Life with machines

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Thursday, February 5, 2015

THEY have accepted the fate that for their entire life, the cleansing of their blood will be relied upon not on their own bodies but on a machine.

It's a fate that Mark Chester Estrera, a 37-year-old who hails from Digos City, has been accustomed to.

He eats a hearty breakfast and preps up for a bus ride to Davao City where he gets his regular dialysis sessions on Wednesdays and Saturdays.


Estrera told Sun.Star Davao in an interview that his doctor recommended him to undergo regular dialysis sessions four years ago. This after his kidneys became problematic due to a complication brought by hypertension.

"Dawat na lang gyud ko ani kay dala na man gyud ni sa akong sakit. Ang lain mu-deny pa pero sa kahimtang na ni, di na man gyud nako madeny kay kung dili pud ko magdialysis musamot man gyud akong gibati (I just had to accept this since after all, it is brought by my ailment. Some would deny but this circumstance, I really can't deny because if I don't undergo dialysis, I will just feel worse)," Estrera said.

He said that when his creatinine level spike, he'd feel weak and nauseated indicative that the kidneys have not played its function to filter out toxins in the blood.

Miguela Añabesa, a 58-year-old Dabawenya, also had the same sentiments after he was told by his doctor to go through dialysis as her diabetes got the best of her kidneys.

"Every after my dialysis, it's tiring. There are also times when I feel really thirsty. If my creatinine is high, I tend to bloat, I vomit a lot, I lose my appetite, I can't sleep and I have a difficulty breathing. I can't do anything anymore as it already hit my kidney so I just have to undergo dialysis," Añabesa said.

Prior to their treatment on the dialyzer machine, Estrera and Añabesa had to undergo the arteriovenous fistula (AVF) which serves as the access for the needles and IV tubes from the dialyzer machine.

Both of them agreed that they had problems with their respective AVFs.

Añabesa had a temporary AVF implanted at the clavicle area on her right shoulder until she had another operation for a permanent one on her right arm.

She said her AVF often had that distinct throbbing pain due to the needle punctures she has sustained over the years. And if you get to feel her AVF with your fingers, you could get an eerie feel of her blood flow under her skin.

Estrera, however, somehow has a gruesome case as the implant on his left arm, particularly near his bicep, had swollen to a size that of a ping-pong ball. He said it had swollen as he kept on lifting heavy things with his left arm. His nurse, meanwhile, said that would be the last time that they will utilize the AVF on his left arm as doctors need to surgically remove the swellings and Estrera also needs another AVF surgically implanted on his other arm.

When asked how much the removal and the new implant are, he said it may cost him around P5,000 or more.

But they are now lucky that dialyzer machines have been more accessible and affordable compared before. Both of them are undergoing dialysis at the Nephrology Center of Davao (NCD) along J. P. Laurel Ave., which boasts the country's most affordable dialysis service center being a part of the Nephro Group Dialysis Centers.

Nephro Group Dialysis Centers regional manager for Mindanao Trinidad Filart-Ola, in an interview with Sun.Star Davao, said NCD has been around for 15 years and the costs of the so-called artificial kidneys back then were pegged at around P4,000 to P5,000. And considering that a usual dialysis patient should have at least 104 sessions to undergo yearly, the price back then was staggering.

But over the years she said that prices have gone down significantly until presently their dialysis sessions cost P2,100. The best thing, however, she said, was that government agencies including the Philippine Health Insurance Co. (PHIC), Philippine Charity Sweepstakes Office (PCSO) and the Department of Social Welfare and Development (DSWD) have offered free dialysis sessions to patients.

"If they pay their premiums to Philhealth and they get grants from PCSO and DSWD, dialysis sessions are now practically free already. And for Davao City, we have the City Government's Lingap so dialysis are now very affordable," Ola said.

PHIC could already cover a total of 45 sessions while NCD adds 15 to it for a total of sessions yearly. The package already includes the needed dialyzers, monthly laboratory tests within six months, six shots of Eposino medicine which aids in the treatment and 30 shots of higher volume of Eposino.

PCSO, meanwhile, Ola said, could also grant around P10,000 to P20,000 worth of assistance which could translate to around 4 to 10 sessions. Other PHIC packages offered by NCD are the P600 package inclusive of 104 sessions, 11 pieces of dialyzers and the monthly series of lab tests covering an entire year and the P900 package which includes 104 sessions and the required amount of dialyzers and Eposino shots for a year.

Estrera said the only expenses he needs to cover are roun-trip bus fares, his Eposino shots costing around P700 to P1,000 in emergency cases.

"I make sure that I pay the Philhealth premiums which is already very cheap. I also get assistance from the PCSO which grants me around P10,000 to P20,000 twice a year so for the entire year, my dialysis is free," Estrera said.

Añabesa, meanwhile, said she has paid for the P600 package at NCD that already covers the entire 104 sessions and the 11 pieces of dialyzers needed yearly. She then goes to Lingap and PCSO for the medicines needed during the treatment.

"I was advised that I could have a transplant but I chose not to because it is really expensive and there is no assurance that I could be cured. I already have diabetes so my kidney would still be affected and I also had co-patients here before who already had transplant but they still ended up undergoing dialysis," Añabesa said.

Ola, on the other hand, said dialysis is not a cure, thus, patients are recommended to take what they call a renal diet of low potassium and phosphorous intake.

But for Añabesa, the diet is something she does not heed religiously, claiming that she still eats food that are prohibited.

"The absence of the prohibited food makes me weak that is why from time to time, I get to eat them. After all, they are going to cleanse our blood so might as well eat. But of course, my number one enemy is still diabetes so I still have to control my food intake," Añabesa said.

As for Estrera, he said eating a hearty meal before and after his dialysis sessions has been his strategy for him to overcome the weakness after the treatment. He also believed that his blood would get a much needed restart anyway after a dialysis session hence, he eats a lot. But he was quick to add that while he follows a low cholesterol diet to avert the symptoms of hypertension, he still has a lot of food options to get him stuffed.

Their complacency to the strict food diet may be an indication that they are trying to take the lighter side of an otherwise harsh reality. The reality that somehow their kidneys have failed them. Yet amid this predicament, they have accepted their fate that their life relies on a machine.

Published in the Sun.Star Davao newspaper on February 06, 2015.


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