All of Me, uh, Us

When I was a little girl, I liked to listen to my father whistle ‘All of Me,’ written by Marks and Simon in 1931 when Charlie, my father, was just 16. Only a few years later, it became a sort of love language for my mother and him. Enter a former husband of my own and my children. When my folks visited from Florida and my then husband’s side of the family journeyed over to Staten Island from Brooklyn to visit them, they all sang the song with great emotion. (By then, Bell’s palsy had robbed my father of the ability to whistle.)

To this day, I start welling up when I hear that song. But then I started thinking about the lyrics:

“All of me
Why not take all of me?”

Suddenly, it popped. For us, those with chronic kidney disease, it should be:

“All of us

Why not take all of us?”

For research purposes. To “speed up health research breakthroughs.” For help in our lifetime. To spare future generations whatever it is we’re suffering… and not just for us, but for our children… and their children, too.

The National Institutes of Health has instituted a new research program for just that purpose, although it’s open to anyone in the U.S. over the age of 18 whether ill with any disease or perfectly healthy. While only English and Spanish are the languages they can accommodate at this time, they are adding other languages.

I’m going to devote most of the rest of this blog to them. By the way, I’m even more inclined to be in favor of this program because they launched on my first born’s birthdate: May 6. All of Us has its own inspiring welcome for you at https://launch.joinallofus.org/

This is how they explain who they are and what they intend to do:

“The goal is to advance precision medicine. Precision medicine is health care that is based on you as an individual. It takes into account factors like where you live, what you do, and your family health history. Precision medicine’s goal is to be able to tell people the best ways to stay healthy. If someone does get sick, precision medicine may help health care teams find the treatment that will work best.

To get there, we need one million or more people. Those who join will share information about their health over time. Researchers will study this data. What they learn could improve health for generations to come. Participants are our partners. We’ll share information back with them over time.”

You’ll be reading more about precision medicine, which I’ve written about before, in upcoming blogs. This is from All of Us’s website at https://www.joinallofus.org/en, as is most of the other information in today’s blog, and makes it easy to understand just what they are doing.

How It Works

Participants Share Data

Participants share health data online. This data includes health surveys and electronic health records. Participants also may be asked to share physical measurements and blood and urine samples.

Data Is Protected

Personal information, like your name, address, and other things that easily identify participants will be removed from all data. Samples—also without any names on them—are stored in a secure biobank.

Researchers Study Data

In the future, approved researchers will use this data to conduct studies. By finding patterns in the data, they may make the next big medical breakthroughs.

Participants Get Information

Participants will get information back about the data they provide, which may help them learn more about their health.

Researchers Share Discoveries

Research may help in many ways. It may help find the best ways for people to stay healthy. It may also help create better tests and find the treatments that will work best for different people.

I’m busy, too busy to take on even one more thing. Or so I thought. When I read the benefits of the program (above) and how easy it is to join (below), I realized I’m not too busy for this and it is another way to advocate for Chronic Kidney Disease awareness. So I joined and hope you will, too.

Benefits of Taking Part

Joining the All of Us Research Program has its benefits.

Our goal is for you to have a direct impact on cutting-edge research. By joining the program, you are helping researchers to learn more about different diseases and treatments.

Here are some of the benefits of participating in All of Us.

Better Information

We’re all human, but we’re not all the same. Often our differences—like age, ethnicity, lifestyle habits, or where we live—can reveal important insights about our health.

By participating in All of Us, you may learn more about your health than ever before. If you like, you can share this information with your health care provider.

Better Tools

The goal of the program is better health for all of us. We want to inspire researchers to create better tools to identify, prevent, and treat disease.

You may also learn how to use tools like mobile devices, cell phones and tablets, to encourage healthier habits.

Better Research

We expect the All of Us Research Program to be here for the long-term. As the program grows, the more features will be added. There’s no telling what we can discover. All thanks to participants like you.

Better Ideas

You’re our partner. And as such, you are invited to help guide All of Us. Share your ideas and let us know what works, and what doesn’t.

Oh, about joining:

Get Started – Sign Up

Here’s a quick overview of what you’ll need to do to join.

1

Create an Account

You will need to give an email address and password.

2

Fill in the Enrollment and Consent Forms

The process usually takes 18-30 minutes. If you leave the portal during the consent process, you will have to start again from the beginning.

3

Complete Surveys and More

Once you have given your consent, you will be asked to complete online health surveys. You may be asked to visit a partner center. There, you’ll be asked to provide blood and urine samples and have your physical measurements taken. We may also ask you to share data from wearables or other personal devices.

Before I leave you today, I have – what else? – a book give away. The reason? Just to share the joy that’s walked into my life lately. It’s easy to share the troubles; why not the joys? If you haven’t received one of my books in a giveaway before, all you have to do is be the first person to let me know you want this copy of SlowItDownCKD 2017.

 

I need to get back to that online health survey for All of Us now.

Until next week,

Keep living your life!

 

Published in: on May 21, 2018 at 10:38 am  Leave a Comment  
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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!

It’s Not Just For Eating

There’s not that much to report on the book, since you already know that sales have been steady.  I’m so close to paying off the costs of printing the book that I can taste it.  Then I’d like to recoup what I paid for having it digitalized and for all the donations I’ve made. This is Book Coveralmost like a game to me because I know I’m just going to take any profits and transform them into books for donation anyway, but it keeps me sharp!

Updates on medical issues here.  I still have macular degeneration – as if it were just going to disappear – and started taking the only two supplements I can with Chronic Kidney Disease.  I’m talking (okay, writing) about the supplements in the comprehensive pill my ophthalmologist offers in an attempt to slow the eye disease down. I’d wanted to take full advantage of the entire 25% chance of slowing the disease that this pill offers, but my kidneys come first.

It turns out Bear CAN wait for the surgery since it’s kind of a last ditch effort to save mobility and he’s not there yet… thank goodness.  Now to find some good pain management for him.  Thank you to Alex Gilmore for showing up to stand for us at the neurosurgeon’s office.  He asked our questions in a form this doctor could understand.  It’s interesting that once Alex was there and we explained why, the doctor started couching his responses to the questions in language that WE could understand.

I’m eager to get into today’s topic: liver, or rather fatty liver disease.  I vaguely remember this showing up on an MRI some time ago and my primary care physician – the ever vigilant Dr. H. Zhao – telling me about it.  That’s when I was obsessed with weight since my nephrologist had just explained I would do better at slowing down the progress of the CKD if I lost weight.  My first response to Dr. Zhao? “That’s fat, too?”

liverOnce she stopped laughing, she explained that many people have fatty livers but you have to be careful about it before you end up with (in my case) NAFLD or Non-Alcoholic Fatty Liver Disease.  Why am I writing about it now?  Beats me, but I dreamed about it so I figured that was enough reason to explore it.

So, we know fat gets deposited in the liver and too much is no good.  The question is how much is too much?  According to WebMD at http://www.webmd.com/hepatitis/fatty-liver-disease,

“Some fat in the liver is normal.  But if fat makes up more than 5%-10% of the weight of your liver, you may have alcoholic or nonalcoholic liver disease.  In some cases, these diseases can lead to serious complications.”

Let’s backtrack a little to find out why the liver is important in the first place.  According to the Mayo Clinic at http://www.mayoclinic.org/liver-disease/?mc_id=comlinkpilot&placement=bottom, these are the functions of the liver:

“Breaking down harmful substances

Removing waste products from the blood

Storing nutrients and vitamins

Moderating chemical levels in the body”

Take a looks at the second function again.  Does it sound familiar?  Yep, that’s one of the functions of your kidneys, your not functioning at capacity kidneys.  You’re already having trouble because one of your organs can’t do its job adequately, you certainly don’t need an additional organ responsible for the same job to be compromised.  Ah, that must be why I’m writing about fatty liver disease on a Chronic Kidney Disease blog.Location of Kidneys

By the way, a liver specialist is called a hepatologist.   That comes from the same word root as hepatitis. Remember I’d urged you to make certain you took the series of hepatitis B inoculations since your kidneys are already comprised? And suggested you might want to be checked for any hepatitis C in your blood work?  Hepatitis is from the same Greek word root, hepa which means liver.  Just in case you’re interested, the University of Hawaii at Manoa has a fairly inclusive list of medical word roots at http://manoa.hawaii.edu/learning/PDFhandouts/StudySkills/Word%20Roots.pdf .  This is right up my alley!

Okay, maybe we need to know a little more about the liver.  It’s a large organ, in fact, the second largest in your body. You’ll find yours under your rib cage on the right side of your body.  My perverse sense of humor found it funny that the kidneys are shaped like – well – kidney beans while your liver is shaped sort of like a football that’s flat on one side. (Can you see the mental image I conjured up of the kidneys tossing the football back and forth?  Can’t really happen but it’s funny… if you’re me, that is.) Oh, yes, weight: three pounds.

Like CKD, NAFLD is mostly a silent disease; it has no symptoms.  When symptoms do occur, it seems to me that they would be hard to pin down as NAFLD since it’s not an array of these symptoms, but any of them. Then again, I’m not a doctor.

“fatigue, weakness, weight loss, loss of appetite, nausea, abdominal pain, spider-like blood vessels (Hey, I have those!), jaundice, itching, edema, ascites {swelling of the abdomen} and mental confusion.”

Thank you to the American Liver Foundation at http://www.liverfoundation.org/abouttheliver/info/nafld/. This is a nifty little fact sheet that is simple to understand.

Then I got to wondering about why this disease could be dangerous.  It’s the possible progression that makes it dangerous.  You’re told you have a fatty liver (AFLD is fatty liver disease caused by alcoholism), you don’t lose weight {if you’re overweight or obese}, lower your cholesterol and triglycerides, control your diabetes {if you have it} or avoid alcohol, and the disease worsens. NAFLD

Your liver swells.  This is called steatohepatitis.  That may cause cirrhosis (Quick!  Go to the University of Hawaii at Manoa’s medical word root site! Or just read on.) or scarring over a long period.  The cirrhosis could eventually cause liver cancer or failure.  The saddest part of all this is that some people develop NAFLD or AFLD for no reason at all.

The good part (There’s a good part?) is that a healthy diet and regular exercise – just like CKD, isn’t it? – may prevent scarring or even reverse it if the disease is caught early enough.  Since there usually aren’t any symptoms, fatty liver disease is most often uncovered by your blood tests.  A high level of liver enzymes could be the tip off.

I almost forgot to mention that Alcoholic Fatty Liver Disease has another name: NASH.  This stands for Nonalcoholic Steatohepatitis.  My parting gift to you today: steat is a word root meaning fat.

Until next week,

Keep living your life!

Oh, The Gall!

I thought I’d write about macular degeneration this week since that’s the newest diagnose in my life.  But my daughter’s  Cholecystectomy is taking precedence in my mind, so we can postpone the macular degeneration.  Her what, you ask?  That, my friends, is what the procedure to remove your gall bladder is called. By the way, I asked what it was, too.       photo

This is Nima’s description of how it all started and what the procedure was like:

“At one point or another we’ve all that had that midnight snack of a slice of cold pizza and maybe some juice to wash it down. So when I woke up with severe sharp pain on my right side I didn’t think much of it, except I shouldn’t have eaten that pizza, and where is the Tums?  After two Tums and a hot shower, the sharp pain continued all around the middle of my back to the middle of my front right side. I finally thought to myself, ‘Don’t be stupid. You have a family history of CKD, and one family member who passed stones a few years back. Better to be safe than sorry, get it checked.’

Off to the ER I went. After I described my symptoms to the first year resident, she picked up very quickly on the fact it could be gallstone/gallbladder related due to the side of the pain (right) and asked for a urine sample, as well as ordering blood work, and a sonogram of that area. I was also given an IV, morphine drip for pain (which honestly did nothing – too much pain- all I wanted to do was rock back and forth or keep walking in circles to help me be in motion so I didn’t have to think about the pain), and eventually antibiotics.

The doctor came back with the results of the blood work to tell me that my white blood count was elevated to 12, an indication the gallbladder was infected. I was finally taken to sonogram. A bariatric first year resident explained I had an impassable 2.7 in. diameter gallstone that was causing blockage in the duct in the front and a bunch of pain. There’d be no way to take it out other than surgery. After meeting with the attending physician, he concurred. He also mentioned that, because the gallbladder was infected, it’d be smart to remove it.

So, I did. I’ll now have to learn an entirely new way to eat (low-fat) as the gallbladder is what processes fat. I’ve learned quickly if I consume the slightest bit of fat, my body’s response is “Um, what the hell are we supposed to do with that?!” and to reject it in a not so nice way. I’ll have to play it smart and step up the exercise and water intake as well to make up for the missing organ and amount of bile that could now possibly be floating in my body because it has nowhere to go. As for pizza at midnight? Well unless, I want another episode like the one I just had, those days are now in my rearview mirror.”

But what do gall stones have to do with chronic kidney disease?  Searching the web only garnered this one article from January, 2009 – that’s four and a half years ago – http://www.ncbi.nlm.nih.gov/pubmed/19352299. The relevant quote is this:

“The prevalence of gallbladder stones in patients with chronic kidney disease is significantly higher than in those without chronic kidney disease. Our findings suggest that increasing age, chronic kidney disease, body mass index > or =27 kg/m {greater than 59 pounds}, metabolic syndrome, and cirrhosis are the related factors for gallbladder stone formation.”

Now think about it another way: you already have a compromised immune system because you have ckd.  Gall stones can cause infection of the gall bladder. As in Nima’s experience, infection causes white blood cell elevation. So you know you have an infection, you might even realize it could be in the bile ducts, too.  But did you check to see if there’s infection in other areas of your body? That would mean you can read your own test results or have the kind of relationship with your doctors – especially your nephrologist – to freely ask questions.

Let’s back track a little since I’m so good at that.  Here’s a picture of the location of the gall bladder. gall_bladder

As for what it does, I went to http://www.nlm.nih.gov/medlineplus/gallbladderdiseases.html.

“The gallbladder is a pear-shaped organ under your liver. It stores bile, a fluid made by your liver to digest fat. As your stomach and intestines digest food, your gallbladder releases bile through a tube called the common bile duct. The duct connects your gallbladder and liver to your small intestine.”

Keep in mind that your liver, the largest organ in your body {the skin is actually the largest organ, but it’s external} is the other organ that filters your blood.  Since your ckd has been diagnosed, your liver is already working harder. Add losing your gall bladder and you’ve got one very hard working – possibly overworked? – liver.

What about the surgery, you ask?  There are two kinds: open which is surgery as we understood it before laparoscopic surgery and laparoscopic surgery.  In the latter kind:

image-07Under general anesthesia, so the patient is asleep throughout the procedure.

  • Using  a cannula (a narrow tube-like instrument), the surgeon enters the abdomen in the area of the belly-button.
  • A  laparoscope (a tiny telescope) connected to a special camera is inserted through the cannula, giving the surgeon a magnified view of the patient’s internal organs on a television screen.
  • Other  cannulas are inserted which allow your surgeon to delicately separate the gallbladder from its attachments and then remove it through one of the openings.
  • Many  surgeons perform an X-ray, called a cholangiogram, to identify stones, which may be located in the bile channels, or to insure that structures  have been identified.
  • If the surgeon finds one or more stones in the common bile duct, (s)he may remove them with a special scope, may choose to have them removed later through a second minimally invasive procedure, or may convert to an open operation in order to remove all the stones during the operation.

After the surgeon removes the gallbladder, the small incisions are closed with a stitch or two or with surgical tape.

Thank you for this information Society of American Gastrointestinal and Endoscopic Surgeons at: http://www.sages.org/publications/patient-information/patient-information-for-laparoscopic-gallbladder-removal-cholecystectomy-from-sages/

And that, ladies and gentlemen, is all I know about the gall bladder and gall stones.

Until next week,

Keep living your life!

Keep That Liver Lively

It feels so good to be (relatively) healthy again. I’ve spent the last several weeks being tested, running to doctors, and feeling like I just plain didn’t want to move… not even for a good cup of coffee.  I like the way I feel now.  Maybe I rest more than I’ve been used to, but I get to do whatever I want again.  That’s the way to live.  I like it so much that I intent to keep my life this way.YGCnpYEUFRtlrF00_f9frLXF_JWiNWNHS9AVZmM1PxI

And that’s why I’m taking the series of Hepatitis B inoculations that are recommended for anyone with a compromised immune system. Chronic Kidney Disease presents us with one of those. Aren’t we just the lucky ones (she wrote with a keyboard that dripped sarcasm)?

“Hepatitis B is one type of hepatitis – a liver disease – caused by the hepatitis B virus (HBV). Hepatitis B spreads by contact with an infected person’s blood, semen or other body fluid. An infected woman can give hepatitis B to her baby at birth,” according to MedlinePlus, a service of the U.S. National Library of Medicine, National Institutes of Health located online at: http://www.nlm.nih.gov/medlineplus/hepatitisb.html.

liverLet’s backtrack for a little etymology here.  The Online Etymology Dictionary at http://etymonline.com/index.php?allowed_in_frame=0&search=hepatitis&searchmode=nl  shows the following: “hepatitis (n.)  1727, coined from Greek hepatos, genitive of hepar “liver,” from PIE root *yekwr- (cf. Sanskrit yakrt, Avestan yakar, Persian jigar, Latin jecur, Old Lithuanian jeknos “liver”) + -itis “inflammation.” While this is probably too much information, we can see that the term comes from the Greek for liver and the Latin for inflammation, and was first commonly used in 1727. The key word here? Liver.

Okay then, what’s the big deal with the liver you’re probably asking. While it performs over 500 different functions to keep your body going, one of its primary functions is to filter your blood – just like your kidneys.  If your kidney function is already compromised, you’ve got to be careful not to let your liver function become compromised, too.

We’ve all heard the stories about people with an alcohol dependency dying of cirrhosis – permanent scarring of the liver.  This is a Bubba Miseh. That’s Yiddish for an old wives’ tale.  You can have liver damage from any number of causes. Hepatitis B is one of them.

“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 from the Mayo Clinic at: http://www.mayoclinic.com/health/hepatitis-b/DS00398.  I especially recommend their site because it is written in the English we all know and is easily understood.

According to the handout from the U.S. Department of Health and Human Services’ Center for Disease Control and Prevention which I was given by my doctor’s medical assistant, the inoculations come in sets of three.  I’ve had the first and was told to come back in a month for the second, with the third scheduled for a month after the second.  In other words, they are spaced over a period of six months.shot

But what if my primary care doctor hadn’t recommended these to me, how would I know if I have Hepatitis B?  According to MedicineNet.com at http://www.medicinenet.com/hepatitis_b/article, “Acute hepatitis B is the period of illness that occurs during the first one to four months after acquiring the virus. Only 30% to 50% of adults develop significant symptoms during acute infection. Early symptoms may be non-specific, including fever, a flu-like illness, and joint pains. Symptoms of acute hepatitis may include:

Those are fairly common symptoms for many illnesses and as many as half the people with this virus may not know they have it.  I might have been one of that 50%.  So might you.

For chronic (long term) Hepatitis B, like Chronic Kidney Disease, there are no symptoms until the damage is done and the liver starts to fail.

Am I urging you to be vaccinated?  No, you’re quite capable of making up your own mind.  Besides, as I keep mentioning, I’m not a doctor.  Did I start the Hepatitis-B inoculations?  Absolutely!  Life is sweeter than it’s ever been.  I want it to go on and on.virus

Talking about life going on, the project to bring Chronic Kidney Disease to the Native American reservations has a name: SlowItDown.  You can expect to see both a Facebook page and a Twitter account with the same name this week.

The National Kidney Foundation asked me to guest blog for them this month and I discussed the project there, too. The address for this is: http://nkfstayinghealthy.wordpress.com/2013/06/06/what-is-it-and-how-did-i-get-it-early-stage-chronic-kidney-disease-experiences/  The NKF expects to promote it on their own Facebook page tomorrow. While this is not the first time they’ve asked me to write for them, each time they do I understand the honor it is and I thank them for the opportunity to spread CKD information via their site.

You already know DaVita (DaVita.com) has offered to supply Chronic Kidney Disease Educators to the tribes within sixty miles of Phoenix.  I have been speaking with the Health Directors of several tribes, but need help getting on the reservations.  I’ve found one or two reservations with Diabetes Education Program that we could easily piggyback on, but none with Chronic Kidney Disease Education Programs.  My appeal to my readers? Please, if you know anyone who is Native American, have him/her email me at myckdexperience.com or ask them for their number or email address and send it to me.

Book CoverIt’s funny: this blog started as publicity for the book and yet I hardly mention it any more.  Thank you to those of you who have bought or recommended the book. Thanks to some lovely people I met at Landmark Worldwide (formerly Landmark Education) the book is now in British Columbia and at the Evans Community Army Hospital in Colorado.  Any way this news can be spread is a good way in my book.  Oh, I meant that literally and figuratively!

Until next week,

Keep living your life!