Tag: peritoneal (Page 16 of 47)

The doldrums refer to the equatorial region of the world’s oceans where sailing ships often became becalmed due to light, variable winds. [1][2][3] I have been there having crossed the equator twice, both times on a nuclear-powered cruiser. Wind for our sails was not a problem. Yes, I am no longer a low-life Polywog, but a bonified Shellback.

While Wednesday/yesterday I did have a 0900 meeting with my dialysis nurse for my monthly lab draw and other normal Fresenius workups, it was all more-or-less ho-hum. My six-foot 200-pound dialysis nurse was in tears; a dialysis patient, not one of hers, died from a nonrelated dialysis ailment. I only include this comment as an example that the Fresenius teams DO care – and show it. The highlight was meeting my wife (of 62 years don’t you see) for breakfast at our Country Club on Pecan Plantation. So I AM in the Doldrums. See below for more on this subject.

The doldrums is the area around the equator where the northeast and southeast trade winds converge, causing a zone of calm with little to no wind. [1][3] This region is also known as the Intertropical Convergence Zone (ITCZ). [1][3]

Sailors dreaded getting stuck in the doldrums, as their ships would be left stranded without wind to power their sails, sometimes for days or weeks. [1][2][3] This lack of progress and feeling of being trapped led to the term “doldrums” also being used to describe a state of inactivity, stagnation, or low mood. [1][2][4]

For example, one could say “The company’s sales have been in the doldrums for the past quarter, with no sign of improvement.” [2] This usage compares the stagnation of the business to a sailing ship becalmed in the windless equatorial doldrums.

Citations:
[1] https://study.com/academy/lesson/doldrums-definition-location.html
[2] https://www.merriam-webster.com/dictionary/doldrums
[3] https://www.britannica.com/science/doldrums
[4] https://www.theeap.com/employees/down-in-the-doldrums-it-might-be-seasonal-affective-disorder-s-a-d
[5] https://www.dictionary.com/browse/doldrums

As readers of this blog are aware, I am also a Type 2 Diabetic, having been so for almost 50 years. As such, I am interested in the broad range of devices and treatments available and becoming available to help manage the disease. Keep in mind, that diabetes is highly correlated with dialysis; on the order of 34+% on dialysis are also diabetics. Thus I surmise more than a passing interest in diabetes care and treatment.

I currently employ an Abbott Libre 3 Continuous Glucose Monitor (CGM) to help manage my diabetes. I recently read on Yahoo Finance about the Eversense CGM system receiving iCGM designation by the US FDA. I had never heard of a device named “iCGM” and this blog below provides information for the reader on what this new device is all about.

Integrated continuous glucose monitoring (iCGMs) systems are a type of continuous glucose monitoring (CGM) device that are designed to be used as part of an integrated diabetes management system. Here are the key points about iCGMs:

iCGMs are the first type of CGM system that the FDA has permitted to be used as part of an integrated system, which may include automated insulin dosing systems, insulin pumps, blood glucose meters, or other electronic devices used for diabetes management.[4] This allows for more seamless integration and flexibility for patients to tailor their diabetes management.

The FDA has established special controls for iCGMs to ensure their accuracy, reliability, and clinical relevance. This enables developers of future iCGM systems to go through a more streamlined premarket review process known as 510(k).[4]

The Dexcom G6 was the first iCGM system authorized by the FDA in 2018. It is a patch device about the size of a quarter that is applied to the skin and continuously measures glucose levels, transmitting the data to a compatible display device.[4] It does not require user calibration, unlike earlier CGM models.[4]

Other iCGM systems in development include those from Profusa, Metronom Health, and Indigo Diabetes, though they have not yet attained regulatory approval.[3] These systems aim to provide continuous monitoring of glucose and other metabolites through minimally invasive or implantable sensors.

iCGMs provide patients with more flexibility and options to integrate CGM data with other diabetes management devices and technologies. This can help improve glucose control and reduce the burden of diabetes self-care.[4] However, patients should still consult their healthcare providers before making any medical decisions based on iCGM data.[2]

We don’t want to be too serious all the time. We recently purchased six flats of flowers to plant in our numerous gardens. Before the flats even had a chance to be planted, butterflies found the flowers and had a field day. That is what the lead photo is about.

Citations:
[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8764584/
[2] https://www.medpagetoday.com/primarycare/diabetes/109047
[3] https://en.wikipedia.org/wiki/Continuous_glucose_monitor
[4] https://www.fda.gov/news-events/press-announcements/fda-authorizes-first-fully-interoperable-continuous-glucose-monitoring-system-streamlines-review
[5] https://www.niddk.nih.gov/health-information/diabetes/overview/managing-diabetes/continuous-glucose-monitoring

Since I have been on my new and latest dialysis prescription, I have been using only 1.5% solution fluids. This holds for both the 2L static treatment I employ about three hours before hooking up to the Liberty Cycler for the night, and the two 6L bags I employ during my night treatment. During the past seven days, I have noticed a developing trend, possibly, that my weight is creeping upwards. See the table below where I have provided the date, weight, and microfiltration values:

As you can ascertain, in a week my weight is up by two pounds which is not “normal” for me, and my dialysis microfiltration, while not steady, appears to be trending downward. So here’s the deal, I know from experience that if I quiz my dialysis team about this it will be suggested that I blend in some 2.5% solution. But I don’t have any number one, and number two, leg craps will certainly accrue if I start using 2.5% again. So I am on the horns of a dilemma: watch my weight creep up or toss and turn all night from leg cramps. Isn’t life wonderful on dialysis?

Yesterday, 4/28/2024 was my wife’s and my 62nd wedding anniversary. Boy, have things  changed since we were first married. Gasoline was less than a quarter a gallon. Computers and cell phones had not been invented. For $20, we could fill two paper shopping bags with enough great red meat to last us weeks. We both worked, she at Purdue where I was a student. We got up early and went to bed early. Life was good and uncomplicated. My kidneys worked. I could drink beer. Did I say life was good?

My wife of 62 years and I met on a blind date at Purdue which was arranged by one of my Navy buddies. We went bowling in October 1961 and were married the following April. I was a student at Purdue attending a program the Navy had at the time named NESEP, for Navy Enlisted Scientific Program. The NESEP incentive intended to provide the Navy with officers with intensive training in needed technical areas like Electrical Engineering to manage the nascent switch to digital technologies that were on the horizon for the Navy. Officers coming out the the US Naval Academy were just not as prepared as was needed. I ended up with a BSEE/MSEE, graduating with Distinction in four years.

This education, along with a perfect wife, has stood me in good stead for these many years. I can’t say how important and central to my general well-being and lately, dialysis care, my wife has been. She is and continues to be the most important reason I get up every morning with the mantra, “Never ring the bell!” Thank you, Linda, for who you are and what you are. I know that you are in my corner regardless of what dialysis throws at us. (The lead graphic is the cover of the anniversary card my wife gave me for our anniversary.)

This blog entry is being written Thursday afternoon late for publishing at 0800 Friday 26 April 2024. Wednesday evening I had a “good” PD experience – no alarms and woke up Thursday morning feeling good. I decided to make a run to town and go to Farm & Fleet to pick up a new battery for our JD ZTR lawn mower that refuses to start, go to Walmart for groceries, and to CVS to pick up a script for my wife. Three stops that even a patient on PD should be able to accomplish without difficulty.

I made it to Farm & Fleet and purchased the battery. I made it to Walmart but by the time I had finished purchasing $128.00 of groceries, I was wiped. Went on to CVS and picked up my wife’s script, and was even more wiped. Got home and my wife helped unload the groceries, I put the battery in the lawn mower and it started right up. I had it hooked to our trailer loaded with mulch and backed it out of the single garage (we have d double garage with a side anteroom and a complete single-car garage too in which we park our lawn mower, golf cart, and other assorted “stuff.”) I positioned the trailer/mulch where we want him to work this evening.

After this, I crashed on the couch. This morning my blood pressure was 97/62. I suspect during my shopping it dropped even more resulting in my being pooped. This is not like me and I don’t appreciate this happening one bit. While we will deal with it, we are seeking a more long-lasting solution.

In a previous blog, I reported on the first Xenotransplantation of a pig’s kidney into a human. A second has been reported by AP reporter Lauren Neergaard in the Health & Science section of the site nbcdfw.com. A condensed version of her article follows; at the bottom is the link to the original article.

Doctors at NYU Langone Health have successfully transplanted a genetically modified pig kidney into a New Jersey woman who was suffering from heart and kidney failure. Lisa Pisano’s condition made her ineligible for a traditional transplant, but doctors came up with a novel solution. They implanted a mechanical pump to keep her heart beating and, days later, transplanted the pig kidney. Pisano is the second patient to receive a pig kidney following a similar procedure at Massachusetts General Hospital. She is recovering well and has taken her first steps since the surgery. The experiment’s early results have been described as transformative, but further monitoring is required. The shortage of donated organs has led to the development of genetic modifications in pigs to make their organs more suitable for human transplantation. Several biotech companies are working on this, and there have been promising results in temporary transplants of pig kidneys and hearts into brain-dead bodies. However, previous attempts at pig heart transplants resulted in the patients’ deaths. The outcome of Pisano’s case, along with that of the Massachusetts General transplant recipient, will play a role in determining the future of xenotransplantation trials.

(Link) to the original article. The lead photo is from this link.

The past week I have been attempting to accomplish some heavy-duty yard work. Here in North Texas where we live, Spring can be short and before you turn around we’re in for suffering heat, as high as 112 F or so. So we have a rather narrow window to get our yards in order before Satan’s Inferno hits.

Tuesday I worked on a bed, we have on the order of 15 flower beds on our 0.52-acre homestead, which is in full sun and borders the side of our main garage. It is mostly clay but grows weeds well. I installed a border around it, made a brick runoff for the drain spout, and augered holes for 12 tomato plants. At this point, I ran out of git up and go. See the lead picture.

In normal times, I would have done this without breaking a sweat. But with my PD-associated low blood pressure, I’m a different person. I have to frequently stop for a breath, and break up any work into chunks. Upon arising Tuesday my blood pressure was 111/74. When I took it before lunch it was 90/57. I have ascertained that once my diastolic drops below 60, I start to feel bummer. Get light-headed and cannot work. Have to sit down. After I rest for five minutes or so I generally can have another go at it.

So here’s the deal. Is this due to dialysis, or is it because I am, after all, 85? I like to think it is dialysis-related. And no, I’m using only 1.5% dialysis solution. And yes, I have worked more salt into my diet. And still, I am experiencing blood pressure readings toward the lower safe boundary.

The most searched subject on this blog is “Alarms.” Seems almost all users of the subject machine experience them, some more than others. In this blog I am going to relate my experience with alarms, and what I have found to somewhat mitigate their occurrence.

First of all, I would like to state up front that Fresenius knows full well that its Liberty Cycler has “alarm challenges.” When they were in the PR mode in pre-rollout of a new Cycler, now since abandoned for business reasons, they touted its reduced alarm rate. Alas, it does not appear that this improved cycler will be available, period. My Dialysis Team, in particular, my nurse, has been most helpful in attempting to troubleshoot alarms. Let’s jump into alarms.

What are alarms? The Cycler throws obnoxious beeping alarms when it determines that something in the Drain-Fill cycle is not going according to its parameters. In general, it appears that the pneumatic pumps in the Cycler have more oomph in the Fill cycle than in the Drain cycle. I have always experienced more alarms during Drain than Fill, by a long shot. This is particularly true if you are slightly lying on or have a bend or kink in your catheter line. But I digress – some history.

I started on PD using the Liberty Cyler on 9/30/2022. At first, I experienced a few alarms, but not so many that I couldn’t handle them sleep-wise. Over time, they increased to the level that I was having multiple alarms, mainly drain, each night, and had to get up out of bed in a verticle position for drains to complete, as much as on every drain. I started calling tech support documenting what was going on and was finally issued a new Cycler. This seemed to alleviate the alarm problem but again, over time I was back to the old alarm situation. Yet another replacement Cycler and the same story. So we had pretty much eliminated the Cycler as being the problem. That left me. Of course, this is what Fresenius tech support said all along.

In concert with my dialysis team, it was decided that I needed to have my catheter placement looked at which required me to go back to the hospital and have a surgeon again look at it which I did. So now I’m on my third Cycler and second catheter placement which seems to be working. In three weeks, I generally have four alarms, This is out of a possible 184 drain/fills which is more than acceptable. What is the secret? I have found through trial and error that I cannot sleep on my left side during any drain cycle, and have to be careful during fills. I can sleep on my back in general but have to make certain my catheter line is flaked out straight from my left side toward the cycler. I should note here that my catheter is positioned on the right side of my body and runs from right to left across my stomach. A natural position for it it exit without obstruction is from left to right thus having to make certain it runs straight to my left side which is also the side where the Cycler is located. My best sleep position is on my right side. While on my right side, I make certain my catheter line is running free and not kinked over my side and toward the Cycler. Turns out my wife of 62 years is prone to sleeping on her right side so as often as not I snuggle up to her back and that’s where I wake up in the morning, alarm-free.

While my configuration may not work for you, the point is there is some optimum sleep-catheter configuration that should minimize alarms. I doubt those of us on PD using the Fresenius Liberty Cycler will ever be without alarms.

Chronic Kidney Disease is projected to be the 5th leading cause of death globally by 2040. Folks, it’s not getting any better. Currently, about 10% of the world’s population is affected by CKD. In 1990 it was the 27th leading cause of death, and by 2010 has risen to 18th. by 2040 it’s expected to skyrocket to 5th.

Here’s the basic research behind these projections from Perplexity:

AstraZeneca has conducted a comprehensive study called “IMPACT CKD” that provides a 10-year forecast on the impact of chronic kidney disease (CKD) across clinical, economic, societal, and environmental dimensions.234 The key findings from the IMPACT CKD study include:

• The study projects that by 2032, up to 16.5% of the population in 8 countries (US, Brazil, UK, Spain, Germany, Netherlands, China, Australia) could suffer from CKD, with a staggering 59.3% rise in advanced-stage cases.23
• The number of people with advanced CKD in these countries is expected to reach nearly 125 million by 2032, a 25% increase from 2022.23
• The economic burden of renal replacement therapy, including dialysis and transplants, is forecast to exceed $186 billion.23
• Dialysis requirements are projected to surge by over 75%, significantly contributing to the healthcare sector’s carbon footprint – equivalent to adding 17.3 million cars’ worth of CO2 emissions.2

The IMPACT CKD study is part of AstraZeneca’s “Accelerating Change Together (ACT) for CKD” initiative, which aims to improve understanding and outcomes of CKD globally. The findings underscore the urgent need for proactive measures to address the growing CKD burden through earlier diagnosis, optimized treatment, and effective policy reforms.24

What can readers of this blog do about this in their own back yard? If you or yours has diabetes hypertension or both have your kidneys checked out annually as part of your annual physical. A simple blood test produces eGFR which is the gold standard (It’s what the US VA looks at and only this) for the status of one’s kidneys. Do it.