I started this blog on January 5, 2023, and since then have made a total of 34 posts, all related to my PD journey at least in a tangential way. Today I’m going to relate a little of the behind-the-scenes data that a few of my plugins are gathering on the fly.
205 unique visitors from 15 different countries have made 590 page views or 2.88 pages per visit. Google has been the top search engine as might be expected. As shown in the graphic below, the maximum number of page views occurred recently and peaked at 69.
PAGE VIEWS DAILY
The top ten countries for participation in the blog are shown below. The United States by far has the most hits, followed by Canada but hey, people in other countries are also interested.
Top Ten Hits
Of interest is also what terms were used in searches that resulted in landings on my blog pages. See the chart below: In the chart, the search term “Fresenius liberty cycler” (45) is followed by “Liberty Cycler” (15) then “Fresenius peritoneal dialysis solution” “(10, and lastly by “Fresenius pd cycler” (8) are the top four searches. This suggests strongly that these terms are good tags for my blogs, assuming they are contained verbally therein.
I may have found a solution to what is the number one problem for those on Peritoneal Dialysis (PD) using the Fresenius Liberty Cycler – Drain Alarms. For those new to PD, the cycler is a computer-controlled 28-pound machine that cyclers a fluid in and out of the user’s stomach lining (Peritoneal area) during the night hours. For me, I experience four fills and four drains of 2 L each, for a total of 8 liters or a little over two gallons of a special fluid each evening.
What happens more often than not, is that during the drain cycles, the drainage slows down to such an extent that the computer throws a message in conjunction with loud warning beeps that would wake the dead that the system is draining slowly. To remedy this situation, more often than not, requires the person on dialysis to get out of bed in a vertical position, or sitting at best, until the draining reaches about 1400 mL or more before going back to bed. Why 1400 – it appears that is the drain threshold the computer is hard-wired for. So back to the solution.
Up until three nights ago, I was adjusting the fill/drain line from my catheter upwards from the entry/exit point in my stomach in a loop up through the hoop in the lanyard I wear around my neck to secure the line, then back down and out back to the cycler. Three nights ago I took the line off the lanyard, and from the access in my stomach ran it in a downward loop thence out and back to the cycler. The rudimental sketch below illustrates this. It is working for me. Further reporting to follow.
Yesterday was a day for the record, being on Dialysis aside. Started off with the last drain cycle hanging up and refusing to proceed. Instead, just kept beeping its slow drain message at me. I was pressed for time because I had a cardiologist appointment that I had to make. I ended up physically cutting the cycler line off just past the blue “Y” and draining the contents of my stomach into the bathroom sink as if I were doing a manual drain. At first, it drained rather slowly but soon picked up and I felt confident that a good drain resulted. I informed my team nurse of this and we decided “to watch it.” This morning and last night for that matter all went well – no alarms so whatever was going on, went away.
In conjunction with the aforementioned, received a phone call from the Fresenius driver that my monthly supply allotment was to be delivered shortly. And, being Wednesday, it was time to resupply our Ready Service Locker. Luckily for me, my wife did this, and also took care of the restocking of the resupply from Fresenius.
Off to the cardiologist where I received a good diagnosis on the state of my heart. In July 2015 I had a triple bypass, so keeping up with visits to the cardiologist for me is mandatory. Got “see you in eight months” which is always good to hear.
Next off to Fresenius in Granbury to pick up an extensive VA (Veteran’s Administration) for documenting my dialysis journey. I am in the midst of applying to the VA to increase my VA disability due to CKF from 80% to 100% and this form is part of that application. This has been a work in process since December 2022. With this voluminous folder in hand, headed home via an Auto Safety Check Station to have the yearly required Texas State Safety Check performed on our BMW X5. This is a $7.00 fee required exercise prior to registration renewal for all Texas-registered vehicles. Took only a couple of minutes and finally headed home.
Once back home had lunch, and started scanning the VA documents into PDFs then merged about 50 odd pages of my nephrologist notes, etc into a single PDF file, wrote a cover letter, and forwarded via the internet the package to the VA’s Private Medical Record facility and also to VA.gov. Was able to pet our golden Dickens for a couple of minutes, then off to recycling with the X5 where I recycled two weeks’ worth of cardboard from dialysis boxes and containers. Finally, back home, where I dined on delicious chicken fried rice my wife whooped up.
Needless to say, I slept well and thank God, the Dialysis Cycler cooperated and I had no alarms waking me up every two hours. There is a God!
The Veterans Administration (VA) provides a disability rating system for veterans with chronic kidney disease (CKD) who require dialysis. This rating system is used to determine the level of compensation that a veteran is eligible to receive for their condition.
The VA rating for dialysis is based on the severity of the veteran’s CKD and the impact that it has on their daily life and ability to work. In general, the higher the rating, the more compensation a veteran is eligible to receive.
The VA uses a 100-point scale to determine a veteran’s disability rating for dialysis. The rating is based on several factors, including the veteran’s symptoms, physical limitations, and ability to perform daily activities. The VA also considers the frequency and length of dialysis treatments and any complications related to the treatment, such as infections.
A veteran with dialysis may receive a rating of 0 to 100, with 100 being the highest rating and indicating the greatest degree of disability. A veteran with a high rating, such as 80 or 100, is eligible for a higher level of compensation and benefits, including tax-free financial compensation, health care benefits, and vocational rehabilitation services.
For the record, I currently am rated at 80% Disability for DKF, or Diabetic Kidney Failure. In December 2022 I applied for an increase in rating to 100%. As with all things having to do with the VA, the request is “moving” at less than a snail’s pace, having been in review since 1/28/23.
In conclusion, the VA’s disability rating system is an important tool for veterans with dialysis who are seeking compensation and support for their condition. By considering the severity of a veteran’s CKD and the impact that it has on their daily life and ability to work, the VA provides a “fair and comprehensive evaluation” of a veteran’s disability related to dialysis.
Monday morning first thing meet with my PD team at Fresenius Granbury, TX. All went well with my lab results mostly being within specs with the exception of possibly iron which may be supplemented next month.
I received a handout from the team’s dietitian which had an interesting statement, to wit: “Avoid heart catheters. PD does not last forever, so plan with your doctor to get an access placed for hemodialysis if you don’t already have one. … should you ever have problems with your PD catheter.” To me, this begs the question, “How long could one expect a PD schema to last?”
So off to Google where I found an interesting article from healio.com titled “Can peritoneal dialysis be a long-term therapy?” The following is excerpted from this source with my clarifying info in brackets.
PD does not necessarily need to be a short-term therapy, and it has longer-term potential if the patient avoids peritonitis, leverages lower hyperosmotic dialysate, and preserves residual renal function.
The main reasons for PD technique failure include psychosocial stressors, [Psychosocial stress is caused by situations that make us feel excluded, not good enough, or as if we don’t belong.] infection, catheter malfunction, inadequate dialysis, hypervolemia [Hypervolemia is a condition in which there is too much fluid in the blood.] and other medical conditions —e.g., uncontrolled diabetes, acute cardiovascular events, etc. Controlling reversible factors is critical to extending the time on therapy for PD patients.
Peritoneal membrane function may be extended by avoiding significant hyperosmotic [The term hyperosmotic is derived from the Greek words hyper, which means “excessive,” and Osmos, which means “push, thrust, or impulse.” ] glucose and uncontrolled diabetes; avoiding peritonitis; considering diuretics to improve urine output when possible to avoid hyperosmotic glucose solutions; and leveraging angiotensin [Angiotensin is a chemical in your body that narrows your blood vessels.] -converting enzymes, angiotensin II receptor blockers, and/ or aldosterone inhibitors to preserve both kidney and membrane function.
Historically, the ideal candidates for PD are individuals wanting to treat their kidney disease in the home and who desire to play a key role in ensuring optimal care results. These patients may be younger, but they can be of any age as long as they are interested in a home modality; employed individuals who want to stay working; and patients with residual renal function and interested in preserving urine volume.
So the answer to my question is, How long should one expect to be able to continue on PD? Is for a long time. This time is directly a function of:
At my monthly meetings with my Fresenius Team, I am provided an “education” module having to do with some aspect of Dialysis. This month, I was given Module 7, Medicines: Tools for Good Health. In the following blog, I am going to excerpt tidbits that should be of interest to those interested in all aspects of Dialysis.
Regarding OTC medicines
Watch out for herbal or other natural home remedies. They can build up and make you sick or even be life-threatening
Never take these OTC medicines:
Alka Seltzer, baking soda, or other bubbling remedies. These are high in sodium.
Antacids containing magnesium (Milk of Magnesia) or aluminum (Mylanta). These chemicals can build up and cause nervous system problems.
Aspirin unless ordered by your doctor. May cause bleeding.
Enemas and laxatives unless prescribed by your kidney doctor – they are high in phosphorus
Vitamins or food supplements. They may have potassium and magnesium in them that build up in your blood.
Any herbal medicines and OTC medicines without prior approval from your kidney doctor.
Phosphorus
Hi phosphorus and low calcium levels can lead to serious bone disease.
Too much phosphorous gets into your skin and may cause very bad itching. It can also get into your heart and cause heart disease.
Kidney disease upsets the balance of phosphorus and calcium in your body. The balance of phosphorus and calcium works like a seesaw. When one goes up the other goes down. Your goal is to restore the balance.
Phosphorus binder medicines taken with iron pills will prevent the iron from getting absorbed by your body. If you take iron pills, take them at least one hour before or after your phosphorus binders.
Antibiotics and CKF:
When your kidneys stop working, they can no longer filter drugs out of your bloodstream. For this reason, antibiotics may build up to dangerous levels in your body.
As your Kidney Doctor about any antibiotics you get from another doctor
Tell your Kidney Doctor about dental work or other surgery you will be having.
Medicines for PD Patients:
Heparin may be given to help stop protein strands from forming. These strands called fibrin may clog the catheter which blocks the flow of dialysate solution in and out of your abdomen.
Epogen is administered as a small shot under the skin.
Iron may be prescribed as IV-delivered or as a pill.
Vitamin D in pill form is often prescribed in pill form also.
Two days ago, I was in the shower and about to get out when I started to feel worse. Upon getting out of the shower, I started feeling like I had cotton between my ears. It went downhill from there. Made it until bedtime – early – and with lots of help from my wife managed to get hooked up on the PD Cycler. Of course, it picked this time to throw drain alarms throughout the night.
The next morning checked in at our GPs office and received meds and a shot for vomiting to treat my upchucking about every four hours. Because of the condition, I’m in (see the video below), I canceled my Team Meeting at Fresenius. I attempted to schedule a Tel-Conference to no avail. Fresenius told me they no longer are doing Tel-Conference and I would have to reschedule. Appears corporate or whoever is looking out for other than their patients in this regard.
Today my goal is to walk up and down the long hallway in our home to try to build some strength. I just took a B12 shot so maybe this will help also. Hopefully, I’ll be back in battery come Monday.
Yesterday I visited Fresenius local to have labs pulled. Today they were available via the Fresenius PatientHub App. In this blog, I will discuss seven of the results. Screenshots of the actual app readings follow the comments.
Albumin 3.7. Staying flat. Watch.
Calcium 8.9. Bounce up. Looks good.
Phosphorus 5.0. The body responded to binders. Continue taking.
Potassium. 4.6 Slightly uptrend. Watch. May have to cut back on tomatoes.
iPTH 239. Looking Good.
BUN 54. Increasing. Not removing enough urea nitrogen from blood? Question Neprologist during this Friday’s Team Meeting??
Creatinine 6.09. Flat. Equates to an eGFR of 8. Snore.
AlbuminPotassiumCalciumPhosphorusBUNCreatinine
In tomorrow’s blog, I intend on discussing more Peritoneal Dialysis and drugs per se insights.
Yesterday @ 0830 CST I visited my local Fresenius Medical facility in Granbury, TX for labs. This blog relates what took place during my visit.
Valentine’s Day is just a short week away. To thank five of the members of my Fresenius dialysis teams, both Hemo and PD, my wife and I bought Valentine cards, candy, and Hoffbrau Restaurant gift certificates for them. I handed the gifts out on the way into the clinic. They were very well received which is always a good feeling.
Straightaway I wan logged in and provided biometric data – Weight, blood pressure, pulse, glucose, and temperature data, and the USB drive from the Cycler that I had removed prior to leaving home. I then signed several forms to catch up on paperwork for Fresenius, there is always paperwork to catch up on, provided my two insurance cards – Medicare and my military ID for Tricare for Life, and signed some more forms.
I was then shifted to a treatment room where I removed my coat and sweatshirt, was seated and attended to by my dialysis nurse and another nurse. The second nurse drew blood samples and gave me two shots, one my last hepatitis B shot, and the second a Pneumovax shot. My dialysis nurse meanwhile asked me a battery of questions to ascertain my general health and well-being, listened to my heart and lungs, thoroughly inspected my feet, and visually and digitally inspected my stomach catheter area. I was provided a sheet with March’s appointments, and my monthly education package, this time Module 7, Medicines; Tools for Good Health.
I was then sent on my way but had to return as I forgot to pick up a replacement USB drive for the Cycler.
I also noted the Glucose reading on my Libre 3 as being 100 at the time the blood sample was drawn, and the corresponding BMI (remember poor man’s A1C reading) was 6.1%. When my labs come back, probably tomorrow, we’ll compare readings. I had my biometric watch on but forgot to take a reading from it.
When my labs come in, we’ll discuss in some detail what the findings are. For now, I feel great, good, awesome.
On Monday 2/6/2023 I am scheduled to have my monthly lab work done at Fresenius Medical Center in Granbury, TX. I thought it would be appropriate to blog about what these tests are all about in a general nature, followed by more specifics of my personal results. So here goes:
Peritoneal dialysis (PD) is a form of renal replacement therapy that is used to treat patients with end-stage renal disease. It involves the use of the patient’s own peritoneal membrane, which is the inner lining of the abdominal cavity, as a filter to remove waste products from the blood. This process is performed through a series of exchanges that are done several times a day, typically at home. For me, I do four exchanges or two hours duration each.
One of the critical components of PD is the use of dialysis solution, which is a sterile solution that is instilled into the peritoneal cavity through a catheter. This solution works by drawing waste products from the blood into the peritoneal cavity, where they are then removed during the next exchange. To ensure the safety and efficacy of the dialysis process, it is essential to regularly monitor the dialysis solution and the patient’s response to it. This is where peritoneal dialysis labs come in.
What are Peritoneal Dialysis Labs?
Peritoneal dialysis labs are specialized facilities that are designed to monitor and evaluate the quality of the dialysis solution and the patient’s response to it. These labs typically use state-of-the-art equipment and technology to perform a series of tests that help to assess the concentration of waste products, electrolytes, glucose, and other important parameters in the dialysis solution and patient’s blood. For me, Fresenius uses spectra laboratories out of Southaven, MS to conduct the labs. At least that’s the letterhead on my lab reports.
The main objective of peritoneal dialysis labs is to ensure that the dialysis solution used in PD is both safe and effective. To achieve this, they perform several key tests, including:
Dialysis Solution Glucose Concentration Test: This test measures the concentration of glucose in the dialysis solution, which is critical to the success of PD. If the glucose concentration is too high or too low, it can affect the efficiency of the dialysis process and cause adverse effects such as hypoglycemia or hyperglycemia.
Peritoneal Equilibration Test (PET): The PET test measures the rate of transfer of glucose and other solutes between the blood and dialysis solution. This test helps to determine the effectiveness of the dialysis solution and the patient’s peritoneal membrane.
Dialysis Solution Electrolyte Concentration Test: This test measures the concentration of electrolytes in the dialysis solution, including sodium, potassium, and calcium. It is important to maintain a proper balance of these electrolytes to ensure the safety and efficacy of PD.
Bacterial Culture Test: This test is performed to assess the presence of bacteria in the dialysis solution. Bacterial contamination of the dialysis solution can cause severe infections, and regular monitoring is critical to prevent this from happening.
The results of these tests are used to adjust the dialysis solution and the patient’s treatment plan, ensuring that the PD process is both safe and effective.
Benefits of Regular Monitoring by Peritoneal Dialysis Labs
Improved patient outcomes: Regular monitoring of the dialysis solution and the patient’s response to it helps to ensure that the PD process is effective and that the patient is receiving the best possible care. This, in turn, leads to improved patient outcomes, including better control of waste product levels, improved electrolyte balance, and a reduced risk of infections.
Increased patient comfort: Regular monitoring helps to identify and address any issues or adverse effects that may be affecting the patient’s comfort and well-being. This helps to improve the overall quality of life for patients undergoing PD.
Improved safety: Regular monitoring by peritoneal dialysis labs helps to ensure that the dialysis solution is used.
In a following blog we’ll discuss my actual labs, what they mean to me, and how I respond to them if at all.
