They’re No Laughing Matter

I may have mentioned a time or two (or ten) that I was recently hospitalized again. This time it was for an abdominal incision hernia. Usually, this is outpatient surgery. However, the surgeon who made the original abdominal incision wanted to take no chances and arranged for me to stay in the hospital overnight. And that turned into five nights since he discovered another hernia under the one he’d expected to repair and then I kept running fevers. 

You probably know that you’re expected to start walking the day of (or the day after) surgery these days. It hastens your recovery. So, I walked the halls with the aid of a nurse and a walker, which fast became annoying although necessary (the walker, not the nurse). Apparently, I didn’t walk enough since for the time in her life, this 73 year developed bed sores.   

Photo by tegh 93 on Pexels.com

Bedsores? Certainly, that’s nothing to be ashamed of. Right? But there was that teeny little kernel of shame, as if I’d done something wrong and was being punished. Did it have to do with Chronic Kidney Disease? Why didn’t this happen during my other hospitalizations this last year? Of had I been just too out of it to realize I had bedsores during those hospitalizations?  

Come along with me as I figure this out. First of all, what are bedsores? The first thing I learned from my all-time favorite dictionary, The Merriam-Webster, at https://www.merriam-webster.com/dictionary/bedsores is that it’s one compound word, not two separate words as I’d always believed. Here’s their definition: 

“an ulceration of tissue deprived of adequate blood supply by prolonged pressure 

— called also decubitus ulcer” 

Wait a minute. What’s an ulcer? According to the same dictionary, but this time at https://www.merriam-webster.com/dictionary/ulcer

“a break in skin or mucous membrane with loss of surface tissue, disintegration and necrosis of epithelial tissue, and often pus” 

Okay, got it. Anyone know what “decubitus” means? I don’t. Back to the dictionary, guys. Well, will you look at that? The joke’s on us. That means “bedsore.” No kidding. Check it out for yourself at  https://www.merriam-webster.com/dictionary/decubitus.  

Now that we know what a bedsore is, let’s see if it has anything to do with CKD. Just keep in mind that diabetes is the foremost cause of CKD. This is from Beacon Health System at https://www.beaconhealthsystem.org/library/diseases-and-conditions/bedsores-pressure-ulcers/ , 

“Medical conditions affecting blood flow. Health problems that can affect blood flow, such as diabetes and vascular disease, can increase the risk of tissue damage such as bedsores.” 

Uh-oh, Type 2 diabetic here. 

Did you know there are stages of bedsores? I didn’t, but emedicine at  

https://emedicine.medscape.com/article/190115-overview educated me: 

” Stage 1 pressure injury – Nonblanchable erythema [Gail here: that means reddening.] of intact skin 

Stage 2 pressure injury – Partial-thickness skin loss with exposed dermis 

Stage 3 pressure injury – Full-thickness skin loss 

Stage 4 pressure injury – Full-thickness skin and tissue loss 

Unstageable pressure injury – Obscured full-thickness skin and tissue loss 

Deep pressure injury – Persistent nonblanchable deep red, maroon or purple discoloration” 

We know that dermis is skin, but “nonblanchable”? We can figure this out. If you remember your high school French, you know that ‘blanch’ means white. Add ‘non’ and we get ‘not white.’ That’s what nonblachable means; your skin does not turn white if you press on it.  

Wow! Lots of new information today. Okay, so how do you know if you have a bedsore? For me, it was the pain. I didn’t even have to look. 

The Mayo Clinic at https://www.mayoclinic.org/diseases-conditions/bed-sores/symptoms-causes/syc-20355893 tells us other symptoms: 

“Unusual changes in skin color or texture 

Swelling 

Pus-like draining 

An area of skin that feels cooler or warmer to the touch than other areas 

Tender areas” 

Come to think of it, the area in question was swollen, tender, and unusually warm. 

Now what? We know what bedsores are, what they have to do with CKD, that they are staged, and what the symptoms are. Ah, of course. What do you do once you have them? 

I was fortunate to come upon Johns Hopkins Medicine at https://www.hopkinsmedicine.org/health/conditions-and-diseases/bedsores for the answer to my question. 

  • “Removing pressure on the affected area 
  • Protecting the wound with medicated gauze or other special dressings 
  • Keeping the wound clean 
  • Ensuring good nutrition 
  • Removing the damaged, infected, or dead tissue (debridement) 
  • Transplanting healthy skin to the wound area (skin grafts) 
  • Negative pressure wound therapy 
  • Medicine (such as antibiotics to treat infections)” 

I’m thankful that removing the pressure on the affected area and a local antibiotic were all I needed. However, those were uncomfortable days for me and I’d like to avoid going through them again. 

Here’s what I should have been doing in the hospital according to Victoria State Government’s Better Health Channel (Canada),  

“Skin care in hospital 

During a stay in hospital, your skin may be affected by the hospital environment, staying in bed or sitting in one position for too long, whether you are eating and drinking enough and your physical condition. Ask hospital staff to regularly check your skin, particularly if you feel any pain. 

There are some things that you can do to look after your skin, including: 

Keep your skin clean and dry.  

Avoid any products that dry out your skin. This includes many soaps, body washes and talcum powder. Ask for skin cleansers that are non-drying. Ask nursing staff or your pharmacist to give you options. 

Use a water-based moisturiser daily. Be careful of bony areas and don’t rub or massage them. Ask staff for help if you need it. 

Check your skin every day or ask for help if you are concerned. Let a doctor or nurse know if there are any changes in your skin, especially redness, swelling or soreness. 

If you are at risk of pressure sores, a nurse will change your position often, including during the night. 

Always use any devices given to you to protect your skin from tearing and pressure sores. These may include protective mattresses, seat cushions, heel wedges and limb protectors.  

Drink plenty of water (unless the doctor has told you not to). 

Eat regular main meals and snacks. Sit out of bed to eat if you can. 

Try to maintain your regular toilet routine.  

If you have a wound, a plan will be developed with you and your family or carers before you leave hospital. It will tell you how to dress and care for the wound.”  

And here I’d been priding myself on sitting the chair from day one. I should have changing my position in that chair more often. 

Until next week, 

Keep living your life! 

You Think It’s All in Your Head?

As I was sitting in my allergist’s office last week, I started to wonder if Chronic Kidney Disease had anything to do with my runny nose. I’d thought it was the usual seasonal allergies, but over the last dozen years or so I’ve learned that almost every malady I experience has some kind of relation to my kidneys…  so why not the runny nose? 

The American Kidney Fund at https://bit.ly/3kvpjb9 explains for us: 

“Granulomatosis with polyangiitis (GPA), formerly known as Wegener’s granulomatosis, is a disease that causes swelling and irritation of blood vessels in the kidneys, nose, sinuses, throat and lungs. Swollen blood vessels make it harder for blood to get to the organs and tissues that need it, which can be harmful. The disease also causes lumps called granulomas to form and damage the area around them. In some people GPA only affects the lungs. GPA that affects the kidneys can lead to chronic kidney disease and kidney failure.” 

Whoa! Not good. Let’s see how it’s treated. The Cleveland Clinic at https://cle.clinic/3mjudss tells us, 

“People with GPA who have critical organ system involvement are generally treated with corticosteroids [Gail here: commonly just called steroids] combined with another immunosuppressive medication such as cyclophosphamide (Cytoxan ®) or rituximab (Rituxan®). In patients who have less severe GPA, corticosteroids and methotrexate can be used initially. The goal of treatment is to stop all injury that is occurring as a result of GPA. If disease activity can be completely ‘turned off,’ this is called ‘remission.’ Once it is apparent that the disease is improving, doctors slowly reduce the corticosteroid dose and eventually hope to discontinue it completely. When cyclophosphamide is used, it is only given until the time of remission (usually around 3 to 6 months), after which time it is switched to another immunosuppressive agent, such as methotrexate, azathioprine (Imuran®), or mycophenolate mofetil (Cellcept®) to maintain remission. The treatment duration of the maintenance immunosuppressive medication may vary between individuals. In most instances, it is given for a minimum of 2 years before consideration is given to slowly reduce the dose toward discontinuation.” 

If this sounds familiar, you’re right. It’s straight out of this year’s May 25th blog. Aha! Now we see the value of using the category drop down to the right of the blog. 

Anyway, while this is interesting (to me, at least), it’s not answering my question: Can CKD cause sinus problems. What was that? You want to know what a runny nose has to do with your sinuses? Let’s find out.  

I returned to the ever-reliable Cleveland Clinic, this time at https://cle.clinic/2FXOm7Q,  for some information: 

“Sinusitis is an inflammation, or swelling, of the tissue lining the sinuses. The sinuses are four paired cavities (spaces) in the head. They are connected by narrow channels. The sinuses make thin mucus that drains out of the channels of the nose. This drainage helps keep the nose clean and free of bacteria. Normally filled with air, the sinuses can get blocked and filled with fluid. When that happens, bacteria can grow and cause an infection (bacterial sinusitis). 

This is also called rhinosinusitis, with ‘rhino’ meaning ‘nose.’ The nasal tissue is almost always swollen if sinus tissue is inflamed.” 

It seems that you need a runny nose to avoid sinusitis. Is that right? I don’t think so, and neither does MedicineNet at https://www.medicinenet.com/sinusitis/article.htm.  

“Sinusitis signs and symptoms include 

sinus headache, 

facial tenderness, 

pressure or pain in the sinuses, in the ears and teeth, 

fever, 

cloudy discolored nasal or postnasal drainage, [I bolded this symptom.] 

feeling of nasal stuffiness, 

sore throat, 

cough, and 

occasionally facial swelling.” 

So, now it seems that a runny nose can be a symptom of sinusitis. 

Photo by Andrea Piacquadio on Pexels.com

And how does that fit in with having CKD? Before we answer that, I think we need to straighten out the differences between allergy and cold symptoms since both conditions may cause sinusitis. 

“The symptoms of allergies and sinusitis overlap a lot. Both can give you a stuffy nose. If it’s allergies, you may also have: 

Runny nose and sneezing 

Watery or itchy eyes 

Wheezing 

If it’s sinusitis, besides a stuffy nose, you may have: 

Thick, colored mucus 

Painful, swollen feeling around your forehead, eyes, and cheeks 

Headache or pain in your teeth 

Post-nasal drip (mucus that moves from the back of your nose into your throat) 

Bad breath 

Cough and sore throat 

Fatigue 

Light fever” 

Thank you to WebMD at https://www.webmd.com/allergies/sinusitis-or-allergies for the list above.  

 On to my original question. This is from Vick’s at https://vicks.com/en-us/treatments/how-to-treat-a-cold/how-to-stop-a-runny-nose. (Who better to go to than a trusted friend since childhood?)  

“A runny nose is a discharge of mucus from the nostrils. It’s the result of excess nasal mucus production. The excess nasal mucus leads to watery nasal secretions that flow out of your nostrils or drip down into your throat. A runny nose is a discharge of mucus from the nostrils. It’s the result of excess nasal mucus production. The excess nasal mucus leads to watery nasal secretions that flow out of your nostrils or drip down into your throat. Nasal congestion is due to the inflammation of the linings of the nasal cavity.” 

Did you notice the word “inflammation” in the last sentence? Ahem, an article by Oleh M Akchurin of Weill Cornell Medical College and Frederick J Kaskel of Albert Einstein College of Medicine published by ResearchGate at https://bit.ly/3jtVzKL states: 

“Chronic inflammation should be regarded as a common comorbid condition in CKD and especially in dialysis patients.”   

And there you have it. Your (and my) runny nose can be caused – in part – from having CKD. Inflammation is the name of the game if you have Chronic Kidney Disease. 

Although, in these times, I wonder if Covid-19 might somehow be involved in certain cases. Just remember, I’m not a doctor and never claimed to be one, so this just might be a question for your medical provider. 

Until next week, 

Keep living your life! (Safely: mask up, wash up, social distance) 
 

Cellulitis, CKD, and Diabetes

My uncle-in-law had it. My children’s father had it. My husband had it. Now the question is what is cellulitis? 

WebMd at https://www.webmd.com/skin-problems-and-treatments/guide/cellulitis#1 answers: 

“Cellulitis is a common infection of the skin and the soft tissues underneath. It happens when bacteria enter a break in the skin and spread. The result is infection, which may cause swelling, redness, pain, or warmth.” 

Alright, but what does that have to do with Chronic Kidney Disease. By the way, only one of the men mentioned in the first paragraph has CKD.  

According to the NHS (National Health Service) in the United Kingdom at https://bit.ly/2IJJrbT: 

“You’re more at risk of cellulitis if you: 

  • have poor circulation in your arms, legs, hands or feet – for example, because you’re overweight 
  • find it difficult to move around 
  • have a weakened immune system because of chemotherapy treatment or diabetes [Gail here: I bolded that.] 
  • have bedsores (pressure ulcers) 
  • have lymphoedema, which causes fluid build-up under the skin 
  • inject drugs 
  • have a wound from surgery 
  • have had cellulitis before” 

Two of the men above were overweight, but one of these did not have CKD. The overweight man who had CKD also had diabetes. One had a wound from surgery which was the cause of his cellulitis. Another had had cellulitis before. (Does this sound like one of those crazy math word questions?) 

CKD is not a cause? Whoa! Whoa! Whoa! Wait just a minute here. Let’s remember that CKD gives you the lovely present of a compromised immune system. A compromised immune system means it doesn’t do such a great job of preventing illnesses and infections. 

Also remember that diabetes is the leading cause of CKD and diabetes can also weaken your immune system. I needed more information about diabetes doing that and I got it from The University of Michigan’s Michigan Medicine at https://www.uofmhealth.org/health-library/uq1148abc:    

“High blood sugar from diabetes can affect the body’s immune system, impairing the ability of white blood cells to come to the site of an infection, stay in the infected area, and kill microorganisms. Because of the buildup of plaque in blood vessels associated with diabetes, areas of infection may receive a poor blood supply, further lowering the body’s ability to fight infections and heal wounds.” 

Remember that cellulitis is an infection. Reading the above, I became aware that I didn’t know anything about plague in the blood vessels and diabetes, so I went right to what I consider the source for vascular information, Vascular.org. This time at https://bit.ly/31dZ0yI:  

“Peripheral artery (or arterial) disease, also known as PAD, occurs when plaque builds up in the arteries and reduces blood flow to the feet and legs. Fairly common among elderly Americans, PAD is even more likely among those with diabetes, which increases plaque buildup.” 

All three of these men were elderly, if you consider in your 70s elderly. Of course, I don’t since I’m in my 70s, but we are talking science here. 

Hmmm, we don’t know yet how cellulitis is treated, do we? Let’s find out. I turned to my old buddy, The MayoClinic at https://www.mayoclinic.org/diseases-conditions/cellulitis/diagnosis-treatment/drc-20370766:  

“Cellulitis treatment usually includes a prescription oral antibiotic. Within three days of starting an antibiotic, let your doctor know whether the infection is responding to treatment. You’ll need to take the antibiotic for as long as your doctor directs, usually five to 10 days but possibly as long as 14 days. 

In most cases, signs and symptoms of cellulitis disappear after a few days. You may need to be hospitalized and receive antibiotics through your veins (intravenously) if: 

Signs and symptoms don’t respond to oral antibiotics 

Signs and symptoms are extensive 

You have a high fever 

Usually, doctors prescribe a drug that’s effective against both streptococci and staphylococci. It’s important that you take the medication as directed and finish the entire course of medication, even after you feel better. 

Your doctor also might recommend elevating the affected area, which may speed recovery…. 

Try these steps to help ease any pain and swelling: 

Place a cool, damp cloth on the affected area as often as needed for your comfort. 

Ask your doctor to suggest an over-the-counter pain medication to treat pain. [Gail again: no NSAIDS, you have CKD.] 

Elevate the affected part of your body.” 

Now the obvious question is how, as CKD patients and possibly diabetics, do we avoid that infection in the first place? 

“Cellulitis cannot always be prevented, but the risk of developing cellulitis can be minimised by avoiding injury to the skin, maintain [sic] good hygiene and by managing skin conditions like tinea and eczema. 

A common cause of infection to the skin is via the fingernails. Handwashing is very important as well as keeping good care of your nails by trimming and cleaning them. Generally maintaining good hygiene such as daily showering and wearing clean clothes may help reduce the skin’s contact with bacteria. 

If you have broken skin, keep the wound clean by washing daily with soap and water or antiseptic. Cover the wound with a gauze dressing or bandaid every day and watch for signs of infection. 

People who are susceptible to cellulitis, for example people with diabetes or with poor circulation, should take care to protect themselves with appropriate footwear, gloves and long pants when gardening or bushwalking, when it’s easy to get scratched or bitten. Look after your skin by regularly checking your feet for signs of injury, moisturising the skin and trimming fingernails and toenails regularly.” 

Thank you to Australia’s HealthDirect at https://www.healthdirect.gov.au/cellulitis-prevention for these common sense reminders. Actually, we need to keep washing our hands while Covid-19 is at our door anyway, so we’ve already got that part of the prevention covered. I suspect that many of us don’t bother to deal with small wounds, but it looks like we’d better start. 

What if you do develop cellulitis? How will you be treated? My old buddy, The Mayo Clinic at https://mayocl.in/2FDxUtf tells us: 

“Cellulitis treatment usually includes a prescription oral antibiotic. Within three days of starting an antibiotic, let your doctor know whether the infection is responding to treatment. You’ll need to take the antibiotic for as long as your doctor directs, usually five to 10 days but possibly as long as 14 days. 

In most cases, signs and symptoms of cellulitis disappear after a few days. You may need to be hospitalized and receive antibiotics through your veins (intravenously) if: 

Signs and symptoms don’t respond to oral antibiotics 

Signs and symptoms are extensive 

You have a high fever 

Usually, doctors prescribe a drug that’s effective against both streptococci and staphylococci. It’s important that you take the medication as directed and finish the entire course of medication, even after you feel better. 

Your doctor also might recommend elevating the affected area, which may speed recovery.” 

Until next week, 

Keep living your life! (Safely, please)