Henry Feeser's Peritoneal Dialysis (PD) journey

Never ring the bell!

Tag: Navy (Page 45 of 47)

The Role of Dialysis Nurses in Managing Cognitive Decline and Anxiety

March 1, 2023 / / 2 Comments
Craiyon.com using AI Prompt “picture of a female nurse treating a patient with extreme anxiety’

A central figure in the management and treatment of CKF/Dialysis is the assigned Dialysis Team Nurse. She/he is the central point of contact for everything and anything having to do with a patient’s Dialysis. This includes being the eyes and ears for the rest of the team should the patient display signs of anxiety, depression, or other cognitive expressions of degrading health and well-being.

In my research for the previous three blog posts where we discussed the potential reduction of cognitive strength caused by dialysis itself, the use of laxatives, and B12 deficiencies, I found a thread running through research on dialysis and cognitive decline suggesting that anxiety in elders, particularly those on dialysis, is a confounding variable. The specific trigger was an article in Feb 26, 2023, New York Times titled “Why Aren’t Doctors Screening Older Americans for Anxiety?” by Paula Span.

Furthermore, I thought it would be interesting to view this aspect of Dialysis from the team’s point person, the Dialysis Nurse. I prompt-engineered my faithful go-to AI engine, Notion, and the following resulted from the perspective of my D-Nurse. Hello Cindy.

As a dialysis nurse, one of the most challenging aspects of the job is managing the cognitive decline and anxiety that many patients experience. Cognitive decline is a common condition that affects many individuals who require dialysis treatment, and it can have a significant impact on their quality of life. Anxiety is also a common issue faced by dialysis patients, and it can exacerbate cognitive decline and other health problems. In this article, we will explore the role of a dialysis nurse in managing cognitive decline and anxiety in patients undergoing dialysis treatment.

Cognitive Decay in Dialysis Patients

Cognitive decay, also known as cognitive impairment or cognitive dysfunction, is a condition that affects an individual’s ability to think, reason, and remember. It is a common problem among dialysis patients, with studies reporting that up to 70% of patients experience some form of cognitive decline. The causes of cognitive decay in dialysis patients are not fully understood, but several factors are believed to contribute to its development, including:

  • Chronic kidney disease
  • Diabetes
  • Cardiovascular disease
  • Anemia
  • Hypertension

Chronic kidney disease (CKD) is a significant risk factor for cognitive decline in dialysis patients. CKD can lead to neurochemical and structural changes in the brain, which can affect cognitive function. Diabetes and cardiovascular disease are also common comorbidities in dialysis patients that can contribute to cognitive decline. Anemia and hypertension are also potential causes of cognitive impairment in dialysis patients. Anemia can lead to reduced oxygen delivery to the brain, while hypertension can lead to cerebral ischemia and impaired cognitive function.

As a dialysis nurse, it is essential to recognize the signs and symptoms of cognitive decline in patients. Common symptoms include forgetfulness, difficulty concentrating, problems with language, and confusion. It is also important to note that cognitive decline can worsen with age and disease progression, leading to more severe symptoms and a decline in the patient’s overall quality of life.

Managing Cognitive Decline

Managing cognitive decline in dialysis patients can be challenging, but several strategies can help slow its progression and improve patients’ quality of life. These include:

  • Regular cognitive assessments to monitor changes in cognitive function
  • Medications to manage underlying conditions, such as hypertension and anemia
  • Brain exercises and cognitive training
  • Diet and lifestyle modifications, such as a low-sodium diet and regular physical activity

Regular cognitive assessments are essential for monitoring changes in cognitive function over time. Medications, such as antihypertensive drugs and erythropoietin-stimulating agents, can help manage underlying conditions that contribute to cognitive decline. Brain exercises and cognitive training have also been shown to improve cognitive function in dialysis patients. Diet and lifestyle modifications, such as a low-sodium diet and regular physical activity, can also help reduce the risk of cognitive decline in dialysis patients.

As a dialysis nurse, it is essential to work closely with other healthcare professionals, such as physicians, dietitians, and social workers, to develop a comprehensive treatment plan for patients with cognitive decline.

Anxiety in Dialysis Patients

Anxiety is another common issue faced by dialysis patients. It is estimated that up to 40% of dialysis patients experience some form of anxiety, which can exacerbate cognitive decline and other health problems. Anxiety can also lead to depression, which is another common mental health issue among dialysis patients.

The causes of anxiety in dialysis patients are not fully understood, but several factors are believed to contribute to its development, including:

  • Fear of needles and medical procedures
  • Changes in body image
  • Loss of independence
  • Fear of death

Fear of needles and medical procedures is a common cause of anxiety in dialysis patients. Many patients require frequent blood draws and vascular access procedures, which can be painful and uncomfortable. Changes in body image, such as weight gain and fluid retention, can also contribute to anxiety in dialysis patients. Loss of independence is another significant stressor for patients undergoing dialysis, as they may require assistance with daily activities and have limited mobility. Fear of death is also a common concern among dialysis patients, as they may feel that their health is out of their control.

As a dialysis nurse, it is essential to recognize the signs and symptoms of anxiety in patients. Common symptoms include restlessness, irritability, difficulty sleeping, and panic attacks.

Managing Anxiety

Managing anxiety in dialysis patients is essential to improve their overall quality of life and prevent the exacerbation of other health problems. Several strategies can help manage anxiety, including:

  • Medications, such as anti-anxiety medications and antidepressants
  • Cognitive-behavioral therapy
  • Relaxation techniques, such as deep breathing and meditation
  • Support groups and counseling

Medications, such as benzodiazepines and selective serotonin reuptake inhibitors, can help manage anxiety symptoms in dialysis patients. Cognitive-behavioral therapy (CBT) is a type of talk therapy that can help patients identify and change negative patterns of thinking that contribute to anxiety. Relaxation techniques, such as deep breathing and meditation, can also help reduce anxiety symptoms. Support groups and counseling can provide patients with social support and help them cope with the emotional challenges of living with a chronic illness.

Since not all anxiety is created equal, I have included a short video (1-min 35 sec) below to explain how anxiety can manifest itself.

As a dialysis nurse, it is essential to work closely with patients and their families to develop a comprehensive treatment plan for anxiety. This may include referrals to mental health professionals, as well as education about the various treatment options available.

Conclusion

In conclusion, cognitive decay and anxiety are common issues faced by dialysis patients, and they can have a significant impact on their quality of life. As a dialysis nurse, it is essential to recognize the signs and symptoms of these conditions and work closely with other healthcare professionals to develop a comprehensive treatment plan for patients. By implementing strategies to manage cognitive decline and anxiety, dialysis nurses can improve their patient’s overall quality of life and help them live a more fulfilling life.

References:

  1. Kurella Tamura M, Yaffe K. Dementia and Cognitive Impairment in ESRD: Diagnostic and Therapeutic Strategies. Kidney Int. 2011;79(1):14-22.
  2. Murray AM, Tupper DE, Knopman DS, et al. Cognitive impairment in hemodialysis patients is common. Neurology. 2006;67(2):216-223.
  3. Cukor D, Coplan J, Brown C, et al. Anxiety disorders in adults treated by hemodialysis: a single-center study. Am J Kidney Dis. 2008;52(1):128-136.
  4. Palmer S, Vecchio M, Craig JC, et al. Prevalence of depression in chronic kidney disease: systematic review and meta-analysis of observational studies. Kidney Int. 2013;84(1):179-191.
  5. Kimmel PL, Peterson RA, Weihs KL, et al. Psychologic functioning, quality of life, and behavioral compliance in patients beginning hemodialysis. J Am Soc Nephrol. 1996;7(2):215-224.
  6. Kimmel PL, Peterson RA, Weihs KL, et al. Multiple measurements of depression predict mortality in a longitudinal study of chronic hemodialysis outpatients. Kidney Int. 2000;57(5):2093-2098.
  7. Kutner NG, Zhang R, Huang Y, et al. Patient-reported quality of life early after kidney transplant: effects of pairing by donor type and recipient age. Clin Transplant. 2013;27(3):E264-E272.
  8. Slickers J, DuBay DA, Finkelstein FO, et al. Quality of life in patients with chronic kidney disease and comorbidities. Adv Chronic Kidney Dis. 2009;16(1):11-19.
  9. Weisbord SD, Fried LF, Arnold RM, et al. Development of a symptom assessment instrument for chronic hemodialysis patients: the Dialysis Symptom Index. J Pain Symptom Manage. 2004;27(3):226-240.
  10. Weisbord SD, Fried LF, Mor MK, et al. Renal provider recognition of symptoms in patients on maintenance hemodialysis. Clin J Am Soc Nephrol. 2007;2(5):960-967.

The Risk of Laxative Use in Dialysis Patients: Even More Cognitive Decline

February 27, 2023 / / 0 Comments
: Piling on football and Dialysis Patients too

Background:

The Fresenius Liberty Cycler has well-documented problems with its drain cycle. Just do a Google and find out for yourself. I am currently experiencing sleep-shattering alarms more than 50% of the time. Last night I had drain alarms on the second and third drains and had to get out of bed and stand upright until the drain was complete before I could go back to bed. Countless dialysis patients have experienced the klaxon-like blare of alarms going off during the drain cycle. This seemingly constant sleep deprivation is akin to the outlawed methodology used by our CIA in illegal intelligence-gathering efforts.

The go-to solution to the alarm situation advised by Fresenius personnel including my Team is to use laxatives such as Miralax. The concept on their part is that blockage in the colon leads to interruption of fluid flow which in turn leads to alarms. Clean intestines, no alarms.

I’m using ClearLAX by “equate” from Walmart as a cost-effective alternative to Miralax. ClearLAX has several Label Warnings including “Do not use if you have kidney disease, except under the advice and supervision of a doctor” and “use not more than 7 days.” I quizzed my team nurse about the latter warning and was informed to continue using the laxative, that “it was OK.”

Recently (February 22, 2023) I ran across an article in CNNHealth titled “Laxative use may be linked to dementia risk, study says.” The article is linked to CNNHealth. This produced yet another “itshay” moment on my behalf. Here I am, on Peritoneal Dialysis which is strongly associated with Cognitive Decline. Here I am on Peritoneal Dialysis while a stage two diabetic which is more strongly associated with Cognitive Decline. And here it goes yet again. I am on Peritoneal Dialysis and told to take laxatives so a company’s dialysis machine will operate. But emerging research suggests a strong and positive correlation between laxative use and Cognitive Decline. In football, this is called “piling on.” Just how many bullets can I take before I go down the primrose path with Cognitive Decline and end up in LaLa Land?

OK? So I felt a need (when younger I had a need for speed which is why I raced Porsches) to look into the subject of laxatives, dialysis, cognitive decline, etc. further. I perturbed my ever-present and all-knowing bot Notion, and the following with modest editing resulted. Be advised. Be aware. Be.

Notion has this to say:

Cognitive decline is a common concern among aging adults, and there is growing evidence that dialysis patients may be at even greater risk for cognitive impairment. I previously blogged about this. Additionally, many dialysis patients experience constipation, which often leads to the use of laxatives. (Such use has been prescribed for me by my Fresenius Dialysis Team.) However, recent research has suggested that the use of laxatives may contribute to cognitive decline in dialysis patients. In this blog post, we will explore the link between cognitive decline and laxative use in dialysis patients.

The Link Between Cognitive Decline and Dialysis

Dialysis patients are at an increased risk for cognitive decline due to a variety of factors. One of the most significant factors is the accumulation of toxins in the blood, which can occur when the kidneys are not functioning properly. These toxins can cross the blood-brain barrier and cause damage to brain cells, leading to cognitive impairment.

Other factors that may contribute to cognitive decline in dialysis patients include changes in blood pressure and blood sugar levels, as well as the use of medications that can affect brain function. These factors can all interact to create a perfect storm for cognitive impairment.

The Risk of Laxative Use in Dialysis Patients

Constipation is a common problem among dialysis patients, and laxatives are often used to alleviate symptoms. However, recent research has suggested that the use of laxatives may actually contribute to cognitive decline in these patients.

One study published in the Journal of Renal Nutrition analyzed data from 271 dialysis patients and found that those who used laxatives had a significantly higher risk of cognitive impairment than those who did not use laxatives. The researchers also found that the use of certain types of laxatives, such as stimulant laxatives, was associated with an increased risk of cognitive impairment.

Another study published in the Journal of the American Society of Nephrology followed 1,361 dialysis patients for two years and found that those who used laxatives had a 50% higher risk of developing dementia than those who did not use laxatives. The study also found that the use of laxatives was associated with a decline in cognitive function over time.

The mechanisms underlying the association between laxative use and cognitive decline are not yet fully understood. However, it has been suggested that the dehydration caused by laxatives may lead to a decrease in blood flow to the brain, which can damage brain cells and contribute to cognitive impairment. Additionally, some types of laxatives, such as stimulant laxatives, may disrupt the balance of neurotransmitters in the brain, which can also contribute to cognitive decline.

Alternative Treatments for Constipation in Dialysis Patients

While laxatives may be effective in relieving constipation, there are alternative treatments that may be less harmful to cognitive function. One option is to increase dietary fiber intake, which can help regulate bowel movements. Another option is to use stool softeners, which can make bowel movements easier and more frequent without the risk of dehydration.

In some cases, laxatives may still be necessary to manage constipation in dialysis patients. In these cases, healthcare providers should be cautious when prescribing laxatives and consider alternative treatments whenever possible. It may also be helpful to monitor cognitive function in patients who use laxatives regularly to detect any signs of cognitive decline early on. (For me, this has not happened at all. Nada, Zip, Zero.)

Conclusion

Cognitive decline is a serious concern for dialysis patients, and the use of laxatives to alleviate constipation may exacerbate the problem. While it is important to manage constipation in dialysis patients, healthcare providers should be cautious when prescribing laxatives and consider alternative treatments whenever possible. By taking steps to prevent cognitive decline, healthcare providers can help dialysis patients maintain their quality of life and cognitive function.

The bottom line if there is one:

I am in Deep Kimchi!

Cognitive Loss in Dialysis Patients & Vitamin B12: What You Need to Know

February 27, 2023 / / 0 Comments
Vitamin B12 the Brain & Dialysis

Introduction

Dialysis is a common treatment for patients with end-stage renal disease (ESRD). It is a life-saving treatment that helps remove waste products and excess fluid from the body when the kidneys are no longer able to do so. However, despite its benefits, dialysis is also associated with several complications, including cognitive impairment. Studies have shown that cognitive dysfunction affects up to 75% of patients on chronic dialysis. Researchers have been investigating the possible causes of cognitive impairment in dialysis patients, and one factor that has emerged as a significant contributor is vitamin B12 deficiency. In this blog post, we will review the literature on the link between cognitive loss in dialysis patients and vitamin B12.

Vitamin B12 Deficiency in Dialysis Patients

Vitamin B12 is an essential nutrient that plays a crucial role in the maintenance of the nervous system. It is involved in the synthesis of myelin, which coats nerve fibers and speeds up the transmission of nerve impulses. Vitamin B12 deficiency can lead to a range of neurological symptoms, including cognitive impairment, memory loss, and depression.

Dialysis patients are at increased risk of developing vitamin B12 deficiency due to several factors. First, they are often on a restricted diet, which may limit their intake of vitamin B12-rich foods. Second, dialysis can lead to the loss of vitamin B12 through the dialysis membrane. Third, patients with ESRD often have comorbid conditions that can affect vitamin B12 absorption, such as gastritis and pernicious anemia.

The Link Between Cognitive Loss and Vitamin B12 Deficiency

Several studies have investigated the link between cognitive loss in dialysis patients and vitamin B12 deficiency. A study published in the Journal of the American Society of Nephrology found that vitamin B12 deficiency was associated with cognitive impairment in patients on chronic dialysis. The study found that patients with vitamin B12 deficiency had significantly lower scores on tests of cognitive function compared to patients with normal vitamin B12 levels.

Another study published in the Journal of Renal Nutrition found that vitamin B12 supplementation improved cognitive function in dialysis patients with vitamin B12 deficiency. The study found that patients who received vitamin B12 supplementation had significant improvements in memory and executive function compared to patients who did not receive supplementation.

Conclusion

In conclusion, cognitive impairment is a common complication of dialysis, and vitamin B12 deficiency may be a significant contributing factor. Dialysis patients are at increased risk of developing vitamin B12 deficiency due to several factors, and studies have shown that vitamin B12 supplementation can improve cognitive function in dialysis patients with vitamin B12 deficiency. Therefore, regular monitoring of vitamin B12 levels and appropriate supplementation may be an important strategy to prevent cognitive decline in dialysis patients.

BTW I take a B12 shot every two weeks and have been doing so for several years. Hank

References:

  1. Drew DA, Bhadelia R, Tighiouart H, Novak V, Scott TM, Lou KV, et al. Anatomic brain disease in hemodialysis patients: a cross-sectional study. Am J Kidney Dis. 2013;61(2):271–8.
  2. Yaffe K, Ackerson L, Hoang TD, et al. Retinopathy and cognitive impairment in adults with CKD. Am J Kidney Dis. 2013;61(2):219–27.
  3. Kurella Tamura M, Yaffe K. Dementia and cognitive impairment in ESRD: diagnostic and therapeutic strategies. Kidney Int. 2011;79(1):14–22.
  4. Boudville N, Li I, Geddes C, et al. Brain atrophy in hemodialysis patients: a prospective study. Am J Kidney Dis. 2015;65(2):167–75.
  5. Kurella Tamura M, Wadley V, Yaffe K, et al. Kidney function and cognitive impairment in US adults: the Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study. Am J Kidney Dis. 2008;52(2):227–34.
  6. Kurella Tamura M, Xie D, Yaffe K, et al. Vascular risk factors and cognitive impairment in chronic kidney disease: the Chronic Renal Insufficiency Cohort (CRIC) study. Clin J Am Soc Nephrol. 2011;6(11):248–56.
  7. Kurella Tamura M, Xie D, Yaffe K, Cohen DL, Teal V, Kasner SE, et al. Regional vascular calcification and cognitive function in hemodialysis patients. Am J Kidney Dis. 2014;64(2):245–52.
  8. Sheshadri S, Wolf PA, Beiser A, et al. Stroke risk profile, brain volume, and cognitive function: the Framingham Offspring Study. Neurology. 2004;63(9):1591–9.
  9. Slinin Y, Guo H, Li S, et al. Association between serum creatinine and cognitive function in diabetic elders. Diabetes Care. 2011;34(12):2527–32.
  10. Xia Z, Friedland J, Brayman K, et al. The association of malnutrition-inflammation score with cognitive functioning in hemodialysis patients. Nephrol Dial Transplant. 2013;28(8):1936–45.
  11. Yamamoto R, Nagasawa Y, Shoji S, et al. Cognitive impairment in chronic kidney disease. Clin Exp Nephrol. 2012;16(1):7–14.
  12. Yoon HE, Ha YC, Choi HJ, et al. Association between cognitive function and serum albumin adjusted for C-reactive protein levels in elderly Korean individuals with normal kidney function. PLoS One. 2015;10(7):e0132450.
  13. Zhu Y, Pandya BJ, Choi HK. Prevalence of gout and hyperuricemia in the US general population: the National Health and Nutrition Examination Survey 2007-2008. Arthritis Rheum. 2011;63(10):3136–41.
  14. Kurella Tamura M, Wadley V, Yaffe K, et al. Kidney function and cognitive impairment in US adults: the Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study. Am J Kidney Dis. 2008;52(2):227–34.
  15. Kurella Tamura M, Xie D, Yaffe K, et al. Vascular risk factors and cognitive impairment in chronic kidney disease: the Chronic Renal Insufficiency Cohort (CRIC) study. Clin J Am Soc Nephrol. 2011;6(11):248–56.
  16. Kurella Tamura M, Xie D, Yaffe K, Cohen DL, Teal V, Kasner SE, et al. Regional vascular calcification and cognitive function in hemodialysis patients. Am J Kidney Dis. 2014;64(2):245–52.
  17. Sheshadri S, Wolf PA, Beiser A, et al. Stroke risk profile, brain volume, and cognitive function: the Framingham Offspring Study. Neurology. 2004;63(9):1591–9.
  18. Slinin Y, Guo H, Li S, et al. Association between serum creatinine and cognitive function in diabetic elders. Diabetes Care. 2011;34(12):2527–32.
  19. Xia Z, Friedland J, Brayman K, et al. The association of malnutrition-inflammation score with cognitive functioning in hemodialysis patients. Nephrol Dial Transplant. 2013;28(8):1936–45.
  20. Yamamoto R, Nagasawa Y, Shoji S, et al. Cognitive impairment in chronic kidney disease. Clin Exp Nephrol. 2012;16(1):7–14.
  21. Yoon HE, Ha YC, Choi HJ, et al. Association between cognitive function and serum albumin adjusted for C-reactive protein levels in elderly Korean individuals with normal kidney function. PLoS One. 2015;10(7):e0132450.
  22. Zhu Y, Pandya BJ, Choi HK. Prevalence of gout and hyperuricemia in the US general population: the National Health and Nutrition Examination Survey 2007-2008. Arthritis Rheum. 2011;63(10):3136–41.

Cognitive Decline in Dialysis Patients

February 24, 2023 / / 0 Comments
From AI Dalla-E Prompt “sketch cognitive decline dialysis patients”

This morning I received in my email the Fresenius Medical Care Newsletter – February 2023 Issue. In it, there is an article entitled Cognitive Dysfunction in Kidney Disease from the Global Medical Office Dialogues. It started off by stating “People with chronic kidney disease (CKD) often present with cognitive dysfunction ranging from mild impairment to dementia.” That got my attention. The article went on to report, inter alia, that some 70-83% of dialysis patients suffer cognitive dysfunction. Since I fall in the general population of those on dialysis, I dug deeper into this topic. Following is what my personal bot had to say. The emphasis is mine. The entire video from the aforementioned dialogue is at the blog end. Hank

Introduction

Dialysis is a treatment for patients with end-stage kidney disease. It removes waste and excess fluid from the blood when the kidneys can no longer perform these functions. While dialysis can prolong the lives of patients, it can also cause cognitive decline. According to studies, up to 70% of dialysis patients suffer from cognitive impairment, with varying degrees of severity. This blog post will discuss the causes and effects of cognitive decline in dialysis patients, as well as potential treatments.

Causes of Cognitive Decline in Dialysis Patients

The exact cause of cognitive decline in dialysis patients is unknown, but it is believed to be multifactorial. One possible cause is the accumulation of toxins in the blood. When the kidneys are not functioning properly, waste products build up in the blood, which can affect brain function. Additionally, dialysis patients often experience fluctuations in blood pressure, which can also impact cognitive function. Other factors that may contribute to cognitive decline include anemia, hypoxia, inflammation, and oxidative stress. Furthermore, depression and anxiety are common in dialysis patients, and these conditions can lead to cognitive impairment.

Effects of Cognitive Decline in Dialysis Patients

Cognitive decline can have a significant impact on the quality of life of dialysis patients. Patients may experience memory loss, difficulty concentrating, and slowed thinking. These symptoms can make it challenging to complete everyday tasks, such as managing medications, preparing meals, and paying bills. Additionally, cognitive decline can increase the risk of falls and accidents, as well as reduce the ability to perform activities of daily living independently. Furthermore, cognitive impairment has been associated with increased mortality in dialysis patients.

Diagnosis of Cognitive Decline in Dialysis Patients

The diagnosis of cognitive impairment in dialysis patients can be challenging because it may be difficult to differentiate cognitive decline from other causes of mental impairment, such as depression or delirium. Neuropsychological testing can be used to assess cognitive function, and imaging studies can help identify structural brain abnormalities. Additionally, screening tools such as the Montreal Cognitive Assessment (MoCA) and the Mini-Mental State Examination (MMSE) can be used to detect cognitive impairment in dialysis patients.

Potential Treatments for Cognitive Decline in Dialysis Patients

There is no cure for cognitive decline, but there are several treatments that may help slow its progression. One potential treatment is improving dialysis efficiency. Studies have shown that patients who receive more efficient dialysis have better cognitive function. Additionally, treating depression and anxiety can improve cognitive function in dialysis patients. Pharmacological agents, such as antidepressants and anxiolytics, may be used to treat these conditions. Finally, regular exercise has been shown to improve cognitive function in the general population, and may also be beneficial for dialysis patients. Furthermore, nutritional interventions, such as vitamin supplementation and dietary modification, have been proposed as potential treatments for cognitive decline in dialysis patients.

Conclusion

Cognitive decline is a common problem for dialysis patients, with a significant impact on their quality of life and increased mortality. The exact cause of cognitive decline is unknown, but it is believed to be multifactorial. Diagnosis can be challenging, but neuropsychological testing and imaging studies can be used to assess cognitive function. While there is no cure for cognitive decline, there are treatments that may help slow its progression. Improving dialysis efficiency, treating depression and anxiety, regular exercise, and nutritional interventions are potential treatment options. By addressing the cognitive decline in dialysis patients, we can improve their quality of life, reduce the risk of accidents, and help them live more independently.

The full video interview of the session that gave rise to this blog entry is provided below for your edification. It is roughly 28 minutes long. May you not be in this population. Hank

Carotid Artery Checkup While On Dialysis

February 22, 2023 / / 0 Comments
Carotid arteries illustrated

Last Monday when I visited my cardiologist he suggested that it was time to again check my carotid arteries. In the past, they have been partially blocked but not to an extent to cause grievous concern. Recall that I was subjected to a triple bypass in 2015 so we keep a close watch on my pump and its associated plumbing. Yesterday I went back to his office where a tech conducted the carotid ultrasound test. Other than having the goop spread over my neck, it went well. It will be days before I hear back from the doc, if at all until the next appointment some 8 months down the road

Thought I would entertain us with what the chatbot would have to say about this test. I input “carotid ultrasound” and below is what was returned.

A carotid sonogram, also known as a carotid ultrasound, is a non-invasive imaging test that uses high-frequency sound waves to create images of the carotid arteries in the neck. These arteries are located on either side of the neck and are responsible for supplying blood to the brain.

During the test, a technician will apply a gel to the skin over the carotid arteries and use a handheld device called a transducer to send sound waves through the skin and into the arteries. The sound waves bounce off the blood vessels and create images that can be viewed on a monitor.

The images can help doctors evaluate the flow of blood through the carotid arteries and look for signs of narrowing or blockages, which can increase the risk of stroke. Carotid sonograms are often used as a screening tool for people who are at risk for stroke or who have symptoms such as dizziness or weakness on one side of the body.

Not too bad a description. I did not edit anything at all. I next did a Google on the subject and received a massive amount of hits. One of the hits, from Webmd, had this to say:

The carotid arteries are major blood vessels in the neck that supply blood to the brain, neck, and face. There are two carotid arteries, one on the right and one on the left. In the neck, each carotid artery branches into two divisions:

  • The internal carotid artery supplies blood to the brain.
  • The external carotid artery supplies blood to the face and neck.

Like all arteries, the carotid arteries are made of three layers of tissue:

  • Intima, the smooth innermost layer
  • Media, the muscular middle layer
  • Adventitia, the outer layer

The carotid sinus, or carotid bulb, is a widening of a carotid artery at its main branch point. The carotid sinus contains sensors that help regulate blood pressure. The carotid artery pulse can normally be felt in the neck by pressing the fingertips against the side of the windpipe, or trachea.

So now we all know more about carotids than we ever need to know. Tomorrow more on social fitness and what’s coming up more often in the popular press about this concept.

More liberty Cycler Alarms and More on Finding Happiness

February 21, 2023 / / 0 Comments
Call a friend

A couple of days ago I reported that by moving the tubing layout on my stomach catheter I had resolved the constant (seemingly) problem of cycler alarms while draining. Alas, such is not the case; I went a record four nights without any alarms, then for the last four, without significant alteration of the tubing configuration, I have had alarms. Looks like we’re back to the drawing board.

Last night was a bad night anyway because the constant intake of the “keep your bowels cleaned out to improve draining adage” caught up with me and I was up several times during the night confined to the bathroom. Luckily for us, I can reach both a potty and a shower while tethered.

There is an interesting article in the Wall Street Journal’s 2/21/23 issue page A11 entitled “Friends Found a Radical Cure For Loneliness: the Phone Call” by Julie Jargon. In it, she references the eight decades of research from Harvard that suggests close relationships are the most critical component of health, happiness, and longevity more so than exercise and a good diet. I blogged about this research not too long ago.

Being lonely leads to chronic stress and has been found to be more detrimental to health than being obese. Read that again and take these words of wisdom to heart!

One of the women she studied, a Ms. Doulton Wiltshire, made it a goal to have one phone call, one video call, and one in-person meetup with friends each week. I think people on Dialysis should embrace this concept. We actually receive most of our interpersonal relationships mainly with our Dialysis Team and other attending physicians. Enlarging our social circles to include reaching out to past friends and associates seems to be a way to increase engagement on our part and in so doing perhaps increase our access to the finite pool of happiness we’re all given at birth. I’m going to give it a shot.

Fresenius Liberty Cycler Setup

A Must Read: Sell Your Kidney Save My Life by Dylan Walsh

February 21, 2023 / / 0 Comments

The only viable alternative to going on dialysis is a kidney transplant. The whole deal on kidney transplants is nontransparent seeming by design. Dylan Walsh writing in the March 2023 issue of Wired Magazine lays out the ins and outs of the kidney transplant world. I have provided a link to his article therein titled “Sell your kidney, save my life.” I strongly suggest you read and study the article for a closer look at this phenomenon. Hank

Looking Back to go Forward in Peritonal Dialysis Blog

February 20, 2023 / / 0 Comments

I started this blog on January 5, 2023, and since then have made a total of 34 posts, all related to my PD journey at least in a tangential way. Today I’m going to relate a little of the behind-the-scenes data that a few of my plugins are gathering on the fly.

205 unique visitors from 15 different countries have made 590 page views or 2.88 pages per visit. Google has been the top search engine as might be expected. As shown in the graphic below, the maximum number of page views occurred recently and peaked at 69.

PAGE VIEWS DAILY

The top ten countries for participation in the blog are shown below. The United States by far has the most hits, followed by Canada but hey, people in other countries are also interested.

Top Ten Hits

Of interest is also what terms were used in searches that resulted in landings on my blog pages. See the chart below: In the chart, the search term “Fresenius liberty cycler” (45) is followed by “Liberty Cycler” (15) then “Fresenius peritoneal dialysis solution” “(10, and lastly by “Fresenius pd cycler” (8) are the top four searches. This suggests strongly that these terms are good tags for my blogs, assuming they are contained verbally therein.

Searches

The solution to Alarms on Drain Cycler Problem?

February 17, 2023 / / 1 Comment
Dickens and Amaryllis

I may have found a solution to what is the number one problem for those on Peritoneal Dialysis (PD) using the Fresenius Liberty Cycler – Drain Alarms. For those new to PD, the cycler is a computer-controlled 28-pound machine that cyclers a fluid in and out of the user’s stomach lining (Peritoneal area) during the night hours. For me, I experience four fills and four drains of 2 L each, for a total of 8 liters or a little over two gallons of a special fluid each evening.

What happens more often than not, is that during the drain cycles, the drainage slows down to such an extent that the computer throws a message in conjunction with loud warning beeps that would wake the dead that the system is draining slowly. To remedy this situation, more often than not, requires the person on dialysis to get out of bed in a vertical position, or sitting at best, until the draining reaches about 1400 mL or more before going back to bed. Why 1400 – it appears that is the drain threshold the computer is hard-wired for. So back to the solution.

Up until three nights ago, I was adjusting the fill/drain line from my catheter upwards from the entry/exit point in my stomach in a loop up through the hoop in the lanyard I wear around my neck to secure the line, then back down and out back to the cycler. Three nights ago I took the line off the lanyard, and from the access in my stomach ran it in a downward loop thence out and back to the cycler. The rudimental sketch below illustrates this. It is working for me. Further reporting to follow.

Rough sketch new cycler line run

Even Without Dialysis, A Day for the Books

February 16, 2023 / / 0 Comments
Thank God it’s over!

Yesterday was a day for the record, being on Dialysis aside. Started off with the last drain cycle hanging up and refusing to proceed. Instead, just kept beeping its slow drain message at me. I was pressed for time because I had a cardiologist appointment that I had to make. I ended up physically cutting the cycler line off just past the blue “Y” and draining the contents of my stomach into the bathroom sink as if I were doing a manual drain. At first, it drained rather slowly but soon picked up and I felt confident that a good drain resulted. I informed my team nurse of this and we decided “to watch it.” This morning and last night for that matter all went well – no alarms so whatever was going on, went away.

In conjunction with the aforementioned, received a phone call from the Fresenius driver that my monthly supply allotment was to be delivered shortly. And, being Wednesday, it was time to resupply our Ready Service Locker. Luckily for me, my wife did this, and also took care of the restocking of the resupply from Fresenius.

Off to the cardiologist where I received a good diagnosis on the state of my heart. In July 2015 I had a triple bypass, so keeping up with visits to the cardiologist for me is mandatory. Got “see you in eight months” which is always good to hear.

Next off to Fresenius in Granbury to pick up an extensive VA (Veteran’s Administration) for documenting my dialysis journey. I am in the midst of applying to the VA to increase my VA disability due to CKF from 80% to 100% and this form is part of that application. This has been a work in process since December 2022. With this voluminous folder in hand, headed home via an Auto Safety Check Station to have the yearly required Texas State Safety Check performed on our BMW X5. This is a $7.00 fee required exercise prior to registration renewal for all Texas-registered vehicles. Took only a couple of minutes and finally headed home.

Once back home had lunch, and started scanning the VA documents into PDFs then merged about 50 odd pages of my nephrologist notes, etc into a single PDF file, wrote a cover letter, and forwarded via the internet the package to the VA’s Private Medical Record facility and also to VA.gov. Was able to pet our golden Dickens for a couple of minutes, then off to recycling with the X5 where I recycled two weeks’ worth of cardboard from dialysis boxes and containers. Finally, back home, where I dined on delicious chicken fried rice my wife whooped up.

Needless to say, I slept well and thank God, the Dialysis Cycler cooperated and I had no alarms waking me up every two hours. There is a God!

« Older posts Newer posts »

© 2025 Henry Feeser's Peritoneal Dialysis (PD) journey

Theme by Anders Noren — Up ↑