Quarterly Meeting of CNSW

Date: Friday, February 9, 2007
Time: 12:00 - 4:30
Place: Community Education Center
Legacy Meridian Park Hospital, Tualatin, OR

Facilitator: Janice Rutschman, LCSW, Co-Chair
DaVita Salem
3550 Liberty Rd S, Suite 100
Salem 97302
(503) 37108047

Attendees: Mary Goranson, Treasurer (DSI, Northeast Portland, home training program); Mary Cady-Rasmussen, Co-Chairman (FMC Quali Centers, Salem); Adrianne Miller (DaVita, Sherwood); Debby Meltzer (PNRS Clackamas); Yvette Arey (PNRS Rose Quarter); Patricia Lee, Secretary (PNRS Tualatin); Katherine Howard-Jones, Board Member (DaVita Roseberg).

Agenda:
Business Meeting Janice Rutschman, LCSW, CNSW Chair

CKD & Sexuality Adrianne Miller, MSW

Legacy Transplant Evaluation John Rafolski, Transplant Coordinator & Lisa Morrison, Financial Coordinator

Chapter Business

Facilitated by Janice Rutschman, chair. Attendees introduced themselves and provided brief updates on recent changes in the dialysis clinics since the Gambro-Davita and the RCG-FMC mergers.

1. Mary Goranson works for home training in Portland that was previously owned by FMC. That program along with the FMC unit that is located in Clackamas was divested and is now owned by DSI. Heather Stilly is the Social Worker for the Clackamas unit and that unit is now offering nocturnal dialysis. Patients arrive at the unit at 7:00PM, lights are turned off by 8:00 and they dialyze until 4:00AM. The nocturnal program is currently full.

2. Pat Lee, Debby Meltzer and Yvette Arey work for units that were all formerly run by RCG. Those units are now owned by FMC, but they are retaining the PNRS (Pacific Northwest Renal Services) label. It was also noted that no major policy changes have taken place so far since the merger.

3. Katherine Howard-Jones' unit in Roseberg was formerly a Gambro unit. It is now owned by DaVita

4. Janice Rutschman of Salem North* reported that she and Terry share the patient loads between two units in Salem. Terry has the Woodburn unit, which was recently surveyed by Medicare, but has now met all Medicare's requirements. She also reports that there have been some management changes at the Salem and Woodburn clinics.

*Since the meeting Jan has been reassigned to work only at DaVita Salem (South). Terry is continuing with DaVita Woodburn and adding Salem North.

5. Adrianne Miller has been splitting limited hours among three small DaVita facilities in the Portland metro area. The facilities are located in Sherwood, Lake Oswego and in Hillsboro. The Sherwood unit now has 13 patients and there are 3 patients at the Lake Oswego and just 1 patient at Hillsboro. Adrianne has given her notice that she will be terminating her employment at the end of this month, which leaves her position open for anyone who may be interested. Adrianne says that she plans to do some private practice and she is also writing a book about her life in Cuba.

Next Meeting


Wendy Hillman, a supervisor from Adult Protective Services has offered to speak with us about reporting abuse at our Spring Meeting. The meeting will be held in May, however, the exact date and place have not been set. (Suggested for May 11.)

Feature: Addressing Sexuality with CKD Patients Adrianne Miller

Professional Experience/Education: In addition to MSW degree, Adrianne has a counseling degree; has been a Marriage and Family Counselor; and has taught Sexuality & Human Behavior at the University of Indiana.

Some of the highlights of Adrianne's presentation:

- Sex is a normal, natural & human function.

- Statistics indicate that the prevalence of sexual dysfunction jumps from 7% for men in the general population to 60-70% for males with CKD & 100% for women with CKD.

- Sexual dysfunction: the most common for men is Erectile Disorder. For women the most common is Arousal Disorder.

- Depression & sexuality: many of our patients are depressed and "depressed people do not feel sexy".

- Hence the importance of addressing sexuality with CKD men & women.

- Asking questions about sexuality during the Initial Psychosocial Assessment. Questions can be integrated with questions about relationships particularly when talking with female CKD patients.

- As Social Workers, we should not address sexuality with patients until comfortable with our own sexuality. But we can and should refer patients whom we suspect to be having sexual issues to their MDs.

- Sexual desire returns post transplant.



Feature: Legacy Transplant Evaluation John Rafolski & Lisa Morrison

This was an informal question/answer/discussion format. Some of the highlights were:

- Transplant Coordinators at Legacy Good Samaritan Hospital are John Rafolski and John Falgron. Lisa Morrison is the Financial Coordinator.

- Legacy is the second transplant program in Oregon. OHSU was the first. Legacy's transplant program has been in operation for 7 years. It is a smaller program and considered to be more personal (than OHSU).

- Legacy does not have pre-transplant classes (like OHSU) so Legacy is now in the process of making educational packets for its pre-transplant patients.

- Legacy does not perform pancreas transplants.

- Evaluation Process:

1) Referral letter from doctor goes to Debra Bowers (Intake Coordinator). She consults with Lisa Morrison about insurance & Debra talks with the medical surgeon.
2) First meeting for patient is with Carrie (Social Worker) & Lisa. Patients must bring a family member or support person to that meeting. Psychosocial issues are addressed first.
3) Following the meeting with Carrie and Lisa, the patient meets with the entire committee. Age is not a factor in the screening process, but health is.
4) Transplant coordinators review medial history (cardiac is always the first item). Anyone over 50 yrs old or with a history of cardiac or diabetes must have an angiogram. Younger patients without cardiac disease or diabetes have an EKG only. Patients with cardiac disease who are on more than one blood thinner run the risk of "a bleeding event". Those patients may be turned down for transplant.
5) Weight consideration: Generally a BMI of 35 is the limit, however patients with BMI of 35-40 may be considered as long as those patients have no co-morbidities.
6) There is no time limit for completing the evaluation. Some tests (pap, EKG & other simple tests) need to be repeated yearly.

- Also discussed:

1) Donor evaluation: cross matching, tissue typing, sibling donors.
2) Antibodies & IVIG medication to "drop down" immune system.
3) Risks: Suppressing immune system increases risk of certain types of cancer. Post transplant steroids cause increase in blood sugar. Patients, who were formerly able to control their diabetes with diet, may become insulin dependent. Obese patients are at higher risk than non-obese patients.
4) Importance of communicating changes in patient data: medical, health insurance, phone numbers/addresses, etc. throughout the evaluation and while patient is on transplant list.
5) Patients are required to remain in the local area for 3 months following transplant surgery.

Respectfully Submitted by Patricia Lee, LCSW, CNSW Secretary
February 22, 2007