Tag: fresenius (Page 50 of 52)

Even Without Dialysis, A Day for the Books

February 16, 2023 / Henry Feeser / 0 Comments

Yesterday was a day for the record, being on Dialysis aside. Started off with the last drain cycle hanging up and refusing to proceed. Instead, just kept beeping its slow drain message at me. I was pressed for time because I had a cardiologist appointment that I had to make. I ended up physically cutting the cycler line off just past the blue “Y” and draining the contents of my stomach into the bathroom sink as if I were doing a manual drain. At first, it drained rather slowly but soon picked up and I felt confident that a good drain resulted. I informed my team nurse of this and we decided “to watch it.” This morning and last night for that matter all went well – no alarms so whatever was going on, went away.

In conjunction with the aforementioned, received a phone call from the Fresenius driver that my monthly supply allotment was to be delivered shortly. And, being Wednesday, it was time to resupply our Ready Service Locker. Luckily for me, my wife did this, and also took care of the restocking of the resupply from Fresenius.

Off to the cardiologist where I received a good diagnosis on the state of my heart. In July 2015 I had a triple bypass, so keeping up with visits to the cardiologist for me is mandatory. Got “see you in eight months” which is always good to hear.

Next off to Fresenius in Granbury to pick up an extensive VA (Veteran’s Administration) for documenting my dialysis journey. I am in the midst of applying to the VA to increase my VA disability due to CKF from 80% to 100% and this form is part of that application. This has been a work in process since December 2022. With this voluminous folder in hand, headed home via an Auto Safety Check Station to have the yearly required Texas State Safety Check performed on our BMW X5. This is a $7.00 fee required exercise prior to registration renewal for all Texas-registered vehicles. Took only a couple of minutes and finally headed home.

Once back home had lunch, and started scanning the VA documents into PDFs then merged about 50 odd pages of my nephrologist notes, etc into a single PDF file, wrote a cover letter, and forwarded via the internet the package to the VA’s Private Medical Record facility and also to VA.gov. Was able to pet our golden Dickens for a couple of minutes, then off to recycling with the X5 where I recycled two weeks’ worth of cardboard from dialysis boxes and containers. Finally, back home, where I dined on delicious chicken fried rice my wife whooped up.

Needless to say, I slept well and thank God, the Dialysis Cycler cooperated and I had no alarms waking me up every two hours. There is a God!

VA Disability Rating for Dialysis

February 15, 2023 / Henry Feeser / 0 Comments

The Veterans Administration (VA) provides a disability rating system for veterans with chronic kidney disease (CKD) who require dialysis. This rating system is used to determine the level of compensation that a veteran is eligible to receive for their condition.

The VA rating for dialysis is based on the severity of the veteran’s CKD and the impact that it has on their daily life and ability to work. In general, the higher the rating, the more compensation a veteran is eligible to receive.

The VA uses a 100-point scale to determine a veteran’s disability rating for dialysis. The rating is based on several factors, including the veteran’s symptoms, physical limitations, and ability to perform daily activities. The VA also considers the frequency and length of dialysis treatments and any complications related to the treatment, such as infections.

A veteran with dialysis may receive a rating of 0 to 100, with 100 being the highest rating and indicating the greatest degree of disability. A veteran with a high rating, such as 80 or 100, is eligible for a higher level of compensation and benefits, including tax-free financial compensation, health care benefits, and vocational rehabilitation services.

For the record, I currently am rated at 80% Disability for DKF, or Diabetic Kidney Failure. In December 2022 I applied for an increase in rating to 100%. As with all things having to do with the VA, the request is “moving” at less than a snail’s pace, having been in review since 1/28/23.

In conclusion, the VA’s disability rating system is an important tool for veterans with dialysis who are seeking compensation and support for their condition. By considering the severity of a veteran’s CKD and the impact that it has on their daily life and ability to work, the VA provides a “fair and comprehensive evaluation” of a veteran’s disability related to dialysis.

Monthly Neprologist Meeting Plus How Long Stay on Peritoneal Dialysis

February 14, 2023 / Henry Feeser / 0 Comments

Monday morning first thing meet with my PD team at Fresenius Granbury, TX. All went well with my lab results mostly being within specs with the exception of possibly iron which may be supplemented next month.

I received a handout from the team’s dietitian which had an interesting statement, to wit: “Avoid heart catheters. PD does not last forever, so plan with your doctor to get an access placed for hemodialysis if you don’t already have one. … should you ever have problems with your PD catheter.” To me, this begs the question, “How long could one expect a PD schema to last?”

So off to Google where I found an interesting article from healio.com titled “Can peritoneal dialysis be a long-term therapy?” The following is excerpted from this source with my clarifying info in brackets.

PD does not necessarily need to be a short-term therapy, and it has longer-term potential if the patient avoids peritonitis, leverages lower hyperosmotic dialysate, and preserves residual renal function.

The main reasons for PD technique failure include psychosocial stressors, [Psychosocial stress is caused by situations that make us feel excluded, not good enough, or as if we don’t belong.] infection, catheter malfunction, inadequate dialysis, hypervolemia [Hypervolemia is a condition in which there is too much fluid in the blood.] and other medical conditions —e.g., uncontrolled diabetes, acute cardiovascular events, etc. Controlling reversible factors is critical to extending the time on therapy for PD patients.

Peritoneal membrane function may be extended by avoiding significant hyperosmotic [The term hyperosmotic is derived from the Greek words hyper, which means “excessive,” and Osmos, which means “push, thrust, or impulse.” ] glucose and uncontrolled diabetes; avoiding peritonitis; considering diuretics to improve urine output when possible to avoid hyperosmotic glucose solutions; and leveraging angiotensin [Angiotensin is a chemical in your body that narrows your blood vessels.] -converting enzymes, angiotensin II receptor blockers, and/ or aldosterone inhibitors to preserve both kidney and membrane function.

Historically, the ideal candidates for PD are individuals wanting to treat their kidney disease in the home and who desire to play a key role in ensuring optimal care results. These patients may be younger, but they can be of any age as long as they are interested in a home modality; employed individuals who want to stay working; and patients with residual renal function and interested in preserving urine volume.

So the answer to my question is, How long should one expect to be able to continue on PD? Is for a long time. This time is directly a function of:

Keeping your catheter site clean as possible
Being positive and in charge of your PD
Keep on peeing.

Medicines for Peritoneal Dialysis

February 13, 2023 / Henry Feeser / 0 Comments

At my monthly meetings with my Fresenius Team, I am provided an “education” module having to do with some aspect of Dialysis. This month, I was given Module 7, Medicines: Tools for Good Health. In the following blog, I am going to excerpt tidbits that should be of interest to those interested in all aspects of Dialysis.

Regarding OTC medicines
- Watch out for herbal or other natural home remedies. They can build up and make you sick or even be life-threatening
Never take these OTC medicines:
- Alka Seltzer, baking soda, or other bubbling remedies. These are high in sodium.
- Antacids containing magnesium (Milk of Magnesia) or aluminum (Mylanta). These chemicals can build up and cause nervous system problems.
- Aspirin unless ordered by your doctor. May cause bleeding.
- Enemas and laxatives unless prescribed by your kidney doctor – they are high in phosphorus
- Vitamins or food supplements. They may have potassium and magnesium in them that build up in your blood.
- Any herbal medicines and OTC medicines without prior approval from your kidney doctor.
Phosphorus
- Hi phosphorus and low calcium levels can lead to serious bone disease.
- Too much phosphorous gets into your skin and may cause very bad itching. It can also get into your heart and cause heart disease.
- Kidney disease upsets the balance of phosphorus and calcium in your body. The balance of phosphorus and calcium works like a seesaw. When one goes up the other goes down. Your goal is to restore the balance.
- Phosphorus binder medicines taken with iron pills will prevent the iron from getting absorbed by your body. If you take iron pills, take them at least one hour before or after your phosphorus binders.
Antibiotics and CKF:
- When your kidneys stop working, they can no longer filter drugs out of your bloodstream. For this reason, antibiotics may build up to dangerous levels in your body.
- As your Kidney Doctor about any antibiotics you get from another doctor
- Tell your Kidney Doctor about dental work or other surgery you will be having.
Medicines for PD Patients:
- Heparin may be given to help stop protein strands from forming. These strands called fibrin may clog the catheter which blocks the flow of dialysate solution in and out of your abdomen.
- Epogen is administered as a small shot under the skin.
- Iron may be prescribed as IV-delivered or as a pill.
- Vitamin D in pill form is often prescribed in pill form also.

On Dialysis while sick

February 10, 2023 / Henry Feeser / 0 Comments

Two days ago, I was in the shower and about to get out when I started to feel worse. Upon getting out of the shower, I started feeling like I had cotton between my ears. It went downhill from there. Made it until bedtime – early – and with lots of help from my wife managed to get hooked up on the PD Cycler. Of course, it picked this time to throw drain alarms throughout the night.

The next morning checked in at our GPs office and received meds and a shot for vomiting to treat my upchucking about every four hours. Because of the condition, I’m in (see the video below), I canceled my Team Meeting at Fresenius. I attempted to schedule a Tel-Conference to no avail. Fresenius told me they no longer are doing Tel-Conference and I would have to reschedule. Appears corporate or whoever is looking out for other than their patients in this regard.

Today my goal is to walk up and down the long hallway in our home to try to build some strength. I just took a B12 shot so maybe this will help also. Hopefully, I’ll be back in battery come Monday.

My Dialysis Labs with Fresenius

February 8, 2023 / Henry Feeser / 0 Comments

Yesterday I visited Fresenius local to have labs pulled. Today they were available via the Fresenius PatientHub App. In this blog, I will discuss seven of the results. Screenshots of the actual app readings follow the comments.

Albumin 3.7. Staying flat. Watch.

Calcium 8.9. Bounce up. Looks good.

Phosphorus 5.0. The body responded to binders. Continue taking.

Potassium. 4.6 Slightly uptrend. Watch. May have to cut back on tomatoes.

iPTH 239. Looking Good.

BUN 54. Increasing. Not removing enough urea nitrogen from blood? Question Neprologist during this Friday’s Team Meeting??

Creatinine 6.09. Flat. Equates to an eGFR of 8. Snore.

In tomorrow’s blog, I intend on discussing more Peritoneal Dialysis and drugs per se insights.

Peritoneal Dialysis Monthly Labs by Fresenius

February 7, 2023 / Henry Feeser / 0 Comments

Yesterday @ 0830 CST I visited my local Fresenius Medical facility in Granbury, TX for labs. This blog relates what took place during my visit.

Valentine’s Day is just a short week away. To thank five of the members of my Fresenius dialysis teams, both Hemo and PD, my wife and I bought Valentine cards, candy, and Hoffbrau Restaurant gift certificates for them. I handed the gifts out on the way into the clinic. They were very well received which is always a good feeling.

Straightaway I wan logged in and provided biometric data – Weight, blood pressure, pulse, glucose, and temperature data, and the USB drive from the Cycler that I had removed prior to leaving home. I then signed several forms to catch up on paperwork for Fresenius, there is always paperwork to catch up on, provided my two insurance cards – Medicare and my military ID for Tricare for Life, and signed some more forms.

I was then shifted to a treatment room where I removed my coat and sweatshirt, was seated and attended to by my dialysis nurse and another nurse. The second nurse drew blood samples and gave me two shots, one my last hepatitis B shot, and the second a Pneumovax shot. My dialysis nurse meanwhile asked me a battery of questions to ascertain my general health and well-being, listened to my heart and lungs, thoroughly inspected my feet, and visually and digitally inspected my stomach catheter area. I was provided a sheet with March’s appointments, and my monthly education package, this time Module 7, Medicines; Tools for Good Health.

I was then sent on my way but had to return as I forgot to pick up a replacement USB drive for the Cycler.

I also noted the Glucose reading on my Libre 3 as being 100 at the time the blood sample was drawn, and the corresponding BMI (remember poor man’s A1C reading) was 6.1%. When my labs come back, probably tomorrow, we’ll compare readings. I had my biometric watch on but forgot to take a reading from it.

When my labs come in, we’ll discuss in some detail what the findings are. For now, I feel great, good, awesome.

Peritoneal Dialysis Labs: An In-Depth Overview

February 6, 2023 / Henry Feeser / 0 Comments

On Monday 2/6/2023 I am scheduled to have my monthly lab work done at Fresenius Medical Center in Granbury, TX. I thought it would be appropriate to blog about what these tests are all about in a general nature, followed by more specifics of my personal results. So here goes:

Peritoneal dialysis (PD) is a form of renal replacement therapy that is used to treat patients with end-stage renal disease. It involves the use of the patient’s own peritoneal membrane, which is the inner lining of the abdominal cavity, as a filter to remove waste products from the blood. This process is performed through a series of exchanges that are done several times a day, typically at home. For me, I do four exchanges or two hours duration each.

One of the critical components of PD is the use of dialysis solution, which is a sterile solution that is instilled into the peritoneal cavity through a catheter. This solution works by drawing waste products from the blood into the peritoneal cavity, where they are then removed during the next exchange. To ensure the safety and efficacy of the dialysis process, it is essential to regularly monitor the dialysis solution and the patient’s response to it. This is where peritoneal dialysis labs come in.

What are Peritoneal Dialysis Labs?

Peritoneal dialysis labs are specialized facilities that are designed to monitor and evaluate the quality of the dialysis solution and the patient’s response to it. These labs typically use state-of-the-art equipment and technology to perform a series of tests that help to assess the concentration of waste products, electrolytes, glucose, and other important parameters in the dialysis solution and patient’s blood. For me, Fresenius uses spectra laboratories out of Southaven, MS to conduct the labs. At least that’s the letterhead on my lab reports.

The main objective of peritoneal dialysis labs is to ensure that the dialysis solution used in PD is both safe and effective. To achieve this, they perform several key tests, including:

Dialysis Solution Glucose Concentration Test: This test measures the concentration of glucose in the dialysis solution, which is critical to the success of PD. If the glucose concentration is too high or too low, it can affect the efficiency of the dialysis process and cause adverse effects such as hypoglycemia or hyperglycemia.
Peritoneal Equilibration Test (PET): The PET test measures the rate of transfer of glucose and other solutes between the blood and dialysis solution. This test helps to determine the effectiveness of the dialysis solution and the patient’s peritoneal membrane.
Dialysis Solution Electrolyte Concentration Test: This test measures the concentration of electrolytes in the dialysis solution, including sodium, potassium, and calcium. It is important to maintain a proper balance of these electrolytes to ensure the safety and efficacy of PD.
Bacterial Culture Test: This test is performed to assess the presence of bacteria in the dialysis solution. Bacterial contamination of the dialysis solution can cause severe infections, and regular monitoring is critical to prevent this from happening.

The results of these tests are used to adjust the dialysis solution and the patient’s treatment plan, ensuring that the PD process is both safe and effective.

Benefits of Regular Monitoring by Peritoneal Dialysis Labs

Improved patient outcomes: Regular monitoring of the dialysis solution and the patient’s response to it helps to ensure that the PD process is effective and that the patient is receiving the best possible care. This, in turn, leads to improved patient outcomes, including better control of waste product levels, improved electrolyte balance, and a reduced risk of infections.
Increased patient comfort: Regular monitoring helps to identify and address any issues or adverse effects that may be affecting the patient’s comfort and well-being. This helps to improve the overall quality of life for patients undergoing PD.
Improved safety: Regular monitoring by peritoneal dialysis labs helps to ensure that the dialysis solution is used.

In a following blog we’ll discuss my actual labs, what they mean to me, and how I respond to them if at all.

The Case for Strong Diabetic Control Before and While On Dialysis Using the E400 Smart Watch

February 2, 2023 / Henry Feeser / 0 Comments

A strong case has been made in a preponderance of reviewed medical journals that diabetes is the primary and number one predictor of a future requirement to go on dialysis. See stats in the table below from CDC here: The extreme need for close diabetic control does not end once a person goes on dialysis; if anything, because PD at a minimum requires dumping a sugar solution into one’s stomach, it becomes even more critical.

For adults with diagnosed diabetes:
- 69% had high blood pressure, and 44% had high cholesterol.
- 39% had chronic kidney disease, and 12% reported having vision impairment or blindness.
- Diabetes was highest among Black and Hispanic/Latino adults, in both men and women.

This blog is not about the how-to of diabetic control, but about one of the new tools just hitting the market to ascertain the degree of control, that is, how is my “blood sugar/glucose doing?”

Coming out of China is a new class of wearable devices in the form of a wristwatch at a very reasonable price called smart watches, or bio watches. They are generally available from Temu.com/App, Aliexpress.com, etc. for about $40.00. I have purchased two from Temu.com via their App for $39.62. See the Graphic below for all they are purported to be able to measure from here: The watches are based on the GR5515 chip and are Model E400 from Vanssa in China. Scroll down this link for more info on all the watch purports to do:

I have been using the watch’s many functions in parallel with my go-to standard blood pressure, O2, temperature, and glucose (I use the Libre 3 CGM) as comparisons. I find some of the readings to be right on, and others to be somewhat consistent. It should be pointed out that the documentation that comes with the device explicitly states they are NOT to be used for medical purposes – yet I might add. As the video describes below, they are great for trends. I have found the E400 watch to be a great addition to a bag of tools for the diabetic/person on dialysis used in conjunction with the associated H Band App. Please watch the video embedded below for an independent review of the E400.

My next blog will discuss using the Libre 3 CGM for diabetic control while on dialysis.

While on Dialysis: Do the things you love!

January 30, 2023 / Henry Feeser / 0 Comments

INC ran an article that explored what gives people the greatest happiness in life. The article suggests “Do the things you love” is central to happiness in life. That got me thinking about how the concept applies to my situation – being on Peritoneal Dialysis and by extension readers of this blog who are also being provided life support via dialysis.

How can we, with the constraints of dialysis, “Do the things we love?” I have found dialysis treatment does not, at least for the most part, affect my life to any great extent so far. Travel is an exception requiring more preplanning and effort.

So what things am I doing that I love while on dialysis?

It’s winter in North Texas so I’m planning for Spring gardening. Looking at Burpee’s seed catalog. Reviewing what went well last year and not so well.
The Rolex 24 Race has just been conducted this past weekend. As an ex-Porsche racer, I enjoy the racing season starting up again
My wife and I are always looking for new food to prepare at home new dishes and new tastes. Yesterday we prepared a couple of filet mignon steaks by first searing them in an iron skillet, then finished cooking them in the same skillet in the oven and topped them with homemade herb butter. We found them to be superior to any we had had anywhere in the world previously.
The deer here in our locale Pecan Plantation have been breeding and laying down for the night in our yard. Always a satisfactory sight to behold.
I enjoy writing this blog and learning more about the ins and outs of dialysis. There is no straight and narrow path I’m beginning to ascertain.
As an engineer, I’m very interested in the rollout of AI-based tools for writing, art, and composition and am exploring Chat in its various forms as we speak. Also, art apps. In the short term, I plan on investing in AI startups when it becomes financially prudent to do so.
We have a seven-month-old Golden Retriever named Dickens. Seven days a week come rain, shine, sleet, or hale I take him to our Dog Park and also walk him for about ¾ of a mile. Good for him and better for me. My wife walks him at night for ½ hour or so. Training-wise, he is a work in progress so this is a constant challenge. As I write this he is asleep on my left foot – never far away and always in touch. That’s what Goldens do.

Like the Statler Brothers in their popular song “Flowers On the Wall,” don’t tell me I’ve nothing to do!”

The Statler Brothers – Flowers on the Wall – YouTube