SHOULD DIALYSIS COMPANIES BE MAKING RECORD PROFITS?

Part of my daily routine is to peruse articles provided by kidneybuzz.com, a free online service provided by a California-based company that also offers patient-related products for those like me who are on dialysis.

I found this morning’s item quite interesting, even though it was read several hours ahead of sunrise. It centered on a report of earnings for the top two dialysis providers in the United States. The headline posed the question: Should Dialysis Companies Treating Chronic Kidney Disease Patients Be Making Record Profits?

The article cites Los Angeles Times-published info that reads: “The two dominant for-profit dialysis firms, Denver-based Davita and German-owned Fresenius, report pretax operating profits in the billions and margins of 18 percent and 19 percent.” More specifically, in 2017, DaVita earned about $1.8 billion in pretax operating profit of $10.1 billion from Dialysis Patient-Related revenue. Fresenius reported pretax operating profit of $2.3 billion on Dialysis Patient-Related revenue of $11.7 billion for North America.

In my recent book Dialing in on DI-AL-Y-SIS, I offered 2015 revenue figures that showed Fresenius with over $1 billion in after-tax dollars and DaVita’s net patient revenue at $668 million.

The kidneybuzz.com article also notes that as Proposition 8 (an initiative to cap Dialysis Company profits at 15 percent) is set to appear on the California Ballot – and possibly ballots in other states across the country afterward – the earnings of dialysis organizations are being put into the spotlight. Large dialysis organizations have already contributed more than $8 million to oppose Proposition 8, while supporters of the measure have amassed $6 million to push the proposition forward. Still, recent figures released by well-known publications are causing some to pause and evaluate massive earnings as it relates to patient care and whether it is good or bad for chronic kidney disease and dialysis patients.

The article continues:

This has been met with mixed responses from the chronic kidney disease community, with some patients applauding the firms for their great care and terrific business savvy, while other patients do not feel as though they are getting high-quality care and find such earnings to be shocking, since they struggle on a fixed income.

Most of the feedback that kidneybuzz.com gets as it relates to clinics is not that they make profit – in fact, having a profitable business ensures that dialysis can continue to be offered to patients. However, the primary difference is in care. Some patients find that they have exceptional care at dialysis with great service and kind and friendly healthcare professionals. Others believe that their treatments can be improved with more staff, safer facilities, more cutting-edge technology, and better-trained professionals.

It is important to note that DaVita and Fresenius combined operate approximately 4,900 outpatient clinics and serve about 400,000 patients – accounting for roughly 70 percent of all dialysis patients. Hence, the dialysis companies are given an awesome responsibility to keep patients alive, but are they making too much money in relation to the service and resources patients are getting? On the other hand, are the profits simply the rewards of a job well-done for caring for the vulnerable population of dialysis patients?

 

Researchers hone in on emotions of CKD patients

When patients are first diagnosed with chronic kidney disease, or first initiate end-stage renal disease treatments (on dialysis) there are times when emotions can take center stage. In my book, Dialing in on DI-AL-Y-SIS, it is noted that “psychologists characterize the gateway into the world of chronic kidney disease – that can end up on dialysis – can create a physical and emotional crossroads.

A pertinent online article, attributed to the American Psychological Association (APA), acknowledges that dialysis requires a considerable amount of time and effort. … And yes, it does take a lot of time to adapt to the necessary changes in lifestyle.

Psychologists, in fact, provide a term – “rollercoaster emotions” – that pretty much describes what are going through the minds of those going on dialysis. Many are feeling hopeless, burdened by this albatross that is already wreaking havoc with their daily life. At other times, some patients may accept dialysis with a sigh of relief, sensing the upcoming treatments thankfully may extend their days on this earth.

Just this week, I noticed a post by noted Indiana kidney disease advocate James Myers that suggests that the emotional toll on CKD patients is underappreciated at times. The post points to an article written by Pam Harrison on medscape.com in reporting a study by Dr. Ann O’Hare, a professor of nephrology at the VA Puget Sound Health Care system and the University of Washington in Seattle, and her colleagues. The study is titled: “A deeper appreciation of patients’ emotional experiences may offer important opportunities to improve care.” The study was published online on June 28, in the Clinical Journal of the American Society of Nephrology.

Harrison’s article follows:

CKD: Emotional Toll Underappreciated

By Pam Harrison, Medscape Medical News

July 06, 2018

 

The emotional toll that chronic kidney disease (CKD) has on patients is likely underestimated by most healthcare professionals, a descriptive study suggests.

“Patients with advanced kidney disease interviewed for this study described feelings of isolation, abandonment, alienation, mistrust, and even self-blame that would probably be surprising to the providers taking care of them,” Ann O’Hare, MD, professor of nephrology at the VA Puget Sound Health Care system and the University of Washington in Seattle and colleagues write.

“A deeper appreciation of patients’ emotional experiences may offer important opportunities to improve care.”

The study was published online June 28 in the Clinical Journal of the American Society of Nephrology.

O’Hare and colleagues enrolled 27 patients who were under care in the nephrology clinic or dialysis unit at the VA Puget Sound Health Care System in Seattle. Participants completed a 45- to 60-minute semi-structured interview that covered “both general questions about their illness experience and encounters with providers and the health system and more specific questions about their experience and perspectives on advance care planning,” the researchers explain.

Among the participants, 37% were receiving hemodialysis at the time of the interview, 19% were receiving peritoneal dialysis, and 44% had not yet started dialysis. The mean age of patients was 63 years, and almost all patients, at 96%, were male.

Three main themes emerged from analysis of the interviews. The first was the emotional impact of interactions with the providers themselves. “When providers seemed to lack insight into the patient’s experience of illness and treatment, this could engender a sense of mistrust, abandonment, isolation, and/or alienation,” the authors elaborate.

The second theme was related to the first and engendered similar feelings of mistrust, abandonment, isolation, and alienation, but this time from encounters that arose through interacting with the healthcare system.

The emotional impact of the illness itself on the patient was the third theme to emerge from the interviews. “Patients struggled to make sense of their illness experience, worked to apportion blame, and sometimes blamed themselves,” O’Hare and colleagues report.

Specific Examples

By way of examples of how these feelings could come about, the authors point to situations where patients felt that providers did not seem to be acknowledging them as a whole person, which led to feelings of alienation. Feelings of mistrust, in turn, could arise upon disease progression, which led some patients to question the quality of the care they had received earlier on. Others cited situations in which they felt unaccompanied or even abandoned in their journey through treatment and procedures.

Often, patients expressed feelings of isolation in their experience of their illness. “Patients could also be impacted emotionally by how care was organized,” the researchers continue. For example, providers were often obliged to move in and out of an individual’s care as their illness progressed, triggering feelings of mistrust. Patients also expressed feelings of abandonment as the care they received appeared to be fragmented or when providers did not appear to collaborate with their colleagues.

Some patients expressed feelings of alienation when, for example, they were given a tour of the dialysis unit, which many of them found quite distressing.

“The question of whether and to what extent [patients] were responsible for the course of their kidney disease (or illness more broadly) was one with which the individuals we interviewed struggled greatly,” the study authors observe. For example, interviewees often assumed that they had brought their illness on by either not doing something they should have or by doing something they should not have done.

“Even patients who understood their kidney disease to be multifactorial seemed to assume that they might have been able to do something to alter the course of disease if they had only known more,” the researchers write. The authors also point out that whether patients felt they were personally responsible for their illness could amount to a matter of “considerable moral importance” to them.

“Even well-intentioned efforts to increase patient engagement in care (e.g., efforts to promote living well with chronic disease, or healthy aging) can have the unintended effect of making patients feel responsible for their ill-health or disability,” the authors note. “Improving education and health literacy among patients with kidney disease and building communication skills among nephrology providers will go some way toward improving communication between patients and providers.”

However, they caution that improving communication between patients and providers will require providers to make a greater effort to more fully understand the emotional toll the illness has on patients.

Real Patient Engagement

In an accompanying editorial, Denise Eilers, BSN, RN, who sits on several of boards of directors, including the board for Home Dialyzors United and the National Kidney Foundation Iowa, notes that all successful discussions about the treatment choices that patients with CKD face must involve real patient engagement. “For patients and their family, choice is about life goals, which are ever changing targets,” Eilers writes.

For example, a young employed parent is very likely to have different treatment goals than an 80-year old being cared for in an assisted-living environment. Conversely, there may well be 80-year-olds who plan to take up sky diving in celebration of making it to their 80th year. “Each patient is an individual and assumptions are detrimental,” Eilers cautions.

She also notes that findings from the study support the need for nephrologists to have difficult conversations “upstream” so when a serious situation does evolve, “there is a clear understanding of the patient’s wishes,” she writes.

Above all, Eilers says this study is “especially timely” given the anticipated wave of baby boomers who are at risk for a variety of chronic diseases, including CKD. “That generation, of which I am a member, has been described in various terms such as goal oriented, self sufficient, questioning, and involved,” Eilers notes.

“The sheer numbers of these older, non-traditional adults will make it necessary to move the needle further toward shared decision making,” she suggests.

Depression not unusual battle for dialysis patients

Today, I received an electronic  communique from Lori Hartwell at rsnhope.org and her Renal Support Network’s RENALERT news issue. The lead article centers on the topic of depression. That reminded me of a blog item I penned back in early March titled Dialysis Has Its Own Pains & Sufferings, where I addressed personal pains relating to physical, mental, emotional, financial, family, and religious concerns.

The RENALERT offering is titled Understanding Depression & Overcoing Depression, and is authored by licensed social worker Mark Meier, executive director the Face It Foundation. He explains in detail the steps to understanding and overcoming depression.

According to Meier, “it isn’t easy, it isn’t quick, and it requires effort, but for many sufferers of depression there are skills you can learn, attitudes you can adopt, and lifestyle changes you can enact that can provide a path to some peace and contentment.”

For those whose fate has found them afflicted with chronic kidney disease, the following article will provide them with a worthwhile read.

 

By Mark Meier — Executive Director, Face It Foundation (June, 2018)

If you’ve ever experienced a soul-crushing Major Depressive Episode, or it’s equally evil brother, Persistent Depressive Disorder (formerly called Dysthymia), I hope I can impart some knowledge to help you battle against such monsters.  For those of you who have never dealt with these characters, count yourself lucky, stop judging those who have, and read this article to gain insight into how you can support family, friends, and fellow CKD patients who are struggling with depression.

According to the American Foundation for Suicide Prevention total about 1.1 million attempts a year; and suicide completions, which according to the Centers for Disease Control totaled 44,965 in 2016.  Depression is real, and deadly.

Depression is complicated. Repeat after me: “Depression is complicated, really complicated!”  Unlike the stages of CKD, delineated by clear biochemical markers, with generally accepted protocols for addressing each stage, depression parades around in many different forms. It is often accompanied by denial about its impact and associated social stigmas.  Our ability to diagnose it is often left to conversations, recollections of painful events, and a completely unexplained etiology. We can’t draw your blood, do a CT of your brain, run you through an MRI, or even order a simple X-ray to determine if you have it.  All of which leave its treatment vulnerable to trial and error, frustration, failure, desperation, and fear.

Depression is characterized by two primary symptoms:

  • Depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad, empty, hopeless) or observation made by others (e.g., appears tearful)
  • Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day

After establishing the presence of at least one of these two symptoms, we then look for five of the following additional symptoms, which have been present for a two-week period and represent a change in previous functioning:

  • Significant weight loss when not dieting or weight gain
  • Insomnia or hypersomnia nearly every day
  • Psychomotor agitation or retardation nearly every day
  • Fatigue or loss of energy nearly every day
  • Feelings of worthlessness or excessive or inappropriate guilt nearly every day
  • Diminished ability to think or concentrate, or indecisiveness, nearly every day
  • Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.

What all of this represents is PAIN, lots of it. This includes both physical and emotional pain. In fact, the pain is so great that the presence of depression is frequently associated with suicide attempts, which according to the American Foundation for Suicide Prevention total about 1.1 million attempts a year; and suicide completions, which according to the Centers for Disease Control totaled 44,965 in 2016.  Depression is real, and deadly.

It isn’t easy, it isn’t quick, and it requires effort, but for many sufferers of depression there are skills you can learn, attitudes you can adopt, and lifestyle changes you can enact that can provide a path to some peace and contentment. 

Further complicating depression is that for so many of us who have or continue to suffer from it, we have a tough time putting our own finger on why we feel so horrible.  We look around and see that we have family, friends, a reasonable upbringing, the ability to pay our bills, and yet we still struggle.  This set of circumstances compounds our guilt and shame, sinking us into self-loathing and disdain that makes no sense to the outside world.  From this place of pain, many of us try to make these feelings go away by self-medicating with food, alcohol, the internet, shopping, gambling, etc.  We become sullen, agitated, and our own worst enemies, as we further isolate ourselves by treating those around us poorly.  We lose hope, we see darkness, and all we desire is for the pain to simply end.The reality is that the onset, recurrence, or exacerbation of a depressive episode is associated with MANY factors. These include: a history of abuse, a lack of coping skills, childhood (or adulthood) trauma, brain structure, dietary intake, a lack of social support, chronic disease (such as CKD), life-hassles, genetics (both our DNA and the environments we grew up in), and a whole host of other factors.

Repeat after me: “Depression is complicated, really complicated!”What causes it? I wish I could tell you that it was simply a “chemical imbalance”, because then we could focus our efforts on developing an antidepressant which could be prescribed and taken correctly, and our problems with depression would be solved.  The truth of the matter is that we simply don’t know what causes depression.  We know that certain chemicals in our body such as serotonin, norepinephrine, dopamine, and others are associated with our moods, but saying that one or the other is out of balance and that is why people are depressed is not accurate nor is it valid science.

Life seems pointless if you are mired in this state . . . but I am here to tell you there is HOPE! In fact, despite all that I have written so far (all of which I experienced firsthand, including a suicide attempt that landed me in the hospital) can be overcome. It isn’t easy, it isn’t quick, and it requires effort, but for many sufferers of depression there are skills you can learn, attitudes you can adopt, and lifestyle changes you can enact that can provide a path to some peace and contentment.

Where to start?

Let’s look at the professional disciplines who can diagnose and treat depression and learn a bit about who they are:

  1. Medical Professionals
    • Psychiatrists –Medical Doctors who have specialized training in the diagnosis and treatment of mental health conditions such as depression. Psychiatry is primarily engaged in the management of mental health issues using medication approaches.
    • Primary Care Providers – Usually Medical Doctors who are trained in Family Practice, Internal Medicine, or OB/GYN. Subsets of these providers might be the Nurse Practitioners or Physician Assistants that work in these practices. These individuals are generally able to dispense medications such as antidepressants.
  1. Mental Health Professionals
    • Psychologists – They generally have a Ph.D. or Master’s degree in Psychology, and deal with mental health issues by screening and providing talk therapy. Generally, these individuals are not able to dispense medications for depression.
    • Social Workers – They generally have a Master’s degree in Social Work and have obtained or are working on obtaining under supervision a clinical designation such as LCSW which stands for Licensed Clinical Social Worker. These individuals are not allowed to dispense medication, and treat depression through talk-therapy.
    • Other Disciplines – Other disciplines such as those with advanced degrees in Counseling, Marriage and Family Therapy, Divinity, and Substance Abuse Counseling also provide talk therapy for dealing with depression.

In addition to consulting professionals who diagnose and treat depression, there are other approaches you can adopt to help improve your mood.  For example, we know that lifestyle choices such as eating a healthy diet, regular exercise, and a regular sleep schedule are all helpful in improving our moods.

Many people who experience deep depression have the tendency to isolate themselves and disengage from their friends and family.  I know how difficult it is to find motivation in the face of depression, but it is critical that you do your best to stay engaged with your social network. Friends, neighbors, family, and others in your community can not only “give you something to do”, they can also help you to challenge your negative beliefs and attitudes (these often accompany and exacerbate depression).

We know that spirituality and/or one’s religion can be a source of comfort, especially if it accomplishes the goal of staying engaged positively with others. Part of spirituality for some is learning to meditate, or develop relaxation techniques such as deep-breathing, hypnosis, and visualizations.

Depression is complex and complicated.  It is impacted by a multitude of factors. Keep that in mind as you consider ways to attack it.  I strongly suggest to you that there are no quick fixes, nor are there any easy solutions.  What works for one person might not work for another.  Don’t give up! Keep asking questions, keep looking for professionals with the necessary energy and professional curiosity to help you discover options that work for you, and understand you’re not alone in this fight!

Mark Meier, MSW, LICSW is a Social Worker and is the co-founder of the Face It Foundation which is a Minneapolis-based organization providing peer support for men who deal with depression.  In addition to his role at Face It, Mark is on staff in the Department of Medicine and Community Health in the University of Minnesota’s School of Medicine.  Mark previously worked in a dialysis clinic as a social worker, trained patient care technician, and facility administrator.

 

2 impactful (??) contributions claimed within a week

Displayng his 2 stickers after casting ballot.

By the end of this calendar year’s first quarter (January-March), I can realistically state that I helped Fresenius Medical Care, the largest dialysis-related conglomerate in the entire world, to increase one of its numbers in a May 3-released financial report reflecting its U.S. and international operations.

I really can’t get too excited, though, about my part in the report. After reading that the Marion County voting turnout (16 percent of those who are registered) was low, I still believe my effort on the political front was more impactful than my contribution was to the Fresenius divulgement.

For those who may have followed my medical concerns, you may recall I went on dialysis a year ago February, and since have documented the journey in my book titled Dialing in on DIAL-Y-SIS. Since that writing, I have shifted my weekly treatments from an independent clinic to a spanking-new center, Fresenius Kidney Care Southport. That transition this past February placed me right in the middle of its parent-company’s financial report.

So, really what was my contribution to this latest Fresenius financial disclosure?

According to this recent report, the company – by the end of March (2018) – was treating 197,339 patients at its 2,419 clinics in North America. The report also documented a 4 percent increase in treatment numbers. Without my contribution, the number of patients would have tallied only 197,338. How about that on my part?

The report also indicated the company increased 4 percent in its number of clinics. While my Fresenius Southport treatment center opened only full-fledge at the start of this calendar year, I did join the Indianapolis Southside clinic in February, being among the first dozen patients at the new 24-bed facility. During the past several weeks, the Southport in-center numbers are increasing by a new patient every day or so. Eventually, the clinic will accommodate more than 70 patients calling the facility their treatment home on three days of each, and every, week.

Being a national and international player in the dialysis industry, it is not surprising that Fresenius is noted to have a major stake in Central Indiana. In Marion County and the eight surrounding counties, Fresenius operates nearly 20 in-center clinics with around 330 chairs providing more than 3,000 treatments a week.

In the Central Indiana area, there are about 40 in-center dialysis clinics that push the total number of in-center dialysis treatments likely to roughly double (6,000 weekly treatments).

In my Dialing in on DI-AL-Y-SIS book (promoted on www.diodialysis.com), I point out the enormity of the dialysis industry. Two mega companies – Fresenius Medical Care, based in the United States at Waltham (Massachusetts), and DaVita, located in Denver (Colorado) – dominate the landscape. Between the two, they operate more than 4,500 treatment facilities, with more than 350,000 patients.

For the year 2015, Fresenius netted more than $1 billion (that’s dollars, now) in after-tax profit; for that same year, DaVita’s net patient revenue was $668 million. Over 90 percent of the machines utilized in the provision of hemodialysis are manufactured by Fresenius, with well over 100,000 of these equipment pieces placed throughout the United States.

So, for this old retired American citizen, it was nice to note that within one week I had impacted both a political election, although just the Primary, and a first-quarter financial report disclosed by my home-away-from-home’s parent company.

By the way, after my ballot was grabbed by the collection machine at the voting poll, one of the ladies at a table handed me a sticker to place on my jacket front that read: I Voted! Did You? I thanked her kindly, so she gave me one for the other front of my jacket. I kept waiting all day for someone to ask me if I had voted twice. I’m staying mum on what my answer would have been. Okay, one of my answers would have been: “No, this is not Detroit.”

TV station reports on bionic kidney project

WSMV News 4, a Nashville (Tennessee) television station, this past week reported on the development and progress of a bionic kidney that is providing hope for the many thousands of dialysis patients across the country.

I came to know of this artificial kidney possibility while researching my book, Dialing in on DI-AL-Y-SIS, and included pertinent information of the progress being made by the two original research collaborators in one of my 16 chapters. The Nashville station’s update on the bionic kidney aired as follows:

There are two options for a person with kidney failure. A kidney transplant or dialysis, a machine that filters the blood of toxins, normally cleaned by healthy kidneys.

Thanks to research conducted at Vanderbilt University Medical Center (located in Nashville) and five other universities around the country, a third option may be available that can mean people on dialysis can lead a normal life as if they didn’t have kidney failure at all.

Right now without dialysis, a person with kidney disease can live for only a few weeks, perhaps months.

A tiny device that can fit in the palm of your hand may be a game changer. It’s called the bionic kidney.

Vanderbilt nephrologist Dr. William Fissell is part of a nationwide team of doctors and biologists who have been working on the device for 17 years. “It’s fair to call it a bionic kidney because it’s a hybrid of technology and living cells,” said Fissell.

It’s been a long journey for Fissell. He hopes to begin clinical trials on the bionic kidney later this year and to get the device to kidney patients as soon as safety permits. “Know that we are doing it as fast as we can, and know that the rest of the country has mobilized in a way you may not expect,” said Fissell.

If the bionic kidney makes that huge jump from clinical trials to where it becomes available to all kidney patients, the implications for someone in renal failure is huge.

“What I want to do is enough, so that sick people can become well, not burdened by the disease, so that patients aren’t stuck to a machine plugged into a wall 15 hours a week, so they don’t have to have a special diet, so that patients don’t have to starve themselves to avoid intoxication with waste products,” said Fissell.

Note: Joining Dr. Fissell as one of the two collaborators in initiating Kidney Project is Dr. Shuvo Roy, the effort’s technical director from his faculty status at University of California San Francisco. The two doctors initiated Kidney Project in collaboration at the Cleveland Clinic in Ohio back in 1998.

This work ethic belongs in World Series

While watching a TV sports show early one morning last week during a dialysis treatment, it was mentioned that the Kansas City Royals (my favorite baseball team) were getting ready to begin their 50th season as an American League franchise. I have been right along on that half century every step of the way, being one of those in the original group of Royals’ fans. Certainly, the highlights have been the two World Series championships (1985, 2015). During my own 50-year career as a journalist, one of my favorite columns centered on a KC player who in the maiden season for the franchise was selected for the American League’s rookie-of-the year award. That particular writing is among my multi-compilation collection titled A Half Century of Writings. The column, written 31 years ago, follows:

(October 17, 1987)

THIS WORK ETHIC BELONGS IN WORLD SERIES

By Bernie Gilmer, Editor, The Belvidere Daily Republican

The field generals on the diamond battlefields today are Whitey Herzog and someone called Tom Kelly. It’s hard to say, but I would be willing to bet a World Series ticket that neither has been down the road a piece from St. Robert, Missouri.

Many generals and their troops have journeyed down the chute from St. Robert to the entrance of Fort Leonard Wood, a sprawling military reservation where Army recruits and “weekend warriors” have had occasions to pitch their footlockers over the years. I pitched mine on that miserable post – somehow Army bases never are listed in travel brochures – twice back in the late 1960s, although the brief, two-week summer camps on behalf of the United States Army Reserves hardly qualified the footlockers as dust collectors.

The summer outing of 1969 did prove to be something special for someone like myself, who found helping to run a mess (dining) hall and serving Army chow less than a career opportunity at that time. It offered a study in human nature as the Army tends to provide a melting pot of the nation’s populace. And each individual element of this olive-drab society does pass through the mess hall for his daily allotment of sustenance, as it were.

Some soldiers pass through mess halls in other than voluntary fashion. Some are placed on kitchen police – a glorified term for duties that include busboys, floor moppers, potato peelers, pots and pans scrubbers and the like. It’s one of the Army’s punishments – do something wrong and you end up on K.P.

That brings us to the summer of 1969. Our unit reported one Saturday morning through the gate at Fort Leonard Wood, settled into some clapboard-sided barracks and promptly got assigned work quarters. For a handful of us, that meant buying (signing for) a mess hall and breaking open some rations for upcoming feasts.

Now that same weekend the Kansas City Royals, playing their first season as an expansion entry in the American League (Charlie O. Finley had vacated his Athletics to Oakland), were involved in a homestand at Municipal Stadium and playing for the most part like the expansion team they were.

The lone bright spot for the Royals was left fielder Lou Piniella, a surprising development as a rookie since he had graced and disgraced several minor league teams since being signed by the Cleveland Indians in 1962 at age 18. Piniella was the first Royal ever to get a base hit, going four for four on Kansas City’s opening day in 1969. He became an instant hero in the Heartland of America, an area where many fans still consider the St. Louis Cardinals the local team and any Kansas City organization merely a farm club of the New York Yankees.

Piniella also became the first Royals’ player to ever scrub pots and pans at Fort Leonard Wood. A member of a reserve component in Kansas City, Piniella elected to play those weekend games and consequently, along with Royals’ pitcher Roger Nelson (a Cincinnati castoff), reported to summer camp a couple moons late. And the two – Piniella and Nelson – promptly were slapped on K.P., which places them under the command of the mess hall cooks. It was only for a day, but what a thrill for someone like me, who is a charter member of the original Royals fandom. Stop by my office and I’ll show you my Royals pennant.

It was also a study in human nature.

Nelson was assigned to peeling potatoes, which he took to with little enthusiasm. He whiled away most of the time tossing potatoes in the air with one hand and attempting to slice them with a knife in the other hand.

Piniella’s approach was quite different. Scrubbing pots and pans is considered the dirtiest, filthiest job in the mess hall – soiling his Army fatigues way before daybreak (K.P. begins about 4 o’clock in the morning) – and when he left that evening (15 hours later) every pot and pan was washed and left hanging in its proper place.

It’s little wonder that few people can relate whatever happened to Nelson and his baseball career. As for Piniella, he went on to become the American League’s Rookie of the Year in 1969. Not too bad for a guy who had lumbered through the minors for seven years with a temper as hot as his West Tampa, Florida, upbringing.

After being signed by Cleveland, Piniella began in Class D with the Selma (Alabama) Cloverleafs. Then – in November of 1962 – he was selected in the Minor League draft by the Washington Senators and the next July traded to the Baltimore Orioles … and then swapped back to Cleveland. During these years, it is possible most players would have found a nice nail for retiring the spikes. Oh, Piniella got cups of coffee with Baltimore (four games in 1964) and Cleveland in 1968 (six games), but never collected a hit.

But Piniella didn’t quit. He kept right on scrubbing. In the expansion draft ahead of the 1969 season – when the Kansas City and Seattle franchises were added to the American League – Piniella had wanted to be picked by the Royals because he had once played for their manager, Joe Gordon. Seattle had the first pick and selected Chico Salmon. Kansas City then plucked Roger Nelson, the pitcher. Piniella then went to the Pilots. But not for long because Piniella then was traded to Kansas City for outfielder Steve Whitaker.

Piniella got off fast with Kansas City. In his first spring training game, he homered off Steve Carlton. And he opened the 1969 season as the Royals lead-off batter and responded with four straight hits. The rest is history. He quickly went from a $12,500 a year rookie ballplayer to become an American League star. Then ahead of the 1974 campaign, the pipeline from Kansas City to New York (the Yankees) vacuumed up Piniella and he became one of the top hitters in baseball for the next 10 years.

And one of his mess hall cooks at Fort Leonard Wood continued to be one of his biggest fans. I always rooted for Piniella to go four for four as long as the Yankees lost. A true Royals’ fan also is a true Yankee hater.

Of course, Piniella two seasons back replaced Billy Martin as manager of the Yankees. And since the Royals aren’t in the 1987 World Series beginning today, I wish the Yankees and their manager were (nothing against Whitey Herzog of the St. Louis Cardinals or Tom Kelly of the Minnesota Twins).

But it is only Piniella who has made that trek from St. Robert to Fort Leonard Wood. I only hope Yankees’ owner George Steinbrenner knows how well Piniella scrubs pots and pans.

NCAA hopes can have their crushing moments

Twice now as a passionate follower of Kansas State men’s basketball have my NCAA tournament hopes been crushed by women. The first time was back in 1964, when K-State was one of the participants in the Final Four at Kansas City. The most recent came a day ago (Thursday, March 22) in Atlanta, where Loyola of Chicago prevented my Wildcats from reaching their first Final Four since that KC hoops spectacle of some 54 seasons ago.

Ever since K-State surprisingly had dispatched the Kentucky Wildcats this past Thursday at Atlanta, I had been thinking about the possibility of my Sunflower State’s Wildcats reaching another Final Four. Much of that consideration came while whiling away time during my early Friday morning dialysis treatment (I was still celebrating from the night before), with thoughts carrying me back to when I had accompanied the Kansas State entourage to Kansas City as the university’s sports publicist.

For a man, it is always demeaning (tongue in cheek) that a psychological setback can be caused by a woman. But this time, there she was – Sister Jean, that spunky 98-year old nun and Loyola of Chicago’s basketball team chaplain for 24 years. She has been a long-time Rambler fan who has witnessed more than a half-century of her team’s basketball history – for almost as long as I have followed my K-State men’s basketball scores. For Sister Jean, though, it would be her school’s first Final Four. My school has reached a quartet of Final Four gatherings (1948, 1951, 1958, 1964), having lost in the championship game to Kentucky in 1951 (I was 10 years old at that time).

The one Final Four (in 1964) that I was able to see first-hand included semifinal match-ups between Kansas State and UCLA and between Duke and Michigan. How that tournament began and how K-State’s basketball team and its fan base were impacted by a group of women is reminisced in a column I wrote two dozen years later while serving as editor of the Belvidere Daily Republican. The column follows:

(April 2, 1988)

POM PON GIRLS STEAL NCAA TITLE

By Bernie Gilmer Belvidere Daily Republican

There are those who contend today’s NCAA semifinal basketball contests and Monday’s title match-up comprise the top attraction in all of sports. That includes the Super Bowl, the Indy 500 and the Calaveras County Frog Jumping Contest.

No doubt about it. Final Four college basketball is big-time. Officials of cities that have hosted the event will substantiate this claim. Ask those in New Orleans where twice in the last six years the NCAA Final Four staging has rivaled the Mardi Gras as an economic draw.

Needless to say, it’s a “really big shew” in Kansas City this season. And so it was 24 years ago when Kansas City last hosted a Final Four tourney. I know because I was there representing one of the Final Four schools – Kansas State University – as sports publicist.

That 1964 extravaganza is a memorable one. Not because of the bitter cold and wintry conditions; those are commonplace for residents of the Great Plains. And not just because I had the opportunity to watch the games in person.

What is memorable is the arrival of the sun-tanned California pom pon girls during one semifinal contest. Also making a distinct impression was the play of a Kansas State team consisting mostly of small-town recruits coached by a very patient taskmaster, Tex Winter. And the fact that the unsuspecting contingent came within minutes of doing something that might have altered drastically the history of college basketball as it was recorded the following dozen years.

On the surface, Kansas State might have looked like it least belonged among the Final Four. Winter’s starting line-up featured a popsicle-stick pivot, two blue-collar guards and one forward who used to sell concessions at rival University of Kansas basketball games as a high school student.

All right, so Winter had one bona fide All-American – a 6-6 forward named Willie Murrell who later that summer led the Olympic trials in scoring but was left off the United States squad by Olympic Coach Hank Iba, the taskmaster at Big Eight foe Oklahoma State. Iba had wanted Murrell, who grew up in the all-black town of Taft (Oklahoma), to come to Oklahoma State. Murrell, however, opted for junior college and then Kansas State.

But possibly the most interesting player was Roger Suttner, the Kansas State center from Ridgway – that’s a Southern Illinois community of fewer than 1,200 residents in Gallatin County (not far from where Illinois, Indiana and Kentucky all share the Ohio River). Suttner was billed as being from the popcorn capital of Illinois, if not the world.

At any rate, Suttner was the first 7-footer in Kansas State history, although on a good day he might have weighed 180 pounds. Deep-voiced Rog discovered early that when the Big Eight basketball winds blew, he toppled over like corn rows in a Dyfonate commercial.

Remember, I said Winter was patient. The first thing he had to teach Suttner was how to walk backwards. In his first varsity game – some three seasons prior to the 1964 Final Four and against the roughhouse St. Louis Billikens – Roger went for a rebound and was deftly hipped into the two-bit seats at Kiel Auditorium. He promptly called time out and informed Winter rather apologetically: “Coach, I don’t think I’m ready yet.”

But three seasons later – after considerable patience on the part of Winter – Suttner was ready. He blended in rather well with the four other small-town guys. By the way, Kansas State’s sixth man was Gary Williams, the highly touted Peoria (Illinois) prep whiz who later would play collegiately at Abilene Christian and Oklahoma City.

So, the 1964 Final Four field was set. The semifinal pairings pitted Kansas State against UCLA and Michigan against Duke. Michigan might have been the tourney favorite had the Wolverines’ All-America selection Cazzie Russell not been out with an ankle injury. As it was, any of the four schools appeared to have a solid chance of winning the NCAA title.

For 33 minutes it appeared Kansas State’s small-town guys would make the championship game. They had big-city UCLA on the ropes and reeling, sporting a seven-point lead with about seven minutes to play.

But then it happened! The weather apparently had broken and a previously delayed flight carrying the UCLA pom pon girls had arrived in Kansas City. And their sudden emergence – sun-tanned California beauties enthusiastically waving pom pons – obviously captivated the crowd, disrupted Kansas State and served to charge up UCLA.

Needless to say, UCLA rallied to beat Kansas State and then went on to defeat Duke in the finals. This represented UCLA’s first NCAA basketball title, a feat the Bruins and fabled Coach John Wooden would repeat nine times in the next 11 seasons.

But as far as I am concerned, the credit shouldn’t go to Wooden and his players – some such as Walt Hazzard, Gail Goodrich and Keith Erickson, who would go on to become household names in the professional ranks.

The true credit for starting UCLA’s dynasty should go to the pom pon girls. Had they not arrived when they did, who knows? …maybe a kid named Lew Alcindor (now Kareem Abdul-Jabbar) from Power Memorial High School in New York might have favored the gently rolling hills of Manhattan in Northeastern Kansas, … or perhaps an academic giant like Duke.

This year’s Final Four will provide additional memories, and certainly add to the history of perhaps the truly greatest spectacle in sports.

But history also carries strange accounts. It is interesting to note this season that three of those Final Four teams that made it to Kansas City some 24 years ago were still hopeful for a return trip after this year’s tourney field had been trimmed to 16 possibilities. Michigan, Duke and Kansas State all had a chance for today’s return journey. Of the 1964 foursome, only UCLA – a school whose program has fallen on rather ordinary times of late – was not a part of this year’s 64-team bracket.

Maybe the Bruins should be out recruiting pom pon girls!

Dialysis has its own pains and sufferings

I came across an interesting blog on www.madogre.com the other day that drew my attention, and it might help me in developing a total perspective on the topic of pain. The title of the writer’s post reads: “You don’t know Pain, until you know Gout Pain.”

His opening paragraph follows: “(Pain), it’s kind of like Gout. Dude, if you have never had a Gout attack, you have no idea what Gout is like. So don’t even think you know.”

In describing the pain, the writer points out that “when the weight of a light bed sheet on your foot is too much agony … when the pain keeps you up all night. I mean, Zero sleep because nothing touches, relieves, or does a dang thing to help the pain … .”

I have never experienced having gout, or a gout attack. But I can tell you there are enough pains and sufferings for those of us who are on dialysis, the end stage of renal disease. Like mentioned on www.madogre.com regarding gout, if you have never been hooked up to a machine that methodically circulates your blood for 3½-4 hours a day (three treatment sessions a week), then you may not have a realistic view of what someone on dialysis is experiencing.

Chronic kidney patients on dialysis are often confronted with sufferings of various kinds. For example:

** Physical pain – actual aches and pains within the body due to chronic kidney disease, and/or those sufferings that can be attributed to other medical concerns, such as heart disease, obesity, diabetes and hypertension, just to name a few.

** Mental pain – worries that painfully can affect the person’s mindset and, at times, cause ongoing stress and perhaps unending sleep apnea.

** Emotional pain – public episodes that might produce embarrassing reactions brought on by medical treatments, medicinal side effects, or blood pressure and/or blood sugar readings that are out of balance.

** Financial pain – dollars & cents matters that painfully can affect the pocketbook.

** Family pain – circumstances that painfully can affect not only the person on dialysis   but oftentimes the relationships with family members, extended relatives, neighbors and friends.

** Religious pain – Sometimes, as a result of intertwined pains and extended sufferings, patients on dialysis might reach a low point of questioning their faith, whether it be Bahá’í Faith, Buddhism, Christianity, Hinduism, Islam or many other religions of the world.

In experiencing the sufferings associated with dialysis, I can vouch for such pains in most every category listed above.

Physical sufferings on my part really had begun several weeks ahead of being placed on dialysis. A sudden, unexpected weight gain had put me over 200 pounds on the bathroom scales, and suddenly the smothering of internal organs (heart, lung, etc.) due to excess fluid had created a lack of stamina and a shortness of breath, both accompanied with an element of pain and suffering.

The stamina and breathing issues came to a climax in January of 2017, when my wife Maureen and I returned home from a weekend in Florida to watch three grandchildren play youth basketball on a Saturday afternoon, and to visit with daughter Sara and her family in Jacksonville. While it was fun watching the three games, it was burdensome for me to sit at length on the aluminum bleachers; at times I would stand up and lean on a structure pole within view of the court. The next day we returned to Indianapolis on a 90-minute flight. I had trouble exiting the chute from the plane into the terminal and required a wheel chair to reach our ride parked at the airport curb.

After starting dialysis treatments on February 1 of 2017, I soon learned about the possibility of cramping up during the process. While only slight, the cramping in my feet and calf areas was quite painful and generally eased by the attending technicians in short order. Mostly, leg cramps while on dialysis result from the following conditions: 1. When blood pressure is lowered quickly, 2. Due to rapid sodium removal, 3. The appearance as a clinical manifestation of low potassium level, and/or 4. Inaccurate fluid removal goal established prior to the start of a treatment session.

When cramping occurs, nurses and technicians can make adjustments that likely will alleviate the pain and the session can continue through completion. If the adjustments do not stop the cramping, then the dialysis process can be halted prematurely.

My second week on dialysis brought about what developed for a neophyte dialysis patient into a catastrophic and somewhat traumatic experience. Certainly, it was not what you would call a “warm welcome” to a new lifestyle.

On the Monday session, I began feeling quite colder as the treatment went on, despite sitting in a heated chair and wrapped up in a sweater and two blankets. Eventually the chills began alternating with an occasional bout of profuse sweating. I left the treatment center, went straight home and immediately sprawled out on the living room couch covered by a blanket. I stayed there until sometime in the night when I moved upstairs to another sofa, where I remained for all of Tuesday and until the time to return to the dialysis center for the Wednesday treatment.

That mid-week hook-up to the dialysis machine was not any more inviting than the one two days before. The chills prevailed once again, only this time noticeable shakes could be characterized more as uncontrollable tremors. About halfway through the treatment, my temperature reached 102 degrees; my wife was notified that it might be wise to take me to the hospital following treatment. However, before she arrived at the center, the temperature had climbed to 104, and clinic personnel already had summoned an ambulance, noticing that I was in a rather hallucinating state.

At the hospital emergency room, I was diagnosed with sepsis and eventually admitted. The doctors determined that my access ports located high up on my right chest for facilitating dialysis were infected. I stayed in the hospital for about a week while antibiotics eliminated the sepsis and a new catheter connecting to the jugular vein was implanted once again.

Needless to say, the introduction to dialysis to this point had already brought on some physical-type pains, not to mention the many painful thoughts that had an effect on my mindset, emotions and family considerations. There were those sleepless nights where thought processes were stressed out to the limit, emotions were challenged, and considerations as to how family members would adapt to the new lifestyle changes I was being forced to live.

The most physical pain and suffering for me came in the second month (March) on dialysis when one of my new medications – Calcium Acetate, known as Phoslo – became quite problematic. One of its many side effects is constipation. Within two weeks, I met up with this big blue pill that is designed to prevent high blood phosphate levels in patients on dialysis due to severe kidney disease. The original dosage called for taking about 35 such pills weekly, and soon the prescription was upped to twice as many.

I never got to increasing the dosage. It soon became quite evident that the pills would unleash the one side effect – that would provide me with some tales that should not be told at the dinner table. Early in my transition to dialysis, I began researching and writing a book that was published in late 2017 that was titled Dialing in on DI-AL-Y-SIS. Chapter 7 (GUESS WHAT NEW MONTH BLEW IN?) documents the two rather personal bouts with Phoslo, the first in my ground-floor bathroom at my condo and the other at the Emergency Room at Community Hospital South. Soon thereafter, my nephrologist dropped that medication from my pillbox list.

Note: Those wanting to read the entire details of Chapter 7, or might be curious about the other 15 chapters of the 174-page book, the quality paperback is available online at www.diodialysis.com or at www.amazon.com.

There was one evening during the early weeks of my being on dialysis that my wife was out of town and unable to pick me up after my treatment. At that time, my dialysis sessions were late in the afternoon. Good friend Jerry Lantz stepped up to handle chauffeur duties, and we planned on eating out.

When he pulled up to the pick-up site next to the center’s main entrance, I walked out and got into the passenger seat. He pulled out of the drive and while entering Madison Avenue on the south side of Indianapolis, he asked me where I wanted to eat. I started to reply, but somehow, painfully, I couldn’t reply.

What an embarrassing moment and more. I knew where I wanted to go eat, but I couldn’t get it out. My lips and mouth were moving, but I just couldn’t get my voice to work. Jerry quickly noticed I was having a major problem with my speech and suggested we get something to go so I wouldn’t have to get out of his vehicle. We settled on a Subway sandwich shop, and with some prying he got the word “tuna” out of me. We went on to my condo where I was still having difficulty with my speech and began eating our sandwiches. In 20 minutes or so my speech slowly returned to somewhat normal and my son Evin showed up to stay the night with me. That would wind up being an account that I can definitely document as having suffered an embarrassment.

Some public episodes have been more embarrassing. I have over the years passed out due to equilibrium issues on several occasions – once conveniently at a funeral home showing, another time at my urologist’s office, and again at a Bob Evans restaurant in New Castle while in between games at the annual boys’ basketball holiday classic. The latter experience was quite painful; when I woke up I was lying on the restaurant floor exchanging stares with eaters while I was being loaded onto an ambulance gurney for treatment in the parking lot. After being tested for blood pressure and blood sugar readings and invited to be taken to a New Castle hospital, I decided to return to the restaurant to eat the lunch that I had already ordered. I also went back to the country’s largest high school gym for the night-time game.

For many, if not most, end stage renal disease patients begin their journey on dialysis in a mental state of denial. “Why me? I really don’t believe this is happening.” It is at this point where some patients may begin to question their spiritual faith. I can admit that my mental state and my emotional being was being challenged.

Before my initial dialysis treatment, I threw a one-night “pity party” with no invited guests. I spent an entire night tossing and turning in a hospital bed ahead of my first-ever time to be tethered to this rather imposing, blood-circulating machine, searching for a way out of doing something I truly totally didn’t understand and truly totally didn’t want to do. As the sun slowly prefaced a new day, the party came to a halt and I ended up doing what I truly totally did not want to do.

That was more than a year ago. Since that beat-down by Phoslo, any pains and sufferings have subsided for the most part, thanks to a great extent to having completed the therapeutic exercise of researching and writing the book Dialing in on DI-AL-Y-SIS, documenting my experiences and overall perspective of being on dialysis.

What bothers me now more than anything is directly witnessing three days each week the ongoing pains and sufferings – whether it be physical, mental, emotional, financial, family or religious – that are endured by fellow patients. What my mind wrestles with almost daily is trying to transition a multi-faceted vision into a realistic and worthwhile project that will help alleviate some of these pains and sufferings. Stay tuned.

 

Wearable artificial kidney could be ‘game-changer’

In a chapter of my book Dialing in on DI-AL-Y-SIS (released in November of 2017), I made mention in a chapter titled Perhaps There Is Hope Ahead that research involving Dr. Jonathan Himmelfarb is working on developing a wearable artificial kidney.

Dr. Himmelfarb is the director of the Kidney Research Institute & Joseph W. Eschbach Endowed Chair in Kidney Research at the University of Washington School of Medicine in Seattle. An update on the progress of his team’s research suggests that the wearable artificial kidney project could reach clinical trials by 2022.

The following account sheds the light on the status of the research effort that hopefully will someday become a game-changer for many patients who are on dialysis today, and many others who will someday wind up as end stage renal disease patients.

By Omar Ford, Managing Editor

Medical Device Business

(Posted online February 8, 2018)

Most innovations medicine occur by asking one simple question. Is there a better way? Physicians at the Kidney Research Institute of the University of Washington have asked that question about hemodialysis treatments – lengthy procedures that filter a patient’s blood when the kidneys no longer function properly.

The institute is developing a wearable artificial kidney that could completely change the paradigm for some of these patients with impaired kidney function.

Earlier this week at MD & M West, Dr. Jonathan Himmelfarb, director of the Kidney Research Institute, spoke about the development of the artificial kidney and gave a timetable on when such a technology could be up for review by the FDA.

“There has been an increase in the number of people with kidney failure who were treated particularly with dialysis and particularly with hemodialysis,” Himmelfarb said. “Now there are about 600,000 people in the United States today in which the vast majority – close to 500,000 – are treated at dialysis centers.”

Typically, these patients go to dialysis three times a week with a four-hour treatment. These treatments have significant impact on lifestyle, but even more than that the mortality and morbidity of these patients is very high.

“The average person, even today, who starts dialysis will survive for about three to four years,” Himmelfarb said. “The mortality is about 20 percent per year. With what we provide for dialysis function today, we don’t really restore kidney health.”

In 2012, the FDA issued out a challenge to innovators to develop a technology to address kidney failure patients.

The Kidney Research Institute submitted an application to the FDA, and was one of three chosen out of 32 applicants to move forward with the development of an artificial kidney. The Institute conducted an initial trial in Seattle.

The wearable artificial kidney is a 10-pound, battery-powered device worn on a belt that provides around-the-clock, continuous dialysis.

“A lot of the components will work like dialysis does today,” Himmelfarb explained. “You take blood out of the body and you circulate it across a membrane that allows certain toxins to move to the other side of the membrane. You drop them on the other side and the blood goes back into the patient. That’s the basic concept of hemodialysis, and that will be the same [for the device].”

An early trial of a prototype of the device showed that five out of seven patients completed the full 24 hours of treatment. Two others had to stop participation in the trial because of technical issues with the device. The treated patients were able to walk in the hospital’s halls while the device continuously cleaned their blood.

Himmelfarb said the Institute’s goal is to take a more refined version of the wearable artificial kidney to take through clinical trials in 2022. He said a commercial vehicle to market such a device hasn’t been established yet.

“First, we have to generate all of the intellectual property and then we’ll eventually develop a commercialization strategy,” he said. “But right now, we’re focused on the science of trying to make this work.”

Why we must not let newspapers disappear

While whiling away time on dialysis, I at times as a retired journalist run across some humorous items on the Internet. This recent finding makes you wonder how some readers never get past the headline. Click on link.Why We Must Not Let Newspapers Disappear