Episode 1: Unlocking the Challenges of Dialysis Through Maurice's Lens

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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.

With hosts Maurice Carlisle and Ira McAliley

Episode Transcript

Speaker 2 (00:17):
This is Ira McAlely, maurice Carlisle, and we're
digging into what's the dealwith dialysis.
We're trying to educate people,trying to educate ourselves on
some of the issues around.
I myself not being from thedialysis world, being a

(00:40):
filmmaker working in Hollywood,having people in my family have
beyond dialysis and havingfriends that have had to deal
with kidney issues I am kind ofnot a blank slate, but I
definitely can be educated,maurice.
You know, as we've talkedbefore, we go back a ways.

(01:02):
Maurice is a technician in Ohioand his heart has brought him
to wanting to do something aboutwhat's going on in the field
that he works in.
So Maurice set it up.
First of all, let's tell thepeople just in general once
again, what is dialysis?

Speaker 3 (01:22):
Yes, absolutely.
Thank you, Ira.
Dialysis is for patients whohave end-stage renal disease.
Their kidneys no longer filtertheir blood and they hold on to
all their impurities because ofthat.
So what happens to a person whois not having dialysis but

(01:45):
needs dialysis, and they may notknow that they need it?
They have symptoms likeswelling of the ankles,
shortness of breath, becausetheir bloodstream has so many
impurities in it that the redblood cells don't survive, don't
carry oxygen around theirbodies, so they end up short of

(02:06):
breath, stuff like that.
So what we do in dialysis is weaccess their circulatory system
with cannulation, with needles,and then we connect lines to
those needles and we take bloodfrom their.
We move blood from their bodythrough this tubing and through

(02:26):
an artificial kidney, and thatartificial kidney does not work
as well as a kidney does, but itis adequate in pulling
impurities out of theirbloodstream so that they so
someone who would come intodialysis short of breath four
hours later leaves dialysis ableto breathe.

(02:47):
They may come in with swollenankles in most cases and if
they're not, you know,chronically continuing to have
those swelling of the ankles.
But in many cases they leavedialysis with ankles that are
normal, that are not swollen,and so we basically do what the

(03:09):
kidneys do with an artificialkidney connected to a machine,
and we basically filter theirblood.
And so that's, you know, thelayman explanation of what
dialysis is.
There's a lot of componentsthat you know work within that
that we'll get to at some point,but just to give a

(03:30):
generalization of what dialysisis, that's it.
We use artificial kidney and wefilter the blood Right on.
That's great.

Speaker 2 (03:40):
Cause that's what we, you know we are aiming to do
here is to take something that'sreally clinical, that's very
scientific, and you know youbeing you, me being me you know
the fact we chop it up, we talkabout things, you tell me the
experiences that you've had inclinics and with people like to
humanize it and, and you know,you know if that we can just

(04:02):
chat about it, and so thank youfor breaking it down like that,
because that makes sense to me.
You know what I mean.
Like all the like levels of pHand all you know all that stuff
is just like whoa, I don't knowwhat.
That is Right, so it's supercomplicated, but but the simple
part of it is number one yourkidneys purify your blood.

(04:23):
When they're not working, yourblood becomes toxic, I guess.
Right, and then, and then youneed to go on dialysis so that
you can live right.
So that that's the thing.
So about like all right.
So we've talked before about youknow the fact that you see that
people are coming in, that youknow that you love, and they

(04:45):
don't know that they're headedthere.
You know they don't know that.
You know they don't know thesigns, 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 aresome of the things that you
think need to be addressed thatpeople need to understand, so

(05:07):
that we can get to a place wherewe can affect some change?

Speaker 3 (05:11):
Absolutely One of the biggest things is you don't
have any symptoms.
Ira, you know, diabetes issimilar in this way, because a
person could be walking aroundwith you know a very high blood
sugar and not know it, and orhigh blood pressure and not know

(05:32):
it.
And dialysis is I mean, kidneyfailure is similar to that.
You don't have any symptomsuntil you're in the very late
stages.
When you start having symptoms,you know you're very close to
needing dialysis and so anythingbefore that, you know, you
really don't feel any different.
You know, that's one of thethings that patients tell me.

(05:55):
You know, I had no clue that mykidneys were failing.
I mean, I, you know, I've evenhad patients tell me when they
come into dialysis, they're toldthat they need dialysis and
they're coming in for theirfirst treatment and or maybe
even their second treatment.
They still aren't convincedthat they need this process, and

(06:16):
the biggest statement that Ialways get is you know, I still
pee, right, I still urinate likeI normally always did, and you
know the answer is is that, eventhough you're urinating, your
kidneys still may not befiltering your blood adequately,
and that's a very complicatedthing to tell someone when they

(06:40):
don't feel any different, youknow, and so you know I can't
tell them, you know how theyshould feel or what their body's
doing, but I can see it in thelab results that you know their
kidneys aren't functioning atthe level they need to function,
and so that's.
The first thing is getting overthat whole idea that you know a

(07:01):
person may not need dialysis onemay in fact do.
That's a big thing.
The other thing is justunderstanding the stage is a
kidney failure, so that you canactually have a conversation
with your family doctor, becauseuntil you are at a critical

(07:22):
stage in kidney function, yourfamily doctor is not referring
you to a nephrologist.
Who is the specialist, who'sthe guy who can tell you that
your kidneys are working at whatlevel or not.
And so your family doctor'skind of like that first
responder.
He's the first person who'sgonna notice that your kidneys
aren't functioning well.

(07:43):
And what I'm finding over theyears by talking to patients,
this isn't anything that you'regonna find in a book or this
isn't anything you're just gonnaask your doctor.
This is something that I'veseen over years and years and
years happening and I was ableto identify this, and what we're
finding out is that familydoctors are not really

(08:05):
well-versed because they're notspecialist in kidney function
and so they're not super, superwell-versed in what, you know, a
person needs to do before theygo on dialysis or how to slow
down that process of kidneyfunction failure.
And what we see is doctors arefinding their patients might be

(08:28):
swollen at the ankles, theymight be a little short of
breath, and what doctors areprescribing is diuretics, and
those are medications thatpromote urinating.
They pull fluid out of the bodyand into the system where a
person would just urinate thosefluids out.
And so we're finding out thatfamily doctors are unfortunately

(08:51):
trying to doctor that issue,which is kidney related, but
they believe, you know, thosediuretics do work for a while.

Speaker 2 (09:04):
But it's dealing with the symptoms.
It's not really dealing withthe root cause, right?

Speaker 3 (09:08):
Absolutely.
We're dealing with the swollenankles and the shortness of
breath, right?
I mean we're dealing with thosespecifically by giving someone
a diuretic that has 50% kidneyfunction or 30, 40% kidney
function.
That's going to work.
I mean that patient's going tourinate more, their ankles
aren't going to be swollen andthey're not going to be short of

(09:30):
breath, and maybe that'll workfor three or four years.
But when we get to thatfour-year mark the kidney
function is still going down.
Now they're at 20% kidneyfunction.
Now the diuretic doesn't workand they probably are taking the
highest amount of diureticsthat they can take, because over

(09:50):
those four years the doctorsincreased it.
As they're, you know, theystart noticing a little bit of
shortness of breath or a littlebit more swelling in the ankles.
Every time they see that, theysay well, you know, this
diuretic start working.
We're going to increase thedose until they get to a maximum
dose and then it isn't working.