I have my dialysis supplies organized and my machine is ready for tonight's treatment - I'll need to pack up after dialysis tomorrow morning to catch my 1PM flight direct to Miami. The cruise leaves Sunday; my Mom and I will have New Years day to search Miami for whatever it is I've forgotten to pack.
Mary S. from NxStage has been instrumental working with Pat and Rich to get the thing organized and she'll be providing updates during the cruise. An introductory post is up, as well as a "Meet the Cruisers" post. Updates are promised there and on NxStageUsers.
The cruise has evolved from my initial concept of a meet-up into what promises to be a interesting group adventure (hopefully no tears). My only expectation is that I will get my lifetime list of countries up to 34 while having a great time.
Here's another local news story on the NxStage Freedom cruise, this one features Susan and Jeff (For some inexplicable reason the videos are not consistently embedding correctly on DSEN's main page (I blame the TV station's embedding software. Why don't people just use YouTube?)). To watch the video click here.
If you're on incenter dialysis you should really be checking out dialyzing at home.
Tomorrow night the year will turn bringing us 2010. I hope it brings you all joy and health. I hope it brings wise decisions by our leaders. But whatever it brings, let's all continue working towards the betterment of our health and the world. And for goodness sakes, have some fun, too! Happy New Year!
Here are the CKD related blogs updated since my last report on 12/27. If you have or know of a blog that should be on the list let Bill know. Comments in parentheses are my reactions or opinions.
Dialysis from the sharp end of the needle Bill is going on the NxStage Freedom cruise and posts a news video about Pat & Ralph, another adventurous couple who are also going (Bon Voyage to all the NxStage cruisers! Enjoy your freedom and the independence that optimal dialysis with NxStage can bring. We look forward to photos and stories to enjoy vicariously.); the blog report.
Kamal Shah's Blog Kamal plays a rowdy family game of Taboo and an ordinarily quiet relative really got into the game; a description of Kamal's morning swim routine.
Toastiest Toastie may have a possibility for a kidney transplant and discovers that his insurance policy has a clause that disallows payment for a transplant with an unrelated living donor, he may be able to change policies. (This is unconscionable! Has it not occured to this insurance company how much a transplant would save over perpetual dialysis? I hope you can change policies.)
The Life of a 20-Something With Lupus Flo describes her last day in Florida which included dialysis, Dairy Queen, mall shopping, and flea markets. She also makes a point of saying that she looks forward to going home to her nocturnal dialysis because in-center, three times a week treatment leaves her not feeling well. (It's a big difference. I wish more people who do conventional in-center HD knew how much better they could feel with more dialysis.)
On the Road to a Lupus Cure New research shows that urine components may indicate the severity of lupus nephritis possibly allowing for diagnosis without a biopsy in the future; how you can help promote Julian Lennon's album "LUCY" and raise funds for Lupus Foundation of America.
I Am. Are you? has a quick look back at some Donate Life Illinois highlights from the past year.
The Ins and Outs of Dialysis John and Gayle had a great Christmas with their grandchildren and dressed up like Santa Claus, photos.
Dialyse This Cassie is into Rock Banding/Guitar Hero-ing and decides she needs a new TV.
Linda Gromko MD kidneycare Steve gets a new Primary Care Physician and Linda explains the importance of having one.
Uremic Frost has a chart showing the top causes of death in 2006-2007. No change is seen in a primary renal cause which remains number 9 in the top 10; a CDC study shows that since 1996, the rate of diabetes-related CKD5 has declined.
Pediatric Nephrology has posts on the role of intradialytic parenteral nutrition; the differences between animal and human models in Acute Kidney Injury; photo and information about Renal Angiomyolipoma; a CKD5 patient finds a kidney donor through Facebook; links to Bill's post about the Freedom Cruise; therapeutic strategies for Encapsulating Peritoneal Sclerosis; a study on the risk of exit-site infection following topical mupirocin and sodium hypochlorite application.
pkdmom2five has links to some articles about courtship vs. dating for religious Christians; lessons about dress and appearance.
Dialysis and Me shares videos from Christmas eve - JoJo the Boxer enjoying her new bone, nephew unwrapping his Transformers gift and family having a wrapping paper ball battle; a review of video game "Fairy Tale Fights"; Dialysis Guy (video) reviews "Avatar" and relates Christmas activities; a video of Barry making a Warhammer model.
Rob and Danielle's Kidney Blog Danielle made Rob a banana split for dinner (Yum, I want one, too!); a potential kidney donor for Rob turns out to be the wrong blood type but Rob is still grateful for the offer and prays that a matching donor will come his way sometime.
I'll be leaving for the cruise on Friday. There will be blogging during the trip but I can't say what the frequency will be from me ... mostly I'm looking to relax. Here's the cruise's official travel agent and organizer Pat with husband Ralph talking up the cruise on local television:
In marketing there is an old saying, sell the sizzle, not the steak. Travel is NxStage's sizzle. Its fine with me if people unmoved by the greatly improved clinical outcomes, look into dialysis with NxStage just so that they can join us on the next cruise.
Here are
the CKD
related blogs updated since my last report on 12/24. If you have or know of a blog
that should be on the list let Bill know. Comments in parentheses are my reactions or opinions.
Dialysis from the sharp end of the needle Bill posts a graphic from National Geographic's blog that shows how the US compares to the other developed nations in terms of dollars spent and life expectancy...the US spends more than twice the average yet is below the average for life expectancy. Bill thinks the US healthcare system is perverse. (I agree with you.)
Toastiest Toastie rates the movie "500 Days of Summer" -- it made him feel terrible and he hated it.
Birdman Sparrow posts a silly (and slightly deranged) animated Christmas video; his wife saved his life when he was unconscious from low blood sugar.
The Life of a 20-Something With Lupus A stranger tries to enter Flo's hotel room, all is later resolved (it was the manager) and she goes shopping by the beach; had a great time at Disney World and Epcot Center, has dialysis at 7AM tomorrow morning.
Jack's Kidney Adventure Jack gets some sort of flu and has to go to the ER to make sure his new transplanted kidney is okay, it is and he recovers in a couple of days; enjoys time at a B&B in Columbus.
Linda Gromko MD kidneycare Linda and Steve love movies. went to see Invictus and found inspiration in the same poem that helped Nelson Mandela persevere despite adversity.
Renal Fellow Network discusses the association between phenytoin and hypocalcemia.
Uremic Frost Excerpts from an interview with DaVita's CEO Kent Thiry where he discusses his view on the current healthcare legislation and the company's explosive stock growth; because of patent infringements, the U.S. District Court in Boston issued a
permanent injunction barring Roche from selling Mircera in the United
States, but a licensing agreement with Amgen will allow it in mid-2014; a study shows that day napping and short night sleeping were found to be associated with a higher risk of the development of diabetes.
UKidney posted a discussion of skin problems in chronic kidney disease; an argument as to why KT/V may not be the best measure of dialysis adequacy; researchers in Boston have identified the genetic cause of focal segmental glomerulosclerosis which mat eventually lead to treatment; a new study finds that the gap between supply and demand for donated kidneys for transplant is widening in Canada.
Pediatric Nephrology has his Pediatric Grand Rounds with links to the articles highlighted from the last two weeks.
Diario de diálisis Crónicas (en Español) Journal dialysis - Chronicles (Google translated from Spanish) In response to a commenter's accusation about improper care at a Fresenius unit in Argentina, Alejandro researches the matter and meets with Fresenius representatives at their Buenos Aires headquarters for an explanation.
pkdmom2five has a wonderful Christmas, including tamales, a church service, family, football, and movies.
Kidney Notes - Exploring the Intersection of Medicine and Technology has a link to an article that logged all the sleep interruptions experienced by a patient in the hospital during a 12-hour period; a link to an article with tips on how to get what you need from your doctor.
Jenna Franks Jenna was able to get home after 27 hours in 4 countries, as the snow in
Europe created many delays. She and mom, Karol, had a great Christmas
together.
Here are
the CKD
related blogs updated since my last report on 12/21. If you have or know of a blog
that should be on the list let Bill know. Comments in parentheses are my reactions or opinions.
Kamal Shah's Blog Kamal struggles with life expectancy questions as he looks at pension plan options; his bone pain is getting worse, nephrologist feels it may be from too low phosphorus; gives his suggestions about what must be done in Telangana, India.
Kaply, Inc. Tracy's cable box goes down, doesn't need to see the nose doctor for 6 weeks, and got her H1N1 shot before she heads out for holiday travel.
Hasten down the wire Michael critiques Google's non-answers when it comes to questions of user privacy.
The Life of a 20-Something With Lupus Flo is vacationing in Florida, hotel is nice but almost slipped on newly washed carpets, likes the free wi-fi, checks out the dialysis unit she will go to and plans a retail therapy day in Orlando; has seafood at Winn-Dixie, describes her shopping day at the outlet mall; dialysis went well and now she's off to another mall to shop, tomorrow she goes to the beach.
On the Road to a Lupus Cure Winter weather skin advice for those with lupus; the Lupus Foundation of America launched a Facebook fan page.
Really, I'm as Old as I Feel? Rob has photos of and describes their family's last minute homemade Christmas gifts; a cute photo of Rob and daughter, Abby, enjoying a snow day.
I Am. Are you? has a description of the Donate Life Rose Parade float and the people who make it happen; Donate Life Illinois and mascot, Morgan D’ Organ, wish everyone Happy Holidays and safe travels!
Linda Gromko MD kidneycare Linda's family Christmas letter reviews the medical difficulties of the year, hopes for a smoother, "medically boring" 2010 (We wish that, too, for us all.)
celebrates their resilience, understanding, love and commitment; Linda and Steve become acutely aware of their blessings in the light of friends' tragic loss of a child.
Precious Bodily Fluids discusses the conflicting data on CKD and injury caused by contrast-medium exposure.
Renal Fellow Network presents a differential diagnosis of red urine; describes a case of a patient who developed acute renal failure shortly after undergoing attempted Angiojet therapy for a pulmonary embolus; announces the winners of the Mt. Rushmore of Nephrology poll.
Uremic Frost has a really gross video of a man drinking fat; a study shows for a person with known or expected heart disease exercise hypertension is actually
good, but for a healthy person exercise hypertension can be bad.
UKidney describes the combined kidney/bone marrow transplant
protocol used at the Massachusetts General Hospital
Kidney Transplant Program They transplant both kidney &
hematopoeitic stem cells from the same donor, which will hopefully
induce a state of immune tolerance that allows a sparing (and ideally a
complete cessation) of immunosuppressive drugs without inducing
rejection.
Pediatric Nephrology has a new section on his website featuring Powerpoint presentations on important nephrology topics - the first is on H1N1; a recent paper from New York discusses the diagnostic yield of renal biopsies by a retrospective review; a study shows that pediatric burn patients with acute kidney injury have a higher mortality rate.
pkdmom2five her son Nick's BP was high, doctor adjusted the medication; describes many Christmas activities, had a pleasant chat with a member of her former church.
Dialysis and Me Barry plays an an impromptu Apocalypse game with his Warhammer figurines and has a blast, photos of the event.
The Ballad of Billy The Kidney John wishes "the Top of the Season" to everyones, whether it be Christmas, Hanukkah, or Festivus. (Back at ya', Mate! Cheers!)
....And Bells on Her Toes Her husband has an angiogram, results show some plaque deposits that may cause problems in the future but don't impede transplant plans; she posts a video of "I want a hippopotamus for Christmas" (Really cute song.) and a saga about getting Zhu Zhu Pets (mechanical hamsters without the mess) for her children for Christmas - she is not a fan of Toys R Us anymore.
The inner game of PKD Richie continues telling his PKD odyssey with how me met his wife.
My New (transplanted) Kidney Journey Al's labs are stable, Cellcept is giving his bowels less trouble, solved his insurance troubles, and is starting back at work.
Berns on Nephrology Dr. Jeff Berns reviews the results of a randomized controlled trial examining the effect of a low-protein diet in patients with chronic kidney disease.
Renal BizBlog The Centers for Disease Control and Prevention posted the proposed
guidelines for prevention of Intravascular Catheter-Related Infections (which included information specific to hemodialysis
catheters) for comment on its Web site - the deadline for comment has passed but nurses would like it extended so that renal nurses will have a chance to contribute based on their expertise.
Kidney Diet Tips suggests using the days between Christmas and New Year's to revisit your CKD management plans so you're read for a healthy 2010.
A little over a week ago I had my home dialysis monthly check-in with a nephrologist that I was meeting for the first time. I found him very knowledgeable and supportive of alternative dialysis strategies including the NxStage System One as well as nocturnal dialysis in its various forms. He recently opened his unit to incenter nocturnal dialysis patients, achieving excellent results with several of those patients who transferred from conventional dialysis care. Unfortunately, one of those patients is now at jeopardy of returning to conventional dialysis care by the decision of their HMO. This, despite the widespread acceptance of the benefits of incenter nocturnal dialysis especially in Canada just to the north and down south in Australia, America continues to dismiss the overwhelming evidence of improved outcomes with this modality.
Remarkably, despite the widespread knowledge that dialysis pioneers originally used eight hour sessions nearly fifty years ago instead of the conventional 3-4 hours sessions we are now familiar with, many health insurance providers perversely consider these alternative strategies unproven and experimental and will not pay for them. They continue to insist upon randomized controlled trials as the only standard of proof which at this time still do not exist. They fail to acknowledge that the current standard of care, 3-4 hours sessions thrice a week, was a business decision unsupported by any randomized controlled trials as well.
A little over a year ago, I contacted the physician overseeing the committee at Southern California Kaiser that evaluates new and evolving technologies after hearing that they were considering nocturnal hemodialysis at that time. After reviewing the available literature mainly from Canada and Australia, they determined that that data was insufficient to support adopting it as a covered benefit for all patients, but they did recommend setting a pilot study which is now in progress. Yet there are many such as Dr. Carl Kjellstrand and Dr. Christopher Blagg who have advocated for optimal dialysis here in America for decades citing the improved outcomes in several other nations that have been able to incorporate this in dialysis practice.
The case of my fellow patient at my center now battling for coverage of optimal dialysis through a well run incenter nocturnal dialysis program takes me back to the current status of many patients in America who still do not have access to these life saving modalities. After observing the positively changing mindset among many in the nephrology community over the last two years that I have been involved in dialysis advocacy, this case reminds us that the battle is not yet won here in America. With the uncertainties that the new prospective payment system could bring to American dialysis patients and these alternative treatment options, I can only wonder whether we are winning or losing this battle. Dr. Belding Scribner spent the last two decades of his life fighting this battle only to tragically die in 2003 before he saw it come to fruition.
Certainly, in the nearly seven years since Dr. Scribner death, dozens of studies have brought forth the profound benefits of daily hemodialysis, especially in regard to daily nocturnal hemodialysis. Many who support these modalities continue to wage the battle against this American dialysis hegemony hoping that we shall never again hear that a patient was denied access to these life changing treatments. It is a battle that one of our fellow dialyzors is waging today, unfortunately it seems, with very little chance of success. A vocal dialysis advocate that I asked to assist in this case summed it up by simply saying, “That's truly appalling!” I agree. The battle continues locally and nationally.
Here are
the CKD
related blogs updated since my last report on 12/18. If you have or know of a blog
that should be on the list let Bill know. Comments in parentheses are my reactions or opinions.
Dialysis from the sharp end of the needle Bill's vote for the best non-dialyzor comment to CMS goes to a renal dietitian from CA; while the immunosuppressant coverage wasn't included in the Manager's Amendment, a GAO study of including dialysis-related oral drugs in the dialysis payment was. This probably means oral drugs won't be in the PPS for now, and hopefully immunosuppressant coverage will be part of the final merger of the House and Senate bills.
Toastiest Toastie is traveling and resolves to institute life changes when he returns.
Hasten down the wire Michael critiques the politicking that pitted immunosuppressant drug coverage against funding for dialysis care; and expresses his great disappointment with President Obama's first year actions.
I Am. Are you? shares a nice reflection post from heart and kidney recipient Bill Coon.
The Ins and Outs of Dialysis Gayle and John wish everyone Happy Holidays and share family photos chronicling their year.
Chronic Chick Talk has a music video of "Silent Night;" suggests that a grandfather clock would make a good wedding gift and gives a source where to get one.
Dialyse This Cassie marks four years on dialysis and has a lot of last minute holiday shopping to do.
Precious Bodily Fluids shares the sign he has in his offices to alert patients to the problem with clopidogrel (Plavix) and omeprazole.
Renal Fellow Network important differences between mouse and human Acute Kidney Injury when considering the warm ischemia-reperfusion model.
Uremic Frost 30 Rock actor, Grizz Chapman, has stage CKD5 and is not sure
a transplant is the right way to go for him; a son finds a kidney donor for his father through Facebook; 24 hr. ambulatory blood pressure monitors can disturb patients sleep patterns and, hence, blood pressure so results from these devices must be carefully evaluated given this information.
UKidney a study looks at the ratio of unnecessary vs necessary procedures in regard to fistula surgery; China will in the next two years set up a data bank of Chinese renal failure patients who might be in need of organ transplants - China currently has 1 million such patients.
Pediatric Nephrology shares an encouraging study from Germany on infants with renal failure; a differential diagnosis for hypertension along with metabolic alkalosis and hypokalemia; research shows that urine might be the next fuel for all our houses, cars and appliances; a study from India done with pediatric CKD3-4 patients comparing short-term efficacy of sevelamer versus calcium acetate.
Neophron's Senescence returns from his cruise, where he met Howard Dean, just in time to see the inadequate Senate healthcare bill get signed.
Team Teddy Bear Bob gets the notification that he is not a match to donate a kidney to his wife so he's starting the process of getting himself into a Donor Swap program.
Biologically Safe Water Filters writes how Nephros Dual Stage Ultrafilters can save hospitals money and aggravation by preventing "Superbug" infections.
Kevin’s Blog Kevin reflects on his life one year post-transplant and finds religious significance there for the season.
Reid released "the Manager's amendment
(pdf)," a single piece of legislation that contains hundreds of
amendments within it. This way, there is one big vote changing the bill
rather than dozens, or even hundreds, of smaller votes.
Unfortunately, the Manager's Amendment does not include any language relating to immunosuppressant drug coverage. There is, however, Section 10336 which calls for a GAO study of including in the dialysis payment, payment for dialysis related oral drugs (Page 249 - 250 PDF link):
SEC. 10336. GAO STUDY AND REPORT ON MEDICARE BENEFICIARY ACCESS TO HIGH-QUALITY DIALYSIS SERVICES.
(a) STUDY.—
(1) IN GENERAL.—The Comptroller General of the United States shall conduct a study on the impact on Medicare beneficiary access to high-quality dialysis services of including specified oral drugs that are furnished to such beneficiaries for the treatment of end stage renal disease in the bundled prospective payment system under section 1881(b)(14)
of the Social Security Act (42 U.S.C. 1395rr(b)(14)) (pursuant to the proposed rule published by the Secretary of Health and Human Services in the Federal Register on September 29, 2009 (74 Fed. Reg.
16 49922 et seq.)). Such study shall include an analysis of—
(A) the ability of providers of services and
renal dialysis facilities to furnish specified oral drugs or arrange for the provision of such drugs;
(B) the ability of providers of services and
renal dialysis facilities to comply, if necessary,
with applicable State laws (such as State pharmacy licensure requirements) in order to furnish specified oral drugs;
(C) whether appropriate quality measures exist to safeguard care for Medicare beneficiaries being furnished specified oral drugs by
providers of services and renal dialysis facilities; and
(D) other areas determined appropriate by the Comptroller General.
(2) SPECIFIED ORAL DRUG DEFINED.—For purposes of paragraph (1), the term ‘‘specified oral drug’’ means a drug or biological for which there is no injectable equivalent (or other non-oral form of administration).
(b) REPORT.—Not later than 1 year after the date of the enactment of this Act, the Comptroller General of
the United States shall submit to Congress a report containing the results of the study conducted under subsection (a), together with recommendations for such legislation and administrative action as the Comptroller General determines appropriate.
I have to believe this means oral drugs will not be included in the PPS required by MIPPA.
As to the immunosuppressant coverage piece, the hope now is that when they bring the House's HR 3962 and the Senate's HR 3590 bills to conference, the immunosuppressant coverage from the House Bill will pass through to the final bill and in the process the House's oral drug pay for will be replaced by the Senate's oral drug GAO study. That would be a great outcome.
The Congressional Budget Office thinks that adding oral drugs to the bundle will save money - $100 million over 10 years - but I can now say, after evaluating the idea in the context of commenting on the PPS, I'm confident that isn't true. Providing Medicare Part B beneficiaries medically appropriate, universal
access to these oral drugs would come at a cost not reflected in
current use and therefor current reimbursement. You can't save money you're not spending.
I hope that "other areas determined appropriate by the Comptroller General" will include evaluation of specific examples, from categories of current Part B beneficiaries
(e.g. those with drug coverage through work, those with drug coverage
through a retirement plan, those with drug coverage through low income
plans, those without any drug coverage) to determine how the proposal would impact each group. How would adding binders to the bundle change their access to these drugs?
The Comptroller General should conduct case studies of current Part B beneficiaries with drug
coverage under Part D to evaluate the appropriateness of their current use. I believe such an analysis would reveal that current coverage
inappropriately limits the use of these effective and important
medications. Current Part D copays and the “donut hole” have a profound
impact on beneficiary's behavior. Evaluating future reimbursement based
on current usage understates the need because under today's
reimbursement nephrologists working closely with their patients will
forgo prescribing medically appropriate drugs due to their financial
cost and the patient's lack of adequate insurance coverage.
I didn't know all that two months ago, but after hours and hours spent thinking about and discussing the idea with scores of people I now have a well informed opinion. I adapted those last two paragraphs directly from the comment I filed last Tuesday. CMS did the dialysis community a great favor by including oral drug under the PPS. There is no way, as a community, we CKD advocates could have come to understand the implications of the seemingly simple idea of adding "specified oral drugs" to Medicare's dialysis treatment payment. We now know that the problems are much deeper than the questions of logistics specified for study under Section 10336.
Thanks to CMS's PPS oral drug trial balloon the entire CKD advocacy community can enumerate numerous challenges that arise from paying for binders and calcimimetics through Part B. From Congress's point of view the big problem will be it doesn't save money. Unless ... the CBO evaluates their inclusion assuming the drug prices are directly negotiated by Medicare. Nothing bars Medicare from negotiating Part B drugs directly with pharmaceutical companies. And that approach might end up saving money, even while expanding access and improving care.
So far I have 1,115 comment on my PPS spreadsheet. They run the gamut from the actionable to those that can be summarily dismissed. I'll have a more in depth analysis once I think all the comments are posted. There were a lot of great comments from dialyzors. Dialyzors using the NxStage are vastly over represented. I can't wait to count up the comments from people using the NxStage (and NxStage family members). I think home dialyzors really came through to improve this rule for everyone. If CMS really listens to their beneficiaries they'll get rid of medical justification and pay fairly for home training.
I'll compile and post from the best dialyzor comments soon, until then here is my favorite comment out of all that were submitted, in the non-dialyzor category.
It's the 1,112th comment I read. Maybe I'm just loopy from all the previous multipage entries, but I thought this one broke through in an engaging way, to tell a story that made the author's point, in fewer than 2,000 characters. (The submission was through the website interface so it was limited to 2,000 characters (the web interface also strips paragraph breaks, I've made a guess where to add them to improve the comment's readability.)):
I will never forget the first time a dialysis patient was upset with me. It was 15 years ago. I was an undergraduate Dietetic Student at the University of Vermont. I was interviewing dialysis pts on their calcium/phosphorus intake. One Saturday morning 2 pts absolutely refused to participate.
I had interviewed each of them 15 times before, but today, interviews were not going to happen. Why? The pts refused, saying; "we're trapped here in a chair. we're prisoners. We're going to sit here for 4-5 hours on a Saturday, and then spend most of our weekend trying to recover. You're going to ask a bunch of questions and then run off to enjoy your day. We don't want to help you".
What they were really saying is that they wanted to be free. They wanted to recover faster and feel better. They wanted a more "normal life". Why do i remember these 2 pts? Having now worked with many home hemodialysis pts, I know that these 2 pts should NOT have been in that center, not these 2.
They should have been treating at home, they should have been enjoying the benefits of daily home hemodialysis. Clinical evidence tells us that pts performing more frequent, home hemodialysis, realize faster recovery times post-treatment, a reduction in BP meds, increased levels of energy, less depressive symptoms, improved mental and physical capabilities, etc...
I applaud CMS for including in the proposed rule a stated goal of encouraging more home dialysis, and for allowing providers the opportunity to bill for more frequent therapy, which has been proven to improve the lives of patients. Unfortunately, because the stated rule fails to appropriately capture the costs associated with providing the essential HHD training required for home patients, I fear you are working against your stated goal.
Please reconsider the elimination of separate payments for home hemodialysis training. You are so close to hitting the mark, improving cost of care and quality of life. Help keep pts home and free.
That's a great comment. If you're the renal dietitian from CA congratulations, you won the best comment nonDialyzor award.
In your honor I went through and corrected the spelling of "Dietitian" in Column P across all 19 page of the spreadsheet.
Here are
the CKD
related blogs updated since my last report on 12/15. If you have or know of a blog
that should be on the list let Bill know. Comments in parentheses are my reactions or opinions.
Dialysis from the sharp end of the needle Bill shares the comment he sent to CMS about the Proposed Payment System and notes the lack of trust evident amongst all the stakeholders.
Kamal Shah's Blog Kamal wishes that he had been able to travel and see the world but CKD5 ended that dream for him at the age of 22 (Maybe you can go on a dialysis cruise sometime like a whole bunch of NxStage users are in a couple of weeks.); he had a DEXA scan which showed he does not have osteoporosis so that is not the cause of his bone pain, the pain is now impinging on his ability to do daily activities.
Kaply, Inc. Tracy's phone is on the fritz and she is really mad about it, so watch out; gets her phone replaced, her surgery went well, and does weird things when under the influence of pain meds.
Toastiest Toastie posts videos of Howard Dean and Al Franken talking about the healthcare reform bill; a video of Al Franken pwn-ing Joe Lieberman.(If you don't know what "pwn" means, go Google it, like I did...and I dare you to pronounce it.)
Hasten down the wire Michael is disgusted with Chase's penalization of responsible credit users; explains why he is replacing his TiVo system and with what; critiques the Huffington Post's new online publishing business model.
On the Road to a Lupus Cure has a video of Julian Lennon and James Scott Cook explaining the story behind and singing the song, LUCY. A portion of the proceeds raised by the song will be donated towards lupus research; Amanda Davenport describes meeting Julian Lennon at the CBS Early Show.
Really, I'm as Old as I Feel? Rob and his beloved, Anny share a birthday, a very young photo of the birthday boy and girl. (We wish you both many happy, healthy years.)
I Am. Are you? A woman describes her emotional meeting with the recipient of her husband's kidney; Donate Life Illinois is giving out 40 free pairs of tickets to a private Phil Vassar concert in Chicago on Jan. 6, details here.
Chronic Chick Talk suggests that men do their holiday shopping online and gives a link to a website that sells nice watches, always a good gift.
Dialyse This has a meeting set up with a radio personality who wants to interview her for a story, has lost a little dry weight, and isn't sleeping very well.
Linda Gromko MD kidneycare Linda recommends that caregivers do strength training (weight lifting, resistance training, etc.) to increase physical strength and emotional endurance.
Precious Bodily Fluids Joel recommends a web service he likes for making booklets; describes a case of tenofovir toxicity and how he came to that diagnosis; discusses the studies on the impact of IV contrast on residual renal function; links to an article on the dietary causes of gout.
Renal Fellow Network posts on the clinical signs of transplant glomerulopathy; reports the results of last week's poll on IgA Nephropathy, and has next week's poll asking which prominent nephrologists are/were most prominent to the field? Write-ins are acceptable.
Uremic Frost The Medicines Company announced a voluntarily recall of eleven lots of Cleviprex (clevidipine
butyrate) injectable emulsion due to the potential presence of visible
particulate matter which has been observed in some vials during a
routine annual inspection; a study shows that a higher hemoglobin level was associated with a significant 26% reduced risk of death or the initiation of dialysis, challenging the results of the CHOIR study; recommends UKidney as a resource and found a free online blood pressure log; video of the RPA Public Policy in a Minute.
UKidney has a post explaining hemoperfusion; and an article on the lifting of Australia's five-year ban on the transplantation of animal cells and organs into humans.
Pediatric Nephrology has information about a study on "Alternative complement pathway activation in D+ HUS"; and a report on experience with combined liver kidney transplants from a center in Germany.
Neophron's Senescence describes the seminars and discussions he has had on his cruise, talked to Howard Dean about healthcare reform.
pkdmom2five celebrates her anniversary, shares photos; photos from "The Messiah."
Lemonade and Kidneys Ruth suggests her friend Leigh's website for last minute gift ideas.Leigh hand crafts beautiful jewelry and ornaments out of silver and copper, with designs ranging from the demure to the baroque, photos of some of the jewelry.
The Ballad of Billy The Kidney John reminds people not to overdo their fluid limitations on the holidays and links to a story from the Liver Transplant Unit at Flinders Medical Centre in his new home of Adelaide, Australia.
....And Bells on Her Toes The caulking from newly installed windows gives Kelly a headache; shares a really sweet Dear Santa note her daughter wrote.
Kidney Community Emergency Response has a Q & A with pertinent information about the recall by Sanofi Pasteur of some lots of pediatric H1N1 vaccine; announces the KCER 2010 Summit will be held April 13 in Orlando, Florida.
Renal BizBlog On Dec. 10, the Medicare Payment Advisory Commission met to discuss
dialysis payments, among other topics, and recommended a 0.9 percent
composite rate increase for 2011. MedPAC will vote on the
recommendation at its January 2010 meeting.
Over 850 comments have been posted (you can view the comments here or download the continuously updated Excel file). The comments run the gamut from unactionable complaints about MIPPA to the 126 page opus submitted by the Kidney Care Partners (PDF link). After reading the KCP comments I would be shocked if oral drugs make it into the final rule. CMS seems to have clearly misread MIPPA to find statutory authority to include oral drugs. You get what you pay for and the KCP comments must have cost a lot of money to produce: they are very good, very compelling.
Reading through all the public comments reveals a deep distrust among all parties involved in the provision of dialysis. Patients don't trust providers who don't trust physicians and the feelings are mutual. And Medicare? Well Medicare doesn't trust us and we don't trust them, times ten. Sigh.
I don't know where this lack of trust will lead. Maybe somewhere on the other side of this seismic change is a reimbursement system that controls cost by promoting optimal dialysis. I think that is possible but it will take a concerted effort.
I don't think it is within the power of humankind to devise an optimal payment system for dialysis in one massive effort. Success will mean revisiting the questions raised by the PPS again and again; ongoing evaluation and improvement should be a routine feature of the payment system. This is an historic change that will guide and constrain the provision of dialysis for a generation. It's critical to get this right.
Tomorrow is the last day left to make your comments to CMS regarding the
proposed payment rules. The deadline is December 16 at the end of
business hours EST. Make your voice heard! It matters.
It has been an interesting week - 13 people received kidneys in a major swap/donation that took place over 6 days; at the same time this is happening the US Senate is deciding whether to increase immunosuppression funding by reducing funding for dialysis. What the future holds for both US dialyzors and transplant recipients may be decided soon. I find myself frightened for us all as I desperately hold on to my life with dialysis with the same passion as a transplant recipient would protect their new kidney. Who is going to win this battle for funding? Or will we all lose?
Here are
the CKD
related blogs updated since my last report on 12/12. If you have or know of a blog
that should be on the list let Bill know. Comments in parentheses are my reactions or opinions.
Kamal Shah's Blog recommends Dr. Sethi's new website on Pediatric Nephrology where an article by Kamal appears in which he describes his emotional reaction to watching a child undergo dialysis. (Very moving, Kamal.)
Kaply, Inc. Tracy's doctor orders her a fistulagram and her friend, Sizzle, orders her a mani-pedi. (I know which one I would rather do.)
Toastiest Toastie posts a moody black and white photo of a water tower against a cloudy sky, tries not to think about his upcoming birthday.
Becky Perry shares an excerpt from Joyce Meyer: A Life of Redemption and Destiny by Richard Young.
On the Road to a Lupus Cure Congress passed the Omnibus Appropriations bill for Fiscal Year 2010 which contained important funding for lupus research and education; from now until March 15, 2010, 100 percent of the proceeds from each iTunes
download of the song “LUCY” by musicians James Scott Cook and Julian Lennon will be donated to lupus research.
I Am. Are you? Donate Life Illinois launched a new website and invite you to take a look; photos from the Donate Life Float floragraph decorating event.
The Ins and Outs of Dialysis Now that John is feeling a little better, he and Gayle are getting back into pot...that means making them. They share photos of some of their beautiful creations.
Lupus and Humor Carla uses Umcka to fight off colds; describes products she uses for pain management. (That suction cup massage device looks pretty weird, Carla!)
Linda Gromko MD kidneycare Linda and Steve attend a party and find inspiration in this quote from Robert Ingersoll: "The time to be happy is now. The place to be happy is here. The way to be happy is to make others so." (Wise words to keep in mind, particularly at this time of year.)
Precious Bodily Fluids demonstrates how he used an iPhone application to access PubMed and get important information about the impact of IV contrast on residual renal function to his colleagues in a flash. (Don't you just love technology!)
Renal Fellow Network gives a differential diagnosis of disease processes which lead to hypokalemia, metabolic alkalosis, AND hypertension; welcomes another new contributor to the blog, nephrology fellow Albert Lam, of Brigham & Women's Hospital, and describes hemoperfusion which is a procedure employed in the treatment of specific
intoxications and consists of running a patient's blood through a
column containing adsorbent particles to which the toxin binds and are
removed from the circulation; a post about atypical Hemolytic Uremic Syndrome(HUS) and a drug recently granted "orphan status" in an attempt to aid its testing in clinical trials for patients with atypical HUS.
Uremic Frost A study shows that patients with stage 3 CKD and symptomatic high-grade carotid stenosis
gain a large benefit in stroke risk reduction after endarterectomy; Australia has lifted its five-year ban on the transplantation of animal cells and organs into humans, bringing concerns from animal rights activists and transplant specialists that the
procedure had not been proven safe and could result in the creation of
deadly viruses.
Renal tsar's blog reviews progress made in renal care and goals yet to reach in his Christmas message; answers a question from a potential kidney donor about getting paid leave from their job in order to donate.
Pediatric Nephrology has an article on enteral feeding of children with CKD; a recollection by Kamal Shah about a child experiencing dialysis for the first time.
Neophron's Senescence continues describing his vacation, had dinner with interesting people.
pkdmom2five links to an article on "spiritual abuse" that sounds like what she went through at her last church.
The Ballad of Billy The Kidney John links to an article describing the terrible lack of dialysis availability in the Australian outback.
....And Bells on Her Toes also links to a story about the 13-way kidney swap/donation and calls it a Christmas miracle.
The inner game of PKD Richie attends a Holiday party given and attended by members of the Long Island Chapter of the PKD Foundation and finds inspiration from all the people with PKD who were there enjoying themselves despite their condition.
Michael W. Newman Michael gets his H1N1 flu shot; in his understaffed HD unit, when one of the patients experienced chest pain requiring attention from both the patient care technician and head nurse, the rest of the patients were unattended.
Berns on Nephrology Dr. Jeffrey Berns raises issues about the treatment of anemia in CKD patients since publication of the TREAT study, which advises against use of darbepoietin alfa.
Encompass Network Partners shares information about Peripheral Arterial Disease; and Chronic Critical Limb Ischemia.
There are just a few days left to make your comments to CMS regarding the
proposed payment rules. The deadline is December 16 at the end of
business hours. Make your voice heard! It matters.
Here are
the CKD
related blogs updated since my last report on 12/9. If you have or know of a blog
that should be on the list let Bill know. Comments in parentheses are my reactions or opinions.
Kamal Shah's Blog Kamal disapproves of the way in which a new Indian state may be formed; goes to a new lab for his Vitamin D test and is pleased as they had online results available for him that evening. (What a concept! To be able to get one's lab results at home when one wants to. I wish a few dialysis and other lab companies would do likewise here in the US.)
Kaply, Inc. Tracy reviews some things she has recently discovered about herself, she also has declared herself Surgery Queen of 2009. (We hope that 2010 will bring you much less surgery and lots more fun.)
On the Road to a Lupus Cure The Lupus Foundation of America is holding its Annual Advocacy Day on March 15- 16. It provides lupus
advocates from across the nation the opportunity to participate in
meetings with their U.S. Senators and Representatives to educate policy
makers about lupus and discuss public policies that impact people with
lupus.
Really, I'm as Old as I Feel? Rob has a cancer scare because of a lump he finds in his breast (he is a 30- year old MAN), had to have a mammogram, and then see a surgeon about a possible biopsy. It turned out to be a non-cancerous lipoma and does not require removal. He is relieved and thanks God. (A scary ordeal but with a good ending.)
I Am. Are you? has links to an excellent interview with Chicago Bears cornerback Charles Tillman who has stepped up as a huge advocate for organ donation; announces a gathering to be held this Saturday to decorate two floragraphs that will be placed on this year’s Donate Life float.
The Ins and Outs of Dialysis John and Gayle get a house call from their dialysis nurse, Yvonne, share photos of her and their unit's social workers.
Lupus and Humor Carla discovers that her chronic shoulder pain was caused by bad guitar playing habits, some acupuncture helps, now taking low dose naltrexone which seems to be helping her lupus, finds her thinking clearer now that she is off pain meds.
Dialyse This meets a boy she likes, gets an interview request from a reporter regarding dialysis.
Linda Gromko MD kidneycare Linda recommends listening to Dr. Peter Laird's interview on Renal Support Network's Kidney Talk and shares what she learned.
Renal Fellow Network posts the poll results from last week's question regarding anemia management in a dialysis patient and relevant research to consider; an article in this month's JASN describes a cohort of 10 bodybuilders with chronic kidney disease,
and makes a compelling case that anabolic steroid use is an
under-recognized cause of secondary Focal Segmental Glomerularsclerosis (FSGS).
Uremic Frost A new study shows that more than 1 in 5 dialysis patients who had a percutaneous coronary intervention (PCI) received a contraindicated antithrombotic, resulting in a significant increase in the risk of a major in-hospital bleeding event; the New York Times posted online an article with an accompanying video about the link between anabolic steroid use and progressive renal disease; the FDA has approved Tris Pharma’s clonidine extended-release tablets and suspension for the treatment of hypertension.
UKidney A study suggests that patients returning to dialysis
after a transplant fails experience improved survival if the kidney is
removed; a study describes an association between CKD5 patients with CMV-positivity and those with EPO resistance.
Pediatric NephrologyA new blog to our list. Dr Sidharth Kumar Sethi is a pediatric nephrologist in India, who has started a Blog for education in Pediatric Nephrology. He will post every two weeks an edition of news, journals, patient experiences and everything related to the fascinating world of Pediatric renal diseases.
Renal tsar's blog The NHS's Secretary of State for Health launches an improvement program that puts an emphasis on home dialysis.
Neophron's Senescence got a challenging ER dialysis patient right before he went on vacation; describes Day 3 of his vacation.
pkdmom2five is feeling much better and ascribes removal of stressors to her new health and energy. (Good advice for us all -- decrease stress.)
Dialysis and Me Barry is done with Christmas shopping and describes adventures in tree trimming; two cute videos of his boxer, Jojo.
Rob and Danielle's Kidney Blog A customer writes an article about Rob's kidney situation and says he will pray for a donor, later a reader of the article offers to be tested to be a donor for Rob.
Michael W. Newman Michael posts an article about troubles with Medicare.
Unfiltered Hope Darren is home from the hospital and feeling good, his creatinine is going down, gratitude for faithful family and friends is expressed.
My New (transplanted) Kidney Journey Al's clinic visit goes well, his labs are okay, hopes to go back to work next month, has insurance company trouble. (Who doesn't?)
Kidney Diet Tips posts information and resources on phosphorus and CKD.
El Blog del programa “R - Hacelo por mí” (en Español) The Blog of "R - Hacelo for me" (Google translated from Spanish) Betoreyna has decided to return to writing this blog after a long hiatus; reports that Fresenius Medical Care Argentina (whose motto ironically is "Innovating for a Better Life") is preparing a new "protocol", in which the dialysis machine is not disinfected between patients, with all the dangers this can bring. (Being a dialyzor in Argentina is scary business!)
I'm-u-no-logic reflects on the nature of friendship and what Facebook has done to destroy authentic connections between people; wishes procrastination was a human quality that would evolve out of the species already.
There are 7 days left to make your comments to CMS regarding the proposed payment rules. The deadline is December 16 at the end of business hours. Make your voice heard! It matters.
Here are
the CKD
related blogs updated since my last report on 12/6. If you have or know of a blog
that should be on the list let Bill know. Comments in parentheses are my reactions or opinions.
Transplant, Tantrums, & Tiaras Holly didn't feel well, thought it was from a change in immunosupressant dosage, her friend Emily Thackery appears in a short documentary called I'd Give You One about organ donation, ; the founder of Bebo, Michael Birch constructed a website, Help Jess Breath, to bring attention to organ donation and to help save Holly's friend, Jess, who needs a lung transplant.
On the Road to a Lupus Cure The Lupus Foundation of America has videos available for viewing about the latest lupus research; a post on lupus-related headaches and ways in which to lessen their frequency and severity.
I Am. Are you? Information about a key part of the Rose Parade float - the Family Circle Garden. This Rose Dedication Program offers families touched by organ and tissue donation the opportunity to honor their loved ones by dedicating a rose that is tagged with a personal message and placed in the Family Circle Garden; Donate Life Illinois announces that there are now 5 million Illinois residents registered as organ/tissue donors!
The Ins and Outs of Dialysis Gayle makes Christmas Kransekake for special people (Go look at her blog for a photo and description if you don't know what that is), John had one laser surgery done and hopes for vision improvement, next week the other eye, they have a busy week of medical appointments.
Chronic Chick Talk finds moving very stressful and exhausting, recommends a moving company in Los Angeles that she likes; shares a snowy photograph and prepares for a freezing day.
Bud's Ramblings Bud hopes the rain and sleet clears before a family gathering and so he can go out in his power chair.
Linda Gromko MD kidneycare Linda describes how home dialysis gives some flexibility to life and they take advantage of their free time whenever they can; Linda discusses discuss the common signs and symptoms of an acute heart attack.(Important for people with CKD and caregivers to know given the pervasiveness of heart problems in CKD5)
Precious Bodily Fluids has a post on cast nephropathy and plasmapharesis; describes two cases of super high glucose and calcium he saw this weekend; his list of the top nephrology stories in the last decade; links to information about potassium from the Linus Pauling Institute; a new study indicates low Vitamin D levels may influence the development of renal disease.
Renal Fellow Network Some CPT coding advice regarding billing that renal fellows should know; hysterical photos of Billy the Kidney demonstrating important principles of kidney disease; a few interesting
tidbits from a Renal Grand Rounds presentation about a case of tenofovir-induced renal failure (a drug commonly used in the HIV population).
Uremic Frost 53 men worldwide have developed breast cancer while taking finasteride
(Proscar), a medication commonly used for benign prostatic
hypertrophy (BPH); the results of a D-dimer test for suspected pulmonary embolism may be less accurate in the setting of a decrease in Glomerular Filtration Rate (GFR); a federal advisory panel recommended the Food and Drug Administration
approve a new anti-rejection drug from Novartis, everolimus; surgeons at the University of Maryland School of Medicine in Baltimore transplanted five kidneys from which they had removed small
masses, three of which were cancerous. Four of the five patients have
survived between nine months and 41 months so far without any evidence
of recurring tumors. The fifth transplant patient died about a year after the operation because of a fall in an accident. (Personally, not my choice for a transplant organ.); a study found that men who drank the most coffee had a 60 percent lower risk of aggressive prostate cancer than men who did not drink any coffee.(So, Guys, go drink your java! It's good for you.)
UKidney There’s now an iPhone app that will walk you through all the steps needed to sign up to be an organ donor; surgeons
who successfully performed kidney transplants after removing small
cancerous and benign masses from the donated organs, have published
their results in the December issue of the urology journal BJUI.
Renal tsar's blog has a drug safety warning about Ciclosporin for transplant patients because switching between different types or formulations without close
monitoring may lead to clinically important changes in blood levels
even if the same dose is taken; information on MRSA and Clostridium difficile rates is available from the UK Health Protection Agency.
pkdmom2five posts a note regarding people who lurk on her website.
The inner game of PKD challenges people with PKD to write him exactly and specifically what the biggest obstacle is in their PKD
Odyssey that keeps them from having the the lifestyle they desire.
Unfiltered Hope Darren is doing better, has a kidney biopsy; biopsy shows no signs of rejection but Darren must learn how to drink more -- after five years of fluid restrictions that is not as easy as it sounds.
DailyHemo - Home Dialysis Advocates New Videos: Promising Discovery in DRA in Long-Term Dialysis; Twitter: Why it's Better Than Traditional Methods of Communication; Tunisian Researcher Invents New Technique of Dialysis.
Kidney Community Emergency Response With the New Year approaching, KCER wants to encourage the renal community to make preparing for an
emergency a resolution and gives steps to take towards that goal.
Libre Clothing links to a story about Natalie Cole when she was on dialysis; links to videos of the Libre elves having holiday fun.
Renal BizBlog Fresenius Medical Care announced a transition to a new
management board structure, which includes a contract extension until
2012 for chairman and chief executive officer Dr. Ben J. Lipps.
Nitey Nite- a nocturnal dialysis blog is still on nocturnal dialysis, drives 1.5 miles to get there, is displeased with her nephrologist who is generally unhelpful, toys with the idea of going to Asia to procure a transplant.
There are 11 days left to make your comments to CMS regarding the proposed payment rules. Make your voice heard! It matters.
Here are
the CKD
related blogs updated since my last report on 12/3. If you have or know of a blog
that should be on the list let Bill know. Comments in parentheses are my reactions or opinions.
Transplant, Tantrums, & Tiaras
Holly describes a star-studded party she attended at Number 10 Downing
Street to which she was personally invited by Sarah Brown, the Prime
Minister's wife; updates on her Live Life Then Give Life campaign.
On the Road to a Lupus Cure reminds how important donations are to the Lupus Foundation of America and different ways to contribute.
Lupus and Humor Carla reviews Model Patient: My Life as an Incurable Wise-Ass
by Karen Duffy, finds it a funny, colorful, well-written, page-turning
memoir, but strongly disagrees with Duffy's attitudes towards
alternative medicine and compliance without question.
Bud's Ramblings Bud describes the first snow of the season, too cold to go out in his power chair.
Linda Gromko MD kidneycare Linda gives caregivers ten tips that may help make the holidays more pleasant and less stressful.
Precious Bodily Fluids Joel Topf, MD shares his recent presentation which looks at five different issues with hyponatremia; saw a patient with the highest urine urea he had ever seen.
Renal Fellow Network shares the results of last week's poll on the use of steroids in treating Acute Interstitial Nephritis; discusses a promising new class of oral hypoglycemic agents for type 2 diabetes; a study describes an association between CKD5 patients with CMV-positivity and those with EPO resistance.
UKidney Blocking the effects of high levels of urea might benefit patients with CKD5; a new model can help physicians determine if a kidney disease patient on dialysis is likely to die within the next few months.
The Ballad of Billy The Kidney John reports that the National Health and Medical Research Council announced that the ban in Australia on xenotransplantation
is about to be lifted; highlights heart transplant recipient, Jerry
Richardson, who is owner and founder of the Carolina Panthers.
....And Bells on Her Toes is proud of her bright daughter, describes a recent parent-teacher conference; Alex undergoes his last pre-transplant tests and they hope for a kidney in January.
Jenna Franks describes her involvement with the Renal Support Network's 2010 Renal Teen Prom and tells how you can help.
Unfiltered Hope Darren's condition improves with steroids but the joint inflammation has gotten worse in his knees and ankles.
DailyHemo - Home Dialysis Advocates New Video: Delivering the Prescription for Hemodialysis; David Rosenbloom,
Kidney Patient, Lectures to USC Med Students; Malaysia Kicked Off Its
First Free Dialysis Clinic; Steven Olsen's Life Changed With Nocturnal
Dialysis; Sometimes Kidney Disease Can Shatter Your American Dream;
Home Dialysis Units Increase Freedom For Kidney Patients;Gambro Prismaflex Sure Looks Home Friendly.
Free range fish sticks After 6 months of silence, this caregiver blogger reports that his wife Sheila has been very ill with CKD5 and often in the hospital, he turns to his faith and religious music for comfort.
There are 14 days left to make your comments to CMS regarding the proposed payment rules. Make your voice heard! It matters.
Here are
the CKD
related blogs updated since my last report on 11/30. If you have or know of a blog
that should be on the list let Bill know. Comments in parentheses are my reactions or opinions.
Kamal Shah's Blog
Kamal is experiencing intense pain from his arterial sites during
dialysis, is going to use sharp needles and establish a new buttonhole
site; his new buttonhole site works well, he has no pain and finally
gets a good night's sleep.
Kaply, Inc.
Tracy loves Christmas, is looking for guest bloggers to write while she
is away; a list of things that make her angry; she goes shopping for
jeans expecting not to find any she looked good in but at Lane Bryant
found two great pairs and a raincoat to boot. (Enjoy!)
Toastiest Toastie feels wiped out by dialysis like he did pre-dialysis and thinks it "sucks." (We agree with you, but you should check in with your doctor to see if he can help. Maybe there is some imbalance or anemia that can be corrected.); makes fun of a story headline; a photo of him at 1:36 AM on nocturnal dialysis.
Birdman
Sparrow spends a few days in the hospital after being found
unconscious outside his home, after release he sees an ophthalmologist
about an eye problem and the doctor examines the wrong eye.
Transplant, Tantrums, & Tiaras Holly mourns the death of a young friend who was waiting for a lung transplant that never came.
On the Road to a Lupus Cure
The Lupus Foundation of America (LFA), Greater Washington Chapter
celebrates its 35th anniversary with a luncheon on Sat., December 5;
the LFA's next "Medication" webchat is Wednesday afternoon, December 9, at 3 p.m.
Eastern Time. Dr. Graciela S. Alarcón will serve as the guest expert.
I Am. Are you? Donate Life Illinois started a two month advertising campaign with ads on trains
and buses around Chicago. Snap a photo if you see one around town and
post it to their Facebook page; heart and kidney transplant recipient Bill Coon shares thoughts about Thanksgiving one month after his transplant.
The Ins and Outs of Dialysis
Gayle took a CPR class, remembers an encounter with Santa Claus from
Christmas in 2002 when John had a stroke and his kidneys failed.
Dialyse This Cassie coughed so hard she damaged her ribs and was in great pain.
Linda Gromko MD kidneycare
Linda and Steve are willing to do a donor exchange to get Steve a
kidney. He needs a Blood Type A or O kidney, and Linda has a Blood
Type B kidney to offer. Contact information is in the post; Linda's two books Arranging Your Life When Dialysis Comes Home: 'The Underwear Factor'andComplications: A Doctor's Love Story are now available for Kindle at Amazon.com.(Definitely worth reading.)
Uremic Frost Davita and Fresenius are accused of Medicare fraud; new research establishes the link between stress and hypertension.
UKidney The Kidney Foundation of Canada conferred the 2009 Founder's Award to all Québec
nurses who have worked in dialysis and/or transplantation for 25 years
or more and have devoted their careers to the care of nephrology
patients. A Gala was held to honor and celebrate them. (Congratulations to all those great nurses!); a
Japanese doctor who helped develop a new transplant method has taught
the technique at a hospital in China that has come under international
criticism for its use of organs from executed prisoners.
Renal tsar's blog writes about the benefits of peer-review for renal unit personnel.
Dialysis and Me Barry is having a bone scan to diagnose an aberrant liver enzyme, his phosphorus and thyroid hormone levels are off, too. (We hope the tests will help you resolve it all soon.); will be participating in his first Warhammer tournament.
Lemonade and Kidneys Ruth loved the bloggerfest she attended but had some unexpected expenses from the day.
The inner game of PKD Richie writes about how he deals with PKD frustration; "Mind Games" for PKD patients.
3 1/2 Hours of Free Cable Jason shares memories of his 25-year old cousin who was just killed in a car crash. (Our hearts go out to you and your family.)
Unfiltered Hope Darren develops severe pain in his hands/arms/shoulders/neck and spiked a temperature, he's in the hospital to determine the cause. (We hope all resolves well and quickly,)
NephrOnline Blogs Mark E. Neumann reports that the National Renal Administrators Association(NRAA), concerned with many aspects of the bundle, has suggested a second public review and comment period before the bundled payment system goes into effect in 2011. (Great idea.)
Renal BizBlog
shares quotes from AAKP President, Roberta Wager, and NxStage CEO Jeff
Burbank, about home training and the bundle, links to their full
interviews.
Kevin’s Blog Kevin describes the hermeneutics class he is taking through his church.
Peter is the subject of the most recent KidneyTalk, Trading Places - What Happens When a Doctor Becomes the Patient? It's a great interview. Peter goes through his whole story from first finding out that his kidneys were compromised through to his transition to home and more frequent dialysis on the NxStage System One.
Readers of DSEN know that as a doctor and dialyzor Peter brings a unique point of view to the complex subject of dialysis and how it is provided in the US. Checkout this week's KidneyTalk and join the conversation with Peter on the Renal Support Network's discussion board KidneySpace.
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