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Video hookups HARRY Kaikuana's blond hair was one of the first things the medical team noticed when the 66-year-old kidney patient appeared in a video hookup between Honolulu and Hilo.
bring medical care
to kidney patients
off island
Doctors can have regular,
visual check-ups on patients
without the expense of travelBy Helen Altonn
Star-Bulletin"He did not have that hair the last time he was here," said Patti Bouhan, kidney transplant coordinator at St. Francis Medical Center.
"Is it true that blondes have more fun?" she teased Kaikuana.
"You look good," Dr. Whitney Limm, medical director of the Kidney Transplant Program, told the patient on the video screen.
Kaikuana was one of six Big Island kidney patients evaluated in a recent teleconference between St. Francis and Hilo Medical Center.
It was the first of what Limm hopes will be a regular event every three months extending to all neighbor islands.
Perhaps it also can be done for Saipan and Guam patients, suggested Joyce Nekoba, another St. Francis kidney transplant coordinator, noting, "We take care of all Pacific Islands."
Limm decided to use teleconference technology to help neighbor island patients because of the difficulties and costs involved in traveling to Honolulu for checkups. "We want to have the best of both worlds, to be able to see them on a regular basis and not have them spend extra money."
Nekoba and Cathy Bailey, kidney transplant evaluation coordinator at St. Francis, went to Hilo to set things up with patients. They took blood pressures, listened to lungs and assembled medical information for Limm and Bouhan. Two of the patients have had kidney transplants, two are on the wait list, and two want to be listed.
The 1 hour session was a little bumpy, with the video and sound going out at times. But the patients were happy they didn't have to go far from home to see the surgeon.
Surgeons also do checkups
Nekoba said Hilo kidney specialist Curtis Lee takes good care of the patients, but they should be checked periodically by the surgeon. Data also are requested by the United Network for Organ Sharing, but some patients aren't seen regularly because they can't make the trips to Honolulu, she said.Kaikuana had a kidney transplant in September 1999 after dialysis for nine years while on the wait list. He was back at St. Francis last fall with some complications.
"Curtis Lee and all the doctors, I give much aloha to them," he said. "They put me together."
Limm said Kaikuana's latest blood tests "looked really good. I'm very pleased." He also was pleased with Susumu Umetsu, 68, who had a kidney transplant five years ago and now has "excellent kidney function."
Via teleconferencing, Umetsu asked if his medications would cause any problems if he has cataract surgery. Limm said it's possible one of the drugs contributed to the cataracts, and it has been reduced.
As Limm talked to the patients, he tried to explore their support system and effects of their physical condition on their lives. He also inquired about possible living kidney donors.
Asked what he does every day, Umetsu said: "I walk a mile a day. I go fishing. I socialize. That's about it. That's life."
Limm said Umetsu, who had been on dialysis for two years, "is a prime example of the benefit of transplant."
A 51-year-old patient, who asked not to be identified, said he wants to be on the wait list because he's "thinking of life, where I can see my grandkids, live longer and stay with my wife." He started dialysis last May.Limm questioned him about smoking and drinking alcohol -- he does neither -- and asked if he knows what a transplant involves.
"I think you should understand you are a high-risk patient for transplant," Limm said, noting the man's kidney failure resulted from diabetes, which also damaged his heart.
The patient now takes 13 medications and might need five or six more after a transplant. Also, his blood type is B.
"Unfortunately, the waiting time for B is the longest -- over seven years," Limm said.
Doctors tell patients of risks
It's important to point out the risks of transplant surgery, but if a patient is cleared medically, it's his decision, Limm said.The man said he wanted to discuss the risks with Lee, his Hilo doctor. If he decides to go on the transplant list and is cleared by a cardiologist, he will need to take an annual heart test, Limm told him.
"We have to make sure every year that your heart is strong enough for surgery," Bailey explained to the man.
Limm said the costs will be covered by the transplant program.
Juan Realpe, 41, a fiberglass technician, has been on dialysis five years waiting for a transplant. He doesn't have diabetes -- a major cause of kidney failure -- but another condition related to kidney disease, Limm said.
The average wait for an organ for Realpe's blood type O is three years, he said.
Limm questioned Realpe about smoking and seeing a cardiologist -- two concerns when he first saw him in 1996.
Realpe said he saw a cardiologist in December and everything was all right. He smokes three cigarettes a day, he said. His wife, sitting next to him, asked Limm if he has a better chance of getting a kidney if he quits smoking.
"We don't penalize him for smoking," Limm said. "The reason he has not received a transplant is because his name hasn't been called."
Smoking slows recovery
Patients are discouraged from smoking, Limm said, because it slows the recovery time from a transplant. Also, it's bad for the heart and lungs."He'll quit smoking as of today," Mrs. Realpe said firmly.
Talking to Kurt Kikuchi, 44, Limm noted that he's the type of patient who tends to do best with a transplant because kidney failure and high blood pressure are his only medical problems.
But he has blood type B, involving an average seven-year wait for a donated organ. He's been on the list since 1994. "Hopefully, within the next year we can find a kidney for you," Limm said.
Seeking to add his name to the wait list was Walter Tinloy, 37, who has been on dialysis for seven years.
He said he had "put it in the back of my mind until recently" because of stories he heard. "I heard more of the bad instead of the good and got a bit nervous."
Limm described the transplant procedure and risks, but said, "You are young and healthy. I think you should be able to handle surgery quite well."
The biggest hurdle for some patients after surgery is having to double their medications. "But most people are happy with the transplant," Limm said. "They have more energy. They can do more things. They can travel."
In an interview after the evaluation, Tinloy said he began having a series of headaches -- so bad they were "beyond painful" -- in 1993. Tests showed his blood pressure was "sky high" and his kidneys had failed.
He was working in a warehouse but was always tired and frequently becoming nauseated. He became so weak, it took him a long time to get up from a chair, and he had to sit after walking a few steps.
A blood test showed a lot of toxin in his body. He started dialysis in 1994, about a year after being diagnosed.
Wrapping up the teleconference, Limm said he "gained a lot from it," but would like to improve a few things, including installing a backup line for video and audio continuity.
In the future, he'd like to use the technology for physical exams, but said there are some security issues that must be addressed.
Though the pilot project was "done at a primitive level," it accomplished its purpose -- allowing the doctor and nurses to evaluate patients visually, while patients were able to meet the medical team and have their concerns addressed.
"Thanks for the opportunity to talk to you guys over there," said the man who is considering a transplant. "I know more or less where I'm heading."
Limm said: "Once in awhile, we have to tell a patient that it's not safe to have a transplant. You can imagine the disappointment, and having to spend the traveling expense."
Because of increased organ donations, 50 kidney transplants were performed at St. Francis Medical Center in 1999 and 40 last year. Only about 30 to 35 were performed annually in previous years. Kidney-patient facts
Other facts:
About 1,000 Hawaii kidney patients are undergoing dialysis, which involves filtering the blood through a special machine. It takes an average of four hours, three times a week.
Source: Kidney Transplant Program, St. Francis Medical Center