Last Thursday I attended my monthly Dialysis Team meeting. We went over my lab results and my doctor did her normal checking me over for obvious things.

Most of the conversation was about my Kt/V reading, and how it had not drastically responded to the last dialysis prescription. Recall, that it increased by 0.1 points to 1.8 from 1.7. We discussed increasing dwells to 6 from the current 5, with the last dwell occurring while I’m awake. A manual drain at some point would follow it during the day. Since there is doubt about the complete accuracy of my last PET and the resulting Transport Function, it was decided to conduct another PET before changing anything. I wrote an in-depth blog about PET that is at this link. Alternatively, you can use the blogs search function and enter either “Transport” or “Pet” to refer to blogs about these subjects.

The second subject that was discussed was my low blood pressure. One of the drugs I take for high blood pressure, Amlodipine Besylate had previously been reduced to a 5 mg cap from 10 mg. This time, we reduced my Irbesartan tab to 150 mg from 300.

Bottom line: More tests and more trial and error in an attempt to increase the efficacy of my dialysis treatment as measured by Kt/V. Ditto blood pressure.

Over the more than a year that I have been on peritoneal dialysis, I have noticed that I am prone to an excessive amount of farting, AKA in nicer terms, “flatulence.” While this occurence is often grinned at by men and made almost a joke of, for me it is way beyond that. Since this blog is meant to share and inform others interested in PD, let it be known that, at least from my perspective, farting is an inherent byproduct of PD. And we’re not talking innocent toots here, but rips that would strike envy in the Paul Bunyans of the world.

With this background, I am more than interested in what research into this area has found. Recall that Perplexity is an AI-powered Google which I turned to with the following query and results in the posed question:

Query: Summarize research into the link between peritoneal dialysis and flatulence.

The link between peritoneal dialysis (PD) and flatulence has been studied, but the results are conflicting. A study on gastrointestinal symptoms in PD patients found that gastrointestinal symptom scores were not significantly different in PD patients, and gastrointestinal life quality was not correlated with the duration of PD treatment

1. Another article mentioned that gastrointestinal symptoms appear to be common in all dialysis patients, with reflux being more prevalent in PD patients compared with those on hemodialysis (HD)2. However, the specific link between PD and flatulence was not explicitly discussed in the available search results. Therefore, the existing research provides limited and conflicting evidence on the relationship between peritoneal dialysis and flatulence. Further investigation may be needed to establish a clear link between the two.

OK, so not any correlation to speak of as reported by Perplexity. I then turned to a straight AI engine that I use a lot, Poe,with the following prompt and results:

Prompt; Write a concise 250-word or so blog entry about the association between peritoneal dialysis and flatulence from a layman’s perspective.

Assistant Poe

Title: Peritoneal Dialysis and Flatulence: A Layman’s Guide

Introduction:
Peritoneal dialysis (PD) is a life-saving treatment for individuals with kidney failure. While it offers numerous benefits, patients may experience certain side effects, including flatulence. In this blog post, we’ll explore the association between peritoneal dialysis and flatulence from a layman’s perspective.

Understanding Peritoneal Dialysis:
A peritoneal dialysis is a form of renal replacement therapy that cleanses the blood by using the peritoneal membrane in the abdomen as a natural filter. During PD, a sterile solution (dialysate) is introduced into the abdominal cavity through a catheter, where it absorbs waste products and excess fluids from the bloodstream. The dialysate is then drained out, carrying the accumulated waste with it.

The Connection to Flatulence:
Flatulence, commonly known as gas or bloating, refers to the release of air from the digestive system through the rectum. In peritoneal dialysis, one potential cause of flatulence is the presence of air in the dialysate. When the dialysate fluid enters the abdomen, it can introduce small amounts of air, which may cause discomfort and lead to increased gas production.

Managing Flatulence:
Here are a few tips to manage flatulence during peritoneal dialysis:

1. Slow and Steady: Take your time during the exchange process to allow any trapped air to escape naturally.
2. Proper Technique: Ensure that the dialysate bags are properly warmed and primed to minimize the introduction of air.
3. Positioning: Changing positions during the exchange can help air bubbles rise to the top of the abdominal cavity, making it easier for them to be drained out.
4. Diet Modification: Some foods known to cause gas, such as beans, cabbage, and carbonated beverages, may exacerbate flatulence. Consider discussing dietary modifications with a healthcare professional.

Conclusion:
While flatulence can be an uncomfortable side effect of peritoneal dialysis, it is often manageable with the right techniques and adjustments. If you experience persistent or severe flatulence, it is important to consult your healthcare team for further evaluation and guidance. Remember, they are your best resource for personalized advice regarding peritoneal dialysis and its potential side effects.

We see that Poe suggests a stronger correlation between PD and flatulence and suggests ways to combat the same. My thesis hypothesis stands: there is a strong correlation between PD and farting. QED

Yesterday on the return leg of my morning walk with our Golden Retriever Dickens, I could feel the dreaded effects of low blood pressure starting. I felt slightly light-headed, was becoming a little short of breath, and had sweat on my upper lip although the wind was blowing and it was on the cold side. I made it home, got Dickens off his leash, had to lean up against the kitchen wall for a bit for my gyros to settle down, and then went into the living room and sat down. After a bit I felt good enough to take my blood pressure: it was 80 over 58, substantially below the target minimum of 90 over 60. So what now?

My wife Linda naturally inquired “What can you do to bring your blood pressure up “immediately?” I have previously reported on this and suggested for lunch we have something prepared like packaged chicken noodle soup and along with it some olives. We did and further, I made myself fried canned potatoes with sausage patties and onions for supper with lots of salt. I also halved my evening BP med.

I informed my dialysis nurse Cindy as soon as this happened and she suggested hydration and using only 1.5% dialysis solution for a couple of days. Tuesday morning my blood pressure was 110 over 64 which I’ll take to the bank any day. On Tuesday’s dog walk, all was copesetic.

In discussions with my dialysis nurse about my blood pressure and associated medications, she informed me that it is not unusual at all for dialysis patients to “go off” of meds as a result of dialysis. I am informing readers of this blog what is going on with me in this area so that they are sensitive to the possibility of change in their prescriptions, especially regarding blood pressure. I have also noted a reduced need for insulin to control my glucose along with insulin requirements becoming much more aligned with exercise. More exercise, less insulin needed.

Introduction:
Howdy, dear readers! Today, I want to share with you the pros and cons of living in the great state of Texas, particularly for someone like me who is an 85-year-old retired naval officer on peritoneal dialysis. Texas offers a unique blend of cowboy culture, a rich mixture of Spanish and American traditions, a friendly atmosphere, and various amenities. So, let’s saddle up and explore the benefits and challenges of calling Texas home!

Cowboy Life:
Living in Texas allows you to immerse yourself in the legendary cowboy lifestyle. From rodeos to western-themed events, Texas offers a vibrant and authentic experience. The state’s rich history and cultural heritage provide numerous opportunities to embrace the cowboy spirit and indulge in activities like horseback riding, attending cattle drives, and exploring ranches. Texas is the perfect place to call home for someone seeking a connection to the rugged Wild West.

A blend of Spanish and American Cultures:
Texas’s unique geographical location and historical background have resulted in a harmonious blend of Spanish and American cultures. This fusion is evident in the state’s architecture, cuisine, music, and festivals. From Tex-Mex delicacies to vibrant celebrations like Fiesta San Antonio, the cultural diversity adds an exciting dimension to everyday life. For someone eager to experience a rich tapestry of traditions, Texas provides an enriching environment.

Friendly Atmosphere:
Texans are renowned for their warmth and hospitality. The friendly atmosphere in Texas can make anyone feel right at home. The state’s residents are known for their welcoming nature, willingness to lend a helping hand, and strong sense of community. As an 85-year-old retired naval officer, you can expect to find support and camaraderie from fellow Texans, making your daily life and peritoneal dialysis journey more comfortable and enjoyable.

Amenities and Quality of Life:
Texas offers a wide range of amenities that cater to various interests and hobbies. Whether you enjoy outdoor activities such as fishing, golfing, or visiting state parks, or prefer cultural pursuits like attending museums, theaters, and live music performances, Texas has it all. Additionally, the state boasts excellent healthcare facilities, ensuring access to quality medical care for individuals like yourself who require peritoneal dialysis.

Financial and Tax Considerations:
One of the significant advantages of living in Texas is the absence of state income tax. This can benefit retirees on fixed incomes, allowing them to keep more of their hard-earned money. Additionally, Texas has a lower cost of living than some other states, which means your retirement savings can go further. However, it’s crucial to consider property taxes, which can vary depending on the county and city you reside in.

Conclusion:
Living in Texas as an 85-year-old retired naval officer on peritoneal dialysis offers a unique blend of advantages and considerations. The cowboy life, cultural diversity, friendly atmosphere, and abundant amenities make Texas an enticing place to call home. The absence of state income tax and lower cost of living can provide financial relief, but it’s essential to research and plan for property taxes. Ultimately, the decision to live in Texas depends on your personal preferences, health needs, and desire for adventure. So, partner, saddle up and explore the Lone Star State—I reckon it might just steal your heart!

You might notice that the blog looks a little bit different than in the past. I updated the WordPress theme I was using to one named “Hemingway” to gain easy access to search functionality. Please give search a try and let me know how it goes in the comments.

This past Friday my dialysis nurse Cindy performed all necessary monthly interfaces with me including labs. Here’s the deal. We recently changed, rather drastically, my dialysis prescription hoping to increase my Kt/V readings toward the goal of 2.0 or more. Also, Kt/V is a lab-derived number indicating how well a patient’s dialysis works. Higher is better in this case.

I am disappointed in the outcome regarding Kt/V. After increasing the dialysis fluid I’m using to 13,500 mL per night from 10,000 mL, and the number of dwells to five from four, I have gained all of 0.1 in the Kt/V reading, and I’m still 0.2 below the desired minimum. See the graph below:

Like lots of things in life, there was also a positive side to my labs. My Phosphorous has been running on the high side. To combat this I doubled the amount of phosphorous binder I have been taking with breakfast. The current labs indicate I am now within the upper bound. See the graph below. In this case, there is half a God. The remainder of my lab results were within specs or expected.

Since it’s Friday’s blog, today will be a little “lighter” than during the previous week’s posts. Within Poe, there are customized bots made available to the public. One such is named ScriptifyPro. I used it with the following prompt and results to write a ballad about myself. I also ran this script through Pictory.ai and made the following video which is embedded first below. Enjoy!

Prompt: Write a ballad about a retired US Navy Commander named Hank who as a result of exposure to Agent Orange in Vietnam is on dialysis.

In the land of heroes, a tale I will weave,
Of a retired Commander, brave and bold, Hank by name,
With a lifetime of service to the Navy, he gave,
But burdened by Agent Orange’s cruel flame.

Hank, a seasoned warrior, sailed through Vietnam’s tide,
Fighting for freedom, with honor and might,
Unaware of the danger that silently lied,
Agent Orange, a toxin that would haunt him at night.

As the years rolled on, his health began to fade,
For the poison had woven its web deep within,
His body weakened, his spirit never swayed,
But the toll on his life, it was a battle to win.

Now retired from duty, a new fight he embraced,
For Hank, it was not the end, but a new chapter’s start,
Seven times a week, dialysis he faced,
A warrior’s spirit, pumping strength to his heart.

With each dialysis session, Hank stood tall,
Gathering courage, never one to complain,
He shared stories of valor with one and all,
A testament to resilience through the pain.

His shipmates rallied, forming a bond so tight,
Supporting their Commander, their friend through the years,
Together they fought, shining a beacon of light,
For Hank, their hero, deserving of cheers.

Though the battle within may never cease,
Hank’s determination remained unwaveringly strong,
A symbol of sacrifice, a true masterpiece,
A Navy Commander, enduring lifelong.

So raise a glass, for Hank, the courageous and true,
A retiree who faced adversity with grace,
His bravery shines, a beacon for me and you,
A testament to the indomitable human race.

In the annals of history, Hank’s story will live,
A ballad of courage, resilience, and might,
A tribute to those who selflessly give,
And a reminder to cherish each precious day and night.

Last Friday at 1600 no less, in a town about 40 miles from home, Stephenville, TX, I met with my new audiologist provided by the VA. He is part of the Livingston chain of hearing aid suppliers in Texas. Everything went as expected as far as assessment etc. Yes, I need new hearing aids – yeah! But in my case, he recommended in-ear rechargeable ones. He took impressions of both of my ear canals with a substance in a tube that felt like caulking for windows. Except it solidified in a short period and he was able to completely remove the impressions in one fell swoop. He said he had to obtain approval from the VA which would take up to a month and we’d go from there. He also said that I would be seeing him quarterly hereafter to ensure my hearing was attended to. This is something new.

This leads to the question “How do over-the-ear aids compare to in-ear aids?” To addresses this query, I turned to Poe again with the following results:

Prompt: Recently my audiologist prescribed an in-ear hearing aid for me for which he took impressions of both of my ear canals. Describe in some detail the differences between an over-the-ear hearing aid and a rechargeable one that fits in the ear canal. Positive and negatives, please.

DoctorSage Poe
Certainly! Let’s compare the differences between an over-the-ear (OTE) hearing aid and a rechargeable in-the-ear (ITE) hearing aid that fits in the ear canal. Both types of hearing aids have their own advantages and disadvantages. Here’s a detailed overview:

Over-the-ear (OTE) Hearing Aid:
Positive aspects:

Amplification power: OTE hearing aids tend to have larger batteries and more space for advanced technology, allowing for higher amplification power and better sound processing capabilities.
Comfort and fit: OTE hearing aids rest behind the ear, making them suitable for individuals with different ear canal sizes. They are generally more comfortable to wear and cause less occlusion (blocked feeling) in the ear canal.
Durability and maintenance: Due to their larger size, OTE hearing aids are often more robust and less prone to damage. They are easier to clean and maintain.
Negative aspects:

Visibility: Some individuals may feel self-conscious about wearing a visible hearing aid since OTE devices are more noticeable than those that fit inside the ear canal.
Wind noise: OTE hearing aids may be more susceptible to wind noise, which can affect sound quality during outdoor activities.
Feedback: Since the microphone and receiver are located outside the ear, the possibility of feedback (whistling sound) is slightly higher compared to ITE hearing aids.
Rechargeable In-the-Ear (ITE) Hearing Aid:
Positive aspects:

Cosmetics: ITE hearing aids are custom-made to fit the shape of the individual’s ear canal, making them discreet and less noticeable.
Convenience: Rechargeable ITE hearing aids eliminate the need for frequent battery changes. They usually come with a portable charging case that allows for easy and on-the-go charging.
Sound quality: ITE hearing aids can provide a more natural sound perception since they are placed closer to the eardrum, allowing for better sound localization and improved directionality.
Negative aspects:

Battery life: Rechargeable ITE hearing aids typically have a shorter battery life compared to traditional disposable battery-powered devices. However, advancements in technology have led to longer-lasting rechargeable batteries.
Size limitations: Due to the size constraints of the ear canal, ITE hearing aids may have limited space for advanced features and larger batteries, potentially impacting the availability of certain high-end functionalities.
Maintenance: ITE hearing aids require regular cleaning and maintenance to avoid wax build-up and ensure optimal performance. They may be more susceptible to damage from moisture and earwax.
It’s important to note that the choice between an OTE hearing aid and a rechargeable ITE hearing aid depends on several factors, including the individual’s hearing loss, lifestyle, personal preference, and the recommendation of the audiologist. A thorough evaluation by an audiologist will help determine the most suitable type of hearing aid for your specific needs.

If you have any further questions or need more specific information, please let me know!

Can you explain how the sound quality of an over-the-ear hearing aid compares to a rechargeable in-the-ear hearing aid?

DoctorSage Poe
Certainly! When comparing the sound quality of an over-the-ear (OTE) hearing aid to a rechargeable in-the-ear (ITE) hearing aid, there are a few factors to consider:

Amplification and Power: OTE hearing aids generally have more space for advanced technology, including larger batteries and amplifiers. This allows for higher amplification power and more sophisticated sound processing capabilities. As a result, OTE devices can often provide a broader frequency response range and more precise sound amplification, which may contribute to improved sound quality.

Proximity to the Ear: ITE hearing aids, being placed directly in the ear canal, can provide a more natural sound perception since the sound is delivered closer to the eardrum. This proximity can enhance sound localization and improve the ability to perceive subtle nuances in speech and environmental sounds. The closer positioning of the microphone and receiver in ITE devices can also reduce the possibility of sound distortion or interference.

Sound Occlusion: OTE hearing aids are positioned behind the ear, which generally results in less occlusion or a blocked feeling in the ear canal. In contrast, ITE hearing aids occupy a portion of the ear canal, potentially leading to a slight occlusion effect. This occlusion may affect the perception of one’s own voice, low-frequency sounds, and overall sound quality. However, modern ITE hearing aids are designed to minimize occlusion and provide more natural sound experiences.

Personalization and Customization: Both types of hearing aids can be programmed and adjusted to an individual’s specific hearing needs. However, ITE hearing aids, being custom-made to fit the shape of the ear canal, can offer a more personalized and tailored fit. This customized fit may improve sound delivery and localization, contributing to a better overall sound experience.

It is important to note that the perception of sound quality is subjective and can vary from person to person based on individual preferences and needs. Factors such as the degree and type of hearing loss, the specific technology and features of the hearing aids, and the expertise of the audiologist in fitting and programming the devices can all influence the perceived sound quality.

Ultimately, the choice between an OTE hearing aid and a rechargeable ITE hearing aid should be based on a comprehensive evaluation by an audiologist, taking into consideration the individual’s hearing profile, lifestyle, and personal preferences.