Peritoneal Dialysis: A Patient’s Experience | UCLAMDChat


So, welcome to our webinar on peritoneal dialysis. My name is Anjay Rastogi, and I will be going over home dialysis, especially pressure analysis, in some detail. And I do have two very special guests today who I’ll be introducing after I go over some slides, so the first one is our baseline, is our contact information. So if you have any questions about home dialysis, dialysis in general, or anything, this is our contact. You can call us directly, or you can email us, and also do visit our website. So, this is the website, we have our previous webinars on dialysis, on transplantation, on medication, high blood pressure, and a lot more that are actually archived. So today’s program is on peritoneal dialysis and home dialysis. But before we can dialysis, just a quick recap in patients with advanced kidney disease. So, this slide is showing the five stages of chronic kidney disease that we call CKD, and these CKD stages are actually defined based on GFR. So one of the things that I would definitely urge to all the audience, if they have kidney disease, is to know what their creatine levels is, and from that we calculate the GFR. So, GFR is the single most important test that we do to assess kidney function, especially if they have chronic kidney disease, and based on GFR, we classify patients in stage 1, which is the earlier stage, and then you progress to go to stage 5– that is CKD stage 5–and in this stage, you will need some help, what we call replacement therapy, and we’ll be talking about what options our patient has. Stage 5 is also called ESRD, end stage renal disease, and that’s a term that you probably have have read about as well. So if you or if someone that your love has advanced kidney disease stage 5, the question comes up– what are the options that they have? And these options are listed over here. One option is dialysis, which we’ll be going over in a lot more detail. The other option is transplant, which I do want to touch on briefly. So if you do have advanced kidney disease, there are, you know, you can either get listed for what we call the cadaveric kidney transplant, or if you have a living donor, then you can even get a preemptive transplant. That means that you get a kidney transplant even before you could go analysis. But if you don’t have a living donor and you get listed, the chances of you getting a transplant before dialysis is very low because the waiting time is long. But you should definitely listed and keep looking for living donors, if there any potential donors, and if there’s any way we can help from the UCLA Kidney Program. Feel free to reach out to us. And the other option that’s listed over here is palliative care. So, there are conditions, and this is something that your nephrologist and and a care team will need to discuss with you, that if they don’t think the transplant and dialysis are best options for you, then there is also palliative care, and UCLA has a very big palliative program as well. But today, we’ll be talking more about about dialysis, and we’ll be talking about about in-center versus home dialysis. So normally, when people think about dialysis, they know about dialysis units that you probably see on the roadway and driving, and you go there, get that dialysis three times a week, and then go home, and that’s why we call in-center hemodialysis, but our focus today is going to be home dialysis, and more specifically, we’ll be looking at peritoneal dialysis. But the periotoneal dialysis is when you get dialysis at home and you do to your own body cavity, called called the peritoneal cavity. There’s also one called hemodialysis, in which you get
a–put a dialysis access in your blood vessels, and you draw the blood out and clean it up, and then you put the blood back in. So that’s what we call hemodialysis, but in peritoneal dialysis, we don’t access the blood, and I think this is one of the key advantages of peritoneal dialysis, is that they preserve–so if you have advanced kidney disease, and you are getting close to dialysis or on dialysis or even transplant, there’s one thing that I always educate my patients is, about vein preservation, blood vessels, because this is the life line, and and if you think about that, their blood draws, there’s a lot of other things that we do that can, over time, damage your blood vessels. So, one of the advantages of peritoneal dialysis, as opposed to hemodialysis, is that we don’t access your veins. So, key point to take home for any patient with CKD is vein preservation, and that’s redone through peritoneal dialysis. So, we’ll be focusing today on peritoneal dialysis and its role. So this is going over our spectrum, so you could be a patient in the clinic, you’re not on dialysis yet, or getting close, and when I say you, it’s not just you. It could be your loved ones or people that you know, so that chronic kidney disease, the CKD clinics, then we have what we call you might be on in-center hemodialysis. That means you’re getting dialysis at home or in the center. And the third one is you’re actually in the hospital, ended up in the hospital for whatever reason, and, you know, you need dialysis as a life saving modality. So all of these things lead into what we call home dialysis. So, all of these patients are potential candidates to be getting dialysis at home. And the other thing that I want to show here is transplantation. So, the way I look at is home dialysis, and this is a bridge over here, home dialysis is a bridge to transplantation, and that should be the eventual goal. Now, some patients are not candidates for transplantation. That’s completely fine. But most of the patients are, and at the end, in majority of cases, transplantation is the best option or best modality, and home dialysis is a close second. So if you’re an in-clinic patient, or you’re in center, hematology center, or in the hospital, or if someone that you know is there, consider home dialysis and explore that option. Now, this is what we call the integrated dialysis care. We work very closely with other teams. We work close with the hospital, we work close with the surgical teams, the transplant teams, dieticians, social workers, and this is what we called the dialysis team. So, you’ll have a whole team taking care of you to make sure that we provide the best care we can do, and this is what a PD or peritoneal dialysis will look like. This is your internal own–so we use your own body cavity, the parietal cavity, to clear your body of waste and toxic products, and this is the catheter that will be coming out. So, instead of going into your blood, this goes into a parietal cavity, and this is something that can be readily easily placed and also removed if needed and this is the the dialysis machine and as you can see is it’s fairly small and People can travel with this machine and will be going in that to is travel on Or if you want travel on dialysis So with that I would like to induce two of my my guests very special guests So first on my right hand side is sue lang. And then I think you’ve seen Marybeth Quite a bit on these webinars. So with that sue do you want to give a bit of introduction who you are and Why you’re here? My name is sue and I was a PA patient for about six years and When did you start dancing? I started by Alice’s No November of 2012 2012 and we’re on on keyboard Alice’s. Yes And for how long were you in the hemodialysis exactly exactly? So she remembers exactly how long she wasn’t on hemodialysis? So six weeks. Thank you so much Marybeth. I Was I diagnosed with end-stage renal failure in? 2012 and I Began my first Round of treatment was I learned about perineal Dialysis, I wasn’t aware of it before but I learned about it and then you are for short time. You’re on hemodialysis as well Yes, very nice. Thank you. So very short time so so now I just want to bring this up because you don’t have to go to hemodialysis to be on PD we You know, especially if you’re getting here much early on that We prepare you to – so you start on PD and there’s also the urgent starts So even if you need does is right away we can put you in PD in in a good number of cases So so we won’t be getting into origin starts But PD as an option is even if you have it fast But normally we try to plan it way in advance you when your kidney function is below the power of 30 We start looking into that So now so let me talk to you about first. So why did you Why’d you pay PD as a modality for paralysis? I take pity because it gave me a lot of flexibility I wanted to go back to school and knowing knowing that when if I were to go into the hemodialysis, I would be stuck three days a week and Pt. Did you PT allowed me to do dialysis and the comfort of my own home And which also allowed me to go back to school? So I think that’s that’s one of the key things about what called home dialysis and the patron Diocese is a kind of home dialysis is flexibility. So you get dialyze at home And you don’t have to go so when you go to in center hemodialysis you you have shifts So you start at 9 o’clock and of it at 1:00, but that’s your your time on analysis You have to prepare for that You have to go there come back and also so petrol doses and and how how often you do paralysis Daily so daily and it was a daytime or nighttime nighttime daytime I did my dialysis based on my school schedule Cusco spunky so so in Paralysis and I think most of the patients what they do is they attach them and I showed you the machine Will call the cycler. They attached themselves to the machine and they go to bed, but ask them they get dialyzed while they’re sleeping and And then they wake up. So so it says it’s done daily, and that’s a big difference So people might say well it’s more than then what we do in center But there’s a difference your kidneys work 24/7 right and when patients go tell us three times a week One of the biggest complaints that I hear from patients and and you probably have forgot to and hemo is if l feel very drained after those that they feel very so That’s one of the other dress is the energy level right and my bath Your energy level so I Know there was an increase in interesting incident and when somebody asked you to sign some forms, that’s right when I was first diagnosed I learned that there was There were really two options And to me one option of in-center was I would go to a center and they would perform Dialysis in me and when I learned about home dialysis I was really interested in home dialysis because I would be doing I would be responsible I would be having more control of my life and as dr. Rastogi said When I was first diagnosed, I remember being informed that I was a hundred percent Disabled and I remembered saying to the person who was talking to me How much longer was that gonna take because I had to get to work I had to get to work so really for me I had control of my own disease with a phenomenal support system And so I was able to work full time like sue said I worked in the school into a daytime job So it was perfect. I would dialyze myself 7:30 Very quickly You learn how to jump into bed and go to sleep and get up and it made for me a much more normal life knowing For many people who said to me well, how can you do that at home? You don’t have people with you? I had full support I had access to all of my physicians everybody who was part of the core team and Along with the Machine that dr. Scobie has said to you was really a 24-hour support You could call it anytime if you had any questions so it really I felt like I had Some control of my life, which was really important to me. I think it a lot of control Raymond. I Did and so going back to you know, flexibility and lead living a normal life And I think that’s one of the first thing I tell patients with advanced kidney disease lead a normal life So it takes first of all, it takes away the tension that you pay too much on your disease state Right that is important. You have to take care of yourself but at the same time, you know, it’s good to focus on other things besides just your disease and you you know, you’re very modest, but you were running a Big school, you know and and a lot responsibility and and you have also made active, you know I still never used to come with your running shoes on and will be running in and run out Because I think part of it is dr Estonia said and sua said the same thing when she was going to school full-time. It was I didn’t want to become the disease. I Wanted to do everything. I possibly could for my own health. So this allowed me to exercise because I had more energy Doing home dialysis because I felt better And could go to a job and feel like I was fulfilling a role that what I found very fulfilling for myself and really having you know through UCLA and The court kidney program a tremendous amount of support that I was not doing this in my house alone And I think that supposed to be a portable to come back to that that you’re not unknown, you know And I want to get back to my my next point about training But just just to recap a couple of points over here one is flexibility Because you’re not bound to to the machines that you have to go I mean, we do want to give you a schedule but some people want they want, you know If you have something at night and you want to tell people that I said during the daytime, you know attest themselves They might break up the cycle sometime as well. So there’s a lot of flexible within limits to do and it’s done daily So it’s very gentle on your body And I think that’s also people sometimes people don’t realize that instead of just getting done as in three times You actually have a much more gentle and the body likes and gentle, you know, they don’t like these big shifts You know in fluid and electrolytes so patients in general Feel better and and it’s not just that your dialogue on the flexibility You need to the energy like you mentioned, right? but and it did you go to school and I’ll come back to that as well because I think that’s that’s important school that he Went to but running a very busy I mean you you were for the party the head of this very busy and high in school and I can tell you I mean I’ve seen your students. I mean from all age groups. It’s not easy. So energy levels are also much higher so so now you mention about training and support and and a lot of people have this fear that oh, I’m gonna be terrorizing at home. So as the medical director of a Dallas unit I can tell you that when when it’s it’s it’s something it’s not a right to be If I can put it that way but it’s a privilege to be at home dialysis because we have to we have to actually clear you that you can do because safety is first and foremost so you we make sure that we give you The proper training and as long as it takes most people can be trained fairly quickly but we will not sign off till we feel that you’re adequate trained and You feel that it wait So if you don’t feel comfortable dialing at home then so I don’t think that’s ever come to me in in my you know the career that that that I don’t feel comfortable I can’t go they it should be royalty but trading part and this is something very important as well that once you you you’re Competing you need to get trained. So let’s talk about the training, right? And and so what what drew you to the Century City, you know the centricity PD program? That’s that’s linked to UCLA So why that program as opposed to any other program that? You know could have gone to well, you know looking back at that as I talk to you I remember reading like we read too much online I had read about this form of dialogue and really wanted to do it and then I read about the intensive training and of course It’s presented a way that is as serious trainee and you have to feel confidence October still be you’re gonna be signed Awesome, and I saw the schedule and once again Century City. I was working full time and I will never forget it. I’m like I Can’t take off a month to come by and get trained and I remember at Century City the extraordinary Joe who trains people at Century City said to me well What time would be good and I said well five o’clock could be great and he said okay five we’ll do it at five o’clock and He met he met me along with my husband. So We could have a support system in place. It was very nice for me and I found a real balance in the training of I really think I got confidence because he gave me confidence it gave me hope that you can do that was very careful about it and what I was not going to be released to do it until everybody really felt confident and when I began it when I actually Became time to do it at home. I Was very confident that I could do this and I was also confident. I had a support system in place that I could call and I look at the four and a half years that I did this at home and Felt like you know, I always had support it gave me a chance to live my life and also put me That it definitely put me PD put me that I really ultimately I had UCLA I had the car I had the experts I had other people to talk to but I was responsible For my own health and I was making decisions. I think it’s really important, right? Right and I think it as you mentioned, you know, the training program is also flexible, you know We we work with the patients. So we want people to work We want them to go to school and we wouldn’t want to interfere But at the same time and I think I mentioned that when your training is this is a very important site It’s easy is I haven’t seen anybody who is not who’s failed training. Let me put it this way Nobody has failed it Some people are very quick learners the two of you were some people take a bit longer and they it’s a comfort level But nobody and we it’s also flexible. Sometimes they can convert to are so 10 they can come for four hours and we work with the schedule of the ania mentioned Joe and and so what when you so one of the Advice that I will have for anybody with advanced skin disease So I tell my patients when they come to see me in the clinic Outpatient clinic they come and see me most the time, you know, but when they come to the dialysis unit They come to see the team right the nurses there the dieticians there the social worker Everybody’s a partner that will call the interdisciplinary IDT’s So I think it’s very important that you go and visit the unit before you go there because you’ll be spending Actually a lot more time with the team than even with your nephrologist right you spend time. You mentioned Joe I mean who’s an amazing and and he trained you as well So so so Joey Fantas who’s our our main trainer an exemplary human being as well But but that’s I think very important that you picked the right. We are at patients coming from out of state I mean we she’s coming from San Diego. We’ve been coming on Hawaii from Vegas And the question is why would they come here because they feel comfortable. I think so So if you go to the diocese unit make sure that you go and visit that unit and feel comfortable and if you don’t feel comfortable you have options of talking to the Physician, you’re the medical director of that unit or look for other, you know It doesn’t and and the good thing about home dialysis Is that you you and how often did you go to once you were trained? How often was your visits? Suanne maybe? Two times a month and and yours too is probably maybe once again, I mean So I don’t know how it was for you, but the accommodation it was twice a month and because I was working a full-time job The Century City really offered that flexibility of not saying well you have to be here by four o’clock in the afternoon I would see we will work it out Then I would come by and see you and see the team, you know When you would visit the great parties We would see the whole team see the social worker or to help you with this with any insurance question those kinds of things there was a whole team that you could ask particular things about that was that was very helpful them to see you and once again that wasn’t Six per city was not an infix in a flexible place to go There was a it was built in and everybody had an attitude of working together with your schedule. Perfect. Perfect And I think that’s that’s also very very important And and so once you’re trained then you can visit two times a month depend upon some people ratico more often But we want them to come one foot the laps and then for the visit with the whole team So so that’s also so you only have to have two visits as opposed to three times a week for four in center hemodialysis So the role of the team is very important I think I can’t stress upon that I mean the dietician the social worker at the nurse, obviously The training is is very critical you mention about exercise, you know feeling the energy level now So your case was was very trusting because you actually went to school while on on dialysis Right. So what kind of school did you go to? Then what were Conners? Register for and what’s what’s your specialty? Harold Alice’s so sue actually went to nursing school while on PD And became a PD nose so a lot of times thought of my daughter’s patients run away from Dallas’s units because they don’t want once they transplanted or they but you actually took it head-on and Became so so sue is now actually a very successful PD patient our sister, so that’s awesome. So that’s that’s great age You know, you know a lot of times we are told that that you know, if you’re over some age You should not be on PD and that’s actually a big misconception to pursue Maybe bet you obviously right I had exactly I had heard that because of my age it previously to Seeing the UCLA team being part of the core team meaning doctoral study I was told that that would be a problem and I found out really that was definitely not a problem It was much more related to Are you a candidate? You’re evaluated are you a candidate for Pitt for PD? And is it gonna work for you? So that’s something that I really learned to get more information because I had already jumped to the conclusion that I was not going to be able to do that and Fortunately, I was evaluated to be a good candidate for PT and so as I said, you know it really it really Changed my life as I said, I can’t focus enough on receiving having somebody give me Dialysis and doing it myself at home. It gave me much more. Hope much more connection to being normal of living a normal life And so this is Marybeth you mentioned about but you know Family support as well. And and that’s something that we really Like to stress on and and your husband obviously was very involved But PD is something that you can do by yourself as well, you know So I think that’s something important to keep it now with home him or at least which is the other kind of home modality We definitely and he’s in our program. We have a partner but for for PD, you know, it’s always good to have support but You know You don’t have to have that but but we always say having the family involvement friends involvement And also sometimes if you get tired We actually bring you back in to To the doctor’s unit and you can we can do hemodialysis as well of Athena for the short-term So we want to make sure that there’s no burnout and we haven’t seen that the the other thing to mention about about age and also things that people Go up on internet look it up and there’s a lot of a lot of myths about PD Paralysis that you get infected and you know, it’s interesting on on this internet. They they have one case that that went wrong So what I can tell you is and these are two example But if you look at our it’s it’s over us a very safe procedure, you know All these things can go wrong and we that’s where education comes in but but worried about infections and all that stuff is is is Actually not true if you go to the right center, and also if you have the right training, right? I just want to comment on that training because the biggest thing I learned and I think it was one of the most important things in the training I now look back at that was after you do You’ve done the dialysis and you woke up in the morning in my training It was so emphasized every single day. You would look at what was removed I’d earned then I won your slap and I was told and I religiously put the bag on top of the LA Times every single day and That was a number one way to make sure you never got infection every single morning if you could read a line From the LA Times with the bag on top of it you are fine And I found that the most accurate testing that I learned because that’s the thing. People are the most afraid of me in it I mean it worked perfectly just learning those little tricks right? I mean now that you know, sue and I have been through that and other people have been through that I mean that’s so important to have a community of people that you can share the information with when you could talk to I mean That’s why you know, we’re here today because we were the people who are actually doing it You teach it but you’ve never done it, right and that’s a very big difference because I’m not on Dallas myself And I’ve never been on that. So so there’s no and and that’s the whole base of circle of core your guinea program So and I know maybe better you and sue you both of you have have provided a lot of support to patients So if you if you want to talk to Mary Beth and so just even as a core kidney and we will connect I Think that’s one of the most important things when I see these webinars all of these webinars being done I keep thinking I wish I had known about the webinars because There’s nothing like talking to someone who’s facing and stage who made the decision Who can help you have a better understanding of things that I mean you on the slide, dr. Rastogi? Really showed the machine when you actually see the machine you realize if I’m working iPhone They have the iPhone technology down with that thing I mean you you it isn’t like it’s this complicated machine like you would see in Center, right? I mean that thing looks really scary. This is something simple But you know We’re doing this and there’s a whole team of people at UCLA that have had treatments and that are available To talk to you about anything, right? And I think maybe with your sister over here sue you have them that too and you actually provide that it from here you do the teaching now you Do the training And we’ll have a different separate program on PD training as well. You know, we’ll be going on the details today It was a time we can’t do that. But I think that the key thing is you’re not alone I mean and a lot of people think oh my god. I’ll be at home There’s 24 set 24/7 support over there, you know other people they can talk to your nurse your physician So there’s a lot of support and if you don’t feel comfortable you can always go back to in Center so but none of my patients ever done that and once they’ve gotten home that says they don’t want to go back to inside and I was just gonna add one Thing I don’t know. So if you found this because you know much more you’re and I did that One time in four and a half years. I Tried to convince myself. I was having a problem with the machine the machine never had a problem It was always something that I had done or hadn’t plugged in right that with the support when you call up. I can’t emphasize Knowing that a question in the three o’clock in the morning because a buzzer is going off because you didn’t press the button it’s such it was so comforting to know that I Would have that you have somebody do you yes and talk to you Absolutely So so I think once again the the recurring theme is that if you’re getting close to dialysis or are on dialysis Definitely ask the question. Why aren’t you on present Dallas’s and there very few patients I could tell you that don’t qualify for being on home dialysis So so speech pathologist speech your health care providers speak Call us if you have any questions and we can and we can also talk to Mary Beth and sue and other Patient that we have to walk you through and see what the experience has been now So as a nurse, you know, we talked about some of the advantages of patient answers One of the biggest one obviously is you spoke about the patient factors the flexibility, right? You know seven days a week So it’s gentler on your body some patient that you do much lesser depend on how much kidney so when I say I was kidney Functions left so there’s something called So even though if you are on dialysis, we monitor your kidney still and and the more urine you make you know The better it is, so that’s what we call residual relief function or rrf So so do you monitor that on another basis on your PD patients? Yes And I think that’s very important So so so and that’s important because we want to maintain The kidney function that’s left, even though it might not eat that much It is still a significant number And and the reason why I bring this up is as composed to a computer in center PD preserves your kidney function for a much longer time So that’s the other advantage of being on personal analysis as opposed to hemodialysis that that it preserves the unit You’re making for a much longer time. So that’s if you were checking up points why to be on PD? now let’s talk about transplant anyway III when I discuss the options available for for patient with advanced kidney disease, I Mentioned those three things there was no analysis We we spoke about palliative care if if in the opinion of your care team and you that you don’t want to pursue any options And then this palliative is making you comfortable But but that’s not what transplant and and in majority of cases transplantation is the best option But obviously you have to have somebody who can donate a kidney either you get on the on the disease donation list And it’s a wait time for that or if you have a living donor you you can you can do But but one thing that we have seen is is if you look at our Century City PD program We have a very high conversion rate for patient getting transplanted And and and a lot of reasons for that but the way we look at and this is published data that patients on pert analysis have have a much better chance of getting a Transplant than patients who are in center. There’s a lot of reasons for that. But but that is published data, but now both of you Have a kidney transplant and and you just celebrated you two years. So right just June 10th And and for you Mary Beth, it’s gonna be two and a half years very soon so let me start with with you Mary Beth first to tell me your experience with transplant and and and the the Transition from PD to to having kidney of your own. Yes. Well I received the miracle of a transplant two and a half years ago and Unfortunately, my husband my sons and my siblings no one was a match for me so I received from a deceased donor a 29 year old young man a very healthy, kidney and Because I think I was on PD. I look back on that Of exercising and seeing doctor Rastogi regularly and really going into Century City I never went in and saw you when you asking me about what I was doing about the Transplant how proactive you were being it was not House PD going. It was like, how’s the transplant process going? So, you know, that was really it was a whole team effort of giving me hope with a hopeless situation where I Received it really in my transition to be honest with you It’s amazing when you receive a transplant of a healthy kidney when you have tried to maintain your health by exercising when following all the plant I mean a Day later, I felt like a new person and have been Celebrating life in my kidney with a new energy. I feel 10 years younger He sent me this picture from oh, I just I showed I sent. Dr. I was showing a picture. I was just in Italy Hiking Chicot era which is the five cities. I really wanted to do it at 45 72 was not the ideal age But hey the new kidney I could do it But what about this picture from Sydney? Oh, yes That was right after the transplant right after the transplant. I climbed the Sydney over the top of the Sydney bridge Which was quite an experience He sent me a picture from the top of this Yes, send them out to all the people who think this can never happen and I think maybe I don’t you also mentioned was that you took care of yourself while I’m down since you never gave up hope You were exercising listening taking your medications on prayer dances. So like I said, it’s like a bridge to transplant So so I look at it as a short-term and for some patients it might be a long-term We were picking for very long time before patients were interest in transplant. I would definitely go with PT That’s one of the other things and so you have a transplant there’s two years now and very good and it looks like everything is going very well and You’re educating Peter people about about transplantation as well And I think that that’s you know you mentioned and I make it a point every time you came both of you came for and I know You want to share that story how you caught that? Call my call June 8 on a Thursday afternoon do Neath when it was having a clinic visit with dr. Rastogi and We were about to finish our clinic but then dr. Estonia was had to run to a meeting But I mean only first meeting could they receive my phone call? Well, you got a phone call and then then you weren’t going to answer it And I think you should answer it and and you did because this was actually during the meeting right? This was actually And everything else is history, you know, and and I got to know your brother very well David was very well then and so it’s all very good Out great and and you mention about travel, right? So, you know well travel right? That’s the one thing that I really learned at Century City from doctoral study Not only do you encourage Working is great. Like oh you have this disease you need to do this You need to keep working and I remember the first time I talked to him I mean within a week a band PD I said I really want to go to Boston and you looked at me and I’m just stunning PD and goes Yeah, I think there are really a lot of good doctors Boston if you need one of them, but you know, I learned how to travel and how to have things delivered and how to take the Machine and Just decide, you know this the attitude of I’m gonna lock myself in the house because I have kidney disease I’m not gonna go anyplace and you know, certainly you had to be cautious and planned, but it’s doable you can do it it’s just a matter of making up your mind you’re going to do it and and I think so going back to so we discuss that and and You know, your husband was very involved with that as well. And you actually wrote some some protocols how to travel Yeah, he’s getting through the screening at the airports and stuff. And they said what is this machine that you try? Okay and we don’t share that actually this will be very nice for one of our future programs people who do not on PD is how To travel and one thing that I always tell my patients so the things that when you go for your visit to your nephrologist your monthly visit or or when you see them in center is Definitely, we always talked about transplant because how we can help right go to the right centers looking for living, too going to school or Having a full time job very important and we really want you to have either one of them You went to school full-time school nursing school wastes Stressful and and you had a very stressful job to Mary Beth I mean I I know what you did and and so but they did that and did it very well so that and the other thing you’ll enjoy life and and don’t be a victim and uh They know better to people than you to say that it’s it’s don’t don’t let that disease defeat you right You’re always hope about being positive but traveling. I mean you have traveled so much and that’s very good But like I said, there should be a plan and we can help you with that I mean we can you can get it with Mary Beth Or su and see there is you know a Proper way and once you have it down just like any training its traveling and now with a transplant you’re traveling you know just came back from Italy and So I think all those things are very very important and and I was just gonna add like two Doctors still need to realize all the resources. There are for anyone suffering With kidney disease, there are so many people As part of UCLA they’re called the circle of the core, right? It’s a group of people that each of us has had a very different experience But they’re all really available for any kind of questions Related to kidney disease and it’s so great to have that kind of support to Pete talk to real people who have gone through the actual process and everything from you know All of the seminars that you’re that you’re offering to listen to those because there’s so much a really good information on them yeah, and and I just want to bring out the circle of course, so the circle of core is actually Group of patients you see the patients who have gotten together to support the core kidney program And they come from all walks of life some our analysis Someone transplant some in center some home some of ADPKD some are clinical trials So if you ever need to talk to any of the patients or support group please email us and we’ll connect and I know maybe I do you have given advice about home design so you obviously For a PD nurse, but of a transplant about what and you are also on one of my clinical trials So I mean to amazing people I mean, I just can’t thank both of you for doing all that he have done and and just you know helping other people when they I mean it’s it’s it’s very comforting when you speak to other person who is in a similar situation or was and They know there is hope and it is gonna be okay, right? And I think that’s that’s very important and both of you are a living example how to give back to society and the tango trial to you know, I do a lot of studies And I oh they asked me so, you know One of the questions that sometimes I get asked not often and you never asked that question But you just said where do I sign? And I said no No, no, not that fast money But let’s go over the informed consent as cover all the you know and I need to go and work and I’m running out so so I held you down it and we went over that but but so what is in a clinical trial and and there are a lot of things but number one is obviously the hope is that Is a better option, you know, that’s not available It’s the care you’ll get you can do much back here and then also giving back to society and I think both of you are giving back in the clinical trials how we advance Medicine so we have a lot of trials going on at UCL as well So if you’re ever interested, but with with that I think so anything you want to add before we and it will be falling upon lot stuff that we discussed today and a lot more And like I said, we this is a contact information if you want to talk to Mary Beth Sue me or our support team Joe You know come and visit us if we can help in any way either for home dialysis or for transplantation But any any passing ending comments you want If you think you know Maybe I was just going to say that you know that the team and the this the program at UCLA I Think that as dr Rastogi has said Really going and visiting a center because we’re all panicked when we get the diagnosis and you want to find out this place It looks closed and it’s a hard thing to do, but I think it’s really important because these people are gonna be your lifeline It’s going to be your teen that’s your team and you have to you have to really trust the team and feel comfortable and confident that you’re Getting the best level of care that you possibly can for yourself because it’s right in your neighborhood I mean, it’s right in your neighborhood. So that’s what I would buys you Thank you. Remember if you have these these groupings. Yes. We have our green pins on and we have a a Wanted out there was still these patients. We really Started this green campaign because March is Kitty month and we came up with the green and so it’s great that people Are wearing these green ribbons and they’ll ask us what is this? What is this for and you realize when you look at the statistical number of the amount of people? Who have kidney disease? it’s really staggering and We wanted to get the kind of attention It really should get right and and both of you have been this getting disease awareness So it’s called the green ribbon campaign, you know pink pink ribbon is for breast cancer there other ones, too So green ribbon is and usually is at the forefront of the other kidney disease awareness and the core kidney program So with that I want to thank you both Thank you very very much for all that you have done and obviously a lot more to do, you know? You’re far far away from our goal to actually cure kidney disease. So I Control it. So it was at some point. We luckily have a control over over over kicking disease. So, thank you So thank you Mary Beth very much. And then I just want to thank everybody This is our contact information. We have other webinars Both at you Sylla health and on YouTube. There’s one on pressure analysis as well Another one we have on hypertension we have on kidney disease in general. So please watch them. Send us our comments and and we hopefully will incorporate will do on another PD program in a couple of months, which we’ll be discussing more but the training what you need to do, but with that thank you very much for attending this and and We’ll see you soon at our next webinar. Thank you very much. And thank you Mary Pat. Thank you. Sue