Dialysis and farming patients

Picture it: being away from home all day, three days a week, every week, with up to five hours travel and traffic time included in that. Wouldn’t you welcome a dialysis unit opening nearer to you that would drastically cut this time commitment?

That’s what has happened for dialysis patients in Co Wexford with the opening of the Wellstone Wexford Renal Care Unit off the Rosslare road. It is the first-green field site, purpose-built haemodialysis unit in Ireland and has the capacity to treat 60 patients a week in 12 treatment bays. It also has a self-care area for up to three patients.

It is a satellite unit of University Hospital Waterford (UHW) and is run in conjunction with it and the HSE by B Braun, a renal care provider that operates over 350 renal centres in 30 countries across the world. Patient ages range from 30 to the mid-80s and now only half days rather than whole days are involved for the patients transferred there for care.

This is a very positive story for patients, Dr Frank Kelly, clinical director and consultant nephrologist at the unit, says: “We would consider travelling an hour now [for dialysis] to be unreasonable. Having the dialysis close to your community is important.”

Dr Kelly talks of the reality 30 years ago, when people needing dialysis had to travel hundreds of miles to Beaumont Hospital. He is glad that day is gone.

He and clinic manager, Debbie MacDonald, have already seen the positive effects on patients in the four months since the centre opened in Wexford on 17 January this year.

“Some patients have put on a bit of weight since coming here,” says Debbie. “That’s because they don’t feel nauseous, due to them not having as big a journey before and after dialysis. They are also more at home now and are feeling better and more likely to feel like eating.”

All patients are still taxied to the centre, but some patients are now considering driving themselves to and from dialysis because of the short distance involved. “One patient even has plans to cycle here,” she says. “The unit being nearby gives all patients that bit more freedom.”

Bernard (Ber) Keane, a retired tillage farmer from Broadway, Co Wexford, certainly agrees. Over the past eight years, he has travelled to University Hospital Waterford for dialysis, being collected at 10.30am and returning home at 6.30pm. Now he is collected at 2pm and is home by 7pm.

“Wexford people were waiting 10 years for this,” he says, “so it’s great that it has finally come about. You wouldn’t be nearly as tired because of less time travelling. Before, you were worn out.”

Theresa, a sheep farmer from north Wexford has also found her life changed for the better. She is now only away from home from 7.15am to 1.15pm, three days’ a week. “The whole day was gone before,” she says. “Now I’m back at lunchtime and have the rest of the day to myself.”

Theresa is actually feeling so physically well that she is planning a cruise-ship holiday this autumn. “I will be able to have dialysis on the liner, arranged by the staff here, which is wonderful,” she says.

NOT A MEDICAL SPACE

Designers of the new unit in Wexford didn’t want it to look like a medical space, explains manager Debbie MacDonald. The foyer of the centre is certainly testimony to that, looking more like a pleasant workplace reception area. “We don’t want it to be like sitting in a hospital,” she says. “While dialysis is part of people’s lives, we want them to feel that they can also have a normal life. We keep the attendance hours family friendly too, so that patients are now at home for lunch with their families.”

DE-INVALIDING THE PATIENT

Patients being able to put themselves on dialysis is also part of the Wexford plan, Dr Kelly says. “Self-care’ is part of the ongoing revolution in dialysis care in Ireland. Traditionally, patients came in for kidney dialysis and lay on a bed – and that’s the way it has been for years and years. What we are trying to do in satellite dialysis units like this is move people back to their communities and develop a minimal-care dialysis setting, for instance a ‘self-care’ room.

“Suitable patients will be trained to sit in a chair and put themselves on dialysis. They can come in at a time that suits them between 7.30am and 7.30pm and they will have access to nursing help, of course, if they need it, as the room will be monitored.”

It’s about re-empowering people, “de-invaliding” them, he says. “It’s about saying: ‘This is just an interruption to your day. It’s not what your day is all about.” CL

Bernard’s story

Ber wanted his photograph taken against the backdrop of a corn field behind his house. This isn’t surprising, as tillage farming has been a huge interest all his life. Although now 82 and retired, he was a major sugar-beet and potato grower in his day and still takes an interest in the tillage farm now run by his son, Nicholas.

Kidney disease meant that Bernard had to begin dialysis eight years ago. Initially he tried home dialysis, but when that didn’t work out he continued to attend UHW three days’ a week.

Ber did get a bit of a shock in 2010, he says, when he was told that kidney disease meant he needed dialysis. “It was a bit frightening, because you knew you were going to be tied up for the rest of your life. That was hard to get used to, but you do get used to it after a while. The dialysis just has to be done. It’s part of life for me now.”

Ber had a triple by-pass in his 60s and, more recently, operations to remove an aneurysm and cataracts.

The Wexford renal unit opening will mean that Ber will be able to enjoy more community interaction too, as he will be able to attend his local day care centre in Tagoat – something he hasn’t been able to do up to now, as appointment days clashed.

“I’m looking forward to it,” he says.

Theresa’s story

While Theresa had high blood pressure from her mid-30s onwards – something that can lead to kidney disease – it was cancer diagnosed in 2015 that led to kidney removal and dialysis in Theresa’s case.

Theresa says that she has come to terms with it now. “You get over the initial shock and learn to accept things. It is a big time commitment, but there isn’t a choice, so you have to get on with it and the staff here are wonderful. I’m also very thankful that the cancer was contained.”

Always a person who loved farming, having the fistula required for dialysis permanently fitted in her left arm means that she is a bit restricted in what she does. “I can’t lift anything heavy now, like buckets of water at lambing time, say, in case I damage it but I do what I can. I can drive and bake and still do a lot.”

>> Kidney disease

WHAT IS KIDNEY DISEASE?

Kidneys filter waste products from the blood before converting them into urine. The kidneys also:

Kidney dialysis is a method of treating kidney failure by using a machine to remove waste material from the kidneys. It is needed if a person’s kidneys have stopped working properly and is essential to life. Without it toxins would build up causing body nausea, shortness of breath and body swelling.

Kidney disease is a progressive illness and can affect young and old and those with diabetes, high blood pressure and some inflammatory diseases are more prone to it.

Typical dialysis involves three sessions a week with each session lasting from three to four hours. Dialysis usually doesn’t take place over the weekend.

“Ideally people wouldn’t have a two-day gap between dialysis sessions,” says Dr Kelly, “because obviously you build up more fluid and toxins over the time. While it works, it is not ideal. The opening of this unit, six days a week, from June, and the self-care unit where patients can put themselves on dialysis will allow patients to have dialysis on Saturdays if needed also.”

DIET IMPORTANT

Diet is very important for patients with kidney disease. “Each patient has a tailored diet, and fluid is restricted,” says Dr Kelly, one of four kidney specialists with UHW. Other key dietary no-no’s are salt, potassium and phosphorus. “Seasonal times can be challenging for patients, for example, when the strawberries and new potatoes come in! Strawberries and potatoes are both full of potassium, so they have to be limited. Potatoes have to be boiled twice, for example, to remove the potassium.”

TRANSPLANTATION FOR SOME

Any patients eligible for transplant will be added to the national transplant data base, Dr Kelly says.

“Transplant-wise 2017 was a very successful year. The shift to living relative donation now means that more people are able to get transplants. It has changed the whole shape of transplant medicine.”

USEFUL WEBSITES

Organ donor cards

You can get an organ donation card at your local pharmacy or telephone the Irish Kidney Association at lo-call 1890 543 639.