I’ll Sleep When I’m Dead

How many times have you said this (before your diagnose) to those who told you to slow down, take it easier, don’t rush so, take some time for yourself, etc.? As a younger person, I was a high school teacher, an actor, a writer, and – most importantly – a mother, actually a single mother once my daughters were double digit aged.

Guess what. You may sleep when you’re dead, but you need to sleep now before you hasten the time to your death. What’s that? You get enough sleep? I thought I did, too, but I wasn’t getting the kind of sleep I needed.

Why do we need sleep anyway? I turned to The Book of Blogs: Moderate Stage Chronic Kidney Disease, Part 1 for some answers. The first reason I stumbled across was in an article from The Journal of The American Society of Nephrologists:

“Hermida tells WebMD that some of the body’s blood pressure control systems are most active while we sleep. So medicines designed to control those systems work better when taken close to the time when the systems are activated most fully.”

Ramon C. Hermida, PhD is the director of the bioengineering and chronobiology labs at the University of Vigo in Spain.

Hmmm, I take medication for hypertension… and I take it at night. I see that I need to sleep for it to work most effectively. I’ve known this for years and written about it. The point is you may need to know about it.

Then I started wondering if I were correct in the amount of sleep I thought I needed. The Book of Blogs: Moderate Stage Chronic Kidney Disease, Part 2 was helpful here:

“How much sleep is enough sleep anyway? According to Dr. Timothy Morgenthaler of The Mayo Clinic site, seven to eight hours is what an adult needs, but then he lists mitigating circumstances under which you might need more:

• Pregnancy. Changes in a woman’s body during early pregnancy can increase the need for sleep.
• Aging. Older adults need about the same amount of sleep as younger adults. As you get older, however, your sleeping patterns might change. Older adults tend to sleep more lightly and for shorter time spans than do younger adults. This might create a need for spending more time in bed to get enough sleep, or a tendency toward daytime napping.
• Previous sleep deprivation. If you’re sleep deprived, the amount of sleep you need increases.
• Sleep quality. If your sleep is frequently interrupted or cut short, you’re not getting quality sleep. The quality of your sleep is just as important as the quantity.”

While I’m not pregnant (and will become a medical miracle if I become pregnant), all the other circumstances do apply to me. During Shiva after my brother’s death, there was very, very little sleeping going on. Hence, sleep deprivation. I’m aging and my sleep quality is not great right now. Those are my circumstances, but they could be yours. Are you getting enough sleep?

Sometimes, simply having Chronic Kidney Disease can be the source of sleep problems. This is something I’ve written about several times. Here’s an excerpt from SlowItDownCKD 2015 about just that:

“We’ve known for a long time that sleep disorders are more common in kidney disease patients than in the general population,” Charles Atwood, MD, associate director of the University of Pittsburgh Medical Center’s Sleep Medicine Center in Pennsylvania, who wasn’t involved in the study, told Medscape Medical News. “A lot of studies in the past focused on the dialysis population. It seems like this group focused on people with milder degrees of kidney disease and basically found that they also have sleep disorders and I’m not surprised by that,” he added.

You can read the entire article at http://www.medscape.com/viewarticle/805342, although you will have to register for a free account.

By digging deep, far and wide, I finally figured out that toxic waste buildup in our systems (from the imperfect blood filtering by our kidneys) could be the cause of my segmented sleep. I took a comment from one study, a sentence from another, and unilaterally decided this was the reason. I am not a doctor – as I keep saying – and I don’t have the facts I’d like to behind this conclusion….”

Oh, right: you need a definition of segmented sleep. Wikipedia provides one:

“Segmented sleep, also known as divided sleep, bimodal sleep pattern, bifurcated sleep, or interrupted sleep, is a polyphasic or biphasic sleep pattern where two or more periods of sleep are punctuated by periods of wakefulness.”

The National Institutes of Health at https://www.nhlbi.nih.gov/health/health-topics/topics/sdd/why sums up our need for sleep beautifully:

“Sleep plays an important role in your physical health. For example, sleep is involved in healing and repair of your heart and blood vessels. Ongoing sleep deficiency is linked to an increased risk of heart disease, kidney disease, high blood pressure, diabetes, and stroke.

Sleep deficiency also increases the risk of obesity. For example, one study of teenagers showed that with each hour of sleep lost, the odds of becoming obese went up. Sleep deficiency increases the risk of obesity in other age groups as well.

Sleep helps maintain a healthy balance of the hormones that make you feel hungry (ghrelin) or full (leptin). When you don’t get enough sleep, your level of ghrelin goes up and your level of leptin goes down. This makes you feel hungrier than when you’re well-rested.

Sleep also affects how your body reacts to insulin, the hormone that controls your blood glucose (sugar) level. Sleep deficiency results in a higher than normal blood sugar level, which may increase your risk for diabetes.

Sleep also supports healthy growth and development. Deep sleep triggers the body to release the hormone that promotes normal growth in children and teens. This hormone also boosts muscle mass and helps repair cells and tissues in children, teens, and adults. Sleep also plays a role in puberty and fertility.

Your immune system relies on sleep to stay healthy. This system defends your body against foreign or harmful substances. Ongoing sleep deficiency can change the way in which your immune system responds. For example, if you’re sleep deficient, you may have trouble fighting common infections.”

I think I need to go to sleep now.

Until next week,
Keep living your life!

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Good Grief!

No, Charlie Brown, grief is not good. Grief is not good at all. My big brother, Alan Peckolick, died 10 days ago. You can read about him in lots of publications and I’ll even provide the links.* But you can’t read about him as my big brother in any of these.

Nowhere do they mention how Alan used our brother Paul’s accordion for sound effects as he told us scary stories when forced to babysit. Nowhere do they mention how this non- violent boy promptly tackled his friend to wash his face in snow after he caught the friend throwing a snowball at me, his little sister. Nowhere do they mention his being told to take Paul and me to his scout meeting and his doing it, inappropriate or not.

Six and a half years is a big age difference when you’re growing up. You sort of catch up as adults. We never did. We lived in different worlds. He was a giant in the art world. I was happy raising my little girls, acting, teaching, and writing on a less than giant scale. Nevertheless, he was my brother and I made sure we kept in touch.

As Jews, we sat shiva. That is the week long period of mourning for the first degree relatives of the deceased. At their loft in Manhattan where shiva was being observed, I met many members of his social circle who were surprised Alan had a brother and sister and who asked me to tell them anecdotes about growing up with him. They praised his art world, and rightly so. I praised the big brother as a child… and then a teenager. They were charmed by the Alan that was this age; I was charmed by the Alan they knew as an adult.

But I found myself grieving. It was not unexpected. I hurt all over, nothing specific, just a general aching… or was it my heart I felt aching? Wait a minute, what was happening to my kidneys throughout this process of grief?

The day he was taken off life support, I was at my lab having the usual quarterly blood draw. Alan and Jessica Weber, his wife, were in Connecticut where they have a country house and where the catastrophic fall that landed him on life support occurred; I was in Arizona. There was nothing I could do from afar and I knew I could trust Jessica to keep me informed. I thought keeping myself to my usual schedule would help me cope.

Except for the values in the next sentence, all my tests came back as low as they could while still being in the normal range. That had never happened before. While my GFR stayed stable, my BUN was at 30 (‘normal’ range is 8-25), Bun/Creatinine Ratio 29.1 (‘normal’ range is 10-28) and my glucose was 113 (‘normal’ range is 65-99). I was underwhelmed. I figured it was my brother’s situation making my body goes haywire. I still am.

PyschCentral at https://psychcentral.com/lib/your-health-and-grief/ offers the following explanation of how grief affects our bodies:
“…. At the death the brain ‘translates’ the stress of grief into a chemical reaction in the body. The pituitary gland located at the base of the brain is stimulated to produce a hormone called adrenocorticotrophin hormone (ACTH). This reaction is a “protective” one and in essence makes the body ready to do battle. The ACTH (from the pituitary gland) then travels to the adrenal gland, a gland at the top of the kidneys, which causes a chemical reaction which ultimately produces cortisone. As the cortisone level increases it causes the production of ACTH to level off.

What happens in the case of grief where the stress continues for many months? The cycle does not operate as it should. Because the stress is continuing, the production of ACTH is continuing thus causing the adrenal gland to produce more and more cortisone. The result is an abnormally high level of cortisone circulating in the blood sometimes exceeding ten to twenty times the normal levels.

A high level of cortisone is one of the things that causes our immune system (the system that normally fights off disease carrying bacteria fungi and viruses) to falter. The high level of cortisone affects yet another gland the thalamus which manufactures the white cells of our blood. With the thalamus not functioning properly, it cannot produce white cells that are effective. Those white cells normally locate and phagocytize (eat up) the invading germs, viral particles or even pre-cancerous cells. Thus with the white cells unable to function properly the individual is 100% more susceptible to the most common germs.”

Well, what is cortisol? As I mentioned in SlowItDownCKD 2016,
“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.”

So our already compromised immune system is compromised even more compromised. Are we now at the mercy of our grief? Nothing that dramatic, folks.

 

We can up our vitamin D – with our nephrologist’s approval first, of course. As mentioned in the glossary of What Is It and How Did I Get It? Early Stage Chronic Kidney Disease,
“Vitamin D: Regulates calcium and phosphorous blood levels as well as promoting bone formation, among other tasks – affects the immune system.”

We can up our NREM (non-rapid eye movement) sleep. I turned to The Book of Blogs: Moderate Stage Chronic Kidney Disease, Part 2 for this information:
“WebMD tells us
During the deep stages of NREM sleep, the body repairs and regenerates tissues, builds bone and muscle, and appears to strengthen the immune system.”

My favorite deterrent to a further compromised immune system? Hugs. MedicalNewsToday at http://www.medicalnewstoday.com/articles/275795.phpat explains:
“Oxytocin has an anti-anxiety (anxiolytic) effect ….”

Less anxiety, less stress. That’s something that could be useful during times of grief. I didn’t have to clear this with my nephrologist, hugging is a way of life with my family and friends, and it somehow, magically, lessens the pain for a little while.

Until next week,

Keep living your life!

*The links to Alan’s obituaries:

http://www.huffingtonpost.com/entry/alan-peckolick-dead_us_5988ae58e4b0d7937388f5be
https://www.washingtonpost.com/local/obituaries/alan-peckolick-influential-designer-from-madison-avenue-to-hollywood-dies-at-76/2017/08/10/ea33134a-7dd7-11e7-9d08-b79f191668ed_story.html?utm_term=.d2b395bfa3c6

Long Term, Short, and your Heart

I received some comments about Acute Kidney Disease (AKI) in the midst of all the support after last week’s blog. It seems this is a new topic for so many of us. By us I mean Chronic Kidney Disease (CKD) patients. I know at stage 3, my nephrologist never brought this up to me.

Ah, but I remembered this from The Book of Blogs: Moderate Stage Chronic Kidney Disease, Part 2:

On the very first page of What Is It and How Did I Get It? Early Stage Chronic Kidney Disease, I wrote “…chronic is not acute. It means long term, whereas acute usually means quick onset and short duration.”

All those years of teaching English in high school and college paid off for me right there in that sentence.

I’d always thought that AKI and CKD were separate issues and I’ll bet you did, too. But Dr. L.S. Chawla and his co-writers based the following conclusion on the labor of epidemiologists and others. (Note: Dr. Chawla et al wrote a review article in the New England Journal of Medicine in 2014.)

“Chronic Kidney Disease is a risk factor for acute kidney injury, acute kidney injury is a risk factor for the development of Chronic Kidney Disease, and both acute kidney injury and Chronic Kidney Disease are risk factors for cardiovascular disease.” …

Not surprisingly, the risk factors for AKI {Once again, that’s acute kidney injury.} are the same as those for CKD… except for one peculiar circumstance. Having CKD itself can raise the risk of AKI 10 times. Whoa! If you’re Black, of an advanced age {Hey!}, or have diabetes, you already know you’re at risk for CKD, or are the one out of nine in our country that has it. Once you’ve developed CKD, you’ve just raised the risk for AKI 10 times. I’m getting a little nervous here….

It makes sense, as researchers and doctors are beginning to see, that these are all connected. I’m not a doctor or a researcher, but I can understand that if you’ve had some kind of insult to your kidney, it would be more apt to develop CKD.

And the CVD risk? Let’s think of it this way. You’ve had AKI. That period of weakness in the kidneys opens them up to CKD. We already know there’s a connection between CKD and CVD. Throw that AKI into the mix, and you have more of a chance to develop CVD whether or not you’ve had a problem in this area before. Let’s not go off the deep end here. If you’ve had AKI, you just need to be monitored to see if CKD develops and avoid nephrotoxic {Kidney poisoning} medications such as NSAIDS… contrast dyes, and radioactive substances. This is just so circular!

As with CKD, your hypertension and diabetes {If you have them.} need to be monitored, too. Then there’s the renal diet, especially low sodium foods. The kicker here is that no one knows if this is helpful in avoiding CKD after an AKI… it’s a ‘just in case’ kind of thing to help ward off any CKD and possible CVD from the CKD.

Has your primary care doctor recommended a daily low dose aspirin with your nephrologist’s approval? This is to protect your heart against CVD since you already have CKD which raises the risk of CVD. Now here’s where it gets confusing, the FDA has recently revoked its endorsement of such a regiment.

Let’s see what more we can find out about this dastardly triumvirate.

The National Kidney Foundation at https://www.kidney.org/atoz/content/AcuteKidneyInjury offers this information about AKI.

Acute kidney injury (AKI) is a sudden episode of kidney failure or kidney damage that happens within a few hours or a few days. AKI causes a build-up of waste products in your blood and makes it hard for your kidneys to keep the right balance of fluid in your body. AKI can also affect other organs such as the brain, heart, and lungs. Acute kidney injury is common in patients who are in the hospital, in intensive care units, and especially in older adults.

You did catch that it can affect the heart, right?

Well, what about the heart and its diseases?

This is from the Mayo Clinic at http://www.mayoclinic.org/diseases-conditions/heart-disease/basics/definition/con-20034056.

The term “heart disease” is often used interchangeably with the term “cardiovascular disease.”

Cardiovascular disease generally refers to conditions that involve narrowed or blocked blood vessels that can lead to a heart attack, chest pain (angina) or stroke. Other heart conditions, such as those that affect your heart’s muscle, valves or rhythm, also are considered forms of heart disease.

Many forms of heart disease can be prevented or treated with healthy lifestyle choices.

Maybe a reminder of what CKD is will help, too. WebMD at http://www.webmd.com/a-to-z-guides/tc/chronic-kidney-disease-topic-overview#1 offers this simple, comprehensive explanation.

Having chronic kidney disease means that for some time your kidneys have not been working the way they should. Your kidneys have the important job of filtering your blood. They remove waste products and extra fluid and flush them from your body as urine. When your kidneys don’t work right, wastes build up in your blood and make you sick.

Chronic kidney disease may seem to have come on suddenly. But it has been happening bit by bit for many years as a result of damage to your kidneys.

Each of your kidneys has about a million tiny filters, called nephrons. If nephrons are damaged, they stop working. For a while, healthy nephrons can take on the extra work. But if the damage continues, more and more nephrons shut down. After a certain point, the nephrons that are left cannot filter your blood well enough to keep you healthy.

My head is spinning. One could – or could not – lead to another which, in turn, could – or could not – lead to the third. There’s no strict order and there’s no way of knowing until you actually have it. My layperson’s suggestion? Take good care of your kidneys.

Until next week,
Keep living your life!

Shocked

When I checked my phone messages this morning, I saw one from the wife of someone I have known and loved my whole life. That shook me. The message was from his wife, not him. I couldn’t bring myself to listen to it until after I’d had a cup of coffee and fed Shiloh, our dog.

It was bad news. He was in the hospital on life support. I was shocked. Immediately, I felt nausea and a band started to tighten around my head. I noticed my voice was rough as I tried to process what his wife was telling me.

She did an exemplary job of explaining what had happened step by step and including what will happen at the hospital now. After reassuring myself that she had friends around her to support her while she’s emergency central, so to speak, we hung up…and I tried to go through my usual early morning routines.

I knew it wasn’t working when I took the wash out of washing machine, put it back in the washing machine, and started the empty dryer. I knew it wasn’t working when I fed the dog I’d just fed.

So I retreated to the library to start the daily ‘kidney work’: checking email, texts, and LinkedIn for messages from readers; posting on Instagram and Facebook; and perusing Twitter for articles that might interest you. I was having trouble concentrating. Maybe thinking about what I’d write in today’s blog would be more productive.

It was obvious, wasn’t it? I’d write about what shock does to your body and to your kidneys.

In befuddedly casting around on the internet for information, I found this at http://www.harleytherapy.co.uk/counselling/7-warning-signs-acute-stress-reaction-emotional-shock.htm.

By Harley Therapy January 23, 2014 Anxiety & stress, Counselling  

…. While it’s true you aren’t in “medical shock” – an acute circulatory condition where blood pressure falls so severely that multiple organ failure can occur – you are still in a medically recognised kind of shock.

Psychological shock, a form of psychological trauma, is the body’s very real stress response to experiencing or witnessing an overwhelming and/or frightening event….

You might feel as if your brain has turned to mush, or you have ‘brain fog’….

Life might even feel unreal, as if you are disconnected, floating slightly outside of your body and watching yourself carry on doing things. This is called dissociation….

When your brain decides that there is ‘danger’ around, it triggers the primal ‘fight, flight, or flight’ response. Back when we were ‘cave people’ these responses where helpful, but nowadays the overload of adrenaline they involve just leave you with a racing heartbeat, muscle tension, headaches, stomach upset, and random aches and pains….

Sleep is often affected by emotional shock. Insomnia is common. Even if you are sleeping more than ever, you are unlikely to get quality sleep but might suffer disturbed sleep, full of stress dreams. It’s common to develop ‘night panic attacks’ where you wake up suddenly with a racing heart and severe anxiety….

I could identify with this. It seemed I had to correct the spelling of every other word today. My husband was trying to pin down dates for a California trip and I was responding with dates for a New York trip. The doorbell rang, so I answered the phone. You get the idea. I’ve already mentioned the particular headache and the nausea. But what about my kidneys? What was happening to them?

The Medical Dictionary at http://medical-dictionary.thefreedictionary.com/shock+organs, defines shock as “a sudden disturbance of mental equilibrium.” That is a pretty accurate description of what happened when I returned that phone call this morning.

The same site goes on to explain that shock “is associated with a dangerously low blood pressure.” And blood pressure, of course is:

pressure that is exerted by the blood upon the walls of the blood vessels and especially arteries and that varies with the muscular efficiency of the heart, the blood volume and viscosity, the age and health of the individual, and the state of the vascular wall

Thank you to the Merriam-Webster Dictionary at https://www.merriam-webster.com/dictionary/blood%20pressure for that definition.

Notice the word “arteries.” Arteries also run into the kidneys. The following is from What Is It and How Did I Get It? Early Stage Chronic Kidney Disease.

Your kidneys have about a million nephrons, which are those tiny structures that produce urine as part of the body’s waste removal process. Each of them has a glomerulus or network of capillaries. This is where the blood from the renal artery is filtered.

In other words, when you’re in shock – even if it’s emotional shock – the pressure of your blood can be dangerously low. But low blood pressure may also lead to Acute Kidney Injury (AKI). Uh-oh, I remember writing about that in The Book of Blogs: Moderate Stage Chronic Kidney Disease, Part 2.

….Chronic Kidney Disease is a risk factor for acute kidney injury, acute kidney injury is a risk factor for the development of Chronic Kidney Disease, and both acute kidney injury and Chronic Kidney Disease are risk factors for cardiovascular disease…. Not surprisingly, the risk factors for AKI {Once again, that’s acute kidney injury.} are the same as those for CKD… except for one peculiar circumstance. Having CKD itself can raise the risk of AKI 10 times. Whoa! If you’re Black, of an advanced age {Hey!}, or have diabetes, you already know you’re at risk for CKD, or are the one out of nine in our country that has it. Once you’ve developed CKD, you’ve just raised the risk for AKI 10 times.

Let me make sure you (and I) understand that this is the worst case scenario. A few thoughts about how cardiovascular disease and the kidneys interact before I get on the phone to check on my beloved friend again. This is from a study that was included in The Book of Blogs: Moderate Stage Chronic Kidney Disease, Part 1.

“The brain and kidney are both organs that are affected by the cardiovascular systems,” said the study’s lead author, Adam Davey, associate professor of public health in Temple’s College of Health Professions and Social Work. “They are both affected by things like blood pressure and hypertension, so it is natural to expect that changes in one organ are going to be linked with changes in another.”

You can find the article at http://www.EurekAlert!.org/pub_releases/2012-11/tu-dkf111312.php

Until next week,
Keep living your life!

CKD and the VA or It’s Not Alphabet Soup at All

Today is Memorial Day in the United States. It is not a day to say Happy Memorial Day since it is a day commemorating those who gave their lives for our freedom. Lots of us have bar-b-ques or go to the park or the beach to celebrate. No problem there as long as we remember WHO we are celebrating. I promise: no political rant here, just plain appreciation of those who serve(d) us both living and dead. Personally, I am honoring my husband, my step son-in-law, and all those cousins who just never came home again.

I explained the origins of this day in SlowItDownCKD 2015 (May 25), so won’t re-explain it here. You can go to the blog and just scroll down to that month and year in the drop down menu on the right side of the page under Archives. I was surprised to read about the origins myself.

We already know that Chronic Kidney Disease will prevent you from serving your country in the military, although there are so many other ways to serve our country. This is from The Book of Blogs: Moderate Stage Chronic Kidney Disease, Part 2:

‘The Department of Defense’s Instruction for Medical Standards for Appointment, Enlistment, or Induction in the Military Services establishes medical standards, which, if not met, are grounds for rejection for military service. Other standards may be prescribed for a mobilization for a national emergency.

As of September 13, 2011, according to Change 1 of this Instruction, the following was included.

‘Current or history of acute (580) nephritis or chronic (582) Chronic Kidney Disease of any type.’

Until this date, Chronic Kidney Disease was not mentioned.”

You can read the entire list of The Department of Defense’s Instruction for Medical Standards for Appointment, Enlistment, or Induction in the Military Services at http://dtic.mil/whs/directives/corres/pdf/613003p.pdf. You’ll also find information there about metabolic syndrome, high blood pressure, high cholesterol, diabetes, and pre-diabetes as conditions for non-enlistment.

This got me to thinking. What if you were had already enlisted when you developed CKD. Yes, you would be discharged as medically unfit, but could you get help as a veteran?

According to the Veterans Administration at https://www.research.va.gov/topics/Kidney_disease.cfm#research4,

“In 2012, VA and the University of Michigan began the work of creating a national kidney disease registry to monitor kidney disease among Veterans. The registry will provide accurate and timely information about the burden and trends related to kidney disease among Veterans and identify Veterans at risk for kidney disease.

VA hopes the kidney disease registry will lead to improvements in access to care, such as kidney transplants. The department also expects the registry will allow VA clinicians to better monitor and prevent kidney disease, and will reduce costs related to kidney disease.”

That’s what was hoped for five years ago. Let’s see if it really came to fruition.

Oh, this is promising and taken directly from The U.S. Department of Veterans Affairs.

“VA eKidney Clinic

The VA eKidney Clinic is now available! The eKidney Clinic offers patient education through interactive virtual classrooms where Veterans can learn how to take care of their kidneys and live a good life with kidney disease. Please visit the VA eKidney Clinic website or click on the picture below. For additional information see the eKidney Clinic Patient Information Brochure.”

The Veterans Health Administration doesn’t just provide information, although I must say I was delighted to see the offer of Social Work Services. There is also treatment available. Notice dialysis mentioned in their mission statement.

“Mission: The VHA Kidney Program’s mission is to improve the quality and consistency of healthcare services delivered to Veterans with kidney disease nationwide. The VHA Kidney Program provides kidney-related services to dialysis centers throughout VA’s medical centers. Professional guidance and services are available in the form of consultation and policies developed by VA kidney experts. These experts are dedicated to furthering the understanding of kidney disease, its impact on Veterans, and developing treatments to help patients manage disease symptoms. In addition, the VHA Kidney Program provides VA healthcare professionals with clinical care, education, research, and informatics resources to improve healthcare at local VA dialysis facilities.”

I did find it strange that there was a cravat on the Veterans Administration site that they do not necessarily endorse the VHA Kidney Program, especially since it is so helpful.

 

 

 

How involved is the VA with CKD patients? Take a look for yourself at this 2015 statistics by going to https://www.va.gov/HEALTH/services/renal/documents/Kidney_Disease_and_Dialysis_Services_Fact%20Sheet_April_2015.pdf

• All Veterans enrolled in VA are eligible for services, regardless of service connection status
• Enrolled Veterans can receive services from the VA or from community providers under the Non-VA Care Program if VA services are unavailable
• 49 VA health care facilities offer kidney disease specialty care (nephrology services)
• 96 VA facilities offer inpatient and/or outpatient dialysis; 25 centers are inpatient-only. Of the 71 VA outpatient dialysis centers, 64 are hospital based units, 2 are joint VA/DoD units, 4 are freestanding units, and one is within a community based outpatient clinic (CBOC)
• VA enrollees must be offered the option of home dialysis provided either directly by the VA or through the Non-VA Care Program
• 36 outpatient hemodialysis centers offer home dialysis care directly.
• 5 VA medical centers host kidney transplantation programs.
• VA Delivered Kidney Care (Calendar Year 2013) 13,794 Unique Veterans receiving dialysis paid for by VA; representing an annual increase of 13% since 2008. 794 Veterans received home dialysis; 55percent (434) by VA facilities and 45percent (360) under the Non-VA Care Program.
• Increasing use of telehealth services to increase Veteran access to kidney specialty care Secure messaging: 7,319 messages, Clinical video telehealth: 4,977 encounters
• VA Kidney Research (FY ’14) the research budget for the study of kidney disease has been $18.5 million per year for the past 5 years (FY ’10-FY ’14). The VA Cooperative Studies Program has supported national clinical trials addressing the best treatment of Veterans with CKD since at least 1998.

It seems to me our veterans are covered. Now if we could only make sure the rest of us stay covered no matter what bills the current administration signs into law.

Until next week,

Keep living your life!

B.U.N. No, not bun. B.U.N.

Let’s consider this part 2 of last week’s blog since all these terms and tests and functions are intertwined for Chronic Kidney Disease patients. Thanks to reader Paul (not my Bear, but another Paul) for emphatically agreeing with me about this.

Bing! Bing! Bing! I know where to start. This is from The National Kidney Disease Education Program at the U.S. Department of Health and Human Services’ information about being tested for CKD.

“If necessary, meaning if your kidney function is compromised, your pcp will make certain you get to a nephrologist promptly.  This specialist will conduct more intensive tests that include:

Blood:

BUN –

BUN stands for blood urea nitrogen. Urea nitrogen is what forms when protein breaks down.”

If you read last week’s blog about creatinine, you know there’s more to the testing than that and that more of the information is in The Book of Blogs: Moderate Stage Chronic Kidney Disease, Part 2. No sense to repeat myself so soon.

Let’s take this very slowly. I don’t think it necessary to define blood, but urea? Maybe. I found this in SlowItDownCKD 2015:

“But how can I explain blood urea?  I’ll allow the experts to do that.

http://www.patient.co.uk/health/routine-kidney-function-blood-test has the simplest explanation.

‘Urea is a waste product formed from the breakdown of proteins. Urea is usually passed out in the urine. A high blood level of urea (‘uraemia’) indicates that the kidneys may not be working properly or that you are dehydrated (have low body water content).’

In the U.S., we call this test B.U.N. or Blood Urea Nitrogen Blood Test.  So as I understand it, if your protein intake is high, more urea is produced.  But since your kidneys are already compromised by CKD, the toxins remaining in your body are not eliminated as well….”

You with me so far? If there’s suspicion of CKD, your nephrologist tests your serum creatinine (see last week’s blog) and your BUN.  Wait a minute; I haven’t explained nitrogen yet. Oh, I see; it has to be defined in conjunction with urea.

Thanks to The National Kidney Foundation at https://www.kidney.org/atoz/content/understanding-your-lab-values for clearing this up:

“Urea nitrogen is a normal waste product in your blood that comes from the breakdown of protein from the foods you eat and from your body metabolism. It is normally removed from your blood by your kidneys, but when kidney function slows down, the BUN level rises. BUN can also rise if you eat more protein, and it can fall if you eat less protein.”

So now the reason for this protein restriction I wrote about in What Is It and How Did I Get It? Early Stage Chronic Kidney Disease should be clear.

“So, why is protein limited? One reason is that it is the source of a great deal of phosphorus. Another is that a number of nephrons were already destroyed before you were even diagnosed. Logically, those that remain compensate for those that are no longer viable. The remaining nephrons are doing more work than they were meant to. Just like a car that is pushed too hard, there will be constant deterioration if you don’t stop pushing. The idea is to stop pushing your remaining nephrons to work even harder in an attempt to slow down the advancement of your CKD.  Restricting protein is a way to reduce the nephrons’ work.”

This is starting to sound like a rabbit warren – one piece leads to another, which verves off to lead to another, and so forth and so on. All right, let’s keep going anyway.

Guess what. Urea is also tested via the urine. Nothing like confusing the issue, at least to those of us who are lay people like me. Let’s see if Healthline at http://www.healthline.com/health/urea-nitrogen-urine#overview1 can straighten this out for us.

“Your body creates ammonia when it breaks down protein from foods. Ammonia contains nitrogen, which mixes with other elements in your body, including carbon, hydrogen, and oxygen to form urea. Urea is a waste product that is excreted by the kidneys when you urinate.

The urine urea nitrogen test determines how much urea is in the urine to assess the amount of protein breakdown. The test can help determine how well the kidneys are functioning, and if your intake of protein is too high or low. Additionally, it can help diagnose whether you have a problem with protein digestion or absorption from the gut.”

Hmmm, these two don’t sound that different to me other than what is being analyzed for the result – blood (although blood serum is used, rather than whole blood) or urine.

What about BUN to Creatinine tests? How do they fit in here? After all, this is part 2 of last week’s blog about creatinine. Thank you to Medicine Net at http://www.medicinenet.com/creatinine_blood_test/article.htm for explaining. “The BUN-to-creatinine ratio generally provides more precise information about kidney function and its possible underlying cause compared with creatinine level alone.”

Dizzy yet? I think that’s enough for one day.

In other news, the price of all my Chronic Kidney Disease books has been reduced by 20%. I think more people will avail themselves of this information if they cost less… and that’s my aim: CKD awareness. If you belong to Kindle’s share program, you can take advantage of the fact that the price there was reduced to $1.99. You can also loan my books to a Kindle friend or borrow them from one for free for 14 days. Or you can ask your local librarian to order all five books, another way of reading them free. I almost forgot: as a member of Kindle Unlimited and the Kindle Owners’ Lending Library, you also read the books for free although you do need to pay your usual monthly subscription fee.

Students: Please be aware that some unscrupulous sites have been offering to rent you my books for a term for much more than it would cost to buy them. I’ve succeeded in getting most of them to stop this practice, but more keep popping up.

Until next week,

Keep living your life!

Recreating Creatinine

I throw a lot of terms around as if we all understood them. Sorry for that. One reader made it clear he needed more information about creatinine. In another part of my life, I belong to a community that calls reviewing or further explanation of a certain topic recreating… and today I’m going to recreate creatinine.

Let’s start in the beginning. This is what I wrote in the beginning of my CKD awareness advocacy in What Is It and How Did I Get It? Early Stage Chronic Kidney Disease :

“Creatinine is a waste product of muscle activity. What actually happens is that our bodies use protein to build muscles and repair themselves. This used protein becomes an amino acid which enters the blood and ends up in the liver where it is once again changed.  This time it’s changed into urea which goes through the kidneys into the urine.

The harder the muscles work, the more creatinine that is produced and carried by the blood to the kidneys where it also enters the urine.  This in itself is not toxic, but measuring the urea and creatinine shows the level of the clearance of the harmful toxins the body does produce.  These harmful toxins do build up if not voided until a certain level is reached which can make us ill. Working kidneys filter this creatinine from your blood.  When the blood levels of creatinine rise, you know your kidneys are slowing down.  During my research, I discovered that a non-CKD patient’s blood is cleaned about 35 times a day. A CKD patient’s blood is cleaned progressively fewer times a day depending upon the stage of the patient’s disease.”

Got it. Well, I did have to read it a couple of times to get it straight in my mind. Now what? Let’s see what more information I can find about what this means to a CKD patient. The Book of Blogs: Moderate Stage Chronic Kidney Disease, Part 1 contains the following explanation from DaVita,

“Because there are often no symptoms of kidney disease, laboratory tests are critical. When you get a screening, a trained technician will draw blood that will be tested for creatinine, a waste product. If kidney function is abnormal, creatinine levels will increase in the blood, due to decreased excretion of creatinine in the urine. Your glomerular filtration rate (GFR) will then be calculated, which factors in age, gender, creatinine and ethnicity. The GFR indicates the person’s stage of Chronic Kidney Disease which provides an evaluation of kidney function.”

I thought you might want to know more about this test, so I turned to The Book of Blogs: Moderate Stage Chronic Kidney Disease, Part 2 since I remembered including The National Kidney Disease Education Program at The U.S. Department of Health and Human Services’ information (including some reminders about definitions) concerning the process of being tested for CKD.

1. “A blood test checks your GFR, which tells how well your kidneys are filtering.…

2. A urine test checks for albumin. Albumin is a protein that can pass into the urine when the kidneys are damaged.

If necessary, meaning if your kidney function is compromised, your PCP will make certain you get to a nephrologist promptly.  This specialist will conduct more intensive tests that include:

Blood:

BUN – BUN stands for blood urea nitrogen.

Creatinine – The creatinine blood test measures the level of creatinine in the blood. This test is done to see how well your kidneys work.

Urine:

Creatinine clearance – The creatinine clearance test helps provide information about how well the kidneys are working. The test compares the creatinine level in urine with the creatinine level in blood.”

Aha! So there are two different creatinine readings: blood or serum and urine. By the way, MedicineNet at http://www.medicinenet.com/script/main/art.asp?articlekey=5470 defines serum as “The clear liquid that can be separated from clotted blood. Serum differs from plasma, the liquid portion of normal unclotted blood containing the red and white cells and platelets. It is the clot that makes the difference between serum and plasma.”

This is starting to get pretty complex. It seems that yet another test for CKD can be conducted with a urine sample. This is from SlowItDown 2015.

“In recent years, researchers have found that a single urine sample can provide the needed information. In the newer technique, the amount of albumin in the urine sample is compared with the amount of creatinine, a waste product of normal muscle breakdown. The measurement is called a urine albumin-to-creatinine ratio (UACR). A urine sample containing more than 30 milligrams of albumin for each gram of creatinine (30 mg/g) is a warning that there may be a problem. If the laboratory test exceeds 30 mg/g, another UACR test should be done 1 to 2 weeks later. If the second test also shows high levels of protein, the person has persistent proteinuria, a sign of declining kidney function, and should have additional tests to evaluate kidney function.

Thank you to the National Kidney and Urologic Diseases Information Clearinghouse, A service of the NIH, at http://kidney.niddk.nih.gov/kudiseases/pubs/proteinuria/#tests for that information.”

Is there more to know about creatinine? Uh-oh, this savory little tidbit was reprinted in SlowItDownCKD 2016 from an earlier book.

“.…Dr. HL Trivedi of the Institute of Kidney Diseases and Research Centre (IKDRC) said, ‘…. Rapid water loss causes the kidney’s functioning to slow down, resulting in temporary or permanent kidney failure.’

Extreme heat causes rapid water loss, resulting in acute electrolyte imbalance. The kidney, unable to cope with the water loss, fails to flush out the requisite amount of Creatinine and other toxins from the body. Coupled with a lack of consistent water intake, this brings about permanent or temporary kidney failure, explain experts.”

This seems to be calling for a Part 2. What do you think? There’s still BUN and albumin to deal with. Let me know what else you’d like to see included in that blog.

Have I mentioned that I’ll be presenting a display about CKD Awareness at Landmark’s Conference for Global Transformation? Or that both an article and an update about CKD Awareness will be included in their journal?

Until next week,

Keep living your life!

Getting Juiced

I have the gentlest nephrologist in the world! Well, I think so anyway. He has been cautioning me about my weight for years. Yes, there it is again: my weight. Here I was finally coming to terms with being a chubby since nothing I was doing seemed to work to lose the weight. That’s when he tossed out a bombshell.

We all know that increased weight can raise your blood pressure which, in turn, negatively affects your kidneys. I was so pleased with myself for having raised my GFR another three points on my last blood test that I didn’t understand how I could be leaking protein into my urine at the same time. Wasn’t protein in the urine simply an indication that you have Chronic Kidney Disease? Didn’t I already know that? So why was protein leaking into my urine to the tune of 252 mg. when the norm was between 15-220 mg?

I know, I know: back up a bit. Thanks for the reminder. GFR is defined in What Is It and How Did I Get It? Early Stage Chronic Kidney Disease this way:

“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.”

Oh, and just in case you’ve forgotten, this excerpt from The Book of Blogs: Moderate Stage Chronic Kidney Disease, Part 2 is a good reminder about the stages of CKD.

“Different stages require different treatment or no treatment at all.  There are five stages with the mid-level stage divided into two parts. The higher the stage, the worse your kidney function.

Think of the stages as a test with 100 being the highest score.  These are the stages and their treatments:

STAGE 1: (normal or high) – above 90 – usually requires watching, not treatment, although many people decide to make life style changes now: following a renal diet, exercising, lowering blood pressure, ceasing to smoke, etc.

 STAGE 2: (mild) – 60-89 – Same as for stage one

STAGE 3A: (moderate) – 45-59 – This is when you are usually referred to a nephrologist [Kidney specialist]. You’ll need a renal [Kidney] dietitian, too, since you need to be rigorous in avoiding more than certain amounts of protein, potassium, phosphorous, and sodium in your diet to slow down the deterioration of your kidneys. Each patient has different needs so there is no one diet.  The diet is based on your lab results.  Medications such as those for high blood pressure may be prescribed to help preserve your kidney function.

STAGE 3B: (moderate) – 30-44 – same as above, except the patient may experience symptoms.

STAGE 4:  (severe 15-29) – Here’s when dialysis may start. A kidney transplant may be necessary instead of dialysis [Artificial cleansing of your blood]. Your nephrologist will probably want to see you every three months and request labs before each visit.

STAGE 5: (End stage) – below 15 – Dialysis or transplant is necessary to continue living.

Many thanks to DaVita for refreshing my memory about each stage.”

Okay, back to the connection between spilling protein into your urine (called proteinuria) and CKD. This is from the recently published SlowItDownCKD 2016:

“In The Book of Blogs: Moderate Chronic Kidney Disease, Part 1, The National Institutes of Health helped me explain why this combination of excess weight and pre-diabetes was a problem for CKD patients:

‘High blood glucose and high blood pressure damage the kidneys’ filters. When the kidneys are damaged, proteins leak out of the kidneys into the urine. The urinary albumin test detects this loss of protein in the urine. Damaged kidneys do not do a good job of filtering out wastes and extra fluid. Wastes and fluid build up in your blood instead of leaving the body in urine.’”

Let’s say you don’t have pre-diabetes, but do have CKD. Does proteinuria still make it worse? Damn! It does. This explanation is from SlowItDownCKD 2015:

“The problem is that antibodies are made up of protein. Antibodies is defined by Dictionary.com at http://dictionary.reference.com/browse/antibodies as

‘A protein substance produced in the blood or tissues in response to a specific antigen, such as a bacterium or a toxin, that destroys or weakens bacteria and neutralizes organic poisons, thus forming the basis of immunity.’

Lose lots of protein into your urine and you’re losing some of your immunity. In other words, you’re open to infection.”

I guess that explains why I magically developed a UTI after years of not having any.

I have gone so far afield from what I intended to write about on this last Monday of National Kidney Month. What was that, you ask? It was my nephrologist’s strong suggestions for immediate weight loss: juicing. I was so surprised.

After all that writing about eating the raw vegetables for roughage and sticking to only three specified amount servings of each daily, this expert in his field was telling me to ignore all that and throw myself into juicing for the immediate future. But you can bet I’ll try it; no way I’m throwing nine years of keeping my kidneys healthier and healthier out the window.

I can’t tell you if it works since I only started yesterday, but I can tell you it doesn’t taste bad. I’m learning how to use this fancy, dancy blender we got three years ago that had just been sitting on the shelf. Experimenting with the consistency has caused a mess here and there, but oh well.

My first juicing experience included kale, celery, lemons, cucumbers, and ginger. I definitely need to play with my combinations. I also think I made far too much. Luckily Bear was in the house and shouted out that the machine was making that noise because I didn’t add enough water. Water? You’re supposed to add water?

I’ll keep you posted on these experiments if you’ll get yourself tested for CKD. It’s just a blood and urine test. Fair deal?

Until next week,

Keep living your life!

Women Marching to the Kidney’s Beat

In keeping with my theme of March being Women’s History Month – minus the history – and National Kidney Month, today’s blog will be about those women around the world who have contributed to Chronic Kidney Disease knowledge. Two such women, Dr. Vanessa Grubbs and Dr. Bessie Young, were highlighted in February’s tribute to Black History Month and women in nephrology. Thank you again, ladies, for all you do for CKD patients.

When you realize the study of nephrology as we know it is only a little over 50 years old (Incredible, isn’t it?), you’ll understand why I raided The International Society of Nephrologists (ISN) October 2010 issue at http://www.theisn.org/images/ISN_News_Archive/ISN_News_35_October_2010_LR.pdf for the following information. I’ve added notes for clarification when needed.

United States: An accomplished researcher and physician, Josephine Briggs is a former ISN councilor and former councilor and Secretary of ASN (American Society of Nephrologists). She is the former director of the Division of Kidney, Urologic, and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), US National Institutes of Health (NIH), and was responsible for all NIH funded renal research in the 1990s. Today, she is Director of the National Center for Complementary and Alternative Medicine. She maintains a lab at NIDDK, researching the renin-angiotensin system, diabetic nephropathy, circadian regulation of blood pressure, and the effect of antioxidants in kidney disease.

Europe: Rene Habib, who passed away (in 2010), was a truly pioneering renal pathologist. She provided the first description of many renal diseases and worked with ISN founder Jean Hamburger to establish nephrology as a new discipline in Europe. Her contributions and energy were central to establishing pathology as an essential and integrated component of this new field worldwide.

India: Vidya N. Acharya was the first woman nephrologist in India and trained some 150 internists in nephrology. For three decades, her research focused on Urinary Tract Infection. She was a consultant nephrologist at Gopalakrishna Piramal Memorial Hospital and director of the Piramal Institute for training in Dialysis Technology, Renal Nutrition and Preventive Nephrology in Mumbai. She received a Lifetime Achievement Award from the Indian Society of Nephrology in 2007.

China: HaiYan Wang is the Editor of Kidney International China and has been an ISN and ASPN (American Society of Pediatric Nephrology) councilor and Executive Committee member as well as a member of the editorial boards of Chinese and international renal journals. She has published over 200 articles and books in Chinese and English. She graduated from Beijing Medical University. After three years of internship, she became a nephrology fellow at the First Hospital Beijing Medical University. Since 1983, she moved on to Chief of Nephrology and later became Professor of the Department of Medicine at the First Hospital Beijing. She has been Chairman of the Chinese Society of Nephrology and is Vice President of the Chinese Medical Association. Her unit is the largest training site for nephrology fellows in China.

United Arab Emirates: Mona Alrukhaimi is co-chair of the ISN GO (International Society of Nephrologists Global Outreach Programs) Middle East Committee, and the leader of the KDIGO (Kidney Disease: Improving Global Outcomes) Implementation Task Force for the Middle East and African regions. She is also a Member of the Governing Board of the Arab Society of Nephrology and Renal Transplantation. Since 2006, she has actively organized World Kidney Day activities in the United Arab Emirates and prepared the past four rounds of the ISN Update Course in Nephrology. Having played an active role in the Declaration of Istanbul on Organ Trafficking and Transplant Tourism, she contributes to serve on the custodian group and takes part in the Steering Committee for Women in Transplantation under The Transplantation Society.

South Africa: Saraladevi Naicker carried the weight of setting standards and provided the first training program for nephrologists in Africa over the last decade (Remember this article was published in 2010.). Specializing in internal medicine, she trained in Durban and later helped set up a Transplant Unit in the Renal Unit at Addington Hospital. In 2001, she became Chief Specialist and Professor of Renal Medicine at University of Witwatersrand in Johannesburg and in 2009 was appointed Chairman of Medicine at Wits. She is proud that there are currently (Again: in 2010) six postgraduate students from Africa studying for higher degrees in nephrology under her tutelage. Over the years, Naicker’s unit has served as the main training site for young nephrologists from across Africa and many individuals trained by her are currently practicing in Africa. Naicker received the Phillip Tobias Distinguished Teaching Award in 2006, an honor which bears testimony to her teaching prowess.

Israel: Batya Kristal is Professor of Medicine at the Technion Medical School, Haifa. She is the first woman to direct an academic nephrology department in Israel. At the Western Galilee Hospital, Nahariya, she leads a translational research project focusing on different aspects of oxidative stress and inflammation. She also heads a large clinical nephrology and dialysis program, which uniquely integrates staff and patients from the diverse ethnic population of the Galilee. Founder of the Israeli NKF, initiator and organizer of the traditional annual international conferences at Nahariya, she is truly an important role model for women in the country.

Australia: After holding resident positions in medicine and surgery and as registrar in medicine at the Baragwanath Hospital in Johannesburg, Priscilla Kincaid-Smith was director and physician of Nephrology at Royal Melbourne Hospital and Professor of Medicine at University of Melbourne. She demonstrated overwhelming evidence of the link between headache powders and kidney damage and contributed to research on the links between high blood pressure and renal malfunction. The only female ISN President so far, she was named Commander of the Order of the British Empire “for services to medicine”, was awarded the David Hume Award from the National Kidney Foundation (USA) and became a Companion of the Order of Australia.

There’s very little room for me to add my own words this week so I’ll use them to add myself as a lay woman in nephrology (What hubris!) to let you know that the edited digital version of SlowItDownCKD 2016 will be out on Amazon later this week. You guessed it: in honor of National Kidney Month.

 

Until next week,

Keep living your life!

The Three Musketeers

I was in Cuba last week with very sketchy internet, so it was not possible to post a blog. But for now, I was thinking about a friend – you know, one of those Facebook friends you never met but you feel an instant kinship with – who told me that her surgeon warned her that her recovery from the spinal fusion surgery she’d recently had would be slow because she has Chronic Kidney Disease.

CKD…bone healing. Let’s start slowly and work this one out.  First of all, what do the kidneys have to do with your bones?

I turned to What Is It and How Did I Get It? Early Stage Chronic Kidney Disease for some answers.

“Both vitamin D and calcium are needed for strong bones. It is yet another job of your kidneys to keep your bones strong and healthy….Vitamin D enables the calcium from the food you eat to be absorbed in the body. CKD may leech the calcium from your bones and body….Be aware that kidney disease can cause excessive phosphorus. And what does that mean for Early Stage CKD patients? Not much if the phosphorous levels are kept low. Later, at Stages 4 and 5, bone problems including pain and breakage may be endured since excess phosphorous means the body tries to maintain balance by using the calcium that should be going to the bones.”

Whoa! Each one of those thoughts needs at least a bit more explanation. Let’s start with the jobs of the kidneys. The Book of Blogs: Moderate Stage Chronic Kidney Disease, Part 1 has a paragraph that mentions some of them. I turned it into a list to make it more visual.

“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.”

Another of those various substances in the blood they help to regulate is phosphorous. That’s where one of the connections between CKD and your bones lies. If your phosphorous is not being correctly regulated by your kidneys (since your kidneys are impaired), yes you do experience pain and broken bones, but did you notice that your body also diverts your necessary-for-bone-health calcium to regulate the other substances in your blood?

I wanted to know more about phosphorous so I turned to The Book of Blogs: Moderate Stage Chronic Kidney Disease, Part 2. I got a chuckle from seeing that I’d quoted from my first book in explaining how phosphorous works. I’d forgotten about that.

“This is the second most plentiful mineral in the body and works closely with the first, calcium. Together, they produce strong bones and teeth. 85% of the phosphorous and calcium in our bodies is stored in the bones and teeth.  The rest circulates in the blood except for about 5% that is in cells and tissues…. Phosphorous balances and metabolizes other vitamins and minerals including vitamin D which is so important to CKD patients. As usual, it performs other functions, such as getting oxygen to tissues and changing protein, fat and carbohydrate into energy.”

Talk about multi-tasking. Let’s focus in on the calcium/phosphorous connection. Kidney Health Australia at http://kidney.org.au/cms_uploads/docs/calcium-and-phosphate-balance-fact-sheet.pdf explained this succinctly:

“When your kidney function declines, you are unable to get rid of excess phosphate. (Me here: that’s what we call phosphorous except when dealing with inorganic chemistry.)  The phosphate builds up in your body and binds to calcium, which, in turn, lowers your calcium levels. When your calcium levels get too low, glands in your neck (called the parathyroid glands) pull the extra calcium your body needs out of your bones. This can make your bones easy to break. The bound phosphate and calcium get deposited in your blood vessels. It can increase your risk of heart disease and stroke. It can also cause skin ulcers and lumps in your joints.”

So where does vitamin D come in? As was mentioned in SlowItDownCKD 2015,

“’Vitamin D: Regulates calcium and phosphorous blood levels as well as promoting bone formation, among other tasks – affects the immune system.’ We know vitamin D can be a real problem for us.  How many of you are taking vitamin D supplements? Notice my hand is raised, too.  How many of you read the blogs about vitamin D?  Good!” 

It sounds like vitamin D is in charge here. Let me get some more information about that for us. Bingo: DaVita at https://www.davita.com/kidney-disease/diet-and-nutrition/diet-basics/vitamin-d-and-chronic-kidney-disease/e/5326 was able to help us out here.

“Vitamin D is responsible for:

• Building and maintaining strong bones
• Keeping the right level of calcium and phosphorus in the blood
• Preventing bones from becoming weak or malformed
• Preventing rickets in children and osteomalacia in adults

Too much vitamin D can be toxic….”

Hmmm, the three work together with vitamin D as their captain.

I wondered what foods would be helpful for my friend in her healing process.

“Calcium

Milk, yogurt, cheese, sardines, spinach, collard greens, kale, soybeans, black-eyed peas, white beans and foods often fortified with calcium: breakfast cereals, orange juice, soy milk, rice milk

Vitamin D

Salmon, mackerel, sardines, tuna, flounder, sole, cod

Phosphorus

Ricotta cheese, barley, soybeans, sunflower seeds, cottage cheese, lentils”

Thank you to Weill Cornell Medical College’s Women’s Health Advisor at http://www.cornellwomenshealth.com/static_local/pdf/WHA0210_BoneHealth.pdf for the above information.

But, you know, it’s never just that easy. As CKD patients, we have limits of how much protein, potassium, sodium, and – wait for it – phosphorous we can eat each day. There is no socking in all the good stuff for kidney disease patients.

I can see why my friend’s surgeon told her the recovery might be slow. Something else that keeps the bones strong is weight bearing exercise, but how can she do that right now?

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.

To 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? Right. 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.”

I 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.”

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.

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  alcohol  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 function 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?”

Until next week,

Keep living your life!

Where Does It All Come From?

For 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 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 encasements 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 Chronic 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 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…

Check 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?

Until next week,

Keep living your life.

Never Too Old to Learn

Last week, we were delighted to have an overnight guest we hadn’t seen for a year or two. While we were all waking ourselves up the next morning, I asked him if he’d like some coffee.  Yep, he’s my family; that look of delight on his face when he thought of coffee confirmed it. Then I asked if he took milk in his coffee. Hmmm, more confirmation: he passed on the milk claiming lactose intolerance, another family trait. But when we got to the sugar question, he startled me. His response was something like no thanks, I have high cholesterol. After a moment of stunned silence, I asked why he connected cholesterol and sugar. He said his doctor told him to cut down on sugars to lower his cholesterol. Hmmm, very interesting.

This is the definition of cholesterol from What Is It and How Did I Get It? Early Stage Chronic Early Disease:

While the basis for both sex hormones and bile, can cause blockages if it accumulates in the lining of a blood vessel.

If that doesn’t ring a bell, here’s the definition of dyslipidemia:

Abnormal levels of cholesterol, triglyceride or both

Now we know there’s a normal and an abnormal level of cholesterol and that can’t be good. Is that a big deal?

It is if you have Chronic Kidney Disease.  Dr. Joseph Vassalotti, one of leading nephrologists in the U.S., explained it to reporter Jane Brody in an interview which is included in The Book of Blogs: Moderate Stage Chronic Kidney Disease, Part 1.

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

I repeat, “…can delay the loss of kidney function.” That has been your ultimate goal since you were diagnosed, hasn’t it?

You may become confused by the three different kinds of cholesterol readings when you see the results of your blood tests.  I know I was, so I researched them and then wrote about them in The Book of Blogs: Moderate Stage Chronic Kidney Disease, Part 2.

HDL is High Density Lipoprotein, the cholesterol that keeps your arteries clear or – as it’s commonly called – the good cholesterol. LDL is Low Density Lipoprotein or the ‘bad’ kind that can clog your arteries. VLDL is Very Low Density Lipoprotein and one of the bad guys, too. It contains more triglycerides than protein and is big on clogging those arteries.

Wait a minute. Where did triglycerides come into this? According to the Mayo Clinic at http://www.mayoclinic.org/diseases-conditions/high-blood-cholesterol/in-depth/triglycerides/ART-20048186

Triglycerides and cholesterol are separate types of lipids that circulate in your blood. Triglycerides store unused calories and provide your body with energy, and cholesterol is used to build cells and certain hormones. Because triglycerides and cholesterol can’t dissolve in blood, they circulate throughout your body with the help of proteins that transport the lipids (lipoproteins).

Still with me?  Good, because you can do something about this.

Sometimes, it’s as simple as lifestyle changes like adjusting your diet. While I don’t agree with all of this advice, DaVita at http://www.davita.com/kidney-disease/diet-and-nutrition/diet-basics/lowering-cholesterol-with-chronic-kidney-disease/e/5304 can get you started.

•  Avoid foods high in saturated fat and cholesterol such as whole milk, cheese and fat from meat.
• Bake, grill, broil and roast your poultry, fish and meat. Choose lean cuts of meat and trim off any fat.
• Eggs are an excellent source of protein, but the yolks are high in cholesterol. Try egg substitutes like Egg Beaters® or Scramblers®, or substitute two egg whites for a whole egg.
• Eat at least two servings of fish every week. Salmon, tuna, herring and trout contain good amounts of omega-3 fatty acids that lower your risk of heart disease.
• Try spreads like Benecol® or Take Control® in place of butter or margarine. Plant sterols and stanols in these spreads help lower cholesterol levels.
• Choose oils that are high in mono- and polyunsaturated fats: canola, olive, peanut, corn, safflower, soybean and sunflower.
• Read food labels and try to eliminate foods with trans-fats (found in hydrogenated oils, margarine and many commercially prepared snack foods).
• Eat kidney-friendly fruits and vegetables.

Of course, if you’re diabetic or prediabetic, you need to modify these suggestions for your diet.

As was suggested in this Everyday Health article (http://www.everydayhealth.com/high-cholesterol/fitness-and-cholesterol.aspx) included in SlowItDownCKD 2015, exercise will help.

       Try these exercise options to help shed pounds and manage high cholesterol:

• Walking
• Jogging or running
• Swimming
• Taking an aerobics class
• Biking
• Playing tennis, basketball, or other sports
• Using weight machines or lifting free weights to build muscle tone

If life style changes don’t work for you, your doctor may prescribe a statin.  The Merriam-Webster Dictionary at http://www.merriam-webster.com/dictionary/statin defines this as:

any of a group of drugs (as lovastatin and simvastatin) that inhibit the synthesis of cholesterol and promote the production of LDL-binding receptors in the liver resulting in a usually marked decrease in the level of LDL and a modest increase in the level of HDL circulating in blood plasma

There are substantial arguments against taking statins, but there are also substantial arguments for taking them.  This is something you have to discuss with your doctors since you have a unique medical condition.

Finally, sugar. What did my cousin’s doctor mean about sugar’s role in lowering his cholesterol? This was news to me, so I researched. Sure enough, my cousin’s doctor was right.  According to Progressive Health at http://www.progressivehealth.com/sugar-may-be-the-cause-of-your-elevated-cholestero.htm:

Sugar is a good example of a carbohydrate with high glycemic index. It can, therefore, increase the amount of small, dense LDL particles in the blood.

Although, health experts used to advocate that we cut the amount of sugar we consume because high blood sugar can cause insulin resistance and increase the risk of diabetes, there is now another reason to cut down on our sugar consumption.

A number of studies show that sugar can affect the kind and amount of cholesterol released into the blood.

So? According to the US National Library of Medicine National Institutes of Health at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4297703/

…patients with pre-dialysis CKD appear to be more likely to die of heart disease than of kidney disease. CKD accelerates coronary artery atherosclerosis by several mechanisms, notably hypertension and dyslipidemia, both of which are known risk factors for coronary artery disease.

That’s a pretty big ‘so.’

Until next week,

Enjoy your life!

Medical Individuals

We all know I write about Chronic Kidney Disease, or CKD, but just what is that? When I wrote What Is It and How Did I Get It? Early Stage Chronic Kidney Disease six years ago, I defined CKD as “Damage to the kidneys for more than three months, which cannot be reversed but may be slowed.” Although I’m not so sure about that “cannot be reversed” any more, this is simple, right?

Well, not exactly. Over the years, many readers have pointed out that they have another form of kidney disease. According to University Kidney Research Organization (UKRO) @ http://ukrocharity.org/kidney-disease/different-types-of-kidney-diseases/, these are all considered kidney disease:

• Alport Syndrome
• Diabetic Nephropathy
• Fabry Disease
• Focal Segmental Glomerulosclerosis
• Glomerulonephritis
• IgA Nephropathy (Berger’s Disease)
• Kidney Stones
• Minimal Change Disease
• Nephrotic Syndrome
• Polycystic Kidney Disease or PKD

Wait a minute. Chronic means of long duration. Then with the exception (hopefully) of kidney stones, these diseases can all be classified as CKD… but are they when it comes to treatment?

Dr. Joel Topf is a nephrologist who writes a blog of his own (Precious Bodily Fluids @pbfluids.com) and is a member of the eAJKD Advisory Board at American Journal of Kidney Disease. He must make great use of his time because he has helped develop teaching games for nephrology students and has written medical works. (Yeah, I’m impressed with him, too.)

He’s also a Twitter friend. He contacted me the other day about an article in the Clinical Journal of the American Society of Nephrology entitled “The CKD Classification System in the Precision Medicine Era,” which was written by Yoshio N. Hall and Jonathan Himmelfarb. You can read it for yourself on their site, but you’ll need to join it and get yourself a user name and password. I didn’t. Joel sent me the copy I needed.

My first reaction to his request was, “Sure!” Then I read the article and wondered if I could handle all the medicalese in it. Several readings later, I see why he asked me to write about it.

I say I have CKD stage 3B. You understand what I mean. So does my nephrologist. That’s due to the KDOQI. As I explained in The Book of Blogs: Moderate Stage Chronic Kidney Disease, Part 2, this is The National Kidney Foundation Kidney Disease Outcomes Quality Initiative which was not put into place until 1997 and then updated only five years later in 2002. It introduced stages and put CKD on the world medical map. By the way, the 2012 revised guidelines helped raised awareness of CKD according to the CJASN article: “…from 4.7% to 9.2% among persons with CKD stages 3 and 4 in the United States ….”

But something is missing. How can my stage 3 CKD be the same for someone who has, say, Nephrotic Syndrome? We may have the same GFR, but are our symptoms the same? Is the progression of our illnesses the same? What about our treatment? Our other test results?

Whoops! A certain someone looking over my shoulder as I type reminded me I need to define GFR. I especially like Medline Plus’s definition that I used in 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.”

I know, I know, I didn’t explain what “the Precision Medicine Era” is, either. According to the article, “The underlying concept behind the Precision Medicine Initiative is that disease prevention and treatment strategies must take individual variability into account.” Actually, President Obama first used the term in his State of the Union Address last year.

Alrighty now, back to why CKD staging is not necessarily precision medicine. It seems to center on one phrase – individual variability. I was diagnosed at age 60. I’m now almost 70. Where is the age adjustment in my treatment plan? Is there one? What about when I’m 80? 90? We know the body reacts differently to medications as we age. Is my nephrologist taking this into account? Is yours? I’m taking liberties with the definition of individual here; I don’t think the authors meant within the individual, but rather amongst individuals.

I check my husband’s blood test results for his GFR. FOR HIS AGE, he does not have CKD. But here’s another point I’ve been ranting about that’s brought up in this article. Many elders (Oh my! We’re in that category already.) are not being told if they have stage 1 or stage 2 CKD because their doctors age adjust and so don’t consider the results CKD. We’re getting a little esoteric here. Is CKD really CKD if you’ve age adjusted your GFR readings?

My brain is starting to hurt and I haven’t even written about the different diseases yet, although I did allude to them earlier. What impressed me most in this article is this (in discussing four different hypothetical patients): “Each would be classified as having stage 3 CKD with approximately the same eGFR, but it is patently obvious that virtually every aspect of clinical decision making … would greatly differ in caring for these four individuals.”

I have to agree in my layman way. I’m not a doctor, but I know that if you have Polycystic Kidney Disease and I don’t, although our GFR is the same, I cannot receive the same treatment you do and you cannot receive the same treatment I do. Yes, they’re both kidney diseases and both chronic, but they are not the same disease despite our having the same GFR.

There is no one size fits all here. Nor does there yet seem to be precision. My CKD at 70 is not the same as it was at 60. If I had diabetes, my CKD treatment would be different, too.  I do have hypertension and that has already changed my CKD treatment.

This got me to thinking. How would every nephrologist find the time for this individualized treatment for each CKD patient? And what other tests will each patient need to determine treatment based on his/her UNIQUE form of CKD?

Thanks for the suggestion, Dr. Topf. This was worth writing about.

Until next week,

Keep living your life!

 

Starting My Day

Every day, I spend the morning doing ‘kidney work’ as I call it. That means looking for Chronic Kidney Disease related articles on Facebook, Twitter, LinkedIn, Instagram, Pinterest, and perusing the various medical newsletters to which I’ve subscribed. This takes a minimum of two hours. I also post something on most of these sites at as SlowItDownCKD.

I noticed I’d been reading more and more about the plant based diet being good for CKD patients, so that’s what I posted on SlowItDownCKD’s Facebook page at https://www.facebook.com/SlowItDownCKD/on November 1. Then I started receiving emails from readers about it.

One was a very interesting, but undocumented, chart concerning how avoiding red meat lowers the risk of CKD. There was no title … and to make it worse, the reader – Cindy – couldn’t remember where she found it. She was frustrated; I was frustrated. So I did a little digging.

I started with a site that’s fast becoming one of my favorites – NephJC, a journal club. According to their website,

“It is the teaching session where trainees and teachers exchange roles. Journal Club is the area where the flipped classroom has been fully implemented in medical education. Read and study the article at home, and then use classroom time to critically debate the methods, results and interpretation of the article.”

As both a former high school and college instructor, I can tell you this method of teaching seemed to have sparked some super creative thoughts in my classroom. Anyhoo, as they say, that’s where I found the chart. More specifically, it’s at http://www.nephjc.com/news/2016/8/17/red-meat-summary. Read the article. It’s got more information.

Cindy also mentioned that she lost so much weight – without being hungry – on the plant based diet that her nephrologist asked her to gain weight so that she wouldn’t “be at the bottom of BMI or below.” You know this grabbed my attention.

At the same time we were corresponding, another CKD Awareness Advocate posted in a private FB group (Hence, the reason he remains unnamed.) that in his last two nephrology labs, he raised his GFR something like eight or nine points and had nothing to attribute it to but changing to a plant based diet.

As a reminder, here’s the definition of GFR from What Is It and How Did I Get It? Early Stage Chronic Kidney Disease:

“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.”

Let’s look at this a little more closely. In The Book of Blogs: Moderate Stage Chronic Kidney Disease, Part 2, I wrote a blog about the limited history of nephrology and included mention of the five stages of CKD. Basically, the higher your GFR, the better your kidneys are working. So this means the other advocate’s kidneys are functioning better now that he’s on a plant based diet. Why?

I turned to Dr. Greger’s NutritionFacts.org on YouTube for a better explanation than any I could offer. Dr. Greger is Michael Greger, described on NutritionFacts.org as:

“a physician, New York Times bestselling author, and internationally recognized speaker on nutrition, food safety, and public health issues. A founding member and Fellow of the American College of Lifestyle Medicine, Dr. Greger is licensed as a general practitioner specializing in clinical nutrition. He is a graduate of the Cornell University School of Agriculture and Tufts University School of Medicine.”

NutritionFacts.org, while new to me, describes itself on its site as:

“a strictly non-commercial, science-based public service provided by Dr. Michael Greger, providing free updates on the latest in nutrition research via bite-sized videos. There are more than a thousand videos on nearly every aspect of healthy eating, with new videos and articles uploaded every day.”

I thoroughly enjoyed his analogy of overloading the kidneys with meat protein to that of constantly revving a car’s engine, especially since that’s the same analogy I used in my first CKD book.  He also mentions inflammation as a contributing cause of lower GFR. I’m glad I’ve discovered his website and intend to take a closer look at it…just not now.

Now I’m really interested in going back to Cindy’s comment about losing weight on the plant based diet. I wanted to know – what else? – why. I spent most of yesterday researching. The consensus seems to be that not having to count calories or portion control may have something to do with it.  Then again, maybe it’s the lack of cookies, cakes, and candies. The few medical studies I did find were far too complicated for me to understand, much less explain. Are there any readers out there who can help? I have one particular reader in mind and hope that she will immediately respond.

Let’s see if I can do any better with finding out why the nephrologist of the reader I’m corresponding with doesn’t want her to “be at the bottom of BMI or below.” Aha! A study by US National Library of Medicine, part of the National Institutes of Health at https://www.ncbi.nlm.nih.gov/pubmed/26920126 suggests that “that combined effects of low BMI … and serum albumin level … are associated with CKD progression.”

Maybe we should take a look at “serum albumin level.” Serum means it’s the clear part of your blood, the part without red or white blood cells. This much is fairly common knowledge. Albumin is not. Medlineplus, part of The National Institutes of Health’s U.S. National Library of Medicine at https://medlineplus.gov/ency/article/003480.htm tells us, “Albumin is a protein made by the liver. A serum albumin test measures the amount of this protein in the clear liquid portion of the blood.” Uh-oh, this is also not good: a high level of serum albumin indicates progression of your kidney disease. Conversely, kidney disease can cause a high level of serum albumin.

Even with yesterday’s research, this blog has taken quite a while to complete … and not just because I was doing the wash while I wrote it, or because I was enjoying having the window to my right open as I wrote. I can see this becoming several additional blogs… if there’s reader interest.

Until next week,

Keep living your life!

How Sweet She Is

For 12 years, sweet Ms. Bella has positioned herself just inside my office door as I wrote, researched, edited, and formatted. For 12 years, sweet Ms. Bella has greeted me as effusively when I returned from a trip to the mailbox as she did when I returned from a trip to Alaska. For 12 years, sweet Ms. Bella has shared one sided conversations with me about any and everything. For 12 years, sweet Ms. Bella has adored me as no other being on earth ever has.

I’ll miss that. Sweet Ms. Bella crossed what I’m told is called The Rainbow Bridge this morning. .. and it was my decision. I’ve known for months that she had lymphedema. First we tried this. Then we tried that. And finally there was nothing else left to try. I am oh-so-sad without my boon companion, but it was time. She knew it and I knew it. May your soul come back to me, my sweet Ms. Bella.

I’ve been sad for a while knowing that I would have to make this decision and wondering how I would know when she’d had enough. I watched…and watched…and watched, yet she made it perfectly clear when her legs wouldn’t hold her up anymore and her cancerous lymph nodes started to impede her eating. She is at rest now.

What have I done to my kidneys with all this sadness, I wondered. I don’t know via my lab reports because I was just tested last Thursday and didn’t know about sweet Ms. Bella’s cancer when my blood and urine were tested three months ago. So I did what I could to find out: I researched.

I found this on the National Kidney Foundation’s site at https://www.kidney.org/news/newsroom/nr/depression-kd:

“New York, NY (July 1, 2012) – People with kidney disease who have symptoms of depression may be on the fast track to dialysis, hospitalization or death, according to a new study published in the July issue of the American Journal of Kidney Diseases, the official journal of the National Kidney Foundation.”

But I’m not depressed; I’m sad.  Well, what’s the difference? I turned to my old buddy WebMD for some help here:

“….Also known as clinical depression, major depressive disorder, or unipolar depression, major depression is a medical condition that goes beyond life’s ordinary ups and downs. Almost 18.8 million American adults experience depression each year, and women are nearly twice as likely as men to develop major depression. People with depression cannot simply ‘pull themselves together’ and get better. Treatment with counseling, medication, or both is key to recovery.”

Since I’m one of those people who always manage to get myself back together – and fairly quickly – I’d say I’m not depressed. I do suggest you read more about depression at http://www.webmd.com/depression/is-it-depression-or-the-blues if this strikes a chord with you.

So let’s go back to sadness and the kidneys. This is from a 5/21/14 article on a site that’s new to me: Medical Daily at http://www.medicaldaily.com/can-powerful-emotions-kill-you-negative-health-effects-anger-stress-sadness-and-shock-283682:

” ‘It’s called heartbreak for a reason. When you’re experiencing deep grief or sadness, it takes a toll on your health, too. One study from St. George’s University of London found that it is actually possible to die of a broken heart — bereavement increases your risk of a heart attack or stroke by nearly double after a partner’s death, the researchers discovered. We often use the term a ‘broken heart’ to signify the pain of losing a loved one and our study shows that bereavement can have a direct effect on the health of the heart,’ Dr. Sunil Shah, senior lecturer in public health at St. George’s, said in a press release.”

There’s a firm connection between heart health and kidney health. This is from SlowItDownCKD 2015:

“We’re used to reading about anemia and high blood pressure as the connection between CKD and Heart Disease, but here are two other causes.

DaVita at http://www.davita.com/kidney-disease/overview/symptoms-and- diagnosis/ chronic-kidney-disease-and-your-heart/e/4730 once again jumps in to educate us:

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

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

Hmmm, just by having Chronic Kidney Disease, we run the risk of heart problems.  Now sadness – maybe ‘deep grief’ is a more apt description – may add to that risk. As much as I love sweet Ms. Bella and will miss her, I can’t honestly say this is true for me. It feels like there’s a big difference between deep grief and sadness.

Just to make certain the difference between depression and sadness is clear, I’m repeating this information from The Book of Blogs: Moderate Stage Chronic Kidney Disease, Part 2:

“Make The Connection, a veterans’ support site tells us

‘Not everyone with depression has the same symptoms or feels the same way. One person might have difficulty sitting still, while another may find it hard to get out of bed each day. Other symptoms that may be signs of depression or may go along with being depressed include:

• Feeling sad or hopeless
• Losing interest in or not getting pleasure from most of your daily activities
• Gaining or losing weight
• Eating  more or less than usual almost every day
• Sleeping  too much or not enough almost every day
• Feeling restless and unable to sit still
• Feeling that moving takes great effort
• Feeling tired or as if you have no  energy almost every day
• Feeling unworthy or guilty nearly every day
• Having low self-esteem or feeling down on yourself
• Finding it hard to focus, remember things, or make decisions nearly every day
• Feeling anxious, worried, or nervous
• Drinking more alcohol or caffeine
• Taking more of a prescription or over-the-medication than as directed
• Smoking or using tobacco more often'”

It doesn’t look like my short term sadness is worsening my kidneys in any way, but if you’re not sure whether you need help with yours, or if it is truly depression, seek help. It can’t hurt to be careful.

I’m certain sweet Ms. Bella is not suffering anymore and that is already doing wonders for my peace of mind… and my sadness.

Until next week,

Keep living your life!

Feeling the Pressure

For those of you in the United States, here’s hoping you have a healthy, safe Labor Day.  I come from a Union family. So much so that my maternal grandfather was in and out of jail for attempting to unionize brass workers. That was quite a bit of pressure on my grandmother, who raised the four children and ran a restaurant.

I knew there was more than my personal history with the holiday so I poked around and found this from http://www.usatoday.com/story/news/nation/2016/09/04/labor-day-history/89826440/

“In the late 1800s, the state of labor was grim as U.S. workers toiled under bleak conditions: 12 or more hour workdays; hazardous work environments; meager pay. Children, some as young as 5, were often fixtures at plants and factories.

The dismal livelihoods fueled the formation of the country’s first labor unions, which began to organize strikes and protests and pushed employers for better hours and pay. Many of the rallies turned violent.

On Sept. 5, 1882 — a Tuesday — 10,000 workers took unpaid time off to march in a parade from City Hall to Union Square in New York City as a tribute to American workers. Organized by New York’s Central Labor Union, It was the country’s first unofficial Labor Day parade. Three years later, some city ordinances marked the first government recognition, and legislation soon followed in a number of states.”

Now that’s pressure, but I want to write about another kind of pressure today: your blood pressure.

Being one of those people who is required to check their blood pressure at least once a day, I was surprised to learn that doctors didn’t realize the importance of maintaining moderate blood pressure until the 1950s. Yet, ancient Chinese, Greeks, and Egyptians knew about the pulse. I wonder what they thought that was.

The American Heart Association explains the difference between the blood pressure and the pulse, and offers a chart to exemplify. The column without the heading refers to ‘Heart Rate.’

	Blood Pressure
What is it?	The force the heart exerts against the walls of arteries as it pumps the blood out to the body	The number of times your heart beats per minute
What is the unit of measurement?	mm Hg (millimeters of mercury)	BPMs (beats per minute)
What do the numbers represent?	Includes two measurements: Systolic pressure (top number): The pressure as the heart beats and forces blood into the arteries Diastolic pressure (bottom number): The pressure as the heart relaxes between beats	Includes a single number representing the number of heart beats per minute
Sample reading	120/80 mm Hg	60 BPM

You can read more about this at http://www.heart.org/HEARTORG/Conditions/HighBloodPressure/AboutHighBloodPressure/Blood-Pressure-vs-Heart-Rate_UCM_301804_Article.jsp.

According to Withings, a French company that sells blood pressure monitoring equipment, at http://blog.withings.com/2014/05/21/the-history-of-blood-pressure/:

“The first study on blood circulation was published in 1628 by William Harvey – an English physician. He came to the conclusion that the heart acts as a pump. At that point it wasn’t clear that blood circulated, but after a little calculation he was pretty sure that blood is not ‘consumed’ by the organs. The physician then concluded that blood must be going though (sic) a cycle.”

Ah, but did his measurement include both numbers? In What Is It and How Did I Get It? Early Stage Chronic Kidney Disease, I satisfied my own curiosity as to why our blood pressure readings always have two numbers, one atop the other:

“The first number… called the systolic is the rate at which the heart contracts, while the second or diastolic … is when the heart is at rest between contractions.  These numbers measure the units of millimeters of mercury to which your heart has raised the mercy.”

Uh, raised the mercury of what? Well it’s not the sphygmomanometer as we now know it. By the way, this is the connection between blood pressure and Chronic Kidney Disease that I mentioned in SlowItDownCKD 2015:

“I wonder how frustrated Dr. Bright became when he first suspected that hypertension had a strong effect on the kidneys, but had no way to prove that theory since the first practical sphygmomanometer (Me here: That’s the device that measures your blood pressure.)  wasn’t yet available.”

Well, why is hypertension – high blood pressure – important in taking care of your kidneys anyway?  It’s the second leading cause of CKD. The Mayo Clinic succinctly explains why at http://www.mayoclinic.org/diseases-conditions/high-blood-pressure/in-depth/high-blood-pressure/art-20045868

“Your kidneys filter excess fluid and waste from your blood — a process that depends on healthy blood vessels. High blood pressure can injure both the blood vessels in and leading to your kidneys, causing several types of kidney disease (nephropathy). “

Well, how do you avoid it then? One way is to take the pressure off yourself. (As a writer, I’m thoroughly enjoying that this kind of pressure can affect the other kind – the blood pressure. As a CKD patient, I’m not.)

Pressure on yourself is usually considered stress. In The Book of Blogs: Moderate Stage Chronic Kidney Disease, Part 2, there’s an explanation of what stress does to your body.

“…we respond the same way whether the stress is positive or negative…. First you feel the fight or flight syndrome which means you are releasing hormones.  The adrenal glands which secrete these hormones lay right on top of your kidneys. Your blood sugar raises, too, and there’s an increase in both heart rate and blood pressure.  Diabetes {High blood sugar} and hypertension {High blood pressure} both play a part in Chronic Kidney Disease. If you still haven’t resolved the stress, additional hormones are secreted for more energy.”

What else? This list from the American Kidney Fund was included in The Book of Blogs: Moderate Stage Chronic Kidney Disease, Part 1:

• Eat a diet low in salt and fat
• Be physically active
• Keep a healthy weight
• Control your cholesterol
• Take medicines as directed
• Limit alcohol
• Avoid tobacco

 Why am I not surprised at how much this looks like the list for healthy kidneys?

I was just thinking: what better day to start working on this list than Labor Day?

Until next week,

Keep living your life!

 

 

The Nutrition Action Health Letter Article

I am now officially excited.  I’d been getting some comments about this article which I thought wasn’t being published until September. I wondered why. It was my mistake. The article was to appear in the September issue, which I didn’t realize is published before the month begins.

The Center for Science in the Public Interest’s September Nutrition Action Health Letter is out… and you can read it online, too. The URL is http://www.nutritionaction.com/wp-content/uploads/cover-Kidney-Check-How-to-Keep-Yours-Going-Strong.pdf. Many thanks to Bonnie Liebman for such a fine job of reporting and aiding in spreading Chronic Kidney Disease Awareness. It’s long, six pages, so what we have here are excerpts.

 

“I didn’t know that I had end-stage renal disease until I was admitted to the hospital in 2009,” says David White, who was then in his mid-40s. “A few days later, I stopped producing urine.”

Doctors told White that he had crashed. “It was scary,” he says. “I went from ‘Something may be wrong’ to ‘Oh my god am I going to die?’ to ‘I have to spend the rest of my life on dialysis.’”

And with four hours of dialysis three times a week, he never felt great.

“People call it the dialysis hangover,” says White, from Temple Hills, Maryland. “You’re so tired that you want to sleep all day after dialysis and most of the following day. And then you gear up for the next treatment.”

And White struggled with his one-quart-a-day limit on fluids. “When you drink too much, moving isn’t comfortable, laying down isn’t comfortable,” he says. “It’s hard to breathe.”

For Gail Rae-Garwood, the news about her kidneys came when she switched to a new doctor closer to her home in Glendale, Arizona.

“She decided that as a new patient, I should have all new tests,” says Rae-Garwood, now 69. “When the results came in, she got me an appointment with a nephrologist the next day. When you get an appointment with a specialist the next day, you know something is not right.”

Rae-Garwood had chronic kidney disease. “My GFR was down to 39, and apparently had been low for quite a while,” she says. (Your GFR, or glomerular filtration rate, is the rate at which your kidneys filter your blood.) “‘What is chronic kidney disease and how did I get it?’ I demanded,” recalls Rae-Garwood.

Every 30 minutes, your kidneys filter all the blood in your body. Without at least one, you need dialysis or a transplant. Yet most people have no idea how well their kidneys are working. “It’s very common for people to have no idea that they have early chronic kidney disease,” says Alex Chang, a nephrologist at Geisinger Health System in Danville, Pennsylvania.

A routine blood test sent to a major lab—like Quest or LabCorp—typically includes your GFR. If it doesn’t, your doctor can calculate it.

“A GFR is pretty routine for anyone who has blood work done,” says Chang. “But if you have very mild kidney disease, and especially if you’re older, a doctor might not mention it since kidney function tends to decline as you age.”

Doctors also look for kidney disease by testing your urine for a protein called albumin …. “That’s usually only done if you have high blood pressure or diabetes or some risk factor for kidney disease other than age,” says Chang.

Rae-Garwood’s previous doctor missed that memo. “I had been on medication for high blood pressure for decades,” she explains. “I wonder how much more of my kidney function I could have preserved if I’d known about it earlier.”

***

David White had kidney transplant in 2015. “It’s given me my life back,” he says. “No more dialysis.”

He takes anti-rejection drugs and steroids, and, like Rae-Garwood, he gets exercise and has to watch what he eats.

“I’ve changed my diet radically,” says Rae-Garwood. “I have to limit the three P’s—protein, potassium, and phosphorus. I’m restricted to 5 ounces of protein a day. We have no red meat in the house. Any product above 7 or 8 percent of a day’s worth of sodium I don’t buy.

“And you know what? It’s fine. It’s been nine years now, and I’ve been able to keep my GFR around 50.”

Both patients are now advocates for preventing kidney disease. “I’ve written four books and almost 400 weekly blogs, and I post a daily fact about chronic kidney disease on Facebook,” says Rae-Garwood. White chairs the the MidAtlantic Renal Coalition’s patient advisory committee, among other things among other things.

“Get tested,” urges Rae-Garwood. “Millions of people have chronic kidney disease and don’t even know it. All it takes is a blood and urine test.”

My hope is that as a result of this article, more libraries, medical schools, and nephrology practices will order copies of What Is It and How Did I Get It? Early Stage Chronic Kidney Disease, The Book of Blogs: Moderate Stage Chronic Kidney Disease, Part 1, The Book of Blogs: Moderate Stage Chronic Kidney Disease, Part 2, and SlowItDownCKD 2015. If you have a Kindle, Amazon has two wonderful low cost or free programs that may make it easier for you, your loved ones, and anyone you think could benefit from these books to read them.

This is how Amazon explains these programs:

“Kindle Unlimited is a subscription program for readers that allows them to read as many books as they want. The Kindle Owners’ Lending Library is a collection of books that Amazon Prime members who own a Kindle can choose one book from each month with no due dates.”

Barnes and Noble doesn’t have any such programs, but they do offer discount deals daily, which you can use to purchase any book.

I urge you to help spread awareness of Chronic Kidney Disease in any way you can. Here’s another quote from the article that may help you understand why:

“One out of ten adults have chronic kidney disease. Most don’t know it because early on, kidney disease has no symptoms. And because the risk rises as you age, roughly one out of two people aged 30 to 64 are likely to get the disease during their lives….”

Until next week,

Keep living your life!

CKD Treatment Interruptus

Recently, someone close to me experienced a major burglary.  After calling the police, he called me. That’s what my friends do and I’m thankful they do. I kept him on the phone while I threw on some clothes and sped over to his house. This is a strong, independent man who was shocked at the intimacy of the invasion of his home. When I got there, we walked from room to room, astonished at how much had been stolen.

That night, I couldn’t leave – not even to go home for my evening medications and supplements. That night, I couldn’t sleep while my buddy was in such turmoil. So we sat up staring at the empty space where the TV had been.  He’s not on the renal diet and all he had that I could eat was some chicken, no fruit, no vegetables. And I was too busy being with him to exercise. This was my good buddy of over 30 years standing.

The next morning, another friend came over to help with security devices and spend time with our mutual friend.  I got to go home, take my morning medications, and crawl into bed for ½ an hour. But then our mutual friend had to go to work, so I went back to my buddy’s house and spent the day helping him try to list what was missing, what to do about the insurance, how to handle going to work, etc. The word spread, and, suddenly, a third friend was coming to spend the night with him and another couple joined them to make dinner.  I could go home again.   

But I was exhausted. I ate stupidly: Chinese restaurant food with all that sodium. I even ate rice, and here I am on a low carbohydrate diet. I sat in the living room like a zombie while Bear waited on me hand and foot.

Even with all this help, my buddy needed to see me daily. I was his strength. So we ran around rummaging up some receipts he’d need for the insurance. But I could see he was feeling better. Our mutual friends were amazing, including those who couldn’t leave work to come so kept phoning and texting instead. A different someone else stayed with him overnight again.  Then he only needed to see me for a quick hug… and yet another someone else stayed with him overnight again. He didn’t really need me anymore, which is great because I started breaking down.

I have Chronic Kidney Disease. I need to sleep adequately – and with my BiPap. I need to follow the renal diet. I need to exercise. I need to rest.  I did very little of any of this during the trauma itself, and that’s alright. This is my long term buddy – as grown up and mature as he is – and he needed me. But what did I do to myself?

You guessed it. Right away, my blood pressure shot up and that’s a bad thing. Why? Let me tell you… or you can go to What Is It and How Did I Get It? Early Stage Chronic Kidney Disease, page 9.  

“Through my research, I began to understand what high blood pressure [HPB] has to do with renal disease.  HPB can damage small blood vessels in the kidneys to the point that they cannot filter the waste from the blood as effectively as they should. Nephrologists may prescribe HBP medication to prevent your CKD from getting worse since these medications reduce the amount of protein in your urine.  Not too surprisingly, most CKD related deaths are caused by cardiovascular problems.”

What about the stress?  What was that doing to my poor overworked kidneys?  I went to The Book of Blogs: Moderate Stage Chronic Kidney Disease, Part 2 for the answer to that one:

“First you feel the fight or flight syndrome which means you are releasing hormones.  The adrenal glands which secrete these hormones lay right on top of your kidneys. Your blood sugar raises, too, and there’s an increase in both heart rate and blood pressure.  Diabetes {Blood sugar} and hypertension {Blood pressure} both play a part in Chronic Kidney Disease.”

That’s two strikes against me. I almost hesitate to think about exercise… or the lack of it for several consecutive days.  This is one of the points about treating prediabetes (which I have and so do so many of you) from the Mayo Clinic at http://www.mayoclinic.org/diseases-conditions/prediabetes/basics/treatment/con-20024420 which was included in SlowItDownCKD 2015:

“Losing excess pounds. If you’re overweight, losing just 5 to 10 percent of your body weight — only 10 to 20 pounds (4.5 to 9 kilograms) if you weigh 200 pounds (91 kilograms) — can reduce the risk of developing type 2 diabetes. To keep your weight in a healthy range, focus on permanent changes to your eating and exercise habits. Motivate yourself by remembering the benefits of losing weight, such as a healthier heart, more energy and improved self-esteem.”

And the renal diet? We mustn’t forget about the renal diet. In The Book of Blogs: Moderate Kidney Disease, Part 1 I quoted from http://www.yourkidneys.com/kidney-education/Treatments/Living-a-full-life-after-a-chronic-kidney-disease-diagnosis/3189 which is part of Yourkidneys.com from DaVita:

“Depending on what stage of Chronic Kidney Disease you’re in, your renal dietitian will adjust the amounts of protein, sodium, phosphorus and potassium in your diet. In addition, carbohydrates and fats may be controlled based on conditions such as diabetes and cardiovascular disease. The CKD non-dialysis diet includes calculated amounts of high quality protein. Damaged kidneys have a difficult time getting rid of protein waste products, so cutting back on non-essential protein will put less stress on your kidneys.”

Have I done more permanent damage to my kidneys? I’m hoping not since it was just a few days and I made the conscious decision to be with my buddy instead of tending to myself. Let’s consider this a cautionary tale instead.

Until next week,

Keep living your life!

What’s Your Type?

Every Sunday night, I take a blues dance lesson taught by my daughter, Abby Wegerski, as Sustainable Blues Phoenix at Saint Nick’s Tavern and stay to dance to the music of the live band – the Rockets 88s – for a while. Last week, my good buddy, Karla Lodge, organized a fund raiser. I like to support Karla in whatever she does, so I decided to push myself and go to the fundraiser (a half hour drive each way) after dancing.

To make it even more fun, Bill Weber, the creator of Avery’s World, was in from Los Angeles visiting a relative in Tucson. They drove up to Scottsdale to join us at the fundraiser.  Now that you’ve been introduced to some of the people and events in my life, forget them. Here’s the important part: as we were having dinner, my Chronic Kidney Disease Awareness Advocacy came up. Bill’s relative lit up. It turns out someone very close to her is a transplantee. Her first question to me: What’s your blood type?

I explained I was in the moderate stages of CKD and not anywhere near transplant, but she insisted it was very important to know your blood type when you have CKD. She didn’t know why. I didn’t know why…so that’s the subject of today’s blog.

Here I am starting in the middle again. We all have a blood type.  That’s fairly common knowledge, but what exactly are blood types? We’ll go about this a bit differently by defining blood group, which is a synonym for blood type. To paraphrase a song we used to sing during the two times I went to a two week stint at summer camp on a farm, “I know because the dictionary tells me so.” In this case it’s the Merriam-Webster Dictionary at http://www.merriam-webster.com/dictionary/blood%20group:

“one of the classes (as those designated A, B, AB, or O) into which individuals or their blood can be separated on the basis of the presence or absence of specific antigens in the blood —called also blood type”

For those of you who are wondering, an antigen is something that’s introduced to the body and causes the body to produce antibodies (think germs). As an undergraduate in good old Hunter College of The City University of New York I learned that ‘anti’ is a prefix meaning against. ‘Gen’ is a root which means causing something to happen.  Got it. An antigen causes something to happen against something else. In this case, your red blood cells.

I see a hand raised in the back of the room. (This does remind me of when I was teaching college out here in Arizona.) Why are there four types you ask? Good question. Anyone have the answer? I don’t either, so let’s look it up together. Look! The Smithsonian Institute sums it up in one sentence: “But why humans and apes have these blood types is still a scientific mystery.” Now I don’t feel so uninformed that I couldn’t answer the question. Anyway, you can read more at: http://www.smithsonianmag.com/science-nature/the-mystery-of-human-blood-types-86993838/#JwJKP357AyhDRy4R.99 and, yes, this is THAT Smithsonian Institute.  Where, oh where, is Bones when you need her?

Did you know there are numerous other blood groups, too? Usually people don’t – unless they happen to be a member of one of them. The same link above can offer you more information about these since we’ll be sticking to the four major ones today. You should know that your blood type is inherited.

Again, why is it important to know your blood group?  Thank you to Disabled World at http://www.disabled-world.com/calculators-charts/blood-chart.php for the following chart, which demonstrates the answer.

They also offer a simple explanation of why blood groups are so important:

“Blood types are very important when a blood transfusion is necessary. In a blood transfusion, a patient must receive a blood type compatible with his or her own blood type. If the blood types are not compatible, red blood cells will clump together, making clots that can block blood vessels and cause death.

If two different blood types are mixed together, the blood cells may begin to clump together in the blood vessels, causing a potentially fatal situation. Therefore, it is important that blood types be matched before blood transfusions take place. In an emergency, type O blood can be given because it is most likely to be accepted by all blood types. However, there is still a risk involved.”

As a CKD patient for the last nine years, I have never needed a blood transfusion. Come to think of it, I’ve never needed one in my almost 70 years on this planet. But that’s not to say I may not need one sometime in the future… or that you might not need one. But I’m interested in why it’s especially important to know your blood type as a moderate stage CKD patient.

I scoured What Is It and How Did I Get It? Early Stage Chronic Kidney Disease, The Book of Blogs: Moderate Stage Chronic Kidney Disease – Part 1, The Book of Blogs: Moderate Stage Chronic Kidney Disease – Part 2, and SlowItDownCKD 2015. Although there is abundant discussion of how the kidneys filter the blood, why their effectiveness in this filtering diminishes in CKD and the production of red blood cells, there is no mention of blood type in any of the books.

I’m beginning to wonder if Bill’s relative meant that knowing your blood type is important in general, not especially if you have CKD. Karla, a Physician’s Assistant, was strangely quiet during this part of the discussion. I attributed that to her being pre-occupied with the fundraiser she was running… maybe that wasn’t the reason.

Although I didn’t find the answer to my question, I did run across some intriguing theories during my research. I’m not endorsing them since I know so little about them, simply offering you the information.

The Blood Type Diet at http://www.dadamo.com/ (I do remember a colleague being interested in this one about a decade ago.)

Blood Type and Your Personality at http://bodyecology.com/articles/link_blood_type_personality_diet.php

Until next week,

Keep living your life!

Bridging the Gap…

Which gap? The anion. What’s that, you say.

“The anion gap deals with the body’s acidity. A high reading for the anion gap could indicate renal failure.”

That’s what I wrote in What Is It and How Did I Get It? Early Stage Chronic Kidney Disease. But you know what? It’s just not enough information any more. Why? I’m glad you asked.  Oh, by the way, if you want to check your own reading look in the Comprehensive Metabolic Panel part of your blood tests, but only if your doctor requested it be tested.

I mentioned a few blogs back that I returned to a rheumatologist I hadn’t seen in years and she chose to treat me as a new patient. Considering how much had happened medically since I’d last seen her, that made sense to me and I agreed to blood tests, an MRI, and a bone density test.

The only reading that surprised me was an abnormally high one for anion gap. The acceptable range is 4 – 18. My reading was 19.  While I have Chronic Kidney Disease, my kidneys have not failed (Thank goodness and my hard work.) In addition, I’ve become quite aware of just how important acidity and alkaline states are and have been dealing with this, although apparently not effectively.

MedFriendly at http://www.medfriendly.com/anion-gap.html – a new site for me written by Dr. Dominic Carone for the express purpose of simplifying complex medical terms for the lay person – explains it this way:

“…. Too high of an anion gap level can mean that there is acidosis (too much acid in the blood) due to diabetes mellitus. The high anion gap level can also be due to lactic acidosis, in which the high level of acid is due a buildup of a substance called lactic acid. … A high anion gap can also be due to drug poisoning or kidney failure. …When the anion gap is high, further tests are usually needed to diagnose the cause of the problem.”

Ah, I remember writing a bit about acidosis in The Book of Blogs: Moderate Stage Chronic Kidney Disease, Part 1. It had to do with fruits and vegetables.

“’After three years, consuming fruits and vegetables or taking the oral medication reduced a marker of metabolic acidosis and preserved kidney function to similar extents. Our findings suggest that an apple a day keeps the nephrologist away,’ study author Dr. Nimrit Goraya, of Texas A&M College of Medicine, said in a university news release.

Apparently, some CKD suffers have metabolic systems that are severely acidic. Fruits and vegetables are highly alkaline.  This may counteract the acidity in the patients mentioned above AND those that have less metabolic acidosis (acid in the body).

You can find the complete article at http://kidneygroup.blogspot.com/2012/11/eating-fruits-and-vegetables-may-help.html”

Okay, I like fruit and I like vegetables. Ummm, will my limitation of three servings of each within the kidney friendly fruit and vegetable lists do the trick, I wonder. Looks like I’ll be questioning both the rheumatologist and the renal dietician about that.

Recently I’ve written about alkaline being the preferred state of a CKD patient’s body. That is the antithesis of an acid body state. Years ago, Dr. Richard Synder was a guest blogger here and also interviewed me on his radio show. He is the author of What You Must Know about Kidney Disease and a huge proponent of alkaline water.  Here’s what he had to say about that (also from Part 1):

“I have taken alkaline water myself and I notice a difference in how I feel. Our bodies are sixty percent water. Why would I not want to put the best type of water into it? Mineralized water helps with bone health.  In alkalinized water, the hydroxyl ions produced from the reaction of the bicarbonate and the gastric acid with a low pH produce more hydroxyl ions which help buffer the acidity we produce on a daily basis. (Me interrupting here: During our visit last Monday, I noticed that my extremely health conscious, non-CKD, Florida friend drinks this.)

Where are these buffers? In the bones and in the cells, as well as some extracellular  buffers. You  are  helping lower  the  total  body  acidity  and decreasing the inflammation brought on by it. You do this early on so that you don’t have a problem with advanced acidosis later. Why wait until you are acidotic before doing something?”

Notice his comment about lowering body acidity and decreasing inflammation.  We already know CKD is an inflammatory disease.  There was something to this. I went back to The Book of Blogs: Moderate Stage Chronic Kidney Disease, Part 2 to tease it out.

“‘Belly fat is also much more inflammatory than fat located elsewhere in the body and can create its own inflammatory chemicals (as a tumor would).’

You can read the entire article at http://www.huffingtonpost.com/2013/03/21/body-fat-facts_n_2902867.html

Inflammatory?  Isn’t CKD an inflammatory disease? I went to The National Center for Biotechnology Information, which took me to the National Library of Medicine and finally to a National Institute of Health study at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3332073/   for the answer.

‘The persistent inflammatory state is common in diabetes and Chronic Kidney Disease (CKD).

This is a lot to take in at once.  What it amounts to is that another way to possibility prevent the onset of CKD is to lower your phosphorous intake so that you don’t accumulate belly fat.’”

Phosphorous? Once we have CKD, we do have phosphorous restrictions. But I have never had high phosphorous readings.  Maybe I should be exploring an abundance of lactic acid as a cause of the high anion gap reading instead.

According to Heathline.com,

“Lactic acidosis occurs when there’s too much lactic acid in your body. Many things can cause a buildup of lactic acid. These include chronic alcohol use, heart failure, cancer, seizures, liver failure, prolonged lack of oxygen, and low blood sugar. Even prolonged exercise can lead to lactic acid buildup.”

I’m definitely barking up the wrong tree here.

Wait a minute. I recently started using a BiPAP since I have sleep apnea and wasn’t exhaling enough CO2. That could cause acidosis, but it would be respiratory acidosis. Say, a basic metabolic panel would expose that. Nope, that’s not it either since my CO2 levels were normal.

It looks like this is going to be one of those blogs that asks more questions than it answers. I do have an appointment with the rheumatologist on the 20^th and will ask for answers then.

Until next week,

Keep living your life!

Deep in the Heart of Texas

Last week I wrote that I’d tell you about our Texas trip this week and that’s just what I’ll do… sort of. We were in San Antonio for the Air Force Basic Training Graduation of a close family friend. I hadn’t wanted to go. The rest of the family was driving 14 hours straight. I thought they were insane.

It turned out I was right about that, but I am glad I went anyway.  The next day, our friend proposed to his girlfriend – who just happened to be our daughter – at The Riverwalk’s Secret Waterfall, Airmen escort and all. THAT was worth the ride. And we got to know his family better, understand them more, and value their company.  As they say in the ad, “Priceless.”

There was only one fly in the ointment. While the temperature was manageable for us since we live in Arizona, the humidity was not for the same reason. For my other than U.S. readers (and there are quite a few of them since I have 107,000 readers in 106 countries), Arizona’s usual humidity is low, very low. We do have a three minute rainy season in August (Okay, maybe it’s a teensy bit more than three minutes.) when it rises, but that’s not the norm.

Last week, the humidity in San Antonio, Texas, was between 68% and 72%. Even the air conditioning in the hotel bowed before it.  Our Airman had scheduled the entire weekend for us: The Airman’s run on an open field, late lunch at a restaurant with no available indoor seating, graduation on the parade field, an afternoon on The Riverwalk. There’s more, but you get the idea.  All of it outdoors, all of it in 68% to 72% humidity, all of it uncomfortable as can be.

And, it turns out, all of it not great for a Chronic Kidney Disease patient. Why? Well, that’s the topic of today’s blog. ResearchGate at https://www.researchgate.net/publication/263084331_Climate_change_and_Chronic_Kidney_Disease published a study from the Asian Journal of Pharmaceutical and Clinical Research from February of 2014 (That’s over two years ago, friends.) which included the following in the conclusion:

“Our data suggest that burden of renal diseases may increase as period of hot weather becomes more frequent. This is further aggravated if age advanced and people with chronic diseases like diabetes and hypertension.”

That makes sense, but how will this happen exactly? I included this June, 2010, article in The Book of Blogs: Moderate Chronic Kidney Disease, Part 1. Apparently, heat (and humidity) has been an acknowledged threat to our kidneys for longer than we’d thought.

“.…Dr. HL Trivedi of the Institute of Kidney Diseases and Research Centre (IKDRC) said, ‘…. Rapid water loss causes the kidney’s functioning to slow down, resulting in temporary or permanent kidney failure.’

Extreme heat causes rapid water loss, resulting in acute electrolyte imbalance. The kidney, unable to cope with the water loss, fails to flush out the requisite amount of Creatinine and other toxins from the body. Coupled with a lack of consistent water intake, this brings about permanent or temporary kidney failure, explain experts.”

The article can be viewed directly at http://www.dnaindia.com/health/report_heat-induced-kidney-ailments-see-40pct-rise_1390589 and is from “Daily News & Analysis.”

By the time this book’s twin, The Book of Blogs: Moderate Chronic Kidney Disease, Part 2, was ready for publication, the (then) spokesman for The National Kidney Foundation – Dr. Leslie Spry – had this to say about heat and humidity:

“Heat illness occurs when body temperature exceeds a person’s ability to dissipate that heat and is commonly diagnosed when the body temperature approaches 104 degrees Fahrenheit and when humidity is greater than 70 percent. Once the humidity is that high, sweating becomes less effective at dispersing body heat, and the core body temperature begins to rise.”

The entire article is at http://www.huffingtonpost.com/leslie-spry-md-facp/heat-illness_b_1727995.html

Oh, so humidity affects sweating and body heat rises.  Humidity greater than 70%. That covers almost the entire time we were in Texas. Well, what’s the connection between heat illness and CKD then?

The CDC offers the following advice to avoid heat illness:

“People with a chronic medical condition are less likely to sense and respond to changes in temperature. Also, they may be taking medications that can worsen the impact of extreme heat. People in this category need the following information.

• Drink more water than usual and don’t wait until you’re thirsty to drink.
• Check on a friend or neighbor, and have someone do the same for you.
• Check the local news for health and safety updates regularly.
• Don’t use the stove or oven to cook——it will make you and your house hotter.
• Wear loose, lightweight, light-colored clothing.
• Take cool showers or baths to cool down.
• Seek medical care immediately if you or someone you know experiences symptoms of heat-related illness(http://www.cdc.gov/extremeheat/warning.html).”

Uh-oh, we’re already in trouble. Look at the first suggestion: our fluid intake is restricted to 64 oz. (Mine is, check with your nephrologist for yours.) I know I carefully space out my fluids – which include anything that can melt to a liquid – to cover my entire day. I can’t drink more water than usual and, sometimes – on those rare occasions when I’ve been careless – have to wait until I’m thirsty to drink.

Diabetes is the foremost cause of CKD. I was curious how heat affected blood sugar so I popped over to Information about Diabetes at http://www.informationaboutdiabetes.com/lifestyle/lifestyle/how-heat-and-humidity-may-affect-blood-sugar and found this:

1. If our body is low on fluids, the kidneys receive less blood flow and work less effectively. This might cause blood glucose concentrations to rise.
2. If someone’s blood sugar is already running high in the heat, not only will they lose water through sweat but they might urinate more frequently too, depleting their body’s fluids even more.

There’s more at the website if this interests you.

So, pretty much, the way to deal with heat and humidity having an effect on your (and my) CKD is to avoid it. That doesn’t mean you have to move, you know.  Stay in air conditioning as long as you can so your body is not overheated and can better handle this kind of weather. Wearing a hat and cool clothes will also help. I certainly learned the value of wearing cotton this past week. It’s a fabric that breathes.

Until next week,

Keep living your life!

How Sweet It Was

I’ve had an interesting turn around in my health this last week of National Kidney Month. You did know it’s still National Kidney Month, right?  You did go get yourself tested for Chronic Kidney Disease, didn’t you? Hurry up! There’re only four more days left to National Kidney Month. You know I’m joking about this month being the time to get yourself tested, but I’m serious (unfortunately, sometimes dead serious) about getting yourself tested.

I know, I know, I’m preaching to the choir. But how many of you have told your friends, neighbors, family, and co-workers about just how simple – and important – these tests are. Let’s not let them become one of the 31 million with Chronic Kidney Disease or worse, one of those that don’t know they have it.

Excuse me while I step off my soap opera. Now, where was I? Oh, yes, the – ahem – interesting turn around in my health this month.

Okay, this is twofold. The first part is the weight. You think I’ve been having trouble keeping that in check since I started blogging four years ago, don’t you? I mean because I write about it so much. The truth is it’s been much, much longer than that.  Even way back in college when I was a size 7 for one day, I weighed more than ‘the charts’ said I should by 20 pounds or so. I looked good, I felt good, and my mom kept telling me I had ‘heavy bones,’ so I let it go.  Who knew any better back then?

What’s so bad about the extra weight you ask? You do know obesity is one of the causes of CKD, don’t you? Don’t feel bad if you didn’t. I didn’t. I just started noticing it showing up in the research in the last couple of years. That doesn’t mean it wasn’t there. It just means I never saw it if it was.

I mentioned weight in passing a few times in What Is It and How Did I Get It? Early Stage Chronic Kidney Disease. This is from my first nephrologist’s report:

“The report, of course, ended with a one – two punch: I would need to exercise for at least 30 minutes a day and possibly decrease food portions, so I could lose weight (all right already!  I got it!) for better blood pressure and renal function.”

Better blood pressure and renal function? That’s when my battle with the numbers became real. And that’s when weighing and measuring food according to the renal diet allotments worked for a while… until I thought I could eye measure. So I went back to weighing and measuring… and it worked…until bomb shell number two fell in my lap: pre-diabetes.

In The Book of Blogs: Moderate Chronic Kidney Disease, Part 1, The National Institutes of Health helped me explain why this combination of excess weight and pre-diabetes was a problem for CKD patients:

“High blood glucose and high blood pressure damage the kidneys’ filters. When the kidneys are damaged, proteins leak out of the kidneys into the urine. The urinary albumin test detects this loss of protein in the urine. Damaged kidneys do not do a good job of filtering out wastes and extra fluid. Wastes and fluid build up in your blood instead of leaving the body in urine.”

Let’s backtrack just a bit here. What does high blood glucose have to do with this? Well, that’s what tested to measure your A1C, which determines whether or not you have diabetes… or even pre-diabetes.

Back to The Book of Blogs: Moderate Chronic Kidney Disease, Part 2 this time, in which I decry my A1C woes:

“This time I went to WebMD for a simple explanation.  In addition to learning that pre diabetes means your glucose, while not diabetic, is higher than normal, I found this interesting statement.

When glucose builds up in the blood, it can damage the tiny blood vessels in the kidneys, heart, eyes, and nervous system.”

What I learned from my primary care physician on my last visit is that the A1C is not the only measure of diabetes. Although my blood glucose readings are still in the pre-diabetes range according to the A1C, my daily readings have sometimes gone over the 126 that’s considered diabetes. My head is spinning here. No one ever mentioned that magic number to me before.

I decided to conduct a little experiment last night. We know that high blood glucose is the result of sugar, but did you know that most carbohydrates turn into sugar? Last night I ate a chocolate bar and devoured at least half a dozen Saltines. This morning, when I pricked my finger and tested the blood, the reading was 129. Damn! Someone had to be the guinea pig and I volunteered myself… but all I’d proven was that sugar and carbs raise your blood sugar pretty quickly.

Now here’s the kicker. This is from SlowItDownCKD 2015 which is presently available digitally and should be out in print later this week:

“The Brits do a masterful job of explaining this effectively.  The following is from Patient.

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

My nephrologist told me to cut out sugar and carbs to lose weight. I’d already cut out sugar, so I cut out (or at least drastically down on) carbs. The result: a very slow weight loss. Of course, this is new to me so I don’t know if that two pound weight loss in a month will continue every month, but I’m willing to give it a try. Say, that’ll have a possible effect on eliminating the diabetes, too!

Until next week,

Keep living your life!

Renal Sally Port

Sometimes things just pop into a writer’s head for no reason at all. The title of this week’s blog did that over and over again. Okay, I thought, I’ll go with it.  Only one problem: I didn’t know what a sally port was and why I should be writing about a renal one.

Hmmmm, I did marry a military man. I asked. He explained but I wanted to see it in writing. Hence, this definition from The Merriam-Webster Dictionary at http://www.merriam-webster.com/dictionary/sally%20port:

1:  a gate or passage in a fortified place for use by troops making a sortie

2:  a secure entryway (as at a prison) that consists of a series of doors or gates

Oh, now I got it. I immediately thought of Fort Wadsworth on Staten Island where I took my little children to Civil War reenactments. There were scary, dank areas between the port and the base which were enclosed between large old gates at either end. No sun got in and it echoed in there. It was a place of fascination and fear for my little ones. What did that have to do with our kidneys?

Then I thought of having visited the friend I’d written about in the hospital when his bipolar medications needed immediate adjustment. One door was unlocked for me, I entered. That door was relocked behind me and another unlocked in front of me. That was a sally port, too.

Our gaggle of grown children has told us enough about ‘Orange is the New Black’ that our interest was piqued. Then Bear read my Hunter College Alumni News Letter and saw that Dascha Polanco – a major character in the series – also graduated from Hunter, although not exactly the same year I did. Those seemed like good enough reasons to give the series a try. It was set in a prison with a series of sally ports to enter or exit.

Now it was more than clear. A sally port is a security feature to guard entry and exit. Good, one half of the renal sally port secret revealed. Now, do our kidneys have sally ports?

This is the structure of your kidney. It’s clear there are three ways in or out of the kidney: the veins, the arteries, and the ureters. Let’s take a look at each to see which, if any, is a sally port.  

In What Is It and How Did I Get It? Early Stage Chronic Kidney Disease, it was explained that the renal (kidney) artery brings the unfiltered blood into the kidney:

“Your kidneys have about a million nephrons, which are those tiny structures that produce urine as part of the body’s waste removal process. Each of them has a glomerulus or network of capillaries.  This is where the blood from the renal artery is filtered.  The glomerulus is connected to a renal tubule, something so small that it is microscopic. The renal tubule is attached to a collection area.  The blood is filtered. Then the waste goes through the tubules to have water and chemicals balanced according to the body’s present needs. Finally, the waste is voided via your urine to the tune of 50 gallons of fluid filtered by the kidneys DAILY.  The renal vein uses blood vessels to take most of the blood back into the body.”

Well, what about the renal vein? Here’s how I explained it in The Book of Blogs: Moderate Stage Chronic Kidney Disease, Part 2:

“If you look at a picture of your kidney, you’ll see that blood with wastes in it is brought to the kidneys by the renal artery and clean blood is exited from the kidneys by the renal vein.  Your kidneys are already compromised which means they are not doing such a great job of filtering your blood.”

Well, if the renal artery is the sally port for the blood entering your kidneys, the renal vein sounds like the more important renal sally port since it’s allowing that poorly filtered blood back into your blood stream.

Oh wait, we forgot the ureter.   There’s an explanation from the presently-being-published SlowItDownCKD 2015 about that.

Many thanks to the ever reliable MedicineNet at http://www.medicinenet.com/script/main/art.asp?articlekey=2472 for the following.

“A hollow organ in the lower abdomen that stores urine. The kidneys filter waste from the blood and produce urine, which enters the bladder through two tubes, called ureters. Urine leaves the bladder through another tube, the urethra. In women, the urethra is a short tube that opens just in front of the vagina. In men, it is longer, passing through the prostate gland and then the penis. Also known as urinary bladder and vesical.”

Uh, no, there’s nothing in that description that indicates the urethra is a sally port.

So… the renal vein then.  How does this poor excuse for allowing filtered blood back into our blood stream affect us? (I do admit that it seems it’s more the fault of the damaged glomeruli than the renal vein acting as a sally port.)

For one thing, we become one of the one-in-three at risk for Chronic Kidney Disease … and that’s only in America. For another, our bodily functions differently as do our minds. I included this not-so-pleasing information from EurekAlert! in a 2012 post in The Book of Blogs: Moderate Stage Chronic Kidney Disease, Part 1:

Decreased kidney function leads to decreased cognitive functioning

“Decreased kidney function is associated with decreased cognitive functioning in areas such as global cognitive ability, abstract reasoning and verbal memory, according to a study led by Temple University. This is the first study describing change in multiple domains of cognitive functioning in order to determine which specific abilities are most affected in individuals with impaired renal function.”

But there’s more. According to the National Kidney Foundation at https://www.kidney.org/news/newsroom/factsheets/FastFacts, this is what is our kidneys are NOT doing for us as well as they should since we have CKD:

• Regulate the body’s fluid levels
• Filter wastes and toxins from the blood
• Release a hormone that regulates blood pressure
• Activate Vitamin D to maintain healthy bones
• Release the hormone that directs production of red blood cells
• Keep blood minerals in balance (sodium, phosphorus, potassium)

I’m glad I got the term renal sally port out of my system, but I wish the news had been better.

Until next week,

Keep living your life!

Inked

There’s a woman I know, younger than I by three and a half decades, who is inked… and I mean inked. She has sleeves on both arms and (almost) a body suit.  Don’t know what I’m talking about? Take a look at http://www.inkedmag.com/tattoo-lingo/. Unfortunately she’s lost a job or two when narrow minded employers saw her arms, but that’s not what I’m writing about today.

Oh, all right. Here are the definitions of the jargon above: inked = tattooed; sleeve= fully tattooed on the arm; body suit= tattoos on the majority of the body.

I was thinking about her the other day and that got me to thinking about tattoos and whether or not they’re safe for us since we have Chronic Kidney Disease. Let’s take a look at the tattooing process itself to see if there’s anything there to worry about.

I turned to The Mayo Clinic at http://www.mayoclinic.org/healthy-lifestyle/adult-health/in-depth/tattoos-and-piercings/art-20045067 for this information.

“A tattoo is a permanent mark or design made on your skin with pigments inserted through pricks into the skin’s top layer. Typically, the tattoo artist uses a hand-held machine that acts much like a sewing machine, with one or more needles piercing the skin repeatedly. With every puncture, the needles insert tiny ink droplets.

The process — which is done without anesthetics — causes a small amount of bleeding and slight to potentially significant pain.”

Personally, I’m too much of a scaredy cat to give tattooing a try now that I know about the possibility of pain. There’s enough of that in my life already… like the endometrial biopsy a few months ago. Ugh! But maybe you’re not…

Well, why might you want a tattoo in the first place? Maybe it’s an artistic requirement for your soul.  Maybe it’s to remind yourself of some life lesson like my New York daughter, Nima’s. Or maybe it’s a medical tattoo to wear rather than a medical alert bracelet.

Hmmm, I’d think again. As CKD patients, our blood is already not that pure. Remember, as I explained in What Is It and How Did I Get It? Early Stage Chronic Kidney Disease,

“The kidneys remove these toxins (e.g. from the blood) and change them into urine ….”

Our kidneys are not functioning at the top of their game. With my current GFR of 51, my kidneys are only functioning at a teeny bit more than half capacity while still trying to filter the blood as kidneys with a GFR of 100% would. Oh, right, GFR. In The Book of Blogs: Moderate Stage Chronic Kidney Disease, Part 1 that’s explained according to the NKDED:

“The National Kidney Disease Education Program at The U.S. Department of Health and Human Services provides the following information.

1. A blood test checks your GFR, which tells how well your kidneys are filtering. GFR stands for glomerular filtration rate. …”

Here’s what I found on Health Impact News at http://healthimpactnews.com/2015/think-before-you-ink-the-little-known-risks-of-tattoos/ that makes me so leery of tattoos.

“In 2011, a study in The British Journal of Dermatology revealed that nanoparticles are indeed found in tattoo inks, with black pigments containing the smallest particles (white pigments had the largest particles and colored pigments were in between).

Nanoparticles are ultramicroscopic in size, making them able to readily penetrate your skin and travel to underlying blood vessels and your bloodstream. Evidence suggests that some nanoparticles may induce toxic effects in your brain and cause nerve damage, and some may also be carcinogenic.”

Whenever I speak to someone who has a tattoo, they tell me the ink only goes as far as the dermis (the second layer of skin) and nowhere near the blood.  I often wondered about that since the dermis is rife with blood vessels. I guess I just learned that the tattoo owners were misinformed. And why we as CKD patients should not be allowing even the possibility of more toxins entering our blood streams for our already overworked kidneys to eliminate.

Are tattos pretty? I think so.  Are they spiritual? Sometimes they are. Are they worth the risk? It’s your decision, but I can’t agree that they are. I found even more evidence to the contrary on WebMd at http://www.webmd.com/skin-problems-and-treatments/laser-tattoo-removal?page=2

“There are minimal side effects to laser tattoo removal. However, you should consider these factors in your decision:

The tattoo removal site is at risk for infection. You may also risk lack of complete pigment removal, and there is a slight chance that the treatment can leave you with a permanent scar….”

I’d also read on various sites that simply being tattooed may leave you open for infection if the autoclave (instrument steaming machine) or needles are not clean enough. I don’t know of any sites to rate the cleanliness of tattoo parlors, but I do know infection opportunities are far more common for us as CKD patients…and they are more dangerous for us.

This paragraph from The Book of Blogs: Moderate Stage Chronic Kidney Disease, Part 2 should clarify the why of avoiding infection possibilities.

“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.”

I wondered if I’d find enough information for a blog about CKD patients and tattoos. On the contrary, I find I could go on and on.

Tuesday is the beginning of National Kidney Month. While I won’t be leading my team in the kidney walk this year (Damn neuropathy!), I’ve got another surprise up my sleeve to celebrate. I may be able to announce that next week.

Don’t forget about the National Kidney Fund of Arizona’s annual conference on March 11^th and 12^th. I’ll be there on the 11^th. You can register at www.SWNC.org.

Until next week,

Keep living your life!

To Wash or Not To Wash

Peggy Rickard belongs to the same Landmark Worldwide Center (an international personal and professional growth, training and development company) as I do here in Arizona.  I didn’t know her, but she wanted to perform a service project for one of her Landmark courses and she wanted it to deal with the kidneys. The manager of the center – the ever affable Philip Rand – knew I did “something with kidneys,” so he asked if I would call her.  When I did, it turned out that she has a medical advocacy business, but that had nothing to do with her project.

We had a wonderful conversation.  Here was someone in one of my other communities who spoke my kidney language. Peggy had already contacted The National Kidney Foundation of Arizona and learned from Dr. James Ivie, the Director of Patient Services, that what was really needed was to have the information leaflets about kidney disease and donation translated into Spanish since Hispanics are at a higher risk for kidney disease.

Maybe I can pick out a few words of Spanish here and there, but she needed more. I couldn’t translate the leaflets into Spanish for her and didn’t know anyone who could.  That night, I went to the center for the completion session of The Wisdom Unlimited course in which I had been participating. In a greet-those-you-don’t-know moment, I spoke with Nathaniel (Nat) Garcia II – since he was the person directly in front of me – only to discover he is a missionary… and fluent in Spanish…and more than willing to do the translations.  Problem solved.

That got me to thinking about language. While taking a shower the next morning, the bottle of shampoo I was using caught my eye. It had the words ‘sulfate free’ in large letters on the label.  Hmmm, sulfate looks a lot like sulphur.  Are they related?

After checking a bunch of dictionaries, I decided to use the definition of The Medical Dictionary at http://medical-dictionary.thefreedictionary.com/sulfate since it seemed the simplest to understand.

“a salt of sulfuric acid”

Uh-oh, sulfuric means made of sulfur. Although the spelling may be different, sulfuric acid is highly corrosive. It’s also a mineral… and is used in both waste water treatment and fertilizer creation. Why would shampoo have this as an ingredient in the first place?

I figured the best person to provide an answer would be a hair stylist so I read Melissa Jongman’s article on http://hubpages.com/style/Sulfates-Are-they-damaging-your-hair-Why-to-opt-for-a-sulfate-free-shampoo

“Sulfates are detergents used to make the shampoo lather. They’re inexpensive to use in shampoos, which explains why more than 90% of shampoos contain them. The most common sulfates used in these shampoos are:

• Sodium Lauryl Sulphate (SLS)
• Sodium Laureth Sulphate (SLES)
• Ammonia Laureth Sulphate (ALS)
• TEA Lauryeth Sulfate (TEA)
• Sodium Myreth Sulphate (SMS)”

This was not looking good.  Sulphur is something we, as Chronic Kidney Disease patients, need to avoid. As I explained in What Is It and How Did I Get It? Early Stage Chronic Kidney Disease, sulphur can further damage your already damaged kidneys.

So what can we do?  Not washing our hair is obviously not the answer. I googled shampoos without sulfates and came up with a list of 43 at http://sulfatefreeshampoos.org/sulfate-free-shampoo-list/#list. While the latest edit of this list was during this new year, I am not familiar with the editors nor the products. However, you can safely bet that I’ll try them.

Let’s go back to why sulfates are not good for CKD patients for a minute. I stumbled across a CKD education site called quizlet.com. Perusing this site, I found the statement that

“Very late CKD is due to reduced excretion of sulfates and phosphates.”

Of course! That makes perfect sense: as our kidney function declines, we are not excreting as much of these substances as we did before we were lucky enough (ouch!) to develop CKD and they build up.  That’s CKD 101.

A nervous me decided to see what other beauty or health products used sulfates. I discovered it’s used in body wash (Wait! Isn’t sulfate a skin irritant?), toothpaste, and nail polish. That tripped a thought. Didn’t I blog about that?

I used the search function on the blog only to find that that blog dealt with other chemicals in nail polish.  (Gritting teeth and crying out in anguish) Is nothing safe anymore? All right, pick a chemical… any chemical.

Looking at the ingredients in both hair products and nail polish, I chose phthalates. The Centers for Disease Control and Prevention (CDC) at http://www.cdc.gov/biomonitoring/Phthalates_FactSheet.html helped us out with this one:

“Phthalates are a group of chemicals used to make plastics more flexible and harder to break. … They are used in hundreds of products, such as vinyl flooring, adhesives, detergents, lubricating oils, automotive plastics, plastic clothes (raincoats), and personal-care products (soaps, shampoos, hair sprays, and nail polishes)….

How Phthalates Affect People’s Health

Human health effects from exposure to low levels of phthalates are unknown. Some types of phthalates have affected the reproductive system of laboratory animals. More research is needed to assess the human health effects of exposure to phthalates.”

Maybe the human health effects are unknown and maybe this passes quickly via the urine, but if you have Chronic Kidney Disease, you are not filtering your blood as well as other people.  Why take a chance of making it worse?

Now that I’ve probably made you fearful of using any beauty product on the market, be aware that there are many products without phthalate. Breast Cancer Action (Yes, there seems to be a connection between breast cancer and phthalates.) at http://www.bcaction.org/our-take-on-breast-cancer/environment/safe-cosmetics/phthalate-free-cosmetics/  offers a list of companies which produce phthalate free beauty aids.

Let’s talk about service and gratitude for just a minute.  While I’ve always believed in service, it’s only since I’ve been diagnosed with Chronic Kidney Disease (way back in in 2008) that I’ve become aware of how very thankful I am for the little things in life – like spreading CKD Awareness by writing this blog, posting some CKD tidbit on Twitter daily, starting an Instagram account for SlowItDownCKD, and offering my books.  Thank YOU for being the readers.

Until next week,

Keep living your life!

Running, but Getting Nowhere

First things first, as usual: Happy Kwanzaa to those who celebrate this week long holiday. For those of you unaware of this particular holiday, Dictionary.com tells us it is

“a harvest festival celebrated from Dec. 26th until Jan. 1st in some African-American communities.”

I was introduced to it by the wondrous Audre Lorde, my neighbor, best friend, and the poet laureate of NYS back on Staten Island in the ‘80s. While I miss her terribly since her death, what’s she’s taught me is part of who I am today.  Thank you, Audre.

Let’s run up to the end of 2015 and restless leg syndrome. (Well, that was an awkward transition, wasn’t it?) I have a new reader who is confounded by it, but can’t get a doctor’s appointment soon enough for some immediate answers at this time of year so let’s see what we can find out for him.

According to The National Institute of Neurological Disorders and Stroke (Don’t let that title scare you; this is just where I went for information) at http://www.ninds.nih.gov/disorders/restless_legs/detail_restless_legs.htm

“Restless legs syndrome (RLS) is a neurological disorder characterized by throbbing, pulling, creeping, or other unpleasant sensations in the legs and an uncontrollable, and sometimes overwhelming, urge to move them.”

While that makes sense, it doesn’t explain why a Chronic Kidney Disease patient might develop RLS. I went to Medscape.com at http://www.medscape.org/viewarticle/707972_4 for some sort of explanation.

“A disturbance of dopaminergic transmission has been postulated to underlie the development of idiopathic RLS, but the increased incidence in CKD might reflect hyperphosphatemia or iron deficiency.”

Whoa, Nellie (as my father used to say)! Let’s slow this down a bit.  I can see that “hyper” means over, and “phosphate” has to do with phosphorous, but how do you put it all together? MedicineNet.com did that for me.

“An elevated level of phosphate in the blood. Higher-than-normal levels can be caused by ingestion of phosphate-rich foods, such as dairy products, or by kidney failure.”

Notice that kidney failure is not the only cause. So does that mean my new reader is eating too much high phosphorous food?  I don’t know. Dwayne, are you?

Being a newbie to all this, he may need a list of high phosphorous foods. Luckily, there is one in The Book of Blogs: Moderate Stage Chronic Kidney Disease, Part 1.

HIGH PHOSPHORUS FOOD TO LIMIT OR AVOID

Beverages

ale                                                     beer

chocolate drinks                            cocoa

drinks made with milk                 dark colas

canned iced teas

 

Dairy Products

cheese cottage cheese                  custard

ice cream                                        milk

pudding                                          cream

soups                                               yogurt

 

Protein

carp                                                  crayfish

beef liver                                         chicken liver

fish roe                                            organ meats

oysters                                             sardines

 

Vegetables

dried beans and peas                   baked beans

black beans                                    chick peas

garbanzo beans                             kidney beans

lentils                                              lima northern beans

pork ’ n beans                                split peas

soy beans

 

Other foods

bran cereals                                   brewer’s yeast

caramels                                         nuts

seeds                                               wheat germ

whole grain products

Does this help any, Dwayne? Let us know.

Next question: What’s so bad about having high phosphorous levels in the blood when you have CKD?

Back What Is It and How Did I Get It? Early Stage Chronic Kidney Disease for the answer to that one.

“This is the second most plentiful mineral in the body and works closely with the first, calcium. Together, they produce strong bones and teeth. 85% of the phosphorous and calcium in our bodies is stored in the bones and teeth.  The rest circulates in the blood except for about 5% that is in cells and tissues. Again, phosphorous is important for the kidneys since it filters out waste via them. Phosphorous balances and metabolizes other vitamins and minerals including vitamin D which is so important to CKD patients. As usual, it performs other functions, such as getting oxygen to tissues and changing protein, fat and carbohydrate into energy.

Be aware that kidney disease can cause excessive phosphorus. And what does that mean for Early Stage CKD patients? Not much if the phosphorous levels are kept low. Later, at Stages 4 and 5, bone problems including pain and breakage may be endured since excess phosphorous means the body tries to maintain balance by using the calcium that should be going to the bones. There are other consequences, but this is the one most easily understood.”

The other possible cause of RLS in CKD (alphabet soup, isn’t it?) is iron deficiency. I wrote about that a bit in The Book of Blogs: Moderate Stage Chronic Kidney Disease, Part 2.

“The National Kidney and Urologic Diseases Information Clearinghouse at http://kidney.niddk.nih.gov/kudiseases/pubs/anemia/anemia_508.pdf 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.’

You can’t correct it by simply taking EPO injections.  It’s just not that simple.  To quote what I wrote in What Is It and How Did I Get It? Early Stage Chronic Kidney

‘…EPO can worsen your HBP – which can both cause and be caused by CKD.  Most nephrologists agree it’s better to take the EPO injections and increase your HBP medication to control your hypertension.’

That was thought to be true when I researched for the book over three  [now almost four] years ago, but since then the medical science community has discovered that synthetic EPO may be harmful to your body in that it may cause the body to produce antibodies for EOP.  Then your liver becomes involved, too, since it produces a small amount of EPO.”

Be certain to make that appointment with your new nephrologist, Dwayne.  After reading today’s blog, write a list of questions for the doctor and have someone with you during your appointment to be sure you ask all your questions and understand the answers. Keep us posted.

Mini-contest. I have one lonely copy of The Book of Blogs: Moderate Stage Chronic Kidney Disease, Part 1 hanging around my office all by itself, just looking for a new home.  Be the first to comment on today’s blog and you’ll have yourself a new book.

Wow! Only three days left in 2015.

Until next year,

Keep living your life!

Blood and Thunder, Without the Thunder

I’ve been thinking a lot about blood lately and realize it’s time for a refresher about blood and CKD. It’s been doctor-visits-week for me and each one of them wanted to talk about blood test numbers… because I have Chronic Kidney Disease and my numbers are the worst they’ve been in seven years.

This made me realize how very little I remember when it comes to how CKD affects your blood.  Soooo, I’m going right back to the very beginning. According to National Institute of Diabetes and Digestive and Kidney Diseases at http://www.niddk.nih.gov/health-information/health-communication-programs/nkdep/a-z/kidney-disease-mean-for-me/Pages/default.aspx, this is how:

“CKD means that your kidneys are damaged and can’t filter blood like they should. This damage can cause wastes to build up in your body. It can also cause other problems that can harm your health.”

By the way, this is a reader friendly page with visuals that the organization freely shares. You’ve seen them in my books and blogs. There is no medicalese here, nor is there any paternalism.  I like their style.

The National Kidney Foundation at https://www.kidney.org/kidneydisease/aboutckd explains in more detail.

“If kidney disease gets worse, wastes can build to high levels in your blood and make you feel sick. You may develop complications like high blood pressure, anemia (low blood count), weak bones, poor nutritional health and nerve damage. Also, kidney disease increases your risk of having heart and blood vessel disease. These problems may happen slowly over a long period of time.”

Maybe seven years is that ‘long period of time’, not that I have heart or blood vessel disease that I know of. But I do have high blood pressure which may have contributed to the development of the CKD. Circular, isn’t it? High blood pressure may cause CKD, but CKD may also cause high blood pressure.  Or is it possible that the two together can cause ever spiraling high blood pressure and worsening CKD?

I’m going to go back to What Is It and How Did I Get It? Early Stage Chronic Kidney Disease here for some basic definitions that may be helpful in understanding today’s blog.

Albumin:   Water soluble protein in the blood.

Chronic Kidney Disease:  Damage to the kidneys for more than three months, which cannot be reversed but may be slowed.

Hypertension: A possible cause of CKD, 140/90 mm Hg is currently considered hypertension, a risk factor for heart disease and stroke, too. (New guidelines say these numbers are for CKD patients.)

Nephrons: The part of the kidney that actually purifies and filters the blood.

Let’s take a detour to see how sodium can affect high blood pressure which can affect so many other conditions.  This is a quote from Healthline.com at http://www.healthline.com/health/fast-food-effects-on-body which appeared The Book of Blogs: Moderate Stage Chronic Kidney Disease, Part 2.

“Too much sodium helps to retain water, so it can cause general bloating and puffiness. Sodium can contribute to high blood pressure {Which, as we know, is the second leading cause of CKD} or enlarged heart muscle. If you have congestive heart failure, cirrhosis, or KIDNEY DISEASE {My bolding and capitalization in this paragraph.}, too much salt can contribute to a dangerous build-up of fluid. Excess sodium may also increase risk for kidney stones, KIDNEY DISEASE, and stomach cancer.

High cholesterol and high blood pressure are among the top risk factors for heart disease and stroke.”

Oh my! Sodium, high blood pressure, enlarged heart muscle, stroke, heart disease, dangerous fluid build-up. They all can be inter-related. And that’s the problem with CKD:  your blood is not being filtered as it should be. There’s waste buildup in your blood now.

It’s that same not well filtered blood that flows through your body possibly causing hearing problems, as was discussed in a previous blog.  It’s that same not well filtered blood that flows through your body possibly causing your high blood pressure. It’s that same not well filtered blood that flows through your body possibly causing “swelling in your ankles, vomiting, weakness, poor sleep, and shortness of breath.” (Thank you WebMD at http://www.webmd.com/a-to-z-guides/understanding-kidney-disease-basic-information for that last quote.)

I’m sorry to say this all makes sense.  All these conditions are inter-related and they may be caused by CKD, or high blood pressure which causes CKD, or both.

I see something I’ve ignored here. I have high blood pressure and I have CKD… and a lot of microalbumin in my urine.  This is new, and it’s a bit scary. Oh, all right, a lot scary.  I write about it so I have to research it and therefore, allay my fear by learning about it.

What did I learn about microalbumin, you ask? The MayoClinic at http://www.mayoclinic.org/tests-procedures/microalbumin/basics/definition/prc-20012767 says it in the simplest manner.

“A urine microalbumin test is a test to detect very small levels of a blood protein (albumin) in your urine. A microalbumin test is used to detect early signs of kidney damage in people who have a risk of kidney disease.

Healthy kidneys filter waste from your blood and keep the healthy components, such as proteins like albumin. Kidney damage can cause proteins to leak through your kidneys and leave your body in your urine. Albumin (al-BYOO-min) is one of the first proteins to leak when kidneys become damaged.”

At first, I laughed it off; I already know I have CKD. Until I saw the results for this test, but I’ve requested what we used to call a do-over when we were kids and my doctor saw the value in that.

Ready for some good news?

Both The Book of Blogs: Moderate Stage Chronic Kidney Disease, Part 1 and The Book of Blogs: Moderate Stage Chronic Kidney Disease, Part 2 have indexes now. I promised them before Christmas and Kwanzaa and I delivered. Sort of, that is.  Amazon came through right away; B&N.com will take another five weeks or so.

Happy, happy holidays to all of you.  I’ll see you once more before 2016. Talk about time flying!

Until next week,

Keep living your life!

Now What? Oh, the Pressure.

I had fully expected to be publishing a guest blog by a personal chef today.  All she needed was a copy of the renal diet I followed.  Well, that was what we had talked about. But, as happens sometimes, that was simply not meant to be. Hmmmm, could this be the universe offering me another indication that I was correct in thinking I needed to stay away from writing about recipes on the blog?

So there I was casting around for a topic that I wanted to know more about and you’d enjoy reading about. Of course, I’d already completed my daily perusal Twitter for any articles about anything related to Chronic Kidney Disease.

Bingo!  This is what I found on Twitter about something I’d never really understood:  ‘Blood Pressure, the Top and Bottom Numbers ‘(and I’ll add here:  the risk of disease). The URL for this is http://well.blogs.nytimes.com/2015/12/09/ask-well-blood-pressure-the-top-and-bottom-numbers/?partner=rss&emc=rss&smid=tw-nythealth&smtyp=cur

“Both elevated systolic blood pressure (the top number) and diastolic (the bottom number), together or alone, increase the risk for cardiovascular disease. The systolic reading indicates the pressure in the arteries produced when the heart beats; the diastolic is the arterial pressure between beats, when the heart is at rest. Readings below 120/80 are considered healthy.

Though high systolic and diastolic readings are both associated with increased risk, they may present different risks for different diseases. In 2014, researchers published a study of more than 1.25 million people 30 and older who were initially free of cardiovascular disease. They recorded their blood pressures, and followed them for an average of 5.2 years, during which 83,098 developed cardiovascular disease.

Over all, those with a reading above 140/90 had a higher risk for cardiovascular disease than those with lower blood pressure — an unsurprising finding.

But the researchers also found that the risk of some diseases could be predicted by a high systolic reading, and others by a high diastolic reading. For example, the risk for heart attack is more strongly associated with an elevated systolic pressure. But the risk for abdominal aortic aneurysm, a swelling or rupture in the large artery that goes from the heart to the chest and abdomen, is higher when the diastolic pressure is elevated.

‘It’s reasonable to say that the systolic effect over all is slightly stronger than the diastolic,’ said the senior author of the study, Dr. Harry Hemingway, a professor of clinical epidemiology at University College London and director of the Farr Institute.

‘But if you have isolated diastolic hypertension,’ he added, ‘you still have hypertension, and you should take measures to lower it.’”

This makes sense, but it certainly got me to wondering. I wanted to know which of these numbers was more important to your health. Here’s what The American Heart Association at http://www.heart.org/HEARTORG/Conditions/HighBloodPressure/AboutHighBloodPressure/Low-Blood-Pressure_UCM_301785_Article.jsp had to say about that.

“Typically more attention is given to the top number (the systolic blood pressure) as a major risk factor for cardiovascular disease for people over 50 years old. In most people, systolic blood pressure rises steadily with age due to increasing stiffness of large arteries, long-term build-up of plaque, and increased incidence of cardiac and vascular disease.”

Wait a minute. Is this contradictory? I get it that you need to pay extra attention to the systolic number if you’re over 50, but this statement seems to be saying that your blood pressure is going to rise anyway because you’re over 50.

I found this age appropriate blood pressure reading chart at Disabled World (http://www.disabled-world.com/artman/publish/bloodpressurechart.shtml)

Age	Systolic BP	Diastolic BP
3-6	116	76
7-10	122	78
11-13	126	82
14-16	136	86
17-19	120	85
20-24	120	79
25-29	121	80
30-34	122	81
35-39	123	82
40-44	125	83
45-49	127	84
50-54	129	85
55-59	131	86
60+	134	87

Ah, so your numbers will rise as you age, but not to any danger level.  Hmmmm, I’m usually in the 60+ range and hadn’t realized that was normal. Good thing I hadn’t spent any time worrying about those readings.

Well, what about the new(ish) guidelines for a healthy blood pressure?  How does that fit in here?

“Adults aged 60 or older should only take blood pressure medication if their blood pressure exceeds 150/90, which sets a higher bar for treatment than the current guideline of 140/90, according to the report, published online Dec. 18 (2013) in the Journal of the American Medical Association.

The expert panel that crafted the guidelines also recommends that diabetes and kidney patients younger than 60 be treated at the same point as everyone else that age, when their blood pressure exceeds 140/90. Until now, people with those chronic conditions have been prescribed medication when their blood pressure reading topped 130/80.”

The above is from WebMD at http://www.webmd.com/hypertension-high-blood-pressure/news/20131218/new-blood-pressure-guidelines-raise-the-bar-for-taking-medications.

One note of warning here: I tested at the usual levels for someone my age when I was in my 50s, so I stopped the Hbp medication.  Yes, there was a six month honeymoon period of in sync readings. But then, they went up and up.  It was the medication that was keeping me in the normal range.

I was delighted to give you and me the Chanukah present of an index for The Book of Blogs: Moderate Stage Chronic Kidney Disease, Part 1. This new edition is now on sale at Amazon.com and should be on B&N.com in between five to seven weeks.  If you’ve already bought a copy of the book and would like an index, email me at SlowItDownCKD@gmail.com and I’ll be glad to send it to you.

Now for an early Christmas/Kwanzaa present for all of us… The Book of Blogs: Moderate Stage Chronic Kidney Disease, Part 2 is now indexed and the new edition should be on sale at Amazon by the end of next week. B&N.com will take an additional six to eight weeks.  The offer to email you an index if you have an older edition of the book stands for Part 2 also.

It feels like What Is It and How Did I Get It? Early Stage Chronic Kidney Disease is being left out so look for a contest for that book around New Year’s.

Until next week,

Keep living your life!

They’re Not Two Separate Things

I know someone who is mentally ill.  You do, too, although you may not be aware of it. PTSD, bipolar, personality disorder, poor impulse control, schizophrenia, depression, anxiety disorders, obsessive-compulsion, even eating disorders. I could go on and on with diagnoses we know nothing about when we meet the person. (Well, maybe we would with an eating disorder.) And why should we?

With medication, this person can function in the world… and function well. For those of you who are successfully treating your psychiatric illness holistically, whatever it is you are taking or doing that works for you will be included in the category of medication for the purposes of this blog.

But what if the person is not taking the medication necessary? What if they’re not and they have CKD? What if they are and have CKD? How does that affect their kidneys?

I came across a 2002 grant proposal on the National Institutes of Health site at http://grants.nih.gov/grants/guide/rfa-files/RFA-DK-02-009.html which made clear that there is a correlation.

“There is substantial evidence that severe chronic illness may be associated with and exacerbated by co-existent mental disorders such as depression, anxiety disorders, schizophrenia, and eating disorders.  Nonetheless, few studies have addressed the natural history and consequences of co-existent mental disorders on chronic diseases of interest to the NIDDK, such as diabetes mellitus, chronic renal disease and obesity and eating disorders.”

The person I know has two parents with CKD. That means he has to be extra vigilant about preventing CKD. But can he with the impulsive, irrational thinking he occasionally experiences?

One of the many complications of Chronic Kidney Disease according to The Mayo Clinic at http://www.mayoclinic.org/diseases-conditions/kidney-disease/basics/complications/con-20026778 is

“Damage to your central nervous system, which can cause difficulty concentrating, personality changes or seizures”

Difficulty concentrating.  Personality changes. Just as in mental illness.

Let me talk about that term a bit. By mental illness, I mean a psychiatric condition rather than a physical one, but one that requires daily treatment, just as diabetes or CKD does. You watch your diet, don’t you? And try to stay away from stress? There’s another kind of daily attention psychiatric patients need to adhere to.

And here’s where it gets muddled. Just as CKD, a physical condition, can cause mental problems, a psychiatric condition can cause physical conditions.  The two are wrapped up in each other. You can’t divorce the physical from the mental or vice-versa. You are one person with all these interrelated parts.

Mental illness is far more prevalent than you think… and that’s with its being ‘out of the closet,’ so to speak, in recent years. The Centers for Disease Control’s Fact Sheet about mental health surveillance at http://www.cdc.gov/mentalhealthsurveillance/fact_sheet.html  contains the following statement.

“According to the World Health Organization, mental illness results in more disability in developed countries than any other group of illnesses, including cancer and heart disease. Other published studies report that about 25% of all U.S. adults have a mental illness and that nearly 50% of U.S. adults will develop at least one mental illness during their lifetime.”

Let me make it worse.  This was in 2002, 13 years ago.

In 2012, the CDC had this to say about mental illness and chronic disease:

“One common finding is that people who suffer from a chronic disease are more likely to also suffer from depression. Scientists have yet to determine if having a chronic disease increases the prevalence of depression or depression increases the risk of obtaining a chronic disease.”

This is from a study about chronic disease and mental health in the workplace. You can read more about that at http://www.cdc.gov/nationalhealthyworksite/docs/Issue-Brief-No-2-Mental-Health-and-Chronic-Disease.pdf

I know little about medications for mental illness except for those prescribed for my friend.  As an example of how drugs for psychiatric conditions may or may not interact with your physical ailments, let’s talk a bit about his drugs.

When my bipolar friend has a manic episode, an anti-psychotic – Zyprexa (generic name Olanzapine) – is prescribed. WebMD at http://www.webmd.com/drugs/2/drug-1699/zyprexa-oral/details# tells us

“This medication can help to decrease hallucinations and help you to think more clearly and positively about yourself, feel less agitated, and take a more active part in everyday life.”

Okay, sometimes my friend needs that, but there are also things he doesn’t need.

“This drug may infrequently make your blood sugar level rise, which can cause or worsen diabetes. Tell your doctor immediately if you develop symptoms of high blood sugar, such as increased thirst and urination. If you already have diabetes, be sure to check your blood sugars regularly. Your doctor may need to adjust your diabetes medication, exercise program, or diet.

This drug may also cause significant weight gain and a rise in your blood cholesterol (or triglyceride) levels…. These effects, along with diabetes, may increase your risk for developing heart disease. “

Not so great for someone that has two parents with CKD, one with CKD caused by diabetes. As for the cholesterol or triglyceride levels,  we could be getting pretty close to heart disease here, as mentioned above. Nothing about the kidneys, yet diabetes is the leading cause of CKD.

What else was he recently prescribed? Oh, yes, lithium.  He’s been taking that off and on since he was 14 and first diagnosed with bipolar disorder. Drugs.com at http://www.drugs.com/sfx/lithium-side-effects.html made me weep – not that this was going to help anything. I keep reminding myself that this is not usual when taking the drug, but my mind keeps placing the image of his two CKD parents before me.

“Moderate reversible increases in blood urea nitrogen and serum creatinine as well as proteinuria have been observed in patients with lithium toxicity. Rarely the decreases in glomerular filtration have been persistent. A variety of renal effects have been reported and include glomerular sclerosis, interstitial fibrosis, chronic interstitial nephritis, nephrotic syndrome, renal tubular acidosis and tubular atrophy.”

Sometimes you need to take a risk to save your life. I’m sure that’s what my friend’s doctors are doing here. I’ve known him all his life. I hope they’re doing the right thing.

On a more positive note, Amazon tells me all three books are now available in the Japanese market as well as being available in Europe and other areas.  Nothing like getting the word about CKD Awareness out to the entire world.

Today is Labor Day. Thank you to all those union organizers that were jailed repeatedly- like Benjamin Binenbaum, my maternal grandfather – for the advantages they won for us.

Until next week,

Keep living your life!

Once Upon a Time, Not So Long Ago…

I always think of myself as a lucky mother… which makes me laugh out loud since – as a retired New York City high school and college teacher – I’m used to hearing that as half a word. But I do refer to being a parent.

Here’s an example of why: I have everything I want, so when my first born asked me what I wanted for Mother’s Day this year I told her I wanted research (She’s an excellent researcher.) into the history of Chronic Kidney Disease. Guess what I got.

I am writing a novel that deals with time travel back to 1885 and needed this information to continue. I knew Chronic Kidney Disease was a relatively new field of medicine, but hadn’t expected it to be this new.

My daughter was astonished at how little she could get, but then again, there isn’t much history is there? So get ready for a (short) history lesson that combines my daughter’s research and mine.

In the 1700’s kidney diseases weren’t recognized for what they were and not often diagnosed, although people were dying of urea poisoning or dropsy.  Urea poisoning is what we now refer to as urea in the blood. Is this starting to sound familiar?

As for dropsy, MedicineNet at http://www.medicinenet.com/script/main/art.asp?articlekey=13311 defines this as

An old term for the swelling of soft tissues due to the accumulation of excess water….The Middle English dropesie came through the Old French hydropsie from the Greek hydrops which in turn came from the Greek hydor meaning water.

Today we call it edema and usually give the cause of it. For instance, if you have CKD, during your office visit the nephrologist will press on the skin of your leg to see if you have edema caused by CKD.

There’s a theory that Mozart may have died of CKD caused by recurrent urinary tract infections. This has been tossed around in fiction about Mozart’s life (Have you read Mozart’s Wife by Juliet Waldron? It’s an excellent historical fiction.), but there seem to be some circumstances validating this. You can read more about this at http://ukrocharity.org/2012/08/diary-of-a-kidney-lover-did-mozart-die-of-kidney-disease/

Let’s move up to 1827 and meet Dr. Richard Bright who worked at Guy’s Hospital in London. You may know of him already as The Father of Nephrology, although he also researched diseases of other parts of the body such as the heart, liver, pancreas, and pulmonary system.  Bright’s Disease, now called glomerulonephritis, is defined by the Mayo Clinic at http://www.mayoclinic.org/diseases-conditions/glomerulonephritis/basics/definition/con-20024691 as

inflammation of the tiny filters in your kidneys (glomeruli). Glomeruli remove excess fluid, electrolytes and waste from your bloodstream and pass them into your urine. Also called glomerular disease, glomerulonephritis can be acute — a sudden attack of inflammation — or chronic — coming on gradually.

Although this designation held for over a century, we now call it nephritis, which is an inflammation of the kidneys. And what is CKD if not an inflammatory disease?

Not quite 100 years later, it was discovered that not all proteinuria (protein in the urine or ‘protein spill’) was considered dangerous. This is from the History of Nephrology by Neil Turner at http://historyofnephrology.blogspot.com/2014/11/marathon-nephritis-and-postural.html

Proteinuria after exertion was first described in 1878. It was memorably characterised by Collier in 1907 in a systematic report on 156 Oxford rowers training for the ‘Torpids’.  57% of urine samples taken 1-1.5h after vigorous rowing contained protein.  Smaller studies in other populations of athletes gave similar results. He compared these results with the historically recorded lifespans of 294 participants in the University Boat Race – they were longer than average.  This made it seem unlikely that post-exertional proteinuria conveyed a bad long term prognosis. 

I wonder how frustrated Dr. Bright became when he first suspected that hypertension had a strong effect on the kidneys, but had no way to prove that theory since the first practical sphygmomanometer wasn’t yet available. It wasn’t brought to the U.S. until 1901, but was available earlier in Britain in an earlier form which was difficult to obtain, manipulate, and calibrate as you can see from the picture.

With all our outcry about following a low sodium diet, it was a bit shocking to realize that when this was first suggested as a way to avoid edema in 1949, it was practically dismissed. It wasn’t until the 1970s that the importance of a low sodium diet in Chronic Kidney Disease was acknowledged.

We’ll end this extremely brief history of nephrology with the words of nephrologist Veeraish Chauhan from his “A Brief History of the Field of Nephrology” at http://kidneydisease.about.com/od/Kidney-Disease/fl/A-Brief-History-of-the-Field-of-Nephrology.htm in which he emphasizes how young the field of modern nephrology is.

 Dr. Smith was an American physician and physiologist who was almost single handedly responsible for our current understanding of how the kidneys work. He dominated the field of twentieth century Nephrology so much that it is called the “Smithian Era of Renal Physiology“. He wrote the veritable modern Bible of Nephrology titled, The Kidney: Structure and Function in Health and Disease. This was only in 1951.

51 years. That was only 64 years ago, ladies and gentlemen. That was during my lifetime. I can’t imagine what my life would be like if these discoveries had never been made… or if I would have a life at all.

Do you have any more tidbits about the history of nephrology to share with us? If so, just add a comment.

On the book front, I wonder how many of you are aware that you don’t need to buy my books to read them. Are you a member of Amazon Prime or is someone in your household? Then you can borrow the books from the Kindle Owners’ Lending Library for free.  Do you have a favorite library? Then you can ask your librarian to order the book and once it arrives, read it for free. You can also borrow library books for free on your Kindle, but first you need to make certain your library has a copy. Then there’s BookLending.com. Enter the title and borrow it for free.  You can also lend it for free. I’m also looking into Lendleme.com, but haven’t explored it enough to recommend it yet.

Until next week,

Keep living your life!

What If…

Have you ever become anxious about the unknown, specifically the future? You are not alone.  Since you have Chronic Kidney Disease, you are so the opposite of not being alone. You have a progressive disease, one which affects two of the most important organs your body possesses.

Most days, I wonder if I’ll stay at Stage 3A for the rest of my life or – despite my best efforts – I’ll end up on dialysis and need a transplant anyway.  It’s one of those things I try really hard not to dwell upon.

Whoops!  I did it again.  Let’s backtrack a bit so we all know what I’m writing about. I went back to the glossary of What Is It and How Did I Get It? Early Stage Chronic Kidney Disease for the following definition of Chronic Kidney Disease (CKD).

Chronic Kidney Disease:  Damage to the kidneys for more than three months, which cannot be reversed but may be slowed.

According to DaVita.com, Stage 3A means:

A person with stage 3 chronic kidney disease (CKD) has moderate kidney damage. This stage is broken up into two: a decrease in glomerular filtration rate (GFR) for Stage 3A is 45-59 mL/min and a decrease in GFR for Stage 3B is 30-44 mL/min.

There’s a wealth of Stage 3 information at http://www.davita.com/kidney-disease/overview/stages-of-kidney-disease/stage-3-of-chronic-kidney-disease/e/4749.

As usual, one definition leads to the need for another, in this case GFR.

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.

Uh-oh, now we need to define both dialysis and transplant. According to the National Kidney Foundation at https://www.kidney.org/atoz/content/dialysisinfo

Dialysis is a treatment that does some of the things done by healthy kidneys. It is needed when your own kidneys can no longer take care of your body’s needs.

There are several different kinds of dialysis. Basically, they each eliminate the wastes and extra fluid in your blood via different methods.

As for transplant, WebMD at http://www.webmd.com/a-to-z-guides/kidney-transplant-20666 tells us

A kidney transplant is surgery to replace your own diseased kidneys with a healthy (donor) kidney.

I should mention that while there are transplants from both living and cadaver donors, both will require lifelong drugs to prevent rejection.

All right, now that our background is in place, let’s deal with that anxiety.  Why worry (ouch!) if you have anxiety and you have CKD?

I went to The Book of Blogs: Moderate Stage Chronic Kidney Disease, Part 1 for help here.

In the August 16, 2012 post, I included this.

Poor mental health linked to reduced life expectancy

There  is  a  possibility  that  mental  health  problems  may  be  associated with  biological  changes  in  the  body  that  increase  the  risk  of  diseases such as heart disease.

In  this  study,  approximately  a  quarter  of  people  suffered  from  minor symptoms  of  anxiety  and  depression,  however,  these  patients  do  not usually come to the attention of mental health services. The authors say that  their  findings  could  have  implications  for  the  way  minor  mental health problems are treated.

The information was originally published on PyschCentral.com at http://psychcentral.com/news/2012/08/01/even-mild-mental-health-problems-linked-to-reduced-life-expectancy/42487.html

Not to be too morbid, but our life expectancy may already be reduced due to our Chronic Kidney Disease. Now we’re reducing it even further with our anxiety… even though we certainly may have cause to be anxious?

Time to deal with that anxiety.  But first, what exactly is anxiety?

The Free Dictionary’s Medical Dictionary at http://medical-dictionary.thefreedictionary.com/Anxiety is fairly explicit about what it is.

Anxiety is a multisystem response to a perceived threat or danger. It reflects a combination of biochemical changes in the body, the patient’s personal history and memory, and the social situation…. a large portion of human anxiety is produced by anticipation of future events.

Nothing I want any part of! So how to I reduce my anxiety about my CKD so that I don’t further reduce my life expectancy?

I was so taken with Barton Goldsmith, Ph.’s advice that I wanted to post it all, but that would make this week’s blog far too long.  You can read what I omitted at https://www.psychologytoday.com/blog/emotional-fitness/201205/top-10-tips-reduce-anxiety

1. If you are prone to anxiety you have two choices .Give in to it or learn to live with it.
2. When you wake up tomorrow start doing something right away, and keep busy all day. Taking action by doing something, almost anything, will help you work through your anxiety.
3. Focus your attention on where the feeling of anxiousness is in your body and keep your attention there until the feeling moves or dissolves.
4. Anxiety will grow if it’s not directed into some positive action.Find someone who needs you and lend him or her a helping hand.
5. Talking to someone is one of the best ways to overcome your anxiety.
6. Exercise is another good way to keep from letting your fears overwhelm you.
7. Start a gratitude journal; write down three to five things that you are grateful for. Do this every night, it works and it’s very easy.
8. The opposite of fear is faith.When you are anxious, a great way to get out of it is to find some faith. Believing that things will get better is sometimes all it takes to make it better.
9. If watching the news fills you with anxiety – turn off the TV!
10. Courage is not the absence of fear, but taking action in spite of fear.

Now it makes sense to me that Bear and I have a gratitude jar into which we drop a slip of paper containing one thing that made each of us happy each day. Now it makes sense to me that I look for ways to help others.  I think I’ve been warding off my own anxiety without knowing it.

Talking about not knowing, have you seen P2P’s Chronic Illness Awareness Buy and Sell page on Facebook?

Until next week,

Keep living your life!

Stop Stressing!

I am retired.  I get up when I want. I go to bed when I want. I stay in when I want. I go out when I want. I have no deadlines except those I impose on myself. But people I love do have stress in their lives: jobs, relationships, mental health…and I am stressed by their stress.

What, in heaven’s name, is this stress doing to my kidneys since I have Chronic Kidney Disease?  It is further reducing my already compromised immune system is what it’s doing.  Let me tell you why I don’t need that and neither do you.

Flashback to Alaska about a month ago. Bear was in the throes of cellulitis. It was about 60 degrees and raining lightly. We needed to return the knee scooter to the rental company before we left the state, which meant I stood outside in the rain for over 40 minutes waiting for them to show up.  They didn’t. I straightened that out and we ended up racing to the airport to be there two hours before our flight, as required. Then Bear felt ill, so we sat in the ice cold military waiting room for over 12 hours until our flight.  There was no sleep that night.  Are you starting to get the picture?

The result was a plain, old ordinary upper respiratory infection that took my already compromised immune system three weeks to heal from.

Let’s do the usual backtracking here and take a look at how Chronic Kidney Disease compromises your immune system in the first place. According to WebMD’s explanation of what stress can do to anyone, CKD or not, at http://www.webmd.com/balance/stress-management/effects-of-stress-on-your-body,

Stress that continues without relief can lead to a condition called distress — a negative stress reaction. Distress can lead to physical symptoms including headaches, upset stomach, elevated blood pressure, chest pain, and problems sleeping. Research suggests that stress also can bring on or worsen certain symptoms or diseases.

Make no mistake. Stress can be a killer for those with CKD.  Did ‘elevated blood pressure’ from the explanation above jump out at you?  A large number of us were already taking blood pressure lowering medication before we developed CKD.  Another large number who were not had blood pressure lowering medication prescribed for them by their nephrologists.  Why?

Let’s go back to basics here. In the glossary of What Is It and How Did I Get It? Early Stage Chronic Kidney Disease, I defined hypertension (high blood pressure) as

A possible cause of CKD,… , a risk factor for heart disease and stroke, too.

Just below that definition is the one for hypertensive nephrosclerosis:

Kidney damage caused by HBP (high blood pressure).

As a reminder, nephron refers to the kidneys and sclerosis to hardening of the – in this case – organ.

Dirty words! So my already high blood pressure MAY have been part of the cause of my CKD which compromised my immune system and then stress further compromised it.  Oh my.

Wait a minute. Let me grab this thought. Got it! How does the immune system work anyway? The National Institutes of Health was helpful here.

The immune system protects the body from possibly harmful substances by recognizing and responding to antigens. Antigens are substances (usually proteins) on the surface of cells, viruses, fungi, or bacteria. Nonliving substances such as toxins, chemicals, drugs, and foreign particles (such as a splinter) can also be antigens. The immune system recognizes and destroys substances that contain antigens (Me here: the body does already contain antigens of its own.) ….The immune system includes certain types of white blood cells. It also includes chemicals and proteins in the blood, such as antibodies, complement proteins, and interferon. Some of these directly attack foreign substances in the body, and others work together to help the immune system cells.

There’s a great deal more of such information at http://www.nlm.nih.gov/medlineplus/ency/article/000821.htm

Keep in mind that our kidneys filter our blood.  If our kidneys are damaged, our blood filtration is not at 100%, including those ever important white blood cells. Ever notice how high your white blood count is when you have an illness?  This is why. You might also look for your leukocyte esterase level on your blood test results since those indicate the presence of white blood cells.

This is so complicated, but then, isn’t everything?  Whatever happened to black and white answers, she whined winningly.

So we have already poorly filtered blood and further reduced blood flow (That’s what hypertension is.) caused by stress. Wonderful, just wonderful. Ugh! Obviously, this is something to be avoided, if possible.  But how?

As CKD patients, we can stop stressing ourselves about the following, those things that common – but misguided – knowledge tells us is our disease worsening when they actually may be anxiety produced:

• Extra Urination Anxiety can actually cause more frequent urination. When you experience anxiety, the part of your brain that controls the withholding urination actually slows down, because anxiety requires resources to be sent to other parts of your brain. This can lead to concerns over your renal health, although generally nothing is wrong.
• Lower Back Pain Lower back pain is also very common with anxiety. Lower back pain comes from severe stress and tension, and yet it’s associated with some conditions that affect the kidneys as well which can have many people worried about their kidney health.
• Life Experiences Anyone that suffers from anxiety and has had a friend or family member diagnosed with a terrible kidney condition is at risk for developing anxiety over the idea of poor kidneys. Anxiety can turn life experiences into very real concerns, and so kidney health concerns are one of the issues that can come up when you see it in others.
• Urine Color Urine color is another issue that can cause anxiety. Many people check their urine color for diseases habitually, and every once in a while the color of a person’s urine may be very different than what they expect. This can create concerns that the urine color changes are due to kidney problems.

Many thanks to Calm Clinic at http://www.calmclinic.com/anxiety/kidney-problems for these reassuring words.

Here’s hoping you can find more ways to reduce any existing stress in your life.  Look hard, we all have stress of some kind of another.

Until next week,

Keep living your life!

It’s Still There

I’ve gotten more questions this week about more different areas of health when you have Chronic Kidney Disease than I’ve gotten in a long time.  Before we start on the one that will be answered today, I have a question for you.

Will you please post a review of The Book of Blogs: Moderate Stage Chronic Kidney Disease, Part 1 or Part 2 (or both) on Amazon?  My sales reports tell me they’re being sold, but I don’t see any reviews.  If we’re going to keep spreading awareness of CKD, we’re going to need these reviews.

A number of people – including my primary care physician – were shocked by the large bruise caused by last week’s partially successful venipuncture. She, of course, knew what happened after I told her how I got it, but many of my readers didn’t.  I’m not so sure I did, either. Nor did I know why it was taking so long to heal.

According to the New York Blood Center at http://nybloodcenter.org/media/filer_public/2013/05/03/bruising06.pdf

Bruising is caused by bleeding under the skin. For example, a hard knock that does not break the skin can damage fragile blood vessels that lie just beneath. These damaged blood vessels leak a small amount of blood, which collects in the area as a bruise. With time, the familiar blue-black discoloration changes to yellow and can move up and down the arm but eventually fades and disappears.

I’m beginning to wonder just how much time. Although, there was evidently a lot of under the skin bleeding happening here.

I remembered using brighthub some time ago and thought I would see what they had to say about this sometimes painful bruise. This is what I found at http://www.brighthub.com/science/medical/articles/92029.aspx

One cause of pain is a hematoma. A hematoma is a collection of blood that forms outside the vein. During a blood draw when the needle pierces the vein, it can become temporarily damaged causing blood to leak out into the tissue. The leaked blood forms a pocket of blood, which can be painful. It’s not uncommon for the area around a hematoma to turn red or blue, and the surrounding tissue to become swollen.

Fortunately, the body gradually reabsorbs the displaced blood cells, and the hematoma slowly resolves – although it can look pretty ugly in the meantime. A hematoma is quite easy to see and is a very visible cause of pain in the arm days after a blood test. Doctors usually recommend that people treat hematomas by applying ice packs, elevating the arm, and taking anti-inflammatory medications for the pain. Hematomas usually resolve in five to seven days.

Ice packs? No one said anything about that. Elevation? No mention of that, either. As for anti-inflammatories, I have to admit I wouldn’t have taken one even if it had been suggested.  Five to seven days, huh? I’m now on day ten and first starting to see a hint of yellow. Well, the site did say “usually.”

I wanted more on the treatment of bruising so I went to WebMD at http://www.webmd.com/skin-problems-and-treatments/guide/bruises-article?print=true

A cold compress such as an ice pack or a bag of frozen vegetables should be applied to the affected area for 20-30 minutes in order to speed healing and reduce swelling. Do not apply ice directly to the skin. Wrap the ice pack in a towel.

If the bruise takes up a large area of the leg or foot, the leg should be kept elevated as much as possible during the first 24 hours after the injury.

Acetaminophen (This is me here.  Acetaminophen is not a NSAID and may be taken by CKD patients.) may be taken for pain as instructed on the bottle. Avoid aspirin or ibuprofen because they slow the blood from clotting and may, in fact, prolong the bleeding.

After about 48 hours, heat in the form of a warm washcloth applied to the bruise for 10 minutes or so two to three times a day may increase blood flow to the bruised area, allowing the skin to reabsorb the blood more quickly. Ultimately, the bruise will fade in color.

Funny, Bear took a look at my arm just this morning and suggested the heat, too.  I guess the man knows what he’s talking about.

Have you ever wondered why veins, rather than arteries, are used for a blood draw? Or am I the only one who ever considered the question? I got my answer from the same site that was so helpful last week: Arotraining. The site address is http://arotraining.com/images/Documents/Venipuncture%20Module%201_Anatomy%20of%20the%20Arm%20and%20Vein%20Location.pdf

(My computer keeps trying to correct the British English spellings, but this is a British site.)

Arteries are:

• Located deeper in the body to protect against haemorrhage.
• Muscular, to withstand heavy pumping and therefore more difficult to puncture.
• Supplied with abundant nerve fibres; therefore, arterial puncture tends to be more painful.
• At risk of extended bleeding after puncture because blood flowing through is under great pressure.

Veins are:

• Generally located closer to the surface in the extremities and are easier to locate
• Easier to puncture than arteries because vein layers contain less tissue
• Supplied with fewer nerve fibres than arteries; therefore venipuncture is less painful.
• Under less pressure so it is easier to stop bleeding after puncture

I hope this helped.  It certainly helped me understand what happened.

I am missing the excitement of a contest.  Since the name of my game is CKD awareness, I propose you send me a comment naming your favorite CKD book and why it’s your favorite.  You can keep it to a paragraph or two.  Notice, I did not write which one of MY CKD books is your favorite. You’ll be introducing us to books we may not be aware of and I will gladly compile the entries into a reading list for all of us.  Digital will be included. Let’s run this baby for a week. The prize? Why a print copy of The Book of Blogs: Part 1, of course.

Don’t forget about free Path to Wellness health screening coming up. This one is in Mesa, Arizona, at Adelante Healthcare 1705 W. Main St. on the 20th from 8 to 1:30 on Saturday, June 20^th.

Until next week,

Keep living your life!

Never Heard of It

Before I write about what I never heard of, let me tell you what I have heard of: The National Kidney Foundation of Arizona Kidney Walk this coming Sunday. Our t-shirts are ready, the banner is on the way, and all we need is you!  Pre-register for Team SlowItDownCKD at kidneywalk.kintera.org or just show up at Chase Stadium to register at 8:00 a.m.  Religious?  No problem; services will be held at the walk if you’d like to attend them.

So what have I never heard of?  The NutrEval (FMV Amino Acids) with Nutrient & Toxic Elements. This is a test my pre-diabetes counselor ordered for me. It consists of a blood drawer and a first void urine sample.

That in itself is interesting.  If you remember, when you have a 24 hour urine test for Chronic Kidney Disease, the first void is not used since this urine has been accumulating in your bladder the whole time you’ve been sleeping.  Apparently, this same accumulated urine is important for this testing.

You and I are exploring this together today. I hadn’t seen the blood drawer orders yet when I was walked into the lab directly from the counselor’s office.  Luckily, Jody Navarro, the tech on duty that day at this Sonora Quest Lab., pointed out that lipids were being tested  – which meant fasting.  I’d already eaten breakfast and lunch.

With a little mental rearranging, I saw I could just come back the next day.  Then Jody emphasized that I needed to bring the first urine void with me. Surprising, I thought.

The next day, back to the lab I went – although I knew the specimens would be sent out to Genova Diagnostics for the actual testing – with my refrigerated urine sample.  I tend to get up early and knew I wasn’t going to eat within half an hour of waking since this was a fasting test, so I wasn’t hurrying anywhere. Hence, the refrigeration.

Both Jody and Abigail Grimwade, who made the actual blood draw practically painlessly, greeted me and gave me copies of everything I asked for, which was everything.  I’m serious about understanding my health.

Okay, let’s backtrack a bit here. According to Genova Diagnostics’ website at https://www.gdx.net/product/nutreval-fm-nutritional-test-blood-urine, this is what the tests cover:

Metabolic Analysis assessment provides information on 45 key organic acids. These biomarkers are grouped into easy-to-understand categories, and provide insight for functional support in the areas of: malabsorption & dysbiosis; cellular energy & mitochondrial metabolism; neurotransmitter metabolism; vitamin deficiencies; and toxin exposure & detoxification need.

Amino Acids analysis features either plasma (37 total) or urine (41 total) amino acids. This assesses nutritionally essential and non-essential amino acids, as well as intermediary metabolites that augment an understanding of B vitamin need, and need for support of protein digestion & absorption.

Essential and Metabolic Fatty Acids Analysis provides a high level overview of the balance of various families of fatty acids in relation to each other: Omega 3, 6 and 9 Fatty Acids; Saturated Fatty Acids; and Monounsaturated Omega 7 and Trans Fats. It also provides key ratios for understanding cardiovascular risk, including the Omega 3 Index.

Elemental Profiles provide information in two categories: Nutrient Elements which evaluates intracellular nutrient status, and Toxic Elements which evaluate short-term toxic element exposure.

Oxidative Stress biomarkers highlight the body’s current state of oxidative stress and reserve capacity. Markers of oxidative injury assess cell membrane (lipid peroxides) and DNA (8-hydroxydeguanosine/8-OHdG) damage, while direct measurement of glutathione and CoQ10 provide insight into antioxidant reserve available to counter free-radical impact. Additional markers are available in our Oxidative Stress 2.0 profile.

Why did we need to know all this? Well, it seems that chronic disease – as in Chronic Kidney Disease – can be caused by nutritional deficiencies… and these tests could find them.  I know my pre-diabetes counselor’s eyes were lit up like the statue of Liberty at night when she realized she could order this testing for me.

Some of my readers have mentioned that this is state of the art testing that isn’t readily available and that they didn’t know Medicare would pay for this.  Looks like I lucked into this by simply choosing the counselor I did.

I would urge anyone with pre-diabetes to get this kind of nutritional counseling if your insurance covers it.  I have a far better understanding of how my blood glucose works now and what I can do to control it… and then there’s this testing to see what can be done about my chronic health problems.

What I found especially interesting is that the Creatinine, Urine (a CKD marker and stager) is present in this testing. I also noticed Potassium on the list of what’s tested for both deficiencies and toxicities. I am eager to receive my results and have them explained in detail, but that could take up to 14 days total, which means I need to wait for possibly 10 days.

Every time I research the test, I’m directed to Genova Diagnostics or a lab that sends the specimens to them.  While this test formerly cost thousands, the price seems to have come to the high hundreds in recent times. In attempting to plot the history of the test, I drew blank after blank.  This is considered pioneer bio testing.

Maybe the best thing to do here is wait for my results and then explain them to you, so you may see if they have any relevance to your own health.

I was curious about first void urine being tested and speculated that it might be more concentrated. Medical Technology Avenue at http://medicaltechnologyavenue.blogspot.com/2008/12/first-morning-specimen.html confirmed my speculations.

The first morning urine is the ideal screening specimen because it is more concentrated than the random specimen.

You’ll definitely see another blog about this once I review my test results.  Meanwhile, read my books!  Buy them on Amazon, borrow them, ask your library to order them if you don’t know anyone who has them (What!) and don’t have the money to buy them, but read them… and then write reviews.  The idea is to spread this info.  We all know I’m not going to get rich here, but I would like to see the information out there.

Until next week,

Keep living your life!

The CKD/Diabetes Dance

Welcome to the last blog for National Kidney Month. First thing I want to do is let you know it’s been made abundantly clear to me that I should be promoting my books {never thought of myself as a sales person} as a way to help spread awareness of Chronic Kidney Disease.

Here goes: What is It and How Did I Get It? Early Stage Chronic Kidney Disease, The Books of Blogs, Part 1 and The Book of Blogs, Part 2 are all available in both print and digital on Amazon.com.

Students: do NOT rent any of these for a semester.  The cost for that is much higher than buying the book.  Having been a college instructor, I know you sometimes have to buy your textbooks before the class begins and the instructor has the chance to tell you this.

Everyone else, there are programs available on Amazon to share the books with others, buy a digital copy at minimal cost if you’ve ever bought a print copy, and periodic free days. Oh, and please do write a review once you’ve read the books.

Another way I’ve been spreading awareness of CKD this month is by guesting on a radio show last Monday night.  Many thanks to Andrea Garrison of Online with Andrea for celebrating National Kidney Month by interviewing me about CKD. Hopefully, you’ve already heard it but here’s the link anyway: http://www.blogtalkradio.com/onlinewithandrea/2015/03/23/chronic-kidney-disease

Still uncomfortable with selling my books, although not at all with spreading Chronic Kidney Disease Awareness, I’m glad to move on to the topic of the day which is what does Diabetes, Type 2 do to your kidneys.  I’ve been researching this, and have found quite a bit of information about Diabetes causing CKD, but not that much about developing Diabetes, Type 2 while you have CKD.

The obvious thing to do here was to start with the American Diabetes Association at http://www.diabetes.org/diabetes-basics/type-2/facts-about-type-2.html.

When glucose {blood sugar} builds up in the blood instead of going into cells, it can cause two problems:

Right away, your cells may be starved for energy.

Over time, high blood glucose levels may hurt your eyes, kidneys, nerves or heart.

Okay, that would help explain why I’m so tired most of the time, but I’m more interested in how Diabetes “may hurt your…kidneys….” right now.

DaVita at http://www.davita.com/kidney-disease/diabetes/the-basics/diabetes-and-chronic-kidney-disease/e/427  explained how and effectively:

When there is too much sugar in your blood, the filters in your kidneys (called nephrons) become overworked.

Tiny blood vessels {glomularli}  transport blood that needs to be filtered into the nephrons. Excess blood sugar can damage these tiny vessels, as well as the nephrons themselves. Even though there are millions of nephrons, the healthy nephrons must work harder to make up for the ones that are damaged. Over time, the healthy nephrons will become overworked and damaged if your blood sugar remains high. Your kidneys may lose their ability to filter fluid and wastes and may no longer be able to keep you healthy.

This sounded awfully familiar to me, especially the last part. Well, no wonder!  On page 82 of What Is It and How Did I Get It? Early Stage Chronic Kidney Disease, I wrote the following.

… a number of nephrons were already destroyed before you were even diagnosed {with CKD}. Logically, those that remain compensate for those that are no longer viable. The remaining nephrons are doing more work than they were meant to. Just like a car that is pushed too hard, there will be constant deterioration if you don’t stop pushing. The idea is to stop pushing your remaining nephrons to work even harder in an attempt to slow down the advancement of your CKD.

Two different diseases, both of them damaging your kidneys in the same way.  Wait a minute here.  I already have kidney damage to the tune of a GFR of 49.  Does this mean I’m in real trouble now with the pre-diabetes that’s been being treated for the last couple of weeks?

Well, no.  The idea of treating the pre-diabetes is so that it doesn’t become Diabetes.  The principle is the same as it is with CKD: catch it early, treat it early, prevent more damage if possible.

But wait.  There are more similarities between CKD and Diabetes, Type 2.  According to The American Kidney Fund at http://www2.kidneyfund.org/site/DocServer/Diabetes_and_Your_Kidneys.pdf?docID=222

African Americans, Native Americans, Latin Americans and Asian Americans are more likely to have Type 2 diabetes.

 Back to What Is It and How Did I Get It? Early Stage Chronic Kidney Disease, page 13 this time.

Nor was I a Native American, Alaskan Native, Hispanic, Pacific Islander or Afro-American, ethnic groups that have a 15 to 17% higher occurrence of CKD.

No wonder Diabetes can cause CKD.  Now I’m wondering if CKD can cause Diabetes or if the two are simply concurrent most often. While the infograph from Healthline at http://www.healthline.com/health/type-2-diabetes/statistics-infographic didn’t answer this question, the information included was too good to pass up. I urge you to take a look at it for yourself by simply clicking on the address.

The following simple, yet eloquent, sentence leaped out to me as I read a study published in the 2010 American Society of Nephrology Journal at http://cjasn.asnjournals.org/content/5/4/673.full.pdf

CKD prevalence is high among people with undiagnosed diabetes and prediabetes.

 Maybe that’s the key: undiagnosed.  I know I wasn’t particularly worried about the several years of a high A1C test result until I heard the word pre-diabetes.  Whoops! Time for a reminder of what this A1C test is from page 54 of my first book.

This measures how well your blood sugar has been regulated for the two or three months before the test.  That’s possible because the glucose adheres to the red blood cells.

While I may not fully understand if CKD can cause pre-diabetes or Diabetes, type 2, it’s very clear to me that the two MAY go hand in hand.  There’s no reason to panic, folks.  But there is plenty of reason to have yourself tested for both pre-diabetes and Diabetes, type 2 via the A1C.  After all, you have CKD.

Until next week,

Keep living your life!

Not Exactly

Before we start, I want to tell you I’ll be the guest on Online with Andrea tonight at http://www.blogtalkradio.com/onlinewith andrea/2015/03/23/chronic-kidney-disease in honor of National Kidney Month 7:30 EST.  This is a good opportunity to share awareness of our disease.

You may have friends, family, co-workers who are still not really sure what CKD is or why it’s important to be tested.  Here’s your chance to have someone else explain it for a change. I haven’t done a radio show in quite a while, but the timing was just too good to pass up this time around.

Now, what’s not exactly?  I’ve been thinking that knowing the definition of something is not the same as knowing whatever it is. {My English teacher senses are tingling right now.}  Specifically, I was thinking about pre-diabetes. We know that ‘pre’ is a prefix – talk about using a word, or in this case a part of a word, to define itself –a group of letters added before a word that changes its meaning. To further complicate this simple explanation, the prefix ‘pre’ means before. So pre-diabetes means before diabetes.

Wait a minute.  Aren’t we all pre-diabetes, or any other condition for that matter, before we actually develop it?  Well, yes.  Something is off here.  Ah, a synonym {The English teachers arises!  That’s a word that means the same as the word you can’t think of.  No, that’s a writer’s definition.  An English teacher will tell you they are words with the same meaning but different spellings and pronunciations.)

The synonym for pre-diabetes is borderline diabetes. That makes sense.  You’re just about there, but not quite.  That’s what my A1C results have been saying for years.  Reminder: the A1C is the blood test that measures how well your body has been using your blood glucose for the past several months before you take the test.  Mine wasn’t doing so well.

We are CKD patients.  We know what diabetes can do to your kidneys and that diabetes is the number one cause of CKD. In case you’ve forgotten, this is from The National Kidney Foundation at https://www.kidney.org/atoz/content/diabetes for information.

With diabetes, the small blood vessels in the body are injured. When the blood vessels in the kidneys are injured, your kidneys cannot clean your blood properly. Your body will retain more water and salt than it should, which can result in weight gain and ankle swelling. You may have protein in your urine. Also, waste materials will build up in your blood.

Diabetes also may cause damage to nerves in your body. This can cause difficulty in emptying your bladder. The pressure resulting from your full bladder can back up and injure the kidneys. Also, if urine remains in your bladder for a long time, you can develop an infection from the rapid growth of bacteria in urine that has a high sugar level.

I’ve repeated this from last week’s blog because you need to understand diabetes so you can understand the importance of not letting your body develop it.

Now borderline diabetes. While WebMD calls that the former name for pre-diabetes, it also talks about insulin resistance at http://www.webmd.com/diabetes/guide/insulin-resistance-syndrome Insulin is a hormone that controls your blood sugar levels. If you have insulin resistance, your body doesn’t respond as well as it should to the insulin it makes. That leaves your blood sugar levels higher than they should be. As a result, your pancreas has to make more insulin to manage your blood sugar.

What I’ve discovered is that sometimes even that extra insulin produced by the pancreas isn’t enough. The first line of treatment for borderline or pre-diabetes according to the Mayo Clinic at http://www.mayoclinic.org/diseases-conditions/prediabetes/basics/treatment/con-20024420 is

• Eating healthy foods. Choose foods low in fat and calories and high in fiber. Focus on fruits, vegetables and whole grains. Strive for variety to help you achieve your goals without compromising taste or nutrition. This type of diet may be referred to as a Mediterranean-style diet.
• Getting more physical activity. Aim for 30 to 60 minutes of moderate physical activity most days of the week. Try not to let more than two days go by without some exercise. Take a brisk daily walk. Ride your bike. Swim laps. If you can’t fit in a long workout, break it up into smaller sessions spread throughout the day. The American Diabetes Association also recommends resistance training, such as weightlifting, twice a week.
• Losing excess pounds. If you’re overweight, losing just 5 to 10 percent of your body weight — only 10 to 20 pounds (4.5 to 9 kilograms) if you weigh 200 pounds (91 kilograms) — can reduce the risk of developing type 2 diabetes. To keep your weight in a healthy range, focus on permanent changes to your eating and exercise habits. Motivate yourself by remembering the benefits of losing weight, such as a healthier heart, more energy and improved self-esteem.

And then there are the folks like me. Despite a hard won nine pound weight loss, daily physical activity, and a renal healthy diet (Hey, I have Chronic Kidney Disease and have had it for the last seven years!), my body still is insulin resistant. That means medication.

I started out on 500 mg. Metformin daily.  This is controversial for kidney patients since there is a school of thought saying it can harm the kidneys.  That meant lots of discussion with my nephrologist, although my primary care doctor prescribed the drug.  The nephrologist felt that 500 mg. once a day would not harm the kidneys I’ve kept at stage 3 CKD since my diagnose.

What we hadn’t figured on was the stomach upset, nausea, and lightheadedness I’d feel.  I was at the point of immediately locating the waste paper baskets in any room I entered – just in case, you understand – when my PCP and I decided to halve the dose.  Things are still better as far as blood glucose and sort of getting there as far as the side effects.

This is all new to me.  As with anything else new, it’s foreign right now. But it’s important to me to protect that kidney function so I know I’ll figure out how to deal with the insulin resistance more effectively and soon.  Yet, I’m awfully thankful I also have nutritional counseling once a week for at least two months.

Until next week,

Keep living your life!

DON’T K.E.E.P. It a Secret

Hello, Week Two of National Kidney Month.  Surely, you’ve gotten yourself checked for Chronic Kidney Disease by now.  After all, more than 20% of us here in the U.S. have it. That’s 10 million people. Mind boggling, isn’t it. Here’s the kicker: that’s as of 2010 – five years ago now – according to The National Kidney and Urologic Disease and Information Clearinghouse at http://kidney.niddk.nih.gov/kudiseases/pubs/kustats/#3

But, wait, it gets worse. If you, like me, are over 50, your risk has increased.  Over 70 {Awk!  That’s only two years away for me.}, it increases even more.  What hurts for me is that so many people don’t know they have Chronic Kidney Disease. I’ve read statistics placing this at anywhere from 20 to 90%.  Rather than go on again about if-I-had-been-diagnosed-at-stage-1-rather-than-stage-3-I-would-have-had-more-time-to-slow-down-the-progression-of-my-ckd, let’s just say it’s easy to have yourself tested.

I’ve written about just needing a simple blood test and a simple urine test.  You can even have this done via the usual blood tests you already take if you usually take blood tests.  I have my pcp’s and nephrologist’s blood draw orders combined if they fall within two weeks of each other – with my doctors’  blessings. It’s not cheating, folks; it’s one less needle in your arm as I see it.

Well, what about if you don’t have blood tests regularly?  You could ask your PCP to write you orders for this. Most won’t do so without a visit, though.  Let’s say you don’t have the money, or can’t get an appointment early enough.  What then?

That’s where K.E.E.P. comes in. The acronym stands for Kidney Early Evaluation Program and is offered by the National Kidney Fund.  According to their website, this is what is offered.

• Risk Survey

• Body Mass Index (BMI): Height and Weight Measurements

• Blood pressure check

• ACR urine test for albumin (a type of protein) – For individuals at risk only!

• Free educational materials

• Opportunity to speak with a health care professional

Notice, no blood test.  Think of K.E.E.P. as a place to begin your kidney education. That risk survey and the urine test for “at risk” individuals are important parts of the program.  Over 50 – go to a K.E.E.P. event. Over 70 – definitely go to one.  These are not the only “at risk” definers, though. Add in the following.

• Anyone with high blood pressure, diabetes

• Anyone with a family history of kidney failure

• African-Americans, Hispanics, Asians, Pacific Islanders and American Indians

• Individuals who are obese (body mass index of 30 or above)

Now you can see why your BMI is measured and your blood pressure read.   Thank you to the National Kidney Fund at https://www.kidney.org/keephealthy for the above information.  If you’re interested – and I’m sure hoping you are – you can find the locations and dates of these on the upper right hand corner of the same page.  You’ll have to enter your geographical information, but that’s it.

That’s another option, but budgets are being cut all over the place.  So let’s say there’s no K.E.E.P. event near you. What now? How about the Path to Wellness program? What’s that, you say. It’s a partnership between the renal and heart communities for the following purpose according to the website of the Cardio Renal Society of America at http://www.cardiorenalsociety.org/ {The website does seem to be aimed toward medical professionals.}

Public Health Education and Early Detection

Path to Wellness is an integrative community-based screening program addressing the interconnections between kidney disease, heart disease, and diabetes. It encourages utilization of community-based or primary care services and empowering a diverse demographic of at-risk patients to make significant, positive changes in their personal well-being and quality of life.

In Arizona, the Arizona Living Well Institute is also involved in this project.  Dr. J. Ivie, the Director of Patient Services at the National Kidney Foundation of Arizona provides a more patient oriented description of the event.

Path to Wellness has already touched close to 400 Arizonans at risk of diabetes, heart disease and kidney disease by providing education, screening, self-management skills and connection to a medical home.  We are scheduling the first screening event of 2015 on Saturday, March 28th at the Salvation Army KROC Corps Community Center near South Mountain in Phoenix.

By the way, they are calling for volunteers to help out at this program, so please contact Dr. James Ivie via any of these methods if this interests you. I was recently made aware that high school students need to perform community service as a graduation requirement and was wondering if this is applicable if the students are over a certain age.  Again, a question for Dr. Ivie.

Phone:         602.845.7905

Fax:              602.845.7955

Address:      360 E. Coronado Rd. #180

                      Phoenix, AZ 85004

Email:          www.azkidney.org

I like to perform community service, too.  In this case, that service is for my kidney community.  Hmmm,  World Kidney Day is March 12. The Book of Blogs: Moderate Stage Chronic Kidney Disease, Part 2 is now available in both print and digital versions on Amazon.com.  The logical connection between the two for me is that World Kidney Book will be the day this book is free.  Remember I offered The Book of Blogs: Moderate Stage Chronic Kidney Disease, Part 1 free on February 2nd because it was my birthday? {Doesn’t every author offer their books free on their birthday?} This works the same way.  You just order the book.

Here’s how my mind works: I have dissolved in laughter because I just realized I was wondering if What Is It and How Did I Get It? Early Stage Chronic Kidney Disease is feeling left out because there’s never been a freebie day for that book.  I get it!  It’s a book {but it’s my baby.}

Whoa!  I’ve been getting calls that the blog address no longer works.  After a little gentle questioning, it came out that the callers were using the old address: https://gailrae.wordpress.com.  If you use that address, you’ll receive the following message:

“gailrae.wordpress.com is no longer available.  The authors have deleted this site.”  No I didn’t! I just changed the name to gailraegarwood.wordpress.com.  I’ll consider this a reminder to myself to leave well enough alone.

I followed a forum user’s advice to simply change the name, not realizing all the old blogs will be deleted.  I thought the site was being deleted and you would be redirected to the new address for all the blogs.  Silly me.  I am extremely thankful The Book of Blogs: Moderate Stage Chronic Kidney Disease, Part 1 and  The Book of Blogs: Moderate Stage Chronic Kidney Disease, Part 2 were published before this mini catastrophe,  but am still not happy with it.  Oh well. Might as well choose it since I have to do the work anyway.

Hang on while I recreate the blog.   Well, actually, if you’re reading this, it’s already recreated.  Yay!

Until next week,

Keep living your life!

They’re Not Twins

March is National Kidney Month here in the United States.  That makes it an even better time to have yourself screened for Chronic Kidney Disease. 28 million people have it and quite a few of them don’t know it.  Don’t be one of them.  All it takes is a simple blood test and a simple urine test.

Talking about blood and urine tests, I mentioned in passing on one or two of my blogs that your values and the reference range values on your lab tests may differ according to the lab you use, and loads of physical factors such as: being adequately hydrated, having voided your bladder, having gotten enough sleep, even how the specimens were handled.

I was in the unique position of taking these two tests once and then again two weeks later. Had the due date of the tests for each doctor been closer, I might have combined them and had the results of the one set of tests sent to each doctor. But my nephrologist needed his tests two weeks before my appointment, and my primary care physician {pcp} needed hers no less and no more than every three months since she was monitoring my liver for the effect of a medication.

She was checking primarily for my cholesterol levels {which are better than ever and finally all within range, thank you very much!} and included the other tests because she is one thorough doctor. He, my nephrologist, was much more concerned with my kidney function.

The reference range values from the two different labs I used were not twins. For example, Sonora Quest, the lab my nephrologist uses, has the acceptable range for creatinine as 0.60 – 1.40.  But my pcp uses LabCorp. which states that it is 0.57 – 1.00 mg/dL. If you look to the right, you’ll see an older test result using mg/dL.

I wasn’t really sure what mg/dL meant, so I looked it up. According to the Free Dictionary at http://acronyms.thefreedictionary.com/mg%2fdL, this means

Milligrams per Deciliter

That was my reaction, too, so I used the same dictionary for both words used in the definition.  Milligrams means

A unit of mass equal to one thousandth (10-3) of a gram

while deciliter means

100 cubic centimeters

We are talking small here!

The results for this test were a little different, too.  On February 10th, it was 1.11, which was not out of range for Sonora Quest.  But two weeks later, it was 1.1 – ever so slightly lower – which was out of range for LabCorp. This is a bit confusing.

Let’s go back to What Is It and How Did I Get It? Early Stage Chronic Kidney Disease to see if we can shed some light on this. On page 21 {Use the word search if you’re using the digital version of the book.}, I wrote

A higher creatinine result could mean the kidneys were not adequately filtering this element from the blood.

By the way,

Creatinine is a chemical waste product that’s produced by your muscle metabolism and to a smaller extent by eating meat.

Thank you to The Mayo Clinic at http://www.mayoclinic.org/tests-procedures/creatinine/basics/definition/prc-20014534 for this clarification.

All I can say is that seemed like earth shattering information when I was first diagnosed with CKD.  Now that it’s seven years late, it just means I have CKD.  It’s sort of like reiterating I have this slow decline in the deterioration of my kidney function no matter which acceptable range we use.

Another difference in value ranges was BUN.  This is your urea nitrogen. Medline Plus at http://www.nlm.nih.gov/medlineplus/ency/article/003474.htm explains

BUN stands for blood urea nitrogen. Urea nitrogen is what forms when protein breaks down.

This could be a ‘Who cares?’  statement except that the BUN is used to measure your kidney health. Sonora Quest’s acceptable range is 8-25 mg/dL, while my LabCorp’s is 8-27. At the first lab, my value was 22 and at the other, two weeks later, it was 17. Both were in range, but let’s say – just for argument’s sake – my value had been 26.  Would that mean I was out of range?  It would at one lab, but not the other.  I think I just answered my own question as to why I need to have my doctor interpret my lab results even though I can read them myself.

Well, what makes these levels go up or down? Thank you WebMD for this simple to understand answer.

If your kidneys are not able to remove urea from the blood normally, your BUN level rises. Heart failure, dehydration, or a diet high in protein can also make your BUN level higher. Liver disease or damage can lower your BUN level. A low BUN level can occur normally in the second or third trimester of pregnancy.

Aha!  We know that as CKD patients we are restricted to five ounces of protein a day. Why combine an inability to “remove urea from the blood normally” with an overabundance of protein?

Hopefully, some of the questions you didn’t even know you had were answered today.

I’m sorry if you missed out on your free copy of The Book of Blogs: Moderate Stage Chronic Kidney Disease, Part 1  by being the third buyer during the last part of February. While I’ve used up my freebies for that book, I’m now working on a free day for The Book of Blogs: Moderate Stage Chronic Kidney Disease, Part 2 on World Kidney Day, March 12.  Keep watching for more news about this as Amazon and I keep working on it.

Again, if you’d like to join us for the Kidney Walk on April 19 at Chase Stadium in Phoenix, why not go to the Walk’s website at http://kidneywalk.kintera.org/faf/home/default.asp?ievent=1125145 and join our team, Team SlowItDown. We’ll be looking forward to seeing you there.

Until next week,

Keep living your life!

Let Them Eat Cake!

We have still not finished celebrating my birthday.  Say, now that you’ve downloaded your free copy of The Book of Blogs: Moderate Stage Chronic Kidney Disease, Part 1 as my gift to you on my birthday, why not share it for free for 14 days on the Kindle Book Lending program?

Another low cost way of getting the book is asking someone who bought the print copy from Amazon to buy the digital one for you via the Kindle MatchBook program for $2.99.  Of course, you can always ask your library to order a copy.  There are lots of low cost and free ways to get the book.

We were up in Flagstaff for two days as part of my birthday celebration.  Bear remembered that I had repeatedly expressed a desire to see Meteor Crater. Yep, I wanted to visit a hole in the ground for my birthday.

While we were there, we also visited Sunset Crater and learned the difference between eruption and meteor craters.  Going whole hog, we drove along to Wakupti and Wukoki to see the ruins of the pueblos there. This is an amazing state we live in.

We had to stay somewhere, so we stayed somewhere special.  The England House Bed & Breakfast was built about 1902, which made me feel right at home since I raised my daughters in an 1899 Victorian house on New York’s Staten Island.  Now, here’s where the renal part of our overnight get-away comes into play and why there’s a blog about it.  I know, I know… you thought I just wanted to share my birthday fun with you.

Well, that too, but the owner of the B & B – Laurel Dunn – asked if we had any eating restrictions.  Good question for renal patients; bad question for those cooking for them.  I told her. In detail. With examples.  And she came through.

While my husband enjoyed fruit soup, I had fresh cut melon, strawberries, and blueberries.  I had never heard of fruit soup before, so Laurel explained that it was fruit liquefied with yoghurt. Uh-oh, the dreaded yoghurt. That’s not recommended on my renal diet due to the phosphorous in it.

As a Chronic Kidney Disease Patient, my kidneys do not filter my blood as well as they were meant to.  Too much phosphorous can cause problems. I went to What Is It and How Did I Get It? Early Stage Chronic Kidney Disease {page 81} to remind myself what phosphorous does for us and why too much of it is not a good thing when you’re a CKD patient.

I have to admit I didn’t know anything about phosphorous. This is the second most plentiful mineral in the body and works closely with the first, calcium. Together, they produce strong bones and teeth. 85% of the phosphorous and calcium in our bodies is stored in the bones and teeth.  The rest circulates in the blood except for about 5% that is in cells and tissues. Again, phosphorous is important for the kidneys since it filters out waste via them. Phosphorous balances and metabolizes other vitamins and minerals including vitamin D which is so important to CKD patients. As usual, it performs other functions, such as getting oxygen to tissues and changing protein, fat and carbohydrate into energy.

Be aware that kidney disease can cause excessive phosphorus. And what does that mean for Early Stage CKD patients? Not much if the phosphorous levels are kept low. Later, at Stages 4 and 5, bone problems including pain and breakage may be endured since excess phosphorous means the body tries to maintain balance by using the calcium that should be going to the bones. There are other consequences, but this is the one most easily understood.

But, of course, there was more to breakfast.  Bear enjoyed a lovely soufflé and muffins.  Bing, bing, bing. A soufflé has a custard base, in other words, a creamy base.  I think I’ve mentioned before that I’m also lactose intolerant.  I’ll say this, it certainly looked tasty.  So what did I have instead?  A simple vegan cheese omelet with four spears of asparagus cunningly arranged over it.

The night before, Laurel had opened her refrigerator to me so I could read the labels on different products.  One was the vegan cheese. It looked all right as far as my sodium, phosphorous, potassium, and protein restrictions, but I had never tasted it before. Let’s just say it’s probably an acquired taste.  My fault, not Laurel’s.

And the excruciatingly aromatic muffins that Richard, Laurel’s partner, baked?  Why did I pass them up? You guessed it.  It was the phosphorous again.  But I did not go away hungry.  Laurel and Richard provided cranberry/blueberry bread from The Wild Flower Baking Company. Apparently this is a specialty item since I could not find it on their website to pull up the ingredients.

Let’s put it this way: this bread was so good that I had it instead of the ugly blue cake I got for the family because I felt bad for it.  I let them {the family} eat cake, while I feasted on the bread.  At least that was the plan.  Once they tasted my bread, they clamored for it.  Ever see five grown children and a husband politely clamor?

But wait, there’s more.  Each juice Laurel had contained added sugar of some kind… except Ceres mango. It was not nectar, but juice sweetened with another juice – pear juice.  And it was delicious.  That became what I was going to have instead of ice cream at my birthday dinner.  Well, until everyone else tasted it.  You know the story.

You don’t think I let a breakfast go by without 1/2 of of my 16 ounces of coffee a day, do you?  It was superb, absolutely superb.

Add chicken cacciatore with brown rice that I made and was totally renal friendly and that, my friends, is how to enjoy your birthday get-away and your birthday dinner without breaking the renal diet.

As for exercise, ummm, well, it was too cold! No, really.  See, I’m even wearing a coat. I console myself with the fact that I got right on the exercise band wagon the very next day.  That’s okay, right?  It is, isn’t it?

Until next week,

Keep living your life.

Urine or You’re Out

How odd that urine is so important to us.  Make no mistake; if you have Chronic Kidney Disease, you’re always keeping an eye on it.  I’m pretty sure you all know about the color chart to see if you’re hydrating enough.  If you don’t hydrate enough, your kidneys can’t do their jobs as well… and they’re already struggling to do them. This is the least complicated urine hydration chart I’ve seen.

Of course, I’ll go back to remind you of just what the jobs of your kidneys are.  My source?  My first book about our disease, What Is It and How Did I Get It? Early Stage Chronic Kidney Disease, page 7.

They filter as many as 200 quarts of blood per day to rid us of roughly two quarts of waste and extra water.

These two organs, the master chemists of our bodies, have several functions: regulating the fluid balance in the body, providing vital hormones, producing erythropoietin, and producing the renin that regulates blood pressure. This is why CKD patients need to be careful about sodium, potassium, chloride, calcium, magnesium, and phosphates. Your nutritionist may not even mention magnesium to you since this constitutes only 1% of extra cellular fluid. Additional important jobs of the kidneys are removing liquid waste from your body and balancing the minerals in the body. The two liquid waste products are urea which has been broken down from protein by the digestive system and creatinine which is a byproduct of muscle activity.

Wait a minute; I think we need to go even further back.  A picture of the urinary tract would probably be helpful here, too.

Okay, now I can start writing about your urine. I’m pretty sure I mentioned in an earlier blog how disturbed I was to be one point over the normal range for microalbumin. Here’s a definition of just what that is.

Micro, or very small amounts, of albumin in the urine. Ur stands for urine. {As in the test for proteinuria.} Albumin is a form of protein that is water soluble. Urine is a liquid, a form of water, so the albumin should have been dissolved. Protein in the urine may be an indication of kidney disease.

Read that last sentence again. There seems to be a Catch 22 here. As a Chronic Kidney Disease patient for the last seven years, this has never shown up in a urine test for me before. I am including both the 24 hour variety and the random {Dipstick} variety in that never.

So now we know about microalbumin.  What about proteinuria?  Notice the ur in the word.  We just learned that means urine.  This is another indication of kidney disease.  I have never been out of acceptable range for this.  According to WebMd at http://www.webmd.com/a-to-z-guides/proteinuria-protein-in-urine

Healthy kidneys do not allow a significant amount of protein to pass through their filters. But filters damaged by kidney disease may let proteins such as albumin leak from the blood into the urine.

Filters?  This diagram of the glomerulus may help.

If albumin is a protein, are proteinuria and microalbumin the same? Well, no.  Health Communities at http://www.healthcommunities.com/proteinuria-and-microalbuminuria/overview-of-proteinuria.shtml tells us

Albumin is particularly useful in absorbing bodily fluid into the blood. Because the albumin molecule is relatively small, it is often among the first proteins to enter the urine after glomeruli are damaged. Therefore, even minor kidney dysfunction is detectable with proper diagnosis of microalbuminuria.

All right, got it?  Albumin is a protein.  It will show up as microalbumin in your urine test.  It may also show up as proteinuria since albumin is a protein. Once upon a time, you always needed to conduct a 24 hour urine test for this information, but…

In recent years, researchers have found that a single urine sample can provide the needed information. In the newer technique, the amount of albumin in the urine sample is compared with the amount of creatinine, a waste product of normal muscle breakdown. The measurement is called a urine albumin-to-creatinine ratio (UACR). A urine sample containing more than 30 milligrams of albumin for each gram of creatinine (30 mg/g) is a warning that there may be a problem. If the laboratory test exceeds 30 mg/g, another UACR test should be done 1 to 2 weeks later. If the second test also shows high levels of protein, the person has persistent proteinuria, a sign of declining kidney function, and should have additional tests to evaluate kidney function.

Thank you to the National Kidney and Urologic Diseases Information Clearinghouse {A service of the NIH} at http://kidney.niddk.nih.gov/kudiseases/pubs/proteinuria/#tests for that information.

And that is where creatinine comes in and why you need to be aware of your creatinine levels in your urinalysis. By the way, blood tests will also report the amount of albumin and creatinine in your blood. This could promote another discussion, one about Blood Urea Nitrogen tests, but it would be out of place here since that’s not part of the urine.

As you can see this is a complex topic.  You need to be aware of what the color of your urine can tell you about your hydration – whether or not you have Chronic Kidney Disease – and monitor both your microalbumin and proteinuria, as well as your creatinine.

Another complex topic is editing the new print books.  The Book of Blogs: Moderate Stage Chronic Kidney Disease, Part 1 and The Book of Blogs: Moderate Stage Chronic Kidney Disease, Part 2 aren’t quite ready.  I’m working with a new publisher and we’re just getting to know each other’s styles.  The good part about that is you get two books for the price of one on Amazon.com digital until the print books are ready.  Look for The Book of Blogs: Moderate Stage Chronic Kidney Disease.  Once the print copies are ready, I promise a day of the digital copy for free… if that perk is still available to me at that time.

I don’t know about you, but I get just as tired from overdoing it for good things as well as bad.  This weekend was a test of how well I could adhere to my renal diet with date day, a memorial dinner, and a celebratory champagne brunch.  Being human, I blew it on ice cream.  My pounding heart and lightheadedness have convinced me: no more sugar treats!  Although, some of my non-CKD friends report the same symptoms upon a sugar overdose…

Until next week,

Keep living your life!

Renal Arterial Stenosis, Huh?

I recently attended a social function at which someone I respect tapped me on the shoulder and said, “Make sure you speak with our mutual friend before you leave.”  So I did … and was mystified when she conducted some small talk with me.  This is what he wanted me to hear?

Later I received a message from our mutual friend and all became clear.  She’d been diagnosed with renal arterial stenosis and her doctor wanted her to have surgery.  Could I help?  At that point, I couldn’t, but I could research for her and I did.

Then I got to thinking about how many of us with Chronic Kidney Disease don’t know what this is or what it might have to do with us, other than it starts with renal – which is from the Latin for kidneys. The Greek root is ‘neph’ as in nephrology.

I turned to What Is It and How Did I Get It? Early Stage Chronic Kidney Disease {Page 129} for the definition of arteries.

Vessels that carry blood from the heart.

So, we’re looking at vessels attached to the kidneys that bring in blood from the heart.  And why do we need that I wondered?  Oh wait.  I remember: the kidneys filter this blood and then send it back to your heart via the veins.

That’s where stenosis comes in.  According to the medical dictionary at http://medical-dictionary.thefreedictionary.com/stenosis, this is

a constriction or narrowing of a duct or passage; a stricture.

That same dictionary gave us a precise definition of renal artery stenosis.

narrowing of one or both renal arteries, so that renal function is impaired,

resulting in renal hypertension and, if stenosis is bilateral, chronic renal failure

So what we’re looking at here is a narrowing of the artery that brings blood from the heart to the kidneys for cleaning by the nephrons.

Now hold on there.  Let’s not panic, folks.  This does not mean automatic chronic renal failure and dialysis or transplant.

Let’s take a look at what might cause renal artery stenosis or RAS. I went directly to a trusted site, U.S. Department Of Health And Human Services, National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC), A service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) at http://kidney.niddk.nih.gov/kudiseases/pubs/RenalArteryStenosis/#cause.

About 90 percent of RAS is caused by atherosclerosis—clogging, narrowing, and hardening of the renal arteries. In these cases, RAS develops when plaque—a sticky substance made up of fat, cholesterol, calcium, and other material found in the blood—builds up on the inner wall of one or both renal arteries. Plaque buildup is what makes the artery wall hard and narrow.

Most other cases of RAS are caused by fibromuscular dysplasia (FMD)—the abnormal development or growth of cells on the renal artery walls—which can cause blood vessels to narrow. Rarely, RAS is caused by other conditions.

Our mutual friend had been making herself out to be a terrible person to herself, one who caused her own RAS.  Well, maybe she did… and maybe she didn’t. It could have been FMD or some other unknown condition.  If it wasn’t, I still can’t see her blaming herself if she didn’t know about preventing atherosclerosis.  The point is she does now and needs to deal with the RAS.

MedicineNet at http://www.medicinenet.com/renal_artery_stenosis/page2.htm#what_are_the_symptoms_of_renal_artery_stenosis tells us that symptoms aren’t that common.

In general, renal artery stenosis is not associated with any obvious or specific symptoms. Suspicious signs for renal artery stenosis include:

• high blood pressure that responds poorly to treatment;
• severe high blood pressure that develops prior to age 30 or greater than age 50;
• an incidental finding (discovered through routine tests or tests performed for another condition) of one small kidney compared to a normal sized one on the other side.

Typically, unilateral (one-sided) renal artery stenosis may be related to high blood pressure whereas bilateral (two-sided) renal artery stenosis is more often related to diminished kidney function.

What about that surgery our mutual friend’s doctor wanted her to have? Is it really necessary?

Sometimes a regiment of several hypertension {High blood pressure} drugs, along with hyperlipidemia {High cholesterol} drugs, and perhaps aspirin can alleviate the problem. Then there’s angioplasty – a procedure in which a catheter is placed in the artery via a blood vessel, a balloon is then opened in the artery and stented to keep the renal artery open. Or, bypass surgery may be performed to avoid the blocked area of the renal artery.  Thank you to WebMD for this information which I paraphrased from http://www.webmd.com/hypertension-high-blood-pressure/guide/renal-artery-stenosis-symptoms-treatments?page=2.

My advice when surgery is suggested?  A second opinion.  Any doctor worth his salt will welcome this request and understand that it in no way casts aspersion on his/her value as a doctor. A second opinion from a nephrologist would be the way that I would go and I urged our mutual to seek one.

Here’s to our mutual friend and all of us who ever wondered what RAS is and what it has to do with CKD.

On another note entirely, here’s a bit of happiness I wanted to share with you.  These are reviews for What Is It and How Did I Get It? Early Stage Chronic Kidney Disease I hadn’t seen on Amazon.com… and all five stars!

One of the best on the subject not so much for the info but the way it was presented. Almost like a novel. Makes you forget your kidney is not behaving the way it should.

It is written for a patient like us, mean that the language it is simple and easy to understand, good sense of humor and a positive aptitude with this silent killer, another book that deserve a place on your personal library. Very informative , excellent book.

A book that is very helpful to CKD3 patients. It gives the facts and figures needed most to those with this condition!

I’ve had this book in paperback for a while and when Amazon offered me the option to buy the digital version at a discounted price since I had purchased the paperback from them, I jumped at it. I’m a sucker for loaning out hard copy and this way if I find a fellow kidney disease sufferer, I can let them have my paperback and I will always have my digital backup for reference. This is a great book by a fellow kidney disease patient who also publishes a very good blog. There are so many details to track with this disease and she talks about the daily life of it. Very helpful and answers so many questions. She’s a born researcher, so all her information has backup links to let you know this is authentic medical advice to get some of those questions answered between doctor’s visits.

Until next week,

Keep living your life!

Smokin’!

When I was in college a million years ago, this was a compliment.  I’d wear the new dress my mother bought me, go to a dance or a party, dance my brains out, and find some guys whispering this under their breath as I passed them.

Not anymore.  True, Mom’s long gone, I’m married, and if anyone whispered this to me now, I’d think they were asking me if I smoked…and that’s a big no-no these days, especially with Chronic Kidney Disease.

We’ve taken for granted for years now that people just don’t smoke anymore. That’s not true, you know.  Other countries still find smoking acceptable, although not all.  There are also people who are so addicted that they just can’t stop.  Today we’ll take a look at what might help.

But first, we need to go back to the basics – as usual. On my very first visit to a nephrologist, I was told to stop smoking, even social smoking.

But why?  DaVita at http://www.davita.com/kidney-disease/overview/living-with-ckd/smoking-and-chronic-kidney-disease/e/4897 offered a succinct answer to my question:

How smoking can harm kidneys

Here are some of the possible ways smoking is thought to harm kidneys:

• Increases blood pressure and heart rate
• Reduces blood flow in the kidneys
• Increases production of angiotensin II (a hormone produced in kidney)
• Narrows the blood vessels in the kidneys
• Damages arterioles (branches of arteries)
• Forms arteriosclerosis (thickening and hardening) of the renal arteries
• Accelerates loss of kidney function

In addition to tobacco, smoking allows other toxins into the body. And according to the American Association of Kidney Patients (AAKP), studies have shown that smoking is harmful for the kidneys, and can cause kidney disease to progress and increases the risk for proteinuria (excessive amount of protein in the urine).

To make this a little more comprehensive, here are some definitions from What Is It and How Did I Get It? Early Stage Chronic Kidney Disease:

Arteries: Vessels that carry blood from the heart.

Hormones: …chemicals that trigger tissues to do whatever their particular job is.

Protein: Amino acids arranged in chains joined by peptide bonds to form a compound, important    because some proteins are hormones, enzymes, and antibodies.

Renal: Of or about the kidneys

Sounds drastic, doesn’t it?  So, what can be done to help those people who are so addicted they can’t stop smoking on their own?

An Israeli PhD student at Weizmann Institute of Science in Rehovot, Anat Arzi, has a novel idea.  She believes that exposing smokers to the smell of smoke and other unpleasant odors while they sleep can make them less eager to smoke.  In her own words, “”This research stems from recent findings suggesting that novel associations can be learned during human sleep and retrieved upon awakening.”While this was only a small study with 76 people, I can’t remember reading about any other cease smoking study that deals with aversive conditioning during REM sleep.  Aversive conditioning is {surprise!} just what it sounds like: using unpleasant stimuli – like the rotten fish Arzi used – to cause some kind of change in behavior.  Quick reminder, REM means Rapid Eye Movement and occurs during the second stage of falling asleep.

You can read about the study yourself at http://www.m.webmd.com/a-to-z-guides/news/20141120/sleep-addiction-cigarettes?page=2

Then, there’s the FDA approved, safe, natural product Smoke Remedy offered on the internet.  You need to remember that FDA approved, safe, and natural does not necessarily mean safe for CKD. I applaud the fact that they list their ingredients, but this is not safe for us.

The homeopathic medicines in Smoke Remedy™ come from several different plant and mineral sources that include:

• Avena sativa – to help with the addiction to nicotine and tobacco;
• Caladium seguinum, Daphne Indica, Eugenia jambosa, Ignatia, Calcarea phosphorica, and Plantago major – these help to stop the craving and desire to smoke;
• Kali phosphoricum, Nux vomica, and Staphysagria – to help prevent the withdrawal symptoms you may experience when quitting;
• The product also contains purified water, citric acid and potassium sorbate.

For example, that last ingredient, potassium sorbate caught my eye because we know that we, as people with CKD, need to limit our potassium.  It turns out to be a preservative and nothing I’d want in my body whether the FDA approves it or not. The Calcarea Phosphorica made me pause, too.  As CKD patients, we do not need more phosphorous, as you already know.

I’m not saying don’t use homeopathic remedies, but I am saying you need to research each and every ingredient AND bring the list of side effects to your nephrologist before you do. Your doctor may not be familiar with homeopathic medicines, which is why you are doing the research to bring to him or her.

Of course, there’s always the patch or special gums, but they have their own problems.  Most feed slow doses of nicotine into your body. That’s the element of tobacco that injures your kidneys. This is to address the withdrawal symptoms.

I went to http://www.stopsmoking.net/free-nicotine-patch.html to see if there are side effects. Don’t you just love products with full disclosure? Here’s what I found:

“It’s worth noting that many of the top nicotine patches often produce undesirable side effects. Common side effects include headaches, dizziness, upset stomach, nausea, chest pain, breathing problems, anxiety, and irregular heartbeat. Furthermore, some people have nicotine patch allergies. The skin becomes red, and their body becomes severely irritated by the patch. If this ever happens, you need to contact a doctor right away. Nicotine patch allergies can produce damaging results.”

Now here’s an eye opener I found at http://thechart.blogs.cnn.com/2012/01/09/study-nicotine-gums-patches-only-help-with-withdrawal/:

“The perception of the public using the product is that these are good forever – that these will result in you not smoking in three, five, 10 years,” says Greg Connolly, Director of the Center for Global Tobacco Control at the Harvard School of Public Health. “Well, they were never designed to do that. They were designed to treat withdrawal, which is a symptom that occurs from stopping to probably six months, and then it usually ends.”

I never realized how really hard it is for addicted smokers to stop.  Now I fully appreciate my father who decided there wasn’t enough money coming in for him to waste it on cigarettes when he had three children.  He simply stopped. Or so I thought.  (This was way before 1996 when the patch and gum first made their appearance.) Thank you, Dad; this must have been really hard.

Until next week,

Keep living your life!

Up and Down…and Up…and Down

I usually base the blog upon what’s happening in my medical life or those of my family members and friends.  I thought I wouldn’t have anything to write about today. But then I got my latest lab results.  Ugh!

eGFR MDRD Non Af Amer

>59 mL/min/1.73

47

There’s been some variation in my eGFR for the last few months and it hasn’t all been good.  What’s the eGFR, you ask.  Let’s start with the GFR and use the glossary in What Is It and How Did I Get It? Early Stage Chronic Kidney Disease {page 132} for the 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.”

Wonderful, except we need to know what glomerulus means since the suffix ‘ar’ tells us that glomerular is an adjective or word that describes a noun – a person, place, thing, or idea.  In this case, the noun is glomerulus.   Thank you dictionary.reference.com for the following:

“Also called Malpighian tuft, a tuft of convoluted capillaries in the nephron of a kidney, functioning to remove certain substances from the blood before it flows into the convoluted tubule.”

Yes, yes, I know more definitions are needed.  Back to the glossary in What Is It and How Did I Get It? Early Stage Chronic Kidney Disease {page 134 this time):

“Nephrons: The part of the kidney that actually purifies and filters the blood.”

A tubule, as you’ve probably guessed, is a very small tube.  This is when having been an English teacher for decades pays off in my kidney work!

Maybe we should define capillary too, in case you’ve forgotten what it is. This time I used Merriam-Webster.com at MedlinePlus.

“a minute thin-walled vessel of the body; especially: any of the smallest blood vessels connecting arteriole with venules and forming networks throughout the body.”

In other words, they’re the smallest blood vessels in the body.

Alright, we’ve got our vocabulary in place; now why is the eGFR so important? As stated in the definition above, it is used for staging your Chronic Kidney Disease.  Different stages require different treatment or no treatment at all.  There are five stages with the mid-level stage divided into two parts.  The higher the stage, the worse your kidney function.

Think of the stages as a test with 100 being the highest score.  These are the stages and their treatments:

STAGE 1: (normal or high) – above 90 – usually requires watching, not treatment, although many people decide to make life style changes now: following a renal diet, exercising, lowering blood pressure, ceasing to smoke, etc.

STAGE 2: (mild) – 60-89 – Same as for stage one

STAGE 3A: (moderate) – 45-59 – This is when you are usually referred to a nephrologist {kidney specialist}. You’ll need a renal {kidney} dietitian, too, since you need to be rigorous in avoiding more than certain amounts of protein, potassium, phosphorous, and sodium in your diet to slow down the deterioration of your kidneys. Each patient has different needs so there is no one diet.  The diet is based on your lab results.  Medications such as those for high blood pressure may be prescribed to help preserve your kidney function.

STAGE 3B: (moderate) – 30-44 – same as above, except the patient may experience symptoms.

STAGE 4:  (severe 15-29) – Here’s when dialysis may start. A kidney transplant may be necessary instead of dialysis {artificial cleansing of your blood}. Your nephrologist will probably want to see you every three months and request labs before each visit.

STAGE 5: (End stage) – below 15 – Dialysis or transplant is necessary to continue living.

Many thanks to DaVita.com for refreshing my memory about each stage.

Back to my original concern about the GFR results in my labs.  Why did it fluctuate from 53 in August of last year, to 47 in February of this year, to 52 in May, to 56 in August, and to 47 last week? All the values are within stage 3A and I know it’s only a total fluctuation of six points, but it’s my fluctuation so I want to know.  And that’s what started this whole blog about GFR.

I discovered that different labs may use slightly different calculations to estimate your GFR, but I always go to the same lab, the one in my doctor’s office.  Nope, that’s not my answer.

According to the American Kidney Fund, “…this test may not be accurate if you are younger than 18, pregnant, very overweight or very muscular.”  No, these situations don’t apply to me either.

Maybe I’m going about this all wrong and should look at the formula for arriving at GFR. The National Kidney Disease Education program lists the formula which includes your serum creatinine.  Aha! Maybe that’s the cause of the variation.  First a reminder: creatinine is the chemical waste product of muscle use. {This is a highly simplified definition.}

You’ll find this on your Comprehensive Metabolic Panel Blood Results, should you have your results. The normal values are between 0.57 and 1.00 mg/dL.  Mine were above normal for each test, a sign that I have CKD.  As if I didn’t already know that. These results were also lower each time my GFR was higher.

I researched and research.  My final understanding is that not only can CKD elevate your creatinine, but so can dehydration, diabetes or high blood pressure.  If your creatinine is elevated, the results of the GFR formula will be lowered.  That’s enough information to allow me to rest easy until I see my doctor next week.

Some of this was pretty technical and I couldn’t give you many exact web addresses since my computer is having its own issues today.  You may want to try an online GFR calculator just to see how it works.  You will need your serum creatinine value {serum means blood, so this is not to be confused with the urine creatinine test} to do so.  I like the one at DaVita.com.

Until next week,

Keep living your life!

Sunshine and Superwoman

Today is just one of those days: Bear’s car is in the shop so I got up early to take him to work, I turned on the dishwasher and nothing happened, I posted what I thought was a non-political message and got a political rant in return, answered a text only to find that my childhood friend thought I was ignoring her.  I’ve got a pretty happy life, so this was a disconcerting start of the day to say the least.

And then I opened the lab results for yet another blood test.  The one I wrote about two weeks ago was from August; this one is from last week. Should have saved it for tomorrow.

While the out of range results weren’t that much out of range, they were out of range.  Since this is one of those days, all of a sudden this became of great concern to me.

The Vitamin D, 25-Hydroxy, Total was 28.6 instead of within the 30.1 -100 normal range.  It would probably help you understand my mystification if I let you know that I’ve been taking 2000 mg. of vitamin D daily for several years.

I went running right back to What Is It and How Did I Get It? Early Stage Chronic Kidney Disease to find out why this is important.  Thank goodness, I have my office copy!  How could anyone memorize everything they need to know about their health, I wonder.

This is what I wrote about vitamin D (page 48):

The kidneys produce calcitrol which is the active form of vitamin D. The kidneys are the organs that transfer this vitamin from your food and skin [sunshine provides it to your skin] into something your body can use. Both vitamin D and calcium are needed for strong bones. It is yet another job of your kidneys to keep your bones strong and healthy. Should you have a deficit of Vitamin D, you’ll need to be treated for this, in addition for any abnormal level of calcium or phosphates. The three work together. Vitamin D enables the calcium from the food you eat to be absorbed in the body. CKD may leech the calcium from your bones and body. Phosphate levels can rise since this is stored in the blood and the bones as is calcium.  With CKD, it’s hard to keep the phosphate levels normal, so you may develop itchiness since the concentration of urea builds up and begins to crystallize through the skin. This is called pruritus.

I have been itchy lately, but since my phosphate levels have never been out of range, I concluded it was just dry skin due to our low to nil humidity here in Arizona.  Maybe it’s not.  We’d been keeping my calcium levels low – but in range – since a bout with kidney stones several years ago. I also definitely stay out of the sun, another source of vitamin D, since a

pre-cancerous face lesion. I’d had a bone density test recently and that was just fine, but had I been doing all the wrong things for my kidney health in protecting myself from kidney stones and melanoma?

Something was nagging at me about vitamin D, so I turned to the glossary of my book (page 136) and that’s where I found it:

“Vitamin D: Regulates calcium and phosphorous blood levels as well as promoting bone formation, among other tasks – affects the immune system.”

Affects the immune system.  But how?  Science Daily at http://www.sciencedaily.com/releases/2010/03/100307215534.htm provided the answer I sought:

“Scientists have found that vitamin D is crucial to activating our immune defenses and that without sufficient intake of the vitamin – the killer cells of the immune system — T cells — will not be able to react to and fight off serious infections in the body. The research team found that T cells first search for vitamin D in order to activate and if they cannot find enough of it will not complete the activation process.”

How did I miss that?  And how many others knew that vitamin D didn’t just build strong bones as we’d been taught in primary school?

I imagine my nephrologist will up my vitamin d dosage when I see him next week, but I still can’t handle the sun or take calcium supplements.  Maybe there’s some food that can provide vast quantities of this vitamin.

But no, according to the National Institutes of Health at http://ods.od.nih.gov/factsheets/VitaminD-HealthProfessional/:

“Vitamin D is a fat-soluble vitamin that is naturally present in very few foods, added to others, and available as a dietary supplement.”

Well, I wanted to know what those foods were even if they could only provide 20% of the needed vitamin d at most.  I clearly remembered salmon, tuna, and egg yolks, but what else?  Mushrooms, of course.  And???

I had to turn to the internet for more suggestions. Fit Day at http://www.fitday.com/fitness-articles/nutrition/vitamins-minerals/5-foods-rich-in-vitamin-d.html informs us that milk, cereal, and even orange juice are vitamin d fortified. For me, that’s a joke.  I’m lactose intolerant, don’t like cereal, and o.j. has too much calcium in it.

I like fish, but two to three times a week?  I’m not sure I want to spend my five ounces of protein that way so often during a week.  I don’t care for eggs much, but am willing to eat them once a week just to eat something healthy. Mushrooms are really tasty, but my ¼ cup doesn’t go very far.

You know, just from moving myself to write, it doesn’t seem like such a bad day after all.

Which leads me to a thought I want to share: action is the road out of unhappiness.  I’m sure someone has thought of that before, but I own it now.  To that end, I’m working on The Book of Blogs and two other long time writing projects as well as having committed myself to Landmark Worldwide’s Wisdom Course.

Of course I still take the time to exercise (ugh!), sleep, and rest, but these projects are fun… and they make me happy.  We are capable of so much more than we think we are.

Until next week,

Keep living your life!

Put your Back into It for a Few Minutes

You can always tell what’s troubling me by the topic of each week’s blog.  This week it turns out I have “irritated disks.”  I kid you not.  It actually makes sense since Bear has some ruptured disks that won’t be treated until Friday and I’ve taken over his chores for a while.

Let’s go back to the very beginning to explain this one. Here’s the definition I’ll be using for disk,

“Fibrocartilaginous material between spinal vertebrae which

 provides a cushion-like support against shock”

Thank you, McGraw-Hill Concise Dictionary of Modern Medicine for that.

Here we go again: a definition that needs another definition to understand the first definition.  Naturally you’d want to know what fibrocartilage is. According to Gale Encyclopedia of Medicine, it’s

“Cartilage that consists of dense fibers.”

Hang on there.  We need one more definition. I went to MedicineNet at http://www.news-medical.net/health/Cartilage-What-is-Cartilage.aspx for this definition of cartilage.

“….It is a firm tissue but is softer and much more flexible than bone.”

So we have soft, firm, flexible, dense fiber material between our spinal vertebrae.

Our what?  Vertebrae is

“a bone of the spinal column, typically consisting of a thick body, a bony arch enclosing a hole for the spinal cord, and stubby projections that connect with adjacent bones.”

 You can learn more about this by searching The Encarta Dictionary.

For the definition of spinal column (and you thought we were done with definitions), I chose to use Collins Dictionary at http://www.collinsdictionary.com/dictionary/english/spinal-column. There I found this definition:

“A series of contiguous or interconnecting bony or cartilaginous segments that surround and protect the spinal cord.”

I used to tell my children when they were little and my back hurt that the stuff between my vertebrae that acts as a cushion wasn’t cushioning right. Simple, direct, and to the point. Apparently I’m on the verge of that again. And I WILL stop it before it gets any worse.

How, you ask?  My chiropractor suggested ice for twenty minutes, then take it off for an hour and repeat… and repeat… and repeat.  With Chronic Kidney Disease, I need the daily exercise to keep my organs – all of them – strong, especially since CKD can eventually affect your other organs.  It’s our not-quite-filtered blood that feeds these organs, so we need to keep them healthy in as many ways as we can.

The icing is helping, but I have re-discovered my inability to do nothing for twenty minutes at a time.

So far, I’ve made sure to wear the dental device that helps my mandible return to normal placement after a night of wearing the Mandibular Advancement Device that treats my sleep apnea.  I’ve also used the twenty minute to peruse Twitter, email, and Facebook for kidney information via iPad.  I’ve even done my banking online in this same twenty minutes.

As you can see, every minute of my time is important to me.  That’s why I was so glad to find new information that every minute you exercise counts.  Obviously with my back sort-of- injury (I don’t consider it an injury unless I can’t walk!), I’ve had to limit my exercise.

That’s the bane of my existence anyway… not the limiting, but the exercise. I usually ride five or six miles on the stationary bike or do a two mile walking tape with weights and stretch bands. I have to admit, I do it only because I have to.  I’d rather read or write anytime.

Although, I love my Sunday night exercise: the blues dance lesson my daughter, Abby Wegerski, and her partner provide at The Blooze Bar.  If you haven’t been there yet and you’re local, why not?  It’s downright fun!

Back to every minute of exercise counts (Hurray!) This is the first paragraph of the news article about this study published on September 13 of this year.  You can tell right away why I like it.

“A new study suggests something encouraging for busy people: Every minute of movement counts toward the 150 minutes of moderate-intensity physical activity we’re all supposed to be getting each week. University of Utah researchers found that each minute spent engaging in some kind of moderate to vigorous physical activity was associated with lower BMI and lower weight.”

I have to admit I don’t break down that 150 minutes each week into daily totals when I think about exercise and it’s overwhelming.  Break it down and it’s only a little less than 22 minutes a day. Hey, that’s MY 22 minutes a day.

So what do they mean by “moderate-intensity physical exercise”?  I specifically looked at other than what we’d already consider exercise which can be incorporated into your everyday activities.

I park a little further away from my destination than I need to whenever I drive somewhere.  If I’m not able to walk too well that day due to plantar fasciitis, I’ll chop vegetables or mix my from scratch pancake batter by hand.  If my hands hurt from arthritis or neuropathy that day, I’ll play with Bella – the cancer free wonder dog.

Wait a minute, these are all suggestions made in the study. And better yet, they count toward my 150 minutes of exercise a week.  I like the idea that you don’t have to chuck the whole idea of exercise if you don’t have time to go to the gym, or climb your friendly, local mountain, or ride a bike 10 miles.

I know it’s hard to believe, so I’d suggest you take a look at the article about the study yourself at http://www.nbcnews.com/health/diet-fitness/every-minute-physical-activity-really-does-count-new-study-shows-f8C11042850.  I especially like that my five minutes of rigorous dancing or riding the bike or exercising to those walking tapes count.  Well, my five minutes usually turns into more since I figure I’ve started so I might as well finish my twenty minutes or thirty minutes of exercise that day.

Book wise, I’m hard at work on The Book of Blogs, but have no finish date yet since I really don’t want to do any work when my beloved brother and sister-in-law are here for the two weeks I convinced them to stay.  Just one more week, just one more week. I’m like a child awaiting Santa!

What Is It And How Did I Get It? Early Stage Chronic Kidney Disease is alive and well.  There just may be a European book signing tour in the spring for this book.  We’re contemplating Germany, Amsterdam, and London.  Readers, please let me know if you’re from these countries.

Until next week,

Keep living your life!

Oh, The Pressure!

We enjoyed a cool, slightly wet, getaway weekend and it was wonderful.  I’m a fan of historical sites and Bear is more than willing to join me in seeing them, so we went to Tumacacori, the Presidio in Tubac, and The Pimeria Alta Museum in Nogales.  I was taken with all of them, but saddened to hear of each of their financial plights. I know this is not the best economy, but this is history.

I was surprised to discover that The Tubac Presidio State Historic Park is manned (and womanned) by a staff of volunteers – except for their director, Shaw Kinsley, who is also the author of the well written Images of America: Tubac. The volunteers do an excellent job, as good as that done by the park rangers at Tumacacori.

That got me to thinking about the pressure they all must be under… which got me to thinking about pressure of all kinds and its effect on blood pressure.  Being on a mini-vacation gave me loads of time to think, but this time I decided to write about just that: blood pressure.

Not only have I written about blood pressure in What Is It and How Did I Get It? Early Stage Chronic Kidney Disease, but you’ll notice several blogs about it if you use the topic search on the right side of the blog page.

So why write about the same topic again, you ask?  This time, I took a look at how to take your blood pressure and some of the machines on the market.

Have I ever told you that when I am at my sleep apnea doctor’s office, my blood pressure always starts at about 150/89?  That’s high and I tell them it’s not my usual reading. We’re way past the white coat syndrome (blood pressure rising simply because you’re in a doctor’s office) here, so they take it again on the other arm and it’s something about 110/72.  I like that, but it’s not my usual reading, either.  Back to the first arm: 130/79.  Bingo!

I asked my primary care physician why this happens and she asked me to describe the monitor they used.  As I did, she started nodding her head.  Apparently, this type of automatic blood pressure monitor is notorious for being incorrect… yet doctors still use it for its ease.

Then she asked me how they held my arm while taking my blood pressure and slowly shook her head as I answered.  It seems there is a right way and a wrong way to hold the arm and – to further complicate matters – they differ depending upon the type of monitor being used.

Allow me to return to my roots for a second: Oy gevalt!  This is fairly complicated so let’s uncomplicate it.

I went to WebMD at http://www.webmd.com/hypertension-high-blood-pressure/guide/hypertension-home-monitoring for the following:

Before Checking Your Blood Pressure

• Find a quiet place to check your blood pressure. You will need to listen for your heartbeat.
• Make sure that you are comfortable and relaxed with a recently emptied bladder (a full bladder may affect your reading).
• Roll up the sleeve on your arm or remove any tight-sleeved clothing.
• Rest in a chair next to a table for 5 to 10 minutes. Your arm should rest comfortably at heart level. Sit up straight with your back against the chair, legs uncrossed. Rest your forearm on the table with the palm of your hand facing up.

Were you surprised as I was at the direction to empty your bladder?  Think for a minute.  Have any of your doctors requested you do that before they took your blood pressure reading?  Yet, it makes sense.  Not only will the full bladder itself affect the reading, so will the worry that you need to get to the restroom as soon as possible.

Okay, now we’re ready.  What’s next?

This time, I went to the Mayo Clinic at http://www.mayoclinic.org/diseases-conditions/high-blood-pressure/in-depth/high-blood-pressure/art-20047889?pg=2

• Check your monitor’s accuracy.
•  Measure your blood pressure twice daily. (Once in the morning before you take any medications, and once in the evening.)
• Don’t measure your blood pressure right after you wake up.
•  Avoid food, caffeine, tobacco and alcohol for 30 minutes before taking a measurement
• Don’t talk while taking your blood pressure.

Whoa!  This simple act of placing your arm, wrist, or finger in a monitor is not simple at all when you break it down into smaller elements. I admit it; I’m a talker and have been told a time or two to stop talking while my blood pressure is being measured.

I also like to get my chores out of the way as soon as I wake up, but I see I can’t. This makes for a long morning routine for me. First I take off the wrist braces I wear at night for the carpal tunnel.  Then I clean the mandibular advancement appliance I’ve had in my mouth all night for the sleep apnea and brush it and my teeth.  Usually I would drink that delicious first cup of coffee now, but if I do, I have to wait for 30 minutes before taking my blood pressure.  Hmmm, I have to wait 15 minutes to use the bite rim to readjust my mandibular anyway. But where do I fit in the medications?  Oh, I’ll work it out.

Well, what about the different kinds of blood pressure monitors? I use a wrist monitor which my PCP is simply not thrilled with.  Her feeling is that I’m taking my pressure through two bones, the radius and the ulna, as opposed to only one bone, the humerus, with an arm device. There’s also the finger monitor, but that could be a problem if you have thin or cold fingers.

There are manual and battery operated versions of these monitors.  If you use an arm monitor, be aware that larger cuffs are available if needed. The one thing most blood pressure sites agree upon is that it’s not a good idea to rely on drug store monitors for your readings.

Most doctors will agree that the old fashioned sphygmomanometer is the best.  You’ll find this defined on page 135 of What Is It and How Did I Get It? Early Stage Chronic Kidney Disease:

The cuff, the measuring device and the wires that connect the two in a machine used

to measure your blood pressure, commonly called a blood pressure meter.

I find myself wanting to make some crack about writing this blog raising my blood pressure, but in all honesty, writing the blog is still one of my joys.

Until next week,

Keep living your life!

It’s All Connected

About those random posts you may be receiving from me… I am transforming the blog into a book as promised.  However, I don’t really know what I’m doing and am learning on the job, so to speak.  I wouldn’t be at all surprised if you heard me yelling, “OH, NO!” (and worse) at least once a day from now until the process is complete.  I guess you’re bearing witness to my learning process. Boy, am I ever grateful you’re a patient lot!

Now, what I really wanted to write about. I got a call from my primary care physician telling me that while I had improved my BUN, Creatinine, BUN/Creatinine Ratio, LDL, and eGFR levels on my last blood test, the Microalbumin, Urine, Random value was abnormal at 17.3. I checked online to make certain I had heard her correctly.

Dr. H. Zhao practices at Deer Valley Family Medicine here in Phoenix.  The practice started using a site to report your results as soon as they’re available, sometimes the next day.  I wonder why I got that call at all when this process is in place.

When I finally finished congratulating myself for all these improvements, I started to question why the Microalbumin value was out of range.  I knew it hadn’t been out of range last year, but I did have Chronic Kidney Disease.  That in itself would have meant it would be out of whack, wouldn’t it?

Here we go again.  I pulled out my trusty copy of What Is It and How Did I Get It? Early Stage Chronic Kidney Disease and turned to Chapter 5, “What Flows Through You,”  The Random Urine Tests,  number 9299 on page 52 (Honestly? I used the word search function for the digital book, even though I had the print copy in front of me.  It’s just plain easier!) and found:

“tests for micro, or very small amounts, of  albumin in the urine. Ur stands for urine. Albumin is a form of protein that is water soluble. Urine is a liquid, a form of water, so the

  albumin should have been dissolved. Protein in the urine may be an indication of kidney disease.”

Of course I wanted more.  We all know micro from micro-mini skirts (Are you old enough to remember those?) and microscope.

Wait, if protein in the urine “may be an indication of kidney disease” – which I have – why was this a problem?  Or was it a problem?

Both high blood pressure (which I do have) and diabetes (which I don’t) could be the cause since both may lead to the proteinuria (protein in the urine, albumin is a protein as mentioned above) which may indicate CKD. Microalbuminia could be the first step to proteinuria.

But, as usual with medical conditions, it’s not that black and white.  I scurried over to our old friend WebMD at http://www.webmd.com/a-to-z-guides/proteinuria-protein-in-urine to look for other risk factors and found these:

• Obesity
• Age over  65
• Family history of kidney disease
• Preeclampsia (high blood pressure and proteinuria in pregnancy)
• Race and ethnicity: African-Americans, Native Americans, Hispanics, and Pacific Islanders are more likely than whites to have high blood pressure and develop kidney disease and proteinuria.

While I’m well past child bearing, I’m also over 65 and, ummm, (how’s this for hedging?) clinically obese.  Does that mean proteinuria is to be my new norm?

Maybe there’s something more I can do about this.  According to U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES‘ National Kidney and Urologic Diseases‘ Information Clearinghouse (NKUDIC), A service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health (NIH) at http://kidney.niddk.nih.gov/kudiseases/pubs/proteinuria/

“In addition to blood glucose and blood pressure control, the National Kidney Foundation recommends restricting dietary salt and protein. A doctor may refer a patient

to a dietitian to help develop and follow a healthy eating plan.”

 This is nuts!  I have CKD.  I already restrict myself to five ounces of protein a day. I’ve abolished table salt from the house and watch the salt content in the foods I eat. I’m handling my blood pressure with Losartan/HCTZ. (See the next paragraph.) I haven’t progressed from microalbuminuria to proteinuria, yet I’m still doing more damage to my body.

MedicineNet at http://www.medicinenet.com/losartan_and_hydrochlorothiazide/article.htm explains the Losartan/HCTZ very well:

“Losartan (more specifically, the chemical formed when the liver converts the inactive losartan into an active chemical) blocks the angiotensin receptor. By blocking

the action of angiotensin, losartan relaxes the muscles, dilates blood vessels and thereby reduces blood pressure….Hydrochlorothiazide (HCTZ) is a diuretic (water

pill) used for treating high blood pressure (hypertension) and accumulation of fluid. It works by blocking salt and fluid reabsorption in the kidneys, causing an

increased amount of urine containing salt (diuresis).”

Uh-oh, that leaves blood glucose, which has never been high for me.  However, my A1C has been high since this whole CKD ride has started.

Let’s back track a little. The Mayo Clinic at http://www.mayoclinic.org/tests-procedures/a1c-test/basics/definition/PRC-20012585  tells us:

“The A1C test result reflects your average blood sugar level for the past two to three months. Specifically, the A1C test measures what percentage of your hemoglobin — a protein in

red blood cells that carries oxygen — is coated with sugar (glycated). The higher your A1C level, the poorer your blood sugar control and the higher your risk of diabetes complications.”

I don’t have diabetes…yet.  It’s becoming clear that I will – in addition to worsening my CKD – if I don’t pay even more attention to my diet and become more stringent about exercising.  It’s sooooo easy to say not today when the arthritis rears its ugly head…or knee.

It’s been said there’s no way to do it, but to do it (by me, folks.  Ask my children.) So now I need to take my own advice and get back to the stricter enforcement of the rules I know I need to live by.  After all, they let me live.

If you ever needed proof that the body is an intricate thing with all its part being integrated, you got it today.

Until next week,

keep living your life!

Never NSAIDS

Never what?  One of the first rules we learn as Chronic Kidney Disease patients is never to take a NSAID, a non-steroidal anti-inflammatory drug.  Raise your hand if you remember why.  Hello fellow with the beard in the back of the room; what do you say?

Correct!  They further damage the kidneys.  Can you tell us how?  No?  Don’t feel bad.  Most people can’t, even those suffering from CKD.

What was that?  Oh, you want over the counter (non-prescription) names of some NSAIDS?  Sure.  Here’s a list courtesy of Nsaids-list at http://www.nsaids-list.com/:

• Aspirin (Aspirin is a brand name; the chemical is called acetylsalicylic acid)
• Celecoxib (Celebrex)
• Dexdetoprofen (Keral)
• Diclofenac (Voltaren, Cataflam, Voltaren-XR)
• Diflunisal (Dolobid)
• Etodolac (Lodine, Lodine XL)
• Etoricoxib (Algix)
• Fenoprofen (Fenopron, Nalfron)
• Firocoxib (Equioxx, Previcox)
• Flurbiprofen (Urbifen, Ansaid, Flurwood, Froben)
• Ibuprofen (Advil, Brufen, Motrin, Nurofen, Medipren, Nuprin)
• Indomethacin (Indocin, Indocin SR, Indocin IV)
• Ketoprofen (Actron, Orudis, Oruvail, Ketoflam)
• Ketorolac (Toradol, Sprix, Toradol IV/IM, Toradol IM)
• Licofelone (under development)
• Lornoxicam (Xefo)
• Loxoprofen (Loxonin, Loxomac, Oxeno)
• Lumiracoxib (Prexige)
• Meclofenamic acid (Meclomen)
• Mefenamic acid (Ponstel)
• Meloxicam (Movalis, Melox, Recoxa, Mobic)
• Nabumetone (Relafen)
• Naproxen (Aleve, Anaprox, Midol Extended Relief, Naprosyn, Naprelan)
• Nimesulide (Sulide, Nimalox, Mesulid)
• Oxaporozin (Daypro, Dayrun, Duraprox)
• Parecoxib (Dynastat)
• Piroxicam (Feldene)
• Rofecoxib (Vioxx, Ceoxx, Ceeoxx)
• Salsalate (Mono-Gesic, Salflex, Disalcid, Salsitab)
• Sulindac (Clinoril)
• Tenoxicam (Mobiflex)
• Tolfenamic acid (Clotam Rapid, Tufnil)
• Valdecoxib (Bextra)

Yes, young lady in the third row. This is a bit more detailed a list than you’d expected? Okay, let’s go back to What Is It And How Did I Get It? Early Stage Chronic Kidney Disease for a simple explanation of NSAID.  Please turn to page 134.  Those of you with digital copies of the book, search the phrase.  Everyone have it?

NSAID: Non-steroidal anti-inflammatory drugs such as ibuprofen, aspirin, Aleve or naproxen usually used for arthritis or pain management, can worsen kidney disease,    sometimes irreversibly.

So now we’re back to the original question.  How do NSAIDS further damage our kidneys?

But first I want to tell you just how important it is not to take them by sharing an anecdote with you. The first year after my CKD diagnose, my nephrologist spent a great deal of his time trying to convince me that I had caused by own CKD by taking NSAIDS very, very often.  He might have been right with another patient, but I was never one to rely on medications.

I would rather have used natural means to relieve myself of pain.  I did have arthritis and usually walked off the pain.  As for headaches, I would do the darkened room, rub the temples, mute the electronics and – my magic – ask one of my daughters to kiss my forehead routine. (Class!  No snickering.  It worked for me.)

Yet, overuse of NSAIDS was so common a cause of CKD that this was the only cause my nephrologist could see.  A while after this, studies showed that aging kidneys will lose their filtering power at the rate of ½% per year.  He switched to this cause, which I could more readily accept.

Yes, yes, I know we were going to discuss how NSAIDS further damage the kidneys today.

By the way, as early as 1984, the National Institutes of Health at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1483278/?page=2 published a journal article from the Canadian Medical Association Journal entitled Adverse effects of NSAIDs on renal function.

Why no, I’m not procrastinating at all.  Here’s the answer to today’s question.

I found this explanation at a site that’s new to me (http://www.empowher.com/wellness/content/what-nsaids-do-your-kidneys):

All NSAIDs work by blocking the action of cyclooxygenase (COX). This enzyme performs a key step in the synthesis of prostaglandins [ me here with a definition of this word from the freedictionary.com at  http://medical-dictionary.thefreedictionary.com/Prostaglandins – a group of potent hormonelike substances that produce a wide range of body responses such as changing capillary permeability, smooth muscle tone, clumping of platelets, and endocrine and exocrine functions. They are involved in the pain process of inflammation.], which produce many effects in the body. Two of the effects are pain and inflammation for injured tissue. Other effects include protection of the stomach and homeostasis (regulation) of kidney function. The COX enzyme comes in two forms, COX-1 and COX-2. For a while, it was thought that COX-2 produces the pain and inflammation prostaglandins, while COX-1 produces the protective and regulatory prostaglandins.

The underlining is mine. That’s right, NSAIDS interfere with the regulation of the kidney function.  How?  Another good question from the middle of the room.

According to the National Kidney Foundation at http://www.kidney.org/atoz/content/painMeds_Analgesics.cfm,

“…because they reduce the blood flow to the kidney.”

So now we need to know why blood flow to the kidneys is important for CKD patients.

If you look at a picture of your kidney, you’ll see that blood with wastes in it is brought to the kidneys by the renal artery and clean blood is exited from the kidneys by the renal vein.  Your kidneys are already compromised which means they are not doing such a great job of filtering your blood.

Reduce the blood flow and you’re exacerbating the problem you already have… and all you need to do is avoid NSAIDS to avoid this problem. You’re right, class, that’s not exactly true, but it will help you preserve more of your kidney function.

Any questions for me?  For each other?

Well then, thank you for being such a willing and involved group of students.

While we all know this isn’t really a classroom and I’m not a doctor, this should answer a great many of the questions I’ve received via email or comments.

I’m also looking for first source research on both chia seeds and Goji Berries for a reader.  It seems there’s quite a bit of conflicting information about the safety of these two for CKD patients.  Please send along what you have, but first source only (not opinion, but fact).

It’s been my pleasure, folks.

Until next week,

Keep living your life!

What If You Don’t Go?

We just got back from New York, which included stays in three different places. Only one- my buddy’s pied `a terre in Bay Ridge had a private bath… one bathroom for the two of us.  In my niece’s house on Long Island, we shared two bathrooms with two other adults and four children.  In Manhattan, we shared two baths with twenty other tourists. This didn’t exactly make for instant bathroom use when you needed it.

To add insult to injury, I’ve grown very accustomed to Arizona’s immaculate public bathrooms with automatic faucets, flushes, soap dispensers, and towels. Let’s just say New York has quite a bit of room for improvement in this area. The end result was that I didn’t use the facilities as often as I needed to.

And I started wondering… what’s happens to the urine you don’t void?

First things first: according to National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC), A service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health (NIH)  at http://kidney.niddk.nih.gov/kudiseases/pubs/yoururinary/#points,

“The amount of urine a person produces depends on many factors, such as the amounts of liquid and food a person consumes and the amount of fluid lost through sweat and breathing.”

It was New York; it was not only hot, it was humid.  I was drinking my allotted 64 ounces of liquid daily. I was breathing – as usual – and I was sweating (perspiring?) quite a bit. Of course, I was eating, too.

In What Is It And How Did I Get It? Early Stage Kidney Disease, I explained that

“Ingested food and liquid are digested in the stomach and bowels, and then absorbed in the blood.  A renal artery carries the blood waste and water to the kidneys while a renal vein carries the filtered and sieved waste from the kidneys…..Additional important jobs of the kidneys are removing liquid waste from your body and balancing the minerals in the body. The two liquid waste products are urea which has been broken down from protein by the digestive system and creatinine which is a byproduct of muscle activity.

The problem with unregulated minerals, such as sodium and potassium is that these minerals are needed to remain healthy but too much in the bloodstream becomes toxic. The kidneys remove these toxins and change them into urine that enters the bladder via the ureter.  Look at the picture of a front view of your internal organs …. [You can see]  the kidneys, then the ureter above the bladder.  Below the bladder is the urethra, the passage to the outside of your body. This is, of course, a highly simplified explanation.  The toxins would build up and poison you if the kidneys were damaged.”

This is right at the beginning of the book on pages 2 and 3.

Now that we know how it works, we can go back to my original question: What if you don’t urinate when your bladder is full?

Well, maybe we should explore the bladder a bit more. WebMD at http://www.webmd.com/urinary-incontinence-oab/picture-of-the-bladder tells us the following about the bladder:

“The bladder stores urine, allowing urination to be infrequent and voluntary. The bladder is lined by layers of muscle tissue that stretch to accommodate urine. The normal capacity of the bladder is 400 to 600 mL. During urination, the bladder muscles contract, and two sphincters (valves) open to allow urine to flow out. Urine exits the bladder into the urethra, which carries urine out of the body.”

So, there I was with a full bladder and my body telling me to empty it, but I didn’t.  What happened to the urine?

It’s time to mention that the ureters don’t have any way to stop the urine flowing back into the kidneys if you don’t void.  There are two sphincters at the bottom of your bladder leading into the urethra, but you can only voluntarily control one of them.

Interesting fact: the urethra is longer in men because it passes through the penis.  Sorry fact: because our urethras are shorter, we women are more prone to urinary tract infections.

Uh-oh, urine was moving back into my poor, already compromised kidneys. This urine flow back could further damage the capillaries and tubules making them even less effective at filtering my blood. The kidney’s pelvis and calyces – their central collection region – might become dilated, causing hydronephrosis.  Or I might end up with a kidney infection from the bacteria forced back in.  This is called pyelonephritis.

Hang on there.  I’m going to use the medical dictionary at http://www.merriam-webster.com/medical  for some definitions here.

CALYX (plural ca·lyx·es or ca·ly·ces  also ca·li·ces): a cuplike division of the renal pelvis surrounding one or more renal papillae

CAPILLARY a: resembling a hair especially in slender elongated form   b: having a very small bore

HYDRONEPHROSIS: cystic distension of the kidney caused by the accumulation of urine in the renal pelvis as a result of obstruction to outflow and accompanied by atrophy of the kidney structure and cyst formation

RENAL PAPILLA: the apex of a renal pyramid which projects into the lumen of a calyx of the kidney and through which collecting tubules discharge urine

RENAL PELVIS: a funnel-shaped structure in each kidney that is formed at one end by the expanded upper portion of the ureter lying in the renal sinus and at the other end by the union of the calyxes of the kidney  

TUBULE: a small tube; especially: a slender elongated anatomical channel

But, wait before you get all excited about the damage I’ve done to myself – or worse, yourself. You should know it would take a tremendous amount of flow back before any of this happens.  Be aware of your urge to urinate, follow through if you can, and don’t worry if you can’t every once in a while (But remember that I’m not a doctor.) And I wonder why I’ve felt the urge to urinate the whole time I’ve been writing today’s blog.

Many thanks to the oddly informative website http://www.straightdope.com/ for pointing me in the right direction for answers to my question. I have a question for all of you:  I am thinking of turning the previous blogs into a book; is that something you’d be interested in?

Until next week,

Keep living your life!