Friday’s Off Topic Day: Origin of R&B

As the title suggests, from time to time, I go off the topic of my dialysis journey. Today is no exception. I’m going to relate to you a little of the background from my formative years, the mid-fifties, when I was 15-17, and a sophomore-senior in high school.

Quite often during the time frame suggested, a small group of boys who were also into fast cars would meet in a friend’s garage (Paul Hinton to be exact) where we would discuss cars, girls, drink beer, play poker, and listen to radio station WLAC Nashville. Guys would drop in after dates, with some bringing their female friends with them. All through this, WLAC took front and center. So what’s with WLAC of yore? WLAC was, at the time, at the front of R&B. It brought R&B to the public’s attention and ours. In short, we listened to artists and music long before it reached the airwaves in Springfield, Ohio. WolfMan Jack hadn’t been invented, but WLAC had. Since WLAC played such a pivotal role in my early music listening, it is worth looking back to see where I am now. I quizzed Perplexity with the following Prompt and results. Following at bottom is a clip from Bo Diddley on how he got started. He was one of the artists on WLAC early on. I also inserted a Howlin’ Wolf rendition to give you a flavor of the tunes coming across from WLAC at the time.

Prompt: In the 50s, there was a station in Nashville, WLAC, that played real R&B sponsored by “white rose petroleum jelly” Tell us about this

John R American radio disc jockey who attained fame in the ...
WLAC - Wikipedia
How America Got Its First Black Radio Station - Atlas Obscura
Radio, TV and the Nashville R&B Scene (Part Two) - E. Mark ...
Bill "Hoss" Allen - Wikipedia

WLAC and Its Pioneering R&B Broadcasts in the 1950s

WLAC was a Nashville, Tennessee, powerhouse AM radio station (1510 AM) that became legendary in the 1950s for broadcasting rhythm and blues (R&B) music across much of the United States, especially at night when its 50,000-watt clear-channel signal reached up to 28 states, parts of Canada, and the Caribbean. WLAC played a crucial role in introducing Black R&B music to both Black and white audiences during a time of deep segregation and limited access to such music on mainstream radio.

The WLAC R&B Format

  • Programming: Starting in the mid-1940s and peaking through the 1950s and 1960s, WLAC’s nighttime airwaves were dominated by a quartet of white DJs—Gene Nobles, John Richbourg (known as “John R.”), Bill “Hoss” Allen, and Herman Grizzard—who played records by Black artists such as Chuck Berry, Fats Domino, Little Richard, Muddy Waters, and Etta James.
  • Audience: The station’s management deliberately targeted Black listeners, knowing their signal reached 80% of Black homes in the country at night. However, the shows also attracted a large number of white teenagers, many of whom were hearing authentic R&B for the first time.
  • Cultural Impact: WLAC’s broadcasts helped lay the groundwork for the rock and roll explosion, influencing future musicians and helping to bridge racial divides in American popular music.

Sponsorship and “White Rose Petroleum Jelly”

  • Advertising Approach: The DJs’ shows were heavily sponsored by products marketed to Black consumers, many of which were sold via mail order and promoted with colorful, sometimes humorous, and often suggestive on-air pitches.
  • White Rose Petroleum Jelly: Among the most famous sponsors was “White Rose Petroleum Jelly,” a brand of white petroleum jelly. The DJs would read lively and sometimes double-entendre-filled commercials for this product, joking about its many supposed uses. The playful, sometimes risqué nature of these ads became part of the station’s mystique and appeal, especially among teenagers who felt they were part of a secret, subversive listening club.
  • Other Products: Alongside White Rose Petroleum Jelly, the station also advertised products like Royal Crown Hair Pomade and even live baby chicks, all targeting the station’s core late-night audience.

Business Model and Legacy

  • Mail-Order Economy: Much of the station’s revenue came from mail-order businesses, such as Randy’s Record Mart, which became the nation’s largest mail-order record seller thanks to WLAC’s reach and influence.
  • Social Change: While the DJs and station management profited from Black music and audiences, many Black musicians appreciated the exposure and career opportunities WLAC provided, even as the station’s aggressive product promotion sometimes took advantage of its listeners.
  • Enduring Influence: WLAC’s R&B shows were instrumental in breaking down racial barriers in American music, inspiring countless musicians (including Bob Dylan and members of The Band) and helping to usher in the rock and roll era.

“During the hours not sponsored by record shops, WLAC featured a whole slew of wonderful commercials for such things as… ‘live baby chicks,’ ‘Royal Crown Hair Dressing’ and ‘White Rose Petroleum Jelly.’ The disc jockeys used to have a lot of fun mentioning creative uses for that versatile substance, many with double entendre meanings.”

Summary Table: WLAC R&B Era Highlights

FeatureDetails
LocationNashville, Tennessee (not Memphis)
Era1940s–1970s (peak R&B influence in 1950s–60s)
Signal Reach50,000 watts; up to 28 states, Canada, Caribbean at night
Key DJsGene Nobles, John Richbourg (“John R.”), Bill “Hoss” Allen, Herman Grizzard
AudiencePrimarily Black listeners, but also white teenagers across the eastern U.S.
Notable SponsorsWhite Rose Petroleum Jelly, Royal Crown Hair Pomade, Randy’s Record Mart, live chicks
LegacyBroke racial barriers, fueled R&B/rock crossover, influenced generations of musicians

WLAC’s nightly R&B programming, with its iconic product pitches for items like White Rose Petroleum Jelly, stands as a pivotal chapter in American radio and music history, shaping tastes and breaking down social barriers in the mid-20th century.

Status of Wearable Glucose Monitors for Dialysis Patients

Since I am no longer taking the oral medication Januvia, my GP suggested I keep a close eye on my glucose to make certain it remains within limits. You may recall from several previous blogs you can search on herein, that in the past I have paid for wearable glucose monitors myself, then Medicare started to pay, and I used one for about two years. Then, somehow, the FDA got involved and stated that the devices had not been cleared for those of us on dialysis. Medicare pulled support for the devices, leaving me to go back to the old school of finger pricks. That’s where I am again. Forty years as a diabetic and nothing’s changed.

So it is of interest to me where this all now stands. I quizzed Perplexity with the following Prompt and results:

Continuous glucose monitors on the rise after FDA approval
Company's new wearable device will help diabetics eat right ...
Surge in FDA Approvals for Diabetes Devices and Product Advances
Abbott finally gets FDA greenlight for FreeStyle Libre 2 ...

Prompt: FDA Approval Status of Wearable Glucose Monitors for Dialysis Patients

No wearable continuous glucose monitors (CGMs) are specifically FDA approved for use in patients on dialysis or those with end-stage renal disease (ESRD). This is a key distinction: while several CGMs are FDA approved for people with diabetes, their use in the dialysis population remains off-label.

Details from Recent Research and FDA Statements

  • According to diabetes technology experts and recent research, “these CGM devices… are not yet FDA approved for patients with ESRD on dialysis” due to the medical complexity of this population and their exclusion from most clinical trials111.
  • Studies have shown that factory-calibrated CGMs (such as the Dexcom G6-Pro) can provide reasonably accurate glucose readings in dialysis patients, but these studies are not large enough to support FDA approval for this specific use111.
  • The FDA has not cleared or approved any smartwatch or smart ring that measures glucose non-invasively (without skin piercing), for any population, including those on dialysis29.

Currently Approved CGMs

  • The Dexcom G7, Abbott FreeStyle Libre 14-Day, and Eversense E3 are all FDA approved for people with diabetes, but not specifically for those on dialysis5671012.
  • Over-the-counter CGMs such as Dexcom Stelo and Abbott Lingo have recently been cleared, but these are not indicated for people using insulin or those with problematic hypoglycemia, and there is no mention of approval for dialysis patients38913.

Off-Label Use in Dialysis

  • Despite the lack of specific FDA approval, many clinicians and patients use CGMs off-label in the dialysis population due to their potential benefits and reasonable accuracy as shown in pilot studies111.
  • If you are considering a CGM and are on dialysis, it is essential to discuss this with your healthcare provider, as they can help interpret the readings and manage any device limitations111.

Summary Table: FDA Status of Wearable Glucose Monitors for Dialysis

Device TypeFDA Approved for General Diabetes?FDA Approved for Dialysis/ESRD?Notes
Dexcom G6/G7YesNoOff-label use in dialysis studied61011
Abbott FreeStyle LibreYesNoOff-label use in dialysis studied510
Eversense E3 (implantable)YesNoNo specific dialysis approval710
Dexcom Stelo (OTC)Yes (non-insulin users)NoNot for insulin users or problematic hypoglycemia389
Abbott Lingo (OTC)No (wellness only)NoNot for diabetes management8
Smartwatches/Smart RingsNoNoNo FDA approval for glucose measurement29

Key Takeaway

No wearable glucose monitor is FDA approved specifically for people on dialysis. However, off-label use of established CGMs is common, and emerging research supports their reasonable accuracy in this population, though further studies and regulatory review are needed before formal approval111. Always consult your healthcare provider before starting CGM use if you are on dialysis.

  1. https://newsroom.uvahealth.com/2022/06/29/off-shelf-glucose-monitors-prove-accurate-for-dialysis-patients/
  2. https://www.fda.gov/medical-devices/safety-communications/do-not-use-smartwatches-or-smart-rings-measure-blood-glucose-levels-fda-safety-communication
  3. https://www.ajmc.com/view/fda-approves-first-over-the-counter-continuous-glucose-monitor
  4. https://texasdiabetes.com/fda-approves-new-otc-continuous-glucose-monitor-cgm/
  5. https://www.abbott.com/corpnewsroom/products-and-innovation/freestyle-libre-14-day.html
  6. https://investors.dexcom.com/news/news-details/2022/Dexcom-G7-Receives-FDA-Clearance-The-Most-Accurate-Continuous-Glucose-Monitoring-System-Cleared-in-the-U.S/default.aspx
  7. https://www.fda.gov/medical-devices/eversense-e3-continuous-glucose-monitoring-system-p160048s016
  8. https://www.goodrx.com/classes/medical-supplies-and-devices/otc-continuous-glucose-monitor-faqs
  9. https://www.theregreview.org/2024/09/25/diaz-reducing-barriers-to-glucose-monitoring/
  10. https://pmc.ncbi.nlm.nih.gov/articles/PMC10012164/
  11. https://www.techtarget.com/virtualhealthcare/news/366597498/Continuous-Glucose-Monitors-Effective-RPM-for-ESRD-Patients
  12. https://www.ncbi.nlm.nih.gov/books/NBK279046/
  13. https://www.cardiometabolichealth.org/the-new-era-of-continuous-glucose-monitoring-cgm-expanding-access-and-improving-outcomes/

Regarding Peritoneal Transport Function: What is better, high or low?

The header captures the thrust of this blog. Is it better to have a stomach lining with high or low transport? I turned to Perplexity to address this question with the following prompt and response. Spoiler, less is better!

Prompt: In peritoneal dialysis, what is better, a high or low transport function, especially regarding dialysis longevity

The best peritoneal transfer function for longevity on the peritoneal lining in peritoneal dialysis (PD) is generally a low transport status—that is, a low peritoneal solute transfer rate (PSTR) or low permeability—rather than a high transport status.

Why Low Transport Is Preferable

  • High Transport Status and Risks:
    • High transport status is associated with increased mortality risk, more comorbid diseases, and a higher likelihood of technical failure (failure to continue PD due to inadequate dialysis or complications)1.
    • High transporters tend to have lower ultrafiltration (fluid removal) and are at greater risk for fluid overload, which can lead to hypertension and cardiac dysfunction1.
    • Over time, the peritoneal membrane in long-term PD patients often becomes more permeable (higher transport), which is linked to worsening functional and morphological states of the membrane, including increased fibrosis and decreased ultrafiltration capacity12.
  • Low Transport Status Benefits:
    • Patients with low transport status generally maintain better ultrafiltration and have less risk of overhydration.
    • Lower transport rates are associated with better preservation of the peritoneal membrane and a lower risk of encapsulating peritoneal sclerosis (EPS), a rare but serious complication of long-term PD23.
    • Studies show that as PD continues, solute transport tends to increase and ultrafiltration declines, but those who start with or maintain lower transport rates have better outcomes12.

Impact of Peritonitis and Glucose Exposure

  • Peritonitis:
    • Frequent peritonitis episodes accelerate the increase in small solute transport and decrease in ultrafiltration, further compromising the peritoneal membrane’s longevity4.
  • Glucose Exposure:
    • Long-term exposure to glucose-based dialysis solutions causes structural and functional alterations, including fibrosis and vasculopathy, which are more pronounced in patients with higher transport rates23.
    • These changes lead to reduced free water transport and, ultimately, ultrafiltration failure23.

Summary Table

Transport StatusUltrafiltrationMortality RiskMembrane LongevityRisk of Fluid Overload
HighLowerHigherWorseHigher
LowHigherLowerBetterLower

Conclusion

For longevity of the peritoneal lining in PD, low transport status is preferable because it is associated with better ultrafiltration, lower mortality, and a reduced risk of serious complications like encapsulating peritoneal sclerosis12. High transport status is linked to worse outcomes and more rapid deterioration of the peritoneal membrane. A little filet is always better than lots of lettuce!

  1. https://pmc.ncbi.nlm.nih.gov/articles/PMC7428920/
  2. https://pmc.ncbi.nlm.nih.gov/articles/PMC9096116/
  3. https://www.frontiersin.org/journals/physiology/articles/10.3389/fphys.2024.1322493/full
  4. https://pmc.ncbi.nlm.nih.gov/articles/PMC4934441/
  5. https://pubmed.ncbi.nlm.nih.gov/8285200/
  6. https://www.sciencedirect.com/science/article/abs/pii/S0272638612808146
  7. https://www.sciencedirect.com/science/article/pii/S0085253815308607
  8. https://www.mdpi.com/2077-0375/12/3/276
  9. http://ispd.org/NAC/wp-content/uploads/2010/11/Modalities-PD-Devita-May-2011.pdf
  10. https://www.ncbi.nlm.nih.gov/books/NBK72297/

More On the Peritoneal Membrane and PD from Consenius.app

Prompt: How long, on average, does the peritoneal membrane operate for peritoneal patients?

The longevity of the peritoneal membrane is a key factor in how long patients can remain on peritoneal dialysis (PD). The average duration varies, but several studies provide insight into typical membrane survival and the factors that influence it.

Average Peritoneal Membrane Survival

  • Medium-term survival: For most patients, peritoneal dialysis is effective for the short to medium term, typically several years. Five-year technique survival rates (the ability to continue PD without switching to hemodialysis) are reported around 63%.
  • Long-term survival: Only about 11% of PD patients remain on therapy beyond 10 years, mainly due to loss of membrane function or complications such as peritonitis or ultrafiltration failure.

Factors Affecting Membrane Longevity

  • Peritonitis: Repeated infections are a major cause of membrane failure and technique dropout389.
  • Transport Status: Patients with higher peritoneal membrane transport rates have lower 2-year technique survival (as low as 68% for high transporters vs. 94% for low transporters).
  • Fibrosis and Aging: Fibrosis of the peritoneal membrane and molecular markers of aging can predict earlier failure, though not all patients with fibrosis experience membrane loss within five years.
  • Training and Care: Continuous patient training and infection prevention can improve survival and reduce complications8.

Survival Rates Table

Time on PDTechnique Survival RatePatient Survival RateSource
1 year93%91%3
3 years73%72%3
5 years63%53%35
10 years11%2

Conclusion

On average, the peritoneal membrane supports effective dialysis for several years, with about two-thirds of patients maintaining function at five years and a small minority beyond ten years. Membrane longevity is influenced by infection rates, membrane characteristics, and quality of care. Regular monitoring and preventive strategies are essential to maximize membrane survival.

Transport Function Review

While I have written about the central importance of the peritoneal lining to peritoneal dialysis, since mine is now somewhat under review and contention, it is appropriate to review this topic.

I turned to a new for me AI engine that specializes in academic research, Consenius.app, with the following prompt and results concerning this topic:

Prompt: Discuss the transport function in layman’s terms and how it may “fatigue,” leading to the need for HD.

Understanding Transport Function in Peritoneal Dialysis

Transport function in peritoneal dialysis (PD) refers to how well the lining of the abdomen (the peritoneal membrane) can move waste products and extra water from the blood into the dialysis fluid. This process is essential for keeping the body balanced when the kidneys are not working.

What Does “Fatigue” of Transport Function Mean?

Over time, the peritoneal membrane can become less effective at this job. This “fatigue” means the membrane doesn’t move wastes and water as efficiently as before. Reasons for this can include changes in the membrane itself, such as thickening or scarring, or the body absorbing the dialysis fluid too quickly. When this happens, patients may notice more swelling, higher blood pressure, or feel generally unwell because the dialysis is not removing enough fluid or toxins.

Why Might This Lead to Switching to Hemodialysis?

PD can no longer keep up with the body’s needs when the peritoneal membrane’s transport function is too “tired” or worn out. At this point, doctors may recommend switching to hemodialysis (HD), which uses a machine to clean the blood more directly and does not rely on the peritoneal membrane. This switch is often necessary to maintain health and prevent complications like fluid overload or toxin buildup910.

Key Points

  • The peritoneal membrane acts as a natural filter in PD.
  • Over time, this filter can become less effective—this is “transport function fatigue.”
  • When PD no longer works well, patients may need to switch to HD for better waste and fluid removal910.

In summary:
Transport function in PD can “wear out” over time, making the treatment less effective and leading to a need for hemodialysis.

Rationalizing Medications

This past Wednesday, I met with my GP, followed by a monthly meeting with my Dialysis Team. For the meeting with our GP, I had a specific agenda laid out as I did with the Dialysis Team, and took the lead. In both cases, one of the THREE items on our (I say our, because my wife, as my Caregiver, was very involved in setting up the agenda for the meetings) agenda was to review the top three drugs I was taking with the thought in mind to reduce or do away with them.

The drug handout we authored is embedded below:

I am pleased to report that after some discussion, I am no longer taking Januvia for diabetes with the caveat that we’re going to watch my glucose closely. My dialysis doctor stated that the majority of her insulin-taking patients take no oral diabetic medicine. Disposing of hydro… was straightforward. My GP strongly suggested halving my statin medication, while my dialysis doctor was Ok with dropping it. As a result, I’m now taking 1/2 of what I was before the meeting.

As a result of going into the meeting with a plan and our ducks in a row, we dropped two meds altogether and reduced the third by 50%, intending to drop it entirely in the future if my cholesterol and triglyceride readings do not go bananas. A win for all of us.

Behind the Eight-Ball in Peritoneal Dialysis

My wife and I met with our GP and Dialysis Team yesterday and today. While many things were discussed, which I intend to cover here in due course, one point stuck out. My dialysis nurse stated that the peritoneal membrane, upon which the entire PD procedure depends, is no longer effective typically in the 3-5 year time frame. I am coming up on three years, so that in and of itself puts me behind the eight ball.

Reminds me of back in the day when I was on the nuclear cruiser USS Long Beach, CG(N) 9, and as part of my qualification as an OOD (Officer of the Deck Underway), we had to qualify in the nuclear plant. It was all about the half-life of the reactor core and how the reactor was controlled.

Back to PD. I quizzed Perplexity about this aspect with the following Prompt and result. Turns out she was more than right on. At some point in time, given that I live long enough, the odds are that I will be back on hemo. Oh joy!

Prompt: How long does the peritoneal membrane continue to work in peritoneal dialysis?

Duration of Peritoneal Membrane Function in Peritoneal Dialysis

Overview

The peritoneal membrane serves as the filter in peritoneal dialysis (PD), but its ability to function effectively declines over time due to ongoing exposure to dialysis solutions and complications such as peritonitis. The length of time the membrane continues to work varies between individuals, but several key findings from research help define typical expectations.

Typical Duration

  • The peritoneal membrane can function adequately for several years in most patients undergoing PD.
  • However, its efficiency tends to decline progressively, especially after 2–4 years of treatment, due to structural and functional changes in the membrane17.
  • Many patients experience a significant reduction in membrane function after about 4–5 years, which may necessitate a switch to hemodialysis257.

Factors Affecting Membrane Longevity

  • Glucose Exposure: Chronic exposure to glucose-based dialysis solutions is a major contributor to membrane deterioration, leading to fibrosis, vasculopathy, and ultrafiltration failure over time1567.
  • Peritonitis: Episodes of peritonitis (infection of the peritoneal cavity) accelerate membrane damage and can shorten the effective lifespan of the peritoneal membrane5.
  • Individual Variation: Some patients maintain good peritoneal membrane function for more than five years, especially if they avoid frequent peritonitis and maintain good residual renal function11.

Functional Decline Timeline

  • First 2 Years: Most patients maintain good peritoneal membrane function, though early changes can begin17.
  • 2–4 Years: Progressive increases in solute transport and decreases in ultrafiltration become more common, indicating early signs of membrane fatigue17.
  • After 4 Years: More pronounced reduction in ultrafiltration and transport efficiency is typical, with some patients developing complications such as encapsulating peritoneal sclerosis (EPS), a severe form of membrane failure1710.

Clinical Practice

  • There is no strict time limit for how long a patient can remain on PD, but many centers monitor membrane function regularly and consider switching to hemodialysis if ultrafiltration failure or other complications arise210.
  • Some experts advocate for a time limit on PD to reduce the risk of severe complications like EPS, but this is individualized based on patient factors and membrane performance10.

Summary Table: Peritoneal Membrane Function Over Time

Time on PDTypical Membrane StatusNotes
0–2 yearsGenerally well-preservedEarly changes possible
2–4 yearsProgressive decline beginsIncreased solute transport, reduced ultrafiltration
4+ yearsMarked decline in many patientsHigher risk of ultrafiltration failure, EPS
5+ yearsSome maintain function, many do notIndividual variation significant

Conclusion

The peritoneal membrane typically continues to work effectively for 2–4 years in most patients on peritoneal dialysis, with gradual decline thereafter. Some patients maintain adequate function for five years or longer, but the risk of ultrafiltration failure and complications increases with time, especially with repeated peritonitis or prolonged exposure to glucose-based solutions125711. Regular monitoring is essential to determine the optimal duration of PD for each patient.

  1. https://pmc.ncbi.nlm.nih.gov/articles/PMC9096116/
  2. https://www.mayoclinic.org/tests-procedures/peritoneal-dialysis/about/pac-20384725
  3. https://www.kidney.org/sites/default/files/11-50-0215_peritonealdialysis.pdf
  4. http://ispd.org/NAC/wp-content/uploads/2010/11/Anatomy-and-Physiology-of-PD-Teitelbaum-April-2011-Notes.pdf
  5. https://pmc.ncbi.nlm.nih.gov/articles/PMC4934441/
  6. https://onlinelibrary.wiley.com/doi/10.1111/jcpt.12318
  7. https://www.frontiersin.org/journals/physiology/articles/10.3389/fphys.2024.1322493/full
  8. https://www.niddk.nih.gov/health-information/kidney-disease/kidney-failure/peritoneal-dialysis
  9. https://th.mykidneyjourney.com/en-TH/peritoneal-dialysis-home
  10. https://journals.sagepub.com/doi/10.3747/pdi.2017.00018
  11. https://www.sciencedirect.com/science/article/pii/S0085253815308607

Short Drug Review

Wife and I reviewing drugs I’m currently taking using my AI resource Perplexity as a guide. First out of the box was the drug I take for diabetes, Januvia.

I currently am taking a 100 mg dose  each morning. Perplexity tells me in a table that if eGFR is less than 30, mine is 9, that my dose should be 25 mg.

We haven’t made it past the first of many drugs, and already we’re crossthreaded. There’s a lesson here for all of us!

Second Caregive Phone Interview

This past Friday, as scheduled, my wife and I had a one-hour and fifteen-minute phone interview with the social worker representing the VA’s Caregiver Program. I was first up. She interviewed what was obviously a script, and questions at first centered on how I feel, how a normal 24-hour day goes, what my caregiver did to aid and abet my daily activities, etc. It then turned to shades of mental health and suicidal thoughts, and included a question about whether we had a gun or guns in the home. She then talked with my wife, asking about 80% of the same type of questions.

After the interview, she informed us in some detail about what’s coming down the pike. Next up is a video interview by a nurse to go over in more detail health issues, then a panel of representatives from various domains in the VA, and lastly, possibly a home visit. After these activities, we will either be informed by this rep that we were accepted into the program, or receive a detailed letter explaining why we were not. If not, we can either appeal or, if so desired, reapply.

Up to now, the two interfaces with the VA leave the impression that they are pretty much sticking to their script and are not all that interested in anything off script. It’s as though my wife, as my caregiver, could have her finger in the dike of my life, and if this did not fit into a box on their form, they would be indifferent to it.

Facing Decline: A Data-Driven Update for My Dialysis Team

Yesterday, I had a candid conversation with the VA social worker who manages the VA’s caregiver program. She informed me that my personal blogs and anecdotal updates aren’t considered sufficient—they want input directly from my doctors. However, I believe my dialysis team is uniquely positioned to provide meaningful insights, given the daily data you receive from my cycler and your frequent interactions with me. You see me and my health trends more consistently than any other provider.

My Current Health: The Data and My Experience

To put it plainly, I feel like I’m on a downward slope—a negative first derivative, for those who appreciate a mathematical analogy. My physical abilities are declining: walking any distance has become a challenge, my knees are stiff, and I often have to pause after standing to regain feeling in my legs and feet. Even minimal exertion leaves me winded and needing to rest.

Dialysis now ties me to the cycler for over 10 hours each night. While I used to be someone who never napped, I now find myself dozing off in the afternoons without even trying. Fatigue is a constant companion.

Increasingly, I rely on Linda for support in daily life—meals, laundry, taking care of Dickens (our Golden Retriever), making decisions, and providing rides. This growing dependence is a direct result of my declining health.

(For those less familiar with calculus: the first derivative measures the rate of change. A negative value means things are getting worse. In this analogy, I am the function, and my health is trending downward.)

Looking Ahead: Questions for the Care Team

Linda will be joining me at our next team meeting with Dr. Turner on June 19. She has a growing list of important questions, including:

  • What support services are available for dialysis patients in our area?
  • Given the data, which suggests I have an average of 11.6 months to live, what is your perspective?
  • Can we review my medications? It seems overdue.
  • What has been your experience with caregiver requirements for patients like me?

I’m sure more concerns will arise before our meeting next week.

Why This Matters

I share this not just for myself, but for my care team. Your ongoing monitoring and feedback are vital. The numbers from my cycler and your observations are the most objective record of how I’m doing. My hope is that, together, we can address these changes proactively and ensure I have the best support possible.

Thank you for being my window into the medical side of this journey.

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