Last night’s Cycler performance did not fail us; it did however fail. I received the same drain alarm on the cycle 1 drain as during the previous night’s usage. The above Cycler screenshot of detailed “My Records” shows cycle 0 had a drain as predicted yesterday. Going down the columns, All cycle fill volumes, as are the times, are reasonable. The dwell time, supposed to be 120 minutes/2 hrs, is inconsistent. Why was cycle 1 133 minutes? Regarding drains, note that the first three drains left fluid in my gut, thus the negative UF (Ultra Filtration, negative indicates fluid left it, positive taken out) readings. Note especially the last drain of 3178 taking 29 minutes. I was up and moving around during this drain, probably resulting in it being quite large and positive. Something is not right in Dialysisville.

In a March 22, 2023 article in SciTechDaily linked here, there was an interesting research report titled “Stay Sharp: Healthy Lifestyle Linked to Slower Memory Decline in Older Adults”

The researchers found that each individual healthy behavior (healthy diet, regular exercise, active social contact, cognitive activity, non-smoking, and never drinking alcohol) was associated with a slower-than-average decline in memory over ten years after accounting for other health, economic, and social factors. A healthy diet, cognitive activity, and physical exercise strongly affected slowing memory decline.

Since cognitive impairment is of central concern to dialysis patients, the research strongly suggests eating right, using your brain, and doing physical exercise. However, we all know this, right? Getting it done is another matter.

The second research article I recently read has to do with the Widowhood Effect. With the widowhood effect, older adults grieving a spouse’s death have an increased mortality risk compared to those whose spouses are living. This effect has even been documented by researchers. A 2013 study that appeared in the Journal of Public Health showed that people had a 66% higher risk of dying within the first 90 days of losing their spouse. This discovery held true for both men and women.

An article on March 22, 2023, in Time BY HALEY WEISS titled “Losing a Spouse Makes Men 70% More Likely to Die Within a Year,” found that Gender and Age were two of the most influential risk factors for the widowhood effect. So if you are on Dialysis and want to beat the odds of dying within 4.5 years of going on the treatment, take good care of your spouse else you are a dead duck.

By the way, our goose is still in her nest in one of our gutters. Many people are interested in her activities up and down our street.

As stated in my blog entry last Friday, yesterday (Monday), I called Fresenius Tech Support concerning the seemingly continuous throwing of drain alarms by my Liberty Cycler. We spent over 20 minutes with the tech rep requesting data from various cycler screens. As of the phone call, the cycler was throwing drain alarms for exactly 50% of the evening dialysis treatments. Let me explain this so those not acquainted with the cycler have a little more insight into what I’m talking about.

The Cycler is a computer-controlled pumping device that controls the three phases of my evening dialysis treatment. After turning on and plugging my catheter into the cycler, it first checks to see if any fluid is left in my stomach cavity and if so pumps it out. It defaults to 50mL or more of such fluid. If there previously had been a “good” drain, the machine can’t remove at least 50mL of fluid so guess what, yes, it throws an alarm. You have to manually bypass this phase to move on.

From here on what takes place depends on what your nephrologist has ordered. From me, I am on 8000 mL total fluids, pumped in and out of my stomach lining 2000mL at a time, for four cycles total. So initially 2000mL is pumped in – called “fill,” which is left in my lining for two hours – called dwell, then pumped out – called a drain. Each fill is supposed to take 10 minutes, and each drain is 20 minutes. If you add up the total fill times 4×10=40 minutes and drain 4×20 = 80 minutes, you have 120 minutes or two hours ideally spent on fill and drain, plus 4×2 hrs = 8 hrs total dwell. So altogether, 10 hours in an ideal world. My best time is 10 hrs 11 minutes, and the worst is right at 11 hours. The problem is with the drain. For me, as previously stated, 50% or more of the time my system has problems with drains. Is it me, the cycler, or God knows?

On the me vector, I have been doing EVERYTHING my team has suggested. We tested my plumbing, and everything is working properly. I am on my second cycler; I have read that some patients have gone through more than 10 with drain problems. The internet is full of complaints by patients concerning drain problems with the Fresenius Cycler. The PR fluff Fresenius has released on their new cycler touts improvement in this area which is moot acknowledgment on their part of the cycler’s intrinsic problems with the current cycler. I guess other than the cycler, it’s in God’s bailiwick.

This morning I received a call from my Dialysis Team Nurse who had been contacted by Fresenius Tech Support. The bottom line is this: Tech Support’s solution to grossly excessive alarms is to turn them off. I was directed to a section in the Cycler manual called “Flow Alerts” wherein it states that if both flow alert and flow alert sound are set to “NO” the sound will not occur, but the cycler will display an alarm when you are draining or filling slowly. So I fired up my Cycler, went to the proper panel, and turned off the flow alert, defaulting the sound to N/A. Note the differences between what the manual stated needed to be accomplished and what took place on my Cycler.

Regardless, the alarm is now off, and we’ll soon know what effect this “fix” has. I’m going to watch what happens to the overall time I’m on the cycler. I suspect it will increase, perhaps drastically, because I’m not getting up to increase the drain flow as I have in the past. We’ll see, and I’ll report back.

CGM: Last week I had a conversation with my online pharmacy, ExpressScripts about an unrelated matter. Upon conclusion of this call, I inquired about their provision of Libre3 CGMs. I was assured that they either have them or will provide them when presented with a valid prescription by my doctor. I call my GP who sent them a script yesterday. My ExpressScripts app notified me they had received a script to fill. Today I received notification from ExpressScripts that a “Prior Authorization Required” has to be in place before they can ship my CGM order. My benefits plan must be approved through prior authorization to ensure my plan covers this medicine.

It looks like governmental red tape is taking over. Meanwhile, I’m paying $204.xx out-of-pocket for the Libre 3. I’ll keep you posted.

Hank

s

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Since I am a Peritoneal Dialysis user/patient, I must have a rudimentary understanding of the history behind this life-saving procedure. Thus, the following blog entry: Please note the many links included in this blog entry to explain the terms and concepts introduced.

Introduction:

Peritoneal dialysis (PD) is a life-saving treatment for patients with end-stage renal disease (ESRD). The history of PD dates back to ancient times when physicians used peritoneal lavage as a therapeutic tool to treat patients with abdominal infections. However, the modern use of peritoneal dialysis for the treatment of renal failure started in the 20th century. This blog will discuss the history of peritoneal dialysis, from its inception to the present day.

Ancient Times:

Peritoneal lavage was first described in ancient Greek medical texts as a treatment for abdominal infections. In the 1st century AD, the Roman physician Asclepiades used peritoneal lavage to treat a patient with peritonitis. This involved injecting warm water into the peritoneal cavity and then draining it out. The use of peritoneal lavage continued through the Middle Ages and the Renaissance, but it was not until the 19th century that peritoneal dialysis began to take shape as a medical procedure.

19th Century:

In the 19th century, the Italian physiologist Carlo Matteucci conducted experiments in which he injected saline solution into the peritoneal cavity of dogs and observed the osmotic transfer of fluid across the peritoneal membrane. In 1856, the German physiologist Carl Ludwig described the transfer of fluids and solutes across the peritoneal membrane in his book “Physiology of the Circulation.” However, it was not until the early 20th century that peritoneal dialysis became a practical treatment option.

Early 20th Century:

In the early 1900s, Russian surgeon Dimitri Ivanovich Abrikossoff used peritoneal lavage as a treatment for uremia. He injected saline solution into the peritoneal cavity of patients with renal failure and then drained it out. Although Abrikossoff’s technique was not very effective, it laid the foundation for using peritoneal dialysis to treat renal failure.

In 1923, the American surgeon Leonard Rowntree and his colleagues at the University of Minnesota performed the first successful peritoneal dialysis in a dog. They injected saline solution into the peritoneal cavity of a dog with uremia and then drained it out. The dog’s condition improved, and it lived for several months after the procedure. Rowntree and his colleagues then performed peritoneal dialysis on a patient with renal failure, but the patient did not survive the procedure.

Mid-20th Century:

In the mid-20th century, several advances in peritoneal dialysis technology were made. In 1959, the Dutch physician Willem Kolff and his colleagues developed the first commercial peritoneal dialysis machine, the Kolff-Brigham dialysis machine. See the picture below. This machine used gravity to circulate the dialysis solution through the peritoneal cavity. In 1965, the American nephrologist Henry Tenckhoff developed the Tenckhoff catheter, which is still used today for peritoneal dialysis.

Late 20th Century:

In the late 20th century, peritoneal dialysis became a widely accepted treatment for ESRD. In 1976, the National Cooperative Dialysis Study showed that peritoneal dialysis was as effective as hemodialysis in the treatment of ESRD. In 1980, the International Society for Peritoneal Dialysis was founded to promote the development of peritoneal dialysis as a treatment for renal failure.

Current Era:

In the current era, peritoneal dialysis remains an important treatment option for patients with ESRD. In 2016, there were approximately 240,000 patients worldwide receiving peritoneal dialysis, with the majority of patients living in developing countries.

Advancements in technology have improved the safety and effectiveness of peritoneal dialysis. Newer machines use automated cycling to circulate the dialysis solution through the peritoneal cavity, reducing the risk of infection and improving patient outcomes. Additionally, the development of newer dialysis solutions has improved the removal of waste products from the blood.

Conclusion:

Peritoneal dialysis has a long and storied history, dating back to ancient times. The modern use of peritoneal dialysis for the treatment of renal failure started in the 20th century, with the development of peritoneal lavage techniques and the first successful peritoneal dialysis procedures. Advancements in technology and the widespread acceptance of peritoneal dialysis as a treatment for ESRD have improved patient outcomes and made peritoneal dialysis an important treatment option for patients around the world.

References:

1. Golper, T. A., & Piraino, B. (2015). Peritoneal dialysis: Its history and current status. American Journal of Kidney Diseases, 66(5), 932-936. doi: 10.1053/j.ajkd.2015.07.008
2. Bleyer, A. J., & Diaz-Buxo, J. A. (2002). The history of peritoneal dialysis. Journal of the American Society of Nephrology, 13(Supplement 1), S23-S28. doi: 10.1097/01.asn.0000031473.60357.2b
3. Oreopoulos, D. G. (1996). Peritoneal dialysis: A personal history. Peritoneal Dialysis International, 16(Supplement 1), S12-S18.
4. Krediet, R. T. (2008). Peritoneal dialysis: From its origins to the twenty-first century. Kidney International, 73(Supplement 108), S3-S12. doi: 10.1038/sj.ki.5002713
5. Li, P. K., Szeto, C. C., & Piraino, B. (2016). Peritoneal dialysis in the modern era: How did we get here and where are we going? American Journal of Kidney Diseases, 68(4), 692-699. doi: 10.1053/j.ajkd.2016.05.020