State of the Unit: Leadership

Dental Resources

Common Medicine Changes When Starting Dialysis

A New Year, a New Resolution to Keep the Weight Off

Important Information

State of the Unit: Leadership
John Hensey, Administrator

Leadership is the theme for my annual "Pathways" article this year. Leaders make a difference in our lives with their creativity, effort and willpower. They help us think differently and find new ways to solve problems, often making our lives better. The world needs new leaders, could you be one?

There are many leaders here at Wisconsin Dialysis (WDI), both among patients and staff members. Leaders have an effect on others through their opinions and behaviors. Anyone can be a leader and almost everyone is a leader at least from time to time. Leaders are inspiring, fair, optimistic, courageous and driven by their goals and dreams. You can be a leader just by setting a positive example for others as a patient on dialysis.

The world is always in need of leaders, especially now it seems, to help find and promote new solutions to problems. In this new world economy with an aging population, government budgets are being stretched thin all over the world.

In particular, Medicare and Medicaid (M&M) budgets are in trouble across the United States. The number of baby boomers, people with disabilities and those without health insurance (in other words, the people who use and need M&M) is going to keep rising. Since M&M pays for more than 75 percent of all dialysis services, it is an area of concern for us here at WDI. This is where leadership comes in as we work to deal with these challenges.

The leadership team and staff members at WDI have been aware of and preparing for difficult economic times for several years. If you have been a WDI patient for a while now, you have seen some of the changes in services and extras offered for patients. The long-term goal has been to keep quality high and costs down so WDI can continue to succeed as a small, non-profit dialysis clinic.

I am happy to report we have had some success so far. In 2009, the average cost per dialysis treatment was too high. M&M paid less than cost and were planning further payment reductions. There have been many changes since 2009 to improve WDI’s finances and all quality indicators have stayed strong during this time. Our goal now is to find new ways to reduce costs while continuing to keep quality high.

Even though we do not yet know where we will reduce costs next, you should expect more changes. And actually, everyone can help. Be a leader and step forward with your ideas to improve efficiency and/or reduce costs here at WDI. We would appreciate it!

As we look to become more cost effective, WDI pledges to make no change that would reduce our high quality of medical care. We may need to change the way we provide care, but it will not be anything expected to lower our clinical outcomes. For example, we may change a brand or type of drug or supply if we find it costs less and is just as clinically effective.

We at WDI plan to be leaders by finding new ways to continue our success. With all of our combined efforts, we are confident we will succeed and thank you in advance for your support!

Let me take a moment to recognize the leadership shown by the Pathways editor and WDI social worker, Anastasia Korbitz. Anastasia came up with the great idea for a patient newsletter back in 2004. She has been the driving force behind publishing Pathways ever since. If you enjoy reading Pathways, take a minute sometime to thank Anastasia for all her efforts over the years.

Important reminders:
• To reduce the chance for billing errors, please stop at the Fitchburg Clinic registration desk or call (608) 270-5600 if you have any updates to your insurance, address, phone number, employer, etc
• We have almost 30 patients who dialyze in the comfort of their own home and on their own schedule. Home dialysis patients tend to have fewer infections, hospitalizations, dietary restrictions and medications. To experience the highest quality of life as a patient on dialysis, WDI strongly suggests home dialysis for all eligible patients. If you are interested in learning more about your home dialysis options, please ask your doctor for more information.

WDI staff members and providers are proud to be providing you with high quality dialysis care. We appreciate and are honored by your trust and faith in us. We take our responsibility for your medical care very seriously and intend to continue providing the most advanced and comprehensive dialysis care in the region. Good luck with your endeavors in 2011, I hope you realize all your dreams and goals!

Dental Resources

Finding a dentist who will accept Medicaid is very difficult, but not hopeless. You should establish primary dental care before you have a crisis. Try one of the resources below. Follow the directions closely. Remember, if you are someone who is considering a kidney transplant, part of the transplant evaluation requires a health clearance from a dentist. So, don’t wait, work toward a healthier smile now.

1. Madison Community Health Center: (608) 443-5482
   3434 East Washington Avenue, Madison
   • Will accept Medicaid or Patients with no insurance
   • The wait for an appointment can be long, so call now to set up an appointment
   • Once you have an appointment, you can call each day to find out if there was a cancellation
   • Don’t miss your scheduled appointment, call to cancel. If you are a no show, you may not be able to make another appointment
2. Dental Hygiene Clinic at MATC: (608) 258-2400
   211 North Carroll Street, Madison
   • This program is designed to train Dental Hygiene students.
   • You can save money on a cleaning while you locate a dentist
   • The cost is $15 for teeth cleaning and x-rays
   • There is no dentist, but reports and x-rays will be sent to your dentist
   • Call for an appointment or to be placed on a waitlist
   • The clinic is only open September through May
3. Max Pohle Dental Clinc: (608) 417-6500
   202 South Park Street, Madison
   • For children ages 4-12, call (608) 417-6500 (press 2) on the third Thursday of the month between 8-9am to schedule an appointment.
   • For ages 13 and older, there is a waiting list. To try to get on the waiting list, call (608) 417-6500 for more information.
   • Once you talk with a receptionist to be placed on the waiting list, you will be given an ID code. Keep this ID code as you will need it when they call you to set up an appointment.
   • You have to be persistent with this program and you cannot be a no-show.
4. For Veterans only: You might be eligible for Veteran’s dental benefits, but you must call and speak with  a representative in the Eligibility Office to find out. Call (608) 256-1901, ext. 17038.
   

Common Medicine Changes When Starting Dialysis
Kim Holdener, PharmD

Starting dialysis can be a big change in your life. It can change your daily schedule, your diet and your medicines, among other things. There are many common medicine changes that are necessary when you start dialysis. This article will list some of those changes and explain why they are needed.

• Multivitamins: Dialysis can remove certain vitamins from your body. These vitamins include folic acid and B vitamins. A special dialysis multivitamin is recommended to replace the vitamins that dialysis removes. Common dialysis multivitamins are Dialyvite, Nephrocap and Nephrovite. There are also many other brands available. Dialysis multivitamins should be taken in the evening so that they are not removed by dialysis.
• Water pills: Diuretics, also called water pills, are medicines such as furosemide (Lasix), metolazone (Zaroxolyn), and bumetanide (Bumez). These medications lower blood pressure and remove excess fluid in your body by causing you to make more urine. Water pills only work if your kidneys are working. Once you start dialysis, water pills do not work as well and are often stopped. Your kidney doctor or nurse practitioner will decide when it’s the right time for you to stop taking water pills.
• Vitamins and minerals: Iron pills and vitamin D (such as calcitriol) that are taken by mouth can be stopped after starting dialysis because these medicines are given to you intravenously (IV) while you are at hemo-dialysis. People who are on peritoneal dialysis usually continue taking these medications by mouth.
• Anemia injections: Some people receive injections to increase red blood cells at a clinic or at home before starting dialysis. The injections are medicines called darbepoetin (Aranesp) or epoetin (Procrit, Epogen). These injections usually continue after starting dialysis, but then can be given to you IV while at dialysis. Home dialysis patients can receive the injections at WDI during monthly clinic visits or at home.
• Phosphorus binders: High phosphorus levels are common in people with kidney disease because the kidneys remove phosphorus form the body. When the kidneys do not work well, phosphorus levels get too high and can cause bone disease and heart disease. Phosphorus binders are taken with food to prevent phosphorus in food from being absorbed into the body. Your dietician will talk to you about binders and a low phosphorus diet if your phosphorus levels are too high.

These are some of the more common changes in medicines that happen after starting dialysis. There could be other changes that are needed, such as changes in blood pressure medicines and diabetes medicines (like insulin and diabetes pills). WDI staff will work with you to make sure you understand what changes are needed for you. Some of these medicine changes can be made right away after starting dialysis and for some people these changes will occur later on when necessary. If you have changes in your medications that you do not understand, the staff at WDI is always available to answer your questions.

A New Year, a New Resolution to Keep the Weight Off
Michaela Covelli, Dietetic Intern

A new year is here! Let’s make 2011 the year that you accomplish your weight-loss goals. As a patient on dialysis, weight loss can be beneficial for main risks factors associated with renal disease, such as hypertension and diabetes. Shedding a few pounds can help to decrease blood pressure, reduce triglyceride levels/overall cholesterol, reduce blood glucose and HbA1C in patients with diabetes and help to slow bone loss. Not only can exercise help decrease all of those risks, but it also can boost your mood, relieve stress and give you energy. The list of benefits from exercise goes on and on, but healthy eating and exercise are the two main components for losing weight.

EXERCISE

Living in the Midwest, motivation can be lacking during the cold winter months. Remember: Start slow and gradually work up to your goal time. Adjust your goals as your routine progresses weekly. Don’t forget to praise yourself along the way - after all, a little exercise is better than no exercise at all! Check with your primary care doctor before starting an exercise program. Here are some tips to get motivated to get in motion:

DIET
Following the standard renal diet - high protein, low potassium, low phosphorus, low sodium and decreased fluids - while losing weight can be difficult, but it is not impossible. 3,500 calories = 1 pound. If you can cut 500 calories per day, you can lose one pound per week.

Important Information

The UW Health Pharmacies offer a variety of options to receive or refill your prescriptions. Talk with your UW pharmacist and sign up for one of these options today! Here are two options:

1. Convenient Prescription Delivery to Your Home.
   Too busy to pick up? Fill your prescription at a UW Health Pharmacy and enjoy.
   • Free home delivery in the Madison, Middleton, Fitchburg and Monona city limits
   • Refills mailed to your home.
2. Online Refills
   Prefer to click rather than call? Refill your UW Health Pharmacy prescription online.

BYOSP! The tentative date for bringing your own sheets and pillows is February 14. The date will depend upon if we have the smaller pillows in stock by that time. Remember, each patient will receive a complimentary neck size pillow in lieu of traditional pillows. You will need to bring any extra pillows or sheets that you need during treatment.