As a Vietnam Veteran, I have a unique perspective on Independence Day, a holiday that celebrates our nation’s birth and its enduring promise of freedom. On July 4, we commemorate the passage of the Declaration of Independence in 1776, a momentous event where the Continental Congress voted in favor of independence from Great Britain.
Independence Day is a day of patriotism, of pride in our nation and its foundational principles. Yet patriotism, as we understand it, is not about blind loyalty or uncritical support for a country or its elected officials. As veterans, we know the difference between true patriotism and hollow nationalism. True patriotism lies in the continued quest to find a more perfect union, a commitment to the ideals encapsulated in the Declaration of Independence and the Constitution of the United States.
The principles that bind us as a nation—freedom, equality, justice, and opportunity— are what we, as veterans, have been prepared to defend. It is about loving our country not for its power or wealth, but for its selflessness and idealism. This sense of devotion to country is not about misleading slogans and empty gestures but about ideals and the hope that this nation can serve as an example to the rest of the world.
Yet, as we celebrate, we must also remember the responsibility that comes with this freedom. Our forefathers knew that the union they were forming was not perfect, but they believed in the possibility of making it “more perfect” with each passing year. They envisioned a nation that belonged to “we the people” – not to the government or political parties.
Independence Day serves as a reminder of our duty to protect this vision and to correct our nation when it strays from its path. In the words of Martin Luther King Jr., “I criticize America because I love her. I want her to stand as a moral example to the world”. We acknowledge our nation’s imperfections, we admit our mistakes and strive to atone for them. This too, is a patriotic act.
As a Vietnam veteran, my experiences have taught me to value freedom, to understand the weight of service, and to appreciate the continual pursuit of a more perfect union. On this Independence Day, let us not just celebrate our freedom but also remember our responsibility to uphold the ideals of our nation and to continue striving for that perfect union our forefathers dreamed of so long ago.
As we celebrate the Fourth of July this year, let us remember the courage, the sacrifice, and the vision that birthed this nation. Let’s continue to strive for a more perfect union, for ourselves, for our children, and for the generations yet to come. For we are not only celebrating a moment in history but a promise, a promise of freedom, equality, and the pursuit of happiness that has been the beating heart of our nation for nearly two and a half centuries.
Happy Independence Day to you all, and let freedom ring! But for individuals on dialysis reading this, NEVER RING THE BELL!
Medicalpress, on June 14, 2023, reported on a new and novel approach to the manufacture of insulin for potential use involving lettuce, yes, lettuce. The article by Lauren Rebecca Thacker, University of Pennsylvania titled “A plant-based, oral delivery of insulin regulates blood sugar levels similar to natural insulin: Study.” A summary of the article follows:
A groundbreaking study led by Henry Daniell of Penn’s School of Dental Medicine has introduced a new, affordable insulin delivery method that could revolutionize diabetes treatment and dramatically lower the risk of hypoglycemia compared to current methods. Insulin, a lifesaving medication for the estimated 537 million adults living with diabetes worldwide, has traditionally been delivered via injection, which can cause hypoglycemia due to insulin reaching the bloodstream too quickly. Although automated insulin pumps can minimize this risk, they are expensive and only accessible to a small portion of diabetes patients globally.
Daniell’s study, published in the journal Biomaterials, presents a plant-based, oral delivery of proinsulin that addresses these drawbacks. The new plant-based insulin contains all three peptides found in natural insulin, which clinical insulin lacks. The plant cell walls protect the insulin from stomach acids and enzymes until gut microbes break it down. The insulin is then delivered to the liver through the gut-liver axis. In trials with diabetic mice, this oral insulin-regulated blood sugar within 15 minutes of ingestion, similar to naturally secreted insulin, and without causing hypoglycemia, a common risk with traditional insulin injections.
The production of this plant-based insulin, using lettuce in this case, involves blasting human insulin genes through plant cell walls using a “gene gun.” The insulin genes then integrate into the plant’s genome. The lettuce is freeze-dried, ground, and prepared for oral delivery following FDA guidelines. This method eliminates the need for expensive fermentation, purification, and cold storage/transportation, significantly reducing production costs. The final product is shelf-stable at room temperature, eliminating the need for cold storage and reducing post-production costs.
Daniell plans to test this plant-based insulin in canine and human subjects in the future. He has previously conducted canine studies and believes this method could significantly alter treatment for diabetes and other diseases. In addition to its advantages in efficacy and affordability, plant-based insulin aligns with Daniell’s commitment to making healthcare globally accessible and affordable. He emphasized that this new method could provide patients with a superior drug at a lower cost.
For readers of this blog, we should take solace in that current research, while still in the animal-testing stage, appears to indicate that oral-based insulin may become available in some of our reader’s lifetimes!
A month or so ago I suffered an Orthostatic Hypotension incident in front of our home while talking to a neighbor. I sensed it coming on and gently fainted onto the payment with his kind help. I recovered quickly and with input from my dialysis nurse Cindy, we altered my dialysis solution mix and it has not occurred since. This is the “why” I’m interested in this malady.
On June 13, 2023, CNBC ran an article announcing a startup, Stat Health was coming out with a wearable device that is placed in the ear per the above picture that gives a warning to the user well in advance of an event such as orthostatic fainting. The CNBC blurb states;
‘When users stand up, the earpiece automatically tracks changes in their heart rate, blood pressure trend and blood flow, which are useful insights for patients who commonly experience dizziness and fainting spells as a result of illnesses like long Covid and postural orthostatic tachycardia syndrome (POTS), among others.
Users can track their metrics in an app on their cellphone and glean insights into how their lifestyle choices affect their symptoms. The STAT earpiece has also proven to predict fainting minutes before it happens, according to peer-reviewed findings published in Journal of the American College of Cardiology this year.”
I followed the bouncing ball and arrived at Stat Health’s website and signed up to be eligible for the device. They charged $1.00 to signup which puts me in the queue to receive the device and pay $50 a month to use the device and their software. More to follow as more is known.
Recently (June 17-18, 2023. P. A5), The Wall Street Journal ran a piece by Betsy McKay titled “Testosterone Therapy Shown Not to Increase Heart Risks.” At first blush, this does not appear to have much impact on those of us on Dialysis. But wait. The fifth paragraph states, “While the study found no risk of major cardiovascular events such as heart attacks, researchers did report a few cases of pulmonary embolism, or a blood clot affecting the lungs; atrial fibrillation, a heart-rhythm disorder; acute kidney injury; and small blood pressure increases among men who received testosterone treatment. (Emphasis provided.)
I am and have been for years on Testosterone Therapy and the “acute kidney injury” got my attention. What is this all about?
McKay’s article cited the study upon which her article was based as being published in the New England Journal of Medicine. It was based on a new clinical trial of about 5,200 men funded by AbbVie et al. With the information, I did a Google, found, and created the original report in searchable PDF format. I then searched for the word “kidney.” This is where things get interesting!
Buried in the body of the report is the following statement: “There were more cases of nonfatal arrhythmias warranting intervention, atrial fibrillation, and acute kidney injury among patients who received testosterone than among those who received placebo; these adverse events were not expected.“ (Again, emphasis provided.) And this is pretty much where it was left for this study – EXCEPT.
Refer to Figure 3 at the end, a screen capture from the report. To impart a little more understanding to what is shown, a little about “p” values in statistics is merited. In this study, it was assumed that there are no differences between the two groups of men, ie, those taking testosterone and those who do not. This is called a null hypothesis in statistical testing. The “p” value, or probability value, describes how likely the data support the null hypothesis, in this case, no difference between the groups. A “p” value of 0.05 or less is generally accepted as a strong indicator that, in this case, THERE IS A DIFFERENCE. 1-p is the inverse, that is, there is a difference rather than there is not. For acute kidney injury, 1-p=1-.04=96% probability that there is a difference in the groups. In layman’s terms, we can be 96% certain that the administration of testosterone therapy adversely affected those from a kidney perspective who took it compared to those who did not.
Like analysis holds true for Atrial Fibrillation, only even stronger, that is, the probability is 98% that those who were on testosterone therapy were adversely affected in this regard compared to those who were not on the therapy.
To me, these are stupendous findings. I recognize that the researchers were investigating therapy as related to cardio aspects, but to state “these adverse events were not expected” is a vast understatement and a disservice. You can see from the table below that 60 men on therapy suffered acute kidney injury compared to 40 not on therapy who did not. Let’s put this into perspective! Full 50% more men on therapy suffered acute kidney injury compared to the 40 men in the control group. That’s right, half again as many. Have your attention yet?
I didn’t stop here. I turned to my faithful AI subscription and asked, “What is the tie, if any, between testosterone-replacement therapy and acute kidney injury?”
The AI summarized findings thusly: “However, the evidence in humans is limited and somewhat mixed. Some observational studies have found higher testosterone associated with lower mortality in CKD patients and higher estimated glomerular filtration rate (eGFR), a measure of kidney function. However, a clinical case report showed testosterone therapy induced renal impairment, and a small randomized controlled trial in 48 men showed that 6-month testosterone treatment lowered eGFR. The lack of large-scale randomized controlled trials makes it difficult to assess the long-term effect of testosterone on CKD definitively.”
So, I’m sitting here thinking, Oh crap, or stronger words, what’s next to crawl out from the woodwork?
In the realm of healthcare, it’s not uncommon for us to focus primarily on the main conditions that affect a patient, such as kidney disease or heart conditions. However, the often overlooked aspect of patient health is how these conditions can affect other areas of a person’s life. For men on dialysis, one such issue is erectile dysfunction (ED).
Understanding the Problem
Erectile dysfunction (ED) is a medical condition where a man cannot get or keep an erection firm enough for sexual intercourse. It’s a common problem, particularly among older men, but is rarely talked about, even in medical consultations, due to the stigma and embarrassment associated with it.
For men on dialysis, the issue is particularly prevalent. Dialysis, a life-saving treatment for kidney failure, can, unfortunately, lead to ED for a number of reasons. First, the underlying health issues necessitating dialysis, such as diabetes or hypertension, are often risk factors for ED. Second, the physical and psychological stress of dialysis can also contribute to the problem. It’s estimated that as many as 70-80% of men on dialysis experience ED to some degree, a far higher rate than in the general population.
The Impact
The impact of ED on men on dialysis is profound. It goes beyond just the inability to have sexual intercourse. Men with ED often experience low self-esteem, depression, and anxiety. It can also strain relationships, creating a significant amount of emotional distress for both the patient and their partner.
Moreover, ED can be a sign of more serious underlying health issues. Cardiovascular disease, diabetes, and kidney disease, among other conditions, can all lead to ED. It’s essential to bring up this topic during medical consultations, as it can provide valuable insight into a patient’s overall health.
Addressing the Issue
The first step in addressing ED among men on dialysis is to break the silence around the issue. Encouraging open and honest discussions between patients and healthcare providers can help to alleviate the embarrassment associated with ED and lead to more effective treatment strategies. Thus this blog entry.
Treatment options for ED in men on dialysis do exist. These can range from medication to lifestyle changes, psychological counseling, or even surgical interventions. However, it’s important to remember that treatment should be tailored to each individual’s situation, considering their overall health, the severity of their ED, and their personal preferences.
The Future
Research is ongoing to understand the connection between dialysis and ED better and to develop more effective treatments. Already, there have been promising developments in the field of regenerative medicine and stem cell therapy that could potentially revolutionize the treatment of ED. This blog will report on a new entry in this field.
To conclude, while dialysis is a life-saving treatment, its impact on a man’s sexual health is undeniable. I
But wait, it is not just a male problem!
Women’s Sexual Health and Dialysis
While the conversation around dialysis and sexual health often focuses on men, it’s crucial to recognize that women on dialysis also experience significant sexual health challenges. A decrease in sexual desire, or libido, is a common issue among women undergoing dialysis treatment.
The reasons behind this decline in sexual drive are multifaceted. First and foremost, the underlying health conditions that necessitate dialysis, such as diabetes or hypertension, can negatively impact sexual drive. Dialysis can also lead to hormonal imbalances, including decreased estrogen, which can further lower libido.
In addition to these physical factors, the psychological toll of living with kidney disease and undergoing dialysis can be substantial. The stress, fatigue, and anxiety often accompanying dialysis can dramatically affect a woman’s mental health, leading to depression in some cases. All of these factors can contribute to a decrease in sexual drive.
Furthermore, body image issues can arise due to changes in physical appearance related to kidney diseases or dialysis treatment, such as weight gain, skin problems, or surgical scars. These changes can significantly affect a woman’s self-esteem and, in turn, her sexual desire.
In conclusion, just like men, women on dialysis face significant sexual health challenges that often go unaddressed due to the focus on treating the primary disease.
The US FDA recently (June 2023) approved an Over-the-Counter solution to ED for men. The following was gleaned from various websites and is provided without attribution. Do a Google, and you can find out more about the subject on your own. I have included a video at the end that describes the product in more detail.
US FDA Grants for Over-the-Counter Marketing Authorization to Futura for Fast-Acting Topical Gel, MED3000, to Treat Erectile Dysfunction
June 12, 2023, 03:39 AM Eastern Daylight Time
GUILDFORD, England–(BUSINESS WIRE)–Futura Medical plc (AIM: FUM) (“Futura” or the “Company”), a pharmaceutical company developing a portfolio of innovative products based on its proprietary, transdermal DermaSys® drug delivery technology currently focused on sexual health, today announces that the US Food and Drug Administration (“FDA”) has granted over the counter sale (“OTC”) Marketing Authorisation for MED3000, the Company’s breakthrough, topical gel formulation for the treatment of erectile dysfunction (“ED”) as a De Novo Medical Device.
MED3000 can now be legally marketed in the USA as the first topical treatment available OTC without needing a prescription. MED3000 is approved as an effective, clinically proven treatment for ED with a 10-minute onset of action. Oral medications (“PDE5i’s”) such as Cialis and Viagra require a doctor’s prescription in the USA and typically are required to be taken at least 30 minutes in advance. The US represents the largest ED market in the world.
The prevalence of ED disrupts the lives of at least 1 in 5 men globally1, with around 22 million men suffering from ED in the US. There has been little innovation in ED treatments for over a decade, and many patients continue to suffer dissatisfaction with current therapies and have limited access to safe and effective treatments.
MED3000 has already been approved as the first pan-European clinically proven topical treatment for ED available OTC and is now available in Belgium and the UK, with multiple commercial agreements in key markets including the European Economic Area, UK, Switzerland, South Korea, Latin America, and the Middle East. Futura continues to establish and expand a network of licensing and distribution partners with strength in brand building, pharmaceutical credibility, regional infrastructure, and marketing expertise for the long-term distribution of MED3000 across the globe. Initial launches commenced under the brand name Eroxon® in March 2023, with further launches planned through 2023 and beyond.
Previously I used Content Analysis to gain insights into the 63 responses to the Frensenius-sponsored forum for dialysis patients moderator’s question “What is the number one problem you face in dialysis?” Recall the data collection spanned four years. See the 6/22/2023 blog post for this nine-factor analysis. For this blog, I posed two different questions in the Prompt to the AI housing the data as follows:
Prompt: Based on the dialog provided, from a patient’s viewpoint what is the number one problem faced in dialysis; from the provider of dialysis services, Fresenius, what is the number one gripe?
From a patient’s viewpoint, based on the dialog provided, the number one problem faced in dialysis can be identified as the various physical and emotional challenges associated with undergoing dialysis treatment. This includes issues such as sleep disturbances, discomfort during treatment, dietary restrictions, weight management, infections, complications, emotional distress, and lifestyle adjustments.
Regarding the provider of dialysis services, Fresenius, the number one gripe mentioned in the dialog is the inefficiency and perceived lack of responsiveness in their supply chain and pharmacy division. Patients express frustration with the difficulties in obtaining supplies, encountering defective products, and the need to actively manage and coordinate their own orders. The lack of adequate communication and support from Fresenius personnel is a recurring complaint.
From my perspective dealing with Fresenius in Granbury, Tx, I have not experienced ANY of the situations documented in the replies to the moderator’s question EXCEPT with the Cycler throwing alarms on the drain cycle. Fresenius personnel across the board have been kind, responsive, earnest, and helpful. I couldn’t ask for better support, especially from my dialysis nurse Cindy. There is only one of her caliber period. Thanks, Cindy for your kind care. We’re hanging in there! I will never ring the bell!
Here are some actual numerical statistics related to the preponderance of dialysis among blacks and other minorities in the USA:
Prevalence of Chronic Kidney Disease (CKD):
According to the National Kidney Foundation, black Americans are almost four times more likely to develop kidney failure than white Americans.
The prevalence of CKD is higher among Hispanics, Native Americans, and Asians than non-Hispanic whites.
Approximately 15% of the adult population in the USA, which is around 37 million people, are estimated to have CKD.
End-Stage Renal Disease (ESRD) and Dialysis:
The ESRD prevalence rate for black Americans is about three times higher than for white Americans.
As of the latest available data (2019), black Americans represented 32% of the ESRD population, despite comprising only around 13% of the total US population.
Hispanics and Native Americans also have higher ESRD rates than non-Hispanic whites.
ESRD patients require dialysis or a kidney transplant to sustain their lives. In 2019, over 550,000 Americans were receiving dialysis treatments.
Healthcare Disparities:
Black Americans are more likely to experience disparities in healthcare access, quality, and outcomes. They have higher rates of uninsured or underinsured individuals compared to white Americans.
Access to early detection, screening, and preventive measures for kidney disease is often limited within minority communities.
Studies have shown racial disparities in kidney transplantation rates, with black Americans facing longer waiting times and lower rates of receiving kidney transplants than white Americans.
Economic Impact:
The cost of dialysis is substantial, with an estimated average annual cost of over $90,000 per patient in the USA.
ESRD disproportionately affects low-income populations, and individuals from minority communities often face financial challenges, leading to increased financial burdens related to dialysis treatments.
Reduced workforce productivity due to dialysis treatments can result in income disparities and economic strain within minority communities.
These statistics provide a glimpse into the disparities and impact of dialysis among blacks and other minorities in the USA. Let’s now look beyond the statistics.
Chronic kidney disease (CKD) and end-stage renal disease (ESRD) disproportionately affect these communities, leading to a myriad of social and economic challenges. In this blog, we will now delve into the factors contributing to the preponderance of dialysis among blacks and minorities and explore the profound social and economic implications it entails.
Understanding the Disparity:
Health Disparities: Blacks and other minority groups face a higher risk of developing CKD due to a combination of genetic predispositions, socioeconomic factors, and healthcare disparities. Conditions like hypertension and diabetes, which are more prevalent in these populations, contribute to the development and progression of kidney disease.
Socioeconomic Factors: Socioeconomic factors such as limited access to quality healthcare, inadequate insurance coverage, lower income levels, and educational disparities are pivotal in exacerbating the prevalence of dialysis among minority communities. Lack of awareness, cultural beliefs, and language barriers may also impede early detection and treatment of kidney disease.
Inequities in Healthcare: Systemic biases within the healthcare system can contribute to the disproportionate burden of dialysis on minority populations. Implicit biases, unequal treatment, and racial disparities in healthcare delivery can hinder timely access to preventive measures, screening, and early interventions, thus leading to a higher incidence of ESRD.
Social Impact:
Diminished Quality of Life: Living with CKD and undergoing dialysis treatments can significantly impact an individual’s quality of life. Dialysis requires substantial time commitments, often several times a week, leading to decreased productivity, limited employment opportunities, and restricted social interactions. These challenges can lead to feelings of isolation, depression, and diminished overall well-being.
Psychological and Emotional Burden: The emotional toll of managing chronic illness and relying on dialysis can be overwhelming. The stress associated with financial burdens, family strain, and uncertainties about the future can adversely affect mental health within minority communities. Moreover, disparities in mental healthcare access can compound these challenges.
Economic Impact:
Healthcare Expenditures: The economic burden of dialysis is substantial, with costs ranging from medication and equipment to dialysis treatments and follow-up care. Individuals from minority communities, who often face financial constraints and limited insurance coverage, are disproportionately impacted by these costs. Moreover, higher rates of dialysis utilization strain public healthcare programs and contribute to rising healthcare expenditures.
Workforce Productivity: The prevalence of dialysis among minority populations leads to decreased workforce productivity. Frequent dialysis sessions and medical appointments make it difficult for individuals to maintain regular employment, resulting in income disparities and perpetuating socioeconomic inequalities.
Summary: As the above shows, in the USA, minorities are at the short end of the stick regarding dialysis and CKF.
Alex Janin writing in recent Wall Street Journal articles describes the longevity benefits of regular workouts. We herein draw on her articles detailing how such insightfulness applies to those of us on peritoneal dialysis regardless of age.
Introduction:
Living with peritoneal dialysis can be a challenging journey, but there are steps we can take to improve our health and well-being. While exercise is often associated with maintaining physical fitness and preventing chronic conditions, its positive impact extends far beyond that. In this blog entry, we will explore how the insightful findings on exercise’s benefits can be applied to peritoneal dialysis patients of all ages, offering a ray of hope and a path to better health. For each, I provide how I operationalize the concept in my own exercise regimen.
Improved Cardiovascular Health:
Regular exercise has a profound effect on cardiovascular health, which is particularly crucial for peritoneal dialysis patients. Engaging in aerobic activities, such as walking, swimming, or cycling, helps strengthen the heart, improve blood circulation, and enhance lung function. By incorporating regular workouts into their routine, peritoneal dialysis patients can reduce the risk of cardiovascular complications, such as heart disease and hypertension, both of which are common among individuals with kidney disease.
As I have previously blogged about, with malice of forethought, my wife and I brought onboard a frisky male golden retriever named Dickens. From my perspective, I agreed to have the third golden in our lives for a very selfish reason – I knew he would need to be exercised night and day, and that I would be part of that effort. It has paid off. I walk him faithfully every morning, regardless of the temperature or weather. He is a golden and essentially impervious to the elements and ready to go without regard to global warming.
The second incentive in this area is I gave my wife an electric bike for Christman. Of course, I have to go on bike rides with her so I bought myself one that also has a seven-speed pedal assist. My intent is to incorporate bike riding into my exercise.
The third incentive I took was to gift my wife and me a set of pickleball rackets and paraphernalia. We have several pickleball courts in Heaven on Earth where we live to take advantage of.
The fourth is we have a massive amount of flowers and veggies growing on the half-acre lot that is our manicured yard which I am essentially the sole caretaker of. This involves gobs of up and down and weeding and pulling and tugging and just plain work. This is especially true in North Texas weather where we are scheduled to be in triple digits for about 40 days this summer.
Lastly, our son is building an ICF home about 45 minutes NE of us. At least once a week I try to spend most of a day with him working on some aspect of the building, usually involving something electrical where I can put my BS/MSEE to best advantage for him. See the video embedded at this blog’s end for a walkaround of what an ICF-built home looks like.
Enhanced Mental Well-being:
Dealing with a chronic illness like peritoneal dialysis can take a toll on mental health. Fortunately, exercise has been proven to be a powerful mood booster and stress reliever. Physical activity stimulates the release of endorphins, which are natural mood enhancers. Engaging in regular workouts not only helps combat anxiety and depression but also promotes a sense of well-being and improves overall mental resilience.
Writing this blog has improved my mental health. It has made me more attentive to detail, and always on the lookout for ideas or concepts that may provide insight to others through my writing.
Weight Management and Muscle Strength:
Maintaining a healthy weight is crucial for peritoneal dialysis patients, as excess weight can put additional strain on the body and exacerbate existing health conditions. Regular exercise, combined with a balanced diet, can help manage weight effectively. Additionally, incorporating strength training exercises into the workout routine can improve muscle strength and endurance, further supporting the body’s ability to perform daily activities and improve the overall quality of life.
Excess weight has not been a problem for me. Before my eGFR tanked, I weighed in the 162-164 range consistently. Once my eGFR tanked, I got down to 137 at which time I started dialysis. My weight now is in the 149-152 range and is fairly consistent and holding.
Bone Health and Joint Function:
Peritoneal dialysis patients are at an increased risk of developing bone and joint problems due to mineral and vitamin deficiencies. Weight-bearing exercises, such as walking or lifting weights, can help improve bone density and strengthen muscles, reducing the risk of fractures and improving overall bone health. Furthermore, regular workouts can alleviate joint pain and stiffness, enhancing mobility and allowing patients to engage in their daily activities with greater ease.
Bone density is of concern to my GP, especially at my age. In the past weeks, I have had a bone density scan and will report results when I know them. This is an area of concern.
Increased Energy Levels:
Living with peritoneal dialysis often leads to feelings of fatigue and low energy levels. Paradoxically, engaging in regular exercise can actually boost energy levels and reduce feelings of tiredness. Exercise increases oxygen and nutrient delivery to the body’s tissues, improves sleep quality, and enhances overall stamina, resulting in increased energy levels throughout the day.
I don’t nap during the day and have no problems going to sleep once I hook up to the cycler and start my nightly dialysis routine. I attribute this to getting plenty of exercise and eating what is dictated that I need to eat.
Conclusion:
While peritoneal dialysis presents its challenges, incorporating regular workouts into your lifestyle can have a transformative impact on your health and well-being. As highlighted by Alex Janin’s insightful Wall Street Journal articles, exercise offers numerous benefits for longevity, and these benefits extend to peritoneal dialysis patients of all ages. By embracing physical activity, you can improve cardiovascular health, boost mental well-being, manage weight effectively, strengthen bones and joints, and increase your energy levels.
Attribution: WSJ ‘s Alex Janin for inspiration, AI for aide and attendance.
On the Fresenius-sponsored PatientHub app, the moderator posted the following question: “What is the biggest hurdle you’ve overcome while on home dialysis?” Over a four-year period, there were 63 responses to the question. I thought it would be nice to summarize for readers of this blog what actual patients on PD reported. Thus, this blog entry.
In statistics, there is a methodology named “content analysis.” Content analysis is a statistical methodology used to analyze text data by categorizing or coding the content into various groups. The process involves identifying specific words, themes, characters, or concepts within the text and quantifying their frequency or pattern of occurrence. This objective, systematic, and quantitative description of the manifest content of communication allows for inferences to be made about the messages within the texts, the sender(s), the audience, or the culture and time of its creation. The methodology can be applied to a broad array of texts, such as speeches, interviews, articles, social media posts, and more, allowing researchers to draw empirical insights from qualitative data.
Methodology: I cut and pasted all of the responses into a Word document. I then copied this Word document and pasted it into my ChatGPT4 bot and instructed it to run a content analysis on the input and provide a summary output. This output is next:
The content analysis of the provided text reveals several themes and challenges faced by individuals undergoing peritoneal dialysis (PD) treatment. The identified themes include:
Diet: Many individuals mention the challenge of managing their diet, particularly in relation to phosphorus intake. The love for certain foods like cheese can make it difficult to adhere to dietary restrictions.
Sleep and discomfort: Sleep-related issues are a common hurdle. People mention difficulty sleeping due to the noise and light from the cycler machine. Staying still during sleep can also be a challenge, leading to concerns about inadvertently causing complications such as infiltrating venous needles.
Storage and space management: The storage and organization of supplies can pose logistical challenges, especially for individuals with limited space. The large quantity of supplies delivered can be overwhelming and may require dedicated storage areas.
Infection and complications: Infections, graft ruptures, and other complications are mentioned as significant hurdles in the PD treatment process. These complications can lead to additional interventions, changes in treatment modalities, and emotional distress.
Weight management: Weight gain or loss can be challenging for individuals on PD. Balancing nutritional needs, limited dietary options, and the effects of dialysis on metabolism can make weight management difficult.
Emotional and psychological impact: Various emotional and psychological challenges are discussed, including guilt, shame, body image concerns, frustration, and anxiety. People share their experiences of feeling like a burden, dealing with insecurities, and navigating changes in relationships and sexuality.
System and healthcare provider challenges: Some individuals express frustration with the supply chain, pharmacy services, and healthcare providers. Issues with ordering, lack of communication, and perceived indifference from healthcare teams are mentioned as challenges that could be addressed to improve the overall experience of PD treatment.
Time management and routine: Establishing and maintaining a routine that accommodates treatment, work, appointments, and other responsibilities is highlighted as an anxiety-inducing task. The need to calculate preparation time, dialysis time, and other factors adds to the complexity.
Fatigue: Several individuals mention feeling tired or experiencing a lack of energy, which can be a persistent challenge in managing daily activities alongside PD treatment.
This content analysis provides insight into the lived experiences of individuals undergoing PD treatment, shedding light on the diverse challenges they face and the strategies they employ to overcome them.
Age, as we traditionally understand it, is a numerical construct, straightforward and unchanging. However, the concept of age is multi-dimensional, encompassing not just chronological age (the number of years a person has lived), but also perceived or subjective age (how old a person feels). Research has shown that there can be a significant discrepancy between a person’s chronological and subjective age, a phenomenon known as subjective age bias.
Subjective age bias is the discrepancy between one’s chronological age and how old one feels. This bias can manifest in two ways: individuals may feel younger or older than their chronological age. While feeling younger may seem like a positive bias, both directions of bias can have implications for health and well-being. For instance, those who feel significantly younger may engage in behaviors that are more suitable for younger individuals, which could potentially harm their health. On the other hand, feeling significantly older could lead to reduced motivation, social engagement, or physical activity.
This concept has important implications in the healthcare setting. Subjective age bias can significantly impact health outcomes, patient compliance, and overall quality of life. One specific area where the subjective age bias is particularly relevant is in patients undergoing peritoneal dialysis for end-stage renal disease.
Peritoneal dialysis (PD) is a treatment for patients with severe chronic kidney disease. The process involves using the patient’s peritoneum in the abdomen as a membrane across which fluids and substances are exchanged from the blood. It requires rigorous self-care practices and adherence to a strict schedule, making it a demanding therapy that can significantly impact a patient’s lifestyle.
Subjective age can influence how these patients perceive their ability to manage their disease and their treatment. For instance, patients who feel younger may be more optimistic and motivated to adhere to the strict routine required by PD. They may view the disease as a temporary setback and remain hopeful about their recovery. This can lead to better compliance with treatment regimens, less psychological distress, and ultimately better health outcomes.
Conversely, PD patients who feel older than their chronological age may feel overwhelmed by their disease and the demands of their treatment. They may perceive the disease as an inevitable part of aging and have less hope for their recovery. This can lead to poorer compliance, increased psychological distress, and worse health outcomes.
However, it’s important to note that these are general trends, and individual experiences can vary widely. Healthcare providers should be aware of the subjective age bias and consider their patient’s subjective age when planning and providing care. For example, motivational interviewing and psychological support could be particularly beneficial for PD patients who feel older than their chronological age. On the other hand, patients who feel younger might benefit from education about the importance of adhering to treatment regimens, despite feeling healthier or more capable than their chronological age would suggest.
In conclusion, subjective age bias is a significant factor that can influence the health and well-being of patients on peritoneal dialysis. By understanding this bias and its implications, healthcare providers can provide more personalized and effective patient care. The psychological aspects of age perception are just as important as the physical realities of aging, and they should be considered an integral part of holistic healthcare.
How do we measure where a person lies along the subjective age bias spectrum?
Subjective age bias is typically measured through self-report questionnaires or surveys. The simplest method involves asking people to state the age they feel, often in comparison to their chronological age. For example, an individual might be asked: “Regardless of your chronological age, what age do you feel most of the time?”
Responses can range from much younger to much older than one’s chronological age, or they may coincide with chronological age if a person feels their ‘actual’ age. These responses can then be analyzed to determine if an individual has a subjective age bias and, if so, in which direction.
Another approach is to ask people to indicate how old they feel on a scale, such as from 0 (as young as possible) to 100 (as old as possible), or to rate their subjective age in relation to a series of age groups.
There are also more detailed questionnaires that consider different aspects of subjective age, such as physical health, mental health, or cognitive functioning. These surveys may ask respondents to rate their perceived age in these specific areas, which can provide a more nuanced understanding of subjective age bias.
However, it’s important to note that subjective age is a complex construct that many factors, including cultural, social, and individual differences, can influence. Therefore, measuring subjective age bias is not an exact science, and the results should be interpreted with this in mind.
It’s also worth noting that subjective age and its biases can change over time, influenced by factors such as health status, life events, or changes in self-perception. Therefore, it can be beneficial to measure subjective age at multiple time points to track these changes and provide a more comprehensive picture of an individual’s subjective age bias.
The above post was seeded by an article in psypost.org on June 7, 2023, by Eric W. Dolan from Social Psychology titled “Subjective age bias Psychologists uncover a fascinating historical trend.” The article’s lead paragraph states, “Do you feel younger than your chronological age? You are not alone. Research has shown that most middle-aged and older adults feel younger than they actually are, and this phenomenon has been labeled subjective age bias. Interestingly, new research provides evidence that this effect is increasing over time. Individuals from more recent birth cohorts tend to exhibit a greater subjective age bias compared to those from earlier cohorts.”
Attribution: I was assisted in this blog post by the referenced article, ChatGPT4, Bing Illustrator for the lead graphic, Grammarly to clean up my typos, and me for the remainder. Any errors are human; any insights are divine.
