Monday, November 8, 2010

It's Not Kidney Disease, It's the Lions

There is a small part of me that knows I'm sick, but generally I feel so good and have adapted so well to dialysis (knock on wood) that I rarely tend to think about it. God is good, all the time. However, it's a comforting feeling to know that should I ever really fall ill in public, there are still caring people in the world that might rush to my aid.

Sunday afternoon Karen and I were shopping at the Nordstrom store in the giant Woodfield Mall outside Chicago. (Ah, Nordstrom: Like so many things in life, I didn't realize how much I appreciated it until it was gone, after I moved to a city that didn't have one.) I was browsing through the men's department while watching pro football updates through the NFL Red Zone app on my Droid cell phone.

(Now let me interject right here that, after years of insisting my cell phone needn't do anything more exotic than send and receive calls, I was given a Droid recently by my wonderful wife when she upgraded to a new model. (Growing up as an only child, this may have been my first hand-me-down ever.) How could I have been so wrong? I am proud to declare that I am a Luddite no longer. This Droid is the best invention since peanut butter cups. With the Red Zone app I can watch NFL game action in real time on my telephone. I feel like Dick Tracy with a two-way wrist radio. My mother, if she were still alive, might faint dead away over these technological marvels we now take for granted.)

While looking over white Oxford shirts – no wardrobe can ever have enough – I was monitoring the Detroit Lions game at home against the powerful New York Jets. I am a foolhardy Detroit sports fanatic, as you may know. And though every Lions fan knows better than to invest too much passion or emotion in the outcome of their games, the team has been playing better of late. They held a 10-point lead over the Jets with mere minutes to play.

I kept shopping and checking the score, back and forth. Nice price on these chinos. The Jets have tied the score! Do you have this shirt in extra jumbo? They're going into overtime! Oh, the Nordstrom shoe department is so wonderful! And the Jets storm back to win the game on a field goal in OT!

I was momentarily crestfallen. Dagnab it, those Lions did it to me again! I emitted an audible groan and slumped against a rack of sale slacks.

In the blink of an eye, a dark-haired young saleswoman was at my side. (It was Nordstrom, after all.)

"Sir, are you all right?" she asked, breathless.

"No, I'm not," I replied.

"Should we get you somebody?"

"Yes. Maybe a better defensive backfield."


"My team just lost in overtime."

A nervous laugh leaped from her lips, a combination of relief and confusion. Then her eyes narrowed, and a shot of anger flashed.

"You mean this is all because your football team lost a game?" she asked.

I straightened up and looked at her with calm resignation.

"Obviously, miss," I said, "you have never been a sports fan."

Go Lions.

Friday, November 5, 2010

Spreadin' the Good News

I arrived promptly at 8:45 a.m. to my DaVita clinic in downtown Decatur to begin my first day as a dialysis counselor. Yes, that's what I said. (Or rather, wrote.)

My lovely and dynamic new dialysis nurse, Leigh Ann Michael – I know, I've been changing dialysis nurses faster than Illinois changes politicians, but more on that later – is on a mission to get more patients to consider Peritoneal Dialysis (PD), the type of therapy I use and recommend. According to some statistics, less than 10 percent of all dialysis patients are even aware that the PD alternative exists, and Leigh Ann asked if I would join her for a morning walkaround in the hemodialysis clinic to talk to the patients one on one about their treatment options. Leigh Anne said I look so good and relatively healthy for a guy with Stage IV kidney failure, she wanted me to accompany her as Exhibit A on the potential benefits of PD.

I was the demonstration model.

Shawn Steele, a rakish young sales guy from Baxter Healthcare's renal division in St. Louis, drove in with a dialysis cycler machine identical to the one I use (see photo) along with accompanying bags of dialysis solution and other accessories. If you're going to do show and tell, you need to have something to show – besides me, of course. Shawn wrestles alligators in Florida for fun and has photos to prove it, so I felt pretty certain patients would hang on his every word no matter what he brought with him.

   The Baxter "Home Choice" Automated PD System (aka, "The Cycler")

However, Shawn chose to stay in the background and do his PD evangelizing from the lobby while Leigh Ann and I strolled the clinic. Shawn kept referring to me as "our superstar," and while I couldn't help but agree with him, I knew what he really meant. When you're trying to persuade anybody to consider a major change in something as personal as medical care, it helps to have someone who's actually living with the same condition to provide some first-person testimony.

Since all but one of the dozen patients in the clinic that morning were African American (a sad reality), I remarked, only half kidding, "It is a good thing I'm going along with Leigh Ann. Anytime black folks see a white person pushing a cart, smiling and stopping to talk to us, we know they're trying to sell us something. Our first response is to say no."

Unfortunately, even with my "superstar" assistance, that's pretty much the way it went in the clinic that day.

Having thoroughly researched my options at the beginning, I chose PD because of the independence and feeling of self control it offers. Yes, it's a daily procedure being attached to the cycler for eight hours at a stretch as opposed to going into a clinic three times a week for hemodialysis, but knowing myself as I do, I knew two things would happen if I was on hemo:

1. I would be late for at least one appointment a week and either miss my treatment or have it delayed.

2. The thought of having a big needle stuck in my vein and seeing my blood sucked out, cleansed and put back in my body three times a week would cause me to either throw up or pass out. Probably both. At once.

With PD I dialyze when I want – overnight while I sleep, if I prefer – without needles, leaving home or suffering the wild swings of energy and mood that accompany hemodialysis. I realize some patients simply may be too weak or sick to manage dialysis on their  own, but I think many people who are familiar with PD prefer hemodialysis (and I'll probably get in trouble for saying this) because they're either scared or lazy. PD requires maintaining an inventory of supplies and setting up and tearing down the cycler every day. It's way easier just to show up at a clinic, settle into a padded reclining chair and let nurses and technicians do all the work. Plus, some patients fear they'll do something wrong on their own during the PD treatment, contract an infection and wind up much worse than they already are.

Among the patients Leigh Ann and I spoke to, the word "infection" seemed to be repeated like a codeword meaning, "Not interested; leave me alone."

"Wouldn't you prefer to do dialysis without needles?" I would ask. "At home? On your own schedule? Without having to come into the clinic?"

"Infection," came the reply.

"Yes," I answered, "infection is always a possibility. It is with hemodialysis, too. But as long as you don't blow into your catheter tube, let your dog lick it or do something else incredibly dumb, your chances of infection are not that great."

Didn't seem to make a dent in the patients' decisions. In hindsight, I think we might have been much better off talking to the hemo patients individually, before they began their treatment, instead of all together in the clinic. These people usually have the same appointment times and get to know each other over the months. I don't think any of them wanted to be viewed as breaking away from the herd, or leaving the old gang behind.

The saddest case for me was a gentleman who said he had been on PD but had to have his catheter removed. He couldn't have it implanted again because scar tissue prevented the procedure. "I hate hemo," he said. "I miss PD every day. I'd go back on it tomorrow if I could."

As if to prove my group-think theory, while we were struggling in the clinic, Shawn was making converts in the lobby. Two people, a man and a woman, both said they wanted to switch to PD and asked what their next step should be. The man was a street hustler who sold purses and other women's accessories from the trunk of his Cadillac. His third weekly hemo appointment fell on Saturdays, he said, "and it messes with my hustle."

Two out of 14 patients sold. Not great, but not bad. I was so overjoyed, I went out to the parking lot with my man and bought a handbag for Karen from his trunk. It's a red Jimmy Choo original. Really, it is. She loves it, too.