Monday I was informed that my dialysis team wanted to conduct a PET (Peritoneal Equilibration Test) to best determine what my current optimum dialysis prescription is. (See link for more info on PET. The first part of the test required me to conduct a manual introduction of 2000 ml of 2.5 % dialysis fluid Monday night which was to be left in my stomach overnight, followed by a visit to the Fresenisus clinic Tuesday morning for three more manual drains and fills, interspersed with a blood draw and siphoning off of 200 ml of expelled dialysis fluids for lab tests. I should know the results later on in the week depending on how Christmas affects lab schedules.
Since a patient on PD is not often required to do a manual process (we were taught how in our training sessions) a refresher was needed. I found the following video which is included to help those who may be in the same situation as I found myself in. The video spells out in detail every step and precaution involved.
During my quarterly GP visit last week, I briefed my doctor, JP Letellier, MD on the status of my Peritoneal Dialysis including my shortfall in the Kt/V area. He quizzed me about what is behind the numbers which I was unable to provide in any detail. The following blog is in response to his questioning and will be provided to him. I used my AI assistant Poe as indicated below. She did a great job summarizing Kt/V for us.
Prompt: I am calculating Kt/V as I am on Peritoneal Dialysis. I conjecture that it has two components: the first is obtained from Peritoneal Dialysis, and the Second is from any Residual Kidney Function. Write a 500-word or so blog entry about the components of Kt/v and how labs calculate it in a professional medical tone.
Assistant Poe
Title: Understanding Kt/V in Peritoneal Dialysis: Examining the Components and Calculation
Introduction: Peritoneal Dialysis (PD) is a life-sustaining treatment for patients with end-stage renal disease (ESRD) that helps remove waste products and excess fluid from the body. One crucial parameter used to assess the adequacy of PD is Kt/V, which measures the efficiency of solute clearance during dialysis. Kt/V incorporates two components: the contribution from Peritoneal Dialysis itself and the residual kidney function. In this blog post, we will explore these components and delve into the professional medical perspective of how laboratories calculate Kt/V.
Component 1: Peritoneal Dialysis (Kt): Peritoneal Dialysis is a process that involves the infusion and drainage of a dialysis solution into the peritoneal cavity. The peritoneal membrane acts as a semipermeable barrier, allowing waste products and excess fluids to diffuse across it. The efficiency of solute removal during PD is represented by the term Kt, where K denotes the dialyzer clearance rate (clearance of solutes) and t represents the duration of the dialysis session.
The dialyzer clearance rate (K) is determined by factors such as the composition of the dialysis solution, the size of the solutes being cleared, and the characteristics of the peritoneal membrane. It is typically measured using the peritoneal equilibration test (PET), which involves measuring the concentrations of solutes in the dialysate and blood at various time points during a dwell period. The rate at which solutes equilibrate between the dialysate and the blood provides an estimate of K.
The duration of the dialysis session (t) refers to the time over which the dialysis solution is dwelling in the peritoneal cavity. Longer dwell times allow for greater clearance of solutes, improving the overall efficiency of Peritoneal Dialysis.
Component 2: Residual Kidney Function (V): Residual Kidney Function (RKF) refers to the remaining functional capacity of the patient’s own kidneys. Even in patients with advanced renal failure, some degree of kidney function may persist. This residual function plays a significant role in the overall clearance of solutes from the body.
To quantify RKF, laboratory tests are performed to measure parameters such as serum creatinine and urea levels, as well as urine output. These values are then used to estimate the glomerular filtration rate (GFR), which reflects the filtering capacity of the kidneys. The GFR is a vital determinant of the second component of Kt/V, represented by V.
Calculation of Kt/V: The total Kt/V is obtained by summing the contributions from Peritoneal Dialysis (Kt) and Residual Kidney Function (V). This summation provides a comprehensive measure of the overall clearance of solutes from the body during a given period.
Laboratories utilize various equations to calculate Kt/V, such as the formula developed by Twardowski et al. or the Daugirdas equation. These equations take into account parameters such as the patient’s total body water, ultrafiltration volume, and the measured or estimated GFR.
Conclusion: Kt/V is a key parameter used to evaluate the adequacy of Peritoneal Dialysis. It incorporates two essential components: the efficiency of Peritoneal Dialysis itself (Kt) and the residual kidney function (V). The calculation of Kt/V involves assessing the dialyzer clearance rate, dwell time, and measurements of residual kidney function.
Accurate determination of Kt/V aids healthcare professionals in optimizing dialysis prescriptions, ensuring adequate solute clearance, and tailoring treatment plans to individual patient needs. By understanding the components and calculation of Kt/V, both patients and healthcare providers can make informed decisions regarding the management of Peritoneal Dialysis therapy.
I then asked Poe about the two methods mentioned above to calculate Kt/V with the following prompt and results:
Prompt: What are the Twardowski and Daugirdas equations for calculating Kt/V?
Assistant Poe
The Twardowski equation and the Daugirdas equation are two commonly used formulas for calculating Kt/V in peritoneal dialysis. Here are the equations:
Twardowski Equation: The Twardowski equation, also known as the modified Watson equation, calculates Kt/V based on the measured dialysate to plasma concentration ratio (D/P ratio) of urea during a peritoneal equilibration test (PET). The equation is as follows:
Kt/V = -ln(R – 0.03) + (4 – 3.5R) × UF/W, where: R = D/P ratio of urea, UF = ultrafiltration volume in liters, W = patient’s weight in kilograms.
In this equation, the D/P ratio of urea is obtained from the measured concentrations of urea in the dialysate and plasma samples taken during a PET. The ultrafiltration volume represents the volume of fluid removed during the dwell period, and the patient’s weight is used to account for body water distribution.
Daugirdas Equation: The Daugirdas equation provides an estimate of Kt/V based on various parameters, including the patient’s total body water, ultrafiltration volume, and the measured or estimated glomerular filtration rate (GFR). The equation is as follows:
Kt/V = -ln(R – 0.008 × t) + (4 – 3.5R) × UF/W + 0.03 × t, where: R = D/P ratio of urea, t = dwell time in hours, UF = ultrafiltration volume in liters, W = patient’s weight in kilograms.
The Daugirdas equation incorporates the dwell time (t) in addition to the parameters used in the Twardowski equation. The dwell time represents the duration of the dialysis session.
It’s important to note that these equations are just two examples of the many formulas available for calculating Kt/V in peritoneal dialysis. Different centers or regions may use slightly different equations or modifications based on local practices and preferences. Additionally, these equations primarily focus on the clearance of urea, which is a commonly used marker for assessing dialysis adequacy. Other solutes may require additional equations or adjustments for accurate Kt/V calculations. It’s always recommended to consult with a healthcare professional or nephrologist for precise calculations and interpretation of Kt/V values in individual cases.
Last Thursday I blogged (link) about a online calculator for Kt/V that is provided by Fresenius (see link). I tossed it out there for patients to play around with but did not articulate about one very important aspect of the calculation. This blog is to rectify that shortcoming on my part. Thus the “cleanup.”
In the left panel center section you have the option of setting “Residual Kidney Function.” For the example I used, I set it to zero. Since I am still urinating, albeit not that much, it is NOT zero but some positive number, probably for me about 0.3. If you increase this from zero to 0.3 in the left panel, the calculations in the right panel, yields 1.7 on the dial. The dial reading is a combination of what your kidney is producing and what Kt/V is obtained from dialysis itself. There are two components. There’s a label at the bottom of the third panel as “Kidney Weekly Kt/V” and “Peritoneal Kt/V.” Thus the dial is showing both.
Sorry for any confusion. Since Kt/V is so central to our dialysis well being, tomorrow’s blog will dig even deeper into it. The more patients know, the better patients they can become. Certainly that is the goal for all of us, regardless of what ails us.
As part of prep for my annual physical in March 2024, on 12/13/2023 my GP had a set of labs done by Quest Labs here in Granbury,TX. One of the labs we are always interested in is how my Testosterone levels are doing. The lead graphic above shows that they have varied since 2018, and my results yesterday indicated they were above the upper bound at 935 or so. Keep in mind that every two weeks I am injected with a 1 ml Testosterone shot so for me, this is not unexpected. My last shot was Sunday a week ago.
Here’s the rest of the story. In our society, we talk in hushed voices about women and their “hot flashes” and even, God bless us, Hormone Replacement Theory. What we NEVER talk about, even among men in the locker room, so to speak, is men and their testosterone levels. Among men, testosterone is inexplicably tied to their perceived sexual prowess, and any discussion along the lines of lack thereof is taboo. It directly attacks their manhood.
This is tragic in that testosterone in men has many many more functions than growing hair on their chests. It extends further than this to severely impacting those of us (males) on peritoneal dialysis. To help in this area, I turned to my AI assistant Poe with the following Prompt and results. Please read what she has to say, and my comments thereafter. Listen up Fresenius Dialysis Team; you are brought to task therein:
Prompt: Write a 500 word blog in a serious tone on how important testosterone is to male patients on peritoneal dialysis.
Assistant Poe
Title: The Significance of Testosterone for Male Patients on Peritoneal Dialysis
Introduction
Peritoneal dialysis is a life-saving treatment for individuals with end-stage renal disease (ESRD). While it offers numerous benefits, it can also have an impact on hormone levels in the body. Specifically, male patients on peritoneal dialysis may experience a decline in testosterone levels. In this blog post, we will explore the importance of testosterone in male patients and shed light on the significance of managing testosterone levels for those undergoing peritoneal dialysis.
Understanding Testosterone
Testosterone is a hormone primarily associated with male sexual development and reproductive function. However, its influence extends far beyond these realms. It plays a crucial role in regulating bone density, muscle mass, red blood cell production, mood, cognitive function, and overall well-being. Testosterone levels naturally decline with age, but in male patients on peritoneal dialysis, this decline may be accelerated due to various factors.
Testosterone and Peritoneal Dialysis
Peritoneal dialysis involves the use of a catheter to filter waste products and excess fluids from the body. While it is an effective treatment, it can lead to hormonal imbalances. The loss of proteins during dialysis can disrupt the delicate equilibrium of hormones, including testosterone. Additionally, factors such as inflammation, oxidative stress, and the presence of comorbidities can further contribute to decreased testosterone levels in these patients.
Impact on Male Patients
The decline in testosterone levels can have significant consequences for male patients on peritoneal dialysis. Firstly, it can lead to a decrease in muscle mass and strength, resulting in fatigue and reduced physical performance. This can impact the patient’s ability to carry out daily activities, diminish their quality of life, and potentially lead to muscle wasting. Moreover, low testosterone levels may contribute to decreased bone mineral density, increasing the risk of osteoporosis and fractures.
Furthermore, testosterone deficiency can affect mood and cognitive function. Male patients may experience symptoms such as depression, irritability, difficulty concentrating, and reduced motivation. These changes can further hinder their ability to participate in social activities and negatively impact their mental well-being.
Managing Testosterone Levels
Recognizing the importance of testosterone in male patients on peritoneal dialysis, it is crucial to monitor and manage testosterone levels effectively. Regular assessment of hormone levels can help identify deficiencies and guide appropriate interventions. Healthcare professionals may consider various treatment options, including testosterone replacement therapy (TRT).
TRT involves the administration of testosterone to supplement or restore levels in the body. It can be administered through different methods, such as injections, gels, patches, or pellets. However, it is essential to evaluate each patient individually and consider potential risks and benefits before initiating TRT.
In addition to TRT, optimizing lifestyle factors can also play a role in managing testosterone levels. Regular exercise, a balanced diet, stress reduction techniques, and adequate sleep can positively influence hormone production and overall well-being.
Conclusion
Testosterone is a vital hormone for male patients on peritoneal dialysis, as it impacts various aspects of their health and well-being. The decline in testosterone levels associated with this treatment can lead to muscle loss, decreased bone density, mood disturbances, and cognitive impairments. By actively monitoring testosterone levels and implementing appropriate interventions, healthcare professionals can help mitigate these adverse effects. It is crucial to individualize treatment plans and utilize a multidisciplinary approach to optimize the overall health and quality of life for male patients on peritoneal dialysis.
My closing comments for Fresenius Dialysis Team: It appears that monitoring testosterone levels for males is central to the overall care and feeding of your patients. Why has this never been a topic of interest or questioned by team members? What are you going to do about it? It would appear to be as central to a male patients’ well being as phosphorous, potassium or other chemical levels you keep a keen eye on?
A couple of days ago I blogged about finding an algorithm to calculate PD prescriptions. Alas, because of cycle restrictions being 6-12 cycles, it did not apply to me. I searched some more, and found a PD Calculator by Fresenius Medical (link) that does not have these restrictions. All of the following three screen shots are from this calculator with my data inputted.
There are three panels that are viewable on my large desktop computer all at once which is nice. The left, or first panel above is where patient-specific data is entered. Notice there are small “i”s next to most values that explain in detail what the required value is all about; I found them to be helpful. The Transport entry allows you to dynamically change this value and see how it impact values of Kt/V which are displayed in the third panel. Values are mostly self-explanatory otherwise.
The second or center panel provides Estimated Prescription Data to obtain a minimum of a Kt/V of 1.7. In my case, for the values entered in the left panel, it suggests a maximum fill volume of 2.7 L per fill, and 6 exchanges.
The right/last panel is labeled Physician Modeling. I inputted my current prescription of 2.5L per fill 4x fills, and 2 hour dwell and the panel provided an estimated Kt/V value of 1.4 for these parameters. This is very close to the lab-provided value of 1.46 and 1.67 my two most recent readings. To obtain these readings, I had to adjust the Transport input in the left panel to the second highest setting which is more Transport than I recall I am getting from my current PD.
So there it is, a way for patients to play around with their numbers and see how variables are interrelated. Go for it!
Tomorrow I have my quarterly meetup with my GP, Dr JP. One of the assorted topics we will be discussing is my diabetic control. In the past, this discussion centered largely on what my A1C readings are. No more. With the advent of the Continuous Glucose Monitor such as the Libre 3, with the press of a button a user can determine what their glucose time in range has been for a variety of time frames. The above graphic is mine for the past 90 days.
In conjunction with my GP, we have tightened the upper bound from the default value of 170 to a more restrictive value of 150. Thus my “range is now 70 to 150. That’s where we strive to keep our glucose readings every hour of every day regardless of food intake, exercise, sickness or health. The latest medical thought is that a diabetic should strive to be in range at least 70% of the time. (link) Here what the foregoing link states:
“Current guidelines recommend most people with type 1 and type 2 diabetes should aim for a time in range of at least 70 percent of readings — meaning you should aim for about 17 out of 24 hours each day to have a glucose level in range (not high or low),” said Dr. Jordan Pinsker, Vice President and Medical Director for Tandem Diabetes Care.”
As is my nature, I speculated that Poe, my AI assistant probably had some interesting insights into this subject. With the following prompt and included results she certainly did. Just like my dialysis team who are all women, you better pay attention to what she has to say.
Prompt: For a diabetic, the concept of “time in range” is of growing importance. Discuss this concept from the aspect of a patient on peritoneal dialysis in a 400 word or less blog in a serious tone.
Assistant Poe Title: The Significance of “Time in Range” for Peritoneal Dialysis Patients with Diabetes
Introduction: Living with diabetes is a challenging journey that requires constant vigilance and management. For individuals undergoing peritoneal dialysis, an effective and harmonious balance between blood glucose control and fluid management becomes paramount. In recent years, the concept of “time in range” has emerged as a critical metric for assessing the overall glycemic control of diabetic patients. This blog input explores the significance of “time in range” from the perspective of patients on peritoneal dialysis, shedding light on its importance in optimizing health outcomes.
Understanding “Time in Range”: “Time in range” refers to the amount of time a person spends within their target blood glucose range. Traditionally, diabetes management has focused on measuring glycated hemoglobin (HbA1c) levels as a marker of long-term glucose control. However, this single-point measurement fails to capture the dynamic fluctuations in blood glucose levels that individuals experience throughout the day. “Time in range” provides a more comprehensive and nuanced assessment by considering both high and low blood glucose excursions within predefined ranges.
Benefits for Peritoneal Dialysis Patients: Peritoneal dialysis patients face unique challenges in managing their diabetes due to the complex interplay between glucose control and fluid balance. Achieving and maintaining an optimal “time in range” has several key benefits for these individuals:
Enhanced Glycemic Stability: Consistently spending more time within the target blood glucose range promotes stability and reduces the risk of acute complications associated with hyperglycemia or hypoglycemia. This stability is particularly crucial for peritoneal dialysis patients, as abnormal blood glucose levels can exacerbate the underlying kidney condition.
Improved Quality of Life: Uncontrolled blood glucose levels can lead to symptoms such as fatigue, frequent urination, and increased thirst, which can significantly impact a patient’s quality of life. By maximizing “time in range,” individuals can minimize these symptoms, allowing them to better engage in daily activities and enjoy an improved overall well-being.
Long-Term Health Outcomes: Effective glucose control has been linked to a reduced risk of diabetes-related complications, such as cardiovascular disease, neuropathy, and retinopathy. By prioritizing “time in range,” peritoneal dialysis patients can potentially mitigate the long-term consequences of diabetes and optimize their overall health and longevity.
Strategies to Optimize “Time in Range”: To maximize “time in range,” peritoneal dialysis patients can employ various strategies:
Continuous Glucose Monitoring (CGM): CGM devices provide real-time glucose readings, allowing patients to monitor their blood glucose levels continuously. This technology facilitates early detection of fluctuations and aids in prompt intervention, fostering improved glycemic control.
Individualized Treatment Plans: Collaborating with healthcare providers to develop personalized diabetes management plans is crucial. These plans should consider the patient’s specific needs, lifestyle factors, and the unique challenges posed by peritoneal dialysis, aiming to strike the right balance between glucose control and fluid management.
Regular Self-Monitoring: Regular self-monitoring of blood glucose levels using fingerstick measurements complements CGM data, enabling patients to gain a comprehensive understanding of their glycemic patterns. This data can serve as a valuable tool for making informed adjustments to their diabetes management strategies.
Conclusion: “Time in range” is an essential concept for peritoneal dialysis patients living with diabetes. By prioritizing this metric and striving to spend more time within their target blood glucose range, patients can enhance glycemic stability, improve their quality of life, and reduce the risk of long-term complications. Through the adoption of continuous glucose monitoring, personalized treatment plans, and regular self-monitoring, patients can effectively navigate the complex dynamics of diabetes management while undergoing peritoneal dialysis, ultimately promoting optimal health outcomes.
As previously reported, I had a Dialysis Team meeting this past Friday. All team members were present – my Renal Doctor, Social Worker, Dietician and Nurse. Before the meeting started, my Dialysis Nurse Cindy mentioned Fresenius had a program to calculate the optimum dialysis solution amount and dwell time but she could not run it because it only ran on Windows 7 which they no longer had access to. Subsequently I volunteered to provide a Windows 7 notebook but have not heard back as of this writing.
This got my thinking, if an algorithm had been developed in the past, it should be available to port to newer systems. So I did a Google search on “Peritoneal Dialysis Algorithms” and came up with what I thought I needed. In a 2020 article in Sage by Chang Yin Chionh et all (link), the graphic above and the following equations were extracted. This article provides the equations we need to calculate both the volume of fluid to use given a target adequacy target (Kt/V) and/or Dwell time.
The top portion of the lead graphic portrays the interconnection between the measurement of how well PD is working, that is Kt/V, and the variables that influence this value incorporated in the prescription, that is # of cycles, dwell volume, and dwell time. These values “influence” Urea which in turn feed into the calculation of Kt/V, which we want to keep at or above 2.0 in my case.
The following screenshot is from the section of the cited article wherein equations are presented to calculate dialysis volume and/or time given a target Kt/V.
Interestingly, at the end of the linked article there is a downloadable Excel spreadsheet that accomplishes their calculations very well. However, there is one big problem that precludes using this article for my particular case. In the fine print it states that their model, or algorithm if you will, is only valid for cycle times of 1 to 4 hours (I am on 2 hours per cycle so we’re OK here) and 6-24 cycles (I am on 4 cycles so the model restrictions fail here.)
Neglecting failure of the cycle restrictions, I ran my numbers anyway, and came up with I should be using 1.17 liters of fluid in 12 cycles to obtain a Kt/V of 2.0, the lower bound. I am currently using 2.0 liters of fluid in 4 cycles and have a Kt/V of 1.67.
Stay with me, we’ll figure this out. I’ll search for more algorithms that accommodate my particular situation and seek to optimize my prescription. Nobody said it would be easy I did learn that there is an entire publication, Peritoneal Dialysis International devoted to peer reviewed research into the subject so all is not naught!
Recently I happened across a group on Facebook named “Home Dialyzers FB Group Research.” Within this group is a young lady at Jefferson.edu (link) that is working on her doctorate in the Health Science area investigating decision regret for ESRD patients who have chosen conservative management compared to those who have chosen dialysis. I responded to her request to beta-test her concepts and the questionnaire she is authoring to gather data to support her dissertation.
Over this past weekend I reviewed her latest product and found that it did not capture the richness of the conceptual phase that predates actually going on dialysis. It is an extremely complex decision-making effort that is surely different for each individual. In my case, I relied mostly on my own research and numerous discussions with my wife Linda and my kidney doctor, Dr. Turner. I studied lots of numbers and odds and expected life given which protocol was employed before making my final decision. In retrospect, it was the best one to make. My decision making was much less emotional and more quantitative-driven, like a good engineer’s should be. My former quant professors at Purdue University are smiling at me now!
This process and what the PhD student is attempting to quantify is captured in the Robert Frost poem “The Road Not Taken” which is included in this blog at bottom for those inclined to refresh their memories along cultural lines. Knowing that my AI Assistant Poe would have something interesting to add to this conversation, I quizzed her with the following prompt and response. It captures the subtleties very well.
Prompt: Robert Frost wrote about the path less traveled. Apply this concept to those of us on peritoneal dialysis in a 500 word or less blog entry in a forthright tone.
Assistant Poe Introduction: Peritoneal dialysis (PD), my friends, is the road less traveled in the world of renal replacement therapy. Just like Robert Frost’s poem, “The Road Not Taken,” it’s a choice that sets us apart from the majority. And let me tell you, choosing this path requires courage, resilience, and a willingness to challenge the status quo.
When faced with the need for dialysis, the common route chosen by many is hemodialysis. It’s the well-trodden path, the one that everyone seems to know about. But for those of us who dare to venture off the beaten track, PD offers a different experience—one that demands self-reliance and a pioneering spirit.
Let’s be honest here: PD is not the easy way out. It comes with its own set of challenges and responsibilities. We must learn to navigate the intricacies of the catheter, master the dialysis process, and maintain a sterile environment. It’s a path that demands discipline and attention to detail. But for those who are willing to put in the effort, the rewards can be significant.
One of the most notable advantages of PD is the freedom it affords us. While hemodialysis patients are tied to fixed treatment schedules and frequent visits to the dialysis center, we have the privilege of performing our treatments in the comfort of our own homes. We are not bound by rigid time constraints or the need to travel to a clinic. Instead, we can adapt our dialysis routine to fit our lives, allowing for greater flexibility and independence.
But let’s not sugarcoat it—PD is not without its obstacles. We may encounter peritonitis, fluid imbalances, or issues with our catheters. These challenges can be daunting, but they are not insurmountable. We must face them head-on, armed with knowledge and a proactive mindset. By staying vigilant, seeking timely medical attention, and adhering to best practices, we can overcome these hurdles and continue on our chosen path.
Choosing PD also means embracing a different mindset—a mindset of self-empowerment and self-advocacy. We become the captains of our own healthcare, taking charge of our treatment and making informed decisions. We must educate ourselves about our condition, stay informed about the latest advancements, and actively participate in our care. It’s a path that demands active engagement, but it also empowers us to take control of our lives.
Moreover, by choosing the path less traveled, we become part of a unique community. We connect with fellow travelers who understand our journey, who have faced similar challenges, and who can offer support and guidance. We share our experiences, exchange tips and tricks, and build a network of individuals who are navigating the same uncharted territory. Together, we become a force to be reckoned with—a collective voice advocating for the recognition and understanding of PD.
So, my friends, as we walk this less traveled path of peritoneal dialysis, let us embrace it with open arms. Let us recognize the strength and courage it takes to choose the unconventional. Let us face the challenges head-on, armed with knowledge and determination. And let us remember that we are not alone—there is a community of warriors by our side, ready to lend a helping hand.
In the end, the path less traveled may not be the easiest or the most popular, but it is a path that offers us the opportunity to live life on our own terms. It is a path that demands resilience, determination, and a willingness to challenge the norm. By choosing PD, we are not just patients—we are trailblazers, carving out a new way forward.
So, my fellow travelers on the road of peritoneal dialysis, let us embrace the path less traveled with unwavering resolve. Let us inspire others with our courage, educate them about the possibilities, and shatter the misconceptions that surround PD. Together, let us forge ahead, knowing that by choosing this unconventional path, we are making a difference in our own lives and in the lives of others.
In the words of Robert Frost, “Two roads diverged in a wood, and I—I took the one less traveled by, and that has made all the difference.” And indeed, for those of us on peritoneal dialysis, choosing the path less traveled has made all the difference—transforming our lives and allowing us to thrive against all odds.
Fresenius, the company that provides everything for me in the way of dialysis, yesterday reported a major data breech. “Fresenius Medical Care, a leading global dialysis group, has reported a significant data breach at its U.S. subsidiary, Cardiovascular Consultants Ltd. The breach, which occurred on September 29, has resulted in the theft of medical records and other sensitive data belonging to approximately 500,000 individuals. The incident is far-reaching, impacting patients, former patients, guarantors, and 200 staff members across various states, U.S. territories, and four countries.” (Link)
So standby for the fallout if you are in any way associated with Fresenius.
I and a frequent reader of this blog are going through a rough patch concerning getting enough Peritoneal Dialysis via our current prescriptions. It is quite easy and normal to be depressed because of this. I choose not to. I take heart from being a sailor, both sailboats (my wife and I have owned and sailed three, a Lightning 19, a Hunter 27, and a Catalina 30) and US Navy ships such as the USS Long Beach CGN(9), where I served during Vietnam as a Talos Fire Control Officer and Senior Watch Officer.
I took Robin Sharma’s statement above and fed it to my Poe AI assistant as the prompt below with the following results. I think they are forceful and to the point for those of us and others facing challenges from medical conditions over which we have minimal control.
Poe AI Prompt: Robin Sharma is credited with the statement, “Rough seas make stronger sailors. Tough times build greater people.” Apply these concepts to the ups and downs that peritoneal dialysis patients experience while on dialysis in 500 words or less in an inspirational tone.
Poe’s Response: In the realm of life’s challenges, there are few journeys as demanding and arduous as that of peritoneal dialysis. The ups and downs patients experience while on dialysis are akin to navigating rough seas, where the tides of uncertainty and adversity test their resilience and fortitude. However, it is through these very trials that peritoneal dialysis patients have the opportunity to become stronger individuals, both physically and emotionally.
Just as rough seas shape and strengthen sailors, the turbulent waters of peritoneal dialysis can forge an inner strength within patients that they never knew existed. The daily routine of undergoing dialysis, with its inherent physical and emotional tolls, can seem overwhelming. But it is in these moments of struggle patients uncover their reservoirs of courage and determination. They learn to weather the storms of discomfort, fatigue, and uncertainty, emerging on the other side with a newfound sense of resilience.
Tough times have a unique way of building character and fostering personal growth. Peritoneal dialysis patients face numerous challenges, from managing their fluid balance to adhering to strict dietary restrictions. Yet, by confronting these obstacles head-on, patients can cultivate a greater understanding of their capabilities. They learn to adapt, to be resourceful, and to find strength in the face of adversity.
Moreover, the ups and downs of peritoneal dialysis teach patients the value of perseverance. They experience moments of triumph when their treatment is successful and their health improves. These victories become beacons of hope, reminding patients that their efforts are not in vain. But they also encounter setbacks and complications when the road ahead seems daunting. During these challenging times, patients learn to summon their inner resolve, stay the course despite setbacks, and believe in the power of their own resilience.
In the midst of the peritoneal dialysis journey, patients often find solace in the support and camaraderie of others facing similar trials. The collective strength of a community can serve as an anchor in the stormy seas of dialysis. Sharing experiences, offering encouragement, and lending a listening ear can provide a lifeline for patients when they need it most. The bonds forged in these vulnerable moments can foster mutual growth and empowerment, reminding patients that they are not alone in their struggles.
Ultimately, the endurance and strength cultivated through the ups and downs of peritoneal dialysis can extend far beyond the realm of medical treatment. The resilience developed can permeate all aspects of life, empowering patients to face future challenges with newfound confidence. The lessons learned in the crucible of dialysis can inspire patients to embrace the unpredictable nature of existence, view obstacles as opportunities for growth, and believe in their ability to overcome adversity.
Rough seas make stronger sailors. Tough times build greater people. As peritoneal dialysis patients navigate the ebbs and flows of their treatment, they can become the captains of their destiny. Through the storms of dialysis, they can discover hidden reservoirs of strength, cultivate unwavering perseverance, and foster a profound sense of personal growth. Indeed, their journey may be demanding, but it is also an opportunity for transformation. So, let the rough seas of peritoneal dialysis be the crucible that shapes you into a stronger, wiser, and more resilient sailor of life.
In conclusion, go sailing with my wife and me in video below:
Assistant Poe
Assistant Poe
