In review, last week I traveled to Ft Worth for a nuclear stress test on my heart. The results were available this past Saturday. The salient part of the reported result is quoted below:
“Procedures Date Name Performed by 10/16/2024 Tte W/doppler Complete Notes: Studycast study 52688127 conclusions (added Sat, 19 Oct 2024 11:26:29 -0400) Normal LV systolic function with EF 53%. Left ventricle cavity is normal in size. No significant wall motion abnormalities in the areas visualized. Left atrial cavity is normal in size. No significant wall motion abnormalities in the areas visualized. Left atrial cavity is moderately dilated at 4.9 cm. RVSP measures 21 mmHg. Impaired left ventricular relaxation”
So what does all this gibberish mean? I copied the above text to Google’s NotebookLLM where I received the following plain English summary:
The patient’s cardiovascular health status presents a mixed picture with both positive and concerning aspects. Positive Findings: ●The patient’s left ventricle (LV) exhibits normal systolic function with an ejection fraction (EF) of 53%, indicating the heart effectively pumps blood out to the body. ●The left ventricle is also normal in size, and no significant wall motion abnormalities are observed in the visualized areas. ●The right ventricular systolic pressure (RVSP) is measured at 21 mmHg, which falls within the normal range. Concerning Findings: ●Despite normal LV function, the patient exhibits impaired left ventricular relaxation. This suggests a problem with the heart’s ability to fill with blood properly during the relaxation phase (diastole). ●The left atrium is moderately dilated at 4.9 cm. This enlargement may result from impaired relaxation of the left ventricle, as blood backs up into the left atrium. Overall: The patient’s cardiovascular health status is not entirely healthy. While his heart is pumping efficiently, the impaired relaxation and dilated left atrium raise concerns. These findings could be indicative of conditions such as diastolic heart failure or other cardiac abnormalities. Further investigation and monitoring are likely necessary to determine the underlying cause and appropriate management for this patient’s cardiovascular health.
It will be interesting to hear what the cardiologist has to say about all of this during our teleconference later this week which I will share. Keep in mind I am an 85-year-old veteran on 100% disability who was exposed to Agent Orange in Vietnam, have had a triple bypass and am currently on PD. In this regard, I bet that we will get a “Let’s keep an eye on it.”
Last week I had an interesting conversation with someone from my (previous) Continuous Glucose Monitor (CGM) supplier. They called initially to inform me that they needed a new script to supply me with Libre 3s for the next year. I wrote a text to my GP requesting they contact the supplier which they did. The supplier got back to me and informed me that I was NOT eligible to receive Libre3s via Medicare now because the FDA had not approved them for use by patients on dialysis, regardless of the type, hemo, or PD.
Seems that inaccurate results were being provided by the Libre3 CGMs. I can vouch for that. For at least 6 early mornings in a row last week I was awakened to a low glucose alarm while I felt fine and knew such NOT to be the case.
So now, at least, it’s back to the finger prick, method of yesterday to ascertain my glucose. And this is in the age of AI etc. It just doesn’t seem right.
It is always of interest to me as a quasi-researcher where today’s topic title is headed. I quizzed my Perplexity-Pro subscription with the title as a prompt and this is what returned:
The number one topic in peritoneal dialysis (PD) research today appears to be the management and prevention of complications, particularly peritoneal dialysis-associated peritonitis (PDAP), as well as improving patient outcomes and quality of life.
Peritoneal Dialysis-Associated Peritonitis (PDAP): PDAP is a significant complication of peritoneal dialysis that leads to increased morbidity and mortality. Research is focused on understanding its epidemiology, risk factors, and economic implications and developing strategies to reduce its incidence and improve treatment outcomes[2]. This includes examining hospital-level factors influencing PDAP outcomes and exploring interventions to mitigate these risks.
Life Participation: Another emerging area of interest is enhancing life participation for patients on PD. This involves interventions aimed at improving the ability of patients to engage in valued life activities, which has been identified as a top priority by patients themselves. Research in this area seeks to address cognitive, affective, and environmental barriers to participation[5].
Patient Education and Training: Ensuring that patients are well-informed about their treatment options and the management of PD is crucial. Studies emphasize the importance of patient education in choosing PD over other modalities, as well as ongoing training to manage PD effectively at home[3].
Technique Survival and Quality of Life: The Peritoneal Dialysis Outcomes and Practice Patterns Study (PDOPPS) aims to improve technique survival and quality of life for PD patients by studying clinical practices globally. This research is crucial for identifying best practices and standardizing care across different regions[1].
These topics reflect a broader trend in PD research towards optimizing patient outcomes, minimizing complications, and enhancing the overall quality of life for individuals undergoing this form of dialysis therapy.
This past Monday and Tuesday, the Fresenius Complaint people contacted me regarding my letter to their CEO, Helen Giza. Their interest was strictly limited to ascertaining the nature and extent of my complaint(s). This arm of Fresenius has nothing to do with the resolution of any shortfalls but only acts as a fact-gathering, independent agency within Fresenius.
During Monday’s call, the complaint-gathering person made a statement that is really bothersome to me as a patient. She stated that Fresenius bears no responsibility for the cassette fiasco in that it was perpetuated by a vendor and they had nothing to do with it. I cannot explain all the ways this does meet any smell test. The CEO of Fresenius is a bean counter – background in accounting and finance – it is a given that the C-Suite is under the gun to keep costs down. Given price pressures on vendors, their response, much like we see at the grocery store and reduced amount of product in a package at the old price, is to cut corners to maintain their margins. How this took place without recognition by Fresenius continues to be a mystery.
In that Fresenius is still in the “fact-gathering phase” of resolution, I don’t see any merit to rumors on such places as PatientHub that Fresenius will be going back to the former cassettes in the short term. Perhaps this is based on wishful thinking.
In today’s blog, I am straying from peritoneal dialysis to present readers with a source of predictive data about future events, such as the US presidential election. First, I will present what Perplexity has to say about Polymarket.com, then show you some screenshots about the coming presidential election. This is not a political statement but is meant to provide readers with the latest tools to spread knowledge.
Polymarket.com has emerged as a prominent player in the world of prediction markets, offering users a unique platform to trade on the outcomes of real-world events. Founded in 2020 by Shayne Coplan, Polymarket has quickly gained traction as a decentralized information market that leverages blockchain technology and the wisdom of crowds to forecast future events57.
How Polymarket Works
Polymarket allows users to buy and sell shares based on the likelihood of specific outcomes occurring. The platform covers a wide range of topics, including politics, sports, pop culture, and science5. For example, in the current 2024 U.S. Presidential Election market, users can trade on the likelihood of various outcomes, with prices reflecting the perceived probabilities1. The platform operates on the Polygon blockchain, ensuring transparency and security in transactions4. Users can deposit USDC cryptocurrency to participate in the markets, with share prices ranging from $0 to $1, representing the probability of an event occurring.
Accuracy and Performance
Polymarket has gained a reputation for accuracy in predicting outcomes, often outperforming traditional polls and surveys. This accuracy is attributed to the “wisdom of crowds” principle, where collective intelligence tends to produce more accurate forecasts than individual experts7. Notable figures have praised Polymarket’s predictive power:
Elon Musk, the billionaire entrepreneur, recently stated that Polymarket is “more accurate than polls, as actual money is on the line”8.
Thomas Miller, a data science professor at Northwestern University, asserted that “Political betting websites excel in reflecting the collective intelligence of the public”3.
The platform’s accuracy has been particularly notable during significant events like the 2020 U.S. Presidential Election, attracting considerable attention and trading volume5.
Growth and Funding
Despite facing regulatory challenges, including a $1.4 million fine from the Commodity Futures Trading Commission in 2022, Polymarket has continued to grow and attract investment25. In 2024, the company raised $45 million in a Series B funding round led by Peter Thiel’s Founders Fund, with participation from Ethereum co-founder Vitalik Buterin5.
Current Status and Future Outlook
As of October 2024, Polymarket has become a significant player in election forecasting. The platform has seen over $1.9 billion wagered on the 2024 U.S. Presidential race alone4. To enhance its credibility and expertise, Polymarket has brought on board notable figures such as Nate Silver, founder of FiveThirtyEight, as an advisor4. While Polymarket continues to operate its election prediction markets offshore due to regulatory constraints, it has shown resilience and adaptability in the face of challenges. The platform’s growing popularity and perceived accuracy suggest that it may play an increasingly important role in shaping public understanding of event probabilities and outcomes in the future. As prediction markets like Polymarket continue to evolve, they offer a compelling alternative to traditional polling methods, providing real-time insights into public sentiment and event probabilities across a wide range of topics9.
I wrote today’s blog as much for me as readers of the blog. While I have never had Peritonitis, I know research has shown it to be the number one most serious problem PD patients face. Below is a summary of my research taken from Google’s NotebookLM and accompanied by a Podcast of the findings. Below that is the original seed I obtained from the DoctorSage Bot in Poe that I fed into NotebookLM.
Summary
This Podcast explains the serious health complication of peritonitis, which is an inflammation of the peritoneum lining the abdominal cavity. It focuses on the specific dangers of peritonitis for patients undergoing peritoneal dialysis, as it can significantly impact the effectiveness of their treatment. The Podcast then delves into the causes, symptoms, diagnosis, treatment, and prevention of peritonitis in peritoneal dialysis patients, highlighting the importance of proper hygiene, technique, and regular medical check-ups to minimize the risk of developing this complication.
Peritonitis is an inflammation of the peritoneum, the abdominal cavity’s membrane. For patients undergoing peritoneal dialysis (PD) , peritonitis is a significant concern, as it can lead to severe complications and impact the effectiveness of the dialysis treatment. This blog post aims to provide a comprehensive overview of peritonitis, including its definition, causes, symptoms, diagnosis, treatment, and preventive measures specifically for PD patients.
What is Peritonitis? Peritonitis is an inflammatory response of the peritoneum, which can occur due to infection or other irritants. In the context of peritoneal dialysis, peritonitis often arises from bacterial infection introduced into the peritoneal cavity through the catheter used for dialysis.
Causes of Peritonitis in PD Patients Bacterial Infection: The most common cause of peritonitis in PD patients is the introduction of bacteria during the exchange process. Common pathogens include: Staphylococcus aureus Streptococcus species Escherichia coli Pseudomonas aeruginosa Non-infectious Causes: While less common, peritonitis can also result from: Chemical irritation from dialysis solutions. Presence of foreign bodies or materials in the peritoneal cavity. Pancreatitis or other inflammatory conditions affecting the abdomen. Symptoms of Peritonitis Patients should be vigilant for the following signs and symptoms, which may indicate the onset of peritonitis:
Abdominal pain: Often diffuse and can be severe. Fever: Elevated body temperature (typically above 38°C or 100.4°F). Nausea and vomiting: May accompany abdominal discomfort. Changes in dialysis effluent: Such as cloudiness or the presence of an unusual odor. Decreased appetite: Often a result of discomfort. Diarrhea: Sometimes present, although not universally. How to Ascertain if You Have Peritonitis Diagnosis of peritonitis typically involves:
Clinical Assessment: A thorough history and physical examination by a healthcare professional. Dialysate Analysis: Examination of the peritoneal dialysis effluent for: Cell count: An elevated white blood cell (WBC) count, especially with a predominance of neutrophils (>100 cells/mm³), suggests infection. Gram stain and culture: To identify the causative organism. Biochemical analysis: To check for glucose and lactate levels. Blood Tests: To assess for systemic infection, including: Complete blood count (CBC) Blood cultures Treatment of Peritonitis The treatment of peritonitis is critical and typically involves:
Antibiotic Therapy: Empirical (initial) antibiotics are started promptly, and adjustments are made based on culture results. Common regimens include: Intravenous antibiotics for severe cases. Intraperitoneal antibiotics for mild to moderate cases. Supportive Care: This may include: Pain management. Volume resuscitation if needed. Nutritional support. Catheter Management: In some cases, the PD catheter may need to be removed or replaced, especially if the infection is recurrent or severe. Surgery: Rarely, surgical intervention may be necessary if there are complications such as abscess formation or bowel perforation. Prevention of Peritonitis Preventing peritonitis is crucial for PD patients. Key strategies include:
Proper Technique: Adhering to strict aseptic techniques during dialysate exchanges. Training and Education: Patients should receive comprehensive training on PD techniques and recognize the signs of infection. Regular Follow-ups: Frequent check-ups with healthcare providers to monitor for potential complications. Good Hygiene: Maintaining clean hands, catheter site, and surroundings. Conclusion Peritonitis remains a significant risk for patients on peritoneal dialysis, but with proper knowledge and preventive measures, the risks can be minimized. Understanding the signs and symptoms and prompt treatment are essential in managing this potential complication. Regular communication with healthcare providers and adherence to recommended practices will enhance the safety and effectiveness of peritoneal dialysis.
Key Takeaways: Peritonitis is a serious complication of PD, primarily caused by bacterial infections. Symptoms include abdominal pain, fever, and changes in dialysate appearance. Diagnosis involves clinical assessment and analysis of dialysate. Treatment typically includes antibiotics and supportive care. Prevention focuses on aseptic technique and patient education. By remaining vigilant and proactive, PD patients can significantly reduce their peritonitis risk and ensure better dialysis treatment outcomes.
The following Podcast discusses learned helplessness, a psychological phenomenon where individuals believe they have no control over their situation, and its implications for solo home peritoneal dialysis patients. These patients, responsible for their treatment, can experience feelings of helplessness due to the demanding nature of their routine, the fear of complications, and isolation. The Podcast explores how long-term dialysis can exacerbate these feelings, leading to a cycle of learned helplessness. Finally, it emphasizes the importance of addressing this phenomenon to promote patients’ well-being and improve their treatment outcomes by empowering them to take control of their health through education, training, and psychological support.
A website named www.homedialysis.org has some good info for everyone involved with or concerned about dialysis. One of the bits of information offered is a resource named PATH-D. PATH-D was developed to help patients and caregivers codify who is responsible for what regarding the care and feeding, so to speak, of all the effort that goes into adding up to successful dialysis. The site states “…PATH-D acts as a behavioral contract between the patient and the partner that explicitly defines the tasks at hand and determines what tasks each person is willing to take on.” If you read down the list, you can get a feeling of all that is involved in successful PD if nothing else. A PDF of PATH-D is available below:
As previously reported, I am scheduled to undergo several tests regarding the condition of my heart and associated plumbing in the next couple of weeks. In this blog, I will share how I generally feel and how this supports the supposition that something is most likely awry.
During a routine annual physical in 2015, my GP saw something on my EKG that was worrisome to him. Sent to a cardiologist who subsequently ordered a treadmill test, I was found to have a blockage which was remediated with a triple bypass. I had no idea anything was amiss and was living a fun-filled life in Corpus Christi which included lots of hours on the water in our and other sailboats/yachts. This is also before my eGFR going south. So it’s been over nine years since my last go around and statistics suggest if I’m going to have problems again, I’m in the window for the same.
But how do I feel this time around? Is it age? After all, I am 85. Is it dialysis pulling me down? Is it a combination? Will we ever know? Let me provide a little insight. When I attempt to accomplish anything even approaching work, I can go for 15-20 minutes and then have to take 5. I seem to rebound fairly quickly and can continue for some time before having to rest longer. My mind still plans all these things I want and intend to accomplish but the body is unable. While not prone to falling, I now have to be careful when walking and do not have the sense of balance that I formerly had. I’m not to the cane stage as of yet but have one just in case. And on and on.
As a group, those of us on PD tend to be older. With age comes a need, no, a requirement, to schedule appointments with a wide variety of doctors more frequently. I am entering such a phase.
This week I have an appointment to have an Ecogram done as a preliminary to checking out my heart. I also am scheduled to have the stitches removed from the surgery to remove the basil cell cancer on my left temple. The following week I have an appointment with my audiologist. My left hearing aid stopped working followed the same day by I hope, minor surgery to remove yet another cancer cell under my left chin. This is followed by an appointment to do a chemical stress test to ascertain more about my heart condition and then at month’s end a video conference with my cardiologist to discuss what all of the tests previously conducted portend for me. That is, where do we go from here?
This leads to introspection, and my mantra in writing this blog is Never Ring the Bell, adopted by US Navy SEALs. For them and me, this symbolizes perseverance and resilience. To do otherwise is to take the easy way out for those who wish to quit. Not ringing the bell is crucial for overcoming life’s obstacles and achieving success, while quitting leads to lifelong regret, and in the case of those of us on PD, potentially death.
This dude will never ring the bell. Bring it on! And yes, I made and make our bed every day suggesting there will be a tomorrow.
