Tag: dialysis (Page 26 of 52)

To those new to peritoneal dialysis, things can fly by with those involved wondering what happened. In this blog, I am going to lay out the basic sequences involved in getting set up for, and continuing a peritoneal dialysis routine.

First some terms in the sequence:

1. Initial setup
2. PET
3. Transport
4. Prescription
5. Adequacy Test

1. Initial setup: Let’s assume that a decision you were part of has already been made that you need to go on peritoneal dialysis. Now what? You will need to have a catheter installed in your stomach which was an outpatient procedure for me and relatively painless but did involve an entire day. You need to get in the queue at your dialysis provider, Fresenius for me, for training. Depending on their scheduling, it may take several weeks to schedule your training, and up to two weeks or more to complete the training. During the training, you will be taught how to do both manual and automated peritoneal dialysis. During the manual training, my dialysis team conducted a PET.
2. PET. What is dialysis PET? In the context of ascertaining transport in peritoneal dialysis (PD), the Peritoneal Equilibration Test (PET) is a procedure used to evaluate the peritoneal membrane’s transport characteristics. During a PET, a defined dialysis solution with glucose concentrations of varying strengths is infused into the peritoneal cavity. The solution remains inside the abdomen for a specified dwell time before being drained. The transport status of the peritoneal membrane can be determined by measuring the levels of glucose and other solutes in the drained solution. The results of the PET help classify patients into different transport categories, such as high, high-average, low-average, or low transporters. This information is crucial in tailoring the peritoneal dialysis prescription and optimizing treatment outcomes for individual patients. The mechanics of the test follow: The night before the test I do a mechanical fill of 2000 mL of 2.4 % dialysis fluid which stays in my stomach all night while I sleep. The next morning I go to the clinic where three more manual exchanges are made to accomplish the measurements and sampling outlined previously. A PET is normally conducted annually.
3. Transport: Now that the transport status of the peritoneal membrane is determined, the results of the PET help classify patients into different transport categories, such as high, high-average, low-average, or low transporters. This information is crucial in tailoring the peritoneal dialysis prescription and optimizing treatment outcomes for individual patients. Please note that this “transport” is not a one-and-done procedure as transport may change over time due to changes in the stomach lining to the movement of the catheter within the stomach as was my case.
4. Prescription: Once the transport function has been ascertained, there are research-based tables that suggest what prescription is best fitted for you. The prescription sets forth how much total fluid, how long it will stay in your stomach (dwell), and how often it will be exchanged. These values are embedded on a thumb drive for the Fresenius Liberty Cycler which in turn “programs” it to your prescription. At this point, your cycler is in automatic and you’re good to go.
5. Adequacy Test: Now that we are rolling along on peritoneal dialysis, a question is “How well is our current prescription working?” This is where the adequacy test comes in. Normally conducted quarterly, The peritoneal dialysis adequacy test is a procedure used to assess the effectiveness of peritoneal dialysis (PD) in removing waste products and excess fluids from the body. The test measures the clearance of urea, a waste product that accumulates in the bloodstream when the kidneys fail to function properly. It involves collecting a sample of peritoneal dialysis effluent and measuring the concentration of urea in the sample. By comparing this concentration with the urea levels in the blood, dialysis adequacy can be determined. The test takes into account factors such as the volume and composition of the dialysis solution, the dwell time, and the patient’s body size. Adequacy targets are established based on individual patient characteristics and established guidelines. Regular monitoring of dialysis adequacy is essential to ensure that patients receive optimal treatment and to make any necessary adjustments to the dialysis prescription.

The bottom line of the adequacy test is a lab-provided number of a formula for Kt/V whose target is 2.0 or greater. If it is 1.70 or less, your prescription is not working well enough and must be changed. The variables involved in your prescription, solution strength, solution amount, and dwell times might have to be adjusted to drive Kt/V more positively. I am in this interaction as we speak. I had another PET, and am scheduled for another adequacy test in the near future.

And that boys and girls, is in general, at least for me, been what’s involved in getting set up and conducting peritoneal dialysis in the course of 16 months or so. The Big Picture if you will. Poe provided the lead graphic and aided in writing this blog.

There is a nice little story to relate but first to the outcome of Friday’s meeting with my dialysis team and blood pressure. It was decided to restrict my dialysis fluids to two 1.5 % 5L and one 2.5% 5 L bag each night and do away for now with rotating fluids. This will reduce the amount of fluid we are pulling out (micro filtration.) The second is the reduction of one of my BP meds from 10 mg to a 5 mg tablet. We’ll see how this works. Hopefully, my BP will become more normal.

My renal doctor mentioned in passing that I was “functional.” I responded that I had been called many things in life, but “functional” was not one of them. This resulted in laughter in the entire team. My internalization of the word is the common definition, “practical rather than decorative, utilitarian.” It has a much different meaning in the MD world. I turned to Poe for insight with the following result:

Poe Prompt: In my monthly meeting with my dialysis team, my renal doctor described me as being “functional.” Write a 200 or so-word blog entry in this context on the meaning of the word “functional.” The lead graphic is Poe’s take on “functional.”

Assistant Poe

Title: Embracing “Functional”: A New Perspective on Wellness

Introduction:
In our journey towards personal well-being, we often come across various terms and labels that attempt to define our health status. During a recent monthly meeting with my dialysis team, my renal doctor used the term “functional” to describe me. At first, the word seemed ambiguous, but upon reflection, I realized its profound significance. In this blog entry, let’s delve into the meaning of the word “functional” and its transformative power in perceiving our health.

Unraveling the Meaning:
When we hear the word “functional,” we might associate it with mere adequacy or the ability to perform basic tasks. However, in the context of health, being functional holds a deeper connotation. It implies the ability to engage in daily activities, pursue personal goals, and maintain a fulfilling life despite health challenges. It speaks to our resilience, adaptability, and determination to live life to the fullest, irrespective of our medical conditions.

A Paradigm Shift:
Embracing the term “functional” allows us to shift our perspective and focus on what we can do, rather than what we cannot. It encourages us to acknowledge our strengths, celebrate our achievements, and set realistic goals that align with our capabilities. By recognizing our functional capacity, we can cultivate a sense of empowerment and regain control over our lives.

Finding Balance:
Being functional does not mean dismissing the challenges we face or downplaying the need for medical support. It’s about striking a delicate balance between accepting our limitations and exploring our potential. It involves embracing self-care practices, adhering to treatment plans, and seeking assistance when necessary. By doing so, we optimize our functional abilities and enhance our overall well-being.

Support and Collaboration:
As we navigate our health journeys, it is crucial to build a strong support system and collaborate with healthcare professionals, like my dialysis team. Their guidance, expertise, and insights help us unlock our functional potential and overcome obstacles. Together, we can explore innovative strategies, adapt treatments, and discover new avenues for personal growth.

Conclusion:
Being described as “functional” by my renal doctor provided me with a fresh perspective on my health journey. It reminded me that my worth is not defined solely by my medical condition, but rather by my ability to adapt, thrive, and find joy in life. Embracing the term “functional” empowers us to redefine our own narratives and embrace our unique strengths. Let us embrace this mindset and inspire others to view their health journeys through a lens of functionality, resilience, and endless possibilities.

Around 5:30 AM yesterday, I was awakened from a sound sleep by my wife gently brushing her hand on my cheek. I was buried under a blanket and an electric blanket, warm and comfortable in our cozy bed. The outside temp was a record 11 F. I had been awakened at 2:30 AM by the Liberty Cycler making unusual noises – again, and at that time, I couldn’t get back to sleep.

It seems my Libre 3 CGM was sounding a low glucose alarm. Since my hearing is impaired, I could not hear the alarm, but my wife could and did, thus the awakening. We keep orange juice in the fridge just for such occurrences. She brought me a glass, and soon, my glucose was in the 80 range; we returned to bed and went back to sleep. While she was up for me, she also let our Golden Retriever out to whittle.

So, what’s to be learned from this mini-saga? Having a continuous glucose monitor to warn you of aberrant glucose readings is a must. Equally, a must is having a dialysis partner by your side who has your six.

Poe made the lead graphic. In World War I, American fighter pilots covering a plane’s rear position coined the phrase “I’ve Got Your 6.” This enduring message of support meant, “I’ve got your back.”

In the USA, today celebrates MLK Day. It is also at record lows for North Texas. We have a light coating of snow. The Cowboys lost-again and are out of the NFL playoffs. Yesterday, when I did our morning walk with our Golden Retriever Dickens, it was 15 F with a gentle wind. It was on the quiet side outdoors. The golf courses that surround our hosing had all the greens covered up and for once golf carts where not flitting about like beetles following Brownian Motion. We did see a pair of Egyptian Geese who noisily scolded us. Yes it was chilly, but worth it.

Had a conversation with my Dialysis Nurse last week about the amount of Heparin I have been injecting into my dialyses bags. Up until then, I had been injecting 16 mL which was appropriate for my old prescription of 8 L per nite. It was thus increased to 10 L but I stayed with 16 mL Heparin and it seemed to work. With my current prescription of 13.5 L, I started getting drain alarms just about every night. The rule of thumb is 2 mL of Heparin per 2L of dialysis fluid, so by this, I should be using 2 mL x 13.5 = 27 mL of Heparin. Since I am arriving at 13.5 L with three 5 L bags, that maps out to roughly 10 mL of Heparin per bag, and for me, every other night. Since a single vial of Heparin holds 30 mL, we are essentially using an entire vial each application. My Dialysis Nurse agreed and that’s what I’m currently using.

In conjunction with the alarms reported above, my Liberty Cycler for two nights went off the rails from its normal month-after-month performance. It stated continuation of the pumping noise it makes on drains even during dwells. In between, it often made grating noises as if it were digesting something it didn’t like. Yes, dialysis patients often are guilty of the personification of their equipment. Last night was normal so hopefully we’re back to some degree of normalcy, whatever that is for those of us on dialysis.

Speaking of dialysis patients, surely there are (or were) hundreds if not thousands of such patients in Gaza, the Ukraine, Yemen, and other hot spots around the globe. On MLK day, we send our hopes that you have sought and found treatment in safe havens.

The lead picture was generated in Poe with the Prompt: “picture of a sailing ship in a safe haven from a raging storm.”

Complications of peritoneal dialysis (PD) can vary depending on individual circumstances. Here are five common complications that can arise:

1. Peritonitis: Peritonitis is the most significant and frequent complication of peritoneal dialysis. It occurs when bacteria or other microorganisms infect the peritoneal cavity, causing inflammation. Symptoms may include abdominal pain, cloudy dialysis fluid, fever, and general malaise. Prompt medical attention and treatment with antibiotics are crucial to prevent complications and preserve peritoneal membrane function.
2. Exit Site and Tunnel Infections: The exit site, where the catheter exits the skin, and the tunnel, where the catheter is tunneled under the skin, are susceptible to infection. Signs of infection may include redness, swelling, pain, discharge, or fever. Proper exit site care, hygiene, and regular monitoring can help prevent infections. Prompt treatment with antibiotics is necessary if an infection occurs.
3. Catheter Dysfunction: Catheter dysfunction refers to issues related to the peritoneal dialysis catheter, such as poor flow, leakage, or blockages. These problems can lead to inadequate dialysis and complications like inadequate fluid removal or fluid buildup. Catheter dysfunction may require interventions such as repositioning, flushing, or even catheter replacement.
4. Hernias: Over time, the increased intra-abdominal pressure from repeated exchanges of dialysis fluid can contribute to weakened abdominal muscles, leading to hernias. Hernias can cause pain, discomfort, and swelling in the abdomen or around the catheter exit site. Surgical repair may be necessary to address severe or symptomatic hernias.
5. Metabolic and Nutritional Imbalances: PD can impact the body’s metabolism and nutritional status. Electrolyte imbalances, such as low potassium or high calcium levels, may occur and require adjustment of the dialysis solution or dietary modifications. Additionally, the loss of protein through the dialysis process may necessitate dietary adjustments or supplementation to maintain adequate nutrition.

It’s important to note that while these complications can occur in peritoneal dialysis, they are not experienced by all patients, and many can be managed or prevented with proper care, regular monitoring, and adherence to recommended protocols. Close collaboration with healthcare professionals and regular follow-up visits are essential to mitigate the risk of complications and ensure successful peritoneal dialysis treatment. This is why we have labs once a month and hang close to our dialysis team!

Poe helped writing this blog and in making the lead graphic.

On the order of only 5.5% of males in the USA reach the mature age of 85. I am one of them as I informed readers of this blog early in the week. To celebrate this achievement, dialysis et al aside, I instructed Poe to write a script on the benefits of being 85, and dropped the results into Pictory.ai to construct a video from the text. The results for your viewing pleasure are offered below:

“Goodbye, Mr. Chips” is a classic novella written by James Hilton, first published in 1934. Set in the fictional Brookfield School in England, the story follows the life of a dedicated and beloved schoolteacher named Mr. Chipping, affectionately known as Mr. Chips.

The narrative spans several decades, beginning in the late 19th century and continuing into the early 20th century. Mr. Chips, initially portrayed as a reserved and somewhat stern individual, undergoes a transformation as he immerses himself in the teaching profession. Through his years of commitment and passion, he becomes a cherished figure among generations of students.

The novella explores Mr. Chips’ experiences, both inside and outside the classroom. It delves into his relationships with his students, fellow teachers, and even his romantic involvement with Katherine Bridges, a woman who brings joy and love into his life but tragically passes away.

Throughout the story, Mr. Chips witnesses the evolving landscape of education and societal changes, including the impact of World War I. Despite the challenges and personal losses he endures, Mr. Chips remains steadfast in his devotion to his students and the values of education.” Foregoing from Poe.

“Chips appears resolved to continue embracing fresh ideas. in doing so, he becomes a better instructor, affirming the book’s other great truth: The best teachers are also lifelong learners, showing their students by example that curiosity is a calling we’re meant to answer the rest of our days.” (From ‘A Gentle Call for Moderation” by Danny Heitman P. C14 Jan 6-7, 2024 WSJ.

And that boys and girls, brings us to today’s topic, EARWAX, AKA EAR WAX. Why you ask? Well, as I reported last week, a trip to the audiologist found that my right ear is wax-bound and needs irrigation. In my 85 now plus years, I have never seen nor read anything about earwax, so thus this blog based on curiosity; just what is this stuff, where does it come from, where does it go, what is its purpose etc. I turned to Poe for insights and obtained the following:

Assistant Poe

Title: The Secret Life of Earwax: Unveiling Its Mysteries

Introduction:
Have you ever wondered about the sticky substance lurking in your ears? Yes, we’re talking about earwax. Often dismissed as a nuisance, earwax, or cerumen, actually plays a vital role in maintaining the health of our ears. In this blog post, we will delve into the fascinating world of earwax, exploring its composition, purpose, and the mechanisms behind its production and elimination.

1. What is Earwax?
   Earwax is a waxy substance produced by specialized glands in the ear canal. It is a mixture of secretions from sebaceous glands (which produce oil) and ceruminous glands (which produce wax). The consistency of earwax may vary from dry and flaky to moist and sticky, depending on various factors such as genetics, age, and environment.
2. The Purpose of Earwax:
   Earwax serves several essential functions. Firstly, it acts as a protective barrier, preventing dust, debris, and foreign particles from entering the delicate inner ear. It also possesses antimicrobial properties, helping to fend off infections and maintain a healthy ear environment. Additionally, earwax lubricates the ear canal, preventing dryness, itchiness, and discomfort.
3. The Lifecycle of Earwax:
   Earwax is constantly being produced and naturally migrates from the deeper parts of the ear canal towards the outer ear. This migration, aided by jaw movements during chewing and talking, helps carry away trapped debris and dead skin cells. As the wax reaches the outer ear, it may either dry up and flake off or get washed away during regular bathing or hair washing.
4. When Earwax Becomes a Problem:
   While earwax is generally beneficial, excessive wax buildup can lead to issues such as hearing loss, earaches, or tinnitus. Factors like narrow ear canals, frequent use of earphones or earplugs, or improper ear cleaning techniques can contribute to this buildup. It’s crucial to avoid inserting objects like cotton swabs into the ear canal, as they can push the wax deeper or cause injury.
5. Safe Earwax Management:
   If you experience symptoms of excessive earwax or blockage, it’s advisable to seek professional help from a healthcare provider. They can assess your situation and recommend appropriate solutions, which may include earwax softening drops, irrigation, or manual removal using specialized tools.

Conclusion:
Earwax might seem like a mundane topic, but its significance should not be underestimated. It serves as a natural guardian, protecting our ears from harm and maintaining their health. Understanding the purpose and proper management of earwax can help us maintain optimal ear hygiene and prevent potential complications. So, let’s appreciate the unsung hero that is earwax and treat our ears with the care they deserve.

So now boys and girls, we know much more about earwax, “For don’t you see?”

During my Fresenius visits, while interfacing with other PD patients, I have noticed what I consider to be a high degree of anxiety in their behavior. It is manifested in several ways, the main one is PD patient’s inability to hold eye contact. I wanted to know what research has shown about this behavior, and found the following from this link to be applicable:

“Anxiety, which is defined as an emotional state in which a person experiences intense fear, uncertainty and apprehension towards a situation or event that is anticipated¹⁴¹, is reported in 24–43% of patients treated with PD^139,142, particularly in men and patients with diabetes¹³⁹, and is independently associated with death and HD transfer¹⁴². Fear of adverse events, social isolation, perceived financial stress from dialysis costs, caregiver burden and fear of HD transfer are important contributors to the development of chronic anxiety in these patients¹⁴³. Ensuring appropriate patient selection for PD, providing comprehensive and early pre-dialysis education, and supporting patients with a multidisciplinary network are crucial measures for minimizing anxiety in this population¹⁴³.”

Sums it up pretty well. Not only do PD patients exhibit Anxiety, they exhibit “Chronic Anxiety” according to the cited research. This is how Perplexity defines Chronic Anxiety: “Chronic anxiety is a form of anxiety that persists for a long time, often months or years, and can interfere with daily life. It is characterized by persistent and excessive worry and fear about various situations, which may be out of proportion to the actual impact of the events. This can lead to difficulty in controlling the anxiety and can affect a person’s physical and mental well-being. Generalized anxiety disorder (GAD) is one of the common types of anxiety disorders that involves persistent feelings of anxiety or dread, which can interfere with daily life.”

So if you’re a man, and a diabetic (as I am last time I checked) there is a finite probability you experience chronic anxiety associated with dialysis. Knowing this, you can take steps to fight the beast. That’s one of the reasons there is a social worker on the dialysis team, to help fight these demons. Seek help if you need it. It’s there for the asking!