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What's the Deal with Dialysis?
A conversation about the kidneys and what happens when they fail.
What's the Deal with Dialysis?
The 10 Critical Steps
When facing kidney failure, the difference between feeling powerless and taking control often comes down to knowledge. That's exactly what we're providing in this eye-opening episode where we unveil our new free ebook: "10 Critical Steps to Take After an End-Stage Renal Disease Diagnosis."
The medical system often rushes patients onto dialysis without exploring all options. Maurice shares a shocking revelation: three recent patients he referred for second opinions discovered they didn't actually need immediate dialysis despite being told otherwise. This pattern highlights why seeking a second opinion should be your first move after receiving an ESRD diagnosis—and why you shouldn't ask your current nephrologist for that referral.
We dive deep into the stages of kidney disease and reveal a crucial insight: at Stage 3A (a GFR of around 61%), patients have approximately a 70% chance of avoiding dialysis altogether with proper nutritional intervention. Yet most medical professionals don't intervene until you reach Stage 4 or 5, missing valuable prevention opportunities. This disconnect explains our strong recommendation to consult a nutritionist immediately upon learning of kidney issues.
The conversation takes a concerning turn as we expose troubling practices around dialysis access surgeries. The "Fistula First" mandate often leads to multiple painful surgeries for patients who aren't suitable candidates, particularly elderly individuals or those with diabetes. Even more disturbing, many of these surgeries fail during first-time use, creating traumatic experiences for new dialysis patients.
Whether you're facing kidney disease yourself or supporting a loved one, this episode provides the knowledge needed to navigate the system effectively. Join our Facebook community to download the free ebook and connect with others who understand what you're going through. Remember: you have more control over your dialysis journey than the medical system might lead you to believe.
With hosts Maurice Carlisle and Ira McAliley
What's up, beautiful people? Ira McAlellan here with Maurice Carlisle for another edition of what's the Deal with Dialysis. And we're here. I'm actually in Costa Rica, I ain't gonna lie. I'm here in paradise and doing a little glow thing. You know she got a little glow here, but this is all part of, you know, the holistic healing. And Mo is in Ohio and you know, still doing the damn thing. So what are we going to do today?
Maurice :We are going to talk about a book that we put together for everybody, and we'll get into it a little bit more. Yeah, it's a surprise. Yeah, it's a surprise. We're going to talk about what you should do when you find out that you may need to go on dialysis. We're going to talk about one of the first things that I suggest you do. That's what this episode is about today.
Ira :Right on, we have our special guest that we love so much, paul terry, coming back in the house. We're gonna chop it up, so, uh, stay tuned, we'll be right back after this little intro. And there we are Back. There he is.
Paul:What's happening. Terry, what's?
Maurice :going on man.
Paul:What's happening?
Maurice :You bro you.
Ira :So here we are. Like I said, I'm in Costa Rica. I'm literally watching a lizard, a gecko, run across the patio, not at your house. Nice. Yeah, we're going to get into it today, Maurice. Tell them what we're going to do today, what our special treat for everybody is.
Maurice :Yeah, so our special treat today is we have put together a short ebook, or there's ten things that I recommend the patients do when they get the news that they're gonna need to go on dialysis, and so today we're just going to talk about the first point, and the first point is is the person needs to get a second opinion?
Ira :All right, so here's we're going to show the cover there you go yeah, so the 10 critical steps before we get into it. If you guys want this, yep, and what we're going to do is we're going to give everybody access to this. We're building our community. We want you to be a part of it, but so you're going to have to go to our Facebook group and join our Facebook group, leave us your information and we will send you this 10 critical steps that have been put together by these two masters right here who have been in the business forever.
Maurice :So that's right. That's right. That's right, yeah, so that's just. That's just a bonus for you guys, and we want you to join the group so that you can get information from us and we can give you some guidance. This is for your families, this is for those of you who might get this diagnosis, and this will help you move right along into the next stage of life and what you need to do.
Paul:It's all about information sharing. That's what this is all about sharing information, recommendations, advice, things that you've learned over the course of your time, your tenure on dialysis, because you just know you never know how you might impact or help somebody else going into or somebody who's been on the ice a long time. That's what this is about.
Maurice :Yes, and we we've been doing this a long time. We've seen what people go through, and that's how we came up with these 10 steps. We realized that they are critical and that if you take these steps, you're going to be more in control of your future than not more in control of your future than not.
Ira :And if I'm correct, correct me if I'm wrong, I'll say these are not necessarily the mainstream. Like you guys are kind of coming at it from a different direction because you've seen it, you see how they do it, and like we're trying to help people be advocates for themselves where the industry may or may not be advocates for them. Correct, exactly.
Paul:Taking your power back. Taking your power from institutions and giving it back to you and your family, because dialysis, as we all know it, encompasses and affects the entire family.
Maurice :It does. I mean, I think that most of the families don't know what's going on. So when you know, when a person gets this news, usually there's nobody in the family that really understands what exactly is going on. And so we see that all the time we see patients who have actually been seeing nephrologists for maybe years. They've never been in a dialysis center. So when they're given the news that they need to go on dialysis, they've never been in a dialysis center. So when they're given the news that they need to go on dialysis, I mean they've been having interaction with their nephrologist eight years but they've never been in the center. He's never walked them into a center. He's never talked to them about what a center looks like or what you know dialysis would encompass. You know the way we hear it. They get a call, they go in for their checkup. He tells them you know, need to go on dialysis and that's when the conversation starts. It usually doesn't start before that.
Maurice :So we wanted to give people a way of navigating that so that they can have their power back, like Paul said. And really they are in control. Patients do have a lot more control than they know, but they're kind of being herded, you know. They kind of herd them into a certain lifestyle, they kind of herd them into what they recommend. And so patients, you know, feel like they don't have any power. And they really do have all the power. They can make all decisions on which nephrologist they want, where they want to have dialysis at, you know what they're going to eat. All of those things are in their control. So they just need to be empowered. So that's what this is really about. Like Paul said, like Iris says, this is about being empowered.
Paul:So excuse me, sorry, but go ahead.
Ira :I was going to say I'm going to ask a question that I kind of know the answer to, but just for the people, why is it that they don't give you all the information?
Maurice :You want to. You want to tackle that one first, or are you already going?
Paul:in the families of the practitioner. They don't give who the information anybody.
Ira :They don't give. Like the family, like you say, like somebody has been going to a nephrologist for years but they've never been into a center, right, they don't know, like you know, haven't been meeting with a nutritionist or whatever, like that to me seems like if you're really trying to help people, you would do all those things right.
Paul:But that is one scenario. But let me introduce another scenario, because a lot of people land on dialysis in a very unfortunate way. You might be at work one day, let's say, for instance, you're driving a truck, right, all of a sudden you fall out. Or you mailman, whatever the case may be, you just fall out. You wake up with a catheter a temporary catheter in your chest which allows for acute dialysis, and the next thing you know all that. You're bombarded by the physician, the nephrologist, the social worker, you know somebody to represent you, your insurance. You don't know what's going on. So you sure you don't know what's going on.
Paul:So you're, you're very vulnerable and you feel, you feel, you feel you know, you feel you just you feel powerless. So, number one, you're definitely afraid, and this is opposite of what Reese talked about when people are have been visiting in their projects, who was referred by their primary, and so they have been communicating and they're still, like he said, they're still. Their families are not informed about what's going on, for whatever reason. But again, when you're at work one day, you're just traveling, doing whatever you're doing, you just you fall out. You end up in the hospital with this catheter in your chest. You're totally vulnerable and you're just afraid, and so you're not going to give you. All you're going to be told is that you need to, you need dialysis, you need this to stay alive. So, once again, you're just shocked, bro. You're just shocked, bro. You're just, you're at the mercy of whoever's attending to you.
Maurice :Yeah, and I mean, the bad part about that is, and we call that parachuting in, basically parachuting in to dialysis center. You know you, you just fell in there, you know, and they call that parachuting in. The thing with that is that whoever's on call is who you get. The thing with that is that whoever's on call is who you get, period, and that person is on call in a community where he has a dialysis center.
Paul:Right Period.
Maurice :That's where he's on call. He's not on call somewhere where he can't see patients Right. He's on call there on a weekend. When you fall in there on a Friday or Saturday or Sunday, he's on call. When they find out you got kidney issues, they call him up and he walks in there. And now you've got the luck of the draw. Like you didn't even get to pick this guy. This guy when you wake up, your family members are the one to sign the paperwork to have the catheter put in your chest. You wasn't even coherent.
Paul:No.
Maurice :So that catheter operation, you don't remember it, you don't know when it happened. Your family members signed the paperwork for that to happen. So when you wake up you know I had a lady tell me she lost 13 days.
Paul:Right, he said on the parachute.
Maurice :She went in the hospital and she parachuted in and for 13 days she don't remember anything. She woke up, it was 13 days later and they was telling you you've been out for 13 days, mom, and they've been dialyzing you, and what is that?
Ira :What is?
Maurice :dialysis. What is it in my chest, you know? And so that's often, that is the scenario.
Paul:It is a scenario. Let me ask something else. There's a lot of profiling done by healthcare practitioners when you land in a hospital. Let me ask something else. There's a lot of profiling done by health care practitioners when you land in a hospital. I'll give an example. Say, for instance, you're a physician. Say, for instance, you're a lawyer. You know, let's say upper echelon professional You're going to get you, you will receive more communication than somebody who, just once again, you're just a layman. Let's say you're a blue collar worker, they're not going to treat you the same. I hate to say this, but if you don't have the top shelf insurance, you're going to get treated accordingly, unfortunately, and that's one of the reasons that if you don't solicit or if you do not press them for information, they're not going to give it to you Because, like he said, they're in a hurry. It's like it's a revolving door the physician's going to come and see you. For how long Reese? 10 minutes, 10 minutes. It's really not funny, but this is unfortunately the situation.
Maurice :How long Reese? Let me tell you 10 minutes.
Ira :Let me tell you what's even more puzzling.
Maurice :The nurse can't teach you anything about dialysis. The nurse that's attending to you it's not allowed to it's not allowed to teach you anything about dialysis.
Maurice :Wow, because she works for a company that leased the space in the hospital for the center. Yes, so let's go back a little bit. Every hospital has a dialysis center, not the ones you see when you're driving by the DeVita signs and the Fresenius signs. No, no, no, no. I'm talking about every hospital, probably 90% of them. I won't say every, because there's probably some rural hospitals that don't have dialysis.
Paul:They provide acute dialysis services Right.
Maurice :So every one of these hospitals has acute dialysis centers. They may have two beds in there. They may have portable machines. Where you're in ICU and your kidneys are failing but you got a bad heart, they got you in ICU working on your heart but they need to give you dialysis. This nurse will push a machine down there to the ICU unit and hook you up and give you dialysis right there in your ICU room. So there's one nurse in the hospital doing that. She doesn't know how many dialysis patients she's going to get that day. She doesn't know. She might know the ones that's already in ICU.
Maurice :There's three people in ICU that's going to need dialysis today, but she don't know who's going to fall in there today. You know what I mean. So she's overworked. She's working 16 hour days. Sometimes they'll send her home for two hours and call her back after 16 hours. We know that that's illegal. We know that it's illegal for somebody to work that many hours, but there's no union and that's a whole another monster. But just know that they're not getting the care that they need and they're not going to get the education they need, at least not in the form it's in right now.
Ira :That's a whole other show, yes, but so just given that Step number one, once you find out that you On the list, get a second opinion right?
Maurice :Yes, yeah, the first thing I would suggest someone do is get a second opinion, right? Yes, yeah, the first thing I would suggest someone do is get a second opinion. And let's talk about what might a second opinion look like. You want to go and find another nephrologist that has some experience, has a track record. It might be a drive your kids might have to drive you to the near city. It might be a drive your kids might have to drive you to the near city, but you need to find someone else to at least look over your labs and give you some information about what their suggestions are. Because in the last maybe 90 days, I sent three people for second opinions in my community. All three of them didn't need to go on dialysis right at that moment, but they were all told that they needed dialysis. So that's just something from my community and that has been happening in every community. But the first thing you need is the second opinion and don't ask your nephrologist for the referral.
Paul:Why not Reese?
Maurice :He's going to retaliate against you, he or she. Is it a competition, are you?
Paul:saying it's a competition for dialysis patients among their partners? Yes, there is. Is it cutthroat?
Maurice :Yeah, it is cutthroat, it is. It is. I mean, let's think about this I'm on call this weekend, you're on call next weekend. I saw a patient this weekend. Next weekend the patient comes back and you see the patient.
Paul:Right, right.
Maurice :I go to see the patient and you walk in and say that's my patient.
Paul:I say well.
Ira :I just saw him.
Maurice :They got. Nephrologists have had disagreements, let's say, about who is the nephrologist for that patient. Now you ain't signed no paperwork saying you needed either one of them. You haven't decided on either one of these guys, but remember they were on call when you came in. They claimed you and that's the rule, listen, you might not or she may not be the best nephrologist in your community. You just got the luck of the draw, the unluck of the draw that day.
Paul:This person is there as opposed to the other person, because it was whoever was on call.
Maurice :It was whoever was on call, and that can be a difference between you. Your complete experience as a dialysis patient can be totally different based on the day that you parachuted into that hospital. It's that fragile.
Ira :And it is. So that's big. Get a second opinion. I know we don't have time to go through the whole list of 10 and that's why people should, you know, go to the Facebook group. Also, just if you're listening to this podcast on a podcast server, you can go to YouTube as well and see us, see our beautiful faces and like and just kind of get a little bit of the antics and just how we are. So there's different places and you can share it from there as well. So that's a little plug for our what's the deal with dialysis? But what is another? What's another tip? One another tip for one of our 10.
Maurice :The next thing you're going to want to do is you're going to want to see a nutritionist, because what you're eating can continue to damage your kidneys and so seeing a nutritionist, you can slow down that process of kidney damage. And you know, quite frankly, if you get ahead of it, you may never go on dialysis at all, you may never need it.
Paul:Quick question Should they be a dialysis-specific nutritionist or just a general nutritionist?
Maurice :I think it can be a general nutritionist. I mean, I think the problems that you know. I mean I think most nutritionists know what kidneys do and I think they understand you know what makes kidneys work. You know harder, I mean, I think you know there's some new studies. You know harder, I mean, I think you know there's some new. There's some new studies out there, and we're going to talk about those in one of our shows with one of the dieticians that I've met, and she is all about organic fruits and vegetables and stuff like that, where before you were told, don't, you know, don't take on potassium, she's saying that there's some types of potassium that can be managed by damaged kidneys and so um, um, you know that's, that's another story, but we'll, we'll get into that later. Uh, but there's another, there's another way to do that and and uh, seeing a nutritionist is just definitely going to slow down your kidney, your kidney failure, quick question.
Maurice :You know we're still trying to figure out why nephrologists and nutritionists aren't in the same, like if I'm a nephrologist, why don't I have a nutritionist in my office for patients who aren't even near dialysis yet? But we can begin to change their diets and they may never go on the machine.
Paul:In your opinion? We can say a renal dietician is more because dialysis is such a niche career field. We can say that a renal dietician is more skilled at advising a dialysis patient prior to dialysis.
Maurice :I would say that I would say that your problem with finding a renal nutritionist is that she's at the dialysis center and until you go on that machine you don't get to talk to her. She works for a company who provides dialysis for patients. You don't meet her until your first day on treatment and so you don't have that.
Paul:You're saying way before you land on dialysis, before you get to end stage renal disease, you need to be talking to a nutritionist. That's right and in before you get to end stage renal disease.
Maurice :You need to be talking to a nutritionist. That's right. And and and, and, and, and, and, and, and, and, and, and, and, and, and, and, and and and, and, and, and and and and you got an auntie or uncle, a couple of cousins, doing dialysis.
Maurice :man, you would definitely behoove yourself by going to see a nutritionist right away. But, like I said, the problem is is that I've got a nephrology practice. You go to my office. There's no nutritionist. I'm not even referring you to a nutritionist, but when you go on dialysis you see me and when I walk out the door I send the dietician in, but I don't let you see her.
Paul:Is that what we're trying to change? How come they're not doing that?
Maurice :That's what we are trying to change because we're asking that question why don't you have a list of people? I mean, I don't care if it's just a piece of paper that you put 10 nutritionist names on it and their numbers and their emails, and you said here, here's a list of nutritionists. Begin to call them and find one that that you feel comfortable with, and and go to them and tell them that I sent you. I don't know why that can't happen.
Maurice :But I mean, you know, I've never seen a nutritionist and a nephrologist in the same office.
Ira :Sounds like we need to do some nutritionist nephrologist luncheons.
Maurice :Yes, we need to get together. Yeah, they need to get together, yeah, you know in my community.
Ira :I'm a little cocktail mixer. Let people meet each other.
Maurice :Exactly, exactly, you know, you know, have some potassium cocktails, whatever, but come together you know what I mean and come up with some ideas. But there's just this to say in my community there's a lady who is a renal nutritionist who has started her own practice. Encourage nutritionists to do that. Are renal nutritionists to start their own practice? Maybe they can work for one of these companies and then they can moonlight on their time off. They can do whatever they want and they can have their own nutrition.
Paul:How would they get to the pros to be able to see these patients if they're not already on the houses? How would that happen?
Maurice :That's going to be us, that's going to be their family practitioner.
Paul:So if a family practitioner feels, so we gotta.
Maurice :Yeah, yeah, if a family practitioner, yeah, the primary. If the primary feels strong enough to refer them to a nephrologist, then be educated enough to refer them to a nutritionist at the same time. Right, if I know, I'm sending you to a nephrologist and I know you're having kidney issues. I know you got diet issues, right.
Maurice :So I'm not you to a nephrologist and I know you're having kidney issues. I know you got diet issues, so I'm not just going to, I'm going to make two referrals out instead of one. I'm going to give you a list of nutritionists and you make a phone call, you know, but I'm going to encourage you to see a nutritionist Because that's going to be the way you can manage that, that, that kidney failure, that kidney damage from furthering itself.
Ira :So I'm going to switch it up real quick and just keep pushing this along so that we can get to the reality. But so for a person new to it, critical step what do they need to look for in terms of like their GFR? Like what is GFR? Let's talk numbers. What percentage? Like what does that look like? What are the percentages that are critical for people to pay attention to? Requests?
Maurice :yeah, I think the critical number and p you can, you can, you can step into this too as well, but I think the critical number that I've seen is 61, 61, yeah, 61 is actually stage two.
Paul:Is it?
Maurice :Yes, that's good to know and it's actually, and let me rephrase that so, actually, 61% is stage 3A. Okay, so the way dialysis function is separated now it used to be five stages, but what they've done is they've made their stage one, which is a hundred percent of kidney function. Then when you fall down into the 90 percentile 91, then you're in stage two. Then when you fall down to 62 61, you're in stage 3a. Then when you go into the 40s, your stage 3b. Then when you get into the 20s, you know low 30s, your stage four. And when you get into the 20s, you know low 30s, you're stage four. And when you get a 15%, you're stage five and you need dialysis. That's considered end-stage renal disease. The issue is yeah, go ahead. Am I pretty close?
Paul:You were right on it. It says stage one your GFR is 90 or greater. Stage two you're 60 to 89. That's mild kidney damage with a decrease in kidney function. Stage three is between 45 and 90. That's mild to moderate loss of kidney function. Stage three B that was three A, three B is between 30 and 44. That's moderate to severe loss of kidney function. Stage four is between 15 and 29. And stage five is less than 15 kidney function yes, yes.
Maurice :So so, with that being said, we, they know that if you're stage 3a and you change your diet right, you got about 70 chance of not going on dialysis. Right, let me tell you where the problem is. Nobody intervenes until you get a 20% or something.
Paul:Especially not the autistic.
Maurice :Right, so they're not even alarmed until you get to 37% or something. Right it just feels like they're waiting.
Ira :It feels like they're just waiting for you to come. It's like that goes in the book of.
Maurice :these are our future clients, some of them would even give you it's like that goes in the book of you know these are our future clients, right?
Paul:Yeah, and some of them will even give you a surgeon and give you access a graft. At what percentage? Reese Dude man, 25%, 30%. You can have the grafts for a year or two, but you already have your access.
Maurice :Yeah, they think that's being proactive. It's not proactive to change your diet, but it's proactive to set you up to have your access. Yeah, they think that's being proactive. It's not proactive to change your diet, but it's proactive to set you up to have dialysis, to have a port right. And listen, let me tell you about 60% of them.
Paul:Accesses don't work. That's terrible.
Maurice :Patients come in who've had an access for a couple months, and they come in and we can't run them.
Paul:The first day is it because the vein artery, vein system is inadequate? Is it because they're diabetic? Why would you? Why is that?
Maurice :we've never used it, we've never tested it, we don't know if it works right. So they bring them into us. They didn't put in a catheter, but they said but they had this thing in their arm three months, it should work. It should work. It should work. Have you used it? Have you used it? No, we haven't used it, but we think it'll work. We fill it. Oh yeah, okay, as soon as you put a needle in, they have an infiltration and arm blows up this big and they can't have dialysis. And it's their first day.
Paul:Well, I'm not you've never been there.
Maurice :You already traumat the first day you're already traumatized First day.
Ira :they won.
Paul:Wow. This is the reality of dialysis, though, bro.
Maurice :It is. I had a patient come in and the doctor said he's good to be cannulated and I said okay. And they said, maurice, you're skilled, you've been doing this for 25 years. We're going to let you do it. Okay, I went over and put the needle in the arm, blew up. I said this thing's not working. I listened to it, it sounded good and all that. But all of that can be there except when you put the needle in. It may not work for whatever reason.
Paul:Isn't a smaller needle? When you first start, don't you take like the smallest needle?
Maurice :Yeah, 17s yeah.
Paul:It's a little needle, that's still infiltrating.
Maurice :Yeah, because if it's a radiophilic, it's on their wrist right here and that bad boy is thin skin right there and it looks good. But as soon as you cannulate it it collapses. Like you're putting in an IV, sometimes it'll collapse and then you can't get it to work. Now, this is the best part. They sent the person back to the doctor. The doctor looked at it and said, yeah, well, I'm going to have to revise it. And he came back and I got the report, and the report said that when they ran the access and they looked at the blood flow rate of it, it wasn't adequate his statement to me was he thought it would work?
Maurice :he sent a patient to me. Was he thought it would work? He sent a patient to me? The report said it didn't meet the adequacy but they sent him to me anyway and he said, I think when all the smoke cleared, his statement was to me. I thought it would work.
Paul:That's terrible Reese At the expense of the patient. Who's out now? The patient traumatized, injured and deathly afraid.
Maurice :And the doctor came to me and said the doctor said, who's the one that cannulated so-and-so? This is before I found out that the doctor didn't get the right blood flow clearances after the surgery. I didn't know that, I wasn't privy to that information until later. The doctor actually told me that he don't want me cannulating his first time fistulas. So I've been. I think at that time I've been in dialysis about 25 years. He'd been a nephrologist for about three years. He says to me I don't want you to cannulate my first time fistulas anymore. Yeah, and then it turns out that when all the smoke clears, the doctor sent me somebody who wasn't even adequate enough for me to cannulate them. It was sort of like I was kind of set up right and the doctor still got paid for the.
Maurice :Right Now, the patient's got to go back and have another surgery and what we're seeing is that's about five times in one year.
Paul:That's terrible.
Maurice :So we got a 70-year-old lady who doesn't have very much circulation and they decided they're going to put a fistula in her arm. Let me just educate you a little bit. Fistulas are natural accesses. They take your veins and arteries and they tie them together and create this access underneath your skin for us to cannulate you with needles. They do that and that's got to happen. Naturally it takes about six weeks, 12 weeks to develop. They do all this and the lady can't really support that.
Paul:Is that Fishtailer First you're referencing. Yeah, that's the fish in the purse program she might have six surgeries in a year. Why would you use the patient's own vasculature?
Maurice :if she's compromised.
Paul:Why would you do that? Is it just a rule that they have to do that?
Maurice :Yeah, because it pays more.
Paul:Oh, don't do that.
Maurice :Follow the money A fistula surgery pays more than a graft surgery. It does.
Paul:And so they incorporated a mandate in dialysis that said fistula first. And us as practitioners are like why would you do that? Why don't we evaluate each patient individually? They're like no rules are rules. So even if the patient has, if they're diabetic, which means they're going to have compromised vasculature, if they're elderly, the heart function is minimal in the first place. And so if they fall into all of these situations, why would you put a fistula in somebody that you know is not going to work? Like Reese said, it's about this.
Maurice :Yeah, and it doesn't develop. They have a lot of trouble.
Ira :Are there doctors who do not follow that regimen that you can go to and find?
Paul:If they do, they won't be nephrologists for long Got it, it's mandated. It's long, it's mandated, it's mandated.
Maurice :And these aren't nephrologists putting in those accesses. Let's just say that these are vascular access surgeons who are mandated to follow the fistula first program. The nephrologist is just. You know, they wrote the orders to get the access put in but they don't. You know, typically they don't do the surgeries.
Paul:Got it.
Maurice :So you know, and it's.
Paul:I mean, it can be pretty ugly. The place of catheter is the best about it.
Maurice :Yeah, they can place the catheter. I mean, I've seen patients have their complete arm cut from the elbow and we really don't need to do that. But they'll cut their arm from the elbow and we really don't need to do that. But they'll cut their arm from the elbow to the wrist. Have you seen it? Where they get?
Paul:the staples. I've seen a lot of body surgeries, bro. I've seen body surgeries from day one.
Maurice :It can be, you know. And then there's some self-esteem issues with that, because if you wear short-sleeved shirts, then you can see these things on people's arms.
Ira :There's just a lot you know, especially for ladies. Yeah, so from where, like just from my perspective, you know, being the kind of on the kind of mindset holistic, like self-healing side, all of that is counterproductive to healing, right? Somebody's constantly thinking about, like how is this affecting me? Like it doesn't create an environment for healing. It doesn't create an environment.
Paul:So no, it's almost like yeah.
Ira :So, um, we've talked about a lot here at this point, you know. Talk about the trauma of it, I mean the. You know we've hit what three, maybe three of the 10 critical yeah, so we'll have to come back to it. But, um, just for the sake of um people being able to digest information and um, you know, kind of um, let's bring it to a bit of a close um, if there was. So we talked about get a second opinion, we talked about the numbers, we talked about man, the whole thing of um, you know fistulas and and like first time, like not being able to, you know, your arm blowing up. All that to me is just like mind blowing and I can only imagine.
Ira :That's what I mean, that's what I'm thinking about, right, and so you know. You talked about somebody who woke up 13 days later not knowing where they are, like hooked up to machines and what that does, right? So we're going to keep going, man. We're going to keep like giving people. We're going to keep giving people information so that it can be easier you know what I mean we're going to keep trying to find a place for people to find their power in their own process.
Ira :I appreciate you guys because, like I said, my sister is on dialysis Interesting Back insylvania getting ready to get back on a list for transplant but we'll talk about transplant as well right, how's it going?
Paul:how's it going for her overall?
Ira :good, you know just, I mean even just mentally. You know she was on peritoneal before, but she's had to be in a center, which she knows is not the best way. So that already is a mental strain on her. And so I can see that and she's a self-advocate she's the person that would take her fluids and put them in a suitcase, send them to Germany and get on a bus with an extra suitcase of her fluid so that she can do peritoneal in her hotel room. But now she's hooked up to a machine which is a bit depressing. Anyway, that's what I see. We'll get back to it in another episode. We'll let people digest this.
Maurice :What do you want to leave? Digest this today on our first chop. Yeah, I just think you know. Just always, you know, empower yourself. So when they give you a diagnosis, you know, you take that. I mean, you got to deal with that, you take it. You walk away from that and you say, okay, now my next step is I need to talk to somebody else and see what their you know, what their view is on what I've just received and and I think that'll and when you start solving questions for yourself, solving problems, you're going to continue to do that always.
Paul:That is just going to be the kind of person you become encourage you guys to really read this e-book because it is very it's very informative, it's very comprehensive and you will learn a lot from it. Right and we don't try to overwhelm you. It's a very comprehensive e-book. It's very it's very informative and, like he said, it's very empowering. You'll learn a lot, whether you're the patient or the family member or the practitioner. So we encourage you to get a hold and the book is free. Go for it.
Maurice :Yeah, we're giving you this. I mean you know we're going to give it to every community that wants it and wants to utilize it.
Ira :So show the cover one more time. 10 critical steps to take after an end stage renal disease diagnosis. So we touched on a couple of things today. We'll come back to it because it's all very important.
Paul:But come see us.
Ira :Come see us in the Facebook group.
Maurice :Yes, please do.
Ira :Our fine faces on the YouTube.
Maurice :Yes, we want to help you navigate this stuff. We want you to be empowered.
Paul:We are all over social media.
Maurice :Yes.
Ira :We are. I apologize because there's bugs out here. I've been scratching.
Maurice :That's all right, man.
Ira :We're going to do a show down there in Costa Rica, with you, we'll all be going to arms up. I'm just bragging a bit, but yeah, that's yeah, as you should man he's chilling in paradise yes, he is what you say.
Paul:You got papayas, you got mangoes, you got the real avocado.
Ira :Yeah, he got everything. I was like right here from the tree behind me man, come on, look at that that's real man.
Maurice :We're on our way, man shoot. I'm gonna get me a mosquito net and jump on a plane exactly, bring the mosquito net, for sure they do not play, they do not play or they do play, however you want to look at it however you want to look at it, yeah, however you want to look at it, yeah, all right, so we're going to say goodbye to the good people, right, you know.
Ira :Thank you for being here, for joining us, paying attention. I've learned a lot.
Paul:That's what this is about sharing information sharing recommendations, sharing experiences, sharing point of views, and all of this is an effort, like we said, to advocate for the patients, to empower the patients and their families so that, in the long run, you have more control over your destiny. Basically, absolutely.
Ira :That creates an ease and flow so that your body can do what it does like we all can heal, but you know, this all has to go together. So empowering folks. Alright, till the next time. Thank you guys peace and blessings fellas three kings, baby three kings.
Paul:Here we go with the triumvirate. That's Ice Cube right there.
Maurice :Three kings, baby Three kings.
Ira :That's Ice Cube right there Today was a good day. Today is a good day, until the next day, y'all be good.
Maurice :Peace and blessings.