John Davis is convinced that Macon County could use its own dialysis center.
Three times a week – on Tuesdays, Thursdays and Saturdays – Davis drives his wife, Sue, to a dialysis center in Sylva where she receives treatment for End Stage Renal Disease. The time, cost and inconvenience associated the 50-mile plus round-trip take their toll. According to Davis, he and his wife are not alone.
“We’ve got about 30 some odd people in Macon County on dialysis,” said Davis, noting that most people must travel outside the county for treatment. At DaVita Sylva Dialysis Center where Davis’ wife receives treatment for end-stage renal disease, six or seven other Macon County residents also receive treatment on the same schedule. The next closest dialysis center is in Clayton, Ga.
On Tuesday, Davis and his wife once again made the trip to Sylva for her dialysis treatment, leaving home before 7 a.m. and returning after 2 p.m. “It’s a long day,” said Davis.
Last month, Davis went before the Macon County Board of Commissioners to ask them for support in pursuing an adjusted need determination from the state which would allow the development of a treatment center in the county. On June 14, the board responded with a resolution, passed unanimously, supporting the cause.
The Department of Health and Human Services regulates the development of all new healthcare facilities in the state, including dialysis centers, for which it analyzes and determines need on a county-by-county basis, as published in the State Medical Facilities Plan.
In order to be cost effective and assure quality of care, the state requires that new dialysis facilities have a projected need for at least 10 dialysis stations (or 32 patients).
According to the most recent Semiannual Dialysis Report issued July 1, the state recorded 23 residents of Macon County were receiving dialysis treatment as of Dec. 31, 2010.
Davis, who retired from military service and moved to Franklin 13 years ago, says that number is even higher now. “We got them,” said Davis. “I can guarantee you we got 32.”
In addition, the state gives favorable consideration to proposed new facilities which would serve patients who are farthest away from existing operational facilities. Ideally, patients should be able to access a facility no more than 30 miles from their home.
Macon County residents must travel a minimum of 20 miles to the nearest dialysis center, with many in the southern parts of the county traveling much more than that. Moreover, as Davis notes, 30 miles in the mountain region represents considerably more inconvenience than in other regions.
Davis’ wife began her treatment in February, so they haven’t had to deal with the worst weather yet, but they know what to expect. “Cowee Mountain in the winter is a mess,” said Davis, adding that many if not most patients have other physical constraints and medical issues which make the trip that much harder.
The resolution passed by the commissioners acknowledges this state of affairs, stating that “more than 30 current dialysis patients must travel out of the county over mountainous terrain, even during inclement weather, in order to receive treatment.” It goes on to note that the county’s end-state renal disease patient population in increasing an average of 10 percent a year, and that a local dialysis facility would be more convenient, provide cost savings to patients and will potentially have a positive economic impact on the county.
Because of the special situation of Macon County, the board requested the state approve a facility for its 2012 State Medical Facilities Plan with eight dialysis stations to serve. According to Commissioner Ronnie Beale, the State Health Coordinating Council has approved similar petitions in the past.
“There’s a real need, and they should understand our situation here,” Beale remarked, noting that the county’s population of seniors has climbed steadily in recent years. He said he felt it was likely a private provider could be found to establish a center in the county.
Marty Wadewitz, chief operations officer of Angel Medical Center in Franklin, says the hospital would support the development of an end-stage renal disease treatment center in the county, though he is unsure whether the state will be able to provide the necessary determination of need. Angel Medical Center itself is not in a position to invest in or operate such a facility at this time, he said.
“Really it’s just something that is not within our financial abilities right now to take on,” he said, while acknowledging that it would be very helpful to the residents that need the service to have it close by. “The biggest reason for the need is that the individuals have to go several to three times a week to have the procedure done. It involves a lot of travel time and puts a strain on the family.”
But Wadewitz also noted that there is significant expense involved in establishing a dialysis center. “It's very expensive and very difficult to find the doctors and staffing that would be involved in that type of facility,” he said.
Meanwhile, the county has forwarded the resolution and other information to the state to facilitate a review of the determination of need. Some residents, including Davis and his wife, are planning to attend the upcoming public hearing of the State Health Coordinating Council, the body charged with making determinations of need for healthcare facilities throughout the state for the upcoming 2012 State Medical Facilities Plan.
In Western North Carolina, the public hearing venue will be at the Mountain Area Health Education at 501 Biltmore Avenue, Asheville. The hearings are scheduled for July 29, from 1:30 to 2:30 p.m. For more information, call (919)855-3865.
How Diet Can Help Improve Dialysis
Eating the right foods can help improve your dialysis and your health. Your clinic has a dietitian to help you plan meals. Follow the dietitian's advice closely to get the most from your hemodialysis treatments. Here are a few general guidelines.
• Fluids. Your dietitian will help you determine how much fluid to drink each day. Extra fluid can raise your blood pressure, make your heart work harder, and increase the stress of dialysis treatments. Remember that many foods-such as soup, ice cream, and fruits-contain plenty of water. Ask your dietitian for tips on controlling your thirst.
• Potassium. The mineral potassium is found in many foods, especially fruits and vegetables. Potassium affects how steadily your heart beats, so eating foods with too much of it can be very dangerous to your heart. To control potassium levels in your blood, avoid foods like oranges, bananas, tomatoes, potatoes, and dried fruits. You can remove some of the potassium from potatoes and other vegetables by peeling and soaking them in a large container of water for several hours, then cooking them in fresh water.
• Phosphorus. The mineral phosphorus can weaken your bones and make your skin itch if you consume too much. Control of phosphorus may be even more important than calcium itself in preventing bone disease and related complications. Foods like milk and cheese, dried beans, peas, colas, nuts, and peanut butter are high in phosphorus and should be avoided. You'll probably need to take a phosphate binder with your food to control the phosphorus in your blood between dialysis sessions.
• Salt (sodium chloride). Most canned foods and frozen dinners contain high amounts of sodium. Too much of it makes you thirsty, and when you drink more fluid, your heart has to work harder to pump the fluid through your body. Over time, this can cause high blood pressure and congestive heart failure. Try to eat fresh foods that are naturally low in sodium, and look for products labeled "low sodium."
• Protein. Before you were on dialysis, your doctor may have told you to follow a low-protein diet to preserve kidney function. But now you have different nutritional priorities. Most people on dialysis are encouraged to eat as much high-quality protein as they can. Protein helps you keep muscle and repair tissue, but protein breaks down into urea (blood urea nitrogen, or BUN) in your body. Some sources of protein, called high-quality proteins, produce less waste than others. High-quality proteins come from meat, fish, poultry, and eggs. Getting most of your protein from these sources can reduce the amount of urea in your blood.
• Calories. Calories provide your body with energy. Some people on dialysis need to gain weight. You may need to find ways to add calories to your diet. Vegetable oils-like olive, canola, and safflower oils-are good sources of calories and do not contribute to problems controlling your cholesterol. Hard candy, sugar, honey, jam, and jelly also provide calories and energy. If you have diabetes, however, be very careful about eating sweets. A dietitian's guidance is especially important for people with diabetes.
• Supplements. Vitamins and minerals may be missing from your diet because you have to avoid so many foods. Dialysis also removes some vitamins from your body. Your doctor may prescribe a vitamin and mineral supplement designed specifically for people with kidney failure. Take your prescribed supplement after treatment on the days you have hemodialysis. Never take vitamins that you can buy off the store shelf, since they may contain vitamins or minerals that are harmful to you.
You can also ask your dietitian for recipes and titles of cookbooks for patients with kidney disease. Following the restrictions of a diet for kidney disease might be hard at first, but with a little creativity, you can make tasty and satisfying meals.
Source: National Kidney & Urologic Diseases Information Clearinghouse