While prepping for my evening shower last Thursday night, my wife noticed a circular pad around my catheter port entry area. I had not noticed it before and had never previously had such a device after catheter placement either. As it was installed, I could not conduct the normal aseptic routine I follow after showering to safeguard my port. Those of us on PD live in constant fear of screwing up and getting something, outside or inside our bodies infected.
I sent an email to my dialysis nurse with pictures of the port and she immediately called me back and said not to worry, that the patch was just a temporary protection against infection, and I should remove it in due course. Since I have never encountered such a patch previously, and I have one now that’s coming off shortly, this blog provides readers background on what is named a “biopatch.” I have embedded a video at the end which tells you all you need to know about the biopatch.
See the three pictures below: The first picture is an overall of my stomach area, showing the biopatch surrounding my catheter at entry via the port in my stomach, the second picture is a closeup of my catheter/port area, and the third picture is a closeup of one of the three “keyholes” my surgeon used to go inside my stomach area to reposition my catheter to preclude drain issues.
Yesterday I informed you that my surgery appears to date to have been successful although one night without drain alarms is not a trend. The purpose of today’s blog is to fill in some of the holes in yesterday’s somewhat cryptic blog. Perhaps you will pick up some pointers that could help you along the way.
The hospital where our surgeon, Dr. Tan has privileges is Texas Health Harris Methodist Hospital. They sent out a request for me to fill in and verify gobs of patient information prior to my visit. I complied and when we arrived to check in, there was no wait. I had to sign one HERPA form for Tricare for Life and provide an ID (Texas Driver’s License), my Medicare card and military ID (for Tricare) and that’s it. We were then immediately escorted back to the surgery prep area where I spent almost the next hour being prepped for surgery.
During this prep, I was intensely quizzed as to the meds I was taking, and WHEN I last took them. Heads up: know your meds and schedule for taking them. This was important to them because I was told NOT to take any meds the morning of surgery except a Satin. Be advised I received a phone call from a nurse at the hospital about a week before my scheduled surgery during which we went over my meds in detail. Throughout the check-in and prior to actually going into surgery, there was repeated checking of details with different people with different skill sets as they made their presence known. The last questioning was as I was being moved from the traveling gurney to the operating table where I was for the umpteenth time asked what my name and date of birth was, my doctor’s name, and the day’s procedure.
I was told to take a shower the morning of the surgery which I did. During prep for surgery, I was provided a medicated heated towel and instructed to wipe down my frontal area to make certain it was ultra-clean.
We were informed that I would be in recovery after surgery for an hour and a half; I was in recovery for 20 minutes before I was in a wheelchair and out the door. The point is, there are estimates and there are estimates. Hospitals seem to have their own concept of time as do the doctors that are Gods therein.
My wife received a constant flow of texts, upwards of ten, during my surgery progress, keeping her updated on my status. At the completion of my surgery, she received a text from Dr. Tan that the surgery was successfully completed and he would be calling her which he did. Dr. Tan explained to my wife what he had found, what he had done to correct it, and post-surgery procedures. She commented to me that she almost had too much status information. My heads up here is that I know many people in our age group do not text. If you fall into this category, you are potentially missing out on an important near real-time data source. This method worked really well for us.
Yesterday I had laparoscopic surgery to ascertain the status of my catheter and if catheter placement was causing or contributing to the excessive amount of drain alarms I have been receiving during PD. A laparoscopy is a type of surgery that lets a surgeon look inside your body without making a large incision (cut). It’s used to help diagnose and sometimes treat conditions that develop in your belly or pelvis. So I now have an additional small incision an inch or south toward my pelvic region from the catheter port which yes, is currently sore but not teeth-grinding sore. I can handle it. I have been told to cool it for 24 hours before resuming normal activities. You can rest assured my wife will enforce this restriction.
So what did the surgeon Dr. Tan find? He found that indeed the placement of my catheter needed to be altered; the end was formerly placed so as to partially block access. He moved “things” around and sent me on my way. For what it’s worth, I experienced no alarms last night.
For the record, we left our home in Pecan Plantation at 0830, checked in at the hospital at 0930, and were home by 1430. The whole operation went perfectly. The hospital even had bed warmers to keep patients warm while in their queue for their procedure. Everyone was friendly and helpful – it went the way you imagine things should go. I was really favorably impressed.
Started off Tuesday/yesterday with a monthly lab visit with my friendly and supportive dialysis nurse. Nothing out of the ordinary except she removed the remaining obvious stitches from cancer surgery on the back of my head. They were supposed to have been removed in the middle of last week but it didn’t happen. Turns out phoned the local/Lafayette, IN VA, and left a message with the nurse’s station about having them removed there but did not receive a return call. Your VA in action supporting your veterans. She did provide me with a handout that described a new injection dongle for our dialysis fluid bags that is easier and more receptive to use. It has a larger look like a blue ring to better be able to hold the entryway for injection into the bag.
Next stop, my dermatologist where basal cancer was removed from my left cheek. A pretty large slice was taken requiring 12 stitches. The numbing hasn’t worn off yet so pain is minimal. Based on past experience, I will be taking a couple of Tylenol before bed.
Wednesday morning we’re off to Fort Worth for surgery to ascertain what is going on with my catheter that perhaps is causing drain problems. In the next blog, I will no doubt have a sore stomach to go along with my sore check. Stay tuned.
There is a phrase “Screwed up as Hogan’s Goat.” The phrase Hogan’s goat refers to something that is faulty messed up, or stinks like a goat. The phrase is a reference to R.F. Outcault’s seminal newspaper comic Hogan’s Alley, which debuted in 1895. The title of the strip changed to The Yellow Kid the following year.
CVS, a national drug store chain in the US, personifies Hogan’t Goat. Let me explain. A couple of weeks ago my wife and I, using the CVS App, made appointments to receive the fall flu shot, the new COVID shot, and the RSV shot. When we arrived for our appointment, we were told they were out of the RSV shots, it would be $200 each for the COVID shots, but we were OK for the fall flu shot which we both received. We passed on the $200 for each COVID shot as the news had been blaring about them being available and free for those of us on Medicare.
The next day I phoned CVS and asked them WTF was going on with the COVID shots. I was informed, the very next day mind you, that our military insurance, TriCare for Life, was now covering the COVID shots. Like this took place overnight!???
Back to the CVS app where I made appointments for my wife and I to receive both the COVID and RSV shots on Monday, 10/2/2023. I called CVS on 10/1/2023 and they assured us that the shots were and would be available for our appointments. So far everything seems to be working – Until!
Until we turned up at CVS in Granbury for our shots. The pharmacy area looked like Grand Central Station on Friday afternoon at 5 p.m. There were people everywhere. We showed up at 1020 for our 1030 appointment, and at noon, yes 1200, we walked out with shots in our arms, a full hour and forty minutes after showing up for our appointments. Seems that some people like us signed up for appointments online which went into their computer base. Some called in for appointments that went somewhere else. Some just showed up. Some made appointments in person for a later date. All of these inputs were not merged into a time-sensitive file so who knows how the queue was established and managed, or mismanaged as the case may be?
The sad part about the mismanaged mess is I saw no indication that anything was going to be done about their inaptitude to preclude similar situations in the future. Luck for us, we now have our shots until next year rolls around. I think we will wait until our local Pecan Plantation pharmacy has the shots to preclude being part of CVS’s Hoagan’s Goat show again. Caveat Emptor!
We’re back home from a week’s trip to visit with my wife’s sisters in Indiana – Central Indiana to be specific, in and around Lafayette, Indiana, close to Purdue University. To say that time changes things is an understatement. Every time we go back, which is infrequently, we cannot believe how much things have changed – traffic, crowds, people, infrastructure, route changes, etc. Like being in an alien world.
Background: In preparation for our trip back to Indiana, a trip of roughly 1000 miles each way, we divided my PD supplies into 7 boxes; two boxes contained supplies for two nights, four boxes contained supplies for one night, and one box contained cassettes. We divided the trip up so we traveled roughly halfway each night, 486 miles as it turns out. So the night on the road we used a single box, and the three nights in Lafayette we used one double and one single, and coming back one single. Upon our return home, we had a single and a double as backup. This worked out well.
Some lessons learned:
Aseptic procedures take twice as long while traveling and are probably more than twice as important. At home, all your aseptic gear is laid out in an orderly fashion. While traveling it is a mess stuffed into your luggage almost at random, especially after a couple of nights on the road. Anything you can do to organize this area is very lucrative.
I have gained about four pounds traveling for one week. En route, we grabbed what we could mostly while stopped for gas. Once we landed in Lafayette, every interface with my wife’s sisters and their families revolved around food. We were literally eating breakfast, getting up from that, and going directly to a lunch date and after a short break to supper. It was a never-ending parade of food. That’s the way it was and I don’t see any way around such social occasions. It is what it is.
We stayed going and coming in a Hilton Inn Express in Springfield, MO. While in Lafayette, IN we stayed in a Drury Inn. The Hilton was somewhat long in the tooth in comparison with Drury with Drury’s ambiance superior as was their food and in general their welcomeness. I would suggest Drury given the choice by far. Prices for an overnight stay were in the $185 per night for Drury in Lafayette and $134 per night for Holiday Inn. Looks like you get what you pay for.
The largest single expense incurred for our week away from home was the boarding of our Golden Retriever Dickens. He was boarded from Saturday to Saturday at a cost of $600 including tip. We supplied his food. You need to factor this cost into your budget for traveling.
We used whatever route our BMW X5’s GPS suggested we take so we hit several tolls. We have the NTTA automatic toll sticker on our car so we did not have to stop to pay tolls. Interestingly, tolls in Oklahoma were also automatically paid via our sticker. Point to note.
We have lots of “stuff” to contend with in the coming week. Monday we are scheduled for COVID and RSV shots at CVS, assuming they have the shots in hand. On Tuesday I have a dialysis lab and will return the cycles case that Fresenius lent to me for our travels along with a dermatology appointment to remove a Basail Cell cancer from my check. Wednesday I have surgery scheduled to have a look-see at my catheter to ascertain if there is any blockage or placement issues causing my incessant drain alarms.
As the song below attests, “Don’t tell me I’ve nothing to do!”
A commentator on this board and I have been comparing notes on our individual treatments. While this is instructive and interesting, you have to keep in mind that we are each individuals into ourselves and it’s easy to fall into the trap of comparing apples to oranges. The following table depicts differences and similarities in our PD:
My Readings
His Readings
UFiltration
4-800 mL
11-1300 mL
# Cycles
4
5
Dwell
120 minutes
90 minutes
Total Time
10-5 to 11 (Hr-min)
10-5 to 12-15
Comparison table me to him
At first glance, it would appear that “him” is pulling lots more fluid out via PD compared to me as indicated by the comparison of the UFiltration (microfiltration) numbers. But this is misleading. What we don’t know and can’t compare is how much urine each of us is still making via normal kidney function. I still pass a plausible amount of urine naturally; does he? Something else we don’t know is what percentage solution each of us is using. The more concentrated the solution (we have a choice of 1.5, 2.5 and 4.25%), the higher the expected microfiltration.
My prescription has me on dwell for a total of 4 times 120 minutes or 480 minutes, while “him” is on dwell for a total of 5 times 90 minutes or 450 minutes. So I have fluid in my stomach for 30 more minutes, all else being equal. This is where things get a little bit more complex to describe and understand.
There is a concept in peritoneal dialysis called Transport, and Transport is measured by something called PET. To help explain these concepts, I turned to Poe with the following result:
Poe Assistant:
In peritoneal dialysis, the transport level refers to the permeability of the peritoneal membrane to solutes during the dialysis process. The peritoneal membrane acts as a semi-permeable barrier between the blood vessels and the dialysis solution (dialysate) that is infused into the peritoneal cavity. The transport level is determined by the characteristics of the peritoneal membrane, which can vary from person to person. There are three main types of transport levels in peritoneal dialysis:
High Transporters: High transporters have a peritoneal membrane that is highly permeable to solutes. This means that solutes, such as waste products and excess fluid, can easily pass through the membrane from the blood vessels into the dialysate. High transporters may require more frequent or longer dwell times during peritoneal dialysis to adequately remove waste products.
Low Transporters: Low transporters have a peritoneal membrane that is less permeable to solutes. In these individuals, the removal of waste products and excess fluid during peritoneal dialysis may be less efficient. Low transporters may require longer dwell times or more exchanges to achieve adequate dialysis.
Medium Transporters: Medium transporters have a peritoneal membrane with intermediate permeability. Their peritoneal membrane allows for a moderate transfer of solutes between the blood vessels and the dialysate.
The transport level is assessed using a test called the peritoneal equilibration test (PET). This test involves measuring the concentrations of certain solutes in the dialysate at different time points during a dwell period. The results of the PET help determine the transport level of an individual and guide the prescription of peritoneal dialysis.
By tailoring the peritoneal dialysis prescription to an individual’s transport level, healthcare providers can optimize the effectiveness of dialysis treatment and improve patient outcomes.
I have what is considered to be a LOW TRANSPORT peritoneal membrane. Without knowing what “his” transport is, we can’t compare “his” dwell times or total times to mine. If we did, it would be comparing apples to oranges and we don’t want to be guilty of that, do we?
A Michigan Medicine study found that the longer an individual has type 2 diabetes, the more likely they are to exhibit changes in brain structure, such as decreased cortical thickness and gray matter volumes. Despite no discernible difference in cognition between those with and without diabetes, complications like chronic kidney disease and vascular damage in diabetes are linked to these brain changes. They also note that diabetic complications increased the odds of developing a cognitive disorder by 2.45 times in 40 to 60-year-olds.
So what is being implied herein? Type 2 diabetes -> brain changes -> also kidney functions -> plus other externalities -> and cognitive functions, i.e., how well our brain works? We already have cited research in previous blogs associating CKF with diabetes. It is a given. Therefore, if diabetes is adversely affecting cognition, then diabetes leading to CKF also imparts to those on dialysis as a result of CKF as potentially having cognition impacted as a comorbidity.
Impact on Cognitive Function: The impact of kidney disease on cognitive function can manifest in various ways. Studies have shown that individuals with kidney disease may experience:
Slowed Processing Speed: Cognitive processing speed, such as the ability to quickly understand and respond to information, may be impaired in individuals with kidney disease.
Reduced Attention and Concentration: Difficulty focusing, sustaining attention, and maintaining concentration are common cognitive challenges observed in some individuals with kidney disease.
Memory Problems: Kidney disease may affect different aspects of memory, including both short-term memory and long-term memory. This can manifest as forgetfulness, difficulty retaining new information, or trouble recalling past events.
Executive Function Deficits: Executive functions, which include skills like planning, organization, problem-solving, and decision-making, may be compromised in individuals with kidney disease.
Increased Risk of Cognitive Disorders: Research suggests that kidney disease, particularly in the presence of diabetes and its complications, may increase the risk of cognitive disorders such as dementia and Alzheimer’s disease.
Take it on board: It’s bad enough to experience CKF resulting in the need for dialysis. In the presence of diabetes which is highly likely, it is a double-edged sword. Perhaps having a “big brain” before onset is helpful?
Recent research has shed light on the potential benefits of incorporating pomegranate juice into the dietary routine of dialysis patients. Pomegranate juice, renowned for its antioxidant properties and numerous health benefits, may offer a ray of hope by addressing complications and improving overall well-being. In this blog post, with the help of Poe, we will delve into the findings of recent studies and explore how pomegranate juice could be a valuable addition to the lives of dialysis patients.
The Power of Antioxidants: One of the key factors that make pomegranate juice remarkable is its high antioxidant content. Antioxidants play a crucial role in protecting cells from oxidative stress, which is prevalent in chronic kidney disease. By neutralizing harmful free radicals, antioxidants can help alleviate inflammation, reduce cellular damage, and potentially slow down the progression of kidney disease.
Managing Hypertension and Cholesterol Levels: Dialysis patients often struggle with hypertension (high blood pressure) and elevated cholesterol levels, which significantly increase the risk of cardiovascular complications. Pomegranate juice has been found to have beneficial effects on both these factors. Studies suggest that the juice may help lower blood pressure, making it particularly valuable for hypertensive dialysis patients. Additionally, pomegranate juice has shown the potential to reduce LDL (bad) cholesterol levels, promoting cardiovascular health.
Protection Against Infections and Cardiovascular Events: Patients undergoing dialysis are susceptible to infections and cardiovascular events, which can have severe consequences. The preliminary findings of a recent study presented at the American Society of Nephrology’s annual meeting indicate that pomegranate juice could be a preventive measure against these complications. The juice’s antioxidant and anti-inflammatory properties may help boost the immune system, reducing the risk of infections. Furthermore, its ability to improve cardiovascular health may contribute to a lower incidence of cardiovascular events, enhancing the overall well-being of dialysis patients.
Enhancing Nutritional Intake: Dialysis patients often face challenges related to their nutritional status. Incorporating pomegranate juice into their diet can be an effective way to supplement their nutritional intake. Pomegranate juice is a rich source of essential vitamins, minerals, and dietary fiber. It provides vital nutrients that support overall health and can help combat common deficiencies observed in dialysis patients.
Considerations and Precautions: Drinking a controlled amount of pomegranate juice with a safe and monitored potassium content may help reduce the complications that often occur in dialysis patients. It is important to consider the risk involved in potassium overload, especially in chronic kidney disease (CKD) patients with dietary potassium restriction.
Incorporating Pomegranate Juice into Your Routine: If you are a dialysis patient interested in incorporating pomegranate juice into your diet, discuss it with your healthcare team. They can provide guidance on the appropriate amount and frequency of consumption based on your unique circumstances. Freshly squeezed pomegranate juice or commercially available varieties with minimal additives are recommended for optimal health benefits.
Conclusion: The potential health benefits of pomegranate juice for dialysis patients present a promising avenue for improved well-being. From its antioxidant properties to its potential to manage blood pressure, and cholesterol levels, and reduce the risk of complications, pomegranate juice offers a natural and accessible option. However, it is essential to remember that dietary changes should always be made under the guidance of healthcare professionals. By exploring the potential advantages of pomegranate juice and incorporating it into a balanced diet, dialysis patients may take a step towards enhancing their quality of life.
For individuals undergoing dialysis, managing blood pressure becomes a critical aspect of their treatment. The kidneys play a crucial role in regulating blood pressure by controlling fluid balance and producing hormones that help relax blood vessels. When kidney function is compromised, blood pressure can rise significantly, leading to hypertension.
My 100% disability rating with the VA states I have CKF with Hypertension. Keep in mind that hypertension is considered to be the No. 1 risk factor for death globally. It is intuitively obvious (didn’t you love those words in geometry proofs?) that those of us on dialysis have a very imperative need to quickly and accurately track our blood pressure readings.
Recent research has shown that a significant number of off-the-shelf blood pressure devices are providing inaccurate readings due to improper fitment of cuffs. In general, the standard size cuff is too small for the majority of adults resulting in blood pressure readings being higher than they actually are. See the lead graph from the cited research link at paragraph head. Note that small and medium cuffs read much higher than large and xlrge for the author who considers himself to require a larger cuff.
I suggest you read and ponder the cited article, and if you possibly have larger arms and/or suspect your organic blood pressure measuring device is overly stating your true blood pressure, take it to your GP for comparison and possibly obtain a better version. After all, it’s only your life and well-being we’re dealing with here!
