Yesterday I visited Fresenius local to have labs pulled. Today they were available via the Fresenius PatientHub App. In this blog, I will discuss seven of the results. Screenshots of the actual app readings follow the comments.
Albumin 3.7. Staying flat. Watch.
Calcium 8.9. Bounce up. Looks good.
Phosphorus 5.0. The body responded to binders. Continue taking.
Potassium. 4.6 Slightly uptrend. Watch. May have to cut back on tomatoes.
iPTH 239. Looking Good.
BUN 54. Increasing. Not removing enough urea nitrogen from blood? Question Neprologist during this Friday’s Team Meeting??
Creatinine 6.09. Flat. Equates to an eGFR of 8. Snore.
AlbuminPotassiumCalciumPhosphorusBUNCreatinine
In tomorrow’s blog, I intend on discussing more Peritoneal Dialysis and drugs per se insights.
Yesterday @ 0830 CST I visited my local Fresenius Medical facility in Granbury, TX for labs. This blog relates what took place during my visit.
Valentine’s Day is just a short week away. To thank five of the members of my Fresenius dialysis teams, both Hemo and PD, my wife and I bought Valentine cards, candy, and Hoffbrau Restaurant gift certificates for them. I handed the gifts out on the way into the clinic. They were very well received which is always a good feeling.
Straightaway I wan logged in and provided biometric data – Weight, blood pressure, pulse, glucose, and temperature data, and the USB drive from the Cycler that I had removed prior to leaving home. I then signed several forms to catch up on paperwork for Fresenius, there is always paperwork to catch up on, provided my two insurance cards – Medicare and my military ID for Tricare for Life, and signed some more forms.
I was then shifted to a treatment room where I removed my coat and sweatshirt, was seated and attended to by my dialysis nurse and another nurse. The second nurse drew blood samples and gave me two shots, one my last hepatitis B shot, and the second a Pneumovax shot. My dialysis nurse meanwhile asked me a battery of questions to ascertain my general health and well-being, listened to my heart and lungs, thoroughly inspected my feet, and visually and digitally inspected my stomach catheter area. I was provided a sheet with March’s appointments, and my monthly education package, this time Module 7, Medicines; Tools for Good Health.
I was then sent on my way but had to return as I forgot to pick up a replacement USB drive for the Cycler.
I also noted the Glucose reading on my Libre 3 as being 100 at the time the blood sample was drawn, and the corresponding BMI (remember poor man’s A1C reading) was 6.1%. When my labs come back, probably tomorrow, we’ll compare readings. I had my biometric watch on but forgot to take a reading from it.
When my labs come in, we’ll discuss in some detail what the findings are. For now, I feel great, good, awesome.
On Monday 2/6/2023 I am scheduled to have my monthly lab work done at Fresenius Medical Center in Granbury, TX. I thought it would be appropriate to blog about what these tests are all about in a general nature, followed by more specifics of my personal results. So here goes:
Peritoneal dialysis (PD) is a form of renal replacement therapy that is used to treat patients with end-stage renal disease. It involves the use of the patient’s own peritoneal membrane, which is the inner lining of the abdominal cavity, as a filter to remove waste products from the blood. This process is performed through a series of exchanges that are done several times a day, typically at home. For me, I do four exchanges or two hours duration each.
One of the critical components of PD is the use of dialysis solution, which is a sterile solution that is instilled into the peritoneal cavity through a catheter. This solution works by drawing waste products from the blood into the peritoneal cavity, where they are then removed during the next exchange. To ensure the safety and efficacy of the dialysis process, it is essential to regularly monitor the dialysis solution and the patient’s response to it. This is where peritoneal dialysis labs come in.
What are Peritoneal Dialysis Labs?
Peritoneal dialysis labs are specialized facilities that are designed to monitor and evaluate the quality of the dialysis solution and the patient’s response to it. These labs typically use state-of-the-art equipment and technology to perform a series of tests that help to assess the concentration of waste products, electrolytes, glucose, and other important parameters in the dialysis solution and patient’s blood. For me, Fresenius uses spectra laboratories out of Southaven, MS to conduct the labs. At least that’s the letterhead on my lab reports.
The main objective of peritoneal dialysis labs is to ensure that the dialysis solution used in PD is both safe and effective. To achieve this, they perform several key tests, including:
Dialysis Solution Glucose Concentration Test: This test measures the concentration of glucose in the dialysis solution, which is critical to the success of PD. If the glucose concentration is too high or too low, it can affect the efficiency of the dialysis process and cause adverse effects such as hypoglycemia or hyperglycemia.
Peritoneal Equilibration Test (PET): The PET test measures the rate of transfer of glucose and other solutes between the blood and dialysis solution. This test helps to determine the effectiveness of the dialysis solution and the patient’s peritoneal membrane.
Dialysis Solution Electrolyte Concentration Test: This test measures the concentration of electrolytes in the dialysis solution, including sodium, potassium, and calcium. It is important to maintain a proper balance of these electrolytes to ensure the safety and efficacy of PD.
Bacterial Culture Test: This test is performed to assess the presence of bacteria in the dialysis solution. Bacterial contamination of the dialysis solution can cause severe infections, and regular monitoring is critical to prevent this from happening.
The results of these tests are used to adjust the dialysis solution and the patient’s treatment plan, ensuring that the PD process is both safe and effective.
Benefits of Regular Monitoring by Peritoneal Dialysis Labs
Improved patient outcomes: Regular monitoring of the dialysis solution and the patient’s response to it helps to ensure that the PD process is effective and that the patient is receiving the best possible care. This, in turn, leads to improved patient outcomes, including better control of waste product levels, improved electrolyte balance, and a reduced risk of infections.
Increased patient comfort: Regular monitoring helps to identify and address any issues or adverse effects that may be affecting the patient’s comfort and well-being. This helps to improve the overall quality of life for patients undergoing PD.
Improved safety: Regular monitoring by peritoneal dialysis labs helps to ensure that the dialysis solution is used.
In a following blog we’ll discuss my actual labs, what they mean to me, and how I respond to them if at all.
A strong case has been made in a preponderance of reviewed medical journals that diabetes is the primary and number one predictor of a future requirement to go on dialysis. See stats in the table below from CDC here: The extreme need for close diabetic control does not end once a person goes on dialysis; if anything, because PD at a minimum requires dumping a sugar solution into one’s stomach, it becomes even more critical.
For adults with diagnosed diabetes:
69% had high blood pressure, and 44% had high cholesterol.
39% had chronic kidney disease, and 12% reported having vision impairment or blindness.
Diabetes was highest among Black and Hispanic/Latino adults, in both men and women.
This blog is not about the how-to of diabetic control, but about one of the new tools just hitting the market to ascertain the degree of control, that is, how is my “blood sugar/glucose doing?”
Coming out of China is a new class of wearable devices in the form of a wristwatch at a very reasonable price called smart watches, or bio watches. They are generally available from Temu.com/App, Aliexpress.com, etc. for about $40.00. I have purchased two from Temu.com via their App for $39.62. See the Graphic below for all they are purported to be able to measure from here: The watches are based on the GR5515 chip and are Model E400 from Vanssa in China. Scroll down this link for more info on all the watch purports to do:
E400 Functions
I have been using the watch’s many functions in parallel with my go-to standard blood pressure, O2, temperature, and glucose (I use the Libre 3 CGM) as comparisons. I find some of the readings to be right on, and others to be somewhat consistent. It should be pointed out that the documentation that comes with the device explicitly states they are NOT to be used for medical purposes – yet I might add. As the video describes below, they are great for trends. I have found the E400 watch to be a great addition to a bag of tools for the diabetic/person on dialysis used in conjunction with the associated H Band App. Please watch the video embedded below for an independent review of the E400.
My next blog will discuss using the Libre 3 CGM for diabetic control while on dialysis.
INC ran an article that explored what gives people the greatest happiness in life. The article suggests “Do the things you love” is central to happiness in life. That got me thinking about how the concept applies to my situation – being on Peritoneal Dialysis and by extension readers of this blog who are also being provided life support via dialysis.
How can we, with the constraints of dialysis, “Do the things we love?” I have found dialysis treatment does not, at least for the most part, affect my life to any great extent so far. Travel is an exception requiring more preplanning and effort.
So what things am I doing that I love while on dialysis?
It’s winter in North Texas so I’m planning for Spring gardening. Looking at Burpee’s seed catalog. Reviewing what went well last year and not so well.
The Rolex 24 Race has just been conducted this past weekend. As an ex-Porsche racer, I enjoy the racing season starting up again
My wife and I are always looking for new food to prepare at home new dishes and new tastes. Yesterday we prepared a couple of filet mignon steaks by first searing them in an iron skillet, then finished cooking them in the same skillet in the oven and topped them with homemade herb butter. We found them to be superior to any we had had anywhere in the world previously.
The deer here in our locale Pecan Plantation have been breeding and laying down for the night in our yard. Always a satisfactory sight to behold.
I enjoy writing this blog and learning more about the ins and outs of dialysis. There is no straight and narrow path I’m beginning to ascertain.
As an engineer, I’m very interested in the rollout of AI-based tools for writing, art, and composition and am exploring Chat in its various forms as we speak. Also, art apps. In the short term, I plan on investing in AI startups when it becomes financially prudent to do so.
We have a seven-month-old Golden Retriever named Dickens. Seven days a week come rain, shine, sleet, or hale I take him to our Dog Park and also walk him for about ¾ of a mile. Good for him and better for me. My wife walks him at night for ½ hour or so. Training-wise, he is a work in progress so this is a constant challenge. As I write this he is asleep on my left foot – never far away and always in touch. That’s what Goldens do.
Like the Statler Brothers in their popular song “Flowers On the Wall,” don’t tell me I’ve nothing to do!”
But first going Forward: a bad night for me and Peritoneal Dialysis. The system would just not drain, regardless of where and how I stood, what dance steps I made or how I held my mouth. The Cycler persisted on sounding its loud “Draining slowly” warning, of course with no reflection on what was causing the slowness. I checked and rechecked both the Drain Line (yellow) and the Blue is You Line to no avail. I removed all tape and fixtures on the Catherer Line, and gently tugged the Catherer Line itself to no avail.
On average over six months, the total time I spend on the Cycler itself is on the order of 10 hrs 30 minutes; last night it approached 11 hrs, an all-time high. For the record, 3/4 nights the Cycler alarms on the Drain Cycle; only 25% of the time do I experience a restful night’s sleep without Drain Alarms.
Expecting that something was just not as it should be, I contacted my PD Nurse at Fresenius. She gracefully agreed to see me as soon as I could get there, some 1/2 hour drive away. Upon arrival at the Fresenius Clinic, she manually drained my PD Access, then added 500 mL of fluid and timed how fast it went in (fill) and how fast it Drained. She then did so with 2000mL. In both cases, specs were exceeded. (She used 100 mL per minute for the drain as the norm, so 20 minutes was the time expected.)
So available tests suggested my PD catheter system is performing to specifications. I am to suit up again tonight with hopefully better results. If not, the next step would be to x-ray my stomach area to ascertain if all is as should be with the catheter interior to my stomach.
BTW, while there I asked about replacing the line on my catheter that leads from the section that actually enters the stomach to the Blue is You connect on the Cycler and was told that this is accomplished every six months as a matter of course. Stand by for updates.
Now an update on how data moves around Fresenius or doesn’t. Clinic personnel do not have a live feed of data coming off the Cycler even though the Cycler has a cellphone-based modem to transmit data. They received stored biometric data when I visit the clinic and bring in the installed USB thumb drive. They can see and respond to any comments I make via the App, but it is unknown how much if any of the other data they can review.
`
Fresenius is touting a new integration of data sources and support via their Kinexus Therapy Management Platform as being specific to both the Liberty Cycler (the current PD device I’m using) and the new-to-the-world VersiPD system in early beta testing I have previously blogged about. See this link for more information. You may view an embedded video from the above link that is embedded below. It seems to take a few seconds to load – maybe.
The Kinexus rollout suggests Fresenius recognizes they need to improve their data integration efforts and lever up on the data they are by default collecting on patients. I’ll post updates as my understanding in this area improves.
Those employing the Fresenius Liberty Cycler to support their daily home peritoneal dialysis, know that when coming off dialysis in the morning, one of the last Cycler screens requests input of a host of biometric data including weight, blood pressure, pulse, type of dextrose used, last bag type, glucose, etc. On the PatientHub app (I use an Android-based Samsung S20+5G) you are required to input a bunch more data including if you entered your vital signs in the Liberty Cycler, solution information, any manual exchanges, etc. Lots of data.
My first observation is that given that I have been faithfully supplying requested data since starting dialysis on 9/30/2022, not one entity or person from my PD team or anywhere else has ever commented on the same. Not one.
We had a philosophy in the Navy that in the face of too many reporting requirements from desk jockeys, just stop sending them and see if anyone squawks. No squawks, no report, that simple. Perhaps that approach should be used here.
My second observation involved the PatientHub App’s “Features” not being implemented in a meaningful way. When you dig down from the login screen to the landing screen, there is a tab in the upper right corner named “Menu.” A menu choice is “Vital Graphs.” One would assume that some if not all of the data being input across the Fresenius Dialysis spectrum would be graphically presented herein. Such is not the case. For me, only my dry weight is listed which is not of much help in viewing data trends graphically.
I submitted a report to the Fresenius App keeper and received the response below a day later. It is the last graphic below.
From the response, it is clear that the most obvious integration of reporting systems is totally lacking, and apparently not a priority either. This further begs the issue of where all this data is going, who is viewing it, and to what end. I want to know and will be pursuing this “issue” further with Fresenius personnel. Standby. Out. (Screenshots of the App are below:)
Signon ScreenMenu ScreenMy Vitals GraphQuery Response from Fresenius
I have put my very life in the hands of the company providing me PD support, Fresenius Medical Care, ticker symbol FMS. They provide Liberty Cycler equipment, medical support personnel, disposables, monthly supply replenishment, labs, and online support. Quite a mouthful. Given the level of my dependence on FMS, it behooves me to know all that is relevant about this company.
Wiki offers the following insights: Fresenius Medical Care AG & Co. KGaA is a German healthcare company that provides kidney dialysis services through a network of 4,171 outpatient dialysis centers, serving 345,425 patients. The company primarily treats end-stage renal disease (ESRD), which requires patients to undergo dialysis 3 times per week for the rest of their lives (When on hemodialysis – I am on Peritoneal dialysis every night.)
With a global headquarters in Bad Homburg vor der Höhe, Germany, and a North American headquarters in Waltham, Massachusetts, it has a 38% market share of the dialysis market in the United States. It also operates 42 production sites, the largest of which are in the U.S., Germany, and Japan.
The company is 32% owned by Fresenius and, as of 2020, generates around 50% of the group’s revenue.
In December 2022 Helen Giza (54) was appointed Chief Executive Officer of FMS. Helen Giza joined Fresenius Medical Care in 2019 as Chief Financial Officer and took on the additional roles of Deputy CEO and Chief Transformation Officer in 2022 heading the FME25 transformation program. Previously, she was Chief Integration and Divestiture Management Officer at Takeda Pharmaceuticals since 2018. Before joining the Takeda Corporate Executive Team, she served as Chief Financial Officer of Takeda’s U.S. business unit since 2008. Prior to that, she held a number of key international finance and controlling positions, amongst others at TAP Pharmaceuticals and Abbott Laboratories. Helen Giza is a U.K. Chartered Certified Accountant and holds a Master of Business Administration from the Kellogg School of Management at Northwestern University in Evanston, Illinois, USA. From here:
Graphical analysis of FMS from a stock perspective from here is below:
FMS Revenue and EarningsFMS 5-year Stock PerformanceFMS by the NumbersShould you buy FMS?
On 1/20/2023 I bought 500 shares of FMS at $18.26 per share. Today, 1/24/2023 I am down $.20 per share. They have plenty of room to run (I hope!)
Novices to the blogging world may be interested in what’s behind my blog on Peritoneal Dialysis, feeser.me. So for those with a slightly more technical bent, this blog documents build status as of the posting date.
To start the blog, I needed a Domain Name and a web hosting company to host the blogging software I intended to use (and am using) to make daily blog entries. I did a Google using WordPress (free open-source blogging software I used while at Purdue) and “hosting” and came up with numerous providers. I sifted through the offerings and decided on Dreamhost.com as optimum. For the grand sum of less than $100, they registered my selected domain name feeser.me. They provided web hosting and offered a simple one-click solution to installing WordPress’s latest version, 6.1.1. According to Wikipedia, WordPress is used by 42.8% of the top 10 million websites as of October 2021.
With the essential blogging computer-based support system set up, I had to figure out how to use it. I used three sources. First, I signed up for a $15.00 Udemy course on WordPress. I browsed through the course content and picked up what I needed to get up and running. Second, I went to Amazon and purchased a book on WordPress, which I have yet to use (frown face!) The book’s title is “WordPress for Beginners 2022” by Dr. Andy Williams. I have it as a reference should I need it. Third, I used and use Google extensively for specific guidance for WordPress’s many bells and whistles. Two of these are Themes and Plugins.
Hundreds of Themes are available, which provide the appearance of the blog/website being constructed by WordPress. I wanted a simple-looking interface and selected Twenty Twenty-One to meet my needs. This is what you see when you visit the site. Spartan in appearance, to the point, clean and uncluttered.
Plugins are a different story. Simply put a WordPress plugin is a piece of code that you can “plug in” to your WordPress website to improve – or add – a specific feature on your site. Keep in mind that the WordPress Plugin Directory has over 55,000 plugins available, which have received over one billion downloads. It is not a trivial task to decide how you can best tweak your WordPress-based blog to perform to your liking. To date, here are the Plugins I have installed and are running unseen in the background:
Visitor Statistics Pro ($29.00). This is my go-to Plugin to see what traffic is coming from where. Because of this, I am going to include in this blog all that this Plugin provides from their website:
Visitor Traffic Pro version is an innovative and easy-to-use plugin for WordPress to display your site traffic statistics in detail with excellent charts.
Full reporting
Online users, visits, visitors, and page statistics
Support shortcodes. Click here to get the list of shortcodes (NEW)
Multisite (network) support (NEW)
Full GDPR
All-in-One SEO ($49.60/year for Basic). SEO, or Search Engine Optimization, takes up most of my post-post editing time. It involves tweaking the title, applying tags, meta concerns, etc., to optimize a given blog post’s probability of receiving a higher ranking by search engines. While I opted for the paid version, to date I am experiencing massive problems getting login credentials from the company.
Grammarly Premium ($151.78/year). Grammarly Premium is a paid extension/app that offers over 400 types of checks and features, checks for grammatical errors provides vocabulary enhancement suggestions, detects plagiarism, and provides citation suggestions. It helps keep my prose in order.
GoogleSiteSit Kit. While I have this Plugin installed, I am not using it to any extent, yet. See this link for additional info on the Kit.
Smush (running free version). Smush is a cloud-based service that optimizes images posted on WordPress to make them smaller in size and load faster. The free version I am running is limited to 25 MB in size. Most of the pictures I upload are larger than this so I haven’t received much value from this plugin.
TablePress (free). Supports the creation of an embedding in WordPress blog’s various types of tables. I haven’t used it yet, but when you view a table in the future you will know that this Plugin was used to create it.
As of 1/21/2023, the blog has been up for a couple of weeks now, with 14 or so posts. We have had visitors from 8 different countries viewing blog posts as follows:
A recent full-page ad in the WSJ paid for by La Foundation Publicis states that “50% of all people with cancer are afraid to tell their employers.” (WSJ 1/18/2023 p. A18) The ad goes on to state “We aim to abolish the stigma and insecurity that exist for people with cancer in the workplace.” I strongly suspect that the word “dialysis” could be substituted for “cancer” with the same implication. If people are afraid of what their employers, and by extension, the population view them as, what does that say about how they view themselves, their feelings, their mental state, and their relationships with others? Feelings are a two-way street. What single factor has been found to keep people physically stronger, minds sharper, experience less depression, less diabetes (keep in mind the strong positive correlation between diabetes and dialysis), recover from illness sooner, and generally live a fulfilled life? Sounds like a lead-in to a TV commercial for a magic pill or a snake oil sales pitch. It’s not.
For more than 85 years a group of Harvard studies has investigated what really keeps people healthy and happy, regardless of their circumstances. Particulars of this research have been published in the book shown above. It is linked to Amazon for reference and linked here also.
ONE factor in their study consistently stands out with a high explanation of ties to physical and mental health and by association longevity, and that is (drum roll please) the “enduring importance of good relationships.” The Harvard researchers found that close personal connections are the single overriding principle for living. good relationships keep us healthier, and happier. Period. End of discussion. So if you desire to be healthiest and happiest while on dialysis, cultivate warm relationships of all kinds. Reach out to your family and friends. Engage with your Dialysis Team. That’s what they are there for. Read this blog and make comments. I will respond to them. Engage your nephrologist. Prepare for our monthly televisits. Read your lab reports. Do research as much as possible to understand what they are telling you and your dialysis team. You are on the one hand your best advocate and on the other your best critic. The bottom line, get it out there and shake a hand. See the video below for a discussion by one of the primary researchers, Robert Waldinger:
In the military, we have a concept of “Having a shipmate’s six.” When someone tells you that they’ve “got your six,” it means they’re watching your back. By extension, that person expects you to have their back as well. “Got your six” is now a ubiquitous term in the military that also highlights the way military members look out for each other. The term derives from aircraft of old that could not see what was behind them. In a relative clock around the aircraft where 12 o’clock is straight ahead, and six is straight behind, having a fellow pilot’s six inferred watching out for enemy aircraft sneaking up behind them and shooting them down.
Example of getting it out there: My wife and I have a Golden Retriever named Dickens. (See picture below at 7 weeks.) Currently, he is a 7-month-old 60-pound bundle of energy that requires exercise at least twice a day. Our routine is I take him to our local Dog Park in the morning and also take him on a long walk. Obviously, this is both good for him and for me. My wife takes him for a long walk in the evening. While on our morning walk I meet lots of people who must pet a Golden and by association meet with me and share the love. I just met an ex-Navy pilot on our walk who lives close to us with a pool. He has an American Golden named Jackson who gets along perfectly with Dickens. He has invited us to exercise our Golden in his pool and interface with his family socially.
Dickens at 7 weeks
As Lavern Baker sang in the 1953 song embedded below, get out there and ‘shake a hand!’ I assure you your dialysis outlook will greatly improve. Who knows, you might get to love a Golden Retriever if you are lucky also! See you at the dog park.
United States (70)
