There is not much new to report on the dialysis front. My weight was 145.2 this morning which rounds to 145 my ideal dry weight. For last night, I stayed with all 1.5% solution. I’m still trying to work more protein into all meals with some degree of success. My lawn crew is here and I’ve asked them to trim our Japanese box plants and Holly bushes. Our high school lad is still chipping away at going through our flower beds and weeding them. Earlier in the day I mowed and my wife started pulling mulch slightly back from all the zinnas we have planted, some sixty or so. She also worked with our lad to clean out debris from our gutters. She is a very hard worker and now runs circles around my dialysis bod. I’m so lucky to have been married to her for now OVER 62 years. Out.
As mentioned in yesterday’s blog, I did contact my dialysis team nurse, requested several boxes of 2.5% 2-liter static dialysis fluid, and picked up four boxes this morning. So now time will tell if I can control my weight using only the 2.5% static bags. Having said that, I would like to inform readers that for an 85-year-old 100% disabled Navy Vet, I am feeling exceptionally well at this point, working hard in the yard, and looking forward to living. Yes I have to pace myself, and yes I have to rest regularly, but things are getting done. I even laugh and smile occasionally. Life is good.
Yesterday exactly on time as advertised, our roofer and the USAA Insurance estimator showed up and investigated hail damage on on roof from the May 9 hail storm previously reported. The estimator found that our roof had sufficient damage from the storm to necessitate replacement, along with several of the gutter guards, and the door to our single garage also has dents in it. All of this info was sent back to USAA and I have been informed (via phoncon 5/14/2024) that our claim is in the mill and should be completed within a matter of day.
Lastly for today’s blog, after years and years of a certain cereal for breakfast, in response to constant nagging as a result of my labs reporting I need more protein, with the help of my wife, I’ve worked eggs and sausage into my breakfast routine. I’ve also included “smear case” for supper on occasion.
Just about everything in Texas is bigger, even HAIL. This past Friday around 1635 the skies opened up and here in Pecan Plantation, depending on where you live (we are about 4400 acres), a golf-ball to softball-sized hail storm passed through, lasting about 10 minutes. Boy did it rip things up. No sooner than the last hail had bounced off roofs, the roofers were coming out of the woodwork, harking their particular company for roof replacement work. We got ahead of the curve, notified our home insurance agent at USAA, have an adjuster scheduled for 10-11 AM today, and a reputable local roofing company on call to also work with the adjuster. The roofing company’s rep came out Saturday and inspected our roof and said it needed replacement. We have three skylights, and the storm took out all three. What you don’t know is that the roof is only three years old having been replaced previously due to hail damage. So here we go again.
Here is a link to a DFW article about the damage in Pecan Plantation. Below is a short video I shot during the hail storm. It is shot from our front porch.
As scheduled, we received our monthly supply delivery from Fresenius. Our storage space is filled to the brim. The first photo below shows the “Ready Service Locker ” adjacent to the Liberty Cycler in our Master Bedroom. I currently use two bags of 6-liter fluid every night, so our locker holds ten nights’ worth of fluid.
The photo below is of a closet in a bedroom adjacent to the Master. In it, we store all of the bulk of fluids. To the right in the picture is our supply of 1.5% 6-liter bags; on the floor under the center shelving are the eight 2.5% 6-liter supplies I will be working in to help alleviate my weight gain; to the left are the 2-liter static bags I use in the early evening. As you can see, it makes up quite a bit but keep in mind I’m using one box of 6-liter every night so it goes down rather quickly.
Yesterday I alluded to mashing up a quick video of some of the yard work that my wife and I are engaged in. At this time of year in North Texas, we have to get out early or late to escape the heat. At 1:30 PM it is currently 86F with high humidity; tomorrow the high is predicted to be 92F so you get the idea. Our property is 0.5211 acres, more or less, with 15 or more flower beds. It is a handful to attempt to keep up with but we are doing just that. We have professional mowers on call, and a hit-and-miss high school lad helping us. It is still rather daunting but isn’t life itself? Keep-up is not in the cards nor is staying even but that’s what challenges are all about, right? Above all else, it makes for a very good counterbalance to the requirements of peritoneal dialysis. Here’s the short of what we have been working on:
I am scheduled for a Monthly Dialysis Team Meeting this Thursday at 0845. I don’t expect any surprises as we have been in the groove, so to speak, except for my concern about weight which appears we are approaching a solution. After using 2.5% 2000 mL for my static Sunday night my weight dropped from 148.4 to 148.0 and ultrafiltration was over 1000. We’re headed incrementally in the right direction.
Regarding my labs: My Albumin dropped to 3.4 from 4 so is below desired. My Calcium dropped to 8.2 from 8.7 and is below desired. My Glucose was 84 down from 149; I didn’t eat any breakfast before labs this time which explains this reading. Interestingly, my Creatinine was 8.76, down from 9.22 and “going in the right direction.” This maps to an eGFR of 5 putting me still in the toilet.
We’ve been steadily working in the yard. This AM my wife and I planted eight Lantana and used a pick to remove some rusted steel bed edging. Our twelve Roma tomato plants all have blossoms and are looking very healthy. A short video clip will be provided in a couple of days. I still get winded easily and have to rest frequently but we’re “gettin’ ‘er done!”
As previously reported herein, since I have been using only 1.5% fluid for my peritoneal dialysis, my weight has crept up from a target dry weight of 143 pounds to 149. Last week, I called Fresenius Supply and am to receive, in addition to my regular supply order, an additional 8 boxes of 6 liters of 2.5% solution.
Before this gets too confusing, let’s review: My current prescription for PD using the Liberty Cycler is a single manual fill of 2 Liters at approximately 6 PM followed by hooking up to the Cycler at about 9:30 PM where there is a drain, followed by four fill/drain cycles of 2700 mLiters each, or a total of 10,800 mLiters. Following this routine/prescription, my last adequacy test of Kt/V of 1.98 is acceptable. My dialysis is working and the Kt/V suggests is adequate.
To preclude leg cramps, I tend toward using a 1.5% solution for all of my PD. My weight gain suggests this does not result in pulling enough fluid. Previously when I was mixing 1.5 and 2.5% solutions, my ultrafiltration, a measure of how much fluid is being removed, was consistently over 1000; now, with 1.5%, it is as low as 378 but mostly in the 6-800 range. The obvious solution is to work in more 2.5% solution but how much is the question?
When the 2.5% 6 liter arrives, I intend to work in a 6 Liter bag of 2.5% every other night as a starting point. I use two 6-liter bags per night, so this will be providing roughly half of the required fluid. Meanwhile, while straightening out our supply closet, I found five 2 Liter static bags and used one of them Saturday evening for my static fill. Sunday morning my weight, which for the last three mornings was 149.0, dropped to 148.4, and my ultrafiltration jumped up to 1109 from 654. This suggests to me that perhaps I can alleviate my weight gain by just using the 2-liter static fill at 2.5%. I did have a slight leg cramp but not of the severity that I had to get up out of bed and walk around. I will be using the 2 liter 2.5% bags for my static fill until Wednesday. I’ll let you know how it goes. There is no formula for this stuff, just cut and try as it were.
Yesterday morning when I weighed myself as part of the routine for completing the night’s peritoneal dialysis, I weighed 149.0 pounds, up in a couple of weeks from 143.0. As I previously mentioned in a former blog, I am using only 1.5% dialysis solution which appears to not pull enough fluids out. I am strongly considering by hook or crook coming up with enough 2.5% fluid so that I can start working it into my daily PD treatment. Meanwhile, I asked Poe about weight and PD with the following results which are enlightening:
Weight management is a crucial aspect for patients on peritoneal dialysis (PD). Maintaining an appropriate weight helps optimize dialysis effectiveness, manage fluid balance, and promote overall health. Here are a few key points regarding weight management in PD patients:
Fluid Balance: PD involves the exchange of fluid in the peritoneal cavity to remove waste products and excess fluid from the body. Weight gain between dialysis sessions can indicate fluid retention, while excessive weight loss can indicate inadequate fluid removal. Close monitoring of weight helps in achieving optimal fluid balance.
Ultrafiltration: Ultrafiltration refers to the removal of excess fluid during dialysis. It is an important parameter for managing fluid balance in PD. The prescribed ultrafiltration target is based on a patient’s individual needs and is often calculated as a percentage of their dry weight. Regular weight measurements help healthcare providers adjust the dialysis prescription and ensure appropriate fluid removal.
Nutritional Status: Weight changes in PD patients can reflect alterations in their nutritional status. Significant weight loss may indicate malnutrition, while weight gain can suggest overeating or excessive calorie intake. Maintaining a healthy weight is essential for ensuring an adequate nutritional status in PD patients.
Cardiovascular Health: Excessive weight gain in PD patients can strain the heart and lead to increased cardiovascular risks. Conversely, rapid weight loss may be associated with muscle wasting and a weakened immune system. Moderate weight loss, if necessary, should be achieved through appropriate dietary modifications and under the guidance of healthcare professionals.
Diabetes Management: Many PD patients have underlying diabetes, and weight management is crucial for glycemic control. Achieving and maintaining a healthy weight can contribute to better glucose control and reduce the risk of complications associated with diabetes.
It’s important to note that weight management should be individualized based on a patient’s specific needs and goals. Regular monitoring of weight, along with close collaboration between patients, healthcare providers, and dietitians, is essential to optimize outcomes for PD patients.
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.
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.
