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Home dialysis patients anxiously watching health care reform unfold

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WOODS CROSS -- About 4,000 people using home dialysis machines are watching to see how health care reform plays out for them.

Most in the group, which is now almost like a club, believe the portable treatments make them feel better and live longer.

Woods Cross resident Dan Larrabee, for example, is a 43-year-old father and husband who hooks himself up to a portable hemodialysis machine almost every night before going to bed. He prefers this over visiting a dialysis center three days a week.

"At home, I do it six nights a weeks, and so I can pull the toxins off a little slower," Larrabee says. "I can pull the fluid that builds up in my body a lot slower, and it feels more natural."

Some of the clinical evidence from Washington University in St. Louis agrees with Larrabee. Investigator Brent Miller, M.D., believes home hemodialysis can lead to better clinical outcomes, perhaps even a longer life.

"The studies that have just come out show extended therapy, like I do, very closely has the same mortality rate as a transplant," Larrabee explains.

That means a lot, since Larrabee will never get a kidney transplant. Battling a severe form of diabetes over the past 26 years, he was once eligible for a new kidney and a pancreas. But when that day arrived, there arose a problem.

"I was on the table," Larrabee says. "The new kidney and pancreas were next to me, but they opened me up and found cancer. So, they aborted the transplant, and I began the fight for cancer."

Larrabee's cancer is now in check, so is his diabetes; but because he needs an active immune system to continue fighting off the slow-growing cancer he'll probably never die from, he can never go on immune-suppressant drugs required in a transplant.

"I'm faced with probably having dialysis the rest of my life," Larrabee says.

While on home dialysis, Larrabee is with his family. On the night of our visit, he was helping his daughter with homework.

The portable machine goes with him when he travels. He's very active, taking his jeep to the mountains or desert. He goes skiing with his kids and will be rafting on a river later this year. He takes pride riding his 1984 Honda Magna.

Home dialysis pays off, but paying for it is expensive. Right now, private insurance foots 80 percent of the bill, while Medicare picks up the rest.

But Larrabee's private insurance coverage will soon end.

"That's going to shift after 30 months," Larrabee says. "Medicare has to pay for most of the bill, while private insurance gets to back out."

But how much Medicare will pay, at that point, remains unclear as health care reform unfolds. Larrabee fears if he has less treatments than what he's undergoing now, he won't feel good and may not be able to work full time.

An active life means a lot to Larrabee, and more frequent portable treatments are keeping that dream alive.

"I'm not one that's wallowing in my sorrow over my health problems," he says. "I still plan to be around and watch my children continue to grow, and their kids, and perhaps some great grandchildren."

Home hemodialysis requires about three weeks of training. Though home treatments are more frequent, the cost is about the same as a visit to a dialysis center three days a week.


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Ed Yeates


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