Many patients including myself have been bamboozled by the new, 15-foot supply and drain lines on the newly provided “improved” Liberty Cycler cassettes. The purpose of this blog is to offer a few solutions from the simple to more technical to deal with the shorter line that connects to our catheter. I’ve previously discussed the availability of a supplemental line for the shorter drain..

1. Most simple: Go old fashion and buy a bed pan. The are available on Amazon for as little as $10.00. See link here:
2. Put Cycler on an extension cord long enough to move cart so can reach target. Suggest buying a 12 gauge cord. They are available on Amazon for less than $20.00. Using this method would require the presense of mind to move the cart without unplugging the cycler, and dealing with making up the cord upon return to its normal place.
3. This is the one I have. Place your UPS (Unirruptable Power Supply) on the bottom shelf of the cycler cart. If you have to move the cart to reach the toilet, just unplug the UPS, roll the cart so you can reach the toilet, do your thing, roll the cart back where it normally is, and plug the UPS back in and it will pick up where it was without any interuption to cycler operation. If you are new to the UPS world, I suggest buying a UPS with at least a 200+Watt-hour rating which should run the cycler for a least an hour or more. Something like this from Amazon would do. See picture at lead.
4. Last and NOT RECOMMENDED is to splice in enough plastic tubing to enable you to reach the toilet. If you could reach your toilet with the former 20 foot line, this jumper should be about five feet and whould require two male connectors of the right size for the tubing that are clinically and asceptically clean. I cut the drain extension off for about a five foot extension to reach our toilet for drain so have plenty of tubing left over, but not the tubing fittings. Amazon has a bunch but you would need to figure out the correct size and a way to keep everything Khoser-Clean.

Little late today with my daily blog. Sorry. Two subjects that should be of interest to PD patients, are Velphoro, our go-to phosphorus binder, and COVID.

Recently I posted the news that after the first of the year, Velphoro would be covered by CMS/Medicare and thus provided to those of us using it and qualifying for no charge. To get ahead of the perceived rush, my dialysis team suggested with get in the FreseniusRx queue ASAP so yesterday, a script was sent in for me. I received a phone call this morning from FreseniusRx stating that the Rx was ready to ship, and it would be $118.00. This is because the system had not nor should it be shifted over to CMS pay. I declined the shipment since I have plenty on hand to due me until after the first of the year. So take this as a heads-up.

Several days ago a gentleman here in Pecan Plantation advertised a 10″ radial arm saw for free. I jumped on the deal for our son who is building an ICF home nearby. The guy nicely provided the trailer to get it to our house and of course, I helped him load and unload it. Yesterday morning I received a text from him stating that he had tested positive and had a mild case of COVID. Since I was in rather proximity to him it was of concern.

Turns out that on the way home from my monthly dialysis team visit yesterday I stopped by CVS and received both the fall flu shot and the new COVID shot. You can ascertain this complicates things because is any reaction I have due to these injections or am I coming down with COVID. For the record, I have had every and all COVID shots offered.

I notified both my dialysis nurse and my GP and in both cases the guidance I received was to sit tight, and if I started to exhibit any symptoms, the dialysis side suggested going to a doc in the box while my GP said let him know under the same circumstance. I feel great and I riding it out – other than a somewhat sore arm from the injections.

Wednesday was my scheduled day to order supplies. I use the Fresenius-sponsored app to do so. It has a wealth of information about most aspects of PD including providing a Forum where people may post questions and start a thread. I browsed through the threads before placing my supply order, BTW I noted we can now order the extension for the new, shorter cassette, and was confounded by several threads having to do with new PD patients in particular, being extremely depressed to the point of being despondent.

Here are a few of the comments at the start of the threads:

1. New to pd. Few weeks now. Does the feeling alone go away.
2. What motivates you to fight kidney disease every day?
3. …I am so nervous, I have anxiety attacks high bp
4. Dealing with depression… advice?
5. I am having a really tough time right now coping with being on PD. I am experiencing a great amount of stress and grief. I don’t know what to do and I feel like I am on an emotional roller coaster. Is there help?
6. And on and on.

PD presents a problem for many patients. None of the threads were started by a person who was a male. This is not to say in any way that only females are prone to this form of behavior and may just be more apt to voice their perceived woes.

The responses, and there were many, mostly stated in one form or another that families were where patients gathered the most strength from. More often than not, children and/or grandchildren and living for them were the reasons offered to keep on truckin’. While this is all well and good, the question as to what is the root cause of these maladies is not addressed. I turned to Perplexity for research into this area with the following results:

Patients on peritoneal dialysis (PD) often experience symptoms of despondence and depression for several reasons:

1. Chronic illness burden: PD is a treatment for end-stage renal disease (ESRD), a chronic condition that significantly impacts a patient’s physical health and daily life[1]. The ongoing management of ESRD and its complications can lead to feelings of hopelessness and despair.
2. Lifestyle restrictions: PD requires patients to adhere to strict schedules, dietary limitations, and fluid restrictions. These constraints can cause frustration and a sense of loss of control over one’s life[1].
3. Physical symptoms: ESRD and dialysis can cause fatigue, pain, and other physical discomforts that may contribute to depressive symptoms[1].
4. Treatment-related stress: The need for regular dialysis procedures, potential complications, and the constant reminder of illness can increase anxiety and depression[2].
5. Social isolation: PD may limit patients’ ability to participate in social activities or maintain employment, leading to feelings of isolation and loneliness[1].
6. Fear and uncertainty: Concerns about the future, potential complications, and mortality can contribute to anxiety and depressive symptoms[4].
7. Body image issues: PD requires a catheter to be permanently inserted into the abdomen, which may affect self-image and contribute to depression[2].
8. Loss of independence: Reliance on dialysis and potential limitations in daily activities can lead to feelings of helplessness and despondency[5].
9. Biological factors: ESRD and dialysis can cause hormonal imbalances and changes in brain chemistry that may contribute to depression[1].
10. High prevalence: Studies have shown that depression is significantly more common in PD patients compared to the general population, with one study reporting a prevalence of 98.5% among PD patients[1].

It’s important to note that depression in dialysis patients, including those on PD, is often underrecognized and undertreated[1]. Regular screening for depression and providing appropriate psychological support and treatment can help improve the mental health and overall well-being of PD patients.

Citations:
[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4394933/
[2] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9784045/
[3] https://karger.com/kbr/article/41/1/86/185661/The-Level-of-Anxiety-and-Depression-in-Dialysis
[4] https://www.davita.com/education/ckd-life/support/your-emotions-and-chronic-kidney-disease-ckd
[5] https://www.elsevier.es/es-revista-european-journal-psychiatry-431-articulo-depression-cognitive-distortions-in-hemodialysis-S021361632100001X
[6] https://www.researchgate.net/publication/364304306_A_cross-sectional_study_on_assessing_depression_among_hemodialysis_patients
[7] https://health.usnews.com/conditions/mental-health/depression

No one talks much about what a typical day for an active 85-year-old male might look like. This blog relates what I have been up to (yesterday) in a day.

Readers of this blog know that my wife and I live in Pecan Plantation near Granbury, TX near Fort Worth. You also know that we maintain 15 flower beds and a well-kept lawn. Today, the bags of mulch/manure that we ordered from our local greenhouse came in. I first hitched up our trailer, then journed about 20 minutes north where we loaded it up with 60, yes 60 bags of the good stuff. Along with this, we loaded 21 bags of pine bark mulch into our X5.

Upon return home, we had to figure out how to get the trailer back into our single-car garage up over a 2″ or so concrete burm in the floor. I ended up using two clamps to clamp 2x2s to the back of the trailer and pushed it in with our ZTR mower. Meanwhile, I noticed on our local Nextdoor that a fellow resident of Pecan Plantation advertised a free Craftsman 10″ radial arm saw. I jumped on this, contacted him, and made arrangements to pick up the saw later in the afternoon.

Had lunch and left to pick up the saw. It’s heavy. The guy who gave us the saw was nice enough to deliver it to our house on his trailer. It is now in the garage. As you can see from the lead picture, it lacks the wooden table but that can be replaced. Let our son know what we had and it turns out he needs one for his new house construction project so everyone wins.

My typical day will finish off with a shower, doing my manual 2 liters of static fill, supper, a little TV, and then on the Cycler. Wake up in the morning to our loving golden retriever Dickens – lead picture – and repeat.

I have previously blogged about the title above. This blog adds to that blog.

I have received my first box of cassette extensions made necessary by Fresenius unilaterally reducing the length of both the drain and hookup line to 15 feet from 20 feet. As previously stated, in my setup, I require at least 20 feet of drain line to reach the toilet where we drain. With the 20-foot extension, I now have 35 feet of drain line, more than enough.

I tried out the new setup with the extended drain and had no alarms so we made it through the first night, from a drain perspective. But wait. The line to hook up to your catheter has also been reduced to 15 feet. I visited the lab last Friday and my attending nurse related that they have been bombarded with patient complaints about the change. People are having to redo their setups, vacation plans, and on and on as a result. For me, I no longer can reach a toilet to relieve myself if necessary; the line is not long enough to reach. I no longer can reach the desk where I accomplish morning biometrics; the line is not long enough. I can no longer reach the blinds in our master bedroom to open them in the morning; the line is not long enough. I barely have enough line to be able to sleep comfortably; the line is not long enough. You get the picture!

Fresenius screwed up in doing this, especially how they did it. Just like Biden pulling us out of Afghanistan but in this case they didn’t even ask.

As you may ascertain from the above, my lab results from this past Friday are in. I am a happy camper. While my Albumin is still low and out of range, we’ve turned the corner and it’s going up. Keep in mind that Albumin responds slowly to “treatment” such as increasing protein intake so we’re on the right track.

The lab reading for Kt/V is likewise reassuring. Recall that last month due to a much higher reading, I asked that the dwell time of the evening cycler routine be reduced to one hour forty-five minutes from two hours for each of four cycles. This was accomplished and this Kt/V being greater than 2.0 indicates we are OK.

The last result I’m sharing is Creatinine. This value maps to an eGFR of 6. Notice that it has steadily been improving. I asked Perplexity about improving Creatinine for a patient on dialysis with the following result:

For patients on peritoneal dialysis, a decreasing creatinine lab result generally indicates improving kidney function or effective dialysis treatment. Here’s a more detailed explanation:

Interpretation of Decreasing Creatinine Levels

A declining creatinine level in peritoneal dialysis patients can signify:

1. Improved Kidney Function: In some cases, residual kidney function may improve, leading to better creatinine clearance by the patient’s kidneys[1].
2. Effective Dialysis: A decrease in serum creatinine suggests that peritoneal dialysis is effectively removing waste products from the blood[1][3].
3. Adequate Dialysis Dose: It may indicate that the prescribed dialysis regimen is sufficient in clearing creatinine and other uremic toxins[3].

Factors to Consider

While decreasing creatinine is generally positive, it’s important to consider:

• Muscle Mass: Creatinine is a byproduct of muscle metabolism. A decrease could also reflect loss of muscle mass, which is not desirable[1][4].
• Nutritional Status: Poor nutrition can lead to decreased creatinine production, so dietary factors should be evaluated[4].
• Hydration Status: Overhydration can dilute serum creatinine, giving a false impression of improvement[2].

Clinical Significance

Healthcare providers use creatinine levels, along with other markers, to:

• Assess the adequacy of dialysis treatment
• Adjust dialysis prescriptions if needed
• Monitor overall kidney function and health status

Additional Considerations

It’s crucial to interpret creatinine results in conjunction with:

• Other laboratory values (e.g., BUN, electrolytes)
• Clinical symptoms
• Overall health status
• Dialysis parameters (e.g., ultrafiltration volume, dialysate composition)

Healthcare providers will consider all these factors when evaluating the significance of decreasing creatinine levels in peritoneal dialysis patients.

Citations:
[1] https://www.mayoclinic.org/tests-procedures/creatinine-test/about/pac-20384646
[2] https://my.clevelandclinic.org/health/diagnostics/16380-creatinine-clearance-test
[3] https://www.ncbi.nlm.nih.gov/books/NBK544228/
[4] https://www.mountsinai.org/health-library/tests/creatinine-blood-test
[5] https://www.medicalnewstoday.com/articles/322380
[6] https://www.kidney.org/kidney-topics/understanding-your-lab-values-and-other-ckd-health-numbers
[7] https://www.medicalnewstoday.com/articles/319892
[8] https://www.healthline.com/health/low-creatinine

There is a fine line in Diabetic Control for those of us on Peritoneal Dialysis. It’s as though we’re balancing on a knife’s edge. Let me explain. Over more than 40 years of being a Type II diabetic, I have learned that my glucose readings are correlated very closely with my weight, and lately, with exercise. Just a few pounds weight variation can make all the difference in my readings. Tie this to work that approaches being strenuous, especially tied to the heat we experience here in N. Texas in the summer, and my glucose drops.

For the last three nights, my wife has been awakened by my Libre 3 alarm because of low glucose readings. (I can’t hear it because I don’t have my hearing aids in.) Each night she has provided orange juice to remedy the situation and we have managed to go back to sleep. My last five glucose entries into the Cycler for morning biometrics have been 85, 86, 75, 67, and 71. Keep in mind the last three entries are after ingesting a full 8 oz of orange juice during the night.

In response to this, I reduced my intake of insulin to 9 units from 10 units. As I write this blog about an hour after breakfast on Wednesday, Libre 3 indicates my glucose to be 93 and this is after putting a mocum of honey on my cereal. So tonight I intend to drop my insulin dose even more, down to 6 or 7 units.

Why did I titled this blog “Diabetic Contol & PD?” Because, unlike many patients with PD, I have not had any problems to date with weight. If anything, It has been constant in the low 140s pounds. This is still the case even though I have upped my protein intake in an attempt to improve my albumin lab results. There’s always something, isn’t there?