Tag: peritoneal (Page 50 of 50)

Dialysis Hints

Over the course of being on dialysis for several months, I have initiated several tweaks to the process to save time, energy, and increase safety of the system. Today’s blog discusses four of these “system improvements.”

The cap on the end of the “Blue is you” fitting that attaches the Cycler to your catheter line can be rather hard to unscrew from its as delivered position in the cassette package. I would surmise that those with arthritic hands would find it particularly difficult to loosen. I have found that it helps to “break loose” the fitting while it is firmly in place in the stay-safe receptacle. Don’t unscrew it -> just loosen so it’s finger tight, then proceed with your hooking up to the Cycler per stated norms. The square fitting on the end of the connection is 10 mm, so having a 10 mm open end wrench by the Cycler supports this operation. I have one as shown below which I use nightly.

10 mm open end wrench

By necessity, the plastic line from the Cycler to my bed travels across the floor in front of the access door to our Master Bedroom. Especially in the dark, this is a potential tripping Hazzard for my wife’s entry and exit from the bedroom. The next two hints address this safety issue.

First of all, the line: From Amazon I purchased a product that is normally used to cover electric cords as a cover for the plastic line. Nightly, as part of the Cycler setup, I run the Cycler attachment line through the bottom slit in the cover, turn it over, and presto, the tripping hazard is alleviated. See picture below.

Line Cover

The second hazard is being able to see the cover etc. in the dark when my wife leaves or enters the bedroom. Again, from Amazon I purchased two LED motion sensor-capable lights that are placed by the door and armoire (pointing toward the bed) that turn on automatically for about 10 seconds with motion, then off. In the dark they provide an abundance of light to light up the pathway to the bedroom.

LED Pathway Light

The last item in this blog involves securing the drain line. I run the Cycler drain line to the shower in our Master Bath. It is common to tape down the drain line but cumbersome to do so. You have to get down on hands and knees to do this I’ve come up with a better way (for me) to secure the end of the drain line. My wife sacrificed a plastic bowl from the kitchen which I modified by drilling a 1/4 ” hole in the side about 1″ down from the edge. I then used scissors to cut out a “V”-shape to the drilled hole. I slip the “Yellow” plastic drain line bitter end into the V and thence to the hole to secure it. Then using the line, I just swing it into position covering the drain under the bowl face downward and I’m done. In the morning as part of cleanup I pull the bowl out of the shower, remove and cap off the line, rinse out the bowl and place it in the shower on the enclosed bench, and I’m done. Pictures follow.

Modified Plastic Bowl

Notch in bowl

And the next blog will be about?

Predicting Kidney Failure

From my history you may correctly ascertain that I spent many years on the edge of a cliff concerning when the kidney failure shoe would drop. I knew firsthand from my lab reports that my eGFR numbers were going the wrong way in conjunction with creatinine values steadily increasing. But to what extent, what timeframe, when would I have to go on dialysis as a result of complete kidney failure? Being an engineer and a Purdue Krannert School of Managment PhD I wanted numbers, probabilities, etc. No doctor even came close to a WAG (Wild-ass Guess) let alone a statement like “The probability is 0.62 that you will not require dialysis for at least five years.) I was just told that there is no cure and it’s only going to get worse.

Edge of Cliff

This blog will fix this gap for readers willing to gather some common lab numbers and click boxes on a website or iPhone/Android app. You will be empowered to calculate what I just laid out above on your own, and to play “what-ifs” with creatinine and other lab variables. For example, how high does my creatinine have to increase to put me in a high-risk category for dialysis? Rather than the current state of worry because your creatinine readings are going south placing you in a static kidney failure category without any indication of timing of pending failure, you will know where the cliff’s edge is. And failure is pending; kidney failure WILL happen if you live long enough to ring the bell. Trust me, I arrived there after thirty years of being under the gun or being on cliff’s edge.

There is a web site named MedCalc that provides free access to hundreds of medical -related calculations. The one of interest herein is by a MD/PhD by the name of Navdeep Tangri and is named

Kidney Failure Risk Calculator

It predicts progression to kidney failure in patients with chronic kidney disease (CKD) and is located at this link. It requires inputting the following information: eGFR, sex, urine albumin-to-creatinine ratio, age in years, albumin, phosphorus, bicarbonate, and calcium. These values are common to labs reports for those with failing kidneys. The output provides an estimate of your five-year risk of experiencing kidney failure. The embedded screenshot below is my result.

Since I am already on dialysis after experiencing greatly diminished kidney functioning, we would expect the dire results thus obtained. Try the algorithm. You might be enlightened.

MedCalc Logo

Grim Reaper & Dialysis

It is normal human nature to raise the question, “Now that I am on dialysis, how does this alter my lifespan?” For me at 84, I have three choices: Dialysis, Heart Transplant, or death. That simple. I chose not to pursue a transplant for one main reason – at my age younger people have much more to gain and potentially give back to society than I have so I defer to them. While I have ruled out a transplant, that does not mean I still can’t give a little back to society, this blog being an example. So it boiled down to Dialysis for me.

But this still begs the question, how has and is dialysis impacting my lifespan, or how much longer statically I will live. In 2018, adjusted mortality was more than twice as high among Medicare beneficiaries ages 66 years or older with CKD (96.0 per 1,000) compared with those without CKD (41.0 per 1,000). According to data from the U.S. Renal Data System, the chart below follows:

  • 70- to 74-year-olds on dialysis live 3.6 years on average, compared with 12.2 years for their healthy peers;
  • 75- to 79-year-olds on dialysis live 3.1 years on average, compared to 9.2 years;
  • 80- to 85-year-olds on dialysis live 2.5 years on average, compared to 6.7 years; and
  • Patients on dialysis ages 85 and up live two years on average, compared to 3.5 years for their healthy peers.

A check on the above is provided by the SSA with a web site in which sex and date of birth are entered to ascertain how numbered your days are. Mine is shown below from their site:

In researching background for this blog, I discovered that there is no simple answer to the question of how dialysis impacts life span. There are so many what is called in statistics “intervening variables” as to defy meaningful computation. A few of these variables are sex, confounding health conditions (approaching unique for each individual), ethnicity, race, age, age upon onset of dialysis, mental approach to dialysis, etc.

However, I did discover research from a group in Canada shown below that provides some interesting data. I fall in the last row of the bottom chart. Obviously being a diabetic AND on Dialysis loaded heavily in their predictive modeling. The last bottom row suggests I have a 4.1% chance of living 10 years after starting dialysis. I’ll take the odds.

Survival Estimates

Bottom line: All of us have a need to be exceptional, don’t we?

Storage Hint

Today being Wednesday, it was time to restock our Ready Service Locker (RSL) with a week’s worth of Cycler supplies. Specifically, 5L dextrose bags, 3 L 1.5 % bags, 2.5 % 3 L bags, and cassettes for the following seven days. We moved the associated boxes and gear from our monthly storage unit in the spare bedroom to the Cycler area.

Making Ready for resupplying our RSL

When your start to open the boxes containing the dextrose fluid for the Cycler, you will notice a large warning not to use a box cutter to open the box.

Box Warning

The short video embedded below shows you how to open the boxes without any possibility of damage to the contents.

Safely Opening Boxes

After opening the boxes, they are unloaded into the four bottom right divisions as shown in the last picture below, with the heavier 5 L bags in the bottom two divisions, and the lighter 1.5 and 2.5 gabs in the upper two divisions. We have moved the cassettes to the shelf under the Cycler so that they don’t have to be bent 180 degrees for storage.

Power Backup Dialysis Cycler

I have seen various takes on the requirements to provision backup power for the Dialysis Cycler (and most of it out in left field.) The purpose of this blog post is to provide my input to this concept (BS/MSEE Purdue University.) The image below from the Cycler Manual shows the max power at USA’s nominal 115vac public power to be 480 watts. Keep in mind that this is MAXIMUM.

What does it take to feed a 480-watt load for say 11 hours (my Cycler times have been in general between 10 hours 25 minutes and 10 hours 50 minutes?) In this case, I am going to address battery backup in the form of a UPS (Uninterruptable Power Supply.) We need to feed a 480 watt load with nominally 115 vac for 11 hours. These are our parameters for calculating the number of and Amp-Hour requirements for batteries for our UPS, as well as the Invertor to invert 12 volt direct current from the battery(ies) to 115 vac.

Luckily for us, there are several USP Calculators available on the web. I have linked the one we will be using. We have to use iteration (try values until desired results are obtained) in the panel.

In the UPS panel, I inputted our power of 480 watts, available battery amp-hours of 200, and number of 200 amp-hour batteries at 3 to obtain the 11 hours 32 minutes runtime which would cover our requirements. From this we have calculated that we require three, 12-volt 200 amp-hour batteries. Turning to our universal off the shelf place, Amazon, we find that Renogy makes such a battery for $359.99 each, or about $1180.00 for the three.

The inverter of at least 600-watt capacity is also sourced from Amazon. A 600-Watt Pure Sine Wave Inverter goes for $78.70.

We need one more component to kluge together a UPS for our Cycler, a trickle charger to keep the batteries up. Amazon has one of these fitting the bill (10-Amp Car Battery Charger, 12V and 24V Smart Fully Automatic Battery Charger Maintainer Trickle Charger w/ Temperature Compensation for Car Truck Motorcycle Lawn Mower Boat Marine Lead Acid Batteries) for less than $27.00.

So, for $1180 + $79 + 27 = $1286 plus tax etc. you can build a healthy UPS that will run your Cycler for a complete Dialysis. You will also have to provide some battery interconnecting cables. Or you can buy a small gas generator such as a Honda 1000, or a new Ford truck with EV and plug into it, or……? You are in “charge.”

Introduction:

Welcome to my blog which is dedicated to sharing my personal experience in traveling the road from a healthy US Naval Officer to a Home Dialysis patient.

 

Background: From December 1971 to October 1972, I served In-Country Vietnam as a USN Naval Advisor to South Vietnam’s Brown Water Navy. As such I traveled extensively throughout Central and South Vietnam’s riverine areas where I was subjected to exposure to Agent Orange. Subsequently I developed Type 2 diabetes which I first was able to control with diet and exercise, then oral medication, and finally insulin. This took place over about a thirty-year timeframe. In the early nineties my GP at the time observed that my eGFR (estimated glomerular filtration rate, a measure of how well the kidneys are functioning) was on a downward trend (not good) and passed through the 60-threshold level indicating pending kidney failure. Some 28 years later, my eGFR reached the 6 level, I felt like crap, and suggested to my Renal Specialist Dr Turner that it was time to move on to dialysis to which she agreed. 

 

On 8/20/22 I started Hemodialysis with Fresenius Granbury, TX which lasted until 9/24/22. On 9/26/22 I started training at Fresenius for PD (Automated Peritoneal Dialysis also known as CCPD, or continuous cycler-assisted Peritoneal Dialysis) and on 9/30/22 accomplished my first at home PD treatment and have been doing so every night since. 

 

I am an engineer (see www.feeser.net for more details on my background) and as such, have been “engineering” small tweaks and making observations concerning the entire PD process. It is the purpose of this blog to document and pass on to those just starting or already on the same path as I am traveling perhaps to lighten the load for some, to share like experiences with others, and just inform others as to what PD is all about.

 

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