WKD March 10, 2011

  • WorldKidneyDay 2011

StatCounter


Tip Jar

Change is good

Tip Jar

DSEN twitter feed

    follow me on Twitter
    Blog powered by Typepad

    « Dialysis and CKD Blog Report March 29 | Main | CKD links and resources »

    March 29, 2008

    TrackBack

    TrackBack URL for this entry:
    http://www.typepad.com/services/trackback/6a00e54fc659eb883400e551820adf8833

    Listed below are links to weblogs that reference Expected dialysis lifespan: How long does someone live who is on dialysis?:

    Comments

    Feed You can follow this conversation by subscribing to the comment feed for this post.

    Zach

    I have maxed out my credit cards.

    Now what?

    --Zach

    Bill Peckham

    I should have mentioned that this advice does not apply to film makers.

    TinaMarie

    So if iam on the machine at night my life spam could be longer because I'm using it as the way my Kidneys would have been doing in the first place and because i'm still like to think i'm young i have a higher chance to live longer is that what i'm getting from this. I'm not on the Hemo I'm on the Pd Machine that runs all not long.

    Bill Peckham

    I'm not fully versed in PD but I think you're right Tina Marie - people who dialyze at home - hemo or PD - do better. If you ever needed to switch from PD I hope your home experience will have you prepared to continue at home on hemo.

    Today's">http://www.billpeckham.com/from_the_sharp_end_of_the/2008/05/peritoneal-di-1.html">Today's post links to the Home Dialysis Central topic of the month that's all about PD.

    Concerned

    How long can someone live on dialysis when their kidneys and liver are 10% functional?

    Tracy Velasquez

    My mother-in-law has just been told that she will need dialysis. She lives with us. She is 76 years old with diabetes. I have been reading about dialysis and it seems to me like the dialysis done at home is a better solution. She told me that in order to do dialysis at home she would need someone with her at all times. My husband and I both work and our children who are still at home are in school. Is it possible for her to learn to do this form of dialysis alone? Why was she not encouraged to go this route? As you can tell we are new to all of this. Is her life expectancy shortened because of the dialysis? That may be a stupid question.

    somerville

    If it were discovered that patients could reduce their risk of having a second stroke by 10% if they spent the rest of their lives walking on their hands rather than on their feet, should this fill the new stroke patient with optimism that the statistics were 10% better than he had first thought? No, because the functional significance of any therapy is determined by what most patients can achieve, not by what the most compliant patients could achieve, and few people could tolerate walking on their hands for the rest of their life, whatever the benefits. The same is true of dialysis: the theoretical ideal is not the real, especially when the ideal depends on factors outside of the patient's control, such as the availability of home hemodialysis programs.

    Zach

    I am real. :)

    Anna Bennett Meinuk@aol.com

    I'll attest to that. I've had dinner with Zach. He is alive and well, and real after 28 years on in-center hemo dialysis (I've even been to his unit - it is real too, and the best in NYC).

    Stauffenville (I would be so happy if you at least gave us a first name - I've named you Henry in my mind) I get it, you are the Yin to DSEN's Yang. You are the voice for the defeated. The voice for the people who just survive, but are bitter because everyone else seems to pretend it is so much better (and you have the journal articles to back you up).

    Life is what we make of it. I choose to plod along hoping that things will get better, and appreciating what I have. I've been there, that point where it all seems futile, and acknowledging that I am going to die. I think that it is safe to say that anyone with a diagnosis of CKD5 has been to that dark place. It is always there, hovering. But outside of that "walking on your hands" as you so succinctly put it - can be a sunny day. It can be a day of picnics and waterfalls. Yeah, we may go home to a machine and needles, but that machine allows us to have that picnic, and experience that waterfall. And that, my friend, makes it all worth it. At least to me.

    Anna Bennett Meinuk@aol.com

    I have more to say (who knew?)

    Stauffenville, do you know how desperate someone is when they type "how long can a person survive on Dialysis"? - whether it is someone with the diagnosis, or someone who loves them - we're talking lifetime low. Facing imminent mortality. Your voice is important in grounding people, letting them know that this is bad, the numbers are against you. But we know that. We knew that the minute we heard the initial diagnosis. Searching is looking for hope. And there is hope out there. It is a lot of work, and you need to maintain perspective, but stories like Zach's and Bill's are becoming more and more common. Because Dialysis has gotten better. Better than the days when you had a big old machine at home that needed so much attention. My machine had disposable parts. Not good for the environment, but I decided that my life superseded my carbon footprint. (I am selfish that way).

    Transplant is amazing for those that can have one. (I have one, and I thank my deceased donor every day) BUT I also thank the pioneers like Dr. Scribner, and the current pioneers like Dr. Steinman et al who are striving to bring nanotechnology into existence. There is a future in dialysis. We need to fight for hope, not wallow in defeat.

    Zach

    Yes, Dr. Theodore Steinman at Beth Israel Deaconess Medical Center in Boston is one of today's true leaders in improving the lives of those on dialysis.

    Bill Peckham

    The 40% of New Zealanders doing HHD (in addition to 40+% doing PD) on the South Island exposes how inapt your analogy is Henry. The structure of the provision of dialysis is the controlling factor, combined with the (or resulting in) the absence of widespread knowledge.

    The path forward is to change the structure and increase the knowledge. Telling people they're doomed is one of the all too common problems.

    At first I was thinking how insensitive and inappropriate your comment was but on reflection it is probably best to expose people to a naysayer. They are everywhere and if given a chance will happily consign people who need dialysis to the dustbin. Resist! If you are just hearing about CKD beware the nattering nabobs of negativism who want to drag dialyzors down. Tell them they are not wanted, I suggest using the British phrase "Piss off" .

    effie hartley

    when one goes to a dialysis center can anyone go and sit with them? i didnt know if anyone was allowed in there or not.

    Larry Thomas

    Grandmother just passed away after having lived on dialysis for approximately 33 years. She avoided all the foods that she was supposed to avoid, unlike most dialysis patients who disregard those warnings.

    susan handley

    i have one patient who has been on dialysis for 36years. she does not follow the renal diet but always takes her phosphate binders i beliebve this is the ansewer for long term survival

    susan handley

    i am sorry for your loss of your grandmother truely.
    i am trying to support many patients who get told ..dont eat this as its bad for you.everyone is individual and should be treated as so.i have had personal bereavement over the last two years so totally understand your grief believe me.

    susan handley

    i have also posted that i feel very sorry for your loss as i have also lost my mom father in law and great niece all from cancer. this did not appear. so i do understand your grief.

    i am very passionate for the best care available for my patients.

    Erum

    My mother was suffering from urine infection, and was urinating way more than normal. She has now been diagnoised with a kidney failure and the doctors have asked her to go for dialysis.
    But a person with a kidney failure gets little or no urine. What's this case with my mother? She has been taking anti depressants for 10 years now.

    Bill Peckham

    Sorry about your mom. The kidneys keep everything in balance. Healthy kidneys remove not just extra fluid but also excess solutes, such as potassium and phosphorus. Also when removing fluid the kidneys are suppose to keep good things in the blood, for instance protein. Unhealthy kidneys can spill protein into the urine which is why that is taken as a sign of kidney disease.

    Your Mom might need dialysis to help her kidneys do their job. Starting dialysis while you are still eliminating urine is easier than starting dialysis with no native urine output.

    ordinary person

    Suzanne

    Interesting posts. I suppose I'm a newbie to CKD as I'm newly dx'd at Stage 3. I have co-existing health issues and have been treated for cancer several years ago, including chemo and radiation. Chemo damaged heart, so ultimately, had open heart surgery to try to correct some of those issues. Also have asthma and just recently dx'd with an aortic aneurysm. Also dx'd with diverticulosis during a routine colonoscopy. Am I just lucky or what? LOL I'd say yes. I'm still here and still kickin.

    Now, I've maintained a good attitude throughout. With the exception of a few days here and there where I honestly questioned whether it was all worth it. My answer was that it was. I have healed well and recovered well from each surgery/treatment, and/or bit of bad news. Now, however, I find that I'm beginning to lose some of my enthusiasm and unlike dealing withe the other issues, am dreading the idea of treatment for CKD. the idea of ultimate hemodialysis is intimidating. Granted, I know I'm fortunate not to need hemodialysis as yet, and who knows, maybe I won't for many years to come. However, I think people are entitled to become tired of so much medical fooling about after a fashion and are solidly entitled to also get down, distressed and tired of it all. Of course, in my experience, we all bounce back. I mean really, consider the alternatives. Yes, we all like to see positive people in action. Surmounting whatever the beast in their lives happens to be. Dealing, coping well, remaining positive, being cheerful and carrying on. Why? I believe it's because we all want to be spared seeing someone being unhappy and suffering emotionally. We just don't want to see it or know about it really. We want that happy face and that generous smile we all know and love. In reality, there are times when it just isn't there. Perhaps not for several days time running. I think we're all wise to realize that it's ok. Allow people space to be "naysayers" or to be down. They're functioning under heavier burdens than they care to paint a positive picture about at the moment. Give everyone space just to be and to feel however they are feeling, without rebuke.

    Misery, just as joy, is part of the human condition. Why must we be so adamant that it not exist/be acknowledged or else throw psychotherapy and/or pills at it, when it is acknowledged? Just because someone's "normal" is not like your own normal, is not always cause for action or concern. It has been my experience that people need time to grieve for things lost. Be that people, health, financial status, pets, career, lifestyle or anything else one considers important to them. Finding new normals that work is perfectly ok. If that means calling a spade a spade once in a while and saying, "this sucks", then it's perfectly ok and can even be healthy in my humble opinion.

    So, "Henry" m'friend, you're ok, just as you are. You aren't spreading gloom and doom so much, as you're sharing how you feel. You are expressing yourself, you're entitled and that's ok by me.

    Not having a crystal ball, I've no clue what my future holds regarding CKD, or any of my other health issues, but one thing is for certain, whatever it holds, I will do my best with it and yes, I may even have an occasional "Henry Day' and that, I surely hope, will be considered ok too, by those closest to me as well as those I've yet to become acquainted with.

    Above all, I wish everyone strength of spirit. I believe it's a major component in managing health issues well, and essential in maintaining focus and yes, even in regaining lost focus.

    Suzanne

    Elzie Lavery

    For anyone whose kidneys have failed, and are facing dialysis, let me tell you my experience, having been on hemodialysis in a DCI clinic, in Mt. Pleasant, Pa.
    I have been going there for 5 years and 8 months. When I first started....well, let's go back to three months before that. I was a victim of arsenic poisoning, and nearly died, but was a pretty hardy fellow, well muscled and sort of athletic in character. Always did plenty of hard work, and rarely if ever drank. No abused drugs ion my entire life, I am a christian and though not a regular churchgoer I live the right life.
    After about a year and a half of my poisoning, my kidenys would work in a manner where they excreted my protein, probably still about 3 liters of urine per day. When I was admitted to the hospital, I weighed 275, about 45 pounds more than my normal weight, my muscles were getting pretty much non-existent, I could hardly walk, that weak.
    First thing to do, was get stuck in the neck with the catheter that goes down the jugular to an inch or two above your heart. I ws dialyzed a few times with that, and then it was removed and the tube arrangement of catheter where it comes out your chest was installed, and I began regular dialysis.
    About 4 months into the 3 times a week regimen, 4 hours each time, one of the tubes broke while I was at the treatment center on the machine!!!
    Plenty of blood squirting out there, to be sure. The nurse immediately got a clamp tip under my skin and found the broken spot, and clamped me off. I was shipped up to the nearest emergency room at Frick hospital nearby, where upon examination, I was scheduled for a catheter replacement the next morning. ( I can only say that since I have been on dialysis, everybody who has tended to me, or advised me on anything, has been incredibly wonderful.)
    More later, another entry.

    Elain

    My brother had a liver transplant in 1990 and because of all the medication he takes has and is destroying his kidneys to the point dialysis is being discussed. He also has some other (lesser) problems.he also has problems with very thin blood. I would like to know would he be ok with dialysis maybe transplant.

    Lorraine

    My husband had peritonitis in Oct.2008 that's when it all started. He went directly on Hemo where he stayed for 2 years;with aprox. 8 surgeries to repair the fistula. There were several clotting issues; then on Sept.30,2010 we got the call.
    Oct 1, 2011 the transplant went well;but several hours later there were problems. Two months later we left the hospital with a non functioning kidney.He went back on Hemo D. but still had issues with the fistula. Finally it shut down and we opted for PD. In the beginning it was like having a new baby in the house.The alarm would go off so often during the night and the first week we had the cycler it broke down and had to have a new one sent. We made an appointment with a Hemotoligist.WE found out that my husband has a rare blood disorder "polycytemia" that causes his white count to escalate. It also affects his RBC and platelets. Could this be the reason for all the clotting? I have my own thoughts on that.
    On a lighter note we now love PD. He feels better and better every day. The cycler now runs pretty smoothly. He used to feel pretty tired after Hemo. and lost his appetite. I would recommend Pd to every one. It's a more natural way to dialyzes.

    roberta mikles

    Lorraine, I am curious. With all the blood work that was done, did you ask why they did not identify this polycythemia prior to your going to a specialist?

    M.  Endanawas

    Hi: i am from the great north, was diagnosed with kidney disease in the fall of 2009. I was devastated of course i was on dialysis machine in the hospital for several weeks, three times a week, then went home and hooked up twice a day, then eventually on home PD, now for about two years. I still have a difficult time coming to grips with this because i was a healthy person, at least i thought i was.I was never really given a thorough examination to see if i had this disease earlier. So folks get checked and rechecked because its your health not anyone else! But now i have to live my days like i never did before. Its a whole new change up. I had two infections , today i am very cautious in what i do and how i care for my self. I do my best in following a diet and exercise daily, take my medications as required. I am getting ready for a transplant, getting prepared is a long ride for me. Follow one day at a time and thank god for each day i have! Thanks.

    Julio Silva

    Today is Jan 31 2010 and its only been 4 day since the doc told me that I have stage 4 Kidney fariler, and I am just a basket case. I try to be strong when I am with my family, but when I am alone like I said a basket case. I have been sick for a while with other things and I just thougt that I was getting sicker. I am so scared and I think of this as the beginning of the end. I came on here to find out how long a person with stage 4 would have to live. I am 47 years and I just want to see my girls get married and it breaks my heart to think that I will not be there. I just want to thank everyone that post on here because I know that I am not alone. I have to return to the doc on Feb 17, 2012 to find out more, and I am so scared, but you guys give me a little hope. Its 2 am and my nerves are oin high gear. Thank you all

    April

    Curtis, I can imagine the disappointment you must have experienced when you found out you were eliminated as a donor. Even though we can't help Jerry directly, perhaps spreading the word about his need for a kidney will help in some small way. Wish we could do more.

    David

    My Mom is 58 - will be 59 in September 2012.

    She recently was told she is in stage 5 kidney disease and they are discussing a 'shunt' of sorts that will go into her arm for dialysis. In the meantime, we are praying for a kidney donor.

    I believe God can work miracles...heck, I'm a miracle...on several accounts, I shouldn't even be alive...so I know God can work something amazing with dialysis in my Mom.

    Anything anyone can offer as advice???

    David

    PS: Something I'll add to this~
    My maternal Grandmother (Mom's Mom), died in dialysis in June 2002. She was almost 83
    My paternal Grandmother died in Feb 2006 while in dialysis...she was 75

    I've had my sugars checked....I'm 40 and so far so good...no diabetes...

    JLH

    My father is a type 2 diabetic and has been advised to start dialysis soon. He must go to heart doctor first to see how well his heart is functioning (he had a quad. bypass six years ago). We are all a little anxious and don't know what to expect. The doctor said he can't go on the donor list to him being overweight. He can't eat and if he does, he gets sick. Any thoughts on how to lose weight for transplant even though he can't eat? I know his odds aren't the best, but us kids are trying to be as optimistic as possible.

    Anna Bennett

    Jim,

    There are some great suppoert forums for patients and care givers. One I love is www.ihatedialysis.com/forum they have support for everyone: caregivers and people living with all forms of CKD.

    You father will be going through a lot of changes as he starts dialysis, and you'll be hearing a lot about weight. Speak bluntly with the Transplant team that is denying him and ask what they want from him. What goal weight will they transplant at? You will be learning about Body Mass Index (BMI) and they may give you a number as a goal (some centers use 35 as a goal) BMI is calculated by using height and weight. Once you have a goal, there should be staff to help your father reach that goal (both at the transplant center and at the dialysis unit).

    When he starts dialysis, the staff will calculate his "dry" weight (what his body weighs AFTER all excess fluid is remived)

    This is a lot of information to take on board, and can be overwhealming at first. Take baby steps. Starting dialysis will change a lot. You are doing the right thing by researching and being optimistic. Reach out to your medical teams, reach out to support groups like IHD (there is a lot of information over there) and hopefully the process will be easier to handle for you and your family.

    Best,

    Anna Bennett

    ted patrick

    I was recently at a davita clinic in northwest Tucson Az.Where i met a 92 year old women that been on dialysis for 35 yrs. she walked with a walker and refused to let anyone help her,she was determined to do things herself.

    John sandula

    Scared in Michigan , my 69 year old mom has been on dialysis for 3 years. Her labs are always good, but her pth has been rising and controlled with meds. Worried something bad will happen to her and hope this is not the end.

    Tracey

    My husband got a transplant 9 years and 8 months ago however in February we got the dreaded phone call that he was in acute failure, he now has 15% left and talks and tests are commencing to see it he can go back on apd.

    He was 31 when he got his transplant and we got our life back, it's heart breaking to think he has to go through dialysis again as he was on it for 3.5 years and became very ill (to the fact I don't know if he would have been here today).

    Thinking positive and reading others comments, things have moved on over the past 10 years and hoping and praying things sort themselves again (UK).

    becky powell/keene, texas

    my name is Becky, I am using a friends computer , and I have been married nine wonderful, happy years to my husband Lincoln. We just got the news yesterday that he needs to be on dialysis. With dialysis, his life span is month by month . Without it , only two weeks . He also is a Type 2 diabetic with early stages of muscular distrophy, he is only 41 yrs. old. My heart is very heavy , and still in a state of shock , trying to process all of this. Thankyou for any and all information as we begin to travel this chapter of our marriage.

    Colleen

    I have a couple of questions, but from reading all of the above, it seems that only a few posts are replied to, so why post here at all? Is Bill Peckham a doctor? Even in the medical field?

    I am 67, female, type 2 diabetic which is under control, and recently told I have CKD stage 4. My GFR (filtration rate)was 23 and since then, I changed my diet dramatically and my GFR is now at 27. Is it possible to raise myself back up the stages if I keep eating healthy? I don't see the point of going on dialsis if you're just going to die anyway. Can anybody relate?

    Colleen

    It's Colleen again. I just saw a video about Bill Peckham and now realize he's one of "us", another patient. And he's very close to where I live if he's still in Seattle. I'm on the other side of the Sound, in the Poulsbo area. I am NOT on dialysis yet. But pondering still whether or not it is for me. Been reading up on it as much as I can, and still not convinced.

    Bill Peckham

    Hi Colleen. You may never need dialysis, diet and exercise goes a long way, but you do live in an area with lots of good nephrology resources. And there're great resources online. Have you tried any of the online discussion boards?

    Colleen

    Hi Bill. I just introduced myself to the IHD discussion bd, have no clue how I found it but I bookmarked it so I wouldn't lose it. Have already rec'd welcomes from the people there. Thanks for bringing that up. I thought this here was a msg. bd. but apparently it is your blog. I'm not real computer savvy, you probably caught that, right? I liked your one sentence that I may never need dialysis, but I neglected to mention, I don't exercise. So hopefully eating healthy w/still go a long way!? Thanks!

    Jack Reynolds

    After 37 years of dialysis in-clinic, I am finding
    it more frustrating in dealing with uncomfortable
    chairs, cold conditions, and the invariable clash
    of personalities. I live alone and so home dialysis is not a good option either as I am
    medically unsuited for PD. I am in good health
    and get by all right otherwise. Any advice from
    some other old pro's?

    Bill Peckham

    Good on ya Jack, 37 years puts you in elite company.

    I live alone, and have lone dialyzed since 2002, so it can and is being done. Is the issue that your center doesn't support lone dialysis or that you feel it isn't right for you?

    Pete

    Hi I have a kidney transplant almost 17 my creatine went up and they want to put me on the transplant list again my base line was 2..5 now it went up 3.7 4.0 the doctor wanted to do a biopsy but the kidney is to thin and may bleed . All the best to everyone on this site thanks

    Jack Reynolds

    Hello Bill,
    I'm cramped for space to do hemo at home, but I appreciate your comments. Where were you trained to do solo dialysis? One other problem I have aquired lately is shaky hands so I am having one
    needle stuck for me at present after doing my own
    cannulation for 30+ years. I visit a DaVita clinic in Des Moines and am a long time Board member at Dialysis Patient Citizens. Thanks,
    Jack Reynolds.

    Bill Peckham

    I've been dialyzing through the Northwest Kidney Centers in Seattle since 1990, I trained to dialyze at home with a helper using the B Braun in September 2001, and to self dialyze at home in September 2002 on the Aksys PHD; I've been a lone dialyzor ever since - I now use the NxStage System One. As of last month I have been dialyzing at home the majority of the 22 years I've used dialysis.

    Jack every situation is different but I know people have lone dialyzed in a NY City sized apartment. And my living space, that I share with an 11 week old puppy, is about 1,000 sq ft. You might be interested in the Hana model http://www.billpeckham.com/from_the_sharp_end_of_the/2009/01/hana-maui-model-of-dialysis.html I haven't heard an update but I think colocating dialysis is an option that a progressive unit should explore.

    Darren Van Der Hoff

    My name is Darren and I live in Wollongong Australia. I first went on dialysis when I was 23. I didn't get a choice as I was told my anatomy was not suitable for PD. I survived pretty well for 5 1/2 yrs doing 5hrs 3 times a week. I worked full-time and played competitive sport during this time and think this all helped me to keep going. I had a transplant from my ex spouse and it lasted almost 5 yrs. In Dec last year I was told that after extensive treatment the kidney could not be saved. During the five years my marriage broke up and I had a new partner. The hardest thing was knowing what was coming and trying to prepare her. Over the last 12 months I have seen her go through so many emotions and it is hard not to blame yourself for the pain your partner is going through. No matter how much you explain what HD is to your friends and families you and your carer really can suffer alone. I still work full-time shift work but in recent months I have really struggled. The strain is getting to both of us. Monetary issues are forcing us to keep working but with the price of my meds we seem to be going nowhere. I believe that is one of the most overlooked issues with dialysis. When your young and working and then this hits you its hard to come to grips with. Buying a house or new car take a back seat to paying for tests and meds. I went through this for 5 long years before the miracle of a transplant. Then just as I thought I was home free I got hit again. You do get down and your partner is always there for you but you can't take them for granted because they got through everything that you do. My partner is suffering at the moment and it breaks my heart. We have the added pressure of going through IVF now which maybe one thing too many for us. We thought we could handle it all and we desperately want children, but the stress of having to go to banks and beg for money could be the straw that breaks the camels back. I hope not. I'm no angel and have a history of not being compliant with doctors orders. Diet and fluid are my worst enemies. BUT without HD where would I be? There is only one alternative. Take your meds, restrict your fluid, be compliant and wait for THAT CALL. That is all you can do.

    Jack Reynolds

    Thanks for your comments Bill. Looks like I'll just
    have to suck up and stay with in-clinic dialysis for now. I believe the reason for my long survival
    is adequate dialysis for my body and not having
    other health problems like diabetes or high blood
    pressure. Sticking reasonably to the diet, in particular the parathyroid hormone levels, (PTH) is important to keep within range and I concur with your comments om the importance of regular
    exercise. Although I dialyzed as long as six hours in my younger years. I now do 4 hours at a 350 bfr. (blood flow rate) I use a small cosmetic mirror to "see" the front of my machine to check all settings and check things like did the tech unclamp my heparin line. Also it saves constantly asking "how much time do I have left. I also have a system for manual fluid profiling. After all, in-clinic machines were designed for
    dialysis providers more so than the patients.
    Jack Reynolds

    chykita mateo

    I been doing this 4 .8 year will I die soon

    Katie

    My husband is 25 years old and was recently diagnosed with CKD and is on permanant dialysis until he can get a transplant. We are praying for the best. He is doing hemo in the hospital until he is released to go to the facility until his PD heals to switch to the PD home dialysis after we are trained of course. His mother went through dialysis and did not make it so this is very devistating because he watched his momther suffer from this. Has dialysis advanced over the last 15 years?

    Lucy

    Hello,

    I recently found out my mom has CKD Stage 5 and doctors are recommending PD. I saw someone said they were able to raise their levels with diet and excercise. Are there any websites that can provide pre-planned menus that can be helpful? My mom is 64 and diabetic (but that is under control). Thank you so much!

    Verify your Comment

    Previewing your Comment

    This is only a preview. Your comment has not yet been posted.

    Working...
    Your comment could not be posted. Error type:
    Your comment has been saved. Comments are moderated and will not appear until approved by the author. Post another comment

    The letters and numbers you entered did not match the image. Please try again.

    As a final step before posting your comment, enter the letters and numbers you see in the image below. This prevents automated programs from posting comments.

    Having trouble reading this image? View an alternate.

    Working...

    Post a comment

    Comments are moderated, and will not appear until the author has approved them.

    My Photo

    Fix Dialysis

    • www.fixdialysis.com

      DSEN in the Press

      "... not evil ...""
      Kent Thiry, 5280 Magazine

    Search DSEN


    • WWW
      WWW.BILLPECKHAM.COM

    Rate DSEN

    August 2013

    Sun Mon Tue Wed Thu Fri Sat
            1 2 3
    4 5 6 7 8 9 10
    11 12 13 14 15 16 17
    18 19 20 21 22 23 24
    25 26 27 28 29 30 31