LIMA ‚?? Bob Baines remembers the date he learned his kidneys quit working: Sept. 21, 1993.
‚??My eyes got black around the rim, my face puffed up. I felt horrible, sick to my stomach,‚?Ě said Baines, 51, of Lima. ‚??It all happened over about two weeks, but I wasn‚??t aware of it.‚?Ě
A hospital emergency room promptly diagnosed kidney failure and ordered dialysis. The treatments have continued three times a week for 19 years.
Baines was 32 at the time, staying with a sister in Benton Harbor, Mich., and working as a meatcutter. Mississippi natives, they‚??d come north with tens of thousands of other Southern blacks in search of job opportunities and better pay.
Baines knew he had extremely high blood pressure, he said during a recent interview at Kidney Services of West Central Ohio, a dialysis center affiliated with St. Rita‚??s Health Partners. He remembers blood pressure readings as high as 194/124 (a normal blood pressure is about 120/80).
‚??The doctor had mentioned I had it and told me to take my medicine,‚?Ě Baines said. ‚??But I didn‚??t. I was just in denial of pills at the time. And my salt intake and eating habits weren‚??t making it any better.‚?Ě
The kidneys are the body‚??s primaray filtration system. They filter the blood and expel the impurities and excess water through the urinary tract. The heart works as a pump, moving the blood through the circulatory system. High blood pressure upsets the balance. It slows the flow of blood and makes the kidneys work harder. Eventually, the overworked kidneys wear out.
Dialysis does what the kidneys do: A machine filters impurities and excess fluid from the blood stream. For Baines and other dialysis patients, it requires three four-hour sessions each week. It also means a restricted diet that slows the buildup of impurities in the system in between the dailysis sessions.
Baines said he‚??s careful to avoid fatty foods and foods rich in potassium ‚?? such as potatoes, strawberries and bananas. He said he can eat essentially whatever he wants, but too much of the wrong foods leaves him feeling sick and weak, especially in the hours before a scheduled dialysis. He‚??s learned through the years to avoid that kind of discomfort. He says he hasn‚??t missed a dialysis session for a long time.
Two months ago, Baines underwent open-heart surgery. The procedure was necessary in order to make him a candidate for a kidney transplant. His kidney doctor, David Imler, said a transplant patient with Baines‚?? blood type faces an average wait of four years on a waiting list before a cadaver kidney becomes available.
The wait for a relative‚??s donor kidney might cut the average wait to two years, Imler said. That‚??s a possibility for Baines; a sibling has volunteered to give him a kidney.
A transplant, all told, costs $80,000 to $100,000, Imler said. By comparison, dialysis costs about $60,000 a year.
‚??In the cost-effectiveness ratio, you can see that over time, the transplant is a cheaper way to go. And the quality-of-life benefits are immeasurable,‚?Ě Imler said.
In the United States today, there are about 350,000 people on dialysis, Imler said. There are about 25,000 Americans with transplanted kidneys.
Imler, a graduate of the University of Chicago Medical School, practiced medicine in South Chicago in the 1970s before locating to Lima. There he encountered a large population of blacks from Mississippi who shared several common traits; among them, high blood pressure and obesity. Curious, he traveled south to find out why.
‚??I drove all around northern Mississippi just to see what it was like and to get some idea about what had happened culturally when folks moved from Mississippi to the North,‚?Ě Imler said.
What he found was telling. In the wake of the Great Depression, the federal government stepped in to help Mississippi, the poorest state in the nation. But the government‚??s good intentions had a negative side-effect. Regular distributions of free federal surplus foods ‚?? including cheese, butter and corn meal ‚?? boosted the caloric intake of a population genetically predisposed to high blood pressure. Health problems became epidemic among the black population.
The Depression also sparked an exodus north. Sharecroppers making a dollar a day could earn $2 an hour in northern factories. The mechanization of cotton harvesting in the late 1960s and early ‚??70s left many more without work and accelerated the migration.
‚??And it was a matriarchal society,‚?Ě Imler said. ‚??But the matriarchs didn‚??t come north. Grandma stayed in the South. So families got disrupted. The social-cultural stability changed.‚?Ě
Baines said his family was among the last to head north when they finally migrated in the late 1970s.
‚??We didn‚??t move,‚?Ě he said. ‚??Everybody moved but we didn‚??t. There were eight or nine of us still on the plantation. I was so terrified. I wanted to move, too.‚?Ě
What Imler saw in Chicago was happening in nearly every industrial city across the North, including Lima.
More recently, Imler has taken mission trips to Haiti, where he treated populations of essentially the same genetic makeup ‚?? West Africans. While the Haitian people also are prone to high blood pressure, their low-calorie diets keep manifestations of hypertension-related diseases in check, Imler said.
Baines said he wanted to talk about his experience in hopes of helping others with hypertension, kidney disease and other chronic disorders. He said it took him several years to find his road to recovery, and others could learn from his mistakes.
His recent heart surgery first was recommended by another doctor in 2005, Baines said. ‚??But I wouldn‚??t follow up with him, and he said, ‚??Forget you, I can‚??t waste my time with someone not willing to go.‚?? I had appointments and wouldn‚??t go. As time went on, I got worse.‚?Ě
Things changed for Baines about five years ago, Imler said.
‚??His buy-in to his health care has increased drastically in the past five years,‚?Ě Imler said. ‚??His commitment to taking care of himself is much better than it has been in the past.‚?Ě
While every medical case is unique, Imler said each patient faces emotional and spiritual challenges to his or her recovery.
‚??Some people will continue to fight the situation and not accept it,‚?Ě Imler said. ‚??Others are forced to accept it, and some people are drawn in pretty aggressively. I don‚??t know if I can say it‚??s a majority or a minority, but there‚??s all variances of different levels.‚?Ě
Kidney Services employs full-time renal care coordinators to help unravel the emotional and spiritual obstacles for each individual patient, said nurse Dodi West, the center‚??s administrator. The renal care coordinators serve as advocate, educator and consultant; they also oversee long-term care of chronically ill patients.
For Baines, who was just 32 when his kidneys failed, he felt young, strong and largely invulnerable.
‚??I remember weighing about 192 and chest sticking out,‚?Ě he said.
Since then, there have been countless bouts of anger and depression as the uncertainty of his future began to sink in.
Imler said a patient‚??s anger can take many forms. Some stay away. Others become passive or uncooperative.
‚??Many of my patients tell me, 'I feel maybe God shorted me on this.‚?? Bob has those feelings,‚?Ě Imler said. ‚??His grieving lasted a long time.‚?Ě
‚??Oh, yeah,‚?Ě Baines agreed. ‚??But coming here with the nurses, what they do and how they treat you ‚?? I don‚??t know about anyone else, but when I‚??m here, the way they treat me helps me get through the day. Sometimes I don‚??t want to leave.‚?Ě
Kidney Services of West Central Ohio‚??s Lima office treats about 100 patients with weekly dialysis. Another 55 do home dialysis. A satellite office in Glandorf provides dialysis for 24 patients. Another in Celina has 35 patients and 15 on home dialysis.
Another 200 patients identified as predialysis: on their way to kidney failure and preparing for the road ahead with education, depression screening and social work. Many of these patients are candidates for transplant before kidney failure.
‚??This has all developed here at St. Rita‚??s in the past eight years,‚?Ě Imler said. ‚??None of these programs existed seven years ago. We now have the fifth-largest home dialysis program in America.‚?Ě