Getting a Little Too Technical

Ah ha!  I’m not totally off the mark.  I have successfully remembered today is Tuesday.  Oh, heck, I might as well tell the truth.  I teach on Tuesdays so it’s easy to remember it’s Tuesday, and only one step from remembering it’s Tuesday to remembering that’s a blog day.  Friday is my challenge, but I’m working on it.

There are many different sections to the nephrologist’s report so I’m going to keep on explaining some more of them for this blog.  We’ll pick up with a list of allergies that didn’t relate to CKD. Perfectly ordinary allergies that anyone could have. It seemed absurd they were even on the same page with the preceding, life changing  information that I now had Chronic Kidney Disease.

Below that, the nephrologist listed Current Medications. The only thing of note here is that I take both Lovastatin 20 mg. p.o. (by mouth) b.i.d.(twice a day) for high cholesterol and Quinaretic 12.5/20 for HBP. These two disorders added to the CKD made my health picture pretty bleak, and I couldn’t pretend it didn’t anymore.

Patient Vitals were the next item in the report and include blood pressure, pulse and weight (can’t get away from that in medical issues). They actually looked pretty good: well within range and appropriate (except for the weight, of course). So how could I have CKD? I kept coming back to that same thought. Now that I look at it in retrospect, I must have been a tough nut to crack: perfectly compliant, but alienated from the disease.

Following is the complete entry for Physical Examination: General. Although a great deal of it is redundant, there is some new information that I’ll explain in a later blog.

GENERAL: Appears as stated age. (I was insulted and decided that my youngish nephrologist just didn’t appreciate older women who didn’t look their age.)  Well nourished. (I was on a roll here and decided he meant I was fat. This is actually a referral to general wellness.)

HEENT [Head, Eyes, Ear, Nose, Throat]: No oral thrush or ulcers. Anicteric sclera. Pink conjunctiva.

NECK: No Lymphadenopathy . No acanthosis nigricans.

CARDIOVASCULAR: Regular rate and rhythm, S1, S2. No murmurs or rubs. No S3 or S4 gallop.

PULMONARY: Lungs are clear to auscultation bilaterally.  No wheezing, rales or rhonchi.

ABDOMEN: Nondistended. Soft.

EXTREMITIES: No lower extremity edema. Acyanosis.

VASCULAR: Good bounding radial pulses, equal and bilateral.

MUSCULOSKELETAL: No flank pain on palpation to the kidney. No paraspinal tenderness.

JOINTS: No effusion or stiffness of the   hands.

SKIN: No rash or unusual discoloration.

NERUO: Able to stand without evidence of orthostatis. Steady gait.

PSYCH: Alert and oriented.  Good insight.

There is nothing in the General Physical Examination that indicates I have CKD, but I do. Just as there is nothing in the Review of Systems that indicates I have CKD, but I do.  I realize many of the terms the nephrologist used are too technical and may need an explanation.  That will be coming when I offer you the glossary, later on.  For right now, they were all negative, so we don’t need to deal with them here and now.

The LABORATORY DATA section of the doctor’s report told a different story. It started with the date of my latest 24 hour urine creatinine clearance followed by a repeat of the readings.

The only ones that caught my eye were the BUN and creatinine. BUN means Blood Urea Nitrogen and may indicate a lowering of kidney function.  While my reading of 20 was not the outside limit for someone in her 60s, it was close enough to the 23 that was outside of normal limits to make me nervous. As for creatinine, the more in your blood, the less the kidneys are filtering via your urine. My 1.2 reading was out of range completely.

I already knew there was a problem, and I was doing my best to understand what it meant. My physician was a peculiar mix of cautionary and reassuring, but I couldn’t seem to get my mind around this information and what it did and did not mean to me.

The next report was IMAGING STUDIES, in this case, an ultrasound. In addition to what was noted in my chart, an ultrasound was also used to determine the number of kidneys you have as well as any blockage, stones or abnormalities. It noted the size and appearance of my kidneys, then described the location and size of several benign cysts.

Now I had cysts on top of kidney disease?  I was afraid to ask any questions for fear of more bad news except this turned out not to be such bad news.  According to the nephrologist, cysts this small were of no consequence and ordinary. I’ve never felt more grateful to have some part of my body described as ordinary.

There’s still more, but not now.  I find that when the information gets technical, less is best.

So, until Friday,

Keep loving your life.

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