What's the Deal with Dialysis?
A conversation about the kidneys and what happens when they fail.
What's the Deal with Dialysis?
Choose Your Transplant Team Wisely
A new diagnosis of end stage renal disease can feel like a conveyor belt: a rushed consult, a default clinic, a procedure you didn’t choose. We hit pause and hand you back the controls with three moves that change your trajectory: how to pick a transplant doctor with real outcomes, why cutting meat before your nutritionist visit lightens the load on your kidneys, and when to seek a second opinion without igniting referral turf wars.
We get candid about the forces you don’t see. Hospital call schedules quietly “assign” you a nephrologist. Clinic incentives can delay diet support until you’re already in the chair. Payment changes suddenly boost peritoneal dialysis offerings, even when PD could have fit your life months earlier. That’s why independent research matters: srtr.org for transplant program performance, hospital and university center data for physician experience, and clear questions that test how a doctor will coordinate your path to transplant, not just maintenance.
On the floor, details decide outcomes. Creatinine reflects meat metabolism and strain on failing kidneys. Needle spacing and angle influence clearance more than most patients realize. A skilled technician can recover precious effectiveness that a rushed stick erases. We talk through the art behind “good numbers,” how to ask for transparency in treatment notes, and why educated techs and curious patients make a powerful team. When you understand how incentives, staffing, and technique shape your care, you can spot shortcuts, request alternatives, and push for modality options like peritoneal dialysis that align with your goals and lifestyle.
If you or someone you love is facing dialysis, this conversation is your field guide to smarter choices: compare transplant centers, trim meat while protecting protein intake, and schedule second opinions on your own terms. Subscribe for more unfiltered, practical kidney care insights, share this with someone who needs it, and leave a review to tell us what you want covered next.
With hosts Maurice Carlisle and Ira McAliley
What's up, beautiful people? Back here with What's the Deal with Dialysis with Ira Makalilly and Maurice Carlisle. Today we're going to continue on the 10 steps that you can take when after you find out you're diagnosed with end stage renal disease. And Maurice is going to get into it. We're going to delve into a little bit of the perspective from a technician. Which Maurice is the master technician. And once again joining us today, we will have uh our good man Paul Terry, who brings the flavor to the to the situation. Absolutely. And we will get back to you right after this brief little introduction. And we are back. There he is, Paul Terry in the house. What's happening? What's happening? What's happening? So yeah, as I was saying, we are back to talk about the 10 steps. We're going to hit a couple three more. I have to excuse myself a little bit because my eyes are itching. So if I'm rubbing my eyes, it you know, it's all good. I'm still alive. I'll be fine.
SPEAKER_03:It'll be fine.
SPEAKER_01:And then I'll just be blinking a lot. But uh we're gonna get into it. You know what I mean? So uh we I think we did one, two, and three before. We're gonna get into number four, continue down a list. So, Mo, hit us with number four.
SPEAKER_00:Yeah, so number four of the 10 critical steps when you get that diagnosis that you're gonna need dialysis is to choose the most effective and experienced transplant doctor in your area. I do provide a place where you can go and see what doctors are you know listed as transplant physicians and see their history and stuff like that. That resource is srtr.org. And you can go there and see that. The reason why you want to do that is that you want somebody who's you know done some transplants to take care of you. And if they haven't done very many transplants, you know, there's a chance that you know you might run into some complications. So it's it's important to find somebody experienced. And it also teaches patients to do a little bit of research because it's really important that they take you know the lead on their disease and kind of do some research and stuff, and it'll get you know people into that mindset of like not being told something. But if you are told something, go back and research it and and and find some some real information that can help you move forward and get you to look up stuff for yourself.
SPEAKER_01:Right. So just in general, part of what we are doing here is empowering people to be an advocate for themselves. And that goes across everything in life, really. Right. Yeah, we're living in a world where there's a lot of misinformation, a lot of disinformation, people are telling you things, people are like experts, gurus, and you're you're the expert on yourself, right? Always. So, you know, my sister as an example, she took control of her renal, you know, end stage renal disease. And you know, what she did was worked for her life. It wouldn't necess wouldn't necessarily work for everybody else's life, and so that's what you're saying, Maurice, is find a doctor that works for you because you might find two doctors that look qualified, and then what what what's your choice, right?
SPEAKER_00:Right, right. And I I think the biggest issue is that when if you're in a hospital and you get this diagnosis, you're given a doctor.
SPEAKER_02:Right.
SPEAKER_00:If you're not in the hospital and you get this diagnosis, it's probably somebody you either have seen before or were referred to by your physician to go see. You're not making any choices. I mean, you know, this is somebody that you're given. So you need to be able to make a choice for yourself. And in order to do that, you need information. You need to go and see who in your area is doing what. And with that information, you can learn a lot. And so, you know, this is to be, you know, that's why it's like number four. Number one, of course, is to get a second opinion, but number four is to find someone in your area that you feel comfortable with and have a conversation with them. I've even included in the ebook some questions to ask that doctor. And so I just think it's important, it's just the first step of somebody taking control of their disease.
SPEAKER_02:Totally. Well, the more informed you are, the more empowered you are. And that's the mission of these podcasts and these discussions that we host, to get to empower you by informing you, because the more informed you are, the better choices you make and the more empowered you become.
SPEAKER_00:Yes, absolutely.
SPEAKER_01:So, yeah, absolutely. So, is there such a thing as being able to find like information from other patients? Who is there like a rating system? Is there a a place where you know people can make comments about their doctor or anything like that?
SPEAKER_00:Yeah, there used to be a place. And lately that I go back, I go back and check, and it's no longer listed. And I'm surprised that it isn't listed anymore. It used to be called the dialysis center tracker. And when you went to that tracker, it would tell you how many transplants were done, how many people had infections in particular centers, and you just take your zip code and put your zip code in, it would list all these things. I think now you can go through CDC and go to their website and you can put in information there, and then information will spit out. But I don't think it was as comprehensive as the dialysis center tracker. But in the case of a transplant doctor, those are that information is going to be probably at university websites and hospital websites where those doctors practice. I don't think transplant doctors usually have their own separate practice for transplant. I think they usually work at transplant centers. And I've I've never known of a transplant doctor to have like a separate, you know, office for just transplant. Usually they work within a system, and that's usually at a university hospital or even one of the other regular hospitals.
unknown:Got it.
SPEAKER_02:You know, it's interesting that you said is there a resource or a place where patients can go and recited one. Also, there was actually a website that was a very comprehensive and open forum. It was called renoweb.com. It actually had it was an open forum. They they had some for technical and technical practitioners like myself, biomeds, and they also had one for the patients, where, like you just said, Ira, people could air their grievances and you would get a whole lot of input from different sources from people all over the world. And that proved, I think I don't know why they got rid of it, but that was a very practical and beneficial resource for patients, you know, and patients' families.
SPEAKER_00:Well, that's interesting, P. I mean, they got rid of both of them. Yeah, they didn't. One you knew about, the one I knew about. Yeah, you know, that's quite interesting.
SPEAKER_02:Well, who knows? This may lead to make you go, hmm. Yeah, this may lead to the formulation of another one. Who knows? We're open, right?
SPEAKER_01:Right, right. I think that I think it's time. It is definitely time.
SPEAKER_00:Yeah, I think next time, before we have our next one, I'll look up and see if there's something to replace those. But the last time I checked, there wasn't. There wasn't anything.
SPEAKER_02:Well, you just gave me you just gave me an assignment because like you just said, I'm gonna research it as well. And yeah, just to check. If it takes for us to to reinvent or recreate another form that allows people a place to go, you know, like we just said, to get information to become empowered, let's do it.
SPEAKER_00:Let's do it. Yeah, yeah. Yeah, I think I mean, I think, you know, it was beneficial to patients, but a lot of patients didn't even know it was there. Right. You know, it was something that they just didn't kind of like announce. Like you didn't walk into the dialysis center and see a posting that says, hey, go to dialysis center tracker and you can get all the information on your center. Like, that's not how they do it. Like they created it, but then nobody knew it was there. I had to tell patients that it was there.
SPEAKER_01:And maybe that's why it went away because nobody was using it.
SPEAKER_03:Right. Yeah. Yeah.
SPEAKER_01:So then that leads to once it's there, how do you let people know? Which is part of what we're doing is educating people and getting the word out. But also to go to like the Kidney Foundation and say, hey, put this on your website, like or go, you know, there's probably a lot more forums now where people are talking about dialysis that you know that can be posted or that you know, ads can be run or something like that.
SPEAKER_00:Yeah, it's I mean, it's really interesting because I it doesn't make sense to keep people in the dark about these issues. And I don't know how come I mean, I don't know how come they, you know, it just seems that they believe that that's the way to do it, but it is not, and it's not beneficial to anybody when nobody knows what's going on. I mean, it helps no one, and I think people need to know, you know what I mean. I don't know why they feel like they gotta shove them in some kind of hole, but they are right on.
SPEAKER_01:Shall we go to number five? Number five. Reduce meat products until your nutritionist visit. Yes. So wait, can you forgive me?
SPEAKER_02:Could you repeat that one more time?
SPEAKER_01:What product is it kind of quick? It's reduced meat products until your nutritionist visit.
SPEAKER_00:Right, because I think if you're taking on all these, you know, if you're eating beef and you're eating meat and your kidneys are already not functioning at a high level, it just gives them more to have to filter. It just makes them work harder. And we know that. I mean, we know that if you know, if you're not eating lean meats, and at this point you don't know to eat lean meats, you're just eating meat. When you say lean, give me an example. Yeah, I mean, I think like if you were to get ground beef, you get, you know, 90% lean, 95% lean, you know what I mean? So most of the fat is is not in there, and that's that's what causes your kidneys to have to work harder, is like the fat and the byproducts of meat. Got it. So if you reduce that until you see no you're a nutritionist, which in the case of the nutritionist I met recently, who just you know, she supports you eating organic fruits and vegetables and stuff. And some of those fruits, I mean, some of those vegetables are gonna give you some protein. And before you see her, if you reduce your meat intake, you know, and then you see a nutritionist, it'll be a lot better off for you. Because your kidneys are gonna work very, you know, it's gonna be difficult for them to filter that those byproducts out if you're already, you know, at 20% kidney function. You're just you're just damaging your kidneys even further. You're you're rushing your time to get on that machine. Like you're shortening your, you know, your window if you continue to eat the way you've been eating that got you there.
SPEAKER_02:Would you recommend actually like fasting for me products until you see a nutritionist? Or you think that would that would help?
SPEAKER_00:I think so. I mean, I think that would help. And even if, you know, maybe you have a short conversation with nutritionists when you're making your appointment and say, hey, what you know, is there anything you recommend me do while I'm waiting for my appointment? You know, even asking that question can be, you know, helpful.
SPEAKER_01:So just for studying, just to make sure people understand, it's not reducing protein, period, it's reducing meat protein specifically, right? Yeah. So you still need your protein, you just got to get it from a different source.
SPEAKER_00:Other sources, yeah, yeah. And eventually when you do see the nutritionist, that that's the same advice they're gonna give you, too. Unfortunately, patients, you know, and and Paul, you can allude to this too. You know, that's not the conversation. The conversation is your kidneys are failing, we need to put an access in you so we can access your bloodstream. And those are all the conversations you're having. And if you do have a conversation about nutrition, it is increase your protein. They're told to eat more meat.
SPEAKER_02:To increase in an in an effort to increase their protein levels, yes, which is what you need to maintain your muscle.
SPEAKER_00:Yes, yes, because you're one of the tests that they run to find out if you are having problems with your kidneys is that they check your urine for protein. If you're if your urine's high in protein and you're spilling protein into your urine, they know that your kidneys are failing because your kidneys filter that out. And so then to just turn around, I mean, I don't even know why patients don't ask, like, why would I do that? Why would I increase my protein when you you know me that my protein is high in my urine, and that's how you found out that my kidneys is failing, they're not having that conversation with patients. Right. You know, and so we can have that conversation here where they can, you know, they can be alluded to, you know, hey, you got to reduce that until you get in there and get a real day-to-day plan and a, you know, a meal plan from a nutritionist, and you know, and they can look at your labs and see how high your protein is and all the all the stuff that's making up your bloodstream, and then they can give you advice from that. Until you do that, you just need to be in general taking on more plant protein and reducing meat proteins.
SPEAKER_02:And it's interesting because one of the markers, like you just alluded to and made mention of, is your creatinine levels. And the more meat that you eat, creatinine is a byproduct of meat metabolism. So you're gonna have high creatinine levels, and that's one of the markers that we gauge, that we use to gauge performance as far as dialysis is concerned. How efficiently we're removing waste products from the blood. And creatinine is a is a high mark. I mean, creatinine is one of the primary markers, primary molecules that we measure. And again, that is that creatinine is high on the list of meat products that are metabolized by the body. So that being said, um once again, you know, I'm always gonna plug fasting. I would I me personally, I would say I abstain from meat altogether. But the problem is people do not possess the strength of character to fast, especially. You've been eating meat all your life, and somebody comes along at 62 years old and says, Okay, Mr. Johnson, we need you to stop eating meat, you're not the chances of you doing it are very slim.
SPEAKER_00:Right. Yeah, yeah, yeah. I mean, it it's difficult. I mean, it's the corner you gotta turn. You know, hopefully we can get to people. You know, hopefully people see this podcast before they even get a diagnosis, right? I mean, the whole point is to have this conversation. I mean, if you had 50% kidney function and you reduce meat, you're gonna slow down that process and you're gonna stay at 50 for a longer time than you would if you just continue to eat the way you're eating. I think the first conversation any nephrologist should have or any doctor should have with a patient that they believe kidneys are beginning to fail is like you're it's it's your diet, man. It's your diet. And you know, I think sometimes the doctors have already given up on that idea that they can get people to change their diet, and I don't know why they would feel like that, but I think sometimes it's for profit, bro.
SPEAKER_02:There's everything we're talking about, and it's totally for profit.
SPEAKER_01:And it's the capitalistic society. I mean, and Maurice, you've talked about many times in the past that they like you can't even talk about a nutritionist, right? You can't even talk nutrition with the doctor there, they're not gonna have the conversation with you, right? Uh which is suspect to begin with, right?
SPEAKER_00:So well, I think the worst part was is when I realized that I don't know any nephrologist that has a relationship with a nutritionist, right?
SPEAKER_01:Stop me.
SPEAKER_00:I I just don't I I've never heard a doctor say, and that doesn't mean that it's not happening. We we sure would welcome a doctor telling us that he has nutritionists attached to his his private practice.
SPEAKER_02:If you're not in sports medicine, it ain't happening.
SPEAKER_00:Yeah, right, right, right, right.
SPEAKER_02:I can see that a physician to tell you about nutrition and really emphasize diet is sports medicine as far as my concern.
SPEAKER_00:Yeah, we need to adopt that same ideology in nephrology, right?
SPEAKER_01:So so from just the technician standpoint, right? So you as a technician being there in that space, seeing what's going on, and we've talked about this before, also is just you know, putting together the team, right? And so the technician is part of the team, a nutritionist is part of the team, a nephrologist part of the team, a nurse is part of the team, a social worker is part of the team, right? Uh I'm sure that financially it doesn't work from a business standpoint to have all those people together at the same time. Or, you know, but now with the advocate, you know, with Zoom, like there's ways if people really care to be able to do it, right?
SPEAKER_02:If you well, when you have care conferences, believe it or not, you actually assemble all of those people. That entire team that you just made mention of, you actually assemble them, you go over the patient's treatment plan, you go over their labs, you go, you basically assess their progress for X amount of time. Is it quarterly weeks that they do care conferences? Yes. Okay, yeah. And you discuss that. And then you're supposed to make a plan of action, a plan of correction. But like Marty said, the fact that the the biomed and the technician are so, you know, first, first, first root, first, what do you call it?
SPEAKER_01:First, not first respondents, but what they're the closest to the patient in terms of regularity.
SPEAKER_02:But we're not. Especially the biomed, because like I always tell people, if the chemistry is not right, if the water's not right, you don't get dialysis anyway. If they don't get good biases, needles, if the placement of the needles in that axis are inadequate, you're gonna get you're gonna lower the amount of clearance. The amount of effectiveness and efficiency is going to be diminished just off of the stick or the catheter. A catheter is very low in terms of getting you know, cleaning clearance, yeah, clearances. And again, if needle placement is not optimal, you're not gonna get the kind of that's why a technician is not a technician, is not a technician. A highly skilled technician, a highly skilled biomed is gonna make all the difference in the world in that particular clinic.
SPEAKER_00:Yeah, I mean, I think, you know, that's you're absolutely right, Paul. I mean, what we're seeing now is you you're having it's like max exodus. We've seen it, you know, here in the last five years of all the experienced technicians. So now you got younger people in there placing needle placements. You might not get as good clearances because they don't put needles as far apart. Because they're new, they go to places that they feel comfortable when they access somebody's arm. Yeah, and they'll stick at the same spots because they don't feel confident enough to move into other areas because if you miss, a patient could not have dialysis that day. Like if you infiltrate them and you don't have anywhere to go above the site, and we'll, you know, this is like lingo that you know most people won't understand, but we'll get to some point where, you know, if you watch the podcast enough, you'll understand what we're talking about. But at the end of the day, you know, needle placement has to be two inches apart. And sometimes you have access to that are only two inches long. And so that's why we those of us who are experienced like that.
SPEAKER_02:You got very you gotta be able to slang that needle, baby.
SPEAKER_00:Yes, yeah, and it's an art form, right? I mean, we talk about it, it's an actual art form. And if you don't know how to do that, if you're just gonna make a decision based on what's easier for you, so you don't have to sweat, then the patient is gonna suffer. The patient's gonna suffer with bad clearances. It's like they came to dialysis and they didn't meet their clearance. I mean, half of their treatment was for nothing. You see what I mean? So they're there for four hours, but they only got good clearances for two of those hours. The other two hours, they forfeited their clearance because of the placement. They don't even know it. They don't even know the patient don't know that. We know.
SPEAKER_02:And the technician is not gonna put it in the in the in the in the treatment notes. They're not gonna say, okay, this was a bad stick, this was inadequate, because that way when they go back to the care conference with the team involved, you can read the notes and say, Oh no, one of the clearances weren't good this day.
SPEAKER_00:That's why we didn't get our KT over V that mind.
SPEAKER_02:Nobody tells that, or you had a bad batch of bicarb, or you're something was bad with the solution. The pH was off, the pH was off, they're not gonna say even if the temperature temperature is off.
SPEAKER_01:Yeah, one degree. How much is the nephralgis involved or not part? Like not at all, not at all.
SPEAKER_00:Right.
SPEAKER_02:Now he's on the phone doing this.
SPEAKER_00:Yeah, he's trusting us to do that. He don't even know what the pH is on the machine, he don't know what that would be. He doesn't, he doesn't have any interaction with the machine, except he looks at the goal and see what we set the goal for.
SPEAKER_01:So this takes us to number six. We'll transition, but number six is don't ask a nephrologist for a referral. Because they don't know if you're gonna start a fight, you know, and they don't know the answer, like and they're not gonna get kicked out that crazy. Yeah, yeah. And so when you say that, and so when you say that, number six, don't ask for referral. Do you mean to another nephrologist, or do you mean to other care nutritionists who yes?
SPEAKER_00:So at number one, I said, get a second opinion.
SPEAKER_01:Right.
SPEAKER_00:A lot of people believe that they need a referral for pretty much anything that they do, and and a lot of times you do, but more and more now you're not needing referrals for stuff. But there's still this whole idea that, oh, I'm gonna ask this doctor to give me a referral to see another doctor. The problem is that you got two different nephrologists and they have a competitive spirit. I mean, they actually go into they actually go into hospitals about the money and compete. Yeah, and they compete. So, for example, a nephrologist takes, they'll take a weekend on call at a hospital, and they're all supposed to do this, they're supposed to rotate. And what happens is when I'm on call and I'm in there and somebody comes in there and they're sick, and then they find out after they looked at their labs, they say, hey, this person's kidneys are failing. So they're gonna call me because I'm on call. And they're gonna say, hey, Maurice, we got a patient here, needs nephrology. You wanna come in and see them? Sure. I go in and see them. And now I'm claiming them. They're my patient now. So when they go on dialysis, I need them to come to my center to have dialysis. When they want to see nutritionists, I need to come, you know, when they want to see nephrologists, they're gonna come to my office and talk with me. You know what I mean? I'm gonna schedule their surgery if they need to put it in access if we're at that point. If I need to talk to them about peritoneal dialysis where they can do dialysis at home, they're gonna have that conversation with me. But no nurses are gonna talk to them in the hospital because they're not allowed. So now the only information they're gonna get is from me, and I'm gonna give them limited information. I'm gonna give them just enough information for them to understand what they need to do. Then I'm gonna tell them what they need to do. And you need a second opinion at that, at that point. You need to get out of the hospital, go home, meet with your family, and say, hey, let's see if there's some other nephrologists in the area and let's get a second opinion. That's not to say that the guy in the hospital, you may choose to be your doctor. You may have liked him, you know what I mean? And you might feel comfortable with that doctor. But you do need a second opinion because sometimes doctors believe that you need something that you're not really actually needing at that very moment. And so you here you go in and get a catheter placed, and you get access placed in your arm, you know, two months later, and we find out you need dialysis a year from now. Whatever you're gonna have to get that access checked out every month, you got to maybe get that catheter pulled or flushed every week. You're gonna have to do things if you have those accesses. And you're not even using it yet.
SPEAKER_02:I got a question. Isn't there a hospital-based social worker that plays a part in you know, suffering and dishing out patients as well? Isn't there a hospital social worker?
SPEAKER_00:I've not seen that. So the social worker just comes because they want to give you support, you know. Are you having trouble understanding that you need dialysis? Are you going into depression? Are you, you know, responding negatively? The social worker's there for that, but the social worker don't refer no to you no doctors or none of that.
SPEAKER_02:You mean they're not supposed to?
SPEAKER_00:They're not supposed to. The good ones probably do. Okay, but there are some, you know, that don't feel comfortable doing that. I've never seen a social worker refer us to nobody.
SPEAKER_02:In a hospital?
SPEAKER_00:Yeah. I ain't never seen them refer to a nephrolog.
SPEAKER_02:Is getting good with the ICU nurses. That's why it's getting good with the social workers because they want those referrals.
unknown:Yeah.
SPEAKER_00:But if you're on court, you're gonna get them anyway, right?
SPEAKER_01:It sounds like a recruiting zone, like a recruiting zone. It's like, you know, doctor comes in on the weekend to like recruit. It's like, yeah, got another one, I got another one, and you can't, you know, it's like I don't know, it's like the lottery you know, the lottery for for it does, and then they get into an argument.
SPEAKER_00:So, perfect example. I fell into the hospital last month, and I saw so-and-so, and then I ain't come back for two or three more months. When I fall back in, somebody else was on call. That doctor sees me. He says, I need to see you in the office. You're like, okay. Then they find out I done went to this dude's office, and the doctor that saw me two months before that, three months before that, said, Oh, that's my patient. Right? Now you got the two doctors going back and forth. Well, I saw them first three months ago.
SPEAKER_02:That's real.
SPEAKER_00:That's real. It is real. And man, you know, I know it sounds crazy, but it's like, like you said, it's like I had the first draft pick. Yeah, yeah. You can't come back three weeks later and get that draft pick from me. You know what I mean? And so that's how they act. I mean, that's I mean, patients don't know that those doctors are on call. They just think, oh, that doctor works for the hospital and they refer me to him.
SPEAKER_03:Right.
SPEAKER_00:He may, he may not, listen, he may not work for the hospital at all. He has privileges in the hospital to be a nephrologist and see patients.
SPEAKER_03:Right, right, right.
SPEAKER_00:But he is not affiliated with that hospital whatsoever. Right. And the doctor has usually their own call for about two or three different hospitals.
SPEAKER_02:They don't call just one. That's why they spend so much time in their vehicles.
SPEAKER_00:On the weekends, they they get called out on the weekend to go see somebody. See, they're at home on the weekend, they're on call, but they're at home. They get the call. We got a we got a call from nephrology. Are you able to come in? So, yeah, you're you were on call, you need to come in to see this patient. Well, what's their creating and what's their what's you know, he's asking questions. Do I really need to come in there? Right, right. And then when he gets the answer, when they give him the the lab value, he goes, Oh, yep, I'll be right in.
SPEAKER_02:What you say that GFR was? What'd you say that was?
SPEAKER_00:I'll be right in, guys. Right? Wow, he don't have to be the best nephrologist in the city, he just has to be on call that weekend. He's got the luck of the draw. Wow. You know, he could be one that don't do no transplants, right? So when he gets you, he's like, Yeah, we eventually get you on that transplant list, but let's get your creatinine under control, let's do these things first. That might take a year because you're still eating beef, you still eating chicken, you still eating all these things. Yeah, you cramping on treatment, you because you're taking on too much fluid, you can't support that much fluid on. You still ain't seeing no nutritionist. Wow, you're not gonna see a dietitian until you on your treatment. You're not seeing no, you're not seeing no dietitian before you go on treatment. I don't care if it's a year before you go on treatment. If that nephrolis is talking to you, you ain't seeing no dietitian until you start your first treatment. Until the number because they know you're your numbers, your numbers matter. So now let's hook you up with the dietitian so we can get good numbers so we can get paid for your treatments. You're not talking to no dietitian before you see, before you get needles or before you connect it to that dialysis machine, you ain't talking to no deep dietitian or nephrolog or nutritionist. That's why I made it one of the most important things you got to do because you're not having that conversation till they got you on the treatment. Till they got you, baby. Look, the dietitian works for the clinic. Got it. So until you are member of that clinic, until you've been in there, till they got a chair for you and a time and a day for you to be on dialysis, you ain't talking to no, you ain't talking to no dietitian. Or what? Your numbers don't matter right now until we get you on treatment, till it matters, it matters when we get paid to do a certain thing for you. And we need a certain outcome. And so people were steered to accesses and different stuff based on outcomes, not because they need a certain access or that they need a certain dialysis, a form of dialysis, only because it's necessary for them to get paid. Got it. You know, nobody was getting. Well, let me just say this one thing and then we move on. But peritoneal dialysis, which your sister did, Ira, that wasn't a priority for dialysis centers.
SPEAKER_01:Right.
SPEAKER_00:Until the president signed a bill that said it's a priority.
unknown:Yeah.
SPEAKER_00:And we'll pay you the same amount of money for putting somebody for letting somebody dialyze at home.
SPEAKER_01:Yeah.
SPEAKER_00:Is we'll pay you to be in a center like the one behind me.
SPEAKER_01:That part. Yeah.
SPEAKER_00:You see a 40% increase in peritoneal dialysis. Wasn't nobody having no conversation with you about no peritoneal? Come on in here to hemodialysis, man. We'll get you on treatment. We'll let the machine go and do its thing. And then when you get on that for a while, then we'll talk about doing something else. But let's see how you do with this.
SPEAKER_01:We got to suck that money out of you.
SPEAKER_00:Oh, yeah. You cramping, you're not following the diet, man. You're not a you're not a good candidate for PD. We're gonna keep bringing you in here until you manage your diet a little better, until you do this, do that. You're non-compliant, you're gaining too much weight, you drink too much fluid, you're doing this, you doing that. Now all of a sudden, they're pushing you back further. You're not on the transplant list either. Guess what? You don't manage your fluid good enough. You're not a good candidate for transplant. But maybe in five years you will be. Now all of a sudden, you you ain't even getting offered transplant. You can spend your next five years, three days a week, going into that treatment. And there's chances are that out of the five of you that started, in five years, one of you gonna be left. Out of the five.
SPEAKER_01:That's the numbers, baby.
SPEAKER_00:That's the numbers. Got it.
SPEAKER_01:So just to kind of wrap it up, we hit three different points today. The first one, number four, was reminder.
SPEAKER_00:Yep, choose the most experienced transplant doctor in your area.
SPEAKER_01:Got it. And then the second one was the meat protein, don't have meat protein.
SPEAKER_00:And the third one.
SPEAKER_01:Yep. Don't ask your nephrologist for a referral, which we just to another nephrologist because you're gonna start a war.
SPEAKER_00:Now, let's talk to technicians just briefly here. This came up in me and one of me and Paul's conversations. And we saw about technicians, and we were like, you know, how do we how do we get technicians to understand this art form that they've become a part of? And that it is an art form, and that they've been tasked to, I mean, to do what they're they're supposed to do and what they've been asked to do as a as a patient advocate, somebody who manages patient treatments, they're gonna be in, they're gonna be in a tug of war with their clinic and with their bottom line. There's no there's no doubt about it. There's no other way to be effective as a tech without being in contention with your clinic, because your clinic has a goal and you have a duty, a responsibility to these people. Your clinic has a responsibility to bottom line. That's why they need you there because you need to tip the scales for them to balance out the scales. And if you're not a strong technician, you're gonna get bullied by your nurse and your doctor. You're gonna be bullied by your and by your facility manager. Oh, you're gonna get bullied if you don't beat that bottom line, we get ready to bully you, man. Like you can't put the patient, you can't put the patients before the money. Or you're gonna have a problem. So this is what I want to say to technicians. If you're a strong tech and you do, you need to, you need to care, first of all, about the patients you're taking care of. But secondly, you need to understand the environment that you're in. You need to recognize that the more and more you advocate for your patients, the more and more you'll be, you're gonna be in contention with your clinic. Unfortunately, this is the narrative that you you're gonna be in. If you stay longer than two years in the clinic and you're doing these kinds of things, your time, your days are numbered. You need to not stay in the clinic longer than two years. And I hate to say that because you're gonna become attached to your patients and they need you. But at the same time, after two years, you're gonna be less and less effective because of your stance. Wouldn't you say, Pete? What's your take on that?
SPEAKER_02:No, I agree. But I also think speaking to technicians specifically, the more you educate yourself, the more you can educate that patient. Which goes, which goes back to our original point. The more informed they are, the more that they can advocate for themselves. So, you know, I'll give you an example. The kidneys are so vital to bodily function. They they take care of water balances, they they remove waste, maintain electrolytic balances, they do acid-based, they balance acid-based, they balance acid-based.
SPEAKER_00:I was gonna say blood pressure.
SPEAKER_02:Yeah, they they they produce hormones that regulate blood pressure, and they also produce hormones that stimulate red blood cell production. So when your kidneys fail, you're losing, you're losing all of that. And that's why, like we say, the more meat you eat, the more your acid content, your rea uric acid content increases, the less effective your bodily function, your systems become. And here comes all that mucus, which again that's another subject. But once again, as a technician, we we it behooves you to educate yourself about your job, what all it entails, and how you can make it better, and how you can educate these people in language terms. You know what I mean?
SPEAKER_00:Yeah, yeah, because you spend a lot of time with them. I mean, we spend more time with them than anybody.
SPEAKER_02:Yeah, yeah.
SPEAKER_00:So we have access to them. And I I think it is important for technicians to educate their self. I mean, that that is a great point. I mean, I never saw, you know, I saw the first one of the first documentaries because of Paul. What's the new? It was called uh uh Yeah, Who Shall Live?
SPEAKER_01:Oh, yeah, yeah, yeah.
SPEAKER_00:And I mean it was yeah, it was way back in like the 65. I think it was like 1965. That was one of the first things that you showed me, which kind of, but technicians have, I mean, the new technicians, probably 90% of them never heard of that.
SPEAKER_01:Right.
SPEAKER_00:You know, that there's nobody in the center that's gonna say, hey man, when you go home today, look at this documentary so you can inform yourself. Those technicians are they're flying under radar themselves. They're trying to, you know, do whatever they can do. Some of them are there to do a job, some of them are there to be patient advocates. They have to decide what their role is in the center.
SPEAKER_02:That's real.
SPEAKER_00:Yeah, but if you take care of somebody, if you begin to take care of patients in the center and you begin to care about them, you're you're gonna arrive at the same thing me and Paul arrived at. Sooner. You're gonna be that person, you're gonna get there. Some takes longer than others, others take a shorter time.
SPEAKER_02:If you have a moral compass.
SPEAKER_00:Yeah, if you have a moral compass, you're gonna end up at the same place me and Paul are at. So I like to tell technicians, don't stay longer than two years because you got a target on your back. And I don't know if technicians, when technicians watch this, they can hear this, but you get these raises based on the percentage of your income. So say you get a two per 2.5% raise. That amounts to 15 or 25 cents after a year's work, man. Okay, you yeah, but when you leave a center after two years and go to another center, you can negotiate anywhere from two to five dollars.
SPEAKER_02:Exactly.
SPEAKER_00:Right? So all of a sudden, you're you're being paid for the for your expertise, you know. And I hate to say that, I, you know, but if you stay, they're gonna treat you bad and they're not gonna pay you. And I hate to say that, but that is the dynamic that you're in. That's the five years when you come back to that clinic, you're gonna be making ten dollars more an hour. If you had to stay, you would have got two and a half dollars more an hour after the five years that you in the next 10 years that you stayed there. You know, and so you you I mean, you know, you're gonna have to, you're gonna have to move. And you're gonna have a target on your back if you don't. And so, I mean, it could it could cost you, you could be fired and go so you know, then you'd be forced to go somewhere else. So I just want to tell technicians that it's important for you to educate yourself. You're not gonna get educated in the center in that way, but then your experiences are gonna educate you, but you need to be in a center for some years. I mean, I think it takes five years to be a great tech. What do you think, P?
SPEAKER_02:At least, in my opinion. I mean, some people come from other, you know, medical fields, other backgrounds that actually prepare for this. So their skill set may are they may have an advantage based on prior knowledge and prior experiences. But for the most, just like a biomed, I don't think you should be a biomed until you've been a technician for at least two years.
SPEAKER_00:Yeah, yeah. And those are good recommendations, people.
SPEAKER_02:You're not gonna know what you're doing.
SPEAKER_00:Yeah, right.
SPEAKER_01:Yeah, well, we're gonna wrap it up.
SPEAKER_00:Thank you guys. Absolutely.
SPEAKER_01:Guys, come back, stay tuned, you know, follow what's the deal with dialysis podcasts. There's go to go to the podcast, look at other subjects, you know, there's different things for different people. We're trying to hit it all as it comes up and as we think it's important. But first and foremost, you know, and at the baseline, be an advocate for yourself, be educated, you know what I mean? And you know, inspire someone else to do the same. You know what I mean? That's the only way we're gonna change things. Absolutely. So with that, we're gonna say peace, y'all. Peace, guys. Until we come back again. Yeah, be well.
SPEAKER_03:Be well.