This is the second time I’m writing this blog. The first time it ended up in the byte bin, it was no fault of mine.
First off, I met with my dialysis nurse, who performed a procedure called a “Power Flush.” She took three large syringes, filled them with fluid from a 2K manual bag, and flushed my catheter line by filling the syringes and then sucking out the fluid. Last night, my time on dropped to 10 hrs, 43 minutes, which is still a little high, but lots better than what it was running.
While setting up the cycler last night, I encountered the fourth System Alarm, which instructs you to contact tech support, which I did. After being on elevator music for 20 minutes, I started the procedure, which I had used the last three times I encountered this, and was well past the step where it bails, just before opening the bag cones, when I received a return call. Bottom line, I’m to receive a replacement Cycler the day after Christmas. I spoke with my dialysis nurse again today, and she told me none of her other patients have reported this problem, so perhaps it is the Cycler and not the cassettes, as tech support led me to believe.
My blood pressure has been running in the low 150s off and on, so she put me on a couple of days of 2.5 6 L to pull out more fluid and also reduce BP. While my microfiltration was over 1000 last night, my BP this morning was 151/64, so we’re not there yet.
A couple of things. First, went to the dermatologist yesterday as scheduled. We decided to cut out the cancer that is painful, high on my left neck area, by my left ear. Shot the area up with dope, cut out the tumor, which was about 1/4 inch, and raised it by the same amount, hit it several times with a laser, and sent me on my way. See you on 12/31, the same day I’m to have the second immunotherapy infusion. Isn’t that just great? He did say he already sees improvement overall.
I continue to experience pretty annoying itching, but it looks like I’m going to have to power through it. The derm doc did prescribe a different ointment for the itch, but our local pharmacist doesn’t carry it. Have to switch it over to CVS, which we’re working on. Isn’t there always a glitch not of your own making?
Got a guy arriving soon to make up an estimate on enclosing our back patio. Can’t wait to see what out-of-the-world estimate we receive. More later.
One of the NANY side effects of Immuniotherapy is itching. I received the first of many infusions on Monday, 8 December. On or about Monday, 12/15, I started itching on my arms, especially above my elbows in the crook. Over time, it has gotten progressively worse. Not to the point, it is driving me crazy, or more so than I usually am, but certainly I’m more than aware of it. I have been applying the cream prescribed for diabetic itch, and it seems to help. At first, after cream application, the relief lasted a long time, even overnight, but not so much now.
I have an appointment with our dermatologist later today, and we’ll see what he has to say – probably bounce the ball onto our oncologist, who is administering the immunotherapy.
As I’ve alluded to previously, I spent too many holidays away from my friends and family. I’m here to relate that it’s not a good feeling. Yes, the Armed Forces do their level best to provide a festive meal, but try as they might, it does not remove the feeling of being in a strange place (land, sea, or air) away from those you love. I created the blues song embedded above to thank those who took my place and wish them the best. Hanj
For the last several evenings, my Cycler has stopped with an alarm on the screen just before cracking the cones. It has a red screen and displays error code 017 and instructs me to shut everything down and call support, which I have now done twice. I have had three red screens in all, one of which I cleared myself.
The “fix” is to pull the power cord and go through a complete setup again, hardly addressing the root of the problem, which, I’m sad to say, is not unusual for Fresenius support. During the last session with support, it was inferred that there is an innate problem with my batch of cassettes, which have an expiration date of 9/30/2028, and I just received them in last week’s supply delivery.
Although my cycler has been installed and running for a couple of years, it IS starting to make all kinds of moans and grones as if a hermit was living inside the box and being prodded at random times. I was informed that if this continues, they MIGHT consider replacing the cycler, but I’m not holding my breath.
It helps with the throes of dialysis to have a cause, a purpose, something outside you that brings comfort and pleasure. While it can take many forms, for me it is going the extra mile for dogs, in particular Canine Companions and a new local one, Friends for Animals.
Recently, there was a call out for dog food for Friends for Animals, a local no-kill adoption shelter run by volunteers. We took two 44-lb bags of dog food to the shelter to help cover December’s requirements. Later on, I went to the shelter and discussed with their personnel the overall requirements for dog food, and volunteered to provide all their needs for 2026. They use an average of 50 lbs per week, or 2600 lbs per year, which is 216.67 lbs per month. They like deliveries from Chewy, so we’re looking at 4.92 44 lb bags or 7.22 30 lb bags per month.
They would like a mixture that includes some puppy food, so this has to be incorporated. I’m going to call Chewy soon to set up automatic delivery of a mix of puppy and adult dog food for the entire year of 2026, so the adoption shelter can focus on other needs.
Next month, I will be 87, which suggests I will be a step closer to “A closer walk with thee.” (Song embeeded at end.)I like data, so I investigated, given my age and health situation, how much longer I have on God’s green earth, all else being equal.
In elderly patients on dialysis, especially with diabetes, average survival is meaningfully shorter than that of age-matched people without kidney failure. Studies of elderly dialysis patients often show mean survival from dialysis start on the order of 3–4 years, with diabetes and low albumin both associated with higher mortality. Since I have all three, dialysis, diabetes, and low albumin, the handwriting on the wall is for me. In most people, this can lead to fear of dying, which is the wrong approach.
The Best Cure for the Fear of Dying Is to Live
Most of us who spend hours on dialysis each week have had quiet moments staring at the ceiling, thinking about life — and yes, about death. It’s not a topic we choose, but the beeping machines and slow rhythm of treatment invite reflection. Over time, I’ve realized something that may sound simple yet carries immense freedom: the best cure for the fear of dying is to live.
Living doesn’t mean pretending everything is fine or ignoring the limitations that come with dialysis. It means choosing to be present — right here, right now — in the small, authentic moments that make life real. The laughter with a nurse. The comfort of warm sunlight after a treatment. The bite of your favorite meal, even if it comes on a day when your energy is low. These are the moments that define living.
Fear thrives in the future, in the what-ifs we can’t control. Life, though, happens in the now. When I finally started to embrace life as it is — and myself as I am — I began to feel lighter. My body might carry scars and limitations, but my spirit doesn’t have to. I remind myself daily: I am more than my condition. I am still learning, loving, creating, and sharing.
So, if the fear of dying visits you — as it sometimes visits all of us — answer it not with despair, but with life. See a sunrise. Call an old friend. Write down three things you’re grateful for. Every act of living pushes fear back a bit and fills the space with purpose.
Because in the end, the fear of dying fades when we remember how to live.
All told, there were 627 women assigned to Vietnam who were not recognized as combatants nor associated with any fighting group. They were not with the USO. As a Lieutenant assigned as Ordnance Advisor to the Brown Water Navy, I never ran across them in my travels in I-3 and I-4, but heard of them.
I submit that those of us in dialysis could profit from associating with our own “Donut Dollies” from time to time. We, too, need care, and our morale boosted from time to time. I’ve included below more information from Perplexity about this incentive, and at the end, a YouTube video about them.
Donut Dollies in Vietnam were American Red Cross women whose primary mission was to boost the morale of U.S. troops and give them a brief emotional break from the war. They were officially part of the Red Cross Supplemental Recreational Activities Overseas (SRAO) program and not combat personnel.redcross
Core purpose
The central purpose of the Donut Dollies was to bring “a touch of home” to service members by offering recreation, conversation, and sympathetic listening in an otherwise brutal and isolating environment. Their presence was meant to remind soldiers of normal life, family, and home, reducing feelings of loneliness and emotional strain.aarp+2
How they carried out the mission
These women ran and staffed recreation centers where troops could play games, listen to music, and relax, and they also created and led structured morale-building activities and programs. Because many units were in remote areas, they frequently traveled by jeep, truck, or helicopter to firebases and outposts to interact directly with soldiers who could not reach the centers.armyhistory+2
Emotional and psychological support
Beyond organized games and events, Donut Dollies provided informal counseling by listening to troops’ worries, fears, and stories without judgment. Veterans later described them as helping men feel less abandoned and “cut off” from what they held dear, giving many a temporary escape from the horrors of combat.wtvr+2
Name and distinction from earlier wars
The nickname “Donut Dollies” came from earlier Red Cross workers in World War II and Korea who actually served coffee and doughnuts from clubmobiles. Still, in Vietnam, the role had evolved to focus on recreation and morale rather than handing out food. In Vietnam, most accounts emphasize that they rarely, if ever, served donuts due to the climate and changed mission, even though the inherited nickname stuck.moaa+2
Risk and commitment
Although their role was noncombatant and recreational, Donut Dollies routinely operated in war zones, traveling into areas subject to rocket attacks, sniper fire, and other dangers, and a few were killed in the line of duty. Their purpose, however, remained consistent: voluntarily accept those risks to support the mental and emotional well-being of American service members in-country.wtvr+1
Over the past year or so, my dialysis team has constantly chided me on my “low” lab albumin, urging me to increase protein in my diet one way or another. What is lacking in this discussion is how, if at all, this situation relates to my peritoneal dialysis treatment. In an attempt ot clarify this situation, I turned to Perplexity with the following Prompt and results. In the findings that were directly applicable to me, I have inserted a bold and italic statement.
Prompt: I am on peritoneal dialysis and consistently have albumin in the 3.4 to 3.5 range regardless of how much protein is in my diet. Write a 500-word or so blog about all the factors in PD that are detrimental to protein.
Peritoneal dialysis (PD) is tough on protein balance in ways that go far beyond how much steak or whey you take in. Even with excellent intake, the therapy itself, plus inflammation and fluid shifts, can keep albumin stuck in the mid‑3s.pubmed.ncbi.nlm.nih+2
Protein lost into the dialysate.
Every exchange removes protein from the bloodstream into the PD fluid. Typical daily losses in PD are on the order of 5–10 g of total protein, with most of that being albumin, and the exact amount rises as membrane transport increases. Those grams do not sound huge, but over weeks and months, they represent a steady negative pull on your circulating albumin pool.pmc.ncbi.nlm.nih+2
High transport membranes or prescriptions with large volumes and long dwell times (My prescription contains both of these. I have four dwells of 2700 ML each lasting an hour and 45 minutes plus a manual fill of 2000 ML and about three hours in length.) tend to increase protein losses. Active or recent peritonitis can temporarily raise losses quite dramatically by making the membrane leakier, which can drag albumin down further even after the infection clears.pubmed.ncbi.nlm.nih+2
Inflammation and the acute‑phase response
Albumin is a “negative acute‑phase protein,” so inflammation actively suppresses its production in the liver. In PD cohorts, objective markers of low‑grade inflammation (CRP, IL‑6, and similar) are prevalent and inversely correlate with albumin levels and protein‑energy wasting. Prior peritonitis, chronic catheter‑related irritation, comorbid illnesses, and even fluid overload can all contribute to this background inflammatory load.pmc.ncbi.nlm.nih+6
Inflammatory signaling does not just reduce synthesis; it also increases muscle protein catabolism and blunts appetite. That combination means that the body is breaking down lean tissue while simultaneously making less albumin, so the lab number underestimates the effort you put into your diet.frontiersin+2
Glucose, appetite, and “hidden” malnutrition
Standard PD fluids deliver a sizable daily glucose load, sometimes approaching 300 grams, depending on the prescription and transport status. This absorbed glucose can dampen appetite and prompt patients to reduce overall food and protein intake, even if they do not feel classically “malnourished.” (While I am maintaining weight in the 143-146 range, undoubtedly this applies to my situation.) When intake slips below about 0.9–1.0 g/kg/day of protein, the body has trouble fully replacing ongoing dialysate losses.frontiersin+1
At the same time, high glucose exposure can promote central weight gain and muscle loss, so weight or BMI may appear stable while lean mass and functional protein stores erode. This disconnect between the mirror, the scale, and the chemistry panel is one reason clinicians now talk about “protein‑energy wasting” rather than simple malnutrition.onlinelibrary.wiley+2
Fluid status and “dilutional” effects
PD patients often battle subtle volume overload, especially when residual kidney function fades (My residual kidney function is considerably less than 100 ML/day) or ultrafiltration becomes less efficient. Extra extracellular fluid expands plasma volume so that the same absolute mass of albumin is distributed in a larger fluid space, lowering the measured concentration without a true parallel collapse in nutrition.tandfonline+3
This pseudo‑hypoalbuminemia can coexist with real protein‑energy wasting and inflammation, making the albumin number a composite of nutritional status, inflammatory state, and fluid balance. In practice, it means that improving ultrafiltration and decongestion can sometimes nudge albumin up, even if diet is unchanged. pubmed.ncbi.nlm.nih+3
Membrane characteristics and time on PD
Peritoneal transport status shapes both solute clearance and protein loss. High transporters tend to lose more protein into the dialysate, are more prone to fluid overload, and show lower albumin on average. Over the years, structural changes in the membrane and cumulative exposure to glucose and inflammation can accentuate this pattern.pmc.ncbi.nlm.nih+4 (As I recall, my transport is low, but I have been on PD for several years, so?)
Despite all of these detrimental forces, many studies suggest that modestly low but stable albumin in a clinically well, eating‑adequately PD patient may reflect the “new normal” of life with the therapy rather than a simple failure of dietary effort. The key is to view that 3.4–3.5 not in isolation, but against the backdrop of dialysate protein losses, inflammation markers, fluid status, body composition, and how you actually feel and function day to day.pmc.ncbi.nlm.nih+4 (I hope my team reads this!!)
As per our schedule, we traveled to Texas Oncology for me to start immunotherapy. In military terms, the infusion was a Piece of Cake (POC). Took about 50 minutes total, and was painless except for the insertion of a feed into my forearm. Felt nothing concerning the infusion itself, so perhaps all of the input about all the possible side effects was lawyer talk.
The picture is the actual view from my chair during the infusion. Up the green line is a smaller bag in which the immo-mix was hanging. The lower bag in view is the saline solution, which is used at the end of the procedure to flush the lines and my internal passages. Again, other than the initial “pain” of sticking a needle in my arm for access, the procedure itself was painless. At the completion, I got a “See you in three weeks,” and off we went.
Yesterday, I provided a first cut at a Comprehensive Guide to Peritoneal Dialysis. It is a first draft, and I plan to add several topics and photos. Examples are a section on the Fresenius-sponsored Patient Hub, pictures of our setup, including storage, and anecdotal stories along the way. Stay tuned.
