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Learning is fundamental

Sun Mar 31 2019 - With a family history like mine, I've done plenty of research on Chronic Kidney Disease ('CKD') as well as Polycystic Kidney Disease ('PKD'). But my opinion is that you can never learn too much and the repetition makes it stick.

So when I heard that the Minnesota Chapter of the National Kidney Foundation was hosting an afternoon seminar I was all in.

There were four separate tracks: early CKD, Dialysis, Transplant and Pediatric. I went to the early CKD/New Diagnosis sessions.

The first session was 'Coping with CKD and Sadness, Despair and Fear' led by a gentleman named Ted Bowman. When he mentioned the name of a book he had written, 'Loss of Dreams: A Special Kind of Grief,' the tears started flowing and continued throughout his presentation.

It's what I need to break through now. I need to grieve the future I thought I had and adjust my plans to include the reality of this disease. I need to figure out how to live my life while accommodating the disease instead of living the disease and accommodating my life.
Nobody can go back and start a new beginning, but anyone can start today and make a new ending. - Maria Robinson
Or to quote Andy in Shawshank Redemption:


The second session was all about treatment options: dialysis vs. transplant, in-home vs. in-center treatment, heomodialysis vs. peritoneal. Great information and Abbey Berry from Fresenius Kidney Care knew her stuff cold! The only bad thing about this session was that it was way to short. So much to learn and consider.

The third session on Nutrition really brought home that CKD truly is a personal disease. There are no absolutes when trying to make wise food choices. Everything depends on individual labs as well as presence of comorbidities (two or more chronic diseases). As I've learned, CKD can be genetic (as in my case) or it can be caused by uncontrolled high blood pressure, diabetes and heart disease. It's so important to find a good Renal Dietician (such as Katie Kondziolka RD LD) but the sad fact is that they're hard to find.

The seminar wrapped up with a presentation on Insurance Basics for CKD and End Stage Renal Disease ('ESRD') - in particular, Medicare. All I can say is WOW! So many potential potholes, misdirections and dead ends. My takeaway was to work with the social workers at the dialysis center to make sure you're navigating the waters wisely and take advantage of services such as Senior LinkAge in Minnesota or SHIP/Medigap Helpline in Wisconsin which are staffed with experts on Medicare.

In addition to the great content, the best part of the day was actually connecting with and talking to others that are familiar with the heartbreak and struggles associated with a chronic disease. That was priceless.

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It's getting real...

I looked at my phone messages on Monday night and was excited to find a call from the Mayo Clinic. Would they tell me that I had to wait for further deterioration before I could be evaluated for transplant? Or would they tell me to make the drive to Rochester to go through a battery of tests and meetings? It turned out to be the latter. Yay! They're going to evaluate me for transplant in April! Wait a minute. They're going to evaluate me for transplant... Crap. As they say in the movies (?), shit's getting real. I'm trying to stay positive, telling myself that this way I'll be able to get my name on the transplant list as soon as my eGFR hits 20. I'll be able to maximize my time on the list. But every so often, the positivity slips and the fear and anxiety appear. And the questions. All the questions... Will I be able to keep working? Will I be able to afford this? How will this affect my retirement? Will I be able to retire early? How will I pay...

Teach us to fish

I've recently started trying to educate myself on current research and insights around PKD and all the diseases that seem to show up along with it.  While it's exciting to learn that we're on the verge of significant innovation in how CKD and PKD are diagnosed and treated, I find myself a bit disappointed. Instead of shouting the news from the roof tops... instead of spreading the excitement, the medical community hides the punchline. They share their findings in dry journal articles, steeped in language that is hard to understand. I realize the audience for the articles is not Joe or Jane Public. I realize that they're scholarly discussions of research methodology, statistics, inference and conclusion. I also realize that this is potentially a single data point that may, or may not, contradict current beliefs. Regardless, wouldn't it be nice if these studies included a simply worded summary of the work? Something easily consumable by the general pu...

Truth

The need is real! I don't know if it's because prior to Tolvaptan I routinely used mind over matter to delay my trips to the restroom, but I think I'm doing okay these days. Is it possible that I built up bladder muscles over the years? Don't get me wrong, the need to pee is omnipresent. But it's one of those things where I can make note of it, finish what I'm doing (or finish a couple more things) and then make my way to the facilities without the fear of letting things fly. But I'm not stupid. You'd better believe I'm making the restroom my last stop before starting my 45 to 60 minute commute to/from work. A soggy crotch is NOT becoming.

Expensive but affordable

There's no denying it. Tolvaptan - brand name Jynarque - is CRAZY expensive. The wholesale price is just north of $13,000... A MONTH! Dear God. I've searched and searched to find out how much pharmacies are beings charged for the drug, as well as my insurance company, but I've yet to find a source. Surely there has to be some kind of 'negotiated price' like you see with healthcare?!? My doctor suggested increasing my dosage - after I'd already received the next month's supply - and I about hyperventilated. There's no returning drugs and the thought of wasting $13,000 of pills left me queasy. So instead, we decided that I'd stay on the lower dose for another month and then increase the dose the next time. Deep breaths... Regardless, Otsuka (manufacturer of the drug) is working to make sure that the patients' out of pocket for the drug is manageable. Through their MyPASS program , patients with commercial insurance can acquire the pr...

Live in the moment

I'm a thinker, a what if-er. I analyze things to within an inch of their life. Live in the moment? What's that? Nothing is straight forward with PKD. The unpredictable nature makes it impossible to create solid plans. And the decisions you think you can make are often conflicting. Case in point, Tolvaptan. Taking it should slow down kidney decline, delaying my need for dialysis and/or transplant. Yet the older I am before I need a transplant, the higher my Expected Post Transplant Survival score is (a lower score means greater survival rate and, if 20 or less, a high quality kidney). But I'm really hoping to stave off dialysis/transplant until there's a viable implantable artificial kidney. See what I mean? I guess the bottom line is that I have to have faith and trust that whatever happens was meant to be. What are the words from the Serenity Prayer? God grant me the SERENITY to accept the thing I cannot change, the COURAGE to change the things I can and ...