Henry Feeser's Peritoneal Dialysis (PD) journey

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Cognitive Decline in Dialysis Patients

February 24, 2023 / / 0 Comments
From AI Dalla-E Prompt “sketch cognitive decline dialysis patients”

This morning I received in my email the Fresenius Medical Care Newsletter – February 2023 Issue. In it, there is an article entitled Cognitive Dysfunction in Kidney Disease from the Global Medical Office Dialogues. It started off by stating “People with chronic kidney disease (CKD) often present with cognitive dysfunction ranging from mild impairment to dementia.” That got my attention. The article went on to report, inter alia, that some 70-83% of dialysis patients suffer cognitive dysfunction. Since I fall in the general population of those on dialysis, I dug deeper into this topic. Following is what my personal bot had to say. The emphasis is mine. The entire video from the aforementioned dialogue is at the blog end. Hank

Introduction

Dialysis is a treatment for patients with end-stage kidney disease. It removes waste and excess fluid from the blood when the kidneys can no longer perform these functions. While dialysis can prolong the lives of patients, it can also cause cognitive decline. According to studies, up to 70% of dialysis patients suffer from cognitive impairment, with varying degrees of severity. This blog post will discuss the causes and effects of cognitive decline in dialysis patients, as well as potential treatments.

Causes of Cognitive Decline in Dialysis Patients

The exact cause of cognitive decline in dialysis patients is unknown, but it is believed to be multifactorial. One possible cause is the accumulation of toxins in the blood. When the kidneys are not functioning properly, waste products build up in the blood, which can affect brain function. Additionally, dialysis patients often experience fluctuations in blood pressure, which can also impact cognitive function. Other factors that may contribute to cognitive decline include anemia, hypoxia, inflammation, and oxidative stress. Furthermore, depression and anxiety are common in dialysis patients, and these conditions can lead to cognitive impairment.

Effects of Cognitive Decline in Dialysis Patients

Cognitive decline can have a significant impact on the quality of life of dialysis patients. Patients may experience memory loss, difficulty concentrating, and slowed thinking. These symptoms can make it challenging to complete everyday tasks, such as managing medications, preparing meals, and paying bills. Additionally, cognitive decline can increase the risk of falls and accidents, as well as reduce the ability to perform activities of daily living independently. Furthermore, cognitive impairment has been associated with increased mortality in dialysis patients.

Diagnosis of Cognitive Decline in Dialysis Patients

The diagnosis of cognitive impairment in dialysis patients can be challenging because it may be difficult to differentiate cognitive decline from other causes of mental impairment, such as depression or delirium. Neuropsychological testing can be used to assess cognitive function, and imaging studies can help identify structural brain abnormalities. Additionally, screening tools such as the Montreal Cognitive Assessment (MoCA) and the Mini-Mental State Examination (MMSE) can be used to detect cognitive impairment in dialysis patients.

Potential Treatments for Cognitive Decline in Dialysis Patients

There is no cure for cognitive decline, but there are several treatments that may help slow its progression. One potential treatment is improving dialysis efficiency. Studies have shown that patients who receive more efficient dialysis have better cognitive function. Additionally, treating depression and anxiety can improve cognitive function in dialysis patients. Pharmacological agents, such as antidepressants and anxiolytics, may be used to treat these conditions. Finally, regular exercise has been shown to improve cognitive function in the general population, and may also be beneficial for dialysis patients. Furthermore, nutritional interventions, such as vitamin supplementation and dietary modification, have been proposed as potential treatments for cognitive decline in dialysis patients.

Conclusion

Cognitive decline is a common problem for dialysis patients, with a significant impact on their quality of life and increased mortality. The exact cause of cognitive decline is unknown, but it is believed to be multifactorial. Diagnosis can be challenging, but neuropsychological testing and imaging studies can be used to assess cognitive function. While there is no cure for cognitive decline, there are treatments that may help slow its progression. Improving dialysis efficiency, treating depression and anxiety, regular exercise, and nutritional interventions are potential treatment options. By addressing the cognitive decline in dialysis patients, we can improve their quality of life, reduce the risk of accidents, and help them live more independently.

The full video interview of the session that gave rise to this blog entry is provided below for your edification. It is roughly 28 minutes long. May you not be in this population. Hank

Social Fitness, Mindfulness, and Dialysis

February 23, 2023 / / 0 Comments

When it comes to dialysis, it’s not just about the physical aspects of the treatment. Mental health and social well-being are also crucial, and incorporating social fitness and mindfulness practices can greatly improve the quality of life for those on dialysis. Dialysis is a lifesaving treatment for those with kidney failure, but it can also be a challenging experience both physically, mentally, and socially.

Midfulness

Social Fitness

Social fitness involves engaging in physical activities with others, which not only promotes physical health but also helps build meaningful connections. For dialysis patients, social fitness can be challenging due to the restrictions of their treatment schedule and physical limitations. However, there are still ways to incorporate social fitness into their routine, such as joining a walking group or participating in chair exercises with other patients during treatment. These activities not only provide physical benefits but also create a sense of community and support.

One example of a social fitness program for dialysis patients is the Kidney Health Initiative’s “Fit for Dialysis” program. This program provides exercise videos and resources for patients to engage in physical activity during their treatment sessions. By participating in these activities, patients not only improve their physical health but also reduce feelings of isolation and improve their overall well-being.

Mindfulness

Mindfulness is the practice of being present and fully engaged in the current moment. For dialysis patients, mindfulness can help reduce stress and anxiety associated with treatment. Mindfulness can involve simple practices such as deep breathing exercises or meditation. Additionally, some dialysis centers offer mindfulness-based stress reduction programs that teach patients techniques to manage their emotions and improve their mental well-being.

One study published in the Clinical Kidney Journal showed that a mindfulness-based stress reduction program improved the mental well-being of dialysis patients. The program included breathing exercises, body scans, and mindfulness meditation. After participating in the program, patients reported lower levels of anxiety, depression, and stress.

Dialysis

Dialysis can be a challenging experience for patients, both physically and mentally. Patients may experience physical discomfort or pain during treatment, which can lead to feelings of anxiety or stress. Additionally, the strict treatment schedule and dietary restrictions can be isolating and difficult to manage.

Incorporating social fitness and mindfulness practices can greatly improve the overall quality of life for dialysis patients. By engaging in physical activities with others and practicing mindfulness techniques, patients can not only improve their physical health but also reduce stress and anxiety associated with treatment.

Conclusion

Social fitness and mindfulness practices are crucial for maintaining the mental and physical well-being of dialysis patients. By incorporating these practices into their routine, patients can improve their quality of life and create a sense of community and support. It’s important for healthcare providers to recognize the importance of social fitness and mindfulness and offer resources for patients to incorporate these practices into their treatment plans. To date, my Fresenius Team has not broached this subject matter with me at all. As research continues to show the benefits of these practices, it’s important to continue to explore new ways to support the mental and physical well-being of dialysis patients. Writing this blog is one outlet for me. Hank

Carotid Artery Checkup While On Dialysis

February 22, 2023 / / 0 Comments
Carotid arteries illustrated

Last Monday when I visited my cardiologist he suggested that it was time to again check my carotid arteries. In the past, they have been partially blocked but not to an extent to cause grievous concern. Recall that I was subjected to a triple bypass in 2015 so we keep a close watch on my pump and its associated plumbing. Yesterday I went back to his office where a tech conducted the carotid ultrasound test. Other than having the goop spread over my neck, it went well. It will be days before I hear back from the doc, if at all until the next appointment some 8 months down the road

Thought I would entertain us with what the chatbot would have to say about this test. I input “carotid ultrasound” and below is what was returned.

A carotid sonogram, also known as a carotid ultrasound, is a non-invasive imaging test that uses high-frequency sound waves to create images of the carotid arteries in the neck. These arteries are located on either side of the neck and are responsible for supplying blood to the brain.

During the test, a technician will apply a gel to the skin over the carotid arteries and use a handheld device called a transducer to send sound waves through the skin and into the arteries. The sound waves bounce off the blood vessels and create images that can be viewed on a monitor.

The images can help doctors evaluate the flow of blood through the carotid arteries and look for signs of narrowing or blockages, which can increase the risk of stroke. Carotid sonograms are often used as a screening tool for people who are at risk for stroke or who have symptoms such as dizziness or weakness on one side of the body.

Not too bad a description. I did not edit anything at all. I next did a Google on the subject and received a massive amount of hits. One of the hits, from Webmd, had this to say:

The carotid arteries are major blood vessels in the neck that supply blood to the brain, neck, and face. There are two carotid arteries, one on the right and one on the left. In the neck, each carotid artery branches into two divisions:

  • The internal carotid artery supplies blood to the brain.
  • The external carotid artery supplies blood to the face and neck.

Like all arteries, the carotid arteries are made of three layers of tissue:

  • Intima, the smooth innermost layer
  • Media, the muscular middle layer
  • Adventitia, the outer layer

The carotid sinus, or carotid bulb, is a widening of a carotid artery at its main branch point. The carotid sinus contains sensors that help regulate blood pressure. The carotid artery pulse can normally be felt in the neck by pressing the fingertips against the side of the windpipe, or trachea.

So now we all know more about carotids than we ever need to know. Tomorrow more on social fitness and what’s coming up more often in the popular press about this concept.

More liberty Cycler Alarms and More on Finding Happiness

February 21, 2023 / / 0 Comments
Call a friend

A couple of days ago I reported that by moving the tubing layout on my stomach catheter I had resolved the constant (seemingly) problem of cycler alarms while draining. Alas, such is not the case; I went a record four nights without any alarms, then for the last four, without significant alteration of the tubing configuration, I have had alarms. Looks like we’re back to the drawing board.

Last night was a bad night anyway because the constant intake of the “keep your bowels cleaned out to improve draining adage” caught up with me and I was up several times during the night confined to the bathroom. Luckily for us, I can reach both a potty and a shower while tethered.

There is an interesting article in the Wall Street Journal’s 2/21/23 issue page A11 entitled “Friends Found a Radical Cure For Loneliness: the Phone Call” by Julie Jargon. In it, she references the eight decades of research from Harvard that suggests close relationships are the most critical component of health, happiness, and longevity more so than exercise and a good diet. I blogged about this research not too long ago.

Being lonely leads to chronic stress and has been found to be more detrimental to health than being obese. Read that again and take these words of wisdom to heart!

One of the women she studied, a Ms. Doulton Wiltshire, made it a goal to have one phone call, one video call, and one in-person meetup with friends each week. I think people on Dialysis should embrace this concept. We actually receive most of our interpersonal relationships mainly with our Dialysis Team and other attending physicians. Enlarging our social circles to include reaching out to past friends and associates seems to be a way to increase engagement on our part and in so doing perhaps increase our access to the finite pool of happiness we’re all given at birth. I’m going to give it a shot.

Fresenius Liberty Cycler Setup

A Must Read: Sell Your Kidney Save My Life by Dylan Walsh

February 21, 2023 / / 0 Comments

The only viable alternative to going on dialysis is a kidney transplant. The whole deal on kidney transplants is nontransparent seeming by design. Dylan Walsh writing in the March 2023 issue of Wired Magazine lays out the ins and outs of the kidney transplant world. I have provided a link to his article therein titled “Sell your kidney, save my life.” I strongly suggest you read and study the article for a closer look at this phenomenon. Hank

Looking Back to go Forward in Peritonal Dialysis Blog

February 20, 2023 / / 0 Comments

I started this blog on January 5, 2023, and since then have made a total of 34 posts, all related to my PD journey at least in a tangential way. Today I’m going to relate a little of the behind-the-scenes data that a few of my plugins are gathering on the fly.

205 unique visitors from 15 different countries have made 590 page views or 2.88 pages per visit. Google has been the top search engine as might be expected. As shown in the graphic below, the maximum number of page views occurred recently and peaked at 69.

PAGE VIEWS DAILY

The top ten countries for participation in the blog are shown below. The United States by far has the most hits, followed by Canada but hey, people in other countries are also interested.

Top Ten Hits

Of interest is also what terms were used in searches that resulted in landings on my blog pages. See the chart below: In the chart, the search term “Fresenius liberty cycler” (45) is followed by “Liberty Cycler” (15) then “Fresenius peritoneal dialysis solution” “(10, and lastly by “Fresenius pd cycler” (8) are the top four searches. This suggests strongly that these terms are good tags for my blogs, assuming they are contained verbally therein.

Searches

The solution to Alarms on Drain Cycler Problem?

February 17, 2023 / / 1 Comment
Dickens and Amaryllis

I may have found a solution to what is the number one problem for those on Peritoneal Dialysis (PD) using the Fresenius Liberty Cycler – Drain Alarms. For those new to PD, the cycler is a computer-controlled 28-pound machine that cyclers a fluid in and out of the user’s stomach lining (Peritoneal area) during the night hours. For me, I experience four fills and four drains of 2 L each, for a total of 8 liters or a little over two gallons of a special fluid each evening.

What happens more often than not, is that during the drain cycles, the drainage slows down to such an extent that the computer throws a message in conjunction with loud warning beeps that would wake the dead that the system is draining slowly. To remedy this situation, more often than not, requires the person on dialysis to get out of bed in a vertical position, or sitting at best, until the draining reaches about 1400 mL or more before going back to bed. Why 1400 – it appears that is the drain threshold the computer is hard-wired for. So back to the solution.

Up until three nights ago, I was adjusting the fill/drain line from my catheter upwards from the entry/exit point in my stomach in a loop up through the hoop in the lanyard I wear around my neck to secure the line, then back down and out back to the cycler. Three nights ago I took the line off the lanyard, and from the access in my stomach ran it in a downward loop thence out and back to the cycler. The rudimental sketch below illustrates this. It is working for me. Further reporting to follow.

Rough sketch new cycler line run

Even Without Dialysis, A Day for the Books

February 16, 2023 / / 0 Comments
Thank God it’s over!

Yesterday was a day for the record, being on Dialysis aside. Started off with the last drain cycle hanging up and refusing to proceed. Instead, just kept beeping its slow drain message at me. I was pressed for time because I had a cardiologist appointment that I had to make. I ended up physically cutting the cycler line off just past the blue “Y” and draining the contents of my stomach into the bathroom sink as if I were doing a manual drain. At first, it drained rather slowly but soon picked up and I felt confident that a good drain resulted. I informed my team nurse of this and we decided “to watch it.” This morning and last night for that matter all went well – no alarms so whatever was going on, went away.

In conjunction with the aforementioned, received a phone call from the Fresenius driver that my monthly supply allotment was to be delivered shortly. And, being Wednesday, it was time to resupply our Ready Service Locker. Luckily for me, my wife did this, and also took care of the restocking of the resupply from Fresenius.

Off to the cardiologist where I received a good diagnosis on the state of my heart. In July 2015 I had a triple bypass, so keeping up with visits to the cardiologist for me is mandatory. Got “see you in eight months” which is always good to hear.

Next off to Fresenius in Granbury to pick up an extensive VA (Veteran’s Administration) for documenting my dialysis journey. I am in the midst of applying to the VA to increase my VA disability due to CKF from 80% to 100% and this form is part of that application. This has been a work in process since December 2022. With this voluminous folder in hand, headed home via an Auto Safety Check Station to have the yearly required Texas State Safety Check performed on our BMW X5. This is a $7.00 fee required exercise prior to registration renewal for all Texas-registered vehicles. Took only a couple of minutes and finally headed home.

Once back home had lunch, and started scanning the VA documents into PDFs then merged about 50 odd pages of my nephrologist notes, etc into a single PDF file, wrote a cover letter, and forwarded via the internet the package to the VA’s Private Medical Record facility and also to VA.gov. Was able to pet our golden Dickens for a couple of minutes, then off to recycling with the X5 where I recycled two weeks’ worth of cardboard from dialysis boxes and containers. Finally, back home, where I dined on delicious chicken fried rice my wife whooped up.

Needless to say, I slept well and thank God, the Dialysis Cycler cooperated and I had no alarms waking me up every two hours. There is a God!

VA Disability Rating for Dialysis

February 15, 2023 / / 0 Comments
VA

The Veterans Administration (VA) provides a disability rating system for veterans with chronic kidney disease (CKD) who require dialysis. This rating system is used to determine the level of compensation that a veteran is eligible to receive for their condition.

The VA rating for dialysis is based on the severity of the veteran’s CKD and the impact that it has on their daily life and ability to work. In general, the higher the rating, the more compensation a veteran is eligible to receive.

The VA uses a 100-point scale to determine a veteran’s disability rating for dialysis. The rating is based on several factors, including the veteran’s symptoms, physical limitations, and ability to perform daily activities. The VA also considers the frequency and length of dialysis treatments and any complications related to the treatment, such as infections.

A veteran with dialysis may receive a rating of 0 to 100, with 100 being the highest rating and indicating the greatest degree of disability. A veteran with a high rating, such as 80 or 100, is eligible for a higher level of compensation and benefits, including tax-free financial compensation, health care benefits, and vocational rehabilitation services.

For the record, I currently am rated at 80% Disability for DKF, or Diabetic Kidney Failure. In December 2022 I applied for an increase in rating to 100%. As with all things having to do with the VA, the request is “moving” at less than a snail’s pace, having been in review since 1/28/23.

In conclusion, the VA’s disability rating system is an important tool for veterans with dialysis who are seeking compensation and support for their condition. By considering the severity of a veteran’s CKD and the impact that it has on their daily life and ability to work, the VA provides a “fair and comprehensive evaluation” of a veteran’s disability related to dialysis.

Monthly Neprologist Meeting Plus How Long Stay on Peritoneal Dialysis

February 14, 2023 / / 0 Comments
Keep on peeing

Monday morning first thing meet with my PD team at Fresenius Granbury, TX. All went well with my lab results mostly being within specs with the exception of possibly iron which may be supplemented next month.

I received a handout from the team’s dietitian which had an interesting statement, to wit: “Avoid heart catheters. PD does not last forever, so plan with your doctor to get an access placed for hemodialysis if you don’t already have one. … should you ever have problems with your PD catheter.” To me, this begs the question, “How long could one expect a PD schema to last?”

So off to Google where I found an interesting article from healio.com titled “Can peritoneal dialysis be a long-term therapy?” The following is excerpted from this source with my clarifying info in brackets.

PD does not necessarily need to be a short-term therapy, and it has longer-term potential if the patient avoids peritonitis, leverages lower hyperosmotic dialysate, and preserves residual renal function.

The main reasons for PD technique failure include psychosocial stressors, [Psychosocial stress is caused by situations that make us feel excluded, not good enough, or as if we don’t belong.] infection, catheter malfunction, inadequate dialysis, hypervolemia  [Hypervolemia is a condition in which there is too much fluid in the blood.] and other medical conditions —e.g., uncontrolled diabetes, acute cardiovascular events, etc. Controlling reversible factors is critical to extending the time on therapy for PD patients.

Peritoneal membrane function may be extended by avoiding significant hyperosmotic [The term hyperosmotic is derived from the Greek words hyper, which means “excessive,” and Osmos, which means “push, thrust, or impulse.” ] glucose and uncontrolled diabetes; avoiding peritonitis; considering diuretics to improve urine output when possible to avoid hyperosmotic glucose solutions; and leveraging angiotensin [Angiotensin is a chemical in your body that narrows your blood vessels.] -converting enzymes, angiotensin II receptor blockers, and/ or aldosterone inhibitors to preserve both kidney and membrane function.

Historically, the ideal candidates for PD are individuals wanting to treat their kidney disease in the home and who desire to play a key role in ensuring optimal care results. These patients may be younger, but they can be of any age as long as they are interested in a home modality; employed individuals who want to stay working; and patients with residual renal function and interested in preserving urine volume.

So the answer to my question is, How long should one expect to be able to continue on PD? Is for a long time. This time is directly a function of:

  1. Keeping your catheter site clean as possible
  2. Being positive and in charge of your PD
  3. Keep on peeing.
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