Double Whammy

Just as the flu was walking out the door, sinusitis walked in. No fair! Although, I must be feeling better because I’m starting to open all the doors and windows again.

I live in Arizona. We don’t have an actual winter, but we do have a flu season with all its accompanying ailments. Having a compromised immune system is not exactly a first choice, but I have Chronic Kidney Disease.

I know I need to slow down with this explanation. Good thinking. First off, what is the immune system? I went to NCBI, The National Center for Biotechnology Information at https://www.ncbi.nlm.nih.gov/books/NBK279364/ for an answer.

“The immune system (from the Latin word immunis, meaning: “free” or “untouched”) protects the body like a guardian from harmful influences from the environment and is essential for survival. It is made up of different organs, cells and proteins and aside from the nervous system, it is the most complex system that the human body has.

As long as our body’s system of defense is running smoothly, we do not notice the immune system. And yet, different groups of cells work together and form alliances against just about any pathogen (germ). But illness can occur if the performance of the immune system is compromised, if the pathogen is especially aggressive, or sometimes also if the body is confronted with a pathogen it has not come into contact before.”

Notice the word “compromised” in the last sentence. According to Dictionary.com at https://www.dictionary.com/browse/compromised, that means

“unable to function optimally, especially with regard to immune response, owing to underlying disease, harmful environmental exposure, or the side effects of a course of treatment.”

So when you have a compromised immune system, you are not receiving the full protection against germs that you could be receiving. Well, how does CKD affect the immune system?

My GFR (the numbers above the arc in the photo to the left and defined later in this blog) is usually between 49% and 59%. That means at any given time I’m missing quite a bit of the function normal kidneys would have. In other words, my kidneys are working more than twice as hard as those of someone without kidney disease. This is a fact that’s easy to forget now that I have the renal diet down pat … until I get sick… and it takes me longer to recuperate… or I slide right into another illness.

Let’s take a look at the jobs performed by the kidneys to see exactly why. This is what I wrote in SlowItDownCKD 2014:

“Your kidneys filter toxins and waste products from your blood.  They also regulate electrolyte levels and blood pressure and produce hormones, among their many jobs.”

Let’s say I eat some bad food. It would take me more than twice as long to recover and I could be more than twice as sick since my kidneys are compromised. Or maybe I actually took one of Bear’s medications instead of my own (which will never happen since they’re kept far, far from mine. This is just an example.) Same thing. I only have less than half the ability to remove a toxin from my body as someone with normal kidney function does. As for germs? You guessed it. My compromised immune system leaves me open to far more than I would be if I didn’t have CKD.

Now for sinusitius. I had that one covered in SlowItDownCKD 2013:

“The Mayo Clinic at https://www.mayoclinic.org/diseases-conditions/acute-sinusitis/symptoms-causes/syc-20351671 has this to say about acute sinusitis:

‘Acute sinusitis (acute rhinosinusitis) causes the cavities around your nasal passages (sinuses) to become inflamed and swollen. This interferes with drainage and causes mucus to build up.

With acute sinusitis, it may be difficult to breathe through your nose. The area around your eyes and face may feel swollen, and you may have throbbing facial pain or a headache.’

Before we get any more detailed here, a few reminders are in order {taken from What Is It and How Did I Get It? Early Stage Chronic Kidney Disease’s Glossary}.

Acute – Extremely painful, severe or serious, quick onset, of short duration; the opposite of chronic.

Antibiotic – Medication used to treat infection.

Chronic – Long term, the opposite of acute.

GFR  – Glomerular filtration rate [if there is a lower case “e” before the term, it means estimated glomerular filtration rate] which determines both the stage of kidney disease and how well
the kidneys are functioning.”

Keeping it plain and simple, that just about covers my double whammy of sliding from the flu into sinusitis.

For those interested in KidneyX, this may be for you:

KidneyX: #RedesignDialysis Twitter Chat
The KidneyX: Redesign Dialysis prize challenge has a total prize purse of $2,625,000 and aims to accelerate the development and commercialization of next-generation dialysis products. Now through February 28, 2019, the KidneyX Redesign Dialysis competition will be accepting proposals for solutions or components of solutions that offer patients significant alternatives to dialysis as it is generally practiced today.
Innovators that are interested in applying for KidneyX: Redesign Dialysis are encouraged to participate in Twitter chat on January 24, 2019 from 1:00pm – 2:00pm EST.
Representatives from the U.S. Department of Health and Human Services and American Society of Nephrology will be available during the chat to answer your questions and provide more information about KidneyX, the Redesign Dialysis competition, and innovation in kidney care.. To participate and follow the chat, use the #RedesignDialysis hashtag.

For those of you who are caretakers for people with CKD, this may interest you:

Please join us on Wednesday, January 23 at 1 p.m. ET for an educational webinar titled: Taking Care of Yourself While Taking Care of Your Loved Ones – Coping Strategies for Kidney Patient Caregivers!
As a caregiver for a loved one with kidney disease, it is important to remember to take time for yourself. Hear from social worker Renee Bova-Collis, MSW, LCSW, and caregivers Brenda Vasser-Taylor and Ashley Martin … as they share coping strategies to help you take care of yourself so that you can support your loved ones.

 

Click here to Register!

 

After registering, you will receive a confirmation email with information on how to join the webinar. To call-in without connecting to a computer, use this #:

United States: +1 (562) 247-8422

You will be asked to enter the following Access Code: 399-056-972#

Audio PIN: Shown after joining the webinar

Until next week,

Keep living your life!

And Yet Again

I didn’t think I’d be writing about the flu this year, yet I am. Why? Because, despite thinking I was safe since I didn’t have it in December as usual, I have it now. Actually, I’m in the I-feel-like-an-old-dishrag stage now. Humph, that’s probably why it took me six days to do the laundry (I’m still not done with the putting away) and the dishes. We were lucky enough to have my daughter and new son-in-law do the marketing for us. But it was only then that it became apparent she has it, too.

I have written before about the fact that the flu shot doesn’t guarantee you won’t get the flu, but that if you are one of the unlucky ones to get the flu after the shot, it will not be as virulent. Thank goodness. It’s day seven and I’m just now reaching the stage where I can do something… writing, dishes, laundry…IF I get back into bed for at least an hour between tasks. To be honest, sometimes I have to interrupt those tasks to take that hour rest.

I have read some good murder mysteries and thrillers while listening to silence. Then I could tolerate the television and discovered Dr. Bramwell on Amazon Prime. Terrific for someone who loves Victoriana (I did write Portal in Time and am seriously considering the requests for a sequel.)

But what’s different about the flu and the flu shot this year, I wondered as soon as I felt better enough to wonder about anything. This is the latest information from the Centers for Disease Control and Prevention (CDC) at https://www.cdc.gov/flu/spotlights/flu-season-updates-2018.htm. By the way, they have loads of information about this year’s flu season, but you may have to use the glossary which they so thoughtfully provide.

January 11, 2019 – With the 2018-2019 flu season well underway, CDC today estimated that so far this season, between about 6 million and 7 million people have been sick with flu, up to half of those people have sought medical care for their illness, and between 69,000 and 84,000 people have been hospitalized from flu. CDC expects flu activity to continue for weeks and continues to recommend flu vaccination and appropriate use of antiviral medications.

Flu vaccination is the first line of defense to prevent flu and its potentially serious complications, including death in children. Flu vaccines have been shown to be life-saving in children, in addition to having other benefits.  Flu vaccination has been shown in several studies to reduce severity of illness in people who get vaccinated but still get sick. Antiviral drugs are a second line of defense that can be used to treat flu illness. CDC recommends that people who are very sick or people who are at high risk of serious flu complications who develop flu symptoms should see a health care provider early in their illness for possible treatment with a flu antiviral drug.

CDC’s weekly FluView reports when and where influenza activity is occurring, what influenza viruses are circulating and their properties, and reports the impact influenza is having on hospitalization and deaths in the United States based on data collected from eight different surveillance systems.

So far this season, H1N1 viruses have predominated nationally, however in the southeast, H3N2 viruses have been most commonly reported. The number of states reporting widespread activity increased this week to 30 from 24 states last week. While levels of influenza-like-illness (ILI) declined slightly over the previous week in this week’s report, ILI remains elevated and 15 states and New York City continue to experience high flu activity. There also was a decline in the percent of respiratory specimens testing positive for flu at clinical laboratories however this number remains elevated also.  During some previous seasons, drops in ILI and the percent of specimens testing positive for flu have been observed following the holidays.”

Surprisingly to me, Business Insider at https://www.businessinsider.com/flu-shot-2018-effectiveness-availability-where-to-get-2018-9 answered my question about how the flu shot is different this year.

“The formulation has been changed in two key ways: the nasty H3N2 strain that sickened many people last year has been updated, and the influenza B virus targeted for protection in the vaccine has been changed, too. So far, the revamped vaccines look promising.

‘It appears that the virus is doing a little better job, if we look at what’s gone on in the southern hemisphere season,’ Webby said. [Richard Webby, an infectious disease expert at St Jude Children’s Research Hospital.]

Down south in Australia, for example, it’s been a fairly mild flu season, with flu activity circulating at ‘low’ levels, according to the Australian Department of Health. That may not perfectly translate to an equally mild flu season up north, but what Webby’s seen so far suggests that the shot is also combatting the flu better than it did last year.

Okay, I took the vaccine, am having a less virulent bout of the flu but it’s still here. Now what? The Kidney Foundation of Canada at https://www.kidney.ca/treating-the-common-cold-and-flu—tips-for-kidney-patients offered a succinct answer:

  1. For most people with kidney disease, acetaminophen(Tylenol®) is safe to use for headache, pain and fever.
  2. Cold and flu medications that contain decongestants may increase blood pressure. In addition, avoid cough and cold medications that contain ASA or NSAIDs (Non-steroidal anti-inflammatory medications) such as ibuprofen (Advil®, Motrin®) or naproxen (Aleve®). If you have to use a decongestant, use a nasal spray or nasal drops. (Note: these nasal sprays are habit forming. If you use them more than three days in a row, the blood vessels in your nose can become dependent on the spray.)
  3. Sore throat?Many cough syrups and throat lozenges contain sugar. Make sure you read the label to check the ingredients list, prior to use. Some sugar free or sucrose-free products are available on the market. Gargling with salt water may also be an effective way to soothe a sore throat.
  4. Avoid herbal remedies.Herbal medications and products are not regulated in the same way that pharmaceutical products are. Therefore, the list of ingredients is not always accurate and some herbal medicines have been found to contain pesticides, poisonous plants, hormones, heavy metals and other compounds that are potentially dangerous. Some herbal medications also include diuretics, high levels of potassium, and/or other ingredients that can affect the kidneys or interact with your prescription medications to change their effectiveness.
  5. Vitamin C is not the answer. High doses of vitamin C (500 mg or more) can cause damage to kidneys. There is a specially formulated multivitamin for people with kidney disease that has the right amount of vitamins that your kidneys can handle. Ask your healthcare team about this.

Questions?  Your pharmacist and members of your kidney health team are the best source of information. Ensure you read the label, even on over the counter medications that you’ve taken before, as ingredients do change from time to time. If you have severe symptoms that are lasting longer than 7 days, you should see your doctor.

Until next week,

Keep living your life!

Joy to the World

As Three Dog Night sang in Hoyt Axton’s song:

“Joy to the world
All the boys and girls now
Joy to the fishes in the deep blue sea
Joy to you and me”

Turn up your speakers and give a listen. See if you don’t feel more joy just from listening. Thanks to Three Dog Night for placing that grin back on my face when it’s gotten lost… and to YouTube, too.

I’ve written about what stress, grief, and shock do to your body, but with recent events I have reason to wonder what happiness does to your body. The birth of our first grandchild has revealed levels of joy I never knew existed. Add to that our youngest’s engagement and you’ll find me floating at least three feet above the ground most of the time.

I did my usual poking around and found some answers.

Calgary Psychology at http://www.calgarypsychology.com/happiness/correlation-health-happiness has some information for us, although it’s not as recent as I’d like it to be since it was published in 2010:

“A study in the journal Proceedings of the National Academy of Sciences examined the link between happiness and a number of health factors in 200 Caucasian adults, age 45-59 years, all of whom worked for the government in London, England. The study assessed each participant on a work day and weekend day, measuring them at work and play for a number of criteria including blood pressure, heart rate and stress hormone (cortisol) levels. Participants were measured under normal conditions and after a mental stress test. Under each condition participants ranked their happiness on a scale of 1 (lowest) to 5 (highest). There were no differences in happiness between people who were married or single, male or female or of varying socioeconomic status; however the happiest participants had the best results across the board for the health markers. I.e. happier people had lower heart rates, and an average of 32% lower levels of cortisol which can have a direct effect on other elements such as blood sugar.”

Cortisol? Anyone remember what that is? Let’s have a reminder, please. I found this in SlowItDownCKD 2016. It’s from Reference.com at https://www.reference.com/science/function-adrenal-gland-72cba864e66d8278.

“Cortisol is a hormone that controls metabolism and helps the body react to stress, according to Endocrineweb. It affects the immune system and lowers inflammatory responses in the body. …”

Want a little reminder about metabolism? I do. According to Dr. Ananya Mandal from News Medical Life Sciences at https://www.news-medical.net/life-sciences/What-is-Metabolism.aspx:

“Metabolism is a term that is used to describe all chemical reactions involved in maintaining the living state of the cells and the organism. Metabolism can be conveniently divided into two categories:

  • Catabolism – the breakdown of molecules to obtain energy
  • Anabolism – the synthesis of all compounds needed by the cells”

Aha! So joy or being happy helps the body produce the hormone that obtains energy and synthesizes what we need to live. Now I get it why I actually feel better physically when I’m happy. I was in the throes of bronchitis when my grandson was born and started getting better right away. Magic? Nope, just plain joy at work in my body.

Notice joy may have an affect via cortisol on your blood sugar, too. Blood sugar ? Why is that important? The following is from a study published in The American Journal of Kidney Disease that was included in SlowItDownCKD 2011

“Good control of blood sugar, blood pressure, cholesterol levels and body weight can delay the loss of kidney

function.”

And lower heart rates? How does that help us? I’ve don’t think I’ve written about that so I hopped right over to my longtime favorite the Mayo Clinic at https://www.mayoclinic.org/healthy-lifestyle/fitness/expert-answers/heart-rate/faq-20057979.

“A normal resting heart rate for adults ranges from 60 to 100 beats a minute. Generally, a lower heart rate at rest implies more efficient heart function and better cardiovascular fitness.”

Good news. Being happy – joyous in my case – is good for the heart, which automatically means it’s good for the kidneys since your heart health has a lot to do with your kidney health and vice-versa.

Let’s not forget that the lower levels of cortisol joy causes “lowers inflammatory responses in the body.” Chronic Kidney Disease is an inflammatory disease. I love it! Just by being happy, I’m helping myself with my CKD.

As the late night television commercials cautioned us once up on a time: But wait, there’s more. I turned to the Greater Good Science Center based at UC Berkeley. According to the website, they, “provide a bridge between the research community and the general public.”

That’s where I found this quote from a 2015 article at: https://greatergood.berkeley.edu/article/item/six_ways_happiness_is_good_for_your_health.

“Love and happiness may not actually originate in the heart, but they are good for it. For example, a 2005 paper found that happiness predicts lower heart rate and blood pressure. In the study, participants rated their happiness over 30 times in one day and then again three years later. The initially happiest participants had a lower heart rate on follow-up (about six beats slower per minute), and the happiest participants during the follow-up had better blood pressure.”

Oh, blood pressure. This is also called hypertension and is defined in What Is It and How Did I Get It? Early Stage Chronic Kidney Disease this way:

“A possible cause of CKD, 140/90mm Hg is currently considered hypertension, a risk factor for heart disease and stroke, too.”

That book was written in 2010. The guidelines changed in November of last year. Take a look at the infogram from the American Heart Association. I’ve also learned that hypertension is the second leading cause of CKD.

What’s the first? You guessed it: diabetes or blood sugar that is not controlled. I am overjoyed at the results of my poking around about joy. By being fully present to the joy in my life, by simply feeling that joy, while I personally can no longer prevent my CKD, I can further slow down the progression of the decline in my kidney function. Being happy is also helping to prevent diabetes from entering my life and working on keeping my blood pressure closer to where it belongs.

This joy just goes on and on for me. This year alone, it’s been celebration after celebration: birthdays, anniversaries, the birth, the engagement, triumphs for those I love. My list grows and grows. Why not consider a little joy for your body’s sake, if not for your mental state?

Until next week,

Keep living your life!

This Former Hippy Wannabe Likes HIPAA

Each day, I post a tidbit about, or relating to, Chronic Kidney Disease on SlowItDownCKD’s Facebook page. This is the quote from Renal and Urology News that I posted just a short while ago:

“Patients with stage 3 and 4 chronic kidney disease (CKD) who were managed by nephrology in addition to primary care experienced greater monitoring for progression and complications, according to a new study.”

My primary care physician is the one who caught my CKD in the first place and is very careful about monitoring its progress. My nephrologist is pleased with that and feels he only needs to see me once a year. The two of them work together well.

From the comments on that post, I realized this is not usual. One of my readers suggested it had to do with HIPPA, so I decided to look into that.

The California Department of Health Care Services (Weird, I know, but I liked their simple explanation.) at http://www.dhcs.ca.gov/formsandpubs/laws/hipaa/Pages/1.00WhatisHIPAA.aspx defined HIPPA and its purposes in the following way:

“HIPAA is the acronym for the Health Insurance Portability and Accountability Act that was passed by Congress in 1996. HIPAA does the following:

• Provides the ability to transfer and continue health insurance coverage for millions of American workers and their families when they change or lose their jobs;
• Reduces health care fraud and abuse;
• Mandates industry-wide standards for health care information on electronic billing and other processes; and
• Requires the protection and confidential handling of protected health information”

Got it. Let’s take a look at its last purpose. There is an infogram from HealthIT.gov at https://www.healthit.gov/sites/default/files/YourHealthInformationYourRights_Infographic-Web.pdf  which greatly clarifies the issue. On item on this infogram caught my eye:

“You hold the key to your health information and can send or have it sent to anyone you want. Only send your health information to someone you trust.”

I always send mine to one of my daughters and Bear… and my other doctors if they are not part of the hospital system most of my doctors belong to.

I stumbled across National Conference of State Legislatures at http://www.ncsl.org/research/health/hipaa-a-state-related-overview.aspx and learned more than I even knew existed about HIPAA. Take a look if you’d like more information. I finally tore myself away from the site to get back to writing the blog after following links for about an hour. It was fascinating, but not germane to today’s blog.

Okay, so sharing. In order to share the information from one doctor that my other doctors may not have, I simply fill out an Authorization to Release Medical Information form. A copy of this is kept in the originating doctor’s files. By the way, it is legal for the originating doctor to charge $.75/page for each page sent, but none of my doctors have ever done so.

I know, I know. What is this about doctors being part of the hospital system? What hospital system? When I first looked for a new physician since the one I had been using was so far away (Over the usual half-an-hour-to-get-anywhere-in-Arizona rule), I saw that my new PCP’s practice was affiliated with the local hospital and thought nothing of it.

Then Electronic Health Records came into widespread use at this hospital. Boom! Any doctor associated with that hospital – and that’s all but two of my myriad doctors – instantly had access to my health records. Wow, no more requesting hard copies of my health records from each doctor, making copies for all my other doctors, and then hand delivering or mailing them. No wonder I’m getting lazy; life is so much easier.

Back to HealthIt.gov for more about EHR. This time at https://www.healthit.gov/buzz-blog/electronic-health-and-medical-records/emr-vs-ehr-difference/:

“With fully functional EHRs, all members of the team have ready access to the latest information allowing for more coordinated, patient-centered care. With EHRs:

• The information gathered by the primary care provider tells the emergency department clinician about the patient’s life threatening allergy, so that care can be adjusted appropriately, even if the patient is unconscious.
• A patient can log on to his own record and see the trend of the lab results over the last year, which can help motivate him to take his medications and keep up with the lifestyle changes that have improved the numbers.
• The lab results run last week are already in the record to tell the specialist what she needs to know without running duplicate tests.
• The clinician’s notes from the patient’s hospital stay can help inform the discharge instructions and follow-up care and enable the patient to move from one care setting to another more smoothly.”

Did you notice the part about what a patient can do? With my patient portal, I can check my labs, ask questions, schedule an appointment, obtain information about medications, and spot trends in my labs. Lazy? Let’s make that even lazier. No more appointments for trivial questions, no more leaving phone messages, no more being on hold for too long. I find my care is quicker, more accessible to me, and – believe it or not – more easily understood since I am a visual, rather than an audial, person.

Kudos to American Association of Kidney Patients for postponing their National Patient Meeting in St. Petersburg from last weekend to this coming spring. The entire state of Florida was declared in a state of emergency by the governor due to the possible impact of Hurricane Irma. The very next day, AAKP acted to postpone placing the safety of its members over any monetary considerations. If I wasn’t proud to be a member before (and I was), I certainly am now.

Aha! That gives me five found days to separate The Book of Blogs: Moderate Stage Chronic Kidney Disease, Part 1 and The Book of Blogs: Moderate Stage Chronic Kidney Disease, Part 2 each into two separate books with indexes. I never was happy with the formatting of those two. I plan to reward myself after this project. How, you ask. By writing a book of short stories. I surmise that will be out next year sometime. Meanwhile, there’s always Portal in Time, a time travel romance. Geesh! Sometimes I wonder at all my plans.

Until next week,
Keep living your life!

The Other Side of the Coin

Here’s hoping everyone had a wonderful Father’s Day. During our relaxed celebration for Bear, I found myself ruminating about how many times we’ve celebrated this holiday for fathers no longer with us and how many more times  we would be able to celebrate it for the fathers who are. They are aging. Wait a minute, that means their kidneys are aging, too.

Yep, that meant a new blog topic. We already know that kidney function declines with age. According to the National Kidney Foundation at https://www.kidney.org/blog/ask-doctor/what-age-do-kidneys-decline-function, “The general ‘Rule of Thumb’ is that kidney function begins to decline at age 40 and declines at a rate of about 1% per year beyond age forty. Rates may differ in different individuals.” 40?

Well, what is a perfect kidney function score… if such exists? Back  to the NKF, although they call this a ‘normal’ not ‘perfect’ GFR, this time at https://www.kidney.org/atoz/content/gfr:

In adults, the normal GFR number is more than 90. GFR declines with age, even in people without kidney disease.
Average estimated GFR
20–29     116
30–39     107
40–49     99
50–59     93
60–69     85
70+         75

Got it. So even for a normal 70+ person, I have CKD with my 50ish GFR.

It seems I’m getting a bit ahead of myself here. I haven’t defined GFR yet. Let’s take a gander at What Is It and How Did I Get It? Early Stage Chronic Kidney Disease for that definition,

“Glomerular filtration rate [if there is a lower case “e” before the term, it means estimated glomerular filtration rate] which determines both the stage of kidney disease and how well the kidneys are functioning.”

No, that won’t do. I think we need more of an explanation. This is from SlowItDownCKD 2015:

“Glomerular filtration rate (GFR) is a test used to check how well the kidneys are working. Specifically, it estimates how much blood passes through  the glomeruli each minute. Glomeruli are the tiny filters in the kidneys that filter waste from the blood.

Many thanks to MedlinePlus at http://www.nlm.nih.gov/medlineplus/ency/article/007305.htm for the definition.”

Okay, I think that’s clear now. However, that’s not what I wanted to know. This is – if kidney function already declines with age, does having CKD age us more quickly?

Premature aging is a process associated with a progressive accumulation of deleterious changes over time, an impairment of physiologic functions, and an increase in the risk of disease and death. Regardless of genetic background, aging can be accelerated by the lifestyle choices and environmental conditions to which our genes are exposed. Chronic kidney disease is a common condition that promotes cellular senescence and premature aging through toxic alterations in the internal milieu. This occurs through several mechanisms, including DNA and mitochondria damage, increased reactive oxygen species generation, persistent inflammation, stem cell exhaustion, phosphate toxicity, decreased klotho expression, and telomere attrition….”

You can read the entire fascinating (to my way of thinking) American Journal of Kidney Disease article at http://www.natap.org/2013/HIV/PIIS0272638612015922.pdf.

Nature.com at http://www.nature.com/nrneph/journal/v10/n12/full/nrneph.2014.185.html seems to agree that CKD accelerates aging:

“Chronic kidney disease (CKD) shares many phenotypic similarities with other chronic diseases, including heart failure, chronic obstructive pulmonary disease, HIV infection and rheumatoid arthritis. The most apparent similarity is premature ageing, involving accelerated vascular disease and muscle wasting. We propose that in addition to a sedentary lifestyle and psychosocial and socioeconomic determinants, four major disease-induced mechanisms underlie premature ageing in CKD: an increase in allostatic load, activation of the ‘stress resistance response’, activation of age-promoting mechanisms and impairment of anti-ageing pathways. The most effective current interventions to modulate premature ageing—treatment of the underlying disease, optimal nutrition, correction of the internal environment and exercise training—reduce systemic inflammation and oxidative stress and induce muscle anabolism. Deeper mechanistic insight into the phenomena of premature ageing as well as early diagnosis of CKD might improve the application and efficacy of these interventions and provide novel leads to combat muscle wasting and vascular impairment in chronic diseases.”

Remember the friend of my daughter’s who hadn’t seen me in five years who (thought) he whispered to her, “Your mom got so old.” Now I understand why, although I have noticed this myself. I look in the mirror and see the bags under my eyes that are not errant eye liner. I see the lines in my faces, especially around my mouth, that weren’t there just a year ago. I see the stubborn fat around my middle that frustrates me no end. I see that it takes me forever (okay, so I’m being figurative here, folks) to recover from the flu, and I see how easily I become – and stay – tired. The dancer in me screams, “No fair!” The adult patient in me says, “Deal with it,” so I do.

I’ve used quite a bit of advanced terminology today, but haven’t explained a great deal of it in the hopes that when you read these articles their meanings will become clear in context. If they don’t, please leave me a comment and I will explore each one of them in future blogs. Who knows? Maybe I’ll need to devote an entire blog to whichever term it is you’d like to know more about.

Don’t let our premature aging get you down. We can work against it and, hopefully, slow it down just as we do with the progress of the decline in our kidney function.

I have been saving this bit of news for the last item in today’s blog. The world is not going to suffer if it doesn’t know about my photography, my teaching ,writing, or acting careers. But, when it comes to CKD, my writing can add something for those 31 million people who have it…especially the 90% that haven’t been diagnosed yet. What I did was completely change my web site so that it deals only with my Chronic Kidney Disease Awareness Advocacy (It’s all caps because that’s the way I think of it.) under the umbrella of SlowItDownCKD. I have to admit, I was surprised to see how active I’ve been in the last decade. It’s different when you see your work listed all in one place. Take a look at www.gail-raegarwood.com and tell me what you think, would you?

Until next week,

Keep living your life!

 

 

I’m Wearing Out

I’ll hold off the Cuba blog for another week because something else seems more relevant right now. I was thinking about last week’s blog and what my friend’s surgeon told her about slow bone healing when you have Chronic Kidney Disease. Some vague memory was nagging me.  And then I got it. Yay for those times we conquer mind fog.

fluRemember I’d had the flu that morphed into a secondary infection recently? My breathing was so wheezy and I was feeling so poorly that I went back to immediate care a second time just ten days after the first time I’d been there.

What is immediate care you ask? That’s a good question. Let’s allow HonorHealth at https://www.honorhealth.com/medical-services/immediate-care-urgent-care to answer.

“If you need medical care quickly for a non-life-threating illness or injury.… Patients of all ages can walk into any one of the four HonorHealth Medical Group immediate care centers, with no appointment needed, for such ailments and injuries as lacerations, back pain, cough, headache, or sinus or urinary tract infections.

…advantages:

  • Your co-pay is lower with immediate care compared to urgent care.
  • All four Valley locations are within offices of HonorHealth primary care physicians. That means any follow-up care you might need will be easy to access.
  • Your medical records, including labs and radiology images, soon will be linked systemwide with other HonorHealth facilities. So if you find yourself in an HonorHealth hospital or at an HonorHealth specialist, your medical information will be easily accessible by trusted caregivers. In addition, you won’t need to provide the same information over and over again; it will be in your medical record.”

It’s also clean, well equipped, and the wait is never too long. That’s where I go when I can’t get an appointment with my primary care doctor. There may be a different immediate care facility in your area.

Back to the bone issue. While I was there, an x-ray of my chest was ordered to check for pneumonia. I’m lucky: there wasn’t any. But, there was the unfolding of the thoraxthoracic aorta which I blogged about, and there was “levoconvex curvature and degenerative spurring of the thoracic spine.”

I am way past the point of panicking when I encounter a medical term I don’t know in a report about my body, but I am still curious… very curious. As I wrote in the blog about the unfolding aorta:

IMG_2982“…. In The Book of Blogs: Moderate Stage Chronic Kidney Disease, Part 1 there’s an explanation of thorax. … ‘the part of the human body between the neck and the diaphragm, partially encased by the ribs and containing the heart and lungs; the chest’ according to The Free Dictionary at http://www.thefreedictionary.com/thorax. Thoracic is the adjective form of thorax.” Adjectives describe the noun – the person, place, thing, or idea.

And degenerative? There’s a poignant discovery about that in What Is It and How Did I Get It? Early Stage Chronic Kidney Disease: “Ah, CKD is a degenerative disease.”  Well, all right then. Both CKD and the spurring of my thoracic spine are degenerative. What exactly does degenerative mean, though? My all-time favorite Merriam-Webster Dictionary tells us it’s the adjective (yep, that means describing) form of degeneration. Their definition of degeneration at https://www.merriam- webster.com/dictionary/degeneration is “deterioration of a tissue or an organ in which its function is diminished or its FullSizeRender (2)structure is impaired.” This doesn’t sound too great; it sounds like CKD.

What about “levoconvex curvature”? I understand curvature and I’m sure you do, too, so let’s just deal with levoconvex. I see convex in the word and know that means curving outward. Levo is new to me. GLOBALRPh at http://www.globalrph.com/medterm6b.htm, which defines itself as The Clinician’s Ultimate Reference, tells us this simply means left. Now how did I miss that when I studied Greek and Latin all those years ago?  Looks like my spine curves outward to the left. I couldn’t find any relationship between this and CKD except that it may cause kidney pain if the curvature is severe enough.

FullSizeRender (3)Sure enough, there is a connection between CKD and the spurring of my thoracic spine and it’s degeneration. But wait. I forget to explain spurring. This is how it was explained in The Book of Blogs: Moderate Stage Chronic Kidney Disease, Part 2:

“…bone spur.  A what?  Oh, an osteophyte!  Osteo comes from the Latin osseusosossis meaning bone and the Greek osteon, also meaning bone. {Thank you for the memory, Hunter College of the City University of New York course in Greek and Latin roots taken a zillion years ago.}”

Funny how the memory works sometimes and others it doesn’t. I can just see one of my kids rolling her eyes and saying, “So?”

So, it means that there is extra bone growing on my poor thoracic spine as part of the degeneration of my body. Even though it’s my body I’m writing about, I find it amusing that bone is growing rather than diminishing as part of the degeneration. It seems backwards to me.

However, there you have it: chronic kidney disease is a degenerative disease.  The spurring of the thoracic spine is also degenerative. Since I just turned 70, I’m not surprised about the spine thing. Keep in mind that CKD can hit at any age.

You knew it. This is turning into a plea to get tested for CKD. Here’s a bit of information from the National Kidney Foundation of Arizona at NKF-logo_Hori_OBhttps://azkidney.org/path-wellness that can help with that:

“Path to Wellness screenings provide free blood and urine testing, which is evaluated onsite is using point-of-care testing devices to assess for the risk of diabetes, heart and kidney diseases. Those screened are also presented with chronic disease management education, an overall health assessment (weight, blood pressure, etc.) and a one-on-one consultation with a physician. Enrollment opportunities are offered for a follow-up 6-week series of Healthy Living workshops that teach chronic disease self-management skills. For more information, click the link above or call our main line at: (602) 840-1644.”

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Until next week,

Keep living your life!

It’s Unfolding Now

Remember when I was lucky enough to catch the flu just after Christmas? (She wrote sarcastically.) When I went to the Immediate Care facility my doctor is associated with, the doctor there had my records and knew I’d had pleurisy at one time. But now, he ordered a chest x-ray to check for pneumonia. What he found instead was news to me… so, of course, I’m telling you about it.

IMG_2982To quote from the final result report of the X-ray: “There is unfolding of the thoracic aorta.” Huh? In The Book of Blogs: Moderate Stage Chronic Kidney Disease, Part 1 there’s an explanation of thorax.

“What?  The what? Oh, the thorax. That’s ‘the part of the human body between the neck and the diaphragm, partially encased by the ribs and containing the heart and lungs; the chest’ according to The Free Dictionary at http://www.thefreedictionary.com/thorax.”

Thoracic is the adjective form of thorax; it describes the aorta in this case.

Do you remember what the aorta is? I sort of, kind of did, but figured I’d better make certain before I started writing about it. MedicineNet at http://www.medicinenet.com/script/main/art.asp?articlekey=2295 was helpful here.

“The aorta gives off branches that go to the head and neck, the arms, the major organs in the chest and abdomen, and the legs. It serves to supply them all with oxygenated blood. The aorta is the central conduit from the heart to the body.”

Now I get the connection between Chronic Kidney Disease and the aorta. Did you catch “oxygenated blood” in that definition? And what organs oxygenate the blood? IMG_2980Right. Your kidneys. This excerpt from SlowItDownCKD 2015 may help.

““The National Kidney and Urologic Diseases Information Clearinghouse …explains.

‘Healthy kidneys produce a hormone called erythropoietin, or EPO, which stimulates the bone marrow to produce the proper number of red blood cells needed to carry oxygen to vital organs.  Diseased kidneys, however, often don’t make enough EPO. As a result, the bone marrow makes fewer red blood cells.’”

With me so far? Now, what the heck is an unfolded aorta? I turned to the British site for radiologists, Radiopaedia.org, at https://radiopaedia.org/articles/unfolded-aorta for the definition. “The term unfolded aorta refers to the widened and ‘opened up’ appearance of the aortic arch on a frontal chest radiograph. It is one of the more common causes for apparent mediastinal widening and is seen with increasing age.

It occurs due to the discrepancy in the growth of the ascending aorta with age, where the length of the ascending aorta increases out of proportion with diameter, causing the plane of the arch to swivel.”

thoracic-aortaI purposely left the click through definitions in so you read them for yourself. You know the drill: click on the link while holding down your control key. For those of you who are reading the print version of the blog, just add the definition of aorta to the common terms we know: arch and ascending.

Mediastinal, according to the Merriam-Webster Dictionary at https://www.merriam-webster.com/dictionary/mediastinum is the adjective (describing) form of mediastinum or “the space in the chest between the pleural sacs of the lungs that contains all the tissues and organs of the chest except the lungs and pleurae; also:  this space with its contents.”

Hang on there, folks, just one more definition. I searched for a new site that wouldn’t offer a terribly technical definition of pleura (or pleurae) and found verywell at https://www.verywell.com/pleura-lungs-definition-conditions-2249162.

“The pleura refers to the 2 membranes that cover the lungs and line the chest cavity. The purpose of the pleura is to cushion the lungs during respiration.

The pleural cavity is the space between these 2 membranes and contains pleural fluid.”graduation

Side note: I definitely feel like I’m back teaching a college class again.

Okay, so now we have a bunch of definitions, we’ve put them together as best we can and where does it bring us? Are you ready for this? Nowhere. An unfolding of the thoracic aorta is nothing more than a function of age.

FullSizeRender (2)However, with CKD, it’s somewhere. As was explained in What Is It and How Did I Get It? Early Stage Chronic Kidney Disease, “Hemoglobin is the protein in red blood cells that carries oxygen from the lungs to the rest of the body.”  We’re already not getting enough oxygen due to our poor, declining in function kidneys.

Am I concerned about the unfolding thoracic aorta? No, not at all. It happens with age; I don’t think I can do anything about that. But, the CKD that also lowers our oxygen production? Oh yes, I can – do – and will do something about that by protecting my kidneys as best I can and keeping the remaining kidney function I have.

Kidneys.com, quoted in The Book of Blogs: Moderate Stage Chronic Kidney Disease, Part 1, did a nice job of laying out a plan for me to do just that.

“Along with taking your prescribed blood pressure medications, lifestyle changes such as losing weight, exercising, meditating, eating less sodium,  drinking  less  IMG_2982alcohol  and  quitting  smoking  can  help  lower  blood pressure. Better blood pressure control helps preserve kidney function.”

I added using my sleep apnea machine and aiming for eight hours of sleep a night. I also stick to my renal diet – which limits protein, phosphorous, potassium, and sodium (as mentioned by kidney.com) – for the most part and keeping my kidneys hydrated by drinking at least 64 ounces of fluid a day.

Is it hard? I don’t know any more. It’s been nine years. They’re simply habits I’ve developed to live as long as I can and, sometimes, even raise the bottled waterfunction of my kidneys.

When my New York daughter was with us over the holidays, I realized how differently we eat than other people do. My husband has chosen to pretty much eat the way I do. So she actually had to go down to the market to pick up the foods that people ordinarily eat.  It would have been funny if I hadn’t been sick. I would have gone with her and laughed each time I answered, “No,” when she asked, “Do you eat this?”laughing

Until next week,

Keep living your life!

Where Does It All Come From?

KwanzaaFor the past two weeks, I’ve had the flu. I’ve missed the Chanukah Gathering at my own house, Kwanzaa, and New Year’s. I even missed my neighbor’s husband/son birthday party and a seminar I enjoy attending.

Before you ask, yes I did have a flu shot. However, Strain A seems to be somewhat resistant to that. True, I have been able to cut down on the severity of the flu by taking the shot, but it leaves me with a burning question: How can anyone produce as much mucus as I have in the last two weeks?

Mucus. Snot. Sputum. Secretion. Phlegm. Whatever you call it, what is it and how is it produced? According to The Medical Dictionary at http://medical-dictionary.thefreedictionary.com/mucus, it’s “the free slime of the mucous membranes, composed of secretion of the glands, various salts, desquamated cells, and leukocytes.” By the way, spelling it mucous makes it an adjective, a word that describes a noun. Mucus is the noun, the thing itself.

Let’s go back to that definition for a minute. We know from What Is It and How Did I Get It? Early Stage Chronic Kidney Disease that “Leukocytes are FullSizeRender (2)one of the white blood cells that fight bacterial infection.” Interesting, the flu as bacterial infection.

Yep, I looked it up and found this on WebMd at http://www.webmd.com/cold-and-flu/tc/flu-signs-of-bacterial-infection-topic-overview: “A bacterial infection may develop following infection with viral influenza.” Oh, so that’s what all the mucus is about. There’s quite a bit more information on this site, but I’m having a hard enough time sticking to my topic as it is.

I still wanted to know how mucus (without the ‘o’) was produced.

Many thanks to Virtual Medical Centre at http://www.myvmc.com/medical-centres/lungs-breathing/anatomy-and-physiology-of-the-nasal-cavity-inner-nose-and-mucosa/ for their help in explaining the following:

The nasal cavity refers to the interior of the nose, or the structure which opens exteriorly at the nostrils. It is the entry point for inspired air and the first of a series of structures which form the respiratory system. The cavity is entirely lined by the nasal mucosa, one of the anatomical structures (others include skin, body anim_nasal_cavityencasements like the skull and non-nasal mucosa such as those of the vagina and bowel) which form the physical barriers of the body’s immune system. These barriers provide mechanical protection from the invasion of infectious and allergenic pathogens.

By now you’re probably questioning what this has to do with Chronic Kidney Disease. I found this on a site with the unlikely name Straightdope at http://www.straightdope.com/columns/read/1246/how-does-my-nose-produce-so-much-snot-so-fast-when-i-have-a-cold :

“The reason you have a seemingly inexhaustible supply of mucus when suffering from a cold is that the mucus-producing cells lining your nasal cavity extract the stuff mostly from your blood, of which needless to say you have a vast supply. The blood transports the raw materials (largely water) from other parts of the body. Fluid from your blood diffuses through the capillary walls and into the cells and moments later winds up in your handkerchief. (This process isn’t unique to mucus; blood is the highway for most of your bodily fluids.)”

While this is not the most scholarly site I’ve quoted, it offers a simple explanation. Blood. Think about that. I turned to The Book of Blogs: Moderate Stage IMG_2982Chronic Kidney Disease, Part 1 for help with my explanation.

“Our kidneys are very busy organs, indeed.  They produce urine, remove potentially harmful waste products from the blood, aid in the maintenance of the local environment around the cells of the body, help to stimulate the production of red blood cells, regulate blood pressure, help regulate various substances in the blood {For example, potassium, sodium, calcium and more}, help to regulate the acidity of the blood, and regulate the amount of water in the body. Mind you, these are just their main jobs.  I haven’t even mentioned their minor ones.”

Get it? Kidneys filter the blood. Our kidneys are not doing such a great job of filtering our blood since we have CKD, which means we also have compromised immune systems. Thank you for that little gift, CKD. (She wrote sarcastically.)

Now you have the flu. Now what? Here are some hints taken from Dr. Leslie Spry’s  ‘Flu Season and Your Kidneys’  reprinted in The Book of Blogs: Moderate Stage Chronic Kidney Disease, Part 2. Dr. Spry is an active member of the Public Policy Committee at the National Kidney Foundation, and, I am honored to FullSizeRender (3)say, a follower on Twitter.

You should get plenty of rest and avoid other individuals who are ill, in order to limit the spread of the disease. If you are ill, stay home and rest. You should drink plenty of fluids …to stay well hydrated. You should eat a balanced diet. If you have gastrointestinal illness including nausea, vomiting or diarrhea, you should contact your physician. Immodium® is generally safe to take to control diarrhea. If you become constipated, medications that contain polyethylene glycol, such as Miralax® and Glycolax® are safe to take. You should avoid laxatives that contain magnesium and phosphates. Gastrointestinal illness can lead to dehydration or may keep you from taking your proper medication. If you are on a diuretic, it may not be a good idea to keep taking that diuretic if you are unable to keep liquids down or if you are experiencing diarrhea. You should monitor your temperature and blood pressure carefully and report concerns to your physician. Any medication you take should be reported to your physician…

National Kidney MonthCheck the National Kidney Foundation itself for even more advice in addition to some suggestions as to how to avoid the flu in the first place.

Every year I decide not to write about the flu again. Every year I do. I think I’m oh-so-careful about my health, yet I end up with the flu every year. Sometimes I wonder if these blogs are for you…or reminders for me. Either way, I’m hoping you’re able to avoid the flu and keep yourself healthy. That would be another kind of miracle, wouldn’t it?IMG_2980

Until next week,

Keep living your life.

Are you kidding????? Again??????

MenorahGuess what I have.  No, it’s not a Chanukah gift from Bear (although I’ve already gotten one of those). Hang on, I’ll give you a hint: I got it even though I took my annual flu shot.

Yep, this is yet another year I’ve come down with the flu despite having been vaccinated.  I realize that the vaccine only covers the anticipated strains of the flu for a particular season, but how is it I manage to get that strain… the unanticipated one… so often?

This week is the beginning of Chanukah. For those of you who celebrate, I wish you the joyous glow of the season all year round. But wait, it’s also National Influenza Vaccination Week.

According to the U.S. government’s Centers for Disease Control and Prevention (CDC) at http://www.cdc.gov/flu/about/season/flu-season-2015-2016.htm,the shot

“National Influenza Vaccination Week (NIVW) is a national observance that was established to highlight the importance of continuing influenza vaccination…. The timing of flu is very unpredictable and can vary in different parts of the country and from season to season. Most seasonal flu activity typically occurs between October and May. Flu activity most commonly peaks in the United States between December and February.”

We’re deep into it now. Well, then, why do I need to keep taking this vaccine that seems to be the wrong one for me each year?

DaVita at http://www.davita.com/kidney-disease/overview/treatment-overview/immunizations–which-shots-you-need-and-why/e/4837 tells us,

“Immunizations may prevent people from contracting other diseases, infections and viruses. The immune system of a person with chronic kidney disease (CKD) becomes weakened, making it difficult to fight off many diseases and infections. Patients with CKD may become more susceptible to illness and even death if they do not receive regular immunization treatment. Getting the proper immunizations is an essential part of a person’s kidney care.”

This tidbit from http://www.esrdnetwork6.org/utils/pdf/immunizations.pdf, which is the website of the Southeastern Kidney Council, Inc. was even more direct.

  • Cardiovascular disease is the leading cause of death among patients with CKD
  •  Infectious diseases are the second most common cause of death among cause of death among patients with CKD

fit the fluIt’s here now. So what do I do about it? I was truly surprised at the OTC (over the counter) medications my former nephrologist recommended to me.  Tylenol Cold?  A steady regime for four days?  This for a CKD patient who has taken ten Tylenol in the last eight years?  But that’s what the man said.

Dylsem Cough Suppression was another OTC he recommended.  (Not the one with the ‘d’ on the label; that could raise your blood pressure.) Then there was the Benedryl that came with a caution not to take it until I was going to sleep. It would knock me out. Oh, and the Mucinex.

The one recommendation I got a kick from was hot tea with lemon and honey (I actually asked him if he knew my mother, but I don’t think he heard me.) laced with whiskey. This for someone who doesn’t drink?

It occurred to me (I do forget this and need to remind myself repeatedly) that when the media refers to the elderly in their public service announcements about the flu, they mean people over 65.  That means me.  I had not been paying attention to any health warnings for the elderly because they didn’t apply to me, or so I thought.  Hah!  Reality smacks me in the face again.

Let’s say you’re one of the lucky ones who has not yet gotten the flu and want to keep it that way. According to Healthfinder.gov, Office of Disease Prevention and Health Promotion, you can protect yourself by doing the following, in addition – of course – to being vaccinated:the flu ends with you

  • Stay away from people who are sick.
  • If you are sick, stay home for at least 24 hours after your fever is gone.
  • Wash your hands often with soap and warm water.
  • Try not to touch your nose, mouth, or eyes.
  • Cover your mouth and nose with a tissue when you cough or sneeze

Note: There is a technical error on their page right now, so you won’t be able to click through.

Knowing me, you’ve probably figured out I just couldn’t watch movies and read while I was sick. Nope, I needed to work. So I did. The print version of The Book of Blogs: Moderate Stage Chronic Kidney Disease, Part 1 now has an index. This new, improved version (Sorry, no crackerjack prize in the box. Uhhhh, you won’t get that joke unless you’re a bit older.) should be available on both Amazon.com and www.BarnesandNoble.com this week.

That is in plenty of time for Chanukah. Remember, there are eight days that the holiday is celebrated. And I’m working on the index for print version of The Book of Blogs: Moderate Stage Chronic Kidney Disease, Part 2, so it will be available before Christmas.

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I like giving you gifts. If you already bought the print copy without the index, email me at SlowItDownCKD@gmail.com and I’ll be very happy to send you the index.

And let’s not forget about What Is It and How Did I Get It? Early Stage Chronic Kidney Disease. Consider that an easy introduction for the newly diagnosed and their friends and family.

Book CoverI think I feel another The Book of Blogs: Moderate Stage Chronic Kidney Disease book coming on. Eeeek! Let’s wait until after the New Year to deal with a title for that one.

I wanted to remind you to use the search function if you have the digital version of any of the books. If you need a little reminder or tutorial as to how to use that, email me. I’ll be glad to help.

This year is flying by. The months flew by. Even today flew by.  Is it that I’m older and everything takes longer?  Or is it that I’ve learned to make the most of the hours in the day…month…years. Whatever it is, thank you for letting me share some of your time each Monday.

Until next week,

Keep living your life.

And (S)He’s Safeeeeeeeeeeeeee

Having had no medical emergencies this past week (thank heavens!), I was casting around for this week’s topic when my dentist reminded me that I need to keep whitening my other teeth for at least another week so they somewhat match the new upper front six tooth sparkling teethbridge.

Whiteners… how do they affect the kidneys if they do at all?   Should I use over the counter products?  A kit I purchase from the dentist?  An in-the-chair dental bleaching?

These are the kinds of questions I keep asking, for deodorant, toothpaste, makeup, even waxing.  Boy, have I ever covered a lot of ground in this area in the last couple of years.  But, as usual, it’s still not enough.  I’ve been playing around with the idea of a newsletter based on what’s safe and what’s not as far as personal products and medical treatments.

smelly armpitsI’ve already written about deodorants and toothpaste.  What a response, especially to the deodorant blog! Most of my readers are not direct email, but read the blog via Facebook and that’s where the lively discussions take place.

Here’s another example.  When I wrote about macular degeneration, I mentioned that my ophthalmologist offered his own designer vitamin that had a 25% chance of slowing down the sight loss involved in this disease.  Once I eliminated the vitamins in the compound that were for preventing cataracts (I’ve already had those removed from both eyes), I was still left with a bunch that might work and a doctor who didn’t know what they would do – if anything – to my kidneys.  I researched them one by one and discovered that only two would be safe for CKD patients.

Now, I don’t mean to whine (Wine? Does that affect the kidneys?), but this is a lot of work for each new product you want to use.  Sometimes even our nephrologists can’t tell us because the product is so new.  I’ve gone to the pharmacist with new products many times and, if they weren’t too busy, they would call the company that made the product immediately.  A call from a pharmacist seems to take precedence over a call from a consumer when it comes to inquiries.

I looked at the ingredients at the dental bleaching product I’d purchased and realized I would have to research them one by one.  The dentist wasn’t sure.  The nephrologist was out of town and I didn’t feel this necessitated a call from his covering doctor.  The pharmacy was very, very busy. (We don’t exactly have winter in Arizona, but we do have flu and cold season).

There are nine ingredients in the dental bleach product I chose.  One is water, so I didn’t research that.  I am not a doctor, never claimed to be one, and repeatedly reminded people that I am not one.  Apparently, my computer hasn’t gotten the message.  But, while I am not a doctor, I’m a terrific researcher.

warningHowever, in this case, I could not understand even one of the articles I found about the eight ingredients I didn’t know about.  This was extremely frustrating. So, I did what I probably should have done in the first place: I called the company.  They looked at the product information and assured me the product had no effect on the kidneys at all, but if I wasn’t comfortable with that, to contact my local pharmacist and/or my doctor.  I was willing to take their word for it (but I will call both the pharmacist and my nephrologist anyway.  Just to be sure, you understand).

Ah, the problems of being a chronic kidney disease patient… and we thought it was all about our doctors’ appointments, diets, sleep, stress levels, and exercise!

On the book front, yet another reminder for you that if you EVER bought a print copy of What Is It And How Did I Get It? Early Stage Chronic Kidney Disease at any price from Amazon.com, you are now eligible for an electronic copy for $2.99.  That is a 70% savings over Book Coverthe usual price of $9.95 for the digital book.  And, yes, I did do that on purpose so that more people will have access to the information they need if they, a loved one, a colleague, or anyone they know and care about has Chronic Kidney Disease.  I can’t take credit for coming up with this Kindle MatchBook program just in time for your holiday shopping, however.  The accolades for that belong solely to Amazon.

SlowItDown is constantly on the lookout for new communities to bring our free Chronic Kidney Disease education taught by trained educators.  If you’re Black, you’re part of a high risk community.  If you’re Hispanic, you’re part of a high risk community.  Heck, if you’re over 60, you’re part of a high risk community!  Gather your friends and family and let’s get SlowItDown over to you so you can all rest a little bit easier by having an understanding of just what your disease means to you and your community.kidney-book-cover

Many, many thanks to Alex Gilman who was our host for Thanksgiving this year.  He made sure the turkey was cooked in a way that I could eat it and was extremely understanding when I forewent certain of the side dishes and of the small portions I chose.

We’ve got to remember it’s not easy for those who have no knowledge of Chronic Kidney Disease to understand why we eat the way we do.  I cannot even count the number of people who were downright insulted that I would do no more than taste what they’d made because the ingredients were not on the renal diet… and that’s after I’ve explained the renal diet!

MenorahTo those who celebrate, I hope you’re enjoying Chanukah.  Kwanzaa, a week-long celebration, won’t start until the day after Christmas, December 26.  I found this informative website for those of you who see me keep mentioning Kwanzaa, but really aren’t sure what it is: http://www.altiusdirectory.com/Society/kwanzaa-festival.php.  As you gear up for these two holidays or enjoy the last three days of Chanukah, consider helping out those with CKD via the book or contacting SlowItDown (ckded@cox.net) for them.

Until next week,

Keep living your life!

A Meta Is Going to Come? Shouldn’t That Be A Change is Going to Come?

Victorian clockYou may notice the blog is late today.  Blame the flu.  Scratch that.  I’ll take responsibility.  While I was debating whether or not it was time to take the flu shot all Chronic Kidney Disease patients are urged to take each year, the flu found me.  No kidding about this compromised immune system business.  I considered this a light case, but was just ordered back to bed… after over a week of laying low.

Keep in mind that this year’s flu’s vaccine only covers three or four of the many strains around, so you may end up with the flu even after having the shot.  My family doctor’s advice?  Once you’re well again have the inoculation and protect yourself from as many strains as you can.flu shot

Dr. Jamal Attalla is my new nephrologist and also a Landmark Graduate.  That’s where I met him way before I even knew he is a nephrologist.  I like that he is non-alarmist, non-paternalistic and easy going.  When I told him that 50 as an eGFR reading was my panic point, he very gently reminded me that readings will vary within a range depending on the day, your hydration, etc. – all variable factors.  I knew that.

Then he reminded me that after 35, we lose about 1% of our kidney function yearly.  I was under the impression it was ½% annually and thought that started at a much later age.  Finally, we talked about my reading of 48%. But I understood better now how that happened and am confident I can raise it again before I see him a year from now.

Enough about me, let’s get to that metabolic syndrome.  Oh, wait, that’s about me too.

Kibow has sent me quite a bit of information about using their probiotics as a method of treating chronic kidney disease.  I need to warn you that this is not an endorsement of their product.  I don’t know enough about it yet.

Along with their press release, they sent me a booklet entitled Kibow’s Educational Guide to Probiotics and Kidney Health written by Natarajan Ranganathan, Ph.D. and Henry D’Silva, M.D.  In the booklet, they discuss metabolic syndrome.  This part of that discussion lists five conditions in metabolic syndrome.  Only three are necessary to diagnose the syndrome:

“1. Abdominal obesity

2. high blood pressure

3. high blood sugarapple shaped

4. low levels of ‘good’ HDL cholesterol

5. high triglycerides”

I’d first heard about metabolic syndrome two years ago when I met an Aussie nurse at a friend’s house.  She assumed I knew all about it.  When I told her I didn’t and asked her to explain, she promised a coffee date to do just that.  We never had the date since she was called home quite suddenly and I forgot about the syndrome.

Then Kibow sent me their material.  Except for the high triglycerides and low levels of ‘good’ HDL cholesterol, I have all these conditions.  Granted, the abdominal obesity is self-diagnosed but you’d have to be blind (and I’m not yet) to miss it.

So what’s the big deal about metabolic syndrome?  By the way, meta does mean change.  According to The National Institutes on their Institute of Heart, Lungs, and Blood page at http://www.nhlbi.nih.gov/health/-topics/ms/:

“The term ‘metabolic’ refers to the biochemical processes involved in the body’s normal functioning. Risk factors are traits, conditions, or habits that increase your chance of developing a disease.”

The National Institutes is a fount of information on all topics that deal with your health.

heart attackAgain, the same question: what’s the big deal about metabolic syndrome?  Usually it’s stated backwards for Chronic Kidney Disease patients.  The MayoClinic at http://www.mayoclinic.com/health/metabolic%20syndrome/DS00522  tells us:

“Metabolic syndrome is a cluster of conditions — increased blood pressure, a high blood sugar level, excess body fat around the waist and abnormal cholesterol levels — that occur together, increasing your risk of heart disease, stroke and diabetes.”

Sometimes, Chronic Kidney Disease is mentioned as one of the diseases this syndrome puts you at risk for.  We, however, already have that, so why should we try to either avoid the syndrome completely or ameliorate it if we do have it?

Before I was diagnosed with Chronic Kidney Disease, I joyfully proclaimed Dr. Andrew Weil as my health guru and actually had pretty good health following his suggestions.  This is what he has to say,

“Doctors may also prescribe medications to lower blood pressure, control cholesterol or help you lose weight. Insulin sensitizers like Glucophage (Metformin) may be prescribed to help your body use insulin more effectively. It lowers blood sugar, which also seems to help lower cholesterol and triglycerides as well as decreasing appetite. The side effects of Metformin (often temporary) include nausea, stomach pain, bloating and diarrhea. A more serious side effect, lactic acidosis, can affect those with kidney or liver disease, severe heart failure or a history of alcohol abuse and is potentially, though rarely, fatal. Aspirin therapy is often given to help reduce risk of heart attack and stroke.”

Notice the mention of kidney damage and that of aspirin therapy.  We just can’t take the chance.

Take a look at his article yourself for even more information: http://www.drweil.com/drw/u/ART03193/Metabolic-Syndrome.html.Dr. Andrew WEil

Sometimes you just have to use your common sense.  We ARE already at risk of heart disease, diabetes, and high blood pressure as CKD sufferers.  Why would we take a chance of doubling our risk of developing these medical problems?  Don’t forget that while diabetes and high blood pressure can cause CKD, the reverse is true, too.

Kindle has offered me the opportunity to correct two spelling errors in the book.  What I want to know – since they are simple words – is how did spell check (and me for that matter) miss these in the first place? I find it amazing that not one single medical term was misspelled, but these two common words were.Book Cover

Keep an eye out for a new print/digital program they’ll be announcing.  It’s theirs so I’m not at liberty to discuss it until they announce it.  That is a bit of a tease, isn’t it?

Exercise is an essential part of slowing down the progression of your CKD, so kudos to Abby Wegerski (that’s my baby!) and her instruction partner, Tyler Robbins, on the One Year Plus dance celebration for Sustainable Blues this past weekend!

Until next week,

Keep living your life!blues

Stop It Before It Starts

Memorial Day

First things first: thank you to Bear and every other veteran – living or not – for the sacrifices you made for the rest of us.  I wasn’t quite sure I believed in the military until I watched the attacks on 9/11… while my children were in the city.  Then I knew.  That day, soldiers and police officers became the most respected people in my world. It’s been close to a dozen years, but I still find myself weeping when I think of it.  If this is post traumatic stress for me, what is it like for our returning soldiers?

There is no way to slide into a blog from that so I won’t. There was a question on What Is It And How Did I Get It? Early Stage Chronic Kidney Disease‘s Facebook page ( https://www.facebook.com/WhatHowearlyCKD) about the inoculations that are suggested for those who have Chronic Kidney Disease.

Before we even get to the different kinds of inoculations, why do we need any in the first place?  According to http://www.davita.com/kidney-disease/overview/treatment-overview/immunizations–which-shots-you-need-and-why/e/4837:

“Immunizations may prevent people from contracting other diseases, infections and viruses. The immune system of a person with chronic kidney disease (CKD) becomes weakened, making it difficult to fight off many diseases and infections. Patients with CKD may become more susceptible to illness and even death if they do not receive regular immunization treatment. Getting the proper immunizations is an essential part of a person’s kidney care.”HBV

I have been on bed rest for several days, ever since I showed up at my primary care physician’s office for my Hepatitis-B vaccine and was told I’d have to come back for that at a later date.  I either had pneumonia or bronchitis. I didn’t know.  I thought I’d just been pushing my physical limits and needed to take some time off. Why mention that here?  Consider it proof that our immune systems become weaker with CKD.

I clearly remember (because it was only a few years ago), becoming sick for only a day at a time.   Then I noticed that maybe once a year I’d end up with the flu which had me down for about ten days.  This year, it’s been ten days with the flu, ten days with sinusitis, and now whatever this is.  You know I’ll be running to Dr. Zhao’s office for the inoculations as soon as my lungs are clear!

Now that I’ve convinced you they’re necessary, what are the inoculations?  There are three that DaVita suggests. The first, as mentioned, is Hepatitis-B. Let’s go back a little bit and define the disease. “Hepatitis B is a serious liver infection caused by the hepatitis B virus (HBV). For some people, hepatitis B infection becomes chronic, leading to liver failure, liver cancer or cirrhosis — a condition that causes permanent scarring of the liver. ” That’s what the Mayo Clinic has to say about it.  You can read more at:  http://www.mayoclinic.com/health/medical/IM02250.

A Hepatitis-B infection may lead to kidney failure. What’s worse is that some adults never exhibit the symptoms of this disease.  Your kidneys areliver already compromised, as is your immune system. To the best of my knowledge, the drugs to treat Hepatitis-B may also adversely affect the kidneys.

Think about it: your liver and your kidneys are the two most important blood filters you have. We already know we need to maintain as steady a blood pressure in the kidneys as we can to do no more damage to them.  The liver does this by releasing angiotensin which constricts your blood vessels. Don’t forget the liver helps maintain your blood sugars.  If it can’t do that due to infection,  kidney function can be further reduced. The liver also filters toxins and drugs from the blood.

The liver performs quite a few of the metabolic functions necessary to keep you alive, much less healthy, certain of which affect the kidneys. Metabolic means the “chemical processes occurring within a living cell or organism that are necessary for the maintenance of life,”  according to www.thefreedictionary.com. If your kidneys are already compromised and then your liver is, what happens to your blood pressure and blood sugars without any kind of regulation?  I know I’m already having problems with both and don’t need any more. This much I knew.

As I researched, I discovered that the liver also converts blood ammonia – which is toxic –  into urea. Remember the kidneys turn urea into urine and that the amount of urea directly affects our kidney function.  What I didn’t know is that Hepatitis-B is one of the infections that can inflame  the glomeruli.  These are the parts of the kidneys that do the filtering.

I’m sure you’ve all heard of cirrhosis of the liver.  Guess what.  It can lead to kidney failure.  Get the vaccine!

fluI’ve spent most of the blog on the Hepatitis-B because it’s relatively new and I, for one, didn’t know much about it.  I’ve already written several blogs about the flu vaccine, so I’ll just add this tidbit from http://www.esrdnetwork6.org/utils/pdf/immunizations.pdf, which is the website of the Southeastern Kidney Council, Inc.”

  • Cardiovascular disease is the leading cause of death among patients with CKD
  •  Infectious diseases are the Infectious diseases are the second most common cause of death among cause of death among patients with CKD

That statement speaks for itself.

Ah, now the third vaccination: Pneumococcal.  Sounds terrible, but it’s really just the pneumonia inoculation. MedicineNet at http://www.medicinenet.com/pneumococcal_vaccination/article.htm#who_should_consider_pneumococcal_vaccination  tells us this is,

” a method of preventing a specific type of lung infection (pneumonia) that is caused by pneumococcus bacterium. There are more than 80 different types of pneumococcus bacteria — 23 of them covered by the vaccine. The vaccine is injected into the body to stimulate the normal immune system to produce antibodies that are directed against pneumococcus bacteria.”

Naturally, the next question is why CKD patients? Dr. Joseph A. Vassalotti, Chief Medical Officer of the National Kidney Foundation and Dr. William Schaffner, President of the National Foundation for Infectious Diseases have explained it better than I ever could:

“One reason people with CKD are at greater risk for pneumococcal disease is because kidney disease can weaken the immune system and make the body more susceptible to infection.

2 Doctors and researchers have found that infections in people with CKD such as those caused by pneumococcal disease are worse and can be more serious than in people who don’t have CKD.pneunomia lungs

3 In some people, infection can cause death.”

You can read more about that at: http://www.kidney.org/atoz/content/Pneumococcal.cfm

It’s time for me to crawl back into bed.

Until next week,

Keep living your life!

Frustrated and Wondering

You’ve seen it all over the book’s Facebook page and on Twitter.  Yesterday was my birthday, my 66th birthday to be exact.  “I feel good.  I knew that I would,” as James Brown sings when someone calls me.  But what does my, uh, advanced age mean to my kidneys?James Brown

According to my nephrologist, I would lose 1/2 % of my kidney function each year since I was older.  Interesting… and wrong.  I’ve gained between 9 and 21 points on my GFR in the last five years.  It does vary depending on numerous factors: diet, sleep, exercise, stress, illness.

I had my blood drawn two weeks ago and the results told me that my GFR was 52, down from the 64 it had been only three months before. My primary care doctor told me not to worry about this lower number since I had clearly been incubating the flu at the time of the draw.

Here’s something you haven’t heard from me in a while (she wrote tongue in cheek): that got me to thinking.  What do illness – other than chronic kidney disease – and age have to do with your Glomerular Filtration Rate, a widely accepted indication of just how well your kidneys are functioning?

I found the following chart on The National Kidney Foundation’s website at http://www.kidney.org/professionals/kls/pdf/12-10-4004_KBB_FAQs_AboutGFR-1.pdf

      Average Measured GFR by Age in People Without CKD 

AGE  (Years)                   Average Measured GFR (mL/min/1.73 m2)

20-29                                                      116

30-39                                                      107

40-40                                                        99

50-59                                                        93

60-69                                                        85

70+                                                           75

Notice this is for people without CKD.   Now I’m not a mathematician, as we all know, but if those without our disease lose almost ten points of their GFR each decade they age, why am I not surprised that we who do have Chronic Kidney Disease are expected to be lose the same number of points?

By the way, that does take into account the 1/2% a year I would be losing on my GFR – according to my nephrologist – due to age.  But it’s just not happening.

This is a good place to mention that a reader was infuriated that her nephrologist never told her to double her rate to see where she was on the charts.  She previously had a kidney removed due to cancer and was living with one kidney.

Until she was given that information, she thought she should be on par with those living with two kidneys and was aghast as how low her GFR was.  I can see where her ire would rise (as well as her blood pressure from all that unnecessary worry).

I have been researching for hours and the only answers I’ve found to the question of how the flu affected my GFR were on forums or pay-an-expert-for-a-medical-answer sites.

kidney anatomySorry, folks, I just don’t trust them.  I will be seeing my nephrologist this week and will make it a point to ask him.

When I had the flu, my nephrologist told me to go right ahead and take the over the counter medications my primary physician had suggested and in the dosages recommended on the labels.  He did caution that I not take anything with the letter  ‘d’ in the name since that might raise my blood pressure.

Here’s what DaVita at http://www1.davita.com/3617 has to say about that:

When the flu season hits, the use of treatments for cold and flu soars. These medications often include compounds that can intensify

hypertension and salt retention. Should you require a product to treat cold and/or flu symptoms, it is strongly recommended that you

take them as prescribed by your doctor and carefully read the package instructions.

Notice we still don’t know if the flu affects the GFR.  Although, logically, if hypertension (high blood pressure) affects your kidneys and these medications may raise your blood pressure… perhaps that means they lower your GFR?

These are the kinds of questions that sent me running to interview different nephrologists, rather than trying to research my answers on the internet, when I was writing the book.

Attempting to research these questions brought me to this chart on the site of The National Kidney Disease Education Program – which is a part of The U.S. Department Of Health And Human Services – at http://www.nkdep.nih.gov/learn/testing/understand-gfr.shtml.GFR

I have included it here due to its clarity.  Seeing numbers written doesn’t always make it obvious just what the guidelines are, especially for those of us who think we’re not that good at math.

I certainly do not mean to beg the issue, but I’m getting nowhere looking for definitive answers as to how my age and any other illness such as the flu affect CKD.

We can all see how age and illness affect us as far as appearance, physical use of our body, and even shrinkage (Proof: I am ½ inch shorter due to the compression of the discs between my vertebrae), as well as the coughing, sneezing, and body aches of the flu.

Apparently, you have to be a doctor, or have the vocabulary of one, to be able to understand the connection of these conditions to your GFR.

On another note, The Southwest Nephrology Conference is on March 1 & 2 at Wild Horse Pass Hotel and Resort in Chandler.  That is simply too close to ignore.  I am thinking about going to meet all the specialists I’ve corresponded with from different parts of the country in person.

Could I interest any of you in joining me?  You can read more information about the conference at http://swnc.org/

54603_4833997811387_1521243709_o

I keep forgetting to mention the book!  Since I no longer do book signings or book talks, the only way to get the information out there is for you to buy books for your friends and family.

Hey!  I’m donating as fast as I can! (Wait until my accountant hears about that.)

Until next week,

Keep living your life!

The Flu: Part 3, The Last

martin-luther-king-jrToday is such a momentous day.  It is not only Martin Luther King, Jr.  Day, but the second inauguration of President Obama.  2013-01-21T024432Z_1452960950_GM1E91L0TCM01_RTRMADP_3_USA-INAUGURATIONAs I sit at my computer, I ruminate how far we’ve come in a relatively short amount of time.  I remember becoming aware of the Civil Rights Movement and crying when I watched fire hoses being turned on the crowds.  I remember how I wondered as a little girl why my friend’s skin was darker… and assumed she’d just been in the sun longer than I had.  And I remember the prejudice both of us experienced as we traveled in the rural south only forty years ago.  She is Black, but I am a Jew.

And now I wonder how to slide into a blog about chronic kidney disease.  There is no sedge way here. That’s all right, though, because we’re not exactly dealing with ckd today, but the flu instead.  I do promise that this will be the last blog about the flu (this year, that is).

I have just spent four uncomfortable days zapped of energy and not enjoying the movies I watched or books I read while enduring the flu. I was truly surprised at the OTC (over the counter) medications my nephrologist recommended to me.  Tylenol Cold?  A steady regime for four days?  This for a CKD patient who has taken six Tylenol in the last five years?  But that’s what the man said.

Dylsem Cough Suppression was another OTC he recommended.  Then there was the Benedryl that came with a caution not to take it until I was going to sleep. It would knock me out. Oh, and the Mucinex.  The one recommendation I got a kick from was hot tea with lemon and honey (I actually asked him if he knew my mother, but I think he didn’t hear me.) laced with whiskey. This for someone who doesn’t drink?

Now that I’m feeling better – even if I don’t sound better – I’m nervous about all this medication.  I carefully read each and every label.  Not a single one mentioned anything about possible kidney damage.

I think I’ve become accustomed to not taking OTC medication and I think that’s done me well. As I finished each bottle – especially the Tylenol Cold – I noticed I felt more alert, more aware of my body, and less… less what?  Tamped down?  Cocooned?  I don’t know the word, but I certainly feel more here.

Is it that the medications did their job?  Probably.  Is it that I got more sleep and rest than I have in quite a while?  Probably that, too.  But maybe, just maybe, my body doesn’t like more medications.  Sounds a bit hocus-pocus, but this is the same body that has slowly raised its GFR with careful guidance from me.

Would I take the flu shot again even though I got the flu after taking it this season?  Absolutely.  It was my misfortune to take the immunization for the wrong strain of flu this year. flu shot That’s never happened before, but then again, there haven’t usually been this many different strains of flu before in the same season.

Another reason is that this inoculation against  influenza also prevents heart attack and stroke.

“If you’re tempted to skip your flu shot, consider this: Getting vaccinated cuts risk for a heart attack or stroke by up to 50 percent, according to two studies presented at the Canadian Cardiovascular Congress.”  This is the lead sentence in Lisa Collier Cool’s Nov. 26, 2012 Yahoo Health article. You can read the whole article (and I urge you to.  There’s information here that was news to me.) at: http://health.yahoo.net/experts/dayinhealth/shot-prevents-heart-attacks

According to a Reuters’ Jan. 18, 2013 article, the number of flu cases is beginning to taper off but this has been a difficult year. We already know that.  Both Boston and New York State have declared Medical Health Emergencies. Look around you.  Are there people missing from your office?  Your school?  I noticed fewer people in the markets, too.

This same article talks about a dearth of Tamiflu.  Weren’t we told just last week that there was a shortage of the vaccine, too?  Do you see where I’m going with this? If you haven’t gotten your inoculation, get it.  If you have, but can’t find Tamiflu (not that everyone is prescribed Tamiflu), ask your doctor. No reason to panic.  Honestly, I sometimes wonder just how objective our news is.  Oh, the article.  It’s at: http://news.yahoo.com/flu-u-still-widespread-starting-ease-cdc-says-191406674–finance.htmlflu

A MedPage Today article offered some startling information on January 19th of this year: “A resounding 85% of 2,000-plus MedPage Today readers voted “yes” to our survey question asking if media attention promoted a “pseudo epidemic” as patients mistake cold symptoms for flu.” Did I do that?  Did you?  As someone who rarely becomes ill for more than a day at a time, did I simply not recognize a bad cold for what it is?

I couldn’t secure an appointment with my pcp (primary care physician) until this coming Wednesday – fully a week after I started to feel symptoms.  Will it be too late for her to tell the difference?  It’s an interesting article, although I’m not necessarily endorsing it.  Read it for yourself at: http://www.medpagetoday.com/InfectiousDisease/Vaccines/36924?utm_content=&utm_medium=email&utm_campaign=DailyHeadlines&utm_source=WC&xid=NL_DHE_2013-01-21&eun=g596983d0r&userid=596983&email=myckdexperience@gmail.com&mu_id=5721543

As I read a New York Times article about the severe flu season (http://www.nytimes.com/2013/01/19/health/flu-season-worse-than-average-officials-say.html?smid=tw-nytimeshealth&seid=auto&_r=1&) from last Saturday, it occurred to me that when the media refers to the elderly, they mean people over 65.  That means me!  I had not been paying attention to any health warnings for the elderly because they didn’t apply to me.  Hah!  Reality smacks me in the face again.

I could go on and on, but you’ve probably read a great deal yourself about the flu.the flu ends with you

As far as the book, I believe I have come close to paying off the initial cost of publication.  When you buy a book (Amazon.com, B&N.com, or DogEarPublishing.com), my profit goes right back into the book.  That’s what has allowed me to donate books to those who could not afford the book, were just diagnosed, and/or were somehow related to CKD patients.

As soon as I earn enough to pay off turning the book into an e-book , paying for the books I ordered to donate, and then translating it into Spanish (my next project), I intend to order more books to donate.

India, Malaysia, Pakistan, Turkey, Tunisia, the United Arab Emirates, Egypt, Saudi Arabia, Singapore, South Africa, The UK, Canada, Australia, Italy, Ireland, Germany, New Zealand, The Philippines, and Mexico, as well as the USA,  thank you.  Buy a book for yourself and help someone else who needs it.

Until next week,

Keep living your life.Book signing

By Request, Ladies and Gentlemen: The Flu (Redux)

We’re back thanks to the ever willing Sean who pitched right in and picked us up from the airport when we realized Abby, who had taken us to the airport, holds a blues dance just about the time we arrived back in Phoenix. Doctors and medical practices in Apollo Beach, Tampa, Mount Dora and Orlando are now proud owners of office copies of the book.

But while we were on the plane both ways, I heard coughing, sneezing, throat clearing and sniffling… lots of it.  Was this the flu?  All my relatives and friends had seemed healthy enough, but they weren’t traveling on these planes.interior of plane

That got me to thinking more about the flu just as it was requested that I re-run the flu blogs. Before doing so, I thought I’d find out more about this season’s flu.  Sure enough, MedPage Today ran just such an article on January 10th of this new year.  According to Todd Neale, who wrote the article, “Last week, the CDC reported that 41 states had widespread influenza activity, and 29 states and New York City had high influenza-like illness activity in the week ending Dec. 29. Although not unprecedented, that level of activity is not usually seen until later in the season.”

Some of the physicians quoted in the article wondered if it’s the reporting of the illness that’s improved thereby making the flu appear more widespread than it really is.  I don’t think I believe that since there seems to be a shortage of both vaccines and drugs to treat this ailment and Boston’s mayor has declared a public health emergency due to the 700 cases reported in his city. You need only click through to http://www.medpagetoday.com/InfectiousDisease/URItheFlu/36801 to read the article for yourself.

According to Healthfinder.gov, you can protect yourself from the flu by doing the following:

Getting the flu vaccine is the most important step in protecting yourself from the flu. Here are some other things you can do to keep from getting and spreading the flu:

  • Stay away from people who are sick.
  • If you are sick, stay home for at least 24 hours after your fever is gone.
  • Wash your hands often with soap and warm water.
  • Try not to touch your nose, mouth, or eyes.
  • Cover your mouth and nose with a tissue when you cough or sneeze

I wondered how to tell the difference between a cold and the flu.  Since being diagnosed with ckd, I make it a point to take the flu vaccine annually, yet there have been times when I just didn’t feel that well. I found my answer in the following: http://abcnews.go.com/health/t/blogEntry?id=17885194  “ ‘With influenza you might also feel very poorly, with aches and pains in your muscles and joints,’ said Dr. William Schaffner, chair of preventive medicine at Vanderbilt University Medical Center in Nashville, Tenn. ‘There’s often a cough, too, which is much more prolonged and pronounced.’ ”

I’m including part of an article by The National Kidney Foundation so you can feel confidant that your kidneys are being covered here.

Flu Season and Your Kidneys

By Leslie Spry, MD FACP FASN

As flu season approaches, kidney patients need to know what they can do and what they should avoid if they become ill. The first and most important action to take is to get a flu shot. All patients with chronic kidney disease, including those with a kidney transplant should have a flu shot. Transplant patients may not have the nasal mist flu vaccine known as FluMist®. Transplant patients should have the regular injection for their flu vaccine. If you are a new transplant recipient, within the first 6 months, it is advisable to check with your transplant coordinator to make sure your transplant team allows flu shots in the first 6 months after transplant. ALL other kidney patients should receive a flu vaccination.

If the influenza virus is spreading in your community, there are medications that you can take to protect against influenza if you have not been vaccinated, however the dose of these medications may have to be modified for your level of kidney function. This is also true of antibiotics or any medication that you take for colds, bacterial infections or other viral infections. [Me: I have written about this in the book and the blog.  You have to tell the prescribing physician about your CKD and/or remind him of it if (s)he already knows each time a prescription is written for you.] The doses of those medications may have to be modified for your level of kidney function. Even if you are vaccinated, it is still possible to get influenza and pneumonia, but the disease is usually much milder.

You should get plenty of rest and avoid other individuals who are ill, in order to limit the spread of the disease. If you are ill, stay home and rest. You should drink plenty of fluids [me again: remember your limit on fluid intake] to stay well hydrated. You should eat a balanced diet. If you have gastrointestinal illness including nausea, vomiting or diarrhea, you should contact your physician. Immodium® is generally safe to take to control diarrhea. If you become constipated, medications that contain polyethylene glycol, such as Miralax® and Glycolax® are safe to take. You should avoid laxatives that contain magnesium and phosphates. Gastrointestinal illness can lead to dehydration or may keep you from taking your proper medication. If you are on a diuretic, it may not be a good idea to keep taking that diuretic if you are unable to keep liquids down or if you are experiencing diarrhea. You should monitor you temperature and blood pressure carefully and report concerns to your physician. Any medication you take should be reported to your physician. [Me: I’ve gotten other advice about those brands, so check with your nephrologist before you take anything.]

fit the flu

Medications to avoid include all non-steroidal medications including ibuprofen, Motrin®, Advil®, Aleve®, and naproxen. Acetaminophen (Tylenol® and others) and aspirin are generally safe to take with kidney disease. Acetaminophen doses should not exceed 4000 milligrams per day [Me: Nobody ever told me that! Why?] If you take any of the over-the-counter medications, you should always drink plenty of water and stay well hydrated. If you take anti-histamines or decongestants, you should avoid those that contain ephedrine or pseudoephedrine. Over-the-counter cold remedies that are safe to take for patients with high blood pressure are generally designated “HBP”. Any over-the-counter medication that you take for a cold or flu should be approved by your doctor.

You can find the article at: http://www.kidney.org/patients/FluSeasonAndYourKidneys.cfm.  Again, although this a nationally respected doctor, it is not your doctor.  Check everything you plan to take with your nephrologist BEFORE you take it. By the way, Medicare covers the cost of the flu shot.

Here is some of the information England’s Department of Health offered in 2011 :

Seasonal flu vaccination: Who should have it and why

What harm can seasonal flu do?

People sometimes think a bad cold is flu, but having flu can be much worse than a cold and you may need to stay in bed for a few days if you have flu. Some people are more susceptible to the effects of seasonal flu. For them it can increase the risk of developing more serious illnesses such as bronchitis and pneumonia, or can make existing conditions worse. In the worst cases, seasonal flu can result in a stay in hospital, or even death.

Am I at greater risk from the effects of seasonal flu?

Even if you feel healthy, you should definitely consider having the free [me: in England, that is] seasonal flu vaccination if you have:

  • a heart problem
  • a chest complaint or breathing difficulties, including bronchitis or emphysema
  • a kidney disease  [Me: I bolded and italicized this for obvious reasons.]
  • lowered immunity due to disease or treatment (such as steroid medication or cancer treatment)
  • a liver disease
  • had a stroke or a transient ischaemic attack (TIA)
  • diabetes
  • a neurological condition, for example multiple sclerosis (MS) or cerebral palsy
  • a problem with your spleen, for example sickle cell disease, or you have had your spleen removed.

Here’s the URL for this article: http://www.dh.gov.uk/health/2011/10/winter-flu/       Book Cover

This is an usually long blog.  That was necessary for you to understand that you can die from influenza… or you can take preventative measures. I don’t want to scare you and need to remind you that “can” doesn’t mean “will.”

Until next week when I’ll try to remember to tell you about Harry Potter’s World,

Keep living your life!

The Flu Flew By

‘Tis the season to be jolly… and get the flu.  You’ll be in crowds at your holiday parties, even in stores when you get your shopping done. Everyone’s got to eat, even Scrooge, so you will be in the markets – and crowds – whether you want to be or not.

Uh-oh, so what do you do about the flu? According to Dec. 3, 2012’s MedPage, the flu has arrived early this year.  Bah! Humbug! Just in time for the holiday season.

“The flu season is officially under way about a month earlier than usual, the CDC announced on a call marking the beginning of National Influenza Vaccination Week. {For your information, that was Dec. 2-8 this year} ‘This is the earliest regular flu season we’ve had in nearly a decade, since the 2003-2004 flu season,’ CDC director Thomas Frieden, MD, MPH, said on a conference call with reporters.”Shoppers1

Who even knew there was a National Influenza Vaccination Week? You can read a bunch of statistics about this early flu season at: http://www.medpagetoday.com/InfectiousDisease/URItheFlu/36225?utm_content=&utm_medium=email&utm_campaign=DailyHeadlines&utm_source=WC&xid=NL_DHE_2012-12-04&eun=g596983d0r&userid=596983

Reminder: as a chronic kidney disease patient, you already have a compromised immune system.  Help yourself to avoid the flu by getting that vaccine.  In some cases (you’ll have to ask health care worker if you are part of this group), you may be able to take the nasal vaccine.  This is especially helpful if you have a great dislike for injections, but if you can’t because you have ckd, just look away during the shot.  That has been proven to make it easier to handle the fear, as I wrote about in an earlier blog.

By the way, Medicare covers the cost of the flu shot.

So, again I ask what do you do about the flu? According to Healthfinder.gov, you can protect yourself from the flu by doing the following:

Getting the flu vaccine is the most important step in protecting yourself from the flu. Here are some other things you can do to keep from getting and spreading the flu:

  • Stay away from people who are sick.
  • If you are sick, stay home for at least 24 hours after your fever is gone.
  • Wash your hands often with soap and warm water.
  • Try not to touch your nose, mouth, or eyes.
  • Cover your mouth and nose with a tissue when you cough or sneeze

The entire article about the flu may be found at: http://healthfinder.gov/prevention/ViewTopicFull.aspx?topicID=18

Most of this sounds fairly obvious. But then Bear told me about someone at work who simply sneezes and coughs into the air around him. That got me to thinking.  Do you find yourself shying away from certain people who do the same?  Maybe you should.

Since the cataract surgery and the sealing off of my tear ducts, I am always touching my eyes to wipe away the extra moisture. Until I read this article, I’d always thought of myself as someone who doesn’t keep touching my face.  But that’s not true, is it?

And how many people in this economy really do take off from work for 24 hours after their fevers break?  Who can afford to do that? We have people struggling to hang on to minimum wage positions while a string of other people are ready and waiting for these same jobs.

It’s worth thinking about this yourself.  Remember when we were taught to cough or sneeze into the inside of our elbows?  Looks like that’s not as effective as stopping the particulate spray immediately at its source – your nostrils.  Makes sense to me.

We live in Arizona.  It’s so dry we try NOT to wash our hands since that dries out the skin.  I’m not saying we’re a dirty demographic, simply that we try to wash our hands only when necessary. That is not often, but it needs to be during flu season.

fluBut have hope!  According to Rob Stein on NPR’s Health News, “One big difference between this year and the 2003-2004 season is that so far the vaccine appears to be a very good match for the strains of flu that are circulating most widely. That’s important because one of the reasons officials are concerned is that one of the strains is similar to the 2003-2004 strain that caused so much illness and so many deaths.”

I think that’s good news.  It sounds like good news.  Is it good news? Why DID the 2003-2004 strain cause so much illness and so many deaths?  Somehow, that’s not as reassuring as I’d like it to be.

The original article is at: http://www.npr.org/blogs/health/2012/12/07/166745954/unusually-early-flu-season-intensifies?ft=1&f=103537970

I wondered how to tell the difference between a cold and the flu.  Since being diagnosed with ckd, I make it a point to take the flu vaccine annually, yet there have been times when I just didn’t feel that well. I found my answer in the following: http://abcnews.go.com/health/t/blogEntry?id=17885194

“ ‘With influenza you might also feel very poorly, with aches and pains in your muscles and joints,’ said Dr. William Schaffner, chair of preventive medicine at Vanderbilt University Medical Center in Nashville, Tenn. ‘There’s often a cough, too, which is much more prolonged and pronounced.’ ”

That does answer my question.  No muscular aches or pains, so what I experienced was just a cold.

Don’t let yourself become run down with the festivities this year, take the time to relax, maybe even put your feet up and read What Is It And How Did I Get It? Early Stage Chronic Kidney Disease. It’s available in digital – which is less expensive than the book – and print at Amazon.com and B&N.com.

You’ll be in good company.  I’ve gotten notice that personal trainers, doctors, medical assistants, phlebotomists, physicians’ assistants, chiropractors, naturopaths and gym owners have been reading it to understand how better to deal with their clients (or patients, as the case may be) who have CKD.  What a nice holiday present for me.

Here’s my wish that you had a Happy Chanukah and/or are happily preparing for Christmas and Kwanzaa.

Until next week,2012-12-12 19.41.37-1

Keep living your life!

Get That Flu Shot!

I’ve written in another blog about  getting a flu shot.  I also mentioned my pharmacist kindly chatting with me so I wouldn’t be so uncomfortable with yet another puncture.  I was already enduring these at least four, if not six, times a year for blood tests.  I don’t think I mentioned what he chatted about.  He knew about the book and the blog, so we talked about how the flu affects CKD patients.

He told me a few things I didn’t know and I told him a few he didn’t know (could have knocked me over with a feather when I realized I knew some information this intelligent, trustworthy pharmacist didn’t). To his credit, he ended the jab session with a thank you for the new information.  No professional ego problem existed for this man.  I’m lucky that I keep running into such health professionals. Just in case that’s not happening for you right now, I thank The National Kidney Foundation for the following article.

Flu Season and Your Kidneys

By Leslie Spry, MD FACP FASN

Flu season and your kidneysAs flu season approaches, kidney patients need to know what they can do and what they should avoid if they become ill. The first and most important action to take is to get a flu shot. All patients with chronic kidney disease, including those with a kidney transplant should have a flu shot. Transplant patients may not have the nasal mist flu vaccine known as FluMist®. Transplant patients should have the regular injection for their flu vaccine. If you are a new transplant recipient, within the first 6 months, it is advisable to check with your transplant
coordinator to make sure your transplant team allows flu shots in the first 6 months after transplant. ALL other kidney patients should receive a flu vaccination.

If the influenza virus is spreading in your community, there are medications that you can take to protect against influenza if you have not been vaccinated, however the dose of these medications may have to be modified for your level of kidney function. This is also true of antibiotics or any medication that you take for colds, bacterial infections or other viral infections. [Gail here: I have written about this in the book and the blog.  You have to tell the prescribing physician about your CKD and/or remind him of it if (s)he already knows each time a prescription is written for you.] The doses of those medications may have to be modified for your level of kidney function. Even if you are vaccinated, it is still possible to get influenza and pneumonia, but the disease is usually much milder.

You should get plenty of rest and avoid other individuals who are ill, in order to limit the spread of the disease. If you are ill, stay home and rest. You should drink plenty of fluids [me again: remember your limit on fluid intake] to stay well hydrated. You should eat a balanced diet. If you have gastrointestinal illness including nausea, vomiting or diarrhea, you should contact your physician. Immodium® is generally safe to take to control diarrhea. If you become constipated, medications that contain polyethylene glycol, such as Miralax® and Glycolax® are safe to take. You should avoid
laxatives that contain magnesium and phosphates. Gastrointestinal illness can lead to dehydration or may keep you from taking your proper
medication. If you are on a diuretic, it may not be a good idea to keep taking that diuretic if you are unable to keep liquids down or if you are experiencing diarrhea. You should monitor you temperature and blood pressure carefully and report concerns to your physician. Any medication
you take should be reported to your physician.

Medications to avoid include all non-steroidal medications including ibuprofen, Motrin®, Advil®, Aleve®, and naproxen. Acetaminophen
(Tylenol® and others) and aspirin are generally safe to take with kidney disease. Acetaminophen doses should not exceed 4000 milligrams per day [Nobody ever told me that! Why?] If you take any of the over-the-counter medications, you should always drink plenty of water and stay well hydrated. If you take anti-histamines or decongestants, you should avoid those that contain ephedrine or pseudoephedrine. Over-the-counter cold remedies that are safe to take for patients with high blood pressure are generally designated “HBP”. Any over-the-counter medication that you take for a cold or flu should be approved by your doctor.

You can find the article at: http://www.kidney.org/patients/FluSeasonAndYourKidneys.cfm

Note: There are different guidelines for those on dialysis, which I haven’t included here.

Everything and nothing is happening on the book front.  I’m awaiting dates for an interview on both a nephrologist’s radio show and an online radio show,  and moderating a twitterchat for Libre.com.  The book is still being reviewed by The National Kidney Foundation, The American Kidney Fund and the Southwest Kidney Institute.  Arizona Kidney Disease And Hypertension Centers has decided to place the book on their recommended list (Thank you Tamara Jansen for so actively promoting this decision).  I’vealso noticed some pretty interesting new followers on Twitter (WhatHowEarlyCKD).

On a non-CKD front, tonight is the first night of a four night premiere for “The Final Contract,” a Christian values film I have a supporting role in.  Locals: it’s at the Ultra Star Cinema in the Scottsdale Pavillions.  Doors open for ticket purchase at 6:30.  Tickets are $7.50. Come join those of us meeting for dinner first at YC’s Mongolian Grill – a place in which I don’t expect to have any problems adhering to the renal diet – at 5 beforehand. Dinner costs vary upon your choices.

Until next week,

Keep living your life!

Published in: on November 14, 2011 at 11:53 am  Comments (5)  

Jab Or Shot: The Message Is The Same

As I dutifully sat in my local minute clinic receiving a flu shot, I concentrated on two things: the chatter my pharmacist so thoughfully provided to distract me from the actual injection and why I was doing this. Once back home, I casted around on the internet for some kind of cogent explanation and stumbled upon this article from England’s Department of Health. I’ve only provided the relevant parts of the article, but the URL is at the end of the article should you want to read it in its entirity.

A couple of notes before you start reading: unfortunately, the vaccinaton is not free here in the states (the UK has socialized medical care) and the English call a shot “a jab.”

Seasonal flu vaccination: Who should have it and why

September 5, 2011

What is seasonal flu?

Seasonal flu occurs every year, usually in the winter. It’s a highly infectious disease caused by a number of flu viruses. The most likely viruses that will cause flu each year are identified in advance and vaccines are then produced to closely match them. As with most seasonal flu vaccines, this year’s vaccine will protect against three
types of flu virus.

Isn’t flu just a heavy cold?

No. Colds are much less serious and usually start gradually with a stuffy or runny nose and a sore throat.

How do I know when I’ve got flu?

Flu symptoms hit you suddenly and sometimes severely. They usually include fever, chills, headaches and aching muscles, and you can often get a cough and sore throat at the same time. Flu is caused by viruses and not bacteria, so antibiotics won’t treat it.

What harm can seasonal flu do?

People sometimes think a bad cold is flu, but having flu can be much worse than a cold and you may need to stay in bed for a few days if you have flu. Some people are more susceptible to the effects of seasonal flu. For them it can increase the risk of developing more serious illnesses such as bronchitis and pneumonia, or can make existing conditions worse. In the worst cases, seasonal flu can result in a stay in hospital, or even death.

Am I at greater risk from the effects of seasonal flu?

Even if you feel healthy, you should definitely consider having the free seasonal flu vaccination if you have:

  • a heart problem
  • a chest complaint or breathing difficulties, including bronchitis or emphysema
  • a kidney disease  (Gail here: I bolded and italicized this for obvious reasons.)
  • lowered immunity due to disease or treatment (such as steroid medication or cancer treatment)
  • a liver disease
  • had a stroke or a transient ischaemic attack (TIA)
  • diabetes
  • a neurological condition, for example multiple sclerosis (MS) or cerebral palsy
  • a problem with your spleen, for example sickle cell disease, or you have had your spleen removed.

Don’t wait until there is a flu outbreak this winter: contact your GP or practice nurse now to get your seasonal flu jab.

Here’s the URL for this article:

http://www.dh.gov.uk/health/2011/10/winter-flu/

On the book front, the “Look Inside This Book” feature is now functional and (hopefully if the formatting is not corrupted during the process) the book will be availabe in digital form on Amazon.com tomorrow.

Until next week,

Keep living your life!

Published in: on October 17, 2011 at 8:02 am  Comments (4)