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Medicines for Peritoneal Dialysis

February 13, 2023 / Henry Feeser / 0 Comments

At my monthly meetings with my Fresenius Team, I am provided an “education” module having to do with some aspect of Dialysis. This month, I was given Module 7, Medicines: Tools for Good Health. In the following blog, I am going to excerpt tidbits that should be of interest to those interested in all aspects of Dialysis.

Regarding OTC medicines
- Watch out for herbal or other natural home remedies. They can build up and make you sick or even be life-threatening
Never take these OTC medicines:
- Alka Seltzer, baking soda, or other bubbling remedies. These are high in sodium.
- Antacids containing magnesium (Milk of Magnesia) or aluminum (Mylanta). These chemicals can build up and cause nervous system problems.
- Aspirin unless ordered by your doctor. May cause bleeding.
- Enemas and laxatives unless prescribed by your kidney doctor – they are high in phosphorus
- Vitamins or food supplements. They may have potassium and magnesium in them that build up in your blood.
- Any herbal medicines and OTC medicines without prior approval from your kidney doctor.
Phosphorus
- Hi phosphorus and low calcium levels can lead to serious bone disease.
- Too much phosphorous gets into your skin and may cause very bad itching. It can also get into your heart and cause heart disease.
- Kidney disease upsets the balance of phosphorus and calcium in your body. The balance of phosphorus and calcium works like a seesaw. When one goes up the other goes down. Your goal is to restore the balance.
- Phosphorus binder medicines taken with iron pills will prevent the iron from getting absorbed by your body. If you take iron pills, take them at least one hour before or after your phosphorus binders.
Antibiotics and CKF:
- When your kidneys stop working, they can no longer filter drugs out of your bloodstream. For this reason, antibiotics may build up to dangerous levels in your body.
- As your Kidney Doctor about any antibiotics you get from another doctor
- Tell your Kidney Doctor about dental work or other surgery you will be having.
Medicines for PD Patients:
- Heparin may be given to help stop protein strands from forming. These strands called fibrin may clog the catheter which blocks the flow of dialysate solution in and out of your abdomen.
- Epogen is administered as a small shot under the skin.
- Iron may be prescribed as IV-delivered or as a pill.
- Vitamin D in pill form is often prescribed in pill form also.

On Dialysis while sick

February 10, 2023 / Henry Feeser / 0 Comments

Two days ago, I was in the shower and about to get out when I started to feel worse. Upon getting out of the shower, I started feeling like I had cotton between my ears. It went downhill from there. Made it until bedtime – early – and with lots of help from my wife managed to get hooked up on the PD Cycler. Of course, it picked this time to throw drain alarms throughout the night.

The next morning checked in at our GPs office and received meds and a shot for vomiting to treat my upchucking about every four hours. Because of the condition, I’m in (see the video below), I canceled my Team Meeting at Fresenius. I attempted to schedule a Tel-Conference to no avail. Fresenius told me they no longer are doing Tel-Conference and I would have to reschedule. Appears corporate or whoever is looking out for other than their patients in this regard.

Today my goal is to walk up and down the long hallway in our home to try to build some strength. I just took a B12 shot so maybe this will help also. Hopefully, I’ll be back in battery come Monday.

My Dialysis Labs with Fresenius

February 8, 2023 / Henry Feeser / 0 Comments

Yesterday I visited Fresenius local to have labs pulled. Today they were available via the Fresenius PatientHub App. In this blog, I will discuss seven of the results. Screenshots of the actual app readings follow the comments.

Albumin 3.7. Staying flat. Watch.

Calcium 8.9. Bounce up. Looks good.

Phosphorus 5.0. The body responded to binders. Continue taking.

Potassium. 4.6 Slightly uptrend. Watch. May have to cut back on tomatoes.

iPTH 239. Looking Good.

BUN 54. Increasing. Not removing enough urea nitrogen from blood? Question Neprologist during this Friday’s Team Meeting??

Creatinine 6.09. Flat. Equates to an eGFR of 8. Snore.

In tomorrow’s blog, I intend on discussing more Peritoneal Dialysis and drugs per se insights.

Peritoneal Dialysis Monthly Labs by Fresenius

February 7, 2023 / Henry Feeser / 0 Comments

Yesterday @ 0830 CST I visited my local Fresenius Medical facility in Granbury, TX for labs. This blog relates what took place during my visit.

Valentine’s Day is just a short week away. To thank five of the members of my Fresenius dialysis teams, both Hemo and PD, my wife and I bought Valentine cards, candy, and Hoffbrau Restaurant gift certificates for them. I handed the gifts out on the way into the clinic. They were very well received which is always a good feeling.

Straightaway I wan logged in and provided biometric data – Weight, blood pressure, pulse, glucose, and temperature data, and the USB drive from the Cycler that I had removed prior to leaving home. I then signed several forms to catch up on paperwork for Fresenius, there is always paperwork to catch up on, provided my two insurance cards – Medicare and my military ID for Tricare for Life, and signed some more forms.

I was then shifted to a treatment room where I removed my coat and sweatshirt, was seated and attended to by my dialysis nurse and another nurse. The second nurse drew blood samples and gave me two shots, one my last hepatitis B shot, and the second a Pneumovax shot. My dialysis nurse meanwhile asked me a battery of questions to ascertain my general health and well-being, listened to my heart and lungs, thoroughly inspected my feet, and visually and digitally inspected my stomach catheter area. I was provided a sheet with March’s appointments, and my monthly education package, this time Module 7, Medicines; Tools for Good Health.

I was then sent on my way but had to return as I forgot to pick up a replacement USB drive for the Cycler.

I also noted the Glucose reading on my Libre 3 as being 100 at the time the blood sample was drawn, and the corresponding BMI (remember poor man’s A1C reading) was 6.1%. When my labs come back, probably tomorrow, we’ll compare readings. I had my biometric watch on but forgot to take a reading from it.

When my labs come in, we’ll discuss in some detail what the findings are. For now, I feel great, good, awesome.

Peritoneal Dialysis Labs: An In-Depth Overview

February 6, 2023 / Henry Feeser / 0 Comments

On Monday 2/6/2023 I am scheduled to have my monthly lab work done at Fresenius Medical Center in Granbury, TX. I thought it would be appropriate to blog about what these tests are all about in a general nature, followed by more specifics of my personal results. So here goes:

Peritoneal dialysis (PD) is a form of renal replacement therapy that is used to treat patients with end-stage renal disease. It involves the use of the patient’s own peritoneal membrane, which is the inner lining of the abdominal cavity, as a filter to remove waste products from the blood. This process is performed through a series of exchanges that are done several times a day, typically at home. For me, I do four exchanges or two hours duration each.

One of the critical components of PD is the use of dialysis solution, which is a sterile solution that is instilled into the peritoneal cavity through a catheter. This solution works by drawing waste products from the blood into the peritoneal cavity, where they are then removed during the next exchange. To ensure the safety and efficacy of the dialysis process, it is essential to regularly monitor the dialysis solution and the patient’s response to it. This is where peritoneal dialysis labs come in.

What are Peritoneal Dialysis Labs?

Peritoneal dialysis labs are specialized facilities that are designed to monitor and evaluate the quality of the dialysis solution and the patient’s response to it. These labs typically use state-of-the-art equipment and technology to perform a series of tests that help to assess the concentration of waste products, electrolytes, glucose, and other important parameters in the dialysis solution and patient’s blood. For me, Fresenius uses spectra laboratories out of Southaven, MS to conduct the labs. At least that’s the letterhead on my lab reports.

The main objective of peritoneal dialysis labs is to ensure that the dialysis solution used in PD is both safe and effective. To achieve this, they perform several key tests, including:

Dialysis Solution Glucose Concentration Test: This test measures the concentration of glucose in the dialysis solution, which is critical to the success of PD. If the glucose concentration is too high or too low, it can affect the efficiency of the dialysis process and cause adverse effects such as hypoglycemia or hyperglycemia.
Peritoneal Equilibration Test (PET): The PET test measures the rate of transfer of glucose and other solutes between the blood and dialysis solution. This test helps to determine the effectiveness of the dialysis solution and the patient’s peritoneal membrane.
Dialysis Solution Electrolyte Concentration Test: This test measures the concentration of electrolytes in the dialysis solution, including sodium, potassium, and calcium. It is important to maintain a proper balance of these electrolytes to ensure the safety and efficacy of PD.
Bacterial Culture Test: This test is performed to assess the presence of bacteria in the dialysis solution. Bacterial contamination of the dialysis solution can cause severe infections, and regular monitoring is critical to prevent this from happening.

The results of these tests are used to adjust the dialysis solution and the patient’s treatment plan, ensuring that the PD process is both safe and effective.

Benefits of Regular Monitoring by Peritoneal Dialysis Labs

Improved patient outcomes: Regular monitoring of the dialysis solution and the patient’s response to it helps to ensure that the PD process is effective and that the patient is receiving the best possible care. This, in turn, leads to improved patient outcomes, including better control of waste product levels, improved electrolyte balance, and a reduced risk of infections.
Increased patient comfort: Regular monitoring helps to identify and address any issues or adverse effects that may be affecting the patient’s comfort and well-being. This helps to improve the overall quality of life for patients undergoing PD.
Improved safety: Regular monitoring by peritoneal dialysis labs helps to ensure that the dialysis solution is used.

In a following blog we’ll discuss my actual labs, what they mean to me, and how I respond to them if at all.

Using the LIBRE 3 for Glucose Control While On Dialysis

February 3, 2023 / Henry Feeser / 0 Comments

We laid out the need for continuous tight diabetic control both before and subsequent to going on dialysis in previous blogs. While a pain in the rear, it is something that diabetics in general, and those with DKD (Diabetic Kidney Disease) MUST deal with.

In general, there are two ways to ascertain one’s degree of diabetic control, either via pricking the skin, gathering a blood sample with a test strip, and reading the resulting glucose with a device. Of course you could go to a lab, have blood drawn, and receive standardized results in a few days.

The second and more recent methodology is via a CGM (Continuous Glucose Monitor.) Yesterday I blogged about a third emerging methodology embedded in watches. I am currently using the Libre 3 Freestyle by Abbott and a watch. It is a follow on to their Libre 2 system which I also used for three months and is a vast improvement in many ways. BTW, Libre comes from the Latin word līber, via the French and Spanish libre; it shares that root with liberty. It denotes “the state of being free”, in the sense of “having freedom” or “liberty”. I’m certain in a marketing sense the word Libre somehow applies herein.

The Libre 3 system is more accurate, does not require an external reader, has an improved app, provides more or less continuous readings, and also provides a form of A1c readings named GMI (Glucose Management Indicator in mmol/mol%) as compared to its predecessor. It is night and day superior to finger pricks. While this is not a sales pitch for this system, it should be recognized that there are several competing products available; I’m just hands-on with the Libre. A quick Google will extoll its virtues for those interested.

Following are some screenshots of what I consider to be useful from Libre3. I use it daily, probably at least six times a day to check my glucose levels. It is often surprising how the body reacts from a glucose viewpoint to the intake of food and beverages and exercise. Just getting up in the morning results in a rising glucose level. It should also be noted that I pay for the Libre 3 system out-of-pocket. Since I take insulin only once a day, currently 8 units of Lantus, I am not eligible for ANY insurance support be it Medicare, Tricare For Life, or VA. It is costing me roughly $210/month for two senders which last 14 days per sender. To me it is more than worth the cost.

The Case for Strong Diabetic Control Before and While On Dialysis Using the E400 Smart Watch

February 2, 2023 / Henry Feeser / 0 Comments

A strong case has been made in a preponderance of reviewed medical journals that diabetes is the primary and number one predictor of a future requirement to go on dialysis. See stats in the table below from CDC here: The extreme need for close diabetic control does not end once a person goes on dialysis; if anything, because PD at a minimum requires dumping a sugar solution into one’s stomach, it becomes even more critical.

For adults with diagnosed diabetes:
- 69% had high blood pressure, and 44% had high cholesterol.
- 39% had chronic kidney disease, and 12% reported having vision impairment or blindness.
- Diabetes was highest among Black and Hispanic/Latino adults, in both men and women.

This blog is not about the how-to of diabetic control, but about one of the new tools just hitting the market to ascertain the degree of control, that is, how is my “blood sugar/glucose doing?”

Coming out of China is a new class of wearable devices in the form of a wristwatch at a very reasonable price called smart watches, or bio watches. They are generally available from Temu.com/App, Aliexpress.com, etc. for about $40.00. I have purchased two from Temu.com via their App for $39.62. See the Graphic below for all they are purported to be able to measure from here: The watches are based on the GR5515 chip and are Model E400 from Vanssa in China. Scroll down this link for more info on all the watch purports to do:

I have been using the watch’s many functions in parallel with my go-to standard blood pressure, O2, temperature, and glucose (I use the Libre 3 CGM) as comparisons. I find some of the readings to be right on, and others to be somewhat consistent. It should be pointed out that the documentation that comes with the device explicitly states they are NOT to be used for medical purposes – yet I might add. As the video describes below, they are great for trends. I have found the E400 watch to be a great addition to a bag of tools for the diabetic/person on dialysis used in conjunction with the associated H Band App. Please watch the video embedded below for an independent review of the E400.

My next blog will discuss using the Libre 3 CGM for diabetic control while on dialysis.

Helpful Dialysis App plus Supply Admin

February 1, 2023 / Henry Feeser / 0 Comments

Today’s blog is about several actions taken this morning. First, it is Wednesday, so I needed to replenish my Ready Service Locker (RSL) with a week’s worth of Cycler dialysate bags and cassettes. From our bulk storage in our spare bedroom closet, I moved 7 cassettes, a 4-container box of 1.5% dialysate, a 4-container box of 2.5% dialysate, and 4 boxes of 2 in each box of 5 L 1.5% dialysate. See the photo below. I had already stowed one box of the 5 L dialysate when I took the photo.

Fresenius Medical provides an adequate albeit somewhat slow App named “PatientHub” for PD patients to use to communicate with their teams, order supplies, enter biometric information, and a host of other activities. I recently reported that the Hub->Menu->Vitals Graphs path was not working. Furthermore, I received guidance from a Fresenius Rep that it only worked if you entered your biometric data into the app itself. Additionally, I came to find out that my team members rely on biometric data being entered into the Cycler which is then also entered into the USB drive inserted into the Cycler which I sneaker-net into the team periodically. If I did not enter data into the Cycler, my team would not receive the data. If I do not enter the data into the app the Vitials Graph function is inop. I figured out a way to solve this dilemma via the app by lying to it that I had not entered any data into the Cycler although I had, which brought up a biometric data entry screen into which I entered data daily. It worked and now the Vitals Graphs portion of the App is useful – to some extent. Below are examples of the App itself on my S20 Samsung phone, the data entry screen, and screenshots of the data graphs, with the timeframe set to 7 days. A 30-day option is also available. I also used the App to order supplies this morning.

7-day Glucose AM glucose readings upon rising

Tomorrow we’ll journey back to the diabetic side of PD and discuss the tools I use to monitor my Glucose levels and also A1c levels. Stay tuned.

Diabetes and Dialysis: What You Need to Know

January 31, 2023 / Henry Feeser / 0 Comments

Diabetes is a serious health condition that affects millions of people worldwide. For those with diabetes, managing the disease can be a complex and challenging task. For those with diabetes and end-stage renal disease (ESRD), dialysis can be an essential part of their care. In this blog, we’ll discuss the connection between diabetes and dialysis, and what patients need to know to stay safe and healthy.

Diabetes can cause a number of complications that can lead to the need for dialysis, including hypertension, heart disease, and nephropathy. (I have all three, having gone through a triple bypass in 2015.) Nephropathy, or kidney disease, is a major complication of diabetes and can cause ESRD. When ESRD occurs, dialysis is necessary to keep the patient alive.

I was first diagnosed as a diabetic in the early nineties via a glucose tolerance test while on active duty in the Navy. I was first diagnosed with the real possibility of Chronic Kidney Failure in the early 2000 timeframe. My diabetic condition progressed from control with diet and exercise to oral meds to insulin plus oral meds until the present day. Same with ESRD only doctors just stated “we’ll watch it.” What they meant was it was going to happen and we’ll just watch it happen. For me, diabetes and dialysis have been a fact of life, that is sooner or later…….

There are two types of dialysis that may be used for those with diabetes: hemodialysis and peritoneal dialysis. The general populace is often confused by this distinction, thinking only that one goes to a dialysis center three times a week for a couple of hours. Hemodialysis involves using a dialysis machine to filter the blood outside of the body. I underwent hemo as it is called for about six weeks while I was getting set up and moving through the queue for peritoneal dialysis aka PD. It is miserable and time-consuming, and a cold experience wipes you out, and I wouldn’t wish it on anybody including my worse enemies (if I had any which I don’t.)

“Although the ancient Egyptians were the first to describe the peritoneal cavity in approximately 3000 BC, the concept of peritoneal dialysis is relatively new. In the late 19th century, Wegner, a German investigator, was the first to use peritoneal solutions in animals.” From here: The solution used is called dextrose dialysate, or dextrose, or more formally dialysate.

What I use is a 1.5% or 2.5% Dextrose solution of Hydrous Dextrose, Sodium Chloride, Sodium Lactate, Calcium Chloride, Magnesium Chloride, and water. 8000 mL or 8 liters of this fluid is pumped into my Peritoneal cavity via a catheter in my stomach 2 liters at a time. When filled it remains there for two hours (dwell) and then is pumped back out (drain.) This takes place four times every night, seven days a week. This is all controlled by the Liberty Cycler apparatus.

Ideally, the drain takes place at 100ml per minute, or 20 minutes for the entire individual drain process. If you add up four dwell periods of two hours each, and four drains at a minimum of 20 minutes each (this rarely happens in this short a timeframe), you end up with eight hours of dwell, and 80 minutes or one hour and 20 minutes of the drain, for a total time on dialysis ideally of nine hours and 20 minutes. This NEVER NEVER happens. With me, it is more like 10 hours and thirty minutes every night. Add to this setup and tear-down times and you can see that PD requires lots of time to accomplish.

Dialysis is not a walk in the park, but short of a kidney transplant, there are no other solutions currently available. I did read that research into using printed kidneys is currently underway. Sign me up. In a follow-up blog, I intend to discuss in more depth the diabetic side of the diabetic dialysis balance.

While on Dialysis: Do the things you love!

January 30, 2023 / Henry Feeser / 0 Comments

INC ran an article that explored what gives people the greatest happiness in life. The article suggests “Do the things you love” is central to happiness in life. That got me thinking about how the concept applies to my situation – being on Peritoneal Dialysis and by extension readers of this blog who are also being provided life support via dialysis.

How can we, with the constraints of dialysis, “Do the things we love?” I have found dialysis treatment does not, at least for the most part, affect my life to any great extent so far. Travel is an exception requiring more preplanning and effort.

So what things am I doing that I love while on dialysis?

It’s winter in North Texas so I’m planning for Spring gardening. Looking at Burpee’s seed catalog. Reviewing what went well last year and not so well.
The Rolex 24 Race has just been conducted this past weekend. As an ex-Porsche racer, I enjoy the racing season starting up again
My wife and I are always looking for new food to prepare at home new dishes and new tastes. Yesterday we prepared a couple of filet mignon steaks by first searing them in an iron skillet, then finished cooking them in the same skillet in the oven and topped them with homemade herb butter. We found them to be superior to any we had had anywhere in the world previously.
The deer here in our locale Pecan Plantation have been breeding and laying down for the night in our yard. Always a satisfactory sight to behold.
I enjoy writing this blog and learning more about the ins and outs of dialysis. There is no straight and narrow path I’m beginning to ascertain.
As an engineer, I’m very interested in the rollout of AI-based tools for writing, art, and composition and am exploring Chat in its various forms as we speak. Also, art apps. In the short term, I plan on investing in AI startups when it becomes financially prudent to do so.
We have a seven-month-old Golden Retriever named Dickens. Seven days a week come rain, shine, sleet, or hale I take him to our Dog Park and also walk him for about ¾ of a mile. Good for him and better for me. My wife walks him at night for ½ hour or so. Training-wise, he is a work in progress so this is a constant challenge. As I write this he is asleep on my left foot – never far away and always in touch. That’s what Goldens do.

Like the Statler Brothers in their popular song “Flowers On the Wall,” don’t tell me I’ve nothing to do!”

The Statler Brothers – Flowers on the Wall – YouTube

Henry Feeser's Peritoneal Dialysis (PD) journey