Thursday, September 12, 2013

Musical Chairs

It's time for a quick update on Mom since a couple of things are going on. First, there is good news and bad news on her lab work. The good news is that her hemoglobin is up to 11.9, so her anemia appears to be getting under control. (The lower end of the normal range for females is around 12, depending on what site you look at.) It got down to 7 last September and it was only 7.4 at the beginning of this year, so 11.9 is a major improvement.

The bad news is that her protein is low and her calcium is high. Her protein being low is likely due to her diet, so she needs to concentrate on eating more protein-rich foods, drinking protein shakes, eating protein bars, etc. Maybe I'll set up an account at for her.

Her calcium being high is a different matter. Her nephrologist, Dr. N, is concerned about that. High calcium is usually caused by a parathyroid condition (hyperparathryoidism), but he gave her a test that ruled that out. So far he has been unable to determine the cause of her high calcium, and he suspects it may be related to her amyloidosis. Dr. N has talked to Mom's hematologist, Dr. C, about it, but I do not think they have reached any conclusions yet. I may try to put him in contact with one of the doctors in Boston, since there are some more serious potential causes of high calcium and we do not want to just assume it is caused by the amyloidosis and leave it at that. Mom has her regular appointment with her internist next month, so the internist may be the doctor that has to chase down the cause of the high calcium. Determining the cause of high calcium can be difficult, since over 99% of the time (maybe not that high, depending on the source) the cause is hyperparathyroidism, which Mom supposedly does not have. So she may very well have one of the rare causes of high calcium. Hooray, another medical mystery!

Now, about the next issue . . . Do you remember that part of my August 24 post where I mentioned it had been about a month since Mom had a significant issue at dialysis, and I said I would regret making that statement? Well guess what? Something happened. They infiltrated her fistula again on Monday, September 9. Mom ended up bleeding quite a bit and some of her clothes were soaked with blood, but not quite as bad as the October 26, 2012 incident. But that's not the full story.

So how did this happen? Aren't they working on getting her started on the buttonhole technique? Yes, the buttonhole is looking good on one access, but the second access point is still under development. Everything I have read about using the buttonhole technique states that the same person should insert the needles each time, until the buttonhole is fully formed and ready to use. Doing that helps ensure that the needle is always inserted at the exact same angle, so the scar can form one narrow tunnel. That has been happening at the clinic, with the same tech (Rick) inserting Mom's needles each time. Until Monday.

Was Rick off on Monday? No, he was working at the clinic.
Didn't they put her in Rick's section like they normally do? No, they didn't.
Couldn't she call Rick over to have him insert her needles? No, Rick was exceptionally busy on Monday.

This Fresenius clinic has decided, probably with good intentions, to rotate the techs around to different bays (sections) so all of their staff can become comfortable working with any staff members, and anybody can fill in anywhere more or less equally. That seems like a reasonable goal, and it certainly has its benefits from a personnel scheduling standpoint. But this is not a factory that is making widgets. It is a clinic providing health care to people, essentially putting them on life support for a few hours at a time. They did not consider the need for Mom to have the same tech insert her needles while her buttonhole is being formed.

Rick did come over after Mom's fistula had been infiltrated on Monday and was not at all happy about it, especially since he had told them this new staff rotation plan was not a good idea. He did not want to try to get the second needle in, so Mom did not have dialysis on Monday and had to go in on Tuesday.

On Tuesday Mom spoke to the head nurse about it and stressed the need for Rick to be available to insert her needles while the buttonholes are being formed. It seemed like the head nurse just wasn't understanding what Mom was talking about, and only wanted to point out how important it was to rotate the staff around and how much better it will be for the patients. At one point she said they might have to stop offering the buttonhole technique until Rick can train some other techs how to do it. Mom eventually asked her if she needed to schedule an appointment to talk to the manager of the clinic, and the nurse told her she would talk to him.

When the manager did come in, Mom saw the head nurse immediately walk over to him and talk with him for several minutes. Then he did something Mom has never seen him do. He went up and down the rows in every bay, briefly speaking to each patient and asking how they were doing. Mom did not talk to him about her issues when he spoke to her, since she would rather do that in his office instead of in a dialysis chair. We figure the nurse talked to the manager and told him Mom was complaining about the rotation, so he talked to all the patients to see if there were any other complaints. ("You seem to be the only patient complaining about the new rotation policy, Ms. Jennings." Well, she is the only one currently developing buttonholes, so, yes, she has concerns that none of the other patients have.)

On Wednesday, Mom was once again not in Rick's area so she had to insist that Rick come over to insert the needles. Rick did not seem very pleased about this, but the needles went in fine and Mom's dialysis was completed without any issues. So now Mom is wondering if the head nurse told Rick not to give Mom any special treatment. It was disheartening to hear that Rick seemed upset about having to insert Mom's needles on Wednesday, since he seemed to really be on Mom's side on Monday. Hopefully this situation will calm down and Mom's buttonholes can get finished. She is really disgusted with the staff at the clinic and how they are dealing with this, and she is even talking about possibly having to switch to a different clinic. So stay tuned for further developments.

[11-13-13: Inserted parenthetical remark near end of third paragraph.]

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