Tag: peritoneal (Page 17 of 47)

Late Tuesday afternoon I was working with a high school senior that we have hired to help us with out 15+ flower beds. He was unloading mulch from our BMW X5 and I was walking from the garage toward him where he was parked in the driveway unloading. My feet lost purchase in mulch that had eased onto the driveway and I fell full frontal forward, scraping a raised sprinkler head on the way down. I ended up with a large scrape across my chest, where my catheter hangs and my stomach access lies, and a huge bruise on my forearm where I landed with all my weight on it. See the lead photo of my arm.

I have been feeling better and better since my last prescription change, and am not prone to falling per se. While this MAY BE an outlier, it is still worth considering what research into the following question offers: “Are patients on PD more prone to falling?” This is what Poe had to say about this topic:

The impact of PD on the risk of falling depends on several factors, including the patient’s overall health, age, comorbidities, and any existing mobility issues.

While there is no direct causal relationship between PD and an increased risk of falling, certain factors associated with PD may contribute to a higher risk. For example:

Fluid and electrolyte imbalances: PD can affect fluid and electrolyte levels in the body, potentially leading to dizziness, weakness, or changes in blood pressure that may increase the risk of falling.

Muscle weakness: If a person on PD experiences muscle wasting or weakness, their balance and coordination could be compromised, potentially increasing the risk of falling.

Underlying health conditions: Many individuals who require PD have underlying health conditions that can impact their mobility and balance, such as diabetes, peripheral neuropathy, or musculoskeletal disorders. These conditions can increase the risk of falling.

Of the possibilities above, I am to a degree suffering from muscle weakness due to dialysis, and also have been diagnosed as having peripheral neuropathy as a result of being a diabetic. I am receiving VA Disability for the latter in both legs. So I suggest readers on PD take this as a warning and lesson learned; out of the blue, so to speak, you may fall through no fault of your own. How to preclude the occurrence is beyond my skill set.

In yesterday’s blog, I wrote about the central position urine has in the calculation of Kt/V, the output of the PD Adequacy Test that informs us as to how well our dialysis is working. Let’s face it, kidneys are about manufacturing urine in our bodies and the eventual discharge of same, whether male or female. Being on dialysis is a result of our kidney’s failure to produce a “normal” amount of urine, that is, to remove waste products from our bodies.

https://www.unilad.com/news/health/peeing-sitting-down-as-a-man-better-806567-20240415Getting the urine out of our bodies is pretty elementary; in general, men in the US are taught and expected to stand up while urinating and by and large, but not in all cultures, women sit while urinating. In an article in UNILAD titled “Doctor claims men in the US are peeing incorrectly and reveals why,” Poppy Bilderberg on April 15, 2024, wrote “…the sitting position is ‘probably the most efficient way’ to properly empty your bladder.” (Link)

So for the men reading this blog, you now must revise centuries of ingrained peeing posture and just sit down when you pee. Good luck with that!

As consistent readers of this blog may recall, I am a Type II diabetic and have been so diagnosed for going on fifty years. I was diagnosed while on active duty USN, controlled diabetes first with diet and exercise, then diet, exercise and medication, and finally, these three along with insulin. Thus I am interested in almost anything related to the treatment of diabetes.

https://diabetesjournals.org/care/article/44/1/89/33032/Worldwide-Epidemiology-of-Diabetes-Related-EndFurthermore, there is a direct correlation between diabetes and End Stage Renal Failure (ESRF) approaching the mid-30 % level. In other words, if you have diabetes, then there is a good chance you will experience ESRF and have to go on dialysis or a kidney transplant route. “The global percentage of the prevalent ESRD patients with diabetes increased from 19.0% in 2000 to 29.7% in 2015 worldwide, while the percentage of incident ESRD patients due to diabetes increased from 22.1% to 31.3%. The global annual incidence of ESRD among patients with diabetes increased from 375.8 to 1,016.0/million with diabetes during 2000–2015. The highest average rates were observed in the Western Pacific Region. Comparatively, the rates of incident ESRD among European patients with diabetes ranged from one-half (309.2 vs. 544.6) to one-third (419.4 vs. 1,245.2) of the rates of the Western Pacific population during 2000–2015.” (Link)

https://www.thebrighterside.news/post/diabetes-breakthrough-out-patient-procedure-eliminates-the-need-for-insulinBrighter Side of the News in an April 4, 2024 article by Joseph Sherit titled “Diabetes breakthrough: Out-Patient procedure eliminates the need for insulin” writes: “Electrical stimulations administered to the duodenum, the initial segment of the small intestine, might offer a one-time outpatient endoscopic procedure for Type 2 diabetes patients, potentially enabling them to sustain glycemic balance and discontinue insulin use, a preliminary study suggests.” (Link)

Needless to say, this research is in the infant stage, but if it bears fruit, will be a Godsend for those of us who are insulin-taking diabetics and may just preclude the future need for dialysis. We can only hope!

I have previously blogged about having to do an Adequacy Test, the output of which is a lab-derived number Kt/V. The higher this number, the better the dialysis is working. As part of the workup for this Test, we are required to gather our urine for 24 hours before the test and submit it, along with our drain bags from the previous peritoneal session. This all got me thinking about something named “Residual Kidney Function.”

When I started on PD, I was still urinating fairly copiously. Over time, my urine production has dwindled to a trickle, This is what Perplexity has to say about RKF:

Residual kidney function (RKF) refers to the remaining ability of the kidneys to filter and excrete waste products and excess fluid from the body in individuals undergoing peritoneal dialysis (PD). In patients with end-stage renal disease (ESRD), the kidneys are severely damaged and their function is significantly impaired. However, even in these cases, some residual kidney function may persist.

RKF plays a crucial role in the overall management of patients undergoing peritoneal dialysis. It provides additional clearance of waste products and fluids, which can help improve patient outcomes and reduce the reliance on dialysis treatments. Here are some key points to understand about residual kidney function in the context of peritoneal dialysis:

Clearance of Waste Products: Residual kidney function contributes to the removal of waste products, such as urea, creatinine, and other toxins, from the bloodstream. This can help reduce the burden on peritoneal dialysis and enhance the overall efficiency of waste removal.

Fluid Balance: Residual kidney function also aids in maintaining fluid balance. The kidneys are responsible for regulating the body’s fluid volume by adjusting urine output. In peritoneal dialysis, RKF helps in the removal of excess fluid, reducing the need for ultrafiltration during dialysis exchanges.

Nutrient and Electrolyte Management: The kidneys play a vital role in maintaining the balance of electrolytes, such as sodium, potassium, and calcium, in the body. Residual kidney function contributes to the regulation of these electrolytes, which is important for maintaining overall health. Additionally, RKF can also impact nutrient management, including the clearance of waste products derived from protein metabolism.

Preservation of Peritoneal Membrane: Residual kidney function has been associated with a decreased rate of decline in peritoneal membrane function. The peritoneal membrane is responsible for the exchange of solutes and fluid during peritoneal dialysis. Preserving the peritoneal membrane function is important for the long-term success of peritoneal dialysis.

Monitoring and Management of Residual Kidney Function:

To assess residual kidney function, regular monitoring of various parameters is conducted. These may include measuring urine output, creatinine clearance, or estimating glomerular filtration rate (eGFR) through blood tests. Monitoring helps healthcare providers understand the extent of residual kidney function and make appropriate adjustments to the dialysis prescription.

In peritoneal dialysis, preservation of residual kidney function is desirable. Strategies to support and protect RKF may include maintaining optimal blood pressure control, managing fluid balance, and avoiding nephrotoxic medications whenever possible. Adequate nutrition and hydration also play a role in supporting residual kidney function.

However, it is important to note that over time, residual kidney function may decline in patients with ESRD. The rate of decline varies among individuals and is influenced by factors such as the underlying kidney disease, comorbidities, and the duration of dialysis therapy.

In conclusion, residual kidney function refers to the remaining kidney function in individuals undergoing peritoneal dialysis. It provides additional clearance of waste products and fluids, contributing to improved outcomes and reduced reliance on dialysis treatments. Monitoring and managing residual kidney function are important aspects of peritoneal dialysis care, aiming to optimize overall patient well-being.

As a result of RKF, I conjecture, we have had to modify my PD prescription over time. I also conjecture that the reduced volume of urine contributes to the calculation of Kt/V and thus impacts the efficacy of my PD. Less urine, smaller Kt/V?

Had my monthly meeting with my Dialysis Team as scheduled yesterday. As expected, they were very pleased with my lab results. We will stay the course on my dialysis prescription, not take any blood pressure meds, and continue to monitor, but work on more protein in my diet. My dialysis nurse Cindy also provided four boxes of 6 liters of 1.5% dialysis solution so I have a buffer against the Sanfu reported yesterday. Again, hopefully, the supply that went missing will be delivered on schedule on 4/17/2024.

My lab results indicate that I am on the cusp of at least from a number of perspectives getting enough dialysis. This is also reflected in how I feel. Upon returning from walking our Golden Retriever, I no longer have to sit down and rest. I am not getting slightly out of breath. I can go longer and stronger and accomplish some yard work without having to take a break every five minutes. While I am some distance from the former lean and mean machine known in Porsche racing circles as “Hammerin’ Hank,” at this stage in my life things look pretty good from where I’m standing. Hope they do for you also!

I have been sailing along ordering dialysis supplies from Fresenius for my dialysis requirements without a hitch since October 2022. The hitch became unhitched with a blaring crash Tuesday. Here’s the deal:

I put in an order of 36 – 6 L 1.5% boxes, 7 – 2 L 1.5% manual boxes, 4 cassette boxes, and 2 StayCap boxes. Only the latter two were delivered. No fluids whatsoever were delivered. I called the Fresenius order desk and was informed they screwed up, something about when they talked to my dialysis nurse to get approval for the larger than typically allowed 6 L request things got discombobulated. I was informed that the “real” order will arrive on 4/17/2024.

I politely inquired as to how this could even happen. Alarms should have gone off when my orders, which from the beginning have included copious amounts of the required fluids, suddenly went to zero! This makes absolutely no sense to me at all. It is an obvious fault line in one of Fresenius’ most important functions. To add to this, the voice on the other end of the phone call indicated that she had no way of reporting this abdication of duty to patients up the chain to preclude it from happening in the future, stating “These things do happen.”

So the message for those on peritoneal dialysis herein: Despite your best effort, the “system” can and will leave you hanging out in left field. Keep your powder dry and have extra supplies on hand. It is a pain and takes up extra space but…

BTW, it turns out I have a meeting with my dialysis team today and have corresponded this situation to my dialysis nurse and have arranged to pick up four 6 Liter 1.5% boxes at our meeting. There is a God!

The US Navy SEAL’s saying “The only easy day was yesterday” applies equally to those of us on dialysis. To drive this point home, take yesterday in my dialysis journey. I am scheduled to receive a monthly shipment from Fresenius of my monthly dialysis supplies this morning. It will consist of 47 sizeable boxes of dialysis fluid, cassettes, and caps. It will take up gobs of room. To prepare for this, my wife and I moved all boxes of fluid on hand to our ready service locker in the master bedroom beside where we have the dialysis machine, the Liberty Cycler, set up.

My point is, that we are seldom steady-state in dialysis. Something is always changing. Something needs to be checked. Something out of our control has changed. It is NEVER a one-and-done situation. Please read Poe’s take on the SEAL motto below. If you are on dialysis like me, it directly pertains to you and your grip on your dialysis life.

“The only easy day was yesterday” is a motto and a popular saying often associated with the United States Navy SEALs, a special operations force within the U.S. Navy. While it is not an official motto of the Navy SEALs, it reflects the mindset and the demanding nature of their training and operations.

The saying encapsulates the SEALs’ commitment to pushing their limits and constantly striving for improvement. It conveys the idea that each day brings new challenges and that the SEALs must be prepared to face them with determination and resolve. It emphasizes the importance of learning from past experiences while recognizing that the future will likely present even greater difficulties.

The Navy SEALs are renowned for their rigorous training and demanding missions, which often involve high-stakes operations in extreme conditions. Their training is designed to test candidates physically, mentally, and emotionally, pushing them to their limits and beyond. By embracing the philosophy of “The only easy day was yesterday,” SEALs maintain a mindset of continuous improvement and resilience.

This saying is not unique to the Navy SEALs and has been adopted by other military and non-military groups as well. It has become a popular motivational phrase, encouraging individuals to persevere and not become complacent in the face of challenges.

Overall, “The only easy day was yesterday” serves as a reminder to the Navy SEALs and others that success is not guaranteed, and each day requires renewed effort, dedication, and a willingness to confront the difficulties that lie ahead.

And that folks, is the mindset those of us on dialysis must daily embrace. “The only easy day was yesterday!”

A question I quite often ask myself and others are interested in also is “How is this blog doing?” While “doing” is not well defined, today I’m going to share with readers some of the dynamic statistics I have as part of the WordPress package of Plugins. While readers never glimpse what is behind running a blog/Website such as feeser.me, lots is going on. Managing such a site is on the one hand very simple and easy, while on the other hand can be as complicated as you want to make it. If anything, I have erred on the simplistic side but there’s still lots going on. I’m going to jump in with five graphs/table grabs with dialog of what’s going on.

The graphic above provides information on overall traffic to the blog.

The graphic above from site stats depicts on a rolling daily basis how many visitors have visited how many pages. It is an overall dynamic view of the “interest” the entire universe has in daily topics.

The table above provides stats for the last 30 days on what part of the world visitors originated from

The table above ranks by topic the top searches. This may be used to generate more blogs about topics of interest. Based on the above, Cycler Alarms are of primary interest and I should consider blogging about the subject more often, assuming I have Germaine input.

Lastly, the table above provides information on the location of and IP address of visitors to this blog. While interesting in and of itself, I don’t use it for anything. A marketing organization might use such info if it were targeting a specific demographic in a specific market to measure the efficiency of a campaign for instance.

My lab results are not back as I write Friday’s blog Thursday afternoon so maybe on Monday, we’ll know how my Kt/V is doing.

Meanwhile, at 4:45 PM Wednesday I had an appointment with an audiologist to get my new VA-provided hearing aids. His storefront is located in Stephensville, some 49 miles away. About 20 miles from his office, traveling legally at 70 MPH (it is Texas people, we have reasonable speed limits) the right rear tire on our 2019 BMW X5 we were traveling in blew. Luckily, we have ran-flats on it, continued to our appointment at a maximum speed of 50, and returned home slowly and safely.

I now have a new set of hearing aids by a company named Starkey. So far so good. They have an AI function that cancels out background noise where it normally causes me real problems in picking out conversations. I seem to have a much greater clarity of sound reproduction also.

Meanwhile, this morning I went to our local tire barn, where for $1880.80 I have a new set of 275X45X20 Bridgestone tires on order for the X5. A couple of years ago the same tires would have been $800. When I was racing Porsches in the nineties a set cost less than $500 for racing tires. Who says prices haven’t gone up?