>> february 21, 2014, >> >> mayor's disability council >> >> >> okay. everybody, we are going to get started. this is the meeting of the mayor's disability council on friday, february 21, 2014. welcome to

you all and now denise will do our introductions. >> good afternoon and welcome to the mayor's disability council, this friday, february 21, 2014, in san francisco city hall. city hall is accessible to person's using wheel chairs and other assistive mobility devices. wheelchair access is provided at the polk street entrance is provided via wheelchair lift. assistable listening devices are available at the meeting and sign language interpreted. our meetings are also

available in braille. to prevent electrical interference in the room, please silence all mobile phones and pda's. your cooperation is appreciated. we welcome the public's participation during public comment. you may complete a speakers card in front of the room or call the bridge line at 415, 554, 9632 where a staff person will handle the question to speak at the appropriate time. the mayor's disability council's meeting are held on the third friday of each month. our next scheduled meeting on march 21, 2014, from 1:00 p.m. to 4:00 p.m. at city hall in room 400. please call the mayor's office on disability for future information or request accommodations at 415,

554-6789, or tty 554-6799. please speak slowly into the microphone to assist our captioner and interpreters. >> thank you. we have roll call. >> cochair chip supanich, present, cochair idell wilson, absent. councilmember tatiana cast, star laura absent, denise present, harriet wong, absent. roland wong absent,

starta absent. >> thank you. the next item is reading and the approval of the agenda. i would like to first make a motion to amend the agenda. seeing as we have a lot of speakers to listen to today, i would like to move the directors report item no. 6 to follow item no. 9. item no. 5 to follow item no. 9. any objections to the amendment? >> no. >> okay. thanks. you can read it now. item 1, welcome, introduction and roll call. item 2, action item. reading and approval of the agenda. item 3, public comment. items not on today's agenda, but within the jurisdiction of

the mdc. each speaker is limit to 3 minutes. >> item 4, information item: report from cochair idell wilson. item 6, information item. life with dialysis. councilmember kostanian will lead a pregnancy and information hearing on the challenges of daily living for individuals who are kidney dials dependent. presentation by dr. eli we'll from the national kidney foundation. public comment is welcome. you'll a break. item 7. discussion and possible action item: mayor's disability council will discuss a possible resolution in support of the increasing the number of accessible way side platforms in the light rail system along with the

enhanced passenger amenities. item 8: information item. affordable care act information. item 9. information item. updates from the department of aging and adult services. presentation by jason adamek. public comment is welcome. ten 5. information item. report from the director of the mayor's office on disability. item 10. information item, report from the disability disaster preparedness committee. item 11. public comment. items not on today's agenda but within the jurisdiction of the mdc. each speaker is limited to 3 minutes. item 12, information item

correspondence. item 13, discussion item. council member comments and announcements. item 14. adjourn. serd a has not arrived and we have a quorum. >> we have john alex lowell. good afternoon. my name is alex lowell and i hold the american advisory pedestrian seat for people with disabilities. i come to you today to share with the members of the public 23

flyers for a forum on pedestrian safety sponsored by the san francisco eleanor roosevelt to occur on february 27th. specified location and time is on this flyer at 6:00 p.m.. accommodations can be provided to all parties who request it 72 hours in advance. there is an e-mail notice at the bottom of the flyer. this form will occur for 2 hours. members of the police department san francisco municipal transportation agendas and several non-profits. including senior disability action and several of the advisory committee will be there to answer questions regarding pedestrians with disabilities and seniors with disabilities.

i read it directly on the left. are you concerned about the pedestrian safety. what can city and citizens do to help. the fdr club for san franciscans for seniors and people with disabilities. thursday, 4:00 p.m.. congregation church. supervisor chiu of district three and he's also president of the board of supervisors. state senator mark leno's office, walk san francisco, the police department, sfmta,

senior disability actions. these flyers will be available at any point during the break or the closing moment of this session for me to hand out to anyone. >> thank you, mr. lowell. >> the final note is the senior who was in the collision yesterday passed away. she is 91 years old. she was at the intersection of fillmore and california. i >> i have no other public comment cards. anyone else? >> good afternoon, my name is mark background and i want to comment favorably on the new

8,000 series munis buses made available and have two wheelchair platforms inside of the bus and these are being used on many of the diesel buses. is there any way that we can work with in the future with the buses munis to make electric buses available with wheelchair access on them. my second comment is i want to thank the commission and the public works for making all the city offices and federal offices in the area disabled accessible with curb ramps. they have put quite a bit of effort in the last months and i certainly appreciate them. thank you. >> okay. moving on. item no. 4, cochair wilson has not

arrived yet. so we'll skip this item and come back to it possibly when she arrives. then we are on to item no. 6. life with dialysis. councilmember kostanian will lead a presentation and informational hearing on the challenges of daily living for individuals who are kidney dials dependent. tonya, would you like to introduce this? >> yes. of course. >> i myself am a dialysis patient so i know pretty much what they are talking about. thank you all for coming today to hear our fine speakers give their presentation on the work with the patients with kidney

dialysis. our first speaker is a well-known and -- esteemed necessity free es nephrologyist. and we have a social worker who works with dialysis patients and transplant patients. we had another speaker but wasn't able to attend. dr. wiel, would you like to give your presentation? my name is dr. eli wiel.

i'm a nephrologyist and i have been taking care of patients with kidney disease. i'm very pleased to be able to talk to the committee today on a very important subject that is not something that is very remote and very rare. the problem is larger than many people think. many people think that dialysis issues and transplant issues are sort of often drugs and things that are very remote. in san francisco i estimate there are about 800 patients on dialysis in the city of san francisco and that there may be up to 12-1300 patients walking around with a kidney transplant and subject to dialysis and being kept

alive by this type of technology. tatiana is one of those with know kidney function that can be kept alive by this modality for many years and kept functioning. many people do not understand that. i'm going to talk a little bit about the kidneys and where they are and what they do and some of the problems that dialysis patients have and what dialysis is. first, i want to mention where the kidneys are and we have two kidneys, each person has usually two kidneys. if you have only one, you can get along with one kidney. they are located in the middle of the back on that slide when the print is off you can see where they are. and the kidneys do not hurt when they are ill. there are exceptions if you have a kidney stone or

kidney tumor. the kind of condition we are talking about today that is chronic kidney disease, progressive kidney disease to the point where the kidneys fail, usually is asymptomatic. that's one of the problems. usually people think they have back pain or my kidney is okay. that is almost not always the kidney pain. i want to talk a little bit about what this kidneys do and how they work. the kidneys if you look at the screen, blood goes in the red major artery and into the kidneys and processed by the kidneys where urine is made and then in the blue field, you can see that blood returns back to the body, the arrow is carrying it back to the center to the heart and meanwhile the process that has been made, the substance that has been

made by the kidneys flows out through the ureter to the bladder. that's basically the overall function of the kidney in the grossest sense. it flows from the kidney to the bladder. the blood contains red blood cells and proteins and lots of water and chemicals many of which you are waste products that go out in the urine. that's an overview of how urine is made. many people have no understanding at all how it got there. it's an affiliate . the blood that goes into the kidneys is filtered and water continuing metabolites and not continuing blood and not continuing protein. those are

retained and go back into the body. then, what actually do the kidneys do once one see's what they have and how mechanically it does and how it works. the kidneys obviously remove fluid from the body. i think that's self-evident. if you drink a lot of fluid, you are going to the bathroom. if not, you have some problem. the opposite, the converse is true. if you do not drink and get dehydrated, the kidneys will conserve fluid. there is a certain amount that will get excreted. that is a home pathic mechanism to conserve fluid. the kidneys remove

waste products from the blood. there are a lot of products that we each especially proteins but other metabolites that are not needed by the body and the body should get rid of those things. the kidney is able to process and take those metabolites and toxins and put them into drugs, for instance. the end parts of a lot of medication that go into urine. there are a lot of things that are cleared through kidney that are in the urine. the urine is not just water, obviously. the kidneys also and i think that's pretty self-evident and generally known. what's not known is that the kidneys make red blood cells. hormone is made by the kidney that stimulates the bone marrow, red blood cells to keep you from developing anemia. if

the kidneys are not working as the case with dialysis patients they become profoundly anemic which they need dialysis which substitutes for that. a kidney is crucial in controlling blood pressure. many people who have kidney disease, kidney a affection infections will have high blood pressure and kidneys can make hormones which increase blood pressure which are stimulated, and sometimes it lowers blood pressure. if there is not enough of that around, the blood pressure will go up. other functions also, but these are the primary functions of the kidneys. what causes kidneys not to work. there are many causes,

but the main ones are diebtd. -- diabetes. these are patients on dialysis. type one, insulin diabetes and there is there is type two. that isn't universal. some people have dieblts diabetes their whole life. high blood pressure is generally well-known and not too hard to understand if the kidney is subjected to continue all

increase dmv blood pressure and can cause high blood pressure and kidney failure and one of the leading causes of kidney failure. this is a whole series of immune logic diseases in that category. will -- lupus and nefrts -- polycystic kidneys and drugs can cause kidney failure. over usage or toxic drugs can cause kidney failure. the bulk of the people that start dialysis is related to these three causes. one of the symptoms of kidney failures and they are

vague. as i said it's not something that highlights itself very easily. people have fatigue. they just do not have the energy that they have. it's tricky because much of the fatigue is a slow onset. people don't really know until they are treated that they have been tired. they are less energetic, they do less, go to bed earlier and fall asleep easier and fatigue is almost universal symptom of kidney failure. loss of appetite. people don't eat as well. they lose weight, they miss meals and that's also a symptom. but, again you can understand that these symptoms that i'm describing are all pretty subtle. it's not something rash. they are all pretty subtle. the next one is poor sleep. that's not

well appreciated but people with arrhythmia, they have trouble falling asleep, they wake up and they have leg cramps and that contributes to the fatigue. they have itching of the skin. that will sometimes bring them to the doctor who the run some blood test to find out they have kidney failure. there are a lot of things, bone pain, heart failure and seizures. these are the main symptoms that are specific to kidney failure. now, if you have kidney failure, if a patient has kidney failure, one of the treatments available and the treatments that are available are hemo dialysis which is the bulk of patients who are on

dialysis who have kidney failure are treated with hemo dialysis and another type of kidney failure. down where the two arrows are down where the open captions are is a transplant which is another treatment available for patients with kidney failure. in the center we have an area that is called conservative management which is some patients simply do not want any kind of substitute iv therapy. they decided they don't want to do any of the sort and they get treatments for symptoms. they get treatments for nausea or blood transfusion or anemia. that's an area that was not well appreciated until the last few years. often people who

really should not be on dialysis, patients maybe with terminal cancer or patients with widespread diseases or patients that are very old and disabled with diabetes. in the past often they would be referred by their doctor and the doctor would tell them, yes we can treat you and begin to talk about dialysis and they often would wind up on dialysis at a short stay on dialysis and miserable stay on dialysis. in the last three or four 4 years we have become aware of the necessity to approach the patient in that sense as a whole patient and say if you don't want dialysis, it may not be appropriate for you. we do not with hold it, but we talk to the patient and say you have the option of not being on dialysis. if they say, yes, absolutely, we have available

a social worker, and psychiatrist and psychologist to help them. they will die in a relative short order. if people who need dialysis and not treated they will live a few months or few weeks. they will die. if they have chosen that, we have hospice to make their last period of life as comfortable as possible. we've talked about the treatments that are available and the first and most common treatment is hemo dialysis. dialysis means cleaning of the blood and removing waste products from the blood and extra fluid from the blood. what i have up there is a dialysis machine and blood is running and you can see arrows, the blood is running

from the patient from the tube that is closer to his elbow. it's running up into machine into a tube which is a cylinder. that cylinder is the orb it to kidney. if you have seen a dialysis, a machine and dialysis center, it looks extremely formidable. the action part is that cylinder. after the waste products and extra fluid are removed, the blood goes off the bottom of that cylinder and the blood goes back in the patient. that means about 4 hours on treatment, three times a week. some people go more, some people go