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#dialysis #uvahealth
If your kidney function is declining and medications and other treatments aren’t working, dialysis can offer life-saving care. UVA has one of the largest dialysis programs in the country. Nephrologist Daphne Knicely, MD, explains the types of home dialysis and how they can work to fit your life.

Find out more at: https://uvahealth.com/services/dialysis

Transcript

Dialysis is just a way to replace the kidneys when they're not working anymore. So when the kidneys stop working, they stop getting rid of water, stop balancing the chemistry, stop getting rid of the toxins. Then dialysis does its job by balancing the chemistries, getting rid of the toxins, and help remove fluid. It doesn't fix the kidneys. It just replaces them.

I usually think of dialysis as two components. There's hemodialysis and peritoneal dialysis. So peritoneal dialysis can only be done at home. Hemodialysis can be done in a center, or it can be done at home.

Hemodialysis is where you have some sort of access to the blood. Either some sort of shunt in the arm that connects an artery and vein, or a catheter. And it allows for blood to leave you, go through a machine, get cleaned, chemistries balanced, and then comes back to you.

For home hemodialysis, the patient actually learns how to do that treatment. It's a very simple machine, very user-friendly. Training is usually about anywhere from four weeks up to eight weeks, and you work one-on-one with a nurse. You still see the physician. You come in about once a month, maybe twice a month, to get labs. You'll see a social worker, and a nutritionist at the same time.

Peritoneal dialysis takes place by putting a tube into your abdomen. And we take dialysis fluid that's chemically balanced. When we put it into the abdomen, it uses those little blood vessels to pull toxins out, to balance chemistries, kind of like little filters. Now, after it sits in there for several hours, we drain it out.

Anyone that needs dialysis is a candidate for home dialysis. There's not one type of dialysis that's going to make you live longer. They're all equal. The goal is to pick the type of dialysis that fits with your life.

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The ureter can become obstructed due to conditions such as kidney stones, tumors, infection, or blood clots. When this happens, physicians can use image guidance to place stents or tubes in the ureter to restore the flow of urine to the bladder. A ureteral stent is a thin, flexible tube threaded into the ureter.

Massive bone defects (>8 cm) will not unite without an additional intervention. They require a predictable, durable, and efficient method to regrow bone. The Ilizarov method of tension stress, or distraction osteogenesis, first involves a low-energy osteotomy1 - 5. The bone segments are then pulled apart, most often using an external device at a specific rate and rhythm (distraction phase), after which the newly formed bone (the regenerate) requires time for consolidation. The consolidation phase is variable and usually requires a substantially greater amount of time before the external device can be removed. Our technique of tibial bone transport over an intramedullary nail using cable and pulleys combines internal and external fixation, allowing the external fixator to be removed at the end of the distraction phase. This increases the efficiency of limb reconstruction and decreases the external-fixator-associated complications.

The removal of a clot is called an embolectomy. An embolectomy might be done during a surgery. Or it might be done with a minimally invasive procedure that uses a catheter (a thin tube that is guided through a blood vessel). This type of treatment for pulmonary embolism is used only in rare cases.

Marfan syndrome is a genetic disorder that affects the body's connective tissue. Connective tissue holds all the body's cells, organs and tissue together. It also plays an important role in helping the body grow and develop properly. Connective tissue is made up of proteins.

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Absence seizures involve brief, sudden lapses of consciousness. They're more common in children than adults. Someone having an absence seizure may look like he or she is staring into space for a few seconds. This type of seizure usually doesn't lead to physical injury. Absence seizures usually can be controlled with anti-seizure medications. Some children who have them also develop other seizures. Many children outgrow absence seizures in their teens.

Emergency contraception is a method of birth control you can use if you had sex without using birth control or if your birth control method did not work correctly. You must use emergency contraception as soon as possible after unprotected sex. Emergency contraception pills are different from the abortion pill. If you are already pregnant, emergency contraception pills do not stop or harm your pregnancy. Emergency contraception has also been called the "morning-after pill," but you do not need to wait until the morning after unprotected sex to take it. Emergency contraception is not meant to be used for regular birth control. Talk to your doctor or nurse about regular birth control to help prevent pregnancy. Nearly half of all pregnancies in the United States are unplanned.1

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Over one million Americans have the sexually transmitted virus, HIV, which can lead to the deadly disease known as AIDS.
HIV can be transmitted in the sexual fluids, blood or breast milk of an infected person. HIV prevention therefore involves a wide range of activities including prevention of mother-to-child transmission, needle exchanges and harm reduction for injecting drug users, and precautions for health care workers.

HSV-1 causes "cold sores" on the mouth, and up to 80% of the population has this virus. However, HSV-1 may also be transmitted to the genitals through oral/genital sex and about 40% of genital herpes is caused by HSV-1. Up to 22% of sexually active adults have genital herpes caused by HSV-2.

Palpation for Abdominal Masses

-Rapidly progressive weakness of the lower extremities following an upper respiratory infection, accompanied by sensory loss and urinary retention, is characteristic for transverse myelitis.

Chronic myeloid leukaemia is a common malignancy worldwide. We have come a long way from the limited treatment options and survival in this condition. Today, CML is a treatable malignancy with more than 80% patients surviving beyond 10 years after diagnosis, in absence of complications. This presentation deals with the definition, diagnostic criteria of chronic phase, accelerated and blastic phase (MD Anderson cancer centre, International bone marrow transplant registry and the WHO for the latter two) and management (first and second generation tyrosine kinase inhibitors) of this condition. Finally, a stepwise approach to chronic myeloid leukaemia is also presented including the definitive modality of treatment, allogeneic stem cell transplantation.

Most times, a pulmonary embolism is caused by blood clots that travel from the legs or, rarely, other parts of the body (deep vein thrombosis, or DVT). Symptoms include shortness of breath, chest pain, and cough. Prompt treatment to break up the clot greatly reduces the risk of death. This can be done with blood thinners and drugs or procedures. Compression stockings and physical activity can help prevent clots from forming in the first place.

Healthcare providers are in the best position to assess for domestic violence, yet have obstacles to doing so. See the benefits to moving beyond these obstacles for those you serve. And discover an accurate, convenient and confidential way to assess for domestic abuse.