Tag: dialysis (Page 50 of 50)

Social Fitness and Dialysis: What is the most important factor?

January 19, 2023 / Henry Feeser / 0 Comments

A recent full-page ad in the WSJ paid for by La Foundation Publicis states that “50% of all people with cancer are afraid to tell their employers.” (WSJ 1/18/2023 p. A18) The ad goes on to state “We aim to abolish the stigma and insecurity that exist for people with cancer in the workplace.” I strongly suspect that the word “dialysis” could be substituted for “cancer” with the same implication. If people are afraid of what their employers, and by extension, the population view them as, what does that say about how they view themselves, their feelings, their mental state, and their relationships with others? Feelings are a two-way street. What single factor has been found to keep people physically stronger, minds sharper, experience less depression, less diabetes (keep in mind the strong positive correlation between diabetes and dialysis), recover from illness sooner, and generally live a fulfilled life? Sounds like a lead-in to a TV commercial for a magic pill or a snake oil sales pitch. It’s not.

For more than 85 years a group of Harvard studies has investigated what really keeps people healthy and happy, regardless of their circumstances. Particulars of this research have been published in the book shown above. It is linked to Amazon for reference and linked here also.

ONE factor in their study consistently stands out with a high explanation of ties to physical and mental health and by association longevity, and that is (drum roll please) the “enduring importance of good relationships.” The Harvard researchers found that close personal connections are the single overriding principle for living. good relationships keep us healthier, and happier. Period. End of discussion. So if you desire to be healthiest and happiest while on dialysis, cultivate warm relationships of all kinds. Reach out to your family and friends. Engage with your Dialysis Team. That’s what they are there for. Read this blog and make comments. I will respond to them. Engage your nephrologist. Prepare for our monthly televisits. Read your lab reports. Do research as much as possible to understand what they are telling you and your dialysis team. You are on the one hand your best advocate and on the other your best critic. The bottom line, get it out there and shake a hand. See the video below for a discussion by one of the primary researchers, Robert Waldinger:

In the military, we have a concept of “Having a shipmate’s six.” When someone tells you that they’ve “got your six,” it means they’re watching your back. By extension, that person expects you to have their back as well. “Got your six” is now a ubiquitous term in the military that also highlights the way military members look out for each other. The term derives from aircraft of old that could not see what was behind them. In a relative clock around the aircraft where 12 o’clock is straight ahead, and six is straight behind, having a fellow pilot’s six inferred watching out for enemy aircraft sneaking up behind them and shooting them down.

Example of getting it out there: My wife and I have a Golden Retriever named Dickens. (See picture below at 7 weeks.) Currently, he is a 7-month-old 60-pound bundle of energy that requires exercise at least twice a day. Our routine is I take him to our local Dog Park in the morning and also take him on a long walk. Obviously, this is both good for him and for me. My wife takes him for a long walk in the evening. While on our morning walk I meet lots of people who must pet a Golden and by association meet with me and share the love. I just met an ex-Navy pilot on our walk who lives close to us with a pool. He has an American Golden named Jackson who gets along perfectly with Dickens. He has invited us to exercise our Golden in his pool and interface with his family socially.

As Lavern Baker sang in the 1953 song embedded below, get out there and ‘shake a hand!’ I assure you your dialysis outlook will greatly improve. Who knows, you might get to love a Golden Retriever if you are lucky also! See you at the dog park.

Dialysis Hints

January 16, 2023 / Henry Feeser / 0 Comments

Over the course of being on dialysis for several months, I have initiated several tweaks to the process to save time, energy, and increase safety of the system. Today’s blog discusses four of these “system improvements.”

The cap on the end of the “Blue is you” fitting that attaches the Cycler to your catheter line can be rather hard to unscrew from its as delivered position in the cassette package. I would surmise that those with arthritic hands would find it particularly difficult to loosen. I have found that it helps to “break loose” the fitting while it is firmly in place in the stay-safe receptacle. Don’t unscrew it -> just loosen so it’s finger tight, then proceed with your hooking up to the Cycler per stated norms. The square fitting on the end of the connection is 10 mm, so having a 10 mm open end wrench by the Cycler supports this operation. I have one as shown below which I use nightly.

By necessity, the plastic line from the Cycler to my bed travels across the floor in front of the access door to our Master Bedroom. Especially in the dark, this is a potential tripping Hazzard for my wife’s entry and exit from the bedroom. The next two hints address this safety issue.

First of all, the line: From Amazon I purchased a product that is normally used to cover electric cords as a cover for the plastic line. Nightly, as part of the Cycler setup, I run the Cycler attachment line through the bottom slit in the cover, turn it over, and presto, the tripping hazard is alleviated. See picture below.

The second hazard is being able to see the cover etc. in the dark when my wife leaves or enters the bedroom. Again, from Amazon I purchased two LED motion sensor-capable lights that are placed by the door and armoire (pointing toward the bed) that turn on automatically for about 10 seconds with motion, then off. In the dark they provide an abundance of light to light up the pathway to the bedroom.

The last item in this blog involves securing the drain line. I run the Cycler drain line to the shower in our Master Bath. It is common to tape down the drain line but cumbersome to do so. You have to get down on hands and knees to do this I’ve come up with a better way (for me) to secure the end of the drain line. My wife sacrificed a plastic bowl from the kitchen which I modified by drilling a 1/4 ” hole in the side about 1″ down from the edge. I then used scissors to cut out a “V”-shape to the drilled hole. I slip the “Yellow” plastic drain line bitter end into the V and thence to the hole to secure it. Then using the line, I just swing it into position covering the drain under the bowl face downward and I’m done. In the morning as part of cleanup I pull the bowl out of the shower, remove and cap off the line, rinse out the bowl and place it in the shower on the enclosed bench, and I’m done. Pictures follow.

And the next blog will be about?

Predicting Kidney Failure

January 13, 2023 / Henry Feeser / 0 Comments

From my history you may correctly ascertain that I spent many years on the edge of a cliff concerning when the kidney failure shoe would drop. I knew firsthand from my lab reports that my eGFR numbers were going the wrong way in conjunction with creatinine values steadily increasing. But to what extent, what timeframe, when would I have to go on dialysis as a result of complete kidney failure? Being an engineer and a Purdue Krannert School of Managment PhD I wanted numbers, probabilities, etc. No doctor even came close to a WAG (Wild-ass Guess) let alone a statement like “The probability is 0.62 that you will not require dialysis for at least five years.) I was just told that there is no cure and it’s only going to get worse.

This blog will fix this gap for readers willing to gather some common lab numbers and click boxes on a website or iPhone/Android app. You will be empowered to calculate what I just laid out above on your own, and to play “what-ifs” with creatinine and other lab variables. For example, how high does my creatinine have to increase to put me in a high-risk category for dialysis? Rather than the current state of worry because your creatinine readings are going south placing you in a static kidney failure category without any indication of timing of pending failure, you will know where the cliff’s edge is. And failure is pending; kidney failure WILL happen if you live long enough to ring the bell. Trust me, I arrived there after thirty years of being under the gun or being on cliff’s edge.

There is a web site named MedCalc that provides free access to hundreds of medical -related calculations. The one of interest herein is by a MD/PhD by the name of Navdeep Tangri and is named

Kidney Failure Risk Calculator

It predicts progression to kidney failure in patients with chronic kidney disease (CKD) and is located at this link. It requires inputting the following information: eGFR, sex, urine albumin-to-creatinine ratio, age in years, albumin, phosphorus, bicarbonate, and calcium. These values are common to labs reports for those with failing kidneys. The output provides an estimate of your five-year risk of experiencing kidney failure. The embedded screenshot below is my result.

Since I am already on dialysis after experiencing greatly diminished kidney functioning, we would expect the dire results thus obtained. Try the algorithm. You might be enlightened.

Grim Reaper & Dialysis

January 12, 2023 / Henry Feeser / 0 Comments

It is normal human nature to raise the question, “Now that I am on dialysis, how does this alter my lifespan?” For me at 84, I have three choices: Dialysis, Heart Transplant, or death. That simple. I chose not to pursue a transplant for one main reason – at my age younger people have much more to gain and potentially give back to society than I have so I defer to them. While I have ruled out a transplant, that does not mean I still can’t give a little back to society, this blog being an example. So it boiled down to Dialysis for me.

But this still begs the question, how has and is dialysis impacting my lifespan, or how much longer statically I will live. In 2018, adjusted mortality was more than twice as high among Medicare beneficiaries ages 66 years or older with CKD (96.0 per 1,000) compared with those without CKD (41.0 per 1,000). According to data from the U.S. Renal Data System, the chart below follows:

70- to 74-year-olds on dialysis live 3.6 years on average, compared with 12.2 years for their healthy peers;
75- to 79-year-olds on dialysis live 3.1 years on average, compared to 9.2 years;
80- to 85-year-olds on dialysis live 2.5 years on average, compared to 6.7 years; and
Patients on dialysis ages 85 and up live two years on average, compared to 3.5 years for their healthy peers.

A check on the above is provided by the SSA with a web site in which sex and date of birth are entered to ascertain how numbered your days are. Mine is shown below from their site:

In researching background for this blog, I discovered that there is no simple answer to the question of how dialysis impacts life span. There are so many what is called in statistics “intervening variables” as to defy meaningful computation. A few of these variables are sex, confounding health conditions (approaching unique for each individual), ethnicity, race, age, age upon onset of dialysis, mental approach to dialysis, etc.

However, I did discover research from a group in Canada shown below that provides some interesting data. I fall in the last row of the bottom chart. Obviously being a diabetic AND on Dialysis loaded heavily in their predictive modeling. The last bottom row suggests I have a 4.1% chance of living 10 years after starting dialysis. I’ll take the odds.

Bottom line: All of us have a need to be exceptional, don’t we?

Storage Hint

January 11, 2023 / Henry Feeser / 0 Comments

Today being Wednesday, it was time to restock our Ready Service Locker (RSL) with a week’s worth of Cycler supplies. Specifically, 5L dextrose bags, 3 L 1.5 % bags, 2.5 % 3 L bags, and cassettes for the following seven days. We moved the associated boxes and gear from our monthly storage unit in the spare bedroom to the Cycler area.

When your start to open the boxes containing the dextrose fluid for the Cycler, you will notice a large warning not to use a box cutter to open the box.

The short video embedded below shows you how to open the boxes without any possibility of damage to the contents.

Safely Opening Boxes

After opening the boxes, they are unloaded into the four bottom right divisions as shown in the last picture below, with the heavier 5 L bags in the bottom two divisions, and the lighter 1.5 and 2.5 gabs in the upper two divisions. We have moved the cassettes to the shelf under the Cycler so that they don’t have to be bent 180 degrees for storage.

Power Backup Dialysis Cycler

January 10, 2023 / Henry Feeser / 0 Comments

I have seen various takes on the requirements to provision backup power for the Dialysis Cycler (and most of it out in left field.) The purpose of this blog post is to provide my input to this concept (BS/MSEE Purdue University.) The image below from the Cycler Manual shows the max power at USA’s nominal 115vac public power to be 480 watts. Keep in mind that this is MAXIMUM.

What does it take to feed a 480-watt load for say 11 hours (my Cycler times have been in general between 10 hours 25 minutes and 10 hours 50 minutes?) In this case, I am going to address battery backup in the form of a UPS (Uninterruptable Power Supply.) We need to feed a 480 watt load with nominally 115 vac for 11 hours. These are our parameters for calculating the number of and Amp-Hour requirements for batteries for our UPS, as well as the Invertor to invert 12 volt direct current from the battery(ies) to 115 vac.

Luckily for us, there are several USP Calculators available on the web. I have linked the one we will be using. We have to use iteration (try values until desired results are obtained) in the panel.

In the UPS panel, I inputted our power of 480 watts, available battery amp-hours of 200, and number of 200 amp-hour batteries at 3 to obtain the 11 hours 32 minutes runtime which would cover our requirements. From this we have calculated that we require three, 12-volt 200 amp-hour batteries. Turning to our universal off the shelf place, Amazon, we find that Renogy makes such a battery for $359.99 each, or about $1180.00 for the three.

The inverter of at least 600-watt capacity is also sourced from Amazon. A 600-Watt Pure Sine Wave Inverter goes for $78.70.

We need one more component to kluge together a UPS for our Cycler, a trickle charger to keep the batteries up. Amazon has one of these fitting the bill (10-Amp Car Battery Charger, 12V and 24V Smart Fully Automatic Battery Charger Maintainer Trickle Charger w/ Temperature Compensation for Car Truck Motorcycle Lawn Mower Boat Marine Lead Acid Batteries) for less than $27.00.

So, for $1180 + $79 + 27 = $1286 plus tax etc. you can build a healthy UPS that will run your Cycler for a complete Dialysis. You will also have to provide some battery interconnecting cables. Or you can buy a small gas generator such as a Honda 1000, or a new Ford truck with EV and plug into it, or……? You are in “charge.”

Last Component of our Dialysis Setup: Master Bath

January 9, 2023 / Henry Feeser / 0 Comments

Our Master Bath is used in two instances in support of my PD treatment. First is to undress and dress my catheter area before and after showering; the second is to cleanse my hands prior to making ready to hook up to the cycler at night. The following items are positioned on or in the sink area of the Master Bath:

Health Guard Antibacterial Hank Soap
ExSept Antimicrobal Exit Site Skin & Wound Cleaner
Gentamicin Sulfate Cream by Perrigo
Paper Towel
2×2 gauze pads
Band-Aid Small 2×2 padded gauze pad
Q-tip
1-minute Timer (to time evening handwashing)
Tape
Lanyard

The following embedded video depicts use of the above itmes:

In & Out Showering with Dialysis Gear

My PD Setup – Storage of Supplies

January 6, 2023 / Henry Feeser / 1 Comment

There are literally hundreds of pounds of supplies associated with PD. The majority are provided by

Storage

Fresenius and a few out-of-pocket by me by my own volition (subject of a future blog). Let’s start with the largest, bulkiest items, the solution boxes. As stated in the last blog post, I am on 8L of PD solution which consists of one 5L bag and one 3L bag per day for 8L total. Fresenius ships the 5L solution two to a box, so a month’s supply (30 days) is 15 boxes. The 3L bags come four to a box, so 30 days’ supply requires 30/4 or 7 1/2 boxes. Cassettes (provide all the plastic lines and special fitting required to interface with the Cycler) come 10 to a box, so a 30-day supply is three boxes. Add all of this up and we have about 26 boxes just for a month. If you add in another 10 days for backup, you have on the order of 35 boxes steady state just for ongoing needs. Our storage schema is shown in the picture which is in our spare bedroom closet. We order supplies on a monthly basis. CAVEAT: The initial solution mixture provided by Fresenius contained much too much 2.5 solution and is not returnable to them. Try to ensure that your initial solution shipment matches what your doctor is recommending for you to start with!.

However, at least at the beginning of PD, things are not steady state. Early on and continuing until today, I experienced EDEMA in my ankles (Puffiness caused by excess fluid trapped in my tissues.) To assist my body in properly disposing of this fluid via PD, my Clinical Nurse and erstwhile guardian (part of the Fresenius-provided team and a Godsend) Cindy suggested upping the strength of the dialysis fluid, called DIALYSATE. (The Components of PD which directly impact efficacy of the PD and can be manipulated to maximize solute and fluid removal are dialysate volume, dwell time, number of exchanges per day and potency of the dialysate itself.) There are three “strengths” of dialysate, 1.5 (yellow), 2.5 (green) and 4.25 (red) where the numbers indicate percentage of dextrose (yes sugar for diabetics reading this) in the solution. I started off on all yellow/1.5. To combat edema, we moved up to 3L of 2.5/green on MWF which to date has at least moderated my ankle swelling. Thus, I have had to juggle types of 3L boxes to accommodate my 1.5 and 2.5 requirements. Same number of boxes but different logistics.

The next blog will address the third leg of our PD effort, the stand-alone workstation.

My PD Setup:

January 6, 2023 / Henry Feeser / 0 Comments

My PD setup consists of four stations:

The Liberty Cycler located adjacent to our bed pictured herein;
A storage area in a spare bedroom closet;
A separate workstation and storage area in our Master Bedroom;
And lastly, a work area in the Master Bath for aseptically cleaning and dressing my catheter access region.

Liberty Cycler

Introduction:

January 5, 2023 / Henry Feeser / 0 Comments

Welcome to my blog which is dedicated to sharing my personal experience in traveling the road from a healthy US Naval Officer to a Home Dialysis patient.

Background: From December 1971 to October 1972, I served In-Country Vietnam as a USN Naval Advisor to South Vietnam’s Brown Water Navy. As such I traveled extensively throughout Central and South Vietnam’s riverine areas where I was subjected to exposure to Agent Orange. Subsequently I developed Type 2 diabetes which I first was able to control with diet and exercise, then oral medication, and finally insulin. This took place over about a thirty-year timeframe. In the early nineties my GP at the time observed that my eGFR (estimated glomerular filtration rate, a measure of how well the kidneys are functioning) was on a downward trend (not good) and passed through the 60-threshold level indicating pending kidney failure. Some 28 years later, my eGFR reached the 6 level, I felt like crap, and suggested to my Renal Specialist Dr Turner that it was time to move on to dialysis to which she agreed.

On 8/20/22 I started Hemodialysis with Fresenius Granbury, TX which lasted until 9/24/22. On 9/26/22 I started training at Fresenius for PD (Automated Peritoneal Dialysis also known as CCPD, or continuous cycler-assisted Peritoneal Dialysis) and on 9/30/22 accomplished my first at home PD treatment and have been doing so every night since.

I am an engineer (see www.feeser.net for more details on my background) and as such, have been “engineering” small tweaks and making observations concerning the entire PD process. It is the purpose of this blog to document and pass on to those just starting or already on the same path as I am traveling perhaps to lighten the load for some, to share like experiences with others, and just inform others as to what PD is all about.