August 24, 2025 • 29 mins
Dr. Sandeep Rao brings the borderland the latest information in healthcare, medicine and technology. He considers himself a hacker in the positive sense, using his intimate knowledge of the medical system to break down some of the barriers to accessing new medical technologies and information.
For more information call Dr. Rao's office at 915-500-4370 or email Rao@medicalhackers.com
Be the first to hear the show in News Radio KTSM-AM Saturdays at noon, an iHeart station.
For more information call Dr. Rao's office at 915-500-4370 or email Rao@medicalhackers.com
Be the first to hear the show in News Radio KTSM-AM Saturdays at noon, an iHeart station.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:05):
Good afternoon. It's another weekend here in the art of
the dusty Chwalla and desert in West Texas. You're listening
to the Medical Hackers. However, you may be tuned in
this week and I'm your host, doctor Sandy Brow. We're
here to bring the Borderland the latest information healthcare, medicine,
and technology on the show. I consider myself a hacker,
a hacker on the positive sense, a hacker who uses
the mind to my knowledge of the medical system, helping
(00:26):
breaking down some of the barriers to accessing new medical technologies.
On this show, I got a guest who's been on
here before, doctor ukber Khn.
Speaker 2 (00:37):
Good afternoon, Great to have you. Thank you for having me.
Speaker 1 (00:41):
And I like the fact that you brought us donuts
this morning because it really goes into a topic I
want to get into, which is dialysis. Because there's a
you may wonder, why can donuts, why can sugars lead
to dialysis? And I want to take this opportunity this
(01:02):
program with you because you are a expert in your
fellowship trained in nephrology and hypertension or high blood pressure,
and I've always associated donuts with high sugars, and so
my folks are always telling me to stay away from them.
But you found my soft spot without even knowing me.
You brought in my most favorite thing, which is donuts,
(01:23):
Pistasio donut, pistasio donut, which is which even takes that
takes the cake, so to speak. So I want to
kind of get into dialysis. I want to kind of
get into what leads to dialysis. What are the risk
factors for diosis, because as you know, there are a
lot of folks in this community who may know somebody
who's being dialized has to go get diasis treatment. So
(01:45):
let's just let's just walk through this from the beginning. Sure,
how do you identify a patient who needs jois do
you first see them in a hospital setting, maybe they
come into your clinic, however they come in to see
you as in afrologist, as a kidney doc. At what
point do you go, wow, you might need dialysis and
(02:06):
then we can probably work our way back and what
caused them to get diasis?
Speaker 2 (02:10):
Sure, thank you, doctor ra. Well, we all know that
the biggest causes of what we do know that the
biggest causes of kidney failure are preventable today in our
day and age, medicine is preventable, so when we see
or hear people on dialysis, it kind of hurts because,
in a sense, we feel that we could almost prevent it.
(02:31):
So we know diabetes and blood pressure cause nearly two
out of three cases of kidney failure leading to dialysis.
So typically there's two ways that I'll be able to
know if you're going to start dialysis. There's the bad way,
which is when what we call quote unquote crash land
into dialysis where you are really really sick, go to
(02:51):
the hospital and everything is going wrong for you and
there's nothing left to do but do dialysis. That's very
more detail, but there's this way, whether you crash land
or there's a way where we are monitoring you, you know,
every three to six months and we get you on
all the right medications.
Speaker 1 (03:10):
Like we discussed last.
Speaker 2 (03:11):
Time, kidney, the kidney world is going through some drastic
changes with the incredible medications coming out.
Speaker 1 (03:18):
So the hope for the.
Speaker 2 (03:20):
Future is that we see you early and we don't
eat and we prevent all these things with the medications
that we have now. So we don't want people on dialysis.
It's not a cure, it's a bridge to an eventual
kidney transplant, but it happens.
Speaker 1 (03:35):
Sure. So the basic way I guess is leading going
back to this point about donuts, is you got to
keep your sugars control. Yea, right.
Speaker 2 (03:42):
We know diabetes and blood pressure are two of the
three main causes of leading to kidney failure requiring dialysis.
So yes, I apologize for bringing you a pistachio donut.
It's good though, I know I see it.
Speaker 1 (03:56):
No, it's definitely I was having a by it right here. Now,
I do want to get into this. It's not that
every single person who has diabetes, or every single person
who even let's go step back, who eats a donut's
gonna get go down this pathway. So I think I
think the bottom line, flower of folks is do everything
in moderation, enjoy the enjoy the occasional donut or whatever
your soft spot, your sweet tooth might involve. But it
(04:20):
definitely means that, you know, I would definitely recommend folks
out there checking their hemoglobin a one CE. That's sort
of a long term view, a long term picture of
how your sugars are controlled. In addition to getting your
maybe your fasting sugars tested, you know. So, so those
are all things that I think it's a good thing
to just keep an eye on if you think you
might be diabetic or pre diabetic, or headed down the road,
(04:43):
or maybe you have a family extra diabetes. But let's
go down that path of when you identify them in clinic.
So obviously, on a very I don't want to get
into the weeds here on how diabetes causes damage to
the kidney. Maybe we could, because a lot of people
might be interested in that, but let's just kind of
(05:04):
go down that route. So let's say you have you
are a chronic diabetics who's sitting out there, who does
not know whether you have kidney disease? How do we
identify that? What would you recommend for that patient? They
have a history, maybe have a history of diabetes, maybe
they've been having a long term sugar's not controlled. What
(05:25):
would you recommend next step to say, you know what,
I want to stave off the possibility of get being
on DALLAS.
Speaker 2 (05:31):
Of course, yes, we hopefully don't want to actually identify
these patients. This should be seen by our primary care physicians.
And we know it's always about having a good primary
care doctor. It's not always the case, and whether it's
you have an HMO PPO or no insurance. We know
getting seen by a doctor is not the best here
(05:52):
in the States, and it's unfortunate, but it's just the
way it is here in America. We have the best
health care system. It just needs to be a little
recalibrated to help everyone. So the kidney patient who mayning
dialysis would definitely be identified by their primary care doctor
(06:12):
where they would start them on their jardiance these medications,
their ACE inhibitor, their ARB way where they're being you know,
their blood pressure is controlled, their systolics are less than
one thirty. These are all targets that are evidence based
guidelines that have been around for a while, that should
already have been in place before they come see me,
the specialty doctor. Right, I'm a kidney doctor. I'm seeing
(06:34):
people who are already sick. I'm not seeing your normal
you know, your normal patients. So a patient who gets
referred to me, a patient who is at risk are
people who have diabetes. Because chronic kidney disease is very
is prevalent in all diabetics. That's why every year a
kidney a diabetic patient needs to get you know, an
(06:57):
eye exam for diabetic retinopathy, because diabetes affects the really
small vessels in your eyeballs and that's why they can
have you know, can lead to you know, blindness and
you know eye problems. They have to get their feet
checked every year right by a pediatrist because sometimes the
nerve endings and diabetes they get hit and then they
can get you know, a sort of mark or soar
(07:18):
on their foot and it can keep going and people
can lose feed amputations. Oh my gosh, that sounds scary, right.
And then also they need to get their A one
C there, you know, every three to four months, you
get their A one C which is a measurement of
their blood glucose levels on average for the last three months.
So we have very powerful medications that work that are
(07:40):
currently in the market that we treat patients with, which
is why we have so many patients that are not
on dialysis. We've been able to kind of hack the
hack the body with the medications we have. So yeah, wow,
I don't know if that was on a little bit
more depth, maybe before this quick break, if you can
capture this thirty seconds I can't, or a minute I
(08:01):
will try.
Speaker 1 (08:02):
Patient comes in sent to you referred for possible kidney
disease related diabetes. How do you determine? We're very quickly
just looking at labs. Sure like, look what is the
what is the top two things that you look for
to say, you know what? I think you need to
be on dialysis?
Speaker 2 (08:19):
Yes, well, we do get a blood test. It's called
a basil a metabolic panel right, a BMP, and we
look at your creatinin right, and your cratinin. We have
a formula which measures your GFR, which is your glomerular
filtration rate, and when your filtration your GFR is thirty
(08:41):
or less, twenty or twenty or less is when you're
eligible for a kidney transplant. You typically want to start
people on dialysis when their GFR is fifteen or less.
But this is all individualized, so it's very hard to
say exact number. But if you come to my office
and your creatinin is you know, and your GFR is
low less than twenty five twenty, and we look at
(09:04):
your urine and there's lots of proteins in your urine,
this is a very bad marker for us. But this
is what we typically look for. And if you come
to my office. I would also look at your urine
urine sediment. I spin it under a centrifuge and look
under the microscope. There's there's many things we can do
to identify that. But you know this is all hopefully
(09:25):
it doesn't. We see you from the get go and
we try and avoid these things, right, but this is
not possible.
Speaker 1 (09:31):
Great, we're gonna take a quick break here on the Hackers,
those doctor ruckbrocon nefrogist myself, doctor Rouse, So we're gonna
take a quick break and go a little bit more
in depth into this area of hemodialysis.
Speaker 3 (09:44):
You're listening to the Medical Hackers with doctor Sandy Brow,
board certified vascular interventionalist, bringing you insights on treatments for
common medical problems on news radio six ninety KTSM. For
more information on the issues being discussed, or to contact
dot call nine one five five hundred four to three
seven zero or by emailing raw at medical Hackers dot com.
Speaker 1 (10:11):
Back here on the Hackers doctor out here with doctor
con and we've been discussing kidney diseases on a global level,
but really trying to do a deep dive here into
dialysis because I send a lot of patients or I
don't send patient dalyasis. You send patients to DALLAS because
you're unfortuning. You're a kidney doc. Yes, I actually treat
(10:31):
patients who are on DALLASIS. Sometimes I have to put
in line. Sometimes I have to deal with it from
the standpoint of Sometimes I have to do leg intervention
cases and patients will ask me, I'm getting dialysis three
times a week Monday, Wednesday, Friday, or maybe Tuesday Thursday.
They have a schedule, and they'll say, you're doing your procedure.
(10:52):
You're going to give me contrast die, which is something
that if your kidneys are not normally clearing that medication out.
That's where DALLASIS comes in your your The Dallass machine
is clearing it out for you. So we have to
time our procedures relative to a DALYSSS. But I'm very
curious because I do see all these patients who are
on Dallass and I'm I just want to know. So
(11:14):
let's say you have now been identified as a patient
who needs DALLASIS. This is your first session. Okay, what
what is something? Walk me through that day? A patient
comes into maybe it's your center, maybe it's some other
center and they're going to be undergoing dallass for the
first time. Let's not we haven't even gotten to the
(11:34):
point of where they access it, because that's that's a
whole different topic, and we could probably do a show
on that.
Speaker 2 (11:39):
We definitely need to whether it's through.
Speaker 1 (11:40):
A cathro, the knack or through the arm. But just
tell me what, what is it, What typically goes on
during a DALLAS session, How long does it last? Everything
I need to know about dallasis in which you can
say within nine minutes, I got you.
Speaker 2 (11:54):
So we so we know people end up on dialysis
because of long term diabetes. The sugar damages our kidney
filter over time, the high blood pressure it can affect
the kidney, the you know, whether you have inherited kidney
disorders or audioimmune diseases, all these can lead you up
to dialysis. So that's why we emphasize prevention, catching kidney
(12:16):
damage early. But let's say it's too late and you
have to go on dialysis. Dialysis has been around for
eighty years. It's actually an incredible invention. So in the
States we have we have we can offer patients a
few different modalities for dialysis, which is also, you know incredible.
(12:38):
We can either do dialysis through the belly through a
way of convection. Convection where we put we instill your
belly with fluid and this is the way that we
can extract the filters and toxins and you would drain out.
It's called peritoneal dialysis. This one is very unique because
(12:58):
you can do it in the comfort of your home.
Nothing's comfortable about this, but you can be at home.
Speaker 1 (13:04):
Will you do this?
Speaker 2 (13:05):
There are lots of rules with this. You would have
to be you know, go through a strict you know,
protocol to see if you can actually if you actually
approve for this, because you you know, for instance, you
can't have pets in the house. You need to be
able to lift the three liter bags. You need to
have a partner to help you. So there's all these
all these rules that they have with it to help
(13:26):
you succeed, and that's why they're there. But we also
have home dialysis, like we typically are aware of the
three days, like you said, Monday, Wednesday, Friday, Tuesday, Thursday, Saturday.
These are dialysis centers in the open where we have
like Davida, you're Forcinious, we have us renal care. We
have one called there's another one I'm blocking, but the
(13:48):
two main ones are DIVIDA and for sinius and US
renal care is a third. So at home, there's something
called home dialysis where if you do qualify, and you
also need a partner, you need somebody to support you,
you can also stick yourself at home, whether it's through
a catheter or officiala And they say official in your
arm in your arm, yes, excuse me? Or you're a
(14:10):
groin depends.
Speaker 1 (14:11):
Okay, that's true.
Speaker 2 (14:12):
Right, So the home dialysis is known to be to
give the most improved quality of life.
Speaker 1 (14:20):
Oh really, yes?
Speaker 2 (14:21):
And the reason what about?
Speaker 1 (14:23):
What about the effectiveness? So if you had to compare,
if you had to undergo dallass, you know, God forbid
to think yeah, and you had the option of getting
this home peritoneal diasis, which sounds easy, right, It sounds
very easy. I don't have to go to a center.
But then you have the traditional dollasis that when I
think of dolls, I actually don't even think about home dollasies.
That's you can do it. I've brought that up, but
(14:44):
most of my patients would say they go to these
big centers da Vida zinias, these big standing centers where
I see a bunch of beds lined up, a bunch
of machines lined up, and patients are essentially all hooked up.
Which is the most effective way to clear your kidneys,
to clear it or blow.
Speaker 2 (15:00):
It would be home dialysis. Good question, Yeah, and I'll
tell you why. So the reason is that you feel
the worst on the second day before you're over the weekend.
So Monday, Wednesday, Friday on Sunday is when you're at
most risk to do feel the worst, and you know,
(15:23):
feel bad. So what happens to me quick?
Speaker 1 (15:26):
I just want to know. So let's I'm actually very curious.
So if you're a patient and so you can actually
tell you need dallasis just by like you so your
your body over all?
Speaker 2 (15:35):
Oh, yes, the symptoms are horrible.
Speaker 1 (15:38):
What what's a classic thing?
Speaker 2 (15:41):
So this is what we ask in the clinic. We go,
do you have any altered taste changes, any metallic taste changes?
And people will be like, yeah, I had pizza tastes
like pennies. You're like what, yeah, so this is one.
But also fatigue, people are sleeping a lot, nausea, nausea, vomiting,
but overall, so and all this is due to the
(16:02):
build up of toxins, which we because your kidneys are
now not clearing and now you have to you're waiting
for yes, your dial session exactly, which if it's ye,
or if it's at home, you can do it at home.
Speaker 1 (16:12):
Yeah.
Speaker 2 (16:12):
And the reason why at home is better because at
these centers we're packing in this you know, this incredible
procedure which is the most common procedure in all of
medicine three days a week that they do in nephrology, right,
that they pack four hours worth of filtering so they
can get the next shift on and then get the
(16:33):
third shift on. Right, So there's three shifts for four
hours at these dialysis centers. It's it's it's it's doesn't
it's incredible.
Speaker 1 (16:42):
It's hard to say. How bad Now if you did
home dials? Yes, how long does that take to do
a home doll.
Speaker 2 (16:48):
Perfect, good question. That's the reason why home dillast is
better is because it's been shown that patients who do
one to two hours a day every day for five
days feel much better because you're able to consistently lower
these toxins, which in the literature we still don't know
what they are, but we just know that they're uremic toxins.
(17:09):
And this was a fun, you know, conversation with my
attendings at Indiana University where they've been studying this for
decades and we still don't know, but we do know
the symptoms that happen. So home dialysis is by far
the best if you're able to do it. But remember
people who start dialysis are all different ages. So I mean,
the eighty year old is going to have a hard
(17:30):
time sticking himself at home because you know, it's just
not as it's much more difficult in later stages of life.
But home dialysis is better. But people like going to
the centers because they just want to go there, get
it over with and come home and live a regular life.
But we know that with dialysis, nothing's regular for the patient,
(17:50):
for the family, friends, pets, I mean, just name it.
Dialysis is incredibly hard on everyone. It's very sad.
Speaker 1 (18:00):
Not onion place. No, it does not plug and play
to be able to just go to a center. They
take care of the dallass for you so you when
your patient comes in. Now, I guess we got about
thirty seconds year before the break so do you offer
the patients that option? You say, you know what you
have the if they are if they qualify, if they're
young enough, they're healthy enough, and you think they could
possibly get peritoneal dogs. Yeah, we most do. So you'd
(18:21):
say you have optioned a home dises versus center dolsas
and your patients that option.
Speaker 2 (18:28):
Oh, we definitely give them the option because it's their
life right. So let's say we are on schedule for
starting dialysis. We could place a PD catheter underneath the belly,
embed it under the skin, and leave it there until
they're ready. And this happens quite often, but usually patients
are in their twenties or thirties, you know, usually because
of high blood pressure untreated. A lot of African Americans,
(18:50):
Latin people, Latinos, they we are afraid to go to
the doctor and they end up coming when it's very
late and irreversible damage has occurred.
Speaker 1 (19:00):
We'll take quick break here on the Hackers and I
want to talk about a controversy that's actually involving some
of these laws Dallas centers.
Speaker 3 (19:06):
After this break, you're listening to the medical Hackers with
doctor Sandy brow Board, certified Vascular interventionalist bringing you insights
on treatments for common medical problems on news radio six
ninety k T s M. For more information on the
issues being discussed, or to contact doctor Raw, call nine
one five five hundred four three seven zero or by
(19:29):
emailing Rao at medical hackers dot com.
Speaker 1 (19:35):
Backgard the Hackers, I'm doctor Rau here. I'm here with
doctor ukber Khon, who is a nephrologist with the I
Vascular Center out on the East Side, along with doctor Gurgis.
That's not like the I as in your I like
E y E. It's like I Vascular like iPhone.
Speaker 2 (19:52):
It's kind of like i VC IVC is like short,
like you're that's like here and exactly let me say
I Scular Center IVC.
Speaker 1 (20:01):
That's cool. So you do a lot of work with
Dallasa's patients. And one of the controversies I want to
get into is and I've seen this in the news
within the last month. This has gotten a lot of
attention on a federal level, which is that close to
seventy seven percent of the market for dials. The centers
is owned by two big companies, Davida and Frezinias, and
(20:24):
they're saying that there isn't much competition in that, so
there's some folks are saying they're raising the the costs
of dalsas. So diasas actually is the highest markup over
medicare compared to a lot of other proceders com for
commercial insurance because of the fact that there's a lot
of concentration there. And interestingly also so physician ownership in
(20:48):
these DALLASA centers is also significant increased. About thirty percent
of these docs have some ownership in it. And so
people are saying that there's this huge vertical model where
this dials company, this national company, partners with kidney docs
who are then inclined to send patients to their own centers.
(21:09):
And it also makes it very hard for new competitors
to enter the market because it's all very consolidated. I
don't want to get into the politics that, but I
just wanted to kind of just mention that because there's
so there's this thing called the Stark Law or the
anti kickback law, which prohibits physicians in general from referring
patients to any entity in which you have a financial stake. Okay,
(21:30):
so that's something that we know at but it's very
interesting DIALSA centers are actually exempt from this law, so
it allows them to do that. But I do think
there are some positives in the sense that you know,
there are now fewer and fewer Americans actually that live
in an area without any DALLASIS facility. So back in
two thousand and five, okay, almost twenty years ago, about
thirty percent of patients lived in an area without any
(21:53):
DIALASA center. Now it's only ten percent. So that's that's
a net positive, I would think, so that you have
a dial the center close to you. And I don't
want to get into this too much, I just wanted
to point that out because you know, I think it's
it's just good to know why we're seeing a lot
of these centers pop up and you only see a
few centers pop up out there. But let's just go
(22:14):
back to the for a patient standpoint, you've now been
told that you have to go to one of these
centers for DALLASIS if.
Speaker 2 (22:21):
You don't qualify for home dialysis. Another reason why home
dialysis has taken has you know, gained popularity amongst patients
given the fact a lot of people who are in
rural areas are having to go on dialysis and centers
aren't around like you said, Yes, they're popping up, but
(22:41):
they're not not everywhere Midwest, especially where I trained in Indiana,
we had a large rural dialysis population and that's why
we were so exposed to home dialysis. But you're correct,
these centers private Equity, along with Prisinius and Davida are
almost eighty percent of the market share, So you are correct.
It's controversial, but the there is you know, antitrust probing
(23:05):
laws that came out last year by the Federal Trade Commission,
so it's not going unnoticed.
Speaker 1 (23:10):
Yes, So let's say you are someone who has been
told you have to go to a dialasis center because
most patients are probably getting dallases at one of these centers, correct,
So they're probably getting it through. Yeah, what is the question?
Next question is what is their access point for dallas
And we can do an entire show on this in
the future, but very you know, the very quick in
(23:33):
thing for me is when I get called for a
patient in the hospital and they say, you know what,
can you put in a quick temporary dalasis line or
a permanent dialasis line. So these are little lines that
we put in. You also are in your center puts
them in as well. Swe do exactly. So these are
lines that you put in a little tiny catheter in
(23:54):
your neck.
Speaker 2 (23:56):
I would say it's a big catheter compared to the
other catheters when you so, okay, it.
Speaker 1 (24:02):
Has to be big, right, Yeah, it's pretty The thing
is this this line, this conduit in your neck, you
have to be able to push take blood out.
Speaker 2 (24:09):
Around fifty around fifty to seventy five liters of blood
filtered every four hour session.
Speaker 1 (24:16):
Wow, So that's how much blood goes through a Dallas's machine.
I didn't realize. Yeah, that's how much.
Speaker 2 (24:21):
Well, our kidneys itself are doing that alone. Right, So
let me just pull up this kidney fact. Our kidneys
filter our blood around forty times a day, so around
fifty gallons of blood every forty hours, which we're doing
just normal.
Speaker 1 (24:36):
That's what we're normally doing. Yeah. So this machine is
basically trying to take over that that function that you
have now lost as a as a patient. And so
it's trying to do it. And so it's doing seventy
five So.
Speaker 2 (24:48):
It cleans the blood. It cleans a pine of blood
every minute.
Speaker 1 (24:52):
What is what? And so that's why this has to
be a big catheter in your neck. Yes, and because
basically through there's two holes right, well, does give me
three three little passages through this catheter. One is to
pull that blood out. Then it goes through the machine
in some the.
Speaker 2 (25:07):
Machine the magic sauce, I call it magic sauce. It
goes like it looks it's like when it first happened
eighty years ago. Is this rotating drum? It's we could
it's genius how they even came up with this. But
what we do now it looks like a cassette player almost,
because like the tubing and it's going around and there's
over two hundred and fifty alarms.
Speaker 1 (25:26):
If you've ever been in.
Speaker 2 (25:26):
A dialysis units, it's madness because you hear all these
beet being and blue being and you know, uh so yeah, and.
Speaker 1 (25:34):
Then you have to then pump that blood back into
the Yes, immediately exact it does seventy five leaders within
that one hour period. I'm very curious if maybe a
patient's mentioned this to you. I don't know if you
have this information. Sure, Let's say it's your first time
having to undergo dialysis. You've now been hooked up to
a machine. What would I expect during the session and
(25:55):
what would I expect after the session? You did say
before the session, you might feel a little bit confused
because now your body's built up all these toxins.
Speaker 2 (26:03):
Yeah, hopefully it doesn't get to that. Being confused is
a bad marker, right, because when you first start dialysis,
that's emerging funds. Yeah, that's the crash landing. As we say,
you don't want to crash land So this is also
you know, the beautiful thing about medicine is with experience,
and you know, all these attendings that I was around
in my training, they have different ways of treating starting dialysis,
(26:27):
but typically what we we aim for is starting dialysis
very slow. We're not trying to shock your body because
it's a major procedure. Right, We're hooking you up to
a big catheter. We're taking out your blood and giving
it back to you. So our goal is to make
sure we do as least well. The term is quote
unquote low flow rates because you want to not let
(26:51):
the body think that you're doing something drastic. You want
to ease them into it. So for the first three
sessions we typically go two hours, the first one three hours,
the second one and four hours the third one to
make it like your first complete one. So we kind
of like baby step you until you're able to do
the full session, and a patient would feel crappy. There's
(27:14):
no other way.
Speaker 1 (27:14):
To say it.
Speaker 2 (27:15):
Dialysis is not fun. And you know, when I entered
this nephrology fellowship, I loved dialysis, and when I got
deep into it, I found out it's it's very sad
and painful for a lot of patients, and that you know,
and that's why it's my job to make sure that
they feel better as much as I can, because it's
(27:36):
not easy.
Speaker 1 (27:37):
Sure, no, I get that. So I have so many
questions about Dallasas which we haven't even covered, including what
is the goal of dialysis? What are you trying to avoid?
Which we'll discuss on a future show. You know, there's
so many different questions got about Dallasis and we'll definitely
have you back. So I'm here, thanks for joining. As
doctor ruckber Conway, the I've asked Yoular center over on Pelicano.
(28:00):
Him and his partner, doctor Gergis are my go to
for kidneycare, nephrologycare, and nephrology questions.
Speaker 2 (28:07):
And so hacking the bodies filter. Yeah, exactly, that's where
we are exactly.
Speaker 1 (28:12):
So if you are interested in any more information on
any of you mentioned truments, you can always call to
get more information at nine to one five five hundred
forty three seventy that's five zero zero four three seven zero.
You can also reach me by email at raw at
medical hackers dot com. That's my last name, r Ao
at medical hackers dot com. Unfortunately, our time, the Saturday,
(28:33):
is up. I hope these healthcare hacks have helped you
navigate our complex medical system. If you've been tuned into
us this whole time, bless your heart and your health.
I'm doctor Sandy Row, and you've been listening to the
medical hackers
Good afternoon. It's another weekend here in the art of
the dusty Chwalla and desert in West Texas. You're listening
to the Medical Hackers. However, you may be tuned in
this week and I'm your host, doctor Sandy Brow. We're
here to bring the Borderland the latest information healthcare, medicine,
and technology on the show. I consider myself a hacker,
a hacker on the positive sense, a hacker who uses
the mind to my knowledge of the medical system, helping
(00:26):
breaking down some of the barriers to accessing new medical technologies.
On this show, I got a guest who's been on
here before, doctor ukber Khn.
Speaker 2 (00:37):
Good afternoon, Great to have you. Thank you for having me.
Speaker 1 (00:41):
And I like the fact that you brought us donuts
this morning because it really goes into a topic I
want to get into, which is dialysis. Because there's a
you may wonder, why can donuts, why can sugars lead
to dialysis? And I want to take this opportunity this
(01:02):
program with you because you are a expert in your
fellowship trained in nephrology and hypertension or high blood pressure,
and I've always associated donuts with high sugars, and so
my folks are always telling me to stay away from them.
But you found my soft spot without even knowing me.
You brought in my most favorite thing, which is donuts,
(01:23):
Pistasio donut, pistasio donut, which is which even takes that
takes the cake, so to speak. So I want to
kind of get into dialysis. I want to kind of
get into what leads to dialysis. What are the risk
factors for diosis, because as you know, there are a
lot of folks in this community who may know somebody
who's being dialized has to go get diasis treatment. So
(01:45):
let's just let's just walk through this from the beginning. Sure,
how do you identify a patient who needs jois do
you first see them in a hospital setting, maybe they
come into your clinic, however they come in to see
you as in afrologist, as a kidney doc. At what
point do you go, wow, you might need dialysis and
(02:06):
then we can probably work our way back and what
caused them to get diasis?
Speaker 2 (02:10):
Sure, thank you, doctor ra. Well, we all know that
the biggest causes of what we do know that the
biggest causes of kidney failure are preventable today in our
day and age, medicine is preventable, so when we see
or hear people on dialysis, it kind of hurts because,
in a sense, we feel that we could almost prevent it.
(02:31):
So we know diabetes and blood pressure cause nearly two
out of three cases of kidney failure leading to dialysis.
So typically there's two ways that I'll be able to
know if you're going to start dialysis. There's the bad way,
which is when what we call quote unquote crash land
into dialysis where you are really really sick, go to
(02:51):
the hospital and everything is going wrong for you and
there's nothing left to do but do dialysis. That's very
more detail, but there's this way, whether you crash land
or there's a way where we are monitoring you, you know,
every three to six months and we get you on
all the right medications.
Speaker 1 (03:10):
Like we discussed last.
Speaker 2 (03:11):
Time, kidney, the kidney world is going through some drastic
changes with the incredible medications coming out.
Speaker 1 (03:18):
So the hope for the.
Speaker 2 (03:20):
Future is that we see you early and we don't
eat and we prevent all these things with the medications
that we have now. So we don't want people on dialysis.
It's not a cure, it's a bridge to an eventual
kidney transplant, but it happens.
Speaker 1 (03:35):
Sure. So the basic way I guess is leading going
back to this point about donuts, is you got to
keep your sugars control. Yea, right.
Speaker 2 (03:42):
We know diabetes and blood pressure are two of the
three main causes of leading to kidney failure requiring dialysis.
So yes, I apologize for bringing you a pistachio donut.
It's good though, I know I see it.
Speaker 1 (03:56):
No, it's definitely I was having a by it right here. Now,
I do want to get into this. It's not that
every single person who has diabetes, or every single person
who even let's go step back, who eats a donut's
gonna get go down this pathway. So I think I
think the bottom line, flower of folks is do everything
in moderation, enjoy the enjoy the occasional donut or whatever
your soft spot, your sweet tooth might involve. But it
(04:20):
definitely means that, you know, I would definitely recommend folks
out there checking their hemoglobin a one CE. That's sort
of a long term view, a long term picture of
how your sugars are controlled. In addition to getting your
maybe your fasting sugars tested, you know. So, so those
are all things that I think it's a good thing
to just keep an eye on if you think you
might be diabetic or pre diabetic, or headed down the road,
(04:43):
or maybe you have a family extra diabetes. But let's
go down that path of when you identify them in clinic.
So obviously, on a very I don't want to get
into the weeds here on how diabetes causes damage to
the kidney. Maybe we could, because a lot of people
might be interested in that, but let's just kind of
(05:04):
go down that route. So let's say you have you
are a chronic diabetics who's sitting out there, who does
not know whether you have kidney disease? How do we
identify that? What would you recommend for that patient? They
have a history, maybe have a history of diabetes, maybe
they've been having a long term sugar's not controlled. What
(05:25):
would you recommend next step to say, you know what,
I want to stave off the possibility of get being
on DALLAS.
Speaker 2 (05:31):
Of course, yes, we hopefully don't want to actually identify
these patients. This should be seen by our primary care physicians.
And we know it's always about having a good primary
care doctor. It's not always the case, and whether it's
you have an HMO PPO or no insurance. We know
getting seen by a doctor is not the best here
(05:52):
in the States, and it's unfortunate, but it's just the
way it is here in America. We have the best
health care system. It just needs to be a little
recalibrated to help everyone. So the kidney patient who mayning
dialysis would definitely be identified by their primary care doctor
(06:12):
where they would start them on their jardiance these medications,
their ACE inhibitor, their ARB way where they're being you know,
their blood pressure is controlled, their systolics are less than
one thirty. These are all targets that are evidence based
guidelines that have been around for a while, that should
already have been in place before they come see me,
the specialty doctor. Right, I'm a kidney doctor. I'm seeing
(06:34):
people who are already sick. I'm not seeing your normal
you know, your normal patients. So a patient who gets
referred to me, a patient who is at risk are
people who have diabetes. Because chronic kidney disease is very
is prevalent in all diabetics. That's why every year a
kidney a diabetic patient needs to get you know, an
(06:57):
eye exam for diabetic retinopathy, because diabetes affects the really
small vessels in your eyeballs and that's why they can
have you know, can lead to you know, blindness and
you know eye problems. They have to get their feet
checked every year right by a pediatrist because sometimes the
nerve endings and diabetes they get hit and then they
can get you know, a sort of mark or soar
(07:18):
on their foot and it can keep going and people
can lose feed amputations. Oh my gosh, that sounds scary, right.
And then also they need to get their A one
C there, you know, every three to four months, you
get their A one C which is a measurement of
their blood glucose levels on average for the last three months.
So we have very powerful medications that work that are
(07:40):
currently in the market that we treat patients with, which
is why we have so many patients that are not
on dialysis. We've been able to kind of hack the
hack the body with the medications we have. So yeah, wow,
I don't know if that was on a little bit
more depth, maybe before this quick break, if you can
capture this thirty seconds I can't, or a minute I
(08:01):
will try.
Speaker 1 (08:02):
Patient comes in sent to you referred for possible kidney
disease related diabetes. How do you determine? We're very quickly
just looking at labs. Sure like, look what is the
what is the top two things that you look for
to say, you know what? I think you need to
be on dialysis?
Speaker 2 (08:19):
Yes, well, we do get a blood test. It's called
a basil a metabolic panel right, a BMP, and we
look at your creatinin right, and your cratinin. We have
a formula which measures your GFR, which is your glomerular
filtration rate, and when your filtration your GFR is thirty
(08:41):
or less, twenty or twenty or less is when you're
eligible for a kidney transplant. You typically want to start
people on dialysis when their GFR is fifteen or less.
But this is all individualized, so it's very hard to
say exact number. But if you come to my office
and your creatinin is you know, and your GFR is
low less than twenty five twenty, and we look at
(09:04):
your urine and there's lots of proteins in your urine,
this is a very bad marker for us. But this
is what we typically look for. And if you come
to my office. I would also look at your urine
urine sediment. I spin it under a centrifuge and look
under the microscope. There's there's many things we can do
to identify that. But you know this is all hopefully
(09:25):
it doesn't. We see you from the get go and
we try and avoid these things, right, but this is
not possible.
Speaker 1 (09:31):
Great, we're gonna take a quick break here on the Hackers,
those doctor ruckbrocon nefrogist myself, doctor Rouse, So we're gonna
take a quick break and go a little bit more
in depth into this area of hemodialysis.
Speaker 3 (09:44):
You're listening to the Medical Hackers with doctor Sandy Brow,
board certified vascular interventionalist, bringing you insights on treatments for
common medical problems on news radio six ninety KTSM. For
more information on the issues being discussed, or to contact
dot call nine one five five hundred four to three
seven zero or by emailing raw at medical Hackers dot com.
Speaker 1 (10:11):
Back here on the Hackers doctor out here with doctor
con and we've been discussing kidney diseases on a global level,
but really trying to do a deep dive here into
dialysis because I send a lot of patients or I
don't send patient dalyasis. You send patients to DALLAS because
you're unfortuning. You're a kidney doc. Yes, I actually treat
(10:31):
patients who are on DALLASIS. Sometimes I have to put
in line. Sometimes I have to deal with it from
the standpoint of Sometimes I have to do leg intervention
cases and patients will ask me, I'm getting dialysis three
times a week Monday, Wednesday, Friday, or maybe Tuesday Thursday.
They have a schedule, and they'll say, you're doing your procedure.
(10:52):
You're going to give me contrast die, which is something
that if your kidneys are not normally clearing that medication out.
That's where DALLASIS comes in your your The Dallass machine
is clearing it out for you. So we have to
time our procedures relative to a DALYSSS. But I'm very
curious because I do see all these patients who are
on Dallass and I'm I just want to know. So
(11:14):
let's say you have now been identified as a patient
who needs DALLASIS. This is your first session. Okay, what
what is something? Walk me through that day? A patient
comes into maybe it's your center, maybe it's some other
center and they're going to be undergoing dallass for the
first time. Let's not we haven't even gotten to the
(11:34):
point of where they access it, because that's that's a
whole different topic, and we could probably do a show
on that.
Speaker 2 (11:39):
We definitely need to whether it's through.
Speaker 1 (11:40):
A cathro, the knack or through the arm. But just
tell me what, what is it, What typically goes on
during a DALLAS session, How long does it last? Everything
I need to know about dallasis in which you can
say within nine minutes, I got you.
Speaker 2 (11:54):
So we so we know people end up on dialysis
because of long term diabetes. The sugar damages our kidney
filter over time, the high blood pressure it can affect
the kidney, the you know, whether you have inherited kidney
disorders or audioimmune diseases, all these can lead you up
to dialysis. So that's why we emphasize prevention, catching kidney
(12:16):
damage early. But let's say it's too late and you
have to go on dialysis. Dialysis has been around for
eighty years. It's actually an incredible invention. So in the
States we have we have we can offer patients a
few different modalities for dialysis, which is also, you know incredible.
(12:38):
We can either do dialysis through the belly through a
way of convection. Convection where we put we instill your
belly with fluid and this is the way that we
can extract the filters and toxins and you would drain out.
It's called peritoneal dialysis. This one is very unique because
(12:58):
you can do it in the comfort of your home.
Nothing's comfortable about this, but you can be at home.
Speaker 1 (13:04):
Will you do this?
Speaker 2 (13:05):
There are lots of rules with this. You would have
to be you know, go through a strict you know,
protocol to see if you can actually if you actually
approve for this, because you you know, for instance, you
can't have pets in the house. You need to be
able to lift the three liter bags. You need to
have a partner to help you. So there's all these
all these rules that they have with it to help
(13:26):
you succeed, and that's why they're there. But we also
have home dialysis, like we typically are aware of the
three days, like you said, Monday, Wednesday, Friday, Tuesday, Thursday, Saturday.
These are dialysis centers in the open where we have
like Davida, you're Forcinious, we have us renal care. We
have one called there's another one I'm blocking, but the
(13:48):
two main ones are DIVIDA and for sinius and US
renal care is a third. So at home, there's something
called home dialysis where if you do qualify, and you
also need a partner, you need somebody to support you,
you can also stick yourself at home, whether it's through
a catheter or officiala And they say official in your
arm in your arm, yes, excuse me? Or you're a
(14:10):
groin depends.
Speaker 1 (14:11):
Okay, that's true.
Speaker 2 (14:12):
Right, So the home dialysis is known to be to
give the most improved quality of life.
Speaker 1 (14:20):
Oh really, yes?
Speaker 2 (14:21):
And the reason what about?
Speaker 1 (14:23):
What about the effectiveness? So if you had to compare,
if you had to undergo dallass, you know, God forbid
to think yeah, and you had the option of getting
this home peritoneal diasis, which sounds easy, right, It sounds
very easy. I don't have to go to a center.
But then you have the traditional dollasis that when I
think of dolls, I actually don't even think about home dollasies.
That's you can do it. I've brought that up, but
(14:44):
most of my patients would say they go to these
big centers da Vida zinias, these big standing centers where
I see a bunch of beds lined up, a bunch
of machines lined up, and patients are essentially all hooked up.
Which is the most effective way to clear your kidneys,
to clear it or blow.
Speaker 2 (15:00):
It would be home dialysis. Good question, Yeah, and I'll
tell you why. So the reason is that you feel
the worst on the second day before you're over the weekend.
So Monday, Wednesday, Friday on Sunday is when you're at
most risk to do feel the worst, and you know,
(15:23):
feel bad. So what happens to me quick?
Speaker 1 (15:26):
I just want to know. So let's I'm actually very curious.
So if you're a patient and so you can actually
tell you need dallasis just by like you so your
your body over all?
Speaker 2 (15:35):
Oh, yes, the symptoms are horrible.
Speaker 1 (15:38):
What what's a classic thing?
Speaker 2 (15:41):
So this is what we ask in the clinic. We go,
do you have any altered taste changes, any metallic taste changes?
And people will be like, yeah, I had pizza tastes
like pennies. You're like what, yeah, so this is one.
But also fatigue, people are sleeping a lot, nausea, nausea, vomiting,
but overall, so and all this is due to the
(16:02):
build up of toxins, which we because your kidneys are
now not clearing and now you have to you're waiting
for yes, your dial session exactly, which if it's ye,
or if it's at home, you can do it at home.
Speaker 1 (16:12):
Yeah.
Speaker 2 (16:12):
And the reason why at home is better because at
these centers we're packing in this you know, this incredible
procedure which is the most common procedure in all of
medicine three days a week that they do in nephrology, right,
that they pack four hours worth of filtering so they
can get the next shift on and then get the
(16:33):
third shift on. Right, So there's three shifts for four
hours at these dialysis centers. It's it's it's it's doesn't
it's incredible.
Speaker 1 (16:42):
It's hard to say. How bad Now if you did
home dials? Yes, how long does that take to do
a home doll.
Speaker 2 (16:48):
Perfect, good question. That's the reason why home dillast is
better is because it's been shown that patients who do
one to two hours a day every day for five
days feel much better because you're able to consistently lower
these toxins, which in the literature we still don't know
what they are, but we just know that they're uremic toxins.
(17:09):
And this was a fun, you know, conversation with my
attendings at Indiana University where they've been studying this for
decades and we still don't know, but we do know
the symptoms that happen. So home dialysis is by far
the best if you're able to do it. But remember
people who start dialysis are all different ages. So I mean,
the eighty year old is going to have a hard
(17:30):
time sticking himself at home because you know, it's just
not as it's much more difficult in later stages of life.
But home dialysis is better. But people like going to
the centers because they just want to go there, get
it over with and come home and live a regular life.
But we know that with dialysis, nothing's regular for the patient,
(17:50):
for the family, friends, pets, I mean, just name it.
Dialysis is incredibly hard on everyone. It's very sad.
Speaker 1 (18:00):
Not onion place. No, it does not plug and play
to be able to just go to a center. They
take care of the dallass for you so you when
your patient comes in. Now, I guess we got about
thirty seconds year before the break so do you offer
the patients that option? You say, you know what you
have the if they are if they qualify, if they're
young enough, they're healthy enough, and you think they could
possibly get peritoneal dogs. Yeah, we most do. So you'd
(18:21):
say you have optioned a home dises versus center dolsas
and your patients that option.
Speaker 2 (18:28):
Oh, we definitely give them the option because it's their
life right. So let's say we are on schedule for
starting dialysis. We could place a PD catheter underneath the belly,
embed it under the skin, and leave it there until
they're ready. And this happens quite often, but usually patients
are in their twenties or thirties, you know, usually because
of high blood pressure untreated. A lot of African Americans,
(18:50):
Latin people, Latinos, they we are afraid to go to
the doctor and they end up coming when it's very
late and irreversible damage has occurred.
Speaker 1 (19:00):
We'll take quick break here on the Hackers and I
want to talk about a controversy that's actually involving some
of these laws Dallas centers.
Speaker 3 (19:06):
After this break, you're listening to the medical Hackers with
doctor Sandy brow Board, certified Vascular interventionalist bringing you insights
on treatments for common medical problems on news radio six
ninety k T s M. For more information on the
issues being discussed, or to contact doctor Raw, call nine
one five five hundred four three seven zero or by
(19:29):
emailing Rao at medical hackers dot com.
Speaker 1 (19:35):
Backgard the Hackers, I'm doctor Rau here. I'm here with
doctor ukber Khon, who is a nephrologist with the I
Vascular Center out on the East Side, along with doctor Gurgis.
That's not like the I as in your I like
E y E. It's like I Vascular like iPhone.
Speaker 2 (19:52):
It's kind of like i VC IVC is like short,
like you're that's like here and exactly let me say
I Scular Center IVC.
Speaker 1 (20:01):
That's cool. So you do a lot of work with
Dallasa's patients. And one of the controversies I want to
get into is and I've seen this in the news
within the last month. This has gotten a lot of
attention on a federal level, which is that close to
seventy seven percent of the market for dials. The centers
is owned by two big companies, Davida and Frezinias, and
(20:24):
they're saying that there isn't much competition in that, so
there's some folks are saying they're raising the the costs
of dalsas. So diasas actually is the highest markup over
medicare compared to a lot of other proceders com for
commercial insurance because of the fact that there's a lot
of concentration there. And interestingly also so physician ownership in
(20:48):
these DALLASA centers is also significant increased. About thirty percent
of these docs have some ownership in it. And so
people are saying that there's this huge vertical model where
this dials company, this national company, partners with kidney docs
who are then inclined to send patients to their own centers.
(21:09):
And it also makes it very hard for new competitors
to enter the market because it's all very consolidated. I
don't want to get into the politics that, but I
just wanted to kind of just mention that because there's
so there's this thing called the Stark Law or the
anti kickback law, which prohibits physicians in general from referring
patients to any entity in which you have a financial stake. Okay,
(21:30):
so that's something that we know at but it's very
interesting DIALSA centers are actually exempt from this law, so
it allows them to do that. But I do think
there are some positives in the sense that you know,
there are now fewer and fewer Americans actually that live
in an area without any DALLASIS facility. So back in
two thousand and five, okay, almost twenty years ago, about
thirty percent of patients lived in an area without any
(21:53):
DIALASA center. Now it's only ten percent. So that's that's
a net positive, I would think, so that you have
a dial the center close to you. And I don't
want to get into this too much, I just wanted
to point that out because you know, I think it's
it's just good to know why we're seeing a lot
of these centers pop up and you only see a
few centers pop up out there. But let's just go
(22:14):
back to the for a patient standpoint, you've now been
told that you have to go to one of these
centers for DALLASIS if.
Speaker 2 (22:21):
You don't qualify for home dialysis. Another reason why home
dialysis has taken has you know, gained popularity amongst patients
given the fact a lot of people who are in
rural areas are having to go on dialysis and centers
aren't around like you said, Yes, they're popping up, but
(22:41):
they're not not everywhere Midwest, especially where I trained in Indiana,
we had a large rural dialysis population and that's why
we were so exposed to home dialysis. But you're correct,
these centers private Equity, along with Prisinius and Davida are
almost eighty percent of the market share, So you are correct.
It's controversial, but the there is you know, antitrust probing
(23:05):
laws that came out last year by the Federal Trade Commission,
so it's not going unnoticed.
Speaker 1 (23:10):
Yes, So let's say you are someone who has been
told you have to go to a dialasis center because
most patients are probably getting dallases at one of these centers, correct,
So they're probably getting it through. Yeah, what is the question?
Next question is what is their access point for dallas
And we can do an entire show on this in
the future, but very you know, the very quick in
(23:33):
thing for me is when I get called for a
patient in the hospital and they say, you know what,
can you put in a quick temporary dalasis line or
a permanent dialasis line. So these are little lines that
we put in. You also are in your center puts
them in as well. Swe do exactly. So these are
lines that you put in a little tiny catheter in
(23:54):
your neck.
Speaker 2 (23:56):
I would say it's a big catheter compared to the
other catheters when you so, okay, it.
Speaker 1 (24:02):
Has to be big, right, Yeah, it's pretty The thing
is this this line, this conduit in your neck, you
have to be able to push take blood out.
Speaker 2 (24:09):
Around fifty around fifty to seventy five liters of blood
filtered every four hour session.
Speaker 1 (24:16):
Wow, So that's how much blood goes through a Dallas's machine.
I didn't realize. Yeah, that's how much.
Speaker 2 (24:21):
Well, our kidneys itself are doing that alone. Right, So
let me just pull up this kidney fact. Our kidneys
filter our blood around forty times a day, so around
fifty gallons of blood every forty hours, which we're doing
just normal.
Speaker 1 (24:36):
That's what we're normally doing. Yeah. So this machine is
basically trying to take over that that function that you
have now lost as a as a patient. And so
it's trying to do it. And so it's doing seventy
five So.
Speaker 2 (24:48):
It cleans the blood. It cleans a pine of blood
every minute.
Speaker 1 (24:52):
What is what? And so that's why this has to
be a big catheter in your neck. Yes, and because
basically through there's two holes right, well, does give me
three three little passages through this catheter. One is to
pull that blood out. Then it goes through the machine
in some the.
Speaker 2 (25:07):
Machine the magic sauce, I call it magic sauce. It
goes like it looks it's like when it first happened
eighty years ago. Is this rotating drum? It's we could
it's genius how they even came up with this. But
what we do now it looks like a cassette player almost,
because like the tubing and it's going around and there's
over two hundred and fifty alarms.
Speaker 1 (25:26):
If you've ever been in.
Speaker 2 (25:26):
A dialysis units, it's madness because you hear all these
beet being and blue being and you know, uh so yeah, and.
Speaker 1 (25:34):
Then you have to then pump that blood back into
the Yes, immediately exact it does seventy five leaders within
that one hour period. I'm very curious if maybe a
patient's mentioned this to you. I don't know if you
have this information. Sure, Let's say it's your first time
having to undergo dialysis. You've now been hooked up to
a machine. What would I expect during the session and
(25:55):
what would I expect after the session? You did say
before the session, you might feel a little bit confused
because now your body's built up all these toxins.
Speaker 2 (26:03):
Yeah, hopefully it doesn't get to that. Being confused is
a bad marker, right, because when you first start dialysis,
that's emerging funds. Yeah, that's the crash landing. As we say,
you don't want to crash land So this is also
you know, the beautiful thing about medicine is with experience,
and you know, all these attendings that I was around
in my training, they have different ways of treating starting dialysis,
(26:27):
but typically what we we aim for is starting dialysis
very slow. We're not trying to shock your body because
it's a major procedure. Right, We're hooking you up to
a big catheter. We're taking out your blood and giving
it back to you. So our goal is to make
sure we do as least well. The term is quote
unquote low flow rates because you want to not let
(26:51):
the body think that you're doing something drastic. You want
to ease them into it. So for the first three
sessions we typically go two hours, the first one three hours,
the second one and four hours the third one to
make it like your first complete one. So we kind
of like baby step you until you're able to do
the full session, and a patient would feel crappy. There's
(27:14):
no other way.
Speaker 1 (27:14):
To say it.
Speaker 2 (27:15):
Dialysis is not fun. And you know, when I entered
this nephrology fellowship, I loved dialysis, and when I got
deep into it, I found out it's it's very sad
and painful for a lot of patients, and that you know,
and that's why it's my job to make sure that
they feel better as much as I can, because it's
(27:36):
not easy.
Speaker 1 (27:37):
Sure, no, I get that. So I have so many
questions about Dallasas which we haven't even covered, including what
is the goal of dialysis? What are you trying to avoid?
Which we'll discuss on a future show. You know, there's
so many different questions got about Dallasis and we'll definitely
have you back. So I'm here, thanks for joining. As
doctor ruckber Conway, the I've asked Yoular center over on Pelicano.
(28:00):
Him and his partner, doctor Gergis are my go to
for kidneycare, nephrologycare, and nephrology questions.
Speaker 2 (28:07):
And so hacking the bodies filter. Yeah, exactly, that's where
we are exactly.
Speaker 1 (28:12):
So if you are interested in any more information on
any of you mentioned truments, you can always call to
get more information at nine to one five five hundred
forty three seventy that's five zero zero four three seven zero.
You can also reach me by email at raw at
medical hackers dot com. That's my last name, r Ao
at medical hackers dot com. Unfortunately, our time, the Saturday,
(28:33):
is up. I hope these healthcare hacks have helped you
navigate our complex medical system. If you've been tuned into
us this whole time, bless your heart and your health.
I'm doctor Sandy Row, and you've been listening to the
medical hackers
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