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Blood Chemistry, Chronic Kidney Failure (CKF), and Dialysis

January 23, 2023 / Henry Feeser / 0 Comments

Hank Feeser 1/3/2023 Labs

Blood chemistry, that is the readings obtained from lab results, is extremely important for those with CKF and/or on Dialysis. Lab results provide markers for your Nephrologist to follow in prescribing Cycler settings, as well as keeping your overall health as optimum as possible.

There are many specifics provided in lab reports, one of which is your Phosphorus level. Over time my phosphorus levels have been increasing beyond normative levels of 5.5. See lead graphic. I attempted to control and/or reduce the level via diet to no avail. Recently my Nephrologist, Dr. Turner prescribed a medication called a Phosphorus Binder.

Phosphorus binders (also called phosphate binders) prevent the body from absorbing the phosphorus from the food you eat.

Phosphorus binders help to pass excess phosphorus out of the body in the stool, reducing the amount of phosphorus that gets into the blood. Usually, phosphate binders are taken within 5 to 10 minutes before or immediately after meals and snacks.

My PD doctor prescribed a non-calcium treatment named Velphoro, which is sucroferric oxyhydroxide in a chewable tablet form, at a 500 mg level. The medication is made in Switzerland and distributed by Fresenius Medical Care North America, the company in charge of my PD care and feeding. It is Rx only. I will start taking it today. Below I’ve included a screenshot of the phosphorus section of my most recent lab report and some additional info on phosphorus.

If you are in Stage 3 or higher of CKF, I would become very familiar with your blood chemistry and what to attempt to mediate to the best of your ability.

What is phosphorus?

Phosphorus is a mineral found in your bones. Along with calcium, phosphorus is needed to build strong healthy bones, as well as keep other parts of your body healthy.

Why is phosphorus important to you?

Normal working kidneys can remove extra phosphorus in your blood. When you have chronic kidney disease (CKD), your kidneys cannot remove phosphorus very well. High phosphorus levels can cause damage to your body. Extra phosphorus causes body changes that pull calcium out of your bones, making them weak. High phosphorus and calcium levels also lead to dangerous calcium deposits in blood vessels, lungs, eyes, and the heart. Over time this can lead to an increased risk of heart attack, stroke or death. Phosphorus and calcium control are very important for your overall health.

Under the Hood: What It Takes to Run This Blog, feeser.me

January 21, 2023 / Henry Feeser / 0 Comments

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
  - Today visitors & visits chart & Today search engines
  - Recent Visitors (GeoIP location by Country, city, and region)
  - Comprehensive overview page (Dashboard), including browser versions, country stats, hits, exclusions, referrers, searches, search words, and visitors
  - Visits, see how many hits your site gets each day and each week & month, Visits time graph to view the daily visitors per hour
  - Visitors, see who’s visiting your site
  - Recent visitors by IP & region
  - Visits, see how many hits your site gets each day
  - Visitors, see who’s visiting your site
  - Page tracking, see which pages are viewed most often
  - Search Engines, see search queries and redirects from popular search engines like Google, Bing, DuckDuckGo, Yahoo, Yandex, and Baidu
  - GeoIP location by Country
  - Interactive map of visitors’ location
  - Widget to display website statistics
  - Overview page for all kinds of data, including; browser versions, country stats, hits, exclusions, referrers, searches, search words, and visitors
  - Exclude IP’s Export primary data, Pagination, and date range search
  - Exclude user role from statistics (NEW)
  - Plugin Accessibility (NEW)
  - Free Mobile App included (NEW)
  - 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:

United States (70)
Egypt (2)
Ghana (1)
El Salvador (1)
Italy (1)
Algeria (1)
Ireland (1)
Canada (1)

The order of referring sites is below:

1	https://www.google.com/	9
2	https://www.pinterest.com/	8
3	http://m.facebook.com/	2
4	https://www.facebook.com/	2
5	android-app://com.google.android.googlequicksearchbox/	2
6	http://blogpros.com/	1
7	https://www.linkedin.com/	1
8	https://lm.facebook.com/	1
9	https://blogpros.com/

Social Fitness and Dialysis: What is the most important factor?

January 19, 2023 / Henry Feeser / 0 Comments

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.

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.

VersiPD Update From Fresenius

January 18, 2023 / Henry Feeser / 0 Comments

I jumped the gun in my previous blog concerning input from Fresenius on their new Cycler. First thing this morning I received a response to my query to them two days ago about the new VersiPD Cycler. For completeness, I am first including my query, followed by their response which is enlightening. Consider the following to all be in quotes. And thanks to Jeff for taking the time to respond!

My name is Hank Feeser, and I currently am on PD via your facility in Granbury, TX. I am reaching out to you because your name was listed as the contact person on the press release back in April 22 that announced FDA approval of the VersiPD Cycler which suggested rollout starting in 22 and gathering steam in 23. (Brad bounced me to you as the current contact.)

Fresenius personnel here know nothing of the VersiPD. When I order supplies monthly for the Liberty Cycler there are no supplies listed for the VersiPD. So my question is, what’s going on with it? When might we begin to see it roll out here in Texas?

FWIW, I am writing a blog about my PD experiences. It is located at feeser.me. You can check me out at feeser.net. I am eternally grateful for the support from Fresenius. Have you ever thought about an AI-driven interface so a patient could ask questions of the cycler, like ” hey Versi, how much longer do I have on drain? That would really really help!

Thanks in advance,

Hank Feeser

Hank,

I received your email from Scott Sayres regarding the VersiPD platform FDA clearance announcement and the current status of the product.

We are in an early phase of the product evaluation in a very small early user experience. This is typical for a medical device. This early user experience is focused on 2 smaller Research Clinics to ensure that the product meets our expectations for consistent reliability. This trial will likely last the entire year of 2023.

It is not surprising that many clinics and personnel have not heard of the product today. We have not started broad based promotion. Our products are recognized in the industry for their safety, reliability, in addition to innovative design. We want to ensure that this new product achieves this same expectation before we define the timeline of broader introduction in the market.

Thanks for the recommendation on the voice activation for our systems. It is a great idea and will need to have a tremendous amount of testing to insure it is safe and reliable. I use both Google Home and Amazon Echo and while I enjoy the ease of use and assistance they often misunderstand my statements. Our goal is to continue to explore these types of technologies to provide improved ease of use and make dialysis a smaller part of a patients life.

Please let me know if you have additional questions.

Best regards,

Jeff

Revolutionizing Pertoneal Dialysis with Fresenius’ New Cycler

January 17, 2023 / Henry Feeser / 0 Comments

In April 2022, Fresenius announced FDA approval of replacing the Liberty Cycler PD machine with the VersiPD. This blog addresses aspects of this new Cycler PD machine. I gleaned most of the included information from the VersiPD Operation Manual linked in the PDF below:

480109_Rev_A Download

->To start with, it is much smaller than the current Liberty Cycler and weighs only 12 pounds compared to 30 or so for the Liberty.

–

It does not have a heating tray on top, but instead a heating bag that comes with the new cassette package and slips in a notch around the front and sides which are evident in the picture.

->The power consumption listed at 700VA (VA is the same as watts) is close to the Liberty also.

->It is controlled by enhanced firmware that is much more sensitive to drain challenges that have plagued the Liberty Cycler, is quieter, and is more customizable to a patient’s needs.

->It also uses a USB thumb drive to input a patient’s prescription, as does the Liberty, and employs a cellphone interface likewise.

->The cassette is completely revised (See last picture). More picture details are provided below.

->As you can see in the photo below of the bottom of the VersiPD, it also contains a battery. The purpose of the battery is undetermined. What is known is that it has to be replaced every two years by Fresenius personnel per the VersiPD manual.

->Not required by the Liberty Cycler is the new VersiPD must be within +/- 19 inches of the patient’s bed level.

In the picture above (from the VersiPD manual) you can clearly see the warming pouch provided with the revised cassette package. At the right you can see the different cassette configurations currently available.

I called and sent an email to the Fresenius Corporate PR Office requesting information on rollout timing, but in three days have yet to hear back. They don’t know either.

Dialysis Hints

January 16, 2023 / Henry Feeser / 0 Comments

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.

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.

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.

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.

And the next blog will be about?

Predicting Kidney Failure

January 13, 2023 / Henry Feeser / 0 Comments

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.

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.

Grim Reaper & Dialysis

January 12, 2023 / Henry Feeser / 0 Comments

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.

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

Storage Hint

January 11, 2023 / Henry Feeser / 0 Comments

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.

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.

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

January 10, 2023 / Henry Feeser / 0 Comments

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.”

Henry Feeser's Peritoneal Dialysis (PD) journey