In Center Dialysis

[kitkatz]

I am looking into doing home dialysis now because I want to be able to travel. However I have been an in center dialysis patient for nine years now.  It is not half bad when you look at the positive things.

1. The unit is clean.
2. The techs are pretty well trained.
3. RNs are available everyday all the time you are there.
4. There is a primed ready machine there for your use.
5. There are other people to talk to.
6. Time to read the newspaper or a book.
7. Supplies are provided.
8. A doctor sees you at least once a week and is on call every day.
9. Water problems are solved by others.
10. All testing done by someone else.
11. Intravenous drugs such as epogen and iron can be given through the machines.

[Wattle]

   Kit are you trying to talk yourself out of Home Haemo?

[KT0930]

I am looking into doing home dialysis now because I want to be able to travel. However I have been an in center dialysis patient for nine years now.  It is not half bad when you look at the positive things.

11. Intravenous drugs such as epogen and iron can be given through the machines.

All your points are valid. The only thing I would point out is that epogen is subcutaneous, not intravenous. It's really very easy to administer yourself. As Wattle said, though, are you trying to talk yourself out of Home Hemo? Just curious. I think you'd be an excellent candidate for home dialysis, since you're so aware of what's up with your health.

[jbeany]

But how do you feel, kit?  Most of the home patients on here or in my center have more energy and feel better on the more frequent home dialysis.  The difference in my health makes up for all the hassles of home dialysis.  Comparing my in-center experience to yours may be apples and oranges, though.  My 3 times a week drive totaled 6 or more hours each week, and that was thru blizzards and bad roads in the winter and tourist drivers in the summer.  If my center had been close and convenient, I might not have pushed as hard to stop going.  I'm glad I did, though - I love being a home-body!

[petey]

Kit, here's my two cents for what it's worth:

1. the in-center unit may appear clean, but I KNOW Marvin's dialysis "room" at home is clean because I clean it.  In-center, you don't always know what was cleaned and cleaned properly and thoroughly.  (Was that chair, machine, side table wiped down after the last patient -- or wiped down with a clorox wipe -- there's a difference.)  At home, you know because you did it.

2. for home hemo, the patient and his/her partner are thoroughly trained.  It's a quick process (not quite three weeks for us), but it's intensive and one-on-one.  Did I learn every single thing in those three weeks ?  No, but then, the techs don't either.  I'm still on on-the-job training -- I learn shortcuts every day.  It's really kind of funny, but when we started the training for home hemo, Marvin knew exactly what to do -- he had been watching for 13 years!  He was the expert, and he helped me learn.  The charge nurse at Marvin's "old" in-center clinic has offered me a job as a tech -- there !  Hey, I don't do this kind of work for just anybody (I'm a teacher in "real" life).

3. On home hemo, we have a RN on call, 24-7 (before, during, and after treatments).  We also have NxStage folks on call, 24-7.  (Also, I got a little put out with in-center because Marvin's company -- DaVita -- came up with a plan for the nurses and techs to be more "efficient" -- I think they meant cost efficient here.  DaVita said a tech/nurse should be allotted six minutes from the time the patient arrives at his/her chair until he/she is running on the machine.  Six minutes per patient per treatment start time! Any more time than this and the nurse/tech wasn't working "efficiently" -- do you read money is the bottom line here?  -- Okay, so when Marvin arrives at his dialysis chair in home hemo, I take as much time as Marvin needs me to take to get him on and running.  If it's a tough stick day, I take my time. I'm not rushed.  I have ONE patient, and he gets all my time, all my attention, and all my concentration.)
In home hemo, money and "cost efficiency" are not the bottom line -- quality, personalized, and individualized care are!
 
4. On home hemo, there is YOUR (an exclusively your) machine ready to be primed (when you want it primed and ready, not when it fits in the overall's clinic's schedule).

5. On home hemo, you can have other people to talk to IF YOU WANT (visitors are allowed -- one, two, ten -- although I do not allow visitors with colds or coughs in Marvin's home clinic -- or visitors who pass out at the sight of blood).  Also, you don't hear any one else complaining, crying, whining, bitching, or vomiting -- the lone patient is the only one allowed to do this on home hemo -- Marvin won't even let me do these things in his home clinic.

6. Once you get hooked up and running, there's plenty of time to read a book, watch a movie, watch tv, sleep, and all those other things you do in-center.

7. On home hemo, supplies are provided.  (I got disgruntled at Marvin's in-center clinic because they were trying to save money -- they did this by having a tech cut the "chucks" -- the blue protective pads -- into thirds.  Each patient only got 1/3 of a chuck per treatment.  This saved the clinic money.  I got tired of it being about money!!!  At home, I use a WHOLE chuck -- sometimes two -- for every one of Marvin's treatments.  This amount is provided by his prescription and supplied to us.)

8. A doctor is on-call 24-7.  We see him once a month (whether we need it or not).  When we go to see him every month, he seems to take a lot more time with us than he did when he was stopping by Marvin's chair in-center only to rush on to the next patient.

9. Haven't had a water problem yet on home hemo.  Have to get back to you on this one.

10. All testing is done by me or Marvin (we think that's a good thing).  We're extra, extra careful because we know it's Marvin's body, health, and life we're dealing with here.  We're not rushed because we have to test 25 chairs/stations.  We have ONE -- and that one is our only concern and gets our full attention.

11. Epo is given sub-cu.  Marvin takes iron pills orally.  True, the NxStage machine can't handle IV drugs, but we're working on changing that -- when NxStage told us, "Tell us what you think we can do to make improvements," we took them at their word.

Also, consider this:
1. energy levels jump drastically -- six treatments per week has made a HUGE difference in how Marvin feels every single day and not just on his "off" days like in-center
2. labs improve -- when you're getting more dialysis, the toxins have less time to build up and, thus, your blood work is more in line with "normal" ranges
3. travel is possible without having to make arrangements at other clinics -- travel with NxStage is not easy, but easier than in-center
4. flexability in treatment times -- you can get a treatment at 6 a.m. today, noon tomorrow, and 8 p.m. the next day.  Your life doesn't revolve around treatments on home hemo -- your treatments fit into your life.
5. you are in control.  If Marvin's been eating like a little piggie for the last day or so, we up his dry weight a half a kilo.  No big deal.  If he has a lot to take off, we don't try to get it all off in one treatment.  We get most of it today, a little more tomorrow, and the rest the next day.  (At in-center, we were OBSESSED with his dry weight because we knew if he didn't get it ALL off today that it would build up for the next treatment.  On home hemo, with treatments six days a week, the dry weight is your goal -- not your obsession.)
6. a LITTLE extra fluid.  On home hemo, you can drink a little more than on in-center -- (NOT guzzle like a fish, mind you).  An extra glass of tea -- maybe two -- is okay.  You're going to take it off this afternoon anyway.
7. it's your body, your life, your treatment.  You are the center of attention on home hemo.  It's all about YOU.
8. no re-use on dialyzers.  Each treatment, you get a brand new, sterile dialyzer.  (I always wondered if they were getting Marvin's dialyzer clean enough between treatments, and his clinic used the same one about 20 times.  Common sense tells you that can't be good.)


Will home hemo be great for you, Kit?  I don't know.  I do know that it has been wonderful (absolutely wonderful) for Marvin.  It has made all the difference.  We love it.  It fits us.  It works really, really good for us.  It's not easy, and it is time consuming.  But, we think it's worth it. 

Note: Marvin was on in-center for 12 1/2 years.  It was a very big jump for us to make.

My advice: It is a commitment on your part and your partner's part.  If you're not willing to make the commitment, don't go home hemo.  Weigh all the pros and cons.  Try it if you want to because you can always go back to in-center.  If you don't try, you will never know.

Someone needs to call NxStage or DaVita At Home and tell them to send me a check -- I sound like a spokesperson!! 

[del]

Amen Petey!!!  I feel the same way.  Hubby has been doing nocturnal home hemo for almost a year and a half now on a Fresenius machine. I cannot believe that they would allot only 6 minutes to put a patient on. What happens if they run into a problem.  Very easy to make a mistake too when you are rushed.  Much more control when you are at home.  There are lots of things we are still learning as well.

[petey]

I didn't mean to make in-center hemo sound awful, Kit.  I don't want to offend the in-center patients or workers.  Marvin did have some wonderful, caring, terrific nurses and techs while he was in-center.  He also made some very, very good friends (other patients) while he was in-center.

Aside from all of those things I mentioned in my previous post, Marvin also felt like he needed a change from in-center because he had become the "longest surviving" patient at his in-center clinic.  When he first started 12 1/2 years earlier, he was 39 years old and the "baby."  All of the other patients treated him like their baby.  Miss Mary, who sat next to Marvin for the first year or so, would loudly call out to the nurses, "Marvin's blood pressure is dropping.  Somebody better come see about him!"  or "Marvin's machine is beeping.  Someone come here!"  or "Was that the doctor who just came in the back door?  Marvin said he wanted to talk to the doctor today!  Somebody go get him!"  or "When the dietician comes in, tell her to come see Marvin first!"  She was sooooo good to Marvin, and the other patients were, too.  Not only was he the "baby" and the "new kid on the block," but Marvin was also on the transplant list and few of the others were (most were older, much older).  I think they saw "hope" in Marvin.  One day, Marvin came in and noticed Miss Mary's chair was empty.  When he asked if she was in the hospital, he was told, "No.  She died last night."

When you're the patient with the longest time at a clinic, that's a good thing.  It means you've survived and you're still surviving.  But, it also means that you've seen a lot of others come and go.  Since so few of the others at Marvin's clinic got transplants, they their chairs were empty because they died.  At the end of his in-center time, this really bothered him terribly.  Now that he's home hemo, he misses his friends and sharing time/tips/stories with the others who are also on dialysis.  He does not, however, miss seeing an empty chair. 

[kitkatz]

I was trying just to see the good of the hemodialysis center, just that. Thought maybe someone needed to see dialysis clinics can be pretty good places.  Just trying to talk myself into staying there for now and waiting until they can do home dialysis for me at another clinic.  Really unusual to hear a happy positive spin from me.  Huh?