RO. We had to have an electrician and a plumber do some modifications (paid by Medicare) to a spare bedroom, they did both in a couple of hours. We put the RO in the closet because it was kind of noisy.  We already had dresser and some cabinets, so storing stuff was not a problem. I drew Len's labs once a month and drove them to clinic. I gave him his EPO and he had the best labs out of the 4 clinics our Neph took care of. Once his treatment was finished, I wipe the machine down and then it did the acid rinse and the heat disinfect by itself. Yeah, the supply order took a couple of minutes to order and a little longer to put away. We figured if Len had of stayed in the clinic, he would of been dead by now. His condition would not of improved enough to get him on the transplant list and finally a transplant. Yes Len did have the "dialysis fatigue" but it was such a blessing that we didn't have to drive 20 miles for him to lay down. The only out of pocket expense we had was a flat screen tv/dvr/cd player that he didn't have to share with anyone and he had the best tech he could possibly ask for. I was careful about sticking his graph and NEVER reused a single needle, I even used separate ones for numbing aterial and venous. I say if someone can do home-hemo, DO IT, you might just be saving your own life. I'll now jump off my soap box.
Title: Re: Barriers to home dialysis
Post by: del on March 02, 2008, 09:32:33 AM
Well said Petey and Willieandwinnie. Hubby has been on home hemo for about a year and a half now and no dialysis fatigue here.  A lot less than when he was in center where he had to drive for over an hr to get to the center 3 times a week.  Because he does nocturnal he doesn't have to give up any time in his day.  As for cleaning the machine I put it in acid clean as soon as he is disconnected.  By the time the needles are out it is time to put it in heat disinfect.  By the time I get a shower and get ready for work everything is cleaned. Hubby strips the machine and dumps the left over baths when he gets up. As for changes to the house we had to put a water hookup to the bedroom and a drain and get an electrical outlet put in. Hubby did that himself so only cost us the price of the materials. We have sensors for the floor and his arm in case there is a leak.  There is a tech on call 24/7 that we can call if we have any problems. Had to call 12:00 on Friday night .  He helped us fix the problem.  Home hemo is the way to go I think!!!  Hubby does not even want to think about having to go back to in center.  As for bloodwork he has to take that to the hospital once a month but we live in a rural area so it is a chance for us to go shopping!!He only sees the kidney specialist once every 2 or 3 months so it is no big deal.  I think there is a lot les chance of something happening at home than in center because at home you are in control and you look after things.
Title: Re: Barriers to home dialysis
Post by: Meinuk on March 02, 2008, 09:44:33 AM
Things are rapidly changing in the dialysis world. 

NxStage shrunk the home hemo machine and with disposable single use cartridges (tubing and artificial kidney) cleaning is really more like a wipe down after a run or the occasional drain flush or sensor wipe.    The exciting news, there are other technologies in development that are just a few years away (less dialysate, more portability).  For me, dialysis is a daily therapy that maintains my well being, allows me to work, vacation and schedule my time as I see fit.  As opposed to the rigid schedule of 3x a week in-center dialysis.  And I can now brag that I have mad skillz with a box cutter.  (comes in handy in my 'hood)

The downsides for me are:

It is not a cure, it is a therapy - no skipping and until I get a transplant, (also not a cure but more portable) this is my life. 
The supplies take up a lot of space, (and I'm using pureflow) of course space in relative, I live in a three room NYC apartment.
It does take dexterity and diligence, and adequate training.  For me, that is amplified, as I dialyze alone.  With a partner, you'd have a built in safeguard.
It cost me $175.00 to have a plumber adapt my kitchen sink for the pureflow connector.  (I have old plumbing, and was unable to do it myself)

Those are my downsides, which are completely negated by the positive impact that daily dialysis has had on my life.

Title: Re: Barriers to home dialysis
Post by: Joe Paul on March 02, 2008, 11:22:21 AM
Ughhh
Title: Re: Barriers to home dialysis
Post by: jbeany on March 02, 2008, 12:27:37 PM
I think the self-cannulation stops a lot of people.  They can't picture putting in the needles themselves.  Having a reliable partner is also an issue - it takes a large time commitment from your training partner.  I know some places offer home hemo training to people without partners, but it's a difficult fight.  Getting the doctors and nurses to accept that home hemo is a better option is tough as well - some of them just do not believe that it's a good option for anyone.  They don't adapt well to change!
Title: Re: Barriers to home dialysis
Post by: BigSky on March 02, 2008, 12:44:47 PM
Actually what stauffenberg said was dead on and often cited as problems people have with home hemo by the industry.  While they may not affect everyone, its still things that people have to deal with at one time or another.
Title: Re: Barriers to home dialysis
Post by: plugger on March 02, 2008, 12:48:20 PM
Ok, this is great!  It is going to take some time to process all this and if anybody has more, join in!  I think I've mentioned a small group of us got that tech training bill through Colorado - we are still in an exploratory phase here, but this could very well be real.
Title: Re: Barriers to home dialysis
Post by: kitkatz on March 02, 2008, 12:51:38 PM
My issues are in getting the center that does the training to agree to MY timetable.  Their schedule and my schedule will not mesh and they are unwilling to make an exception.  I will not take six weeks off of work to train for dialysis.  This is a ridiculous expectation on their part!
Title: Re: Barriers to home dialysis
Post by: petey on March 02, 2008, 01:20:34 PM
kit -- Marvin and I trained in the summer (when I was out of school).  Would this be an option for you?
Title: Re: Barriers to home dialysis
Post by: kitkatz on March 02, 2008, 01:27:02 PM
These people say I do not have the right time table for them
Title: Re: Barriers to home dialysis
Post by: KT0930 on March 02, 2008, 02:07:03 PM
I have not had the chance to talk to other dialysis patients (aside from the ones on IHD, of course), but if it weren't for IHD, I would be completely uninformed about home hemo - wouldn't know it was a possibility! Also, both times in my life that I have been on in-center hemo, I had a permcath, and the machine was set so far back from my chair that if I had attempted to turn and see what was going on, I would have caused the cath to kink and an alarm on the machine. So for me, hemo was a very scary proposition of not knowing what was going on, not understanding enough to even begin asking questions, and being "thrown into it" based on a very rapid, unexpected decline of kidney function. At least if I could have seen the machine and what was going on, I would have had somewhere to begin. It's almost like the nurses and techs wanted to keep it all a big secret, so their jobs were secure.  :banghead;

Basically what I'm saying is, more education before, during and after initiation of dialysis treatment so the patients know what's going on and what ALL their options are would probably get many more patients interested in this type of treatment. Especially the ones who are not the stereotypical "old and frail" patients that you see in-center.
Title: Re: Barriers to home dialysis
Post by: Roadrunner on March 02, 2008, 04:57:58 PM
When we moved we wound up is an awful dialysis center.  I called around and begged and cried. All the good centers were full.  One social worker who I talked to 3 or 4 times finally told me that there was an alternative.  HOME HEMO.  She asked if I would like to find out more.  I jumped at it.  We were the second pair they were training.  We had a wonderful nurse and we wouldn't go back to in-center for anything.  My husband feels better, looks better and is getting stronger.  My biggest fear is that I get sick or too old to do this.  We are both in our 70's and it is a concern. 

How old our other partners?
Title: Re: Barriers to home dialysis
Post by: petey on March 02, 2008, 05:08:03 PM
roadrunner -- even though Marvin and I are relatively young (he's 52 and I'm 45), I worry about what would happen if something happens to me.  Yes, I'm quite healthy, but I could break an arm, need some type of emergency surgery, or something like this in the next minute, hour, or day.  I'm the only one who trained with him, and he WILL NOT cannulate himself -- he won't even look when I put the needles in.  This worry hangs over my head daily; he needs me now more than he ever has before.
Title: Re: Barriers to home dialysis
Post by: stauffenberg on March 02, 2008, 06:38:37 PM
Petey, I believe that what you regard as 'errors' in my account of my personal experience while I was on home hemodialysis has to do with the fact that you are comparing your experience with NxStage with my experience with a conventional Fresenius dialysis machine placed in the home.  NxStage was not available in Canada when I was on home hemodialysis in 1996. 

Needless to say, I stayed with that form of treatment only a short while, mainly because it interfered with my psychological coping mechanism for surviving on dialysis.  For me, in-center hemodialysis was just a ritual which required me to sit in a given chair for four and a half hours while nurses ran around me doing one thing or another, and while I read books.  I used to think to myself: so what's the problem with having to sit in this chair reading rather than having to sit in a different chair at home and read?  But that whole intellectual strategy was defeated when I had to involve myself actively in the whole treatment process which, as I have said before, was for me like being a condemned man being forced to build the scaffold that would hang him.  You don't want to have to spend years of your life staring at the photograph of the person who will some day kill you, or taking apart and putting together the car that will one day run you over and end your life.  In the same way, you don't want to spend every day of your life fiddling with the machine that symbolizes the fact that disease has destroyed your chance of a normal life.
Title: Re: Barriers to home dialysis
Post by: livecam on March 02, 2008, 06:51:06 PM
I will not take six weeks off of work to train for dialysis.  This is a ridiculous expectation on their part!

Do it when school is out of session for summer break. 
Title: Re: Barriers to home dialysis
Post by: kitkatz on March 02, 2008, 08:09:43 PM
They will not work with me for that time frame. It has to be in their time frame. How convenient is that for me?
Title: Re: Barriers to home dialysis
Post by: Joe Paul on March 02, 2008, 08:27:14 PM
Petey, I believe that what you regard as 'errors' in my account of my personal experience while I was on home hemodialysis has to do with the fact that you are comparing your experience with NxStage with my experience with a conventional Fresenius dialysis machine placed in the home.  NxStage was not available in Canada when I was on home hemodialysis in 1996. 

Needless to say, I stayed with that form of treatment only a short while, mainly because it interfered with my psychological coping mechanism for surviving on dialysis.  For me, in-center hemodialysis was just a ritual which required me to sit in a given chair for four and a half hours while nurses ran around me doing one thing or another, and while I read books.  I used to think to myself: so what's the problem with having to sit in this chair reading rather than having to sit in a different chair at home and read?  But that whole intellectual strategy was defeated when I had to involve myself actively in the whole treatment process which, as I have said before, was for me like being a condemned man being forced to build the scaffold that would hang him.  You don't want to have to spend years of your life staring at the photograph of the person who will some day kill you, or taking apart and putting together the car that will one day run you over and end your life.  In the same way, you don't want to spend every day of your life fiddling with the machine that symbolizes the fact that disease has destroyed your chance of a normal life.
I am glad you responded stauffenberg, as I started to defend your point of view (edited my response to just say Ugh). People who are caregivers, though they SEE dialysis first hand, have no idea of the horrors we as patients may see dialysis and its machines, no matter what kind of front we put up. I am not slamming caregivers, they are important, its just living on a machine doesn't mean the same thing to every person, after all the name of the site is I HATE DIALYSIS, in capitol letters no less.
Title: Re: Barriers to home dialysis
Post by: brenda on March 02, 2008, 08:59:33 PM
Home-hemo is nothing like it was in 1996. I know I was there then and I am here now. Going home was the best thing I ever did. Yes it was a little scary at first needling yourself, and yes I worried about the possible emergencies that could occur and yes I doubted that I could handle having the machine in my house 24/7. Home-hemo doesn't necessarily mean 6 night's a week. I still just do three evenings a week after work and have been for 14 years. Everything here in Alberta anyway is paid for. The electrical and plumbing is all taken care of. There are space issues. First of all you have to have a comfortable space for you and your machine, then there is the RO tanks etc, then room for your supplies. The contract with the Health Region for delivering supplies requires that they place it exactly where I want it. All I have to do is show up when they call me and unlock my door.

The freedom obtained from Home-hemo far outweighs the worries. I can run any evening I want. And I certainly don't think about dialysis just because my machine is setting there. It's all what you make of it really. But i would far sooner sit in my own home, in my own chair, nap or watch TV than sit and look at what's going on in those units. It's a lot easier to sit here for 4 hours then at the unit for 4 hours.

And Kit, I know it seems frustrating trying to get the time to train but it's only 6 weeks once and it's freedom for the rest of your dialysis life.
Title: Re: Barriers to home dialysis
Post by: CW on March 02, 2008, 10:34:01 PM
My biggest barrier is that I do not have a partner but some others are
fear of home hemo
fear of sticking needles in my own arm
fear of having to make changes to the home I am in
fear that my home hemo machine is watching me sleep and plotting my demise :o
Title: Re: Barriers to home dialysis
Post by: petey on March 03, 2008, 06:00:37 AM
Stauffenberg -- Perhaps the reason why I questioned your accuracy in home hemo facts was that, in your original post, you predominantly used the third person pronoun ("he") rather than the first person ("I").  This seems to group all people together, and, as we all know, no two dialysis patients are alike and each has a different opinion/outlook of dialysis and a different experience.  The only time you used "I" was when you told how much you had to pay to have plumbing adjustments made to your home to accommodate the home dialysis machine.  The rest of the post, you used "he."  For example, you said having a dialysis machine in the home was like "...being a condemned man having to build his own scaffold, and the patient has to be prepared to have his faced rubbed every day in the fact of the disease and the machine which have ruined his life...."

I merely wanted to point out that not all dialysis patients feel this way.  I wanted to make sure that someone reading your post knew that Marvin and I did not have the same opinions of home hemo as you detailed in your post; we have had a very different experience.  If you'll check my post, you'll see that I used the first person point-of-view because I wanted to explain my and Marvin's experience with home hemo.  I wanted any "new" dialysis folks to see that not all of us consider home hemo a "horror," and the best way to do this, I thought, was to tell our positive experience with home hemo.  Instead of generalizing your comments and seeming to lump all dialysis patients into the same category, you might consider starting your posts with, "It has been my experience...."  This would make it more clear that you are expressing your feelings (instead of speaking for all of us).



And, Joe Paul, don't you dare insult me by saying this...

People who are caregivers, though they SEE dialysis first hand, have no idea of the horrors we as patients may see dialysis and its machines, no matter what kind of front we put up.

For your information, I live with ESRD and dialysis, too (and I'm the healthy one).  This is not merely something that I SEE happening in my husband's life; it's affecting my (and OUR) life, too.  Dialysis has changed my life and has created obstacles that I must deal with, also.  I'm not a spectator in Marvin's life -- I'm an active participant.  Even though the needles are not put in my arm every day and even though I don't have to stay hooked up to that machine for hours every day, I'm in this with Marvin every step of the way.  I hurt when he hurts (even though his is a physical hurt, mine is no less because it's hurting my soul to see him in pain).  There has not been a minute (NOT A MINUTE) in the last 13 years when I haven't been right beside Marvin in everything he's been through with ESRD, dialysis, and transplantation.  When you said that caregivers have "no idea" of the horrors that dialysis patients live with, you were most definitely incorrect where I am concerned.

Perhaps Marvin and I are different from some other dialysis patients and their respective partners.  We are a team.  What he has to live with, I have to live with, too.  What he has endure, I have to endure, too.  When he hurts, I hurt.  When he succeeds, I succeed.

For you, Joe Paul, to infer that I only SEE the experience of ESRD and dialysis because I'm only Marvin's caregiver is insensitive, offensive, and just plain wrong! 
Title: Re: Barriers to home dialysis
Post by: willieandwinnie on March 03, 2008, 06:25:55 AM
petey, AMEN. Len said last night that everything he has gone through has been harder on me (I didn't receive pain medication or medication that doesn't let you remember). I was the one that sat through (never left his side for 6 months he was in the hospital) his 3 months of an induced coma, at least 21 operations (I have put my time into many surgical waiting rooms), when he died twice (my whole being was sucked out of me), he said he was not in pain and didn't know what was going on (thank God), but I did, every second. I was the one that went to him about home dialysis (I have a fear of needles), I wanted to take care of my soul mate, my best friend, my lover and my husband. I wasn't the one physically going through the dialysis process, but rest assured I felt his pain in my heart and soul (I still do, everyday). This is OUR life and we are ONES dealing with everything that is related to ESRD. If the need arises again for dialysis, WE will again do home-hemo for OUR benefit. This has just has plain PISSED ME OFF.
Title: Re: Barriers to home dialysis
Post by: paris on March 03, 2008, 09:42:42 AM
I have been thinking about these posts for a couple of hours.  I must speak up as the one with ESRD, not the caregiver.  Joe Paul wasn't trying to offend anyone. We, as the patients, need a safe place to vent, to share, to complain or just compare.  My husband is loving, caring and worries about me all the time.  But, late at night, when it is dark and quiet, he can't know the fear, the pain, the disappointment, that I have.  He does all he can, but in the end, it is still me who has kidney failure.  We love our caregivers and know they make our lives easier.  I wouldn't wish this disease on anyone and I would rather it be me than my husband.  My sister-in-law died of breast cancer. Her loving husband never left her side. He was the perfect caregiver and support.  But, Lisa died and Dick still lives. He is heartbroken, but is going about rebuilding his life.  He knew she was in pain and very worried, but it wasn't him.  There is a difference.    Joe Paul is one of the sweetest members and always gives encouragement to others.  So, understand, we need to beable to scream somethimes that unless you have ESRD, you can't know the full impact of the disease.  That doesn't take away from the incredible bond you have with your spouses.  Your husbands are very fortunate to have you. 

I know this post if off topic. Most of this belongs in the "caregivers" section.
Title: Re: Barriers to home dialysis
Post by: lola on March 03, 2008, 10:23:54 AM
I have been thinking about these posts for a couple of hours.  I must speak up as the one with ESRD, not the caregiver.  Joe Paul wasn't trying to offend anyone. We, as the patients, need a safe place to vent, to share, to complain or just compare.  My husband is loving, caring and worries about me all the time.  But, late at night, when it is dark and quiet, he can't know the fear, the pain, the disappointment, that I have.  He does all he can, but in the end, it is still me who has kidney failure.  We love our caregivers and know they make our lives easier.  I wouldn't wish this disease on anyone and I would rather it be me than my husband.  My sister-in-law died of breast cancer. Her loving husband never left her side. He was the perfect caregiver and support.  But, Lisa died and Dick still lives. He is heartbroken, but is going about rebuilding his life.  He knew she was in pain and very worried, but it wasn't him.  There is a difference.    Joe Paul is one of the sweetest members and always gives encouragement to others.  So, understand, we need to beable to scream somethimes that unless you have ESRD, you can't know the full impact of the disease.  That doesn't take away from the incredible bond you have with your spouses.  Your husbands are very fortunate to have you. 

I know this post if off topic. Most of this belongs in the "caregivers" section.
as a caregiver, I two need to "stick" up for JP he would NEVER mean to say something to offend a caregiver he has been nothing but kind and helpful to me. Sometimes we say things here that others take personal even though that is not the intent.  :cuddle;
Title: Re: Barriers to home dialysis
Post by: okarol on March 03, 2008, 10:40:34 AM
Caregivers ROCK!

That being said...

Let's try to stick to the topic "Barriers to home dialysis" - it's gotten a little off track here.


okarol/moderator
Title: Re: Barriers to home dialysis
Post by: aharris2 on March 03, 2008, 03:31:21 PM
No doubt the main bottleneck is the extremely limited number of machines available for home hemodialysis.  Another problem for some people is that they have to have the water pipes leading into their house modernized to allow for safe hemodialysis, and this can be too expensive for some people.  I had to pay $3400 to have the old pipes leading from the water mains to my house replaced before I could start home hemodialysis.

There are further subjective factors that make people not want this option.  They are forced to deal with dialysis constantly, rather than just three days a week, since they endure treatments for six nights and then have to clean the machine on the seventh day, so the well-known phenomenon of 'dialysis fatigue,' usually found in PD patients, begins to set in.  Some patients are afraid of the danger of lines coming loose or some other emergency occurring outside of a hospital setting where it could be corrected in time to prevent death.  There is also the problem of space, since one room is taken up as a sterile area for the machine, while another room is wasted for storage of supplies.  The need to be in charge of the logistics of getting the dialysis supplies ordered, checked, and stored can also be draining.  Even with all this effort at home, the patient still has to go to the hospital or clinic periodically for certain types of blood tests and for medical appointments, both of which would otherwise have been much more conveniently handled during the in-center hemodialysis sessions.  Finally there is the psychological stress of being a condemned man having to build his own scaffold, and the patient has to be prepared to have his face rubbed every day in the fact of the disease and the machine which have ruined his life, since he is much more intimately involved in the details of his medical tragedy when he has to do his own dialysis.  The difference for some people between home dialysis and in-center is like that between doing your own housework and having a professional maid do it for you: why would you want to do your own dialysis if professionals are available to take care of it for you, while all you have to do is show up at the dialysis center, sit down, and read for four hours?  There is also the added psychological stress of having the machine come into your own home, rather than being able to confine that horror at some place away from where you live.  The feeling that your life has been invaded and taken over by the disease discourages many people from this treatment, despite its better medical outcome.

The question asked was "Barriers to home dialysis"
Stauffenberg's post is valid. In it he mentions a number of barriers - logistical, financial (which may or may not be easily resolved), and, most importantly, psychological. Very simply, one who feels as Stauffenberg described is not a good candidate for home dialysis. This is not a value judgement. By remaining "in-center", this individual is best able to distance him/herself from ESRD. I absolutely understand that a person might feel that way.

That said, all of us - caregivers, those whose kidneys have failed them, family and friends, live in our own private little hells because of ESRD. Stauffenberg has described one hell and others have described their own. One does not invalidate the other (more in the caregivers section.)

Alene
Title: Re: Barriers to home dialysis
Post by: aharris2 on March 03, 2008, 03:38:17 PM
(more in the caregivers section.)

...or not. That thread has been locked :-\
Title: Re: Barriers to home dialysis
Post by: kitkatz on March 03, 2008, 08:31:17 PM
Now remember everyone opinions expressed on this board are just that, opinions.  Opinions are a dime a dozen.  Play friendly now.
Title: Re: Barriers to home dialysis
Post by: okarol on March 03, 2008, 08:37:31 PM
This thread might be helpful to learn more about deciding on home hemo http://ihatedialysis.com/forum/index.php?topic=43.0
Title: Re: Barriers to home dialysis
Post by: Sluff on March 04, 2008, 03:41:51 AM
(more in the caregivers section.)

...or not. That thread has been locked :-\


Yup it sure was. I don't feel we need two threads to discuss one subject.

Sluff/ Admin
Title: Re: Barriers to home dialysis
Post by: Zach on March 04, 2008, 06:08:38 AM
Some more thoughts:
 8)

http://www.nephronline.com/nephnews/index.php?option=com_content&task=view&id=2358&Itemid=136

Report from Orlando           
Symposium pushes the HHD button

Mark E. Neumann, Executive Editor, Nephrology News & Issues

Dialyzing at home was the only option in the 1960s if you wanted to survive. The bedrooms of households of the lucky few gave birth to a treatment that today helps more than 350,000 individuals.

One of the nephrologists who remembers those days—Christopher Blagg—was the main organizer behind a full-day symposium this past Saturday in Orlando, Fla. that focused on sending more people with renal disease back home. The objectives of the symposium, jointly sponsored by the Annual Dialysis Conference and the International Society for Hemodialysis, were to compare experiences with home hemodialysis in the United States to that of Finland and Australia, discuss strategies to develop or improve home hemodialysis programs, identify resources for HHD patients, and provide updates on ongoing studies and an international registry.

All told, 25 presentations were squeezed into the nearly 10-hour day, and the symposium’s official title, “The Renaissance of Home Hemodialysis: Lessons from the World Over,” aptly represented the discussion and review.

What was the take-home message? Primarily, we need to offer HHD to more patients in the United States. It is an option that needs to be presented—optimally, during the pre-dialysis period—along with peritoneal dialysis, transplant and in-center dialysis. And for some, there is a belief that it remains the best option.

“In the 1960s, when we did dialysis at home, we didn’t call it home dialysis,” said Nancy Spaeth, a Seattle native with a transplant who experienced a number of modalities. “We just called in dialysis.”

Certainly, HHD is not for everyone. The discussions during the day made it clear that home dialysis––whether short daily hemodialysis, nocturnal, standard HD at home three times/week, or PD—requires an individual who understands the rigors of self-care. But others suggested that patients may not need to make HHD a permanent decision. What makes more sense is that it becomes part of a life plan of therapeutic options, as needed. If short daily at home becomes overwhelming, switch to in-center nocturnal, or consider PD. A respite may help ease the workload, but still allow patients to maintain self-care.

The international perspectives at the symposium focused on the value of HHD and patient quality of life. And the good news from these programs in Finland and Australia is they also found cost savings. Ecro Honkanen, and MD from Finland, told the packed audience that the costs of HHD are the lowest among all therapies in his country––if you look long term. Those cost savings for their health care system come from patients who experience improvements in cardiac function, “dramatic” improvement in phosphorus control (particularly in patients who do nocturnal dialysis), reductions in blood pressure, and improved energy levels—which leads, Australian nephrologist John Agar said, to people returning to work in his country.

To get more patients interested in HHD, dialysis staff push a “home first” policy in Finland. Similar to experiences in Australia, patients want flexibility in treatment options.
Not all patients say yes, said Hankinson. There is some reluctance from patients about “hospitalizing” their home. Others show concern about the complicated equipment, self-needling, and the support of a partner. Insomnia is also a problem in about 40% of patients who are on nocturnal, even after three months. But the Finnish nephrologist said the patients dialyzing at home “will not give it up.”

In the United States, home hemodialysis is experiencing a renaissance. Obstacles remain: patients are not always offered the therapy, particularly in rural communities where it makes the most sense. And the issue of reimbursement remains a sticking point. Renal providers need to see Medciare’s willingness to pay for more frequent dialysis as private health care plans now do. The recent push to bundle dialysis payments may not bode well for more expensive therapy like short daily or nocturnal treatments. Will government see the long-term value and pay for “outlier” treatments like home therapy?

Let’s apply the “lessons from the world over” and give home hemodialysis the rebirth it deserves.

For more information on the Annual Dialysis Conference, taking place March 1-4 in Orlando, visit http://som.missouri.edu/dialysis.
Title: Re: Barriers to home dialysis
Post by: plugger on March 04, 2008, 06:47:09 AM
If you can stand another thread, I did start the same discussion at:
http://forums.homedialysis.org/forumdisplay.php?f=10

More the merrier I say!
Title: Re: Barriers to home dialysis
Post by: petey on March 04, 2008, 08:26:20 AM
Good thoughts on that other thread, Plugger!  I think it all boils down to what one person there said, "Knowledge is POWER."
Title: Re: Barriers to home dialysis
Post by: Psim on March 04, 2008, 08:31:01 AM
They will not work with me for that time frame. It has to be in their time frame. How convenient is that for me?

This makes me fume, kitkatz. I'm sure there are others who would be able to train in the summer. How I love bureaucracy!  :sarcasm;
Title: Re: Barriers to home dialysis
Post by: okarol on March 04, 2008, 10:36:16 AM
Some more thoughts:
 8)

http://www.nephronline.com/nephnews/index.php?option=com_content&task=view&id=2358&Itemid=136

Report from Orlando           
Symposium pushes the HHD button

Mark E. Neumann, Executive Editor, Nephrology News & Issues....


Also in the news articles section  :waving;
Title: Re: Barriers to home dialysis
Post by: plugger on March 04, 2008, 11:03:53 AM
A lot of great info!  I just wanted to mention if you are tired of reading, here are some great videos - classic:

http://www.lynchburgnephrology.com/index.php?pmenu=NHHD&info=/Videos.php&p=&tmenu=Left

Title: Re: Barriers to home dialysis
Post by: Zach on March 04, 2008, 11:28:46 AM

Also in the news articles section  :waving;



Opps!  Sorry about that.
 8)
Title: Re: Barriers to home dialysis
Post by: okarol on March 04, 2008, 11:53:30 AM

Also in the news articles section  :waving;



Opps!  Sorry about that.
 8)


That's okay Zach  :-* You can do no wrong in my book!
Epoman created the news section so I would stop randomly posting news stories all over the forum.
Title: Re: Barriers to home dialysis
Post by: petey on March 04, 2008, 01:37:34 PM
I think that Epoman was a smart dude, Karol!  But...maybe instead of calling it the "News Article Section," he should have named it "Karol's stuff."   :rofl;  That's the first place I go when I log on to this site, Karol!  Without you, I'd be uninformed and in the dark.  Thanks for all you do!
Title: Re: Barriers to home dialysis
Post by: plugger on March 04, 2008, 02:18:20 PM
Good thoughts on that other thread, Plugger!  I think it all boils down to what one person there said, "Knowledge is POWER."

Thanks Petey!  I think we have to create the demand.  I'm thinking of trying for roadshows, I'm hearing about DVDs that might already be out there, followed by tradeshows from the various manufacturers of home dialysis equipment - might have to see a demand first.
Title: Re: Barriers to home dialysis
Post by: okarol on March 04, 2008, 03:36:56 PM
I think that Epoman was a smart dude, Karol!  But...maybe instead of calling it the "News Article Section," he should have named it "Karol's stuff."   :rofl;  That's the first place I go when I log on to this site, Karol!  Without you, I'd be uninformed and in the dark.  Thanks for all you do!

Thanks petey!  :thumbup;
Title: Re: Barriers to home dialysis
Post by: Zach on March 05, 2008, 04:45:37 PM

That's okay Zach  :-* You can do no wrong in my book!


 :-*

Title: Re: Barriers to home dialysis
Post by: del on March 05, 2008, 05:28:01 PM
Here in Newfoundland most of the home hemo dialysis patients live in rural areas. There are only 6 or 7 centers in all of Newfoundland which means a lot of people have long drives for treatments unless they move from there community. Newfoundland does not look like a very big province but it is an odd shape.  From St. John's (the capitol city )to St. Anthony is about a 10 hour drive.   Travel was the main reason for us wanting home hemo. The weather is so uncertain here that you could leave home in the morning with it being a nice day and by the time you had to come home could be the middle of a snow storm n the winter. If we had not gottten it we would have moved to the town where the center was by now.  We were lucky only having to drive for an hour, a lot of people had a 3 hr drive to get to the center but after 6 years of driving every second day it was getting to be a pain.  In Newfoundland home hemo is really catching on.   Like people here have said it has to be a special group of people for home hemo.  You have to be diligent about your treatments. Hubby had the insomnia at the beginning and considered giving it up and going back to in center at the beginning. He kept at it and finally after about 6 months he relaxed enugh that he was able to sleep. Now after a year and a half he does not even consider going back to in center.  It is stressful sometimes especially when there is machine problems but we have techs(the people who fix the machines) on call 24/7.

 We have had to call several times and they have always solved the problem for us.  I know some people on forums have said that they couldn't do home hemo because they lived in an apartment and the landlord would not allow them to have it. We do not have nxstage in Canada so you have to make the plumbing and electrical changes.  I only know of one prson in Newfoundland who does dalysis without a partner and his sister lives with him.  All the others I know have a partner who is there for every treatment.  I won't even leave the house while hubby is hooked to the machine.

In Canada everything is paid for by MCP so it is no cost to the patient.  The cost of plumbing and electrical changes you have to make is tax deductable as well.
Title: Re: Barriers to home dialysis
Post by: Bill Peckham on March 06, 2008, 05:02:52 PM
Have you all see the article by Mel Hodges? It is in the most recent issue of Hemodialysis International.
The actual article is here:http://www.blackwell-synergy.com/doi/full/10.1111/j.1542-4758.2008.00232.x
And here are two blog posts by me on the topic: http://www.billpeckham.com/from_the_sharp_end_of_the/2008/02/live-longer-and.html
http://www.billpeckham.com/from_the_sharp_end_of_the/2008/02/getting-buy-in.html
And here is a link to the HDC thread http://forums.homedialysis.org/showthread.php?t=1743

One obvious barrier to home hemodialysis - specifically more frequent home hemo is Medicare reimbursement for the training. Right now there is a small differential - $20 - for every training session but the payments is still limited to three times a week. If one is training to go home on the NxStage for example, you train five days in a week; two of the training session are not reimbursed at all. This increases the startup costs of a program and it makes it harder for providers to let dialyzors try home hemo. Most providers reckon they need someone to stay on for a year to recoup training costs, particularly when considering the current high NxStage washout rate.

Reimbursing for each training session would cost around 2 million a year (7 extra payments for around 2,000 people) but would do incalculable good. It's the best value available to Medicare.
Title: Re: Barriers to home dialysis
Post by: plugger on March 09, 2008, 08:07:55 AM
I think I have enough to make suggestions to my state rep about what could be done to help overcome the things that are preventing people from choosing home dialysis.

*Require DVDs on home dialysis be given to patients starting dialysis – I recall being given a packet of information when my daughter started dialysis, would have been nice to see more on home dialysis.  (I’m going to be getting a DVD from Home Dialysis Central for my friends and I to look at for starters)

*Lunches and conferences for nephrologists where the idea of home dialysis could be presented

*Road shows with doctors and nurses presenting the idea of home dialysis to patients and staff – maybe even finding a consultant like Dr. Christopher Blagg from Northwest Kidney Centers to help put something together

*Tradeshows with the different manufacturers of home dialysis equipment in areas that have been identified as having a strong demand for home dialysis

*State inspections would include making sure patients have been informed of the different modalities of dialysis

*The state board of health could look into including home dialysis in the nephrologists’ training and exams

*State might consider helping out with the training expenses for home dialysis

Comments are welcome.
Title: Re: Barriers to home dialysis
Post by: Sluff on March 09, 2008, 09:09:42 AM
Sounds like a great list Plugger.
Title: Re: Barriers to home dialysis
Post by: plugger on March 09, 2008, 03:21:14 PM
Thanks Sluff, I'm thinking of asking also for a requirement for regional home dialysis training centers after reading what is going on over at Home Dialysis Central - couldn't hurt to ask I suppose, but I'm still thinking about it.
Title: Re: Barriers to home dialysis
Post by: plugger on July 03, 2008, 06:59:13 AM
I figured it was about time for an update on what could be done legislatively to help promote home dialysis here in Colorado.  I gave the list of suggestions to my state senator and last I heard he was looking it over and he did make the suggestion I might consider forming a non-profit to accomplish many of the objectives - I might have to think about that one.  It would be a really big step and I'm not sure I could pull it off.

I also gave the list to my state rep and he did ask if any other states have done something similar?  I don't have an answer for that one. 

I also just heard from my rep about some neighbors he ran into. One of them has a father who is on dialysis here in town and they are upset about the high tech turnover they are seeing and the fact the father came home one day with blood all over his clothes.  I did mention one thing I hope I would consider under such circumstances - home dialysis.  I used the search on the Home Dialysis Central website and found three places in Denver and Lakewood Colorado that offer both nocturnal and daily dialysis and sent off the info to my rep - this is a great feature!!
http://search.homedialysis.org/locate/search/
Title: Re: Barriers to home dialysis
Post by: Hemodoc on July 03, 2008, 02:53:20 PM
I just read over the posts on this topic today and the home hemo option in America is the option that it is in most other developed nations.

I believe that there are several barriers to home hemo programs here in the US.

1) Medicare payment.  Home hemo is not part of the recipe to a large extent.  In many ways it is a funding issue that is the barrier to home hemo programs.

2) Physician awareness.  As a physician, as I have learned more of the home hemo option for myself, I have become increasingly more aware of the fact that many of my colleagues are not aware of this option.  In fact, most physicians experience with hemodialysis is limited to the sick and often unstable ICU patient needing dialysis who promptly crashes as soon as the machine is started.  For myself, it has taken me over a year to get over my fear of hemodialysis.  It is a safe procedure when done correctly and competently. 

3) Patient awareness.  Interestingly, many patients give up their autonomy with this disease much more so than with other types of illnesses.  Promoting patient involvement in their own disease process has been shown to improve outcomes and most especially with CKD-5.

4) Home machine options.  I have had much discussion with Bill Peckham recently on the choices before us.  Yesterday, while at my unit, I spoke for quite some time with my unit director on this issue as I will soon be the first patient on their soon to open home dialysis program.  I brought up the issue of the portable machines and how dialysate flow being one of the rate limiting factors for portable machines.  He countered with his experience with the old REDI machines that had a self cleansing apparatus for the dialysis so that you could use pond water and still do safe dialysis.  If a company was able to develop a portable machine with recirculated dialysate and up to F 200 kidneys, then we would be able to utilize the technology with a great economy of scale yet to be duplicated.  This would put the discussion on transplant vs dialysis costs back into the framework that it should be.  Thus, the patient would then have the choices before them to choose between two excellent modes of renal replacement therapies.

5) Lastly, even among patients on hemodialysis, one final barrier is the mistaken negative attitude towards dialysis in general.  I am so grateful my Lord and God has provided me with a means of living longer than I would have naturally been able to live because people like Dr. Scribner dedicated so much of their own time and talent so that I could continue to enjoy the life that God has given me.  It is time to be grateful and not hateful for such an amazing and wonderful technology.  Yes, there are difficulties, but, folks, you are all living on borrowed time.  I shall never be ungrateful for the time I now enjoy above and beyond my natural expectation.  Wow, what a blessing to be alive today to enjoy life without functioning kidneys. 

Yes, perhaps that is the greatest barrier because if even the patient on dialysis "hates" dialysis, what will all those crying over expensive technological health care expenditures believe.

Just my own opinion on the wonderful gift of life that dialysis continues to give me.
Title: Re: Barriers to home dialysis
Post by: stauffenberg on July 03, 2008, 03:38:15 PM
In the history of most incurable diseases requiring onerous management there is a gradual evolution of patient attitudes from first being thankful for the treatment to eventually regarding the burden of the treatment and the disease itself as the same thing.  When I was a child with type 1 diabetes in the 1960s, I can remember how all the medical propaganda we were fed from morning to night was about how thankful we should be for the 'medical miracle' of insulin and how wonderful that made everything.  Now that patients have become more aware of how utterly inadequate any regimen of insulin therapy is for sustaining health, and how obtrusive and lethal intensive management of the disease can be, the chief website for type 1 diabetics is called "Society for an Insulin-Free World," because insulin therapy is now hated as the chief embodiment of the disease itself, rather than being regarded as a positive treatment.

The same evolution of attitudes can observed with respect to dialysis, depending on how the patient needs to understand the predicament of ESRD in order to be able to survive with it psychologically.  Some people recognize dialysis as the everyday embodiment of their disease and hate it, others persist in seeing it as benefiting them by keeping them from death.  But the fact that 20% of dialysis patients ultimately kill themselves by voluntarily withdrawing from dialysis shows that dialysis cannot siimply be regarded as a positive thing, since even death can be preferable to it.
Title: Re: Barriers to home dialysis
Post by: Hemodoc on July 03, 2008, 06:06:27 PM
Dear Stauffenberg,

By your own admission, you have had nearly 50 years of life opportunities that would not have been without insulin.  I call that a modern medical miracle.

I am sorry that you feel that it was a burden to you, but for myself, let the burdens continue by the grace of God as long as He wills.

In kindness,

Peter
Title: Re: Barriers to home dialysis
Post by: del on July 03, 2008, 06:31:53 PM
Hemodoc, Stauffenberg's opinion is not the opinion of everybody.  He is entitled to his opinion but that's all it is is an opinion..  I really don't care how many articles or books or statistics he quotes to back up his opinion.  My husband has been on dialysis for 11 years now.  he is thankful every single day for dialysis traetments. without them he would have died. He has lived so much more in the 11 years than he did in the years before he started dialysis when he was sick.  His life does not revolve around dialysis rather he fits dialysis into his life.  If it wasn't for dialysis he would have missed so much in life.  His days are so busy that by the time comes to hook up to the dialysis machine nighttime he is tired and sleeps right through his treatment.  He for one does not hate dialysis (sometimes he doesn't really want to hook up to the machine).  He realizes how sick he would be without it.  He was in center for almost 7 years. The people who gave up dialysis treatments were older people with a lot of other medical issues and dialysis just wasn't working for them.  They were really sick and miserable.  So take stauffenberg's posts for what they are just his opinion!!  I respect his opinion as I do everybodys but I don't have to agree with it.  What a terrible world if everybody was negative!!  Hubby's motto is make the best of what you have.
Title: Re: Barriers to home dialysis
Post by: monrein on July 03, 2008, 08:10:44 PM
I am very grateful not to be additionally burdened by Stauffenberg's outlook.  My Mum died at 46 of malignant melanoma after a brief three month struggle and she would without question have chosen (as would all of her family have preferred) ESRD and the option of dialysis.  We do deal with a lot and all of us would prefer to be illness free but sitting around looking through a glass darkly just seems like a colossal waste of time, intelligence, spirit, energy, strength, opportunity and of course the totally frivolous potential for fun.  Not even those who have never been sick a day in their lives are happy and contented all the time and to natter on endlessly about the depth of gloom that we ought to be experiencing, based on the "literature" is in my opinion a downright silly approach.  The Buddhist notion of duka, that ordinary life is full of suffering and sorrow is quite freeing as it seeks to help people lose some of their unrealistic expectations about life but it certainly does not culminate in advocating  mass suicide as a way out.  On the contrary, it leads to the concept of individual enlightenment despite the inescapable challenges of the world. When one thinks about various forms of suffering and misfortune in the world, people living in constant physical fear, people starving, being tortured, dying of AIDS without access to medicines, abused or exploited children, the degree of poverty in so many places, I find it quite easy actually to be grateful for my personal "burdens".  To carry on incessantly about how victimized we are by the healthy majority, maltreated by the medical community, cajoled and condescended to by the journalistic community seems crazily self-indulgent, isolating and quite futile.  Advocacy for better medical treatment is one thing, and a crucial thing at that, but apparently advocating depressive navel-gazing, panic attacks or ultimately suicide as the only sane responses to CKD seems beyond extreme.  To focus always on the 20% who may choose death over dialysis is to marginalize the larger 80% who don't do so and to minimize the creative and adaptive ways they have found of coping and of carrying on lives of meaning.

Del, your husband has it right in my opinion and his attitude mirrors my own.  We all must make the most of our lives and that includes finding ways to live with our limitations.  People who withdraw from dialysis, it seems to me are NOT saying they prefer death to dialysis.  More likely dialysis (a mere treatment tool) is simply not working well enough to return sufficient quality of life to them.  Some perfectly healthy people also decide for a variety of reasons that life isn't worth living.

Life is imperfect, live with it.  Or, as a good friend of mine at the gym tells me all the time if I want to quit my routine early or if I'm complaining..."Just suck it up".  And I do.  Makes me feel quite normal.

Title: Re: Barriers to home dialysis
Post by: stauffenberg on July 04, 2008, 12:33:40 PM
When you give people the alternative between death and accepting anything else, the fact that they generally choose the alternative can hardly be cited as evidence for how positive that alternative is!  So the fact that 80% of patients continue to find dialysis preferable to suicide hardly means that dialysis is something to be grateful for, but instead just shows how difficult it is -- because of blind, irrational, instinctive forces compelling us to keep living however hideous our lives may be -- deliberately to choose death as an escape.

The Ancient Stoics had a theory that no experience had to produce suffering, since all our suffering consisted only in our negative response to experience, which was always in principle under our control.  But at a certain point you have to become so divorced from reality as to be positively psychotic not to register in your feelings and perceptions the negativity coming at you from the objective reality around you.

Zen Buddhist monks in Japan sometimes commit suicide by eating a diet of pine needles and drinking tannic acid tea and then starving themselves to death, becoming a living mummy sealed in a stone tomb.  If they manage to preserve their corpse this way, this is regarded as the greatest achievement of Nirvana.  So I would hardly count Buddhists generally as opposed to suicide.

Christian mythology generally views the world as some sort of 'gift' from an invisible intellect in the sky, which in turn encourages an attitude of perpetual gratefulness for everything that happens, on the assumption that it must all be part of the plan of some infinite wisdom and goodness.  But this requires viewing many things which are obviously senseless and evil as somehow, by mysterious, hidden purposes which no one can discern, the products of intelligence and goodness, and as things to be grateful for rather than hated.  No wonder dialysis seen from that perspective has to seem just too wonderful for words! But that is a piece of intellectual acrobatics I am not able to master.
Title: Re: Barriers to home dialysis
Post by: Zach on July 04, 2008, 01:07:27 PM

When you give people the alternative between death and accepting anything else, the fact that they generally choose the alternative can hardly be cited as evidence for how positive that alternative is!  So the fact that 80% of patients continue to find dialysis preferable to suicide hardly means that dialysis is something to be grateful for, but instead just shows how difficult it is -- because of blind, irrational, instinctive forces compelling us to keep living however hideous our lives may be -- deliberately to choose death as an escape.



I guess, Bertolt Brecht was right:

Der Mensch ist gar nicht gut, d’rum hau ihn auf den Hut
hast du ihn auf den Hut gehaut, dann wird er vielleicht gut.
Denn für dieses Leben ist der Mensch nicht gut genug
darum hau ihn eben ruhig auf den Hut.

 8)

Title: Re: Barriers to home dialysis
Post by: stauffenberg on July 04, 2008, 04:31:10 PM
Another line from Brecht's 'Dreigroschenoper' I remember from that song might also be appropriate to this discussion: "Der Mensch ist gar nicht gluecklich."
Title: Re: Barriers to home dialysis
Post by: del on July 04, 2008, 05:37:59 PM
Stauffenberg, my husbands life, as well as a lot of other people's lives, is NOT hideous!!!  I really don't like you suggesting that it is.  If everybody had your opinion there would be very few people in this world!!!  The world seems to be a much better place when we focus on the good things instead of always trying to down everything!!  Maybe you should try looking on the positive side of life.  Just a suggestion.
Title: Re: Barriers to home dialysis
Post by: okarol on July 04, 2008, 07:09:27 PM

Life on dialysis is difficult, and perhaps it is hideous for a few. But I think many, many patients are grateful for the dialysis. Life is worth living.

Not everyone is fortunate enough to get a transplant. Or wants one. 
Title: Re: Barriers to home dialysis
Post by: flip on July 04, 2008, 07:33:15 PM
I think a drink or two of moonshine might help him.
Title: Re: Barriers to home dialysis
Post by: petey on July 05, 2008, 04:37:50 AM
Stauffenberg, my husbands life, as well as a lot of other people's lives, is NOT hideous!!! I really don't like you suggesting that it is. If everybody had your opinion there would be very few people in this world!!! The world seems to be a much better place when we focus on the good things instead of always trying to down everything!! Maybe you should try looking on the positive side of life. Just a suggestion.

I totally agree with Del -- and second everything she said.  My husband's life is not hideous, either -- even after 13 years and 4 months of dialysis, transplantation, and now dialysis again.  Marvin and I have a busy, active, productive, fun, and happy life.  No, it's not easy to be a dialysis patient and a dialysis caregiver, and it's definitely not the "hand" we would have chosen.  It is, however, the "hand" we were dealt.  We're making the most of it.  To us, life is good -- very, very good.  Life (and dialysis) is what you make of it.  With all of its troubles, hardships, and struggles, dialysis is still something we are grateful for.  Without it, Marvin would have been dead over 13 years ago and I would have been widowed and alone at age 32, and any kind of "life" (however difficult, however plagued with illness, however unattractive to others -- even others with the same disease and same medical treatments) is better than that option.
Title: Re: Barriers to home dialysis
Post by: Hemodoc on July 05, 2008, 09:58:28 AM
Returning to the topic of this thread,

One of the barriers to home dialysis is as demonstrated the negative attitude many on dialysis have towards dialysis.  It does readily appear that vocal dissent from the patients themselves even if only a few is what the nephrologists and politicians and ethicists seem to focus on most.  Yet, the many success stories of dialysis get shorter shrift and are not listened to. 

It is almost always easier to be a critic than a supporter.  It is almost always easier to publish a negative story than a positive story.
Title: Re: Barriers to home dialysis
Post by: stauffenberg on July 05, 2008, 10:11:11 AM
As for life on dialysis being hideous, don't take my word for it, just look at the remarks of other patients taken from some of the news stories posted by Okarol yesterday.  Mrs. Flannery was quoted as saying that "You're not really living, just existing, until you can get a kidney," "it's not a great way to live." (From "A Bloody Long Wait")  Mr. McGhee said of his own experience with dialysis: "There were times when I couldn't get out of bed.  (From "She Gives a Kidney to a Friend") For years it felt like I had the flu for a year."  Now what's the appropriate word to describe such an existence?  'Hideous' comes to mind.

I believe that potential home dialysis patients should speak the truth about how they feel about being hooked up to a machine that invades their home and forces them 'to build their own scaffold' rather than allowing them to sit back, relax, and let a professional do the job. If their negative feelings discourage some dialysis providers from offering more home dialysis, then the supply will have simply matched the demand.
 
Title: Re: Barriers to home dialysis
Post by: Meinuk on July 05, 2008, 10:42:25 AM

I believe that potential home dialysis patients should speak the truth about how they feel about being hooked up to a machine that invades their home and forces them 'to build their own scaffold' rather than allowing them to sit back, relax, and let a professional do the job. If their negative feelings discourage some dialysis providers from offering more home dialysis, then the supply will have simply matched the demand.
 

Comeon - are we back to beating this dead horse again??  I am on home dialysis and I am speaking my clear unadulterated truth.  I feel better, my life is minimally impacted (deliveries can still make me lose my temper) and I've returned to an almost pre-dialysis existence.  Stauffenberg, your views on home hemo are outdated.  You have been out of the game too long, and you seem to refuse to believe that people can actually survive and not want to die on dialysis.

People who are sick can often be depressed.  People who have been recently transplanted can also be suddenly euphoric in the change that has occurred in their body.  The press often only deals in headlines, extreme examples of good or bad - it is the nature of journalism.

Look for the middle ground, we are sick, but we are surviving by any means possible.  For me, and others that is home hemo.  It is a positive and beneficial therapy.  I am also on the UNOS list, and I have had newspaper articles done about my home hemo experience, and I'll have a reporter following my transplant as it happens.  I expect highs and lows, just don't take them out of context to advance your biased point.  I know that you are the voice for those who just can't handle home hemo, and for those who are suffering on dialysis - but you are no longer walking in their shoes.  Give them some credit that they can have good days too.
Title: Re: Barriers to home dialysis
Post by: petey on July 05, 2008, 11:25:39 AM
Thank you, Meinuk, for saying what I was thinking.


Look for the middle ground, we are sick, but we are surviving by any means possible. For me, and others that is home hemo. It is a positive and beneficial therapy. I am also on the UNOS list, and I have had newspaper articles done about my home hemo experience, and I'll have a reporter following my transplant as it happens. I expect highs and lows, just don't take them out of context to advance your biased point. I know that you are the voice for those who just can't handle home hemo, and for those who are suffering on dialysis - but you are no longer walking in their shoes. Give them some credit that they can have good days too.

Home hemo is definitely "a positive and beneficial therapy" for Marvin.  And, to him, each day that he wakes up is a GOOD day.   Marvin loves life -- and he loves HIS life (home hemo and all).
Title: Re: Barriers to home dialysis
Post by: jbeany on July 05, 2008, 11:41:52 AM

I guess, Bertolt Brecht was right:

Der Mensch ist gar nicht gut, d’rum hau ihn auf den Hut
hast du ihn auf den Hut gehaut, dann wird er vielleicht gut.
Denn für dieses Leben ist der Mensch nicht gut genug
darum hau ihn eben ruhig auf den Hut.

 8)



My high school German needs work -
Men are not good enough, so hit them in the head and they might become good enough for life.  
Am I close?

 :rofl;

Another line from Brecht's 'Dreigroschenoper' I remember from that song might also be appropriate to this discussion: "Der Mensch ist gar nicht gluecklich."

Men are not happy.  - But that doesn't mean we don't strive to be so. . .

As for being able to "sit back, relax, and let a professional" handle my dialysis treatments - I'm able to relax at home, knowing I'm in charge.  I was never able to relax in center, constantly wondering when I was going to crash, and frustrated by the lack of control.

If more people want home dialysis, they are going to have to push for it themselves, like I did at my center.  Around here, most patients didn't know it was an option.  Once they found out about, we joined forces and pushed our center into offering it.  The supply still hasn't caught up with the demand - there are more patients who want it than can be trained at one time!



Title: Re: Barriers to home dialysis
Post by: plugger on July 05, 2008, 11:50:46 AM
Interesting discussion on the psychology of this.  I suppose one viewpoint reminds us this can be a difficult thing to deal with, the other that it can be dealt with.

Anyway, I think one thing that would help is more choices in treatment.  It seems to be coming about - but boy, is it slow.
Title: Re: Barriers to home dialysis
Post by: stauffenberg on July 05, 2008, 01:20:18 PM
Hallo Jbeany: Deine Uebersetzung ist genau richtig!  Du hast ja offenbar die Zeit beim Abiturstudium nicht vergeudet.
Title: Re: Barriers to home dialysis
Post by: lola on July 05, 2008, 01:28:00 PM
 ???
Title: Re: Barriers to home dialysis
Post by: flip on July 05, 2008, 06:29:56 PM
Another Hideous Day on Dialysis

I slept in this morning because I was out late at a 4th of July party. I had a late breakfast at Cracker Barrell and went to dialysis. I spent my 3 hrs. in the chair watching a good movie on my laptop. After I left, I weeant to the golf course and played nine holes and had a couple of Bud Lights in the club house. When I got home, friends came over and we grilled out and pitched horseshoes.

Yes, dialysis is a pitiful life and I have a big decision to make when I wake up in the morning. Should I go fishing as planned or just go stick my head in the oven.

Viva Dialysis
Title: Re: Barriers to home dialysis
Post by: Hemodoc on July 05, 2008, 07:02:57 PM
Flip that is true torture eating at the Cracker Barrel.  Wow, what a terrible day.  I just suffered through my wifes spaghetti sauce and meatballs but someone had to endure such torment as well.

Thanks for the laugh Flip, but you are killing me.

Peter
Title: Re: Barriers to home dialysis
Post by: del on July 05, 2008, 07:23:35 PM
Sounds like a really hideous day flip  :rofl; :rofl;.  Our days are always packed full too.  I guess life is just what we make it!! And we choose to make it GOOD!!!  Hubby spent the day on the roof of his shed shingling. It is about 25 feet from the ground to the peak of the roof on the shed!!  Tomorrow we are launching our boat for the summer.  That will be lots of enjoyment!! Just got home from visiting friends.  Relaxing for a little while before we set up the dialysis machine for tonight.  No big deal.  Hubby will probably watch tv for a little while and sleep for the rest of the night.  Pretty normal life.  He is drinking a can of pop now because he does not have much fluid on (only 400 ml ) after a night off the machine!!  Tomorrow will bring many more interesting things to do!! 

Friends of ours had there 35 year old daughter die from cancer last week. She had 2 little girls about 6 and 8 years old.  She would have been more than happy to hook up to a dialysis machine everyday to stay alive!! And she definetely would not have hated it and she would have enjoyed every day. She fought right to the end.  In Dec she was told she had about one week to live. She went to her youngest girls Kindergarten grad the week before she died.

Back to barriers - a lot of professionals are not well informed about home dialysis.  They are still thinking only pd when you say home dialysis.  We have had to explain to a lot of people that we have a dialysis machine same as at a dialysis unit.  We had to ask to be trained.  It was never mentioned to us that we might be good candidates for it. It wasn't until we were called to go for our training that we even knew nocturnal home hemo was an option.  It has been an excellent option for us.  No tme gone from our day at all.  You have to sleep so why not do dialysis then. 
Here in Canada cost is not an option for the patient because machine and supplies are all provided. 
Title: Re: Barriers to home dialysis
Post by: Adam_W on July 05, 2008, 09:42:08 PM
I can relate to the part about everyone thinking of PD whenever home dialysis is mentioned. I don't know how many times I had to explain my NxStage machine to medical professionals, and tell them that it is HEMO. I won't personally have that problem anymore though, because I am actually on PD now, but it seems it will always happen until home hemo is advocated more. One question to Stauffenburg. Out of curiosity, what will you do if your transplant fails? You seem to think dialysis is so brutal and evil and torturous, but will you go back on it if you lose the kidney? I'm not trying to flame you or bait you, I'm simply curious what you would do in such a situation. I hope your kidney lasts a long time and you won't need dialysis anymore.

Adam
Title: Re: Barriers to home dialysis
Post by: stauffenberg on July 06, 2008, 10:06:25 AM
I'll cross that bridge when I come to it, as they say. But since I will be probably be too old or have too many complications for another transplant when the time comes, and also have less remaining on my life's "to do" list by then, I will seriously consider taking advantage of the assisted suicide program offered by the Dignitas organization in Switzerland rather than returning to dialysis.  A major part of the barrier to escaping life in intolerable circumstances is just the technical difficulty of exiting it without making a mistake and simply making yourself more debilitated while yet not releasing yourself, so the Swiss organization, run by doctors with government approval who provide a certain route to painless death, provides an essential service in such a circumstance.
Title: Re: Barriers to home dialysis
Post by: Razman on July 06, 2008, 12:01:36 PM
Suicide may be your decision Stauffenberg and I feel sorry for you and when you go you will soon be forgotten.  But, there are too many of us that look at life differently.  I do not know the next step but I do have a faith and a trust to take each day as they come.  I cannot change tomorrow but I can change the way I look at it and I appreciate the positive comments that I read from so many people.  The majority wins and in this case and with this group we have chosen life !!! 
Title: Re: Barriers to home dialysis
Post by: jbeany on July 06, 2008, 12:53:51 PM
Hallo Jbeany: Deine Uebersetzung ist genau richtig! Du hast ja offenbar die Zeit beim Abiturstudium nicht vergeudet.

Danke!  I don't know about it not being a waste of time, though.  This is probably only the 3rd time I've had any use for it since I graduated in 88.  My understanding of the proper grammar is still just as atrocious as it was in high school!
(Can we switch back to English, now please?)

life in intolerable circumstances

Please, everyone, while you are bashing Stauffenburg's choices, remember that everyone's definition of what is tolerable is different.  For myself, I'm choosing dialysis right now.  Knowing that it is a choice, and that I can refuse it any time I want to is what keeps me sane.  I've fought for every bit of control I can get over my treatment.  If it comes to the point where I can't tolerate it anymore, I want the control to be in my hands at the end of my life as well.
Title: Re: Barriers to home dialysis
Post by: tamara on July 06, 2008, 01:59:31 PM
Suicide may be your decision Stauffenberg and I feel sorry for you and when you go you will soon be forgotten. But, there are too many of us that look at life differently. I do not know the next step but I do have a faith and a trust to take each day as they come. I cannot change tomorrow but I can change the way I look at it and I appreciate the positive comments that I read from so many people. The majority wins and in this case and with this group we have chosen life !!!


Do the attacks have to get so personal ?
Title: Re: Barriers to home dialysis
Post by: del on July 06, 2008, 05:55:03 PM
Let's try to get back on topic here and talk about the barriers to home dialysis and not discuss our opinions on whether or not it is the best treatment or not.  We could carry on with beckering back and forth for years and years and just cause bad feeling among everyone.  For those of us that have had experiences with dialysis we have to choose the treatment that is best for us individually whether that be PD, in center hemo, home hemo or transplant or death. It is an individual choice that we have to make after we are informed of all the choices. 

Title: Re: Barriers to home dialysis
Post by: Hemodoc on July 06, 2008, 07:28:21 PM
Thank you del for trying to get back on topic, it appears that there is a small minority that keeps most of the threads from going forward and all we ever hear is a completely negative monologue over and over again no matter what the original topic was.  Sorry, but when, by the grace of the good LORD I am able to get my own renal issues blog on line, it will not include commentaries since I have seen not only this blog dominated by a small minority of critics but several other blogs as well.  What a great resource for exchange of information, yet it tragically is underutilized due to the difficulty of staying on topic.

Nevertheless, once again, as a physician and as a CKD-5 patient, I know personally that one of the greatest barriers is lack of knowledge of the true benefits of home dialysis by the majority of my colleagues I have talked to.  In fact, until I myself was faced with the issue of declining renal function, I likewise had a very negative impression of how dangerous dialysis was.  This came about from my greatest exposure to dialysis from the ICU patients that uniformly did poorly once dialysis was started.  The recent article in the NEJM on the VA experience with standard vs more frequent dialysis underscores the fact that acute renal failure is a different disease process than chronic renal failure where more frequent and longer duration of dialysis is the whole game in saving lives and reducing overall costs.

Thus, I would highly recommend a supportive educational effort on the part of the patient to his own doctor since there is a very negative attitude in American medicine against dialysis that is unwarranted.  Other than the government's lack of financial support, my own opinion is that the lack of knowledge and negative attitudes towards home dialysis is one of the greatest barriers to home dialysis here in America.  Other countries do not suffer from this.

I would hope that we may stay on topic for some more discussion of this and avoid simply negative dissertations that are completely lacking in relevance to the discussion at hand.

Just my own opinion.
Title: Re: Barriers to home dialysis
Post by: Adam_W on July 06, 2008, 07:45:02 PM
I have been talking to a lot of in-centre patients at my current centre, and a lot of them have seemed interested in home dialysis, but back off whenever the topic of self-cannulation comes up. I don't know how many times I've heard "I'd love to do it but I could never stick myself". Obviously there are some people who simply cannot stick themselves. In fact I know of patients who are so terrified of needles that they can't even have someone else put them in, and they continue to use a catheter for hemodialysis. I've encountered less resistance when it comes to PD, and several in-centre patients I know are wanting to switch to PD. The biggest barrier that I've encountered regarding PD is dealing with fluid sloshing around in the body all the time. That was a concern for me for a while, but now that I'm doing PD myself, it is not as bad as I was expecting. I have also encountered people who back off from PD because of the location and size of the catheter. As we all know, for so many patients, in-centre dialysis is the only option, but there are so many people that could do it (home dialysis) if they knew about it and wanted to. Oh, well, I plan to keep advocating for home dialysis for as long as I can.

Adam
Title: Re: Barriers to home dialysis
Post by: flip on July 06, 2008, 07:55:38 PM
My only barrier to home dialysis is the fact that I don't have a caregiver. I've played around a lot at the dialysis center and I do have trouble sticking myself with one hand. I also have a similar problem pulling my needles. I'm assuming there must be a trick to it that I don't know.
Title: Re: Barriers to home dialysis
Post by: jbeany on July 06, 2008, 08:05:01 PM
flip, the trick to a one-handed pull is attaching a syringe to the end of the cannulation needle.  It gives you enough length to be able to pull the needle out with the fistula hand, while holding a gauze pad with the other.
Title: Re: Barriers to home dialysis
Post by: flip on July 06, 2008, 08:14:01 PM
What if I just pull the tubes with my fistula hand? It should be easy if I remove the tape from the butterfly.
Title: Re: Barriers to home dialysis
Post by: tamara on July 06, 2008, 08:20:07 PM
flip, the trick to a one-handed pull is attaching a syringe to the end of the cannulation needle. It gives you enough length to be able to pull the needle out with the fistula hand, while holding a gauze pad with the other.





Also you can get longer than the standard needle tube length, that really helps.
Title: Re: Barriers to home dialysis
Post by: flip on July 06, 2008, 08:32:01 PM
I had thought about trying it with my teeth. No wonder the nurses panic when I'm coming off. We always have 4 patients coming off at the same time and I do tend to get impatient.
Title: Re: Barriers to home dialysis
Post by: Adam_W on July 06, 2008, 09:16:36 PM
My last few weeks on hemo, I started using an arm clamp to hold my sites, and I would simply put a sureseal over the site, put the arm clamp over the sureseal after removing all the tape, then once I was sure that the clamp was directly over the hole, I pulled the needle out. Most of the time that worked fine, and there was no bleeding, but occasionally I would have a small jet of blood shoot out from under the clamp and run down my arm. If that happened, I had to drop the needle (carefully) and push down on the clamp for a few seconds, and the bleeding would stop. As for one handed sticking, I used the same arm clamp to hold my graft in place, so I didn't have to worry about trying to hold the bloody thing down as I was putting the needle in. Both of those techniques worked really well for me.

Adam
Title: Re: Barriers to home dialysis
Post by: Hemodoc on July 06, 2008, 09:21:15 PM
Dear Flip,

I met Bill Peckham a month ago while I was on vacation and he showed me his methods of self cannulating and removing his needles by himself.  I am sure that he would love to go over his methods with you.

bill.peckham@yahoo.com
Title: Re: Barriers to home dialysis
Post by: flip on July 06, 2008, 10:00:29 PM
Thanks, Peter. I've seen some of Bill's videos and have visited his site frequently.
Title: Re: Barriers to home dialysis
Post by: petey on July 07, 2008, 04:58:06 AM
Marvin and I have found that the main barrier to home dialysis (specifically, home hemo) is a lack of knowledge that it exists and that it is "do-able."  I discovered the whole concept (and the NxStage program -- the one we currently use) a little over a year ago when I was surfing on the net.  When we asked about it for Marvin, we heard, "It isn't offered in our area yet."  We started "pushing" for it to be an option for those in our area.  Luckily for us, the clinic in Wilmington, NC (about an hour from us) started training for it about three months after we started asking for it.  (And, it looked so promising and so good to us that we checked into programs offered in Durham, NC -- three hours away -- and also Charlotte, NC -- four hours away -- and seriously considered trying to get into those!)  Marvin was the second patient trained in home hemo (last July) in Wilmington.  When we went back for our one-month check up (we go back to the clinic in Wilmington once a month for checkups), we learned that there was a waiting list forming for those in the area who wanted to train for home hemo.  Today, that list is a year-long (if you want the training in Wilmington now, it will be a year's wait before you can start) because there are so many people who want home hemo.  We simply didn't know that it was an option for Marvin -- no one had ever mentioned it to us.

Other thoughts about the barriers --  Marvin is terrified of needles, too (even after 13 years of hemodialysis), but our training required a partner.  So, I do all the cannulating.  I really don't think that Marvin could ever learn to cannulate himself, so I constantly remind him how much he needs me  :rofl; !

Also, several medical professionals (including a doctor or two) when told that we do "home dialysis" have said, "When did you do your last exchange?"  or "Do you keep a close watch on your stomach catheter?"  "No," we say, "it's home HEMO."  One time, Marvin had to pull down his pants and show the doctor that he didn't have a PD catheter -- the doc was insistant that "home" dialysis meant PD!  "I didn't know you could do home HEMO," the doctor said.  Another example of lack of knowledge -- but you would think that a medical professional would have at least HEARD that people are doing hemodialysis at home!

For the ones we've encountered who do realize home hemo is an option, they mostly have questions like -- where do you store all that stuff?  doesn't it take a lot of time?  isn't it a lot of work on you?  what would you do in case of an emergency (on the machine)? -- questions that center around the "negative" aspects of home hemo.  And, yes, home hemo does have some drawbacks, but it also has lots more positive benefits for Marvin.

So, until we get the word out that home hemo is available, is do-able, is not all negative, and has lots of benefits for the patient, we're going to continue to see barriers to home hemo.  I don't think that the "medical community" is doing a good job of getting the word out on home hemo, so I think it's up to those of us who have experience with it to tell others about it. 

Title: Re: Barriers to home dialysis
Post by: stauffenberg on July 07, 2008, 09:28:57 AM
I don't think the whole problem with home hemodialysis can be ascribed to lack of education and understanding of what it involves, since I endured it for some time myself and found it horrible.  The psychological dimension should not be ignored, since home dialysis means having to endure the disease actively coming into your life and your home every single day, rather than being at least to some extent mercifully sealed off from the rest of your existence by being kept at the dialysis center away from your home and occurring only three out of every seven days.  It also means having your face rubbed every day in the actual operation of the machine that defines your life as forever afflicted by a catastrophic and  incurable illness, and if you are the type who would prefer having to operate your own electric chair rather than just having the state's executioner throwing the switch, then I suppose home hemodialysis is for you.  Finally, there are the concerns about possible technical failures while using the machine at home (no one can save you, no matter how much support you have via telephone, if your lines come loose while you are sleeping), plus all the hassle with respect to ordering supplies, maintaining inventory, and setting aside a spare room of your house for all the equipment.
Title: Re: Barriers to home dialysis
Post by: petey on July 07, 2008, 10:33:48 AM
It is -- just like everything else -- a matter of your perspective.  If a person sees dialysis -- and more specifically, home hemodialysis -- as a horrible, torturous, "death sentence"-type process, then that's exactly what it will be for that person.  I'm so very thankful that my husband's experience with, and attitude about, dialysis has not been such.

To us, home dialysis does NOT mean "having to endure the disease actively coming into your life and your home every single day."  To us, dialysis is a PART (not the whole) of Marvin's everyday life.  Just because he could have four days "off" from dialysis if he continued to do in-center treatments does not mean that those four days would make him a dialysis-free and ESRD-free person.  "It is what it is," Marvin often says.  Even on the off days, a dialysis patient is still a dialysis patient.  In-center hemodialysis, to us, doesn't mean that the process itself is "sealed off from the rest of Marvin's existence."  It's kind of like the person who thinks that if they ignore a problem, it doesn't exist.  Well, "on" days or "off" days, Marvin's still a dialysis patient every day.  Just because you can TRY to ignore dialysis on the "off" days doesn't mean that it goes away.

Additionally, we do not see home hemodialysis as having Marvin's "face rubbed every day in the actual operation of the machine that defines your life as forever afflicted by" ESRD.  It is what it is ... Marvin's life is forever -- and will be forever -- afflicted by ESRD.  That's a fact.  As long as he's alive, he will have ESRD (a transplant is, afterall, just another form of treatment -- it's not a cure).

The recliner that we have in Marvin's home "clinic" (yes, we cleaned out a bedroom and equipped it as nice and as modern as any in-center clinic) is not his "execution chair."  To us, it is his "life chair."  When he sits in that recliner and has a home dialysis treatment, it is extending his life.  It is not killing him; it is helping him live just a little bit longer.  We have an affinity for Marvin's machine -- he has a picture of it on his cell phone that he shows off often, we take good care of it, we even named it ("Hercules" -- after the mythological hero who once cleaned out an entire stable by diverting a river to wash away the waste -- appropriate for a dialysis machine, huh?).  His "clinic" here at our house always has the door open to it.  It is a bright, cheerful room and a part (not the defining whole) of our home.  It is a part of our home just as ESRD is a part of Marvin's life.  It is a warm and inviting room.  Visitors to our house for the first time always get the "tour" of Marvin's "clinic" first.  We have extra chairs in there for company, and, you're not going to believe this, but sometimes Marvin and I sit in there and talk late at night -- and he's not even running on the machine then!  We feel comfortable in there at any time.  It is a happy place because we have CHOSEN to make it such. 

When we were in training for home hemo and nearing the end, my family and Marvin's family got together and hosted a "shower" for Marvin.  It was a "Bring Home Hercules" shower.  Our friends and family brought presents (paper towels, Clorox wipes, Band-Aids, trash bags, Kleenex, liquid soap, hand sanitizer, a clock, posters, calendars, cabinets, shelves, ink pins, paper clips, clip boards, a dry erase board and markers, etc.).  My brother bought Marvin a big TV for his "clinic."  One of Marvin's brothers bought the recliner.  My sister bought a small refrigerator.  My parents had a sink installed in the room.  We had a fabulous, joyous time CELEBRATING the start of Marvin's home hemo experience.  We made it a party!  (And, we haven't had to buy a single thing for the clinic in a year now!!!!  That was great!)

We have chosen (and we made this choice from the very beginning -- all the way back in 1995) to claim Marvin's disease.  It's ours.  We didn't ask for it, but he got it.  We have faced this disease.  We are fighting this disease.  We own it -- it doesn't own us.  We control it (as much as we can), and it doesn't control us.  We are not afraid of it, and we will not be conquered by it.  We want -- and we have -- the upper hand over this disease.  If this be a battle, we are WINNING !  We have accepted it.  We have embraced it.  We think that home hemodialysis helps us accomplish all of the tasks listed in this paragraph.

I think the whole problem with the barriers to home hemodialysis could be erased if more of the positive -- and less of the negative -- factors were publicized.  When just one story of a horrible home hemo scenario blares out at people, the uneducated, unexperienced ones will automatically assume that this is true with every home hemo patient...and, it simply is not true.  For many (including Marvin and me), home hemo is a wonderful experience with many rewards.  Do we think that the horrible stories of home hemo should be squelched?  Oh, no, definitely not!  We do, however, think that the home hemo patients with positive stories (and we think you'll find many more of these than the former) should stand up and say, "Hey!  It's not like that with me!  Home hemo works for me!  Don't let one bad apple spoil the whole bunch!"  To help eradicate the barriers to home hemo, the benefits of it (and there are many for Marvin and for others) should be flaunted.  We should say to those dialysis patients who haven't tried home hemo, "Here's another option.  Here's something you might find better than the modality you're using now.  Try it ... you might like it!"

Home hemo is what you make it to be.
Title: Re: Barriers to home dialysis
Post by: stauffenberg on July 07, 2008, 11:06:26 AM
It was the attitude of the Ancient Stoics that nothing in the objective world is good or bad, but it all depends on whether you want to see it as good or bad.  One of the Stoics, Epictetus, had his arm broken and purportedly was not bothered by the experience, since he had decided he would not let it bother him.  I think there are limits to how far you can take that attitude and still claim to be objectively present in your life, rather than living in the delusional fantasies of a psychotic.  Perhaps because I've been an academic all my life and the goal of academia is to discover what is true and present it with ruthless honesty, I just lack the talent now to turn off my sensitivities when I'm confronted with something it would be better to ignore.

On the one hand you say that Marvin is perpetually an ESRD patient whether he is doing dialysis or not, but then on the other hand you say that you own ESRD.  I don't know how you can be sure that such an enormous intrusion, that is part of your life all the time as you say, is not owning you rather than the other way around.

It was the practice in the days when people were beheaded for capital offenses to hide the executioner's axe under straw so the person about to be decapitated did not have to see it and be further horrified just before dying.  The person knew he was about to die, but actually seeing the instrument of death so near could still be disturbing.  I feel the same way about home hemodialysis.  Even though I was aware every moment of being an ESRD patient as you say Marvin is, I still preferred not to have to see its principal manifestation right in front of my face all the time.

Diseases that are marked by their treatment are usually named in common parlance after the treatment rather than the disease itself, because people recognize that the treatment has become the disease.  Thus we hear "he is confined to a wheelchair," "he's on insulin," "he's in an iron lung," or "he's on dialysis."  Common intuition seems exceptionally insightful here, since it acknowledges that the treatment is not what helps make the patient normal and healthy, but instead what defines him as abnormal and sick.

I think the most appropriate Greek God to symbolize the dialysis experience is not Hercules but Prometheus, who was chained to a rock forever, having to endure the intermittent but never ending visits of an eagle who would eat his exposed liver.
Title: Re: Barriers to home dialysis
Post by: Adam_W on July 07, 2008, 12:04:02 PM
Oh, Geeze! I cant take this shit anymore. Not everyone is like you DEAL WITH IT!
Title: Re: Barriers to home dialysis
Post by: del on July 07, 2008, 01:19:13 PM
Well I tried to get it back on topic but guess it didn't work  :banghead; I won't be responding to this thread any more .  In fact I won't even be reading what stauffenberg has to say on the subject.  Seems like he's that only one who has the right opinion and I for one have no time for that. 

Everybody has individual choices.  I think the purpose of this thread was to talk about how difficult it can sometimes be to get home hemo.  It has gone from that to everyone who is on home hemo or on dialysis being told what a horrible life they have. People don't need to hear that!!!  Stauffenberg, you should spend some time with people like my hubby to see what home hemo is really like!!  maybe then you would have a different opinion.   
Title: Re: Barriers to home dialysis
Post by: Adam_W on July 07, 2008, 01:26:17 PM
Thanks for trying, Del. I also probably won't be replying anymore. Stauffenberg has the "I'm right and everyone else is wrong" attitude, and like you said, people don't need to hear that. I guess we can't change everyone, and maybe we shouldn't even try. Again, thanks for your efforts.

Adam
Title: Re: Barriers to home dialysis
Post by: tamara on July 07, 2008, 01:45:42 PM
Once I got into the routine of home dialysis it was the closest thing to normality I could get at that time.

No more running in and out of hospital for treatment, if I felt tired when I got off, hey I was home in my pj's and I could sleep. People could come around and see me in my own relaxed environment talk about anything we wanted, tv with the sound at the max without complaints, hey I could get on in just my undies if I wanted and hey I did !

It made the whole more experience more personal for me, I was not relying on anyone to put me on take me off, not waiting on a nurse to fix the machine if it was beeping or if I was feeling flat.

In some ways I felt like kidney failure was less in my life even though it was with me at all times, hey you can't escape. I was not exposed to the hospital environment as much, so it actually made me feel less like I had something major that needed to be dealt with, but again each to their own, whats good for the goose, yada yada yada.

My greek god that symbolises my dialysis experience was Prometheus' sister.She chained herself to the rock intermittently but was able to release herself from the rock because she had the knowledge too, and knew what freedom she could obtain by learning too.Since she could release herself from the rock she visited the eagle at his working place and they both discussed how best to treat the "exposed liver".  ;D
Title: Re: Barriers to home dialysis
Post by: petey on July 07, 2008, 02:39:44 PM
It was the attitude of the Ancient Stoics that nothing in the objective world is good or bad, but it all depends on whether you want to see it as good or bad.

Exactly -- and Marvin and I chose (and still choose every day) to see it as "good."  We feel pity for those who see it as "bad."

One of the Stoics, Epictetus, had his arm broken and purportedly was not bothered by the experience, since he had decided he would not let it bother him. I think there are limits to how far you can take that attitude and still claim to be objectively present in your life, rather than living in the delusional fantasies of a psychotic.

There are NO limits as to how far we can take this attitude and still be objectively present in our lives.  Those who dwell constantly on their misfortunes, bad luck, ill health, etc., to us, are robbing themselves of that very thing -- life.  We are not delusional fantasy-laden psychotics; rather, we are survivors.  It is this attitude that will help us survive, and it makes life so much sweeter when you have a positive attitude.

On the one hand you say that Marvin is perpetually an ESRD patient whether he is doing dialysis or not, but then on the other hand you say that you own ESRD. I don't know how you can be sure that such an enormous intrusion, that is part of your life all the time as you say, is not owning you rather than the other way around.

My dear Stauffenberg, you've missed the point!  Yes, Marvin is perpetually an ESRD patient (as are you and many others).  But, we "own" his disease because we try to find the good in it and in dialysis (and there is good in dialysis -- at least there is to us).  If we spend all of our time hating this disease and its subsequent treatments and constantly spreading macabre and horrific opinions of it, we would not have time to enjoy the very life that has been extended by the treatments.  I say we own ESRD because we REFUSE to let it defeat us.  We do not let ourselves become mired down in the intrusions, the discomforts, and the absolute necessity of it; we chose, instead, to treat it as a part of Marvin's survival.  Take it in stride and go with it!


It was the practice in the days when people were beheaded for capital offenses to hide the executioner's axe under straw so the person about to be decapitated did not have to see it and be further horrified just before dying. The person knew he was about to die, but actually seeing the instrument of death so near could still be disturbing. I feel the same way about home hemodialysis. Even though I was aware every moment of being an ESRD patient as you say Marvin is, I still preferred not to have to see its principal manifestation right in front of my face all the time.

We differ again (imagine that!).  If I were to be sentenced to such a punishment, I would WANT to see the axe.  Weird?  Maybe.  But, I am not a coward and I am not afraid to face my fate -- whatever it may be.  But, we're talking about a punishment in this instance.  For us, Marvin's ESRD and dialysis is not a punishment; he did nothing to deserve this.

I think the most appropriate Greek God to symbolize the dialysis experience is not Hercules but Prometheus, who was chained to a rock forever, having to endure the intermittent but never ending visits of an eagle who would eat his exposed liver.

Let's discuss your choice for the Greek god who symbolizes the dialysis experience TO YOU -- Prometheus.    Prometheus was, if you recall, chained to the rock forever having to endure the daily eating of his liver by a vulture (some stories say eagle) -- only to have it regenerate at night and eaten again the next day, over and over again -- because he was being PUNISHED by Zeus for giving fire to man.  While Prometheus can be your epitome god of the dialysis experience, he's definitely not ours!  We would not pick a sufferer who was being punished for his disobedience to be our role model.  This dialysis experience is not a punishment for Marvin (it may be for you -- but it's NOT for him).  We would, rather, pick a god who symbolized strength and courage; yes, that's our role model.  Also, wasn't there a story somewhere in Greek mythology where Hercules (our choice) shot and killed the vulture -- or eagle -- that was hounding Prometheus (your choice)?  Hmmmmmm, very interesting analogy, my academic friend -- very interesting indeed.


Title: Re: Barriers to home dialysis
Post by: jbeany on July 07, 2008, 02:51:03 PM
Oh, Geeze! I cant take this shit anymore. Not everyone is like you DEAL WITH IT!

Adam, this is how he deals with it.
Title: Re: Barriers to home dialysis
Post by: stauffenberg on July 07, 2008, 05:31:47 PM
It is bizarre how everyone jumps to the totally unsubstantiated conclusion that I was ever at any time saying that MY experience with home hemodialysis somehow HAD to be everyone else's.  Show me where I ever said that!  I simply said that in considering the costs and benefits of home hemodialysis, the potentially negative psychological factors, which I noted in my own experience of home hemodialysis, should be weighed in the balance against the undoubted health benefits of that option.  Until you try it for yourself, you can't know how you will react, so you have to consider the possibility that your reaction will be like mine. For me the psychological costs outweighed the benefits, for others the balance could well be different. I also don't see how my discussion of my own psychological barriers to home hemodialysis were somehow, as many have asserted, "off topic" for a discussion entitled "barriers to home dialysis."
Title: Re: Barriers to home dialysis
Post by: petey on July 07, 2008, 06:32:44 PM
It is bizarre how everyone jumps to the totally unsubstantiated conclusion that I was ever at any time saying that MY experience with home hemodialysis somehow HAD to be everyone else's. Show me where I ever said that! I simply said that in considering the costs and benefits of home hemodialysis, the potentially negative psychological factors, which I noted in my own experience of home hemodialysis, should be weighed in the balance against the undoubted health benefits of that option. Until you try it for yourself, you can't know how you will react, so you have to consider the possibility that your reaction will be like mine. For me the psychological costs outweighed the benefits, for others the balance could well be different. I also don't see how my discussion of my own psychological barriers to home hemodialysis were somehow, as many have asserted, "off topic" for a discussion entitled "barriers to home dialysis."

Stauffenberg, dear, I didn't imply that your experience with HHD was what everyone else's would be like.  Through your words, I fully understand that your experience with HHD was not pleasant and not the best modality FOR YOU.  However, your words and descriptions of HHD are strong, caustic, and dismal.  For the ones who are new to dialysis, pre-dialysis, or inexperienced in HHD, I wanted them to know that your experience isn't like many others' experiences.  I wanted them to see "the other side of the coin."  Let me also use some of your words and say to the newbies, "Until you try it for yourself, you can't know how you will react, so you have to consider the possibility that your reaction will be like MARVIN'S" (which has been wonderful, refreshing, revitalizing, promising, optimistic, happy, etc.).

Like you, Stauffenberg, I don't think we've gotten off topic, either.  In fact, I think all of your posts serve as the root of one of the major "barriers to home dialysis" -- the negativity of one bad experience overshadowing the heartening, encouraging experience of many others.  For every one Stauffenberg out there who has tried HHD and didn't like it, there are thousands of Marvins who tried it and loved it!
Title: Re: Barriers to home dialysis
Post by: mark m on July 07, 2008, 08:15:22 PM
I like to look at the positives of home hemo.

In center I saw a rat run across the floor, I have yet to see one in my room.

True story, cheers.

-Mark.
Title: Re: Barriers to home dialysis
Post by: Zach on July 07, 2008, 08:17:06 PM

It is bizarre ...


Yes, bizarre pronouncements may produce bizarre reactions.

Cassius was right:
"The fault, dear Brutus, is not in our stars, but in ourselves."

8)

Title: Re: Barriers to home dialysis
Post by: flip on July 07, 2008, 08:28:35 PM
That's why I went to the center, Mark.....to get away from the rats
 :Kit n Stik;
Title: Re: Barriers to home dialysis
Post by: stauffenberg on July 08, 2008, 05:03:41 AM
Or again, Zach, the same theme appears in 'Hamlet': "There is nothing good or bad, but thinking makes it so."
Title: Re: Barriers to home dialysis
Post by: monrein on July 08, 2008, 11:59:05 AM
The impression I have here in Canada is that home hemo is recognized quite well by the nephs and is presented routinely as a viable option for patients capable of managing it.  Could be because it saves money for our medical system in addition to being more comfortable for many patients.  When I was on home hemo, some 28 years ago, it was truly the best choice for me as I lived 60 miles from the nearest hospital that did dialysis and the winter conditions in Nova Scotia on that particular stretch of road were often awful.  I felt pretty comfortable with my set-up in the big kitchen of the house we rented and used to pass some of the time (5 hour runs then) by having small dinner parties while I was hooked up.  Gruesome to some people I'm sure but we had many good times and one of my current potential donors lives in France now but attended many of those feasts.  I also used to do extra private tutoring for some of my more motivated students during the first two hours of each run.  After that I felt too fuzzy to be bothered trying to be clear.
I also had a machine up at our cottage because that was where we spent the summers and I would have many visitors in during my runs.  They'd visit with me, play scrabble or whatever, go for a swim in the lake, visit some more, barbeque and so on.  Not as good for me obviously as being a "regular" person but certainly way way better and much more fun than going to a hospital or other centre at some distance away.  These were two entirely separate provincial systems that provided home hemo for me but both were readily offered when I started on dialysis.

The one thing that makes me hesitate this time around about home dialysis is the fact that my husband would need to be here and would so be tied down with me.  He isn't concerned about this but I am and since the self-care unit is close to me and is nice I think I prefer that for now.  I actually wouldn't be nervous about going solo but not sure how the medical people would feel about that. I am talking to them however about going to 5 days a week most likely 2 1/2 hour runs to minimize the ups and downs.  Another option is 5 nights per week nocturnal at the hospital downtown.  Not as convenient for me but still not bad.
Title: Re: Barriers to home dialysis
Post by: Hemodoc on July 08, 2008, 12:57:10 PM
Thank you for the update Monrein.

Yes, Canada and the rest of the modernized nations are way ahead of America.  We developed the first chronic dialysis treatments after the Scribner shunt with most of those patients in the 1960's at home.  Home dialysis is often called "new" therapy which it is not.  We further developed the fistula and yet today have only 30% of our patients with this lifesaving access.  America has not kept up with its own innovations.  Sadly, we do this with many of our technologies.

I am looking forward to home dialysis since my wife and I are already doing most of our own care in center right now.  As long as my access holds out, dialysis is not a burden compared to the alternative.  In fact, I continue to marvel that it is as safe and effective as it is despite my tainted impression of dialysis as a practicing physician.  Dialysis and dialysis patients seen in the hospitals with the many complications negatively impact the larger number of dialysis patients who are taking care of themselves with exercise, diet and daily dialysis and are doing remarkably well.

America is the country with the barriers to dialysis since we have forgotten our own history of dialysis in this nation.  Perhaps soon, the access to daily home hemo will be a true reality here in the US and the impact on cost savings will likewise be substantial.
Title: Re: Barriers to home dialysis
Post by: del on July 08, 2008, 02:45:09 PM
monrein is it posible for you to do nocturnal at home. I know a couple of people (in Canada) who do it alone.  One did it completely alone but he is now transplanted. Another lady I know does it herself - hubby doesn't help at all.  There are many times during the summer when her husband and sons go camping and she stays alone and does nocturnal.  She is hooked to a monitoring system though.  She uses a perm cath.  I can see a problem doing it alone if you are usisg needles.

Stauffenberg the reason I said to try to get things back on topic was the fact that whatever was said positive about home hemo you always came back with a negative of why it wasn't good.   That's fine but you don't have to down the treatments so much and imply that life on dialysis is hideous. It isn't for most people. New people need to listen to all sides of the discussion of the treatment.  Home hemo dialysis has changed so much over the years. The main barrier I think to home hemo dialysis is the attitude people have towards it because of the way dialysis used to be.  People who were on dialysis years ago were usually very sick.  For the most part they aren't now because of new drugs and kidneys.  The long ,slow treatment of nocturnal dialysis has really made a difference in the lives of people who chose that option.

Title: Re: Barriers to home dialysis
Post by: monrein on July 08, 2008, 03:00:44 PM
Yes Del I would for sure consider all options available to me and nocturnal sounds good.  I'm not a fan of the permacath, much preferring the fistula and I actually would not object to doing needles even to sleep.  Also that would tie my husband down less as he's always home at night and if he went to the cottage he'd go when I could go too or I'd stay alone occasionally.

Right now, we're in the process of testing 4 potential donors for a transplant and I have 4 back-ups in the wings.  (Just received my last serious offer from a family friend at a party on Saturday). They do them in batches of four at a time here.  My neph wanted me to do about 6 months of dialysis in order to stabilize some medication issues and they prefer not to train me for home hemo if I was going to be on for less than a year.  If the transplant option fades away and dialysis becomes more long term then I'll think about rearranging the house etc. to do home hemo.  For the moment though, the self care clinic is a very good option.  It's close, somewhat flexible, nice staff, I set up, do my needles but they clean up and take care of all equipment etc.  Can't complain.
Title: Re: Barriers to home dialysis
Post by: stauffenberg on July 08, 2008, 03:30:56 PM
I have never seen any statistics on how many people refuse home hemodialysis when they hear about what it entails rather than proceed with that option, nor have I ever seen any statistics about how many people withdraw from home hemodialysis, as I did, rather than continue with it after starting.  So I don't think we can simply assume that positive views of it among patients constitute the 'vast majority' of responses to it as many people posting comments take for granted.

Monrein raises a good point about home hemodialysis, which is the added burden this places on the helper, who is usually the spouse.  If you accept that there is some moral duty to try to contain the impact of a tragedy like renal failure, you also have to question whether this additional extension of that tragedy to your home dialysis helper is something you can live with.  Almost everyone I knew at my dialysis unit who was doing home dialysis had a helper who was either not employed or was employed only part-time.  But since my helper, my wife, was the head of a major federal government department, she had to be at work every day from 8 AM to 7:30 PM, and having to help with home dialysis on top of that seemed to me to be a cruel burden to impose on her, since the added work left her totally exhausted.
Title: Re: Barriers to home dialysis
Post by: petey on July 08, 2008, 04:07:40 PM
Monrein raises a good point about home hemodialysis, which is the added burden this places on the helper, who is usually the spouse. If you accept that there is some moral duty to try to contain the impact of a tragedy like renal failure, you also have to question whether this additional extension of that tragedy to your home dialysis helper is something you can live with. Almost everyone I knew at my dialysis unit who was doing home dialysis had a helper who was either not employed or was employed only part-time. But since my helper, my wife, was the head of a major federal government department, she had to be at work every day from 8 AM to 7:30 PM, and having to help with home dialysis on top of that seemed to me to be a cruel burden to impose on her, since the added work left her totally exhausted.

Once again, it is a matter of perspective.  I am Marvin's home hemo "helper" (though I choose the word "partner" to define my role).  I am employed full-time; I am a high school English teacher.  I leave for work at around 7 a.m., and I usually am home by 4 p.m.   After work, I have various "jobs" to do: cook supper, wash clothes, tidy up the house, grade papers, plan lessons, tend to one very precious dog, and assist Marvin with his 6x week home hemo treatments.  Additionally, Marvin and I both volunteer in our community (youth baseball program) where we both give generously 15-20 hours a week of our time so the children in our community have an excellent recreational program and facility in which to play baseball; we do not have any children of our own.  There are also certain days when I have "extracurricular" work at school -- ballgame duty, prom duty, faculty meetings, graduation practice, etc.

I have NEVER felt that my serving as Marvin's home hemo partner is a "cruel burden" or any kind of imposition on me or my time.  When we ventured into this modality of treatment last summer, we went into it -- just as we have with every other endeavor in the past 22 years -- as a TEAM.  He does his part, and I do mine.  Together, we might quite an impressive duo.  Marvin does everything he can to help me; while I am at school every day, he does as much "housework" as he is physically able to do.  He has become quite a good cook, an expert at sorting, washing, and folding clothes, and a whiz at dusting, straightening, and "picking up" around the house.  I do the "heavy" (physically challenging) housework that he is not able to do (however, with his regained strength, energy, and stamina now that he's on home hemo, the list of things he can't do is dwindling).  Also, Marvin has his machine totally "set up" and ready to go when I get home.  I walk in the door, put my bookbag down, give Marv a kiss, pat the dog on the head, wash my hands, and cannulate Marvin's access.  (Please note:  Marvin IS NOT allowed to grade papers -- his spelling is atrocious and his grammar skills, severely lacking.  However, he would certainly try to do this if he thought it would help me.)

Whatever "burden" of time and energy there may be to me as Marvin's home hemo partner is no burden at all.  I would gladly do more for this most precious husband of mine.  If he needed to run for eight hours a day on home hemo, I would find a way to make it work for him.  If he needed my last breath or my remaining kidney, I would give it to him right now.  With all that's good in a marrige, home hemo is another case of "give and take."  Sometimes I give more, and sometimes I take more.  It all evens out, and it all works for the good of both (Marvin is healthier on home hemo -- statistics or not -- and I am better because he's healthier).  Marvin is lucky to have me as his home hemo partner; he knows that and appreciates that.  I am lucky that I get one more day to spend with this truly inspiring, wonderful man.  There is no cost too high for me to pay to make his life easier, better, and happier.
Title: Re: Barriers to home dialysis
Post by: Adam_W on July 08, 2008, 04:25:03 PM
I know I posted earlier that I would no longer respond to this thread, but Stauffenberg brought up an interesting comment regarding the partner/helper. I think for a lot of people, the helper issue is a very big barrier to home hemo. A lot of people, like Marvin, have very good, willing, and able partners. When I trained for home hemo a little over a year ago, my dad trained with me, even though I did everything myself. I'm going to be moving soon, and I'm going to be living alone. I'm capable and confident to continue home hemodialysis completely alone, but my doctor and the centre won't let me. That, along with some access issues is why I had to switch to PD. I'd much rather do home hemo because I think it's a superior treatment compared with PD (PD is very good, however), but if it was ever discovered that I was continuing to do home hemodialysis without a partner, they would boot me out of the home dialysis program completely, and I would be thrown back in-centre, where I would probably get depressed again, and possibly end up stopping dialysis period. Other people may want to do home hemo, but they don't have a partner at all, or their spouse or whoever their "partner" may be might not want to be responsible for some or all of the patient's treatment. That is especially and issue for patients who are not able to do 100% of the dialysis themselves and HAVE to have a partner. So yes, the partner issue can be a huge barrier to home dialysis.

Adam
Title: Re: Barriers to home dialysis
Post by: petey on July 08, 2008, 04:47:48 PM
Adam, I understand that some dialysis folks do not have partners to help.  And I can see how that could be a barrier to home dialysis.  Marvin could not do this alone (even if his center allowed it solo -- which it doesn't).  Marvin cannot cannulate himself -- he just can't look when the needles are going in, and he never has been able to.  So, this set-up works perfectly for us; others must find another way.  I justed wanted Monrein to understand that not all partners/situations are like Stauffenberg's.  Monrein, have you seriously talked to your husband about this?  Maybe he wants to do this, maybe it wouldn't be too much on him, maybe he wouldn't see it as a "burden."
Title: Re: Barriers to home dialysis
Post by: flip on July 08, 2008, 05:15:22 PM
I know what you mean, Adam. I'm sure I could do mine without a helper but they won't let me.
Title: Re: Barriers to home dialysis
Post by: del on July 08, 2008, 05:19:17 PM
I definitely do not find it any burden to be my husband's partner with his dialysis and it has nothing to do with my moral duties. Everything we do we do together anyway and we enjoy each others company. I am a grade 2 teacher.  I live almost next door to the school!!!  I leave for work about 8 a.m and get home about 4 ish (often bringing work home with me to do in the night).  It takes about 30 -45 minutes each night to get the machine and needles ready.  Most of that time we spend chatting waiting for the machine to do all the tests and go through recirculation.  Takes me probably 10 minutes to set up the machine - put lines on etc.  and it takes hubby about 5 mins to do the needles.  To actually get the needles put in and machine up and running about 5 or 10 minutes.  It takes probably 5 minutes for disconnect in the morning.  I put the machine in vinegar before I pull his needles and by the time the needles are out it is time to put the machine in heat disinfect. By the time I shower the temp is high enough to turn off the RO.  Hubby strips the lines off the machine when he gets up.  The time it actually takes in the day is less than an hr for set up and everything.  he usually sleeps the whole 7 hrs he is on.  The rest of our day we have for ourselves from about 7 in the morning until 11 or 11:30 at night.  Only maintenance is once a week disinfect the RO.  Takes about a minute to put the wand in the RO and the RO does the rest automatically. Have to Javex the dialysis machine once a week.  I do this on Sunday instead of a heat disinfect.  

We live a little over 100 km away from the closest dialysis unit so this was a really good option for us.  Winter was always an issue with driving. The roads were never done well after it snowed.  Plus after 6 years driving to the unit 3 days a week it was home hemo or move!!!  Right now if we were to move closer to the center we would still want home hemo.
Title: Re: Barriers to home dialysis
Post by: monrein on July 08, 2008, 05:21:03 PM
Many factors go into choosing the right treatment modality and those factors are different for each of us.  Undoubtedly some find that home hemo doesn't suit them and the same can be said for PD or in-center or any modality.  Choice is the key.  Situations differ also depending on the ages of those involved, their jobs, other responsibilities and very importantly the nature of the relationship between patient and "helper" or partner.  You all know the old saying "One man's cruel burden is another man's inspiration and pleasure".

A decision, about something such as home hemo and requiring varying degrees of cooperation between two people, would need to be a joint one and like many decisions made in a marriage would not automatically be viewed as a burden.  In my case my husband would far rather help me dialyze actually than help me in my garden, which he would likely turn into an ornamental tennis court if he had to have anything to do with it.  My husband always grew up with a cottage and so always wanted one.  We bought ours in 1974 and now have two.  Now, let's talk about BURDENS.  Anyone care to guess which partner has over the course of this marriage done the most work, maintenance etc just so one person could be where they feel their most comfortable?  Oh, while we're at it, I've gone on 11 major white water canoe trips including one to the Arctic because my husband prefers sleeping on the ground to a really good quality bed.  The one very scary bear attack used up my life's supply of adrenaline, not to mention the fact that Lee was born blind in one eye so his depth perception is suspect at best so I had to get very good at "reading" rapids and especially ledges or drops.  I might have chosen to spend all that money spent on going as far into the bush as possible on a world-class spa.  He'd rather stick hot nails in his eyes than have someone mess with his toes.

However, chores, burdens, impositions, inconveniences, travails, hmmm, compromises...whatever we want to call them...entered into willingly, mutually and non-coercively are not usually experienced as horrible.  If any arrangement ever becomes too onerous, that's where the possibility of alternate options comes in and something else can be chosen.  (Seriously considering selling a cottage on this end but it won't be easy giving up such a beloved burden.)  It must also be said that every modality has pros and cons, just like most things in life (even chocolate) and its always a matter of which column runs longer than the other at any given point in time.

We on this site perhaps do not represent the entire spectrum of the ESRD population but there are quite a few of us here with a wide range of experiences.  We could always ask the question "Have you ever tried home hemo?  Was it good for you?  Did you quit because you preferred something else?  If you have never tried it what would your fears/concerns/hesitations be?  Would you like it to be available to you?  Would you do it if you could pay an outside helper and get a tax deduction?"  From the posts I've read home hemo seems to suit quite a few really really well. (For heavens sake, Flip would consider marrying a nurse so HE could do it.  Stauff would rather stick hot nails into every last inch of his body).  Not statistics, but still informed opinions and therefore valid and helpful in my book.
Title: Re: Barriers to home dialysis
Post by: del on July 08, 2008, 05:48:06 PM
Monrein, nocturnal dialysis is so new that apparently there has not reallty been any long term studies done on it. I have visited a lot of sites on the internet dealling with nocturnal dialysis. They are just going by what the people who are on it are saying right now.  You are right monrein what treatment works for one does not necessarily work for another.  I very rarely talk about the awful experience hubby had with PD because I don't want to scare anybody from trying it.  Some people do PD for years without any problems and love it.  Hubby does not want a transplant because he is scared of some of the side effects of the drugs.  That is his choice. He sometimes talks about having to hook up to a machine all the time but he says what's the good to complain.  It's not going to do any good. Just accept each day and deal with it as best he can. His way of dealing with it is keeping busy.  he always has several projects on the go!!  He would really like a portable machine though so that we could travel a bit more.  That will probably come in time.  If I was in his situation I might very well choose a transplant.  People have to choose what works best for them.  They just need to be educated to all of the options so they can make an informed choice.
Title: Re: Barriers to home dialysis
Post by: monrein on July 08, 2008, 07:00:42 PM
You know Del it's funny about the transplant option because although I had a super fantastically successful first one for a very long time, I'm a bit nervous about another.  I'll do it for sure if I have a chance but am well aware that there's no guarantee it'll be a walk in the park.  I also liked my forearm fistula better than the upper arm one I have now but know others who have had exactly the opposite experience.  I love how well home nocturnal works for you guys and I really admire your husband and all his projects.   :cuddle;
Title: Re: Barriers to home dialysis
Post by: del on July 09, 2008, 06:20:41 AM
Hubby has an av fistula that goes from his wrist up his arm like a piece of garden hose!!!  been working perfectly for 8 years.
Title: Re: Barriers to home dialysis
Post by: flip on July 09, 2008, 07:57:11 AM
mine looks like the sprinkler version now
Title: Re: Barriers to home dialysis
Post by: del on July 09, 2008, 09:06:47 AM
 :rofl; flip you are sooo funny.  So did hubby's!!!  He has been doing buttonholes for the past 2 years so now only 2 sprinkler holes!!!
Title: Re: Barriers to home dialysis
Post by: lola on July 09, 2008, 09:29:04 AM
Otto starts training on Monday for Home-Hemo and when I asked about me needing to be there everyday they said I can come as much or little. Otto also can do it at home alone they just want to know if that's what he is doing so the Dr can know. I plan to go as much as I can but with 3 little ones at home I don't think I will be there as much as I would like to be, although I think it will be good for Otto to learn how to do this himself since I always tell him he's in big trouble if I ever get hit by a bus
Title: Re: Barriers to home dialysis
Post by: flip on July 09, 2008, 09:47:39 AM
del...I've often considered buttonholes. Give me your honest opinion.
Title: Re: Barriers to home dialysis
Post by: del on July 09, 2008, 05:22:22 PM
In hubby's words "butonholes are the best thing I have ever done"  He says once they are established they are completely painless. You don't pierce the skin anymore. I do the needling.  Just clean the site get the scab off with tweezers , clean the site again and the needle almost falls in the hole. Once it is established the track is very easy to follow because the needle won't go anywhere else.  It's not sharp enough to puncture.  There are times especially after a night off when the needle will go in the track fine but when it gets to the vein I have to give it an extra nudge to get it through. If a buttonhole stops working for some reason you just establish a new one. Sometimes (very rarely) we have to use a sharp in the buttonhole just to open it up again.  Haven't had to do that now for months.  I have never infiltrated him with the blunt buttonhole needles. Take about 2 weeks using a sharp everytime to get the track established.  If you keep the sites clean when you are needling very little chance of infection. I was told never to take the needle out and reinsert it.  If I had to take it out use a new needle.  He sleeps with the 2 blunt needles in his arm and has never had any problems with it.
Title: Re: Barriers to home dialysis
Post by: flip on July 09, 2008, 05:47:41 PM
Baxter has a kit that includes a needle and a plug for establishing new buttonholes. Just a couple of questions:

How hard is it to stop the bleeding?
Can you go swimming without danger of infection?
Does it shorten the life of the fistula?
Title: Re: Barriers to home dialysis
Post by: del on July 09, 2008, 05:59:06 PM
Actually flip according to everything I have been told and read it is supposed to be easier on the fistula.  Hubby does not bleed a lot never has - in about 5 -10 minutes he is ready to tape. He just folds a 2x2 puts it over the hole holds it for 5 to 10 mins and tapes it over with one inch tape.  He hasn't had any problems with bleeding.  Don't know about swimming but hubby does everything with his arm (it gets awfully dirty sometimes!!!) .  Have to check with a doc or nurse about the swimming.  I don't know anything about a plug for establishing buttonholes.  We just use sharp needles. We have a marker like they use in surgery for marking the skin to show the angle the needle goes in at.
Title: Re: Barriers to home dialysis
Post by: Adam_W on July 09, 2008, 06:13:09 PM
I'm pretty sure it's ok to swim with a fistula, with or without buttonholes. Like del said though, I'd ask your doc to make sure.

Adam
Title: Re: Barriers to home dialysis
Post by: flip on July 09, 2008, 06:40:08 PM
I swim in the lakes with my fistula but someone told me there was an extra danger of infection with buttonholes. I'm just exploring my options. I don't think I would want to sleep with needles in nor would I want to do nocturnal dialysis for the same reason.
Title: Re: Barriers to home dialysis
Post by: monrein on July 09, 2008, 07:54:13 PM
I'm establishing my buttonholes now and when I asked about the biohole plug I was told by the nurses that they've found they can lead to infection so they don't like to use them here.  I'm getting my arterial in pretty easily each time now but my venous is more tricky because it's much deeper.  I keep trying however and the holes are getting bigger and easier.  No problems with bleeding, exactly as Del described.  I soak the scabs with swabs, then pull the skin taut one way then the opposite way to try to loosen the scabs a bit, then I use a new needle (same as the one I use on my heparin bottle) to remove the scabs.  If I were worried about infection from swimming (I've never been told it's a problem but I'll ask)  I think I'd get some tegaderm bandages to put over the buttonholes.  You could cut fairly small pieces from a larger bandage.
My understanding also is that buttonholes prolong the life of the fistula and also they reduce the likelihood of aneurysms and bulges in the fistula. 

I'm very pleased so far with how they're coming along and glad I decided to establish them immediately upon starting to use my fistula.  I'm going to get a marker as Del suggested to help me with the venous because it's at a funny angle in addition to being deep.
Title: Re: Barriers to home dialysis
Post by: flip on July 09, 2008, 08:42:15 PM
My arterial is the toughest because I have a nerve that runs down it. If you miss the stick a fraction of an inch, it's very painful.
Title: Re: Barriers to home dialysis
Post by: G-Ma on July 29, 2008, 10:08:08 AM
As for one handed sticking, I used the same arm clamp to hold my graft in place, so I didn't have to worry about trying to hold the bloody thing down as I was putting the needle in. Both of those techniques worked really well for me.
Adam

Thanks Adam.  I'm going to try this as my veinous area rolls.
Ann
Title: Re: Barriers to home dialysis
Post by: del on July 29, 2008, 05:44:59 PM
We were also told that buttonholes were supposed to prolong the life of the fistula.  We were told when we trained to use a needle like monrein does to remove the loosen the scab and then use sterile tweezers to remove the scab. A few months ago we were told not to use the needle any more to loosen the scab (could cause infection)  We were supposed to just use the tweezers to get the scab off. Well we are back to using the needle to loosen the scab just didn't work well with just the tweezers.  Haven't told his dialysis nurse that we are using the needle lol. What she doesn't know...   For a year and a half we were using the needles and no nfection.  Seems they were getting some infections in the buttonholes in center.  Different at home - not as many germs!!! I hope not anyway!!  By the way what is a biohole plug???
Title: Re: Barriers to home dialysis
Post by: flip on July 29, 2008, 05:53:34 PM
It's a kit made by Baxter for developing buttonholes. It has a needle and a plug. The way I understand it, you insert the plug after removing the needle. I've seen them on Baxter's website but don't know anyone who has tried them. The kit runs about $85.
Title: Re: Barriers to home dialysis
Post by: monrein on July 29, 2008, 06:02:57 PM
I use a sterile needle (the same kind I use for the heparin bottle) on a cleaned arm.  First thing is to use the fingers to stretch the skin over the scab area one way then the other (fingers on each side then pull gently) then use sterile gauze with liquid anti-septic to soak a little, then gently pick off scab.  If they were getting infections, something careless must have been happening somewhere.  

Unfortunately, I've gone back to laddering with sharps for a while to develop my fistula evenly up the arm a ways.  Once it's bigger and stronger I'll establish the buttonholes which shouldn't take too much time with daily runs.  I sometimes do my arterial cuz it's easy but the venous is deep, tricky and rolls so I let the nurses do it.  I insist however that they proceed a little higher each and every time so that the vein develops as evenly as possible.  They sometimes want to go where it's "easiest" but I don't let them.  I was very strict about this with my first fistula and had no aneurysms or lumpy bits so we'll see what happens.  The vein is strengthening nicely and I'm running now always at 400 pump speed with 15 g needles.  

Title: Re: Barriers to home dialysis
Post by: del on July 29, 2008, 06:30:48 PM
That's the same as we use monrein sterile needles on a cleaned arm.  I agree someone is being careless if they are getting infections.  Never heard of bioplugs. We deveoped the buttonholes just using regular 15 g sharps.  Hubby's fistula developed to well above the elbow.  has lots of room for needling!!  He always told the nurse where he wanted the needle put when he was in center.
Title: Re: Barriers to home dialysis
Post by: Hemodoc on July 30, 2008, 07:16:39 PM
Monrein, it sounds like you are doing well with a good strategy.  The most important aspect is to establish control over your own arm.  If they ruin your access, they will think it was going to happen anyway which is not true.

As far as the buttonhole button, I believe that is potentially a great way to get a serious infection quickly.  I am now on treatment 5 of a new buttonhole and it is almost completed.  I have done the new stick all by myself when I noticed some enlargement at the other site.  The body forms scar tissue quite quickly.  I really see no reason why anyone would take the risk of infection with an indwelling device.  Not needed at all.  Just my opinion.


Title: Re: Barriers to home dialysis
Post by: bette1 on August 15, 2008, 01:56:12 AM
I was offered home hemo, and I could do it, I have done pd before, but I refused it.  I did not want to have to worry about dialysis 7 days a week.  I like being able to think of dialysis as my part time job.  I can get may treatment and then be 'off'" for a while.  I have a young child at home and I didn't want my illness to take over our home, and that is what happens with home dialysis. 

I think home hemo is a great option, but it is not for everyone.  I do think that not enough patients are educated about the option
Title: Re: Barriers to home dialysis
Post by: plugger on September 17, 2008, 05:42:56 PM
Just thought I would stop by and say hello.  Thought I would mention it is a good time to get involved with the elections and make some of our politicians aware of what is happening in this field of medicine.  I'm trying to do what I can to make sure my state reps stay in office - they were great in getting a bill for certification of dialysis techs through!  Hope I will be able to revisit how they might help with home dialysis after the election.
Title: Re: Barriers to home dialysis
Post by: kitkatz on September 19, 2008, 06:26:22 PM
I asked my hubby if he could stick me and he does not now if he can.   He is also not comfortable with the idea of having me on home dialysis if he is gone. He wants to travel one month a year. I can train my sister to help me if I need to on an emergency basis. I do not know if I can have him stick me.
Title: Re: Barriers to home dialysis
Post by: Wallyz on September 19, 2008, 10:17:19 PM
I have been talking to people who are good candidates for Home hemo in my center. And one guy was complaining about having to stick himself. I said- "Are you still able to have sex with your wife?" He said no, and I told him that his chances of regaining his ability to maintain erection would go up dramatically if he did home hemo, especially extended therapy.  When faced with that trade off he was encouraged to get over his fear of self cannulation.
Title: Re: Barriers to home dialysis
Post by: petey on September 20, 2008, 07:13:13 AM
I have been talking to people who are good candidates for Home hemo in my center. And one guy was complaining about having to stick himself. I said- "Are you still able to have sex with your wife?" He said no, and I told him that his chances of regaining his ability to maintain erection would go up dramatically if he did home hemo, especially extended therapy. When faced with that trade off he was encouraged to get over his fear of self cannulation.

Home hemo doesn't always mean self-cannulation.  If you have a partner, and if your partner can -- and will -- learn the technique, the partner can cannulate.  That's what Marvin and I do.  He's the patient (and can and does do every other thing required for home hemo), while I am the "sticker."  (I also can do all of the other things required for his home hemo treatments, but he wants to do everything else -- machine set-up, ordering supplies, care and maintenance on his machine, etc. -- by himself.)  Marvin doesn't look while he's being cannulated -- he didn't when he was in-center (almost 14 years) and he doesn't look now.
Title: Re: Barriers to home dialysis
Post by: Wallyz on September 20, 2008, 04:15:27 PM
I agree- but he felt that his wife cannulating him wasn't an option either.  Sorry I wasn't clear. 
Title: Re: Barriers to home dialysis
Post by: del on September 20, 2008, 05:52:02 PM
Your health is so much better on home hemo. Hubby thought he was doing really well on in cener hemo ( 3 X a week) but it was nothing compared to noctural!!! Bloodwork is pretty close to "normal"  .  Doing nocturnal home hemo has made a BIG difference in our lives.  But it is not for everybody.
Title: Re: Barriers to home dialysis
Post by: G-Ma on September 21, 2008, 12:13:00 AM
del is right...on nxstage I now feel like getting up and going even after dialysis and any other day, I'm finally getting my house sorted out from when I felt horrible all the time...the only thing I now wish I could do is self cannulate totally alone...I just have so much trouble holding that vein.  :clap;
Title: Re: Barriers to home dialysis
Post by: lruffner on September 21, 2008, 01:44:42 PM
I am in the process of trying to learn as much as I can about all dialysis options, so I can make the best informed decision for my husband and I. I would think that more frequent dialysis would benefit anyone with ESRD, but I do have a few concerns. I live in a rural area and I am afraid what would happen in an emergency, as well as the frequent power outages we rural people face here in KY. I guess we would just have to notify our electric company and threaten the crap out of them? lol  We have an ambulance station within 6 miles of us, but no one is usually there everyday....kind of pointless for them to build this station to sit empty...but that's our good tax dollars at work  :sarcasm;

As offensive as it may be to some here, I have to agree with some of the things Stauff has said. I also belong to another kidney site and have heard from other people the same type of psychological issues dealing with dialysis at home...even PD. One lady went back to in-center, instead of PD, because that is the only way she thought that she and her family could have a little bit of normalcy in life. She couldn't handle seeing the supplies and machine all day long, as it was depressing to her. I guess I can understand that and I am sure that I would love to pretend it wasn't there too, especially if you have small children and such. I worry about putting any burden on my husband, not that he wouldn't walk through fire for me, but I feel it is unfair to him and my guilt would eat me up. My reasoning for saying that, is because I have had to take of my mother since '03, shortly after my husband and I met, and just when it looked like we could live our own life a little and actually go on a honeymoon.....sorry, but you have CKD stage 4. He stuck by me and m mother through her liver failure and transplant, without ever complaining once, except how no other sibling would pitch in. He sacrificed as much as I did, by me being 4 hours away, for weeks at a time. Bla, bla,bla.

As far as a caregiver's role, it is the most rewarding and heartbreaking to go through. We may not be able to FEEL what the illness is like, but the emotional drain, heartbreak, and uncontrollable worry is also something. I promise that no one can know how hard it is to play that role, unless they have walked in their shoes either. I am now playing both. I have CKD and I still completely manage my mother's healthcare and part of her financial responsibilities. Del, Petey, W&W, you are all warriors in what you do everyday. :2thumbsup; Having done it myself, I just don't know if I can ask my husband to do it until I die.

Sorry if off topic a bit in places, but I just read all 8 pages :o
Title: Re: Barriers to home dialysis
Post by: monrein on September 21, 2008, 02:22:30 PM
I think you've covered the different issues really well in your post.  It's tough to decide the best option and each of us has different factors to consider when choosing our personal best option. 
It is true that home nocturnal offers the best clearances and is probably easiest on the body.  It also poses the fewest diet restrictions.  It does however take up space at home and often requires a partner to be present which could be or become burdensome.  (I did it for five years starting when I was 26).   Any travel time you gain might be eclipsed by the setup and cleaning time you will need to do.  A small generator might solve the power outage situation but I read your concerns to be not so much about that as about the intrusiveness factor.

Then there's short daily which your centre probably won't allow so that's a second at home option with the same drawbacks as home nocturnal.  I do short daily at a self-care centre which is a fairly decent compromise solution but that may be unavailable to you.

Then there are the PD modalities which some people really like but again there is the supplies at home business all over again, plus the catheter being ever present.  Personally, I dislike the catheter thing way more than the needle thing but that's just me and everyone is different.  Many people who do PD successfully would never switch unless forced to.

Then there's in-centre three times a week.  This may be your best bet (unless you decide to try PD first of course) to start with until you get used the whole process and the ins and outs which can seem very overwhelming at first.  When it has become routine for you, you may then be in a better position to decide if you and your family could not only manage it at  home but in fact find that the benefits outweigh the disadvantages.  No one else can know what will be best for your family in this regard and it isn't a choice between right and wrong. 

I'm curious about what you'll decide in the end but remember that you can always change your mind later if you choose one modality and it isn't suitable.  Your first decision however will need to be hemo or PD.
Title: Re: Barriers to home dialysis
Post by: Lucinda on September 21, 2008, 04:01:56 PM
This has been a really interesting post.  I start my home hemo training next month.  Because I have known about my kidney problem for years - and had my graft in the past two years, I have had plenty of time to weigh up the options.  My father did PD at home then in centre dialysis but I am opting for home hemo as I am lucky enough to be able to dedicate a special area  of my house to home hemo so I can shut it off when I am not on the machine.  I am going to be writing fulltime from now on so I can still work while I am dialysising and escape into a fantasy world and work during dialysis.  I don't think I am going to have too many problems getting use to the needling and my husband is also going to come to the last couple of weeks of training.  In Australia there is a huge preference for home hemo if you are a suitable candidate.  I am just lucky enough to have had the time to adjust and ready myself.  I feel very sorry for those who have no "adjustment" period before they start the process.  I don't think it is going to be a walk in the park by any measure but I believe I have picked the best option for me.  I am no stranger to dialysis or transplants with family members going through both but home hemo is a preference for me even over a transplant.  In time I may change my mind but while I am capable of handling my own treatments I am happy to go that way.  As for any emergencies, I am only 10 minutes from a hospital and it would be a case of crossing that bridge if I came to it.  It doesn't matter which method of treatment it is, in-centre, home hemo, PD or transplant, there is always a chance something can go wrong with all of them so all the treatments are Russian roulette for everyone with ESRD.  The best chance of dodging the bullet is to pick which one best suits you personally - physically, emotionally and mentally.  There is no right and wrong here.  What works for one may not work for another.  Everyone's experience is different.  For example Zach and Stauffenberg have had two totally different experiences with dialysis.  Doesn't make one right and one wrong.  Both are highly intelligent and informed with strong, yet differing, opinions in relation to treatment options.  Their colours are very different and it makes you realise that with this disease there is no such thing as just black and white. 
Title: Re: Barriers to home dialysis
Post by: del on September 21, 2008, 05:22:51 PM
You are right lucinda there is no such thing as black and white with kidney failure and dialysis. It seems like no 2 people are alike - what works for one person does not necessarilly work for another.  We are about an hour and 10 mins drive away from a hospital luckily we have never had an emergency.  We are lucky enough to have room in our house for the hemo supplies (just get about a month's supply at a time).  When hubby finally does the doors to the cabinet in the bathroom you won't even be able to see the supplies. Neither of us mind the dialysis machine and ro in the bedroom .  It is much better than driving 3 times a week to dialysis.  We have only lost the power once for about 2 or 3 mins in the 2 years hubby has been on home hemo.  You are trained on how to wash back manually so power outages aren't really a big issue.  A lot of the training involved emergency situations that you probably will never have but just need to know how to handle just in case.  We have never had to wash back manually (yet).

Home hemo is not for everybody though. Same as PD is not for everyone.  Some people really like PD whereas hubby always hated it!!  Some people just find it too hard psychologically or are too nervous that something is going to happen.  But for the people who want to do it and are able it is the probably the best form of treatment next to a transplant.  As for being a burden on your spouse talk to them and see how they feel. I do not consider it a burden at all. I consider myself a partner rather than a caregiver anyway.  Hubby has just as much to do with his dialysis as I do. More most times!!!

I just thing everyone should be educated on all the treatment options for ESRD and be able to make their own decision of which option is best for them.
Title: Re: Barriers to home dialysis
Post by: kidney4traci on September 21, 2008, 07:08:50 PM
I agree with how the thought of home dialysis would be a turn off.  We have my machine our bedroom and a corner of the room is filled with boxes too.  It is not very romantic, but hubby has not minded.  The only thing we minded is that the machines make noise 24/7.  I do turn off the cycler occasionally as it is louder.  But after 4 years we have gotten used to it.  Do dream of what I will do with that side of my room once I get a transplant!  But as for now, it has been wonderful and life changing to have it at home.  I know the topic heading was barriers to home dialysis, but for the most part, I would never want to do any other mode again.  I am only 41 and have have three children.  My kids see my during the dialysis that I don't have to leave for it.  I already work part time so I am away from home less now because of Nxstage.  I would rather stick myself, I have had no problems with that this year as opposed to being in center and getting stuck by tech's that were just learning their job.  I can add fluid myself or shut off the pull myself if I feel like I am too dry.  I can do it at whatever time of day I want.  I can do it what ever day I want - I keep my own schedule.  I only have to see my nurse and dr once a month.  I don't have to listen to someone else's tv on too loud.  I don't have to listen to others getting sick right next to me ( and other body functions we will leave off here...).  I can do it in my pj's and don't have to wear a bra (ha!).  I can take a nap and not be interrupted by others.  I can eat something.  I can go on my laptop.  I feel better too as mentioned since I do it more often at home, getting a  better clearance.  During the hurricane, our center lost power for over a week - I had mine on the next day thankfully and had no interruption in treatments.  We do have a genterator if needed.  We have a RV trailer and we go camping often, and I take my machine with us.  No more having to plan to go to another center during a trip.  So, all in all, my vote is for home hemo.
Title: Re: Barriers to home dialysis
Post by: lruffner on September 21, 2008, 08:42:49 PM
Thanks for all of the great posts and advice. I do believe that whichever type of dialysis I choose, it will be at home....really Love the "no bra" thing Traci!! I believe they should be illegal, because for me, they are the most suffocating, uncomfortable contraptions on the planet, next to underwear up your butt! :sir ken;

I never thought about the generator, so that is an idea. I am a visual learner and I wish that I could actually SEE people doing the different types first hand. I have visited my local clinic and everyone looked absolutely miserable. I am sure that they are, but I am not much into "showing" how I feel when it is bad. I would rather be out of the public eye. PD sounded cool, except for the infections, it not being permanent (peritoneal lining), and that it is much harder on the heart. I have some seriously, horrible hereditary cardiac issues in my family, so that is my biggest concern. The docs are pushing hard for the transplant, but I don't think I will be a candidate due to having peripheral artery disease, calcification of my abdominal aorta, and both iliacs. I know that I would be facing some major surgeries just to see if I could qualify and that is a turn off. Besides all of that, FSGS has a very bad reputation for making a comeback, so I am not sure it is even worth it. I know one person who has had 4 transplants and is back on the big D....sorry, but SCREW THAT!

I am not worried about the intrusiveness of it, but I worry for everyone else's convenience. I don't want to disrupt anyone's life anymore than I have to. We have a 4 bedroom house, but 2 of the bedrooms are for my step-children...who we only get to see once a year....and the other bedroom, besides ours, is in the basement. I refuse to be stuck in the dungeon! It's too cold and if I had an emergency, I want someone to be able to get to me! :o

My biggest problem monrein, in all honesty, is that I am the most indecisive person on the planet. I can go to McDonald's and look at the menu for 20 minutes undecided, but order the same old thing. I do that everywhere! I am completely ridiculous in that dept. and it drives me bonkers, as much as my very patient husband..lol
Title: Re: Barriers to home dialysis
Post by: kidney4traci on September 22, 2008, 05:03:10 AM
I like your response. but one thing comes to mind.  You don't have to stick with whatever mode you choose.  If you are unhappy, talk with your doctor and they can make changes, adding pd after home, vise versa... you are in control.  You are the patient, you have the right to choose at any time.  So don't feel pressured to make the "right" decision now.  The point os to get on one so you can start to remove toxins and feel better.  You may actually feel like you can think better once you have started this process. 
Title: Re: Barriers to home dialysis
Post by: lruffner on September 22, 2008, 05:22:54 AM
Thanks Traci. I am not at the dialysis stage just yet, but when you are at stage 4, they say there is no exact timeline. I am just trying to learn as much as I can right now, so that I don't feel as if I have been hit by a truck when it does come! I also want to take my other health problems into consideration when choosing, so that I can live as long as possible, and feel the best that anyone can on dialysis. My IU/ Mayo doc thinks that PD would be the worst option for me, due to protein loss, so I will have to make him explain that better.

Have a great day!  :bandance;
Title: Re: Barriers to home dialysis
Post by: monrein on September 22, 2008, 05:28:30 AM
I agree with k4t.  Maybe you just need to pick one, get the access put in so it can heal and you're ready and if it seems undoable you can switch.  It's also a really good point about how the toxins make us "fuzzy" in our thinking.  I am usually very quick in my recall and in my logical reasoning but for now I am "not as good as I once was" to quote a Toby Keith country song.  I notice the mental stuff especially in my puzzle solving abilities.  This aspect of things was WAY worse pre-dialysis and has improved although I still feel I've lost more than a few IQ points.  (I'm a natural blonde so most people don't expect too much of me anyhow....just kidding.  No letters to the editor in defense of blondes please. lol)
Title: Re: Barriers to home dialysis
Post by: lruffner on September 22, 2008, 05:50:05 AM
This may be an embarrassing thing to admit, but I am not even close to anyone even discussing an access yet. In all actuality, no neph wants to discuss dialysis at all, just trasnplant, but I am making them discuss it. As of 3 months ago, they speculated about 1 year. The way I see it, that is not a long time, especially when talking about fistulas. I want enough time to get mine as strong as possible, way before I start getting stuck. I am probably a little overboard in the "have to know and being prepared" dept., but that is just the way I work. I want to know all I can and then have all of my choices prioritized. I go back up north in a few weeks and at that time I plan on blocking the door (to prevent doc runaways) and discussing all of the options.

Even though my GFR is still in the lower 20's, I have noticed huge changes in my short-term memory. I can't remember squat, which is not good at all. I worry about that especially since I am still in charge of my mother's healthcare and terrified that I will screw up somewhere. I can't even tell you what I watched on tv yesterday, so something must be up. Who knows.
Title: Re: Barriers to home dialysis
Post by: monrein on September 22, 2008, 05:56:43 AM
Lists are my friend and saving grace.  Lists of anything remotely important.  I started D with a GFR or about 18 I think and my creatinine was 3.5 or thereabouts but I felt like crap, bad ammonia breath and some nausea, no appetite really.  I didn't want to get too sick before starting.  I tried holding off till my fistula was mature but still ended up with a permacath as I couldn't wait any longer.

I'm a need to know everything to be prepared kind of person also.
Title: Re: Barriers to home dialysis
Post by: Wallyz on September 22, 2008, 07:57:46 AM
Quote
I also want to take my other health problems into consideration when choosing, so that I can live as long as possible, and feel the best that anyone can on dialysis.

Home hemo, extended therapy. Slow, gentle, thorough dialysis.  That's my vote.
Title: Re: Barriers to home dialysis
Post by: del on September 22, 2008, 04:50:06 PM
As everyone probably knows I am a firm supporter of nocturnal home hemo. A long , slow gentle treatment.  I just wish that someone would devop a portable machine that would be available in Canada-then we could travel without having to do in center treatments.  Hubby hates having to do in center treatments now.

What ever treatment you choose though you can always change if you really don't like it.  The treatment you choose has to be the one that suits you best. Hubby has chosen not to be placed on the transplant list mostly because he has to travel out of province for the transplant and because of the side effects of a lot of the meds. 
Title: Re: Barriers to home dialysis
Post by: petey on September 22, 2008, 07:08:24 PM
Del, Petey, W&W, you are all warriors in what you do everyday. :2thumbsup; Having done it myself, I just don't know if I can ask my husband to do it until I die.

Thanks for your words, lruffner, but I've never considered myself a warrior -- or even a caregiver.  I'm Marvin's partner, and this (dialysis) is just one more thing that we've taken on as a team (especially since he switched from in-center hemo to home hemo).  When you add it all up, Marvin's "contribution" to his home hemo treatments is much more than mine; he does most of the work.  I'm just his "sticker" (he can't cannulate himself).

I love him.  When I became his wife, I promised -- before God and everybody and mainly to him -- that I'd be there in good times and bad, in sickness and in health, for better and for worse.  And, believe it or not, in the 22 years we've been married (the last 14 with ESRD, dialysis, transplantation, and dialysis again), we've had many, many more "good" times than bad and many, many more "better" times than worse.  If I thought that Marvin really wanted to do home hemo (for better overall health, more convenience for him, more control, or whatever the reason) and didn't try it -- or at least look seriously into it -- simply because he wouldn't want to "burden" me with it too, I'd be heart-broken.  It's not a burden to me; it's an opportunity to assist this wonderful man I married and I love with every fiber of my being in his life's journey.  And, though I'm not a dialysis patient, Marvin helps me with my life's journey, too.

Talk to your husband, and see what he thinks.
Title: Re: Barriers to home dialysis
Post by: willieandwinnie on September 23, 2008, 03:14:06 PM
lruffner, First, thank you for thinking I am a warrior, believe me, when I tell you that is not correct. I agree totally with what petey said.  :waving;

Please talk to your husband and lay out all your feelings. Look at your living situation and see if it is feasible for machine and supplies and remember that supplies will have to be ordered bi-weekly or monthly and they do take up space. Talk about what treatment would be best for you and your overall health. If and when you make the decision, things will just start falling into place. If you need more information or answers, please ask away, we'll be more then happy to help you.  :cuddle;
Title: Re: Barriers to home dialysis
Post by: del on September 23, 2008, 05:06:55 PM
Amen petey!!!  That is exactly what I would have said if I could have found the right words like you did petey!!  :2thumbsup;