The entry is different from past entries. I bought into Pictory.AI which supports rendering text into videos. I used it with judicial editing on my part with a script captured from the normal blog entryway below and produced the following video. I will be doing this from time to time because I can. Enjoy!
At about 6 PM on Tuesday, April 24, 2023, I received another call from Fresenius Medical Corporate. This time via number 781-699-13211. There was a very young and sweet voice on the other side, inquiring about my last call on or about 9 April to “Tech Support” concerning the never-ending drain alarms I have been experiencing since starting PD on 9/30/2022. But she was not the least bit interested in drain alarms. During the call, I related to the soulless voice on the other end that I was experiencing swelling in my face, hands, and feet which was and is true. My dialysis nurse and I have since adjusted the strength of the solution I’m using in the Cycler, which has been mitigating.
No, she asked if I was able to complete my dialysis???? I replied yes, and then she inquired if I had been hospitalized. It should be plain as day to anyone with a grain of gray matter that this was not a call to ascertain the status of my health or respond to incessant Cycler drain alarms. Plain and simple, it is Fresenius covering its legal exposure. Yes, in the Navy, I would have said ass. So there I did. It was very apparent that she (it was a she, but that’s not the point) was merely going down a checklist and either could not or would not deviate from it.
At the call’s end, she encouraged me to contact “Tech Support” with any more problems, to which I replied that putting tech and support together regarding Fresenius is an oxymoron. That comment didn’t fit her script, and she signed off.
As I commented after my first corporate call along the same lines, my Dialysis Team knows my medical status at all times. I have complete and essentially instantaneous access to my Dialysis Nurse, who is most attentive to my situation. She knows every minutia about my dialysis journey. Why isn’t Fresenius Corporate talking to the locals about patient care and feeding? A faceless and emotionless phone call that accomplishes nothing except filling in some blanks on a legal form doesn’t get it for me. How about you?
On 3/14/2023 the lead to my blog entry for that day was as follows:
“Practicing mindfulness and gratitude can contribute to happiness while on dialysis. Mindfulness involves being present and aware of one’s thoughts and feelings without judgment. Dialysis treatments can be stressful, and it is easy to become overwhelmed by negative thoughts and emotions. However, practicing mindfulness can help to reduce stress and anxiety levels. Additionally, focusing on things to be grateful for can help to shift one’s perspective and create a more positive outlook. It can be as simple as being grateful for the healthcare team, supportive loved ones, or even the ability to receive life-sustaining treatments.”
There is a new (not tested by me and I have absolutely no business ties to the company) website ogimi.ai that professes to provide online and free Mindfulness support for individuals.
They provide a Chrome extension for that browser and provide the following verbiage about the same:
Ogimi generates custom-guided meditations tailored to your specific needs.
Introducing Ogimi, the chrome extension for your personalized AI Meditation Coach.
Ogimi generates custom guided meditations tailored to your specific needs, allowing you to target specific challenges in your life. A consistent guided meditation practice can help you:
1. Improved focus and concentration
2. Reduced stress and anxiety
3. Shift your mindset to positivity and gratitude
4. Sleep Better
5. Increase self-awareness and process emotions
6. Improve relationships
Track your meditation practice and maintain your consistency with features
Check it out on your own. It is AI-driven so it may surprise all of us.
Friday’s April 21, 2023, WSJ page B4 ran an article by Brian Gormley titled “Startups Are Making Human ‘Organoids’ for Drug Testing.” Startups in the field include Xilis Inc., Herophilus Inc., and Parallel Biosystems Inc. Xilis uses cancer cells and aims to help inform cancer treatment decisions. Parallel creates organoids of lymph nodes, and Herophilus created organoids to model the rare disorder Rett syndrome according to the article.
The article triggered the thought for me along the lines “I wonder if Organoids are being used in kidney research, and if so, where does the research stand? A new source of kidneys and/or kidney replacement obviously could obviate the need for dialysis in the future. So this topic is of interest to those on dialysis, especially those who are much younger than I am. As I have been trained to do so in such instances, I turned to my research assistant ChatGPT for input which is included below with modest editing by Grammarly and yours truly. The first paragraph below is the Prompt I generated to quiz ChatGBP Pro, followed by the edited response. The lead picture was generated in Dalle Ai with the Prompt “provide a picture of a potential organoid used for kidney research.”
Prompt: There is a relatively new research field involving organoids. Please provide a 2000 or more-word essay with citations and end references on the use of organoids in kidney research. Consider the audience to be people on or interested in dialysis.
Title: The Role of Organoids in Kidney Research: A New Hope for Dialysis Patients
Introduction
Organoids are three-dimensional (3D) structures generated from stem cells that mimic the organization and functionality of real organs. They have emerged as a promising tool in various fields of biomedical research, including kidney research. For patients on dialysis or interested in dialysis, advancements in organoid technology offer hope for improved treatments and, potentially, a cure for kidney diseases.
This essay will provide an overview of organoids and their applications in kidney research, focusing on the potential benefits for dialysis patients. It will discuss the use of organoids in understanding kidney development, disease modeling, drug screening, and regenerative medicine.
Organoids: A Brief Overview
Organoids are 3D multicellular structures derived from stem cells that closely resemble the architecture and functionality of real organs (1). They can be generated from different types of stem cells, such as pluripotent stem cells (PSCs) and adult stem cells. By providing the appropriate environmental cues, stem cells can differentiate into specific cell types and self-organize to form organoids that mimic the organ’s structure (2).
The use of organoids in biomedical research has several advantages over conventional two-dimensional (2D) cell culture and animal models. Organoids offer a more physiologically relevant model for studying organ development, disease, and response to drugs. They can also be generated from patient-derived cells, allowing personalized medicine approaches and reducing the need for animal testing (3).
Organoids in Kidney Research
Kidney organoids have been successfully generated from both human PSCs and adult stem cells (4). These organoids contain multiple cell types found in the kidney, including nephrons, collecting ducts, and endothelial and stromal cells. Kidney organoids have been used to study kidney development, disease modeling, drug screening, and regenerative medicine.
Understanding Kidney Development
Kidney organoids serve as valuable models for studying the complex processes involved in kidney development, such as nephron formation, branching morphogenesis, and vascularization (5). By examining how organoids develop and comparing them to real kidneys, researchers can gain insights into the signaling pathways and molecular mechanisms underlying kidney development. This knowledge is crucial for understanding kidney diseases and developing new therapeutic strategies.
Disease Modeling
Kidney organoids derived from patient-specific cells provide a powerful platform for modeling kidney diseases and understanding their underlying mechanisms. For example, organoids have been used to model polycystic kidney disease (PKD), a genetic disorder characterized by the formation of cysts in the kidney (6). By generating organoids from PKD patients’ cells, researchers can study the disease’s progression and identify potential therapeutic targets.
Another example is the use of organoids to model kidney diseases caused by mutations in the podocyte, a specialized cell type crucial for kidney filtration (7). Organoids derived from patients with podocyte mutations can help researchers understand the cellular and molecular mechanisms leading to kidney dysfunction and identify potential therapeutic targets.
Drug Screening
Kidney organoids provide a physiologically relevant platform for screening potential drug candidates for kidney diseases. As they contain multiple cell types found in the kidney, organoids can more accurately predict a drug’s efficacy and safety compared to conventional 2D cell cultures (8).
For example, kidney organoids have been used to screen drugs for nephrotoxicity, a common side effect of many medications that can lead to kidney damage (9). By identifying drugs with lower nephrotoxicity, researchers can develop safer treatment options for patients.
Regenerative Medicine
Organoids hold great promise in regenerative medicine, particularly for patients with end-stage kidney disease (ESKD) who require dialysis or a kidney transplant. The generation of functional kidney tissue from patient-derived cells could potentially lead to the development of bioengineered kidneys, reducing the need for donor organs and providing a life-saving solution for patients on dialysis waiting for a transplant (10).
While the prospect of bioengineered kidneys is still far from clinical reality, significant progress has been made in recent years. For instance, researchers have successfully generated vascularized kidney organoids by combining human PSC-derived kidney cells with human endothelial cells and mesenchymal stem cells (11). These vascularized organoids displayed improved functionality compared to non-vascularized organoids, demonstrating the potential of organoid-based approaches for kidney tissue engineering.
Another promising approach involves the use of decellularized kidney scaffolds, which are obtained by removing all cells from a donor’s kidney, leaving behind the extracellular matrix (12). These scaffolds can be repopulated with patient-derived kidney cells, such as those from organoids, to create a functional, bioengineered kidney. While this approach has shown promise in preclinical studies, significant challenges remain, such as achieving the necessary cell density and functional maturity of the engineered kidney tissue.
Challenges and Future Directions
Despite the significant advancements in kidney organoid research, several challenges need to be addressed before organoids can be widely adopted in clinical settings. One major challenge is the variability and reproducibility of organoid cultures. Factors such as the cell source, differentiation protocols, and culture conditions can affect organoid morphology and functionality, leading to variability between different laboratories (13).
Another challenge is the limited maturity of kidney organoids compared to native kidneys. Currently, kidney organoids resemble fetal kidneys rather than adult kidneys, which may limit their applicability for modeling adult kidney diseases and drug responses (14). Further research is needed to optimize organoid culture conditions and protocols to achieve more mature and functional kidney organoids.
Finally, the ethical considerations surrounding the use of human stem cells and organoids should be taken into account. As organoids become more complex and closely resemble human organs, concerns regarding the potential for organoid “consciousness” or pain perception may arise (15). Clear ethical guidelines and regulations will be necessary to ensure the responsible use of organoids in research and clinical applications.
Conclusion
Organoids represent a revolutionary tool in kidney research, offering new possibilities for understanding kidney development, modeling diseases, screening drugs, and exploring regenerative medicine approaches. For dialysis patients, advancements in organoid technology bring hope for improved treatments and, potentially, a cure for kidney diseases. Although significant challenges remain, ongoing research and collaboration between scientists, clinicians, and ethicists will continue to drive progress in this promising field.
References
Clevers, H. (2016). Modeling development and disease with organoids. Cell, 165(7), 1586-1597.
Fatehullah, A., Tan, S. H., & Barker, N. (2016). Organoids as an in vitro model of human development and disease. Nature cell biology, 18(3), 246-254.
Lancaster, M. A., & Huch, M. (2019). Disease modelling in human organoids. Disease Models & Mechanisms, 12(7), dmm039347.
Takasato, M., Er, P. X., Chiu, H. S., & Little, M. H. (2015). Generation of kidney organoids from human pluripotent stem cells. Nature protocols, 11(9), 1681-1692.
5. Lindström, N. O., De Sena Brandine, G., & Tran, T. (2018). Progressive recruitment of mesenchymal progenitors reveals a time-dependent processof cell fate acquisition in mouse and human nephrogenesis. Developmental Cell, 45(5), 651-660. 6. Cruz, N. M., Song, X., Czerniecki, S. M., & Freedman, B. S. (2017). Organoid cystogenesis reveals a critical role of microenvironment in human polycystic kidney disease. Nature materials, 16(11), 1112-1119.
6. Hale, L. J., Howden, S. E., Phipson, B., Lonsdale, A., Er, P. X., Ghobrial, I., … & Little, M. H. (2018). 3D organoid-derived human glomeruli for personalised podocyte disease modelling and drug screening. Nature Communications, 9(1), 1-14.
7. Low, J. H., Li, P., Chew, E. G., Zhou, B., Suzuki, K., Zhang, T., & Xia, L. (2019). Generation of human PSC-derived kidney organoids with patterned nephron segments and a de novo vascular network. Cell stem cell, 25(3), 373-387.
8. Phipson, B., Er, P. X., Combes, A. N., Forbes, T. A., Howden, S. E., Zappia, L., & Little, M. H. (2019). Evaluation of variability in human kidney organoids. Nature Methods, 16(1), 79-87.
9. Bonventre, J. V. (2018). Kidney organoids: accurate models or fortunate accidents. Genes & Development, 32(19-20), 1319-1321.
10. van den Berg, C. W., Ritsma, L., Avramut, M. C., Wiersma, L. E., van den Berg, B. M., Leuning, D. G., … & Mummery, C. L. (2018). Renal subcapsular transplantation of PSC-derived kidney organoids induces neo-vasculogenesis and significant glomerular and tubular maturation in vivo. Stem cell reports, 10(3), 751-765.
11. Song, J. J., Guyette, J. P., Gilpin, S. E., Gonzalez, G., Vacanti, J. P., & Ott, H. C. (2013). Regeneration and experimental orthotopic transplantation of a bioengineered kidney. Nature medicine, 19(5), 646-651.
12. Przepiorski, A., Sander, V., Tran, T., Hollywood, J. A., Sorrenson, B., Shih, J. H., … & Davidson, A. J. (2018). A simple bioreactor-based method to generate kidney organoids from pluripotent stem cells. Stem Cell Reports, 11(2), 470-484.
13. Takasato, M., & Little, M. H. (2015). The origin of the mammalian kidney: implications for recreating the kidney in vitro. Development, 142(11), 1937-1947.
14. Hyun, I., Scharf-Deering, J. C., & Lunshof, J. E. (2020). Ethical issues related to brain organoid research. Brain Research, 1732, 146653.
As patients on Dialysis, we can learn a lot from US Navy SEALS and their credos. This blog will offer insights from my loose association with the SEAL Community during my 25 years in the Navy.
A recent 2023 study suggests that psychological and physiological changes are associated with training to become a Navy SEAL. No less than Steve Jobs, the co-founder of Apple Computer, suggested that to succeed, we must “Think Different.”
How do SEALs “Think Different” that, as mere mortals on Dialysis, might be to our advantage to incorporate into our merely mortal lives? Read on.
The tagline for the blog is “Never ring the bell.” This credo comes from US Navy SEAL BUDs training. When the going gets too tough for SEAL trainees, they can “ring the bell and opt-out.” They have given up. As Dialysis patients, we can’t give up. I take inspiration from the SEAL credo, “Never ring the bell.” If they can do it, so can I. At least I’m in a warm bed, and no one is shooting at me in comparison. Never ring the bell!
Another adage from a top SEAL that I have incorporated into my daily routine is making our bed upon my rising in the morning. My wife always proceeds me to take care of our Golden Retriever, Dickens. Admiral McCraven in a 2014 commencement speech at his alma mater University of Texas, spoke about many aspects of SEAL training, including making your bed every day. He stated that making your bed first starts the day off with an accomplishment extending to little things that matter. Start with little things in Dialysis that matter, like keeping your catheter area clean and tidy, and the rest will follow.
Admiral McCracken said that in SEAL training, everyone must paddle to succeed in the mission to pass BUDs. In Dialysis, you must surround yourself with a strong team that “paddles” together to keep you not only afloat but moving in the right direction. In the surf off Coronado, CA, you can’t paddle alone, nor can you in your Dialysis journey.
I’ve embedded a video of his speech at the blog’s end. Watch it. He has lots to say that pertains directly to Dialysis as well as successfully getting through BUDs and becoming a Seal.
I want to relate one more SEAL story that is personal to me. When I went through Vietnamese Language School in Coronado, CA, I had a room in the Bachelor Officers Quarters along with many SEALs. Cornado is the West Coast base for SEALs. Directly across the hall from me, door to door, so to speak, a Navy SEAL Lt was housed. We came to be on speaking terms as we came and went from our rooms. His name is Tom Norris. See this link. He is a Medal of Honor, recipient. My family had stayed in the Long Beach, CA area while I was in school in Coronado as I had orders after school to go In-Country Vietnam as an Advisor. My wife decided to bring our two boys down on a train and stay with me in the BAQ for an outing for our two sons. I related this to Tom in a casual conversation, and he informed me that he would be out of town on a mission and volunteered his room for our sons to stay in, which they did.
After my posting to Vietnam, I ran across Tom on various social occasions in Saigon. He was awarded the MOH and soon after was wounded, losing sight in one eye. And this is where the SEAL credo kicks in. Tom medically retired from the Navy but joined the FBI and qualified with small arms with one eye and met all other physical requirements, almost like a one-armed paper hanger.
The point taken from SEAL Credo is that just because we’re on Dialysis doesn’t mean that life’s over for us. As Admiral McCraven states in his commencement speech, the will to succeed is based on the size of the heart, not the size of one’s swim flippers.
It’s been an interesting week from many perspectives. (Graphic above from Designs.AI’s Illustrator. It reminds me of my Dialysis nurse for some reason.)
Our Granddaughter, who lives in the Seattle area, visited
I got tangled up in ExpressScripts bureaucratic nightmare.
My Fresenius Liberty Cycler continues, on a random basis, to illicit drain alarms and, this week, one fill alarm. For the past 15 nights, seven have had no alarms (47%), and eight have had alarms (53%). Disregarding the fourth and last drain, when I am always up and moving about, 15X3=45 possible drain alarms, of which I have experienced 10, or 10/45=22%. So more than half of the time I go to bed, my sleep is interrupted by Cycler alarms. Remember that Fresenius’ tech support is oblivious to this fact, telling me to shut off the alarms as a “fix.” What BS!
I can’t seem to articulate to my GP’s script person that I want all scripts written for a 90-day supply. Why is this so difficult to understand?
At one point, our Fresenius stock was up $5.00 per share from our by-in price. Not too shabby.
My GP script person sent a prescription to CVS for a Libre 3. But it was sent in for three, not six, covering 90 days, more or less. My CVS app shows they have been working on it since 4/13/2023. Why is it that I can buy direct from HealthWarehouse.com, which I am, and receive Libre 3s like clockwork, but the large government-contracted agencies cannot? What’s wrong with this picture?
I have a normal monthly meeting next Thursday with my Dialysis Team. I’ll share my going-in discussion points with you next week.
Our goose eggs hatched with six little ones that have been seen paddling around in our local ponds. Life does go on, even on Dialysis!
I used AI to generate the feeser.me ad is shown below, which I then posted to Facebook and Linkedin. Enjoy what AI can do for you if you can 🙂
I asked Craiyon.com to generate a picture of ChatGPT to insert in this blog. Below is what was provided. My Prompt was “picture of chatgpt.”
The most often question I receive other than “How’s it going?” pertaining to Peritoneal Dialysis, is how long does it normally last which is code for how long can I expect to live given I’m on dialysis. Trying to explain to the layman the differences between PD and Hemo quite often cause their eyes to gloss over. This blog is aimed at those one PD and/or interested in PD and answers the question “What determines how long one can expect, all else being equal, to be able to be on PD? And then what?”
First the “Then what.” At the point where it becomes obvious from quarterly lab visits that PD is not hacking it, the nephrologist should encourage the patient to get set up for Hemo as a treatment of last resort. When PD is no longer viable, Hemo is the go-to treatment. Yes, to me it appears to be going backward, but hey, it beats the hell out of being without breath and a beating heart six feet under!
As the following from my trusty ChatGPT assistant will show, PD Transport Rate and Status of the Peritoneum are determining factors in how long a patient has a chance of using PD. Shown first is the Prompt I used to quiz the AI front end, and then the result. Pretty interesting and adds context to the PD longevity question. Here goes.
Model: Default (GPT-3.5)
Prompt to ChatGPT: Consider yourself to be a trained and experienced Nephrologist. Discuss in explicit detail the longevity of Peritoneal Dialysis as relates to 1. Transport Rate and 2. Status of Peritoneum. Write in explicit concise and understandable English at the MBA level terminology in at least a 2000-word essay with citations and an end reference list.
Introduction
Peritoneal dialysis (PD) is a form of renal replacement therapy used in the treatment of end-stage renal disease (ESRD). This therapy uses the peritoneum, a thin membrane that lines the abdominal cavity, as a semipermeable membrane to remove waste products and excess fluids from the body. Unlike hemodialysis, which uses an external machine to filter blood, PD allows the patient to perform the therapy at home with the help of a catheter inserted into the abdomen.
The longevity of PD as a form of renal replacement therapy depends on several factors, including the transport rate and the status of the peritoneum. In this essay, we will discuss each of these factors in detail, along with their impact on the longevity of PD.
Transport Rate
The transport rate refers to the rate at which solutes move across the peritoneal membrane during PD. There are three types of transport rates: high, high-average, and low average. The transport rate is determined by measuring the rate at which glucose, a solute used in PD, is absorbed by the peritoneal membrane.
High transporters have a peritoneal glucose absorption rate of more than 0.81 mmol/L/h. High-average transporters have a peritoneal glucose absorption rate between 0.60 and 0.81 mmol/L/h, and low-average transporters have a peritoneal glucose absorption rate of fewer than 0.60 mmol/L/h.
The transport rate has a significant impact on the longevity of PD. High transporters have been shown to have a higher risk of technique failure and a shorter PD duration compared to low transporters. In a study of 360 patients, high transporters had a median PD duration of 17 months, while low transporters had a median PD duration of 37 months.
The reason for this difference in PD duration is thought to be due to the increased exposure of high transporters to glucose, which can lead to peritoneal fibrosis and membrane damage. This damage can lead to a decline in ultrafiltration capacity and an increased risk of infection, both of which can contribute to technique failure and the need to switch to another form of renal replacement therapy.
In addition to the transport rate, other factors such as age, diabetes, and the presence of cardiovascular disease can also impact the longevity of PD. Older patients, those with diabetes, and those with cardiovascular disease have been shown to have a shorter PD duration compared to younger patients without these comorbidities.
Status of Peritoneum
The status of the peritoneum is another factor that can impact the longevity of PD. The peritoneal membrane is a dynamic structure that can undergo changes over time, including thickening, fibrosis, and neovascularization. These changes can impact the function of the peritoneum and lead to a decline in ultrafiltration capacity and an increased risk of infection.
Several factors can contribute to peritoneal membrane damage, including long-term exposure to glucose, infection, and exposure to other toxins. Infection is a particularly important risk factor for peritoneal membrane damage, as it can lead to the development of peritonitis, a serious complication of PD that can lead to technique failure and the need to switch to another form of renal replacement therapy.
Peritoneal membrane damage can be assessed using imaging techniques such as peritoneal scintigraphy, which can measure the peritoneal thickness and blood flow. These assessments can be useful in predicting the longevity of PD and identifying patients who may be at higher risk of technique failure.
Several interventions can be used to protect the peritoneal membrane and prolong the longevity of PD. These include the use of biocompatible dialysis solutions, which have been shown to reduce peritoneal membrane damage and improve patient outcomes. Biocompatible solutions have a lower concentration of glucose and other osmotically active solutes, which can reduce peritoneal fibrosis and inflammation.
In addition to biocompatible solutions, the use of intermittent peritoneal dialysis (IPD) has also been shown to improve peritoneal membrane function and prolong the longevity of PD. IPD involves performing short, frequent exchanges of dialysis solution, which can reduce the exposure of the peritoneal membrane to glucose and other toxins.
Other interventions that may help to protect the peritoneal membrane and prolong the longevity of PD include the use of low-GDP dialysis solutions, which have a lower concentration of glucose degradation products, and the use of agents that can reduce oxidative stress and inflammation.
Conclusion
In conclusion, the longevity of PD as a form of renal replacement therapy depends on several factors, including the transport rate and the status of the peritoneum. High transporters and patients with peritoneal membrane damage are at higher risk of technique failure and may require a switch to another form of renal replacement therapy.
However, interventions such as the use of biocompatible solutions, intermittent peritoneal dialysis, and low-GDP dialysis solutions can help to protect the peritoneal membrane and prolong the longevity of PD.
It is important for nephrologists to carefully monitor the transport rate and status of the peritoneum in patients undergoing PD and to make appropriate interventions to protect the peritoneal membrane and ensure the best possible outcomes for their patients.
References:
Li PK, Szeto CC, Piraino B, et al. Peritoneal dialysis-related infections recommendations: 2010 update. Perit Dial Int. 2010;30(4):393-423.
Lameire NH, Van Biesen W, Vanholder R. The longevity of peritoneal dialysis: still an open question? Kidney Int Suppl. 2008;(108):S45-51.
Davies SJ. Longitudinal relationship between solute transport and ultrafiltration capacity in peritoneal dialysis patients. Kidney Int. 2005;67(1):237-242.
Holmes CJ, Patel PR, Perez J, et al. Peritoneal dialysis: recent advancements and future challenges. Int J Nephrol Renovasc Dis. 2019;12:223-233.
Dong J, Yuan Z, Zhang L, et al. Effects of different glucose concentrations in dialysate on peritoneal membrane function in peritoneal dialysis patients: a systematic review and meta-analysis. PLoS One. 2017;12(1):e0170535.
Krediet RT. Biocompatible peritoneal dialysis solutions: do they exist? Contrib Nephrol. 2011;173:99-107.
Peppelenbosch A, van Kuijk WH, Bouvy ND, et al. The effect of peritoneal dialysis fluid containing low glucose degradation product on peritoneal transport and markers of peritoneal damage. Kidney Int. 2004;66(3):1047-1053.
Bright and early this morning, almost at 0800, I received a direct real person phone call from a pharmacist at ExpressScripts. He attempted to explain why the script for a Libre 3 Continuous Glucose Monitor from my GP was not being filled by them. The reason he stated, was that ExpressScripts does not yet carry the Libre 3; they could however fill a script for a Libre2. Hummmm?
I attempted to relate that I received a letter from ExpressScripts stating that the reason they refused to fill the order was that my GP was just that, a GP and not a diabetic specialist. He apologized and stated that was not correct. When I told him I was buying Libre 3s directly from an online supplier, not a problem but at an out-of-pocket cost of over $200 per month he essentially wished me luck.
Keep what’s going on here in perspective. ExpressScripts’ contract with the government started in January 2023 and runs through 2029. It has value in the billions of dollars and serves over 9.6 million active-duty service members, their family members, and retirees.
Yesterday I received a letter (included at bottom of this blog as a PDF) whose logic totally escapes me. My request for Tricare to provide me with CGMs to aid in the treatment of my diabetes was turned down BECAUSE the script came from my GP, not an endocrinologist or diabetes management expert. Seems that they maintain that such people are “experienced in the management of insulin-dependent diabetics…and familiar with the operation and reports necessary for proper management of continuous glucose monitoring systems.”
The logic in this approach is totally counter to the PR the manufacturer, Abbott advertises as to how simple the CGM is to deploy and use. What operation and reports are they speaking of?
This appears to me to be just another instance of bureaucratic BS hiding behind obfuscation.
Over the weekend I received a couple of robo-calls from ExpressScripts. Recall I am having a go at them attempting to have Continuour Glucose Monitors covered. The calls asked me if I wanted to continue to wait on my doctor to get back to them on some unnamed prescription which I assume to be CGMs. Same set of scripts they told my GP rep they would not cover? What is the logic in this?
Second continuing sage is that for the last 12 days, I have had exactly five nights without any alarms. Recall this is after Fresenius tech support told me to solve the problem of nightly alarms on their Liberty Cycler to shut them off which I did. So much for their wisdom when 58% of the time I’m still experiencing alarms.
How would you like to have to get up out of bed with a line sticking out of your gut to assuage an incessant screaming of an alarm?
Yesterday was an eventful day for me, but not in a good way. Started at the breakfast table with a call from ExpressScripts (recall my military-provided pharmacy) stating that they needed to talk to my GP about two related items concerning my recent request for the Libre 3 CGM to help with my diabetic control. First, they had to confirm that no drug interaction was present. How a device that measures glucose interacts with medication is beyond my Ph.D. understanding. Second, they wanted to confirm insurance coverage. Get this: ES, which administers the military’s pharmacy program, wanted to know if the government’s pharmacy program (Tricare for Life) covered CGMs. This also escapes any logic known to humans.
So I called my GP and explained the situation to them, and they assured me they would contact ES and resolve the problem. I left home and traveled about an hour north to where our son is building an ICF (Integrated Concrete Form) home to help him install temporary electrical service in the basement/ground floor of the building where they will live until the upper stories are completed. We went to Mineral Wells, TX, for a TexMex lunch, during which I received another RoboCall from ES. This time ES stated that they had not received any contact from my GP, and if they did not hear back by the end of the business day, they would unilaterally cancel the CGM script.
I went back to calling my GP’s office, where luckily, I got hold of the nurse who had been handling my requests previously. We reviewed all past conversations with her office, by now at least five, and again she assured me she would contact ES and resolve the matter and get back to me.
Get back to me she did with the news that the ES insurance would not cover CGMs for me. So here I am, a 100%+++ retired USN Naval Officer who served at the pleasure of the President of the United States and, while doing was subjected to Agent Orange and, as a result, is on Dialysis. They denied coverage for a CGM to aid in the exact diabetes that they, the US Government, were directly instrumental in subjected me to conditions where the probability of becoming diabetic was greatly exacerbated.
The “logic” of all of this escapes me. I’ll cool my jets and see what is under the next rock. Meanwhile, my GP will contact CVS to ascertain if they will accept Tricare coverage for CGMs for me. Stay tuned. I’m certain the saga will continue.
