Nurse's Experience With Dialysis Offers Hope to Patients

Nurse's Experience With Dialysis Offers Hope to Patients

Heather Stringer
Monday December 3, 2007

Diana Casino, RN, was starting to worry that something was wrong with her kidneys. Her breath tasted like acetone, and she felt pain in her lower back. Casino had been diagnosed with lupus at age 23, and although the disease had been in remission for 15 years, she knew that status could change. Perhaps her kidneys had fallen victim to the disease.

A kidney biopsy confirmed her suspicions, and the physicians started her on low-dose cyclophosphamide (Cytoxan) to slow the damage, but the drug didn't work. Then the symptoms became worse — her legs swelled, she lost her appetite, and she struggled to breathe.

Casino was experiencing renal failure, and she was immediately hospitalized. While in the hospital, Casino learned she would need dialysis to survive. For an adventurous Filipino woman who had left her country to work in the United States, the limitations of dialysis seemed like a death sentence.

But over time, Casino's journey into dialysis disproved her worst fears. Her experience was so compelling that Casino eventually made a career move to work as a dialysis nurse in order to offer hope to patients whose situations were not unlike her own. She has personal experience not only with two types of dialysis and the complications that can arise, but also can speak about life after a kidney transplant.

To be a nurse

Casino's desire to pursue nursing was first ignited when she was in the sixth grade in the Philippines. She was homesick when a cousin who was a nurse visited her. She was impressed with her cousin and dazzled by the discussion about job opportunities for nurses in the United States.

However, just as Casino was finishing nursing school in the Philippines, she started to suffer from severe arthritic pain in her hands and knees. She also noticed rashes on her cheeks when she was in the sun. After a series of tests, physicians diagnosed Casino with systemic lupus erythematosus.

Casino started taking prednisone, and luckily her symptoms greatly improved after a few weeks. She felt strong enough to apply for jobs in the United States, and landed a position on a med/surg unit at Jewish Memorial Hospital and Rehabilitation Center near Boston.

Casino enjoyed good health for 15 years in the United States, but then began to notice the early symptoms of renal failure. When she later learned in the hospital that she would need dialysis, she was devastated.

"I felt so scared," she says. "I was a nurse, but I had no idea what it was. I was afraid because I didn't know what I would go through. I lived by myself, and my family was in the Philippines, so I knew I would have to do this alone."

After the initial shock, Casino's sense of determination took over. She was given the choice of going to a dialysis center three times a week for hemodialysis, or learning how to do peritoneal dialysis independently. She chose the latter. She had a Tenckhoff catheter inserted into her stomach, and four times a day she drained the contents of a bag of fluid through the catheter into her stomach. In this method of dialysis, the peritoneum acts as a filter for the blood. When she needed to do this routine during work hours, she would find a room where she could drain the bag for 15 minutes. Four hours later, she would then open the catheter and drain out the fluid. She repeated this procedure four times a day.

Casino also learned how to take care of her kidneys by watching her fluid intake and her consumption of potassium and salt. In fact, she cut salt out of her diet completely and began seasoning her foods with lemon.

After a successful year of peritoneal dialysis, though, the area around the catheter became infected and the infection spread to her peritoneum. She was hospitalized and became so sick that she barely escaped sepsis.

At that point Casino decided to transition to hemodialysis because she did not want to risk another bout of peritonitis. Physicians created a loop graft on her left arm, and she checked in to a kidney center three times a week at 5:30 a.m. She finished dialysis around 11 a.m. and then worked as a nurse from 3 to 11 p.m.

Then after three years of dialysis, Casino received a call she had been waiting for. She had been selected as a recipient for a kidney transplant.

"I felt excited but also a little afraid," says Casino, who was 36 at the time. "I was afraid that it might not work and then I'd have to do dialysis again, and I wondered how I would do with the immunosuppressant medication. But I was excited to get back to my normal life."

Luckily Casino's transplant was successful. She not only stopped dialysis, but also married and moved to California. While in California, she met a renal case manager at Kaiser Permanente who referred her to Cathy Rosaia, RN, BSN, director of renal services for Mills-Peninsula Health Services in the San Francisco Bay Area. Although Casino had no work experience in dialysis, Rosaia knew Casino would have something unique to offer to patients once she was trained as a dialysis nurse.

"I thought it would be a great opportunity to have someone with such real experience," Rosaia says. "Dealing with any chronic illness is hard, and life as a dialysis patient can be especially demanding. Diana's personal experience provides hope and encouragement to patients learning to cope."

Casino was hired at the Burlingame Dialysis Center — which is operated by Mills-Peninsula — and patient education is one of her favorite parts of the job. She teaches patients why they are on dialysis, the different options for dialysis, how the machines work, about nutritional restrictions, and how the kidneys function. And when patients have questions or fears, she takes the cue to share her own story. One time she had a patient who did not want to start dialysis, and the patient was becoming increasingly sick as a result.

"I told her that a lot of people think it is the end of life, but it is not like that," Casino says. "It is just the beginning of a new life. It doesn't have to stop you from doing things, and it will help you feel better. Now that patient calls me her angel."

Heather Stringer is a freelance writer for NurseWeek. To comment, e-mail editorCA@nurseweek.com

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