I am scheduled for a Monthly Dialysis Team Meeting this Thursday at 0845. I don’t expect any surprises as we have been in the groove, so to speak, except for my concern about weight which appears we are approaching a solution. After using 2.5% 2000 mL for my static Sunday night my weight dropped from 148.4 to 148.0 and ultrafiltration was over 1000. We’re headed incrementally in the right direction.
Regarding my labs: My Albumin dropped to 3.4 from 4 so is below desired. My Calcium dropped to 8.2 from 8.7 and is below desired. My Glucose was 84 down from 149; I didn’t eat any breakfast before labs this time which explains this reading. Interestingly, my Creatinine was 8.76, down from 9.22 and “going in the right direction.” This maps to an eGFR of 5 putting me still in the toilet.
We’ve been steadily working in the yard. This AM my wife and I planted eight Lantana and used a pick to remove some rusted steel bed edging. Our twelve Roma tomato plants all have blossoms and are looking very healthy. A short video clip will be provided in a couple of days. I still get winded easily and have to rest frequently but we’re “gettin’ ‘er done!”
As previously reported herein, since I have been using only 1.5% fluid for my peritoneal dialysis, my weight has crept up from a target dry weight of 143 pounds to 149. Last week, I called Fresenius Supply and am to receive, in addition to my regular supply order, an additional 8 boxes of 6 liters of 2.5% solution.
Before this gets too confusing, let’s review: My current prescription for PD using the Liberty Cycler is a single manual fill of 2 Liters at approximately 6 PM followed by hooking up to the Cycler at about 9:30 PM where there is a drain, followed by four fill/drain cycles of 2700 mLiters each, or a total of 10,800 mLiters. Following this routine/prescription, my last adequacy test of Kt/V of 1.98 is acceptable. My dialysis is working and the Kt/V suggests is adequate.
To preclude leg cramps, I tend toward using a 1.5% solution for all of my PD. My weight gain suggests this does not result in pulling enough fluid. Previously when I was mixing 1.5 and 2.5% solutions, my ultrafiltration, a measure of how much fluid is being removed, was consistently over 1000; now, with 1.5%, it is as low as 378 but mostly in the 6-800 range. The obvious solution is to work in more 2.5% solution but how much is the question?
When the 2.5% 6 liter arrives, I intend to work in a 6 Liter bag of 2.5% every other night as a starting point. I use two 6-liter bags per night, so this will be providing roughly half of the required fluid. Meanwhile, while straightening out our supply closet, I found five 2 Liter static bags and used one of them Saturday evening for my static fill. Sunday morning my weight, which for the last three mornings was 149.0, dropped to 148.4, and my ultrafiltration jumped up to 1109 from 654. This suggests to me that perhaps I can alleviate my weight gain by just using the 2-liter static fill at 2.5%. I did have a slight leg cramp but not of the severity that I had to get up out of bed and walk around. I will be using the 2 liter 2.5% bags for my static fill until Wednesday. I’ll let you know how it goes. There is no formula for this stuff, just cut and try as it were.
Yesterday morning when I weighed myself as part of the routine for completing the night’s peritoneal dialysis, I weighed 149.0 pounds, up in a couple of weeks from 143.0. As I previously mentioned in a former blog, I am using only 1.5% dialysis solution which appears to not pull enough fluids out. I am strongly considering by hook or crook coming up with enough 2.5% fluid so that I can start working it into my daily PD treatment. Meanwhile, I asked Poe about weight and PD with the following results which are enlightening:
Weight management is a crucial aspect for patients on peritoneal dialysis (PD). Maintaining an appropriate weight helps optimize dialysis effectiveness, manage fluid balance, and promote overall health. Here are a few key points regarding weight management in PD patients:
Fluid Balance: PD involves the exchange of fluid in the peritoneal cavity to remove waste products and excess fluid from the body. Weight gain between dialysis sessions can indicate fluid retention, while excessive weight loss can indicate inadequate fluid removal. Close monitoring of weight helps in achieving optimal fluid balance.
Ultrafiltration: Ultrafiltration refers to the removal of excess fluid during dialysis. It is an important parameter for managing fluid balance in PD. The prescribed ultrafiltration target is based on a patient’s individual needs and is often calculated as a percentage of their dry weight. Regular weight measurements help healthcare providers adjust the dialysis prescription and ensure appropriate fluid removal.
Nutritional Status: Weight changes in PD patients can reflect alterations in their nutritional status. Significant weight loss may indicate malnutrition, while weight gain can suggest overeating or excessive calorie intake. Maintaining a healthy weight is essential for ensuring an adequate nutritional status in PD patients.
Cardiovascular Health: Excessive weight gain in PD patients can strain the heart and lead to increased cardiovascular risks. Conversely, rapid weight loss may be associated with muscle wasting and a weakened immune system. Moderate weight loss, if necessary, should be achieved through appropriate dietary modifications and under the guidance of healthcare professionals.
Diabetes Management: Many PD patients have underlying diabetes, and weight management is crucial for glycemic control. Achieving and maintaining a healthy weight can contribute to better glucose control and reduce the risk of complications associated with diabetes.
It’s important to note that weight management should be individualized based on a patient’s specific needs and goals. Regular monitoring of weight, along with close collaboration between patients, healthcare providers, and dietitians, is essential to optimize outcomes for PD patients.
The doldrums refer to the equatorial region of the world’s oceans where sailing ships often became becalmed due to light, variable winds. [1][2][3] I have been there having crossed the equator twice, both times on a nuclear-powered cruiser. Wind for our sails was not a problem. Yes, I am no longer a low-life Polywog, but a bonified Shellback.
While Wednesday/yesterday I did have a 0900 meeting with my dialysis nurse for my monthly lab draw and other normal Fresenius workups, it was all more-or-less ho-hum. My six-foot 200-pound dialysis nurse was in tears; a dialysis patient, not one of hers, died from a nonrelated dialysis ailment. I only include this comment as an example that the Fresenius teams DO care – and show it. The highlight was meeting my wife (of 62 years don’t you see) for breakfast at our Country Club on Pecan Plantation. So I AM in the Doldrums. See below for more on this subject.
The doldrums is the area around the equator where the northeast and southeast trade winds converge, causing a zone of calm with little to no wind. [1][3] This region is also known as the Intertropical Convergence Zone (ITCZ). [1][3]
Sailors dreaded getting stuck in the doldrums, as their ships would be left stranded without wind to power their sails, sometimes for days or weeks. [1][2][3] This lack of progress and feeling of being trapped led to the term “doldrums” also being used to describe a state of inactivity, stagnation, or low mood. [1][2][4]
For example, one could say “The company’s sales have been in the doldrums for the past quarter, with no sign of improvement.” [2] This usage compares the stagnation of the business to a sailing ship becalmed in the windless equatorial doldrums.
As readers of this blog are aware, I am also a Type 2 Diabetic, having been so for almost 50 years. As such, I am interested in the broad range of devices and treatments available and becoming available to help manage the disease. Keep in mind, that diabetes is highly correlated with dialysis; on the order of 34+% on dialysis are also diabetics. Thus I surmise more than a passing interest in diabetes care and treatment.
I currently employ an Abbott Libre 3 Continuous Glucose Monitor (CGM) to help manage my diabetes. I recently read on Yahoo Finance about the Eversense CGM system receiving iCGM designation by the US FDA. I had never heard of a device named “iCGM” and this blog below provides information for the reader on what this new device is all about.
Integrated continuous glucose monitoring (iCGMs) systems are a type of continuous glucose monitoring (CGM) device that are designed to be used as part of an integrated diabetes management system. Here are the key points about iCGMs:
iCGMs are the first type of CGM system that the FDA has permitted to be used as part of an integrated system, which may include automated insulin dosing systems, insulin pumps, blood glucose meters, or other electronic devices used for diabetes management.[4] This allows for more seamless integration and flexibility for patients to tailor their diabetes management.
The FDA has established special controls for iCGMs to ensure their accuracy, reliability, and clinical relevance. This enables developers of future iCGM systems to go through a more streamlined premarket review process known as 510(k).[4]
The Dexcom G6 was the first iCGM system authorized by the FDA in 2018. It is a patch device about the size of a quarter that is applied to the skin and continuously measures glucose levels, transmitting the data to a compatible display device.[4] It does not require user calibration, unlike earlier CGM models.[4]
Other iCGM systems in development include those from Profusa, Metronom Health, and Indigo Diabetes, though they have not yet attained regulatory approval.[3] These systems aim to provide continuous monitoring of glucose and other metabolites through minimally invasive or implantable sensors.
iCGMs provide patients with more flexibility and options to integrate CGM data with other diabetes management devices and technologies. This can help improve glucose control and reduce the burden of diabetes self-care.[4] However, patients should still consult their healthcare providers before making any medical decisions based on iCGM data.[2]
We don’t want to be too serious all the time. We recently purchased six flats of flowers to plant in our numerous gardens. Before the flats even had a chance to be planted, butterflies found the flowers and had a field day. That is what the lead photo is about.
Since I have been on my new and latest dialysis prescription, I have been using only 1.5% solution fluids. This holds for both the 2L static treatment I employ about three hours before hooking up to the Liberty Cycler for the night, and the two 6L bags I employ during my night treatment. During the past seven days, I have noticed a developing trend, possibly, that my weight is creeping upwards. See the table below where I have provided the date, weight, and microfiltration values:
Date
Weight
Microflitration
23
146.0
1005
24
146.0
1131
25
146.0
1107
26
146.8
824
27
147.2
694
28
147.2
1026
29
148.0
648
Table Weight and Microfiltration April 23-29, 2024 Henry Feeser
As you can ascertain, in a week my weight is up by two pounds which is not “normal” for me, and my dialysis microfiltration, while not steady, appears to be trending downward. So here’s the deal, I know from experience that if I quiz my dialysis team about this it will be suggested that I blend in some 2.5% solution. But I don’t have any number one, and number two, leg craps will certainly accrue if I start using 2.5% again. So I am on the horns of a dilemma: watch my weight creep up or toss and turn all night from leg cramps. Isn’t life wonderful on dialysis?
Yesterday, 4/28/2024 was my wife’s and my 62nd wedding anniversary. Boy, have things changed since we were first married. Gasoline was less than a quarter a gallon. Computers and cell phones had not been invented. For $20, we could fill two paper shopping bags with enough great red meat to last us weeks. We both worked, she at Purdue where I was a student. We got up early and went to bed early. Life was good and uncomplicated. My kidneys worked. I could drink beer. Did I say life was good?
My wife of 62 years and I met on a blind date at Purdue which was arranged by one of my Navy buddies. We went bowling in October 1961 and were married the following April. I was a student at Purdue attending a program the Navy had at the time named NESEP, for Navy Enlisted Scientific Program. The NESEP incentive intended to provide the Navy with officers with intensive training in needed technical areas like Electrical Engineering to manage the nascent switch to digital technologies that were on the horizon for the Navy. Officers coming out the the US Naval Academy were just not as prepared as was needed. I ended up with a BSEE/MSEE, graduating with Distinction in four years.
This education, along with a perfect wife, has stood me in good stead for these many years. I can’t say how important and central to my general well-being and lately, dialysis care, my wife has been. She is and continues to be the most important reason I get up every morning with the mantra, “Never ring the bell!” Thank you, Linda, for who you are and what you are. I know that you are in my corner regardless of what dialysis throws at us. (The lead graphic is the cover of the anniversary card my wife gave me for our anniversary.)
This blog entry is being written Thursday afternoon late for publishing at 0800 Friday 26 April 2024. Wednesday evening I had a “good” PD experience – no alarms and woke up Thursday morning feeling good. I decided to make a run to town and go to Farm & Fleet to pick up a new battery for our JD ZTR lawn mower that refuses to start, go to Walmart for groceries, and to CVS to pick up a script for my wife. Three stops that even a patient on PD should be able to accomplish without difficulty.
I made it to Farm & Fleet and purchased the battery. I made it to Walmart but by the time I had finished purchasing $128.00 of groceries, I was wiped. Went on to CVS and picked up my wife’s script, and was even more wiped. Got home and my wife helped unload the groceries, I put the battery in the lawn mower and it started right up. I had it hooked to our trailer loaded with mulch and backed it out of the single garage (we have d double garage with a side anteroom and a complete single-car garage too in which we park our lawn mower, golf cart, and other assorted “stuff.”) I positioned the trailer/mulch where we want him to work this evening.
After this, I crashed on the couch. This morning my blood pressure was 97/62. I suspect during my shopping it dropped even more resulting in my being pooped. This is not like me and I don’t appreciate this happening one bit. While we will deal with it, we are seeking a more long-lasting solution.
In a previous blog, I reported on the first Xenotransplantation of a pig’s kidney into a human. A second has been reported by AP reporter Lauren Neergaard in the Health & Science section of the site nbcdfw.com. A condensed version of her article follows; at the bottom is the link to the original article.
Doctors at NYU Langone Health have successfully transplanted a genetically modified pig kidney into a New Jersey woman who was suffering from heart and kidney failure. Lisa Pisano’s condition made her ineligible for a traditional transplant, but doctors came up with a novel solution. They implanted a mechanical pump to keep her heart beating and, days later, transplanted the pig kidney. Pisano is the second patient to receive a pig kidney following a similar procedure at Massachusetts General Hospital. She is recovering well and has taken her first steps since the surgery. The experiment’s early results have been described as transformative, but further monitoring is required. The shortage of donated organs has led to the development of genetic modifications in pigs to make their organs more suitable for human transplantation. Several biotech companies are working on this, and there have been promising results in temporary transplants of pig kidneys and hearts into brain-dead bodies. However, previous attempts at pig heart transplants resulted in the patients’ deaths. The outcome of Pisano’s case, along with that of the Massachusetts General transplant recipient, will play a role in determining the future of xenotransplantation trials.
(Link) to the original article. The lead photo is from this link.
The past week I have been attempting to accomplish some heavy-duty yard work. Here in North Texas where we live, Spring can be short and before you turn around we’re in for suffering heat, as high as 112 F or so. So we have a rather narrow window to get our yards in order before Satan’s Inferno hits.
Tuesday I worked on a bed, we have on the order of 15 flower beds on our 0.52-acre homestead, which is in full sun and borders the side of our main garage. It is mostly clay but grows weeds well. I installed a border around it, made a brick runoff for the drain spout, and augered holes for 12 tomato plants. At this point, I ran out of git up and go. See the lead picture.
In normal times, I would have done this without breaking a sweat. But with my PD-associated low blood pressure, I’m a different person. I have to frequently stop for a breath, and break up any work into chunks. Upon arising Tuesday my blood pressure was 111/74. When I took it before lunch it was 90/57. I have ascertained that once my diastolic drops below 60, I start to feel bummer. Get light-headed and cannot work. Have to sit down. After I rest for five minutes or so I generally can have another go at it.
So here’s the deal. Is this due to dialysis, or is it because I am, after all, 85? I like to think it is dialysis-related. And no, I’m using only 1.5% dialysis solution. And yes, I have worked more salt into my diet. And still, I am experiencing blood pressure readings toward the lower safe boundary.
