I recently received a letter from the parent health organization of my kidney doctor. They suggest an annual Chronic Disease Management Visit for complete health screening is in order. They will assess my medical conditions, medicines, lab results, and other health information to support my care management for the rest of the year. They also suggest this will help with care coordination.
I talked about these meetings with my dialysis nurse, and some patients do it and others don’t. I am of the mind to schedule an appointment and see what happens. Who knows, it might be worthwhile.
Meanwhile, back home in North Texas, my wife and I finished weeding the former iris bed and have decided we are going to sod the area. This will result in one less flower bed to maintain. Yesterday I harvested our first crop of Roma tomatoes and one hot pepper. See lead photo.
Some observations about my biometrics for the last 13 days:
My weight has varied from a low of 141.6 to a high of 143,0 with the mode being 142.4 with 8 hits followed by 143.0 at 4 hits. So you can ascertain that I am staying in a very narrow pattern of weight. I am NOT on a diet, I more or less eat what I want within the constraints of being diabetic and on dialysis. I continue to work hard outside on our flower beds in which we are making progress.
During the same time frame, my blood pressure has ranged from a high of 123/74 to a low of 102/70. The actual systolic low has been 66. So once again, I am nailing it. AND I am taking NO blood pressure medications!
Lastly, my glucose has varied from a high of 109 to a low of 88 upon arising (fasting reading.) Once again, I’m nailing it. My GP and I have set the range we’d like to keep my glucose within of 50-150 and in general I’m there. On occasion, it may exceed 150, but soon drops to within range.
I have used only 1.5% solutions throughout the above timeframe for both my static fill and Cycler use. My microfiltration has ranged from 511 to 868 with an average more toward to high end.
I feel good, can work outside, and howl with the big dogs. What more could you ask for?
This past Friday I blogged about two occurrences of unprovoked Liberty Cycler Errors on the same usage evening. I’m more than glad to report that they have not reoccurred and all ops have been normal, at least for the Liberty Cycler. All users know from experience that the Liberty Cycler has a mind of its own, speaks its own language, and marches to its own drummer.
This brings up a somewhat related subject – that of the usage of fluid bags on the Cycler. Last Thursday I wrote a blog entitled “Dialysis Fluid Strength Considerations.” In this blog, I related that my dialysis nurse suggested only using as strong a dialysis mixture as required to maintain weight and BP. While this is all well and good, keeping an inventory of dialysis fluid on hand to support such an effort can become complex. For my last Fresensius delivery of supplies, I kinda split on 1.5% and 2.5% 6-liter bags. I am fast approaching a situation where I will not have enough 1.5% 6-liter bags to continue to support using two per day without resolution of my inventory.
Speaking of inventory, for the third time, Fresenius did not provide what I ordered. The last two times they shorted me was on cassettes, delivering none, nada, zip. I understand that from time to time they may run short of some items, but they do not give us a heads-up, intervene, or otherwise reach out. Of course, the local clinic has nothing to do with the branch of Fresenius that takes orders and provides supplies so their hands are tied. Hell of a way to run a railroad.
Today has been a day far removed from the shackles of dialysis. I accomplished a normal PD session and was finished and off the system, bed made, and all else accomplished by 0900. Our recent high school grad showed up on time and my wife put him to work. About 30 minutes later I had read the WSJ, had my breakfast, and started weeding one of our flower beds. Finished that some 2 hours later and went to work on yet another flower bed. I’ll post a picture of it tomorrow. Went to recycling to properly dispose of a week’s worth of PD-related cardboard boxes. Now I’m ready to start the shower, static fill, supper, TV, and bed routine all over again.
Life is good, and it’s hot and humid again in North Texas.
Thought I’d provide feedback on how my slightly modified PD routine is working out so far. As background, my wife and I have over 15 flower beds that require constant maintenance. While we have hired a college freshman to help us out, let’s face it, no one does it as well as we do. By noon or so the temps here in North Texas often are in the mid-nineties, which precludes us from working especially in the sun. So just about the only alternative is being able to go to work outside earlier which requires me to come off of PD earlier. I have been accomplishing this, the earliest so far has been 38 minutes, by increasing the dwell time of my static fill in the afternoon a like amount. We are “in” in the afternoon heat, so taking a shower, accomplishing my static fill, and setting up the Cycler is not a problem.
Thus far it has been working out for me and I’m feeling fine. BTW, I read books while I’m doing the static fill. The latest one I’m reading it named “The Women,” a story about a young woman who joined the Army as a nurse, did two tours in Vietnam, and lived to “tell about it.” You can view the Amazon link here:
Last night was a comedy of errors regarding my Liberty Cycler. To start off, upon initial setup, the cycler refused to acknowledge first that a 6 L bag was installed on the heater tray, then that an additional 6-liter bag was installed on white cap one, the first additional source of dialysis fluid. Most of you with experience have seen this happen and it’s usually caused by the bag cones not being properly “broken.” In the case last night, I broke them six ways from Sunday and ALSO changed out both bags to no avail. The Cycler just would not recognize that it in fact had not only bags, but adequate bags for my prescription.
I called the duty nurse who happened to be my dialysis nurse. I had been to labs and she suggested that perhaps I had not properly responded to the setup question as to what bag was installed on the heater tray. The only way out of this was to start all over. So I rebooted the cycler and this time it recognized the bags properly. Nothing was incorrect in the setup so it leads me to the conclusion that the Cycler had a glitch in the initial setup, a first for me
So everything went as it should during the night until it didn’t. At about 6 AM on the last fill, I was awakened to a loud “Stop” alarm telling me in red that there was not enough fluid in the heater tray bag. Well, there was no fluid in it per usual but plenty in the bag on line one, the second bag. It was not full so some had been used out of it during the night. I set and reset the alarm three times before I swapped out the empty heater tray bag for the second bag and the Cycler immediately started pumping 77 F fluid into my stomach liner. Felt a little weird but at least it went on. I finished my treatment without any more excitement.
So is it the Cycler, the cassette, or ?? I debated calling “tech support” but concluded that although I would be documenting Cycler faults, after spending large amounts of my time on the phone answering inane questions there would be no resolution. However, if it happens tonight, stand by.
Wednesday I had my monthly lab visit, and inter alia, we discussed my current prescription for peritoneal dialysis. I mentioned that lately, I have been using only 1.5 % solutions across the board, with BP while low OK, and weight hanging in there. She responded that as much as possible we should be using the lowest strength solutions that maintain an acceptable BP and weight. She went on to state that too many of her patients (PD) intake too much fluid, and just resort to using stronger dialysis solutions to pull it off. This in turn damages the lining of the stomach (peritoneum) AND ONCE DAMAGED, DOES NOT HEAL ITSELF.
I had not taken this on board to the extent that I should have. Please take this on board if you are on PD. Walk a straight line. As much as possible, keep fluids to an acceptable level, and DO NOT use stronger dialysis fluid to cover for your weakness and then complain when you have to go on hemo.
I saw out of the corner of my eye in scanning the news Tuesday that Abbott had been granted FDC approval for a CGM that does not require a prescription named Lingo. This makes lots of business sense since they already dominate the prescription CGM market for diabetics’ use of their Libre 3 System. Why not extend their reach into the much larger health-oriented market? BTW, Lingo is currently only available in the UK market. See this link.
From a larger perspective, Abbott and other such companies are going after much larger markets with biowearables. See the video below made in conjunction with CES 2023 for examples.
Elizabeth Cohen wrote an article titled “Bandages of the Future Will Talk to Your Doctor” in the 6/3/24 issue of WSJ, p. A11. This application of technology to bandages is just starting to get off the ground. Basically you have a “normal” bandage with a pocket in it in which some kind of micro device is housed that senses what is going on with the wound underneath the bandages and can take steps to treat it or signal the user of others of the status. The smart bandage is often connected to a smartphone via an app such as my Libre 3 for glucose readings,
Two immediate applications of this evolving technology come to mind: PD patients such as myself and military use.
Smart bandages for PD catheter exit sites could offer improved wound healing, infection prevention, and remote monitoring compared to traditional dressings. This includes:
Sensors to track wound healing progress (e.g., fluid levels,
Bacterial load) Automated dressing changes or alerts for intervention
Wireless data transmission to healthcare providers
Antimicrobial coatings or drug delivery capabilities
Here is how the concept of smart bandages could be applied to military use:
Smart Bandages for the Battlefield
One area where smart bandages could have a significant impact is in military medical care on the battlefield. The unique challenges of treating injuries in combat environments make smart bandage technology particularly useful.
Real-Time Monitoring: Smart bandages equipped with sensors could continuously monitor a soldier’s vital signs, tracking metrics like heart rate, blood pressure, oxygen levels, and temperature. This provides medics with constant updates on a patient’s condition, allowing them to respond quickly to any concerning changes.
Wound Assessment: Smart bandages could assess the type and severity of a wound, detecting things like bleeding, infection, and tissue damage. This allows field medics to properly triage patients and administer the right treatment.
Targeted Drug Delivery: Some smart bandages can be designed to release medications or other therapeutic agents directly into the wound site. This enables precise, localized treatment without systemic exposure.
Wound Healing Promotion: Active bandages could use electrical stimulation, drug release, or other techniques to actively promote wound healing and tissue regeneration, getting soldiers back into the fight faster.
Remote Communication: Smart bandages could relay data wirelessly to field hospitals or even command centers. This gives doctors far from the front lines the ability to monitor and advise on the treatment of battlefield injuries in real time.
Simplified Treatment: The advanced capabilities of smart bandages could simplify the jobs of military medics, who often have to make quick decisions under intense pressure. Automated monitoring and treatment recommendations could help less-experienced personnel provide high-quality care.
The unique challenges of military medicine make smart bandage technology a valuable tool for the battlefield of the future. By enhancing wound treatment and providing critical data, these advanced dressings could save lives and get injured soldiers back into action more quickly.
