Very Interesting!

Very Interesting!

Causes, Growing Organs for people who need them.

Causes

Transplants!!!

                        Very Excited to report THREE Kidney Transplants in my system this past week! Two adults and one small child were the recipients. One of the adults received from a related donor and the others from the transplant list. The child was in need of a Kidney and a Liver and therefore received the liver transplant too! All these transplants done at Strong Memorial Hospital, University of Rochester, Rochester,NY.  Transplant, an awesome option!

National Kidney Foundation!

Double Donation: Husband and Wife Each Give Gift of Life

When Marcus and Monica Gilbert decided to purchase a Charley’s Grilled Subs franchise in a food court at a Utah mall, the idea of saving two lives was not in their business plan. Yet, that is exactly what resulted. Together, this couple, married seven years, has shared many successes --owning a thriving business, raising four healthy children and, within a 16-month span, giving the gift of life through kidney donation to two individuals.
Like many married couples, Marcus and Monica balance their days between running after their four children -- Jessica, Taylor, Christian and Emma –and managing a business. Unlike many married couples, they found the time and opportunity to each donate a kidney.
It all began when Marcus hired 17-year old Juan Delgado to work at one of his Charley’s Grilled Subs franchises. Marcus was determined to help Juan and his family, knowing that he had a difficult schedule to work around while undergoing thrice-weekly dialysis treatment. He even arranged a few fundraisers at Charley’s to defray Juan’s rising medical costs. But Marcus was still not satisfied with his results and decided to take his efforts one step further and get tested to become his employee’s kidney donor. After hearing that he was a perfect match, Marcus and Juan underwent successful kidney transplant surgery in September 2008.
“I felt I was in a good spot to donate and that I couldn’t pass up on the opportunity of giving someone so young his life back,” said Marcus.
After watching her husband donate his kidney without a hitch, Monica decided she too wanted to be a living donor. So she underwent tests with the goal of donating her kidney to anyone in need.
A few weeks later, Monica was notified that she was a match for a 44-year old named Pepe Sione Lee, a husband and father from Salt Lake City. Pepe’s kidneys had failed due to diabetes and he had been receiving dialysis treatment for 18 months. On February 11, 2010, Monica successfully donated a kidney.
In recognition of Monica’s gift, Pepe and his wife are planning a luau party this summer—just around the time when Juan plans to graduate from high school. Like both their kidney recipients, Marcus and Monica have returned to their daily routines with plenty of energy, which they will use to continue to chase their children around the house.

Our friend Jim Sloand to the Ways and Means Commitee.

Testimony By James Sloand, M.D., Statement

Statement of James Sloand, M.D., Medical Affairs U.S., Baxter Healthcare

My name is James Sloand, M.D. and I direct medical affairs for renal services at Baxter Healthcare for the U.S.  I have also been a practicing physician for over 30 years. Baxter’s renal business has long served the needs of people with end stage renal disease (ESRD). ESRD is the most serious form of kidney disease and occurs when the kidneys lose approximately 85-90 percent of their natural function.  Kidney disease is life threatening and requires treatment in order to remove toxins from the bloodstream.  In 1956, the company introduced the first commercially available and disposable dialyzer to act as an artificial kidney in hemodialysis.  Nearly 20 years later, Baxter pioneered peritoneal dialysis a primarily home-based treatment for ESRD patients that is used all over the world.
The development of kidney dialysis therapy and the many improvements made to it over the past several decades have vastly improved survival for patients with end-stage renal disease.  Improvements in the care of patients with kidney disease, for example, have meant that more individuals are undergoing dialysis therapy for longer periods.[1]  As such, total costs will continue to rise as the prevalence of patients on dialysis increases, (estimated to increase by 62% by 2020.[2] )
Finding a way to delay entry into dialysis and to lower the costs of car­ing by preventing hospitalizations for people with chronic kidney disease (CKD) is critical to reducing health care spending.  Patients can play an important role preventing deterioration in health once they have been diagnosed with a chronic condition. Building in patient self-management and empowerment through provider reimbursement policies may be key to reducing costs.[3]
A patient with end stage renal disease has  two different options for renal replacement therapy (dialysis) if a pre-emptive renal transplant is not available: treatment at home with either peritoneal or home hemodialysis  or by in-facility hemodialysis.  Home peritoneal dialysis is underutilized in the U.S. compared with (for example) Canada (7.6% in U.S. versus 37% in Canada in 2005).  A recent study of nephrologists indicated that if maximizing survival, wellness and quality of life were the most important factors in deciding mode for dialysis, 33% should be on PD.[4]  The underutilization of PD in the U.S. may thus have a negative impact on quality of life for patients that might otherwise use this modality and the data show that this deficiency increases costs to the Medicare program:

• MedPAC said in a recent report "Home dialysis offers several advantages related to quality of life and satisfaction to those patients who are able to dialyze at home.”[5]  
• The Centers for Medicare and Medicaid Services states that, "If 5 percent additional patients were to opt for home peritoneal dialysis, which provides added health and quality of life benefits….the potential savings for these 5 percent additional patients could be as much as $295 million."  (Page 20471 Final Regulation on the Medicare Conditions of Coverage for End-stage Renal Disease Patients).  [Note: these savings are through reduced hospitalizations and improved outcomes and over 10 years would result in at least $3 billion in savings.]

A lack of education about different modalities has been one of the significant reasons for underutilization in the U.S.  In fact, only 25% of patients on hemodialysis ever remember receiving information about peritoneal dialysis as an option.[6]  The provision of information to patients is also associated with greater willingness to adhere to therapies[7] and may include delayed progression to ESRD.[8]
 In 2008, the Congress added an education benefit to the Medicare program to educate patients in the final stages of kidney diseases to delay the onset of dialysis and to increase the information on dialysis options for care.  The benefit allows up to six educational sessions for Stage 4 kidney disease patients including instruction on the management of co-morbidities, with the goal of delaying the need for dialysis.  The educational sessions are also required to include a discussion of the treatment options available to patients.  The Centers for Medicare and Medicaid Services (CMS) now has responsibility for implementing this important benefit.  It is my hope that they recognize the need for a collaborative model between the physician and his staff where both contribute to the process to ensure that the therapy is as the law requires: individualized and aiding the patient in managing complications and co-morbidities of kidney failure.
I recommend that Congress further improve the management of kidney disease within the Medicare program by recognizing the direct link with the initial coverage under the Medicaid program for the low-income.  However, almost one-third of all new starts in dialysis begin in Medicaid and then transition after three months to Medicare.   Data show that Medicaid patients are less likely to have access to nephrologists and to critical information on diet.[9]  Increasing information to empower patients on how to manage their co-morbidities and significant metabolic issues-- prior to kidney failure-- is both equitable (increasing patient satisfaction) and, by reducing avoidable hospitalizations during the months immediately preceding and following the initiation of dialysis, it reduces costs for Medicaid program. 
Therefore Congress should specify that Stage 4 CKD patients should be part of targeted Medicaid case management services.[10]  In this instance, the case manager (a nurse or social worker) could ensure through community outreach that Medicaid eligibles with Stage 4 CKD have access to information on kidney disease, to kidney care providers, and they evaluate whether patients are receiving the appropriate information.  Further, similar to the recently enacted Medicare physician and practitioner model for renal education, the case manager would refer the Medicaid eligible to a physician for training on managing their co-morbidities, diet and metabolic issues, as well as the modalities of care and preparing for the appropriate access for dialysis.  It could also be a required case management activity for Medicaid managed care plans, through a case manager and through separate payments to physicians. 
In addition, prevention should be a cornerstone of all aspects of the health care system rather than an afterthought. This shift requires a fundamental change in the way providers are reimbursed in the system to reward those that are increasing the value of the health care services and reducing preventable admissions.  The Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) requirement on pay for performance was an important step, as discussed further in my testimony as follows on vaccines for patients with end-stage kidney disease. Dialysis patients have long been recognized as a vulnerable and an underserved population that would benefit from immunizations.  Since 1995, hospitalization rates for dialysis patients for infection have risen 19 percent overall, and 28% for African Americans. The rates of death due to infection are also highest among African Americans.  Studies show that vaccination will result in reduced risk of hospitalization and death from infections.  As a result, the CDC has recommended that all dialysis patients and staff be immunized to improve anti-microbial resistance. 
Patients with ESRD are under immunized (60% in 2002 and no significant improvement in the reported data since then [11]), with an even lower rate for the dual eligible population.  A CMS objective is to increase the annual ESRD patient influenza vaccination rate to 90% by 2010.  Vaccines are cost effective overall for the population over 65, reducing costs by $117 per person.[12]  Specifically, vaccinations reduce the risk of any hospitalization for hemodialysis patients by 7% (see chart below.)

Influenza vaccine delivery and effectiveness[13]
Hospitalization	Reduction in Risk
-Any cause -Influenza -Bacteremia -Respiratory infection	-7%
	-16%
	-24%
	-12%

Mr. Chairman, I request that your Committee urge CMS to include a measure concerning the percentage of vaccines, which is a national Quality Forum, for use in the pay for performance system that is required under the new dialysis payment system, effective January 2011.  The statute provides for flexibility in the measures to be used for dialysis pay for performance, but does not specifically require vaccination for influenza as a measure.  Given that spending on hospital services for patients undergoing dialysis was $7.05 billion a year in 2006, the estimated savings for an increase up to the CMS influenza vaccine target would be $150 million a year, or roughly $800 million over 5 years.  This could be a key part of aligning incentives for excellence of care for providers in the Medicare program and also for reducing disparities for vulnerable kidney patients.
Thank you for this opportunity to submit testimony for the record on health care reform and reforming the delivery system.

---

[1] “Technological Change and the Growth of the Health Care System”, Congressional Budget Office, January 2008.
[2] Gilbertson and Collins, USRDS (the NIH US Renal Data System).
[3] “The Healthcare Delivery System: A Blueprint for Reform, from Chapter 5, Second Generation Consumerism: Increasing Consumer Activation to Improve Health Outcomes and Lower Costs for Patients with Chronic Disease by Judith Hibbard, and Katherine Hayes, J.D., Center for American Progress
[4] Mendelssohn et al, 2001
[5] MedPAC
[6] Golper, 2001 
[7] Swatz, Robinson, Davy and Poltoski, 1999
[8] Golper, 2001
[9] Solid, Collins, USRDS, Minneapolis, Medical Research Foundation, 2007
[10] Case management is not the direct provision of medical and related services, but rather is assistance to help beneficiaries receive care by identifying needed services, finding providers, and monitoring and evaluating the services delivered.1 Targeted case management (TCM) refers to case management that is restricted to specific beneficiary groups. Targeted beneficiary groups can be defined by disease or medical
condition, or by geographic regions, such as a county or a city within a state. Targeted populations, for example, may include individuals with chronic physical or mental illness, developmental disabilities, or other groups identified by a state and approved by the Centers for Medicare and Medicaid (CMS). TCM and case management are optional services that states may elect to cover, but which must be approved by CMS through state plan amendment (SPAs).  CRS Report to Congress: Medicaid Targeted Case Management Benefits, March 27, 2008
[11] One large chain recently reported an 85% vaccination rate.
[12] The Efficacy and Cost Effectiveness of Vaccination against Influenza among Elderly Persons Living in the Community, Nichol et al, NEJM September 1994).
[13] Odds ratios for the impact of vaccinations on mortality and morbidity in hemodialysis patients during the period 1998-1999 from  “Influenza vaccine delivery and effectiveness in end stage renal disease”, Gilbertson et al, Kidney International, 2003

Patient Champion Series: I wanted to share some of these awesome human stories that FMC has shared with me.

Harvey Jones
Age 56 • Greensboro, N.C. • Featured on March 18, 2010

Dialysis Patient Uses Voice to Inspire Peers, Legislators           


After years on the road as a singer with Al Green, Mary J. Blige, Hall & Oates, Michael McDonald and many others, Harvey Jones wasn’t about to let kidney failure stop his momentum. Rather, he embraced his diagnosis and puts all his extra energy into helping other chronic kidney disease patients.

Since beginning dialysis in June 2001, Harvey continues to sing all over the United States, as well as internationally. Over the past 19 years, he has been on in-center hemodialysis, peritoneal dialysis and received a transplant which his body rejected after 8 years. Harvey is currently on in-center hemodialysis, and is on the kidney transplant waiting list.

Being on the road, traveling from one music venue to another makes it hard for Harvey to sit still. He owns a publishing company, enjoys reading and is also a minister. In order to keep physically fit, he walks two to three miles a day.

One of Harvey's most rewarding activities is his participation in an end stage renal disease (ESRD) patient support group in Greensboro, N.C., called the Dialysis Action Committee (D.A.C.). The D.A.C. is a nonprofit which provides patient support through celebrations and picnics, kidney disease screenings with the local National Kidney Foundation chapter, and meetings with local legislators about laws that impact the ESRD community.

Harvey receives a tremendous amount of support from his family. He has been happily married for 38 years and is a father of three. He also loves his local dialysis care team and facility, and says, “I wouldn’t dialyze anywhere other than Fresenius Medical Care.”

Harvey’s goal is to assist others living with ESRD and help them embrace their diagnosis, and remain optimistic and happy. “Attitude and laughter are part of the medicine needed to help you live with kidney failure," he says.

AWARENESS!!! It's Organ donation Month!!!

Licorice Chemical Question as related to Transplant!

Licorice May Block Effectiveness Of Drug Widely Used By Transplant Patients

ScienceDaily (2009-03-31) -- Chemists in Taiwan are reporting that an ingredient in licorice -- widely used in various foods and herbal medicines -- appears to block the absorption of cyclosporine, a drug used by transplant patients to prevent organ rejection. This drug interaction could potentially result in illness and death among transplant patients and others taking cyclosporine and licorice together, they caution. ... > read full article

FMC- Patient Champion Series

                                                         I wanted to share some of these awesome human stories that FMC has shared with me.

Marlene Meza, a 62 year-old dialysis patient in Miami, is not afraid anymore. When first diagnosed with end-stage kidney disease in June 2009, Marlene did not know what life had in store for her. What she did know was that she wanted to continue working, traveling and spending lots of time with her family. After going through Fresenius Medical Care’s educational Treatment Options Program (TOPs), Marlene realized there was a dialysis treatment that fit her future goals perfectly. Today, she receives peritoneal dialysis through the home treatment program at Fresenius Medical Care Homestead.
Marlene's nurse says she is a big help and enjoys talking to new dialysis patients about their treatments. She offers them hope and reassures them that there are different treatment options for kidney disease that allow for flexible and fulfilling lifestyles. With seven children, 19 grandchildren and five great-grandchildren, it is not hard to understand why Marlene would want exactly that.
Marlene believes that anything is possible with the help of family and doctors. For her, home dialysis has been the answer. She continues to work at Goodwill Industries, where she has been employed for 16 years. In May, Marlene is planning an extended trip home to Nicaragua. Until then, she is busy planning the next family dinner, where all 32 members of her family will get together to eat and enjoy each other’s company.
 

FMC- Patient Champion Series

I wanted to share some of these awesome human stories that FMC has shared with me.

Ronnie Glasper, a 38-year-old dialysis patient from Monroe, La., believes taking a proactive role in your health care is one of the keys to a successful life on dialysis. Ronnie has been on dialysis for two years because of kidney failure related to juvenile diabetes. He receives hemodialysis treatments at the Fresenius Medical Care Northeast Louisiana dialysis facility.
Every three days, when Ronnie arrives at the facility, he visits with the other patients, asking how they are doing and sharing information he has learned regarding kidney disease. He believes that, ultimately, your health is your own responsibility. He encourages dialysis patients to take an active role in their health care by asking questions, learning how the machines work, and understanding all of their dialysis needs. Currently, he’s a Network Patient Representative and has been nominated to be a member the Fresenius Medical Care Patient Advisory Board.
Beyond his support of fellow dialysis patients, Ronnie is an inspiration to children and adults through his work at Big Brothers Big Sisters of Northeast Louisiana. As a case manager, he matches children with mentors, who provide them with guidance and support. He also volunteers as a mentor. For Ronnie, having an activity he enjoys outside of dialysis is extremely important, and he advises other patients to find that outlet. Ronnie loves to read and research his family’s genealogy. That hobby takes him frequently to his hometown of Clayton, La., with the help of the Fresenius Medical Care Patient Travel Service.
Ronnie is currently on the waiting list for a kidney and pancreas transplant. His ultimate goals are to educate young people and give back to the community. That includes raising awareness about kidney health among adolescents.
 

FMC- Patient Champion Series

I wanted to share some of these awesome human stories that FMC has shared with me.

         Mary Ann Milo is a 39-year-old dialysis patient who lives in Avondale, Ariz. Mary Ann was diagnosed with kidney disease at the age of two, and her kidneys lost all function by the time she was nine. At that point, she started her first round of peritoneal dialysis. Her first transplant, from her father, lasted 12 years but eventually failed. Then she returned to peritoneal dialysis. She was able to get a second transplant that lasted up until three years ago, and is now currently on in-center hemodialysis at Fresenius Medical Care Avondale.
Despite her ups and downs, Mary Ann’s mission in life is to bring happiness to those around her and help patients on dialysis. Mary Ann has taken great interest in educating other patients about dialysis, and she created a patient council that meets every month. She has also volunteered to be a patient representative at her clinic. Mary Ann is very dedicated to her treatment program, and has even learned to help set up her own dialysis treatment at the clinic.
Mary Ann is a fourth-grade teacher at Freedom Elementary School located in Buckeye, Ariz., where she has taught for nine years. Prior to teaching, she volunteered at the Geisinger Medical Center where she worked with pediatric dialysis patients. Mary Ann loves to hike, travel, and remain as active as possible. Mary Ann is planning a vacation to visit her sister in El Paso this year, and intends to study nursing with a focus in nephrology. 
https://www.ultracare-dialysis.com/engine/renderpage.asp?pid=s1581
  

Kidney Walk to call attention to organ donors

Caroline McKay wants people to know kidney donation changes lives, but it won’t impact the day-to-day life of a donor.
“Even three years later you can’t tell that I’m functioning with one kidney,” she says.
There is very thorough testing performed on potential donors and a healthy donor should experience a relatively quick recovery and continue regular activities with no side effects from the surgery.
“The only potential downfall for me would be the rare case that one of my family members would need a kidney, I wouldn’t have one to donate,” explains McKay.
McKay generously donated her kidney to a high-school classmate, Danny Bonner, whose sole kidney was failing.
At their 20-year reunion, his classmates held a silent auction to raise money for his medical costs, and awareness of his condition. Bonner had been on dialysis every other day for years, his health deteriorating.
All of his family members and his girlfriend were unable to donate due to age, health problems, or incompatibility. The two were not close in high school, but that did not matter to McKay. She just wanted to help.
She approached him after the silent auction at the reunion and told him her intentions. She knew at that point that she was the same blood type, but still needed to go through further physical tests.
“When people come forward to help you like that, it’s hard to describe the feeling,” said Bonner.
“When someone is willing to give up a part of their body to help you…it’s like a miracle.”
Following the surgery, McKay needed to avoid heavy lifting for a few months, a minor setback as a server at Applebee’s and a house-painter.
McKay is leading a team, “Givers of Hope,” in the upcoming kidney walk in Geneseo for the National Kidney Foundation. So far she has raised $1,000, 80 percent of her initial goal.
She is interested in becoming more active in raising awareness of kidney disease and organ donation. According to the National Kidney Foundation, one in nine people in the Livingston County area has chronic kidney disease and there are 400 people on the kidney transplant waiting list at Strong Memorial Hospital.
Proceeds from the kidney walk provide funding for free kidney check-ups, kidney health classes, Kidney Kinship patient support programs, professional medical programs, kidney transplant options, and local research grants. Take Care of Your Kidneys So They Can Take Care of You.

This is only the second year that a kidney walk is being held in Geneseo, to be held Friday, March 26 at SUNY Geneseo in the Wilson Ice Arena. Registration begins at 6 p.m. and the walk begins at 7 p.m.
The walk last year raised nearly $20,000 and with 21 teams already registered this year, the local NKF chapter hopes to raise $25,000, according to Special Events Manager Michelle Castrogiovanni.
For more information on how to participate or to donate, visit donate.kidney.org or call Michelle at 697-0874, ext. 30.

National Kidney Foundation: Newsletters

National Kidney Foundation: Newsletters

Transplant!!!!!

Awesome!!! one of my Primary patients received a Kidney transplant on Sunday!!!! This was from the Kidney transplant list(non-living donor). So please people sign your license for donation cuz this is one of the best examples that life does go on if you will please help it!!!