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Re: [IP] Dialysis in N.Y. Lags as Diabetes Ruins Kidneys

>> Tens of thousands of people across the country, their kidneys ruined by 
>> Type 2 diabetes, have been forced into the grim routine of dialysis 
>> care,>>

hmmmm - then what am I, a Type 1, doing there???? Oh, and I am not the only 
T-1 at my clinic. Here is a time they should have just said *diabetes.* We 
complain because they do not differentiate the types in an article, and this 
one should not be.

>> It is surprisingly quiet; patients are so beset by side effects like 
>> fatigue, cramps or thirst, that mere conversation seems like an effort.>>

hmmm - there is a thing of patient privacy, but while reclining in a LaZBoy 
chair it is very difficult (try watching TV at home that way) and NOT fall 
asleep. I miss many endings of Murder She Wrote or Law & Order because I 
couldn't stay awake as much as I fight it. I also miss parts of movies 
because I couldn't fight the drowsies. Many of us laugh and joke and carry 
on conversations with each other. Sure, it's not pleasant and some who have 
been dx'd with cancer as well and on chemo do not feel like chatting, but it 
should not be a surprise it is quiet. It is not *surprisingly* quiet. It 
*is* a hospital-like setting and that should also be quiet. Oh, BTW, if we 
are thirsty they bring us a drink of water.

>> Most will never be healthy enough to qualify for a transplant that would 
>> free them of this burden, and there are far too few donated kidneys, 
>> anyway.>>

Well, let's see. There's the young man who has had 2 tx's and rejected them 
both. His bod will not accept another's kidney so he is on dialysis the rest 
of his life. He is now 20 years old, in college, and not a DMer. Then there 
is I who has 6 heart blockages and refuse to be sawed open to get repaired, 
therefore, I do not qualify for a tx. I am *stuck* (pardon the intended pun) 
there the rest of my life which will increase the statistics of death at 
some point. DUH! I also do not want to go through the anti-rejection drugs, 
etc. required.

>> New drugs and dialysis techniques have improved their chances of survival 
>> since the 1980s, despite the fact that patients today are older, heavier 
>> and sicker. Even so, the average dialysis patient spends 15 days a year 
>> hospitalized, and the death rate is about one in five each year.>>

I spent 0 days in the hospital in 2006. DMers may be older due to better 
tools for care (home BG testing for one) than in the '80s. I went 51.5 years 
w/DM before submitting to the d.chair. The longer we all live, the chances 
are greater we will need dialysis.

>>The federal agency does limited comparisons of individual dialysis 
>>centers, which show that nationally, 4 percent of them have unusually poor 
>>patient survival rates, defined as at least 20 percent below average.>>

Well, sad to say, it actually is with 100% assuredness that none of us will 
live past 100 years after beginning dialysis.

>> A recent report by the United States Renal Data System Coordinating 
>> Center, a quasi-governmental agency that compiles the records of most 
>> dialysis patients, shows that patients at the major chains were less 
>> likely to die than those treated by smaller companies. >>

I'm changing clinics! I'll be less likely to die?? I thought the ratio was 
1-1 on death in this life for all of us. Dialysis gives us a longer life, 
but not a guarantee of never dying. ;-)

>> But the government's figures show that the national chains' patients are 
>> actually sicker when they begin dialysis - more anemic, more overweight, 
>> and with more advanced kidney disease.>>

As I have said before, from my knowledge a DMer who starts dialysis at 12% 
function instead of the usual 10% has a much better quality of life. I know 
a DMer who started at 8% and dried up urine output in a year. I started at 
12% and still have about 28oz. output a day which gives me much more freedom 
of fluid intake and diet. I want quality versus quantity - I'm 67.5 and a T1 
DMer for 56 years. YMMV

>> Researchers and state and federal officials say they have known, or at 
>> least suspected, for years that patients fare better at the major chains, 
>> but they cannot be sure why.>>

Perhaps it is because we get EPO/Epogen/Procrit/Arenesp/Demplar/Venofir 
infused directly into us in our lines? My clinic is about 14 years old. 
There are now 5 facilities in the chain owned by a group of doctors. The 
next closest to me is about 75 miles away - mine is 4 miles away from my 
house. PTL!! That's a lot of gas savings. We get labs done 2x monthly.

>> One factor believed to play a role is that the average Medicare 
>> reimbursement rate for a dialysis session, $140 to $150, has changed 
>> little since the 1970s, making it difficult for the smaller operators who 
>> cannot realize economies of scale.>>

Then why are my costs $19,000.00 a month? Medicare pays. There are 3 ways to 
get on MC = 65 y/o, disability, ESRD (End Stage Renal Disease).

>> Even when there are persistent problems, regulators would rather coax a 
>> center into improving than shut it, even temporarily, because the 
>> dialysis supply barely keeps up with demand. >>

Ya think? Sure, if it is shut down, we die in 2-15 days. That sure wouldn't 
look good on the state's record. You just can't walk into any facility and 
get a treatment. They have to have the equipment. DUH.

Jan T-1 11/50 http://tinyurl.com/hqsk2  - http://tinyurl.com/z4j5f - 
http://tinyurl.com/er5c3 including evolution of pumps
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