One of the first exercises conducted by social workers at DaVita Tahlequah Dialysis Center is writing down 10 important aspects of their day-to-day life.
Cary Odom, regional point social worker with DaVita, said things like family, career, health, church and different hobbies are often put on the list. Odom then asks for the lists to be passed to the right, and each person who receives the respective list must cross out five things at random before passing it back to the person who wrote it. Odom then makes the social workers cross off another two items from their own lists.
Odom does this exercise to show DaVita employees what dialysis patients are facing as they go through treatment.
“There are so many losses we take for granted,” said Odom. “They’ve lost control over everything and [their treatment] is the only thing they can control.”
Dr. James Madison, nephrologist and the center’s director, said helping patients maintain control over their life is one reason he encourages home modality dialysis. The DaVita Center in Tahlequah is focusing its educational resources on that type of treatment during August, which is Dialysis Month.
“All stages of kidney disease need something,” said Madison.
The dialysis center in Tahlequah has been able to address many of these needs since it was opened, but parents on dialysis have been constrained by the center’s schedule, “so there are not a lot of options,” according to Madison.
“The crux used to be that Tahlequah wasn’t one of the centers that could train patients to do this,” said Madison.
The few dialysis patients in the area doing treatment at home were forced to train in Tulsa, then continue to do lab work and other follow-up procedures in Tulsa.
Odom said the cost, both in fuel and time spent driving, were too much for many patients from Stilwell and West Siloam Springs.
“That might have been the only reason they weren’t doing home dialysis, because of the cost of going to Tulsa,” said Odom.
Advancement in the technology of home dialysis systems had already lessened the cost for patients wanting to go through dialysis at home. Previous systems required users to install a special water system, but new models have filters within the machines and only need to be attached to a faucet.
When the DaVita center in Tahlequah expanded, providing home dialysis training and support was a priority.
A training area was built, and staff were trained, in turn, to train patients how to set up and run both forms of home dialysis. The center has been training patients for home dialysis for three to four months now.
Not everyone undergoing treatment can do home dialysis, though.
Madison said dialysis patients must have “a stable home environment with someone to support them” for home dialysis to be an option.
There are two different types of in-home dialysis and three in-center dialysis options. All are five are now offered at the Tahlequah center.
Peritoneal dialysis, one of the two home modularity dialysis options, involves a solution called dialysate, working with the lining of the patient’s abdomen to remove impurities and extra fluid from the blood. This form of dialysis must be done once every 24 hours, usually overnight. It involves a minor surgery to place a flexible tube into the patient’s abdomen, which will stay in the patient until they are finished with dialysis.
The second form of home dialysis is called hemodialysis, and it involves cycling the patient’s blood through a special filter on a dialysis machine. This form is usually done three times a week and lasts between three and five hours. It also involves a minor surgery, but a vascular access is placed in the patient, instead of a catheter.
Hemodialysis can also be done in-center during the same time frame, with different degrees of assistance, or it can be done over during an overnight visit. It is also the most common dialysis done by kidney disease patients.
“When you are replacing a vital organ system, the more often you can do that, the better,” said Madison.
Through DaVita’s partnership with Northeastern Health System, the center has been able to expand and build a center in Sallisaw, as well as partnering with dialysis centers in Muskogee and Stilwell.
All in-home dialysis must be done at the Tahlequah site, but labs monitoring home dialysis patients can be conducted at any of these sites with Tahlequah doctors.
“Now, partnering with Northeastern Health Services, the center has grown,” said Madison. “It has almost doubled.”
The center has also been awarded a five-star rating Medicare service, which has just begun comparing dialysis locations.
“In a short period of time, we went from a small center to a five-star center,” said Madison.
The center served around 70 patients when Madison and Odom first started and now serves about 120 in its nocturnal, in-center and in-home dialysis options.
“We can continue to serve more,” said Madison.