During my last scheduled visit with my GP, he suggested due to my age and dialysis status it was prudent that I have a bone density test conducted which I did. You can view the result below:

As you may ascertain, the bottom line is that the results of my bone density test indicate that I indeed am experiencing Osteoporosis. This phenomenon is a lot like diabetes; in my case, you can’t see it or feel it, it’s just there for a doctor’s prognosis. So the question becomes, in the pickle that I am currently in with dialysis, what can be or should be done about it? And just what is this ailment that I have now been flagged with? It can’t cause my hair to fall out because that has already happened – like when I was but sixteen.

So the first thing let’s look at is the measurements used in flagging me with this fragility, and what does WHO have to do with it?

I asked Poe to provide insight in this area with the following results:

The criteria for osteoporosis diagnosis are primarily established by the World Health Organization (WHO) and are commonly referred to as the “WHO criteria.” The WHO criteria for osteoporosis are based on bone mineral density (BMD) measurements obtained through dual-energy X-ray absorptiometry (DXA) scans. The criteria are as follows:

Normal: A T-score of -1.0 or above indicates normal bone density. A T-score compares a person’s BMD to the average BMD of young, healthy adults of the same sex.

Osteopenia: Osteopenia refers to low bone mass, which is a precursor to osteoporosis. Osteopenia is diagnosed when the T-score is between -1.0 and -2.5.

Osteoporosis: Osteoporosis is diagnosed when the T-score is -2.5 or below. This indicates significantly low bone density and an increased risk of fractures.

It’s important to note that the WHO criteria are primarily focused on postmenopausal women and men aged 50 and older. For individuals under the age of 50, other criteria may be used, such as the Z-score, which compares the BMD to the average BMD of individuals of the same age, sex, and ethnic background.

Lastly, I queried Poe about the relationship between dialysis and osteoporosis with the following results:

Poe Assistant

Osteoporosis and dialysis are two separate medical conditions that can often coexist or be linked in certain individuals. Let’s discuss each condition individually and then explore their potential relationship.

1. Osteoporosis:
   Osteoporosis is a skeletal disorder characterized by low bone mass and microarchitectural deterioration of bone tissue, leading to increased bone fragility and susceptibility to fractures. It is a common condition, particularly among postmenopausal women, but it can affect both men and women of all ages.

The development of osteoporosis is influenced by several factors, including genetics, hormonal changes, lifestyle choices, and certain medical conditions or treatments. Risk factors for osteoporosis include advanced age, female gender, low body weight, sedentary lifestyle, smoking, excessive alcohol consumption, family history of osteoporosis, and the long-term use of certain medications like corticosteroids.

2. Dialysis:
   Dialysis is a medical procedure used to artificially replace some of the kidney’s functions in individuals with end-stage renal disease (ESRD) or severe kidney failure. ESRD occurs when the kidneys are no longer able to effectively filter waste products and excess fluid from the bloodstream. Dialysis helps in removing waste products, regulating electrolyte balance, and managing fluid levels.

Now, let’s explore the potential relationship between osteoporosis and dialysis:

Chronic kidney disease (CKD), which often leads to ESRD requiring dialysis, can be associated with an increased risk of osteoporosis. Several factors contribute to this increased risk, including hormonal imbalances, reduced vitamin D activation, impaired calcium-phosphate metabolism, and the use of certain medications like corticosteroids during dialysis treatment.

Moreover, individuals on long-term dialysis may experience mineral and bone disorders (MBD), which encompass a spectrum of bone-related abnormalities. MBD in dialysis patients is characterized by alterations in bone turnover, mineralization, and volume, leading to various bone disorders, including osteoporosis.

The management of osteoporosis in individuals undergoing dialysis involves a multidisciplinary approach. It may include optimizing dialysis treatment, ensuring an adequate intake of calcium and vitamin D, encouraging weight-bearing exercise, and, in some cases, prescribing medications to improve bone density.

It’s important to note that the relationship between osteoporosis and dialysis is complex, and not all individuals on dialysis will develop osteoporosis. However, if you or someone you know is undergoing dialysis and has concerns about osteoporosis, it is advisable to consult with a healthcare professional for an accurate assessment and appropriate management plan.

My GP recommended that I start on a regimen of OTC drugs Vitamin D3 and K2 along with Ca. My nephrologist vetoed calcium as my current dialysis labs indicate I’m doing OK in this area.

So what’s the bottom line? Seems that If dialysis, then Maybe/Perhaps Osteoporosis, and the link is casual but not inclusive. But it got me, didn’t it?

Wednesday night was the worst night I have had in almost a year while on peritoneal dialysis. It makes the Beatles “Hard Day’s Night” song seem trivial. (Song embedded at blog’s end.) The first of four drain cycles I was awakened by a drain alarm, and got out of bed in a vertical position. and fifteen minutes later was able to jump back in bed with the first drain cycle completed. The second drain cycle alarmed with negligible drain started. Despite doing everything including standing, laying, massaging my stomach, doing joga with my wife, praying, cursing, you name it, the cycler would at times drain 13 mL, then 8, then 4 then stall, over and over again with constant alarms in between. (The numbers are for illustration only; they were all over the spectrum.)

I tried unhooking from the Cycler and draining into the bathroom sink but only a dribble came out of the catheter. Hooked back up to the Cycler, and an hour later or so about 1500 mL of expected 2000 had drained. At this point, the Cycler automatically kicked over to the third fill and we went back to bed. This time, the Cycler made it through fill 3 and drain 3, and I got up during drain 4, the last drain, which was also normal.

During the ordeal with drain 2, I called the off-duty nurse and talked to her about what was going on and we agreed that I should talk to my Fresenius Dialysis Nurse in the morning which is what I did. My Dialysis Nurse, Cindy had me come to Fresenius and started me on a week’s worth of Heparin. Heparin (Heparin Sodium) is a medicine that prevents clots and in peritoneal dialysis is used to prevent fibrin formation.

So what is this “fibrin formation?” Fibrin occurs as a result of protein formation from fibrinogen in the blood. Also referred to as “worms,” strands of it lead to poor drainage (inflow and outflow) and may be seen in the drain inspection window or in collection bags. None of this has been evident for me, but in the interim, until Dr Tan bores a hold in my stomach and looks around, at my catheter end, this is the best we can do.

So starting tonight, I have added to my evening dialysis prep routine by injecting 16 mL of heparin into my 5L Dialysate (the fluid used in dialysis.) Wish me luck and some sleep also!

BTW, labs are not up yet so more on this aspect later.

There is a saying “You can’t make a silk purse out of a sow’s ear.”This proverb is first found in English in Alexander Barclay’s Eclogues. Barclay (1475? – 1552) was a Scottish clergyman and poet who is believed to have been the first to write pastoral eclogues in English. In this use, it means you can’t make something good out of something bad. However, research into the use of pig’s parts in humans has been anything but unsuccessful.

In the far distant past, while a junior in electrical engineering at Purdue University, I was part of a research team exploring the electrical synopsis of swine, aka, pigs. We would put the pigs to sleep, go into their spinal cord, and attempt to ascertain what electrical signals resulted in various stimuli applied to the pig. It was interesting stuff and I got paid well for having fun learning more about lab procedures and working across the aisle with veterinarians.

Ed Cara stated in the 8/31/2023 Gizmodo “Surgeons at New York University have reportedly reached another milestone in making pig-to-human organ transplants a reality. They now claim to have transplanted a genetically engineered pig kidney that has survived inside a human body for six weeks and counting—the longest period yet. It’s likely that larger clinical trials will be in the near future.” You may read the entire article at this link:

Given my background and interests especially in research leading to better outcomes for kidney failure treatment, I next turned to my Poe AI to ascertain more about the historical background of pig parts. The following for your historic edification is from Poe:

Introduction:

Throughout history, humans have sought innovative solutions to overcome various health challenges. One such solution that has captured the imagination of medical professionals and researchers alike is the use of pig parts to repair human ailments. The idea of xenotransplantation, the transplantation of organs or tissues from one species to another, has been a topic of interest for centuries. In this blog post, we will explore the fascinating history of using pig parts in medicine and delve into the current status of this practice.

Ancient Origins:

The concept of xenotransplantation can be traced back to ancient civilizations where it was believed that the properties of an animal could be transferred to a human recipient. In ancient India, for example, the Sushruta Samhita, a Sanskrit text dating back to the 6th century BCE, described the use of animal bladders to repair damaged human bladders.

Advancements in Transplantation:

Fast forward to the 20th century, when significant advancements in transplantation techniques and immunosuppressive therapies paved the way for the exploration of xenotransplantation. Pigs emerged as the most promising candidates due to their anatomical and physiological similarities to humans, making their organs and tissues compatible for transplantation.

Pig Heart Valve Transplants:

One of the earliest and most successful applications of pig parts in human medicine has been the transplantation of pig heart valves. The first pig-to-human heart valve transplant took place in 1962, and since then, millions of patients have benefited from this procedure. Pig heart valves are used to replace damaged or diseased human valves, providing a lifeline for those suffering from heart conditions. ( I do believe my sister-in-law has benefitted from such valve replacement.)

Insulin Production:

Another significant breakthrough came in the field of diabetes treatment. Before the advent of synthetic human insulin, pig insulin was widely used to manage diabetes. Pigs possess a similar insulin structure to humans, making their insulin compatible for therapeutic use. Although synthetic insulin has largely replaced pig insulin today, the early use of pig insulin revolutionized diabetes care and saved countless lives.

Challenges and Ethical Considerations:

While the use of pig parts in human medicine has demonstrated immense potential, it is not without challenges. One of the primary concerns is the risk of transmitting infectious diseases from pigs to humans. Pigs harbor retroviruses, such as porcine endogenous retroviruses (PERVs), which could potentially infect human recipients. Extensive research is being conducted to develop strategies to eliminate PERVs and ensure the safety of xenotransplantation.

The Future of Xenotransplantation:

Despite the hurdles, recent scientific advancements have reignited interest in xenotransplantation. Researchers are exploring genetic engineering techniques, such as CRISPR-Cas9, to modify pig genes and eliminate the risk of viral transmission. This breakthrough could potentially open doors to more widespread use of pig organs in human transplantation, addressing the critical shortage of human donor organs. This is the thrust of the linked article at the lead.

Conclusion:

The use of pig parts to repair human ills has a rich and storied history. From ancient civilizations to the cutting-edge research of today, this field has shown remarkable promise in improving human health outcomes. While challenges and ethical considerations persist, advancements in genetic engineering offer hope for a future where xenotransplantation becomes a viable and widespread solution to the organ shortage crisis. As science continues to push boundaries, the journey from pigs to people is poised to transform the landscape of modern medicine, ushering in a new era of hope and healing.

End Poe

I have been using the newly replaced Fresenius Liberty Cycler long enough now to be able to make meaningful comparisons to the previous, alarm-prone cycler I was stuck with for so many months.

Before we jump into any data, a few comparisons:

1. The new cycler is much much quieter and faster. Faster how? My total time on the cycler which I log every morning has reached a low of 10 hrs 5 minutes on two occasions.
2. While I have experienced a few alarms, I do not have to get out of bed and hit OK twice to silence them. After a warning alarm they fade into the background on their own.
3. After alarms, it seems to take forever for the old cycler to resume drain activity. It appears to me that the new cycler picks up the pace much quicker.

Some data: For the past 12 nights I have experienced alarms on 3 of 12 nights, so 9 out of 12 or 75% of nights I have had no alarms. I have experienced 5 cyclic drain alarms out of 36 possible, for a 31/36 or 86% of cycles with no alarms.

The previous 12 nights on the old cycler 9 of 12 nights I experienced alarms, or 3/12 or 25 % I did not. During this same period, I had 17 cycle alarms out of 36 possible which maps to 19 of 36 no alarms on a cycle basis for 52%.

Now comparing data in the paragraphs above of old versus new, I had three times as many days of alarms, and 5 versus 17 alarms which is over three times as many. So it’s safe to say my new cycler is a least three times better at not throwing alarms than my old cycler. This comparison completely discredits the stand taken by Fresenius “tech support” and the faceless entity “Susan” who flagrantly blocked my receipt of a replacement for months. Shame on you!