As a retired US Navy officer who tangentially served on the same planet as SEALs, I am interested in what makes them tick. As a group, they endure and persevere through much pain and suffering in pursuit of their missions, somewhat like what those of us on PD face every day. In the next paragraph I’ve listed some of the sayings accredited to the SEAL community, and following that apply one to PD patients.

“The only easy day was yesterday.”
“Adapt, Improvise, Overcome.”
“Pain is just weakness leaving the body.”
“Slow is smooth, smooth is fast.”
“Be humble, be hungry, and always be the hardest worker in the room.”
“Get comfortable being uncomfortable.”
“The only person you have to be better than is the person you were yesterday.”
“Under pressure, you don’t rise to the occasion, you sink to the level of your training.”
“SEAL training is not for the faint of heart.”
“The only way is through.”

Today I’ve chosen the sixth SEAL saying to apply to PD patients. Here’s how the Navy SEAL saying “Get comfortable being uncomfortable” could be applied to peritoneal dialysis patients:

Adopting a “get comfortable being uncomfortable” attitude can help peritoneal dialysis patients persevere through challenges, adapt to changes, and maintain a positive outlook on their treatment. This mindset can be empowering and improve their overall quality of life.

Peritoneal dialysis can be an uncomfortable process, as it involves inserting a catheter into the abdomen and performing dialysis exchanges several times per day. This can be physically and psychologically challenging.

However, patients need to get comfortable with this discomfort to successfully manage their condition. The more they can embrace and adapt to the uncomfortable aspects of peritoneal dialysis, the more smoothly the process will go.

Just as Navy SEALs must train themselves to operate effectively in uncomfortable and stressful situations, peritoneal dialysis patients need to mentally and physically prepare themselves to handle the daily discomfort of the dialysis process.

Over time, with practice and a mindset of embracing the discomfort, it can become the “new normal” for peritoneal dialysis patients. What was once an unpleasant experience can become a routine part of their healthcare regimen.

Speaking of routines, my weight has edged upwards to 145.2. So starting last night and for the next couple of nights, I will be using a mixture of 1.5 and 2.5% solutions for my evening dialysis. This should bring my weight back down to the 140-1 range, where we will fall back to only 1.5% solution and start the game all over again.

According to a recent article in Politico, the FTC is going after Fresenius and Da Vita for their business practices. I’ve condensed the article to its essence in the following paragraph and provided a link to the original article at the end. Interesting reading.

The Federal Trade Commission is investigating the two largest dialysis providers, DaVita and Fresenius Medical Care, over allegations that they illegally hinder smaller competitors. The probe focuses on how the companies make it difficult for physicians working in their clinics to leave for rivals and start new businesses, through the use of non-compete agreements. The investigation examines the business models of the two companies, which control at least 70% of the U.S. dialysis market. The FTC’s action is part of the Biden administration’s efforts to curb corporate concentration across the economy. The companies say they are cooperating with the investigation and are confident it will show they have enhanced competition. The non-compete agreements under scrutiny concern nephrologists, and specialists in treating kidney disease, and restrict them from serving as medical directors in competing settings, including home dialysis, which is becoming more profitable. Home dialysis access is improving, but slowly, and the non-compete clauses can limit patient choice and treatment options.

Link to original article:

That’s the way it has been with me and PD the last several days. I have an appointment with my dialysis team come Friday, and hopefully, the saying will still hold after that. Have you ever wondered where the title saying comes from? Read on:

The origin of the phrase “No news is good news” can be traced back to the 17th century. Here are the key points about its origin:

1. The earliest recorded use of this exact expression in English is attributed to James Howell in 1640. He wrote, “I am of the Italians’ mind that said, ‘Nulla nuova, buona nuova’ (no news, good news)”[1].
2. However, a similar sentiment was expressed even earlier by King James I of England (who was also James VI of Scotland). He wrote, “No News is better than evil news” some years before Howell’s usage[1].
3. The phrase is believed to have been coined by King James I during the 17th century. He reportedly said, “No new is is bettir than evill newis” (in modern English: “No news is better than evil news”)[2].
4. The idiom has been referenced in several published works throughout the years, including James Howell’s “Familiar Letters” and Stuart and Doris Flexner’s book “Wise Words and Wives’ Tales: The Origins, Meanings, and Time-Honored Wisdom of Proverbs and Folk Sayings Olde and New”[2].

The longevity of this phrase demonstrates its enduring relevance in human communication. It reflects the common belief that if there’s no news about a situation, it’s likely that nothing bad has happened, which is generally considered a good thing[2].

Citations:
[1] https://www.bookbrowse.com/expressions/detail/index.cfm/expression_number/325/no-news-is-good-news
[2] https://grammarist.com/idiom/no-news-is-good-news/
[3] https://www.merriam-webster.com/dictionary/no%20news%20is%20good%20news
[4] https://dictionary.cambridge.org/us/dictionary/english/no-news-is-good-news
[5] https://www.theidioms.com/no-news-is-good-news/

I am a US Navy veteran. When I hit 25 years of service I had a decision to make. I had been in the procurement business in the Navy for many years. The powers in Washington that prevail decided I needed a sea tour and wanted to send me to a destroyer tender named USS Gompers as the Repair Office which is a senior billet and desirable job, if you want it. I did not. I had had enough of being away from family with three Vietnam tours under my belt.

So I had a decision to make. What to do with my life henceforth? Since I enjoyed furthering my learning I decided to go back to my alma mater, Purdue University, and earn a PhD. At this point, with a BS/MSEE and an MSM, I had to decide if I am going technical, that is pursuing a PhD in Electrical Engineering or one in Management. From my interfaces in the shipbuilding industry and all of the supporting industries to shipbuilding, I knew the shots were called by the white shirts in management in the C-suite, so I decided on Management. Management has many avenues, but one of them at Purdue was Strategic Management, the study of how managers set the path forward for companies. This is the path I choose. Since I had never had a course in Marketing, I decided to pursue marketing as my minor.

It turns out I could not have made better choices. The marketing path at Purdue required me to essentially meet the requirements of a PhD in marketing, minus the dissertation. My first job teaching at Butler University was MBA marketing.

So here I am now, approaching 40 years hence. You might ask, just what does a PhD do for you, aside from the satisfaction of obtaining one? I turned to Perplexity for some answers in data form.

I asked Perplexity “How many millionaires in the USA have PhDs?”

Based on the search results, we can infer the following about millionaires with PhDs in the USA: While there isn’t an exact figure provided for the number of millionaires with PhDs, we can draw some conclusions from the available data:

1. Approximately 3.5% of the US population are millionaires, which is about 12 million people.
2. About 1.2% of the US population holds a PhD.
3. 52% of millionaires have a master’s or doctoral degree.
4. 45% of Americans who pursue PhDs become millionaires.

Given these statistics, we can estimate that a significant portion of millionaires in the USA have PhDs, likely numbering in the hundreds of thousands to low millions. However, it’s important to note that while education is strongly linked to wealth, it’s not the sole determining factor. Other aspects, such as good financial habits, long-term investing, and managing spending well, also play crucial roles in becoming a millionaire. Additionally, the distribution of PhDs among millionaires varies across different fields, with some industries like technology, finance, and biotechnology having a higher concentration of PhD millionaires.

My wife was interested in how many millionaires do not have college degrees which is the converse of what I asked.

How many millionaires in the USA don’t have a college degree?

Based on the search results provided, we can infer the following about millionaires in the USA without college degrees: Approximately 12% of millionaires in the USA do not have a college degree. This conclusion is drawn from the statistic that 88% of millionaires graduated from college. To put this into perspective:

1. There are about 12 million millionaires in the United States.
2. If 88% of these millionaires have college degrees, then 12% do not.
3. This means roughly 1.44 million millionaires in the USA do not have a college degree.

It’s important to note that while education is strongly linked to wealth, it’s not the only factor. Good financial habits, such as long-term investing and managing spending well, are crucial for becoming a millionaire. Additionally, some extremely successful individuals, including billionaires like Bill Gates, Mark Zuckerberg, and Michael Dell, dropped out of college but still achieved significant wealth.

The conclusion from all of this, the bottom line, is that almost 50% or half of USA PhDs are millionaires. So if you desire a reasonable shot at becoming a millionaire, earn a real PhD from a university such as Purdue. Nuff said.

I was fortunate enough to have several Indian students in my classes when I taught at Purdue University. I consistently found them to be more than a cut above competing students from both other countries and certainly the USA. I ran across an article recently in the WSJ about the Indian population. The thrust of the article was that they don’t complain, don’t seek quota advantages, they just go about excelling. I used Poe to extract in bullet point format the highlights of the Indian population in the USA which is provided below. They ARE gaining on the US population in just about any important category you can imagine. Following from this link.

• Indians constitute just under 1.5% of the country’s population.
• Two Indian-Americans (Nikki Haley and Vivek Ramaswamy) competed for the Republican presidential nomination in 2023.
• Vice President Kamala Harris was born to an Indian mother.
• Indian-American CEOs run major companies like Google, Microsoft, Novartis, Starbucks, FedEx, Adobe, and IBM.
• Indian-Americans have the highest median household income in the U.S. by ethnic group, almost twice that of white households and three times that of black households.
• Two-thirds of Indian-Americans have college degrees, and 40% have postgraduate degrees.
• Indian Americans have the lowest divorce rates of any ethnic group in the country.
• Indian Americans own 60% of all hotels in the U.S.
• One in every 20 doctors in the U.S. is Indian, and 1 in every 10 students entering medical school is Indian.
• Indian deans are common at top U.S. business schools, including Chicago, Georgetown, Harvard, Northwestern, and New York University.
• Indian Americans are not known for grievances or pushing for increased “representation” or special accommodations.
• Indian-Americans are unapologetic about their drive to thrive and believe in the American Dream.

I have recently related my weight gain and my action to do something about it. In review, In a matter of days, my weight increased from 139.6 to 144.2 with no changes in ANYTHING – same diet, same exercise, same dialysis. I informed readers that I was going to start using 2.5% bags for my static afternoon fill which I did to no avail. My weight instead went up to 144.6. So, again as I previously suggested, I switched to a 2.5% static bag AND a 2.%5 6 L bag for my evening on the Liberty Cycler, along with an additional 1.5% 6 L bag. My weight with this in one evening dropped to 144.2 and the morning microfiltration was 907, up from the 28, 0, 73, and 71 on previous mornings.

I intend on continuing with the 1/5 and 2.5 % 6 L bags until my weight gets back down in the 140 +/- range, and then switch back to all 1.5% bags. I have zero confidence at this point that I won’t have to repeat the above sequence. History does have a way of repeating itself – reminds me of Churchill:

Winston Churchill famously emphasized the importance of learning from history to avoid repeating past mistakes. His well-known quote on this topic is:

“Those that fail to learn from history are doomed to repeat it.”[1][4]

Churchill delivered this line in a 1948 speech to the British House of Commons, paraphrasing an earlier sentiment expressed by philosopher George Santayana[3][4]. The full context of Churchill’s statement emphasized the need to study and understand historical events to make better decisions in the present and future.

This perspective aligned with Churchill’s deep interest in history. He was known to be an avid reader of historical works, particularly Shakespeare, Gibbon, and Macaulay[4]. Churchill believed that studying history provided valuable lessons and insights that could be applied to contemporary challenges.

Churchill put this philosophy into practice during his leadership in World War II. He drew upon his knowledge of history, including Shakespeare’s works, to inspire and guide his actions during critical moments[4]. For example, he invoked Henry V’s speech before the Battle of Agincourt to rally British resolve during the London Blitz.

The enduring popularity of Churchill’s quote reflects a widespread belief in the value of historical knowledge for informed decision-making and avoiding past errors. It serves as a reminder of the importance of learning from previous experiences, both successes and failures, to shape a better future[1][5].

Citations:
[1] https://liberalarts.vt.edu/magazine/2017/history-repeating.html
[2] https://www.medicalconfidence.com/blog/those-that-fail-to-learn-from-history-are-doomed-to-repeat-it-winston-churchill/
[3] https://www.invasiveplantswesternusa.org/history-are-we-doomed-to-repeat-it.html
[4] https://winstonchurchill.org/resources/in-the-media/churchill-in-the-news/folger-library-churchills-shakespeare/
[5] https://www.nwfdailynews.com/story/opinion/2020/06/11/letter-dont-make-me-repeat-myself-history/41983691/

For weeks my weight has been in the 139.6 – 142.2 range with UltraFiltration ranging from 493 to 2072, all this while on 1.5% solution. The last couple of days things have drastically changed. In the last three days, my weight has been 142.0, 143.0, and 144.2. Correspondingly, my UF has been 28, 0, and 73. I am retaining fluid. But this begs the question why all of a sudden? Nothing has changed with my routine, exercise, diet, dialysis, etc.

To counteract this tendency, starting tonight I’m using a 2 L bag of 2.5% for my static fill. I’ll try this, and if this doesn’t bring my readings around I’ll start mixing in 2.5% 6 L bags as needed. Recall my reluctance to use higher solutions than needed is based on my dialysis nurse informing me that higher percent solutions are harder on your stomach lining and over time can cause the efficacy of the PD process to degrade – not a good thing. So it is my overreaching goal to stay as close to 1.5% as possible.

The whole point of this blog is not the nitty gritty of my dialysis prescription, but that while the steady state is a goal, it’s not easily achieved. Things change all the time in the Peritoneal Dialysis world. We have to adapt.

Last week I blogged that I was being put on Renaplex D and I included all the good things that are associated with its intake from Perplexity. What was not included was just what Renaplex D consists of from a component viewpoint. This blog adds that information plus the results of my B12 lab are in. I have included the lab in the header. As you can see, my B12 level is smack in the middle of the lab-provided range but where we go from here I won’t know until my next team meeting in a couple of weeks. See below for what Perplexity indicates constitutes Renaplex D:

Based on the search results, Renaplex-D is a multivitamin and mineral supplement that contains the following components:

1. Vitamin D3 (2000 IU)
2. Vitamin E (35 IU)
3. Vitamin C (60 mg)
4. Thiamine (1.5 mg)
5. Riboflavin (1.7 mg)
6. Pyridoxine (10 mg)
7. Cyanocobalamin (6 mcg)
8. Pantothenic Acid (10 mg)
9. Biotin (300 mcg)
10. Niacinamide (20 mg)
11. Zinc (12.5 mg)
12. Selenium (70 mcg)
13. Folic Acid (800 mcg)[9]

The supplement also contains other ingredients such as microcrystalline cellulose, stearic acid, croscarmellose sodium, FD&C Yellow #6, magnesium stearate, and silicon dioxide NF[9].

It’s worth noting that Renaplex-D is a prescription medication used to treat or prevent vitamin deficiency due to poor diet, certain illnesses, or during pregnancy[11]. The supplement is designed to provide essential vitamins and minerals to help maintain good health and address specific nutritional needs[11][12].

Citations:
[1] https://www.pureformulas.com/product/vitamin-d3-1000-iu-by-pure-encapsulations/1000002501?skuId=PE1634
[2] https://irwinnaturals.com/products/high-potency-d3-k2-complex?currency=USD&variant=32209598775414
[3] https://www.amazon.com/Nature-Made-Vitamin-Selenium-Supplements/dp/B0B8Q83NV6?psc=1&smid=ATVPDKIKX0DER
[4] https://www.algaecal.com/products/vitamin-d3-complete/?item=DC1-V
[5] https://blueskyvitamin.com/products/vitamin-d3-5000-iu-pure-encapsulations?currency=USD&variant=41782975365304
[6] https://www.herbkart.com/vitamin-d3-cholecalciferol-supplement-5000-iu-60-liquid-filled-capsules/
[7] https://www.naturemade.com/products/vitamin-d3-maximum-strength-10000-iu
[8] https://www.ebay.com/itm/156087297795?chn=ps&mkcid=28&mkevt=1&var=456811908892
[9] https://nephrotech.com/product/renaplex-d/
[10] https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=9ac36ba6-c47e-4429-902a-3be9ef6e9d48&type=display
[11] https://www.webmd.com/drugs/2/drug-174969/renaplex-d-oral/details
[12] https://qwarkhealth.com/drugs/renaplex-d/
[13] https://www.drugs.com/sfx/renaplex-d-side-effects.html

During my lab visit yesterday, I was asked if I was taking Renaplex D to which I replied no. Later on, I received an email from my dietician stating that a script had been sent to Fresenius for this RX. Since I have never taken or heard of Renaplex D, I turned to Perplexity to find out more about it. Read on:

Renaplex-D is a multivitamin supplement specifically formulated for patients with kidney disease, including those on peritoneal dialysis. Here’s an explanation of its use for patients on peritoneal dialysis:

1. Addressing vitamin deficiencies: Patients on peritoneal dialysis often experience vitamin deficiencies due to dietary restrictions, poor appetite, and loss of vitamins during dialysis treatments. Renaplex-D is designed to supplement essential vitamins that these patients may be lacking[1][3].
2. Customized formulation: Renaplex-D contains a specific blend of vitamins tailored to the needs of dialysis patients. It typically includes higher amounts of water-soluble vitamins (such as vitamin C, B-complex vitamins, and folic acid) that are lost during dialysis and need daily replacement[3].
3. Avoiding harmful ingredients: Unlike over-the-counter multivitamins, Renaplex-D does not contain high levels of vitamins A, E, and K, which can build up to harmful levels in patients with impaired kidney function[3].
4. Supporting overall health: Regular use of Renaplex-D can help maintain proper vitamin levels, potentially improving overall health and quality of life for peritoneal dialysis patients[3].
5. Preventing complications: Adequate vitamin D supplementation, which is often included in renal vitamins like Renaplex-D, may help prevent complications associated with peritoneal dialysis, such as peritonitis[4].

It’s important to note that patients should always consult with their healthcare provider before starting any new supplement, including Renaplex-D. The dosage and specific formulation may need to be adjusted based on individual patient needs and lab results. Additionally, patients should be aware that some brands of renal vitamins may not be suitable for those with severe kidney disease or on dialysis, so it’s crucial to use only the formulation prescribed by a healthcare professional[5].

Citations:
[1] https://www.webmd.com/drugs/2/drug-174969/renaplex-d-oral/details
[2] https://www.jrnjournal.org/article/S1051-2276%2805%2900186-X/pdf
[3] https://www.davita.com/diet-nutrition/articles/basics/renal-vitamins-for-people-on-dialysis
[4] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6883549/
[5] https://www.singlecare.com/prescription/renaplex-d/what-is