These days they try to squeeze in those errands only if she feels well enough after her dialysis treatment.
See, Carlyon must commute to Missoula at least three times a week for dialysis to clean toxins from her blood because her kidneys no longer perform that function. She had an illness as a child that damaged her kidneys and they have been slowly deteriorating ever since. In January, they reached the point where they could no longer function fully.
Ruth Sackey, another dialysis patient who lives down Mullan Road, estimates her gas bill has doubled in the past year. She tries hard to catch the bus, which stops near her house, at least twice a week, and she recently started picking up janitorial jobs on the weekend just to help cover her fuel costs.
That's in addition to the 34 hours a week she puts in at her weekday job, which she considers a good-paying one. What's more, her employer offers a good insurance package, which goes a long way toward covering her medical bills. Though Medicare is her primary insurer, it doesn't cover the full cost of dialysis, which runs about $700 per treatment, Sackey explained.
She's been undergoing dialysis three times a week for the past four years, and when she doesn't take the bus she drives herself to the dialysis center for treatments. It costs her about $45 to fill up her tank, and she fills it up about once a week. That may look like small potatoes compared to her monthly medical bill - but it's potatoes she must pick up herself, on top of other necessities, without the benefit of insurance.
“(The price of) everything else went up, too,” Sackey noted. “Groceries are going up, and (many dialysis patients) have to eat a specific diet that's high in protein. That means meat.” And beef, pork and chicken can be pretty pricey, she added.
While many of us complain about the rising price of gas, food and other basics, these costs are especially hard on people with fixed incomes, or those who require expensive medical care. In a rural state like Montana, high gas prices in particular are felt by anyone who has to travel long distances frequently.
And that applies to a lot of Montana's dialysis patients.
The state is home to more than 600 people who need dialysis to survive, and has only a dozen dialysis centers to serve them.
While dialysis services are readily available, they are not located in close proximity to many patients' homes, explained Meg Eddy, a Missoula nephrologist - meaning she specializes in the diagnosis and treatment of kidney diseases.
More than 26 million people in the United States have some form of kidney disease, and approximately 400,000 are living with kidney failure. Yet chronic kidney disease is under-recognized and under-diagnosed, Eddy said.
Sackey, for one, is amazed that people don't know more about such a vital organ, she said: “To me it's so surprising that people really do not know how important their kidney is.”
Dialysis is a relatively labor-intensive and complex treatment, and it's not economically feasible for medical providers to operate dialysis units in smaller communities. As a consequence, patients in rural communities are left to figure out how to get themselves to treatment three times a week.
There are some programs and foundations in Montana that provide patients with free bus tokens or taxi vouchers, and tribal members living on the reservation receive free transportation to dialysis centers as well, but many patients either drive themselves or rely on family members.
Eddy often hears about the financial hardships borne by her patients and their families.
“They're living in a constant state of financial strain,” Eddy said. “The majority of our patients don't work - can't work - and are on limited, fixed incomes. So it's an enormous hardship for them.”
In addition to the cost of dialysis, there are often certain medications patients must take, and some struggle to pay for all their prescriptions, particularly if they've hit the infamous “donut hole” in Medicare Part D, Eddy says.
Alice Luehr, a certified nephrology nurse in Helena, often hears similar complaints from her patients. One patient, for instance, receives disability payments of $600 a month - and the price of his medication alone is double that, Luehr noted.
“You frequently hear stories about people who have to choose whether to buy medication or food,” she said. “We see their lab results and we ask, ‘Why aren't you taking your blood pressure medication?' They just can't afford it. It's a tremendous challenge for them.”
Cindy Schaumberg, a licensed clinical social worker at St. Patrick Hospital in Missoula, noted that although Medicare doesn't pay for gas, it does provide an allowance for travel expenses. Of course, this doesn't do much good for the majority of patients who are not yet eligible for Medicare.
“Gas prices do make a difference in how easy it is for people to travel,” Schaumberg said, adding that patients come to St. Pat's for dialysis services from as far away as Hamilton, Polson and Superior.
Charles Moody, for one, drives himself to Missoula from his home in Polson three times a week for dialysis treatment - because there are no dialysis services in Polson.
Though he's officially retired, Moody continues to work a couple of days a week at a small supermarket. He has diabetes, and he's been receiving dialysis treatments for 20 years. Medicare helps pay for his treatment, but it doesn't help with his fuel costs. It costs Moody close to $60 to fill up his vehicle, and he fills up every two trips.
“My fuel costs are about double what they were a year ago,” he estimated.
The dialysis center in Polson closed in 2004, and unfortunately, that seems to be the trend in most rural areas, according to Kidney Care Partners, a national coalition of various kidney care advocates and organizations. Sooner or later, most dialysis providers in smaller communities come to realize they can't make it on Medicare reimbursements alone.
Fortunately, the Medicare bill recently approved by Congress is expected to help by allowing for an update to the dialysis reimbursement mechanism, said Edward Jones, chairman of KCP and a practicing nephrologist, via telephone from Philadelphia. That update will amount to a roughly 5 percent increase in payments to providers - which ought to help more of them hang in there, Jones said.
What's more, the legislation also contained a provision for an education program many in the dialysis community have long pushed for, he added. The program is aimed at prevention - at helping people recognize that they have kidney disease before they need dialysis.
“If we get to the patients early enough,” Jones said, “we have well-known services that can prevent the need for dialysis.”
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