In yesterday’s blog, I alluded to things being out of sorts and that today I hoped to clarify my situation. That’s what this blog is about.

Saturday night I hooked up to the Fresenius Cycler in a normal fashion. All indications in the setup were as they had been for the previous couple of years. When I woke up Sunday morning the second setup screen was displayed, and neither of the 6-liter bags had been used; they were both full. The treatment screen did not show usage for the date 10/9/2024. I had not received any treatment although the setup had been completed properly and treatment initiated.

I called the local nurse on duty and woke her up – sorry. She had no clue what was happening and directed me to tech support – that oxymoron term. After spending time going through tech support’s wickets, their solution was to try it Sunday night and see what happens which I did. Sunday night everything worked as it was designed to. So I’m stuck with the lingering sickness in my stomach that just perhaps, everything is not right with my Cycler butI’m stuck with it.

That’s my story and I’m stickin’ with it.

I previously quizzed my dialysis nurse about Calcitriol and my Calcification and she passed my query on to the team nutritionist who provided the following input:

“You are on the next to lowest dose we prescribe to control parathyroid hormone levels, and your trend is very stable near the lower end of our recommended range 160 to 399  (up to 720 is considered “in goal” but less stable). The algorithm I use instructs me to leave your dose as is, however due to the recent finding of calcification, I will leave a note for Dr. Turner to ask if she wants to decrease to twice a week or discontinue and see how you respond.”

I am scheduled to meet with my dialysis team this morning to see the bottom line shortly. Stand by.

In a nutshell, I have Type II Diabetes, am on PD, and have exhibited signs of vascular calcification. I am also currently prescribed a 0.25 MCG capsule of Calcitriol five days a week. That’s a lot to place on an intersecting Venn Diagram. My question is, has the injecting of calcitriol led to or contributed to my vascular calcification? I turned to Perplexity to find out more about this drug with the following drug and results:

Prompt: Everything about the drug Calcitriol as prescribed to a peritoneal dialysis patient including chemical composition and potential side effects for calcificationAnswer

Answer: Calcitriol is an active form of vitamin D commonly prescribed to peritoneal dialysis patients. Here’s an overview of its key aspects:

Chemical Composition

Calcitriol is a synthetic version of the active form of vitamin D3, also known as 1,25-dihydroxycholecalciferol. Its chemical formula is C27H44O3

1.

Uses for Peritoneal Dialysis Patients

Calcitriol is prescribed to peritoneal dialysis patients primarily to:

• Treat and prevent low calcium levels
• Manage secondary hyperparathyroidism
• Prevent and treat metabolic bone disease

In kidney failure, the body cannot produce enough active vitamin D, which is essential for calcium absorption and bone health

4.

Mechanism of Action

Calcitriol works by:

• Increasing calcium absorption from the intestines
• Promoting calcium reabsorption in the kidneys
• Regulating parathyroid hormone (PTH) production
• Enhancing bone mineralization

Dosage and Administration

• Dosage is individualized based on the patient’s calcium and PTH levels
• Typically taken orally as capsules or liquid
• Dosing frequency may range from daily to three times per week

Potential Side Effects

Common side effects include:

• Nausea and vomiting
• Constipation
• Dry mouth
• Headache
• Muscle or bone pain

More serious side effects can include:

• High calcium levels (hypercalcemia)
• Dehydration
• Confusion
• Weakness
• Irregular heartbeat

Risk of Calcification

One significant concern for peritoneal dialysis patients taking calcitriol is the increased risk of calcification, particularly:

• Vascular calcification
• Soft tissue calcification
• Nephrocalcinosis (kidney calcification)

This risk is due to the medication’s effect on calcium levels and metabolism. Careful monitoring of calcium, phosphate, and PTH levels is crucial to minimize this risk

12.

Precautions and Monitoring

For peritoneal dialysis patients on calcitriol:

• Regular blood tests to monitor calcium, phosphate, and PTH levels
• Dietary restrictions may be necessary to control calcium and phosphate intake
• Dose adjustments based on lab results and clinical response
• Vigilance for signs of hypercalcemia or calcification

Drug Interactions

Calcitriol may interact with:

• Phosphate binders
• Calcium supplements
• Certain antacids
• Thiazide diuretics
• Digoxin

Healthcare providers should be aware of all medications a patient is taking to avoid potential interactionsIn conclusion, while calcitriol is an essential medication for many peritoneal dialysis patients, its use requires careful management and monitoring to maximize benefits while minimizing risks, particularly the risk of calcification.

In review, while having Moh’s surgery to remove cancer on my left temple my dermatologist commented that he had never seen as much artery calcification. I brought this up to my cardiologist, who suggested I visit a neurologist. This led me to conduct some due diligence to determine a neurologist’s involvement. Along the way, I found something disturbing. This is the reference document: https://pmc.ncbi.nlm.nih.gov/articles/PMC8439554/

The bottom line is that medial arterial calcification (MAC) in the temporal arteries, often seen in conditions like end-stage renal disease, lacks a specific causal treatment. However, managing associated conditions such as chronic kidney disease or diabetes can help slow progression6. What this says to me is that the calcification my dermatologist found has a possible high correlation with my CKD and 50 years of being diabetic and further, cannot be treated -> “lacks a specific causal treatment.”

I’m screwed!

Monday at 1300 I had the stitches removed from my latest go-around with the dermatologist. Upon removal of the stitches, I was informed that there was some residual cancer and the doctor wanted to talk to me. He said the squamous cells were there and few and we had three choices: 1. Do nothing which he recommended, 2. Cut away again, or 3. Freeze. We agreed with 1. and that’s where we stand.

I will introduce the use of a Bot named Doctor Sage which is available for general use on the AI Poe. I inputted the following prompt and received a layman’s version of the Dermatopathology report provided below. I encourage readers to start using such online tools for their medical reports.

Prompt: I received the following dermatopathology report, which I need a layman’s version of: Skin left inferior postauricular: Residual squamous cell carcinoma in situ and central reparative changes. The lesion extends to the black-inked 6-9 o’clock margin. No residual invasive squamous cell carcinoma was identified.

DoctorSage

Poe

Sure! Here’s a layman’s version of the dermatopathology report you received:

• Sample Location: The skin sample was taken from the area behind the left ear (postauricular).
• Findings:
  • There are leftover (residual) cancerous cells known as squamous cell carcinoma (SCC) that are in a very early stage and have not spread to deeper layers (this is referred to as “in situ”).
  • The report mentions that there are signs of healing or repair in the skin where the cancer was.
• The extent of the Lesion: The cancerous area extends to the edges marked with black ink, specifically at the 6 to 9 o’clock positions on a clock face (imagine the area being around the back of the ear).
• Invasive Cancer: Importantly, the report states that there are no signs of more serious, invasive squamous cell carcinoma, which would mean the cancer has spread deeper into the surrounding tissues.

In summary, the report indicates that while there are still some cancerous cells present, they are not in an advanced stage, and there is no evidence of the cancer spreading further into the skin. It suggests that healing is occurring, but monitoring or further treatment may be necessary.

And that my friends, is the rest of the story.

Had the teleconference with my cardiologist at the end of last week. He was two hours late for the call – go figure. Not a good way to start; it went downhill from there. After some dancing around, the bottom line is that he recommended putting me under and taking a looksee at my system. His experience is that blockage may be causing the abnormalities previously reported herein. He suggested doing the procedure at Baylor in Fort Worth in a couple of weeks, essentially as soon as it could be normally scheduled.

While this is not what I had expected, it is what it is and we’ll take it in stride. My wife Linda has spent valuable time the last couple of days learning all the ins and outs of setting up my Liberty Cycler for my dialysis treatment and has it in hand. We’ll go from there.

As a sidelight, I did clinic lab on Thursday. There is nothing exciting to report from my labs. We took three dozen yellow roses in and presented them to the three main players on my dialysis team, and we also presented the poem embedded below at the same time. Read it—I mean every word in it. Thanks, Team Feeser!!!

Although we haven’t finished cleaning up the yard for “winter,” we look forward to our next season’s gardens. While we grew abundant tomato plants, they did not bear all that many tomatoes. Based on what other neighbors are having luck with here in Pecan Plantation, we will try Early Girl and Best Boy plants next spring.

I ran across the lead graphic recently presenting predicted weather for our location. Based on this, it suggests that as early as mid-February 2025 daytime temperatures will be in the sixties and nighttime lows in the forties, plenty warm enough for tomatoes. Tenu has some plastic cone-shaped individual covers that look like they should work well for such plants. In a nutshell, that’s our tomato plan for 2025.

Those of you who have been reading this blog for some time know that I am an engineer very interested in AI. I use it quite often to gather background for my blog entries and generally know it has a real place in the future. I am so avidly convinced of its future that I have invested six figures in two AI-related stocks, NVDY and AIYY. Given this background, it should not be surprising that the current and future application of AI to peritoneal dialysis is also of interest. The following is provided to increase our knowledge in this important area.

Peritoneal dialysis (PD) is a vital renal replacement therapy for patients with chronic kidney disease (CKD) or end-stage renal disease (ESRD). It utilizes the peritoneum (as a natural semipermeable membrane to remove waste products and excess fluid from the blood. The advent of artificial intelligence (AI) in healthcare has the potential to revolutionize PD by enhancing patient outcomes, personalizing treatment, and optimizing clinical workflows. This blog explores the current applications of AI in PD and its projected future. 

Current Applications of AI in Peritoneal Dialysis 

Predictive Analytics: 

AI algorithms can analyze large datasets to predict complications in PD patients, such as peritonitis (, catheter dysfunction, and fluid overload. Machine learning models can identify patterns that might go unnoticed by human clinicians, allowing for timely interventions. 

Personalized Treatment: 

AI can help tailor PD regimens to individual patients by analyzing historical data and real-time information. For instance, AI-driven tools can optimize dialysate ( composition and the frequency of exchanges based on a patient’s unique physiological characteristics, leading to improved biochemical control and quality of life. 

Telehealth and Remote Monitoring: 

AI is enhancing telehealth capabilities for PD patients by enabling remote monitoring of vital signs and dialysis parameters. Smart devices equipped with AI can alert healthcare providers to potential issues, facilitating proactive management of patient health and reducing hospital visits. 

Decision Support Systems: 

AI-based decision support systems (DSS) assist healthcare providers in making informed clinical decisions. These systems can integrate various data sources, including laboratory results and patient history, to recommend optimal treatment plans and improve overall patient management. 

Projected Future of AI in Peritoneal Dialysis 

Enhanced Patient Engagement: 

The future of AI in PD will likely focus on improving patient engagement through personalized applications. These apps could provide patients with real-time feedback on their treatment, dietary recommendations, and reminders for dialysis exchanges, enhancing adherence to therapy. 

Integration with Wearable Technology: 

The integration of AI with wearable devices may allow continuous monitoring of biomarkers such as blood pressure, heart rate, and fluid status. This data can be used to adjust PD prescriptions dynamically, promoting individualized care and minimizing complications. 

Natural Language Processing (NLP): 

NLP technologies could revolutionize patient-provider communications by analyzing patient-reported symptoms and concerns, thus allowing for more nuanced and timely interventions. This could lead to more personalized care plans based on patients’ subjective experiences. 

Data-Driven Research: 

AI can facilitate data-driven research by identifying trends and correlations in large datasets that are often too complex for traditional statistical analyses. This could lead to new insights into patient outcomes and a better understanding of factors influencing the success of PD. 

Automated Workflow Optimization: 

Future AI systems could automate various administrative aspects of PD management, such as scheduling, documentation, and billing, allowing healthcare providers to focus more on patient care rather than administrative tasks. 

Conclusion 

The integration of AI into peritoneal dialysis is already showing promising results, with advancements in predictive analytics, personalized treatment, and remote monitoring. As technology continues to evolve, the future holds immense potential for AI to enhance patient engagement, improve clinical decision-making, and optimize workflows in PD management. The ongoing collaboration between healthcare professionals and AI developers will be crucial in harnessing these technologies to improve outcomes for patients with kidney disease. The journey towards fully realizing the potential of AI in PD is just beginning, and it promises to reshape the landscape of renal care in profound ways. 

In summary, the synergy between AI and peritoneal dialysis could lead to a more effective, patient-centered approach to managing chronic kidney disease, ultimately improving the quality and longevity of patients’ lives. 

In review, last week I traveled to Ft Worth for a nuclear stress test on my heart. The results were available this past Saturday. The salient part of the reported result is quoted below:

“Procedures Date Name Performed by 10/16/2024 Tte W/doppler Complete
Notes: Studycast study 52688127 conclusions (added Sat, 19 Oct 2024 11:26:29 -0400) Normal LV systolic function with EF 53%. Left ventricle cavity is normal in size. No significant wall motion abnormalities in the areas visualized. Left atrial cavity is normal in size. No significant wall motion abnormalities in the areas visualized. Left atrial cavity is moderately dilated at 4.9 cm. RVSP measures 21 mmHg. Impaired left ventricular relaxation”

So what does all this gibberish mean? I copied the above text to Google’s NotebookLLM where I received the following plain English summary:

The patient’s cardiovascular health status presents a mixed picture with both positive and concerning aspects.
Positive Findings:
●The patient’s left ventricle (LV) exhibits normal systolic function with an ejection fraction (EF) of 53%, indicating the heart effectively pumps blood out to the body.
●The left ventricle is also normal in size, and no significant wall motion abnormalities are observed in the visualized areas.
●The right ventricular systolic pressure (RVSP) is measured at 21 mmHg, which falls within the normal range.
Concerning Findings:
●Despite normal LV function, the patient exhibits impaired left ventricular relaxation. This suggests a problem with the heart’s ability to fill with blood properly during the relaxation phase (diastole).
●The left atrium is moderately dilated at 4.9 cm. This enlargement may result from impaired relaxation of the left ventricle, as blood backs up into the left atrium.
Overall:
The patient’s cardiovascular health status is not entirely healthy. While his heart is pumping efficiently, the impaired relaxation and dilated left atrium raise concerns. These findings could be indicative of conditions such as diastolic heart failure or other cardiac abnormalities. Further investigation and monitoring are likely necessary to determine the underlying cause and appropriate management for this patient’s cardiovascular health.

It will be interesting to hear what the cardiologist has to say about all of this during our teleconference later this week which I will share. Keep in mind I am an 85-year-old veteran on 100% disability who was exposed to Agent Orange in Vietnam, have had a triple bypass and am currently on PD. In this regard, I bet that we will get a “Let’s keep an eye on it.”