Tag: fresenius (Page 32 of 49)

Comparing PDs + Transport and PET

September 29, 2023 / Henry Feeser / 0 Comments

A commentator on this board and I have been comparing notes on our individual treatments. While this is instructive and interesting, you have to keep in mind that we are each individuals into ourselves and it’s easy to fall into the trap of comparing apples to oranges. The following table depicts differences and similarities in our PD:

	My Readings	His Readings
UFiltration	4-800 mL	11-1300 mL
# Cycles	4	5
Dwell	120 minutes	90 minutes
Total Time	10-5 to 11 (Hr-min)	10-5 to 12-15

Comparison table me to him

At first glance, it would appear that “him” is pulling lots more fluid out via PD compared to me as indicated by the comparison of the UFiltration (microfiltration) numbers. But this is misleading. What we don’t know and can’t compare is how much urine each of us is still making via normal kidney function. I still pass a plausible amount of urine naturally; does he? Something else we don’t know is what percentage solution each of us is using. The more concentrated the solution (we have a choice of 1.5, 2.5 and 4.25%), the higher the expected microfiltration.

My prescription has me on dwell for a total of 4 times 120 minutes or 480 minutes, while “him” is on dwell for a total of 5 times 90 minutes or 450 minutes. So I have fluid in my stomach for 30 more minutes, all else being equal. This is where things get a little bit more complex to describe and understand.

There is a concept in peritoneal dialysis called Transport, and Transport is measured by something called PET. To help explain these concepts, I turned to Poe with the following result:

Poe Assistant:

In peritoneal dialysis, the transport level refers to the permeability of the peritoneal membrane to solutes during the dialysis process. The peritoneal membrane acts as a semi-permeable barrier between the blood vessels and the dialysis solution (dialysate) that is infused into the peritoneal cavity. The transport level is determined by the characteristics of the peritoneal membrane, which can vary from person to person. There are three main types of transport levels in peritoneal dialysis:

High Transporters: High transporters have a peritoneal membrane that is highly permeable to solutes. This means that solutes, such as waste products and excess fluid, can easily pass through the membrane from the blood vessels into the dialysate. High transporters may require more frequent or longer dwell times during peritoneal dialysis to adequately remove waste products.

Low Transporters: Low transporters have a peritoneal membrane that is less permeable to solutes. In these individuals, the removal of waste products and excess fluid during peritoneal dialysis may be less efficient. Low transporters may require longer dwell times or more exchanges to achieve adequate dialysis.

Medium Transporters: Medium transporters have a peritoneal membrane with intermediate permeability. Their peritoneal membrane allows for a moderate transfer of solutes between the blood vessels and the dialysate.

The transport level is assessed using a test called the peritoneal equilibration test (PET). This test involves measuring the concentrations of certain solutes in the dialysate at different time points during a dwell period. The results of the PET help determine the transport level of an individual and guide the prescription of peritoneal dialysis.

By tailoring the peritoneal dialysis prescription to an individual’s transport level, healthcare providers can optimize the effectiveness of dialysis treatment and improve patient outcomes.

I have what is considered to be a LOW TRANSPORT peritoneal membrane. Without knowing what “his” transport is, we can’t compare “his” dwell times or total times to mine. If we did, it would be comparing apples to oranges and we don’t want to be guilty of that, do we?

The Connection Between Diabetes, Kidney Disease, and Cognitive Function

September 28, 2023 / Henry Feeser / 0 Comments

A Michigan Medicine study found that the longer an individual has type 2 diabetes, the more likely they are to exhibit changes in brain structure, such as decreased cortical thickness and gray matter volumes. Despite no discernible difference in cognition between those with and without diabetes, complications like chronic kidney disease and vascular damage in diabetes are linked to these brain changes. They also note that diabetic complications increased the odds of developing a cognitive disorder by 2.45 times in 40 to 60-year-olds.

So what is being implied herein? Type 2 diabetes -> brain changes -> also kidney functions -> plus other externalities -> and cognitive functions, i.e., how well our brain works? We already have cited research in previous blogs associating CKF with diabetes. It is a given. Therefore, if diabetes is adversely affecting cognition, then diabetes leading to CKF also imparts to those on dialysis as a result of CKF as potentially having cognition impacted as a comorbidity.

Impact on Cognitive Function:
The impact of kidney disease on cognitive function can manifest in various ways. Studies have shown that individuals with kidney disease may experience:

Slowed Processing Speed: Cognitive processing speed, such as the ability to quickly understand and respond to information, may be impaired in individuals with kidney disease.

Reduced Attention and Concentration: Difficulty focusing, sustaining attention, and maintaining concentration are common cognitive challenges observed in some individuals with kidney disease.

Memory Problems: Kidney disease may affect different aspects of memory, including both short-term memory and long-term memory. This can manifest as forgetfulness, difficulty retaining new information, or trouble recalling past events.

Executive Function Deficits: Executive functions, which include skills like planning, organization, problem-solving, and decision-making, may be compromised in individuals with kidney disease.

Increased Risk of Cognitive Disorders: Research suggests that kidney disease, particularly in the presence of diabetes and its complications, may increase the risk of cognitive disorders such as dementia and Alzheimer’s disease.

Take it on board: It’s bad enough to experience CKF resulting in the need for dialysis. In the presence of diabetes which is highly likely, it is a double-edged sword. Perhaps having a “big brain” before onset is helpful?

Harnessing the Power of Pomegranate Juice: A Promising Aid for Dialysis Patients

September 27, 2023 / Henry Feeser / 0 Comments

Recent research has shed light on the potential benefits of incorporating pomegranate juice into the dietary routine of dialysis patients. Pomegranate juice, renowned for its antioxidant properties and numerous health benefits, may offer a ray of hope by addressing complications and improving overall well-being. In this blog post, with the help of Poe, we will delve into the findings of recent studies and explore how pomegranate juice could be a valuable addition to the lives of dialysis patients.

The Power of Antioxidants:
One of the key factors that make pomegranate juice remarkable is its high antioxidant content. Antioxidants play a crucial role in protecting cells from oxidative stress, which is prevalent in chronic kidney disease. By neutralizing harmful free radicals, antioxidants can help alleviate inflammation, reduce cellular damage, and potentially slow down the progression of kidney disease.

Managing Hypertension and Cholesterol Levels:
Dialysis patients often struggle with hypertension (high blood pressure) and elevated cholesterol levels, which significantly increase the risk of cardiovascular complications. Pomegranate juice has been found to have beneficial effects on both these factors. Studies suggest that the juice may help lower blood pressure, making it particularly valuable for hypertensive dialysis patients. Additionally, pomegranate juice has shown the potential to reduce LDL (bad) cholesterol levels, promoting cardiovascular health.

Protection Against Infections and Cardiovascular Events:
Patients undergoing dialysis are susceptible to infections and cardiovascular events, which can have severe consequences. The preliminary findings of a recent study presented at the American Society of Nephrology’s annual meeting indicate that pomegranate juice could be a preventive measure against these complications. The juice’s antioxidant and anti-inflammatory properties may help boost the immune system, reducing the risk of infections. Furthermore, its ability to improve cardiovascular health may contribute to a lower incidence of cardiovascular events, enhancing the overall well-being of dialysis patients.

Enhancing Nutritional Intake:
Dialysis patients often face challenges related to their nutritional status. Incorporating pomegranate juice into their diet can be an effective way to supplement their nutritional intake. Pomegranate juice is a rich source of essential vitamins, minerals, and dietary fiber. It provides vital nutrients that support overall health and can help combat common deficiencies observed in dialysis patients.

Considerations and Precautions:
Drinking a controlled amount of pomegranate juice with a safe and monitored potassium content may help reduce the complications that often occur in dialysis patients. It is important to consider the risk involved in potassium overload, especially in chronic kidney disease (CKD) patients with dietary potassium restriction.

Incorporating Pomegranate Juice into Your Routine:
If you are a dialysis patient interested in incorporating pomegranate juice into your diet, discuss it with your healthcare team. They can provide guidance on the appropriate amount and frequency of consumption based on your unique circumstances. Freshly squeezed pomegranate juice or commercially available varieties with minimal additives are recommended for optimal health benefits.

Conclusion:
The potential health benefits of pomegranate juice for dialysis patients present a promising avenue for improved well-being. From its antioxidant properties to its potential to manage blood pressure, and cholesterol levels, and reduce the risk of complications, pomegranate juice offers a natural and accessible option. However, it is essential to remember that dietary changes should always be made under the guidance of healthcare professionals. By exploring the potential advantages of pomegranate juice and incorporating it into a balanced diet, dialysis patients may take a step towards enhancing their quality of life.

I’m looking into it for myself!

Are you obtaining accurate blood pressure readings?

September 26, 2023 / Henry Feeser / 0 Comments

For individuals undergoing dialysis, managing blood pressure becomes a critical aspect of their treatment. The kidneys play a crucial role in regulating blood pressure by controlling fluid balance and producing hormones that help relax blood vessels. When kidney function is compromised, blood pressure can rise significantly, leading to hypertension.

My 100% disability rating with the VA states I have CKF with Hypertension. Keep in mind that hypertension is considered to be the No. 1 risk factor for death globally. It is intuitively obvious (didn’t you love those words in geometry proofs?) that those of us on dialysis have a very imperative need to quickly and accurately track our blood pressure readings.

Recent research has shown that a significant number of off-the-shelf blood pressure devices are providing inaccurate readings due to improper fitment of cuffs. In general, the standard size cuff is too small for the majority of adults resulting in blood pressure readings being higher than they actually are. See the lead graph from the cited research link at paragraph head. Note that small and medium cuffs read much higher than large and xlrge for the author who considers himself to require a larger cuff.

I suggest you read and ponder the cited article, and if you possibly have larger arms and/or suspect your organic blood pressure measuring device is overly stating your true blood pressure, take it to your GP for comparison and possibly obtain a better version. After all, it’s only your life and well-being we’re dealing with here!

Aspirin and Diabetes and Dialysis

September 25, 2023 / Henry Feeser / 0 Comments

In July 2015 during my annual physical, my GP noticed something not quite right with my EKG. He passed me on to a cardiologist who ordered a stress test followed by a dye test that uncovered blockage. Within three days of my GP’s initial prognosis, I was in the ICU recovering from triple bypass surgery. Bear in mind that as a person I did not feel anything to be out of order. I was not overly tired nor did I present, and MDs like to phrase it, any other outward discernable symptoms.

As a result of this history, I have been prescribed baby aspirin by both the cardiologists I have been associated with, one in Corpus Christi, TX, and one here in Granbury, TX where I now live. Other than bruising and marginally thinner blood, I have observed no other effects of taking the prescribed aspirin.

Now to the story. Recent research has found that “taking 100mg of aspirin every day could lower the risk of people aged 65 and over developing type 2 diabetes…” The research also noted previous researchers have found that aspirin use was associated with a significantly increased risk of bleeding, primarily in the gastrointestinal tract. Since CKF is strongly correlated with the presence of diabetes, this finding has merit for those experiencing kidney degradation and/or failure.

I used Poe to construct a 500-word summary of the article cited above which follows:

A recent study suggests that taking a daily dose of 100mg aspirin may reduce the risk of developing type 2 diabetes in individuals aged 65 and older. Led by Professor Sophia Zoungas from Monash University, the study involved over 16,000 participants who were either given aspirin or a placebo. The results indicated that the group taking aspirin experienced a 15% reduction in type 2 diabetes risk and a slower increase in fasting plasma glucose levels. However, the study’s authors emphasize that further research is needed before any changes are made to current clinical guidelines regarding aspirin use in older adults. It’s worth noting that a previous trial called ASPREE, published in 2018, found that taking aspirin led to an increased risk of major bleeding without a reduction in cardiovascular disease incidence. Thus, while the recent findings are interesting, they do not alter the current clinical advice on aspirin use in older individuals.

Traveling With Peritoneal Dialysis

September 22, 2023 / Henry Feeser / 1 Comment

Starting Sunday and for a week, my wife are I are traveling to Indiana via our BMW X5 to visit with family. She has three sisters living there. This is our first trip since I started Peritoneal Dialysis on 9/30/2023 and we’re probably over preparing in the face of so many unknowns.

One of the first things we accomplished was to borrow from our local Fresenius group the travel case for the Cycler. The picture at lead is of our Cycler with the case to the right of it. It is the HUGE black blob to the right of the picture. I mean as in enormous. It has a large yellow sign on it stating “Medical Device” I assume for shipping on airlines etc.

In addition to our normal luggage for a week’s travel to a foreign land, we will have eight boxes devoted solely to dialysis supplies. Four of the boxes contain one night’s supply of Dialysate ( one 5L and one 3L bag), trash bag, sta-keeper, etc. Two boxes double this up. The strategy here is we will spend one night going and coming on the road (staying over in Springfield, MO) and two nights in Lafayette, IN for a total of four nights. The other boxes with dialysate are backups. We have one box of cassettes, and one box containing all the other supplies required for dialysis such as 2x2s, tape, cleaning liquids, towels, heparin, syringes, etc.

It is going to end up being quite a bit of “stuff” but needed for a week’s trip. Even if we had arranged for dialysate to be shipped to our hotel in Lafayette, we would still need the bulk of supplies to conduct PD on the road. Another thing, each night we use one of the single boxes it is one less box we have to haul in the BMW.

The picture at the end (our golden Dickens had to supervise the taking of the picture) shows where we stand at packing out some 4 days in advance. I will share our traveling experiences when we return. Meanwhile, I have written a week’s worth of blogs which will continue automatically (aren’t computers wonderful) while we journey up to our Nation’s Breadbasket.

Patients = f(numbers), especially Dialysis Patients

September 21, 2023 / Henry Feeser / 0 Comments

In this modern-day world, we all are a function of numbers. Be they income qualifications for SNAP or a home loan, or the amount of taxes on income. We live in a swirl of numbers; how tall we are, what our BMI is, what our blood pressure is, and during the phases of CKF, what our eGFR is.

It seems to me that medical personnel are relying more on numbers and less on the patients as an individual. They spend less time getting to know the patient and more on lab results. Is this a good or bad thing? I don’t really know but I do know that this model of operation by medical personnel, has by its very nature, made patients become more in tune with their numbers, be they biometric or lab-based.

It is conjectured that being human, some patients obsess over their numbers, and this is especially so when small or random changes in their lab results occur. In this setting, I have never had a conversation with medical personnel about how accurate the presented lab results are. What is the margin of error? How repeatable are the results? Do they depend on the time of day taken? Do they vary significantly from lab to lab? Do the lab results in fact measure what they proport to, or are they a proxy? Instead, they are taken prima facia as factual and direct explicit health regimens.

Patients can use philosophical help in dealing with the deluge of lab-produced numbers they are by their very nature forced to live with and by. I turned to my AI assistant, Poe seeking help in this area with the following prompt and results. Hopefully, it will help readers deal with the number onslaught.

Poe Prompt: Increasingly patients are subjected to numbers in their care, especially lab results. This is especially true of those of us on peritoneal dialysis. We live and die by these numbers. It can become an obsession with patients that is not constructive. Write a brief blog entry targeting peritoneal patients and their caregivers on how to deal with pressure from lab numbers.

Assistant Poe

Title: Navigating the Pressure of Lab Numbers: A Guide for Peritoneal Dialysis Patients and Caregivers

Introduction:

Living with peritoneal dialysis brings about a unique set of challenges, and one of them is navigating the pressure that often comes with monitoring lab numbers. While these numbers are crucial indicators of your health, it’s essential to maintain a balanced perspective and avoid becoming obsessed with them. In this blog entry, we’ll discuss some practical strategies for peritoneal dialysis patients and their caregivers to cope with the pressure of lab numbers and promote a healthier mindset.

Understand the Purpose of Lab Numbers:

First and foremost, it’s crucial to understand the purpose and significance of lab numbers. They provide valuable information about your health status and help healthcare professionals make informed decisions about your care. Recognize that these numbers are tools to guide your treatment, and they should not define your self-worth or overall well-being.

Establish Open Communication with Your Healthcare Team:

Developing a strong, communicative relationship with your healthcare team is vital. Regularly discuss your lab results with your healthcare provider and ask questions to gain a better understanding of what each number means for your health. This collaborative approach will foster trust and empower you to actively participate in your own care.

Focus on Trends, Not Isolated Results:

Lab numbers can fluctuate from time to time, and it’s important to remember that isolated results don’t always tell the whole story. Instead of fixating on individual values, pay attention to the trends over time. This will provide a more accurate reflection of your health and help you and your healthcare team make more informed decisions about your treatment plan.

Seek Emotional Support:

Living with the pressure of lab numbers can sometimes lead to anxiety and stress. It’s crucial to seek emotional support from loved ones, support groups, or mental health professionals. Sharing your concerns, fears, and frustrations with others who understand your situation can be immensely helpful in navigating this journey.

Focus on Overall Well-being:

Remember that your overall well-being extends beyond lab numbers. While they are essential, they are just one piece of the puzzle. Maintain a holistic approach to your health by focusing on other aspects such as maintaining a balanced diet, engaging in regular physical activity, managing stress, and getting adequate rest. Taking care of your mental and emotional well-being is equally important.

Celebrate Small Victories:

Lab numbers may not always be perfect, but it’s essential to celebrate the small victories along the way. Recognize and appreciate the progress you make, regardless of whether it matches your ideal expectations. Celebrating achievements, no matter how small can help shift your focus from solely relying on lab numbers and promote a more positive outlook.

Conclusion:

Peritoneal dialysis patients and their caregivers face the pressure of lab numbers, which can sometimes become overwhelming. By understanding the purpose of these numbers, maintaining open communication with your healthcare team, focusing on trends rather than isolated results, seeking emotional support, prioritizing overall well-being, and celebrating small victories, you can navigate this pressure more effectively. Remember, you are more than just the numbers on a lab report, and your well-being is a holistic journey encompassing both physical and emotional aspects.

Comparing Dialysis Lab Results

September 20, 2023 / Henry Feeser / 0 Comments

It may be constructive if readers of this blog have an opportunity to compare lab readings from two different individuals. We are each unto our own, and lab readings follow this discourse. But, if we look at lab readings as “how are we doing vis-a-is “the competition,” perhaps insights are derivable that would not be apparent by just comparison with what labs state are goals.

A respondent to blog posts on this blog and I have developed rapport due to our common interest in peritoneal dialysis employing the Fresenius Liberty Cycler. He recently shared his lab readings and I constructed the table below so our readings may be compared side-by-side and with stated lab goals where established. See the table below and the comments following.

Reading	Him	Me	Goal
Albumin	3.9	3.4	=>4.0
Potassium	4.0	4.2	3.5-5.5
wKt/V	1.87	1.86	=>2.0
Calcium	9.2	8.5	8.5-10
Phosphorus	5.5	5.4	3-5.5
IPTH	206	380	100-720
Hemoglobin	10.2	10.9	10-11
BUN	68	52	Not Established
Creatinine	8.98	7.27	Not Established

Comparison His labs to mine

Pulling out some numbers now. Neither of us are where we should be regarding Albumin. I’m always low regardless of how much red meat I ingest. Low Albumin is a plague for those of us on dialysis.

His Calcium is much better than mine but this could be due to his younger age (74 versus 84.) My IPTH is much higher. IPTH indicates a balance of calcium and phosphorus in our blood. High phosphorous can cause high IPTH which can lead to bone and heart damage.

Both of us are down on wkt/V which measures whether or not we’re getting enough dialysis to adequately clean our blood. However, at least from my dialysis team’s perspective, we are close enough to keep on doing what we are doing without alteration of our dialysis prescription.

For kicks, I calculated eGFR for both of us using my Android App for this purpose. For him I used age = 74 and the Creatinine value of 8.98. His eGFR is 6. For me, I used age = 84 and a Creatinine value of 7.27 and obtained an eGFR of 7. So we’re both in the tank from an eGFR perspective as should be expected since both of us are on PD.

Bottom line: As the table above suggests, although we are two entirely different individuals, our labs don’t really vary that much, given that we are both on dialysis.

Dialysis, Exercise and Fairy Rings

September 19, 2023 / Henry Feeser / 1 Comment

One of the tantamount aspects of successful dialysis is for patients to one way or the other get enough physical exercise. Granted, this can be difficult, at times downright painful, but a central necessity for us to keep everything going in the right direction. It is too easy to just pay lip service to this requirement and to hide our heads in shame when asked about our exercise regimen by attending physicians.

Don’t go there. I don’t and you shouldn’t. While it can be a pain, some wonderful things can happen while involved in exercise if you just are in tune with nature.

As I have stated several times on this blog, my wife and I are the proud keepers of a Golden Retriever named Dickens. He is, at 15 months, a 76.2-pound bundle of energy that we do our best to see that he gets a daily walk around Pecan Plantation where we live. Dickens is in the lead picture. You can easily see his muscular structure. He is strong in muscles but stronger in his innate desire to please us and the people he meets. For the record, he is 75% English golden and 25% American golden, thus the unique mixture of colors. We are seriously considering training him as a therapy dog he is so good and well-mannered.

Back to my story. While on our morning walk on Saturday, 9/16/2023 Dickens and I came upon Fairy Rings that were not there yesterday on our walk. Typically we see herds of deer, Egyptian Geese, ducks, snakes, and other creepie-crawly things. After all, we do live in Texas.

These growths are the epitome of Nature at its best and well worth viewing despite the slight discomfort walking for exercise might entail. I have embedded a picture of the Fairy Rings we saw followed by a background on the Fairy Ring phenomena for those interested in how they came to be from Poe.

Poe Assistant:

Title: The Enchanting World of Fairy Rings: Nature’s Mystical Circles

Introduction:
Nature has an uncanny ability to surprise and mystify us with its wonders. One such enchanting phenomenon that has fascinated people for centuries is the fairy ring. Also known as elf circles, fairy circles, or pixie rings, these mysterious formations capture our imagination and evoke a sense of magic and folklore. In this blog, we will delve into the captivating world of fairy rings, exploring their origins, formation, and the folklore surrounding these whimsical natural wonders.

What are Fairy Rings?
Fairy rings are circular patterns of mushrooms that appear in grassy areas, forests, and meadows. They consist of a ring or arc of mushrooms, often with a bare patch of ground in the center. These rings can range in size from just a few feet to several meters in diameter. They are most commonly found in temperate regions around the world.

Formation and Growth:
The formation of fairy rings is attributed to a fascinating natural process. It begins when a mushroom spore lands in the soil and germinates, producing a network of underground fungal threads called mycelium. The mycelium grows outward in a circular pattern, feeding on decaying organic matter in the soil. As the mycelium expands, it releases enzymes that break down organic material, making nutrients more available for the fungus. This enhanced nutrient availability creates a visible ring of mushrooms above the ground, as the mycelium reaches the outer edge of the circle.

Folklore and Legends:
Throughout history, fairy rings have been steeped in folklore and legends. They are often associated with supernatural beings such as fairies, elves, and spirits. In European folklore, it was believed that these rings were formed by dancing fairies or elves who left behind a ring as evidence of their revelry. Stepping inside a fairy ring was said to bring good luck or grant wishes, but it was also considered risky, as it could anger the fairies and bring about their mischief.

Scientific Explanations and Ecological Significance:
While the folklore surrounding fairy rings is captivating, science provides a more rational explanation for their formation. The circular shape of the rings is a result of the outward growth of the mycelium, which expands radially in search of nutrients. Over time, the mycelium depletes the organic matter in the center of the circle, causing the mushrooms to appear more abundant at the outer edges.

Fairy rings also play a crucial ecological role. The mycelium in the soil acts as a decomposer, breaking down dead plant material and recycling nutrients. This process contributes to the overall health of the ecosystem. Additionally, the bare patches in the center of the rings can create microhabitats for other plants and organisms, adding to the biodiversity of the area.

Variations and Similar Phenomena:
While the classic fairy ring consists of a circular formation of mushrooms, variations, and similar phenomena can also occur. Some fairy rings form arcs or incomplete circles, while others can form multiple concentric rings. In certain instances, the mycelium may colonize the roots of grass, causing a lush, vibrant ring of grass to appear. These variations add to the intrigue and diversity of fairy ring formations.

Conclusion:
Fairy rings continue to captivate our imaginations, blending nature and folklore into an enchanting tapestry. Whether you see them as mystical portals or simply fascinating natural phenomena, there’s no denying the allure of these circular formations. The next time you stumble upon a fairy ring, take a moment to appreciate the intricate beauty and ecological significance they hold. Within these rings, there is a reminder that the natural world is full of wonders that can transport us to a realm of magic and mystery.

Monthly Dialysis Team Meeting

September 18, 2023 / Henry Feeser / 1 Comment

On Friday, 9/15/2023 at 0900 I attended my monthly Dialysis Team Meeting. Present were my nephrologist, my dialysis nurse, my dietitian, and my social worker. The purpose of this blog is to provide readers insight into the workings of the dialysis process from a ground level.

We started off with just my dialysis nurse and myself. I had requested enough heparin to last me until my surgery with Dr. Tan on 10/4/2023 and she provided me with this. We went over a Fresenius form that is required annually that covered the particulars of my mental health, our dialysis setup at home, and other such issues. She also injected me with an iron fusion to keep my labs up to snuff.

By this time the doctor came, along with the rest of the team and we got to it promptly at 0900. I’m always glad to see the team runs on Navy time. If a meeting is scheduled for 0900, it starts at 0900. The doctor asked how I was doing, went over my labs, checked my stomach port, listened to my heart, felt my ankles for swelling, and we discussed my new meds (K2 and D3) for osteoporosis.

There is a Fresenius-sponsored program in Fort Worth that addresses all aspects of dialysis with current and potential patients and their associates. A representative from this effort came in and made a pitch to me to join the group in October and be on a panel to make a short presentation and field questions about treatment modalities. Seems that this blog has made a positive impression on those involved in such matters and I agreed along with my wife, to attend.

By 0920 or so the meeting was concluded and I was on my way to pick up take-out breakfasts for my wife and me at the 19th Hole here where we live in Pecan Plantation. The secret to having a good meeting is to be prepared. Pour over your lab results and know the wheat from the chaff. Consult with your dialysis nurse prior to the meeting with any questions you might have. 99% can/should be answered by your nurse. Consult with your caretaker/wife/spouse/? prior to your meeting and be prepared to discuss any concerns. Same for input from your GP.

It boils down to the team is there for you; you have to come to the table prepared and be there for your team.