Tag: alarms (Page 14 of 43)

This past Thursday at 1000 I arrived at the local CVS in Granbury, TX, and received a COVID and Shingles shot. So far so good. Later on the day, my arm was a little sore but no big deal. We had a late lunch, and in the middle of eating a salmon pattie all of a sudden, I had to vomit and deposited the contents of my stomach into a toilet. Let’s regress here.

In my 25 years in the US Navy, I received countless injections with multiple shots on the same day. I had NEVER had a reaction of any kind taking whatever was thrown at me in stride. You can’t believe the number of shots we were required to have before going In-Country Vietnam. So this is something new for me. I have had previous shingle shots and six COVID shots also.

On Friday morning my Biometrics were whacked. My BP was 89/59, temp was 99.4, and my pulse was 104. Friday night was hell on earth. I had to get up and vomit at least six times with nothing coming up toward the end. We tried some OTC meds to stop vomiting and I just puked it up. Saturday morning things settled down at I slept in until noon. Saturday I was able to keep soup down, and Sunday I was fully back in battery, but stayed in bed until 1000. I was able to blow off storm debris from the porch and driveway and finish putting a border on a front flower bed, even though the humidity was very high and the temp was 90F.

Throughout all of this, I maintained my normal dialysis schedule without any problems or challenges. One lesson to be taken from this is bodies do change in ways you cannot predict. Will I continue to receive shots? Yes, but perhaps with a more critical reading of potential side effects. And life does go on. We just saw our first fawn of the season through our kitchen window. There is a God!

It’s been a couple of weeks since I posted an update on how my latest schema to control my weight by adjusting the strength of my dialysis fluids so here goes an update:

I have 21 recent days of data to share. During this period, my weight has varied from a low of 143.2 to a high of 147.0. When it reaches 145.0 I use a 2.5% 2-liter bag on my early evening static fill. When it equals or exceeds 146.0 I use a 2.5% 6-liter bag along with a 1.5% 6-liter bag on the Cycler. So far, I have used the 2.5% 2-liter treatment five times, and the 2.5% 6-liter bag four times out of 21. Keep in mind that my assigned dry weight is 145.0 so I’m keeping a tight variance on my weight around this value by adjusting the dialysis fluid strength on the fly.

One of the last tasks I do after coming off of dialysis every morning is to weigh myself. Based on this weight, I determine what mixture of bags of fluid I need to keep my weight where I want it, at or below 145.0. Sometimes I can adjust it a pound or two with just the 2.5% 2-liter bags for my static fill; sometimes I have to use the 6-liter 2.5% bags if my weight jumps too much. But it is working for me.

Keep in mind that the rubric I am using does not take into consideration any weight fluctuation from diet or any effect of exercise. But intrinsically, these are factored into my weight. Again, my weight has responded well to this schema.

On May 28, 2024, in the Opinion Section, WSJ ran an article titled “Bureaucrats vs. Kidney Patients” by The Editorial Board. Below is a 250-word condensed version of the article followed by information from Perplexity on just what the tests are that are highlighted in the article. I previously did not know such tests existed.

In August 2023, the National Committee for Quality Assurance (NCQA) removed an at-home kidney test from its list of approved tests, denying patients an easy way to check their risk for kidney disease. The convenient semi-quantitative test uses a urine sample to measure albumin, an early indicator of kidney problems.

NCQA claims the test was “erroneously misclassified” as a lab test, but this seems like bureaucratic confusion. Both the American Diabetes Association and the National Kidney Foundation have endorsed home tests to improve access, especially for rural patients. Eliminating this option will “take us backward rather than forward,” says Dr. George Bakris, who co-authored the guidelines.

Kidney disease often goes undiagnosed until it has caused substantial damage. Over 37 million Americans have chronic kidney disease, and 90% are unaware. Frequent testing is crucial, especially for the 38.4 million Americans with diabetes, a third of whom have kidney disease. Early detection can prevent the need for dialysis, which costs Medicare over $153 billion annually.

While NCQA acknowledges home tests may play a role in the future, they already serve an important purpose. This decision appears to prioritize cost and bureaucratic control over patient needs. Doctors and patients are now pushing back, arguing that easy access to screening is vital for catching kidney issues early and improving outcomes.

Home kidney test kits can provide a semi-quantitative detection of small quantities of albumin in urine, which is an indicator of potential kidney disease. The Accu-Tell Microalbumin Semi-quantitative Rapid Test Strip is designed to detect albumin levels between 20-100 mg/L by showing varying color intensities on the test strip. Similarly, the Healthy.io Minuteful Kidney kit uses a urine dipstick and smartphone app to rapidly detect albumin levels, though it does not provide detailed results. These semi-quantitative tests can help screen for microalbuminuria, an early sign of kidney damage, but positive results should be confirmed with further quantitative testing by a doctor.

A May 24, 2024 article in The New England Journal of Medicine is of interest to all readers of this blog. The lead graphic is captured from the article which is quoted in its entirety below. You can read for yourself that the intake of Ozempic, largely employed as a weight-loss drug, may have salubrious effects way beyond weight.

Abstract

BACKGROUND

Patients with type 2 diabetes and chronic kidney disease are at high risk for kidney failure, cardiovascular events, and death. Whether treatment with semaglutide would mitigate these risks is unknown.

METHODS

We randomly assigned patients with type 2 diabetes and chronic kidney disease (defined by an estimated glomerular filtration rate [eGFR] of 50 to 75 ml per minute per 1.73 m² of body-surface area and a urinary albumin-to-creatinine ratio [with albumin measured in milligrams and creatinine measured in grams] of >300 and <5000 or an eGFR of 25 to <50 ml per minute per 1.73 m² and a urinary albumin-to-creatinine ratio of >100 and <5000) to receive subcutaneous semaglutide at a dose of 1.0 mg weekly or placebo. The primary outcome was major kidney disease events, a composite of the onset of kidney failure (dialysis, transplantation, or an eGFR of <15 ml per minute per 1.73 m²), at least a 50% reduction in the eGFR from baseline, or death from kidney-related or cardiovascular causes. Prespecified confirmatory secondary outcomes were tested hierarchically.

RESULTS

Among the 3533 participants who underwent randomization (1767 in the semaglutide group and 1766 in the placebo group), median follow-up was 3.4 years, after early trial cessation was recommended at a prespecified interim analysis. The risk of a primary-outcome event was 24% lower in the semaglutide group than in the placebo group (331 vs. 410 first events; hazard ratio, 0.76; 95% confidence interval [CI], 0.66 to 0.88; P=0.0003). Results were similar for a composite of the kidney-specific components of the primary outcome (hazard ratio, 0.79; 95% CI, 0.66 to 0.94) and for death from cardiovascular causes (hazard ratio, 0.71; 95% CI, 0.56 to 0.89). The results for all confirmatory secondary outcomes favored semaglutide: the mean annual eGFR slope was less steep (indicating a slower decrease) by 1.16 ml per minute per 1.73 m² in the semaglutide group (P<0.001), the risk of major cardiovascular events 18% lower (hazard ratio, 0.82; 95% CI, 0.68 to 0.98; P=0.029), and the risk of death from any cause 20% lower (hazard ratio, 0.80; 95% CI, 0.67 to 0.95, P=0.01). Serious adverse events were reported in a lower percentage of participants in the semaglutide group than in the placebo group (49.6% vs. 53.8%).

CONCLUSIONS

Semaglutide reduced the risk of clinically important kidney outcomes and death from cardiovascular causes in patients with type 2 diabetes and chronic kidney disease. (Funded by Novo Nordisk; FLOW ClinicalTrials.gov number, NCT03819153.)

This past Friday I authored a post relating the anxiety, fear, uncertainty, and doubt expressed by many in dialysis forums on Facebook. I related while I did not experience such feelings, perhaps it would be lucrative to delve into what research has suggested. Below is what I uncovered.

Research has found that patients new to dialysis often experience significant anxiety, fear, and doubt. Some key findings:

• Anxiety disorders are estimated to affect 12-52% of patients with end-stage kidney disease on dialysis. 
• Starting dialysis is a major life transition that can trigger anxiety as patients adjust to the new diagnosis, treatment regimen, and lifestyle changes. 
• Common sources of anxiety include fear of the unknown, uncertainty about the future, invasive procedures like needle insertions, alarms on dialysis machines, and dependence on medical staff and equipment. 
• Patients may feel anxious about being able to follow the strict dietary and fluid restrictions, remember medication schedules, and manage supplies for home dialysis. 
• The loss of independence, inability to work, financial strain, and disruption to social roles can contribute to feelings of anxiety and doubt. 
• Anxiety can make it harder for new dialysis patients to learn important self-care skills, follow treatment plans, and cope with the physical and emotional demands of their condition. 

In summary, the transition to dialysis brings many stressors and uncertainties that commonly trigger significant anxiety, fear, and doubt in new patients as they adjust to end-stage kidney disease and dialysis treatment. 

Back in the day, I was Officer In Charge of a US Navy Unit stationed at Sperry Systems Management in Ronkoma, NY. Our mission was to test and evaluate a new weapon system designed to go aboard the new Oliver Hazard Perry Class FFG-7. One of the enlisted working for me at that time was a first-class petty officer by the name of Robert Shippee. Fire Control Senior Chief Petty Officer (FCCS) Robert Shippee died in the USS Stark (FFG-31) when she was struck by two Iraqi Exocet missiles on 17 May 1987.. My thoughts always go out to him today with wishes of fair winds and following seas. The lead photo is of him.

For those from other countries reading this blog, the below is offered to provide insight into Memorial Day in the USA:

Memorial Day

Federal holiday in the United States

Origins

Originally known as Decoration Day, it marked the remembrance of U.S. military personnel who died in service

First Observance

The first national observance of Memorial Day was on May 30, 1868

Current Date

Observed on the last Monday in May since 1971

Memorial Day is a federal holiday in the United States that honors the men and women who died while serving in the U.S. military. It originated after the Civil War to commemorate the Union soldiers who perished in that conflict.

Origins and History

The first Memorial Day observance was held on May 30, 1868, originally called “Decoration Day,” when General John A. Logan proclaimed that flowers should be placed on the graves of Union soldiers who died in the Civil War. On that first Decoration Day, General James Garfield delivered a speech at Arlington National Cemetery, and 5,000 participants decorated the graves of 20,000 Union and Confederate soldiers buried there. While the exact origins are disputed, the practice of decorating soldiers’ graves with flowers began in various towns across the country in the years following the Civil War. By 1890, Memorial Day was an official state holiday in all the northern states. After World War I, it became a day to honor all American military personnel who died in any war.

Modern Observances

In 1971, Congress declared Memorial Day a federal holiday and changed the observance date to the last Monday in May to create a three-day weekend. On Memorial Day, many Americans visit cemeteries and memorials to honor the fallen soldiers. American flags are placed on graves in national cemeteries, and volunteers often decorate graves with flowers and wreaths. The National Memorial Day Parade is held annually in Washington D.C., and the President or Vice President traditionally lays a wreath at the Tomb of the Unknown Soldier at Arlington National Cemetery. A National Moment of Remembrance is observed at 3 pm local time, when all Americans are encouraged to pause for a moment of silence. While Memorial Day marks the unofficial start of summer for many, it remains an important day of reflection and remembrance for those who made the ultimate sacrifice in service to the nation.

I spent a little bit of time recently browsing through some of the posts on Facebook having to do with peritoneal dialysis. There was a common thread throughout most of the posts. In general, they were made by patients new to dialysis, and more often than not, voiced fear and/or trepidation concerning their entry into the PD world.

While this is understandable to a point, my position is that the care and feeding of new patients is not serving them well. On Facebook, they are reaching out to more seasoned PD patients for consultation and input that obviously they are not receiving as part of their training. In retrospect, I did not have an opportunity to speak to a PD patient or group before or during training. It was not until much later that I was requested to talk to a large group of potential newbies in Fort Worth.

But this begs another issue and involves behavior. Why are patients entering the PD portal so afraid of what they are facing? What is so scary to raise so much fear and doubt among them? Numerous YouTube videos lay out what’s involved in excruciating detail. In training, you are encouraged to ask as many questions as you feel a need to and also progress at a pace you’re comfortable with. Personally, at the onset, I did not experience such feelings nor have I since. Perhaps it’s my military training to take charge and deal with life as it’s dealt to you. I’m certain shrinks have develved into this aspect of PD. I’ll see what I can dig up for a future blog.

I have gone eleven straight nights without ANY cycler alarms. This is a new record for me. I attribute the lack of alarms to my being more in tune with keeping kinks out of my catheter tubing. I am very aware of what’s going on with it, sometimes to the point that I am losing sleep over it. But that’s the price you pay. Kinks and alarms or no kinks and no alarms. Your choice.

I am writing this post on Wednesday for posting on Thursday. As we speak we are under a flood watch from 10 AM Wednesday until Thursday evening, and a tornado watch was just implemented. Our mowers are here doing our lawn ahead of the impending storm(s). There is a good side to all the rain we have been having this spring – our neighbor just dropped off a big bag of fresh Texas-grown sweet corn from his ranch toward Houston.

Ahead of the storms I did manage to get a little yard work in. I finished cleaning up the flower bed behind the master bedroom and installed new edging around it. See the first picture below. I also got started on installing manure/compost covering over the drip irrigation lines. See the second photo below. See, life can go on despite being on dialysis.

From time to time I have advocated for those of us on dialysis to indeed maintain some semblance of life as we knew it before. It is way too easy to become totally ensconced in dialysis in and of itself. I have attempted to maintain a life outside of dialysis requirements, and one of the aspects of this life is taking care of our large number of garden beds. Although the temps have been in the nineties, I have been steadily chipping away at several tasks we have laid out, one of which is the installation of a drip irrigation system for the flower and tomato plants I recently provided a video of.

In the video below, I show what is entailed in assembling such an automatic watering system, how it is laid out, the components, and the final product. Enjoy the video.

My wife and I try our best to keep our home including the grounds surrounding it in decent shape despite my dialysis. From time to time I have mentioned us having on the order of 15 garden beds which we are going through one-by-one to bring up to snuff. The video below shows some of them we have been working on. We have lots to go! BTW, the weather here in North Texas is now in the 90s most days so we have to pace ourselves accordingly . Enjoy the video.