Meet One of the First Home Hemodialysis Patients in Southeastern Iowa
Terry and his wife Marlene used to spend hours commuting from their rural town to a dialysis center for Terry’s hemodialysis. After his nephrologist started a new HHD program with Tablo, they enjoy having their time back.
Known for its rolling hills and picturesque farmland, rural southeastern Iowa is also becoming known for something less expected: home hemodialysis.
Meet Terry. Following challenging experiences with in-center and peritoneal dialysis (PD), he is one of the first patients to treat on home hemodialysis for chronic kidney disease (CKD) in his area, thanks to the efforts of patient-centered nephrologist Maria Story, MD. Dr. Story is the Medical Director at Southeastern Renal Dialysis, with a practice at Southeast Iowa Regional Medical Center. Over the past year, her team has established a successful home hemodialysis program unique for their area, featuring the Tablo® Hemodialysis System.
Terry, who is in his 70s, and his wife Marlene live in the 1,400-population town of La Harpe, Illinois, on the Iowa border. He spent 32 years as a postmaster, then worked as a casino pit boss and dealer. His CKD journey started in 2013, when he underwent quadruple bypass surgery, and doctors discovered he had early-stage kidney disease. He and his wife spent nine years going to regular check-ups, and managing his Type 2 diabetes to try and preserve his kidney function for as long as possible. He also has chronic obstructive pulmonary disease (COPD) after smoking for 47 years, up until his heart surgery.
Finally in May 2022, while in the hospital with pneumonia (CKD patients are at higher risk of this condition), Terry found out his kidney disease had progressed to the point where he needed to begin regular dialysis. For the next year, Terry’s dialysis got in the way of doing the activities he loves, both with in-center hemodialysis followed by PD.
Then, Dr. Story’s home hemodialysis program changed his life. In May of this year, Terry became one of the first patients in their remote area to go home using the Tablo system. Now, with three months of experience treating at home, he and Marlene are enjoying the convenience and control of managing his dialysis around their schedule and lifestyle.
Life Dominated by In-Center Dialysis and PD
In May 2022, Terry started going to in-center treatment three times a week at Southeastern Renal Dialysis in Burlington, Iowa, located about 40 miles from their home. Although he liked the nursing staff, he and Marlene’s lives were overtaken by his dialysis schedule.
Terry doesn’t drive a car due to vision problems, so Marlene took him back and forth to his 1 p.m. chair time for his four-hour treatments, on two-lane country roads and sometimes snowy weather. It took a financial toll having to drive back and forth to the center, from March through August 2022. It also took a toll on their quality of life. Terry would sometimes experience painful muscle cramping during treatment, and after treatment he would often feel very drained and couldn’t keep food down.
As for Marlene, time spent on Terry’s care kept her from helping with their two grandchildren, ages 11 and 13, and other activities she wasn’t able to get to at home, such as watching the grandkids after school and attending their baseball and basketball games.
Last August, Dr. Story mentioned to Terry there were options for him to do dialysis at home. He and Marlene discussed it, and he opted for PD so he could run his dialysis from home, nocturnally while he slept. He underwent surgery to place an abdominal catheter and started treating seven days a week, through this March. Terry says although he appreciated being able to treat from home, PD was very burdensome. He had to lift large heavy bags of fluid and was connected to a cycler machine for about nine hours a night. PD dominated every evening, and he and Marlene would often need to leave their grandkids’ sporting events or other activities early to get home and start his treatment.
A Move to Flexibility
Dr. Story then told him about her team’s new Tablo home hemodialysis program, that would enable he and Marlene to continue managing his dialysis at home. She said the user-friendly machine could give Terry and his wife the autonomy they were looking for, treatment would be four days a week instead of the seven he was spending on PD, and they could schedule his dialysis around their lives. They were impressed when they were first introduced to the machine, and soon after they began training on Tablo at Southeastern Renal Dialysis in Burlington.
In March of this year, their training was delayed as Terry spent five weeks in the hospital being treated for health issues including an abdominal aortic aneurysm and ulcers in his colon. During that time, he received dialysis in the hospital.
Convenience Instead of a Commute
After he was back home, they resumed Tablo training and in May, they began managing Terry’s treatments at home.
“I was scared to set him up for dialysis at first, but now it’s simple,” says Marlene. “I set everything out the night before treatment. Tablo walks you through each step on the touchscreen. Terry and I work together to get the machine set up, connect to his chest catheter and start treatment within about 30 minutes.” Marlene also handles the machine cleaning and maintenance cycles, and water testing. Tablo supplies are delivered in advance, and they store them in a closet.
Terry usually starts his dialysis at 6:30 or 7 in the morning, so he has the rest of the day free. He treats four days a week — Monday, Tuesday, Thursday and Friday — for three hours, and usually watches TV during treatment. Right afterward, he usually has breakfast then heads outside to work on projects around their two-acre property. “I don’t need to nap like I used to after getting back from the dialysis center,” he says.
Terry also enjoys carpentry, and a few years ago he even helped build a home by hand in 100 days. He is now teaching carpentry skills to his grandson, who assists him with projects. Lately they’ve been working to clear fallen trees after a recent storm, using a four-wheel-drive ATV. He takes weekends off of treatment, and he and Marlene usually enjoy time with their grandkids, shopping or gambling at the local casino.
“We like Tablo because we can get his treatments done when it works for our schedule, and around medical appointments or other activities. We have the whole weekend to ourselves,” says Marlene.
Terry says what he likes most about Tablo home hemodialysis is the freedom. “My dialysis works around what we want to do, and we don’t have to drive to a center anymore,” he says. His health has been improving following his recent hospital stay, including having more energy, and his blood sugar has stabilized so he hasn’t needed insulin for his diabetes.
Terry and Marlene want to give a special thanks to Terry’s care team, including Dr. Story, Southeastern Renal Dialysis Home Hemodialysis Nurse Manager Carry Holtkamp, RN, BSN, and Outset Medical Field Service Engineer Anthony Manoli, who have all had a huge part in their success at home. “They’ve all gone out of their way to make sure this works for us and we have what we need,” says Marlene.
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The Tablo® Hemodialysis System is indicated for use in patients with acute and/or chronic renal failure, with or without ultrafiltration, in an acute or chronic care facility. Treatments must be administered under a physician’s prescription and observed by a trained individual who is considered competent in the use of the device. The Tablo Hemodialysis System is also indicated for use in the home. Treatment types available include Intermittent Hemodialysis (IHD), Sustained Low Efficiency Dialysis (SLED/ SLEDD), Prolonged Intermittent Renal Replacement Therapy (PIRRT), and Isolated Ultrafiltration.<
Results may vary. Keep in mind that all treatment and outcome results are specific to the individual patient. Please consult your physician for a complete list of indications, warnings, precautions, adverse events, clinical results and other important medical information. It is important that you discuss the potential risks, complications and benefits of this product with your doctor prior to receiving treatment, and that you rely on your physician’s judgment. Only your doctor can determine if home dialysis is suitable for you, and if you are a suitable candidate for treatment with the Tablo Hemodialysis System.
The views and opinions expressed in this blog post represent the personal opinions of the parties interviewed. The content should not be taken as medical advice. Never ignore professional medical advice in seeking treatment because of content you have read on the Outset Medical website.