Summary: Bob, an accomplished clinical psychologist, author, artist and sailor, is enjoying what he appreciates most, quality time with family and friends, while managing his hemodialysis at home with Tablo.

For most end-stage renal disease (ESRD) patients, one of the major drawbacks of going on dialysis is the limitations it can place on lifestyle and activities. Bob and his large, close-knit family show that it doesn’t have to be that way.

In his career spanning more than 50 years, Bob has established a comprehensive body of clinical psychology and psychotherapy work, including authoring many books and films. He is also an artist. Across both fields, he aspires to make an important contribution to people’s appreciation of life and personal fulfillment.

At 93, Bob is very much appreciating his life, and actively enjoying sailing excursions with his family—an activity they have enjoyed together for more than 40 years. And, since starting home dialysis on the Tablo® Hemodialysis System this past June, coordinated by his dialysis clinic, Spectrum Dialysis, nephrologist and Outset Medical, he has been enjoying the flexibility of fitting treatment around their lifestyle.

“My psychology work has been very important to me, and the many books I’ve written,” says Bob. “Now we enjoy ourselves sitting in the sun on the boat, and we travel. That’s exciting.”

“Our sailing has always been the focus of the family. Every summer and winter, we spend months aboard,” says Steve, Bob’s oldest son out of 12 children. Steve and his siblings are involved in several different businesses, with Steve serving as founder and chairman of a capital management firm.

“Bob is the patriarch of this family, and an inspiration to all of us in life, business and sailing,” adds Steve. “It’s a blessing for our extended family to get to share this much time with him, as we can be with him during treatment.”

Bob’s story shows that the need for life-sustaining dialysis doesn’t have to mean a life restricted by an in-center schedule, because with Tablo he has the flexibility to treat when and where he wants.

In-Center “D-Day”

Bob first discovered that his kidney function was declining about five years ago. He started going to a nephrologist who tracked his labs and put him on medication to hold off dialysis as long as possible, because of his active lifestyle.

In September of last year, after a couple of hospital visits, his nephrologist told Bob his kidney function had declined to the point where regular dialysis treatment was needed. He started dialysis in the hospital with a chest catheter. After Bob was back home, he began treatments three days a week in-center in Santa Barbara, where he lives with his wife, Tamsen, and family. He also had fistula surgery in his arm.

The nine months he spent in-center were very difficult and disruptive for Bob and his family. The commute and treatment were time-consuming, and guests weren’t allowed to accompany patients during treatment due to health protocols.

 

“All of us used to dread dialysis days, which we called D-Day,” says Steve. “Now since he’s able to have Tablo treatments here with us, we have so much more flexibility, and we don’t lose those days of not being able to be together.”

“He was very isolated,” adds Tamsen. “His treatments were three hours, then it took a lot of time driving there and driving back. All in all, it took about five hours out of the day.”

“When he started dialysis at a center, we weren’t able to travel,” adds Steve. “We even tried having his treatments at dialysis centers in different cities while we were in port, but it wasn’t convenient.

Tamsen also says that Bob’s quality of life wasn’t as good during his time in-center.

“The biggest thing I noticed is when he would come out of the center after treatment, he would always say he felt beat up,” she says. “He would go home and just sit in a chair, and even the next day he would feel bad. He was out of commission for at least a day.”

Freedom at Home

Steve started researching alternatives, and discovered Outset Medical and Tablo online. Bob’s nephrologist had also talked to Bob and his family about the possibility of having his hemodialysis at home, as he thought he would be an excellent candidate.

“Before this, we didn’t even think it was possible to do dialysis at home,” says Tamsen. 

Steve reached out to Outset Medical to discuss Tablo, and then he contacted Spectrum Dialysis, as they offer home dialysis using the system. The family attended a Tablo demonstration with the Outset and Spectrum Dialysis teams in early May.

Steve also considered peritoneal dialysis and another dialysis system FDA-cleared for use in the home, but Bob and the family, with support from his nephrologist, decided that Tablo was most conducive to his needs and lifestyle. 

At the initial meeting, the family had their concerns over whether it would work to do Bob’s treatments while vacationing. Once they learned more about home hemodialysis and Tablo, and decided to move forward, Bob’s transition from in-center to home treatment proceeded quickly.

“I’ll be honest, at first, I was concerned that it wouldn’t work. I didn’t think it would be safe, or easy,” says Tamsen. “I see now that it’s very doable.” 

“The decision coincided with our summer vacation on the boat, so we decided to start there, and it’s working out very well,” says Steve. “I was very impressed with the technology. With Tablo, we have much more freedom.”

Just like in other patient home settings, the water and electrical system aboard the boat were inspected by the Outset field service team to ensure they met the treatment specifications for Tablo, prior to the machine being delivered and set up. The compact console, that fits in a corner of Bob’s study and is secured in place during travel, only needs tap water and an electrical outlet to operate. Bob’s nurse and nephrologist are connected to his treatment information wirelessly. A month’s supplies fit in a small storage area, and whenever more are needed, they are shipped for local pickup.

“The level of technical support along the way that we’ve received from Outset and the team at Spectrum has been very reassuring,” says Steve.

 

Bob’s Nurse Offers Her Perspective

Ada is a home hemodialysis training nurse who is handling Bob’s treatments three times a week. She says she was skeptical at first about Tablo when she was first introduced to it at her clinic, because she was so used to other dialysis machines.
“After working hands-on with it, and understanding how the Tablo touchscreen walks you through the processes and any troubleshooting, I was surprised how quickly and easily I transitioned to using it flawlessly,” she says.

 

She adds that Bob is a very stable patient and is doing well on his dialysis. “He is able to tolerate the level of fluid removal that is needed, he is feeling well and his labs have been good,” she says. “I like using Tablo with a patient at home because it’s user-friendly, and the patient has flexibility. When I’m running Bob’s dialysis, usually starting around 2 in the afternoon, he can eat snacks, spend time with his family watching TV or having a conversation, or singing to some music,” she says.

The ability to treat on a flexible schedule at home allows Bob to stay out of the dialysis center, and enjoy time with his 12 children, many grandchildren and friends. Steve says that home dialysis has contributed greatly to his father’s well-being.

“The big difference we’ve noticed is that it seems to take a lot less out of him,” he says. “When he’s done, he’s not wiped out like he used to be. More importantly, we’re not losing a whole day to having to go to a center. Now, we can all be together watching a movie, TV or sports, or listen to music, and we can all still interact. That’s been a really big change, a better quality of life during the time he’s having treatment.”

“We were concerned at first about how it would go, but Tablo here at home is much less of an intrusion into Bob’s and our lives than when he was going in-center,” adds Tamsen. “I’ve noticed also that there’s not a difference between how he feels before and after treatment. And we can change his treatment times if we need to, say if we’re leaving on a trip. We’re already planning our upcoming vacation season,” adds Tamsen.

 

Original Source Article October 2023:

https://www.outsetmedical.com/perspective/bob_home_dialysis_success_story/