As director of the Wayne County Hospital’s dialysis unit, Lindsey advocates early detection and awareness of the growing problem of kidney diseaseby Jason W. Selby
This article appeared in the March 11, 2014 edition of The Corydon Times Republican
As director of the Wayne County Hospital’s dialysis unit, Lindsey advocates early detection and awareness of the growing problem of kidney disease.
Maggie Lindsey, a 1999 graduate of Seymour Community High School, returned home when a job at the Wayne County Hospital’s dialysis unit opened up. People tend to keep their jobs at WCH—the hospital has earned a reputation as a great employer—so the opening was a welcome opportunity. But Lindsey didn’t know that her position as director of the dialysis unit would become so personal. She assists her second family of dialysis patients during the week, while at home, her husband Cody was recently diagnosed with a kidney disorder.
March is National Kidney Month, and March 13 is World Kidney Day. Lindsey would like the community to become more aware of how common kidney disorders have become, and how it is important to catch symptoms early.
Corydon’s dialysis unit has been open since April of 2000. Lindsey has been working there for nine years. Before that, she served at Mercy Hospital in Des Moines for around three years. She graduated from Mercy College in 2001.
“We’ve serviced a lot of people,” Lindsey says. “Wayne County’s very fortunate to have this here. I love it. I get to know our patients very well. They become family to us. I actually see a lot of them more than I see my family, seeing them three times a week. All of our patients come every Monday, Wednesday and Friday. Their average treatment time is around three to four hours.”
Lindsey is also a Registered Nurse. She has twin six-year-olds, Lucas and Breegan, who go to school at Central Decatur.
“I drive a little bit, but it’s my only quiet time of the day. I actually have a personal connection to kidney disease. My husband found out six months ago that he was in stage-two kidney failure. He had routine work physicals, and they kept finding blood in his urine. The doctors here at the clinic referred him on to a nephrologist. They did a biopsy, and discovered he has an autoimmune disease called IGA nephropathy, where antibodies attack his kidneys. With controlling blood pressure and a healthy lifestyle, doctors hope to prevent further damage. He’s only 34. The doctors are hoping it’s an early enough diagnosis that through yearly follow-ups with a kidney doctor, he’ll be okay. It was by chance that they caught it.”
“A lot of people ask me what are the chances that I would become a dialysis nurse, and that my husband would develop kidney disease. It was hard for him at first, because he knows so much about what I do, and what patients go through. But he’s got a good outlook. The doctors said that he could live his whole life and not have much more damage or even need dialysis.”
The Lindsey family has a team and T-shirts ready for a May 4 walk at the Iowa State Fairgrounds sponsored by the National Kidney Foundation to fight kidney disease. It’s on a Sunday, because most dialysis patients are free that day of the week.
“My husband feels pretty good about doing this, helping others out, plus helping his disease out, too. He feels motivated that he can help with awareness, and maybe find a cure for it.”
In the beginning, Karen Boswell, a nurse practitioner, suggested they send Cody on to get more tests. It was Boswell’s diligence that helped diagnose Cody early.
“We’re very thankful she looked into it,” Lindsey says. “I see a lot of people, and some are in denial, and they don’t go to the doctor. They might know they have high blood pressure, but they don’t follow up with the doctor. In your younger years, you don’t think much about it, but as you get older, the damage has set in, and it could’ve been controlled by taking a blood pressure pill or having routine checkups that could’ve prevented this from occurring.
It’s definitely okay to ask questions of your provider if they find something abnormal. Especially if you have a family history.”
“Life expectancy of someone who gets involved in their care and takes their medications as they’re supposed to and follows up with their doctors—a person can survive for 30 years. It varies on the patient and their perspective, what they want to gain from it.”
“The most common reasons patients develop kidney disease is because of high blood pressure or diabetes, which are very common in our society. The percentage that has one or the other has grown tremendously in the last decade.”
“The goal is to prevent or make patients aware before they develop the first few stages of kidney disease. There are five stages of kidney disease, the fifth being the need for dialysis.”
“There are several risk factors that people need to take into consideration. Family history of kidney disease—if family members have had those problems, then there is a greater likelihood of possessing those genetic tendencies. We’ve had some patients that have had drug reactions—whether it is antibiotics or anti-rejection drugs from other transplants. Another disorder we see is polycystic kidney disease, where the kidneys develop so many cysts they become problematic, and can actually cause dysfunction of the kidneys.”
“Early detection, going to your primary care doctor to get your blood pressure checked and labs drawn, they can see some early signs and detect problems.”
Though Lindsey loves her job, there is much about it that is difficult. She sees many people pass on during her duties.
“It’s hard, because you get attached to the patients. Some of the patients get attached to each other, so it’s like losing a family member when someone passes away. I always try to go to the funeral services, and it’s amazing how many of the services and programs that we’ve been mentioned in. It’s a closure for us, too.”
“They come to us in different stages. A lot of these patients don’t just have the kidney disease, they have heart problems and other problems.
“We’re starting to see younger patients—patients in their 40s or 50s are becoming more common. We seem to have a higher prominence of male patients right now. Statistics show that males carry a higher rate of having kidney problems. African-Americans seem to have more kidney problems.”
“I worked in Des Moines on a floor that had a wide variety, that actually took care of fresh kidney transplants.”
After working at Mercy Hospital, home and new opportunities drew Lindsey back to southcentral Iowa.
“This is the best place to work—I truly feel that way. The organization of this place is just amazing. The administration here goes above and beyond. They really care not only for the staff but also for the patients. They have a good heart here. It’s a fabulous organization.”
Wesley Selby is the longest tenured dialysis patient at WCH’s unit. His fourth anniversary of taking dialysis is April. He started in 2010. “They’re like my second family,” Selby says. “I’m lucky to be so close to a good dialysis center.”
Often, the dialysis staff will start his pickup and clean off the snow for him on cold days. “Wes is just a good ole boy,” Lindsey says. “We always ask him about his family and about his wife. He takes very good care of himself, and the doctors see that through his lab work. He’s good with taking care of his dialysis needs, which will help him in the long run. He knows he needs to come and do the whole process. I think that’s made a difference with how well he’s done with his dialysis. He’s adherent to the rules.”
“Patients are on a strict diet. You have to be careful about dairy products and fruits and vegetables, which is hard, because a lot of people have grown up as farmers and have big gardens.”
“There’re some days Wes doesn’t feel like coming, and he’ll say, ‘I showed up early, because I didn’t think I wanted to come today.’ He’s always here first thing—a lot of times, he’ll beat me here in the morning. “Wes has been here the longest of the patients we have. He talks about his grandkids most every morning when he comes in. He has a really good relationship with his doctors, and his doctors respect him.
“I learn so much from these patients. It’s very important in my job to hold that positive attitude, because most of these people see this as a negative thing—it’s really hard for them to get up and come, and want to complete the full treatment. It’s important to keep a positive approach to them because they definitely need that with what they’re dealing with.”
“Kidney transplant is actually a treatment for these patients. The problem with kidney transplant is that it takes so long to get a kidney. It used to be an average of four years. They’ve increased that to six years because there are more people on dialysis. That’s definitely an option. We refer our patients on to Des Moines for that. Methodist and Mercy have transplant programs.”
“It’s an intense process of getting evaluated for the kidney. Usually, once the first referral is made, there’s a lot of testing they have to do. They basically check patients from head to toe to make sure everything’s up to par and there are no problems.”
Even after being on dialysis, the goal of kidney transplant is for the patient to no longer need treatment. Living donor patients tend to do better than patients that receive kidneys from a deceased person.
Sometimes, dialysis treatment becomes too much for patients, often because of other health problems. “I get asked a lot, ‘What happens when someone chooses to stop dialysis?’ And we’ve seen that it’s been really hard for families when a patient makes that decision to stop. They definitely need good support. A lot of times they’ll mention [discontinuing treatment], and the conversation comes up more and more.
“Our social worker, Sandy Heller, is excellent. She’s very good with those difficult situations. She provides support, and she can offer other resources that are out there. Our primary care doctors are great, and we’ll pull them in if we need to.”
Because of her close connection to her patients, and the impact of kidney disease on her own family, Lindsey stays active outside of the clinic. “I try to do a lot of things in the Leon community, as far as wellness and prevention,” Lindsey says. “I’ve given a lot of presentations on dialysis, because a lot of people don’t know what’s involved with dialysis. Just making people aware, especially since two of the most common reasons are high blood pressure and diabetes—I think everyone can think of someone in their life that has one of those medical problems.”
“I don’t think people are aware of all that kidneys do. They actually have a lot more functions than helping you urinate—they help regulate the body’s pH, which is important in all organ functions. They help regulate the water that a body controls, which is going to help blood pressure. They help produce red blood cells—a lot of our patients become anemic and weak through that. They help with hormone release and with bone health.”
Lindsey also wants people to be aware of the help offered to them by the federal government. She points out that kidney failure is the only medical diagnosis where people can apply for Medicare at any age, from infant to elderly.
“There’s been some issues, we’ve seen a lot of changes with the government,” Lindsey says. “One of those things, in 2011, they went into a bundling reimbursement. All labs, the treatments, all of it was bundled into one payment, where the government said, ‘We’ll give you this amount for complete treatment.’ So that played a huge factor in how units looked at what labs are absolutely necessary, and what can be followed up with primary care.
“Most places have said it is more of a hindrance. As far as saving money, maybe it’s saved some money for the government.”
“Since this bundling has went into effect, some smaller units have closed, like our neighbor at Mount Ayr, which closed last September. “A patient might need extra treatment or extra medication that costs more, and we’re not going to get reimbursed for that.”
The rationale is to get control over the Medicare budget. Sometimes that comes at the expense of those currently on dialysis, who need the procedure three times a week in order to survive. Without dialysis, it usually takes kidney failure a week to a month to end a person’s life.
“Our population of Medicare patients is about one percent, but we make up about 10 percent of the budget. Basically, our hospital has been very good about providing the service, because we’re not a large moneymaker for our hospital. We provide the service, and that’s important to people in the community that rely on our service.”
In the end, the question is whether the hospital is here to make a profit, or if it’s here to help people. Either way, it is clear how Lindsey feels about her second family:
“At this time, where we stand, we’re definitely here to help people.”