Ask the Doctor
Questions about kidney disease? Risk factors? Signs and symptoms? Are you concerned about yourself, a friend or family member? Ask Dr. Spry.
Kim Zuber, PA–C, MSPS
Between the listserv being abuzz with discussions of hospice and my mother’s recent death (thank you but it was a blessing—her Alzheimer’s was at end stage), I am going to take my bully pulpit and discuss what we do and why we do it. When I first moved to nephrology from orthopedics, I had more patients die in the first month than I had in 10 years of orthopedics. This is the ‘secret’ of nephrology—we have a higher death rate than oncology; yet, we pick ourselves up and come back and face it day after day. And sometimes, it is very hard.
The tradition in my group is to write a letter of condolence to the family of each dialysis patient that we lose. When we lose a patient, a letter is sent to the family, noting how we enjoyed and treasured our time with their family member and to please contact us if we can do anything. These are people we have seen week after week, year after year. We have celebrated weddings and graduations, holidays and reunions, births of grandchildren, and losses of spouses and loved ones with them. We have seen them at their worst, when they thought they were doing to die. And we have seen them at their best, when they have risen from the ICU to live another day. However, as the old saying goes, nothing in life is certain except death and taxes…and death will come to all our patients.
These letters, which of course became my responsibility more than 15 years ago, have become a tradition with my practice. By the time I dictate them, we all sign them and they are finally sent, often 2–3 months have passed from the time of death. This time allows families to acknowledge a death and allows us a chance to reach out to a family after the initial commotion has passed. They can be a hassle to write, to send and to get signed. They are hard for me to write, although I have found that there are some well–worn phrases I use often. But I know these letters have brought comfort and peace to those who have received them.
After my mom’s recent death, I have received emails and calls and letters. I never really thought that these things were all that important. But, I am seeing another side now. I really do appreciate the thoughts. We lose patients often. A note acknowledging the trust that these patients and their families have placed in us is important. I think all of us should consider a letter to the families not just a nicety but a necessity. I encourage all of us to remember that trusting us with their lives is a leap of faith for our patients. We need to acknowledge this and thank them for it.
The tentative program for the 2011 Spring Clinical Meetings in Las Vegas is too exciting not to share. At the risk of sounding trite, we say don’t take a chance and miss these—they are a sure bet! Wednesday through Saturday are filled with old favorites, new twists on old favorites, and some exciting new offerings. Nephrology 201 is always a popular, standing room only offering. It will live up to its reputation covering the vast range of CKD from diagnosis to transplant with all stops in between when it takes place on Tuesday.
Tuesday night we officially kick off the Spring Meetings with the Advanced Practitioner Networking Reception, and we’ll get to bed early because Wednesday begins three days of information filled sessions including Geriatric Pharmacology, MIPPA, case studies, a town hall discussion and everything a renal professional could ask for. This is just a brief overview of what awaits. Come to Vegas and see for yourself!
On Wednesday, all advanced practitioners are invited to the CAP luncheon which promises a recap of our accomplishments for the year, good food and fun, and a chance to meet and talk to those we have grown to know on the Listserv.
So all bets are on in Las Vegas, April 26–29, 2011. Come spend four days and expand your knowledge and skills more than four fold. Laurie Benton, PA–C, Ph.D., and Amma Sewaah–Bonsu, NP, CAP Education Chair and Co–Chair, have really outdone themselves planning this extraordinary program.
We are pleased to announce the recipient of NKF–CAP’s first research grant. Elizabeth C. Evans, DNP‚ will use the awarded funds for her study “Intensive CKD Management through SMAs.” Dr. Evans’ research began July 1, 2010 and she will present her findings at the 2012 NKF Spring Clinical Meetings.
The purpose of the study is to compare a shared medical appointment (SMA) format for intensive management of advanced chronic kidney disease to outcomes from standard care (management based on current national practice as outlined in the USRDS 2007). Shared medical appointments combine group education, individual medical attention and the psychosocial benefits of shared experience. Management of these patients with advancing kidney failure, by use of SMAs, could contribute to decreasing the use of hemodialysis catheters and more effective preparation for renal replacement therapy.
Dr. Evans will study 20 patients currently seen in the practice who are diagnosed as CKD Stage 4 patients and are newly referred to the CKD clinic. They will receive SMAs and their outcomes will be compared to similar patients receiving standard care in the CKD clinic (individual appointments). The outcomes will include pre- and post-tests, BP values, and quality of life tools/assessments. Data concerning cost of treatment for the two groups also will be evaluated. This pilot project hopes to show that this is a cost–effective and patient- and provider–friendly process that will advance the evolution of chronic care in the CKD population.
Dr. Evans received her Masters in Nursing from the University of New Mexico and her Doctorate in Nursing Practice (DNP) from Saint Louis University. Since 2002, she has been employed at Renal Medicine Associates in Albuquerque, NM. She will serve as the co–Principal Investigator of this study along with Ms. Leslie Dork, CNP. Ms. Dork is presently enrolled in the Saint Louis University Doctorate of Nursing Practice program, with this study being her capstone project.
The target dates for the application process for the 2011 CAP research award have not been finalized at this time. Please contact the CAP Research Chair, Peter Juergensen, PA–C, if you would like more information.
If you happen to be in Kingston, NY, and someone whizzes by you on a red Vespa scooter, it might just be Laura MacGregor, CAP’s Cybernephrology Chair and the grand prize winner of the 2010 NKF 60th Anniversary Art Contest for her digital creation.
To celebrate 60 years of service, the NKF held an art competition with several categories. Laura’s artwork depicted hands (her husband’s) holding a tree with kidney blooms. The roots of the tree are growing from a kidney. Interestingly, there were more than 80 entries across three categories and the tree motif was very popular.
Laura is currently a NP in private practice. She works with two nephrologists in a multi–specialty practice. Her duties run the spectrum from dialysis rounds to hospital rounds to outpatient clinics. Laura did not follow a straight path to nursing or nephrology. Originally she was a medical sculptor and has a BFA from UCONN and an MFA from SUNY New Paltz. In addition, she has a strong background in digital art and web design which has earned her the appointment to CAP Cybernephrology Chair. In her life as professional sculptor, she owned Custom Model, a company specializing in custom–made medical models which were used by medical design companies and as exhibits in malpractice lawsuits. The complexity of nephrology attracted her. She enjoys fitting together the pieces of the puzzle to arrive at an answer.
When she is not performing her many duties as a nephrology NP, Laura can often be found on her eight acres of land gardening and working the property. She has a Vespa scooter and uses it to go to work and just to ride around. Since she bought hers, two physicians in the area have also purchased one. She and her husband of 21 years have a chocolate lab, Russell, a bird, and three ducks which adopted them.
Fahmid Kamal worked as the NKF Professional Membership Intern from March 2007–July 2010. Below are his parting words to the Professional Council Executive Committees and members.
I started working at the National Kidney Foundation in March of 2007 as the Professional Membership Intern. This position interested me for various reasons. As an individual with a family history of kidney disease, I wanted to know more about a disease which affects more than 200 million people globally. I was curious to understand the effects, prevalence and management of chronic kidney disease. Suffice to say, I gained insight into all these topics and much more by working closely with each of the Professional Councils. Perhaps more significantly, I saw the tremendous level of commitment renal health professionals displayed in caring, educating and advocating for patients. My experience at the NKF culminated with the 2010 Spring Clinical Meetings where I had the opportunity to interact with technicians, dietitians, nurses, social workers, advanced practitioners and physicians from all over the country. I was also touched by hearing personal stories from transplant recipients, donors and family members who have lost their loved ones due to kidney disease.
As I look back at the past 3 years, I continue to be amazed at the dedication of NKF volunteers and the outstanding work you all do on a daily basis. I am very proud to have been part of this important process. With the combined efforts of the staff and such a highly mobilized group of volunteers, I truly believe NKF is leading the effort to improve the lives of people affected by kidney disease worldwide.