Had my monthly meeting with my Dialysis Team as scheduled yesterday. As expected, they were very pleased with my lab results. We will stay the course on my dialysis prescription, not take any blood pressure meds, and continue to monitor, but work on more protein in my diet. My dialysis nurse Cindy also provided four boxes of 6 liters of 1.5% dialysis solution so I have a buffer against the Sanfu reported yesterday. Again, hopefully, the supply that went missing will be delivered on schedule on 4/17/2024.
My lab results indicate that I am on the cusp of at least from a number of perspectives getting enough dialysis. This is also reflected in how I feel. Upon returning from walking our Golden Retriever, I no longer have to sit down and rest. I am not getting slightly out of breath. I can go longer and stronger and accomplish some yard work without having to take a break every five minutes. While I am some distance from the former lean and mean machine known in Porsche racing circles as “Hammerin’ Hank,” at this stage in my life things look pretty good from where I’m standing. Hope they do for you also!
I have been sailing along ordering dialysis supplies from Fresenius for my dialysis requirements without a hitch since October 2022. The hitch became unhitched with a blaring crash Tuesday. Here’s the deal:
I put in an order of 36 – 6 L 1.5% boxes, 7 – 2 L 1.5% manual boxes, 4 cassette boxes, and 2 StayCap boxes. Only the latter two were delivered. No fluids whatsoever were delivered. I called the Fresenius order desk and was informed they screwed up, something about when they talked to my dialysis nurse to get approval for the larger than typically allowed 6 L request things got discombobulated. I was informed that the “real” order will arrive on 4/17/2024.
I politely inquired as to how this could even happen. Alarms should have gone off when my orders, which from the beginning have included copious amounts of the required fluids, suddenly went to zero! This makes absolutely no sense to me at all. It is an obvious fault line in one of Fresenius’ most important functions. To add to this, the voice on the other end of the phone call indicated that she had no way of reporting this abdication of duty to patients up the chain to preclude it from happening in the future, stating “These things do happen.”
So the message for those on peritoneal dialysis herein: Despite your best effort, the “system” can and will leave you hanging out in left field. Keep your powder dry and have extra supplies on hand. It is a pain and takes up extra space but…
BTW, it turns out I have a meeting with my dialysis team today and have corresponded this situation to my dialysis nurse and have arranged to pick up four 6 Liter 1.5% boxes at our meeting. There is a God!
The US Navy SEAL’s saying “The only easy day was yesterday” applies equally to those of us on dialysis. To drive this point home, take yesterday in my dialysis journey. I am scheduled to receive a monthly shipment from Fresenius of my monthly dialysis supplies this morning. It will consist of 47 sizeable boxes of dialysis fluid, cassettes, and caps. It will take up gobs of room. To prepare for this, my wife and I moved all boxes of fluid on hand to our ready service locker in the master bedroom beside where we have the dialysis machine, the Liberty Cycler, set up.
My point is, that we are seldom steady-state in dialysis. Something is always changing. Something needs to be checked. Something out of our control has changed. It is NEVER a one-and-done situation. Please read Poe’s take on the SEAL motto below. If you are on dialysis like me, it directly pertains to you and your grip on your dialysis life.
“The only easy day was yesterday” is a motto and a popular saying often associated with the United States Navy SEALs, a special operations force within the U.S. Navy. While it is not an official motto of the Navy SEALs, it reflects the mindset and the demanding nature of their training and operations.
The saying encapsulates the SEALs’ commitment to pushing their limits and constantly striving for improvement. It conveys the idea that each day brings new challenges and that the SEALs must be prepared to face them with determination and resolve. It emphasizes the importance of learning from past experiences while recognizing that the future will likely present even greater difficulties.
The Navy SEALs are renowned for their rigorous training and demanding missions, which often involve high-stakes operations in extreme conditions. Their training is designed to test candidates physically, mentally, and emotionally, pushing them to their limits and beyond. By embracing the philosophy of “The only easy day was yesterday,” SEALs maintain a mindset of continuous improvement and resilience.
This saying is not unique to the Navy SEALs and has been adopted by other military and non-military groups as well. It has become a popular motivational phrase, encouraging individuals to persevere and not become complacent in the face of challenges.
Overall, “The only easy day was yesterday” serves as a reminder to the Navy SEALs and others that success is not guaranteed, and each day requires renewed effort, dedication, and a willingness to confront the difficulties that lie ahead.
And that folks, is the mindset those of us on dialysis must daily embrace. “The only easy day was yesterday!”
A question I quite often ask myself and others are interested in also is “How is this blog doing?” While “doing” is not well defined, today I’m going to share with readers some of the dynamic statistics I have as part of the WordPress package of Plugins. While readers never glimpse what is behind running a blog/Website such as feeser.me, lots is going on. Managing such a site is on the one hand very simple and easy, while on the other hand can be as complicated as you want to make it. If anything, I have erred on the simplistic side but there’s still lots going on. I’m going to jump in with five graphs/table grabs with dialog of what’s going on.
The graphic above provides information on overall traffic to the blog.
The graphic above from site stats depicts on a rolling daily basis how many visitors have visited how many pages. It is an overall dynamic view of the “interest” the entire universe has in daily topics.
The table above provides stats for the last 30 days on what part of the world visitors originated from
The table above ranks by topic the top searches. This may be used to generate more blogs about topics of interest. Based on the above, Cycler Alarms are of primary interest and I should consider blogging about the subject more often, assuming I have Germaine input.
Lastly, the table above provides information on the location of and IP address of visitors to this blog. While interesting in and of itself, I don’t use it for anything. A marketing organization might use such info if it were targeting a specific demographic in a specific market to measure the efficiency of a campaign for instance.
This past Friday I was able to get a new set of Bridgestone tires installed on our BMW X5 to replace the one blown out. Thought readers might be interested in seeing what a tire looks like that blew out at 70 MPH and was driven on the run-flat feature for another 120 or so miles. It seems obvious to me that we ran over a brick or other sharp object that completely tore the inner wire mesh system of the tire apart. The tire had 33, 450 miles on it and you can see from the tire wear indicators that it was nearing need for replacement.
Last Thursday evening, after 10 PM I received an email from the lab that my results were available. I’m very pleased to state that my new and latest Kt/V was 1.98, up from 1.79 previously, and up from an overall low of 1.44. So my new dialysis prescription seems to be getting the results we needed. Keep in mind that Fresenius rounds this reading so for their records it’s a 2, the target minimum.
A couple of other readings were also worth mentioning. My Albumin was 4.0 the first time ever that it has reached the minimum. From this, you should take on board that ingesting only ONE Brazil nut per day can improve Albumin. My Potassium, Calcium, and Phosphorus were all within specs. My quarterly A1c was 6.3, a little higher than I wanted but less than the 7 goal. All of my docs will be pleased with this reading.
Have a busy week ahead. Monday at 1400 we visit with our CPA to pay our Federal Taxes, a yearly event that I’m OK with. Wednesday I have an appointment with our new dentist, and soon thereafter, an appointment with the audiologist. While the new hearing aids work great, for some reason the left one does not want to recharge in the provided charging cradle. Thursday we have our monthly delivery of dialysis supplies. With this delivery, I’m shifting over to two 6 L bags per session, along with the 2 L manual for my “new” prescription.
My lab results are not back as I write Friday’s blog Thursday afternoon so maybe on Monday, we’ll know how my Kt/V is doing.
Meanwhile, at 4:45 PM Wednesday I had an appointment with an audiologist to get my new VA-provided hearing aids. His storefront is located in Stephensville, some 49 miles away. About 20 miles from his office, traveling legally at 70 MPH (it is Texas people, we have reasonable speed limits) the right rear tire on our 2019 BMW X5 we were traveling in blew. Luckily, we have ran-flats on it, continued to our appointment at a maximum speed of 50, and returned home slowly and safely.
I now have a new set of hearing aids by a company named Starkey. So far so good. They have an AI function that cancels out background noise where it normally causes me real problems in picking out conversations. I seem to have a much greater clarity of sound reproduction also.
Meanwhile, this morning I went to our local tire barn, where for $1880.80 I have a new set of 275X45X20 Bridgestone tires on order for the X5. A couple of years ago the same tires would have been $800. When I was racing Porsches in the nineties a set cost less than $500 for racing tires. Who says prices haven’t gone up?
Yesterday I made my 0900 Fresenius Clinic lab appointment. This appointment I had with me my urine collection, as sparse as it was, and collection of all the 2.5% solution from my previous evening’s cycler session. This along with the blood draw taken as part of my lab routine, will produce a new and hopefully improved Kt/V. Perhaps we will know by tomorrow.
For the past three upon arising blood pressure readings, all have been in the 100+/60+ range, and this is without any BP meds. It would appear we are out of the danger range therein. I have also walked our golden retriever for three mornings straight. My wife and I are also getting small jobs that we have put off around the house accomplished so we are returning to some degree of normalcy.
One thing was different with my labs this morning. The lab tech had me coat my hands with an orange-colored liquid, then wash my hands as usual and dry them. She then turned off the lights and checked my hands with a black light. I had a little bit of residue between my fingers and the rest of my hands were clear – I passed. I was informed that I was one of a few patients who cleaned their fingernails against their palms properly and it showed in the results. I have to do this procedure twice a day, once for my manual fill and once at night when I hook up to the cycler so it’s good to know my routine is effective.
My dialysis team dietician recently provided me a resourse that suggests eating just one Brazil nut per day can help to raise your Albumin. The resourse states in part:
“You can think of albumin as your body’s mail carrier — it delivers nutrients, vitamins, minerals and energy you get from food to the rest of your body. It also helps the fluid you drink stay in your cells and blood vessels, and it helps fight infection.
You need more albumin when you are on dialysis. When your kidneys are not working properly, both hemodialysis and peritoneal dialysis remove the buildup of waste and fluid in your blood. But dialysis also removes some of the albumin in your blood. This is why it is important for people on dialysis to have a protein source at every meal and sometimes with snacks.
Albumin helps fluid stay in your blood vessels, something that is especially important when you are on dialysis because you are not going to the bathroom like you used to. Dialysis pulls the extra fluid out of your blood, and albumin helps keep fluid in your blood — instead of pooling around your feet and ankles or around your lungs — so dialysis can remove it more easily and it causes less stress on the rest of your body.”
As you can easily ascertain from the lead graphic from recent lab results, I am deficient in Albumin. I went to Amazon and bought a two pound bag of Brazil nuts for $21.98 and am eating one per day. We’ll see what the results are in my labs. I quizzed Perplexity about the benefits of eating one Brazil nut for dialysis patients with the following results:
Based on the search results provided, here is why a dialysis patient should eat one Brazil nut per day:
Benefits of Brazil Nuts for Dialysis Patients
Selenium Source: Brazil nuts are an excellent source of selenium, containing about 96 micrograms per nut, which is 175% of the recommended daily intake. Selenium is vital for proper thyroid function and overall health, but dialysis patients often have low selenium levels. 134
Antioxidant and Anti-inflammatory Effects: Brazil nuts contain antioxidants and have been shown to reduce oxidative stress and inflammation in dialysis patients. This can help slow the progression of chronic kidney disease. 24
Improved Glutathione Peroxidase Activity: Supplementation with one Brazil nut per day has been found to increase the activity of the antioxidant enzyme glutathione peroxidase in dialysis patients. This helps protect against oxidative damage. 4
Potential Cardioprotective Effects: The healthy fats, fiber, and antioxidants in Brazil nuts may help improve cholesterol levels and reduce the risk of cardiovascular disease, which is a major concern for dialysis patients. 35
Thyroid Support: The high selenium content in Brazil nuts can help support proper thyroid hormone production, which is important for dialysis patients who often have thyroid dysfunction. 3
In summary, the unique nutrient profile of Brazil nuts, especially their exceptionally high selenium content, makes them a beneficial dietary addition for dialysis patients to help manage oxidative stress, inflammation, and other complications associated with chronic kidney disease. Eating one Brazil nut per day is recommended. 124
I was informed by my dialysis nurse Cindy that on Wednesday I am to participate in Yet Another Adequacy Test (YAAT.) For the uninitiated, this means that on Tuesday I start collecting my urine, and use only 2.5% solution for dialysis, all of which will be collected and taken to the Fresenius Clinic on Wednesday. I will have a blood draw at the clinic, and all this “stuff” will be sent to the lab where they will calculate a Kt/V based on these biologicals. Hopefully, this latest measurement will be improved over the rounded 1.8 number I have been exhibiting indicating that my latest dialysis prescription is an improvement over past ones.
Today, Monday my BP is hanging in there in the 100/60 area. Since BP is such an important and central measurement in our overall health, not just those of us on dialysis, below I’ve included a copy of the handout provided by Fresenius relating to this subject. Note that the target Systolic range Fresenius suggests is between 100 and 140; they do not provide a target Diastolic range, which I have operationalized as above 60. I know when I’m below this number I start to feel it. See the PDF embedded below.
The lead photo is to remind me that I have not always been subjected to the restraints of dialysis. It is a picture taken about 10 years ago of our sailboat, a 1988 Catalina 30 tied up at the main pier of Padre Island Yacht Club in Corpus Christi, TX flying flags in memory of the person we bought the boat from. Times were different then, a venturesome life embedded in my memory. Sometimes thoughts and memories are the medicine that guides us over, through, and around rocks and shoales.
The purpose of this blog entry is to provide data for my dialysis team to diagnose my current situation of hypotension (low blood pressure.) It should also communicate to readers of this blog that all is not necessarily smooth sailing in peritoneal dialysis.
Background: This past Wednesday I had a rather large amount of Basal Cell Skin Cancer surgically removed from over my right ear. As a consequence, I have about a two-inch incision with multiple stitches. My dermatologist prescribed Cephalexin 500 MG caps 2x per day for infection. I took three before stopping. I stopped because I had no idea what influence this had on BP. Whether this has any bearing is purely conjecture.
My BP the next morning was 98/59 (see chart below) and I wasn’t feeling all that hot. The next day (3/28) my BP was even lower and I notified Cindy, my dialysis nurse that something was awry. At this point, we stopped all BP meds (Irbesartan 150 MG tabs and Amlodipine Besylate 5 MG tabs), and switched to ONLY 1.5% dialysis solution including the manual 2000 ML pre-fill. I am still taking Hydrochlorothiazide 25 MG tabs. It is obvious from a cursory analysis of my BP readings in the chart below that it is lower when I arise, and goes up to marginally acceptable ranges by evening, falling back down during the night to rise the next day.
During all of this, I have not been feeling all that great. I’m ok when seated or lying down, but get slightly winded and have to rest after minimal exertion. I have not felt comfortable even attempting to walk our golden retriever during all of this. I have not been able to do any yard work or anything involving a minimum amount of exertion. I have been sleeping longer, still have an appetite, and have not had a temperature. My weight has fallen from the 155 range back down to the 144 range during all of this so we have been pulling water via dialysis.
