Over the past week or so my wife has been working with my cardiologist’s group out of Fort Worth to nail down what is going on with my forthcoming heart procedure(s). She finally cornered them and we now know I am scheduled. I am to be at Baylor White at 0630 *That’s right, 6:30 AM) on 12/30/2024 for the procedure at 1000. If I don’t have a stent or stents I should be dismissed and sent home that day. They did not say what happens if ballons are involved by I assume the same – I will be dismissed. This past Friday I went to Quest and had labs drawn for them. They require labs to be accomplished within 20 days of their procedures.
In advance of this, I am doing better, but I still have to rest after walking a short distance, and I have to pace myself otherwise. I’m not even on the same planet physically as in the past, even more recently. Hopefully, this procedure will be able to repair something and at least let me get back on the road again. I’ve got a yard to clean up after the first killing frost and other projects in mind that deserve my attention. But remember the saying, “Adversity is the prosperity of the great!”
The title says it all. Since I became ill, it seems I have had to pee all the time over the past week or so. Yesterday, I had labs at my GP for my scheduled annual physical on Friday, and try as I might, hardily a dribble resulted. This is not something I’ve experienced before nor it is something I know to be associated with peritoneal dialysis. To check out research in this area, I turned to the Dr Sage bot on Poe and obtained the following results from which you can see for yourselves it IS quite common:
Yes, it can be normal for a male on peritoneal dialysis to experience a sensation of needing to urinate frequently, even if little or nothing comes out. This symptom can be attributed to several factors:
Possible Explanations: 1. Fluid Overload: Patients on peritoneal dialysis may sometimes retain fluid due to inadequate ultrafiltration. This excess fluid can lead to increased pressure on the bladder, causing a sensation of urgency. 2. Bladder Irritation: The presence of retained fluids or infections, such as urinary tract infections), can irritate the bladder, leading to frequent urges to urinate. 3. Decreased Bladder Capacity: Patients with kidney disease may have a reduced bladder capacity or dysfunction, leading to frequent sensations of needing to void. 4. Residual Kidney Function: If the patient has some residual kidney function, they may still produce a small amount of urine, which can contribute to the urge to urinate, even if the volume is insufficient. 5. Psychological Factors: Anxiety and stress related to their medical condition can also manifest as increased urinary urgency. Considerations: Assessment: It is essential for the patient to communicate these symptoms to their healthcare provider. A thorough evaluation may be needed to rule out any underlying conditions, such as urinary tract infections or bladder dysfunction. Monitoring Fluid Intake: Keeping track of fluid intake and output can help manage the sensation of urgency and assist in evaluating overall fluid balance. Conclusion: While this sensation can be common among those on peritoneal dialysis, it is important to investigate persistent or worsening symptoms to ensure that there are no other underlying issues that need to be addressed. If you have further questions or need clarification on any points, feel free to ask!
First, I’m on track to recuperate completely from my ailments. Saturday night for the first time in over a week I more or less slept through the night with only two Cycler alarms. My appetite is coming back, I’m picking up more of the tasks having to do with dialysis, eating better, and seeing light at the end of the tunnel. Some things learned from this ordeal:
Cycler Alarms: I had been going along doing fine with the Cycler several nights in a row without alarms. Then suddenly I wasn’t and short of getting up was not able to silence them. The bed that we use is actually two XL beds side by side that make up a California King-sized bed that also articulates at the head and foot and vibrates etc. I tried elevating the head and hey, it worked. The alarms went away. Now I’m tweaking the system for the optimum angle that also supports a restful night.
In preparation for my upcoming surgery, we had started training my wife Linda on setting everything up for dialysis. While she attended initially training with me, she has never been in a position where she had to do setups on her own. It’s a good thing we started this earlier because for several nights she had to all of the setups on her own as I could barely stand up in front of the Cycler.
In times past, I have never been subject to any of the side effects of medicine. Boy, when it came on did it ever! I’m on a strict take my blood pressure in the AM which I do anyway. and if the upper # is 105 or less, do not take the prescribed dose; this morning it was 95 so I didn’t. The moral of this story is that bodies change and we have to be sensitive to what new meds might bring as unexpected.
As dialysis patients, we might experience smooth sailing for months or even years as I did, only to hit a wall. At this point, although previously not required, we need a strong support system to carry us over rocks and shoals.
We think we may have uncovered the recent cause of my dizzy spells which include, on occasion, passing out, and a weird desire to vomit although feeling ok otherwise.
In preparation for my heart procedure at the end of the month, my cardiologist prescribed two additional drugs, one of which is Ranolazine TAB 500MG ER. See for yourself what Perplexity has to say. This may be the cause.
Ranolazine is an extended-release medication primarily used to treat chronic angina (chest pain) in patients with coronary artery disease. The 500 MG ER (extended-release) tablet is one of the common formulations of this drug. Here’s a detailed overview of ranolazine, with a focus on its side effects, particularly dizziness and vomiting:
Mechanism of Action
Ranolazine works by affecting sodium and calcium channels in the heart, which helps improve blood flow to the heart muscle and reduces the workload on the heart[1]. This mechanism allows it to alleviate angina symptoms without significantly affecting heart rate or blood pressure.
Side Effects
While ranolazine can be effective in managing chronic angina, it may cause various side effects. Two of the more common and notable side effects are dizziness and vomiting:
Dizziness
Dizziness is one of the most frequently reported side effects of ranolazine:
Prevalence: Approximately 6.2% of patients taking ranolazine experience dizziness[2].
Characteristics: The dizziness may manifest as a light-headed feeling or a sensation of spinning (vertigo)[1][3].
Onset: It can occur shortly after starting the medication or after increasing the dose[3].
Severity: Dizziness is often dose-related, meaning higher doses may increase the likelihood or severity of this side effect[3].
Management: If dizziness persists or becomes severe, patients should consult their healthcare provider. In some cases, dose adjustment may be necessary[1].
Vomiting
While less common than dizziness, vomiting is another potential side effect of ranolazine:
Prevalence: Vomiting is less frequent than nausea, which affects about 4.4% of patients[2].
Characteristics: Vomiting may be accompanied by nausea and can range from mild to severe[1][3].
Risk factors: High doses of ranolazine can increase the likelihood of vomiting[3].
Management: If vomiting persists or is severe, medical attention should be sought. Staying hydrated and taking the medication with food may help alleviate this side effect[1].
Other Common Side Effects
Besides dizziness and vomiting, other frequently reported side effects of ranolazine include:
Headache (5.5% of patients)
Constipation (4.5% of patients)
Nausea (4.4% of patients)[2]
Serious Side Effects
While less common, ranolazine can potentially cause more serious side effects, including:
QT prolongation (a heart rhythm disorder)
Kidney problems
Allergic reactions[1][3]
Precautions and Interactions
Ranolazine interacts with various medications and should not be taken with certain drugs, including some antifungals, HIV medications, and antibiotics[1]. It’s also important to avoid consuming grapefruit or grapefruit juice while taking ranolazine, as this can increase the drug’s concentration in the blood[6].
Dosage and Administration
The typical starting dose of ranolazine is 500 mg twice daily, which may be increased to 1000 mg twice daily as needed. The medication should be taken with or without food and swallowed whole, not crushed or chewed[1].
In conclusion, while ranolazine 500 MG ER can be an effective treatment for chronic angina, patients should be aware of potential side effects, particularly dizziness and vomiting. It’s crucial to follow the prescribed dosage and report any persistent or severe side effects to a healthcare provider promptly.
I’ve not posted for a few days due to the crash I had earlier. My ankle is coming along fine but a new defrugality has made itself known. In the past, I have experienced nasty vertigo. I don’t know if that’s what’s going on now, however. The bedroom ceiling is not spinning around but has some weird patterns. I have passed out once and started to on two more occasions. My blood pressure has been turning low. Today it was 100/58. All my other biometrics are fine. I stopped taking any BP meds.
Through all of this, I have been in contact with my dialysis nurse. We’ll work our way through this and come out the outer end better for it.
This week, on Monday, I have dialysis labs, including my quarterly adequacy test. In review, the adequacy test produces a measurement named Kt/V. The parameters of this measurement are such that if the value produced by Kt/V is 2.0 or more, I am getting adequate peritoneal dialysis. For the past two quarters, I have been in the 2.2 range, so based on the past, I’m doing OK.
It is worth looking deeper into this lab result for future reference for me as well as you. I turned to the Dr. Sage bot available in Poe and asked about Kt/V with the following result:
Kt/V is a crucial parameter used to assess the adequacy of dialysis, particularly in patients undergoing peritoneal dialysis (PD). Understanding this measurement is vital for optimal patient management. Below are the key points regarding Kt/V in the context of peritoneal dialysis:
Definition Kt/V: This is a dimensionless number that quantifies the efficiency of dialysis. It represents the ratio of the amount of dialysis delivered (K, clearance of urea) multiplied by the time (t, duration of dialysis) to the volume of distribution of urea (V). Components K (Clearance): This refers to the effectiveness of the dialysis process in removing urea from the blood. In peritoneal dialysis, this is influenced by factors such as the surface area of the peritoneal membrane and the dialysate flow rate.t (Time): The duration of the dialysis session. Longer sessions typically allow for greater clearance of toxins. V (Volume): This is approximately equal to the patient’s total body water, which is used as a proxy for the volume of distribution of urea in the body. Calculation K can be estimated from the level of urea in the dialysate and blood samples taken before and after dialysis.
Interpretation A Kt/V value of:≥ 1.7: Generally considered adequate for peritoneal dialysis; indicates sufficient removal of urea.< 1.7: Indicates inadequate dialysis, which may necessitate adjustments in the dialysis regimen (e.g., increasing the number of exchanges or dwell time). Clinical Implications Inadequate Dialysis: A low Kt/V can lead to the accumulation of uremic toxins, resulting in symptoms such as fatigue, nausea, and pruritus. Patient Monitoring: Regular assessment of Kt/V is essential to ensure that patients are receiving adequate dialysis and to make necessary adjustments to their treatment regimen. Quality of Life: Adequate dialysis as indicated by sufficient Kt/V can improve patient outcomes and overall quality of life. Factors Affecting Kt/V Peritoneal Membrane Characteristics: The permeability and surface area of the peritoneal membrane can influence K. Dialysate Volume and Composition: The volume and concentration of the dialysate can impact the efficiency of urea clearance. Patient Factors: Body size, age, and overall health status can affect V and Kt/V readings. Summary Kt/V is a critical measure for evaluating the adequacy of peritoneal dialysis. Regular monitoring and adjustments based on Kt/V can significantly affect patient health outcomes and quality of life. Understanding Kt/V and its implications in peritoneal dialysis is essential for managing patients effectively and ensuring they receive adequate treatment. If you have any follow-up questions or need clarification on specific aspects, feel free to ask!
The title is a phrase that I have attempted to void throughout my life. I did not want to reach the place in life where I am now lamenting over opportunities missed, not taken advantage of, or passed up. For instance, in my fifties I bought a Porsche for my wife and a track weekend to familiarize her with the new car. Porsche racers were at the track as instructors, and during breaks, were out on the track having a good time. Not long after this weekend, I found a 911 basket case, bought it, and turned it into a track car. I raced for several seasons and it was a blast. I had a great time, and met lots of great people, and “Should’ve, could’ve, would’ve” does not apply. I did and have the memories to live with for the rest of my life.
Turning to this phrase as applies to those of us on peritoneal dialysis I asked Poe to apply the concept to us with the following results:
“Should’ve, could’ve, would’ve”—these words carry a weight of regret and what-ifs that can linger heavily on the mind. For many peritoneal dialysis patients, these sentiments may surface as they reflect on their health journey and the decisions that led them to this treatment. However, it is essential to shift perspective and recognize the strength, resilience, and courage it takes to navigate life on peritoneal dialysis.
The phrase “should’ve” often implies a sense of missed opportunities or actions that one regrets not taking. In the context of peritoneal dialysis patients, it may be tempting to dwell on the past and think about what could have been done differently to avoid kidney disease or the need for dialysis. Thoughts like “I should’ve taken better care of my health” or “I should’ve listened to my doctor sooner” can cloud the mind with guilt and self-blame.
But instead of getting caught up in the “should’ve,” peritoneal dialysis patients can reframe this perspective into one of empowerment and learning. Rather than focusing on past choices, they can acknowledge the courage it takes to face their health challenges head-on and make the decision to pursue peritoneal dialysis as a life-saving treatment. Every day on dialysis is a testament to their resilience and determination to prioritize their health and well-being.
“Could’ve” often brings to mind missed opportunities or potential outcomes that weren’t realized. In the world of peritoneal dialysis, patients may think about the freedom they could’ve had if they didn’t need to undergo dialysis treatments regularly. They might imagine a life without the constraints of a treatment schedule or dietary restrictions, longing for the spontaneity and normalcy that kidney disease has disrupted.
However, peritoneal dialysis patients can shift the focus from what could’ve been to what is possible now. By embracing the opportunities for self-care, connection with healthcare providers, and support from loved ones, they can create a fulfilling and meaningful life despite the challenges of their condition. Each dialysis session becomes not a limitation but a chance to prioritize their health and well-being, nurturing a sense of empowerment and control over their bodies.
“Would’ve” often speaks to intentions or desires that were not fulfilled or acted upon. In the realm of peritoneal dialysis, patients may find themselves longing for a life without the burdens of chronic illness, dreaming of a future that is free from the constraints of medical treatments and health complications. They may wish they would’ve been spared the struggles and hardships that come with managing kidney disease.
Yet, peritoneal dialysis patients can transform these wishes into a sense of gratitude for the present moment. Despite the challenges they face, they can find solace in the strength they have discovered within themselves, the relationships they have cultivated, and the resilience they have demonstrated in the face of adversity. Each day on peritoneal dialysis is an opportunity to embrace the gift of life and health, to find joy in the small victories, and to appreciate the support and care that surrounds them.
In conclusion, the journey of a peritoneal dialysis patient is one marked by courage, resilience, and gratitude. Rather than getting lost in the “should’ve, could’ve, would’ve,” they can celebrate the strength it takes to navigate life with a chronic illness, the opportunities for growth and learning, and the moments of joy and connection that make each day meaningful. By shifting the perspective from regret to resilience, peritoneal dialysis patients can find peace in the present moment and hope for the future, embracing the power of gratitude and grace in their health journey.
As Thanksgiving approaches this year, I find myself reflecting on all the things I have to be thankful for, especially regarding my health journey on peritoneal dialysis. It has been over two years since I started this treatment, and I am truly grateful for how well I am doing on it.
First and foremost, I am thankful for the opportunity to receive peritoneal dialysis. This treatment has been a lifeline for me, allowing me to manage my kidney disease and maintain a good quality of life. The fact that I can perform this treatment at home, on my schedule, has given me a sense of independence and control over my health that I never thought possible.
I am also grateful for the support of my healthcare team throughout this journey. From my nephrologist to the nurses and technicians who have guided me through the ins and outs of peritoneal dialysis, I am thankful for their expertise, compassion, and dedication to helping me thrive on this treatment. Their encouragement and knowledge have been invaluable in keeping me healthy and confident in managing my condition.
In addition, I am thankful for my family and friends who have been there for me every step of the way. Their unwavering support, love, and understanding have strengthened me during the challenging moments of my health journey. Whether it’s helping me with dialysis exchanges, running errands, or simply being a listening ear, their presence in my life is a constant reminder of the blessings I have.
I am grateful for the advancements in medical technology that have made peritoneal dialysis not only possible but also more efficient and convenient. The innovation and research in the field of kidney health have led to improvements in treatments like mine, offering patients like me a better quality of life and more options for managing our conditions.
Furthermore, I am thankful for the resilience and determination that I have discovered within myself since starting peritoneal dialysis. This journey has challenged me in ways I never imagined, but it has also shown me the depth of my strength and ability to adapt to new circumstances. I am proud of how far I have come and the progress I have made in taking control of my health and well-being.
As I sit down to celebrate Thanksgiving this year, I am filled with gratitude for all these blessings in my life. Peritoneal dialysis has been a central part of my health journey, and I am thankful for the stability, comfort, and hope it has brought me. I am reminded that even in the face of adversity, there is always something to be thankful for, and for me, that is the gift of health and the support of those around me.
This past weekend’s WSJ had an interesting article for me by Joe M. Moore titled “I Was in Great Health. So Why Were My Arteries Clogged?”
Joe M. Moore’s essay recounts his unexpected diagnosis of Sitosterolemia, a rare genetic disorder causing arterial plaque buildup, despite a healthy lifestyle. His high calcium score, revealed by a cardiac CT scan, initially baffled doctors. After further testing, Sitosterolemia was identified, highlighting the challenges of rare disease diagnosis and the importance of patient advocacy. Moore emphasizes proactive screenings and persistent questioning to ensure accurate diagnoses. The essay also discusses the high rate of misdiagnosis in the US and advocates for increased patient involvement in healthcare decisions.
So what you may ask. You may recall that while undergoing a dermatology procedure to remove skin cancer from my left temple the physician commented that he had never seen a temporal artery with such a large amount of calcification as mine. I fed this info to my cardiologist and received nothing back. Nada, Zip. This article provides insight into plausible steps to take to ascertain if Sitosterolemia is the case, and indeed, what degree of calcification I display.
As a side note, thanks to the persistence of my wife, I am now scheduled for a heart procedure/look-see on 12/30/2024. I have to go to Ft Worth on 12/26/2024 to see the attending nephrologist since my local kidney doctor does not have privileges there. We have been advised to take our cycler and associated gear in case we have to stay overnight. An overnight stay is in order if I have stents installed. One day at a time sweet Jesus.
As a current peritoneal dialysis patient, it is in my best interest to keep abreast of the latest research on the subject. Here’s what Perplexity has to say about this:
Peritoneal dialysis (PD) remains a crucial treatment option for patients with kidney failure, and recent research has focused on improving outcomes and addressing challenges associated with this modality. Here are some of the latest developments in PD research:
Technological Advancements
Recent innovations in PD technology aim to enhance patient outcomes and reduce treatment-associated harm:
Early Detection of Peritonitis: New technologies are being developed to enable point-of-care detection of peritonitis, potentially extending the treatment period on PD by preventing transfer to hemodialysis[1].
Glucose Exposure Reduction: Novel approaches are being explored to minimize the harmful effects of peritoneal glucose exposure, including:
Devices designed to deliver constant infusion of glucose at lower concentrations
Alternative osmotic agents such as xylitol
Protective additives like alanyl-glutamine or carnitine[1]
Clinical Practice Guidelines
The 2024 update of the Clinical Practice Guideline for the Prevention and Management of Peritoneal Dialysis Associated Infection in Children provides comprehensive treatment guidance based on recent literature and registry data. Key updates include:
New recommendations for antibiotic therapy of peritonitis, reflecting evolving antibiotic susceptibilities and stewardship practices
Updated clinical benchmarks
Recommendations for future research to address important knowledge gaps[3]
Outcomes and Practice Patterns
The Peritoneal Dialysis Outcomes and Practice Patterns Study (PDOPPS) continues to advance the understanding of optimal PD practices worldwide:
Phase 1 of PDOPPS included 7,629 patients from 215 dialysis facilities across 7 countries
Phase 2 is expanding to include Colombia and South Korea, focusing on novel areas of research
The study aims to promote appropriate use of PD, extend technique survival, and improve quality of life for PD patients[4]
Emerging Research Areas
Recent studies have explored various aspects of PD care:
Optimization of ultrafiltration and prevention of volume overload
Improved detection and prevention of cardiovascular disease in PD patients
Investigation of risk factors for peritonitis and technique failure
Associations between CKD-MBD biomarkers and survival
Use of PD for patients with chronic liver failure and acute kidney injury
Impact of periodontal disease on PD patients
Methods to increase physical activity and quality of life
Pathophysiology of peritoneal membrane aging[6][7]
Future Directions
Ongoing research efforts are focused on:
Developing goal-directed dialysis prescriptions that take a holistic view of patient outcomes
Addressing inequities in access to PD across different regions and populations
Improving PD education and training for both patients and healthcare providers
Investigating the potential of incremental PD approaches
Exploring the use of PD in various patient populations, including those with comorbidities[1][5]
As the field of PD continues to evolve, these research efforts aim to improve patient outcomes, increase the availability and utilization of PD worldwide, and address the ongoing challenges associated with this important kidney replacement therapy.
