Now We Start with the Nephrologist

Whoa!  It’s happened!  I’m officially at that stage of life when you get your days mixed up.  I thought today was Friday until I finally looked at the calendar to see what work I had scheduled for today.  So much for Friday’s blog, which has become Saturday’s blog this week.  Oh well, I can always try to get the day right next week. (Positive attitude, positive attitude, positive attitude.)

All right, so the blood tests and urine anlyses have been explained.  It’s time to start dealing with the nephrologist’s report.  After an appointment with him, he sent just such a report to my primary care physician and a copy of that report to me. Just as with the primary care physician’s report, it was on letterhead stationary and began with all the identifying information: Patient Name, Date of Birth [DOB], Date of Service [DOS], Physician, and then my primary care doctor’s name and address. Nothing earth shattering here, but this information does insure you’re reading your own appointment report, and just as with the Patient Exam report from my family physician, there’s too much personal information for me to include a sample in the blog.

Following the identifying information is the History of Present Illness.  This is important because this is your specialist writing about his specialty as it concerns your body.  Since my body was no longer telling me what was going on inside it, someone had to, and I trusted my nephrologist. I’ve copied parts of it here, so I can explain it to you but deleted the personal information.

As you know, Gail is a [age omitted here] female who was initially seen by my partner [name omitted here] for management of Chronic Kidney Disease Stage 2, which is presumably secondary to hypertensive nephrosclerosis [Chronic Kidney Disease caused by high blood pressure]. She did a 24-hour urine collection on [date omitted here] showing creatinine clearance of 68.0 milliliters per minute [mL/min] with no significant proteinuria [protein in the urine]. During the interim her blood pressure seems to be controlled and here in the office it is at 110/62 [first number is the pressure of the blood during heartbeats, the second at rest between heartbeats]. She reported to me that she had nephrolithiasis [kidney stone] per ultrasound but asymptomatic [without symptoms]. That was me in a nutshell as far as this doctor was concerned, and I thanked him for it. He reported my condition accurately, and I felt he was going to do his very best to help me slow this damned disease as much as possible.

Logically, the Past Medical History followed the History of Present Illness. These are the items concerning my CKD that my doctor included:

  1. Chronic Kidney Disease Stage 2; estimated glomerular filtration rate of 60-65 mL/min presumably secondary to hypertensive nephrosclerosis.
  2. Hypertension for more than 20 years.
  3. Dyslipidemia [high cholesterol]/ hypertriglyceridemia [high triglycerides].      

This did not look so good for me. I was thrilled that the stage of my CKD was now 2 instead of 3 when I first read the notes because I thought I’d somehow managed to reverse the direction of my illness. My nephrologist burst my bubble by explaining that the stages changed due to the changes in the formula used to assess staging of CKD once I lost weight since weight is part of the formula. The combination of CKD, high blood pressure, high cholesterol, and high triglycerides placed me in the position of being a prime candidate for a heart attack or stroke.  Me? Healthy me? Oh, right, that wasn’t who I was anymore. This was truly a case of the truth hurts.

This brings me to some fairly lightweight information. I realize it’s necessary to present a full medical picture of the patient but so little of it had to do with CKD. This information was included in: Past Surgical History, none of which relates to CKD, so I won’t duplicate it here; Social History, which is similar to the one in my primary care doctor’s report except that this one included my marital status, the medical history of my two grown daughters [I can only guess that this was requested to see if I was a carrier, since neither the internet nor the physicians I questioned could give me a satisfactory answer when I asked why this was included], and my former career;  Family History which states the ages and causes of death for my parents, and ends with the following sentence: “There is no Chronic Kidney Disease or dialysis dependency in the family.” Somehow, I didn’t count myself lucky for being the first here.

The Review of Systems is very different from the one my family doctor wrote:

Energy level and appetite are fair. No fever chills or night sweats.  No acute visual disturbance or oral thrush [mouth disease that can occur in people with compromised immune systems] . No chest pain at rest or exertion.  No paroxysmal nocturnal dyspnea [ sudden, reoccuring bouts of shortness of breath at night] . No shortness of breath, chronic cough or hemoptysis [coughing up blood]. No nausea, vomiting, diarrhea or melena [black, tarry stool]. No gross hematuria [blood in the urine] or dysuria [difficult or painful urination]. No foaminess in the urine.  No difficulty with urine stream or sensation of incomplete bladder emptying.  No lower extremity edema [swelling due to fluid retention in the tissues of the body] or claudification [leg weakness associated with circulatory problems]. No rash or unusual discoloration.  No effusion [leaking] or stiffness. No flank pain on urination [may be an indication of possible kidney trouble] or severe back pain. No severe headaches or orthostatis [fall in blood pressure which produces dizziness upon standing].

I realized immediately that, although I didn’t understand all of this, it all dealt with the kidney problems or indications of kidney problems. It seems silly now, but that’s when I realized that this doctor was, indeed, a specialist who treated serious disease and that this was real, I did have this serious disease. It was all so focused, so pointed in one direction. I think that’s when I started to understand that I really needed to read a book that would help me grasp how this was happening to me, a book that neither my nephrologist (doctor who specializes in renal health and blood pressure), my librarian, nor I could find.  That’s when I decided to write one.

Now that I’ve gotten to shamelessly plug my upcoming book, it’s time to say good bye until Tuesday.

Until then, keep loving your life!

Published in: on November 13, 2010 at 2:39 pm  Leave a Comment  

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