Do I call them idiots?? I do!

[kitkatz]

This morning after three and a half hours of sleep I get a phone call from my dialysis center social worker asking me if I called the travel network for my travel dates in September and October.  I said of course I have.  She called back a few minutes later... Fresenius Travel never heard of me or my request.  I called Fresenius Travel and had a fit at them.  They lost me in their never ending quest for service.  So I gave them the dates a  SECOND time and asked him to get it moving quickly.  When I asked why my first request made MONTHS ago was lost, when they had called me back to verify dates and such already ONE time, he had no answer to give me. The first on line request I made was two months ago....they called me about my request and assured me it was going through. HAH!  I would have been screwed if my clinic had not followed up for me.

I am irritated because:
1. My center knows i am a nocturnal patient. Did the social worker even think about the eight o'clock time when she called me? I was dealing with all of this crap on three hours of sleep this morning.
2.  Why can't people do the job they are supposed to do the first time?   They MAKE me use their services in order to travel so don't screw it up for me!
3. Fresenius Travel needs to email that they have talked to you so the patient has proof they talked to someone.
4. I have not had any problems with travel until this time.  The social worker would take information and do all 0f the contacts for me. Now they just give me a number or website.  Where is the service I am paying for?
5. The social worker comes once a month to the nocturnal patients at the clinic.  This is not enough time for her to get these things done.  I feel we are an afterthought.

I am now going to be a pain in the ass about the travel arrangements. I have the number and a name now, so once a week I will call to see if the travel arrangements have been made for September and October.
I already warned him I was going to do it.

[iolaire]

5. The social worker comes once a month to the nocturnal patients at the clinic.  This is not enough time for her to get these things done.  I feel we are an afterthought.

Can you get the email address of the social worker?  For US travel I use my (DaVita) center and my coordinator was happy to have me email her the dates rather than do it in center.

[Deanne]

Idiots is putting it mildly! I think I'd be so angry I'd be incoherent.

[Rerun]

That is why I don't travel.  It is easier and less stressful to stay home.

               

[kitkatz]

So...today I call Fresenius and talk to the nice lady.  Paperwork has to go. Ready for Tucson I think.  Oh by the by we are going to give you a TB test, ummmm cannot do that, it has to be an x-ray for me.  Oh let me get back to you.  So here I sit waiting on things that should have been done weeks ago.  If they told me I needed a TB test I would have gotten one early this month.  I knew this stupidity was going to run rampant.

[Hemodoc]

So...today I call Fresenius and talk to the nice lady.  Paperwork has to go. Ready for Tucson I think.  Oh by the by we are going to give you a TB test, ummmm cannot do that, it has to be an x-ray for me.  Oh let me get back to you.  So here I sit waiting on things that should have been done weeks ago.  If they told me I needed a TB test I would have gotten one early this month.  I knew this stupidity was going to run rampant.

For anyone that is PPD positive, further testing is contraindicated There is a serious complication in some of these cases where a a PPD positive patient is given a PPD, not sure why, and it results in an "Arthus Reaction" which can be quite nasty leading to necrosis and gangrene in that area of the skin.

So, if that applies to your case, then yes, a CXR is the correct follow up and further PPD testing is contraindicated. Ask your nurse if she has ever heard of an Arthus Reaction to PPD.

[Michael Murphy]

what really annoys me is when I use the Fresenius clinic in the Adirondacks I get a snotty letter telling me that if I continue to skip treatments I could die.  I have never missed a treatment in 18 months I 2 or 3 times a year use the travel services to go to my second home upstate new york and every time I go I get a letter about missing sessions.  Never mind all the paper work I need to fill in each time I travel.  Now when the social worker shows up I hand her a packet of all the info she needs less stress on me.  You think Fresenius could coordinate the data between sites.

[iolaire]

If they told me I needed a TB test I would have gotten one early this month. 

For DaVita to DaVita visits a 90 days recent TB test is a new requirement as of the last month or so.  So there is a chance its a new requirement with Fresenius.

[kitkatz]

TELL me I NEED one before I run up on vacation time!

[PrimeTimer]

I hate it when their left hand doesn't know what their right hand is doing -and THEY SHOULD! Every Fresenius should be ran the same, their policies consistent. This is probably a logistical problem for upper management to work out. As for TB tests, my guess is that with the sudden influx of thousands of immigrants from foreign countries and not knowing their health history, it is best to safeguard ourselves from potential diseases that could spiral out of control within the population, especially among those with compromised immune systems doing dialysis and/or waiting to qualify for a kidney transplant or who have actually recently received a transplant. Angering that we have to go thru all the paperwork and tests...how many of the thousand of foreigners that were let in to the U.S. were tested/treated for TB or any other dangerous lifethreatening disease BEFORE being allowed to enter the United States? How many of these people might we come in contact with and where? Oh, that's right! We don't know where they sent them!

Hope you get everything you need done before your vacay, kitkatz so that you will be able to enjoy some "life and living" out there that you so deserve! Have fun!     

[iolaire]

TELL me I NEED one before I run up on vacation time!

DaVita did one the day before I left for vacation incase I needed to go to a different center the day I returned - and of course the next morning the nurse refused to look at it because it would not tell anything after 12 hours.  It seemed like it was a new requirement that my nurse was not aware of - I went to two out of state DaVita's over the summer and it was not required then.

So on this item it might be something new.

[iolaire]

As for TB tests, my guess is that with the sudden influx of thousands of immigrants from foreign countries and not knowing their health history, it is best to safeguard ourselves from potential diseases that could spiral out of control within the population, especially among those with compromised immune systems doing dialysis and/or waiting to qualify for a kidney transplant or who have actually recently received a transplant.

What are you referring to? 

(I am aware of the constant migration to the US for the last few hundred years.)

[Deanne]

I guess in a way I understand testing patients in general, but not it doesn't make sense to test just because someone wants to travel across the country. It'd make more sense if testing was standard protocol every 5 years or so.

I understand testing for it in general because I tested negative at my initial transplant evaluation, but two years later when I had to go through the re-evaluation process, I tested positive. It took me by surprise. Since then I've been thinking that there are a lot of people who are probably positive for it and don't know it. I didn't have any risk factors before testing positive. I haven't traveled outside the country for 20 years. I've only traveled between Oregon and Minnesota for about the last 15 years. I work in a place that has people who are from foreign places, but I almost always work from home, so my exposure there isn't high, either.

I'm sorry you have to deal with continued idiocy kitkatz.

[Rerun]

If it is a 90 day TB test requirement to go to another Davita than it should be a 90 day requirement at the Davita you are at.  If we are one big family and you go to one Davita then you should be able to go to Aunt Davita house without the TB test.  If it is a yearly thing at your Davita then it should be a yearly requirement if you visit.  It is just a money grabbing ploy; Im sure Medicare pays for the test.

Yearly should be fine.  We don't even test for Polio...  Sorry, I've been watching The Roosevelts' .

[Hemodoc]

As for TB tests, my guess is that with the sudden influx of thousands of immigrants from foreign countries and not knowing their health history, it is best to safeguard ourselves from potential diseases that could spiral out of control within the population, especially among those with compromised immune systems doing dialysis and/or waiting to qualify for a kidney transplant or who have actually recently received a transplant.

What are you referring to? 

(I am aware of the constant migration to the US for the last few hundred years.)

Actually, this IS a serious natinal public health issue. When my wife immigrated from the philippines, she had to pass a rigorous health examination for TB, syphylis etc. People who have serious communicable diseases are not allowed to immigrate legally, it is a disqualifier and well it should be in reality.

The recent influx of thousands and thousands of illegal aliens from south of the border is bringing in cases of multi-drug resistant TB. The only effective treatment is quaranteen and and some old fashioned approaches to TB management that doesn't really work all that well.

So, not being political whatsoever, but I hope folks look at the real public health risks including TB from the latest border "crisis."

[obsidianom]

So...today I call Fresenius and talk to the nice lady.  Paperwork has to go. Ready for Tucson I think.  Oh by the by we are going to give you a TB test, ummmm cannot do that, it has to be an x-ray for me.  Oh let me get back to you.  So here I sit waiting on things that should have been done weeks ago.  If they told me I needed a TB test I would have gotten one early this month.  I knew this stupidity was going to run rampant.

For anyone that is PPD positive, further testing is contraindicated There is a serious complication in some of these cases where a a PPD positive patient is given a PPD, not sure why, and it results in an "Arthus Reaction" which can be quite nasty leading to necrosis and gangrene in that area of the skin.

So, if that applies to your case, then yes, a CXR is the correct follow up and further PPD testing is contraindicated. Ask your nurse if she has ever heard of an Arthus Reaction to PPD.

The arthrus reaction is an immune complex mediated reaction which can cause production and release of tumor necrosis factor .
My guess is that if a person is stimulated by the protein a second time after being sensitized , there is the risk of setting off the immune system complex creating this .

[kitkatz]

UPDATE:  I made it to both vacation areas. I managed to secure dialysis even with all the fretting Fresenius put me through.
Tucson dialysis center I would rate at a B-. They left me sitting in blood after take off each time.  Not good.
The Vegas Center I would rate at an A-. They were concerned the night the blood decided to creep out and cleaned up everything around me quickly and apologized for the mess we had made. LOL.

So I learned to pester Fresenius when setting up travel plans. Sigh.  And to get a TB test done before they ask for one. Another loud sigh.

Now that it is all over I am drafting a few letters to a few people.

[iolaire]

UPDATE:  I made it to both vacation areas. I managed to secure dialysis even with all the fretting Fresenius put me through.
Tucson dialysis center I would rate at a B-. They left me sitting in blood after take off each time.  Not good.
The Vegas Center I would rate at an A-. They were concerned the night the blood decided to creep out and cleaned up everything around me quickly and apologized for the mess we had made. LOL.

So I learned to pester Fresenius when setting up travel plans. Sigh.  And to get a TB test done before they ask for one. Another loud sigh.

Now that it is all over I am drafting a few letters to a few people.

Glad that you made it!  Do you mind sharing the name/address of each center?  Its good to have a reference.  I'll be in Vegas for Thanksgiving but I'm a DaVita client so we might not cross centers...

[kitkatz]

I am off to Oklahoma next week. Fresenius managed to get dialysis arranged for me in two days. My youngest gets married Monday!

[Simon Dog]

If you are traveling, KNOW YOUR Rx.   I've visited about a half dozen different clinics (one DaVita, hte rest Fresenius), and I have almost NEVER had them get the Rx completely right.

Errors I've encountered:

- No heparin Rx when 4000 units was specified
- Clinic read "takes 10,000 EPO at home" to mean "give patient 10000 EPO"
- Bicarb set way to high
- 3K line plugged in when Rx, and local orders at the transient clinic, specified 2K
- 3 hour instead of 4 hour treatment (because the NP who prescribes "just sort of guesses" - words from the RN doing the treatment)

There was one small clinic in Exeter, NH that got everything right - and as a visitor I somehow rated a visit from the MD running the operation to make sure everything was going well.