State of the Unit
Sodium and You
Prescription For Health:
Are You Taking Your Medications Correctly?
From the Director’s Chair
Home Hemodialysis – Is It For You?
Remembered Wellness

State of the Unit
John Hensey, Administrator

Greetings and Happy New Year! This is my annual opportunity to inform you of some fun facts and figures, our successes and where we can still improve at Wisconsin Dialysis (WDI). As part of our planning process, we take time to recognize what went well in the past year and identify issues that still need our attention. Two lessons I’ve learned are that: 1) a good plan for the future requires a careful look at the past and 2) good plans tend to be realized. Below is a brief summary of highlights from the past year, a year in which most of our goals and objectives were achieved here at WDI.

• WDI staff members provided about 22,500 treatments to over 225 patients. We also provided over 425 inpatient treatments at Meriter Hospital . Did you know that WDI-Fitchburg is one of the largest dialysis clinics in Wisconsin , second only to one clinic in Milwaukee ? We believe our size helps us afford to offer extra services and benefits to our patients.
• The overall patient satisfaction score remained the same this year as last year at 3.6 (on a scale of 0-4). The highest scores were 3.6’s and 3.7’s for services received from nurses, patient care techs, social workers, dieticians, and receptionists along with our respect for your privacy and dignity. One of our highest priorities is to provide support to you in a caring, helpful, friendly and confidential way so it is rewarding to see our efforts are successful and being noticed by you. The lowest scores were 3.1 for trans- portation to the unit, 3.2 for treatment time convenience and 3.3’s for telephone access to the unit and waiting time. We were very pleased to see all average satisfaction scores higher than 3.0.

The lower scores will help identify our priorities for improvement this next year.
I’m pleased to report that the rate of kidney transplantation at WDI was twice the national average for patients on dialysis. If you are not sure of your transplant status, ask your doctor if you qualify to be on the transplant list

• Hopefully you know that infections pose a serious health risk for every dialysis patient. According to a CDC study we participate in, the infection rate is very low at WDI. Hospitalizations due to infection were 75% lower than the national average. Keeping you out of the hospital and avoiding infections are crucial quality goals of ours and I’m happy to report that we are succeeding!
• Twice as many WDIpatients perform self-dialysis treatments at home compared to the national average. WDI promotes home dialysis to eligible patients since it keeps you in control of your life. We also believe it maximizes your quality of life. If you are interested in a home based dialysis therapy, please talk to your doctor about the many requirements to find out if you qualify.
• 38% of WDI patients had a job at the start of dialysis vs. only 22% nationally. We believe that having a job is very beneficial to the quality of life for all patients who are able to work. Patients who have a job are given first choice of treatment times to accommodate their work schedule.
• More WDI hemodialysis patients need to have an A/V fistula placed this coming year. Only 34% were in use at WDI vs. 43% nationally. Natural A/V fistulas are universally recognized as the access that provides the most effective hemodialysis treatments and are known to reduce your risk of infection. Please ask your doctor about an A/V fistula if you don’t already have one in place.
• Fewer WDI hemodialysis patients should have a catheter in place 90 days after starting dialysis. The rate was 29% here vs. only 13% nationally. Catheters provide the least effective hemodialysis treatment and pose a higher risk of infection. If you still use a catheter for hemodialysis, please ask your doctor if any other options are available to you.
• All monthly lab results were close to or at the national standards this past year. We need to do more to help monitor and manage your medications, diet and length of treatment since one of our new goals is to exceed national standards for all routinely measured lab values. Please help us succeed in this quality care improvement effort by cooperating fully with your treatment plan! This includes coming to every treatment and staying for the full treatment. Your doctor and/or dietitian, either Ann Mader or Fran Kittell, are good resources for questions about your lab values and what you can do to help improve them.

In conclusion, we are proud to be providing you with high quality dialysis care and thank you for your trust in us. We have worked hard to earn your trust and will continue making every effort to continue doing so in the future. We take our responsibility to provide quality patient care very seriously and intend to always provide the most advanced and comprehensive dialysis care in the region. I hope each of you has a great 2006. You can count on Wisconsin Dialysis to do our part to help make it great for you.

Sodium and You
Fran Kittell, Dietitian
Sarah Kleman, Dietetic Intern

Tired of being told to lower your sodium intake? Here is all you need to know about sodium and delicious food suggestions to help you cut back on your intake!

Sodium is a mineral that your body needs to survive.  However, over time, too much sodium in your diet can have damaging effects on your body.  Too much sodium can raise your blood pressure and can lead to a condition called hypertension.  When too much sodium is consumed, your body has an increase in its thirst mechanism causing you to drink more fluids.  This increase in fluid expands the volume of blood in your body, thus resulting in increased blood pressure. 

Over time, this increase in blood volume and blood pressure increases the workload of your heart. With kidney disease, it is important to keep blood pressure at or below the optimal level of 120/80.  Continuously elevated blood pressure can further damage sick kidneys, leading to more complications. Taking your blood pressure medications, according to your doctor’s prescription, can help delay the progression of kidney disease and thereby delay the need for dialysis.

Reductions in blood pressure can be made by changing your food choices.  Refer to the list at your right of high-sodium foods and suggested alternatives that are lower in sodium.

Let’s not forget that your foods can be seasoned without having to necessarily add salt. You can cut the calories and the salt but not the flavor by using these herbs and spices on your favorite foods. You’ll find which spices you like best by experimenting! Try some of the suggestions offered following this article.

Maintaining a low-sodium diet does not mean you must eliminate favorite foods from your diet.  Look at the suggestions provided after the article to help guide your food choices. Eating foods lower in sodium can help better control your blood pressure and protect your kidneys from further damage.

Read below for suggested alternatives to flavoring with salt!

Beef : dry mustard, marjoram, sage, thyme, pepper, bay leaf, onion
Pork : sage, onion, garlic
Poultry : paprika, thyme, sage, parsley, mushrooms
Fish : dry mustard, paprika, curry, bay leaf, lemon juice, mushrooms
Eggs : dry mustard, paprika, curry, pepper, mushrooms, green pepper
Vegetables : basil, oregano, nutmeg, dill, parsley, ginger, lemon juice, onion, garlic

Prescription For Health:
Are You Taking Your Medications Correctly?
Kimberly Holdener, PharmD

Did you know that half of the people who use medications do not take them correctly? Improper use of medications causes 125,000 deaths each year, leads to 10-25% of hospital and nursing home admissions, and costs billions of dollars each year. Many people don’t even realize they are taking their medications incorrectly. Dialysis patients take an average of eleven medications a day. This puts you at a higher risk of medications errors compared to the general public. There are several things you can do to make sure you are taking your medications correctly and, therefore, get the most benefit from them.

First, know your medications. You should know the purpose of every medication you are taking, what is used to measure its efficacy, how it should be taken, and when to take it. If you do not know any one of these things, ASK! Never hesitate to ask your doctor, nurse, or pharmacist these questions. They may assume you already know if you don’t ask. Most importantly, if you know why it is important for you to take a medication, you are more likely to take it correctly.

Second, use a reminder system to help you remember to take your medications. A pillbox is a great example of an easy reminder system. If you use a pillbox, it is easy to see if you have missed a dose of your medication because it will still be in the box. Keep your pillbox in a visible location, such as by the place at the table where you eat your meals, which will help you to remember to take your pills. Many pharmacies will actually fill weekly pillboxes for you at no extra charge. This service can be a real benefit to people with poor vision who have difficulty reading the print on prescriptions vials, or to those who have trouble filling a pillbox themselves due to acomplicated medication regimen. If this sounds like a service you would like, call around to different pharmacies near you and see if they offer this service.

Some other ideas are to use a medicine calendar where you check off the medications you take each day as you take them, take your medications at the same time each day, and take them along with meals or other daily events like brushing your teeth. If you take medications several times a day, but don’t like to use pill boxes, try getting several differently colored stickers and putting them on your medicine bottles with each color standing for a different time of day. For example, red can be for morning, blue for noon , green for evening, etc. To make this system more portable, put the colored stickers on small resealable bags and then put the appropriate pills in the bags. You can put the bags in your purse or briefcase and go out for the day without having to bring all of your bottles with you.

Lastly, it is very important to have an up-to-date medication list with you at all times. Include on this list all prescription medications, over the counter (non-prescription) medications, and herbal supplements you take and why you take them. Your medication list should also include any drug allergies you have. An up-to-date medication list will be needed for any medical emergencies, admissions to a hospital, doctor’s office visits, and even updating your medication list with WDI. The health care professionals who are caring for you need to know your correct medication list so they can avoid medication errors, check for drug interactions, and provide the best care possible. On the same note, it is highly recommended that you choose one pharmacy and get all your medications through that pharmacy. The pharmacy will then have a complete list of your medications and can check for problems or interactions between your medications. Make sure you tell us at WDI if any of your medications change so that we have your accurate medication list, also.

If you have a hard time taking your medications as prescribed, try one of these methods. If you have a complicated medication regimen, it may be possible to simplify your medications. Let us know if you are having trouble with your medication regimen. We want you to get the most benefit out of your medications!

From the Director’s Chair:

I am happy to announce that in this newletter, my colleague, Dr. Lisa Nanovic, will sit in the Chair as Associate Director of Home Dialysis Programs and educate all of us about home hemodialysis, a new program that Wisconsin Dialysis, Inc. has initiated with her leadership.

Sincerely,

Paul Kellerman, M.D.
Medical Director

Home Hemodialysis – Is It For You?
Lisa Nanovic, MD Associate Director

For those patients reaching end stage kidney disease, hemodialysis becomes an integral part of their daily lives. It affects their daily schedules, affects their eating and drinking habits, and affects their overall quality of life. Three times a week, patients are driven to a dialysis center, and spend up to 4 hours on a dialysis machine. Hemodialysis becomes a second job. For those continuing to maintain an active lifestyle, this necessary 4 to 5 hour period three times a week can interfere with daily activities, work, and school schedules. A diet limited in phosphorous, potassium and sometimes sodium can be difficult to maintain. Limiting what you drink during any given day can also be quite difficult. The stress and strain of daily dietary and scheduling changes can wear on a person undergoing hemodialysis, and their families.

Just think, three times weekly hemodialysis is now in place of a previously functioning kidney that was working 24 hours a day, 7 days a week. Dialyzing daily would better represent a functioning kidney. But who has the time? Who has that type of schedule? Home hemodialysis may be the answer. With home hemodialysis, dialysis can be done in the comforts of one’s own home. Due to the fact that dialysis is done by the patient, in the home, the patient can decide on an appropriate time of the day to have a dialysis session. This creates better schedules for the patient, and allows for daily dialysis. As it is daily, the changes in fluids and toxins are less severe as compared to three times weekly hemodialysis, and patients report less fatigue, nausea, and cramping. Daily dialysis allows for liberation of diet.

Transitioning over to home hemodialysis is not instantaneous. It takes a highly motivated patient and an active, in home support person whether it is a spouse, family member, or significant other. There are many qualifying factors to ensure that in home dialysis will be beneficial to the patient.

Currently at WDI our home hemodialysis program utilizes NxStage machines. These are advantageous, as they do not require a water treatment system, which created a costly opposition for patients starting home hemodialysis with other systems. Using the NxStage system patients need to be approximately 100kg (220 lbs) or less in weight. Whether dialyzing through a fistula, graft, or catheter, blood flow rates should be above 400. Both weight and blood flow rates work together for assessing time on home hemodialysis.

Patients must be willing to allow 2 to 3 weeks of half day training (5 days each week). The patient’s support person will need to be present for a majority of the training, and will have agreed to be present for each dialysis session once at home.

Although it seems like a lot of work up front, the pay off is great. Our first two home hemodialysis patients have recently completed their training and are now dialyzing 6 days a week at home. They are both extremely pleased with the results. One of the patients no longer feels the stress of trying to get to dialysis on time after work, and reports much less fatigue after daily dialysis compared to his previous thrice-weekly regimen. He has been able to liberate his diet, and is able to maintain a more active lifestyle. The other patient is able to maintain a better lifestyle with family and friends, and no longer has dialysis interfering with his school schedule, remarking on how overall, “I just feel better.”

If you are a hemodialysis patient and feel you are ready to take on the responsibility of home hemodialysis, talk to your dialysis nurse and nephrologist. Our home dialysis program staff would be delighted to meet with you and your support person to further discuss the possibilities of home hemodialysis.

Remembered Wellness
Chaplain Penny Andrews

In December, I had a chance to attend a conference hosted by Herbert Benson, a Harvard Cardiologist. The topic of the conference was Spirituality and Health. Benson’s work has been groundbreaking in showing the ways that a person’s most deeply held beliefs can influence their well being no matter what their physical condition may be. Interesting to note, that he himself has never been a religious person, but his research has made him re-examine his beliefs more deeply.

One of the ideas he promotes is the idea of Remembered Wellness, he writes: “Remember the vigor from the time you felt healthiest in your life. Remember the blessing your mother said to you before you left for school, the smell of incense at church or the tranquility you felt picking up stones at the beach. Remember the time the penicillin vanquished your ear infection, or the time the surgeon removed the splinter from deep in your foot and your pain immediately ceased. Remember how full-throated you sang in the choir or how long you stayed on the dance floor of a nightclub. Remember the way you felt when you had your first kiss or held your son or daughter when they were born. Then let go and believe.”

Remembering in your mind’s eye the times when you felt good can have a beneficial effect on the body. For one thing, it gets us out of what Herbert Benson calls our ‘worry cycles’. These are ‘unproductive grooves’ or ‘rutted thinking’ that cause the mind to play over and over again uncreative, anxious thought patterns that can be health-impairing.

What Dr. Benson is most famous for is something he calls The Relaxation Response. It is done in four steps:

1. Find a quiet environment
2. Consciously relax the body’s muscles
3. Focus on a word or meaningful phrase (example: repeat the word peace or one) for several minutes
4. If thoughts come in, simply return to the word you were focusing on.

The Relaxation Response, focusing on remembered times of wellness and finding ways to laugh are important therapeutic tools for self-care that can be done relatively easily.

Finally, Dr. Benson shares this:

“Believe in something good, if you can. Or even better, believe in something better than anything you can fathom, because for us mortals, this is very profound medicine.”