'JumpStart' uses retired Rochester officer's story to highlight kidney disease

(CARLOS ORTIZ staff photographer)

Jon Hand • Staff writer • April 29, 2010  JHAND@DemocratandChronicle.com

The current story line of the comic strip JumpStart has been pulled from the real-life health problems of retired Rochester police Officer Greg Raggi, a dialysis patient who has been in line for a life-saving kidney transplant for 3 ½ years.
Artist Robb Armstrong's strip, which is printed daily in the Democrat and Chronicle, features the lives of a fictional police officer, Joe, and his wife, Marcy, a nurse.
Since April 12, the strip has focused on Joe's "cop lifestyle" of eating fast fatty foods, working long hours and dealing with high stress. In the past few days, Joe and Marcy have discussed how that lifestyle can lead to diabetes and renal failure. In a subplot of the comic, Joe's partner, Crunchy, has left the fictional world of JumpStart to give his brother, Stanley (also a police officer), a kidney because Stanley has diabetes.
Armstrong said he developed the story line after a phone call from Mike Mazzeo, a friend and longtime partner of Raggi's in the narcotics unit of the Rochester Police Department.
Mazzeo, who is also the president of the Locust Club, the city police officer's union, first met Armstrong last year during a dust-up over a strip by Armstrong depicting a police shooting. The strip ran about the same time two city officers were shot and some in the community criticized Armstrong and the newspaper for being insensitive.
Mazzeo disagreed and publicly came to Armstrong's defense.
A bond was formed and the next time Mazzeo talked to Armstrong, he was asking him to help his friend, Raggi, and bring awareness to a problem many officers are concerned about.
"It's something that has affected many of us," said Mazzeo, who spent many hours taking his own father to dialysis treatments.
At least one other retired Rochester officer, Stan Prewasnick, is on dialysis and a third, Lt. Lou Genovese, died this past year after spending a year on dialysis, Mazzeo said.
Armstrong said he loved the idea right away.
"I have people walking up to me all the time saying, 'This is so funny, you have to write about it in JumpStart,'" Armstrong said from his home in Pasadena, Calif. "Mike came up to me and told me about something that wasn't funny but was so important. I said: 'Wow, this isn't just good for JumpStart, this is perfect.'"
Dr. Carlos Marroquin, a transplant surgeon from Strong Memorial Hospital, said no studies have been done to calculate whether police officers have a higher incidence of renal failure compared to other professions. But it's clear, Marroquin said, poor diet and stress can be a harmful combination.
"Clearly it is an issue, given the lifestyle, the stress, the dietary habits of a police officer," said Marroquin, who, at Mazzeo's invitation, spoke to union members in March to discuss kidney health and the safety of becoming "live donors." Donna Dixon, education director for the local chapter of the National Kidney Foundation, also spoke to the officers.
For his part, Raggi acknowledges that many of his old habits as an officer likely "caught up with him."
"I'm sure, eating the way I did, sleeping the way I did, middle shifts, night shifts, waking up early for court, it all took a toll on me," he said. "I'm not complaining. I loved it. But I wish I'd known better."
He retired in 1993 after 20 years in the department, and was diagnosed with Type 2 diabetes in 1995. The symptoms became more prevalent following a heart attack in 2004 and he went on the donor list in 2006.
He began peritoneal dialysis about 18 months ago, which requires Raggi to attach a tube leading from a suitcase-sized machine to a permanent tube in his abdomen each night for about nine hours while he sleeps. The process takes the place of the natural function of Raggi's kidneys, to filter toxins from his blood.
"I feel OK. I have good days and bad days; my doctor tells me to hang in there," said Raggi.
Doctors told him to expect it to take four to five years to find a donor kidney from the date he was placed on the list.
That surgery would change his life, he said. He's been looking forward to one thing, in particular.
"We never travel anymore because of the dialysis," he said. "I'd like to take a trip with my wife."
JHAND@DemocratandChronicle.com 
http://www.democratandchronicle.com/article/20100429/NEWS01/4290339/1003/-JumpStart--uses-retired-Rochester-officer-s-story-to-highlight-kidney-disease

Nasal mupirocin prevents Staphylococcus aureus

If you are a Peritoneal Dialysis patient or a PD Nurse you may want to mention this study in your clinic and ask for the opinion of the professionals in the office. 
J Am Soc Nephrol. 1996 Nov;7(11):2403-8.

Nasal mupirocin prevents Staphylococcus aureus exit-site infection during peritoneal dialysis. Mupirocin Study Group.

[No authors listed]

Abstract

A total of 1144 patients receiving continuous ambulatory peritoneal dialysis in nine European centers was screened for nasal carriage of Staphylococcus aureus. Two hundred sixty-seven subjects were defined as carriers of S. aureus by having had at least two positive swab results from samples taken on separate occasions, and were randomly allocated to treatment or control groups. Members of each group used a nasal ointment twice daily for 5 consecutive days every 4 wk. The treatment group used calcium mupirocin 2% (Bactroban nasal; SmithKline Beecham, Welwyn Garden City, United Kingdom) and the control group used placebo ointment. Patients were followed-up for a maximum period of 18 months. There were 134 individuals in the mupirocin group, and 133 individuals acted as control subjects. There were no differences in demographic data, cause of renal failure, type of catheter, system used, or method of exit-site care between the groups. Similarly, there were no differences in patient outcome or incidence of adverse events between both groups. Nasal carriage fell to 10% in those subjects who received active treatment and 48% in those who used the placebo ointment. There were 55 exit-site infections in 1236 patient-months in the control group and 33 in 1390 patient-months in the treatment group (not significant). S. aureus caused 14 episodes of exit-site infection in the mupirocin group and 44 in the control group (P = 0.006, mixed effects Poisson regression model). There were no differences in the rate of tunnel infection or peritonitis. There was no evidence of a progressive increase in resistance to mupirocin with time. Regular use of nasal mupirocin in continuous ambulatory peritoneal dialysis patients who are nasal carriers of S. aureus significantly reduces the rate of exit-site infections that occurs because of this organism.

PMID: 8959632 [PubMed - indexed for MEDLINE]

The PD Option

When a person reaches the point where they have been categorized as ESRD(End Stage Renal Disease) and it has been determined that they must start Dialysis treatment to stay alive there are two treatment options. One is Hemodialysis(HD) usually where the Patient has a scheduled treatment time at an outpatient treatment center three times a week for most commonly 3 to 4 hours each treatment.


The other option is Peritoneal Dialysis(PD). In this treatment the blood stream is not accessed directly. A special tube(PD Catheter) is surgically placed in the Abdomen and via this tube Dialysate solutions are exchanged in and out of the Peritoneal Cavity. The Peritoneum is a membrane that encompasses our internal organs and this membrane is the natural filter that makes PD possible.


These treatments are done at home. The person does the treatment by themselves or with the assistance of a partner. Treatments can be preformed in two ways, Manual exchanges of Dialysis solution 4 to 5 times a day or automated with a PD Cycler mechanically doing the exchanges for you usually while you sleep.


With the Hemodialysis Option you have to comply to the outpatient treatment center schedule, there are more dietary restrictions and there can be more drastic physical reactions to the treatment such as extremes in blood pressures,nausea,electrolyte imbalances.
With Peritoneal Dialysis your treatment can be worked around your own schedule,you can travel more easily with PD. I think the single most important advantage to the PD option is that you are always being dialyzed like your kidneys it is a natural process occurring inside you.
One disadvantage is that in most cases patients are usually on PD for only a few to several years and then if not transplanted they have to move to Hemodialysis. This is usually because after some time the Peritoneum lessens in its ability to adequately preform the dialysis commonly because of infection(Peritonitis.


As a Nurse working in both PD & HD for 5 years, personally if I had to made the choice I would opt for the more natural treatment PD at first if I could. There are many more specifics to these options but I feel like I have covered the basics for now. Thanks, Joe Macomber RN

PD Cycler Commitment

I wanted to talk a bit today about an option inside of options. For ESRD patients there are four basic options: Transplant, PD(peritoneal dialysis),HD(hemodialysis) and to do nothing and go without treatment.
Some may notice that my order puts PD in front of HD and my reason for this is that PD would be my choice before HD and I would recommend PD before HD to anyone seeking my advice. This choice is based upon a lot of PD advantages but in short it is the kinder and gentler dialysis.
Once PD has been chosen there two options inside of PD. CAPD(continuous ambulatory peritoneal dialysis) these are manual bag exchanges usually done four times throughout the day.
The other is CCPD(continuous cycling peritoneal dialysis) these are automated exchanges while connected to a small machine overnight.
When I begin the CCPD training for patients there seems to be a common misconception as to time commitment needed to receive adequate CCPD. The patient mindset seems to be that whatever their normal sleep time is will be equal to their total CCPD treatment time. When doing CCPD it is very common that your total treatment time can be nine or more hours. This is because the nighttime cycler prescription is written for several cycles and each cycle has a drain/dwell/fill time and again this is necessary for the Patient to receive enough dialysis.
Once the Patient understands this requirement it is almost never enough to deter them from doing CCPD. I think that this PD shortcoming in information can be avoided in the future by including this cycler information in whatever options program your system may provide. Hopefully this post will help too!

New Study Suggests Peritoneal Dialysis May Offer Significant Savings to Medicare

New Study Suggests Peritoneal Dialysis May Offer Significant Savings to Medicare

May 13, 2009

by Astrid Fiano, DOTmed News Writer

The Clinical Therapeutics Journal is publishing a new paper, "The Financial Implications for Medicare of Greater Peritoneal Dialysis Use" by Nancy Neil, PhD, Steve Guest, MD, and several associates. The paper details the use of in-home versus in-center dialysis, including the patterns of dialysis utilization and the results of a budget-impact analysis that indicate if the peritoneal dialysis (PD) share of total dialysis were to increase to 15%, Medicare could yield over one billion dollars in savings over five years.

Dr. Steve Guest, Medical Affairs, Baxter Healthcare, Renal Division, McGaw Park, IL, spoke to DOTmed about the issues and findings in the paper. Dr. Guest first explained that providing care to patients with end stage renal disease (ESRD) is very costly due to the therapy itself but also for the care required to manage the oftentimes concurrent advanced co-morbidities. The overall impact to Medicare is significant as the ESRD Medicare patients represent less than 1% of Medicare enrollees but consume approximately 7% of Medicare resources as measured by payments for medical care billed to Medicare in a given calendar year.

"However, in reality," Dr. Guest said, "the differences in Medicare expenditures between peritoneal dialysis and in-center hemodialysis are very complex with resources being applied to a variety of cost centers."

For example, Dr. Guest described peritoneal dialysis as being most dependent upon disposable resources such as the dialysis solutions and supplies, used to perform the therapy at home. By comparison, in-center hemodialysis is most dependent upon fixed resources, in which investments have been made in bricks and mortar facilities, water treatment capabilities, hemodialysis machines and in-center staffing requirements. "The cost of an unused investment is high and so as not to waste those investments, they must be used to repay the capital outlay." The article is an analysis of these more comprehensive fixed resources used for in-center hemodialysis that include:

-- the facilities in which the hemodialysis is performed;
--the capital investment in the machines themselves;
--the supporting equipment necessary to treat municipal water to become medical grade water and the equipment needed to prepare the dialysate from this treated water;
--ongoing maintenance of the facilities and machines;
-- health personnel, including nurses, technicians, medical assistants, receptionists, etc.

PD does not have the same requirements for a special facility as the home is the site of care. However, Dr. Guest points out that while there is less of a capital investment for peritoneal dialysis, there are significant costs for PD therapy nonetheless: "These costs impact the dialysis providers if they are supplying the patient's dialysis supplies for peritoneal dialysis. But other economies can be realized with home therapy, such as a ratio of 20 patients to 25 patients per nurse for peritoneal dialysis compared to four to six patients per staff member for in-center hemodialysis."

Dr. Guest further detailed the findings regarding the differences in spending. "The differences in spending for hospitalization, outpatient use of erythropoiesis stimulating agents, vitamin D injectables, iron and vascular access reveal that the medical care provided to patients receiving in-center hemodialysis is more costly than that provided to patients on the home-based peritoneal dialysis therapy". Additionally, transportation costs were analyzed as in-center therapy such as hemodialysis requires the typical patient to present to the center at least three times per week for their hemodialysis treatments while peritoneal dialysis, as a home-based therapy, generally requires a patient to visit their nurse and physician only once per month. "This alone represents at least a 12-fold higher monthly cost of transportation for many in-center hemodialysis patients."

"Medicare expenditure differences in favor of peritoneal dialysis compared to in-center hemodialysis are significant" and Dr. Guest states may have been attenuated due to the fact that, in the United States, it appears that peritoneal dialysis patients are generally healthier overall than patients receiving in-center hemodialysis.
In the paper, it is mentioned that factors influencing the lesser use of PD include physician bias and lack of patient awareness due to insufficient exposure to full dialysis options education. Dr. Guest spoke of addressing the factors. "In testimony we recently submitted to the record for the House Ways and Means Committee, we provided recommendations to strengthen the education received by patients living with kidney disease who are Medicaid eligible. Medicaid accounts for one third of the starts on end stage kidney disease. As peritoneal dialysis patients rate greater satisfaction with this therapy compared to in-center hemodialysis, we point out the benefit of both increasing patient satisfaction and reducing overall Medicare costs as the Medicaid eligibles transition onto Medicare after 90 days".

In House testimony by colleague James Sloand, M.D., Medical Affairs U.S., Baxter Healthcare Dr. Sloand referenced that the lack of education about different modalities has been one of the significant reasons for underutilization in the U.S and surveys have shown that only 25% of patients on hemodialysis recall receiving information about the more cost-effective and cost-efficient peritoneal dialysis option. Dr. Sloand also commented that dialysis patients are a vulnerable and an underserved population that would benefit from improved influenza and bacterial pneumonia immunizations and greater vaccination rates could result in reduced risk of hospitalization and death from infections, which could further reduce Medicare expenditures

FMC - Liberty Cycler

This is a nice new cycler. I train all my new Patients on this cycler with the exception of Pediatrics.