Tag: Agent Orange (Page 2 of 53)

Yesterday, we reviewed the results of a recent Doppler Scan I underwent as part of a workup for treating the numbness in my legs. Today, we will review an adjacent MRI, followed by a blog on what is projected to be done about the numbness.

Below, I will first post in layman’s terms the result of the MRI that Perplexity provides, followed by an embedded three-page PDF of the actual findings for your comparison.

Layman’s version:

Thoracic Spine MRI (middle back)

• No evidence of active bone injury or fracture.
• Increased thoracic kyphosis: The curve of the upper back is more pronounced than average, which is common with aging or weakened spinal support.
• Degenerative disc disease: The discs between the vertebrae in the middle back are worn out (“dehydrated”) and narrowed. Some rough bony outgrowths (“osteophytes”) and uneven endplates are seen—signs of arthritis in the spine.
• No protruding (“bulging”) discs, no joint arthritis, and no pinched nerves: The spinal cord, nerves, and bone structures look normal.
• Other tissues, blood vessels, and areas around the spine look normal.
• No signs of cancer or other destructive processes.

Summary: The changes seen are typical age-related “wear and tear” (degeneration) of the discs and spine in the middle back, but nothing immediately dangerous or unusual was found.

Lumbar Spine MRI (lower back)

• Age-related changes are present (“degenerative disc disease”) throughout the lower back. This includes worn-out discs, bone spurs, and arthritis in the joints between the spine bones.
• Mild scoliosis: The lower spine curves to the right a bit.
• Evidence of muscle spasms, with the low back being “straighter” than normal.
• Hemangioma at L1: A benign (non-cancerous) blood vessel growth in one of the bones of the spine—this is typically harmless.
• No evidence of acute fracture or bone marrow problems.
• Nerve canal narrowing (spinal stenosis) and “pinched nerves” at several levels:
  • L5-S1, L4-5, and L3-4: There are disc bulges and joint changes that significantly narrow the spaces where the nerves exit the spine (“neuroforaminal narrowing”) and the central spinal canal (stenosis). This can cause pain, numbness, or weakness in the legs (radiculopathy).
  • No herniated discs or significant narrowing at L1-L2 or L2-L3.
• A small fluid-filled area in the abdomen (“peritoneal fluid signal structure”) is noticed by chance and needs more scans (CT or MRI) to figure out what it is, but it may not be related to the back symptoms.

Summary: There are multiple sites in the lower back with “wear and tear” changes, some causing significant narrowing around nerves, which matches complaints of nerve pain. There is also a note about a non-spine-related fluid area in the abdomen that needs further checking, but otherwise, there’s no sign of serious bone disease or cancer.

Takeaway: Both MRI reports show typical age-related changes in the back with areas that could cause pain, stiffness, or nerve issues, but no immediate life-threatening findings. There is one unrelated area in the abdomen that needs further evaluation to determine its nature.

Actual MRI:

Yesterday, we had a visit from a VA social worker to conduct a home visit as part of the process to attain Caretaker status for my wife, who is acting as such. It was straightforward as far as the visit went. He asked a list of canned questions about my abilities to care for myself, and by extension, what my wife was doing to assist me. He took a walking tour of our home to check for safety-related items, trip hazards, in-place smoke alarms, etc. All pretty standard stuff; he found no items missing or needing correction.

We did pick up a few requirements we did not know about and other tidbits.

1. We must finish the online Caretaker course before our file goes to the final decision board.
2. In over several hundred such inspections, only two have been rejected at the point we are now at.
3. I am required as part of the program to travel to the VA in Ft Worth once a year to be reviewed by my VA team. It is a requirement to be in the program.
4. The VA will provide my transportation if requested for the meetup in 3.
5. We will be eligible to receive 12-17 respite hours per week for my wife at our request.
6. While we have out work cutout for us to finish the caregive course, the end, regardless of the outcome, is in sight.

While it’s a mouthful, the subject is what was conducted on my tired old bones yesterday. My GP ordered it in an attempt to get a handle on what is going on with the numbness in my legs, and in particular, my right leg. The test was called an MRA by my GP. This Friday, I am to have an MRI ordered by Trinity Paine Management to aid in the diagnosis of the same problem. Naturally, we need to know more about this procedure, so I turned to Perplexity with the following result:

A Doppler ultrasound scan of the legs from groin to ankles—often called a lower extremity arterial and venous Doppler—is a noninvasive test used to assess blood flow in the arteries and veins of your legs124. Here’s what the results can tell you:

What the Test Evaluates

• Blood Flow: Measures the speed and direction of blood flow through the major arteries and veins in your legs, detecting any abnormalities124.
• Blockages or Narrowing: Identifies areas where arteries or veins are narrowed or blocked, which could be due to atherosclerosis (plaque buildup), blood clots (such as DVT), or other vascular diseases1247.
• Venous Insufficiency: Detects if blood is flowing backward in veins (venous reflux), which can lead to varicose veins or swelling2.
• Arterial Insufficiency: Assesses for reduced blood flow due to narrowed or hardened arteries, which can cause leg pain, cramping, or skin discoloration12.
• Other Abnormalities: Can identify vascular tumors, inflammation, or structural changes in blood vessels1.

Normal Results

• No Narrowing or Blockages: Arteries and veins are open, with normal blood flow.
• No Blood Clots: No evidence of deep vein thrombosis (DVT) or other clots.
• Normal Blood Pressure Differences: Blood pressure measurements at the thigh, calf, and ankle are within expected ranges, indicating healthy circulation5.

Abnormal Results

• Arterial Blockage: May indicate peripheral artery disease (PAD), often due to atherosclerosis. This can cause pain, cramping, or even non-healing wounds in severe cases25.
• Venous Blockage or Clot: Suggests deep vein thrombosis (DVT), which is a risk for pulmonary embolism if the clot travels to the lungs24.
• Venous Insufficiency: Backflow of blood in veins, leading to swelling, varicose veins, or skin changes2.
• Other Findings: May reveal vessel narrowing (stenosis), widening (aneurysm), or inflammation.

How the Test Is Performed

• Gel and Transducer: A gel is applied to your skin, and a handheld device (transducer) is moved along your leg from the groin to the ankle to capture images and measure blood flow124.
• Blood Pressure Cuffs: Cuffs may be placed at various points (thigh, calf, ankle) to compare blood pressures and help pinpoint blockages5.

Why It’s Ordered

• Symptoms: Leg pain, swelling, discoloration, ulcers, or suspected blood clots.
• Risk Factors: History of vascular disease, diabetes, smoking, or prior clots.

Preparation and Risks

• Preparation: Usually minimal; you may be asked not to smoke before the test, as nicotine can constrict blood vessels and affect results12.
• Risks: The test is painless, noninvasive, and has no associated risks124.

In summary: A Doppler ultrasound of the legs from groin to ankles provides detailed information about blood flow, helping diagnose blockages, clots, and circulation problems in the lower extremities. Normal results show open vessels and healthy flow; abnormal results may indicate serious vascular conditions requiring further treatment or monitoring1245.

1. https://www.beatscardiology.com/arterial-and-venous-lower-extremity-doppler.html
2. https://www.mountsinai.org/health-library/tests/doppler-ultrasound-exam-of-an-arm-or-leg
3. https://www.mayoclinic.org/tests-procedures/ultrasound/expert-answers/doppler-ultrasound/faq-20058452
4. https://my.clevelandclinic.org/health/diagnostics/22715-doppler-ultrasound
5. https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/vascular-studies
6. https://www.mayoclinic.org/tests-procedures/echocardiogram/about/pac-20393856
7. https://www.heartandstroke.ca/heart-disease/tests/doppler-ultrasound
8. https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/echocardiogram
9. https://www.ncbi.nlm.nih.gov/books/NBK576430/
10. https://www.sciencedirect.com/science/article/pii/S0914508709002731

So far, I have been on IPN for four bags full, that is to say, four nights. The procedure is very straightforward. I set up the Cycler in the morning as part of my morning routine, which includes making the bed and preparing the night’s Cycler supplies. In this case, I remove a modified IPN bag from the provided refrigerator, place it on the hanging protrusion on the left side of the Cycler cart, and in the evening, connect it to the first white bag connector. My regular 6-liter bag goes on the heater tray, and we’re good to go.

My weight thus far has not varied more than a pound, down for me. My appetite is about the same as far as I can tell. Nothing weird has happened to my bowels. I sense that I am feeling a little more energetic and look forward to taking Dickens on his twice-daily golf cart rides. At least on the onset, it looks like we may be headed in the right direction. So Be Happy!

1

The purpose of this blog is to provide pertinent information we received on Tuesday from our contact at Pentac concerning the deployment of their IPN product.

1. Tuesday, Lowe’s delivered the refrigerator to be used for keeping the IPN-infused bags cool. We received a Hisense 4.4 Cu Ft Model # HRC044AVE ($139.00) with an additional standalone thermostat. We are to keep the IPN bags between 36 and 46 F in the frig until up to 24 hours before use. After that, it must be disposed of and replacement(s) ordered.
2. Pentac’s Clinical Nutrition Pharmacy (800-223-4376, then 4, then option 2) will ship the product to us overnight via UPS or FedEx. We don’t have to be home to receive the product; it will be left on the porch. We opted to receive one shipment of seven bags on Tuesdays every week. Our first shipment of six will arrive on Thursday, my first treatment day.
3. If hospitalized, call the pharmacy to “hold” the shipment. For travel, notify Pharm so supplies can be shipped anywhere in the USA.
4. Inspect bags upon arrival. It should be cold, not frozen, and clear. Check white tags on bags. In a given shipment, all should have the same expiring date.
5. We are to receive 5 L bags, which for the IPN procedure should be placed on a peg as the second bag, with the normal, yellow bag for me, on the heater. Note this is contrary to direction elsewhere.
6. If you feel bad, notify the dialysis nurse. Adjustments will be made for too much or too little IPN. May experience an upset stomach and affect hydration, but this is unusual.
7. Call the Pharmacy if problems – physical problems with bags or shipment. Call Cynthia with Clinical questions (385-230-5388).

My wife, Linda, received a phone call from our IPN provider, Pentec Health. She was informed that we would receive a shipment of three of their protein-enhanced five-liter dialysis bags today/Tuesday, and four on Friday. Assuming Lowe’s delivers the refrigerator on Tuesday, we should be good. Also, we are to receive a phone call this afternoon at 1330 to bring us up to speed on the IPN gambit.

In doing research on IPN, a basic question arises. To wit, why do I need this? Why am I not getting enough protein via my diet, which lately has seen a large increase in protein-rich foods? What’s going on here?

I turned to Perplexity with the following Prompt and response:

Prompt: Is it possible that peritoneal dialysis reduces body protein to the extent that the patient is weak, gets winded after the slightest exertion, etc.

Peritoneal dialysis (PD) can contribute to significant protein loss, which may lead to muscle wasting, weakness, and fatigue. Here’s a detailed analysis:

Protein Loss in Peritoneal Dialysis

• PD patients lose 5–7 grams of protein daily through dialysate, primarily albumin217.
• This loss occurs because the peritoneum allows serum proteins to leak into the dialysis fluid during exchanges27.

Mechanisms Linking Protein Loss to Weakness

1. Muscle Wasting (Sarcopenia)
   • Chronic protein loss exacerbates protein-energy wasting, reducing muscle mass and strength37.
   • Uremia, inflammation, and hormonal imbalances further accelerate muscle breakdown34.
2. Fatigue and Exertional Limitations
   • Protein depletion impairs muscle repair and energy metabolism, causing fatigue and breathlessness during minimal exertion456.
   • Anemia (common in dialysis) reduces oxygen delivery, worsening fatigue6.
3. Inflammation and Metabolic Dysfunction
   • Chronic inflammation from PD increases catabolism (muscle breakdown)37.
   • Acidosis and insulin resistance further disrupt protein synthesis34.

Contributing Factors

• Fluid Overload: Exacerbates protein loss and inflammation7.
• Inadequate Nutrition: PD patients require 1.3g/kg/day of protein to offset losses1. Failure to meet this accelerates muscle loss.
• Physical Inactivity: A vicious cycle where fatigue reduces activity, further diminishing muscle mass45.

Management Strategies

• Nutritional Intervention: High-protein diets (e.g., eggs, lean meats) to counter losses13.
• Exercise: Resistance training preserves muscle mass and reduces fatigue56.
• Volume Control: Optimizing fluid removal minimizes overhydration-related protein leakage7.

Conclusion

Yes, peritoneal dialysis can deplete body proteins sufficiently to cause weakness and exertional intolerance. This stems from direct protein loss, compounded by inflammation, metabolic dysregulation, and inadequate nutritional compensation. Addressing protein intake, volume status, and physical activity is crucial to mitigate these effects2137.

1. https://www.dpcedcenter.org/wp-content/uploads/2021/02/Protein-and-Dialysis.pdf
2. https://pmc.ncbi.nlm.nih.gov/articles/PMC3082414/
3. https://pmc.ncbi.nlm.nih.gov/articles/PMC12005912/
4. https://pmc.ncbi.nlm.nih.gov/articles/PMC2582327/
5. https://www.nhs.uk/tests-and-treatments/dialysis/side-effects/
6. https://www.dpcedcenter.org/news-events/news/conquering-dialysis-fatigue/
7. https://pmc.ncbi.nlm.nih.gov/articles/PMC9178188/
8. https://www.sciencedirect.com/science/article/pii/S0085253815324741
9. https://onlinelibrary.wiley.com/doi/10.1111/sdi.13194
10. https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2021.653807/full
11. https://www.mdpi.com/2077-0383/12/7/2670
12. http://www.davita.com/treatment-services/peritoneal-dialysis/protein-and-your-peritoneal-dialysis-diet
13. https://advancingdialysis.org/peritoneal-dialysis/nutritional-status-concerns-for-peritoneal-dialysis-patients/
14. https://www.kidney.org/kidney-topics/getting-more-protein-while-dialysis
15. https://homedialysis.org/news-and-research/blog/547-muscle-stiffness-in-dialysis-patients-tips-to-prevent-and-overcome
16. https://onlinelibrary.wiley.com/doi/10.1155/2014/614846

As I have been blogging about, I am in the throes of entry into the world of IPN. The refrigerator to cool the mixture is due to arrive tomorrow from Lowe’s. We expect to hear soon from Pentec to receive the training they provide for IPN usage. Soon to follow this should be the actual receipt of our weekly allotment of IPN-fused dialysis bags.

In preparation for our IPN gig, I quizzed Perplexity about the nuts and bolts of IPN actual use with the following Prompt and results. Doesn’t seem to be all that complicated after all.

Prompt: What are the nuts and bolts of actually using IPN from Pentec?

The nuts and bolts of actually using IPN (Intraperitoneal Nutrition) from Pentec Health involve several key steps and considerations to ensure safe and effective therapy for peritoneal dialysis patients who need additional protein supplementation:

What is IPN from Pentec?

• IPN is a nutritional therapy that adds protein directly into the peritoneal dialysis fluid (dialysate) by replacing some of the usual dextrose with protein. This helps replenish protein losses that dialysis patients experience and supports nutritional status without requiring oral intake123.

How IPN is Prepared and Delivered

• Pentec Health prepares customized IPN bags based on the patient’s specific dialysis regimen and nutritional needs. A Pentec nurse or pharmacist compounds the sterile bags by adding protein to the patient’s cycler or CAPD bag, removing some dextrose to maintain fluid balance14.
• The IPN bags are shipped weekly to the patient’s home and must be refrigerated between 36-46°F. Pentec provides a refrigerator for storage. Patients are instructed to inspect bags for damage or discoloration immediately upon delivery and before use25.

Administration of IPN

• IPN is typically administered daily at home as a replacement for one of the patient’s regular exchange bags, either manually or via cycler. Patients are trained on how to handle and infuse the bags safely25.
• The IPN bag is usually the first bag on the cycler machine or hung to replace one exchange5.

Monitoring and Clinical Support

• Pentec provides a clinical case manager and registered dietitians who work closely with the patient’s nephrologist and dialysis clinic. They:
  • Confirm patient eligibility and customize the IPN prescription.
  • Monitor nutritional status through labs (e.g., albumin levels) and clinical assessments.
  • Adjust therapy as needed based on patient response.
  • Help manage any side effects, such as dehydration, which can occur if IPN causes additional ultrafiltration14.
• Fluid removal goals during dialysis are adjusted carefully. For example, for IDPN (similar therapy for hemodialysis), 75-80% of the total volume is suggested to be removed; similar judgment applies to IPN fluid management14.

Duration and Goals of Therapy

• The length of IPN therapy varies per individual and depends on nutritional needs and response. Typically, improvements in appetite, strength, and energy are expected within a few months2.
• Once protein levels normalize, clinicians may consider discontinuing or pausing therapy to see if nutrition can be maintained independently1.

Insurance and Financial Considerations

• IPN therapy is covered by many commercial and Medicaid insurance plans. Pentec Health handles billing directly and offers flexible payment options and assistance programs if needed2.

Summary Table of Key Steps in Using Pentec IPN

Step	Description
Prescription	Nephrologist and dietitian determine need; PD nurse completes IPN prescription form with Pentec CCM
Preparation	Pentec compounds sterile, patient-specific IPN bags by adding protein and removing dextrose
Delivery & Storage	Weekly home shipment; refrigerate at 36-46°F; inspect bags for damage or discoloration
Administration	Replace one PD exchange bag daily with IPN bag; use cycler or manual exchange
Monitoring & Support	Regular lab tests (albumin), clinical assessments, therapy adjustments by Pentec clinical team
Side Effect Management	Watch for dehydration or other issues; clinical team intervenes as needed
Duration	Individualized; often several months until nutritional goals met
Insurance & Billing	Pentec handles insurance; offers payment plans and assistance

In essence, using Pentec’s IPN involves a coordinated clinical approach with personalized sterile nutrition bags integrated into the patient’s peritoneal dialysis routine, supported by ongoing clinical monitoring and patient education to optimize nutritional outcomes safely and effectively1245.

1. https://pentechealth.com/idpnipn/
2. https://pentechealth.com/media/hi4hdpco/23pen01008-0124-ipn-patient-brochure.pdf
3. https://pentechealth.com/newsroom/idpn-ipn-nutrition-therapy-for-dialysis-patients-what-s-the-difference/
4. https://pentechealth.com/renal-nutrition-faqs/
5. https://pentechealth.com/media/lxgjflej/23pen01071_ipn-home-therapies.pdf
6. https://pentechealth.com
7. https://pentechealth.com/media/bfolvrox/pentechealth_guide-to-idpn.pdf
8. https://www.pharmko.com/blog/understanding-intraperitoneal-nutrition-ipn-and-its-uses
9. https://pentechealth.com/dialysis-clinics/
10. https://pentechealth.com/media/g0kbui5t/patient-and-hcp-proplete-info-sheets.pdf
11. https://www.pharmko.com/blog/how-ipn-supports-patients-with-severe-malnutrition
12. https://pentechealth.com/clinical-assistance-program/
13. https://www.pharmko.com/blog/how-to-monitor-and-adjust-ipn-for-optimal-patient-outcomes
14. https://pentechealth.com/patient-information/
15. https://pentechealth.com/patient-education/
16. https://www.kidneywi.org/wp-content/uploads/2020/11/How-IDPN-and-IPN-Can-Benefit-Your-Patinets.pdf
17. https://www.reddit.com/r/dietetics/comments/17f4zgj/renal_question_idpn/