[Congressional Record Volume 145, Number 138 (Wednesday, October 13, 1999)]
[Extensions of Remarks]
[Page E2087]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




              DR. PETER LUNDIN, A VERY SPECIAL ROLE MODEL

                                 ______
                                 

                        HON. FORTNEY PETE STARK

                             of california

                    in the house of representatives

                      Wednesday, October 13, 1999

  Mr. STARK. Mr. Speaker, kidney failure, and the need for dialysis 3 
times weekly, is a devastating disease that grinds many people down.
  One of the most remarkable people I know is Dr. A. Peter Lundin, who 
experienced kidney failure as a young man 33 years ago, but who entered 
the world of medicine, became a nephrologist, and has had a remarkable 
and successful medical practice since then. He has been President of 
the American Association of Kidney Patients and a tireless advocate for 
the Nation's quarter million renal patients.
  He is truly a role model, a figure of courage and determination, to 
thousands. I would like to include in the Record at this point an 
article he recently wrote for RenaLIFE entitled ``Dialysis at the 
Beginning.''
  Thank you, Dr. Lundin, for the great help and inspiration you have 
given to so many.

                       Dialysis at the Beginning

                        (By A. Peter Lundin, MD)

       Patients starting on dialysis today do not realize how easy 
     and routine it has become. Since the 1960s when it began, 
     dialysis therapy has grown into a well-organized, efficiently 
     run, multi-billion dollar industry. From the perspective of 
     the doctor and provider, it is no big deal to start a patient 
     on dialysis today. Everybody who needs it, can get it. 
     Patients really cannot be blamed for their ignorance of how 
     relatively easy they have it because the emotional trauma of 
     losing your kidneys and beginning a new and restricted life 
     with dialysis has not changed. What has changed in this 
     regard is much less attention today is paid to emotional 
     adjustment. Patients are told when they need an access placed 
     and when to start dialysis, often with little consideration 
     of the impact of this new and dramatic event on their lives. 
     Dialysis units are often compared with factory assembly lines 
     where patients come, get their treatment and leave without so 
     much as a word of concern.
       It was not like this when I began on hemodialysis in 1966. 
     Then it was available in only a few centers scattered across 
     the country. You had to have a willing insurance company or 
     pay for it yourself. Because there were very few slots 
     available you were chosen by a committee based on your social 
     worth. Only breadwinners or housewives caring for working 
     husbands and children were eligible. You were expected to 
     continue working after you started dialysis. If you had 
     another complicating disease such as diabetes or were over 50 
     years of age, dialysis was not even offered to you.
       The therapy itself was cumbersome and took a long time. It 
     was done in settings where lots of nurses and doctors were 
     available because of the uncertainty of how stable patients 
     would be. Everybody was carefully observed by a psychiatrist 
     for signs of distress. Everything was being measured because 
     there was much to learn about this new therapy. How much time 
     to spend on the machine and how often during the week to 
     dialyze were still being developed. The few medications 
     available for high blood pressure had powerful side effects 
     and were rarely effective. There were no replacements for the 
     erythropoietin and active vitamin D, which the dying kidneys 
     had stopped making, therefore we were all constantly anemic. 
     To get my hematocrit (amount of red cells in the blood) above 
     20 percent I needed frequent blood transfusions. The only way 
     to control phosphorous in the blood was to eat a diet without 
     phosphorous containing foods and to take Amphogel, an 
     aluminum containing antacid. In those days Amphogel tasted 
     like chalk. It came only as large unswallowable tablets or 
     in liquid form and was extremely constipating. Due in part 
     to the unpalatability of this therapy, some patients 
     already had severe crippling bone disease. Others were 
     already running out of areas for new accesses, their 
     arteries and veins having been used up by multiple 
     external catheters.
       In those days we did not have grafts or fistulas. We 
     dialyzed through an external shunt in the arm or leg. In my 
     case it was in my leg so I had more independence in putting 
     myself on and off the machine. While I did not have to worry 
     about getting stuck with needles, the shunts caused serious 
     concerns of their own. They easily got infected, damaged the 
     veins and arteries, and often clotted. All of these problems 
     led to a shunt life expectancy of about six months. One of 
     mine was chronically leaking from the arterial side, forcing 
     me to walk on crutches from class to class. After getting 
     heparin for dialysis it might take several hours with 
     pressure to stop bleeding. When it clotted I had my own 
     declotting kits. Sometimes it would take several hours to 
     open the shunt up again.
       I was an undergraduate student at Santa Clara University in 
     California when my kidneys failed. I was not a candidate for 
     transplant, and as a student I was not a dialysis candidate 
     either because I would have to become dependent on my family 
     again. Nevertheless by a series of fortunate events the 
     future came about and I am here 33 years later to tell about 
     it.
       I learned how to dialyze myself at the University of 
     Washington in Seattle in their Remote Home Dialysis Program. 
     After three months of training I returned to Northern 
     California and to school. I had the hope and expectation of 
     becoming a medical doctor, and I transferred to Stanford 
     University, feeling it would be easier to get into medical 
     school from there. While taking a full course load of 
     physics, chemistry, biology and mathematics I dialyzed at 
     home. The treatments were done, then as now, three times per 
     week, but they lasted for 10 hours. Clearly, to be able to go 
     to school the dialysis sessions had to occur overnight. 
     After setting up the machine I would get on about 7 p.m. 
     and off at 5 a.m. Of course, I had to sleep and did while 
     the machine was washing the blood.
       When I started dialyzing at home, dialyzers and blood 
     tubing did not yet come in clean packages out of a box. They 
     had to be put together by hand. At first, I had specially 
     made glass drip chambers and long roles of plastic tubing. 
     Dialysis membranes came in a large flat box. The open end of 
     the tubing had to be softened by sticking it in acetone and 
     was then attached to both ends of the glass drip chamber. The 
     dialysis membranes were soaked and sanitized for several 
     hours in a container filled with acetic acid. Carefully 
     removed, they had to be stretched over long plastic boards. 
     There were four membranes divided into two layers each 
     between three boards. Then this construction was filled with 
     formaldehyde overnight before the next dialysis. With 
     practice I was able to put it all together in a bit less than 
     an hour. Taking it apart when the dialysis was over took less 
     time, but before the next dialysis it had to be put together 
     again.
       My break came in 1968 when I was accepted to medical school 
     in Brooklyn. It was my salvation. I was put on dialysis for 
     14 hours overnight, three times per week. I felt much better. 
     I was learning to become a doctor. I got my first and only 
     fistula which works well to this day. It was from that period 
     of my life I learned some very important lessons about how to 
     survive with dialysis: the importance of good dialysis and a 
     reliable blood access.
       Getting dialysis treatments today is, in many ways, very 
     much easier on the patient, who is on average older and 
     having many more medical problems. Supplies, equipment, 
     medications and ways to treat other medical problems have 
     greatly improved over the years. While having one's access 
     fail is no less traumatic today than it was back then, the 
     future promises to bring additional advances to improve the 
     lives of patients with kidney failure.

     

                          ____________________