The Mid-term Elections are Over

Good Morning America!

The Public has voted and the results are what they are. Now it is time to get to work. As one who exercised their right to vote, I can now say to those elected.”Remember what your duty is as an elected Public Servant

Your are the peoples voice that elected you. You Must Decide if your are going to represent all of them or just the party that elected you.

When the House of Representatives elects the new Speaker, I urge them to do so with that in mind. Lead by example!

If you are in it to seek revenge for 2016 you should resign.

If you are in the house to make America stronger, Safer, and a better place to live, work with the others to do so in a civil and honorable manner.

You have the right to disagree as do I. But find enough common ground to work for the country not your self or a particular party.Yes that goes to Democrats, Republicans and Independents.

You have a duty to the country so let’s be clear , all legislation should be “Read thoroughly before it is voted on“!

Backroom politics, and shutting out the debate is not how an Honorable Representation is done.

To those of you that have been newly elected to Congress for the First time, Congratulations!

Remember what you ran on and promised to all those that you represent.

It’s now time to heal the divide, and that can only be down through civility, and respect for others.

Stop the hate speech and decisiveness. Stop the squandering of our Tax dollars on on obstructive search and destroy tactics.

I have a phrase that sometimes is misconstrued as condescending and arrogant, but in reality it is about as truthful  as it gets.

“If you don’t like the past and feel rejected, GET OVER IT! Move on, get passed the hate and descension. The world will not come to a screeching halt because you lost.

Learn from it and try to see what is more important.

Many that read this may be offended by that, but as I say, they too will get over it, eventually.

I wish the entire country a great day and better life.

 

What has become of our compassion and understanding in the healthcare system

Having recently visited a local ER it has become apparent to me that the medical staff of today has lost some of its compassion and the ability to listen to the patient. When the nurse that was going to start an IV was looking at the arm, they were informed that the patient was a difficult stick, the veins were deep and full of valves. It was requested not to have the IV started in the AC (bend of the elbow). The nurse only looked at a crooked vein in the AC and that was where they started the line. Last year when a person was going to have surgery the staff in the pre-op area was informed that the patient was a difficult stick and if they could not get a peripheral line in one or two sticks to put in a central line. When the anesthesiologist resident came to do their pre-op assessment the same information was passed to them. Was the patient’s request followed? No! After approximately 20 attempts in both arms and IV was established for surgery. This was done after the patient had been sedated and when surgery was over the patient was horrified to see their extremities had been used as pincushion’s. The hands were bruised the arms were bruised and the IV that was started infiltrated. A formal complaint was made to the hospital and to the surgeon and that’s as far as I know, as far as it went.

What ever happened to the patient knows their body better than the medical staff, and their rights to have procedures done per their wishes seems to be ignored. I understand that sometimes it is more important to establish IV access to be able to administer emergency medications, but to directly ignore the patient that knows their body and knows the condition of their vessels better than the nurse trying to start the IV I think is a severe lack of professionalism and borderline malpractice. I say this not as a layperson, I say this not as someone who is angry and upset. I say this as someone who has been in the medical field for 40 years, worked in the emergency room, been a paramedic on an ambulance, been a nurse in the ICU/CCU, thoracic intensive care unit, and has been trained as a hemodialysis nurse. I understand the physiology of the vessels and how to cannulated a vessel that is considered fragile and difficult. But to see the results of what I have stated above and the total disregard for the patient’s wishes horrifies me.

United States had in the past been known for having the best medical care system worldwide. Not to be political, but since the government has decided that they know how to take care of patients better than the professionals and regulated reimbursement the quality has declined. Doctors and nurses are leaving the field because it’s just too difficult to maneuver through the regulations and try to do what’s best for the patient without being sued. It used to be thought that physicians made millions of dollars a year, I spoke with my cardiologist and discovered that his practice barely broke even for the past five years because of the changes in reimbursement from Medicare and the insurance companies.

Everyone has heard of the affordable care act. It is anything but affordable, you were lied to when you were told you could keep your Dr. and your premiums would go down! Of course when you have to pass a bill before you can read it, what do you expect? You may agree with this or not. You may be able to relate to this or not. You may think I’m crazy, but my favorite saying is you’ll get over it! Next time you go to the emergency room and they come in to do a procedure and you asked them to do a specific task in a specific way like don’t start the IV in my right arm because if I’m admitted I won’t be able to eat and they started in your right AC means you can’t bend your arm and it means you’re going to eat left-handed if you can, think about this post.

Dealing with Chronic Kidney Disease

Imagine being informed that your hours old baby has developed Acute Renal Failure. What that means is that for some reason the kidneys have stopped doing their job. The outcomes are not good, but with the appropriate treatment and care should be fatal…. Yet! The infant rose from a mere 8lbs 13oz at birth to 12lbs in less than 24 hours. The NICU staff worked with the Pediatric Nephrologist to helps the baby’s’ Kidneys start on their own. Within 24 hours the staff had succeed in waking up the kidney’s. What does this mean for the child? The cause of the Acute Failure had to be determined to see if this was just a fluke or if the Kidneys would eventual fail. As a parent and being in the medical field, the outlook was not clear as to what the infant would need in the future. Two very concerned parents praying for the best but mentally preparing for the worst. The questions of why did this happen? Could something have been done to prevent this? Will my child live to be a Father/Mother? Having a medical background, both parents realized that this was not because God was punishing them, but he was tasking them with a course that would make them a very strong family. Faith and Medicine go hand in hand. Regular visits to the Pediatric Nephrologists getting urine and blood each visit and watching the trends was a part of life. The shock to the father was when at the tender age of 18 months he was told the kidneys are working well enough that the child would not need a transplant very soon. This was not something that had even been brought up. Fast Forward 16 years. Child continue regular visits with the Pediatric nephrologist’s and is in what was called Stage 3 CKD (Chronic Kidney Disease), Although he was not progressing towards the worsening stages the parents had already been made aware that it could happen at any time. The Child was active in after school activities and doing fairly well with adjustments to their medications. In February 2015, The child became very symptomatic, complaining of extreme fatigue, having difficulty remembering things Nausea, The Lab work showed that level of function had dropped from 33 to 18 in just a couple of weeks. That being a significant drop might be indicating that the kidneys were about to quite being able to filter the waste products well enough and that the child may need to start Dialysis very soon. The child would also need to be worked up for a transplant. The Nephrologist realizing that the child would be turning 18 before the transplant process to get the child on the list an active would be very difficult. The decision was made to work up the patient through the pediatric transplant center as the wait time would be less.

Having delved into this scenario what would the complications be that could prevent the patient from getting listed and receive an organ sooner than later? To start with there are not enough Organ donors to get all that need transplant an organ. They must prioritize. The best organ donor would be a family member that had the best match. This is called a living related donor. The next best would be someone else non-related that was a match and was willing to donate. Having neither of those available then it would come from a cadaveric donor. That means some that has marked the box on their Driver’s License to be an organ donor and when they are fatally wounded our traumatized in an accident The Organ sharing network goes into action. All this is regulated by the Federal Government and Medicare. They set the standards and the way the list is kept. This is to prevent someone with a big pocket book getting moved up to the top over a patient that has been waiting for up to three years. The standards change once the patient reaches the age of 18. As a pediatric patient the patient would be listed when their value reached 22. At the age of 18, the value for them to be listed is 18 or below. The problem with a value that low ids will the patient be able to remain healthy enough to receive the kidney. The lower that value the more chance that the patient will need to be started on dialysis. The value I have referred to is the GFR (Glomerular Filtration Rate) and the Table for the stages of Chronic Kidney Disease were downloaded 02/19/2016 @ 01:46 from Renal Function – Wikipedia



This issue has become a question to me. Why do you wait to work up pediatric patients until they are so close to needing dialysis that they are almost too sick to survive the transplant surgery and recover? Preventative measures would be to start the process for any Renal patient that has reached stage 3, the could be put on the list and start accumulating time at a slower rate that say a stage 4 or stage 5. If there was a kidney available that had enough points to match the could be call as an alternate maybe even a 3rd or 4th alternate. Changing the rate required for pediatrics at 18 and requiring them to fall under the adult guidelines makes no sense. Of course the ideal situation would be to have enough donors that were willing to help another human being on the list that the wait time would not be so long.

I am not complaining about the system in as much as It is a personal issue as my child is the model I gave. We finished all the work up and when it was time for the final labs to qualify the GFR that had been 18 and 19 went up to 22 to 25. Good news as it means no dialysis but it also means can’t be on the active list.

If you would like more information on Chronic Renal Disease just click on the following link that will take you to the National Kidney Foundation website. National Kidney Foundation.