Tag: dialysis (Page 23 of 50)

Yesterday on the return leg of my morning walk with our Golden Retriever Dickens, I could feel the dreaded effects of low blood pressure starting. I felt slightly light-headed, was becoming a little short of breath, and had sweat on my upper lip although the wind was blowing and it was on the cold side. I made it home, got Dickens off his leash, had to lean up against the kitchen wall for a bit for my gyros to settle down, and then went into the living room and sat down. After a bit I felt good enough to take my blood pressure: it was 80 over 58, substantially below the target minimum of 90 over 60. So what now?

My wife Linda naturally inquired “What can you do to bring your blood pressure up “immediately?” I have previously reported on this and suggested for lunch we have something prepared like packaged chicken noodle soup and along with it some olives. We did and further, I made myself fried canned potatoes with sausage patties and onions for supper with lots of salt. I also halved my evening BP med.

I informed my dialysis nurse Cindy as soon as this happened and she suggested hydration and using only 1.5% dialysis solution for a couple of days. Tuesday morning my blood pressure was 110 over 64 which I’ll take to the bank any day. On Tuesday’s dog walk, all was copesetic.

In discussions with my dialysis nurse about my blood pressure and associated medications, she informed me that it is not unusual at all for dialysis patients to “go off” of meds as a result of dialysis. I am informing readers of this blog what is going on with me in this area so that they are sensitive to the possibility of change in their prescriptions, especially regarding blood pressure. I have also noted a reduced need for insulin to control my glucose along with insulin requirements becoming much more aligned with exercise. More exercise, less insulin needed.

Introduction:
Howdy, dear readers! Today, I want to share with you the pros and cons of living in the great state of Texas, particularly for someone like me who is an 85-year-old retired naval officer on peritoneal dialysis. Texas offers a unique blend of cowboy culture, a rich mixture of Spanish and American traditions, a friendly atmosphere, and various amenities. So, let’s saddle up and explore the benefits and challenges of calling Texas home!

Cowboy Life:
Living in Texas allows you to immerse yourself in the legendary cowboy lifestyle. From rodeos to western-themed events, Texas offers a vibrant and authentic experience. The state’s rich history and cultural heritage provide numerous opportunities to embrace the cowboy spirit and indulge in activities like horseback riding, attending cattle drives, and exploring ranches. Texas is the perfect place to call home for someone seeking a connection to the rugged Wild West.

A blend of Spanish and American Cultures:
Texas’s unique geographical location and historical background have resulted in a harmonious blend of Spanish and American cultures. This fusion is evident in the state’s architecture, cuisine, music, and festivals. From Tex-Mex delicacies to vibrant celebrations like Fiesta San Antonio, the cultural diversity adds an exciting dimension to everyday life. For someone eager to experience a rich tapestry of traditions, Texas provides an enriching environment.

Friendly Atmosphere:
Texans are renowned for their warmth and hospitality. The friendly atmosphere in Texas can make anyone feel right at home. The state’s residents are known for their welcoming nature, willingness to lend a helping hand, and strong sense of community. As an 85-year-old retired naval officer, you can expect to find support and camaraderie from fellow Texans, making your daily life and peritoneal dialysis journey more comfortable and enjoyable.

Amenities and Quality of Life:
Texas offers a wide range of amenities that cater to various interests and hobbies. Whether you enjoy outdoor activities such as fishing, golfing, or visiting state parks, or prefer cultural pursuits like attending museums, theaters, and live music performances, Texas has it all. Additionally, the state boasts excellent healthcare facilities, ensuring access to quality medical care for individuals like yourself who require peritoneal dialysis.

Financial and Tax Considerations:
One of the significant advantages of living in Texas is the absence of state income tax. This can benefit retirees on fixed incomes, allowing them to keep more of their hard-earned money. Additionally, Texas has a lower cost of living than some other states, which means your retirement savings can go further. However, it’s crucial to consider property taxes, which can vary depending on the county and city you reside in.

Conclusion:
Living in Texas as an 85-year-old retired naval officer on peritoneal dialysis offers a unique blend of advantages and considerations. The cowboy life, cultural diversity, friendly atmosphere, and abundant amenities make Texas an enticing place to call home. The absence of state income tax and lower cost of living can provide financial relief, but it’s essential to research and plan for property taxes. Ultimately, the decision to live in Texas depends on your personal preferences, health needs, and desire for adventure. So, partner, saddle up and explore the Lone Star State—I reckon it might just steal your heart!

You might notice that the blog looks a little bit different than in the past. I updated the WordPress theme I was using to one named “Hemingway” to gain easy access to search functionality. Please give search a try and let me know how it goes in the comments.

This past Friday my dialysis nurse Cindy performed all necessary monthly interfaces with me including labs. Here’s the deal. We recently changed, rather drastically, my dialysis prescription hoping to increase my Kt/V readings toward the goal of 2.0 or more. Also, Kt/V is a lab-derived number indicating how well a patient’s dialysis works. Higher is better in this case.

I am disappointed in the outcome regarding Kt/V. After increasing the dialysis fluid I’m using to 13,500 mL per night from 10,000 mL, and the number of dwells to five from four, I have gained all of 0.1 in the Kt/V reading, and I’m still 0.2 below the desired minimum. See the graph below:

Like lots of things in life, there was also a positive side to my labs. My Phosphorous has been running on the high side. To combat this I doubled the amount of phosphorous binder I have been taking with breakfast. The current labs indicate I am now within the upper bound. See the graph below. In this case, there is half a God. The remainder of my lab results were within specs or expected.

Since it’s Friday’s blog, today will be a little “lighter” than during the previous week’s posts. Within Poe, there are customized bots made available to the public. One such is named ScriptifyPro. I used it with the following prompt and results to write a ballad about myself. I also ran this script through Pictory.ai and made the following video which is embedded first below. Enjoy!

Prompt: Write a ballad about a retired US Navy Commander named Hank who as a result of exposure to Agent Orange in Vietnam is on dialysis.

In the land of heroes, a tale I will weave,
Of a retired Commander, brave and bold, Hank by name,
With a lifetime of service to the Navy, he gave,
But burdened by Agent Orange’s cruel flame.

Hank, a seasoned warrior, sailed through Vietnam’s tide,
Fighting for freedom, with honor and might,
Unaware of the danger that silently lied,
Agent Orange, a toxin that would haunt him at night.

As the years rolled on, his health began to fade,
For the poison had woven its web deep within,
His body weakened, his spirit never swayed,
But the toll on his life, it was a battle to win.

Now retired from duty, a new fight he embraced,
For Hank, it was not the end, but a new chapter’s start,
Seven times a week, dialysis he faced,
A warrior’s spirit, pumping strength to his heart.

With each dialysis session, Hank stood tall,
Gathering courage, never one to complain,
He shared stories of valor with one and all,
A testament to resilience through the pain.

His shipmates rallied, forming a bond so tight,
Supporting their Commander, their friend through the years,
Together they fought, shining a beacon of light,
For Hank, their hero, deserving of cheers.

Though the battle within may never cease,
Hank’s determination remained unwaveringly strong,
A symbol of sacrifice, a true masterpiece,
A Navy Commander, enduring lifelong.

So raise a glass, for Hank, the courageous and true,
A retiree who faced adversity with grace,
His bravery shines, a beacon for me and you,
A testament to the indomitable human race.

In the annals of history, Hank’s story will live,
A ballad of courage, resilience, and might,
A tribute to those who selflessly give,
And a reminder to cherish each precious day and night.

Last Friday at 1600 no less, in a town about 40 miles from home, Stephenville, TX, I met with my new audiologist provided by the VA. He is part of the Livingston chain of hearing aid suppliers in Texas. Everything went as expected as far as assessment etc. Yes, I need new hearing aids – yeah! But in my case, he recommended in-ear rechargeable ones. He took impressions of both of my ear canals with a substance in a tube that felt like caulking for windows. Except it solidified in a short period and he was able to completely remove the impressions in one fell swoop. He said he had to obtain approval from the VA which would take up to a month and we’d go from there. He also said that I would be seeing him quarterly hereafter to ensure my hearing was attended to. This is something new.

This leads to the question “How do over-the-ear aids compare to in-ear aids?” To addresses this query, I turned to Poe again with the following results:

Prompt: Recently my audiologist prescribed an in-ear hearing aid for me for which he took impressions of both of my ear canals. Describe in some detail the differences between an over-the-ear hearing aid and a rechargeable one that fits in the ear canal. Positive and negatives, please.

DoctorSage Poe
Certainly! Let’s compare the differences between an over-the-ear (OTE) hearing aid and a rechargeable in-the-ear (ITE) hearing aid that fits in the ear canal. Both types of hearing aids have their own advantages and disadvantages. Here’s a detailed overview:

Over-the-ear (OTE) Hearing Aid:
Positive aspects:

Amplification power: OTE hearing aids tend to have larger batteries and more space for advanced technology, allowing for higher amplification power and better sound processing capabilities.
Comfort and fit: OTE hearing aids rest behind the ear, making them suitable for individuals with different ear canal sizes. They are generally more comfortable to wear and cause less occlusion (blocked feeling) in the ear canal.
Durability and maintenance: Due to their larger size, OTE hearing aids are often more robust and less prone to damage. They are easier to clean and maintain.
Negative aspects:

Visibility: Some individuals may feel self-conscious about wearing a visible hearing aid since OTE devices are more noticeable than those that fit inside the ear canal.
Wind noise: OTE hearing aids may be more susceptible to wind noise, which can affect sound quality during outdoor activities.
Feedback: Since the microphone and receiver are located outside the ear, the possibility of feedback (whistling sound) is slightly higher compared to ITE hearing aids.
Rechargeable In-the-Ear (ITE) Hearing Aid:
Positive aspects:

Cosmetics: ITE hearing aids are custom-made to fit the shape of the individual’s ear canal, making them discreet and less noticeable.
Convenience: Rechargeable ITE hearing aids eliminate the need for frequent battery changes. They usually come with a portable charging case that allows for easy and on-the-go charging.
Sound quality: ITE hearing aids can provide a more natural sound perception since they are placed closer to the eardrum, allowing for better sound localization and improved directionality.
Negative aspects:

Battery life: Rechargeable ITE hearing aids typically have a shorter battery life compared to traditional disposable battery-powered devices. However, advancements in technology have led to longer-lasting rechargeable batteries.
Size limitations: Due to the size constraints of the ear canal, ITE hearing aids may have limited space for advanced features and larger batteries, potentially impacting the availability of certain high-end functionalities.
Maintenance: ITE hearing aids require regular cleaning and maintenance to avoid wax build-up and ensure optimal performance. They may be more susceptible to damage from moisture and earwax.
It’s important to note that the choice between an OTE hearing aid and a rechargeable ITE hearing aid depends on several factors, including the individual’s hearing loss, lifestyle, personal preference, and the recommendation of the audiologist. A thorough evaluation by an audiologist will help determine the most suitable type of hearing aid for your specific needs.

If you have any further questions or need more specific information, please let me know!

Can you explain how the sound quality of an over-the-ear hearing aid compares to a rechargeable in-the-ear hearing aid?

DoctorSage Poe
Certainly! When comparing the sound quality of an over-the-ear (OTE) hearing aid to a rechargeable in-the-ear (ITE) hearing aid, there are a few factors to consider:

Amplification and Power: OTE hearing aids generally have more space for advanced technology, including larger batteries and amplifiers. This allows for higher amplification power and more sophisticated sound processing capabilities. As a result, OTE devices can often provide a broader frequency response range and more precise sound amplification, which may contribute to improved sound quality.

Proximity to the Ear: ITE hearing aids, being placed directly in the ear canal, can provide a more natural sound perception since the sound is delivered closer to the eardrum. This proximity can enhance sound localization and improve the ability to perceive subtle nuances in speech and environmental sounds. The closer positioning of the microphone and receiver in ITE devices can also reduce the possibility of sound distortion or interference.

Sound Occlusion: OTE hearing aids are positioned behind the ear, which generally results in less occlusion or a blocked feeling in the ear canal. In contrast, ITE hearing aids occupy a portion of the ear canal, potentially leading to a slight occlusion effect. This occlusion may affect the perception of one’s own voice, low-frequency sounds, and overall sound quality. However, modern ITE hearing aids are designed to minimize occlusion and provide more natural sound experiences.

Personalization and Customization: Both types of hearing aids can be programmed and adjusted to an individual’s specific hearing needs. However, ITE hearing aids, being custom-made to fit the shape of the ear canal, can offer a more personalized and tailored fit. This customized fit may improve sound delivery and localization, contributing to a better overall sound experience.

It is important to note that the perception of sound quality is subjective and can vary from person to person based on individual preferences and needs. Factors such as the degree and type of hearing loss, the specific technology and features of the hearing aids, and the expertise of the audiologist in fitting and programming the devices can all influence the perceived sound quality.

Ultimately, the choice between an OTE hearing aid and a rechargeable ITE hearing aid should be based on a comprehensive evaluation by an audiologist, taking into consideration the individual’s hearing profile, lifestyle, and personal preferences.

In yesterday’s blog, I cited in its entirety an article by DavidJ_PLMin in which he cited two new drugs that show promise in the treatment of CKF. In this blog, we will investigate the first of the two cited, namely sodium-glucose cotransporter 2 (SGLT2).To accomplish this I turned to my AI right hand Poe. Poe has a customized bot named DoctorSage that addresses medical questions. I queried the bot with the following prompt and results:

Prompt: There is a new drug used in treating CKD named sodium-glucose cotransporter 2 (SGLT2). Tell me everything there is to know about this treatment.

DoctorSage Poe

Sodium-glucose cotransporter 2 inhibitors (SGLT2 inhibitors) are a relatively new class of medications used in the treatment of chronic kidney disease (CKD). These medications work by inhibiting the reabsorption of glucose in the kidneys, leading to increased urinary glucose excretion. This mechanism of action not only helps in controlling blood sugar levels but also offers potential benefits in managing CKD. Here’s everything you need to know about SGLT2 inhibitors:

1. Mechanism of action: SGLT2 inhibitors primarily target the SGLT2 transporter located in the proximal tubules of the kidneys. By inhibiting this transporter, they prevent the reabsorption of glucose, resulting in increased glucose excretion in the urine.
2. Glycemic control: SGLT2 inhibitors are primarily used in the management of type 2 diabetes mellitus (T2DM). By reducing renal glucose reabsorption, these medications lower blood glucose levels, leading to improved glycemic control. They can be used as monotherapy or in combination with other antidiabetic medications.
3. Cardiovascular benefits: SGLT2 inhibitors have shown significant cardiovascular benefits in patients with T2DM and established cardiovascular disease (CVD). Studies have demonstrated a reduction in the risk of major adverse cardiovascular events, including heart attack, stroke, and cardiovascular death, with the use of SGLT2 inhibitors.
4. Renal benefits: The use of SGLT2 inhibitors has shown promising results in preserving kidney function and preventing the progression of CKD. These medications have been associated with a reduction in albuminuria (the presence of albumin in the urine) and a decrease in the risk of end-stage renal disease (ESRD) or the need for renal replacement therapy.
5. Blood pressure and weight reduction: SGLT2 inhibitors have been found to have a mild blood pressure-lowering effect. Additionally, they promote weight loss, which can be beneficial in patients with T2DM who are overweight or obese.
6. Adverse effects: The most common side effects of SGLT2 inhibitors include urinary tract infections, genital fungal infections, and increased urination. There have been rare cases of euglycemic diabetic ketoacidosis (DKA), a serious condition characterized by elevated ketone levels in the absence of high blood sugar levels. Therefore, it is essential to monitor for signs of DKA, especially in patients with T1DM or a history of DKA.
7. Contraindications and precautions: SGLT2 inhibitors should be used with caution in patients with impaired renal function, as they may increase the risk of acute kidney injury. They are contraindicated in patients with severe renal impairment or end-stage renal disease. It is important to assess renal function before starting treatment and regularly monitor renal function during therapy.

It’s worth noting that specific SGLT2 inhibitors available in the market may have slight differences in their pharmacokinetics and clinical effects. Therefore, it is crucial to consult the prescribing guidelines and individual drug information for detailed information on specific SGLT2 inhibitors.

A listing of SGLT2 drugs is provided at this link for further information.

Friday is a good day to mentally reflect on the past week and update the blog on some of the more gritty aspects of a dialysis life. So here’s some of the back stories in my life this week:

1. Since reducing one of my blood pressure meds from 10 mg to a 5 mg dose, my blood pressure responded well and the last six mornings have been over the minimum of 90 over 60. Thursday morning it was 110/62, just about perfect. It appears we have this defugality resolved, at least for now.
2. I have been having problems with my Abbott Libre 3 sensor. Recall this sensor provides me with real-time glucose readings to aid my diabetes control. Normally at night, I plug my phone into its AC charger on my desk in our study which is about 15 feet from our bed. Usually, the phone stays connected to the CGM and all is well. On rare occasions, the phone breaks connection, and the glucose reading goes down reaching the alarm stage of about 53. This causes my wife to get up and ascertain what the alarm is all about. She often wants me to chug orange juice to alleviate low glucose when in fact I feel fine and am not experiencing lows – no sweating and feeling it. The only way around this is to turn the phone off. This morning when I turned the phone back on the Libre 3 app informed me that my sensor had crapped out and to install a new one. This is two days before it was up for a normal last two-week replacement. From all of this, I ascertain that potentially there is something amiss with Libre 3 sensors.
3. I fought the VA and I won! I have previously related that I had to travel to the Ft Worth VA audiology clinic to be fitted for new hearing aids. The doctor there stood up for me and as a result, I received notification that a civilian audiologist in Granbury would be providing me hearing aids with an appointment in March. Since one of my hearing aids is in for repair, I desired to move this up if possible. I called the civilian office and got an appointment for 1600 today in Stevensville, some 43 miles away. Although this is roughly the same distance as we are from Ft Worth VA, it is a pleasurable drive through the remote Texas countryside from our digs. What’s not to like?
4. I spent some time last Saturday at our son’s new digs in the Palo Pinto TX area installing a new 5G Tp-Link Deco Mesh network system in his partially completed ICF (insulated concrete forms) home. He and his wife have now completed moved into the first floor/garage area from the trailer they were living in. His wife works from home and uses the internet heavily in her work as a graphic artist. As such, she requires as good an internet connection as she can get; the mesh network in connection with a T-Mobile 5G internet setup provided her on the order of a 150 Mbps down and 30 Mbps up connection which is more than adequate, even through the concrete wall of their digs.

The lead graphic was made using Poe with the prompt: “picture of the English shops selling “bits and bobs.” In England, Bits and Bobs equates to “this and that,” the subject of today’s blog.