Tag: fresenius (Page 25 of 49)

“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!

.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?