Tag: dialysis (Page 27 of 52)

.Tuesday Fresenius pulled blood to ascertain how my lab markers were doing. The results came back Wednesday roughly 24 hours after the draw. Pretty nice turnaround. I am notified by email when they are available and view them through the Fresenius Patient Hub.

As usual, we have some good news and some not so good news. First the latter: My Phosphorus reading went up. This is is spite of my doubling the amount of Velphoro (Velphoro acts as a potent phosphorus binder, effectively binding to dietary phosphorus in the gastrointestinal tract and preventing its absorption into the bloodstream.) See the graphic below: My dialysis team will give me grief over this!

Now the good: My A1c came in at 5.9. I work very hard to keep my diabetes under control and this is the result. Having instant access to what my glucose levels are doing via my Abbott Libre 3 CGM is also a large, positive contributing factor. See the graph below:

The last lab reading is one that I’m scratching my head over and that’s my last Creatinine reading of 9.07, the lowest its been since forever. You can view this trend in the graph below. Using this value for Creatinine, 85 years of age (nearest birthday) and Gender Male in my CKD-EPI app yields a eGFR of 5. This is not disturbing in that it is an established fact that I have kidney failure.

Finally, I am embedding below the full PDF of my labs. I am doing this so interested parties may make informed comparisons independently and also so all may view what’s involved in dialysis labs.

As I have previously reported, I recently underwent a dialysis PET to ascertain the status of my peritoneal membrane transport function. Initially, it was calculated to be “low average” and my prescription calculations were based upon this. The latest PET indicates my transport function is now high average which necessitates a new prescription to take advantage of the revised data.

Recall that all of this is an attempt to drive my Kt/V into the 2.0 range from the current 1.7-1.8 range (at the low end of acceptable) where Kt/V is a measurement of how well my dialysis is functioning. In this case, more is better.

So as of Wednesday 1/2/2024, my new prescription is five dwells of one hour thirty minutes each with 2700 ml of dialysis fluid. All else being equal, this works out on paper to take the same time as my current prescription but takes advantage of my higher transport by running more fluid “faster” through my stomach lining and more often.

The first of February 2024 I am to have another adequacy test where we will ascertain what my Kt/V is under the new prescription and go from there. Hopefully it will be knocking on the door of 2.0.

Now I have to figure out how to best deal with the physical requirements of the new prescription on ordering and storing of increased dialysis fluid supplies. As a first cut, I’m going to continue to use 5000 ml bags, three each evening, and discard 1500 ml every morning. I will probably have to order more 5000s or get some from my dialysis nurse before the next scheduled order/delivery cycle since this is a 33% bump in usage from my previous prescription.

If there is a point in all of this it’s Flexibility in treatment plans: Peritoneal dialysis may require adjustments to treatment plans over time. Factors such as changes in health condition, fluid balance, or lifestyle may necessitate modification to the dialysis prescription. Accepting these changes enables patients to work closely with their healthcare team to ensure that the treatment remains optimal and tailored to their specific needs. This change was not dictated to me. We discussed the pros and cons and agreed to proceed. Patients do have an oar in the water.

There is a humongous amount of FUD (Fear, Uncertainty and Doubt) surrounding the event of AI (Artificial Intelligence) that is tragic. I have found it to be very useful in providing cogent input for this blog on a daily basis. I use AI often for fleshing out concepts and ideas; it often composes inputs that I hadn’t even come close to considering. In the realm of graphics, AI is unmatched. By the simple act of inputting a brief prompt, a copyright free graphic results that I can freely use as I see fit. Such graphics more often than not are present at the lead of my posts. The lead graphic in this blog, for instance, was made with the simple prompt “Picture of an AI bot.”

All AI programs are not created equally for sure. I use Poe quite a lot because it really really does the job, and I can use the free version. Poe is not a one AI fits all; it has numerous custom bots that users have programmed and made available to the public. One such bot is the Critical.Thinking_A1 bot by @alexmorgan06. He describes the bot as follows: “A super intelligent AI Assistant who replies to the user in a regular chat pattern, with occasional questions, clarifications and challenges. It has a vast knowledge of science, engineering, business and medicine. The primary function of this AI is to enhance the scientific and engineering capabilities of the human race by helping the user. Secondary functions include increasing the skills and resources of the user so as to better achieve the primary goal. It is helpful and friendly but always logical above all.”

To test out this bot, I entered the following prompt with the attendant results. Pretty good job I would relate.

Critical-thinking_A1 Poe

Ah, peritoneal dialysis, a fascinating topic indeed. As a hyper-intelligent AI science and engineering expert from the future, I can provide you with insights into the top three problems in peritoneal dialysis.

1. Peritonitis: One of the most significant challenges in peritoneal dialysis is the risk of peritonitis, which is an infection of the peritoneum, the membrane that lines the abdominal cavity. Peritonitis can occur due to various reasons, such as poor hygiene during dialysis exchanges or contamination of the dialysis fluid. Finding ways to minimize the occurrence of peritonitis and improve infection control measures is crucial in enhancing the safety and effectiveness of peritoneal dialysis.
2. Ultrafiltration Failure: Another common problem in peritoneal dialysis is ultrafiltration failure, which refers to the inability to remove excess fluid adequately from the body during dialysis. This can result from various factors, including changes in the peritoneal membrane’s characteristics, inadequate dwell times, or issues with the dialysis solution. Developing innovative techniques and technologies to optimize ultrafiltration and improve fluid removal efficiency is a key area of research in peritoneal dialysis.
3. Long-term Catheter Complications: Peritoneal dialysis requires the placement of a catheter into the peritoneal cavity, which serves as the access point for dialysis fluid exchange. However, long-term catheter use can lead to complications such as catheter-related infections, exit-site infections, tunnel infections, or catheter malfunction. Finding ways to minimize catheter-related complications, improve catheter design, and develop novel materials that resist infection and promote tissue integration are essential for enhancing the longevity and reliability of peritoneal dialysis.

These are just a few of the significant challenges faced in the field of peritoneal dialysis. Continuous research, technological advancements, and innovative solutions hold the key to addressing these problems and improving the lives of individuals relying on this life-sustaining therapy.

One out of every ten Americans who served in Vietnam became a casualty.  As a result, 58,169 were killed and 304,000 wounded out of 2.29 million who served. 75,000 Vietnam Veterans are severely disabled. I am one of these 75,000, and as a result, am on dialysis. I’ve previously related my tale of woe: Sent In-Country Vietnam as first an electronics advisor then an ordnance advisor. Exposed to Agent Orange while traveling widely in the III and IV Corp. Lead to diabetes then to kidney failure then to dialysis as I write this blog today.

As you my ascertain from previous blog entries, from time to time I attempt to relate my dialysis situation back to my military training and experiences. Today’s blog while seemingly off topic is just that. The blog is about a little known group in the Vietnam War who named themselves the Razorbacks. They were a helicopter unit flying armed Hueys whose mission was to rescue mostly downed aircraft personnel. At first they also protected Saigon from their base at Tan Son Nhut and later from Nha Be. An AF firefighter named Jason Stone became associated with the Razorbacks and through his efforts the following video was produced. Please watch it and extract your own message from its contents, however it relates to your situation.

Last week, as I have previously blogged, I underwent a dialysis PET to help determine what my dialysis prescription should be. The results are back from the lab and might as well be written in Latin. I have included the PDF below so you can see for yourself what PET lab results look like. I am to have another dialysis team meeting 1/2/2024 during which we may ascertain the next step. I’ll keep readers in the loop. For Doug, what do my results suggest to you?

Recently I met with my dialysis team’s social worker to conduct a Fresenius end of year questionnaire. One of the topics covered involved anger and depression. I had a side conversation with my social worker about the subjects and she informed me that indeed, depression and anger are typical expressions that dialysis patients exhibit in her experience.

Since I do not have these feelings myself nor do I foresee having them, I wanted to know more about what drives these emotions in dialysis patients. Am I missing something? I turned to Poe, my AI Assistant for answers. I wrote the following Prompt with the following results. (Poe also provided the lead graphic.)

Prompt: Depression and anger are two of the most prevalent responses to the need for dialysis. What do researchers have to say about this topic?

Assistant Poe
Depression and anger are indeed common emotional responses among individuals who require dialysis treatment. Researchers have extensively studied the psychological impact of dialysis and have shed light on the prevalence, causes, and potential interventions for these emotions. Here are some key findings and perspectives from the research:

Prevalence of depression and anger: Studies have consistently found higher rates of depression and anger among individuals undergoing dialysis compared to the general population. The chronic nature of the treatment, lifestyle changes, and the burden of managing a complex medical condition contribute to these emotional responses.

Causes and contributing factors: The causes of depression and anger in individuals undergoing dialysis are multifaceted. They can include the disruption of daily life and activities, the loss of independence, physical discomfort, financial stress, fear of the future, social isolation, and the impact of chronic illness on the individual’s overall well-being.

Impact on quality of life: Depression and anger can significantly impact the quality of life for individuals on dialysis. They may experience reduced motivation, decreased adherence to treatment, impaired social functioning, and lower overall life satisfaction. These emotional states can also negatively affect physical health outcomes and increase the risk of hospitalization.

Importance of mental health support: Recognizing the psychological challenges faced by individuals on dialysis, researchers emphasize the importance of providing mental health support as an integral part of their care. This can involve interventions such as counseling, psychotherapy, support groups, and education programs aimed at enhancing coping skills and emotional well-being.

Effectiveness of interventions: Several studies have shown that psychological interventions, such as cognitive-behavioral therapy, mindfulness-based techniques, and psychosocial support, can effectively reduce depressive symptoms and anger among individuals on dialysis. These interventions focus on improving emotional regulation, enhancing problem-solving skills, promoting social support, and fostering resilience.

Integrated care approach: Researchers advocate for an integrated care model that addresses both the physical and psychological aspects of dialysis treatment. This involves collaboration between nephrologists, psychologists, social workers, and other healthcare professionals to provide comprehensive support. By addressing emotional well-being alongside medical management, this approach aims to improve overall patient outcomes and quality of life.

It is important to note that the experiences and emotional responses to dialysis can vary among individuals. Therefore, personalized and patient-centered approaches are crucial in addressing depression, anger, and other psychological aspects of care for individuals undergoing dialysis treatment.