March 6, 2024 • 12 mins
Did you know that the choices you make today can significantly alter the course of your kidney health tomorrow? As someone who has witnessed the ebb and flow of kidney function over nearly two decades at a dialysis center, I'm here to take you through the lesser-known impacts of medication on renal health and the pivotal role that stage three A kidney failure plays. With the emotional weight of healthcare work as our backdrop, we delve into the personal connections that not only shape patient care but also the caregivers' experience. It's not just a discussion; it's a gateway to understanding how a proactive approach and timely lifestyle adjustments can transform the trajectory of kidney disease.
This episode also sails into the stormy seas of the healthcare industry, where the pursuit of profits often overshadows patient care. Through heartfelt conversations with colleagues nationwide, we confront the inner turmoil healthcare professionals face, torn between their healing aspirations and the pressures of a system skewed towards the bottom line. We bring to light the stark contrast between nonprofit and for-profit healthcare models and their influence on the quality of care. By fostering a dialogue about these critical issues, we're not only peering into the heart of modern healthcare challenges but also seeking pathways to positive change and better patient experiences during the most crucial stages of kidney failure.
With hosts Maurice Carlisle and Ira McAliley
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:10):
until then.
Speaker 2 (00:20):
Bite FX Day Sek please.
Speaker 3 (00:23):
Then I don't encourage you to.
Not that I know of, but theydon't promote healthy kidney
function.
Speaker 2 (00:31):
Right.
So I was curious because youknow how you hear the commercial
and you hear, like you know,commercial is like the side
effects and like some of them islike maybe suicidal, maybe this
, maybe that, and it's just likewait a minute, like why would I
ever want to take that?
So that's why I asked thequestion.
(00:51):
But to get back to what you'resaying is they're on diuretics
basically, which is like a bandaid for like a gash right, which
is just kind of like you knowstopping stuff for a minute, but
it's still, you're stillheading down the same road.
It's not changing the direction, it's.
You're not.
You're not getting on adifferent road to go to a
different place, you're stillgoing to the same place.
(01:13):
You just might be in the, youknow you might be in the more
comfortable car getting there,right but you're still going to
end up in that chair, right?
Speaker 3 (01:23):
You're still going to end up with somebody like me
putting you on a machine andmanaging your treatment and
you're going to be beholding tothat machine to keep you alive.
And so you know that's the badpart.
And because I have been dealingwith patients and I've done
this for so many years, Istarted seeing that trend.
(01:45):
This is like again.
You know and I spoke about tothis before you know, somebody
who's in dialysis for 10 years.
They're not going to recognizethis, because I stayed at one
center for 19 years, I was ableto see it, but I don't know that
my colleagues see this.
I don't know if they'verecognized this.
(02:05):
And that's one of the thingsthat you know we'll do here is,
we'll talk to some of mycolleagues, some of those people
that I, you know, met over theyears, that are in different
parts of the country, and see ifthey recognize this, as I did.
But for the most part, you know,dialysis technicians either,
you know, leave a center after acouple of years and go to
(02:26):
somewhere else because they wantto make more money, or that
they, you know, maybe theirfamilies relocate, they move to
a different city.
Maybe they don't work indialysis anymore.
Maybe, you know, they didn'tlike the experience.
You know, sometimes you know ifyou're just looking for a job,
this probably isn't it, becausethis is about taking care of
(02:50):
people.
And if you're just looking fora job, this will get too intense
for you.
This will get too personal foryou.
You might not want to be a partof this and that's what kept me
here.
Was that personal, you know,interaction with my patients.
I felt like I was doingsomething good and, you know, I
think all healthcareprofessionals should feel that
(03:11):
way about being in healthcare.
But, to be honest with you,that is not the case for
everyone and you know we have torespect that.
But some people need a job andif they come into this looking
for a job, this is gonna be waytoo personal.
This is gonna require too muchemotion for someone who just
wants to work at a job and gohome and not take it with them
(03:34):
because, believe me, they'regonna build relationships in
this process and because ofthose relationships I was able
to identify these issues.
Without you know, withoutbuilding those relationships,
those patients couldn't havetold me what they told me.
That allowed me to connect thedots Right.
Speaker 2 (03:53):
So, in that, not to cut you off Absolutely, so just
like.
So what was I gonna say?
So it's a complex issue.
It's not like there's one thingthat needs to be corrected.
I mean, you've seen the biggerpicture.
You've seen that there is, youknow, there's almost like a
cocktail of things that could bedone, that could make things
(04:15):
better.
Speak to some of that, speak tosome of the issues that we're
gonna deal with, some of thethings that we're gonna look at
that we can, you know, maybeaffect some change here, maybe
affect some change here.
Maybe put some people togetherto have conversations Like what
are some of those issues that wecan deal with so that people,
like, have a better experience,you know, in the stages of
(04:40):
kidney failure as well as in thetreatment.
Speaker 3 (04:44):
Yeah, so one of the things that has to happen and I,
you know, I read an articlerecently maybe not recently, I
think this article is about ayear ago but there's an article
that talks about the 10 thingsthat nephrologists wish family
practitioners knew, and theseare things like the you know the
(05:04):
five stages of kidney failureand let's just talk about those
just really quickly.
So one of the things is thatyou know there's these stages of
kidney failure and when you getto you know there's stage one,
which you know.
You have kidney functionbetween 190%, and that's a
person whose kidneys arefunctioning at a high level.
(05:25):
And then you're gonna have astage two where kidney function
is between 60 and 80% and again,in these two stages you don't
see any symptoms.
I mean, you feel fine, yourlevels of creatinine in your
bloodstream are fine, youralbumin is fine, which is
(05:46):
protein, which is huge indicatorthat your kidneys aren't
functioning correctly.
When you have high levels ofprotein in your urine and that
can be done at your doctor'soffice when you do a urine test,
when they do your yearlycheckup, they can see if you
have protein in your urinespilling into your urine.
That tells us that your kidneysaren't functioning correctly.
(06:07):
Then there's stage three A,which is 45 to 59% kidney
function.
Now we're getting into an areawhere we can affect change.
If we change our diet at thisstage, if we are more cognitive
about what we're eating andthinking about how that can
(06:29):
affect our kidney function, wecan stop kidney failure or slow
it down at that point.
And so that's a pivotal pointfor me.
I mean, I think we've talkedabout it before, but I've
created a class that I wanna goaround and teach members of the
community to teach this classand I in fact wanna teach that
(06:52):
class to them.
And three A is where that classhas to happen in the equation
of kidney function.
If it happens after that, it'snot as effective.
I know that when a patient getsto stage three B, which is 30
to 44% kidney function, thatthere may not be a time to turn
(07:16):
it around, that our time isshort, because when a patient
gets to stage four, which is 15to 29% kidney function, they're
gonna go into Alice's Ira,they're headed there and they're
not so far off future, and sothose are just.
(07:38):
I mean, that's just one thingthat I wish family doctors were
aware of.
So how we tackle those issuesis with the class.
We need to be able to identifypeople who are at stage 3A and
we need to bring them to a class, and that's gonna have to
happen through familypractitioners.
The nephrologists hasn't seenthese people yet.
(07:59):
They haven't even been referredto a nephrologist yet.
They're not even talking aboutdialysis.
They've not even beenintroduced to the idea that
their kidneys aren't functioningat a certain level and all
these people fall under what'scalled chronic kidney disease,
which is not is right before youget to end stage renal disease,
(08:20):
and so all these people areconsidered CKD patients.
They're not having thatconversation with their family
doctors at all.
Family doctors aren't referringthem to nutritionists.
In fact, when patients get totheir nephrologists and are
referred to nephrologists atstage 4 and 5, they're not even
(08:44):
being referred to a nutritionist, and so those are just issues
that I think that we need totighten up on.
That we can fix, but creating aclass for me was one of the ways
that I could, that we couldaffect change and we could begin
to have this conversation, andthat's what needs to happen.
That conversation needs to behappening at stage 3A and that
(09:09):
conversation is not happening.
We know that because when Imeet these patients in dialysis
and it's their first day theystill haven't had the
conversation, and we're maybe 10years into their disease, ira.
And so that's what havingconversations with these
patients was so important to me,because I thought I was just
(09:31):
getting to know them, but theyhelped me connect the dots.
I didn't know that I would endup here.
I had no clue.
I just thought I was doing thething that human beings should
be doing, and when they'retaking care of somebody is
getting to know them and havinga conversation with them, and
over the years, their storystarted to link.
(09:52):
I started to see reoccurringelements in each of these
people's stories, and that'swhat began my journey in trying
to figure out how to connectthose dots, and this is what
we've come up with.
Speaker 2 (10:07):
Right.
So the other side of it.
So that's you dealing with thepatient and all the things that
are physically going on with thepatient, but in that image
behind you, it's like I'm alwayslooking at.
That's the system, right Is theclinic and there's like it's
big business.
You know what I mean.
(10:27):
Like a lot of our healthcare, alot of our issues, cancer.
You know what I mean.
The COVID like people aremaking big money off of people
being sick, right, yes, and soyou're faced with someone who
you're, as someone who caresabout the patient in a system
that isn't necessarily alwaysabout the best care for the
(10:48):
patient.
It's about crunching numbersand it's about managing a system
, right.
So talk to me about the systemthat you're a part of without
getting yourself in too muchtrouble.
But I know that that is part ofwhat drives you is the
frustration of dealing with asystem that isn't always about
the patient.
Speaker 3 (11:10):
Yeah, this is the toughest part.
I mean, I think you know takingcare of the patients and caring
.
You know, certainly I get paida salary to do that, you know,
we all know that healthcare is anecessary thing.
One of the things that was veryilluminating to me is that I
(11:30):
was working in the system beforeit changed over to a corporate
model.
So again, that allowed me somevantage point that maybe others
don't have, Because I worked inthis system when it was a
nonprofit, when, primarily, mostof the companies I would say
90% of the companies werenonprofits.
(11:54):
And because they werenonprofits their goal wasn't
profit, their goal was toprovide a service and they were
compensated for that service.
Speaker 1 (12:05):
Najib Ayidaniways, head of começar training, first
retired.
until then.
Speaker 2 (00:20):
Bite FX Day Sek please.
Speaker 3 (00:23):
Then I don't encourage you to.
Not that I know of, but theydon't promote healthy kidney
function.
Speaker 2 (00:31):
Right.
So I was curious because youknow how you hear the commercial
and you hear, like you know,commercial is like the side
effects and like some of them islike maybe suicidal, maybe this
, maybe that, and it's just likewait a minute, like why would I
ever want to take that?
So that's why I asked thequestion.
(00:51):
But to get back to what you'resaying is they're on diuretics
basically, which is like a bandaid for like a gash right, which
is just kind of like you knowstopping stuff for a minute, but
it's still, you're stillheading down the same road.
It's not changing the direction, it's.
You're not.
You're not getting on adifferent road to go to a
different place, you're stillgoing to the same place.
(01:13):
You just might be in the, youknow you might be in the more
comfortable car getting there,right but you're still going to
end up in that chair, right?
Speaker 3 (01:23):
You're still going to end up with somebody like me
putting you on a machine andmanaging your treatment and
you're going to be beholding tothat machine to keep you alive.
And so you know that's the badpart.
And because I have been dealingwith patients and I've done
this for so many years, Istarted seeing that trend.
(01:45):
This is like again.
You know and I spoke about tothis before you know, somebody
who's in dialysis for 10 years.
They're not going to recognizethis, because I stayed at one
center for 19 years, I was ableto see it, but I don't know that
my colleagues see this.
I don't know if they'verecognized this.
(02:05):
And that's one of the thingsthat you know we'll do here is,
we'll talk to some of mycolleagues, some of those people
that I, you know, met over theyears, that are in different
parts of the country, and see ifthey recognize this, as I did.
But for the most part, you know,dialysis technicians either,
you know, leave a center after acouple of years and go to
(02:26):
somewhere else because they wantto make more money, or that
they, you know, maybe theirfamilies relocate, they move to
a different city.
Maybe they don't work indialysis anymore.
Maybe, you know, they didn'tlike the experience.
You know, sometimes you know ifyou're just looking for a job,
this probably isn't it, becausethis is about taking care of
(02:50):
people.
And if you're just looking fora job, this will get too intense
for you.
This will get too personal foryou.
You might not want to be a partof this and that's what kept me
here.
Was that personal, you know,interaction with my patients.
I felt like I was doingsomething good and, you know, I
think all healthcareprofessionals should feel that
(03:11):
way about being in healthcare.
But, to be honest with you,that is not the case for
everyone and you know we have torespect that.
But some people need a job andif they come into this looking
for a job, this is gonna be waytoo personal.
This is gonna require too muchemotion for someone who just
wants to work at a job and gohome and not take it with them
(03:34):
because, believe me, they'regonna build relationships in
this process and because ofthose relationships I was able
to identify these issues.
Without you know, withoutbuilding those relationships,
those patients couldn't havetold me what they told me.
That allowed me to connect thedots Right.
Speaker 2 (03:53):
So, in that, not to cut you off Absolutely, so just
like.
So what was I gonna say?
So it's a complex issue.
It's not like there's one thingthat needs to be corrected.
I mean, you've seen the biggerpicture.
You've seen that there is, youknow, there's almost like a
cocktail of things that could bedone, that could make things
(04:15):
better.
Speak to some of that, speak tosome of the issues that we're
gonna deal with, some of thethings that we're gonna look at
that we can, you know, maybeaffect some change here, maybe
affect some change here.
Maybe put some people togetherto have conversations Like what
are some of those issues that wecan deal with so that people,
like, have a better experience,you know, in the stages of
(04:40):
kidney failure as well as in thetreatment.
Speaker 3 (04:44):
Yeah, so one of the things that has to happen and I,
you know, I read an articlerecently maybe not recently, I
think this article is about ayear ago but there's an article
that talks about the 10 thingsthat nephrologists wish family
practitioners knew, and theseare things like the you know the
(05:04):
five stages of kidney failureand let's just talk about those
just really quickly.
So one of the things is thatyou know there's these stages of
kidney failure and when you getto you know there's stage one,
which you know.
You have kidney functionbetween 190%, and that's a
person whose kidneys arefunctioning at a high level.
(05:25):
And then you're gonna have astage two where kidney function
is between 60 and 80% and again,in these two stages you don't
see any symptoms.
I mean, you feel fine, yourlevels of creatinine in your
bloodstream are fine, youralbumin is fine, which is
(05:46):
protein, which is huge indicatorthat your kidneys aren't
functioning correctly.
When you have high levels ofprotein in your urine and that
can be done at your doctor'soffice when you do a urine test,
when they do your yearlycheckup, they can see if you
have protein in your urinespilling into your urine.
That tells us that your kidneysaren't functioning correctly.
(06:07):
Then there's stage three A,which is 45 to 59% kidney
function.
Now we're getting into an areawhere we can affect change.
If we change our diet at thisstage, if we are more cognitive
about what we're eating andthinking about how that can
(06:29):
affect our kidney function, wecan stop kidney failure or slow
it down at that point.
And so that's a pivotal pointfor me.
I mean, I think we've talkedabout it before, but I've
created a class that I wanna goaround and teach members of the
community to teach this classand I in fact wanna teach that
(06:52):
class to them.
And three A is where that classhas to happen in the equation
of kidney function.
If it happens after that, it'snot as effective.
I know that when a patient getsto stage three B, which is 30
to 44% kidney function, thatthere may not be a time to turn
(07:16):
it around, that our time isshort, because when a patient
gets to stage four, which is 15to 29% kidney function, they're
gonna go into Alice's Ira,they're headed there and they're
not so far off future, and sothose are just.
(07:38):
I mean, that's just one thingthat I wish family doctors were
aware of.
So how we tackle those issuesis with the class.
We need to be able to identifypeople who are at stage 3A and
we need to bring them to a class, and that's gonna have to
happen through familypractitioners.
The nephrologists hasn't seenthese people yet.
(07:59):
They haven't even been referredto a nephrologist yet.
They're not even talking aboutdialysis.
They've not even beenintroduced to the idea that
their kidneys aren't functioningat a certain level and all
these people fall under what'scalled chronic kidney disease,
which is not is right before youget to end stage renal disease,
(08:20):
and so all these people areconsidered CKD patients.
They're not having thatconversation with their family
doctors at all.
Family doctors aren't referringthem to nutritionists.
In fact, when patients get totheir nephrologists and are
referred to nephrologists atstage 4 and 5, they're not even
(08:44):
being referred to a nutritionist, and so those are just issues
that I think that we need totighten up on.
That we can fix, but creating aclass for me was one of the ways
that I could, that we couldaffect change and we could begin
to have this conversation, andthat's what needs to happen.
That conversation needs to behappening at stage 3A and that
(09:09):
conversation is not happening.
We know that because when Imeet these patients in dialysis
and it's their first day theystill haven't had the
conversation, and we're maybe 10years into their disease, ira.
And so that's what havingconversations with these
patients was so important to me,because I thought I was just
(09:31):
getting to know them, but theyhelped me connect the dots.
I didn't know that I would endup here.
I had no clue.
I just thought I was doing thething that human beings should
be doing, and when they'retaking care of somebody is
getting to know them and havinga conversation with them, and
over the years, their storystarted to link.
(09:52):
I started to see reoccurringelements in each of these
people's stories, and that'swhat began my journey in trying
to figure out how to connectthose dots, and this is what
we've come up with.
Speaker 2 (10:07):
Right.
So the other side of it.
So that's you dealing with thepatient and all the things that
are physically going on with thepatient, but in that image
behind you, it's like I'm alwayslooking at.
That's the system, right Is theclinic and there's like it's
big business.
You know what I mean.
(10:27):
Like a lot of our healthcare, alot of our issues, cancer.
You know what I mean.
The COVID like people aremaking big money off of people
being sick, right, yes, and soyou're faced with someone who
you're, as someone who caresabout the patient in a system
that isn't necessarily alwaysabout the best care for the
(10:48):
patient.
It's about crunching numbersand it's about managing a system
, right.
So talk to me about the systemthat you're a part of without
getting yourself in too muchtrouble.
But I know that that is part ofwhat drives you is the
frustration of dealing with asystem that isn't always about
the patient.
Speaker 3 (11:10):
Yeah, this is the toughest part.
I mean, I think you know takingcare of the patients and caring
.
You know, certainly I get paida salary to do that, you know,
we all know that healthcare is anecessary thing.
One of the things that was veryilluminating to me is that I
(11:30):
was working in the system beforeit changed over to a corporate
model.
So again, that allowed me somevantage point that maybe others
don't have, Because I worked inthis system when it was a
nonprofit, when, primarily, mostof the companies I would say
90% of the companies werenonprofits.
(11:54):
And because they werenonprofits their goal wasn't
profit, their goal was toprovide a service and they were
compensated for that service.
Speaker 1 (12:05):
Najib Ayidaniways, head of começar training, first
retired.
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