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Published in CenterView on October 22, 2012
Home dialysis nurse Vanda Echols, left, discusses medications with Martha Patrick.
Home dialysis nurse Vanda Echols, left, discusses medications with Martha Patrick.

40 years of home dialysis makes Forest woman ‘one of the longest surviving patients in the world’

By Gary Pettus

The story of Martha Patrick’s disease is carved in the landscape of her rust-brown limbs – a ridged, flesh-and-blood geology resembling a bird’s-eye view of the Grand Canyon at sunset.

This is the spoiled “topsoil” of her arms, which Patrick has pierced so many times, it has played out, forcing her to plant the needle in her legs.

The scarring is the price of long-term home hemodialysis using an artificial kidney, which has purchased Patrick’s life for more years, perhaps, than for anyone else.

 “Forty— it’s just a number to me,” said Patrick of Forest. “That’s just my life. I don’t think it’s that great.”

That’s not the opinion of Dr. John Bower, 80, a semi-retired nephrologist who has not fully retired, in part, out of his regard for her.

“You can’t just walk off and leave a patient you’ve been seeing for 40 years,” said Bower, professor emeritus at UMMC.

Nor is it the opinion of Dr. Christopher Blagg, emeritus executive director of Northwest Kidney Centers in Seattle.

“Forty years on home hemodialysis is, as far as I know, a record,” said Blagg, a home hemodialysis expert.

The record of survival for anyone with kidney, or renal, failure is 49 years, said Blagg, whose advocacy in the 1970s helped usher in Medicare coverage for dialysis and kidney transplantation.

Patrick, who’s never had a transplant and has survived this long strictly on home hemodialysis “is one of the longest surviving patients in the world,” Blagg said.

She has survived “end-stage renal disease (ESRD)”: permanent kidney failure, which must be treated by a transplant or artificial filtering – dialysis.

For Patrick, it started in 1972, with nosebleeds, loss of appetite, insomnia.

“I’d sleep during school, I was so tired,” she said.

Born with abnormally small kidneys, she had outgrown them by age 15, like an old pair of shoes.

Her kidneys were working at 10 percent of normal capacity; wastes piled up in her blood, like a biotic landfill.

Untreated, she would have died.

“Martha’s mother said, ‘I want her to live,’ ” Bower recalled.

 Dorothy Sanders Patrick learned how to use an artificial kidney machine so Patrick could do home dialysis.

Martha Patrick’s own training served her well after her mother died in the late 1980s, ironically, of kidney cancer.

Later, her sister, Linda Leclerc of Forest, served as Patrick’s “third hand.”

“It’s the concept of the ‘dumb neighbor,’” said Bower, who gives Patrick monthly checkups at the Jackson Medical Mall’s UMMC Outpatient Dialysis Unit.

 “We try to make the training so simple, even your dumb neighbor could do it. The key is that patients accept responsibility.”

Some patients choose peritoneal dialysis, in which a hollow tube is surgically placed in the abdomen; a material called dialysate absorbs toxins before they’re drained from the body. This, too, is a home treatment but wasn’t an option when Patrick’s kidneys failed.

Hemodialysis, her choice, requires a fistula, a surgically created access joining an artery with a vein. Patrick, who has had several fistulas, is among the 1 to 2 percent of dialysis patients who dialyze at home rather than at a center.

Of the more than 400,000 in the country, only about 6,000 do home dialysis, which would cost several thousand dollars yearly without Medicare, Bower said.

“At a dialysis center, you schedule your life around dialysis. Do it at home, and you schedule dialysis around your life.” 

During each session, Patrick inserts into her fistula two needles attached to plastic tubes that connect them to the dialyzer, or artificial kidney, supplied by the center.

One needle removes the blood from the body so it can be pumped through, and scrubbed by, the machine. The clean blood returns to the body through the second needle.

Calculating at least two piercings per shift, Patrick has stuck herself some 13,000 times. “If the first stick is a bad one, I stick myself again,” she said.

 For the four-a-week, 3 1/2 –hour sessions, her bedroom is her dialysis unit. “I get in bed and watch TV at the same time,” she said.

Patrick has turned down transplants, she said. “I didn’t want a big surgery, and I’ve been doing good.”

But because of dialysis’ limitations, she has high blood pressure, hardening of the arteries and metabolic bone disease. She must use a walker.

“The kidney also controls blood pressure and bone-material content in the body,” Bower said. “The artificial kidney can’t.” Medication has to.

“Transplants improve the quality of life,” Bower said, “but you need a donor, and the patient will probably need more than one during a lifetime.”

After years of dialysis, Brenda Dyson received a kidney from each of her two sisters. “Which is better, a transplant or dialysis? It depends on the individual,” said Dyson, Community Outreach Coordinator for Network 8 in Jackson, which serves kidney patients in Mississippi, Alabama and Tennessee.

“When I first met Martha, I was amazed that someone would look that good and do that well on dialysis. She’s an inspiration to everybody.”
 
On May 22, Patrick reached the 40-year milestone, a month following her retirement as a part-time library book-shelver.

“She’s responsible, takes good care of herself, eats right,” said her sister Leclerc, 63. “That’s why she’s done so well all these years.

“I don’t care what she says; anyone who can do what she’s done, that’s impressive.”


End Stage Renal Disease (ESRD) Patients 

2010 (population affected as of Dec. 31)

MISSISSIPPI
Per million
Center hemodialysis: 5,643
Center self hemodialysis: 0
Home hemodialysis: 79
Continuous ambulatory peritoneal dialysis (CAPD): 187
Continuous cyclic peritoneal dialysis (CCPD): 340
Transplant: 1,594
Unaccounted for by the USRDS : 18
Total: 7,861

Patients alive with ESRD
Per million
1980 (as of Dec. 31): 682
2010 (as of Dec. 31): 7,861

Source: 2012 United States Renal Data System
(www.usrds.org/reference.aspx)