'This Is Surreal': Houston Dialysis Center Struggles To Treat Patients

[Bill Peckham]

http://www.npr.org/sections/health-shots/2017/08/30/547004371/this-is-surreal-houston-dialysis-center-struggles-to-treat-patients
follow the link for the article with hyperlinks and photos


By Rebecca Hersher and  Andrea Hsu

Among the most pressing medical needs facing Houston at the moment: getting people to dialysis treatment.

At DaVita Med Center Dialysis on Tuesday afternoon, nurses tended to dozens of patients on dialysis machines while another 100 people waited their turn. Some were clearly uncomfortable, and a number said they hadn't been dialyzed in four days.

Those delays can be life-threatening.

Typically, patients with kidney failure undergo dialysis every other day, or three times a week, for four hours each time. To try to move more people through, nurses were doing two-hour sessions at this center in Houston, enough to keep patients out of danger.

Dialysis replaces the functions of the kidneys. Healthy kidneys remove toxic waste and excess fluid from the body in the form of urine. For dialysis patients, a filter, sometimes called an artificial kidney, does the job. A patient's blood is pulled through the filter and pumped back into the body.

Dialysis does not cure kidney failure, but it does help people feel better and can extend their life. According to the National Kidney Foundation, average life expectancy for patients on dialysis is 5 to 10 years, though many patients live as long as 20 years or more.

But it's crucial that patients get regular treatment.

Dr. Steve Fadem, medical director at DaVita Med Center Dialysis, says many of the facility's nurses are unable to get to work. As a result, the center is struggling to keep up with the number of patients who are showing up.

"If they don't dialyze three times a week, they can easily become fluid-overloaded, or they can have a high potassium level in their blood, and they can become very, very sick," says Dr. Steve Fadem, medical director at the DaVita center, which is one of about 100 the company operates in the Houston area, about half of which are open. Muscles, including the heart, can stop functioning correctly. "Over so many days, they can't survive."

In the wake of Harvey, DaVita has opened its doors to all dialysis patients, not just their own. But the company has been struggling with staffing shortages.

"Many of our nurses are locked in, flooded out of their homes, and they're either somewhere else, or they can't get out of our neighborhoods," Fadem says. "As a consequence, we don't have enough nurses to dialyze the numbers of patients that are coming here."

They've been helped by a team from Baton Rouge, La., who showed up with boats to ferry both patients and nurses from their flooded homes to the center.

Scott waited almost four hours to start dialysis after arriving on Tuesday. Part of the reason is because the DaVita center is open to all dialysis patients this week, not just regulars such as Scott.

"This is surreal. I've never seen anything like this ever in my career. I've been doing this for almost 40 years," says Fadem.

After missing his regular Monday session, William Scott and his wife Teresa arrived at the center just before 10 a.m. He finally started dialysis almost four hours later.

"It was a long wait, but we could understand because it was a lot of people," Teresa Scott says with a laugh. "It's just good he got in here."

Yesuf Said, a nurse who's worked at this center for four years, says it's been difficult dealing with so many patients at once and so many who are new to this center. "We have to do it, because nobody can do it," he says. "It's life and death for patients."

He's worried about the coming days. Normally, if patients don't show up for dialysis, they get a phone call from the center. Now, Said says, he's not sure they can reach everyone.

DaVita serves around 6,700 patients in Houston, according to Chakilla Robinson White, who oversees operations for the company's dialysis centers in Texas and neighboring states. On Tuesday, she sent a company-wide email with the subject line "Rally For Help in Texas," appealing to staff in other places to travel to Houston to help.

Dialysis patients who are unable to find an open center can get help from the nationwide Kidney Community Emergency Response coalition by calling 1-866-901-3773.

[Rerun]

It is just horrible to watch this major metropolitan 21st Century City turn into a third world country over night.  It is just heartbreaking.  I have a guest bedroom with it's own bath I wish I could just scoop up a family.  The pets.... at least some of them are getting out and flown to other cities. 

 

[iolaire]

I'd like to know more about the people who specifically came with a boat to transport patients. I have to assume they have family who are patients (outside the flood zone) so they know the need.

Regarding center working availability, at my (former) center all the staff made it in after heavy snow. I hope the Houston staff that stayed at the center get some recognition, that has to be hard covering for everyone including non patients.  Dialysis workers already have hellish schedules, I'm sure they are putting in even more hellish hours and I'm sure its appreciated.

[Bill Peckham]

I'd like to know more about the people who specifically came with a boat to transport patients. I have to assume they have family who are patients (outside the flood zone) so they know the need.

I too would like to hear more about them.

I would guess that they are/were a contingent of the Cajun Navy that responds to these flooding situation year after year in LA (and will likely need to do just that in next couple days). I would not be surprised that they are targeting dialysis staff and patients because of their experience in previous floods. 

I've written the reporters to see if we can connect with them and see if there is anything they need that we could supply. update: email bounced back so I tweeted one of them

[kickingandscreaming]

Can't read this without feeling how fragile and vulnerable we are with this affliction.  My heart goes out to all Houstonites but especially to those tied to dialysis machines.

[Michael Murphy]

When Houston evacuated for Hurricane Rita in 2005 it was a nightmare and over 100 people died during the evacuation.  When I see pictures of the interstates looking like rivers I imagine that a evacuation would have been catastrophic. It appears there is some movement to move critical patients to other areas by military transport.

[Bill Peckham]

PBS Video and story


http://www.pbs.org/newshour/bb/houston-dialysis-patients-getting-treatment-disaster-means-life-death/

[iolaire]

PBS Video and story


http://www.pbs.org/newshour/bb/houston-dialysis-patients-getting-treatment-disaster-means-life-death/

Good story.  Thanks.

Also a good reminder of why I hate having video the only option (not in this case), I scanned the text in under 30 seconds where the video with the same content is 3:39!

[Rerun]

I had to subscribe so I didn't get to watch it.

 

[iolaire]

I had to subscribe so I didn't get to watch it.

 

Odd I prompted me to select my local station but let me watch it otherwise.  Could you read the text below?  If not I can copy.

[Rerun]

Oh, Thank you!  I got it.  The reporter didn't know enough to explain how crutial Dialysis is, but you can't know every thing about every story. 

          

[justagirl2325]

I listened to MSNBC today at lunch and they were talking to the doctor about evacuating the patients from the hospital in Beaumont as they had lost access to clean water.  The sickest patients were going first- the dialysis patients were being loaded into helicopters and going to Jasper, 80 miles away.

[Michael Murphy]

It appears that the military is being sent to Houston in a big way.  Aircraft assets from large transports to helicopters  and ospreys are bing sent, along with USS Kersage a 40,000 ton Wasp class LPH slightly bigger than a WW2 Aircraft Carrier.  It contains berthing for 1800 Marines, 6 operating rooms 64 hospital beds and 536 additional positions that can be used as hospital beds.  It will serve a a maintaience base for choppers plus refueling.  In addition a LPD with additional facilities is being deployed.  While not announced I assume the Marineswill be deploying AAV s which are amphibious assault craft which are tracked and should be able to transport up to 25 people through water or land.  I

[Bill Peckham]

One thing that stands out to me is that they are forced to dialyze everyone for 2 hours ... even if it's the patient is a local and not otherwise impacted by the storm ... just because of the situation and needing to sustain everyone including displaced dialyzors.

What this means is that everyone should be eating an emergency dialysis diet. An emergency diet +2 hours of dialysis 3x/week can keep you alive but eating within emergency dietary guidelines during an event can be difficult or impossible for patients. MREs and most canned food (soups, stew, etc.) are very high in sodium. The Renal Emergency diet, which is almost always put forward as a three day bridge for those on an incenter schedule who miss one treatment, is designed to meet minimal nutritional requirements but while the nutrition numbers might pencil out, who eats this? According to standard dialysis industry advice we're suppose to stock: soda, bread, peanut butter, marshmallows. The message is that in an emergency it's time for fluffernutter sandwiches. This is not well conceived advice. The renal community should stop thoughtlessly passing this along, it is not practical advice.

There is an easier and more robust option. All three of the emergency bars featured in this taste test are Coast Guard approved and are renal-ly equivalent to the suggested three day Emergency Renal Diet. I tried one (the lowest rated, the ER Bar) it's not bad, kind of a peanut butter smell with a plain dense cracker taste. Not at all bad with coffee. And being Coast Guard approved they are very low salt since you don't want to get thirsty if you find yourself adrift in a life raft.

The Kidney Community Emergency Response Coalition suggest a minimum stockpile of 2 weeks (including medicine and home dialysis supplies). A two week emergency diet stockpile is much much easier to do using ER Bars v. the Fluffernutter emergency dialysis diet. The cost would be about $30 a person for ER bars for two weeks (14 - 1,800 calorie portions). It's not ideal but I could live on them for two weeks in conjunction with some minimum dose of dialysis.

Using the emergency bars to meet the food piece of emergency planning would cost about $30. Because the shelf life of the bars is over 5 years but kept in a cool, dry & dark storage space they should be fine indefinitely. That means that stocking ER Bars is a less than $6 a year insurance policy for dialyzors, a bargain in my book. And much better guidance than the standard renal community advice.

[kickingandscreaming]

Here's a rescue of dialysis children in TX..

http://www.huffingtonpost.com/entry/inside-the-rescue-mission-of-33-children-in-need-of-dialysis-during-harvey_us_59a8e389e4b0b5e530fd8beb?ncid=inblnkushpmg00000009

[iolaire]

Here's a rescue of dialysis children in TX..

http://www.huffingtonpost.com/entry/inside-the-rescue-mission-of-33-children-in-need-of-dialysis-during-harvey_us_59a8e389e4b0b5e530fd8beb?ncid=inblnkushpmg00000009

Good story.