“A stent is a tiny tube that can play a big role in treating your heart disease. It helps keep your arteries — the blood vessels that carry blood from your heart to other parts of your body, including the heart muscle itself — open.

Most stents are made out of wire mesh and are permanent. Some are made out of fabric. These are called stent grafts and are often used for larger arteries.”

Web M.D.

“People with schizophrenia require lifelong treatment.  Diagnosis of schizophrenia involves ruling out other mental health disorders and determining that symptoms are not due to substance abuse, medication or a medical condition.”

MAYO CLINIC

“The two types of hemodialysis are home hemodialysis and in-center hemodialysis. Both types have pros and cons. You should talk with your healthcare team, family, caregivers, or others you trust to help you decide what’s best for you. If you choose one type of hemodialysis first, you can usually change to the other.”

Kidney.org

PERITONEAL DIALYSIS    VERSUS                 HEMODIALYSIS

There is not always a simple easy answer for a patient that has chronic renal disease regarding which choice or option of dialysis that is best for him or her ; so let’s investigate the options & know you can always change the choice of dialysis you initially go on.  But remember you are going from a tube placed in your circulatory system to a tube now in your abdomen or visa versa (depending on what your first choice of dialysis was) and that both tubes take time to be ideally ready and final for dialysis after inserted.  So definitely take consideration in your choice both for your body and time it takes to allow the tube (especially in hemodialysis) in getting at its optimal level or state in being used:

More than 1/2 a million patients in USA suffer from stage V CKD commonly referred to as Renal Failure (or End Stage Renal Disease (ESRD)) with nearly similar number of patients suffering with the pre-dialysis, stage IV CKD. The management of ESRD involves either replacement of the lost kidney function through the kidney transplantation, or clearing body of the accumulating toxins through maintenance dialysis. Unfortunately, kidney transplantation is not a viable option for a majority of ESRD patients due to a limited availability of donor organs, further compounded by the fact that many of the dialysis patients are medically unsuitable for transplantation. Thus, maintenance dialysis forms mainstay of the treatment for this large majority of the ESRD patients.

1.  Peritoneal Dialysis (PD): This has been argued as one of the simplest form of dialysis with limited life style interruptions and high degree of freedom. In this form of dialysis a synthetic tube is placed in the abdominal cavity which then allows dialysis by exchange of dialysis fluid at regular intervals. It can be tailored to individual needs so that the patient can perform this at night while asleep with the help of a small machine called “Cycler” or during daytime by performing around four manual exchanges, each lasting around 15-30 minutes. Because of its simplicity, PD is many times a chosen modality for persons with busy lifestyle, active family responsibilities and significant time constraints.
2. Home Hemodialysis (HHD): Advances in dialysis technologies in recent times has highly simplified the above-mentioned form of hemodialysis allowing it to be performed in the comforts of patients’ home. Development of smaller dialysis machine that can be placed on a nightstand; and simpler blood tubing and dialyzer connections, has resulted in increasing number of patients choosing this modality of dialysis to preserve their independence and high functional status. Though the typical duration for individual patient varies, these form of dialysis can be tailored for an individual’s needs with 5-6 times a week frequency for dialysis with each individual session duration ranging from 3-6 hours. The shorter versions called short daily hemodialysis (SDHD) whereas the longer versions are typically performed at night and thus called nocturnal hemodialysis (NHD). The typical home hemodialysis allows a much higher clearance compared to other forms of dialysis and thus gives greater freedom in terms of dietary restriction and life style choice.
3. In Center Hemodialysis (HD): Where blood is taken out of the body through a complex set of tubes, run through a filter called dialyzer, cleaned off various impurities, and returned back to the patient. During its passage through the filter, the blood comes in contact with dialysate, which mirrors the body fluid except for the presence of impurities.  This is conventionally performed in dialysis centers across various medical and commercial facilities and typically involves patients receiving dialysis three times a week (either on Monday, Wednesday and Friday OR Tuesday, Thursday and Saturday) with four hour session each time. This is a relatively complex form of dialysis with rigid treatment structure and limited flexibility in terms of patients’ time, mobility and transportation. Additionally, this involves creation and maintenance of vascular access such as dialysis catheter or creation of AV fistula or graft, in either arm or groin to access high flows of blood needed to perform dialysis.

It is uniformly agreed that no single type of dialysis (home Vs In-center dialysis, or Hemo Vs peritoneal dialysis) is superior to others in terms of hard clinical endpoints e.g. mortality or cardiovascular deaths.  However, home dialysis modalities (both PD and HHD) provide significant advantages in multiple outcome parameters important to the management of patients with ESRD namely quality of life, freedom of travel, greater liberty from dietary restrictions, preservation of residual kidney function etc.

Historically, analyses of various patient cohorts in US have consistently revealed that; a privileged patient cohort more frequently chooses a home dialysis. This in many circumstances have been reflected by higher use of peritoneal dialysis in patients that are Caucasians, patients with higher education, patient under the care of nephrologists during the pre-ESRD period, patients receiving pre-dialysis education etc. In fact, nearly half of the patients when provided with a comprehensive pre-dialysis education (CPE) opt for home dialysis. Additionally both individual kidney physician surveys and recommendations of various professional medical societies now recommend a higher utilization of home dialysis. Despite these, only a minority of ESRD patients in US are on Home dialysis modalities. Lack of patient awareness due to lack of pre-dialysis education and scarcity of medical experts performing the home dialysis therapies are the two principle reasons for this underutilization of Home dialysis therapies.

Considering these facts, University of Florida and DCI have established a specialized clinic and education set up where a comprehensive pre-dialysis education (CPE) will be provided to the patients with stage IV (pre-dialysis) CKD along with their multispecialty care for various ailments of CKD. This clinic will put a special emphasis on the comprehensive care of CKD patients with special attention towards their dietary needs, their social and pharmacological concerns and their awareness and needs for decision making for their eventual dialysis or transplant therapies.

In conclusion of renal failure and if you are chronic, it’s not always easy to decide which type of treatment is best for you. Your decision depends on your medical condition, lifestyle, and personal likes and dislikes.

**Discuss the pros and cons of each with your health care team. If you start one form of treatment and decide you’d like to try another, talk it over with your doctor. The key is to learn as much as you can about your choices. With that knowledge, you and your doctor will choose a treatment that suits you best.**

I hope this article help you in some small way or more in dealing with your chronic renal failure.  Know your not alone and have many sites and places in giving you direction and support!

“Today’s flu vaccines cannot prevent a devastating 1918-style pandemic. New advances are fueling a push for a long-lasting, broadly protective vaccine. Influenza kills hundreds of thousands of people each year.  Influenza is tough to stop because both major types of influenza virus — type A and type B — encompass a vast number of distinct strains, and immunity to one strain often does not confer protection from another. Researchers make educated guesses as to which strains are likely to spread in a given year, then develop a vaccine meant to stop them.”

nature.com

Influenza A (H1N1), Influenza A (H3N2), and one or two influenza B viruses (depending on the vaccine) are included in each year’s influenza vaccine now.

How Influenza even got started to now:

Influenza was discovered not by a direct study of the disease in humans, but rather from studies on animal diseases. In 1918, J.S. Koen, a veterinarian, observed a disease in pigs which was believed to be the same disease as the now famous “Spanish” influenza pandemic of 1918.

In the 20th century, three influenza pandemics occurred: Spanish influenza in 1918 (~50 million deaths), Asian influenza in 1957 (two million deaths), and Hong Kong influenza in 1968 (one million deaths).  The World Health Organization declared an outbreak of a new type of influenza A/H1N1 to be a pandemic in June 2009.  Influenza may also affect other wild life which are horses, chickens and birds along with the pigs. In late 1917, military pathologists reported the onset of a new disease with high mortality that they later recognized as the flu. The overcrowded camp and hospital — which treated thousands of victims of chemical attacks and other casualties of war — was an ideal site for the spreading of a respiratory virus; 100,000 soldiers were in transit every day. It also was home to a live piggery, and poultry were regularly brought in for food supplies from surrounding villages. Oxford and his team postulated that a significant precursor virus, harbored in birds, mutated so it could migrate to pigs that were kept near the front.

Influenza A virus subtype H5N1, also known as A(H5N1) or simply H5N1, is a subtype of the influenza A virus which can cause illness in humans and many other animal species.  A bird-adapted strain of H5N1, called HPAI A(H5N1) for highly pathogenic avian influenza virus of type A of subtype H5N1, is the highly pathogenic causative agent of H5N1 flu, commonly known as avian influenza (“bird flu“).  It is enzootic (maintained in the population) in many bird populations, especially in Southeast Asia.

CDC Centers for Disease Control blog site states, “There are four types of influenza viruses: A, B, C and D. Human influenza A and B viruses cause seasonal epidemics of disease almost every winter in the United States. The emergence of a new and very different influenza A virus to infect people can cause an influenza pandemic. Influenza type C infections generally cause a mild respiratory illness and are not thought to cause epidemics. Influenza D viruses primarily affect cattle and are not known to infect or cause illness in people.

PMC U.S. National Library of Medicine (National Institutes of Health) states, “the announcement in 2005 that a virus causing fatal influenza during the great influenza pandemic of 1918–1919 had been sequenced in its entirety [1], in the laboratory of co-author JKT, has prompted renewed interest in the 1918 virus. The ongoing H5N1 avian influenza epizootic, and the possibility that it might also cause a pandemic [2], increase the importance of understanding what happened in 1918. However, in reviewing the scientific approach to unlocking an old puzzle, it is important to note that the sequencing of the 1918 virus took place after more than century of exhaustive and sometimes disheartening efforts to discover the cause of influenza (Figure 1). Indeed, the influenza search not only pre-dated the great pandemic of 1918, but also attracted the efforts of some of the greatest researchers of the 19th and 20th centuries. Along the way, the new fields of bacteriology and virology were advanced, and a productive marriage between microbiology, epidemiology and experimental science began. In describing here the 10-year effort (1995–2005) to sequence the genome of the 1918 pandemic influenza virus, we attempt also to place it within this important historical perspective.”

Influenza virus C is a genus in the virus family Orthomyxoviridae, which includes the viruses that cause influenza.  Nearly all adults have been infected with influenza C virus, which causes mild upper respiratory infections. Cold-like symptoms are associated with the virus including fever (38-40ᵒC=100.4 to 104F), dry cough, rhinorrhea (nasal discharge), headache, muscle pain, and achiness. The virus may lead to more severe infections such as bronchitis and pneumonia.  Lower tract complications are rare.  There is no vaccine against influenza C virus.

The species in this genus is called Influenza C virus. Influenza C viruses are known to infect humans and pigs.

Influenza D viruses primarily affect cattle and are not known to infect or cause illness in people.

“Good hand washing is the first line of defense against the spread of many illnesses — from the common cold to more serious infections, such as meningitis, bronchiolitis, the flu, hepatitis A, and many types of diarrhea.”.

Kids Health (kidshealth.org)

“According to the World Bank, hygiene promotion is the most cost-effective health action to reduce disease.¹ As of 2020, 2.3 billion people lacked basic hygiene services (handwashing facility with soap and water), and 1.6 billion people had access to handwashing facilities that lacked water or soap.^{2 Research shows that washing hands with soap and water could reduce deaths from diarrheal disease by up to 50%.}3″ ^.”

Centers for Disease Prevention and Control (CDC)

“It’s national handwashing awareness week! The first step to preventing infection is good handwashing! Alcohol-based hand sanitizer kills most of the bad germs that make you sick and is the preferred way to clean your hands in healthcare settings. Alcohol-based hand sanitizer is more effective and less drying than using soap and water, & does not create antibiotic-resistant superbugs.”.