Tahlequah Daily Press

February 21, 2014

Dialysis offers many patients longevity

Expanded local services allow freedom of movement, greater access to care

Staff Writer

TAHLEQUAH — When Linda Torrez first began dialysis treatment four years ago, she signed a new lease on life.

Torrez suffers from chronic kidney disease as a result of congestive heart disease stemming from diabetes. It was her son and the promise of grandchildren that prompted her to seek help.

“I was really scared,” said Torrez. “But my son caught in the middle of a drive to Tulsa and just asked me, ‘Don’t you want to see your granddaughter grow up?’ That’s what made me decide to do it.”

According to the National Kidney Foundation, dialysis is a treatment that takes over some of the functions of healthy kidneys. It is needed when a person’s kidneys can no longer take care of the body’s needs.

When kidneys fail, dialysis keeps the body in balance by removing waste, salt and extra water to prevent them from building up in the body. It also keeps a safe level of certain chemicals in the blood, such as potassium, sodium and bicarbonate, and helps control blood pressure.

Dr. James Madison, nephrologist for Tahlequah City Hospital, said the key point is recognizing dialysis is not a treatment of kidney disease, but is rather a replacement of kidney function.

“Dialysis is used to aid kidney function after damage, whether that be chronic failure – which happens gradually over time due to complications from hypertension, diabetes or lupus – or acute kidney injury, which is kidney damage caused by a heart attack, car accident or something like that,” he said. “In either circumstance, kidneys can go into failure, which is where dialysis comes in.”

Madison said in the case of acute injury, once the kidneys heal and other aberrations are corrected, dialysis may no longer be needed. Treatments may be limited to a couple while the patient is in the hospital, or several spanning a number of months.

In the case of chronic kidney disease, once dialysis is established, it does not cease unless a transplant is considered.

“There are several types of treatment available, including hemodialysis, peritoneal dialysis and transplant,” said Madison. “The crown jewel of what we’re doing here in Tahlequah is we are the only center in Oklahoma that offers every modality, with the exception of transplants.”

TCH services include home-based, self-directed dialysis; peritoneal home dialysis; in-center dialysis; and a nocturnal shift.

In hemodialysis, an artificial kidney (hemodialyzer) is used to remove waste and extra chemicals and fluid from the blood. To get blood into the artificial kidney, the doctor makes an access into the blood vessels, which is done by minor surgery to the arm or leg.

In peritoneal dialysis, the blood is cleansed inside the body. The doctor, via surgery, places a plastic tube, or catheter, into the patient’s abdomen to make an access. During the treatment, the abdominal area is slowly filled with dialysate through the catheter. The blood stays in the arteries and veins that line the peritoneal cavity. Extra fluid and waste product are drawn from the blood and into the dialysate.

Dr. Anna Miller is a physician at W.W. Hastings Hospital, which also offers dialysis. She said treatments are generally given three to four hours per session, three times a week.

“[With peritoneal dialysis], patients can receive treatment at home for up to 16 hours per day,” Miller said.

Madison said a number of people prefer the nocturnal shift at the TCH center.

“Patients who use the nocturnal shift arrive at the dialysis center around 7-8 p.m. and spend the night,” said Madison. “The environment promotes rest, the lights are dimmed, and we make them as comfortable as possible.”

Torrez receives treatment in the Tahlequah dialysis center at TCH’s Medical Office Building three days per week. She said her quality of life has improved dramatically.

“It’s gotten so much better,” said Torrez. “I’m still in a wheelchair, but I can get up and walk a little. I have a lot less fluid retention. Home dialysis was an option, but I prefer to go to the center. You make a whole new set of friends, and we’re bonded together through dialysis.”

TCH CEO Brian Woodliff said dialysis life expectancy standards for the center are set by Medicaid and the hospital’s regulating body, Network 13.

“Since Madison’s arrival and daily attention to our patients, our life expectancy rate has increased dramatically,” said Woodliff. “One of Madison’s first patients had a life expectancy of 18 months to two years and lived for six years, with a productive end of life.”

Madison has been recognized by the Integris Oklahoma City Multi-Organ Transplant Center, and coordinates transplants in Northeast Oklahoma.

“Local patients would not have had that access before,” said Woodliff. “It’s truly overwhelming when a transplantee tells his story.”

TCH has dialysis centers in Stilwell, Sallisaw, Muskogee and Tahlequah. There’s an additional center in Pryor, which is not owned by TCH.

“One center is unique, in that we partnered with the Cherokee Nation to build a center on tribal land in Sallisaw,” said Woodliff. “It is open not only to tribal citizens, but to all dialysis patients in Sequoyah County. Madison was there to provide the first treatment. It’s wonderful expanded access to care.”

Torrez highly recommends seeking dialysis in the case of chronic disease.

“It makes your life happier, you live longer, you can enjoy your grandbabies and children,” said Torrez. “The thought of treatment shouldn’t get you down. You’re not chained to a single location. I can go to the zoo in OKC with my family, or go to the mall with them, and I couldn’t do that before.”

Torrez is going to visit her daughter in New Jersey this summer, and her dialysis is all taken care of.

“They’ve set up dialysis appointments for me there, and my daughter will take me,” said Torrez. “Traveling is something I’ve never been able to do before. Now that I’m older, I want to travel and I’m able to do that.”

Torrez also appreciates the one-stop shop TCH provides with regard to mutli-symptom care.

“I can see my heart doctor and dialysis doctor right there on one floor, so I can get all the services I need,” said Torrez. “And the nurses at the dialysis center become like family. They give you birthday parties; we celebrate all holidays together. Some of those nurses are like my own children. They are so gentle. They take care of you.”

Madison has a great deal of respect for his patients.

“Dialysis patients come from all walks of life. They’re doctors, lawyers, school teachers, stay-at-home parents, the elderly, and more and more often these days, young people,” said Madison. “I have tremendous empathy, passion and respect for these people, because it’s got to be rough. I want them to know they are brave and courageous people to seek treatment, and caregivers need to recognize that.”