Tag: fresenius (Page 35 of 49)

Peritoneal Dialysis Tidbit(s)

August 18, 2023 / Henry Feeser / 0 Comments

As I write Friday’s blog it is approaching noon on Thursday and no replacement cycler has arrived nor have we been contacted by anyone from Fresenius. However, I did manage to achieve other housekeeping chores.

We have been trying to move a brokerage account to our main Schwab account with difficulty. Lots of t’s to cross etc. This morning I journeyed to UPS to send a copy of the monthly statement from the account we desire to close to a Schwab rep to process.

The second gate was the delivery of our golf cart. We bought a refurbed 2019 Club Car to putt around Pecan Plantation. Upon testing on our dead-end street, it crapped out and was trailed back to the dealer. Troubleshooting found that a main electrical connection between the battery and generator had battery acid on it and the interior wire had corroded and opened. This prevented charging the battery and supplying power while the engine attempted to run. The wire was replaced as was the battery. We did another test run with good results.

Yesterday was the supply order date for me to order supplies from Fresenius which I did. We will be in Indiana on vacation on the scheduled delivery date at the end of September so I called support and worked with them for an alternative date. We came up with delivery the first week in October so that’s taken care of.

I also made a call to Fresenius customer service to inquire about cassettes with shorter hookup lines. I had previously read that you could order one with a 10-foot instead of a 20-foot catheter line. My thinking is maybe this will help alleviate the drain alarms I have been plagued with for almost a year. I was informed that the cassette with the 10-foot catheter line only comes with a 10-foot drain line which won’t work for me; I need a 20-foot drain line to reach our master bath shower drain. I was also informed that to receive such a cassette my “prescription” had to be altered by my Dialysis Nurse. I could not just order one on my own. The shorter cassettes do not show up in the Fresenius Patient Portal FYI.

In closing, nada concerning the new cycler delivery supposedly scheduled for today.

Where Forth Art Thou Fresenius?

August 17, 2023 / Henry Feeser / 0 Comments

The saga continues. The situation with Fresenius and my cycler replacement is getting worse than any soap opera you could imagine.

The latest go-around yesterday unfolded like this: after being informed by tech support that a replacement cycler would be in my hands within 24 hours and it didn’t happen, I sent a text to my dialysis nurse pleading for insight into what was going on. She called tech support and got me on a three-way phone call with her and tech and me. Turns out tech support DID recommend the replacement of my cycler but the next and last gatekeeper based totally on a paper audit still held out in the face of insurmountable evidence to the contrary that the new cycler was NOT merited and denied the request. Her retort seemed to be that although xrays had been taken and cleared by my nephrologist and dialysis team, there still could be “positional blockage” that was causing my consistent and incessant and obscene alarms. What BS!!!

The tech support person on line with us, Amy, reworked the request and somehow behind closed curtains, my request for a replacement cycler was again granted. Wednesday morning I received a call from Fresenius stating that a replacement cycler would be delivered to our home on Thursday, 8/18/23 with the return of the junk one I am currently “blessed with” on 8/20/23.

Once again, I will believe Fresenius when a replacement AND TOTALLY OPERATIONAL cycler is in use by me.

Thus far there is one lesson to be learned from all of this. In the case of Fresenius, don’t try to fight city hall or think that they care, have any responsibility to patients, or even have hearts. They do not. Every time I had an alarm, regardless of the hour, Fresenius expected me to get on the phone with tech support to document whatever they are filling out on the other end. They would not accept my verbal input on how many drain alarms etc. I had been experiencing, would not accept my doctor’s input on xrays, nor my Fresenius dialysis nurses’ input. It is a one-way street and they maintain all traffic flow and access.

Fresenius is the epidemy of a for-profit at all costs capitalistic company that cares less about patients in pursuit of their bottom line. I’m glad I sold my stock in Fresenius.

Having said all of the above, I want to make it abundantly clear that my local Fresenius group here in Granbury, TX could not be more dedicated to patient care! They are a loving, caring, hard-working group that is my pleasure to deal with! None of the above ventings applies to them; only kudos!

Finally (Maybe) Fresenius Tech Support Responds?

August 16, 2023 / Henry Feeser / 0 Comments

Called Fresenius “Tech Support” again Monday AM. Seems like my Cycler is going downhill. In the last seven days, I have experienced 13 alarms on the drain cycle. It seems to be developing a pattern of sorts where it drains 12-1400 mL of “distillate”, then hangs. The time on dialysis reflects this in that instead of 10 hours 30 +/- minutes, it jumps up to over eleven hours.

For the record, the support person, after asking expected questions like the cycler’s serial number and software version, was interested in where the system drains (straight into a shower drain), how long a run this is, had the drain line been modified, the data off the cassette (lot #, etc.), and “how long has this been going on? When I responded at least six months it got her attention and even more when I explained my dialysis team and I had exhausted all other possibilities other than the cycler itself and were in unanimous agreement I needed a new cycler.

I’m supposed to receive a phone call that a new unit is en route (haven’t) and receive it within 24 hours. Not holding my breath but praying!

một lần nữa: Or in English, One More Time we visit the Beast, the Cycler

August 15, 2023 / Henry Feeser / 0 Comments

One of the first phrases I learned in Vietnamese language school before going In-Country was một lần nữa, meaning one more time. It just kinda rolls off the tongue when speaking Vietnamese. In the military, you learn to do lots of things, One More Time. So it is with alarms on my company-issue Liberty Cycler.

Last Wednesday night on the first main drain cycle the cycler hung up and essentially at every “pump” drained only 1 or 2 mL of fluid instead of the normal 12 to 13 mL. I called “tech support” and after over half an hour on the phone, it was agreed that my case would be “escalated.” What this means, in reality, is that a faceless, clueless, and heartless representative of Fresenius would contact my clinic dialysis nurse and deny me cycler replacement. This is exactly what happened. The excuse was that I had not been faithfully calling tech support every time I received alarms and thus they could not justify replacement. Nothing was said nor has it ever been regarding just how many times something like alarms have to be reported before action is taken.

Along the way, Fresenius always comes back to everything which does not include their cycler as being at fault. This incident included questions as to whether my catheter was properly placed and operational/not blocked. Responding to the blocked aspect, the cycler always fills well, and recently I had a manual drain test conducted by my Fresenius team with no abnormalities detected.

So, in consort with my dialysis nurse, we scheduled a xray exam to look inside to see if anything is untoward in my stomach with my catheter system. The full report is below: I’m good so my strategy is to report every burp of the cycler’s drain problems until someone smells the coffee or I die from sleep deprivation.

Exam AR Acute Abdomen Series 08/10/2023

History: Poorly draining PD Catheter

Technique: 5 views of the lumbosacral spine

Comparison: None

Findings: There is moderate curvature of the lumbar spine with convex to the right. Moderate degenerative changes lower thoracic and lumbar spine.

No fractures of dislocation. Large amount of formed stool is seen within the right colon. Curvilinear tube overlying left lower quadrant of the abdomen. There is a larger bore catheter identified with the distal tip overlying the mid aspect of the lumbar spine at the L4 level on the AP view and overlying the area of the LS level on the lateral view.. CT may be more helpful.

Moderate degenerative changes lumbar spine. Mild to moderate degenerative changes of the hip joints bilaterally.

Moderate vascular calcifications of the abdominal aorta and iliac vessels.

Impression:

There is mild to moderate curvature of the lumbar spine with mixed the right.
2. There is a curvilinear catheter seen overlying the left lower quadrant of the abdomen. There is a larger bore catheter is seen overlying the lower mid abdomen. CT may be more helpful for placement if no drainage..
3. There is a moderate to large amount of degenerative changes lumbar spine.
4. Significant amount of stool is seen within the right colon.

Fresenius: You are invited to walk a mile in my shoes!

August 14, 2023 / Henry Feeser / 0 Comments

General Stanley McChrystal is credited with stating “Don’t follow my orders, follow the orders I would have given you if I were there and know what you know.” I only wish that Fresenius followed such a dictum with its “tech support.” My continuing frustration with Fresenius’ tech support is their total lack of empathy, understanding, and certainly action on my behalf as a result of continuous drain alarms from their Liberty Cycler, taking place over half the time.

Their position seems to be if you can get through a night of treatment, REGARDLESS OF THE CONSEQUENCES OF DOING SO, that’s good enough and they wipe their hands of any further responsibility, caring, or interest. Dealing with Fresenius “tech support” is worse than sticking your finger into a cloud; at least with a cloud, you may end up with a moist finger.

For those of you not familiar with a Peritoneal Dialysis treatment here’s a short primer. For me, the Fresenius Liberty Cycler, a computer-controlled pump and drain system, upon attachment to my stomach catheter at night, checks to see if I have any fluid that needs to be drained, then pumps in two liters of special fluid (fill), that it times to stay in my stomach liner for two hours (dwell), then pumps this fluid and any extra it has pulled out (drain). It accomplishes this over four cycles which takes upwards of eleven hours to accomplish.

So in the normal operation of the Cycler, I have four drain cycles. This is where my cycler has difficulty. More often than not, during the drain cycle, the cycler does not, can not, will not or something else not operate as designed, and it throws a Klaxon-like alarm where I have to wake up, get out of bed to push buttons on the cycler to reset the alarm and drain cycle. From experience, I know that I cannot just jump back in bed but must remain in an upright position for it to complete the drain cycle before I can get back in bed and attempt to go back to sleep. This can take anywhere from 20 minutes or less to accomplish. Only then can I get back in bed and attempt to return to sleep.

Keep in mind that I am not the only Liberty Cycler user experiencing such alarms!

Erin Davis writing in the 8/7/2023 issue of diaTribeLearn wrote an article titled “Sleep Hygiene; A Checklist for People with Diabetes.” Erin states “

“You may have noticed that when you have a bad night’s sleep, your blood sugars are high. It’s not just a fluke. Sleep, or lack thereof, impacts blood glucose levels, and in turn, glucose can affect sleep quality.

While you’re sleeping, your body is performing serious maintenance. Say if your sleep is interrupted – due to something like waking for a baby or dealing with continuous glucose monitor (CGM) alarms – you may find it difficult to manage your blood sugar. “

I’m laying the foundation that Fresenius’s adamant refusal to alleviate my cycler alarm situation has consequences beyond lack of sleep; Fresenius may well be the cause of my demise at an earlier date than God has planned. God help us all (Especially those of us using Fresenius’s Liberty Cycler!)

Some Nuts and Bolts About Peritoneal Dialysis

August 11, 2023 / Henry Feeser / 0 Comments

Writing in the August 5-6, 2023 edition of The Wall Street Journal Review p. C14, Ed Catmull, a co-founder of Pixar (along with Steve Jobs and Alvy Ray Smith in 1986), mused “Failure is a natural byproduct of innovation, and change is the only constant in every industry.” We are certainly seeing this in all things that touch us as peritoneal dialysis patients.

Take failure. From my perspective, the Fresenius Liberty Cycler is plagued by many “failures,” idiosyncrasies, and inconsistencies, and at times seems to have a personality of its own. I’d like to relate what took place last Sunday night.

As per usual I was on the fill cycle of the cycler by 2135, having installed the Cassette with my new and revised methodology. I awoke in the morning at 0900 with the dialysis treatment completed. On the surface this would appear to be a thumbs up but not so. Yes, I experienced no alarms, but… I usually put about 7900+ mL of fluid in, and have about a microfiltration rate of 6-900 mL. This means I am pulling a little less than one liter of fluid out of my body during dialysis in excess of what was put in. This is good in that this is the way we get rid of excess fluid by dialysis. During this dialysis cycle, 218 mL of fluid in excess of what was pumped in as part of dialysis remained. The bottom line my weight was up 2.2 lbs this morning. When I light off the Cycler tonight I expect it to immediately drain off excess fluid before starting its normal fill-dwell-drain X 4 cycles.

Change IS all around us regarding dialysis and those maladies that contribute to it. Take Continuous Glucose Monitors (CGMs) for instance. While they have been around for some time, and have been improved over time, our governmental bureaucracies are still fumbling around with funding their obvious value to diabetic and dialysis patients. People and organizations resist change, even if it is good.

Newton’s first law of motion states “In the absence of any net force, an object in motion continues in motion in a straight line at a constant speed.” I intend to be and hope to be part of that force to aid and abet meaningful change in the dialysis world and worlds that intersect it on a Venn Diagram.

Why High Hemoglobin Dialysis Labs?

August 10, 2023 / Henry Feeser / 1 Comment

For the last five monthly labs, my Hemoglobin readings have exceeded the upper limit of 11 with readings of 11.6, 12.2, 11.4, 12.9, and the last reading of 11.4. My brother-in-law Jerry is currently in the hospital with a reading of 6.0 and is receiving blood transfusions to help alleviate his shortfall. This value indicates the amount of red blood cells in my body. These cells contain iron and carry oxygen from my lungs to the rest of my body. My O2 readings which I take every morning or always 98 or 99.

For most of my life, I have engaged in one form or other of exercise. While in the US Navy, I was required to maintain a high level of physical fitness as “part of my job.” To do this, I ran in 5k, 10k, and 15k races just about every weekend for the better part of four years.

After retirement, I ran in a couple of marathons organized around the Indianapolis 500 race, joined a fitness club to stay in shape to race my Porsche (I did quite well BTW), and even after triple bypass surgery hired a personal trainer for years to continue to work with me on my personal fitness. I’m still, even with dialysis, not a couch potato and can hold my own.

According to several web references, The typical female athlete tested in 2019 had a hemoglobin of 13.6, while the male athlete has an average hemoglobin level of 14.7. Both are well above the levels of anemia and fall into, what is termed, the “optimal” athlete range.

I posit that my higher levels ARE NOT a problem, nor have they been flagged as such by my Dialysis Team, but are a holdover from my more athletic endeavors. Comments?

Abbott Libre 3 Sensor Warning!

August 9, 2023 / Henry Feeser / 0 Comments

This falls into the category of “It happened to me and it could happen to you!” So what is this “happening?”

The last time I applied a new Libre 3 sender to the underside of my upper arm, it bleed like a stuck pig, however stuck pigs bleed. It WAS somewhat profusely and went through my sweatshirt and elicited from my wife “What is that?” in an alarming fashion. I knew I was in trouble – again, but NOT WHAT FOR. Keep in mind I have been using the Libre 3 without any such occurrence for months and months.

We cleaned up my underarm area with alcohol swabs but left the expensive new sensor in place. I did not bleed anymore and it has been in place and operating normally ever since.

If it happened to me, it can happen to you also…… Be forewarned.

TIR – What is it and why it matters

August 8, 2023 / Henry Feeser / 0 Comments

Glucose control isn’t just a buzzword for those on Peritoneal Dialysis (PD); it’s a vital aspect of managing overall health and wellness. For individuals depending on PD, maintaining the right balance of glucose is about more than just avoiding highs and lows—it plays a critical role in preventing complications and ensuring the effectiveness of the dialysis treatment itself. Thus, anything that aids and abets control is a matter of interest to those of us on PD, especially those who are also diabetic. That includes me.

TIR, or Time in Range, recently has come to the forefront in diabetic care and control. Hayden E. Klein writing in the August 3, 2023 edition of AJMC in an article titled “Why Time in Range Matters for Diabetes Care Beyond A1c” found essentially universal support for the use of CGMs (Continuous Glucose Monitors) to monitor TIR.

The American Diabetes Association (Link here) suggests “The time in range method works with your CGM’s data by looking at the amount of time your blood glucose has been in target range and the times you’ve been high (hyperglycemia) or low (hypoglycemia). Time in range is often depicted as a bar graph showing the percentage of time over a specific amount of time when your blood glucose was low, in range, and high. This data is helpful in finding out which types of foods and what activity level causes your blood glucose to rise and fall.

Most people with type 1 and type 2 diabetes should aim for a time in range of at least 70 percent of readings—meaning 70 percent of readings, you should aim for roughly 17 out of 24 hours each day to be in range (not high or low),”

So what does this look like in real life? Using my Samsung S23 Ultra phone and the Libre 3 app I captured the screen of the CGMS’s home screen showing the preset upper and lower glucose readings (the shaded area around the actual glucose reading line), and after hitting the three bars in the upper left corner and under “Reports” selecting “Time in Ranges” obtained the second graphics.

The first graph with a glucose reading of 131 is about 1 1/2 hr after lunch and is accepted as good. All of my glucose readings for the last 24 hours have been within the set limits. The second graph shows for the last seven days 95% of the time I have been within limits. There is no reason this couldn’t be 100% so I have work to do.

The last graph is included just to give the world an idea of what the weather is like here in the Dallas-Fort Worth area where we live. Pecan Plantation is actually some 40 or so miles SW of DFW.

Cycler Alarms + Lab Results

August 7, 2023 / Henry Feeser / 1 Comment

Sorry to have to report that the modified methodology I am using to close the cover on the Cassette for my Fresenius Liberty Cycler IS NOT precluding alarms. Last Thursday night I have alarms on both the first and second drain cycles so it’s back to the drawing board for me.

I have constructed a table shown below of my August 2 lab results. Below the table are comments about its contents.

What	Aug 2, 2023	Range	For what
Albumin	3.4	=>4.0	Protein in blood
nPCR	0.97	=>1.2	Enough protein
Potassium	4.6	3.5-5.5	Heart & muscles
wKt/V	1.86	=> 2.0	Enough dialysis
Calcium	8.8	8.5-10	Bones & muscles
Phosphorus	5.3	3.0-5.5	Bones & heart
Hemoglobin	11.4	10-11	Red blood cells
Glucose	121	70-160	Energy for cells
Creatinine	7.5	Low	Impacts eGFR

Lab Readings 2 August 2023

From the table above, the big three that my nephrologist keeps on top of, K, Ca, and P (Potassium, Calcium, and Phosphorus) are all within specs, a good thing. I’ll take these readings as a win.

Albumin is always low, along with nPCR. I am working on eating more red meat but that also has the downside of increasing P so I have an additional P-Binder to take with my steak.

The wKt/V reading indicates my dialysis treatment is not quite up to where it should be but higher than what would trigger action.

My glucose reading of 121 is very acceptable in that I had breakfast some one hour before the blood draw for the labs. I’ll take this reading all day every day.

Lastly, for some reason, my Creatinine reading fell almost one full point from last month. Plugging 7.5 into my eGFR app yields an eGFR of 7 for the record. All else being equal, the creatinine test is a measure of how well kidneys are performing their job of filtering waste from the blood. So from this perspective, the drop is a good thing indicating my kidneys are still trying to function. I am also still making urine but not nearly as much as when I drank lots of beer.