I’ve not posted for a few days due to the crash I had earlier. My ankle is coming along fine but a new defrugality has made itself known. In the past, I have experienced nasty vertigo. I don’t know if that’s what’s going on now, however. The bedroom ceiling is not spinning around but has some weird patterns. I have passed out once and started to on two more occasions. My blood pressure has been turning low. Today it was 100/58. All my other biometrics are fine. I stopped taking any BP meds.
Through all of this, I have been in contact with my dialysis nurse. We’ll work our way through this and come out the outer end better for it.
Yesterday I informed readers that I was to undergo a peritoneal dialysis adequacy test. Indeed, I accomplished all the requirements, until I didn’t. I must get up earlier to fulfill the home requirements and drive to the clinic. So I set two alarms to make sure I got up – and I did. Normally I sit on the side of the bed to give my head gyros time to cage; this morning I did not shut off the alarms—my first mistake. I made it to the cycler to do a Stat Drain. I started to get lightheaded, made it toward a chair in our master bedroom, and began to crash and went down over the dialysis cabinet we have by the chair. In so doing I also turned my left ankle. My wife immediately jumped out of bed to attend to me. 45 minutes later my head was still woozy.
The lesson here: Don’t jump out of bed if you have been sitting on the side to enable your head to adapt to new positioning.
During the morning workup to get ready to go to the clinic I took my morning biometrics which included blood glucose. My first reading was 212, second 220, and third 212. In the over two years that I have been on dialysis my glucose never has been 150 let alone over 200 so something was whacked here also.
My wife convinced me that it would be best If she called the clinic and canceled my appointment which I agreed to. My dialysis nurse, Cindy suggested she had a break in her schedule and she would come to our home and gather the required adequacy test bios which she did. While she was here we questioned her regarding the high glucose and she suggested it could be from my using a 25% solution for the adequacy test as compared to the 1.5% I have steadily been on in the past. Further, the 2.5% could have whacked my blood pressure and caused my fainting spell.
The lesson here: Sometimes just following instructions can have unintended consequences. I had done about seven adequacy test previously without any problems, and now this.
When you are on Peritoneal Dialysis, you never know when something is going to jump up and bite you on your ass!
This week, on Monday, I have dialysis labs, including my quarterly adequacy test. In review, the adequacy test produces a measurement named Kt/V. The parameters of this measurement are such that if the value produced by Kt/V is 2.0 or more, I am getting adequate peritoneal dialysis. For the past two quarters, I have been in the 2.2 range, so based on the past, I’m doing OK.
It is worth looking deeper into this lab result for future reference for me as well as you. I turned to the Dr. Sage bot available in Poe and asked about Kt/V with the following result:
Kt/V is a crucial parameter used to assess the adequacy of dialysis, particularly in patients undergoing peritoneal dialysis (PD). Understanding this measurement is vital for optimal patient management. Below are the key points regarding Kt/V in the context of peritoneal dialysis:
Definition Kt/V: This is a dimensionless number that quantifies the efficiency of dialysis. It represents the ratio of the amount of dialysis delivered (K, clearance of urea) multiplied by the time (t, duration of dialysis) to the volume of distribution of urea (V). Components K (Clearance): This refers to the effectiveness of the dialysis process in removing urea from the blood. In peritoneal dialysis, this is influenced by factors such as the surface area of the peritoneal membrane and the dialysate flow rate.t (Time): The duration of the dialysis session. Longer sessions typically allow for greater clearance of toxins. V (Volume): This is approximately equal to the patient’s total body water, which is used as a proxy for the volume of distribution of urea in the body. Calculation K can be estimated from the level of urea in the dialysate and blood samples taken before and after dialysis.
Interpretation A Kt/V value of:≥ 1.7: Generally considered adequate for peritoneal dialysis; indicates sufficient removal of urea.< 1.7: Indicates inadequate dialysis, which may necessitate adjustments in the dialysis regimen (e.g., increasing the number of exchanges or dwell time). Clinical Implications Inadequate Dialysis: A low Kt/V can lead to the accumulation of uremic toxins, resulting in symptoms such as fatigue, nausea, and pruritus. Patient Monitoring: Regular assessment of Kt/V is essential to ensure that patients are receiving adequate dialysis and to make necessary adjustments to their treatment regimen. Quality of Life: Adequate dialysis as indicated by sufficient Kt/V can improve patient outcomes and overall quality of life. Factors Affecting Kt/V Peritoneal Membrane Characteristics: The permeability and surface area of the peritoneal membrane can influence K. Dialysate Volume and Composition: The volume and concentration of the dialysate can impact the efficiency of urea clearance. Patient Factors: Body size, age, and overall health status can affect V and Kt/V readings. Summary Kt/V is a critical measure for evaluating the adequacy of peritoneal dialysis. Regular monitoring and adjustments based on Kt/V can significantly affect patient health outcomes and quality of life. Understanding Kt/V and its implications in peritoneal dialysis is essential for managing patients effectively and ensuring they receive adequate treatment. If you have any follow-up questions or need clarification on specific aspects, feel free to ask!
The title is a phrase that I have attempted to void throughout my life. I did not want to reach the place in life where I am now lamenting over opportunities missed, not taken advantage of, or passed up. For instance, in my fifties I bought a Porsche for my wife and a track weekend to familiarize her with the new car. Porsche racers were at the track as instructors, and during breaks, were out on the track having a good time. Not long after this weekend, I found a 911 basket case, bought it, and turned it into a track car. I raced for several seasons and it was a blast. I had a great time, and met lots of great people, and “Should’ve, could’ve, would’ve” does not apply. I did and have the memories to live with for the rest of my life.
Turning to this phrase as applies to those of us on peritoneal dialysis I asked Poe to apply the concept to us with the following results:
“Should’ve, could’ve, would’ve”—these words carry a weight of regret and what-ifs that can linger heavily on the mind. For many peritoneal dialysis patients, these sentiments may surface as they reflect on their health journey and the decisions that led them to this treatment. However, it is essential to shift perspective and recognize the strength, resilience, and courage it takes to navigate life on peritoneal dialysis.
The phrase “should’ve” often implies a sense of missed opportunities or actions that one regrets not taking. In the context of peritoneal dialysis patients, it may be tempting to dwell on the past and think about what could have been done differently to avoid kidney disease or the need for dialysis. Thoughts like “I should’ve taken better care of my health” or “I should’ve listened to my doctor sooner” can cloud the mind with guilt and self-blame.
But instead of getting caught up in the “should’ve,” peritoneal dialysis patients can reframe this perspective into one of empowerment and learning. Rather than focusing on past choices, they can acknowledge the courage it takes to face their health challenges head-on and make the decision to pursue peritoneal dialysis as a life-saving treatment. Every day on dialysis is a testament to their resilience and determination to prioritize their health and well-being.
“Could’ve” often brings to mind missed opportunities or potential outcomes that weren’t realized. In the world of peritoneal dialysis, patients may think about the freedom they could’ve had if they didn’t need to undergo dialysis treatments regularly. They might imagine a life without the constraints of a treatment schedule or dietary restrictions, longing for the spontaneity and normalcy that kidney disease has disrupted.
However, peritoneal dialysis patients can shift the focus from what could’ve been to what is possible now. By embracing the opportunities for self-care, connection with healthcare providers, and support from loved ones, they can create a fulfilling and meaningful life despite the challenges of their condition. Each dialysis session becomes not a limitation but a chance to prioritize their health and well-being, nurturing a sense of empowerment and control over their bodies.
“Would’ve” often speaks to intentions or desires that were not fulfilled or acted upon. In the realm of peritoneal dialysis, patients may find themselves longing for a life without the burdens of chronic illness, dreaming of a future that is free from the constraints of medical treatments and health complications. They may wish they would’ve been spared the struggles and hardships that come with managing kidney disease.
Yet, peritoneal dialysis patients can transform these wishes into a sense of gratitude for the present moment. Despite the challenges they face, they can find solace in the strength they have discovered within themselves, the relationships they have cultivated, and the resilience they have demonstrated in the face of adversity. Each day on peritoneal dialysis is an opportunity to embrace the gift of life and health, to find joy in the small victories, and to appreciate the support and care that surrounds them.
In conclusion, the journey of a peritoneal dialysis patient is one marked by courage, resilience, and gratitude. Rather than getting lost in the “should’ve, could’ve, would’ve,” they can celebrate the strength it takes to navigate life with a chronic illness, the opportunities for growth and learning, and the moments of joy and connection that make each day meaningful. By shifting the perspective from regret to resilience, peritoneal dialysis patients can find peace in the present moment and hope for the future, embracing the power of gratitude and grace in their health journey.
As Thanksgiving approaches this year, I find myself reflecting on all the things I have to be thankful for, especially regarding my health journey on peritoneal dialysis. It has been over two years since I started this treatment, and I am truly grateful for how well I am doing on it.
First and foremost, I am thankful for the opportunity to receive peritoneal dialysis. This treatment has been a lifeline for me, allowing me to manage my kidney disease and maintain a good quality of life. The fact that I can perform this treatment at home, on my schedule, has given me a sense of independence and control over my health that I never thought possible.
I am also grateful for the support of my healthcare team throughout this journey. From my nephrologist to the nurses and technicians who have guided me through the ins and outs of peritoneal dialysis, I am thankful for their expertise, compassion, and dedication to helping me thrive on this treatment. Their encouragement and knowledge have been invaluable in keeping me healthy and confident in managing my condition.
In addition, I am thankful for my family and friends who have been there for me every step of the way. Their unwavering support, love, and understanding have strengthened me during the challenging moments of my health journey. Whether it’s helping me with dialysis exchanges, running errands, or simply being a listening ear, their presence in my life is a constant reminder of the blessings I have.
I am grateful for the advancements in medical technology that have made peritoneal dialysis not only possible but also more efficient and convenient. The innovation and research in the field of kidney health have led to improvements in treatments like mine, offering patients like me a better quality of life and more options for managing our conditions.
Furthermore, I am thankful for the resilience and determination that I have discovered within myself since starting peritoneal dialysis. This journey has challenged me in ways I never imagined, but it has also shown me the depth of my strength and ability to adapt to new circumstances. I am proud of how far I have come and the progress I have made in taking control of my health and well-being.
As I sit down to celebrate Thanksgiving this year, I am filled with gratitude for all these blessings in my life. Peritoneal dialysis has been a central part of my health journey, and I am thankful for the stability, comfort, and hope it has brought me. I am reminded that even in the face of adversity, there is always something to be thankful for, and for me, that is the gift of health and the support of those around me.
This past weekend’s WSJ had an interesting article for me by Joe M. Moore titled “I Was in Great Health. So Why Were My Arteries Clogged?”
Joe M. Moore’s essay recounts his unexpected diagnosis of Sitosterolemia, a rare genetic disorder causing arterial plaque buildup, despite a healthy lifestyle. His high calcium score, revealed by a cardiac CT scan, initially baffled doctors. After further testing, Sitosterolemia was identified, highlighting the challenges of rare disease diagnosis and the importance of patient advocacy. Moore emphasizes proactive screenings and persistent questioning to ensure accurate diagnoses. The essay also discusses the high rate of misdiagnosis in the US and advocates for increased patient involvement in healthcare decisions.
So what you may ask. You may recall that while undergoing a dermatology procedure to remove skin cancer from my left temple the physician commented that he had never seen a temporal artery with such a large amount of calcification as mine. I fed this info to my cardiologist and received nothing back. Nada, Zip. This article provides insight into plausible steps to take to ascertain if Sitosterolemia is the case, and indeed, what degree of calcification I display.
As a side note, thanks to the persistence of my wife, I am now scheduled for a heart procedure/look-see on 12/30/2024. I have to go to Ft Worth on 12/26/2024 to see the attending nephrologist since my local kidney doctor does not have privileges there. We have been advised to take our cycler and associated gear in case we have to stay overnight. An overnight stay is in order if I have stents installed. One day at a time sweet Jesus.
As a current peritoneal dialysis patient, it is in my best interest to keep abreast of the latest research on the subject. Here’s what Perplexity has to say about this:
Peritoneal dialysis (PD) remains a crucial treatment option for patients with kidney failure, and recent research has focused on improving outcomes and addressing challenges associated with this modality. Here are some of the latest developments in PD research:
Technological Advancements
Recent innovations in PD technology aim to enhance patient outcomes and reduce treatment-associated harm:
Early Detection of Peritonitis: New technologies are being developed to enable point-of-care detection of peritonitis, potentially extending the treatment period on PD by preventing transfer to hemodialysis[1].
Glucose Exposure Reduction: Novel approaches are being explored to minimize the harmful effects of peritoneal glucose exposure, including:
Devices designed to deliver constant infusion of glucose at lower concentrations
Alternative osmotic agents such as xylitol
Protective additives like alanyl-glutamine or carnitine[1]
Clinical Practice Guidelines
The 2024 update of the Clinical Practice Guideline for the Prevention and Management of Peritoneal Dialysis Associated Infection in Children provides comprehensive treatment guidance based on recent literature and registry data. Key updates include:
New recommendations for antibiotic therapy of peritonitis, reflecting evolving antibiotic susceptibilities and stewardship practices
Updated clinical benchmarks
Recommendations for future research to address important knowledge gaps[3]
Outcomes and Practice Patterns
The Peritoneal Dialysis Outcomes and Practice Patterns Study (PDOPPS) continues to advance the understanding of optimal PD practices worldwide:
Phase 1 of PDOPPS included 7,629 patients from 215 dialysis facilities across 7 countries
Phase 2 is expanding to include Colombia and South Korea, focusing on novel areas of research
The study aims to promote appropriate use of PD, extend technique survival, and improve quality of life for PD patients[4]
Emerging Research Areas
Recent studies have explored various aspects of PD care:
Optimization of ultrafiltration and prevention of volume overload
Improved detection and prevention of cardiovascular disease in PD patients
Investigation of risk factors for peritonitis and technique failure
Associations between CKD-MBD biomarkers and survival
Use of PD for patients with chronic liver failure and acute kidney injury
Impact of periodontal disease on PD patients
Methods to increase physical activity and quality of life
Pathophysiology of peritoneal membrane aging[6][7]
Future Directions
Ongoing research efforts are focused on:
Developing goal-directed dialysis prescriptions that take a holistic view of patient outcomes
Addressing inequities in access to PD across different regions and populations
Improving PD education and training for both patients and healthcare providers
Investigating the potential of incremental PD approaches
Exploring the use of PD in various patient populations, including those with comorbidities[1][5]
As the field of PD continues to evolve, these research efforts aim to improve patient outcomes, increase the availability and utilization of PD worldwide, and address the ongoing challenges associated with this important kidney replacement therapy.
I subscribe to an AI service named Pictory. Using Pictory, you can input text via AI to be turned into a video. Recently Kate from Pictory sent users a fairly complicated prompt to use in your AI engine of choice to generate a script to be inputted into Pictory to turn into a video. I tried two scripts in Poe, one in the main Poe and one in a specific bot to author scripts. The first is the first below and the second is the specific script bot. Pretty cool stuff.
Last night my wife and I watched a movie on AcronTV that was based on a true story of the introduction of Viagra in the UK. It took place in the early nineties and was targeted toward men who were diabetics. The story centered on five men and their female companion’s social interaction resulting from the medication’s first trials. It was well done and interesting.
At breakfast, my wife and I discussed the film and in so doing the subject of diabetes and women’s sexual drive came up. Neither of us had ever heard of any research into this potential duality and thus this blog.
I turned to Perplexity with the following Prompt and results: is there any research into the impact of diabetes on the sexual drive of females?
Yes, there is a relationship between diabetes and sexual drive in females. Women with diabetes are more likely to experience a decrease in libido or lower sex drive compared to women without diabetes[1][2][5]. This can be attributed to several factors:
Hormonal changes: Diabetes can disrupt the normal balance of sex hormones like estrogen and testosterone, which can reduce sex drive and make it harder to become aroused[5].
Nerve damage: High blood sugar levels can cause nerve damage, affecting sensation in the genitals and making it difficult to feel sexual stimulation[1][5].
Reduced blood flow: Diabetes can damage blood vessels, restricting blood flow to sexual organs and potentially affecting arousal[5].
Psychological factors: Depression, anxiety, and stress associated with managing diabetes can contribute to a lower libido[2][5].
Medication side effects: Some medications used to treat diabetes or its complications, such as blood pressure drugs or antidepressants, can negatively impact sex drive[2][5].
Vaginal dryness: Women with diabetes may experience vaginal dryness due to reduced blood flow and nerve damage, which can make sex uncomfortable and decrease desire[1][5][8].
It’s important to note that while diabetes can affect sexual function, the impact varies among individuals. Open communication with healthcare providers and partners, along with proper diabetes management, can help address these issues and maintain a healthy sex life[2][5].
Now that I have reviewed the two-year point (9/30/202), it’s appropriate to investigate the ensconced thinking about longer-term effects on patients. To accomplish this I turned to Poe with the following results:
Peritoneal dialysis (PD) can be an effective long-term treatment option for patients with kidney failure, but it does come with potential side effects that may arise over time. Here are some of the long-term side effects associated with peritoneal dialysis:
Peritonitis Peritonitis is an infection of the peritoneum, one of the most serious complications of PD. It can occur if bacteria enter the peritoneal cavity through the catheter. Symptoms include abdominal pain, fever, and cloudy dialysate. Recurrent episodes can lead to scarring of the peritoneum and reduced effectiveness of PD.
Catheter-Related Issues The catheter used for PD can lead to complications such as blockage, leakage, or dislodgement. Long-term use may also result in skin infections or tunnel infections at the catheter site.
Changes in Body Composition Patients on PD may experience changes in body composition, such as increased body fat and decreased muscle mass. This is often due to the caloric content of the dialysate, which can lead to weight gain if not managed properly.
Abdominal Complications Over time, the presence of the dialysate in the abdominal cavity can cause issues such as abdominal distension or hernias. The increased pressure from the fluid can also affect abdominal organs.
Glucose Metabolism Issues The glucose in the dialysate can contribute to insulin resistance and worsen diabetes control in diabetic patients. Long-term exposure may increase the risk of developing diabetes.
Electrolyte Imbalances Patients on PD may experience imbalances in electrolytes, such as potassium and sodium. Monitoring and adjustments in treatment are necessary to maintain proper levels.
Bone and Mineral Disorders Long-term dialysis can affect bone health, leading to conditions such as renal osteodystrophy. This occurs due to altered calcium, phosphorus, and vitamin D metabolism.
Psychosocial Impact Living with a chronic condition like kidney failure can lead to psychological effects such as anxiety, depression, or social isolation. Patients may struggle with the demands of treatment and lifestyle changes.
Conclusion While peritoneal dialysis can be a beneficial treatment for many patients, it is important to be aware of the potential long-term side effects. Regular follow-ups with healthcare providers, proper training in catheter care, nutritional management, and psychological support can help mitigate these risks and improve the overall quality of life for patients on PD. Each patient’s experience is unique, so tailored care and monitoring are essential.
