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Saturday, November 20, 2010


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Matt Sparks

Look forward to following. Great site. Will link to it on RFN.

Peter Laird, MD

Thanks Matt. I continue to read RFN daily and highly recommend it for patients and docs alike.

roberta mikles

Peter, this is fantastic and have sent the link to my many patient safety advocate contacts and organizations for them to distribute.

Roberta Mikles RN BA
Director, Advocates4QualitySafePatientCare
San Diego, CA


I love this blog!


Peter Laird, MD

Dear Moosemom, thanks for the kind comment. Please don't hesitate to let us know what topics and information that may be of help.


Hemodoc, I'd be quite interested to know more about the interaction between you and your nephrologist? What do you suppose it is like for your doctor to treat you, a fellow doctor?

Peter Laird, MD

Actually, my current nephrologist, Dr. Scott Rasgon, is the head of the nephrology program at Kaiser Sunset in LA. We have a very good relationship and he is open to my requests. He tells me I keep him on his toes. He is also an advocate of nocturnal dialysis and short daily. If all nephrologists would put the interest of the patient upfront and foremost, we wouldn't have the problems that we do today.


I've heard of Dr. Rasgon. You're a fortunate man. I know my neph supports NxStage, but we've not yet had that discussion. Usually I just want to flee his office, but one day I'm going to have to bite the bullet and tell him how I want to receive dialysis. I hope he'll be amenable to my requests. I don't fancy the notion of having to talk my own doc into allowing me to have the best treatment available. We're always told that we have to be our own best advocate, but not all docs make that easy to do.

Peter Laird, MD

Actually, I did discuss the issue with Dr. Rasgon and he was going to look into getting sterile disposable tweezers for his patients. I see him tomorrow morning for my monthly visit.

The key to getting the best out of any doctor is communication and bribing him of course simple little gifts at Christmas time. Truthfully, finding a truly altruistic nephrologist today is a chore. I am fortunate that my HMO is non-profit and that the nephrologist get no financial incentives for reducing care as do many that work in the for-profit world. I searched for a long time to find a good nephrologist who not only listens to his patients but genuinely cares how they do. That is the halmark of a good doctor, no matter what field they represent.

Rod McDonald

I really enjoy this blog and thank you for writing it. It addresses so many of the issues faced by home hemo patients. I was on PD for four years and by the end, I was a very, very sick man. I was sleeping sixteen to twenty hours a day. My energy level was low and I no longer enjoyed life.
There was a new program for home hemo set up in my health district and I phoned continually until I was accepted into it. I was their eighth patient. I have been using the Fresinus Home 2008, three nights on for eight hours, one night off. I am a double needle. My blood levels and general health have improved considerably. I am a convert. I, along with the other patients, there are fourteen of us now, detest going to the clinic for treatment. The staff are good to us but the culture of sitting in a ward with thirty six other patients is less than pleasant. At home, I choose the time to go on and off. My wife and my cat wander in to my bedroom to visit. I have my books, my computer and television. I enjoy taking responsibility for myself and my health. My only complaint is that I have never been able to sleep on home hemo. I can handle the light but the noise from The Millenium RO machine prohibits me from dropping off. Most nights, I read or lie there. The Nx Stage is not presently available in Canada or else I would take a look at that program. One of your articles addressed the expense of hemo in The USA. In my region, a patient on in centre costs a $100,000 per annum and a home patient is $50,000 per year. Considerably less than the American charges. One of the differences is that a law suit against a medical doctor is extremely rare in Canada and insurance is not the same issue as it is south of the border.
Your article on Stewart Mott's twirly bird method of cannulation really helped me out. I switched to that insertion method four months ago and so far, I have been one hundred percent successful.
Thank you.
Rod McDonald in Regina, Canada

Peter Laird, MD

Cost of medical care in the US is greatly inflated compared to the rest of the world. With the so called Affordable Care Act, they project an average family will pay $20,000 a year for health insurance alone. Things will only get worse here in the US not to speak of the impending physician shortage which will create huge waiting times. I am not happy with this situation at all. Looks like it is too late to reverse the damage done already. This will lead eventually to a single payor system which is not something I am looking forward to at all. Things will not get better in the US at all. Quite sad to see what is happening to health care here.

Rod McDonald

As the Nx Stage is not available in Canada yet, would you please tell me what the schedule of treatment is for most patients. Someone told me that it is three and half hours a treatment. Is that every day or are there days off? Also, is there a reverse osmosis water treatment machine as a part of the therapy or is the water handled by saline bags? Thanks.
Rod McDonald in Regina, Canada

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