[B]I was watching the news yesterday, when a story about power wheelchairs came on. Apparently, Senator Claire McCaskill is proposing the dropping of Medicare funding of electric wheelchairs to the disabled. Hmmm! Really? Now, I have been having PTH and mobility problems for nigh on a year. I have been pondering getting one of these things, because it is difficult for me walk any significant distance and makes taking a vacation or just plain going anywhere a process. My biggest hinderance has been, don’t laugh, my male pride. I generally walk with a cane or crutch. Since my Parathyroidectomy, the pain has decreased to tolerable levels, but I still can’t walk any significant distances. I realized that as a dialysis patient, I would probably need a power chair in the future, but the thought of it not being available when I need it, kind of tees me off and helped me make up my mind. On Monday, I will start the ball rolling on getting mypowerchair. Thanks Senator McCaskill for helping me to make up my mind.
Hi Roy,
This isn’t directly relevant to a wheelchair itself, but rather to helping avoid the need for it. It’s REALLY important for folks with CKD-5 to exercise. As your surgery works and your pain lessens, please ask your doctor for a physical therapy referral if your mobility is still less than you’d like. It’s not necessarily a given that you have to accept the need for a power wheelchair one day because you’re on dialysis!
Perhaps you’ve seen Shad Ireland? (http://www.ironshad.com/). He’s been on dialysis for 20 years or so, if I recall correctly, and he does Ironman triathlons. He didn’t start from a good place, either. A failed transplant left him near death and down about 50 lbs. from his usual weight–and he’s not a large man. Rather than plan on a power wheelchair plan to get moving so you can become more active and STAY active.
[B]I partially agree with revamping Medicare, there’s alot of fraud going on over billing Medicare for un-needed medical items or even over-billing Medicare for services rendered. However, there are patients like you and me that may need these medical items one day.
Shad Ireland is a very young man and in no comparison to older folks on hemodialysis. Bone disease in ESRD is a slow killer and progresses along the way until its not bearable anymore. Along with aging comes Osteoporosis and mix that with ESRD and you have quite a challenge to get around…
I think Medicare should still pay for wheelchairs but under significant patient need and Dr approval…[/B]
[QUOTE=AMBASSADOR-ROY;18591][B]I was watching the news yesterday, when a story about power wheelchairs came on. Apparently, Senator Claire McCaskill is proposing the dropping of Medicare funding of electric wheelchairs to the disabled. Hmmm! Really? Now, I have been having PTH and mobility problems for nigh on a year. I have been pondering getting one of these things, because it is difficult for me walk any significant distance and makes taking a vacation or just plain going anywhere a process. My biggest hinderance has been, don’t laugh, my male pride. I generally walk with a cane or crutch. Since my Parathyroidectomy, the pain has decreased to tolerable levels, but I still can’t walk any significant distances. I realized that as a dialysis patient, I would probably need a power chair in the future, but the thought of it not being available when I need it, kind of tees me off and helped me make up my mind. On Monday, I will start the ball rolling on getting mypowerchair. Thanks Senator McCaskill for helping me to make up my mind.
Roy is relatively young, too (probably about Shad’s age), which is one reason I mentioned this, Gus. And bone disease may well be preventable IF folks get better dialysis from the get-go instead of doing years of standard in-center treatment before switching to something that will do a better job of controlling phosphorus and PTH. I’m not disagreeing that Medicare should pay for essential equipment, just saying that we shouldn’t assume that everyone will need a wheelchair one day just because they are on dialysis.
Dealing with chronic illnesses such as ESRD most will use them one day. Even folks without ESRD who have orthopedic problems use them. The chronic conditions vary, but once your Parathyroid glands are removed you’ll never be the same anymore, you’ll manage somewhat to near average. The ESRD population is of older age and most likey these group of people will need them more than the younger group, regardless whether they are on dialysis or not. Am glad you support Medicare’s reimbursement for these items…
I watched the video. In typical Fox News fashion, their producers pulled a snippet of an answer to a question and then the Fox News commentator and doctor took that snippet to its illogical conclusion.
I suspect that McCaskill was talking about Medicare reducing fraud and abuse in the scooter industry. Fraud is rampant in the durable medical equipment industry. This includes all kinds of equipment, not just electric wheelchairs and scooters. She said she mentioned scooters because they are marketed so heavily on TV by companies that appear to promise just about anyone can get one. I’ve seen ads where companies say if they give you a scooter and Medicare doesn’t pay, they won’t charge you a dime. Are there people who need scooters like the doctor on Fox News described? Certainly. Are there others who may have scooters who don’t need them because a doctor may be in cahoots with a supply company that gives him/her a kickback? Probably. The General Accountability Office investigated this industry and published a scathing report in November 2004 of how poorly CMS was monitoring fraud and abuse in the industry:
DME suppliers in different states have been convicted of Medicare fraud related to electric wheelchairs/scooters. Interestingly, some DME suppliers in S FL admitted to being former drug dealers who got into the DME business to make quick money without the risk of being shot while figuring that if they got caught, they’d be sent to a white collar prison. In 2007 when this story was aired on NPR. At that time, it estimated that fraud and abuse accounted for 20% of the Medicare budget. The dishonest DME companies and those in cahoots with them may end up making it harder for people who genuinely need durable medical equipment to get it. McCaskill isn’t the “bad guy.” Be angry at those who have defrauded Medicare that will likely lead to a need for better medical justification to get equipment like this. http://www.npr.org/templates/story/story.php?storyID=15178883
As Dori said, the best course of action is to try to prevent problems that require people to need assistive devices like scooters whenever possible. This will save the patient from being limited where he/she can go and what he/she can do while saving Medicare money. With people who have kidney failure, the better the clearance of toxins from the body (longer and more frequent dialysis), management of mineral and bone disease (diet, removal of phosphorus by better dialysis, exercise/PT, and/or medications), the better control of other conditions like diabetes, cardiovascular disease, diseases of the nervous system, etc., the longer and better people will be able to function without any assistive devices.
Having worked in dialysis for 18 years before I started consulting with MEI, I worked with patients who needed canes, walkers, wheelchairs, and scooters. However, they were few and far between, even among patients who had had kidney disease for 10-20 years. Most of the home and in-center patients walked in and out of the clinic under their own power. Maybe this was because the doctors I worked with believed in better dialysis, the importance of managing the calcium/phosphorus balance, and making sure that patients were referred for physical rehab as soon as there was any change in their ability to walk or do other activities of daily living. This was before daily and nocturnal dialysis even existed. It appears from various studies that patients starting dialysis today have an advantage with these more efficient treatments over patients who started dialysis years ago. Hopefully fewer of them will have the complications that some long-term patients experience today.
Fraud and abuse have been EVERYWHERE in the medical system, not just wheelchairs, which she specifically singled out. She said they could save Billions of dollars. I seriously doubt that there are Billions of dollars of fraud in the wheelchair part of the medical industry, which would lead one to conclude that the Fox News snipet was correct. She meant not covering ALL electric scooters and wheelchairs. As for my personal situation, I am a mere 40 years old, but most of my life I had stiffness and joint pain, the high PTH since being on dialysis just compounded it. Even though the pain has subsided a bit, there is still pain from neuropathy, calcification of the joints and arthritis. These will get worse the older I get and the longer I am on dialysis, so I am putting in for my chair now before the Senator gets rid of them.
Claire McCaskill is only one of 100 senators and there are 435 representatives. Each one of our elected officials has only 1 vote on bills. Scare tactics are being used by insurers, providers, and suppliers to try to keep the status quo. You can separate facts from myths at the non-partisan website which identifies scare tactics used by members of both parties, including these Medicare-specific myth-busters: http://www.factcheck.org/tag/medicare/
I don’t believe for a minute that Medicare will stop covering mobility assistive equipment, including wheelchairs (electric or manual), scooters, etc. I do believe Medicare will screen for those who meet criteria to qualify for the equipment and to reduce Medicare fraud and abuse so money is available to help people that do need Medicare covered services. Here’s a Medicare fact sheet that discusses current Medicare coverage of mobility devices: http://www.medicare.gov/Publications/Pubs/pdf/11046.pdf
I agree with Beth–mobility devices are not something that Medicare will stop covering. But you said this:
You may think I’m nuts, but have you ever tried completely eliminating wheat and gluten from your diet? There are proteins in wheat that can leak into your gut and trigger autoimmune problems–joint pain in particular. Gluten sensitivity is NOT just a gastrointestinal problem. (My husband, who has some arthritis in his fingers and a family history, didn’t believe me–until he tried NO WHEAT for 2 weeks. Now he does.)
You know, before I started dialysis 6 years ago, I weighed 530 lbs. Yep, I was a hefty dude. Since I have been on dialysis, I have lost a total of 230 lbs. When I first started, my Neph told me that I would be doing myself a big favor by losing weight, even though a lot of my weight was fluid. I asked him how. He told me the words that changed my life. To all of you who want to lose weight, I am going to give you the key to it. He said “don’t eat anything WHITE or USED TO BE WHITE”. This is not a racist thing…lol. I said “doc, you are trying to kill me. That’s mostly my ENTIRE diet and I just bought a breadmaker. I’m a Southerner. What or what used to be white?” He laughed and said “yep, that’s the way to do it”. I sat back in the chair and thought of all the beloved foods I cherished so much. Rice, Mashed Potatoes, all the different breads made with white flour, cakes, everything made with sugar, eggs. That meant drinking coffee, black…I love coffee flavored sugar cream. Sweet tea is the official drink of the South. Most meats are covered with gravy…GRAVY…AHHHHH…no smothered chicken, porkchops,…AHHHH…PORK, ham, sausage, bacon. No fair doc, you’re killing me. After coming back from my catatonic state, I went home and gave it a legitimate try. I cut all of the things the doc said. I thought I would die the 1st week. The 2nd week a strange thing happened. That black coffee didn’t taste so bitter. Diet soft drinks were too sweet. When I did cheat and eat some white bread, it was too sweet. Sweet tea was waaayyy too sweet. Oh the horror, I didn’t like sugar anymore. I got on the scale and the weight just dropped off without effort. In one month I had lost almost 40 pounds. For the next couple of months, the weight fell off at the same rate. Another strange thing happened. The amount of food I used to able to consume began to shrink as well. I couldn’t eat 1/2 of what I used to. I told this to my doc and he said that my stomach has shrunk. Shrunk? I over ate so much that my stomach expanded to hold it, along with the extra fluid I was holding due to kidney failure. When I started dialysis and got closer to the dry weight, plus cut down on amount of foods consumed, my stomach shrunk. When I hit the 1st hundred pound weight loss, it was like I hit a brick wall and no more weight would fall off. I slowly reintroduced the white foods back into my diet and then went back on the plan. The weight loss started again. To this day I have maintained a 200lb weight loss. So yes, when I started cutting out the white foods, it spilled over into the glutenous foods also. I have been trying to walk more without my cane, and I have, and I am doing my own exercises and pushing myself more, sort of my own type of rehab. I hope this helps someone else.
Thanks for sharing your experience, Roy, and congratulations on maintaining that weight loss! Wow, very impressive!
Avoiding all “white” foods is a great way to lose weight, stop craving starches, and feel better. Plus, there are trans-fats in a lot of those white foods. Baked goods tend to have them. Trans fats are “fake” fats made by injecting oxygen into oil to make it stable at room temperature (like the original Crisco, which now comes in a trans-fat free version). The problem is, your body makes cell walls out of lipids–fats. Cell walls have receptors for hormones, like insulin, tiny pumps, and other active ways to move substances in and out. When your body makes cell membranes out of fake fats, they are not biologically active. They can’t move insulin and other substances in and out. This leads to insulin resistance and many other health problems. We literally are what we eat. We build our cells out of what we eat. So, one thing you’ve done for yourself is rebuilt your cells out of real food instead of fake food, which helps your whole body work better.
