Unlocking the Challenges of Dialysis Through Maurice's Lens

Maurice, a seasoned dialysis technician, joins us from Ohio to unravel the complexities of dialysis, the lifesaver for those grappling with end-stage renal disease. We promise that by the end of our conversation, you'll have a clearer understanding of the warning signs of kidney failure, including swollen ankles and shortness of breath, and why recognizing these symptoms early could be a game-changer in managing your health. Maurice illuminates the often-overshadowed nuances of this artificial kidney process that purifies patients' blood, offering a beacon of hope and knowledge to anyone touched by this condition.

As we converse, we delve into the overlooked challenges family physicians encounter with early detection and treatment of chronic kidney disease. Discover how the commonplace prescription of diuretics, while providing short-term relief, might be inadvertently masking a more sinister decline in kidney function. We discuss the pressing need for specialized care and the pivotal role it plays not just in slowing the disease's progression, but in equipping patients for the reality of dialysis. This episode is an exploration of the critical communication required between patients and healthcare providers, and a reminder of the humanity that underpins the medical world we navigate.

A conversation about the kidneys and what happens when they fail.

Transcript

Speaker 2: 0:17

This is Ira McAlely, maurice Carlisle, and we're digging into what's the deal with dialysis. We're trying to educate people, trying to educate ourselves on some of the issues around. I myself not being from the dialysis world, being a filmmaker working in Hollywood, having people in my family have beyond dialysis and having friends that have had to deal with kidney issues I am kind of not a blank slate, but I definitely can be educated, maurice. You know, as we've talked before, we go back a ways. Maurice is a technician in Ohio and his heart has brought him to wanting to do something about what's going on in the field that he works in. So Maurice set it up. First of all, let's tell the people just in general once again, what is dialysis?

Speaker 3: 1:22

Yes, absolutely. Thank you, Ira. Dialysis is for patients who have end-stage renal disease. Their kidneys no longer filter their blood and they hold on to all their impurities because of that. So what happens to a person who is not having dialysis but needs dialysis, and they may not know that they need it? They have symptoms like swelling of the ankles, shortness of breath, because their bloodstream has so many impurities in it that the red blood cells don't survive, don't carry oxygen around their bodies, so they end up short of breath, stuff like that.

Speaker 3: 2:07

So what we do in dialysis is we access their circulatory system with cannulation, with needles, and then we connect lines to those needles and we take blood from their.

Speaker 3: 2:22

We move blood from their body through this tubing and through an artificial kidney, and that artificial kidney does not work as well as a kidney does, but it is adequate in pulling impurities out of their bloodstream so that they so someone who would come into dialysis short of breath four hours later leaves dialysis able to breathe. They may come in with swollen ankles in most cases and if they're not, you know, chronically continuing to have those swelling of the ankles. But in many cases they leave dialysis with ankles that are normal, that are not swollen, and so we basically do what the kidneys do with an artificial kidney connected to a machine, and we basically filter their blood. And so that's, you know, the layman explanation of what dialysis is. There's a lot of components that you know work within that that we'll get to at some point, but just to give a generalization of what dialysis is, that's it. We use artificial kidney and we filter the blood Right on. That's great.

Speaker 2: 3:40

Cause that's what we, you know we are aiming to do here is to take something that's really clinical, that's very scientific, and you know you being you, me being me you know the fact we chop it up, we talk about things, you tell me the experiences that you've had in clinics and with people like to humanize it and, and you know, you know if that we can just chat about it, and so thank you for breaking it down like that, because that makes sense to me. You know what I mean. Like all the like levels of pH and all you know all that stuff is just like whoa, I don't know what. That is Right, so it's super complicated, but but the simple part of it is number one your kidneys purify your blood. When they're not working, your blood becomes toxic, I guess. Right, and then, and then you need to go on dialysis so that you can live right. So that that's the thing. So about like all right.

Speaker 2: 4:38

So we've talked before about you know the fact that you see that people are coming in, that you know that you love, and they don't know that they're headed there. You know they don't know that. You know they don't know the signs, even though they may have been told. They don't know the severity, they don't know the urgency behind it. So, just overall, like what are some of the things that you think need to be addressed that people need to understand, so that we can get to a place where we can affect some change?

Speaker 3: 5:11

Absolutely One of the biggest things is you don't have any symptoms. Ira, you know, diabetes is similar in this way, because a person could be walking around with you know a very high blood sugar and not know it, and or high blood pressure and not know it. And dialysis is I mean, kidney failure is similar to that. You don't have any symptoms until you're in the very late stages. When you start having symptoms, you know you're very close to needing dialysis and so anything before that, you know, you really don't feel any different. You know, that's one of the things that patients tell me. You know, I had no clue that my kidneys were failing. I mean, I, you know, I've even had patients tell me when they come into dialysis, they're told that they need dialysis and they're coming in for their first treatment and or maybe even their second treatment. They still aren't convinced that they need this process, and the biggest statement that I always get is you know, I still pee, right, I still urinate like I normally always did, and you know the answer is is that, even though you're urinating, your kidneys still may not be filtering your blood adequately, and that's a very complicated thing to tell someone when they don't feel any different, you know, and so you know I can't tell them, you know how they should feel or what their body's doing, but I can see it in the lab results that you know their kidneys aren't functioning at the level they need to function, and so that's.

Speaker 3: 6:57

The first thing is getting over that whole idea that you know a person may not need dialysis one may in fact do. That's a big thing. The other thing is just understanding the stage is a kidney failure, so that you can actually have a conversation with your family doctor, because until you are at a critical stage in kidney function, your family doctor is not referring you to a nephrologist. Who is the specialist, who's the guy who can tell you that your kidneys are working at what level or not. And so your family doctor's kind of like that first responder. He's the first person who's gonna notice that your kidneys aren't functioning well.

Speaker 3: 7:43

And what I'm finding over the years by talking to patients, this isn't anything that you're gonna find in a book or this isn't anything you're just gonna ask your doctor. This is something that I've seen over years and years and years happening and I was able to identify this, and what we're finding out is that family doctors are not really well-versed because they're not specialist in kidney function and so they're not super, super well-versed in what, you know, a person needs to do before they go on dialysis or how to slow down that process of kidney function failure. And what we see is doctors are finding their patients might be swollen at the ankles, they might be a little short of breath, and what doctors are prescribing is diuretics, and those are medications that promote urinating. They pull fluid out of the body and into the system where a person would just urinate those fluids out. And so we're finding out that family doctors are unfortunately trying to doctor that issue, which is kidney related, but they believe, you know, those diuretics do work for a while.

Speaker 2: 9:04

But it's dealing with the symptoms. It's not really dealing with the root cause, right?

Speaker 3: 9:08

Absolutely. We're dealing with the swollen ankles and the shortness of breath, right? I mean we're dealing with those specifically by giving someone a diuretic that has 50% kidney function or 30, 40% kidney function. That's going to work. I mean that patient's going to urinate more, their ankles aren't going to be swollen and they're not going to be short of breath, and maybe that'll work for three or four years. But when we get to that four-year mark the kidney function is still going down. Now they're at 20% kidney function. Now the diuretic doesn't work and they probably are taking the highest amount of diuretics that they can take, because over those four years the doctors increased it. As they're, you know, they start noticing a little bit of shortness of breath or a little bit more swelling in the ankles. Every time they see that, they say well, you know, this diuretic start working. We're going to increase the dose until they get to a maximum dose and then it isn't working.