An author named Andy Andrews has a book out about an individual who is a “noticer.” Here’s some detail on the concept:

The concept of being a “noticer” refers to the ability to observe and pay attention to the small, often overlooked details in one’s surroundings and daily life. Here’s a more detailed explanation of what it means to be a “noticer”:

Heightened Awareness:
Noticers cultivate a heightened state of awareness, constantly scanning their environment and attuning themselves to the subtleties that often go unnoticed by others.
They are keenly observant, taking in the sights, sounds, smells, and sensations around them with a level of sensitivity that allows them to perceive the world in a more nuanced way.
Attention to Detail:
Noticers have a natural inclination to pay attention to the small, seemingly insignificant details that others might overlook or dismiss as unimportant.
They might notice the way the light filters through a window, the unique patterns in the bark of a tree, or the slight changes in someone’s facial expression.
This attention to detail allows them to gain a deeper understanding and appreciation for the world around them.
Curiosity and Exploration:
Noticers are inherently curious individuals, constantly driven to explore and discover new things. They are not content with simply accepting the surface-level appearance of the world.
They actively seek out opportunities to learn, investigate, and uncover the hidden layers of meaning and significance that lie beneath the obvious.
This curiosity leads them to ask questions, seek out new perspectives, and engage in deeper exploration of the world and the people in it.
Mindfulness and Presence:
Being a noticer requires a certain level of mindfulness and presence in the moment. Noticers are adept at staying focused on the present, rather than being distracted by the past or the future.
They can fully immerse themselves in the here and now, allowing them to fully absorb and appreciate the richness of their experiences.
This mindfulness and presence helps noticers to derive more meaning and fulfillment from their daily lives, as they can savor the small, often overlooked moments that others may miss.
Empathy and Connection:
Noticers often possess a heightened sense of empathy, as their attention to detail and nuanced understanding of the world allows them to better relate to the experiences and perspectives of others.

By noticing the subtle cues and expressions of those around them, noticers can more readily connect with others on a deeper level, fostering meaningful relationships and a greater sense of understanding and compassion.
In summary, being a “noticer” involves cultivating a heightened awareness, attention to detail, curiosity, mindfulness, and empathy – qualities that can enrich one’s life and deepen one’s connections with the world and the people in it.

I submit to you, that to be at the zenith of peritoneal dialysis, we must become astute “noticers.” As a side, it is obvious to me that PhDs have this mindset to some extent in that by their nature, PhDs are trained to see patterns or behaviors or associations that are not necessarily self-evident. That’s what we are trained to do, sometimes largely through statistics, but not always. This ability often is the starting point of research that ends up going down many rabbit holes but in the end, is very productive.

For example: After its initial approval for type 2 diabetes, Ozempic has since been approved for additional indications:
In 2021, the FDA approved Ozempic for the treatment of chronic weight management in adults with obesity or overweight with at least one weight-related condition.
In 2022, the FDA approved Ozempic for the treatment of cardiovascular disease risk reduction in adults with type 2 diabetes.

We are still plugging away at getting more Proteins into my diet to bring up my lab albuminn reading. Our son, who is on a rather strict Keto diet, recently recommended the cereal Magic Spoon, which is available at both Amazon and WalMart. It comes in four flavors, is low in carbs, and has zero sugar and grains. The peanut butter-flavored variety has 14 G of protein, counting milk.

Post markets a hi-protein cereal advertising 20 g of protein. I bought two of these to try. Lastly, there is a granola cereal with something like 14 g of protein. I tried it this morning and didn’t think too much of it.

I happened to stop by the already-prepared salad display at WalMart and found some salads with 17 g of protein in them so I bought several. I also bought cube steak, filet mignon, bacon-wrapped tenderloin, and a package of 93/7 hamburger patties to round out this week’s protein as a start.

BTW, my weight this morning was 141.0, hanging in there. In the dentist’s chair yesterday afternoon having my teeth cleaned my blood pressure was 110/66. Keep in mind this is without any BP meds for some time. As I write this blog at 1710 on 8/20/2024, the temp outside is 108. See lead graphic. Yes, it is warm in North Texas.

I have previously blogged about my recent low lab albumin reading, about albumin itself, and how much daily protein is the norm to raise it. This blog is a little about what we are incorporating into my diet as a result.

I am eating a serving of smear case daily, usually with my evening meal along with a healthy serving of a fruit like strawberries. This provides about 21 g of protein. with supper plus. I have this along with a fortified drink with the stuff Fresenius provided which is another 16 g for a total of 37 g of protein for supper.

For breakfast, I’m having a cereal such as mini wheat (5g), a heaping tablespoon of peanut butter (4+g), and a Brazil nut (1/2g) along with 6 oz of V8 (2g).

For lunch, it varies. Today I’m having a shake consisting of vanilla powder with 31 g of protein, a little 2% milk, strawberries, and sucrose sweetener.

If you add this up, you’ll ascertain that I’m right at 72-80 or so as the recommended amount to raise albumin. I have labs on 9/6/2024 so we’ll see.

My Dialysis Team Meeting took place as scheduled this morning. We had a meeting that did not resolve my low Albumin reading from my latest lab. Recall that it dropped from 3.6 to 3.1 and an acceptable reading is over 4. We discussed six ways from Sunday what may have changed in my life and/or lifestyle to merit this change with no conclusions. As often happens in medicine, we’re now going to wait and see what my labs are as a result of my next scheduled lab on 9/6/2024. I will be doing an adequacy test at that time also so there will be a lot on the table.

One unique aspect of the meeting was that my dietician provided me with a 32 oz bottle of LiquaCel to try out as a protein supplement. My nephrologist also approved my use of protein powder to improve my protein intake. I’ve included a PR-type video below from the company that makes LiquaCel to familiarize readers with their products.

One of the many little nagging things that plague me as a result of kidney failure is bad breath. I do all the right things having to do with my teeth and mouth. I have my teeth cleaned three times a year and see the dentist like clockwork. I floss and brush every night without fail. Still, my wife informs me constantly that I have bad breath and to go brush my teeth. This leads to me wonder what the correlation is between being on peritoneal dialysis and bad breath. I quizzed Perxiplity about this with the following results:

There is a correlation between peritoneal dialysis (PD) and bad breath, also known as halitosis, in patients with end-stage renal disease (ESRD). Studies have shown that high blood urea nitrogen (BUN) levels and low salivary flow rates are associated with halitosis. Peritoneal dialysis can help decrease the level of halitosis by reducing BUN levels and increasing salivary flow rates over time[1][3][5].

Chronic renal failure, which leads to a buildup of waste in the blood (uremia), can result in halitosis. This condition is often described as having an ammonia-like odor, and it is one of the non-oral causes of bad breath in patients with kidney disease[4][5]. Additionally, oral health issues such as dry mouth and changes in taste are common in patients undergoing peritoneal dialysis, particularly those with diabetes[2].

Overall, while peritoneal dialysis can help reduce halitosis, the presence of bad breath may still occur due to underlying renal issues or other oral health conditions.

Citations:
[1] https://pubmed.ncbi.nlm.nih.gov/20338971/
[2] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3525369/
[3] https://journals.sagepub.com/doi/10.3747/pdi.2009.00089
[4] https://southgablesdental.com/what-your-kidneys-and-bad-breath-have-in-common/
[5] https://www.ejgm.co.uk/download/comparison-of-systemic-oral-malodor-in-patients-undergoing-hemodialysis-and-peritoneal-dialysis-7176.pdf

Of interest to all of us on PD, is today’s topic, “What’s the hottest and most recent topic in peritoneal dialysis?” I turned to Perplexity with this topic as a prompt with the following results. Read on to stay up-to-date:

The hottest and most recent topics in peritoneal dialysis (PD) focus on several key areas of research and clinical practice:

1. Peritoneal Membrane Biology and Physiology: Understanding the biology and physiology of the peritoneal membrane is crucial for improving PD outcomes. This includes studying how the membrane functions and changes over time with PD treatment[1].
2. Metabolic Disturbances: Researchers are examining metabolic disturbances that occur in patients undergoing PD, which can affect overall health and treatment efficacy[1].
3. COVID-19 Impact: The pandemic has influenced PD practices and outcomes, prompting studies on how COVID-19 affects PD patients and their treatment[1].
4. Infections Related to PD: Peritoneal dialysis-related infections, such as peritonitis, remain a significant concern. Research is ongoing to better understand and prevent these infections[1][2].
5. Technological Advancements: The use of physiological modeling and artificial intelligence in PD is an emerging area, aimed at enhancing treatment personalization and improving patient outcomes[1].
6. Volume Management: Evaluating and managing the volume status of PD patients is a current research hotspot, which is essential for optimizing treatment and preventing complications[4].
7. Patient Outcomes and Trends: Studies have shown improvements in patient survival rates and reductions in peritonitis rates over time, indicating advancements in PD care and infrastructure[2].

These topics represent the forefront of research and development in peritoneal dialysis, aiming to improve patient care and treatment outcomes.

Citations:
[1] https://www.frontiersin.org/research-topics/20156/peritoneal-dialysis-recent-advances-and-state-of-the-art
[2] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8476299/
[3] https://journals.lww.com/cjasn/fulltext/2019/12000/trends_in_peritoneal_dialysis_use_in_the_united.14.aspx
[4] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11001717/
[5] https://www.kidney.org/kidney-topics/taking-care-your-peritoneal-dialysis-pd-catheter

esterday I blogged about my Albumin lab result being in the toilet. From my July 2024 labs, my Cholesterol was at 218 where the goal is less than 200. For the same labs, my Triglycerides were 191 where the goal is less than 150. As a side, my Creatinine for the current lab was 8.20 which maps to an eGFR of 6 which is par for the course for someone on dialysis.

So here’s the deal as I see it. My wife and are are concentrating on bringing Albumin up with diet. The diet to do this also tends to reduce Cholesterol and Triglycerides resulting in a win-win combination. We are going to start working more salmon, tofu, smear case, and such foods into our diet.

I have a meeting with my dialysis team this coming Friday during which I’m certain I will first, get raked over the coals, and second, receive firm guidance as to what steps to take. Stand by for action.

TYhe lead graphic is from Poe’s FLUX-dev bot with Prompt: Picture of Popeye standing by for action on a sailing ship.