State of the Unit: Dealing with Uncertainty

Anyone Can Exercise!

The Kidney Desensitization Program at UW Hospital

It’s New Year's Resolution Time!

New Year's Traditions: A Brief History

For Your Safety

State of the Unit: Dealing with Uncertainty
By John Hensey, Administrator

Most of us try to minimize the degree of uncertainty in our lives. We like having control over how and when we have to deal with a problem or responsibility. Often we have choices to make about how we respond to a challenge but at other times there are no good options.

During times of economic uncertainties, like we are experiencing now, people tend to stay home, save more and spend less. We worry about the financial health of our family, friends and employer. During times of uncertainty with our health, we tend to worry, curse our fate, sometimes regret past decisions and make promises to ourselves for the future. We are compelled as human beings to change and adapt to new conditions in our lives as they arise. The determination and strength of the human spirit in dealing with life's toughest challenges is quite amazing.

The resolve of patients with kidney disease is an inspiration to those of us who work here. But remember, as strong as you are, you are not on your own. WDI staff members are here to help reduce the uncertainty in your life related to living well with kidney disease. I encourage you to be very involved here at WDI, ask questions, learn everything you can about kidney disease and treatment, and make personal decisions that help keep you independent and living with the highest quality of life possible. Simple choices you can make to help stay healthy and independent include:

• Attending all your dialysis treatments and staying for the full treatment time.
• As hard as it might be, making the lifestyle and diet changes recommended by your health care team. This includes exercising, eating the right foods and minimizing your fluid intake.
• Taking all your medications as prescribed.

WDI staff members are here to help you anticipate, plan for and accept the changes occurring in your life as a patient on dialysis. Please rely on your social worker, dietitian, nurse and providers for help in dealing with the uncertainties of your health status as well as with your life in general. I want to take this opportunity to provide you with a few updates and reminders:

• New Medicare regulations for dialysis programs went into effect on October 14, 2008. There were many changes intended to help improve the quality and safety of care provided to dialysis patients. WDI is compliant with the new requirements at this time.
• Our intent to re-open the WDI East Clinic for Tuesday/Thursday/Saturday treatments was postponed indefinitely due to a lack of sufficient patient interest to transfer there. We will continue to monitor patient interest in the East site.
• A suggestion box is available in the Fitchburg Clinic lobby. We welcome your suggestions in person but you can also submit them in writing if you prefer. Include your name for a direct response or remain anonymous if you prefer.
• If you do not have a storage cubby assigned to you and would like one, please request it from any staff member.
• Stop at the Fitchburg Clinic registration desk or call (608) 270-5600 or if you have any registration updates such as: home address, phone number, emergency contact, employer, insurance, etc…
• We continue to promote our home dialysis programs. If you are interested in a home based dialysis therapy, please ask your doctor if you qualify.

Anyone Can Exercise!
by Laurie Barger, PT

“Use it or lose it.”  That phrase is relevant for all of us but is especially true for people with kidney disease. There are many well known benefits of exercise such as increasing strength and flexibility, maintaining muscle mass, increasing endurance and cardiovascular fitness, and increasing quality of life and improved general sense of well being.

Flexibility exercises, or stretches, warm up your muscles before exercise and cool down your muscles after exercise. This helps prevent muscle injury but can also minimize soreness from your workout. They are also helpful just to keep more limber and better able to do the things you want to do.

Cardiovascular conditioning is exercise that gets your heart rate up and should be sustained 20-30 minutes. Ideally, this is performed 2-3 times per week and will increase your endurance for activity and help ward off fatigue. Walking or using a stationary bike is the most common and easiest way to get this kind of exercise.

Another key type of exercise is general strengthening to help not only prevent loss of strength and muscle mass, but to improve these. These exercises should be performed 10-12 repetitions every other day for optimal effect. Exercises can be made easier or more challenging to be appropriate for your own physical abilities.

You can use hand weights, cuff weights or resistive bands or simply move your body against gravity to perform these exercises.

Any of these exercises can be performed at home but some of the stretching exercise and nearly all of the strengthening exercises can be performed during your dialysis session as well. It is recommended that you perform exercise within the first hour of dialysis to avoid potential decreases in blood pressure. If you are interested in learning an exercise program, please inform Wisconsin Dialysis staff. We are hoping to begin developing a more complete program in 2009.

The Kidney Desensitization Program at UW Hospital
by Millie Samaniego, MD

The renowned transplant program at UW Hospital is performing kidney transplants in patients who normally would be ineligible. This is accomplished through the kidney desensitization program.

Approximately 30% of patients who are awaiting a kidney transplant are considered “sensitized.”  Likewise, 30% of kidney transplant candidates cannot receive a kidney transplant due to blood incompatibility with the donor.

Sensitization and blood incompatibility are defined by the presence of antibodies against human cells or blood types – antibodies are proteins that are produced by white blood cells to help the body fight infection. These proteins are also produced any time that the immune system encounters a “foreign” protein inside the body.

A person develops antibodies against human cells from previous transplants, blood transfusions, or pregnancy. Antibodies against blood types are developed after birth – a normal response in humans. Subjects with blood type O have antibodies against blood types A and B, and can only receive blood or transplants from donors with blood type O. Individuals with blood type A have antibodies against blood type B and cannot receive transplants or transfusions from type B donors. Similarly, subjects with blood type B cannot receive blood or transplants from type A donors.

If a kidney transplant is performed in a patient with antibodies against human cells or blood types, antibodies will bind to the transplant causing severe rejection and destruction of the kidney.

A process called desensitization removes unwanted antibodies from the bloodstream to prepare for a successful kidney transplant. Desensitization can be performed in patients with a potential living donor against whom they have antibodies, patients waiting for a deceased donor transplant, and patients who have a living donor who is “blood type incompatible”.

Desensitization includes plasmapheresis treatments and immunosuppressant medications. Plasmapheresis is similar to dialysis. While dialysis removes toxic chemicals from blood, plasmapheresis removes harmful antibodies. Plasmapheresis lasts about 2 hours, is done 3 times/week, and is followed by an IV medication called Immune Globulin (IVIg) that prevents harmful antibodies from coming back. For sensitized patients who are waiting for a deceased donor transplant, desensitization consists of 6 monthly IVIg infusions followed by two additional doses 9 months and 1 year after the treatment is started.

The success of desensitization depends on the amount of antibodies. Patients with very high levels of antibodies are likely to fail this treatment and their best option is to join a Paired Kidney Exchange Program.

It’s New Years Resolution Time!
by Christine Kasper, MS, Dietetic Intern

Now that 2008 has come and gone, it is time to start thinking about renewal for 2009.  How can we improve ourselves, our health, and our well-being?  Many people choose the New Year as a time to change eating habits, increase exercise, quit smoking, or spend more time with loved ones.  Likely, many of you at Wisconsin Dialysis have similar goals.  Why not take action and implement positive changes in your life?  Only you have the power to conform your ideas into behaviors.  If you repeat your desired behaviors often enough, they will become habit.  Habitually taking an active role in your health will result in a longer, healthier, and a more gratifying life. 

Determining your New Year’s resolution is a highly individualized process. What works for one person may not work for another.  It is important to first reflect on your own life and health over 2008 before you decide on a resolution.  It is easy to be tempted into a decision that the media or friends and family has marketed to you.  But only you know about your personal past successes, attempts, mistakes, and failures.  Have the courage to face your past, self-reflect on your needs, and base your plan for future resolutions on your past experiences.

We all know that changing behavior is hard, especially when your desired behavior is something you have never done before or have failed with in the past.  However, there is hope!  Research shows that there are certain criteria necessary to make an idealized goal a reality.  Goals should be small, attainable, measurable, and specific.

Although having long-term goals in mind is a great tool for developing short-term goals, try to focus on what you can do TODAY and everyday.  Small goals allow you to achieve success promptly and regularly.  For example, to accomplish a long-term goal of lowering your phosphorus levels, create a small goal of leaving your phosphate binders on the dining room table.  Having your binders ready when you need them will help you stick to your treatment plan.  Repeated small successes will build your confidence, motivating you to continue striving for your long-term goals!

Next, make sure your goals are attainable.  It may be ambitious to declare, “I will avoid all high-fat foods this year,” but is that something you can actually achieve?  Make sure to be realistic as to whether you can incorporate your goal into your daily life.  If you have to make more than a few minor adjustments to your daily routine in order to achieve success, try to redefine your goal.

Another important point is that goals are measurable.  If you have no way to assess how well you are accomplishing your goal, how will you know?  You can track weights, nutrient intakes, laboratory blood values, minutes of exercise per week, or anything else you can think to track.  Keeping records of your measured progress is proven to enhance motivation to continue striving for your goal.

Finally, make your resolution goals specific. Instead of saying, “I will eat less cheese,” you can say, “I will have three 1-ounce servings of cheese per week with my afternoon meal.”  With a specific goal, you can create a plan to achieve your desired outcome.

Here is an example New Year's resolution. Long-term goal: to lose 10 pounds in the next three months. Short-term (small) goal: wake up 1 hour earlier before work (attainable) to walk on the treadmill at Gold's Gym (specific) for 20 minutes on Tuesday and Thursday mornings (measurable).

New Year's Traditions: A Brief History
by Anastasia Korbitz

Who came up with the New Year's resolution? Well, the tradition may be older than you think. According to some very “in depth” web research, I found that New Year celebrations dates back to153 B.C. In ancient times, Janus, a mythical king was placed at the beginning of the Roman calendar. This mythical king was said to have had two faces, one on the front of his head and the other on the back. At midnight on December 31, the Romans imagined that Janus could use his mythic power to look back on the old year and forward to the year ahead.              

The idea of the New Years resolution comes from the early Babylonians. Their most popular resolution was to return borrowed farm equipment. Wow, that seems easy!  And what of the well-known tune “Auld Lang Syne”? Well, it was written by a Scottish composer, Robert Burns in 1788. Translated Auld Lang Syne literally means “old long since” or we may think of it as, “time gone by.”

The timeless tune of Auld Lang Syne is still sung each year and resolutions continue to exist today. A New Year's resolution can be a positive effort to seek change, even if you only keep in for a short time. Some change is better than no change, and one of these years it just might stick.

What are you resolving to change in 2009?

For Your Safety
by Kelly Coloso, RN

It seems as though that ringing in the New Year also means change and the need for improvement, dialysis is no exception. Since patients undergoing dialysis are at risk for acquiring infections due to any underlying diseases or conditions (e.g., hypertension, cardiovascular disease, immunosuppressive therapy) and/or critical illness, Medicare has decided that some changes are in order to improve the quality of care as it relates to your safety.

WDI agrees with the new Medicare rules and plans to make important changes. Read below to learn more about these changes that affect all of you.

Your responsibilities as a WDI patient:

1. Gloves: You must wear gloves when holding needle sites and wash your hands when you are done. If your hands are visibly soiled you must wash with soap and water, otherwise you can use the green Purell instant hand sanitizer that are found in many areas of the unit.
2. Clamps: You are asked to NOT leave your chair (to get weighed, go to the bathroom, etc.) if you are wearing clamps. The concern is clamps can become loose and the site could start bleeding. So remember: If clamps are on, you must remain at your chair.
3. Access: During your treatment your dialysis access must be visible at all times and cannot be covered. Staff need to be able to observe your access site to ensure the needles did not infiltrate, become dislodged or that the dialysis tubing has not become disconnected and starts to bleed without staff being aware.
4. Safety: We ask that your family and friends remain in the waiting room during dialysis put on and take off. This will help limit the amount of traffic during these busy times and to help keep you and others safe. If you need to have a loved one at your side during this time, please have your dialysis care provider give you special instructions about protective clothing to wear, that we will provide, while in the dialysis unit.

Change is never easy and good habit building is a process. Everyone needs to be aware of their surroundings and do their part to maximize infection control for ALL. Thank you for being partners with us in improving your kidney care and working with us to keep you and those around you safe. Happy 2009!