Tag: Navy (Page 39 of 45)

ChatGPT and Fresenius Liberty Cycler

The Fresenius Liberty Cycler is the machine I use to conduct Peritoneal Dialysis EVERY night. In general, although noisy in its operation, it gets the job done. EXCEPT the other 75% of the time when it wakes me out of a sound sleep to tend to drain alarms. By getting out of bed and standing upright, the alarms may mitigate to the point that eventually, I can go back to bed and sleep for another two hours until my sleep is interrupted again. And on and on.

This has been going on for months and months with no resolution on the horizon.

None of the common tactics to alleviate this situation work so according to Fresenius Tech Support, I’m stuck with it. No help there. No Cycler replacement. No love. Just live with it.

I’v gotten to the point where it’s almost laughable. I have been reading about ChatGPT’s ability to write stories, so I thought I would put it to the test to write a story based on my situation. I wrote the following Prompt and submitted it to my ChatGPT3.5 subscription with the following story. Concluding remarks are at the end.

Prompt: Write a 500-word or so fictitious story about a science fiction realm where a patient on dialysis battles with his Fresenius Liberty cycler over alarms.

ChatGPT

In the distant future, medical technology has advanced to the point where people suffering from chronic kidney disease are able to undergo dialysis from the comfort of their own homes. The Fresenius Liberty cycler is the latest in a line of cutting-edge dialysis machines that have made this possible. However, for one patient, the Liberty Cycler has become the source of constant frustration and anxiety. (That’s me for certain, and a host of others!)

Jared had been on dialysis for years, and the Liberty Cycler had been a lifesaver for him. But as time went on, he found himself becoming increasingly annoyed by the constant beeping and flashing lights that seemed to accompany every dialysis session. The cycler was designed to alert patients to any issues or abnormalities during treatment, but for Jared, it seemed like every session was plagued with false alarms.

At first, he tried to ignore it. He would grit his teeth and try to tune out the beeps and blips that filled the room as the cycler worked its magic. But over time, it became harder and harder to ignore. The beeping grew louder and more insistent, and the flashing lights seemed to pierce his eyes like lasers.

Jared became obsessed with the alarms. He would spend hours poring over the manual, trying to figure out what was causing them. He experimented with different dialysis settings, adjusted his position on the bed, and even tried to meditate his way through the beeps and blips. But nothing worked.

As time went on, Jared began to feel like he was battling the Liberty Cycler itself. He would glare at the machine as it beeped and blinked as if daring it to give him another false alarm. He became convinced that the cycler was out to get him, that it was deliberately trying to drive him crazy.

And then, one day, something snapped. Jared had just settled in for a dialysis session when the alarms began to sound. As usual, he tried to ignore them at first, but they only grew louder and more insistent. He leaped out of bed and rushed over to the cycler, determined to silence it once and for all.

But as he approached the machine, something strange happened. The beeping and blinking seemed to grow more intense, almost as if the cycler was angry at him for trying to shut it down. And then, without warning, the machine sprang to life.

Jared watched in horror as the cycler’s various arms and hoses began to flail wildly, almost as if they had a mind of their own. The beeping and blinking grew even more intense, and Jared felt like he was caught in the middle of a storm.

He tried to fight back, but the cycler was too powerful. Its arms and hoses wrapped around him like tentacles, squeezing the breath out of his body. The alarms blared in his ears, drowning out all other sounds.

And then, just as suddenly as it had started, it was over. The cycler went still, its arms and hoses dropping away from Jared’s body. The alarms fell silent, and Jared was left gasping for breath on the floor.

For a long moment, he lay there, staring up at the ceiling in shock. And then he started to laugh. He laughed and laughed until tears streamed down his face. He knew it was crazy, but he couldn’t help feeling like he had just fought a battle with the Liberty Cycler and come out victorious.

From that day on, things were different. The alarms still sounded, but Jared was no longer afraid of them. He had faced his fear head-on and emerged stronger for it. And although he would never forget that fateful dialysis session, he knew he would always be able to face whatever challenges came his way.

Closing Remarks: Back from the realm of fiction to the here and now. My Liberty Cycler and I are NOT on speaking terms; at least 75% of the time, I am awakened from a sound sleep to tend to the needs of the Cycler. It has a life of its own and, as such, takes precedence over mine. It requires me to tend to it while I hope and pray it will tend to me. And the world is worried and concerned about Artificial Intelligence and their livelihood. I wish beyond wishing that the Liberty Cycler and the people concerned with its deployment had some modicum of AI themselves. Any “Intelligence” in this area would be a breath of fresh air, which is totally lacking at this point!

The lead picture was created by Microsoft’s Bing using the prompt: Using the Fresenius Liberty Cycler as a basis, create a creature with hoses and pipes and sounds coming out of it

Test of WiseCut AI Video Editor

I am constantly on the lookout for new tools to use in editing this blog’s content. The use of AI is very much in the news now, and AI tools to provide video content are at the head of the pack. I use Pictory.ai to make many of the videos for the blog. I use Grammarly to assist in my editing. I use ChatGPT for ideas and content. I use text to pictures, and illustrations for some of the graphics. AI makes life much easier for bloggers such as myself.

Recently I tried out a newcomer – to me at least – named WiseCut. You provide an mp4 video, and it does all kinds of wonderful things to the provided video, like take out pauses, provide audio-to-text overlays, background music, and other purported magic. It does not work for me. It is sluggish, slow, and does not faithfully transcribe audio to text. Granted, you can go through and clean up the text, but Pictory.ai does a much better job. Rendering is slow. It’s just slow. I was running the free version, which might have something to do with this but…. The video output from WiseCut is embedded below — you can see for yourself what AI video editing can do. I’ve included a screenshot of what WiseCut purported to have done to my source video.

The Glass Story and Reducing Stress for Dialysis Patients

There is a widely circulated story about “putting down the glass.” The story goes like this:

Put down the glass video

A psychologist was giving a lecture on stress management to a group of students. As she raised a glass of water, the students expected her to ask the typical “half full or half empty” question. Instead, she asked, “How heavy is this glass of water?”

The students shouted out answers ranging from a few ounces to a couple of pounds. The psychologist replied, “The absolute weight doesn’t matter. It depends on how long I hold it. If I hold it for a minute, it’s not a problem. If I hold it for an hour, I’ll have an ache in my arm. If I hold it for a day, my arm will feel numb and paralyzed. In each case, the weight of the glass doesn’t change, but the longer I hold it, the heavier it becomes.”

The lesson of the story is that we must put down the glass of water to give our arms a break. This applies to stress management as well. We all have stress in our lives, but it’s important to put it down for a while and give ourselves a break.

This lesson is particularly relevant for those on dialysis. Dialysis patients have to deal with numerous physical and emotional stressors, such as the time commitment of dialysis treatments, dietary restrictions, and potential complications. These stressors can take a toll on a patient’s mental and physical health.

To reduce stress, dialysis patients should practice self-care and engage in activities that bring them joy and relaxation. This could include exercise, meditation, spending time with loved ones, or pursuing a hobby. I do this by writing this blog, making what I think are cool videos, and taking care of our 1/2 acre part of heaven. It’s also important for patients to communicate with their healthcare team about any concerns or stressors they may be experiencing. I have found mine to be always open, caring, and interested in my well-being.

In conclusion, the “glass story” teaches us an important lesson about stress management. By putting down the glass and taking a break from stress, we can improve our mental and physical well-being. This lesson is particularly relevant for those on dialysis, who face numerous stressors in their daily lives. By practicing self-care and communicating with their healthcare team, dialysis patients can reduce stress and improve their quality of life.

Speaking of self-care, I’m off to take my evening shower.

Dialysis-related News

Today’s blog will look into recent medical developments for those interested in Dialysis regardless of viewpoint.

This past Sunday’s The Wall Street Journal, in a front-page article titled “ChatGPT Doctors Will See You Now” by Nidhi Subbaraman, reported that already, in California and Wisconsin, Open AI’s GPT is being used to scan patient messages and draft responses from their doctors. Such use is being rolled out as we “speak.” Here’s the kicker: ChatGPT scored better than real doctors at responding to patient queries, according to a study posted in the JAMA Internal Medicine Journal, a peer-reviewed source. The use of Artificial Intelligence is coming like a freight train. Be prepared to get onboard or get run over.

Recently, Garmin, the GPS/navigation people, rolled out the Dexcom Connect IQ app for Garmin devices. This app supports tracking glucose levels on a Garmin Smartwatch or bike computer. Remember that you need the watch and a Dexcom G6 or G7. Using the app, users should be able to glance at their watch while bike riding to ascertain their current glucose level.

In an article by Robert Hart on April 28, 2023, titled “One-Hour Diabetes Procedure Offers Fresh Hope For Ditching Insulin,” in Forbes, it was reported that a single outpatient endoscopic procedure provides glucose control, a potential improvement over drug treatment. They don’t know why it works at this time, but blind tests are encouraging. The procedure is nonsurgical and involves flexible tubes, lights, and cameras that aid doctors in seeing inside the body, and patients are discharged on the same day as the procedure. Sounds almost too good to be true. Standby.

Lastly, Fierce Healhcare in an article published in Digital Health on April 26, 2023, by Annie Burky titled “DocGo aims to bring kidney care the final mile by partnering with Fresenius Medical Care” to include remote patient monitoring, chronic care management, and urgent care services. Since 2019 DocGo has been FMC’s preferred medical transportation partner. The new service aims to “offer a solution for nephrologists to help patients truly manage their chronic conditions.” Centering around the analysis of “Big Data,” DocGo suggests it will catch trends before they become life-threatening and greatly aid patients toward the “really needing help” end of the spectrum. We’ll see. I already feel that I have more than enough of “Big Brother watching me.”

My week in Review: ExpressScripts, CGMs, Liberty Cycler, and other stuff

It’s been an interesting week from many perspectives. (Graphic above from Designs.AI’s Illustrator. It reminds me of my Dialysis nurse for some reason.)

  • Our Granddaughter, who lives in the Seattle area, visited
  • I got tangled up in ExpressScripts bureaucratic nightmare.
  • My Fresenius Liberty Cycler continues, on a random basis, to illicit drain alarms and, this week, one fill alarm. For the past 15 nights, seven have had no alarms (47%), and eight have had alarms (53%). Disregarding the fourth and last drain, when I am always up and moving about, 15X3=45 possible drain alarms, of which I have experienced 10, or 10/45=22%. So more than half of the time I go to bed, my sleep is interrupted by Cycler alarms. Remember that Fresenius’ tech support is oblivious to this fact, telling me to shut off the alarms as a “fix.” What BS!
  • I can’t seem to articulate to my GP’s script person that I want all scripts written for a 90-day supply. Why is this so difficult to understand?
  • At one point, our Fresenius stock was up $5.00 per share from our by-in price. Not too shabby.
  • My GP script person sent a prescription to CVS for a Libre 3. But it was sent in for three, not six, covering 90 days, more or less. My CVS app shows they have been working on it since 4/13/2023. Why is it that I can buy direct from HealthWarehouse.com, which I am, and receive Libre 3s like clockwork, but the large government-contracted agencies cannot? What’s wrong with this picture?
  • I have a normal monthly meeting next Thursday with my Dialysis Team. I’ll share my going-in discussion points with you next week.
  • Our goose eggs hatched with six little ones that have been seen paddling around in our local ponds. Life does go on, even on Dialysis!

I used AI to generate the feeser.me ad is shown below, which I then posted to Facebook and Linkedin. Enjoy what AI can do for you if you can 🙂

What determines how long you are apt to stay on Peritoneal Dialysis?: What ChatGPT has to say about it

I asked Craiyon.com to generate a picture of ChatGPT to insert in this blog. Below is what was provided. My Prompt was “picture of chatgpt.”

The most often question I receive other than “How’s it going?” pertaining to Peritoneal Dialysis, is how long does it normally last which is code for how long can I expect to live given I’m on dialysis. Trying to explain to the layman the differences between PD and Hemo quite often cause their eyes to gloss over. This blog is aimed at those one PD and/or interested in PD and answers the question “What determines how long one can expect, all else being equal, to be able to be on PD? And then what?”

First the “Then what.” At the point where it becomes obvious from quarterly lab visits that PD is not hacking it, the nephrologist should encourage the patient to get set up for Hemo as a treatment of last resort. When PD is no longer viable, Hemo is the go-to treatment. Yes, to me it appears to be going backward, but hey, it beats the hell out of being without breath and a beating heart six feet under!

As the following from my trusty ChatGPT assistant will show, PD Transport Rate and Status of the Peritoneum are determining factors in how long a patient has a chance of using PD. Shown first is the Prompt I used to quiz the AI front end, and then the result. Pretty interesting and adds context to the PD longevity question. Here goes.

Model: Default (GPT-3.5)

Prompt to ChatGPT: Consider yourself to be a trained and experienced Nephrologist. Discuss in explicit detail the longevity of Peritoneal Dialysis as relates to 1. Transport Rate and 2. Status of Peritoneum. Write in explicit concise and understandable English at the MBA level terminology in at least a 2000-word essay with citations and an end reference list.

Introduction

Peritoneal dialysis (PD) is a form of renal replacement therapy used in the treatment of end-stage renal disease (ESRD). This therapy uses the peritoneum, a thin membrane that lines the abdominal cavity, as a semipermeable membrane to remove waste products and excess fluids from the body. Unlike hemodialysis, which uses an external machine to filter blood, PD allows the patient to perform the therapy at home with the help of a catheter inserted into the abdomen.

The longevity of PD as a form of renal replacement therapy depends on several factors, including the transport rate and the status of the peritoneum. In this essay, we will discuss each of these factors in detail, along with their impact on the longevity of PD.

Transport Rate

The transport rate refers to the rate at which solutes move across the peritoneal membrane during PD. There are three types of transport rates: high, high-average, and low average. The transport rate is determined by measuring the rate at which glucose, a solute used in PD, is absorbed by the peritoneal membrane.

High transporters have a peritoneal glucose absorption rate of more than 0.81 mmol/L/h. High-average transporters have a peritoneal glucose absorption rate between 0.60 and 0.81 mmol/L/h, and low-average transporters have a peritoneal glucose absorption rate of fewer than 0.60 mmol/L/h.

The transport rate has a significant impact on the longevity of PD. High transporters have been shown to have a higher risk of technique failure and a shorter PD duration compared to low transporters. In a study of 360 patients, high transporters had a median PD duration of 17 months, while low transporters had a median PD duration of 37 months.

The reason for this difference in PD duration is thought to be due to the increased exposure of high transporters to glucose, which can lead to peritoneal fibrosis and membrane damage. This damage can lead to a decline in ultrafiltration capacity and an increased risk of infection, both of which can contribute to technique failure and the need to switch to another form of renal replacement therapy.

In addition to the transport rate, other factors such as age, diabetes, and the presence of cardiovascular disease can also impact the longevity of PD. Older patients, those with diabetes, and those with cardiovascular disease have been shown to have a shorter PD duration compared to younger patients without these comorbidities.

Status of Peritoneum

The status of the peritoneum is another factor that can impact the longevity of PD. The peritoneal membrane is a dynamic structure that can undergo changes over time, including thickening, fibrosis, and neovascularization. These changes can impact the function of the peritoneum and lead to a decline in ultrafiltration capacity and an increased risk of infection.

Several factors can contribute to peritoneal membrane damage, including long-term exposure to glucose, infection, and exposure to other toxins. Infection is a particularly important risk factor for peritoneal membrane damage, as it can lead to the development of peritonitis, a serious complication of PD that can lead to technique failure and the need to switch to another form of renal replacement therapy.

Peritoneal membrane damage can be assessed using imaging techniques such as peritoneal scintigraphy, which can measure the peritoneal thickness and blood flow. These assessments can be useful in predicting the longevity of PD and identifying patients who may be at higher risk of technique failure.

Several interventions can be used to protect the peritoneal membrane and prolong the longevity of PD. These include the use of biocompatible dialysis solutions, which have been shown to reduce peritoneal membrane damage and improve patient outcomes. Biocompatible solutions have a lower concentration of glucose and other osmotically active solutes, which can reduce peritoneal fibrosis and inflammation.

In addition to biocompatible solutions, the use of intermittent peritoneal dialysis (IPD) has also been shown to improve peritoneal membrane function and prolong the longevity of PD. IPD involves performing short, frequent exchanges of dialysis solution, which can reduce the exposure of the peritoneal membrane to glucose and other toxins.

Other interventions that may help to protect the peritoneal membrane and prolong the longevity of PD include the use of low-GDP dialysis solutions, which have a lower concentration of glucose degradation products, and the use of agents that can reduce oxidative stress and inflammation.

Conclusion

In conclusion, the longevity of PD as a form of renal replacement therapy depends on several factors, including the transport rate and the status of the peritoneum. High transporters and patients with peritoneal membrane damage are at higher risk of technique failure and may require a switch to another form of renal replacement therapy.

However, interventions such as the use of biocompatible solutions, intermittent peritoneal dialysis, and low-GDP dialysis solutions can help to protect the peritoneal membrane and prolong the longevity of PD.

It is important for nephrologists to carefully monitor the transport rate and status of the peritoneum in patients undergoing PD and to make appropriate interventions to protect the peritoneal membrane and ensure the best possible outcomes for their patients.

References:

  1. Li PK, Szeto CC, Piraino B, et al. Peritoneal dialysis-related infections recommendations: 2010 update. Perit Dial Int. 2010;30(4):393-423.
  2. Lameire NH, Van Biesen W, Vanholder R. The longevity of peritoneal dialysis: still an open question? Kidney Int Suppl. 2008;(108):S45-51.
  3. Davies SJ. Longitudinal relationship between solute transport and ultrafiltration capacity in peritoneal dialysis patients. Kidney Int. 2005;67(1):237-242.
  4. Holmes CJ, Patel PR, Perez J, et al. Peritoneal dialysis: recent advancements and future challenges. Int J Nephrol Renovasc Dis. 2019;12:223-233.
  5. Dong J, Yuan Z, Zhang L, et al. Effects of different glucose concentrations in dialysate on peritoneal membrane function in peritoneal dialysis patients: a systematic review and meta-analysis. PLoS One. 2017;12(1):e0170535.
  6. Krediet RT. Biocompatible peritoneal dialysis solutions: do they exist? Contrib Nephrol. 2011;173:99-107.
  7. Peppelenbosch A, van Kuijk WH, Bouvy ND, et al. The effect of peritoneal dialysis fluid containing low glucose degradation product on peritoneal transport and markers of peritoneal damage. Kidney Int. 2004;66(3):1047-1053.

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