In mid-December 1944, Allied forces were surprised by a massive German offensive through the Ardennes Forrest that created a “bulge” in the Allied lines. Caught in what would become known as the “Battle of the Bulge,” the 101st Airborne Division of the United States Armed Forces was holed up in Bastogne while German armored divisions encircled the town. Outnumbered, outgunned, and running out of food, ammunition, and medical supplies, the embattled assistant division commander, Brigadier General Anthony McAuliffe, faced bleak prospects.
On December 22, the American troops were sent an ultimatum from the German forces outside of the town, demanding “the honorable surrender” of the town within two hours. General McAuliffe’s reply was brief and succinct:
Why “Nuts!?” I received my lab results back from my most recent Adequacy Test, and once again they are Inadequate. See the graphic below:
In the chart above, my wKt/V has fallen from 1.56 to 1.44 despite increasing my dwell fluids to 2.5 L from 2.0 L. We are going the wrong direction people. I haven’t heard anything from my dialysis team as a result of this finding due to the Thanksgiving holiday in the United States but standby.
Another finding was also disturbing. See the graph below: My Phosphorus jumped from 5.8 to 7.1. Although the wheels appear to be falling off, Nuts! still applies. Reminds me of another story about the 101st Airborne at the battle above. When asked if they didn’t know they were surrounded by Germans their response was, “Paratroopers are supposed to be surrounded. That’s where we’re meant to be.” In other words, “Never ring the Bell!.”
In the video below, I show how we store and ensure we are using the dialysis fluids nearest to expiration. It pertains to those of us on Peritoneal Dialysis using the Fresenius Liberty Cycler products for treatment. It was shot using my Samsung S23 Ultra phone and edited using ByteDance’s CapCut free video editor. BTW, the parent company also has TikTok in its portfolio. CapCut is the best free video editor I’ve found. Enjoy the video:
While on dialysis, one of the important things is to have hobbies that keeps your mind active. I have several, one of which is this blog. Another is attempting to keep up with all of the new stuff that’s coming out as a result of artificial intelligence (AI). One of these new products is Create Studio 3. I made a short advert using this software. (It just crashed when I attempted to make a longer video BTW.) See it below:
Yesterday, 11/21/2023, as previously stated in Tuesday’s blog, I went to my dialysis center at Fresenius in Granbury, TX for the lab work associated with my latest Adequacy Test. While there, I was quizzed by my dialysis nurse Cindy as to how it was going since my PD fluid volume was increased to 10,000 mL from 8,000 mL, or to 2,500 mL from 2,000 mL per dwell. I informed her that I was doing fine and had noticed no difference in feeling in my stomach area and was feeling better overall.
She related to me an interesting story about one of her previous patients. Previous because he is dead.
One dictionary definition of “Discord” is a lack of agreement or harmony (as between person things, or ideas.) A previous patient was advised of the need to increase fluids from 1,800 mL to 2,500 mL but refused, stating that his stomach just couldn’t handle it. This, by the way, was based on no empirical evidence, just conjecture. He was a strapping six-plus footer that should have had plenty of room in his gut for increased fluid but refused. His plight was complicated by the fact that he had had Covid which severely impacted his lungs to the point that he was short of breath and was seeing a pulmonologist. The Discord between his state and prescribed dialysis treatment is obvious. He died as a result.
The lesson here is obvious also. Chances are your dialysis team is acting in your best interest and knows what they are doing, from empirical evidence if nothing else. Listen and weigh carefully their advice. It might just be the difference between life and death.
Today, 11/21/2023, I had my latest Adequacy Test at Fresenius in Granbury, TX. It will be a day or so before the lab results come back, and subsequent meetings with my dialysis team. Recall that I started feeling on the bum side, a microcosm of when I first Rang the Bell to start Peritoneal Dialysis. I tired easily, was rendered short of breath under moderate to light exertion, and knew something was not right.
As a first cut at alleviating this challenge, my dwell fluids were increased to 2500 mL from 2000 mL with the same number of dwells, four. I say first cut on purpose. We like to think that all things medical are absolute, if this, then that, but they are not. In fact, much of medical knowledge is a heuristic or a rule of thumb. They are based on practical experience and knowledge learned over time. So we are “trying” an increase of 500 ml because “experience” has shown that 250 mL isn’t enough.
Hopefully, in the next couple of days, I will be able to report that my wKt/V has increased toward the generally accepted goal of over 2.0 and we will be, from a lab perspective, in the green zone. I am feeling better day by day and have reported the same to my dialysis team.
On 11/14/2023 WSJ ran an article by Jen Murphy titled Learning How to Fall Safely with Help From Martial Arts. Research indicates that by far the heavy half of those of us on Peritoneal Dialysis are over 66 putting us at risk for falls because of age if nothing else. Consider the following:
Increased Vulnerability: Patients on peritoneal dialysis often experience health conditions that can compromise their balance, coordination, and muscle strength. These factors contribute to an increased vulnerability to falls.
Bone Health Concerns: Chronic kidney disease, which necessitates peritoneal dialysis, can lead to weakened bones, making individuals more susceptible to fractures and injuries in the event of a fall. Osteoporosis, a condition characterized by low bone density, is prevalent among dialysis patients. The reader may recall that I suffer from Osteoporosis as measured by a recent bone density test and a frequent visitor from NC does also.
Given that a case be made for doing something about falling, what can we do is the thrust of this blog. Seems that research suggests the main tenant of judo and like sports is learning how to fall without hurting oneself as falling is central to the activity. The WSJ article states “Globally, one-third of people 65 and older fall at least once a year, with 5% of these falls resulting in a fracture… Falls are the leading cause of injury and injury-related death among Americans 65 and older….The fear of falling can significantly affect the quality of life…”
I’ll leave it up to the reader to take it from here. What I’m advocating is that maybe, just maybe, learning how to fall, however, you accomplish it, is a good idea. This is especially so for those of us on dialysis, regardless of our age. The video below explains the concept in more detail:
Recently I have come across several articles from the likes of Harvard Medical citing the physical, health, and mental advantages of dog ownership. Even those of us on PD can, with proper adjustments, have a dog in our lives. My wife and I have a 17-month-old Golden Retriever who is a constant delight, entertainment, and “forces” us into exercise of mind and body. His name is Dickens and he always lives up to his name. I walk him every morning, and my wife walks him every evening. In between we take turns going out with him to do his tricks and explore our ever-changing North Texas landscape.
I recently made a short video of pictures of him (lead video) and put it up on YouTube. The video was mashed together using Pictory.AI. It has received, as of this writing, going on 90 views already and hasn’t been up a week. People really like Goldens.
As I have cited numerous times in my blogs, I use poe.com as my ChatGPT/AI go-to source. One of the many special-purpose AI engines it hosts is one that deals with medical issues named DoctorSage. I quizzed this app with the following Prompt and obtained the included results. Dogs are good for us, especially those of us on dialysis.
Prompt: Write a blog entry about the health advantages of dog ownership
DoctorSage
Poe Title: The Health Advantages of Dog Ownership: More Than Just a Furry Friend
Introduction: Dogs have been man’s best friend for centuries, providing companionship, loyalty, and love. But did you know that owning a dog can also have numerous health advantages? From physical to mental well-being, having a canine companion can positively impact our overall health. In this blog entry, we will explore some of the remarkable health benefits that come with dog ownership.
Increased Physical Activity: Owning a dog naturally encourages physical activity, as they require regular exercise. This can be particularly beneficial for those who struggle with motivation or find it challenging to stick to an exercise routine. The following points highlight how dog ownership promotes physical activity:
Regular walks and outdoor activities: Dogs need daily exercise, such as walks, runs, or games of fetch. This encourages their owners to get outside and engage in physical activity. Improved heart health: Consistent exercise, such as walking or jogging with your dog, can reduce the risk of cardiovascular diseases, lower blood pressure, and improve overall heart health. Enhanced Mental Well-being: Dogs provide more than just physical benefits; they also contribute to our mental well-being. Here’s how:
Stress relief: Spending time with a dog has been shown to reduce stress levels and promote relaxation. Petting or cuddling a dog releases endorphins, which are natural mood boosters. Decreased feelings of loneliness: Dogs offer companionship and unconditional love, combating feelings of loneliness and isolation. This is particularly important for individuals living alone or struggling with mental health conditions. Increased social interaction: Dogs are excellent conversation starters and can help facilitate social connections. Taking your dog for walks or visiting dog parks can provide opportunities for socializing with other dog owners. Improved Immunity and Allergy Prevention: While it may seem counterintuitive, owning a dog can actually improve our immune system and protect against allergies. Consider the following points:
Boosted immune system: Studies suggest that children who grow up with dogs have a lower risk of developing allergies and asthma. Exposure to pet dander and microbes from dogs at an early age can help strengthen the immune system. Allergy prevention: Contrary to popular belief, owning a dog may actually reduce the risk of allergies later in life. It is believed that early exposure to pet allergens can help build tolerance and prevent the development of allergies. Conclusion: Owning a dog brings immense joy and companionship, but it also offers a myriad of health advantages. From increased physical activity and enhanced mental well-being to improved immune system function, dogs truly have a positive impact on our overall health. So, if you’ve been contemplating getting a furry friend, remember that along with their wagging tails and wet noses, they also bring a multitude of health benefits into your life.
I thought about naming this post “The Good and the Ugly; No Bad Here” but thought better of it. After viewing numerous ads on Facebook touting their company providing Abbott’s Libre 3 Continuous Glucose Monitor (CGM) as being covered by Medicare subject to some restrictions, I first tried US Med aka the ugly!
But first, a little background: I have been using the newer Libre 3 CGM for a year now, paying for it out of pocket to the tune of $154 to $192 per month. In the past, it has not been covered by Medicare because it required the user to have a smartphone on which to load the associated app to work. This past April Abbott received the OK from the FDA for their associated, stand-alone reader, so now the new package, consisting of the reader and required sender is becoming available and is covered by Medicare.
Back to US Med. Don’t go there. Despite numerous, and I mean numerous follow-ups, they just could not, or would not, get their order to my GP for fulfillment. I was promised by multiple CSRs and Order Fulfillment Reps that I would receive follow-up phone calls but never received one.
The second place I tried, Family Medical Supplies (301-479-3500) was the good and proved to be as different from USMed as the day is night. They immediately provided me with a link to their Intake Form (Link) which I filled out and followed up with a phone call to make certain it went through which it did. I then informed my GP that they would be contacting him for a script. In due course, I received a text from my GP that he had received the fax and replied. I then inquired about some particulars of the order, specifically to make certain I would be receiving the Libre 3 and NOT a Libre 2, and received a text smartly back informing me that it would be a Libre 3, what was in the shipment, when it was scheduled to ship, and when I should receive it.
Disclaimer: I do not and have not had any financial interest of any sort in the companies cited above. If interested, on Medicare, a diabetic and take insulin, check the link embedded above out.
Update: Order arrived Monday, 11/13/2023 as advertised at zero cost to me.
I have received numerous questions about this blog such as “Are people reading it?” etc. and a few about the nuts and bolts of running a blog such as this one. First to the nuts and bolts:
As I write this entry on 11/3/2023, I am running version 6.3.4 of WordPress as a Content Management System. It is an Open Source software that is literally in use by millions of users across the globe. First released on May 27, 2003, the soon-to-be-released version 6.4 (due out 11/7/2023) will be the 48th release. It is an absolutely solid piece of work with which I had had zero, nada, zip issues. It just works.
It costs $32.95 per year to register the domain name feeser.me. I am hosting the site on Dreamhost.com and they provide the resources for WordPress as part of the hosting. I signed up for two-year hosting at something like $99.00.
One of the strongest features of WordPress is since it is open software, there have been literally hundreds of plugins developed by independent developers for it. These include themes, SEO, search, table, and other enhancements. I am running the 23 theme and may try out the new 24 theme when it is released on 11/7/23. I am running a Search Engine Optimization program that provides me insights into who is visiting the site, what they read, for how long, where they came from, and so on. In the following screenshots with comments, I’ll share a small portion of these analytics.
The above screenshot suggests that as of 11/3/2023 there have been 6,576 pages viewed by 1,710 visitors of which 1,635 were unique. This is for a blog that has been up since 1/5/2023 with over 200 entries.
The next screenshot above provides data on the last 30 days during which there were 537 page views by 152 visitors of which 140 were first timers and overall visitors looked at 3.47 pages per visit. The graph further indicates page views on a given date which is indicative of interest in a given subject.
This screenshot depicts the geographical distribution of people are located that are visiting the blog. On the right side is a listing of the most recent visitors, from the United States, Canada, China, Columbia, Singapore, and Israel.
The screenshot above is of that portion of the WordPress analytics that provides a more precise location of visitors by IP address, and physical location of the IP address as you can ascertain.
The last screenshot above provides further analytics on the specifics of the blog entries that visitors landed on.
The above is but a taste of the information that is available to me and others posting their blogs using WordPress. Big Brother is watching!
My wife often tells me that I get the plow in too deep for many readers of this blog who may be at the onset of research into what PD is all about. For that audience, I recently viewed the video embedded below from YouTube that speaks very well to the basics of PD, especially the manual version. For that audience, the video below is for you:
