At the Heart of the Matter

Before we begin, I’d like to answer the questions of Arizona readers who want to join Team SlowItDown for the April 19 Arizona Kidney Walk.  So, if you’re not in Arizona, you may want to skip this first paragraph. Turns out you need to add yourself to the team. You can do this by going Kidney Arizonato Kidneywalk.kintera.org. You’ll see “Register Here” in blue on the top left. Click it. Then you’ll need to sign an agreement, click join a team, choose SlowItDown from the dropdown. Hit continue and it will ask you to create a sign on with the usual basis questions asked. {Follow This Link to visit my personal web page and help me in my efforts to support National Kidney Foundation of Arizona.} By the way, ALL are welcome to join the team – not just those who asked how to do so.

Thanks to everyone else for your patience.  How do I begin this very personal blog… not to say the others weren’t.  Both my biological children are being affected by the plight of a relative who ignored his Chronic Kidney Disease.  Things are not good in his world.

At first, he was diagnosed with Chronic Obstructive Pulmonary Disease {COPD}. According to copd.com at http://www.copd.com/about- copd/?rotation=71700000006631907&banner=58700000274916307 &kw=5479263038&cc=us:p1114c00183:e1:w1:p25&pid=9263038&bing=p

When you breathe, air travels through tubes in your lungs—called airways—to millions of tiny air sacs. In a healthy lung, the airways are open and the air sacs fill up with air. Then the air goes quickly out. COPD makes it hard to get air through the airways and into and out of the air sacs.

copdIf this interests you, I would recommend going to their site.  I learned more from it than I needed to know for this blog. The COPD made sense since this man was a chain smoker when I knew him decades ago and continued to smoke until just a few years ago. Smoking is one of the leading causes of COPD.

But then, he developed diabetes. We know this is the foremost cause of Chronic Kidney Disease, but what I didn’t know is that COPD may cause diabetes. I went to The COPD Foundation at http://blog.copdfoundation.org/diabetes-in-patients-with-copd/ for the following information.

It is unknown why people with COPD are affected with diabetes more often, but it is thought to be the consequence of the systemic inflammation associated with lung disease, although it is likely that the use of systemic corticosteroids and inhaled corticosteroids also contribute significantly to this elevated risk.

Systemic inflammation?  Isn’t CKD also caused by inflammation?  And what are corticosteroids, anyway? AudioEnglish.org at http://www.audioenglish.org/dictionary/corticosteroid.htm  offered the most easily understood definition.

a steroid hormone produced by the adrenal cortex or synthesized; administered as drugs they reduce swelling and decrease the body’s immune response

It also makes sense that COPD patients use anti-inflammatories for their inflammatory disease. But these steroids have an adverse effect on diabetes.

“Among all medications available to treat different medical conditions, prednisone and similar steroids have the most profound effect on glucose metabolism. Medications such as prednisone can significantly increase glucose levels in patients with diabetes as well as individuals with impaired glucose tolerance or pre-diabetes,” says William Sullivan, M.D., a senior staff physician at Joslin Clinic in Boston and the Medical Director at the Joslin Clinic at Beth Israel Deaconess Hospital, Needham.diabetes

I found the above quote on Diabetes Day 2 Day at http://blog.joslin.org/2014/02/how-prednisone-affects-blood-sugar/. I don’t know if my children’s relative was taking prednisone – a type of steroid – but, if he were, we can now understand how it affected his Diabetes.  There were also life style changes that should have been made, but weren’t as far as I can tell.

So this man may have needed steroids for the COPD, but that worsened his Diabetes. Lack of lifestyle changes exacerbated the diabetes. And then he was diagnosed with CKD, stage 4. Well, how did that happen?

The Brits do a masterful job of explaining this effectively.  The following is from Patient at http://www.patient.co.uk/health/diabetic-kidney-disease-leaflet

A raised blood sugar (glucose) level that occurs in people with diabetes can cause a rise in the level of some chemicals within the kidney. These chemicals tend to make the glomeruli {what filters the blood in your kidneys} more ‘leaky’ which then allows albumin to leak into the urine. In addition, the raised blood glucose level may cause some proteins in the glomeruli to link together. These ‘cross-linked’ proteins can trigger a localised scarring process. This scarring process in the glomeruli is called glomerulosclerosis. It usually takes several years for glomerulosclerosis to develop and it only happens in some people with diabetes.

Okay, so we sort of understand how the COPD led to Diabetes which, in turn, led to CKD.  Now we get to the heart of the matter.

It is very difficult to differentiate between the symptoms of COPD and Heart Disease. While his cardiologist {heart specialist} has taken over this man’s care {Thank goodness someone other than an exceedingly overworked Emergency Room doctor is on the case.}, I do not believe his pulmonologist {respiratory tract specialist} was contacted. So while the palpitations that brought him to the E.R. in the first place were heart related, has his COPD worsened?  And if so, what can be done about it in the face of his Heart Disease, Diabetes, and CKD diagnoses?

Let’s take a look at how Diabetes affects the heart. It can weaken the heart muscles via the thickening of the blood vessels which may occur in Diabetes and which impairs blood flow. The National Diabetes Education Program at http://ndep.nih.gov/publications/publicationdetail.aspx?pubid=127 has many suggestions – many of them lifestyle changes – for caring for both your Heart Disease and your Diabetes. Hmmm, was this man’s Endocrinologist {endocrinology or gland specialist. Glands release the hormones involved in Diabetes} consulted?

CKDAnd finally CKD.  We know this one, folks.  Consider this a reminder. We’re used to reading about anemia and high blood pressure as the connection between CKD and Heart Disease, but here are two other causes.  DaVita at http://www.davita.com/kidney-disease/overview/symptoms-and- diagnosis/ chronic-kidney-disease-and-your-heart/e/4730  once again jumps in to educate us.  Call this man’s nephrologist {kidney and hbp specialist}, please!

High homocysteine levels: Damaged kidneys cannot remove extra homocysteine, an amino acid in the blood. High levels of homocysteine can lead to coronary artery disease, stroke and heart attack.

Calcium-phosphate levels: Damaged kidneys cannot keep calcium and phosphorus levels in balance. Often, there’s too much phosphorus and calcium in the blood. When this happens, there’s a risk for coronary artery disease.

I am sad for my children today, knowing that lifestyle changes could have prevented this progression of diseases, but also proud of them for the way they are dealing with this situation.  I wanted to find hope for them, but without the lifestyle changes, I can’t figure out how.

Until next week,

Keep living your life!Book CoverThe_Book_of_Blogs-_M_Cover_for_Kindle

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Published in: on February 16, 2015 at 2:01 pm  Leave a Comment  

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