As I write this blog on Sunday for posting at 0800 CDT Monday I have been adding Heparin to my dialysis solution for three nights. In all cases, the drain function has not stalled as it did on one previous night of hell. All three nights there has been an alarm on the first drain; only on the first night of heparin use was there a second drain alarm. The last two nights I have had only an alarm on the first drain taking place roughly at midnight after turning out the lights by 10 PM. I can live with this and am holding out that things will improve.
A little on the technical side of using heparin. My dialysis nurse provided me with what is labeled 30 mL bottles of heparin for my use. My dosage is determined by the rule of thumb 2 mL of heparin for each Liter of dialysis fluid in use. Since I am using 8 L total, this suggests injecting 2 mL x 8 = 16 mL of heparin. While the bottle is labeled 30 mL which infers you can’t get two nights out of each bottle of heparin, at least my first bottle had more than enough heparin in it to draw two night’s worth, or 32 mL of heparin.
My labs continue to be so-so. By the numbers:
Albumin 3.4 versus a goal of 4.0 or higher. It has never reached this goal.
nPCR 0.97 versus a goal of 1.2 or higher. Again, never been close.
Potassium 4.2 goal 3.5-5.5. I’m good here.
wKt/V 1.86 versus goal of 2.0 or higher. On been over 2.0 once.
Calcium 85 versus goal of 8.5-10.0 Ok here.
Phosphorus 5.4 versus goal of 3.0-5.5. Close to top of range and corrected phosphorus is probably over.
Hemoglobin 10.9 versus goal of 10-11. First time under 11 – Yeah!!!!
Glucose 121 versus goal 70-160. Blood draw was non-fasting and after breakfast so this is outstanding!
Lastly, Creatinine of 7.27 down from 7.5 last month. Just of interest and since I am on dialysis does not, to my knowledge, factor into my treatment.
Coming up later this week, I have a dermatologist appointment to cut out some skin cancer and look at a funky growth on the back of my head that is bothersome, and a GP appointment for a blood draw to ensure that my blood still clots as it should so I can keep on using testosterone injections, and whatever else pops up out the woodwork. Stay tuned.
BTW I just noticed on the lead photo I took of the Heparin bottles Fresenius supplied that heparin is derived from “porcine intestines” which is a polite way of saying pig intestines.
Wednesday night was the worst night I have had in almost a year while on peritoneal dialysis. It makes the Beatles “Hard Day’s Night” song seem trivial. (Song embedded at blog’s end.) The first of four drain cycles I was awakened by a drain alarm, and got out of bed in a vertical position. and fifteen minutes later was able to jump back in bed with the first drain cycle completed. The second drain cycle alarmed with negligible drain started. Despite doing everything including standing, laying, massaging my stomach, doing joga with my wife, praying, cursing, you name it, the cycler would at times drain 13 mL, then 8, then 4 then stall, over and over again with constant alarms in between. (The numbers are for illustration only; they were all over the spectrum.)
I tried unhooking from the Cycler and draining into the bathroom sink but only a dribble came out of the catheter. Hooked back up to the Cycler, and an hour later or so about 1500 mL of expected 2000 had drained. At this point, the Cycler automatically kicked over to the third fill and we went back to bed. This time, the Cycler made it through fill 3 and drain 3, and I got up during drain 4, the last drain, which was also normal.
During the ordeal with drain 2, I called the off-duty nurse and talked to her about what was going on and we agreed that I should talk to my Fresenius Dialysis Nurse in the morning which is what I did. My Dialysis Nurse, Cindy had me come to Fresenius and started me on a week’s worth of Heparin. Heparin (Heparin Sodium) is a medicine that prevents clots and in peritoneal dialysis is used to prevent fibrin formation.
So what is this “fibrin formation?” Fibrin occurs as a result of protein formation from fibrinogen in the blood. Also referred to as “worms,” strands of it lead to poor drainage (inflow and outflow) and may be seen in the drain inspection window or in collection bags. None of this has been evident for me, but in the interim, until Dr Tan bores a hold in my stomach and looks around, at my catheter end, this is the best we can do.
So starting tonight, I have added to my evening dialysis prep routine by injecting 16 mL of heparin into my 5L Dialysate (the fluid used in dialysis.) Wish me luck and some sleep also!
BTW, labs are not up yet so more on this aspect later.
Chuck Berry had a less-than-well-known song named “Too Much Monkey Business.” It is embedded at the blog’s end. That’s what my last several days have felt like. My wife and I have driven thousands of miles without a flat tire. In the last week, we have had two, one on each of our two BMWs. The BMW X5 that we are going to load up with peritoneal dialysis supplies for our forthcoming trip to visit with relatives in Indiana is in the body shop to have a dent removed from the rear hatch door where I put the garage door down on it. We took it in Monday and not a word has been heard from the shop since although I was promised that we would be informed ASAP on how long repair was going to take.
Yesterday I had my monthly labs with Fresenius. Since it was my quarterly visit, my catheter lead was changed out which takes some time, I picked up supplies that Fresenius provides, had blood drawn, etc. I was informed that Fresenius will be providing flu shots but they as yet don’t have info on when they will be available. Both my wife and I are scheduled to have the standard flu shot, the new COVID shot, and an RVS in the coming weeks at CVS. Tomorrow I hope to have the initial lab readout and will share on tomorrow’s blog any/all areas of apparent deviation from expected norms. Chuck Berry is next:
There is a saying “You can’t make a silk purse out of a sow’s ear.”This proverb is first found in English in Alexander Barclay’s Eclogues. Barclay (1475? – 1552) was a Scottish clergyman and poet who is believed to have been the first to write pastoral eclogues in English. In this use, it means you can’t make something good out of something bad. However, research into the use of pig’s parts in humans has been anything but unsuccessful.
In the far distant past, while a junior in electrical engineering at Purdue University, I was part of a research team exploring the electrical synopsis of swine, aka, pigs. We would put the pigs to sleep, go into their spinal cord, and attempt to ascertain what electrical signals resulted in various stimuli applied to the pig. It was interesting stuff and I got paid well for having fun learning more about lab procedures and working across the aisle with veterinarians.
Ed Cara stated in the 8/31/2023 Gizmodo “Surgeons at New York University have reportedly reached another milestone in making pig-to-human organ transplants a reality. They now claim to have transplanted a genetically engineered pig kidney that has survived inside a human body for six weeks and counting—the longest period yet. It’s likely that larger clinical trials will be in the near future.” You may read the entire article at this link:
Given my background and interests especially in research leading to better outcomes for kidney failure treatment, I next turned to my Poe AI to ascertain more about the historical background of pig parts. The following for your historic edification is from Poe:
Introduction:
Throughout history, humans have sought innovative solutions to overcome various health challenges. One such solution that has captured the imagination of medical professionals and researchers alike is the use of pig parts to repair human ailments. The idea of xenotransplantation, the transplantation of organs or tissues from one species to another, has been a topic of interest for centuries. In this blog post, we will explore the fascinating history of using pig parts in medicine and delve into the current status of this practice.
Ancient Origins:
The concept of xenotransplantation can be traced back to ancient civilizations where it was believed that the properties of an animal could be transferred to a human recipient. In ancient India, for example, the Sushruta Samhita, a Sanskrit text dating back to the 6th century BCE, described the use of animal bladders to repair damaged human bladders.
Advancements in Transplantation:
Fast forward to the 20th century, when significant advancements in transplantation techniques and immunosuppressive therapies paved the way for the exploration of xenotransplantation. Pigs emerged as the most promising candidates due to their anatomical and physiological similarities to humans, making their organs and tissues compatible for transplantation.
Pig Heart Valve Transplants:
One of the earliest and most successful applications of pig parts in human medicine has been the transplantation of pig heart valves. The first pig-to-human heart valve transplant took place in 1962, and since then, millions of patients have benefited from this procedure. Pig heart valves are used to replace damaged or diseased human valves, providing a lifeline for those suffering from heart conditions. ( I do believe my sister-in-law has benefitted from such valve replacement.)
Insulin Production:
Another significant breakthrough came in the field of diabetes treatment. Before the advent of synthetic human insulin, pig insulin was widely used to manage diabetes. Pigs possess a similar insulin structure to humans, making their insulin compatible for therapeutic use. Although synthetic insulin has largely replaced pig insulin today, the early use of pig insulin revolutionized diabetes care and saved countless lives.
Challenges and Ethical Considerations:
While the use of pig parts in human medicine has demonstrated immense potential, it is not without challenges. One of the primary concerns is the risk of transmitting infectious diseases from pigs to humans. Pigs harbor retroviruses, such as porcine endogenous retroviruses (PERVs), which could potentially infect human recipients. Extensive research is being conducted to develop strategies to eliminate PERVs and ensure the safety of xenotransplantation.
The Future of Xenotransplantation:
Despite the hurdles, recent scientific advancements have reignited interest in xenotransplantation. Researchers are exploring genetic engineering techniques, such as CRISPR-Cas9, to modify pig genes and eliminate the risk of viral transmission. This breakthrough could potentially open doors to more widespread use of pig organs in human transplantation, addressing the critical shortage of human donor organs. This is the thrust of the linked article at the lead.
Conclusion:
The use of pig parts to repair human ills has a rich and storied history. From ancient civilizations to the cutting-edge research of today, this field has shown remarkable promise in improving human health outcomes. While challenges and ethical considerations persist, advancements in genetic engineering offer hope for a future where xenotransplantation becomes a viable and widespread solution to the organ shortage crisis. As science continues to push boundaries, the journey from pigs to people is poised to transform the landscape of modern medicine, ushering in a new era of hope and healing.
Julie Wernau in an article in the August 31, 2023, WSJ titled “Female Surgeons Achieve Better Results Than Male Counterparts” states “…the differences aren’t about technical skill, but about listening to patients and choosing appropriate care.” While this study was based on surgeons, we can postulate that it applies across a broader spectrum of health care in general. At the end of this blog, I’ve included a summary of the article provided by Poe for your edification.
Medicine is by far NOT the only area where it has been postulated that women’s involvement “improves the breed.” Numerous studies have found that Women on boards can have a significant impact on firm performance. They can improve managerial duties through their preparation of meetings, different viewpoints, and leadership skills. Women on boards can also improve companies’ strategic decision-making, leading them to consider a wider range of options. While in an academic position at Purdue University, my own research found that increasing the number of women in senior positions in a company, called the C-Suite, improved the happiness rating of the firm as captured by employee turnover. More women on boards, less turnover. (Turnover is employees leaving the company for their own reasons.)
I am blessed to have as my Nephrologist a female doctor named Dr. Taryn Turner, DO. She is the embodiment of the findings for surgeons cited above and summarized below. Her online Google evaluation – of 76 respondents is a perfect 5.0 out of 5.0. Comments include “Dr Turner is kind, professional, competent and cares about her patients. She is a very good communicator and takes the time to listen to her patients and their concerns.” And on and on of the same ilk.
The bottom line of this blog is, at least if all else is equal, strongly consider a female doctor for your dialysis treatment. My experience is you will be well cared for with empathy and understanding. Odds are, more so with a female nephrologist.
The following is a Poe AI summary of the WSJ article:
Two research studies published in JAMA Surgery have found that female surgeons spend more time in the operating room and their patients experience fewer postoperative complications compared to patients treated by male surgeons. The first study followed 1.2 million Canadian patients undergoing common surgeries between 2007 and 2020. It found that patients treated by female surgeons were less likely to experience adverse postoperative issues, including death, at both 90 days and one year after surgery. Even after accounting for various factors that could affect surgical outcomes, such as patient age, surgeon experience, and hospital setting, the results remained consistent. The study also revealed that when male surgeons treated female patients, outcomes were slightly worse. The second study analyzed over 100,000 Swedish patients who had undergone gallbladder removal surgery. Female surgeons had longer operation times but their patients had shorter hospital stays and less invasive surgeries. Male surgeons spent less time per operation and experienced complications more frequently. These findings add to the existing body of literature that suggests better outcomes for patients treated by female doctors. It is important for hospital systems to examine their own data and practices to understand the underlying factors contributing to these differences. However, the studies emphasize that gender should not be the sole basis for choosing a physician. The field of surgery is still predominantly male-dominated, and efforts are being made to encourage more women to enter the profession.
After not hearing from the Fort Worth General Surgeon’s office that is supposed to be scheduling me for a look-see at my catheter, I called them this morning. I was informed that indeed I was on their schedule for surgery by Dr. Tan at 1130 hours on 10/04/2023. Recall that this is in connection with the plethora of slow drain issues I have been experiencing from the get-go with the Fresenius Liberty Cycler. Obviously Dr. Tan is a very busy surgeon scheduling me as far out as his office did. Luckily, I am not in extremus.
A while back I posted a video walk-around of the storage areas in our home which house my Peritoneal Dialysis supplies. Today we had our monthly delivery by Fresenius and I thought it would be of interest to view what our storge looks like “full up.” By full up I mean we have stored a month’s supply plus a could of weeks which is what is recommended. The video won’t win any Pulitzer Prizes but here it is:
I have been using the newly replaced Fresenius Liberty Cycler long enough now to be able to make meaningful comparisons to the previous, alarm-prone cycler I was stuck with for so many months.
Before we jump into any data, a few comparisons:
The new cycler is much much quieter and faster. Faster how? My total time on the cycler which I log every morning has reached a low of 10 hrs 5 minutes on two occasions.
While I have experienced a few alarms, I do not have to get out of bed and hit OK twice to silence them. After a warning alarm they fade into the background on their own.
After alarms, it seems to take forever for the old cycler to resume drain activity. It appears to me that the new cycler picks up the pace much quicker.
Some data: For the past 12 nights I have experienced alarms on 3 of 12 nights, so 9 out of 12 or 75% of nights I have had no alarms. I have experienced 5 cyclic drain alarms out of 36 possible, for a 31/36 or 86% of cycles with no alarms.
The previous 12 nights on the old cycler 9 of 12 nights I experienced alarms, or 3/12 or 25 % I did not. During this same period, I had 17 cycle alarms out of 36 possible which maps to 19 of 36 no alarms on a cycle basis for 52%.
Now comparing data in the paragraphs above of old versus new, I had three times as many days of alarms, and 5 versus 17 alarms which is over three times as many. So it’s safe to say my new cycler is a least three times better at not throwing alarms than my old cycler. This comparison completely discredits the stand taken by Fresenius “tech support” and the faceless entity “Susan” who flagrantly blocked my receipt of a replacement for months. Shame on you!
Paul Kix in writing about the 1963 Birmingham Campaign that shaped the course of the Civil Rights Movement in the USA, coined the phrase “You have to be prepared to die before you can live.” I am of the mind and strongly take the position that this is equally true of accepting and becoming a successful dialysis patient. Let’s delve deeper into the concepts embodied in the phrase “You have to be prepared to die before you can live.” and how they apply to those of us on dialysis or contemplating doing so.
The concept “You have to be prepared to die before you can live” encapsulates a profound and thought-provoking idea about personal growth and living a fulfilling life. At its core, it suggests that true transformation and living authentically require a willingness to let go of old patterns, beliefs, and attachments, even if it feels like a part of oneself is dying in the process. Such acceptance and transformation of personal thought are also the basis for successful dialysis.
To fully grasp the meaning of this concept, it’s important to explore its various dimensions:
Letting go of fear: Death often symbolizes the ultimate fear and uncertainty. To truly live, one must confront and overcome their fears. This means embracing the unknown, taking risks, and pushing beyond self-imposed limitations. By being prepared to face the possibility of “dying” in a metaphorical sense, individuals can break free from the constraints that hold them back and discover new paths of growth. FUD, Fear Uncertainty, and Doubt plague those new to the thought of Dialysis. They lose sight of or never envision the thousands of other mere mortals who have successfully scaled the dialysis mountain.
Shedding the old self: Personal transformation requires a shedding of old identities, beliefs, and behaviors that no longer serve one’s growth. This can be a challenging and uncomfortable process, as it often involves stepping outside of one’s comfort zone and reevaluating deeply ingrained patterns. By metaphorically “dying” to the old self, individuals create space for personal evolution and the emergence of a more authentic and fulfilling way of living. My experience in researching the dialysis forums is that those new to the concept of dialysis do not and often cannot see their way clear to a new life in which dialysis is often at the center. Rather than ask what can’t I do anymore, ask why not and what can I do.
Embracing impermanence: The concept also highlights the transient nature of life. It reminds us that everything is impermanent, including our own existence. By acknowledging the impermanence of life, we can cultivate a deeper appreciation for the present moment and the experiences we encounter. This awareness can motivate us to make the most of our time, pursue our passions, and nurture meaningful connections with others. Even saddled with dialysis, it behooves us to “seize the moment.”
“Seize the moment” comes from “Carpe diem,” a Latin phrase coined by the Roman poet Horace in 23 BCE.
In his work Odes, Horace says, “carpe diem quam minimum credula postero,” which literally means, “pluck the day, trusting as little as possible in the next one.”
Translation? To seize the moment can mean many things! Things like:
∙ Expressing gratitude for the present — for your life, the lives of others, and all the good in this world
∙ Saying “yes” to good opportunities that come your way
∙ Embracing your inner power, and creating opportunities of your own
∙ Going after your goals, even when you’re afraid
Overcoming attachment: Attachment to people, possessions, or outcomes can create emotional dependence and restrict personal growth. Being prepared to let go of attachments allows individuals to cultivate a sense of inner freedom and resilience. It liberates them from the fear of loss and empowers them to live fully in the present moment, without being weighed down by the past or anxiously fixated on the future.
Embracing mortality as a catalyst for living: Recognizing the inevitability of death can serve as a powerful catalyst for embracing life’s possibilities and living with intention. Contemplating the finite nature of existence can evoke a sense of urgency to make the most of every moment, pursue meaningful goals, and prioritize what truly matters. It encourages individuals to align their actions with their values and aspirations, leading to a more purposeful and fulfilling life.
In summary, the concept “You have to be prepared to die before you can live” invites us to embrace change, face our fears, let go of attachments, and fully engage with the transient nature of life. By metaphorically dying to old selves and embracing the impermanence of existence, we open ourselves up to personal growth, authenticity, and a deeper appreciation for the richness of the present moment.
And that boys and girls, applies more than equally to those of us on dialysis! Never ring the bell! (Poe AI assisted in the writing of this blog with the Prompt captured in the lead graphic.)
During the process of troubleshooting drain problems with my previous Liberty Cycler, I had x-rays of my stomach area taken, and read by a radiologist, with the results forwarded to my nephrologist. All pretty standard procedure. In referring these tests to the specialist who initially implanted my catheter for further evaluation and possible repositioning my catheter to help alleviate possible drain obstruction(s), the results were forwarded to this specialist, Dr. Tan in Forth Worth. I am in the process of getting on his schedule for a look-see at my catheter placement. Hopefully this week I will have a date.
As part of this back-and-forth communication between my dialysis team at Fresenius Granbury and Dr. Tan’s office in Fort Worth, my dialysis nurse texted me that they had sent Dr. Tan’s office “a copy of the KUB.” I had never heard of the term “KUB” so I fired up my faithful AI companion, Poe with the results below. Now all of us know what a KUB test regarding dialysis is.
Poe (The Prompt I used is the lead graphic to this post.)
In the context of dialysis patients, a KUB refers to a radiographic imaging procedure called a Kidneys, Ureters, and Bladder X-ray. It is also known as an abdominal X-ray or a plain film of the abdomen.
The purpose of a KUB for dialysis patients is to visualize the kidneys, ureters, and bladder to assess their size, shape, and position. This imaging technique helps healthcare providers evaluate the condition of these organs and detect any abnormalities that may affect dialysis treatment.
During dialysis, the kidneys’ primary function of filtering waste products and excess fluid from the blood is partially or completely impaired. As a result, dialysis machines are used to perform this vital task. However, it is important to monitor the condition of the patient’s kidneys and urinary system to ensure proper functioning and identify any complications.
A KUB X-ray can provide valuable information to healthcare professionals. It can help identify kidney stones, which can hinder the effectiveness of dialysis treatment or cause pain and discomfort. It can also reveal the presence of urinary tract infections, bladder abnormalities, or other issues that may affect dialysis or require additional medical interventions.
By obtaining a clear image of the kidneys, ureters, and bladder, healthcare providers can make informed decisions regarding a patient’s dialysis treatment plan. They can assess the need for additional interventions, such as medication or surgical procedures, to address any identified complications.
It’s important to note that the KUB X-ray is just one diagnostic tool among many used to evaluate dialysis patients. The specific tests and imaging studies recommended may vary depending on the patient’s individual circumstances and the judgment of the healthcare team. It’s always best to consult with healthcare professionals for personalized advice and information regarding a patient’s condition and treatment.
Last week my wife had an appointment with her GP to discuss her hypertension. During the conversation, inter alia, she commented in passing to her GP that I was on peritoneal dialysis. His response was somewhat baffling to me: “You know dialysis does not replace many of the functions of the kidneys.” When my wife related this interface to me, I immediately thought, “What Functions?” In all my training with Fresenius, dialysis research, and discussions with dialysis experts this subject had never been even hinted at let alone broached!
With my research assistant in hand, I wrote the following Prompt with the following results. Please, those on PD or considering PD read on. The AI-provided response sheds light on why my Dialysis Team is so intent on many of the lab results and also on other aspects of PD. By the way, I canceled my subscription to ChatGPT from OpenAI because readily available AI sources are at the forefront. In this instance, I am using my “new” go-to AI assistant, Poe, from Poe.com. I am running the Android App version.
Prompt: A natural kidney performs many functions. Explore the functions that ARE NOT addressed by peritoneal dialysis.
Poe AI Assistant’s Response:
Peritoneal dialysis is a form of renal replacement therapy that helps remove waste products and excess fluid from the body in individuals with kidney failure. While peritoneal dialysis is effective in addressing some aspects of kidney function, there are several functions of the natural kidneys that it does not fully replicate. Here are some functions that are not addressed by peritoneal dialysis:
Hormone Production: The kidneys play a crucial role in hormone production. They produce erythropoietin (EPO), which stimulates the production of red blood cells in the bone marrow. Peritoneal dialysis does not produce EPO, so patients may require additional medications or injections to maintain adequate red blood cell production.
Vitamin D Activation: The kidneys convert inactive vitamin D into its active form (calcitriol). Active vitamin D is essential for the absorption of calcium and phosphorus from the intestines and the regulation of bone health. In peritoneal dialysis, the kidneys’ ability to activate vitamin D is impaired, leading to the potential for vitamin D deficiency and subsequent bone problems.
Acid-Base Balance: The kidneys help regulate the body’s acid-base balance by excreting hydrogen ions and reabsorbing bicarbonate ions. When the kidneys are not functioning properly, acid-base imbalances can occur. Peritoneal dialysis primarily focuses on fluid and waste removal and may not adequately address acid-base imbalances, requiring additional interventions or medications.
Electrolyte Regulation: The kidneys play a vital role in maintaining the balance of electrolytes such as sodium, potassium, calcium, and phosphate in the body. Peritoneal dialysis helps remove some electrolytes, but it may not provide the same degree of fine-tuned regulation as healthy kidneys. Frequent monitoring and adjustments in diet or medications may be necessary to maintain proper electrolyte balance.
Blood Pressure Regulation: Healthy kidneys help regulate blood pressure by controlling the balance of water and sodium in the body. In peritoneal dialysis, blood pressure management may be more challenging, and patients may require additional medications to control hypertension.
Toxin Clearance: While peritoneal dialysis effectively removes waste products from the blood, it may not be as efficient as healthy kidneys in clearing certain toxins. Some toxins, such as certain medications or substances with larger molecular sizes, may not be effectively cleared by peritoneal dialysis alone.
It’s important to note that peritoneal dialysis is a valuable treatment option, and its benefits often outweigh the limitations compared to natural kidney functions. However, patients undergoing peritoneal dialysis may require additional medical interventions and close monitoring to address the functions that are not fully replicated by the therapy.
