On May 26, 2023, in CNBC Tech Erin Black ran a story “How Dexcom and Abbott are moving beyond diabetes with blood sugar monitoring.” Since I am also a Type 2 diabetic and paying out of pocket for an Abbott Freestyle Libre 3 Continuous Glucose Monitoring system, this blurb was of interest to me. Watch the embedded video below for more insights into this growing market for CGMs.
Tag: peritoneal (Page 38 of 47)
Writing in the May 31, 2023 issue of News Medical Life Sciences, Lily Ramsey LLM wrote an article titled ‘A simple tweak to first meal of the day may benefit people with Type 2 diabetes.” Since about 44% of those of us on dialysis also have been blessed with Type 2 diabetes, such a finding is of interest to us also. A link to the article is here. A summary of the article is below.
- A study led by UBC Okanagan researchers suggests that people with Type 2 diabetes (T2D) can better control their blood sugar levels by modifying their breakfast to be low in carbs and high in protein and fats.
- This single meal modification was found to help control blood sugar levels throughout the day, potentially limiting hyperglycemic swings.
- The 12-week study involved 121 participants divided into two groups, one consuming a low-carb, high-protein, high-fat breakfast and the other consuming a traditional, high-carb, low-fat breakfast.
- While there were no significant differences in weight, body mass index, or waist circumference between the groups, the low-carb group saw reduced blood sugar levels, and some participants could reduce their glucose-lowering medication.
- Additionally, participants with a low-carb breakfast reported lower calorie and carbohydrate intake at lunch and for the rest of the day, suggesting that a low-carb breakfast could impact overall daily eating habits.
Attribution: Bing Illustrator for the lead graph, ChatGPT4 for summarizing the article, Grammarly for cleaning up after me, and me for the idea, concept, and any mistakes.
I have previously blogged, soon after her death, about Tina Turner and her disregard for her high blood pressure, which was a contributing cause to her kidney failure and ultimate demise. Since that blog, more information about Tina has come to light, which is captured in the video embedded below. She certainly didn’t have it easy, and all of us can draw positive lessons from her will and tenacity in the face of adversity.
Once upon a time, in a small coastal town in Maine, lived an old man named Commander John Sullivan. He was a retired US Navy Commander, a veteran of three combat tours in Vietnam, and an advisor to the brown water navy during his last tour. His house, a quaint cottage, was perched on a cliff overlooking the vast, endless sea. The rhythmic sound of the waves crashing against the rocks was his constant companion, a soothing lullaby that lulled him to sleep every night.
Commander Sullivan was a man of the sea, but he was also a man of the world. He had seen the horrors of war, the beauty of foreign lands, and the resilience of the human spirit. His life was a tapestry of experiences woven with threads of joy, sorrow, courage, and wisdom. He had stories to tell, lessons to impart, and a desire to share his life’s journey with the world.
However, age had taken its toll on Commander Sullivan. He was on dialysis, a reality that confined him to his home, tethered to a machine that kept him alive. But he was not a man to be easily defeated. He was a sailor, after all, a man who had braved the stormy seas and the bullets of war. He was determined to turn the tide in his favor.
Commander Sullivan was a man of the old world but was not a stranger to the new. He was well-versed in technology, a skill he had honed during his years in the Navy. He had a high-speed internet connection, a powerful computer, and a burning desire to share his experiences with the world.
And so he decided to write a blog. He named it “The Digital Mariner,” a nod to his love for the sea and his newfound role as a digital storyteller. Every day, he would sit in front of his computer, the sea as his backdrop, and write. He wrote about his experiences in the Navy, his tours in Vietnam, his life as a sailor, and his insights on life, war, and resilience.
His blog quickly gained traction. People from all walks of life started reading his posts. Veterans found solace in his words, young people found inspiration, and fellow dialysis patients found strength. His stories resonated with people, his wisdom touched hearts, and his courage inspired many.
Commander Sullivan also started hosting live webinars, where he would share his stories in real-time, answer questions, and engage with his readers. He used technology to break the barriers of his physical confinement, reaching out to people across the globe, touching lives, and making a difference.
Despite his health challenges, Commander Sullivan found a way to share his lifetime of experiences with mankind. He used technology as his vessel, his words as his compass, and his will as his wind. He sailed the digital seas, charting a course that was uniquely his, leaving a legacy that would continue to inspire future generations.
Ultimately, Commander John Sullivan, the old man by the sea, became more than just a retired navy commander. He became a beacon of hope, a symbol of resilience, and a digital mariner, sailing the vast seas of the internet, sharing his wisdom, and lighting the way for others.
And that person dear readers of this blog, is me, Hank Feeser. Commander, United States Navy Retired. AI assistance was used in writing this blog per past attributions.
One of the many requirements those on dialysis have to contend with is blood pressure. At a minimum, I take mine once in the morning with a cuff device to log biometrics into the Fresenius Liberty Cycler data collection system.
Those who have dealt with cuff systems know that they ofttimes present challenges with error messages being thrown, requiring fussing around with the Velcro cuff, etc, to gain a proper reading.
Just starting to come to market are systems embodied in watches. However, my experience with such devices indicates that their accuracy leaves lots to be desired.
A group of researchers in La Hoya California have just released a paper on a novel system. Xuan, Y., Barry, C., De Souza, J. et al. Ultra-low-cost mechanical smartphone attachment for no-calibration blood pressure measurement. Sci Rep 13, 8105 (2023). https://doi.org/10.1038/s41598-023-34431-1
The Abstract from the above reference is quoted in its entirety below. See the link above for more information.
Abstract
We propose an ultra-low-cost at-home blood pressure monitor that leverages a plastic clip with a spring-loaded mechanism to enable a smartphone with a flash LED and camera to measure blood pressure. Our system, called BPClip, is based on the scientific premise of measuring oscillometry at the fingertip to measure blood pressure. To enable a smartphone to measure the pressure applied to the digital artery, a moveable pinhole projection moves closer to the camera as the user presses down on the clip with increased force. As a user presses on the device with increased force, the spring-loaded mechanism compresses. The size of the pinhole thus encodes the pressure applied to the finger. In conjunction, the brightness fluctuation of the pinhole projection correlates to the arterial pulse amplitude. By capturing the size and brightness of the pinhole projection with the built-in camera, the smartphone can measure a user’s blood pressure with only a low-cost, plastic clip and an app. Unlike prior approaches, this system does not require a blood pressure cuff measurement for a user-specific calibration compared to pulse transit time and pulse wave analysis based blood pressure monitoring solutions. Our solution also does not require specialized smartphone models with custom sensors. Our early feasibility finding demonstrates that in a validation study with N = 29 participants with systolic blood pressures ranging from 88 to 157 mmHg, the BPClip system can achieve a mean absolute error of 8.72 and 5.49 for systolic and diastolic blood pressure, respectively. In an estimated cost projection study, we demonstrate that in small-batch manufacturing of 1000 units, the material cost is an estimated $0.80, suggesting that at full-scale production, our proposed BPClip concept can be produced at very low cost compared to existing cuff-based monitors for at-home blood pressure management.
Artificial Intelligence (AI) can help tailor dietary advice for dialysis patients and consider their unique needs and responses to their treatment. This video gives an overview of such use of AI with real-world examples and patient testimonials.
The script was written with the assistance of ChatGPT4 with oversight by Grammarly. The video was mastered and rendered in the AI app Pictory.AI.
Recently, one of the music icons died at her home in Switzerland. Her Offical Death Certificate suggests natural causes, but this veils what took place behind the scenes.
It seems like in 1978, Tina was diagnosed with hypertension and told by her doctors that she needed to take medication to help alleviate this malady. She chose not to take precautions believing her body would take care of itself. In 2017 her husband, Erwin Back donated a kidney to her, but she suffered forms of rejection.
Two months before her death, she opened up about putting herself in great danger. In an Instagram post, she wrote, “I have put myself in great danger by refusing to face the reality that I need daily lifelong therapy with medication. For far too long, I believed that my body was an untouchable and indestructible bastion.” At her death, there was a dialysis machine in her home (as reported by Cher), the implication being she was on dialysis.
What do we know about the link between hypertension and Kidney Failure? Kidney failure in general?
• Hypertension is the second leading cause of kidney failure behind Diabetes in the US.
• Untreated hypertension causes blood vessels to narrow, decreasing blood flow to the kidneys.
• It’s a dangerous cycle that can lead to irreversible kidney damage.
• About 37 million Americans have kidney disease.
• About 807,000 Americans are living with kidney failure.
• More than 562,000 Americans are on dialysis.
• More than 245,000 Americans are living with a kidney transplant.
• Kidney disease is growing at an alarming rate. It currently affects more than 1 in 7 — or 15% — of American adults, with people of color at greater risk for kidney failure.
• There were about 130,000 Americans newly diagnosed with kidney failure in 2020 (the most recent data available)
• 9 out of 10 people with kidney disease are unaware they have it, and half of those with severely reduced kidney function (but not yet on dialysis) do not know they have it.
• About 1 in 3 adults with diabetes may have kidney disease. Diabetes is the top cause of kidney failure, causing nearly half (45%) of new cases.
• 1 in 5 adults with high blood pressure may have kidney disease. High blood pressure is the second most common cause of kidney failure, causing 28% of new cases.
• For every two women who develop kidney failure, three men develop kidney failure. However, kidney disease is more common in women than men (14.3% vs. 12.4%).
• There are more than 90,000 Americans on the kidney transplant waiting list, but in 2022, just 26,309 — or about 1 in 4 — were able to get a kidney. There were 5,863 living donor transplants performed in the U.S. last year.
• The shortage of available donor kidneys means most kidney failure patients are treated with dialysis. Of the 130,000 Americans newly diagnosed with kidney failure in 2020 (most recent data), nearly 97% of them began dialysis. Only 3,979 were able to receive a preemptive kidney transplant.
• Compared to white Americans:
o Black Americans are 4.2 times more likely to develop kidney failure
o Native Americans are 1.9 times more likely
o Asian Americans are 1.5 times more likely
• Compared to non-Hispanic Americans:
o Americans of Hispanic ethnicity are 2.3 times more likely to develop kidney failure
What can we learn from the Tina Turner saga? The main point is that ignorance has its price. I don’t believe that Tina’s doctors didn’t do their best to convince her that she needed to take care of herself. Some of us can reach a point where we think bad things only happen to others. Kidney failure is a silent killer – I know from experience. It wasn’t until the final failure days when my eGFR went into the single digits that I started feeling bad – but when I did, it came on like a freight train.
If your kidneys are still working, take care of them, and they will take care of you. You can still piss in the wind, while those of us on dialysis can only dribble. And not into the wind so much.
To close, below, I have embedded my favorite song from Tina. Somewhere in heaven, she’s “Rolling on the River.”
Robert N. McCauley, Ph.D. wrote an article in the May 20, 2023 issue of Psychology Today titled “The Psychological Potency of Riualized Behaviors.” He suggests that when stressed or anxious, people are inclined to perform ritualized behaviors such as continuing to push elevator buttons. Let’s face it, those of us who are on dialysis can often be stressed and/or anxious over the process and perturbations attendant to it.
With this thought in mind, I turned on my AI assistant which produced the following (with my help and that of Grammarly of course.) I am “guilty” of much of the ritualized behavior therein cited. I try to set up the Cycler at about the same time every day. I have a particular sequence of setting it up. My shower routine is ritualized, as is my make-ready for bed and activity upon waking – all related to Dialysis.
Introduction
The experience of diminished control over one’s life events can often trigger feelings of anxiety and uncertainty. Humans have a predisposition to establish and maintain control over their environment and circumstances. When faced with situations that challenge this control, individuals often resort to ritualized behaviors. These behaviors, which are characterized as non-instrumental and causally opaque, serve as coping mechanisms and provide a sense of control over unpredictable or uncontrollable circumstances (Boyer, Liénard, 2006). Within the context of health and illness, this phenomenon becomes increasingly relevant. This post will explore how these behaviors manifest in people undergoing peritoneal dialysis, a treatment for advanced kidney disease.
The Challenge of Peritoneal Dialysis
Peritoneal dialysis is a type of treatment that uses the body’s own peritoneum as a natural filter to remove waste products from the blood when the kidneys can no longer perform this function effectively. The patient typically performs this treatment at home, making it a constant reminder of their medical condition. This persistent awareness can lead to feelings of anxiety and diminished control, due to the dependence on a medical procedure for survival and the potential complications associated with it (Morton, Tong, Howard, Snelling, Webster, 2010).
Ritualized Behaviors in Peritoneal Dialysis
Given the invasive nature and necessary regularity of peritoneal dialysis, it’s not surprising to observe ritualized behaviors in patients undergoing this treatment. These behaviors may take the form of meticulous preparation of the dialysis materials, strict adherence to the dialysis schedule, or even creating a dedicated space within the home for the procedure. While these behaviors may not have a direct impact on the effectiveness of the dialysis, they provide patients with a sense of control over an aspect of their life that may otherwise seem beyond their grasp. By transforming the treatment into a routine, patients are able to reduce the uncertainty and unpredictability associated with their medical condition (Lang, France, Williams, Humphris, Wells, 2016).
The Psychological Impact and Importance of Control
Ritualized behavior and the perception of control are important psychological factors in managing the stress and anxiety associated with long-term medical treatments. Patients who report a higher sense of control over their treatment tend to have better psychological outcomes, including lower levels of anxiety and depression (Peterson, Moon, 1999). It’s important for healthcare providers to recognize and understand these behaviors, as they can provide valuable insights into the patient’s mental and emotional state. By acknowledging and supporting these behaviors, healthcare providers can aid in improving patients’ psychological well-being and overall quality of life.
Conclusion
In conclusion, the experience of diminished control in patients undergoing peritoneal dialysis can often lead to the emergence of ritualized behaviors. These behaviors, while not directly affecting the medical outcomes of the dialysis, provide the patients with a much-needed sense of control over their situation, thus aiding in managing the psychological distress associated with their condition.
When the going gets tough, I always fall back to my interfaces with the US Navy SEAL Community in Coronado, CA, while I was in a Vietnamese language school in 1972. Their Ethos has much to offer those of us who are mere mortals on Dialysis. I have extracted some of the more cogent phrases and ran them past my Chatbot for a take on how these “rules to live and die by” provide inspiration to those of us on dialysis. I then constructed a dialog from the outcome, which I ran through my subscription to Pictory.AI. The resulting video is below. Remember, Never ring the bell!
As an individual on Peritoneal Dialysis, I must gather and manually submit tons of data to my provider, Fresenius Medical. This starts with a thumb drive in the Cycler that gathers info I sneaker net to Fresenius whenever I visit, say for monthly labs. Every morning upon completion of my dialysis for the day, I am required to enter weight, blood pressure, glucose, heart rate, amount and type of fluid used, and body temperature into the cycler. I am required to use the Fresenius app Patienthub daily to enter the fact that I entered the required info in the Cycler, what my PD fluid looked like, what my exit site looks like, and did I apply antibiotic cream. Lastly, it requires confirmation that I did or did not perform any manual drains.
Lots of data, but here’s the deal. I have yet to hear anything back from ANYBODY concerning the use of this data, feedback to alter any treatment, or whatever. Nada, zip, zero. I have been led to believe by my dialysis nurse that the raw data is eyeballed, but no hardcore statistical analysis is employed. No trends, outliers, moving averages, changes, improvements, etc.
It is obvious to the most casual observer that a tremendous opportunity exists herein for using AI to improve patient outcomes. And that patient is me. I am interested in improving outcomes, and I know Ai can greatly assist in this area. Read on.
In the world of healthcare, the potential of Artificial Intelligence (AI) and Machine Learning (ML) is becoming increasingly apparent. One area where these technologies are making a significant impact is in managing chronic kidney disease, specifically in the personalization of dialysis treatment plans.
Dialysis, a life-saving treatment for individuals with kidney failure, traditionally follows a one-size-fits-all approach. However, every patient is unique, with different health histories, lifestyles, and responses to treatment. This is where AI and ML come into play.
AI and ML algorithms can analyze vast amounts of data quickly and accurately. In the context of dialysis treatment, these technologies can be used to examine the unique medical information of individual patients. This includes data from electronic health records, lab results, and even real-time data from dialysis machines.
By analyzing these data points, ML algorithms can identify patterns and trends that might not be immediately apparent to healthcare providers. For example, an algorithm might notice that a patient’s blood pressure tends to spike after dialysis or that their kidney function improves when dialysis is performed at a specific time of day.
Based on these insights, the AI system can recommend personalized dialysis treatment plans tailored to the individual needs and responses of each patient. This could involve adjusting the frequency or duration of dialysis sessions, altering the dialysis fluid composition, or recommending lifestyle changes that could improve the patient’s overall health.
The potential benefits of this personalized approach are significant. By tailoring dialysis treatment to the individual patient, we can potentially improve their quality of life and health outcomes. For instance, personalized treatment plans could reduce side effects, improve kidney function, and extend the patient’s lifespan.
Moreover, this approach could also lead to more efficient use of healthcare resources. By predicting and preventing complications before they occur, we can reduce hospital admissions and healthcare costs.
In conclusion, the integration of AI and ML in dialysis treatment is a promising development in the field of nephrology. By leveraging these technologies, we can move away from a one-size-fits-all approach and towards personalized treatment plans that improve patient outcomes.
I was assisted by Prompt Perfect, ChatGPT4, Grammarly, and Bing Illustrator in authoring the above post.
