Make Mine Rare. Or Not

Today and tomorrow stretch the limits of diseases. Today, as it is every year on the last day of February, is Rare Diseases Day and tomorrow, as does every March 1, begins National Kidney Month one of the most common medical conditions. I am one of the chosen who get to experience both up close and personal.

Rare diseases and kidney diseases share more than just the cusp of the second and third months of the year. What makes a rare disease a rare disease changes a little from country to country. In Europe a disease or condition affecting is considered rare when it affects fewer than 1 in 2,000 people. In the U.S. that consideration is extended to those disorders affecting fewer than 200,000 people in total. Either way, that’s not a lot of people for a disease. There are over 6,000 conditions listed as rare diseases by the National Organization for Rare Diseases (NORD) and Rare Diseases Europe (EURODIS) affecting over 30 million people. Meanwhile, kidney disease affects over 30 million Americans alone. Coincidence? Maybe not.

RDDayIf you go back far enough all diseases have been rare at some time. The more common conditions like diseases of the kidneys didn’t become less rare because they affected more people. They became more common as those treating them spoke with others treating similar conditions comparing symptoms, patient histories, disease progression, and constants in presentation. Often when enough data is collected it becomes apparent the rare disease wasn’t as much rare as unrecognized. Treatment options and the responses then get shared, refined, retried, and publicized and the goal shifts from just education and proper diagnosis of the disease so difficult with the rare ones to effective treatment and some day eradication of the disease.

Obviously a disease becoming “common” doesn’t automatically mean we know enough about it to say were well in the way to effectively treating or possibly eradicating it. If it did we’d need far fewer fun runs every weekend. The National Kidney Foundation may not face the recognition challenge like NORD and EURODIS but treatment improvements are still badly needed and 30 million people can attest that eradication is not just around the corner.

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Sometimes, whether rare or common, the patient gets lost in the struggle to recognize or combat the disease. The rare disease sufferer often suffers in silence while it’s “clear” to his and her friends and coworkers that it’s all in his head or she just complains a lot. The End Stage Renal Disease patient “fortunate” enough to be able to still work is made to feel guilty that he might be a little slower on the day after dialysis even though he got a whole half day off for it, or that she never wants to take a real vacation, just a weekend here or there when she can work it around her dialysis days.

If you know one of the 30 million people with a rare disease or one of the 30 million people with kidney disease or maybe one of each or one with both take some time today and tomorrow to learn what they go through, what they need, or how you can help. If you feel generous, a donation to one of the hundreds of organizations looking to educate people on, or advance recognition and treatment of one the diseases affecting your friend can’t hurt.

But if you’re feeling really generous, give a call to your friend and say, “Hi, can I do anything for you today?” That could be the rare treat that really makes a day.

The Next Step

Welcome to another episode of As the Kidney Turns. When we last left our hero he had just been referred to the local transplant team for evaluation for a potential transplant. Yesterday he got the call to schedule that appointment.

Yes, I got the call Wednesday afternoon for a phone review and to schedule the first kidney transplant evaluation appointment! Even though I spent my career in health care and even participated in post-transplant processes (more on that in another post coming soon), this is going to be a new experience for me. I said I’d keep you in the loop with the process and we start here if you’re still interested in coming along for the ride.

The telephone interview ran a little over a half hour and included a review of systems (current health status and medical conditions, medical history, past surgeries, recent tests, and physical abilities and limitations), and a brief description of what to expect from the evaluation appointment.

The first contact with every new provider always starts with the review of demographic information – height, weight, date of birth, and those sorts of etcetera. One of the questions posed was actually the second time I was asked it this week and the first time was by Tax Guy. You remember him from the last post as one of the stops on my whirlwind appointment tour on Monday. What could a tax return preparing team and a kidney transplant evaluation team have in common? It was “are you working?” It was actually a two parter. First “are you working” and that was easy to answer. No. The follow up was more difficult. “Why?”

It wasn’t put so bluntly by either, but both had to put something down on their forms. The US tax return includes a space for “occupation” that must be filled. Since I am not working I have three choices: unemployed, retired, disabled. I’m sort of all three. I am not being employed to anyone’s good use.  I am old enough that I could retire but not so old that I can draw on pension benefits. And I am not working due to the loss of function that was required to perform my job. Since my income is from disability benefits rather than pension benefits I am disabled rather than retired for the purpose of paying taxes. So that satisfied the accounting world.

The transplant evaluation people need to know if I am physically able to withstand the rigors of the operation and recovery. Being disabled affects not only the need for the potential transplant but the response to the transplant and it’s after effects. A kidney transplant is different from a heart, lung, or liver transplant in that for most potential kidney transplant recipients, if one does not receive the transplant there is still another option to maintain life. Dialysis. It’s not a perfect alternative but for the patient who cannot tolerate the surgery or recovery associated with a transplant it is a means of replacing not the kidney but what the kidney does. Knowing that, it is in the patient’s best interest to not subject him or her to a major surgery that poses significant and severe risks if those will be more harmful than not having the transplant.

So, to make a long story short (which I almost always cannot and once again I fear I have not), in the medical world there are basic functions that I cannot perform on my own including walking and standing without assistance, the loss of my bladder and associated parts requiring me to rely on self-catheterization for what the bladder and other parts usually do, and the ongoing and chronic progression of Wegener’s Granulomatosis and its effects. In the medical world, I am also disabled. But enough of me is still functional enough and strong enough to, on paper, appear to be able to withstand the rigors of transplant surgery and recovery, I can now progress to the evaluation stage to determine if the theoretical transfers positively to the practical.

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Source: National Kidney Foundation

I’d be very happy and honored if you’d stick with me for that progression. Hopefully this will be the only time that you have to make such a journey. March is World and National Kidney Month. Even though my appointment isn’t until April I’m going to take it as a good omen that I got my call this month. You can make my journey yours and not have to make one on your own, if you remember to, in the words of the National Kidney Foundation, “heart your kidneys.”


Related Post:
First Steps (Feb. 15, 2018)