Tag: fresenius (Page 42 of 49)

The Glass Story and Reducing Stress for Dialysis Patients

May 4, 2023 / Henry Feeser / 1 Comment

There is a widely circulated story about “putting down the glass.” The story goes like this:

Put down the glass video

A psychologist was giving a lecture on stress management to a group of students. As she raised a glass of water, the students expected her to ask the typical “half full or half empty” question. Instead, she asked, “How heavy is this glass of water?”

The students shouted out answers ranging from a few ounces to a couple of pounds. The psychologist replied, “The absolute weight doesn’t matter. It depends on how long I hold it. If I hold it for a minute, it’s not a problem. If I hold it for an hour, I’ll have an ache in my arm. If I hold it for a day, my arm will feel numb and paralyzed. In each case, the weight of the glass doesn’t change, but the longer I hold it, the heavier it becomes.”

The lesson of the story is that we must put down the glass of water to give our arms a break. This applies to stress management as well. We all have stress in our lives, but it’s important to put it down for a while and give ourselves a break.

This lesson is particularly relevant for those on dialysis. Dialysis patients have to deal with numerous physical and emotional stressors, such as the time commitment of dialysis treatments, dietary restrictions, and potential complications. These stressors can take a toll on a patient’s mental and physical health.

To reduce stress, dialysis patients should practice self-care and engage in activities that bring them joy and relaxation. This could include exercise, meditation, spending time with loved ones, or pursuing a hobby. I do this by writing this blog, making what I think are cool videos, and taking care of our 1/2 acre part of heaven. It’s also important for patients to communicate with their healthcare team about any concerns or stressors they may be experiencing. I have found mine to be always open, caring, and interested in my well-being.

In conclusion, the “glass story” teaches us an important lesson about stress management. By putting down the glass and taking a break from stress, we can improve our mental and physical well-being. This lesson is particularly relevant for those on dialysis, who face numerous stressors in their daily lives. By practicing self-care and communicating with their healthcare team, dialysis patients can reduce stress and improve their quality of life.

Speaking of self-care, I’m off to take my evening shower.

Dialysis-related News

May 3, 2023 / Henry Feeser / 0 Comments

Today’s blog will look into recent medical developments for those interested in Dialysis regardless of viewpoint.

This past Sunday’s The Wall Street Journal, in a front-page article titled “ChatGPT Doctors Will See You Now” by Nidhi Subbaraman, reported that already, in California and Wisconsin, Open AI’s GPT is being used to scan patient messages and draft responses from their doctors. Such use is being rolled out as we “speak.” Here’s the kicker: ChatGPT scored better than real doctors at responding to patient queries, according to a study posted in the JAMA Internal Medicine Journal, a peer-reviewed source. The use of Artificial Intelligence is coming like a freight train. Be prepared to get onboard or get run over.

Recently, Garmin, the GPS/navigation people, rolled out the Dexcom Connect IQ app for Garmin devices. This app supports tracking glucose levels on a Garmin Smartwatch or bike computer. Remember that you need the watch and a Dexcom G6 or G7. Using the app, users should be able to glance at their watch while bike riding to ascertain their current glucose level.

In an article by Robert Hart on April 28, 2023, titled “One-Hour Diabetes Procedure Offers Fresh Hope For Ditching Insulin,” in Forbes, it was reported that a single outpatient endoscopic procedure provides glucose control, a potential improvement over drug treatment. They don’t know why it works at this time, but blind tests are encouraging. The procedure is nonsurgical and involves flexible tubes, lights, and cameras that aid doctors in seeing inside the body, and patients are discharged on the same day as the procedure. Sounds almost too good to be true. Standby.

Lastly, Fierce Healhcare in an article published in Digital Health on April 26, 2023, by Annie Burky titled “DocGo aims to bring kidney care the final mile by partnering with Fresenius Medical Care” to include remote patient monitoring, chronic care management, and urgent care services. Since 2019 DocGo has been FMC’s preferred medical transportation partner. The new service aims to “offer a solution for nephrologists to help patients truly manage their chronic conditions.” Centering around the analysis of “Big Data,” DocGo suggests it will catch trends before they become life-threatening and greatly aid patients toward the “really needing help” end of the spectrum. We’ll see. I already feel that I have more than enough of “Big Brother watching me.”

Dogs and Dialysis

May 2, 2023 / Henry Feeser / 1 Comment

The Pursuit of Happiness: How Emulating America’s Happiest People Can Improve the Quality of Life for Dialysis Patients

May 1, 2023 / Henry Feeser / 1 Comment

On Monday, April 24, 2023, on page A12, The Wall Street Journal ran an article by Aaron Zitner titled “‘Very Happy’ Americans Are Pleased to Say Why.” The article concluded America’s happiest people have a few traits in common: They value community, close personal relationships, tend to believe in God, and generally are older and often in their retirement years. As I tend to do, I pondered how this set of concepts or behaviors might apply to those on Dialysis, the target market of this blog. With this in mind, I cranked up my subscription to ChatGPT and entered the following Prompt into ChatGPT’s GPT-4 Model. The results are given below.

Model: GPT-4

Prompt: America’s happiest people have a few traits in common: They value community, close personal relationships, tend to believe in God, and generally are older and often in their retirement years. Write a 2000-page or more word essay expanding on this with emphasis on how this might help dialysis patients with citations and references at the end. Write at least at the college level.

Introduction

Happiness is a universal human pursuit. It is the emotional state that everyone yearns to experience, and it is often considered the ultimate goal in life. Various factors contribute to the happiness of an individual, and studying these factors can help us understand the foundations of happiness better. In the United States, research has shown that the happiest people tend to have certain common traits: they value community, have close personal relationships, believe in God, and are usually older individuals, often in their retirement years (Westerhof & Keyes, 2010). This essay will explore these traits in-depth, focusing on their potential to improve the quality of life for dialysis patients.

I. The Importance of Community

A sense of community has been identified as a key contributor to happiness. Studies have shown that people who feel a strong connection to a social group are more likely to report higher levels of happiness and life satisfaction (McMillan & Chavis, 1986). This sense of belonging can be even more crucial for dialysis patients undergoing a physically and emotionally demanding treatment process. Inclusion in a community can provide these individuals with emotional support, practical assistance, and a sense of identity and purpose (Davidson, 2017).

Dialysis patients can benefit from being part of a patient support group, where they can share experiences, advice, and encouragement with others going through the same treatment (Cohen & Wills, 1985). Additionally, healthcare providers can help facilitate the creation of these communities and involve patients’ families and friends to create a more inclusive and supportive environment (Davidson, 2017).

II. The Role of Close Personal Relationships

Strong personal relationships, including friendships and familial bonds, are fundamental to happiness (Diener & Seligman, 2002). These relationships provide emotional support, companionship, and a sense of security that contribute to overall well-being. For dialysis patients, nurturing close personal relationships is essential for maintaining mental health and coping with the challenges of treatment.

Studies have shown that patients with strong social support have better adherence to treatment, lower levels of depression, and improved overall quality of life (Gallant, 2003). Healthcare providers can encourage the involvement of family members and friends in patients’ care by educating them about the treatment process and providing them with resources for support (Davidson, 2017).

III. The Impact of Spiritual Beliefs

Belief in God or a higher power has been linked to higher levels of happiness and life satisfaction (Diener, Tay, & Myers, 2011). For dialysis patients, faith can provide comfort, hope, and a sense of meaning during difficult times. Spiritual beliefs can also help individuals cope with the uncertainty and challenges associated with their treatment, providing a sense of purpose and direction (Park, 2010).

Healthcare providers can support the spiritual well-being of dialysis patients by acknowledging and respecting their beliefs and by facilitating access to spiritual care resources, such as chaplains or support groups (Davidson, 2017).

IV. The Wisdom of Age

Older adults, particularly those in their retirement years, tend to report higher levels of happiness compared to their younger counterparts (Stone, Schwartz, Broderick, & Deaton, 2010). This increased happiness can be attributed to factors such as accumulated wisdom, greater emotional regulation, and a focus on meaningful activities and relationships (Carstensen, 2006).

Dialysis patients, regardless of age, can learn from the happiness of older adults by prioritizing meaningful relationships, practicing emotional regulation, and seeking out activities that provide a sense of purpose and accomplishment. Healthcare providers can help facilitate this process by offering resources and support for patients to engage in activities that promote well-being and personal growth (Davidson, 2017).

V. Applying the Traits of America’s Happiest People to Dialysis Patients

By understanding the traits that contribute to the happiness of America’s happiest people, healthcare providers, and caregivers can develop targeted interventions and support systems to improve the quality of life for dialysis patients. Emphasizing the importance of community, close personal relationships, spiritual beliefs, and the wisdom of age can help these patients cope with the challenges of their treatment, foster resilience, and enhance their overall well-being.

Conclusion

In conclusion, the pursuit of happiness is a universal endeavor, and understanding the factors that contribute to happiness can provide valuable insights for improving the quality of life for dialysis patients. By focusing on the traits shared by America’s happiest people, such as valuing community, nurturing close personal relationships, maintaining spiritual beliefs, and emulating the wisdom of age, dialysis patients can enhance their well-being, cope more effectively with the challenges of treatment, and ultimately, experience greater happiness and life satisfaction.

References

Carstensen, L. L. (2006). The influence of a sense of time on human development. Science, 312(5782), 1913-1915.

Cohen, S., & Wills, T. A. (1985). Stress, social support, and the buffering hypothesis. Psychological Bulletin, 98(2), 310-357.

Davidson, K. W. (2017). Creating a supportive environment for dialysis patients. In C. R. Thomas & S. M. Smith (Eds.), Comprehensive Clinical Nephrology (6th ed., pp. 171-180). Elsevier.

Diener, E., & Seligman, M. E. (2002). Very happy people. Psychological Science, 13(1), 81-84.

Diener, E., Tay, L., & Myers, D. G. (2011). The religion paradox: If religion makes people happy, why are so many dropping out? Journal of Personality and Social Psychology, 101(6), 1278-1290.

Gallant, M. P. (2003). The influence of social support on chronic illness self-management: A review and directions for research. Health Education & Behavior, 30(2), 170-195.

McMillan, D. W., & Chavis, D. M. (1986). Sense of community: A definition and theory. Journal of Community Psychology, 14(1), 6-23.

Park, C. L. (2010). Making sense of the meaning literature: An integrative review of meaning making and its effects on adjustment to stressful life events. Psychological Bulletin, 136(2), 257-301.

Stone, A. A., Schwartz, J. E., Broderick, J. E., & Deaton, A. (2010). A snapshot of the age distribution of psychological well-being in the United States. Proceedings of the National Academy of Sciences, 107(22), 9985-9990.

Westerhof, G. J., & Keyes, C. L. (2010). Mental illness and mental health: The two continua model across the lifespan. Journal of Adult Development, 17(2), 110-119.

My week in Review: ExpressScripts, CGMs, Liberty Cycler, and other stuff

April 21, 2023 / Henry Feeser / 0 Comments

It’s been an interesting week from many perspectives. (Graphic above from Designs.AI’s Illustrator. It reminds me of my Dialysis nurse for some reason.)

Our Granddaughter, who lives in the Seattle area, visited
I got tangled up in ExpressScripts bureaucratic nightmare.
My Fresenius Liberty Cycler continues, on a random basis, to illicit drain alarms and, this week, one fill alarm. For the past 15 nights, seven have had no alarms (47%), and eight have had alarms (53%). Disregarding the fourth and last drain, when I am always up and moving about, 15X3=45 possible drain alarms, of which I have experienced 10, or 10/45=22%. So more than half of the time I go to bed, my sleep is interrupted by Cycler alarms. Remember that Fresenius’ tech support is oblivious to this fact, telling me to shut off the alarms as a “fix.” What BS!
I can’t seem to articulate to my GP’s script person that I want all scripts written for a 90-day supply. Why is this so difficult to understand?
At one point, our Fresenius stock was up $5.00 per share from our by-in price. Not too shabby.
My GP script person sent a prescription to CVS for a Libre 3. But it was sent in for three, not six, covering 90 days, more or less. My CVS app shows they have been working on it since 4/13/2023. Why is it that I can buy direct from HealthWarehouse.com, which I am, and receive Libre 3s like clockwork, but the large government-contracted agencies cannot? What’s wrong with this picture?
I have a normal monthly meeting next Thursday with my Dialysis Team. I’ll share my going-in discussion points with you next week.
Our goose eggs hatched with six little ones that have been seen paddling around in our local ponds. Life does go on, even on Dialysis!

I used AI to generate the feeser.me ad is shown below, which I then posted to Facebook and Linkedin. Enjoy what AI can do for you if you can 🙂

What determines how long you are apt to stay on Peritoneal Dialysis?: What ChatGPT has to say about it

April 20, 2023 / Henry Feeser / 0 Comments

I asked Craiyon.com to generate a picture of ChatGPT to insert in this blog. Below is what was provided. My Prompt was “picture of chatgpt.”

The most often question I receive other than “How’s it going?” pertaining to Peritoneal Dialysis, is how long does it normally last which is code for how long can I expect to live given I’m on dialysis. Trying to explain to the layman the differences between PD and Hemo quite often cause their eyes to gloss over. This blog is aimed at those one PD and/or interested in PD and answers the question “What determines how long one can expect, all else being equal, to be able to be on PD? And then what?”

First the “Then what.” At the point where it becomes obvious from quarterly lab visits that PD is not hacking it, the nephrologist should encourage the patient to get set up for Hemo as a treatment of last resort. When PD is no longer viable, Hemo is the go-to treatment. Yes, to me it appears to be going backward, but hey, it beats the hell out of being without breath and a beating heart six feet under!

As the following from my trusty ChatGPT assistant will show, PD Transport Rate and Status of the Peritoneum are determining factors in how long a patient has a chance of using PD. Shown first is the Prompt I used to quiz the AI front end, and then the result. Pretty interesting and adds context to the PD longevity question. Here goes.

Model: Default (GPT-3.5)

Prompt to ChatGPT: Consider yourself to be a trained and experienced Nephrologist. Discuss in explicit detail the longevity of Peritoneal Dialysis as relates to 1. Transport Rate and 2. Status of Peritoneum. Write in explicit concise and understandable English at the MBA level terminology in at least a 2000-word essay with citations and an end reference list.

Introduction

Peritoneal dialysis (PD) is a form of renal replacement therapy used in the treatment of end-stage renal disease (ESRD). This therapy uses the peritoneum, a thin membrane that lines the abdominal cavity, as a semipermeable membrane to remove waste products and excess fluids from the body. Unlike hemodialysis, which uses an external machine to filter blood, PD allows the patient to perform the therapy at home with the help of a catheter inserted into the abdomen.

The longevity of PD as a form of renal replacement therapy depends on several factors, including the transport rate and the status of the peritoneum. In this essay, we will discuss each of these factors in detail, along with their impact on the longevity of PD.

Transport Rate

The transport rate refers to the rate at which solutes move across the peritoneal membrane during PD. There are three types of transport rates: high, high-average, and low average. The transport rate is determined by measuring the rate at which glucose, a solute used in PD, is absorbed by the peritoneal membrane.

High transporters have a peritoneal glucose absorption rate of more than 0.81 mmol/L/h. High-average transporters have a peritoneal glucose absorption rate between 0.60 and 0.81 mmol/L/h, and low-average transporters have a peritoneal glucose absorption rate of fewer than 0.60 mmol/L/h.

The transport rate has a significant impact on the longevity of PD. High transporters have been shown to have a higher risk of technique failure and a shorter PD duration compared to low transporters. In a study of 360 patients, high transporters had a median PD duration of 17 months, while low transporters had a median PD duration of 37 months.

The reason for this difference in PD duration is thought to be due to the increased exposure of high transporters to glucose, which can lead to peritoneal fibrosis and membrane damage. This damage can lead to a decline in ultrafiltration capacity and an increased risk of infection, both of which can contribute to technique failure and the need to switch to another form of renal replacement therapy.

In addition to the transport rate, other factors such as age, diabetes, and the presence of cardiovascular disease can also impact the longevity of PD. Older patients, those with diabetes, and those with cardiovascular disease have been shown to have a shorter PD duration compared to younger patients without these comorbidities.

Status of Peritoneum

The status of the peritoneum is another factor that can impact the longevity of PD. The peritoneal membrane is a dynamic structure that can undergo changes over time, including thickening, fibrosis, and neovascularization. These changes can impact the function of the peritoneum and lead to a decline in ultrafiltration capacity and an increased risk of infection.

Several factors can contribute to peritoneal membrane damage, including long-term exposure to glucose, infection, and exposure to other toxins. Infection is a particularly important risk factor for peritoneal membrane damage, as it can lead to the development of peritonitis, a serious complication of PD that can lead to technique failure and the need to switch to another form of renal replacement therapy.

Peritoneal membrane damage can be assessed using imaging techniques such as peritoneal scintigraphy, which can measure the peritoneal thickness and blood flow. These assessments can be useful in predicting the longevity of PD and identifying patients who may be at higher risk of technique failure.

Several interventions can be used to protect the peritoneal membrane and prolong the longevity of PD. These include the use of biocompatible dialysis solutions, which have been shown to reduce peritoneal membrane damage and improve patient outcomes. Biocompatible solutions have a lower concentration of glucose and other osmotically active solutes, which can reduce peritoneal fibrosis and inflammation.

In addition to biocompatible solutions, the use of intermittent peritoneal dialysis (IPD) has also been shown to improve peritoneal membrane function and prolong the longevity of PD. IPD involves performing short, frequent exchanges of dialysis solution, which can reduce the exposure of the peritoneal membrane to glucose and other toxins.

Other interventions that may help to protect the peritoneal membrane and prolong the longevity of PD include the use of low-GDP dialysis solutions, which have a lower concentration of glucose degradation products, and the use of agents that can reduce oxidative stress and inflammation.

Conclusion

In conclusion, the longevity of PD as a form of renal replacement therapy depends on several factors, including the transport rate and the status of the peritoneum. High transporters and patients with peritoneal membrane damage are at higher risk of technique failure and may require a switch to another form of renal replacement therapy.

However, interventions such as the use of biocompatible solutions, intermittent peritoneal dialysis, and low-GDP dialysis solutions can help to protect the peritoneal membrane and prolong the longevity of PD.

It is important for nephrologists to carefully monitor the transport rate and status of the peritoneum in patients undergoing PD and to make appropriate interventions to protect the peritoneal membrane and ensure the best possible outcomes for their patients.

References:

Li PK, Szeto CC, Piraino B, et al. Peritoneal dialysis-related infections recommendations: 2010 update. Perit Dial Int. 2010;30(4):393-423.
Lameire NH, Van Biesen W, Vanholder R. The longevity of peritoneal dialysis: still an open question? Kidney Int Suppl. 2008;(108):S45-51.
Davies SJ. Longitudinal relationship between solute transport and ultrafiltration capacity in peritoneal dialysis patients. Kidney Int. 2005;67(1):237-242.
Holmes CJ, Patel PR, Perez J, et al. Peritoneal dialysis: recent advancements and future challenges. Int J Nephrol Renovasc Dis. 2019;12:223-233.
Dong J, Yuan Z, Zhang L, et al. Effects of different glucose concentrations in dialysate on peritoneal membrane function in peritoneal dialysis patients: a systematic review and meta-analysis. PLoS One. 2017;12(1):e0170535.
Krediet RT. Biocompatible peritoneal dialysis solutions: do they exist? Contrib Nephrol. 2011;173:99-107.
Peppelenbosch A, van Kuijk WH, Bouvy ND, et al. The effect of peritoneal dialysis fluid containing low glucose degradation product on peritoneal transport and markers of peritoneal damage. Kidney Int. 2004;66(3):1047-1053.

The ExpressScripts Libre 3 CGM Saga Continues

April 19, 2023 / Henry Feeser / 0 Comments

Bright and early this morning, almost at 0800, I received a direct real person phone call from a pharmacist at ExpressScripts. He attempted to explain why the script for a Libre 3 Continuous Glucose Monitor from my GP was not being filled by them. The reason he stated, was that ExpressScripts does not yet carry the Libre 3; they could however fill a script for a Libre2. Hummmm?

I attempted to relate that I received a letter from ExpressScripts stating that the reason they refused to fill the order was that my GP was just that, a GP and not a diabetic specialist. He apologized and stated that was not correct. When I told him I was buying Libre 3s directly from an online supplier, not a problem but at an out-of-pocket cost of over $200 per month he essentially wished me luck.

Keep what’s going on here in perspective. ExpressScripts’ contract with the government started in January 2023 and runs through 2029. It has value in the billions of dollars and serves over 9.6 million active-duty service members, their family members, and retirees.

It would appear we’re in deep kimchi!

CGM & Tricare-ExpressScripts: Their Rationale

April 18, 2023 / Henry Feeser / 0 Comments

Yesterday I received a letter (included at bottom of this blog as a PDF) whose logic totally escapes me. My request for Tricare to provide me with CGMs to aid in the treatment of my diabetes was turned down BECAUSE the script came from my GP, not an endocrinologist or diabetes management expert. Seems that they maintain that such people are “experienced in the management of insulin-dependent diabetics…and familiar with the operation and reports necessary for proper management of continuous glucose monitoring systems.”

The logic in this approach is totally counter to the PR the manufacturer, Abbott advertises as to how simple the CGM is to deploy and use. What operation and reports are they speaking of?

This appears to me to be just another instance of bureaucratic BS hiding behind obfuscation.

cgm-tricare Download

ES & Cycler Saga Continues

April 17, 2023 / Henry Feeser / 0 Comments

Over the weekend I received a couple of robo-calls from ExpressScripts. Recall I am having a go at them attempting to have Continuour Glucose Monitors covered. The calls asked me if I wanted to continue to wait on my doctor to get back to them on some unnamed prescription which I assume to be CGMs. Same set of scripts they told my GP rep they would not cover? What is the logic in this?

Second continuing sage is that for the last 12 days, I have had exactly five nights without any alarms. Recall this is after Fresenius tech support told me to solve the problem of nightly alarms on their Liberty Cycler to shut them off which I did. So much for their wisdom when 58% of the time I’m still experiencing alarms.

How would you like to have to get up out of bed with a line sticking out of your gut to assuage an incessant screaming of an alarm?

ExpressScripts Saga Continues

April 14, 2023 / Henry Feeser / 0 Comments

Yesterday was an eventful day for me, but not in a good way. Started at the breakfast table with a call from ExpressScripts (recall my military-provided pharmacy) stating that they needed to talk to my GP about two related items concerning my recent request for the Libre 3 CGM to help with my diabetic control. First, they had to confirm that no drug interaction was present. How a device that measures glucose interacts with medication is beyond my Ph.D. understanding. Second, they wanted to confirm insurance coverage. Get this: ES, which administers the military’s pharmacy program, wanted to know if the government’s pharmacy program (Tricare for Life) covered CGMs. This also escapes any logic known to humans.

So I called my GP and explained the situation to them, and they assured me they would contact ES and resolve the problem. I left home and traveled about an hour north to where our son is building an ICF (Integrated Concrete Form) home to help him install temporary electrical service in the basement/ground floor of the building where they will live until the upper stories are completed. We went to Mineral Wells, TX, for a TexMex lunch, during which I received another RoboCall from ES. This time ES stated that they had not received any contact from my GP, and if they did not hear back by the end of the business day, they would unilaterally cancel the CGM script.

I went back to calling my GP’s office, where luckily, I got hold of the nurse who had been handling my requests previously. We reviewed all past conversations with her office, by now at least five, and again she assured me she would contact ES and resolve the matter and get back to me.

Get back to me she did with the news that the ES insurance would not cover CGMs for me. So here I am, a 100%+++ retired USN Naval Officer who served at the pleasure of the President of the United States and, while doing was subjected to Agent Orange and, as a result, is on Dialysis. They denied coverage for a CGM to aid in the exact diabetes that they, the US Government, were directly instrumental in subjected me to conditions where the probability of becoming diabetic was greatly exacerbated.

The “logic” of all of this escapes me. I’ll cool my jets and see what is under the next rock. Meanwhile, my GP will contact CVS to ascertain if they will accept Tricare coverage for CGMs for me. Stay tuned. I’m certain the saga will continue.