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New Cycler Alarm

January 10, 2023 / Henry Feeser / 0 Comments

I have been on Dialysis using the Fresenius Liberty Cycler for over three months. Last night was just another night, until. Until after hooking up to the Cycler per usual and going to bed, the Cycler screamed at me with a blaring alarm with its “Stop” button flashing. Thought what the hell now?

While my wife broke out the manual in an attempt to ascertain what was going on, I checked every obvious possible conflict point of origin to no avail. See chart from manual below. Yes, I triple-checked everything and even installed new 5000 ml and 3000 ml dextrose bags. Still throwing “Slow Fill” warning.

Bottom line, the procedure could not go on, we had no fault codes to indicate what was happening, other than a screen display “Slow Fill” and alarms. Having been through the song and dance with tech support before – you have to spend an inordinate amount of time filling them in on the boiler plate of your setup before resolution is even attempted (which to a degree I understand), I shut the Cycler down, went through the lost power sequence at boot up, and effected a startup as if from scratch with new bags and new cassette.

This fixed things for me, and I was able to get some sleep after over an hour of wrestling with the “Slow fill” alarm. What caused it? Who knows, maybe the bugs of Cycler Past?

Last Component of our Dialysis Setup: Master Bath

January 9, 2023 / Henry Feeser / 0 Comments

Our Master Bath is used in two instances in support of my PD treatment. First is to undress and dress my catheter area before and after showering; the second is to cleanse my hands prior to making ready to hook up to the cycler at night. The following items are positioned on or in the sink area of the Master Bath:

Health Guard Antibacterial Hank Soap
ExSept Antimicrobal Exit Site Skin & Wound Cleaner
Gentamicin Sulfate Cream by Perrigo
Paper Towel
2×2 gauze pads
Band-Aid Small 2×2 padded gauze pad
Q-tip
1-minute Timer (to time evening handwashing)
Tape
Lanyard

The following embedded video depicts use of the above itmes:

In & Out Showering with Dialysis Gear

My PD Setup: Standalone Workstation + Ready Service Locker

January 7, 2023 / Henry Feeser / 1 Comment

This bog entry addresses two aspects of our PD setup; what in the Navy is referred to as a “Ready Service Locker (RSL),” an area in which supplies that are to be used shortly and/or daily are stored usually in close proximity to where their end use takes place, and secondly, an added combination table/storage area that is used daily in preparation for hooking up to the Cycler.

First our RSL: We have adjacent to the Cycler and the Cycler prep area an Armoire in which we typically store linens. It has six divided sections in the top half which nicely house a week’s supply of 5L and 3L dextrose bags, and cassettes for the Cycler. As part of my morning disconnect from the Cycler, I breakout new dextrose bags and a new cassette and place on the Cycler for that night’s use. I don’t open the cassette plastic bag until evening when I set up the Cycler for that

Armoire

night’s run. See left picture. In the picture to right you can see the supplies in the bottom four sections of our armoire. Once a week, usually on Wednesday, our recycling day, I break out 3 or 4 boxes of 5L, one box of 3L 1.5 %, and one box of 3L 2.5 % solution along with seven cassettes and load the RSL. I have to fold the cassettes to get them into the armoire so I can close the doors which does not harm them in any way.

Combination Work and Storage Area adjacent to our armoire TSL and Cycler:

We have a white cabinet from Wayfair that was originally intended to be used in a kitchen that has a natural wood-finish top, two drawers, a storage area to the top left and a paper towel holder to the right, four doors in the front and one shelf therein. I use the top area every night, twice, once to break out supplies to use to clean and administer to my stomach catheter after showering, and once to prepare to hook up to the Cycler at night.

The following will be detail-laden but is of upmost importance to those embarking on a dialysis journey – you have to have ready access to needed and/or required components of the treatment. For ready access on the top of the work area I have:

Face masks
Aniosgel Hand Sanitizing Gel Hands Rub (Used after a medical 2-minute wash of hands)
Alcaris 50 Disinfectant (used to disinfectant Cycler attachments)
A 2-minute timer (disinfecting Cycler attachments)
Storage for Q-tips and 2×2 gauze pads (Used to clean catheter area and Cycler attachments)
Plastic clothes pin (Used to hold 2×2 pads soaked in Alcaris on Cycler connection for 2-minutes)
Sanin cloth Bleach Wipes (Used to clean all work surfaces, Cycler and Cycler stand)
Paper towels (Used to clean and dry surfaces)
LED light (Used to enable viewing of work surface at night before bed)
Daily log sheet (Used to scribe and transcribe required biometric data to Cycler after treatment)
Paper tape (Used to secure tubing to stomach after hooking up to the Cycler)

Stored in the cabinets I have:

stay*safe caps (One used each day to seal off catheter upon disconnection from Cycler)
Dental towels (Used to prevent bleach from bleaching clothes)
Blood pressure apparatus
Heater blanket (Used to heat Dextrose bags for manual dialysis)
Gentamlcin Cream (Used on catheter-stomach access every night after showering)
13-Gal kitchen trash bags (used to dispose of all dialysis waste products)
Extra paper towels
Kleenex
Backup/clean tubing lanyard (discussed in a subsequent blog)
Band-Aid 2×2 small, padded gauze pads (Used after shower to dress catheter access)
Alcohol prep pads (clean tubing etc)
3M Micropore paper tape (Used for catheter dressing and tubing restraints)
Ready Locker 2×2 pads (used after showering for catheter access dressing and pre-cycler tubing fitting sterilizing)

The next bog entry will address the area in our Master Bath used to prepare for showering, post shower catheter administrations, and pre-cycler hookup prep.

My PD Setup – Storage of Supplies

January 6, 2023 / Henry Feeser / 1 Comment

There are literally hundreds of pounds of supplies associated with PD. The majority are provided by

Storage

Fresenius and a few out-of-pocket by me by my own volition (subject of a future blog). Let’s start with the largest, bulkiest items, the solution boxes. As stated in the last blog post, I am on 8L of PD solution which consists of one 5L bag and one 3L bag per day for 8L total. Fresenius ships the 5L solution two to a box, so a month’s supply (30 days) is 15 boxes. The 3L bags come four to a box, so 30 days’ supply requires 30/4 or 7 1/2 boxes. Cassettes (provide all the plastic lines and special fitting required to interface with the Cycler) come 10 to a box, so a 30-day supply is three boxes. Add all of this up and we have about 26 boxes just for a month. If you add in another 10 days for backup, you have on the order of 35 boxes steady state just for ongoing needs. Our storage schema is shown in the picture which is in our spare bedroom closet. We order supplies on a monthly basis. CAVEAT: The initial solution mixture provided by Fresenius contained much too much 2.5 solution and is not returnable to them. Try to ensure that your initial solution shipment matches what your doctor is recommending for you to start with!.

However, at least at the beginning of PD, things are not steady state. Early on and continuing until today, I experienced EDEMA in my ankles (Puffiness caused by excess fluid trapped in my tissues.) To assist my body in properly disposing of this fluid via PD, my Clinical Nurse and erstwhile guardian (part of the Fresenius-provided team and a Godsend) Cindy suggested upping the strength of the dialysis fluid, called DIALYSATE. (The Components of PD which directly impact efficacy of the PD and can be manipulated to maximize solute and fluid removal are dialysate volume, dwell time, number of exchanges per day and potency of the dialysate itself.) There are three “strengths” of dialysate, 1.5 (yellow), 2.5 (green) and 4.25 (red) where the numbers indicate percentage of dextrose (yes sugar for diabetics reading this) in the solution. I started off on all yellow/1.5. To combat edema, we moved up to 3L of 2.5/green on MWF which to date has at least moderated my ankle swelling. Thus, I have had to juggle types of 3L boxes to accommodate my 1.5 and 2.5 requirements. Same number of boxes but different logistics.

The next blog will address the third leg of our PD effort, the stand-alone workstation.

My PD Setup:

January 6, 2023 / Henry Feeser / 0 Comments

My PD setup consists of four stations:

The Liberty Cycler located adjacent to our bed pictured herein;
A storage area in a spare bedroom closet;
A separate workstation and storage area in our Master Bedroom;
And lastly, a work area in the Master Bath for aseptically cleaning and dressing my catheter access region.

Liberty Cycler

Introduction:

January 5, 2023 / Henry Feeser / 0 Comments

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.

Henry Feeser's Peritoneal Dialysis (PD) journey