In preparing for questions about our recent application for the VA’s Caregiver Program, I considered the weight of all the various components in successful treatment. Heretofore, it’s been about the bulk of the components that must be stored and replenished, not the weight that patients and/or their caregivers must bear. This blog clarifies this aspect from my viewpoint and experience.
My daily dialysis treatment requires me to use two six-liter bags of fluid for the cycler and a cassette. My evening static fill requires a two-liter bag of fluid for the pole with an attached drain bag. There are various other requirements that I will just lump into “other.”
I weighed one of the six-liter bags, and it weighed 13.6 pounds, so two each night is 27.2 pounds. They are shipped in a very heavy-duty cardboard box so let’s assume we’re looking at 30 pounds gross weight here that must be man-handled by the patient and/or caregiver. Assuming 30 days in the month, that’s 30 pounds times 30 days/month or 900 pounds per month.
Let’s look at the static two-liter bags now. If a 6-liter bag weighs 13.6 pounds, a 2-liter bag weighs 13.6/3, or 4.53 pounds. Now, 4.53 times 30 is 136 pounds. Now add this to the 900 for the six-liter bags, and we have 1036 pounds, well over 1/2 ton of “stuff” we must lug to and fro every month, to accomplish our dialysis routines.
Obviously, this does not include dealing with all the dunnage that results from unpacking all this stuff, which in and of itself, for us, is a heavy garbage bag each day, day in and day out. It never stops.
I posit that PD for us requires moving from the delivery truck to our home storage to where the dialysis fungibles are used, to use, to responsible disposable is more like 1500 pounds total. Now, we’re looking at at least 3/4 tons of effort required by someone to support home-based peritoneal dialysis.
Puts a different spin on things, doesn’t it? File under things they don’t tell you during training!
Relating the song “Stand by Me” to our application for the VA’s Caregiver Assistance Program (PCAFC) provides a powerful way to express the heart and purpose behind seeking this support.
The Message of “Stand by Me” and Caregiving
“Stand by Me” is fundamentally about love, support, strength, and courage in the face of adversity. The lyrics speak to the universal human need for someone to rely on—someone who will stand by our side when times are tough, when darkness falls, and when challenges seem insurmountable. This message resonates deeply in the context of caregiving, especially for veterans such as me.
“Whenever you’re in trouble, won’t you stand by me?” — Stand by Me
As caregivers, you embody this promise. You are there for your loved one—standing by them through illness, recovery, and daily challenges. The song’s call for steadfast support mirrors the role of a caregiver: providing strength and reassurance, especially when the “night has come and the land is dark”1.
Connecting “Stand by Me” to the VA Caregiver Assistance Program
The VA’s Program of Comprehensive Assistance for Family Caregivers (PCAFC) is designed to support those who stand by veterans every day. The program recognizes that caregivers are essential partners in a veteran’s well-being, much like the unwavering companion described in the song235. This is how my wife, as my Caregiver, has, is and will continue to support me.
How the Program “Stands by” Caregivers and Veterans
Financial Support: The monthly stipend helps caregivers continue to stand by their loved one, even when caregiving makes outside employment difficult35.
Training and Education: Just as the song speaks to finding strength and courage together, the program equips caregivers with the skills and knowledge needed to provide the best care possible24.
Mental Health Counseling: The emotional toll of caregiving can be significant. The program offers counseling, acknowledging the importance of mental resilience and the need for someone to “stand by” the caregiver as well235.
Respite Care: Recognizing that everyone needs a break, the program offers respite care, allowing caregivers to recharge so they can continue their vital role35.
Health Care Access: For those without other coverage, the program provides health insurance, ensuring caregivers are cared for too25.
Framing Your Application
When applying, you can express that, like the song “Stand by Me,” your commitment as a caregiver is rooted in love, loyalty, and the courage to face challenges together. The PCAFC is not just about practical benefits—it is about recognizing and supporting the profound bond between veterans and their caregivers. The program helps ensure that, no matter what comes, you can continue to stand by your loved one, just as the song promises1235.
In summary: “Stand by Me” beautifully captures the spirit of caregiving—unwavering support through life’s darkest and brightest moments. The VA Caregiver Assistance Program is designed to stand by you, the caregiver, so you can continue to stand by your veteran, ensuring neither of you has to face the journey alone.
And that folks, is a summary of how the song “Stand by Me” applies in spades to the VA Caregiver program and the relationship I have with my wife as my Caregiver.
Merits of a Companion Dog for a Veteran on 100% Disability (Including Peritoneal Dialysis and Heart Conditions)
Note: the picture above is of me and my companion, Golden Retriever, Dickens. Bottom picture is of Dickens in back backyard with his horse ball. My caregiver/wife tends to all of Dickens’ needs. She feeds him, picks up his waste, sees that he gets exercised, takes him to the vet and groomer – EVERYTHING. Without her, I would be unable to have a companion dog. The following provides background on how important and central such animals are to disabled vets such as myself.
For veterans with significant disabilities, such as those requiring peritoneal dialysis and managing heart conditions (me), a companion dog can offer a range of physical, emotional, and practical benefits. These advantages are especially relevant within the context of the VA’s Caregiver Support Program.
Physical and Health Benefits
Improved Physical Activity: Studies in VA populations show that having a companion dog increases daily steps, time spent in moderate activity, and overall physical function. A companion dog can be an effective alternative for veterans not inclined to participate in gym-based exercise, leading to improved endurance, strength, and even weight loss for those with higher BMI81.
Heart Health: Dog ownership is associated with reduced stress, lower blood pressure, and decreased heart rate. Interacting with a dog can trigger the release of oxytocin (“the love hormone”), which helps reduce anxiety and promotes cardiovascular health—an important consideration for veterans with heart conditions61.
Routine and Motivation: The responsibility of caring for a dog can help establish daily routines, which is beneficial for those managing complex medical regimens like peritoneal dialysis5.
Emotional and Psychological Benefits
Reduced Depression and Anxiety: Companion dogs provide emotional support, reduce feelings of loneliness, and help manage depression and anxiety, which are common among dialysis patients and veterans with chronic illness547.
Social Support and Engagement: Dogs act as social catalysts, encouraging interaction with others and reducing isolation. Studies show that veterans with companion dogs report increased participation in social activities and improved quality of life815.
Therapy for Dialysis Patients: Research specifically on dialysis patients demonstrates that therapy dogs can reduce pain and depression, improve mood, and enhance treatment adherence—a critical factor in long-term health outcomes45.
Practical and Caregiver Program Considerations
Caregiver Support Synergy: The VA Caregiver Support Program is designed to assist caregivers of veterans with daily living needs, offering stipends, training, health care, mental health support, and respite care3. A companion dog can complement these supports by:
Providing additional emotional stability for both the veteran and caregiver.
Encouraging physical activity and engagement can reduce caregiver burden.
Enhancing the home environment, making caregiving more rewarding and less stressful.
Eligibility and Support: While the VA does not provide companion dogs directly, it does offer veterinary insurance for service dogs prescribed for substantial mobility, visual, or hearing impairments9. For a companion dog (not a service dog), the primary benefits are emotional and physical rather than task-based assistance, but the positive impact on daily living and well-being is well documented815.
Special Considerations for Your Medical Profile
Peritoneal Dialysis: Animal companionship can help manage the emotional and physical challenges of dialysis, but hygiene is critical. It is essential to maintain a clean environment to prevent infection at dialysis access sites. With proper precautions, the benefits outweigh the risks.
Heart Conditions: The stress-reducing and activity-promoting effects of dog ownership are particularly advantageous for heart health, provided that physical activity is tailored to your capabilities and medical advice61.
Summary Table: Benefits of a Companion Dog for Veterans on 100% Disability
Benefit Category
Companion Dog Impact
Physical Health
Better adherence to treatment, stress relief, and motivation for self-care
Emotional Well-being
Reduced depression/anxiety, less loneliness, improved mood
Social Engagement
More social activity, reduced isolation, strengthened support network
Caregiver Program Synergy
Eases caregiver burden, complements VA support services, improves quality of life
Dialysis/Heart Condition
Eases caregiver burden, complements VA support services, and improves quality of life
Conclusion
A companion dog can significantly enhance the quality of life for veterans with complex medical needs, including those on peritoneal dialysis and with heart conditions. The benefits—spanning physical, emotional, and social domains—align well with the goals of the VA’s Caregiver Support Program, which supports both the veteran and their caregiver in daily living and overall well-being83456.
This is the third in a series of blogs documenting my conditions in which and for which my wife Linda, acting as my Caregiver, aids and abets my ability to soldier on. In the first blog, I discussed dialysis-related tasks, cardio yesterday, and the situation with my legs today.
The VA has assigned me the following disability ratings for “extremity diabetic neuropathy “in my legs: upper right 40%, lower right 20%, upper left 30%, and lower right 20%. Given my VA ratings for diabetic neuropathy—40% for right upper extremity, 30% for left upper, 20% for right lower, and 20% for left lower—the actual combined VA disability rating is 73%, which in and of itself exceeds the Caregiver Support requirement of at least 70%. For clarification, just what is “extremity diabetic neuropathy?”
Extremity diabetic neuropathy is nerve damage caused by diabetes that most often affects the legs, feet, hands, and arms. High blood sugar over time injures nerves, leading to symptoms such as pain, numbness, tingling, weakness, and sometimes loss of coordination or muscle function in the affected limbs145. In severe cases, neuropathy can cause significant disability, increase the risk of falls, and make everyday tasks, like walking, driving, or using your hands, difficult or unsafe. I am experiencing most of these traits – falling, getting up from a chair after sitting down, and legs going to sleep, ditto driving, etc.
Relation to the VA Caregiver Program
For veterans, extremity diabetic neuropathy is often recognized as a service-connected disability, especially if linked to exposure to Agent Orange or as a secondary condition to diabetes. Both of these apply to me, and I have been so rated.
The VA’s Program of Comprehensive Assistance for Family Caregivers (PCAFC) provides support to veterans who need in-person personal care due to serious service-connected conditions. Neuropathy qualifies if:
It causes an inability to perform activities of daily living (like bathing, dressing, or moving safely). Again, two of these apply to me.
It creates a need for supervision or protection due to neurological impairment (such as loss of sensation in the feet, leading to falls or danger while driving). These conditions apply directly to my situation.
The combined VA disability rating is 70% or higher, which I qualify for in spades..
If neuropathy limits your mobility, safety, or independence, which it does, then –
My situation—having significant diabetic neuropathy in all four extremities, with symptoms such as my right foot “going to sleep” while sitting or driving—directly relates to the eligibility and assessment process for the VA’s Program of Comprehensive Assistance for Family Caregivers (PCAFC). Here’s how my leg and foot issues factor into our application and the program:
How My Neuropathy Affects Eligibility
Combined Disability Rating: Your ratings (40% right upper, 30% left upper, 20% right lower, 20% left lower) likely result in a combined VA disability rating of 70% or higher, which is a threshold for PCAFC eligibility34.
Need for Personal Care Services: The program requires that the veteran needs in-person personal care for at least six months due to:
An inability to perform activities of daily living (ADLs), or
A need for supervision, protection, or instruction due to neurological or other impairment. I indeed do.
How Your Symptoms Relate to “Need for Care”
Safety and Supervision: The numbness and loss of sensation in my right foot, especially when driving, create a significant safety risk. This kind of impairment means I may need supervision or assistance to prevent injury to myself or others, particularly during activities like driving or transferring from sitting to standing.
Mobility and ADLs: Neuropathy can interfere with walking, standing, balance, and transferring, as well as with tasks like bathing, dressing, and toileting if you have difficulty feeling your feet or legs. If your spouse needs to help you move safely, prevent falls, or assist with these tasks, this supports your case for needing personal care services. Again, this applies to my situation.
Instrumental Activities of Daily Living (IADLs): Your spouse may also need to take on household tasks, manage medications, and ensure you are safe from hazards due to my impaired sensation and mobility. As a caregiver, my wife has assumed the duties of ensuring I’m correct in all aspects of medications.
In summary, I meet, no! exceed, the VA’s requirements for Cargiver Support based just on what’s going on with my legs. I have an appointment with my cardiologist in July, the soonest appointment I could get, to discuss my leg situation. In the interim, we have purchased a foot electronic device that provides programmed and adjustable shocks to my feet in an attempt to treat my extremity diabetic neuropathy.
This is the second blog in our effort to prepare for whatever the VA may ask and/or require to support our application for Caretaker Support. In yesterday’s blog, I laid out our case for the Dialysis Bucket. Today, we will address the Heart/Cardio Bucket. But first, some news:
I ascertained yesterday that while we were notified of an appointment this coming Friday, we were not informed of the location. I called the Caretaker national support line and was told they would check in with the support responsible for the area in which we live. When I didn’t hear anything in a reasonable amount of time, I did a Google and called the Texas support line and was informed the text was for an audiology appointment, which has since been rescheduled by the provider, and no appointment had yet been made regarding our caretaker request. So we are ahead of the game at this point. In this regard, I have also started a daily log of all the activities my wife engages in to provide me direct caretage support.
Regarding my heart. I am currently receiving 60% VA disability as a result of a triple bypass in 2015, the need for which is directly tied to being a diabetic, which in turn is directly related to exposure to Agent Orange in Vietnam. The current status of my heart, which was ascertained in February 2025, is that all is not as it should be on the backside, but due to my age and condition, nothing will be done about it. This condition manifests itself in several ways. I can not walk for any distance without becoming short of breath. My blood pressure is whacked; at times, it runs in the 150/80 range, low in the 100/55 range. Same with my pulse. At times, it is in the 80s, while at others in the 40s and 50s. Quite often, as a result, I just feel like crap.
What does my caregiver have to do with this? On numerous occasions, I have fainted just out of the blue. I can feel it coming on and do my best to gracefully go down if I’m outside, as I have been on at least three occasions or head for a couch or chair if inside. The EMTs have been called as a result of such behavior. My wife, as a caregiver, is sensitive to signals that I may be having an episode and ensures that I am cared for. In addition, she has assumed many of the household chores I normally took care of, such as taking out the weekly trash, working in the yard, many functions having to do with care and maintance of my dialysis equipment, sheduling support workers for home repairs, and other tasks involved in running a household.
Her caregiver support is essential and central to my continued living at home, also due to my compromised conditions, including my cardio deterioration
Last week, I posted on this blog that we (my wife and I) were applying for the VA assistance program cited in the title. Already, we have been scheduled for our first meeting with local authorities as the first step in their process. The meeting is this Friday, June 6th. Some things do move quickly.
Remember that this program is about the caregiver and was put in place to support caregivers so that they can and will continue to provide care and attendance to disabled vets. It is intended to support them in their effort to provide care and comfort to the vet, in this case, me.
We are currently developing a strategy to present our situation in a favorable light to the boards we will encounter. In blogs, for the remainder of the week, I intend to share our process. Starting with today, I will outline what we have defined as a starting point, that of the specifics of my VA disability ratings.
A firm requirement of the caregiver program is that the vet be rated at 70% disability or greater, have served on active duty for at least two years, and their disability be related to their active duty. I qualify on all of these counts as I am currently rated at 100% disability, served 25 years active duty, and all my VA ratings are tied back to Agent Orange exposure while in Combat Zones in Vietnam.
We have sorted my ratings into four baskets: 1 100% rating for nephropathy with hypertension resulting in seven days a week peritoneal dialysis, 2 60% rating for coronary artery disease resulting in shortness of breath given any exertion, and 3 60$ % rating for right leg diabetic neuropathy and 50% in left leg. Everything else is in basket 4.
Over the next three blogs, I will expand on the conditions cited in the previous paragraph and how my spouse, acting as a caregiver, is central to my being able to soldier on.
It’s a fantastic Friday for those who work forty hours a week. For those of us on dialysis, it’s just another day. It’s been this way for a couple of weeks for me. Quite uncommon. Next week, the schedule picks up again. I start my quarterly Adequacy Text on Tuesday. On Wednesday, we have Supply Delivery plus at 1000 dialysis labs. On Thursday, it is my privilege to visit our dermatologist for more skin cancer removal. Then we’re back to another fantastic Friday.
With the frequent rains recently in North Texas, weeds are growing profusely. We’re going to have to get out there on hands and knees pretty soon, or things will get out of hand. Luckily, the landscape crew found a window on Wednesday and got the grass mowed. It’s now up to my wife and me to get the rest up to snuff—a never-ending task.
Dialysis continues to roll along without any surprises, pretty much on schedule. My wife continues to provide invaluable emotional and physical support in keeping all the moving parts to my dialysis all going in the right direction. Speaking of my wife, today I filed the VA Form to start the ball rolling to get her properly compensated for her effort (VA 10- 10sc) online. Wish us luck!
Life is serious enough without concentrating on and/or ignoring other aspects of life. I like music, especially blues and, by extension, boogie woogie. It reminds me of my younger days, before dialysis, when I could and did “go all night.”
There was a dude in the Boston area named Preacher Jack. It was a character, but a talented musician. Enjoy one of his renditions below:
I don’t recall much being said during my PD training several years ago about handling “emergencies.” I’m referring to power outages and/or the need to disconnect from the cycler quickly in case of a tornado or other such threat.
Sunday night, right on cue, we were awakened to a message on my wife’s phone that a thunderstorm warning had been issued. As per usual, she was concerned and turned our household into one of turmoil, which lasted until well after 5 AM. Along the way, we dropped power, my cycler automatically switched over to its UPS, and our bedroom TV continued to work because of the UPS on it and our T-Mobile internet connection.
Since tornado threats were also involved, my wife placed a set ot clothes and shoes in our pantry off the kitchen, which is enclosed entirely by interior walls and is large enough for the two of us and our Golden, Dickens, to take cover in.
The power came back on after about 45 minutes of being down, and in the interim, I instructed my wife on how to use her phone to obtain real-time weather radar info, and how to obtain local tv news stations on the bedroom TV. So all-in-all it was a good drill in emergency preparedness.
BTW, regarding the Cycler: My plan is to just turn it off if it hasn’t already been shut down due to lack of power, unhook, and worry about draining any remaining fluid out when the dust settles. This could be into a sink, on the ground, into provided drain bags, etc. Worry about this later if the brown stuff hits the fan.
While on active duty in the US Navy, I was privileged to be the Officer-In-Charge of a first-of-its-kind land-based test site in Ronkonkomo, NY, out on Long Island. One of my crew at that time was a First Class Petty Officer named Robert Shippe. He went on to accomplish great things in the Navy, the last of which was to give his all. Read on below. Today I remember Shippie and all the Shippies who gave their all.
