Linda is an 88 year old lady with a hump on her back. I initially stared when she first was brought by Rose, her daughter, to our Renal unit. I know I should not have stared I know but these my eyes! Humped she might be but her humor was as straight as a roundabout. She joked that what God denied her in shape compensated in her buttery mouth.
Linda had been attending a medical outpatient clinic somewhere in the leafy suburbs of Nairobi. The consultant she had been seeing had declared her to have a myriad of age-related problems. These are Rose’s words not mine. Hypertension to Diabetes to Arthritis and an array of others that I have forgotten to remember.
The events leading to their visit on that sunny Thursday afternoon was a more recent hospitalization at yet another well-to-do private hospital. Interestingly, the same consultant saw her at this hospital with a severe case of headache, irretractable vomiting and diagnosed her with End Stage Renal Disease and acute hemodialysis was started.
Later, Rose and her mother were to learn that that was just the beginning to a lifelong visit to renal unit. Given the close proximity of our Unit to the interior parts of central Kenya where this family lives, they came to book a slot for this fine lady. Linda had a prescription of about fifteen medications and supplements most of which counteracted with each other. I remember calling Doctor K with palpable anguish in my voice.
He is our renal pharmacist. He has become a darling to all the patients on hemodialysis. He has helped many manage their medications with a rationale behind each and every tablet. He came and I could see the look of dismay as he went through the prescription that dear old Linda was on.
Mom and daughter were initially skeptical seeing that it is a consultant who had been dealing with them in a major private hospital but here we were, in a government owned facility, with some young-ish lad wearing a white lab coat telling them that we had to get rid of some of these impossibly expensive drugs. It has been five months and the blood parameters of Linda have greatly improved painting a vivid picture of adequate dialysis. A fete impossible to achieve if the medication regime is a display of rumors and suggestions.
#TeamPhoenix that brings me to the gist of our #KidneyWednesday today. In our Kenyan setup, rarely does End Stage Renal Disease happen overnight. Moreso in the elderly, and those with Diabetes Mellitus and/or hypertension, End Stage Renal Disease does not come upon us like a thief in the night. Linda did not suddenly develop renal failure. It was a case of omission from the doctor attending her. He had omitted telling her that she was in the early stages of renal disease and therefore refer her to a nephrologist early enough.
The medications that a renal patient uses must be carefully examined by a clinical renal pharmacist. Most of the drugs used to treat hypertension will more often than not raise Potassium levels . Now ,in a Patient with end stage renal disease, high Potassium levels is the last thing you want to deal with. Some of them will cause fluid retention in the body. In end stage renal disease, fluid retention in the lungs, heart and other areas of the body is the last thing you want to handle.
Renal Pharmacology is a very ignored area as far as management of renal patients go. That coupled with our lack of regulation of public chemists place our patients at dire risks of renal emergencies and deterioration of the disease. #TeamPhoenix, We learnt that the only thing we can do with chronic kidney disease is slow its progression, right? Please tell me you remember that lesson…
In our endevour to slow the disease progression, we alleviate the sting of complications and help the patients live lives that are as close to normal as possible. Unless we do not really mean what we say, these tablets must be evaluated to give them a clean bill of health. These tablets must come with renal instructions. Pharmacists at the chemist must at least ask the customer about their kidney health. You as the mwananchi must learn to ask the pharmacist if the drug you want to buy is safe for you or someone suffering kidney disease.
Learn to ask because there are always safer options.
As the Nephrology nurses, we can only do so much in terms of dialysis. We need a robust support from the Pharmacists and the general medicine-buying-culture in Kenya to achieve some sort of milestones in our ardent fight against Chronic Kidney Disease. There are many classes of anti hypertensives and not all are to be used in a patient on dialysis. The same applies to anti-diabetics. I must say I am proud of Doctor K. He manages to explain to the patients the WHY before changing the drugs for the patients. That is a character lacking in many of our doctors and nurses in Kenya.
Not many medics teach before treating. That to a great extent, explain the huge percentage of non-compliance to treatment modalities. It is futile to tell people to follow some way without explaining why they need to follow it. I am an avid advocate of public health education so this touches my heart.
It is your health and that of your loved ones. Please ask questions as far as medications go.
Thank you for passing by.