Another Holiday

Holidays abound! Or maybe it just feels that way. No sooner did my Russian Jewish almost son-in-law and I co-host our Seder then it was time to get ourselves together for Easter. Sometimes it’s a lot of work to have such an integrated family.

passover This time, no one stepped up to bat and I soon found out why. Another almost son-in-law had minor surgery, but was still in pain and not ready for people. A third adult child had weekend guests and had to work Sunday evening. But one couple wanted an Easter celebration.

So I quickly figured out that I could go to the weekly Sustainable Blues dance lesson that my youngest, Abby Wegerski, taught every week AND make dinner for these adult children if I planned carefully. That’s when I realized I wasn’t weighing and measuring or looking at my renal diet Bible before cooking. All the ingredients I needed were renal friendly and readily available in our house.blues

What a relief! It took almost seven years for this information and this way of being to become part of me. The point here is that the renal diet has become a way of life, one I don’t often think about too much anymore. I can easily remember a time I needed to pull out the diet list to see what I could eat, then another list to see if the protein, potassium, phosphorous, or sodium (3 Ps and and S, as I call them in What Is It And How Did I Get It? Early Stage Chronic Kidney Disease) levels were too high and finally the KidneyDiet app to make sure I hadn’t gone over my limits for each of these and a calorie count.

This wonderful revelation doesn’t mean that I don’t hit my own ‘refresh’ button periodically to make sure I really am correctly eye judging the amounts of each food I use in cooking and eating or that I don’t need to occasionally check to see if I’m right about the amount of whatever is in it.

I still carry all three of these – Northern Arizona Council on Renal Nutrition Diet, AAKP Nutrition Counter, and KidneyDiet app – as my talismen. There’s a certain security in knowing I have them if I need them. I also find that sometimes I just don’t remember exactly what I read in each, so it’s a comfort to have them at hand.Book Cover In Chapter 8: The Renal Diet of What Is It And How Did I Get It? Early Stage Chronic Kidney Disease, I offer an example of the intricate and annoyingly painstaking little notebook I devised to keep track of my CKD nutrition. Ladies and Gentlemen: I am pleased (for CKD sufferers) to announce this is now obsolete!!!

One of the very first apps I purchased was KidneyDiet. It is not the same as my little notebook, but works equally well. The only thing it doesn’t do is tell you if you’ve reached your daily limit in each category of food (milk, meat or meat substitutes, grains, fruits, vegetables, and fats).

android_welcomeYou’re an intelligent person. You can figure out just by looking at a display of your entries if you’ve had your one four ounce serving of milk, five ounces of meat or meat substitutes, however many servings of grain (depends upon your sex, weight, and whether or not you want to lose weight), your three servings each of fruits and vegetables and your fill of fat intake. You’re the one entering your limits (as prescribed by your dietician), and they show up red if you’ve gone over them. Calories and cholesterol are also included, as is fluid intake. The nicest part is that if there’s a food you like which isn’t on the pre-existing list that comes with the app, you can add it. Do that once and you have the information for that food every time you enter it.

No, I do not own stock in the KidneyDiet app, although that might not be such a bad idea. I am thrilled that life keeps getting easier for us as CKD patients. I know I’ve written about the app before, but each time I use it, I’m grateful for how it’s made my life easier.

Wait a minute! I just realized the next holiday on the calendar is Mother’s Day. This should be interesting because I’m not cooking for that. If Bear does, no problem. He knows my dietary restrictions almost as well as I do. But if it’s one of the kids, especially one of the newer additions to the family…. Maybe it’s time to be more stringent when they ask me what I can eat, or better yet, tell them in advance.

When we went to Florida and stayed with my brother, Paul, and sister-in-law, Judy Peck (she of the magnificent cooking), Judy asked me what I could eat. So I sent her the renal diet I follow. It was overwhelming to her, just as it is to new CKD patients. As usual, she successfully simplified the matter. By asking me what I could eat instead of adhering to the list, she saved herself from having to pick and choose from a double sided page of dietary restrictions and I (of course) only told her the foods Bear and I liked. The moral of the story: everyone was happy once this was briefly discussed. photo (2)

The theme of today’s blog is that life is becoming easier for CKD patients but we’ve got to keep talking, keep exchanging ideas, keep each other updated about new information. CKD is part of me now, but it sure isn’t all of me.

About keeping each other informed: The Free Health Screening by Path to Wellness is on Saturday, 4/26 from 8:30 to 1:30 at The Golden Gate Community Center 1625 N. 30th Ave. in Phoenix, Az. While it is free you need to call for an appointment – the number if you speak English is 602 840 1644. For Spanish speakers, the number is 602 845 7905. You must be over 18 and have a family member with diabetes, heart or kidney disease, or have diabetes or high blood pressure yourself.

Have you looked at Dr. Mario Trucillo’s American Recall Center (www. recallcenter.com)? That was the site discussed in last week’s blog. I’d be interested to hear what you think of it.

I challenged myself to create a business card for SlowItDown doing all the formatting and graphics myself.  This is the final product:SlowItDown business card

Feedback?

 

Until next week,

Keep living your life!

It’s the Salt of the Earth

passoverPassover begins tonight at sundown. A Guten Pesach for all those who celebrate.  We’re hosting the first seder here tonight.  Only  three of our eleven guests are Jewish, although there is a hint of Jewish blood in a few others.  All are welcome… including Elijah.

Yesterday, I attended a Palm Sunday Brunch hosted by an acting colleague. Unfortunately for me, none of the food she carefully made from scratch was on the renal diet (I can’t eat many of the traditional Passover foods either), so I did my taste-each-food-to-be-polite thing. I had such minimal amounts of each that I wasn’t doing damage to my kidneys, but I also discovered new tastes.

I realized none of this food tasted salty to me, as food not on the renal diet usually does. When asked, she told me she doesn’t use salt but spices instead. This stuff was delicious! If I weren’t on the renal diet, I would have asked her for the recipes for each dish she’d made.

Nancy’s not using salt in her cooking got me to thinking if we needed salt at all. Actually, I knew we did, but I didn’t know why. I poked around and found the following on an NPR blog:

“If you don’t keep up your sodium level in your body, you will die,” explains Paul Breslin, a researcher at the Monell Center, a research institute in downtown Philadelphia devoted to the senses of taste and smell. (Breslin also teaches at Rutgers University.) “

That’s extraordinarily blunt, but there’s quite a bit more about this at http://www.npr.org/blogs/thesalt/2012/12/20/167619010/the-paradox-and-mystery-of-our-taste-for-salt. What I got from this is the same question I usually have: why?Whatever Happened to Common Sense?

I remembered that salt regulates your hydration but decided to check this anyway. According to The Royal Academy of Chemistry at http://www.rsc.org/get-involved/hot-topics/Salt/do-we-need-salt.asp,

It is the sodium (ions) present in salt that the body requires in order to perform a variety of essential functions. Salt helps maintain the fluid in our blood cells and is used to transmit information in our nerves and muscles. It is also used in the uptake of certain nutrients from our small intestines. The body cannot make salt and so we are reliant on food to ensure that we get the required intake.

An EurekAlert at http://www.eurekalert.org/pub_releases/2013-08/mu-anr082013.php made me realize another important function of sodium, the element our bodies cannot produce:

Researchers at McGill University have found that sodium – the main chemical component in table salt – is a unique “on/off” switch for a major neurotransmitter  receptor in the brain. This receptor, known as the kainate receptor, is fundamental for normal brain function and is implicated in numerous diseases, such as epilepsy neuropathic pain.

Normal brain function!brain

Just in case you didn’t take chemistry in high school or college – which I admit was too intimidating for me – salt is 40% sodium and 60% chloride. It’s the 40% sodium that causes a problem if you have too much of it. This is a quandary. You need salt to live and function well, but too much can kill you via raising your blood pressure.

There is an ongoing controversy of how much salt we need on a daily basis. This is what is on Colorado State’s website at http://www.ext.colostate.edu/pubs/foodnut/09354.html:

The Dietary Guidelines for Americans recommended reducing sodium intake to no more than 2,300 milligrams per day. However, those with hypertension, over the age of 51, or who are African American, should consume no more than 1,500 milligrams of sodium per day. This recommendation includes over half of all Americans.

But have they taken into account the fact that we sweat during the summer or when we work out and lose a great deal of sodium that way? Does that mean we need more sodium during these times? And how do you judge how much sodium is too much anyway? Or do we use the Goldilocks Theory of ‘just right’ here.

All right, then. The next logical question would be how much is usually too much. Hello Medical News Today at http://www.medicalnewstoday.com/articles/146677.php. That’s where I found this handy, dandy, how much chart.

food labelHow to read food labels and identify high and low salt foods

You should check the labels of foods to find out which ones are high and low in salt

content. If the label has more than 1.5g of salt (or 0.6g of sodium) per 100g it is a

high salt content food.

If it has 0.3g of salt (0.1g of sodium) per 100g then it is a low salt content food. Anything in

between is a medium salt content food.

  • High salt content food = 1.5g of salt (or 0.6g of sodium) per 100g
  • Medium salt content food = between the High and Low figures
  • Low salt content food = 0.3g of salt (0.1g of sodium) per 100g

The amount you eat of a particular food decides how much salt you will get from it.

As renal patients, we need to pay special attention to the amount of sodium we ingest. I’m on the Northern Arizona Council of Renal Dietitians’ diet which permits 2,000 mg. of sodium a day. That’s really limited since a teaspoon of salt has about 2,300 mg. of sodium. Of course, now that I’m over 51 (okay, way over), I’m down to 1,500 mg. of sodium daily.

How do I keep within my guidelines, you ask? It’s become easy, but don’t forget I’ve had seven years to perfect it. We do have filled salt shakers available in the kitchen, but they’re invisible to me. I use spices in cooking instead. My best friend there is Mrs. Dash’s, although there are many other spices on the renal diet. I just like her (its?) blends. I check labels copiously when I do the marketing and Bear does too. If there’s hidden sodium in foods, there’s not much I can do about it. However, checking labels and ignoring the salt shaker will help keep my kidneys safe from too much sodium. (Pssst: I also ignore whatever food you can buy at gas stations.)salt shakers

As DaVita tells us (http://www.davita.com/kidney-disease/diet-and-nutrition/diet-basics/sodium-and-chronic-kidney-disease/e/5310)

Particularly damaging is sodium’s link to high blood pressure. High blood pressure can cause more damage to unhealthy kidneys. This damage further reduces kidney function, resulting in even more fluid and waste build up in the body.

Other sodium-related complications include the following:

  1. Edema: noticeable swelling in your legs, hands and face
  2. Heart failure: excess fluid in the bloodstream can overwork your heart making it enlarged and weak
  3. Shortness of breath: fluid can build up in the lungs, making it difficult to breatheUntil next week,

So lay off the salt, my friends.

recall centerBefore I leave you this week, I wanted to let you know that Dr. Mario Trucillo contacted me about his new company.  He is a Ph.D. with the American Recall Center (www. recallcenter.com) “a brand new medical information site aimed at bringing consumers the most up-to-date FDA information in easy to understand, plain language terms,” according to his e-mail.  I have been looking at the site and am pleased to announce I understood everything I read there… not often the case for me.  Why not take a look for yourself?  There are not that many plain language medical websites available. The more I look at this one, the more I like it.

Until next week,

Keep living your life!

March and National Kidney Month are Hare, I Mean Here.

My wake up alarm is the song ‘Good Morning,’ and that’s exactly what this is.  The sun is out, it’s warm but not hot, I’m listening to some good music, and I’m alone in the house for the first time since Bear’s October surgery.  I am thankful that he is driving himself to his doctors’ appointments. That is progress!   desktop

Talking about progress, it’s National Kidney Month and you know what that means… a recap of many of the organizations listed in What Is It And How Did I Get It? Early Stage Chronic Kidney Disease that may help with your Chronic Kidney Disease.  Ready?  Let’s start.

{I’m only including online addresses since this is on online blog.}

 

American Association of Kidney Patients (AAKP) 

https://www.aakp.org

MARCH IS NATIONAL KIDNEY MONTH (from AAKP’s website)

This is an advocacy group originally started by several dialysis patients in Brooklyn in 1969.  While they are highly involved with legislation, I see their education as the most important aspect of the group for my readers.

“Take some time and browse through our educational resources including our Resource Library that contains past and present published information from the American Association of Kidney Patients. Educate yourself on specific conditions, medicine, lifestyle improvement and get the latest news and information from the renal community.”

kidney-month-2014-v1  The American Kidney Fund

     http://www.kidneyfund.org/

While they work more with end stage Chronic Kidney Disease patients, they also have an education and a get tested program.

“The mission of the American Kidney Fund is to fight kidney disease through direct financial support to patients in need; health education; and prevention efforts.”

National Kidney Disease Education Program

www.nkdep.nih.gov

This is an example of the many videos available on this site.  They are also available in Spanish.

What is chronic kidney disease? Approach 1 A doctor explains what chronic kidney disease (CKD) is and who is most at risk. Learn more about diabetes, high blood pressure, and other kidney disease risk factors. Length 00:53  Category CKD & Risk

One of my favorites for their easily understood explanations and suggestions.  Their mission? “Improving the understanding, detection, and management of kidney disease.”  They succeed.

National Kidney Foundation

www.kidney.org

http://www.youtube.com/watch?v=s2U2iZQxkqI#t=1 (This is the link to their National Kidney Month Rap with Sidney the Kidney)

I have guest blogged for them several times and been glad to work with them whenever they need me.  The website is thoroughly helpful and easy to navigate. This is what you find if you click on ‘Kidney Disease’ at the top of their home page. What I really like about this site is that it’s totally not intimidating.  Come to think of it, none of them are, but this one feels the best to me.  (I can just hear my friends now, “Oh, there she goes with that spiritual stuff again.”  One word to them: absolutely!) Notice the Ask the Doctor function.

National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC)

www.kidney.niddk.nih.gov  National Institute of Diabetes and Digestive and Kidney Diseases Logo.

“Just the facts, ma’am,” said Sergeant Friday on an old television show and that’s what you get here.

This is their mission statement:

The National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC) is a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). The NIDDK is part of the National Institutes of Health of the U.S. Department of Health and Human Services.

Established in 1987, the Clearinghouse provides information about diseases of the kidneys and urologic system to people with kidney and urologic disorders and to their families, health care professionals, and the public. The NKUDIC answers inquiries, develops and distributes publications, and works closely with professional and patient organizations and Government agencies to coordinate resources about kidney and urologic diseases.

And let’s not forget

 Renal Support Network

www.rsnhope.org

This was initiated by a Chronic Kidney Disease survivor.  The part I like the best is the Hopeline.  While I have not called myself, I have referred people who were newly diagnosed and, well, freaking out.  I couldn’t tell them what the experience of dialysis is like, but these people can.

Renal Support Network (RSN) is a nonprofit, patient-focused, patient-run organization that provides non-medical services to those affected by chronic kidney disease (CKD)….  Call our Hopeline (800) 579-1970 (toll-free) Monday through Friday from 10am to 6pm (PT) to talk to a Person who has lived kidney disease.

Baxter Healthcare Corporation.

http://www.renalinfo.com/us

“… web site designed and developed to provide information and support to those affected by kidney failure. Renalinfo.com is supported through and educational grant from Baxter Healthcare Ltd, a company that supplies dialysis equipment and services to kidney patients worldwide.

They have all the information a newly diagnosed CKD patient could want and, while funded by a private company, do not allow paid advertisements.  Their site map is proof of just how comprehensive they are.

While many of the other sites offer their information in Spanish as well as English, if you click through the change language function here, you’ll notice there are many languages available.

Rest assured that these are not the only organizations that offer support and education.  Who knows?  We may even decide to continue this next week, although that’s so close to March 13th’s World Kidney Day that we’ll probably blog about that for next week.

I interrupt myself here to give you what I consider an important commercial message.  Remember that game I play about using the money from the book to pay off what I paid to produce the book so I can put more money into donations of the book?  There was a point when sales covered the cost of publishing.  Now they’ve covered the cost of digitalizing the book so it could be sold as an e-book.  Another milestone!  (Now there’s just about $15,000 worth of donations to pay off.)54603_4833997811387_1521243709_o

While I’m at it, I find I cannot recommend Medical Surgical Nursing: Critical Thinking for Collaborative Care, 4th Ed. but only because it was published in 2002.  The world of nephrology has changed quite a bit since then and continues to change daily. While I enjoyed the information, I’m simply not convinced it’s still applicable.

For those of you who are newly diagnosed, I sincerely wish these websites give you a starting point so you don’t feel so alone. (I’m sorry the book isn’t interactive.)

Until next week,

Keep living your life!

Control That Chronic Condition

NKF-logo_Hori_OBThe National Kidney Foundation referred this reporter to me to discuss how I handle my chronic kidney disease.  Once she’d interviewed me, she decided to save the material and quotes I’d given her to use in an article on patient participation in their illnesses.

I have one thing to say to you, Laura Landro:  thank you.  Thank you from the bottom of my heart for making it clear that we CAN slow down the decline of our kidneys.  Thank you from the bottom of my heart for getting that message to so many people in one fell swoop.  And thank you from the bottom of my heart for making certain people know about SlowItDown.

While I added the images for the blog, this is the article as it appeared in the Wall Street Journal last Monday:  wsj

Patients Can Do More to Control Chronic Conditions

In the absence of cures, people can learn how to slow kidney disease, diabetes and other ills

By Laura Landro

By the time Gail Rae-Garwood was diagnosed with chronic kidney disease at age 60, it was already too late for prevention, and there is no cure. But Ms. Rae-Garwood decided she could do something else to preserve her quality of life: slow the progression of the disease.

For the millions of Americans over 50 who have already been diagnosed with chronic ailments like kidney disease, diabetes, heart disease, rheumatoid arthritis and chronic obstructive pulmonary disease, careful management can’t turn back the clock, but it can buy time. It takes adherence to medications, sticking to recommended diet and exercise plans, and getting regular checkups.

As simple as that sounds, experts say, patients often don’t hold up their end of the bargain, and doctors don’t always have the time to help between visits. Chronic ailments may also lead to depression, which itself is associated with poor adherence to medication across a range of chronic illness, according to a 2011 study in the Journal of General Internal Medicine.

“The whole goal in conditions that are lifelong, and aren’t going to go away, is to stabilize them and keep them as stable as possible for as long as possible,” says Edward Wagner, a researcher and founding director at Seattle-based Group Health Research Institute.

Patients’ Role

Dr. Wagner developed a protocol known as the chronic-care model in the 1990s, which has been increasingly adopted by many health-care providers. One of its primary goals, in addition to careful monitoring, is teaching patients self-management skills. “Evidence is mounting that the more engaged and activated patients are in their own care, the better the outcomes,” Dr. Wagner says.

Take kidney disease. One of the fastest-growing chronic conditions world-wide, it affects 26 million Americans, and millions of others are at increased risk, according to the National Kidney Foundation. Over time, the kidneys lose their ability to filter waste and excess fluid from the blood; the condition may be caused by diabetes, high blood pressure and other disorders. But patients may not have symptoms until it is fairly advanced. As dangerous levels of fluid and wastes build up in the body, it can progress to so-called end-stage renal disease, or kidney failure. Without artificial filtering, known as dialysis, or a kidney transplant, the disease can be quickly fatal.

But especially in earlier stages, lifestyle changes that ease the burden on the kidneys can have a marked effect, including eating less salt, drinking less alcohol and keeping blood pressure under control. Doctors may suggest a “renal diet” that includes limiting protein, phosphorous and potassium, because kidneys can lose the ability to filter such products.

Sometimes modest changes can make a difference. Even small amounts of activity such as walking 60 minutes a week might slow the progression of kidney disease, according to a study published last month in the Journal of the American Society of Nephrology.

There are plenty of resources to help kidney patients manage their disease, including the kidney foundation website (kidney.org) and classes offered by the dialysis division of DaVita HealthCare Partners Inc.  The company says it educates about 10,000 patients annually at free “Kidney Smart” classes across the country.

Getting the Word Out                     Book Cover

Ms. Rae-Garwood says she decided to become engaged in her own care and share what she learned with fellow patients, after she was diagnosed in 2008 with Stage 3 kidney disease.

“People need to be educated and learn how to manage it so that they are not immediately on dialysis or on death’s door,” she says.

Ms. Rae-Garwood wrote a 2011 book, “What Is It and How Did I Get It? Early Stage Chronic Kidney Disease,” and started a blog to offer its contents free online. She developed an educational program, kidney-book-coverSlowItDown, which is used by health educators to provide free classes in various communities such as the Salt River Pima-Maricopa Indian Community in Phoenix.

She acknowledges that it isn’t always easy to follow her own advice. “The disease is somewhat in control, but I’m getting older,” Ms. Rae-Garwood says. “And while I can control my renal diet, it’s harder to lose weight, and exercise isn’t always an option since I’ve hurt this or that on my body.” She takes blood-pressure and cholesterol medications, and tries to keep stress levels down.

She retired from both a college teaching post and acting last year but still keeps up a Facebook page, Twitter account and her blog to get the word out. “I’m serious about getting the necessary education to the communities that need it,” she says.

The article was published while I was still in Los Angeles after a Landmark Worldwide weekend.  I had no car, didn’t really know where I was, and had no idea how to get to a newsstand… if those even still exist.  Luckily, my daughter Nima – all the way on the other side of the United States – had gotten a print copy.  She’ll be mailing it to me any day now. (Right, Nima?).

I’m old fashioned enough that even if I’ve printed a copy of the article from the internet, I want to feel the pulp of the paper (if that’s what paper is still made from) in my hands and let it yellow with age in my files.  I am one happy Chronic Kidney Disease advocate these days.

Until next week,

Keep living your life!

Book It!

With the holidays over and more time to think about what I’d like to write, I decided this would be a good time to update you about whatever other books are available that also concern Chronic Kidney Disease.

You know there are many out there, too many to mention here, so I eliminated any book that couldn’t be understood by a lay person (those without specific training in a certain field – in this case, medical) and renal diet books.  You can easily find those for yourself by going to Amazon.com and B&N.com. I also excluded those I found to be dubious… the spelling errors were a dead give-away that these were not professional.

I’m not going to tell you about What Is It And How Did I Get It? Early Stage Chronic Kidney Disease since you already know about it from this blog.  Let’s change that, I will tell you one or two things.  First, the books included in ‘Additional Resources’ (Chapter 13) won’t appear here, as good as they are.Book Cover

And – pay attention – students, be aware that both Campus Book Rentals and Chegg are attempting to rent the book to you for more than it costs to buy it.  The digital edition – when I was teaching college, my students always seemed to prefer the digital edition – is even less expensive.

Don’t forget about The KindleMatchBook program which allows you to buy the digital version at 70% discount if you’ve ever bought the print copy. Gather your classmates: pool your money so you can save. One of you buy the print edition, then the others can get the digital edition at deep discount (I have no idea why, but I love that phrase).

Disclaimer:  I am not a doctor, have never have claimed to be one , AND am not endorsing the following books, simply letting you know they exist. For the most part, the descriptions were written by the author. The ‘Look Inside!’ function only works if you follow the link to Amazon.com – sorry! I have been dreaming about this list, so let’s get it out of my dreams and on the blog:

510smylYevL._SL160_PIsitb-sticker-arrow-dp,TopRight,12,-18_SH30_OU01_AA160_Ford, Mathea A., RD (Registered Dietician) Kidney Disease: Common Labs and Medical Terminology: The Patient’s Perspective (Renal Diet HQ IQ Pre-Dialysis Living) (Volume 4)

New to kidney failure? Have no idea what your physician just said about your kidneys? Kidney disease labs and terminology can quite often be a challenge to understand and digest. Did your doctor use the “stages of kidney disease”? Did you physician refer to “eGFR”? What does all this mean for your health and future with kidney disease, lifestyle and nutrition choices. This book is the basic platform for understanding all the common labs and terminology that your doctors and nurses will use. This book with give you and your caregivers the confidence to manage your condition knowing that you have an understanding of all the ins and outs of the nephrology jargon. (Mrs. Mathea seems to have an entire series of books about CKD.)

Hunt, Walter A. Kidney Disease: A Guide for Living. 

When Hunt learned he had kidney disease, he was overwhelmed by the prospect of facing kidney failure. He had so many questions: Why are my kidneys failing? Is there anything I can do to save them? How will I know when my kidneys have failed? What will it feel like? 41nNk5SdqIL._AA160_What treatments are available for me? Is there a cure for kidney failure? The good news, as Hunt found out, is that kidney failure is highly treatable. People with the disease can lead full and productive lives, and Hunt’s readable and empathetic book will help them do just that. It discusses the latest scientific and medical findings about kidney disease, including what kidneys do; the underlying diseases that cause failure; diagnosis, treatment, and prevention; dietary factors; clinical trials; and the future direction of research on kidney failure. Kidney disease is difficult, but as Hunt’s narrative reveals, people living with it can take control of their health and their future. By understanding kidney failure — what causes it, how it may affect their lives, and what treatment options they have — people with the disease can improve their quality of life and achieve the best possible outcome.

51nUIkG8kSL._AA160_Lewis, Dr. Robert. Understanding Chronic Kidney Disease: A guide for the Non-Specialist.

This is meant for primary care physicians, but can be easily understood by the layman. I looked under the covers of this one and was delighted to see that the information we, as patients with CKD, need to know is also what our primary care physicians need to know. (I wrote this description.)

National Kidney Foundation of Southern California. Living Well With Kidney Disease.

The first edition of “Living Well With Kidney Disease” was developed and published by the National Kidney Foundation of Southern California. Based on the handbook “When Your Kidneys Fail” (originally published in 1982), this new and 41jxZoYLGzL._AA160_updated edition provides detailed information specifically intended for people coping with Kidney Disease and other renal failure, as well as their friends and families. The question and answer format provides a clear and manageable guide for those seeking support and answers. Among the topics covered are the principles of kidney function, methods of treatment, transplantation, and financial resources available to patients. With all of the ramifications of kidney failure and the rise of Chronic Kidney Disease and Type 2 Diabetes, there is a growing population of people afflicted with kidney failure. Although it was written with the patient in mind, family members, friends and health care professionals will also find this handbook a valuable resource.

517GaXFXNPL._SL160_PIsitb-sticker-arrow-dp,TopRight,12,-18_SH30_OU01_AA160_Synder, Rich DO (Doctor of Osteopathic Medicine) What You Must Know About Kidney Disease: A Practical Guide to Using Conventional and Complementary Treatments

The book is divided into three parts. Part One provides an overview of the kidneys’ structure and function, as well as common kidney disorders. It also guides you in asking your doctor questions that will help you better understand both status and prognosis. Part Two examines kidney problems and their conventional treatments. Part Three provides an in depth look at the most effective complementary treatments, from lifestyle changes to alternative healing methods. The diagnosis of kidney disease is the first step of an unexpected journey.

*Yes, this is the same Dr. Rich Snyder who interviewed me on his radio show twice since What Is It And How Did I Get It? Early Stage Chronic Kidney Disease was published.

It’s always hard to find good books about CKD that non-medical personnel can understand.  I hope this four (and mine!) help you feel more comfortable and knowledgeable about your diagnosis.

Here’s a little hint about your own health.  I’m back to no sweets or desserts and, I hate to admit it, but I’m feeling better.  Don’t you just hate when that happens?sugar

Until next week (when I’ll in in Culver City for a weekend of Landmark),

Keep living your life!

A Healthy Diet is Not Necessarily a Renal Healthy Diet

Many people have asked me why I just don’t follow a healthy diet for my kidney disease.  It’s one of those questions we hear again and again as early stage chronic kidney disease patients … and not just from those who think they know better, but from those who genuinely care about us and want to help. Today’s blog is meant to answer that question.imagesCALEX9DU

There were many food guides from the government before the introduction of the one we usually hear about, the USDA’s 1992 Food Pyramid. (See http://www.huffingtonpost.com/2011/06/02/usda-food for a fascinating history of the older ones if that interests you.) Although updated in 2005, this was the gold standard for a healthy diet.  We’ll be dealing with the 2005 revised version in this blog.

Michelle Obama changed all that in 2011 when she supported MyPlate as the new U.S. nutrition guideline in an effort to help control the obesity epidemic.  By then, I was already on the renal diet so didn’t really pay attention.

I wanted to use the government’s website since both Pyramid and MyPlate are their concepts, but since that wasn’t up due to the government shut down (didn’t expect to see that again in my lifetime), I relied on http://www.usaring.com/health/food/food.htm for information about the 2005 Pyramid and http://www.medicinenet.com/myplate/page2.htm#difference for the MyPlate information.  The renal diet information is from the diet my own renal nutritionist helped formulate. food plate

So what are the differences you ask?

measuring cupsLet’s start with the base of the Food Pyramid which includes 6 oz. of bread, cereal, rice and pasta a day with the stipulation that half of these be whole grain.  Sounds like heaven for a miller’s grand-daughter like me.  MyPlate suggests the same amounts. However, my renal diet considers a portion of pasta as 1/3 cup, not the ½ cup in the other two eating guides… however many calories a day I can eat.

That makes a difference because of the phosphorous and potassium CKD patients need to curb, to say nothing of our daily calorie limits.  Even the protein adds up.  For example, I’m limited to 60 grams of protein a day.  That doesn’t mean just meat.  My favorite angel hair pasta has 7 grams of protein for a 2 oz. serving.  Let’s say I’d like half a cup.  That’s 4 oz. and already 14 of my 60 protein grams.  Got to save some of those protein grams for the meat (turkey) balls!

Sometimes my 1200 calories seem like an awful lot, but not on the days I eat pasta or rice. You also need to keep in mind that the USDA bases their portion suggestions on a 2000 calorie diet. That means I, for one, will need to eat less food in each category and so will you if you don’t require 2000 calories a day.colander

What about vegetables?  Those are healthy, right? The 2005 Pyramid suggests 3-5 cups a day.  I can’t do that.  MyPlate suggests 2.5 cups daily, but their cup for leafy salad greens is actually two cups.  For the renal diet, one serving is ½ a cup. The government also recommends beans and sweet potatoes which CKD patients cannot eat due to their high phosphorous and potassium levels.    We need to stick to vegetables that are low carb and to limit or avoid salty ones.veggies

Are you with me so far?  The pyramid suggests two cups of fruit a day, while MyPlate suggests 2-4.  That wouldn’t be a problem except for the serving sizes which are different between these two and the renal diet.  So no matter how healthy these are, I’m limited to three ½ cup servings a day.  What does that look like?  Today it was half a banana, ½ cup of blueberries, and one very small mandarin orange. As CKD patients, we need to be careful about (yep, here it comes again) phosphorous and potassium.  As a matter of fact, bananas are a once in a great while treat due to their high potassium content.

Meat and Beans is a little bit of a joke since beans are a no-no for us.  The pyramid suggests including nuts and seeds, too.  Uh, not for CKD patients.  Why?  Because of the (you know it!) phosphorous and potassium.  There’s also the calorie consideration here.  MyPlate has the same difficulties for us, although they suggest lean meat.  We are urged not to have red meat too often and cheese – I know it’s a dairy product – is included in our meat group.  As renal patients, protein is not our friend with many of us being limited to 5 oz. This group is where you get most of your protein.salt

Hang in there, almost done. The pyramid recommends 3 cups of dairy. MyPlate recommends 2 to 3 servings and they include cheese.  (I find myself wondering if they mean real cups or MyPlate cups.) The most glaring difference is that the renal diet allows ½ cup of milk or plain yoghurt per day. I use a substitute since I’m lactose intolerant, but that’s still only 4 oz. Why such drastic limitations?  Tricked you.  This time, it’s not only the phosphorus and potassium, but also the sodium.

As far as oils, although nothing is mentioned about them on the actual plate for MyPlate, the pyramid does mention they should be used sparingly.  The renal diet restricts them to 4 or 5  one teaspoon servings a day and is quite specific about which to use and which to avoid.

Whee, what a trip that was.  You do need to understand that this blog is based on MY renal diet for MY weight with MY restrictions at MY stage of the disease.  Other CKD patients’ diets will vary, but none of us can “just eat a healthy diet.”

The TableSlowItDown continues to educate in The Salt River Pima – Maricopa Indian Community and has been invited to present at their November 5th Health Fair.  Follow us on Twitter and Facebook.  I see big things in our future.

Likewise, book sales – both digital and print at Amazon.com and B&N.com – are holding their own especially in India and Germany where the book is considered the cheapest (hey!) form of self-education about CKD.

I’m hungry.  Now let’s see, maybe there’s a vegetable unit – low carb, of course – in today’s menu.  Better go check my KidneyDiet app.android_welcome

Until next week,

Keep living your life!

It Is Not All In Your Mind; It’s In Your Organs, Too.

It’s National Kidney Month and National Kidney Day on March 13th is coming up fast, so – naturally – the Southwest Nephrology Conference was this past weekend.  It was the usual   Az. Kid Walk pleasure to see Dr. James Ivie, Director of Patient Services at The National Kidney Foundation of Arizona.  The man is wonderfully generous and will be distributing business cards for the book and blog at the Arizona Kidney Walk on April 7th at Chase Field as he allowed Dr. Jamal Atalla from Arizona Kidney Disease and Hypertension Center (AKDHC) to do at the last KEEP (Kidney Early Evaluation Program) event here.

I am up to my elbows in wedding preparations and had to push to make the time to attend the conference and, other than the non-renal diet food (geared to nephrology related practitioners, not patients), I was glad I did.

So much of the material was right up my alley, even though I’m what’s called ‘Allied Health’ rather than medical practitioner. True, I couldn’t quite understand the very technical medical issues, but what I did understand is worth sharing here.

There’s so much to share that I wasn’t sure what to concentrate on this week… until I spoke with Nima. We went from discussing my great-niece’s first birthday party to Nima’s god-mother’s youngest granddaughter’s Bat Mitzvah to lithium. That part of that family has a number of male members who have taken lithium for extended periods for bipolar disorder years ago.

According to Wikipedia, “Trace amounts of lithium are present in all organisms. The element serves no apparent vital biological function, since animals and plants survive in good health without it. Nonvital functions have not been ruled out. The lithium ion Li+ administered as any of several lithium salts has proved to be useful as a mood-stabilizing drug in the treatment of bipolar disorder, due to neurological effects of the ion in the human body.” The operant word in this definition is SALTS.  You can read more about lithium at:   http://en.wikipedia.org/wiki/Lithium.

There were two Plenary Sessions.  It was at the second one, “Psychiatric issues in kidney patients” presented by Dr. Christian Cornelius from Phoenix’s own Banner Good Samaritan Medical Center (where two of Cheryl’s grandchildren were born and also where she was diagnosed with the colorectal cancer that ended her life) that I suddenly sprang into attention again.

Hey, it had been a long morning and lunch was coming up soon.  I hadn’t been able to eat the mid-morning snack of cookies, soda, or coffee. I was tired from getting up at 5:30 to get to the conference down in Chandler in time. Tired and hungry – not the greatest combination.

cookiesWhat was this man saying?  Something about lithium doubling the risk for Chronic Kidney Disease?  And I was off… how many psychiatric patients knew that fact?  How many of their caretakers knew that just in case the patient was not responsible at the time of treatment?  What about children?  Did their parents know?  Was a screening for CKD performed BEFORE lithium was prescribed?

26 million Americans have kidney disease that is not yet diagnosed.  What if one of these psychiatric patients belongs to that group?  What if they all do?  Currently, kidney disease is the ninth leading cause of death in the United States.  Ninth!!!  Are these undiagnosed psychiatric patients moving it to the eighth?  And what about the 73 million at risk for kidney disease due to high blood pressure, diabetes, or family history?  Are they being given lithium without screening?  (You can read more facts about kidney disease at: http://www.kidney.org/news/newsroom/factsheets/FastFacts.cfm.)

I decided to dig deeper, as I often do.  Again and again on different sites about side effects of different psychiatric drugs, I found warnings that patients need to have a complete medical exam before starting the drug and then periodical exams to check whether or not the patient has developed some damage from taking the drug.  Here’s my question: do these exams include kidney screening?lithum

First I looked at my Twitter feed and found this at: http://www.winnipegfreepress.com/local/screening-for-kidney-disease-on-first-nations-193767521.html

“The $1.6-million federally funded project — First Nations Community Based Screening to Improve Kidney Health and Dialysis — will launch in March.

The project, co-led by Manitoba First Nations’ Diabetes Integration Project and Manitoba Health’s Manitoba Renal Program, provides early detection and treatment to several First Nations communities.

Detection of the disease in people as young as eight can take less than 15 minutes.”

The article deals with a KEEP type program for some Canadian First Nations and is included here to demonstrate the growing awareness of the need to screen for kidney disease, not to infer that First Nations have psychiatric disorders.

Other than that article, there is nothing about screening for kidney disease.  If medical practitioners aren’t aware of the prevalence of CKD – and, obviously, I am not referring to the entire medical professions – how can psychiatric practitioners be expected to know to do this?

I am not a psychiatric patient, not even for minor psychiatric issues, so I don’t know what the screening process is first hand.  However, I do know people who have confided in me (no names for privacy’s sake) that they are taking drugs for some psychiatric condition.  Big mouth here always asks what effect that drug might have on their kidneys… or liver for that matter since such drugs may hit the liver negatively.

That is not enough.  We need a lot more big mouths to ask the right question about drugs: How will this affect my kidneys?

I’m asking for one, no two, wedding presents from each and every one of you.

  1. Have yourself tested for kidney disease
  2.  Before you take any drug for any reason, ask how it will affect your kidneys.

Wow!  You have it in your power to make me a happy bride.  Please do it for your sake and mine.  wedding dress

Until next week,

Keep living your life!

Back To Basics

My daughter Abby and I just spent the weekend at Landmark Education’s Access to Communication Course.  If I weren’t already a Landmark graduate, I’d say I couldn’t believe what I learned.  Since I am a Landmark graduate, I’ll share with you my delight at learning just how simple and loving communication can be. people talking

Of course, I’d urge you graduates reading this blog to register for this course and those of you who aren’t yet graduates to explore the Landmark Forum.  You might get an idea of how forceful this work is when I tell you that my upcoming marriage is a result of it.

As a matter of fact, there’s an introduction this Wednesday night at the Scottsdale center from 7 – 11.  The address is 16100 North Greenway-Hayden Loop, Suite 108, and the phone number is 602-222-1110. You can always contact me and we can go together.

I chose communication about CKD as the topic for this week’s blog because I have been doing just that… and being startled over and over again at the number of people I’ve spoken with that know nothing about Chronic Kidney Disease.  So, this week, we go back to basics.

Anyone know what the kidneys are and what they do?  Will the gentleman with his hand raised in the back of the room answer the question, please?  Oh, it’s my future son-in-law, Sean, and he’s quoting me!

kidney locationOn page 1 of What Is It And How Did I Get It? Early Stage Chronic Kidney Disease, Gail Rae wrote, “Later, I learned that the kidneys were two reddish brown organs which lay on the muscles of the back on either side of your spine above hipbone level and below the diaphragm… Some have compared their size to that of a clenched fist or a large computer mouse, and the right one lies lower than the left since the liver is on that side.” [You can order digital copies of the book at Amazon.com and B&N.com.  Print copies are available at Amazon.com and myckdexperience@gmail.com.]

I couldn’t have said it better myself.  [ Ha Ha. Get it?  I DID say it.] Now about their function… Ah, lady on the left side of the room. Estelle, my dear East Coast buddy, I didn’t know you were here.

According to The 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/yourkidneys/#kidneys, “Every day, a person’s kidneys process about 200 quarts of blood to sift out about 2 quarts of waste products and extra water. The wastes and extra water become urine, which flows to the bladder through tubes called ureters. The bladder stores urine until releasing it through urination.” Nice job!

What else do they do?  Nima?  Yes, you may answer questions even though you’re my daughter.  Well then:

  • Control your body’s chemical balance
  • Help control your blood pressure
  • Help keep your bones healthyBook signing
  • Help you make red blood cells

You’ve learned well.  What was your source?  The American Kidney Fund at http://www.kidneyfund.org/kidney-health/kidney-basics/your-kidneys.html.

That’s a good one, as are all the others mentioned here.  They each contain far more information than we’ve included in today’s blog and can make you a sort of neophyte kidney expert.  Well, maybe someone who knows about his/her early stage chronic kidney disease or that of someone you know and/or love might be a more realistic title.

More?  Okay.  How many people have chronic kidney disease?  Look there.  Lara, my step-daughter, who is in very good health (thank the powers that be) is here.  Ummm, I did tell you that number but it’s changed a bit since then.  It’s 26 million in the USA alone and raising.  Those are the diagnosed people.  There are millions of other who have not yet realized they have CKD according to The National Kidney Foundation at     http://www.kidney.org/kidneydisease/aboutckd.cfm#facts

How do you know if you have it?  Excellent question, Kelly. As another healthy person, my step-daughter has asked an important question. Since there are rarely symptoms, it’s all about blood and urine tests.  A simply stated E-how article at http://www.ehow.com/how_2051919_test-kidney-disease.html explains without overwhelming.  Basically, your doctor is looking for protein in your urine and at the following values in your blood test: GFR (glomerular filtration rate) and bun (blood urea nitrogen).  I don’t advocate eHow for medical information, but this one is not that bad.

I will, Bear, right now.  The wonderful man I’ll be marrying in April asked me to make certain I write about the renal diet.  He follows it with me so we don’t have to cook two different meals when we do cook and he lost 60 pounds in the first several months of doing so.  I could hate him for that, except that I already love him.

The renal diet is only one part of the treatment. [There’s also exercise, adequate sleep and lack of stress.] I thought the one at Buzzle (http://www.buzzle.com/articles/diet-for-chronic-kidney-disease-ckd.html) was a good example until I realized there was no potassium restriction on this diet.  I follow that of the Northern Arizona Council of Renal Dietitians. What this tells us is that you need to pay attention to the specific renal diet the nephrologist (kidney and high blood pressure expert) has given you or your loved one, friend, and/or co-worker.water melon

Basically, sodium, phosphorous, protein, potassium and fluids are restricted. Sometimes, I feel like my fluids are exaggerated rather than restricted – like when I’m writing – and have to remind myself to drink so I can meet my 64 ounces/per day ‘limit.’

My neighbor and friend, Amy, just asked me to backtrack a bit and discuss the causes of CKD.  That would be helpful, wouldn’t it?

eMedicine at http://www.emedicinehealth.com/chronic_kidney_disease/page3_em.htmers this.  Two thirds of ckd is caused by high blood pressure or diabetes, but they neglected to mention that sometimes ckd is simply a result of growing older – as in my case.

You know the people I mentioned are not in my office as I write this blog, so here’s a public thank you to each of them for the loan of their names.  I kind of think they would have offered those answers or asked these questions if they were here with me right now.

Check out those websites.  They offer quite a bit of information.

Until next week,

Keep living your life!

Renal Foodie

It’s that time of year again. We have holidays of religious significance.  We get to see friends – old and new – that we haven’t seen for a while.  If we’re lucky parents, we get to see all the kids at one time. We even get to play with busy members of our families, such as when my step-daughter, Lara Garwood, asked me to go to our local Glendale Glitters event to see the lights.photo (2)

I’ve figured out how to stay within the renal diet guidelines at the parties we’re invited to and when we entertain here, but this time it’s different.  Our future son-in-law, Sean Rasbury, has taken over yet another family tradition: Christmas Eve dinner. The Arizona family alone has six members. Add assorted boyfriends and best friends and the number can go much higher.

I didn’t think it fair that he cook for everyone even if he is the one who has the day off, so I offered my help.  And he accepted, suggesting I cook a side dish.  Great!  Now I can get some veggies in!

When I went to the market for the ingredients I needed for this dish, I became aware of just how carefully I look at nutrition labels (the number of people politely waiting for me to move out of the way and then ahem-ing when I didn’t notice them may have had something to do with that) and wondered how many other people knew how to read them.

We are chronic kidney disease patients.  We do not have the luxury of tossing anything into our systems, yet we need to make the food we share with others tasty.  How to do that?

Leave it to the FDA to make this easier for us. When you go to: http://www.fda.gov/Food/ResourcesForYou/Consumers/NFLPM/ucm274593.htm you’ll find this chart.label

If you explore the page, you’ll find explanations for each designation on the chart.  It’s been color coded for your convenience, nice touch that.

Notice not all the electrolytes you need to watch are itemized, but at least you now know what you’re looking at when you see these labels. You can always use the downloadable booklet at http://www.aakp.org/brochures/nutrition-counter/nutrition-counter-english/ to see the electrolyte contents of each of the 300 foods listed in this booklet.  By the way, it’s been mentioned repeatedly that portion size is the key to the success of the kidney (renal) diet.

On the FDA site that has the chart, you’ll find explanations of serving sizes (Boy, do we ever need that!), links to specific recipes for low sodium diets, diabetic diets, pregnancy needs, heart friendly food, even a daily food tracker. In addition, there are downloadable shopping lists for healthy food. There’s also advice about how to pick out healthy food and including your children in planning the family meals.

Come to think of it, I seem to remember, my youngest daughter, Abby Wegerski’s teacher using this chart to re-enforce her math lessons in third grade. What a clever young woman she was. Or was she simply nutrition conscious?

Chicken-Dumpling-Stew-7DaVita has some holiday cooking tips of their own.

“Use kidney-friendly substitutions for your meals

Are you cooking a dish for a party and want to make sure it doesn’t pack on the pounds? If you cook, use healthy recipe substitutions for your kidney diet dishes. Listed are some ingredients a recipe may call for and the kidney-friendly substitute to use instead.”

Recipe calls for: Substitute with:
1 whole egg 2 egg whites or 1/4   cup egg substitute
Sour cream or cream   cheese Low fat sour cream   or low fat cream cheese
Sugar Splenda® or other   low calorie sweetener
Oil (for baking) Unsweetened   applesauce
Regular Jello® Sugar-free Jello® or   gelatin
Fruit packed in   syrup Fruit packed in   juice

You can find more of their holiday eating tips at: http://www.davita.com/education/article.cfm?educationMainFolder=diet-and-nutrition&category=special-occasions&articleTitle=five-holiday-eating-tips-for-people-with-kidney-disease&articleID=5371&cmp=dva1203_feat_art_five_holiday_tips

I do have to write something about the use of the sugar free products.  I wouldn’t use the substitutes, but would lower the amounts of sugar used in the recipe instead.  Sugar is 15 calories per tablespoon and is much healthier than any substance that has been altered in any way.

Until recently, I felt safe substituting unsweetened applesauce for sugar, but with the recent publicizing of genetically modified foods, I don’t trust the product anymore.  I would expect to see some central clearing house to list GMOs in the near future.

According to Wikipedia, “Genetically modified foods (GM foods, or biotech foods) are foods derived from genetically modified organisms (GMOs), specifically, genetically modified crops. GMOs have had specific changes introduced into their DNA by genetic engineering techniques.”  You can read more about this at: http://en.wikipedia.org/wiki/Genetically_modified_food

As I researched GMOs for this blog, it seemed to me articles were either written and posted by health proponents urging they be avoided or businesses promoting them.  Cravat: this is not something I researched in depth and this is simply my opinion.

So, are you now afraid to eat or cook this holiday season?  Don’t be.  Part of the enjoyment in life is sharing good meals with our loved ones, maybe even with those we want to become our loved ones.   Enjoy yours.th

On a more private note, I’ll be taking both a copy of the renal diet and my own copy of the AAKP’s nutritional content booklet with me (And, of course, my book which has an entire chapter on the renal diet) when we go to Florida next month. I know what I can eat here at home, but we’ll be in a different place with different people cooking for us and going out to restaurants I probably never heard of.  I am so eager for my brother and sister-in-law – Paul and Judy Peck – and my cousin Nina Peck and her partner, Sandra, to finally meet Bear after all these years of hearing about him.  And, icing on the cake (of course I’d use a foodie phrase in this blog), we get to see my junior high school buddy Joanne Dana Young-Melnick and her husband Norman again!!!!

I know tomorrow is Christmas and the day after is Kwaanza, but you can download the electronic version of What Is It And How Did I Get It? Early Stage Chronic Kidney Disease immediately as a last minute gift for someone who has CKD, has a family member or friend who has it, is in the renal field, or is just plain curious.  It’s $9.95 at both Amazon.com and B&N.com. The Table

Until next week – and the last day of 2012,

Keep living your life!

Back To The Salt Minds

Here we are right smack in the middle of Chanukah with Christmas and Kwaanza coming up. We’ve read all the health articles about how to plan our party eating

including the Menorahmenorah lighting and latkes one at our house later this week – and we all know to avoid sodium since it causes so much havoc with blood pressure which causes further problems, right?  Maybe not.

Be prepared to have your minds blown (ahem, I am a child of the 60s):

Scant Evidence That Salt Raises BP, Review Finds

Published: December 04, 2012

The evidence for health benefits associated with salt reduction is controversial and the “concealment of scientific uncertainty” is a mistake, researchers suggested.

salt

Because this is such a treatment shattering controversy, I decided to let the experts speak for themselves. Do go to the following link and listen to them yourselves. (Notice the doctors insist that sodium restriction needs to depend upon the individual patient, not that it should be universally discarded.)

You can read the rest of the article and hear the doctors at: http://www.medpagetoday.com/Cardiology/Hypertension/36248?utm_content=&utm_medium=email&utm_campaign=DailyHeadlines&utm_source=WC&xid=NL_DHE_2012-12-05&eun=g596983d0r&userid=596983&email=myckdexperience@gmail.com&mu_id=5721543

So, what does this mean for us as Chronic Kidney Disease patients?  Well… let’s go back to CKD basics for a moment.  We are restricted as far as the three ps (protein, potassium, phosphorous) and sodium, not to mention fluid intake and – for some of us – caloric intake.  {That’s odd, these restrictions don’t seem that complicated anymore, but when I type them, they look a bit daunting.}

Okay, so sodium.  Too much sodium can lead to hypertension (or can it?), which may lead to CKD. You already have CKD.  You are still at risk for edema, which is swelling caused by fluid retention in the tissues of the body.  Since this is already a potential problem for CKD patients, why exacerbate it?

This is what I wrote about sodium in What Is It And How Did I Get It? Early Stage Chronic Kidney Disease:

“What makes it worse is that there is no internal mechanism that tells us if we need more or less salt.  CKD sufferers are in a spot because the kidneys are the only route by which to eliminate excess salt.

Basically, sodium balances fluid levels outside your cells.  You need it because it is responsible for watering your cells.  This watering is the prompt for potassium to dump waste [cell process by-products] from your cells. Sodium does deal with other functions of the body, but this is a pretty important one.

If you have damaged kidneys and cannot excrete most of the sodium you ingest, you’re up again higher blood pressure {is that still true?} which may worsen your CKD which may further cut down on your elimination of sodium and so on and so forth in an ever spiraling cycle.  In addition, for CKD patients, too much sodium causes fluid retention, thereby causing swelling, further resulting in weight gain, leading to shortness of breath. That’s why your nephrologist asks if you’ve experiences shortness of breath.”

It gets worse.  Too much sodium can increase your need for potassium. While potassium is a necessity since it “dumps waste from your cells, but also helps the kidneys, heart and muscles to function normally.  Too much potassium can cause irregular heart beat and even heart attack.  This can be the most immediate danger of not limiting your potassium.” (also from my book)                                                                bbq-chips-beer-230

That is a simple, direct and universally accepted explanation of the horrors of sodium for CKD patients.  But is it still true for you?  With these newly uncovered controversies, who knows?  Speak with your nephrologist, but use common sense, too. I would not recommend running for the salt shaker under any circumstances, but is it safe to eat the fresh made potato chips you ordered at the local brewery (not that I drank any beer. Oh – I mean, not that you drank any beer.) when you tasted a bit of salt on them?

We are not an overly social couple, yet we have our Chanukah party, a friend’s huge pot luck, Bear’s work holiday social (Let’s hear it for Rockler’s!  They know how to do it right.), Christmas eve at Sean and Kelly’s (wow, another family tradition torch passed to the next generation) and now I’m playing around with the idea of a quiet champagne and caviar – neither of which I can eat – new year’s eve if that’s something the Arizona grown children and the assorted fiancés and boyfriends or best friends would be interested in.  That’s a lot of food intake planning.

I thought about taking it party by party and that has worked well for me.  Prior to that, I had a forbidden list I carried around in my head.  That was a total bust.  I would become frustrated at all the foods I couldn’t eat even though they were beautifully and enticingly displayed in front of me and just go whole hog.  Then I had to deal with the guilt, to say nothing of the bodily discomfort, that I felt after.

Yes, party by party is better for me. But that’s not all.  I am analytic, so I peruse the offerings and then – slowly – mentally check off what I can ingest, all the while socializing. That works for me. So does the old dieter’s motto: do-not-stay-seated-at-the-table-with-that-wonderfully-aromatic-food-in-front-of-you.  Feeling well armed to go to your holdiay parties with sodium intake well in hand?  Go party!

Until next week,

keep living your life!                       1129852_Christmas_Buffet_Smoked_salmon_Ham_Mini_quiches___Sausage_rolls_Pizza_Mincemeat_Lattice__nibbles_etc

From Veterans’ Day Salt To Dense Breasts

Veterans’ Day is observed today, although it was technically yesterday.  People here in Arizona take their veterans seriously.  For example, Texas Roadhouse offers the proverbial free lunch (even though we all know these patriotic men and women have already paid the price) for veterans.    

Bear is a retired Army Lieutenant Colonel – addressed as Colonel by military personnel – so we partook. There were so many discussions around us about where the veterans had been stationed or seen action.  What most impressed me is that an employee, a veteran himself, went from table to table to personally thank the other veterans.

As a chronic kidney disease patient, I usually avoid this particular restaurant chain due to their heavy use of salt. I already knew they salted the French fries as they left the kitchen, so I simply ordered a Cesar salad sans dressing and croutons as my side and ate very little of the full fat, full sodium Parmesan cheese topping my iceberg lettuce.

The cheeseburger was a bit of a surprise.  I rarely eat meat preferring ground turkey, which I buy 99% fat free. As for the cheese, they were perfectly willing to switch cheddar for the usual American. This was also full fat, full sodium but I wasn’t concerned because I only planned to eat half of this 8 ounce burger, which meant only half the cheese, too.

What I hadn’t figured on was the steak seasoning.  I never use salt so when I took my first bite, it tasted as if I’d taken a bite out of some  cow’s errant salt lick. The waitress must have seen the look on my face.                   

I didn’t want to cause a fuss because the place was jam packed.  Unbeknownst to me, the waitress told the manager who came over and insisted he make me a new burger without any seasoning.  How kind of him… and I hadn’t even mentioned that I have ckd.

So let’s hear it for Texas Roadhouse for both their respect for veterans and the ease with which they accommodate food restrictions.

Keeping it salty today (Get it? Sodium? Salty?) MedicineNet.com has an article about six top sources of sodium at: http://www.medicinenet.com/script/main/art.asp?articlekey=164822#.UJyT0_ncLdE.email.

1. Bread and rolls – One piece of bread can have as much as 230 mg of sodium. That’s 15% of the recommended daily amount. Although each serving may not sound like much, it can quickly add up throughout the day, with toast at breakfast, a sandwich at lunch, and a roll at dinner, etc.

2. Cold cuts and cured meats – Deli or pre-packaged turkey can have as much as 1,050 mg of sodium. It’s added to most cooked and processed meats to reduce spoilage.

3. Pizza – One slice can have up to 760 mg of sodium. That means two slices accounts for a day’s worth of salt.

4. Poultry – Packaged raw chicken often contains an added salt solution. Depending on how it’s prepared the sodium level can quickly add up. Just 3 ounces of frozen and breaded chicken nuggets contains about 600 mg of sodium.

5. Soup – This cold-weather staple can contain a day’s worth of sodium in a single bowl. One cup of canned chicken soup can have up to 940 mg of sodium.

6. Sandwiches – Breads and cured meats are already high in salt, and putting them together with salty condiments like ketchup and mustard can add up to more than 1,500 mg of sodium in a single sandwich.

There was another surprise for me here.  Chicken?  I went through the material my nutritionist gave me and found that this did need to be limited since it was protein, but nothing about sodium.  Notice #1 talks about 230 mg. of sodium being 15% of the recommended daily amounts.  It’s a higher percentage for us.  We are limited to 2,000 mg. of sodium daily – another ‘perk’ of having ckd – not the 2,400 mg. usually recommended. If you’re following the teaspoon of salt guideline, it is 2,300 mg.

Take heart (pun intended), we are in good company.  The American Heart Association made this recommendation on November 5th of this year:

” ‘Americans of all ages, regardless of individual risk factors, can improve their heart health and reduce their risk of cardiovascular disease by restricting their daily consumption of sodium to less than 1,500 mg’AHA chief executive officer Nancy Brown said in a statement. ”

You can read more at: http://healthland.time.com/2012/11/05/why-even-healthy-people-should-watch-their-salt-intake/#ixzz2C2ab5zjp

A note about mammographies and dense breast tissue before we end.  This caught my eye because, even though I recently had biopsies due to lumps felt upon manual palpitation, I also have dense breasts and was told so several years ago. Arizona has not passed this law yet.  I was just lucky enough to have a caring mammographist.

 “In a move that has irked medical groups and delighted patient advocates, states have begun passing laws requiring clinics that perform  mammograms to tell patients whether they have something that many women have never even heard of: dense breast tissue. Women who have dense tissue must, under those laws, also be told that it can hide tumors on a mammogram, that it may increase the risk of breast cancer and that they should ask their doctors if they need additional screening tests, like ultrasound or M.R.I. scans.”

Left, a scan of a dense breast, which has more glandular or connective tissue than a non-dense breast, right. The denser tissue, with more milk ducts and lobes, can block X-rays.

Thomas Kolb, M.D.

I urge you to read this important Oct. 24th article by Denise Grady which can be found at: http://www.nytimes.com/2012/10/25/health/laws-tell-mammogram-clinics-to-address-breast-density.html?pagewanted=1&_r=0&adxnnl=1&seid=auto&smid=tw-nytimeshealth&adxnnlx=1352751446-kOG7vFMn6dRGqN4ipe4FCQ

If you hurry up, you may still be able to partake of Libre Clothing’s contest and give away on Pininterest.  They have been really good friends to us.

Question: would you like to see What It Is And How Did I Get It? Early Stage Chronic Kidney Disease at the Southwest Nephrology Conference in March?

Until next week,

Keep living your life!

This One’s For Cheryl… And Amy… And…

It’s true, the world is a sadder place these days.  Two dynamic women have lost their lives to cancer this week, and both of them touched me.  One fought valiantly until there was nothing more to fight with. One didn’t. The end result is they’re both gone.  The cause of their deaths? Cancer.

I simply accepted that Cheryl Cook Vincent and I would grow to be outrageous old ladies together.  Now my partner in crime is no more and I am so sad. I cannot think of a single purpose her death served.

Or maybe I can. Let’s take a little detour from the usual ckd related material and talk about cancer.  It’s my way of honoring both Cheryl and my cousin, Amy Bernard-Herman.

Cancer is defined by the World English Dictionary as, “any type of malignant growth or tumour, caused by abnormal and uncontrolled cell division: it may spread through the lymphatic system or blood stream to other parts of the body.”

One of these women went to her doctors regularly; the other hadn’t been in decades. Had she gone, she would have been told pretty much the same as the one who did.  Cancer is treatable in the early stages, sometimes even curable as with skin cancer, the most common form of cancer.  Sometimes, it is not as with some breast cancer which is the second leading cause of cancer deaths in women. For men, the second leading cause of cancer is prostate cancer.

It seems that cancer really covers over one hundred different diseases rather than just being a disease all by itself according to medterms (http://www.medterms.com/script/main/art.asp?articlekey=2580). Even though it may appear in different parts of the body once it’s metastasized (spread), it’s referred to by the site where the tumors first appeared.  For example, back in 1988, my father died of pancreatic cancer.  The cancer had metastasized throughout his body by the time he died, but it was still referred to as pancreatic cancer.

Being an English teacher and a writer, I wanted to know why it’s called cancer. I found the most informative answer to my question at: http://wiki.answers.com/Q/Why_is_the_disease_cancer_called_cancer. Basically, the tumors themselves have a crab like appearance.  In the zodiac, the crab is called cancer. I enjoyed the etymology more than I should have, but that’s my ‘thing’ so I won’t bore you with it here.

Colon cancer caused Cheryl’s death, directly or not. How could she have known she had this disease? According to the Mayo Clinic, these are the symptoms (although the disease may be asymptomatic in the early stages in which case a colonoscopy would have detected it):

  • A change in your bowel habits, including diarrhea or constipation or a change in the consistency of your stool
  • Unexplained weight loss
  • Rectal bleeding or blood in your stool
  • Persistent abdominal discomfort, such as cramps, gas or pain
  • A feeling that your bowel doesn’t empty completely
  • Weakness or fatigue

Their address for more colon cancer information is: http://www.mayoclinic.com/health/colon-cancer/DS00035.

You may need a reminder as to just what these parts of the body are.  According to WebMD, who also provided the picture, the colon is the last part of the digestive system.  This is where fluid, salt, and some nutrients are removed from your body’s wastes as the digestive process occurs.  Peristalsis, or the movement of the muscles lining the colon, helps with this.  You can read more about this at: http://www.webmd.com/colorectal-cancer/default.htm.  The rectum is the last four inches of the colon, ending with the anus.

Cancer has stages just as CKD does. MedicineNet has a better explanation of just what this is and why it’s done than I could have come up with: “The stage of a cancer is a measure of the extent to which a cancer has spread in the body. Staging involves evaluation of a cancer’s size and its penetration into surrounding tissue as well as the presence or absence of metastases in the lymph nodes or other organs. Staging is important for determining how a particular cancer should be treated… cancer therapies are geared toward specific stages. Staging of a cancer also is critical in estimating the prognosis of a given patient, with higher-stage cancers generally having a worse prognosis than lower-stage cancers.”  They are on the internet at: www.MedicineNet.com.  You’d have to know which type of cancer you are dealing with since there is no general cancer site at this address.

Cheryl told me she could never do what I did.  She was talking about researching my diagnosis, writing a book about it, and urging all others with chronic kidney disease to pay attention to their condition.

After having to research each sentence of this blog, I see what she meant. It was heart wrenching.

And I never got to tell my most excellent buddy that I was able to raise my eGFR from 50 to 60 in just three months. She would get so excited about good medical news for me whether she understood it or not.

Rest in peace Cheryl… and Amy… and every other person who has died of cancer.

To those of you who remain behind, I offer you every bit of good energy I can find. After all, if we’re not here to help each other, why are we here?

No book news today, folks.

Until next week,

Keep living your life – for yourself and those around you.

Published in: on October 15, 2012 at 11:13 am  Comments (5)  
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Blue Monday – But Only When It Comes To Sugar

If you read the Facebook page, you already know I received good news when I visited my primary care doctor, the ever educating Dr. H. Zhao of Deer Valley Family Practice here in Phoenix. The visit was for her to more carefully read the results of the blood tests than I am capable of since I’m not a doctor. I take these tests quarterly because I was prescribed Pravastatin which might have an effect on the liver.

By the way, pravastatin is used with hyperlipidemia (high cholesterol). Luckily for me, I have had no side effects from this drug.  As with every other patient taking the drug, it wasn’t even prescribed until after we had tried dietary changes, exercise and weight reduction.  My body seems to have a mind of its own (love the juxtaposition of body and mind), and paid no attention to any of my efforts; hence, the drug regimen.

That’s a pretty long involved explanation of why I was in Dr. Zhao’s office at all.  The good news is that with all my complaining – and there’s been plenty – about the exercise and renal diet, my eGFR (estimated glomerular filtration rate) went up to 60 from 50.  That is borderline between stage 1 or normal kidney function and stage 2 or mild chronic kidney disease. This, after three years of being at stage 3 or moderate ckd. I was so floored I was speechless, not at all usual for me.

Of course, along with the good came the bad.  Funny how it always works that way.  It seems my A1c, a blood test which measures how your body handles sugar over a three month period, had risen again.  This has been on a very slow incline for quite a while.  Now it’s 6.3.  At 6.4, I officially have type 2 diabetes.

What is that specifically?  Type 2 is the type that can be controlled by – surprise! – life style changes, while type 1 is insulin dependent or the kind that requires a daily injection.  But wait a minute!  I already limit the sweets (sugar) and make it a point to exercise, so how could this be?

When I asked Dr. Zhao to help me with this, she was able to print out material about diabetic exchanges for meals. I also made an appointment with Crystal Barrera, my nutritionist at Arizona Kidney Disease and Hypertension Center, so she could help me combine the renal, hyperlipidemia, diabetic, and hypertension diets I need to follow. But that’s later on this month. Meanwhile, let’s deal with the material I was given.

Lo and behold, sweets are only one aspect of the diet. I hadn’t realized carbohydrates had so much to do with diabetes. It seems they turn into sugar. Now that I know this, it makes perfect sense.  I just never made the connection. I learned that too many carbohydrates at the same time raise the blood sugar.

Well, I got myself another eye opener as I read.  I always thought of carbohydrates as starches – bread, cereal, starchy vegetables and the beans that I can’t eat anyway since they’re not on the renal diet. But I learned they are also milk and yoghurt (I have never been so thankful to be lactose intolerant), and fruit.

I wasn’t terribly upset since I’m already limited to six units of starches, three of vegetables (starchy or not), three of fruit and one of dairy.  Uh-oh, doesn’t that mean I was already being careful about my food intake? It was a struggle for this miller’s grand-daughter to keep within the bread limits.  What else was I going to have to struggle with?

It turns out the limits for each of the categories of food in the diabetic diet is more liberal than those on the renal diet.  For example, Sunday morning I make gluten free, organic blueberry pancakes. They’re simple, quick and tasty. Bear uses butter and syrup (got some terrific huckleberry syrup for him when I was in Portland, Oregon, for the Landmark Education Advanced Course in June, but I like them plain.) According to the diabetes exchange, one of these counts as a starch (1 4-inch pancake about ¼” thick) and ½ of a fruit exchange (one-half cup of canned or fresh fruit). Wait, there’s more.  I used 1 teaspoon of extra virgin olive oil which is a fat exchange. Hmmmm, this is simply not that different from counting units for the renal diet.

Ah, so the diabetic exchange meal is not that much of a problem for me, it’s combining the restrictions of the four diets I need to follow. I’ve already decided to follow the lowest allowable amount of anything.  For instance, the diabetic exchange allows 2,300 mg. of sodium per day while the renal diet only allows 2,000 mg.  I stay well under 2,000 mg.

I’m beginning to see that I can figure out how to do this myself, but I am so glad to have my nutritionist to verify my conclusions.  You know, the government pays for your nutritionist consultation once a year if you have chronic kidney disease.  It’s not a bad idea to make an appointment.  You may surprise yourself by not being aware of new dietary findings about the renal diet or discovering you’ve accidentally fallen into some bad dietary habit.

Also, as expected, exercise is also important if you (or I) have diabetes. It helps keep your blood sugar levels under control.  The recommendation is 30 minutes five times a week.  I’m already striving for 30 minutes a day every day and don’t want to let that go.  I’m hoping to make that a habit.

I am SUCH a writer!  One of my first thoughts after I was told about the A1c level was, “Maybe I should write a book about type 2 diabetes.”  As far as the ckd book, I was just informed I have blog readers in China who are ordering the book.  Let’s see if we can disseminate the information all over the world.  Here’s to no more terrified newly diagnosed patients!

Until next week,

Keep living your life!

Whatever Happened to Common Sense?

I’d thought I’d be telling you all about Portland for this blog, but two different severe medical emergencies in the family have me thinking it’s more important to keep to medical issues today.  Boy, Bear is a tremendous support. I’d previously blogged about the importance of friends and family in the face of your illness, now I see how important they are in the face of loved one’s (or in this case: ones’) illnesses. Let them in, boys and girls.  They need to be there in support of you as much as you need to be there in support of the one enduring the medical crisis.

Both of these beloved people are in hospitals, two different hospitals in two different states. I looked at the menu of the one in an Arizona hospital and realized that, while this unrestricted diet was tasty and enticing, it was sodium laden.  That reminded me of a Canadian study about the sodium content of hospital food there that I’d read recently. It’s an eye opener and made me wonder about just plain common sense

Hospital meals need to hold the salt

Prepared, processed foods often too high in sodium

 Jul 16, 2012   4:00 PM ET

Hospital patients are getting too much sodium in their food, CBC's Melanie Nagy reports.Salty hospital meals

Hospital patients get too much salt even when they’re on a sodium-restricted diet, says a Canadian study.

On average, Canadians consume 3,400 milligrams of sodium a day, which is 1,100 milligrams over the recommended levels. At least three-quarters of that sodium comes from processed foods.

Restricting sodium is particularly important for certain hospital patients, such as those with heart failure.

Registered dietitian and postdoctoral researcher JoAnne Arcand of the University of Toronto and her colleagues and Mount Sinai Hospital analyzed 84 standard menus for regular, diabetic and sodium-restricted diets at three hospitals in Ontario between 2010 and 2011.

“We demonstrated that hospital patient menus contain excessive levels of sodium,” the study’s authors concluded in a letter published in Monday’s online issue of the Archives of Internal Medicine. [I could not ascertain if they meant Monday, 7/23/12, or the previous Monday.  Sorry, folks.]

You can find the entire article at: http://www.cbc.ca/news/health/story/2012/07/16/salt-hospital-food.html?cmp=rss

This reminded me of another article I’d read that seemed somewhat unnecessary since I’d thought it was just common sense.  Maybe it isn’t. Basically the article discussed the salt content of fast foods and how that pertains to CKD patients.

Salt Intake and Hypertension – the plot thickens….

 

There is good evidence to support a connection between salt intake and population-based blood pressure levels. Excess dietary salt is associated with increased blood pressure in individuals. It has also been argued that like the effects of restraining tobacco consumption there would also be a salutary effect on population outcomes if salt intake was constrained. A recent article in the June 12 issue of CMAJ by Elizabeth Dunford and colleagues is a must-read because of it’s practical importance.
Basically, Dunford and co-workers performed a survey assessing the salt content of food items sold by 6 trans-national food companies operating in the US, Australia, Canada, France, New Zealand, and the UK. They calculated mean salt content and compared these within and between countries and companies. The companies involved were: Burger King (known as Hungry Jack’s in Australia), Domino’s Pizza, Kentucky Fried Chicken, McDonald’s, Pizza Hut and Subway….

The authors conclude: “Decreasing salt in fast foods would appear to be technically feasible and is likely to produce important gains in population health — the mean salt levels of fast foods are high, and these foods are eaten often. Governments setting and enforcing salt targets for industry would provide a level playing field, and no company could gain a commercial advantage by using high levels of salt.”
 
The other practical point, of course, is that when we see patients with CKD  who invariably have hypertension that is difficult to control, we should educate them about salt content in fast food items and how much variability there currently is.
 
I simply could not accept that we were as senseless as these two articles seemed to indicate, so I mined all the articles I’d saved about sodium and thankfully came up to this one.  It’s clear and offers you some control about the sodium in your life.

According to CDC [that’s the Centers for Disease Control and Prevention] Director Thomas Frieden, MD, “Too much sodium raises blood pressure, which is a major risk factor for heart disease and stroke. These diseases kill more than 800,000 Americans each year and contribute an estimated $273 billion in healthcare costs.”  But nutritionists believe that salt poured at the table is rarely the  culprit in sending Americans past the threshold, because eaters can more  easily control the salt shaker at home; it’s the hidden salt found in many processed foods, or in meals eaten outside the home, that help push Americans over the limits. CDC estimates that reducing the sodium content of the 10 leading sodium sources by 25% would lower total dietary sodium by more than 10% and could play a role in preventing up to an estimated 28,000 deaths per year.

The article contained a chart and suggestions that made it simple to understand  table salt is not the culprit.  Here we are congratulating ourselves for banishing the salt shaker from our tables only to discover it’s the salt INSIDE the foods we eat that do much damage, too. You can see that chart and those  terrific suggestions at: http://www.primaryissues.org/2012/03/lick-the-salt/?utm_source=rss&utm_medium=rss&utm_campaign=lick-the-salt

Many thanks to Tamara Jansen at AKDHC for her continued support via the flyer campaign in their offices. Don’t want to forget about being grateful in the midst of my personal woes right now.

To Cheryl, Nima and everyone else who is hospitalized at this time: keep faith – there are such wonderful, medical innovations being used these days and, please, let those of us who want to support you do it.  You have no idea how much it means to us.

Until next week,

Keep living your life!

World Kidney Day Is Over, But It’s Still National Kidney Month

Maybe it’s because I’m so enmeshed with anything early stage Chronic Kidney Disease, but I find myself constantly surprised by all the people who don’t know a thing about it – many of them suffering from high blood pressure (the second most prevalent cause of CKD) or diabetes (the first most prevalent cause of CKD).  I shouldn’t be.  I was one of them until I was diagnosed… and that’s why I’m so adamant about ‘getting the word out there,’ as I’ve come to call my passion.

One of my daughters, a blogger, asked me to guest blog about this issue last week.  While Nima was making her request to me, her sister – Abby – was surprising us all with a ticket for Nima to visit.  Abby and I live in Arizona; Nima lives in New York so visits are not all that frequent. I was thrilled!!!!

Unfortunatley, Abby ended up getting pretty sick, so Nima stayed with us for a few days.  And we talked, and talked, and talked.  I told her I was still angry that, because I have CKD, the chances of her (and her sister) developing it is higher.  She asked me questions about the diet and exercise.  We ended up sharing a meal each and every time we went to a restaurant and leaning more toward the food on the renal diet rather than food that isn’t. Right now, she’s walking my dog while I blog (*sigh* guess I’ll have to figure out my own exercise for today later).

Maybe today is the day to go back to basics about dealing with Chronic Kidney Disease in my blog.  Let’s start with the American Kidney Fund’s information:

Eat a diet low in salt and fat

Eating healthy can help prevent or control diabetes, high blood pressure and kidney disease.  A healthy diet has a balance of fruits, vegetables, whole grains, dairy products, lean meats and beans.  Even small changes like limiting salt (sodium) and fat, can make a big difference in your health.

Limit salt

  • Do not add salt to your food when cooking or eating.  Try cooking with fresh herbs, lemon juice or other spices.
  • Choose fresh or frozen vegetables instead of canned vegetables.  If you do use canned vegetables, rinse them before eating or cooking with them to remove extra salt.
  • Shop for items that say “reduced-sodium” or “low-sodium.”
  • Avoid processed foods like frozen dinners and lunch meats.
  • Limit fast food and salty snacks, like chips, pretzels and salted nuts.

Limit fat

  • Choose lean meats or fish.  Remove the skin and trim the fat off your meats before you cook them.
  • Bake, grill or broil your foods instead of frying them.
  • Shop for fat-free and low-fat dairy products, salad dressing and mayonnaise.
  • Try olive oil or canola oil instead of vegetable oil.
  • Choose egg whites or egg substitute rather than whole eggs.

Choosing healthy foods is a great start, but eating too much of healthy foods can also be a problem.  The other part of a healthy diet is portion control (watching how much you eat).  To help control your portions, you might:

  • Eat slowly and stop eating when you are not hungry anymore.  It takes about 20 minutes for your stomach to tell your brain that you are full.
  • Check nutrition facts to learn the true serving size of a food.  For example, a 20-ounce bottle of soda is really two and a half servings.
  • Do not eat directly from the bag or box.  Take out one serving and put the box or bag away.
  • Avoid eating when watching TV or driving.
  • Be mindful of your portions even when you do not have a measuring cup, spoon or scale.

 Be physically active

Exercise can help you stay healthy.  To get the most benefit, exercise for at least 30 minutes, 5 days of the week.  If that seems like too much, start out slow and work your way up.  Look for fun activities that you enjoy.  Try walking with a friend, dancing, swimming or playing a sport.  Adding just a little more activity to your routine can help.  Exercise can also help relieve stress, another common cause of high blood pressure.

 Keep a healthy weight

Keeping a healthy weight can help you manage your blood sugar, control your blood pressure, and lower your risk for kidney disease.  Being overweight puts you more at risk for diabetes and high blood pressure.  Talk to your doctor about how much you should weigh.  If you are overweight, losing just a few pounds can make a big difference.

 Control your cholesterol

Having high cholesterol, especially if you have diabetes, puts you more at risk for kidney disease, heart disease and stroke.  It can also cause diabetic kidney disease to get worse faster.

For most people, normal cholesterol levels are:

  • Total Cholesterol: Less than 200
  • HDL (“good” cholesterol): More than 40
  • LDL (“bad” cholesterol): Less than 100

Your triglycerides are also important.  People with high triglycerides are more at risk for kidney disease, heart disease and stroke.  For most people, a healthy triglyceride level is less than 150.

If your total cholesterol, LDL or triglycerides are high, or if your HDL is low, talk to your doctor.  Your doctor may suggest exercise, diet changes or medicines to help you get to a healthy cholesterol level.

 Take medicines as directed

To help protect your kidneys, take medicines as directed.

Some medicines may help you manage conditions that can damage your kidneys, like diabetes or high blood pressure.  Ask your doctor how to take any medicines he or she prescribes.  Make sure to take the medicines just how your doctor tells you.  This may mean taking some medicines, like blood pressure medicines, even when you feel fine.   Other medicines can harm your kidneys if you take them too much.  For example, even over-the-counter pain medicines can damage your kidneys over time.  Follow the label directions for any medicines you take.  Share with your doctor a list of all of your medicines (even over-the-counter medicines and vitamins) to help make sure that you are not taking anything that may harm your kidneys.

 Limit alcohol

Drinking alcohol in large amounts can cause your blood pressure to rise.  Limiting how much alcohol you drink can help you keep a healthy blood pressure.  Have no more than two drinks per day if you’re a man and no more than one drink per day if you’re a woman.

 Avoid tobacco

Using tobacco (smoking or chewing) puts you more at risk for high blood pressure, kidney disease and many other health problems.  If you already have kidney disease, using tobacco can make it get worse faster.

If you use tobacco, quitting can help lower your chances of getting kidney disease or help slow the disease down if you already have it.

You can find this information and more at: http://www.kidneyfund.org

This blog has a p.s. after the farewell.  Be sure to read it for a another really delightful surprise and until next week,

Keep living your life!

Nima is also my computer guru, so she showed me quite a bit while she’s here – including how to see the number of people ‘Talking About’  the Facebook page at Facebook.com/WhatHowEarlyCKD (which includes this blog).  Sit down before you read these numbers.

  • Countries
    12,968,464
    United States of America
    1,802,022
    United Kingdom
    1,324,900
    India
    997,242
    Canada
    735,784
    Australia
    718,074
    Philippines
    278,090
    Malaysia
    265,313
    Pakistan
    146,796
    Italy
    139,240
    Ireland
    137,382
    Turkey
    137,199
    Tunisia
    133,749
    Germany
    132,983
    United Arab Emirates
    131,905
    New Zealand
    122,384
    Egypt
    106,798
    Mexico
    104,727
    Saudi Arabia
    102,007
    Singapore
    90,359
    South Africa
  • Languages
    17,461,481
    English (US)
    3,197,319
    English (UK)
    248,597
    French (France)
    236,736
    Spanish
    132,372
    Turkish
    127,798
    Italian
    104,827
    German
    74,151
    Spanish (Spain)
    65,797
    Arabic
    61,022
    English (Pirate)
    52,742
    Indonesian
    51,763
    Portuguese (Brazil)
    43,362
    Thai
    31,794
    Dutch
    27,905
    Greek
    24,778
    Hungarian
    24,629
    Portuguese (Portugal)
    24,559
    Korean
    20,136
    Polish
    19,728
    Simplified Chinese (China)

So That’s What It Means

I have spent almost four years researching, reading, printing, and then promptly forgetting about phosphorous.  I keep writing about the three Ps and salt and ending up having to remind myself what phosphorous is and why we need to limit our intake of it each time I write about it.  I was comfortable with protein and easily remembered what I learned about potassium, but phosphorous?  This one just plain eluded me.

I keep a log of interesting articles I run across just in case there’s a Monday that I can’t think of anything special.  That’s what I thought today was going to be.  I tried to start the blog with something about the downright beautiful Arabians we saw at the Arabian Horse Show on Saturday and couldn’t figure out where to go with that.  Then I thought I’d write something about being sick with the flu if you’re a CKDer, but worked on that one on the Facebook page. Maybe something about the wood shop being constructed in my garage?  Naw.  What does that have to do with CKD?

Before I looked over my backlog of articles, I took a quick peek at Twitter.  Bingo.  Seems that my backlog will just have to stay my backlog until the second part of this blog.  An article from Food Navigator.com caught my eye.  I understand it and it feels like I’ll remember it.  Sometimes it just works like that.  So here is the mystery of phosphorous in our daily lives solved.  The article is copy right protected so I can only give you the link, but I’d urge you to read it:

http://www.foodnavigator.com/Science-Nutrition/Phosphate-in-food-is-health-risk-that-should-be-labelled-claim-researchers

As I was scurrying around making dinner yesterday, my mind consumed with phosphorous, I noticed the bread I was munching on (You know the story: grandfather was a miller in the Ukraine, love of bread in my genes, hardest part of the renal diet for me) tasted salty.  Sure enough, when I started poking around in my files, I found this Feb. 7, 2012 article from NPR.com. Notice that last sentence reference to potassium.

To Hold The Salt, It’s Time To Hold The Bread

by Eliza Barclay

                                                            The sandwich on the left has a total of 1,522 milligrams of salt (per whole sandwich), while the other one has only 853 mg.

                          The sandwich on the left has a total of 1,522 milligrams of salt (per whole sandwich), while the other one has only 853 mg.

It’s no secret that some of the tastiest snacks around — potato  chips, french fries, and processed deli meats — are terrific vehicles  for salt. Without salt, they’d be bland, too starchy, or just plain  dull.

But would you guess that the white bread on your turkey sandwich  could be delivering almost as much as the turkey — up to 400 mg of sodium, or about one-third of  the daily recommended limit for 6 of every 10 adults?

A report out today from the U.S. Centers for Disease Control and Prevention  unmasks bread and some other sneaky sodium-heavy foods. It turns out  that 10 foods — from bread to poultry to cheese to pasta dishes — are responsible  for more than 40 percent of people’s sodium  intake.

According to  the CDC, the average American consumes about 3,300 milligrams of sodium   per day, not including any salt that may be added during a meal.  That’s way more than we need, and puts us at risk for high blood pressure, which can lead to heart disease and stroke.

The U.S. Dietary Guidelines recommend no more than 2,300 mg a day, except if you’re over 51 years  or African American or have high blood pressure, diabetes or chronic  kidney disease. For those groups, the recommendation is 1,500 mg a day.

But   it’s clearly hard to stay within the limits, especially because we can’t control the sodium in some of our foods. Some 65  percent of sodium comes from food  sold in stores, and 25 percent comes  from restaurants. The salt shaker on the kitchen table  isn’t really the problem — it’s the industrial quantities of saline  sodium and crystals that are dumped into processed food to help preserve them and boost their addictiveness.

As public health institutions and other health groups have zeroed in on sodium, sugar and other ingredients in food that can negatively impact health, they’re increasingly looking to food companies to make some changes. Some have responded with commitments. Kraft Foods, purveyor of such salty snacks as Velveeta and Ritz crackers, said in 2010 it would reduce sodium by 10 percent over a two-year period. Last  year, Walmart also said it would cut the sodium in packaged foods by 25  percent by 2016.

Food companies also need to worry about how much potassium is left in food, as Shots has reported.   It turns out that consuming a lot of salt in combination with  too  little potassium is  associated with a greater risk of death, according to researchers from  the Centers for Disease Control and Prevention, Emory and Harvard.

Phosphorous, sodium, potassium.  Apologies to protein for not including it in this blog.

Before I say goodbye, notice the buttons for both the Facebook page and Twitter beneath the blog roll.  We aim to make life easier!

Until next week,

Keep living your life!

Why is high blood pressure important again?

ScienceDaily (Sep. 23, 2011)

The kidney performs several vital functions. It filters blood, removes waste products from the body, balances the body’s fluids, and releases hormones that regulate blood pressure. A number of diseases and conditions can damage the kidney’s filtration apparatus, such as diabetes and immune disorders. This damage leads to a condition called nephrotic syndrome, which is characterized by protein in the urine, high cholesterol and triglycerides, and swelling (edema). People with
nephrotic syndrome retain salt and water in their bodies and develop swelling and high blood pressure as a result.

Scientists have now begun to understand kidney damage on a cellular level and how the activity of certain molecules in damaged kidneys contributes to salt and water retention in nephrotic syndrome. Several new insights in this area of research will be presented at the 7th International Symposium on Aldosterone and the ENaC/Degenerin Family of Ion Channels, being held September 18-22 in Pacific Grove, Calif. The meeting is sponsored by the American Physiological Society.

Faulty Filtration

The kidneys are marvels of filtration, processing roughly 150 to 200 quarts of blood each day through tiny structures called nephrons. There are about 1 million nephrons per kidney, and each nephron consists of a filtering unit of blood vessels called a glomerulus, which is attached to a tubule. Filtered blood enters the tubule, where various substances are either added to or removed from the filtrate as necessary, and most of the filtered sodium and water is removed. The filtrate that exits the tubule is excreted as urine.

In nephrotic syndrome, a damaged filtration barrier allows substances that are not normally filtered to appear in the filtrate. One of these substances is the protein plasminogen, which is converted in kidney tubules to the protease plasmin. In their research, Thomas R. Kleyman, Professor of Medicine and of Cell biology and Physiology at the University of Pittsburgh School of Medicine and the Symposium’s co-organizer, and Ole Skøtt, Professor of Physiology and Pharmacology
and Dean at the University of Southern Denmark in Odense, independently found that plasmin plays a role in activating the epithelial sodium channel (ENaC) on cells in the nephron. ENaC is a protein embedded in cell membranes that facilitates the absorption of filtered sodium from tubules. When ENaC is becomes overactive, excessive absorption of filtered sodium may lead to sodium and water retention.

According to Dr. Kleyman, these findings provide an explanation of how damage to the glomeruli in the kidney’s nephrons leads to edema and high blood pressure. Dr. Kleyman explains: “When plasminogen is cleaved, it can act on several targets. One of those targets is ENaC. Another is the protein prostasin, which, once cleaved, will activate ENaC, as well.”

Dr. Kleyman noted the implications these findings have for treating edema and high blood pressure in patients suffering from nephrotic syndrome. “This is important because if plasmin activates ENaC, it suggests that targeting ENaC in the kidneys with ENaC inhibitors may be a treatment option.”

You can find the article at: http://www.sciencedaily.com/releases/2011/09/110922134615.htm  

Story Source:

The above story is reprinted (with editorial adaptations by ScienceDaily staff) from materials provided by American Physiological Society, via EurekAlert!, a service of AASS.

While CKD and Nephrotic Syndrome are not the same, the explanation of the inter-relationship between high blood pressure and kidney damage (which wasn’t bold type in the original article – I did that because it’s in the middle of the article) is very clear.

Looks like WordPress is having formatting problems for which I apologize even though I’m not in control of that.  Now put down that salt shaker and go back to checking food labels for sodium content.

Until next week,

Keep living your life!

One Third Of The Three Ps

The book singing at Dog Eared Pages was both successful and fun.  Thank you to Melanie Tigh who invited me to join this event and, of course, to everyone who attended.  I only took a few pictures with my camera, so if you have pictures from the event you’d like me to post on the blog, please send me links to them and I will.  That’s Dawn Meyers with me in one of the pictures. 

 

 

 

 

 

 
 

I’ve written about the three Ps and salt in my book and on the blog, too. The one third of the three Ps discussed in this article from The Los Angeles Times is potassium. To refresh your memory, potassium counteracts sodium’s effect on blood pressure. There was also a banana in my breakfast; that’s one fruit unit on the renal diet and 467 mg of potassium.  That’s not bragging.  It’s to show you just how easy it is to incorporate potassium into yor meals.

 

In with potassium, out with sodium                    

People whose diets have roughly equal amounts of sodium and potassium are at the lowest risk of dying from heart attack and stroke, new study finds.

By Jill U. Adams, Special to the Los Angeles Times

July 24, 2011

For decades now, we’ve heard that too much sodium can cause hypertension and raise the risk of cardiovascular disease.People have paid far less attention to potassium, a mineral that has opposite effects on health: Get enough of it, and it can actually lower your blood pressure and protect your heart.

Now a study of more than 12,000 adults has underscored something that doctors and nutritionists have been saying for years: If you watch your sodium but ignore potassium, you’re missing an important part of the picture.

The study, published in the July 11 issue of the journal Archives of Internal Medicine, found that people whose diets had the lowest ratio of sodium to potassium (translating to roughly equal amounts of the two nutrients) were at the lowest risk of dying from heart attack and stroke. Those who consumed the highest amounts of sodium relative to potassium — 50% more, on average — had a 46% higher risk of dying from cardiovascular-related illness.

However, the study did not prove a cause-and-effect relationship, said coauthor Dr. Elena Kuklina, a nutritional epidemiologist at the U.S. Centers for Disease Control and Prevention in Atlanta. “We found some relationship between diet and mortality, but since it was not a clinical trial, we can’t say for sure that diet is a
cause of mortality.” To show cause and effect, scientists would have to put people on set diets, randomly assigned, for a long period of time and follow them until they died — an inordinately difficult undertaking.

Though doctors know that potassium plays a significant role in heart health, many are reluctant to take any attention away from sodium, said Dr. Gordon Tomaselli, president of the American Heart Assn. and chief of cardiology at Johns Hopkins University in Baltimore. “Sodium is important,” he reiterated. People can improve
their cardiovascular health simply by eating less of it, he said, and any benefit from high potassium foods would be a bonus.

The new study followed 12,267 adults for an average of 14.8 years. Researchers used dietary surveys to estimate the potassium and sodium intakes at the start of the study. As expected, people who consumed the most sodium were also the most likely to die during the study — a 73% increase over those who consumed the least sodium — while people who consumed the most potassium had relatively low death rates — a 39% lower risk than those who consumed the least.

But the balance between sodium and potassium mattered, too. Those participants who got high sodium and low potassium had the highest death rates of all: a 46% higher risk of dying from any cause than those who ate equal proportions of the nutrients. They were especially vulnerable to death from heart attack, for which the risks doubled.

Tomaselli said the study was noteworthy because of the large number of participants representing a cross-section of Americans and because they were followed for long enough to include a significant number of deaths. However, dietary intake was not directly measured but was estimated based on each subject’s memory. And even assuming that the estimates are accurate, Tomaselli noted that diets heavy in sodium and light in potassium may be unhealthful in ways that have little to do directly with the two minerals.

A  previous study, published in the Archives of Internal Medicine in 2009, also found an association between cardiovascular disease and the balance between sodium and potassium. Rather than estimating dietary intake, researchers measured actual levels of sodium and potassium in the urine of 2,275 subjects with prehypertension (diastolic blood pressure between 80 and 89) and followed them for 10 to 15 years.

Again, higher sodium seemed to increase the risk of heart attack and stroke, and potassium seemed to have the opposite effect. But the only association that passed muster statistically was the balance between sodium and potassium. “The size of the effect was very similar to the CDC study,” noted study coauthor Nancy Cook, a researcher in preventative medicine at Brigham and Women’s Hospital in Boston.

Focusing on the ratio between sodium and potassium makes biological sense because the minerals are known to have opposite effects on blood pressure, Kuklina said. Sodium generally increases blood pressure and signals the body to retain fluids. Potassium, however, relaxes blood vessels, lowers blood pressure and helps rid the body of excess fluids.

The U.S. dietary guidelines recommend limiting sodium intake to 2,300 milligrams per day and even lower — 1,500 mg — for those 51 and older and people of any age who are African American or have high blood pressure, kidney disease or diabetes. (The American Heart Assn. recently switched to a target of 1,500 mg per day for everyone.)

The average daily intake of sodium by Americans is much higher than that — more than 3,400 mg per day, according to CDC estimates.

Recommended potassium intake is 4,700 mg per day, but average U.S.intake is in the range of only 2,000-2,500 mg per day, Cook said.

For those whose eyes already glaze over when told to read nutrition labels, there’s a simpler way to reduce sodium and increase potassium in your diet: Choose fresh, whole foods over packaged, processed ones.

More than 75% of American sodium intake comes in the form of processed foods, Kuklina said. And the best potassium sources are fruits and vegetables such as potatoes, bananas, grapes, carrots, greens and citrus fruits. Simply by eating fewer processed foods you can decrease your sodium intake and increase your potassium intake in one fell swoop.

“The message is to eat a healthy balanced diet,” Kuklina said. “It’s good for health in general and for cardiovascular health.”

The article’s address is: http://www.latimes.com/health/la-he-salt-potassium-heart-20110724,0,5730467.story

For those of you who are local and know a member who will invite you,  I’ll be speaking at the North Phoenix Kiwanis Club on September 20th.  That’s a week from Tuesday.  It is a lunch time meeting.
 
Until next week,
Keep living your life!

 

 

 

 

 

 

 

 

 

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Published in: on September 12, 2011 at 12:20 pm  Leave a Comment  

Yes! Yes! Yes!

I read this New York Times article and jumped up exclaiming, “He understands! He really understands!”  The he to whom I referred is Dr. Joseph Vassalotti of Mount Sinai Medical Center and private practice in New York. He also just happens to be chief medical oficer of the National Kidney Foundation.

If you read this blog, you know I wrote “What Is It And How Did I Get It? Early Stage Chronic Kidney Disease” because I didn’t want anyone else to be in the position I’d been in: newly diagnosed, scared, not taking in what my nephrologist was telling me and not knowing that I could take a more active part in maintaining my kidney function nor how to do that.  Dr. Vassalotti realized how new patients react to the information their doctors give them by simply asking a patient what he had heard.  All the patient heard was the diagnose. But I’ll let you read about this yourselves:

 

Doctors sharpen message on kidney disease

By JANE E. BRODY

Twenty-six million Americans have chronic kidney disease, and avoiding complications depends heavily on how well patients care for themselves.

A patient with early stage kidney disease provided a recent wake-up call for Dr. Joseph Vassalotti, a leading kidney specialist. After explaining the diagnosis in great detail, the doctor asked his patient to repeat what he had heard in his own words.

With a rather bored look on his face, the man said, “Kidney disease, yada yada yada yada.”

Vassalotti, a nephrologist at Mount Sinai Medical Center in New York and chief medical officer of the National Kidney Foundation, was stunned. It was hardly the first time he had explained kidney disease to one of his patients, and he thought he knew how to help them recognize its seriousness and to motivate them to do what they could to forestall the day when their kidneys failed and dialysis or a transplant would be the only option for survival.

“I learned a lot from this patient,” Vassalotti told me. “Clearly my explanation was not pitched correctly to fit his level of understanding and his attitude toward his health.”

Twenty-six million Americans have chronic kidney disease, which has a number of causes — most often diabetes and high blood pressure. As the kidneys begin to fail, the body’s waste products build up in the bloodstream, leading to anemia, nerve damage, heart disease and other ailments.

As with heart disease and diabetes, avoiding these complications depends heavily on how well patients care for themselves. But the disease is symptomless, at least in the early stages, and many patients fail to appreciate that they are gradually heading toward a precipice.

The medical profession has been trying harder in recent years to communicate better with patients, but clearly there are serious impediments. Doctors are grappling with shortage of time and lack of training on how best to get needed information and advice across in terms that patients can hear and understand.

Too often, doctors speak in medicalese, a foreign language to their patients. Or they may be reluctant to place all the cards on the table, concerned that patients may become so fearful they fail to hear important information. Unlike Vassalotti, some doctors never ask patients what they understood.

Medicare now reimburses for educating patients with relatively advanced kidney disease, but not for those in the early stages.

MANY CARELESS PATIENTS

Communication is a two-way street, however, and patients with chronic kidney disease also are contributing to its failure in several ways. Many lack health literacy. Unable to understand even simplified medical terms, they may misinterpret what a doctor tells them or forget it entirely.

They may be too intimidated to ask questions or request a clarification. They may regard all medical matters to be the doctor’s purview. Or they may be fatalists who assume whatever will be, will be.

What kidney patients do, and don’t do, can make a huge difference in the quality and length of their lives. Whether they follow through on medical advice depends heavily on what they know about their disease and  what can make matters better or worse, Vassalotti said in an interview.

In a study published in March in The American Journal of Kidney Disease, a research team at Vanderbilt University Medical Center in Nashville uncovered serious knowledge gaps among 401 patients with various stages of the disease.

The team, headed by Dr. Kerri L. Cavanaugh, a nephrologist, pointed out that within the general population, most people with kidney disease don’t know they have it. And among those who do know, a previous study of 676 patients with moderate to advanced kidney disease had found that more than a third knew little or nothing about it and nearly half knew nothing about treatment options should their kidneys fail completely.

Participants in the Vanderbilt study were being treated at the university’s nephrology clinic for chronic kidney disease. They ranged in age from 46 to 68; 53 percent were men, 83 percent were white and 94 percent had completed high school or higher. More than half had seen a nephrologist at least three times in the past year, and 17 percent had attended a kidney education session.

When asked whether they had chronic kidney disease, however, more than a third answered “no.” The 28-question survey revealed that only about 1 in 5 knew that protein in the urine was a sign of poor kidney function and that kidney disease often progresses without causing any symptoms.

Only 2 in 5 knew that controlling blood sugar is important in kidney disease, although more than 90 percent knew it is important to control blood pressure.

The usual lack of symptoms as kidney disease progresses is especially critical for patients to understand, because many fail to seek medical care or follow medical recommendations when they feel well.

Dr. Julie Anne Wright, an author of the Vanderbilt study, said that it “highlights the need for providers to ensure that communication is not only delivered but understood by all parties involved.”

LIFE-ENHANCING FACTS

Here is what everyone with chronic kidney disease and those at increased risk of developing it should know.

• There are four main risk factors for kidney disease: diabetes, high blood pressure, age over 60 and a family history of the disease. Anyone with these risk factors should have a test of kidney function at least once a year, Vassalotti said. Members of certain ethnic groups are also at higher than average risk: blacks, Hispanics, Pacific Islanders and Native Americans.

• Two simple, relatively inexpensive tests, easily done during a routine doctor visit, can detect declining kidney function: a blood test called eGFR (for estimated glomerular filtration rate, a measure of kidney function) and urine albumin, which shows whether the kidneys are spilling protein.

• Early detection can delay progression to kidney failure, when dialysis or transplant is the only option. Good control of blood sugar, blood pressure, cholesterol levels and body weight can delay the loss of kidney function. Not smoking and getting regular physical activity and sleep are also important.

• Certain drugs and dyes are toxic to the kidneys and should be avoided by people with kidney disease. The drugs include painkillers like acetaminophen, aspirin and ibuprofen; laxatives and antacids that contain magnesium and aluminum (Mylanta and Milk of Magnesia); ulcer drugs like Tagamet and Zantac; decongestants like Sudafed; enemas that contain phosphorus (Fleet); and Alka-Seltzer, which is high in salt. Contrast dyes used for certain tests, like angiograms and some MRIs, can
also be harmful to kidney patients.

• When kidney disease progresses, patients can develop symptoms like changes in urination; swelling in the legs, ankles, feet, hands or face; fatigue; skin rashes and itching; a metallic taste in the mouth; nausea and vomiting; shortness of breath; feeling cold even when it is warm; dizziness and trouble concentrating; and back or leg pain. If any of these occur, they should be brought to a doctor’s attention without delay.

You can read the article for yourselves at: http://topics.nytimes.com/topics/reference/timestopics/people/b/jane_e_brody/index.html?inline=nyt-per
I immediately e-mailed Dr. Vassalotti and Ms. Brody to thank them for making this common knowledge.  I only wish there was enough money in my bank account to get a copy of the book into every newly diagnosed chrnic kidney disease patient.
 
Until next week,
 
Keep living your life!

 
 
 

A Salty Dilemma

Just as I realize all these years of watching the sodium content of foods has left me with a distinct dislike for salty foods – you know, the ones with the most flavor – the salt controversy comes to the fore.  I think you’ll need to take this information with a grain of salt (sorry, couldn’t resist) in light of other recent posts about sodium and health despite the fact that this is Campbell Soup, for heaven’s sake!  The article is long, but clearly presents both sides of the controversy.

Campbell Soup Increases Sodium As New Studies Vindicate Salt

Jul. 18, 2011

Cheddar Cheese canvas from Campbell's Soup Can...

Image via Wikipedia

In February 2010, Campbell Soup announced that it would re-formulate over 60% of its condensed soups to reduce the sodium content of 23 of them up to 45%. With high salt diets having been previously linked to cardiovascular disease in medical studies, health advocates were delighted. Last week the company’s
CEO-elect, Denise Morrison, made another announcement, this time a somewhat more alarming one. The company is putting the salt back in. With Campbell’s soup sales sliding in recent times, Morrison believes that lower salt levels have translated to lower taste for their customers, and that the tweaked offerings may have been responsible for the flagging financials. The company hopes to tempt soup-lovers back by increasing sodium levels up to about 650mg per serving (they had been
brought down from 800mg to 480mg) in many of the cans in their Select Harvest line.

Campbell’s new strategy appears all the more startling in light of the fact that the US Department of Agriculture’s 2011 Dietary Guidelines couldn’t be any clearer on the point that, as a nation, we need to step away from the salt shaker. “Virtually all Americans consume more sodium than they need,” it says.

According to research by the U.S. Centers for Disease Control and Prevention, the average American adult currently consumes 3,436 mg of salt a day. With an estimated 75% of our salt intake coming from processed and packaged foods, the USDA guidelines go on to add: “An immediate, deliberate reduction in the sodium content of foods in the marketplace is necessary to allow consumers to reduce sodium intake to less than 2,300 mg or 1,500 mg per day [for those aged 51+, all African Americans, plus anyone with hypertension, diabetes, or chronic kidney disease] now.”

Faced with pressure to ease up on sodium, big players in the food industry, such as Kraft Foods, Heinz and Unilever have responded by recently joining the National Salt Reduction Initiative (NSRI), which aims to slash salt content in retail and foodservice throughout the country by 20% in five years.

Again, next to this, Campbell’s renegade approach seems irresponsible.  Surely the company should continue to encourage a healthier consumer base which, presumably, will stick around longer to enjoy its products? This is especially since research shows that our perceptions of saltiness and taste intensities can
change over a relatively short period of time. In plain speak, this means that if Campbell’s perseveres with the lower salt offerings and convinces its customers to do the same, diners will quickly grow accustomed to the more modestly seasoned soups.

But, maybe we shouldn’t be so quick to condemn Campbell’s new strategy. After all, recently published pro-sodium studies suggest that
food manufacturers across the board should actually be following Campbell’s lead.
Contrary to everything we’ve been previously fed, a high-profile scientific paper by The Cochrane Library, came to the following straight-stalking conclusion: “cutting down on the amount of salt has no clear benefits in terms of likelihood of dying or experiencing cardiovascular disease”.

The paper, published last week in the Journal of Hypertension, reviewed seven studies, which in total included 6489 participants, a number which, the authors say, provides sufficiently reliable results. The study – led by Professor Rod Taylor from Peninsula College of Medicine and Denistry in the UK, found no evidence to
support the theory that a reduction in salt intake decreases cardiovascular disease or all-cause mortality in those with normal or raised blood pressure. Astonishingly, it also concluded that salt reduction could be detrimental to health. In people with congestive heart failure, salt restriction actually increases the risk of death from all causes, the paper claims.

If this all sounds a little sketchy to you, especially since salt has been demonized no end until now, there’s more research to support the idea that we  should give the tasty mineral a break. You might recall a perplexing study published in the May issue of the Journal of the American Medical Association. It surmised that people who eat lower amounts of sodium are more likely to die from cardiovascular disease and that, among those with normal blood pressure, sodium intake didn’t lead to high blood pressure.

Certainly these pro-salt studies have created something of a media frenzy, and they have amassed critics aplenty. The May study was so riddled with problems and flaws it prompted Harvard researchers to deem its conclusions as “most certainly wrong.” The main complaint was that most of the participants in the study were in their early 40s when the research began, and were only tracked for about eight years. This entailed that the population was too young to reliably determine how
sodium intake could impact their long-term health.

As for the Cochrane Review, medical experts are equally unimpressed. The chief criticism is that one of the studies involved patients with heart failure, meaning the results aren’t relevant to the general population. Participants also only reduced their sodium intake by fairly moderate increments, and were followed for relatively short periods, again, not enough to see a significant difference in their long-term health. To further lessen the credibility of the study, the editor-in-chief of the Journal of Hypertension, Michael Alderman who accepted the paper, once worked as a consultant for the Salt Institute. As you might suspect, this Virginia-based advocacy group touts the benefits of higher sodium consumption while warning efforts to cut salt could be disastrous for the population’s wellbeing.

Indeed the Salt Institute couldn’t be more delighted with the recent research, as well as Campbell’s announcement of its intention to up salt levels. “The scientific evidence is overwhelming,” said Lori Roman, President of the Institute, clearly unconvinced of the criticism lobbed at the pro-sodium studies. “[I]t is time for the government to cease its costly and wasteful efforts to reduce salt consumption until it can conclusively prove a tangible benefit for all consumers.”

But before you throw caution to the wind, and open up that bag of salt and vinegar chips in anticipation of Campbell’s tastier potages, you might want to consider another study that was also published last week, this time in the Archives of Internal Medicine. Researchers from the Centers of Disease Prevention and Control concluded that Americans who consume a diet high in sodium and low in potassium have a 50% increased risk of death from any cause, and have twice the risk of death from heart attacks. The group found that high salt intake was associated with a 20% increased risk of death, while high potassium intake was associated with a 20% decreased risk of dying. Also, don’t forget the link between a salt-heavy diet and high blood pressure is relatively well established, even the Cochrane Review couldn’t undermine this widely accepted relationship.

So where does this leave Campbell’s? In light of the lack of conclusive evidence linking sodium to an increased risk of cardiovascular disease, is the company justified in increasing salt? Perhaps the assertion that customers should have the right to choose whether they consume higher or lower levels of salt is in fact a fair and balanced one? After all, Campbell’s still plans to include a number of low-sodium options among its soup offerings. And let’s face an unfortunate reality; consumers are less concerned about salt in their diet than they are about other nutritional no-no’s such as fat and sugar. The bottom line is that fat and sugar makes us well, fat, and there’s no escaping this truth. We read it in magazines; we see it on TV, and even posters on the subway shout about the blubberizing impact of sugary, fatty foods. Salt, on the other hand, doesn’t effect our appearance in the same way  – although admittedly, it can lead to bloating and water retention, but not everyone is cognizant of this. So while we might compromise on taste to save our figures, we don’t make the same allowances to save our insides. Indeed, Campbell’s
incoming CEO Denise Morrison was explicit in her analysis that sodium reduction is not a priority USP for many consumers.

Campbell’s big mistake might have been boasting about its salt reduction initiatives. Change doesn’t always sell. Remember when Coca-Cola launched New Coke in 1985, and accompanied the re-jigged recipe with a massive marketing campaign? The altered drink was a huge failure and the original formula had to be reinstated. Who knows, had Coca-Cola kept the change quiet maybe we’d all be drinking New Coke now. Similarly, had Campbell’s gone about reducing salt in small increments and not made a lot of noise about it, maybe its consumer base wouldn’t have even noticed. Unilever found in a 2007 study in the Netherlands that when consumers were given two identical samples of Lipton Cup-a-Soup and were told one had 25% less sodium, the majority of respondents said the soup labeled as low-salt tasted inferior.

You can find Nadia Arumugan’s well written and documented  “Chew On This ” blog at:  http://blogs.forbes.com/nadiaarumugam/feed/.  She raises some interesting points. As CKD patients, does it behoove us to keep our sodium levels low?  I say it does, since hypertension plays a part in our disease. You need to remember that we are NOT part of the general population anymore.  As I mention in my book, CKD affects all your other medical issues.

On to another topic, my vote on www.baselineyourhealth.org is yes. Everything you need is right there: background information, calculators, and reading material. It’s well organized and easy to use.

By the way, I was interviewed by The Wellness Show about the book and will let you know when the show will be aired.

Until Friday,

Keep living your life!

Published in: on August 9, 2011 at 9:56 am  Leave a Comment  

They’re Connected

If  you’ve had the chance to read my book yet, you’ll know there was a time when I had a low potassium count.  That’s when the nephologist gave me a list of low, medium and high potassium foods and told me to eat more of the high potassium foods.  There was no accompanying explanation for why as far as I can remember.
According to BrightHub.com’s February 13th article “The Importance of the Potassium and Sodium Balance”:
            When there is a potassium and sodium balance, cells, nerves and muscles can all function smoothly. With an imbalance, which
             is almost always due to both an excess of sodium, and a deficiency of potassium, a set of reactions occurs leading to high blood
            pressure and unnecessary strain on blood vessels, the heart and the kidneys. Research has shown that there is a direct link bet-
            ween chronic levels of low potassium and kidney disease, lung disorders, hypertension and stroke.
You can read the entire article at: http://www.brighthub.com/health/alternative-medicine/articles/43423.aspx#ixzz1TtfbTgxQ
Now that you and I know how the two minerals interact, the following article makes sense.  As a matter of fact, it makes me wonder why these guidelines were not put into place a long time ago.   Applause for Nurses.com, please! They’re the ones who have explained in terms we can all understand why the Dietary Guidelines for Americans needed to be changed.  Now, if only I could figure out how we became such a sodium loving culture in the first place….

Study: Sodium, potassium both affect mortality

Nurse.com News
Saturday July 16, 2011Americans who eat a diet high in sodium and low in potassium have a 50% increased risk of death from any cause, and about twice the
risk of death from a myocardial infarction, according to a study.
Researchers with the Centers for Disease Control and Prevention, Emory University and Harvard University said the study is the first to examine, using a nationally representative sample, the association between mortality and people’s usual intake of sodium and potassium. The study analyzed data from the National Health and Nutrition Examination Survey, a survey designed to assess the health and nutritional status of adults in the United States. Usual intake of sodium and potassium was based on dietary recall.

“The study’s findings are particularly troubling because U.S. adults consume an average of 3,300 milligrams of sodium a day, more than twice the current recommended limit for most Americans,” Elena Kuklina, MD, PhD, an investigator on the study and a nutritional epidemiologist with the CDC’s Division for Heart Disease and Stroke Prevention, said in a news release.

“This study provides further evidence to support current public health recommendations to reduce sodium levels in processed foods, given that nearly 80% of people’s sodium intake comes from packaged and restaurant foods. Increasing potassium intake may have additional health benefits.”

The 2010 Dietary Guidelines for Americans recommend limiting intake of sodium to 1,500 milligrams a day for people 51 and older, African Americans and those who have hypertension, diabetes, or chronic kidney disease — about half the U.S. population ages 2 and older. The dietary guidelines recommend that all other people consume less than 2,300 milligrams of sodium a day. In addition, the guidelines recommend that people choose more potassium-rich foods, advising 4,700 milligrams of potassium per day.

Sodium, primarily consumed as salt, is commonly added to many processed and restaurant foods, while potassium is naturally present in many fresh foods. For example, cheese, processed meats, breads, soups, fast foods and pastries tend to have more sodium than potassium. Yogurt, milk, fruits and vegetables tend to have less sodium and more potassium. Potassium-rich fruits and vegetables include leafy greens such as spinach and collards, grapes, blackberries, carrots, potatoes and citrus fruits such as oranges and grapefruit.

In general, people who reduce their sodium consumption or increase their potassium consumption — or do both — benefit from improved blood
pressure and reduce their risk for developing other serious health problems, according to the researchers. They said adults can improve their health by knowing recommended limits for daily sodium intake; choosing foods such as fresh or frozen fruits and vegetables, unprocessed or minimally processed meat or poultry, low-fat milk or plain yogurt; asking for foods with no or low salt at restaurants, and reading the nutrition labels of foods before purchasing can improve health for all adults.

The CDC is working with public- and private-sector partners at the national, state, and local levels to educate the public about the health effects of sodium and to reduce sodium intake. The agency is also enhancing the monitoring of sodium intake and expanding the scientific literature on sodium and health.

The study appeared July 11 in the Archives of Internal Medicine: http://archinte.ama-assn.org/cgi/content/short/171/13/1183. (I found this to be a dead link, but was able to locate the original AMA article at:http://researchmedicalcenter.com/your-health/index.dot?id=NRCN654756&lang=English&db=nrcn&ebscoType=healthindex&widgetTitle=EBSCO%20Health%20Library%20Index .)

http://news.nurse.com/article/20110716/NATIONAL02/107180022/-1/frontpage is the URL for the Nurse.com article.

Until Friday, watch your sodium/potassium balance and
Keep living your life!    

 

Published in: on August 2, 2011 at 11:50 am  Leave a Comment  
Tags: , ,

Another Job For The Kidneys

Our kidneys are very busy organs, indeed.  The 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 stimuate 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.  And now, scientists have discovered they perform yet another function for us.

Science Daily ran the following article on the 21st of this month:

Science News

Kidney Dopamine Regulates Blood Pressure, Life Span

 The neurotransmitter dopamine is best known for its roles in the brain — in signaling pathways that control movement, motivation, reward, learning and memory.

Now, Vanderbilt University Medical Center investigators have demonstrated that dopamine produced outside the brain — in the kidneys — is important for renal function, blood pressure regulation and life span. Their studies, published in the July Journal of Clinical Investigation, suggest that the kidney-specific dopamine system may be a therapeutic target for treating hypertension and kidney diseases such as diabetic nephropathy.

Previous studies had suggested a role for dopamine in regulating kidney function and total body fluid volume, “but how that mechanism works was not clear,” said Raymond Harris, M.D., chief of the Division of Nephrology and Hypertension at Vanderbilt.

To explore dopamine’s role in the kidney, Harris and Ming-Zhi Zhang, M.D., assistant professor of Medicine at Vanderbilt, eliminated kidney-specific dopamine production in mice (by knocking out a dopamine-generating enzyme only in the kidney) and studied the outcome.

They found that mice lacking kidney dopamine had high blood pressure at baseline and became more hypertensive when they consumed a high-salt diet, suggesting they may be a good model of salt-sensitive (essential) hypertension, Harris said. Alterations in the kidney dopamine system may predispose individuals to hypertension, he noted.

The investigators also showed that elimination of kidney dopamine increased renin production, which activates the angiotensin II system to increase salt and water reabsorption — and produce hypertension.

“These animals retain salt and water when they don’t have sufficient dopamine production in the kidney,” Harris said. “Our studies highlight this whole other hormonal system that appears to balance or put the brakes on the renin-angiotensin system.”

Currently, the renin-angiotensin system is the major target for treating chronic kidney diseases. Discovering another target — the kidney dopamine system — is exciting, the researchers said. They are exploring whether specific drugs that enhance the kidney dopamine system are effective in blocking hypertension and treating progressive kidney diseases.

The investigators predicted changes in kidney function in the mouse model, but they were “very surprised” to discover that the modified mice only lived about half as long as normal mice (15 months versus 30 months). They found increases in stress-related proteins in the kidney, heart and vasculature, suggesting that elimination of kidney dopamine causes systemic effects, Harris said.

“This kidney-specific dopamine system is not only important for kidney function and blood pressure regulation, but also for the overall health of the animal,” Harris said. “If the dopamine system in the kidney is altered, the animals have a markedly shortened life span.”

The research was supported by the National Institutes of Health, the Vanderbilt O’Brien Center and by the Veterans Administration. Harris is the Ann and Roscoe R. Robinson Professor of Nephrology.

Story Source:

The above story is reprinted (with editorial adaptations by ScienceDaily staff) from materials provided by Vanderbilt University Medical Center, via EurekAlert!, a service of AAAS.

Journal Reference:

  1. Ming-Zhi Zhang, Bing Yao, Suwan Wang, Xiaofeng Fan, Guanqing Wu, Haichun Yang, Huiyong Yin, Shilin Yang, Raymond C. Harris. Intrarenal dopamine deficiency leads to hypertension and decreased longevity in mice. Journal of Clinical Investigation, 2011; 121 (7): 2845 DOI: 10.1172/JCI57324

You can fnd the article at: http://www.sciencedaily.com/releases/2011/07/110719151920.htm

Once before I ran across research that suggested chronic kidney disease could be treated with a drug.  Now here it is again.  For someone who felt hopeless when I first heard my diagnosis, I am becoming more and more hopeful with each round of research I do.

Until Friday,

Keep living your life.

Published in: on July 26, 2011 at 11:54 am  Leave a Comment  

The 24 Hour Urine Collection Revisited

I’ve just realized I’m a tweaker.  Let me explain:  I’m not a druggie, but rather someone who tries to finesse instructions in the way that best suits her.  I know, I know.  You’re asking yourself, “What is she talking about?”  You see the title of today’s blog and already know it’s 24 hour urine collection day for me. I woke up at 6:30 today after desperately trying to stay asleep and out of the bathroom until a more reasonable hour – say 7:30 – because I know I’ll have to get up a little bit earlier than I did today to complete the 24 hour urine collection tomorrow.  It IS a 24 hour test, after all.  I just wanted to sleep a little later and didn’t realize I could just start the collection period a little later until I read the 9/5/09 blog of Carolyn Cooper, MPH, RN at: http://promotinghealthandpatienteducation.blogspot.com/2009/09/24-hour-urine-collection-how-to-do-it.html

This is the most complete explanation and set of instructions I’ve uncovered since I first began exploring this test and how to do it.  If you remember (and even if you don’t), I’ve mentioned that sometimes the instructions your lab or doctor’s office give you are simply not clear or thorough. I think we can thank Ms. Cooper for taking care of that problem for us.

24 Hour Urine Collection: How to do it and Why it’s done

What’s the Purpose of Urine Testing?
An incredible amount of information can be obtained from examining a urine sample. In fact, over 100 different tests can be performed on a single specimen.Most of the time a simple “quick catch” specimen of urine (voided into a cup) is sufficient for a basic urine test. Urinalysis results may reveal problems with the body’s electrolytes or hormones, the presence of infection, dehydration, evidence of microscopic blood (that can’t be seen with the naked eye), drug levels, or problems with kidney function.Why a 24-Hour Urine Collection?
A small sample of urine isn’t always sufficient. In addition to blood tests, physicians will order a 24-hour urine collection if they have reason to be concerned about overall kidney function. This test typically focuses on creatinine clearance, sodium, protein, and urine osmolality. Other substances may be examined in a 24-hour collection; for example, hormone levels, urea nitrogen, or copper. The volume of urine that is voided during the 24-hour period also yields important information.  The laboratory will make calculations based on your 24-hour (or 12-hour) urine collection that will help determine how well your body is clearing waste products via the urine.  This finding will be compared to a blood test that measures how much of the waste products are circulating in your blood.

If your physician hasn’t explained WHY he or she is requesting the 24-hour urine collection, ask for details. As a patient, being informed is one of your fundamental rights

 
Tips for Collecting Your 24-Hour Urine Specimen
A 24-hour urine collection is easy to mess up, and that can be very frustrating. Just one moment of accidentally forgetting to collect and save the urine during the 24-hours ruins the test, and the collection might have to start all over again . . .

Before the test: Your doctor’s office will provide you with one or two brown plastic collection jugs and written instructions. Certain tests may require that urine be placed in a “double container” or that a preservative be added to the collected urine; you’ll be given the supplies and containers appropriate for your test.What you need from your lab or doctor’s office:

  • Special instructions for the test and a lab sticker with your patient information to attach to the collection container(s).
  • Collection container(s)–depending on the size of container the lab stocks–you may receive one or two of these jugs. They are made of heavy brown plastic, not just any container will do for this collection, so be sure to use the container(s) provided.
  • Nice to have items–I’d ask for these if they don’t offer them to you. For men: A plastic urinal to void into. For women: a plastic “nun’s hat” to set in the toilet to collect the voided urine. If you don’t have these items, it’s okay to void into a bedpan, large plastic cup or bowl, etc. You will pour the collected urine into the brown collection container after each void, so it’s nice to have something that pours easily.
  • You’ll also need:a way to keep the collected urine cool during the collection period. One of the most common ways to do this is to set the brown urine collection jug in larger container filled with icy water (an ice bath). An ice chest (cooler) is another option. It’s also possible to place the collection jug in the refrigerator, although there are many reasons to make this impractical.
When to begin?
 Find out in advance when and where to return your 24-hour urine collection. This information will help you decide when to begin, because if the lab or physician’s office isn’t going to be open when you finish the collection, you’ll have to keep the sample in a refrigerator, cooler, or in an ice bath until you can turn in your specimen. It’s often suggested that you begin a 24-hour collection first thing in the morning–but that is certainly not required. However, it is essentialthat you make note of the date and time that the specimen collection was started and stopped. This information will need to be recorded on the specimen container (and/or label).Ready to start?

Completely empty your bladder by voiding into the toilet and flushing–DO NOT save this first urine sample. The first time you empty your bladder you are flushing away urine that has been building up in your bladder for several hours or more.  That hours-old urine will yield incorrect results if we collect it for our 24-hour specimen.  We want to start with an empty bladder to collect only the urine our body makes during the 24-hour-period. Record the start time and determine your stop time. 

All other urine during the 24-hours will need to be saved and poured into the collection jug. It’s helpful to use the same bathroom all day long and post a note with the start/stop time to help remind you to collect all of your samples. Replenish the ice in the basin surrounding your collection jug from time-to-time in order to keep the specimen cool.Ending the collection:

  • When the 24-hour-collection period is ending, make a last effort to urinate–even if you don’t have the urge to “go,” you will still be able to produce an ounce or two of urine. Make sure your collecton jugs are tightly capped and labelled with your name, date of birth, collection date and start/stop times.   (Note: If you weren’t given a label for your specimen jug, make oneand tape it securely to your jug.) Keep the specimen in the ice bath, cooler, or refrigerator until you are ready to return it to the lab or doctor’s office. Place your specimen jug(s) in a sturdy plastic bag for easy carrying. (Your specimen will be just fine without being on ice while you return it to the lab or doctor’s office—as long as you are not exposing it to heat for a prolonged period of time.)What If . . . ? Special circumstances .                                                                                                                 
    You filled up the container the lab provided, but your 24-hour-collection is not yet complete.Use a very clean glass or plastic container to continue collecting your urine.  Your brown jug protects the collected urine from light–so if you have to use a transparent collection bottle, be sure to guard it from the light along with keeping it chilled. Using an ice chest would be a good strategy for you in this case–if that’s not possible, cover the transparent container with a brown paper bag to protect it from the light.  When you return your sample to the lab, keep the transparent container in a brown paper bag, or some similar technique to keep it protected from the light.
  • You have started the 24-hour-collection, but find you need to leave the house for several hours.  Take a backpack with you, a plastic bottle with a secure lid, and a large ziplock bag full of ice.  This will allow you to carry your collection items discreetly.  For ladies, a wide mouthed plastic container will allow you to urinate and pour the sample into your capped bottle.  Your ziplock bag of ice will help keep your sample cool while you are on the go. I know this is a rather bulky idea, but the best I can come up with at the moment.
  • For patients with urinary catheters. It would be preferable to start your collection with a fresh catheter bag in place–if that’s not possible, it would be nice to clean the existing bag–at least remove the bag from the catheter and give it a good rinse out.. Begin your collection by completely emptying the current catheter bag and flushing the accumulated urine.Record this as your start time. During the remainder of the 24-hour-collection period, empty the foley bag into the brown collection jugs at regular intervals and keep the collection jugs in the refrigerator on in an ice bath just as anyone else would do. At the designated stop time, empty your collection bag for the last time.
  • Urine becomes mixed with feces or blood. Do not empty any urine that has been contaminated by feces or menstrual blood into your collection jug. Make note of the time and stop the collection. Contact your lab or physician’s office to inform them. In some cases, if enough time has elapsed (12 hours or more), your physician may give the go-ahead to stop the test early. Possibly, you may be asked to start all over again.
  • Patients who are incontinent (cannot hold their urine).  Certainly your physician may not realize (or remember) that a particular patient struggles with complete or partial incontinence.  Do let your doctor know about incontinence issues.  Perhaps the 24-hour-test will be impossible because of complete incontinence; perhaps they might recommend a bladder catheter for the test, or perhaps they might allow a shorter period of time (12-hours or thereabouts) for the urine collection. 
  • “Oops! I didn’t collect every void during the 24 hours!” If you forget to collect all of your urine, the test results may be inaccurate. Talk to your lab or doctor’s office before disposing of all that you’ve collected. If you have already completed at least 12 hours of the urine collection, mark down the time of the last urination and keep your container on ice or in the refrigerator as discussed later in this article.  Talk to your physcian’s office or lab to let them know what you have been able to collect.  They should be able to use your sample and calculate the important information based on the number of hours you have collected–but it’s important that they know the correct number of hours when you turn in the sample.  It’s possible that you’ll be asked to start all over again, but there’s a good chance that they can use what you’ve collected and make adjustments to correctly calculate the results.
  • Why keep the urine specimen on ice?  The ice bath is just a technique for keeping the urine cool enough so that bacterial growth doesn’t overwhelm your specimen.  The ice bath should keep your specimen in the 40-45 degree Farenheit range as would your refrigerator.  Keeping a 24-hour-specimen in the refrigerator is really awkward and inconvenient.  Having your specimen container right there in the bathroom “on ice” is so much easier.
  • Other questions? Call your physician’s office or lab.

I realize I’d also forgotten the purpose of not collecting that first void of the morning until I read this blog.  There’s something about being reminded of what you know that’s almost as satisfying as learning something new – which is what I hope you’ve done today.

Until Friday,

Keep living your life.

National Kidney Month Continues

To continue the celebration of National Kidney Month, today we visit DaVita’s wonderfully informational site.  Again, I’ve tried to preserve the click throughs.  Just in case your computer didn’t receive today’s blog that way, their address is: www.DaVita.com.  Or, you can check out their discussion forum through the blogroll to the right of the blog. Notice: only the information pertinent to Early Stage Chronic Kidney Disease is included in today’s blog.

March is National Kidney Month

March is National Kidney Month…. DaVita has teamed with The Kidney TRUST, an organization that aims to benefit the estimated 31 million adults living in the United States who have chronic kidney disease (CKD), as well as the 550,000 Americans with end stage renal disease (ESRD) who need dialysis or a kidney transplant, to help raise awareness about kidney disease.

Chronic kidney disease develops when kidneys lose their ability to remove waste and maintain fluid and chemical balances in the body. The severity of chronic kidney disease depends on how well the kidneys filter wastes from the blood.  It can progress quickly or take many years to develop.

More than 31 million adults in the US – one in six – have chronic kidney disease and most of them are not even aware of it. Often there are no symptoms until kidney disease reaches the later stages, including kidney failure.

Risk factors for chronic kidney disease

High-risk populations include those with diabetes, high blood pressure, cardiovascular disease and family history of kidney disease. Eleven percent of the U.S. population has diabetes, the number one cause of kidney disease. One out of three Americans has high blood pressure, the second leading cause of kidney disease.

More than 32 percent of kidney failure patients are African American. Other high-risk groups include HispanicsPacific Islanders, Native Americans and seniors 65 and older.

Who should be screened for chronic kidney disease?

Anyone 18 years old or older with diabetes, high blood pressure, cardiovascular disease or a family history of kidney disease should be screened for kidney disease. If you live in an area that is offering a free screening, plan to attend. If not, visit your doctor and ask that you be screened for chronic kidney disease.

What is involved in a kidney screening?

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.

Treatment for chronic kidney disease

In many cases, kidney failure can be prevented or delayed through early detection and proper treatment of underlying diseases, such as diabetes and high blood pressure to slow additional damage to the kidneys. Also helpful are an eating plan with the right amounts of sodium, fluid and protein.  Additionally, one should exercise and avoiding dehydration. Treating diabetes and high blood pressure will slow additional damage to kidneys.

Related articles on DaVita.com

More features

It’s Friday.  The weather is beautiful out here and you know, if you have Chronic Kidney Disease, one way to deal with it (while complying with your nephrologist’s instructions after you’ve thoroughly questioned him or her about them) is to:

Keep living your life.

Kidney Month Redux

Still in keeping with the spirit of National Kidney Month, I’m posting the National Kidney Disease Education Program’s (NKDEP) suggestions. NKDEP is an initiative of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health (NIH), U.S. Department of Health & Human Services (DHHS).
I’ve left them clickable in the hopes that will make it easier for you to take their advice. If they don’t work on your computer for whatever your computer’s secret reasons, here’s the link to the article so you can click through from there: http://www.nkdep.nih.gov/kidneymonth/
10 things you can do to protect your kidneys and help family and friends protect theirs.
If you have diabetes, high blood pressure, or a family history of kidney failure, get your blood and urine checked for kidney disease.
At your next family gathering, talk to loved ones with diabetes and high blood pressure about getting tested for kidney disease.
Learn how to keep your kidneys healthy.
Educate your faith-based community about the kidney connection.
Use spices, herbs and sodium-free seasonings in place of salt.
For those recently diagnosed with kidney disease, find out about the basics of kidney disease and what it means for you.
Watch videos to hear about the different treatment options for kidney failure.
Health care professionals: Learn more about two key markers for chronic kidney disease: urine albumin and estimated glomerular filtration rate.
Become an organ donor.
“Like” the NKDEP’s Make the Kidney Connection Facebook page.I’m keeping this month’s posts short and to the point so that you can spend the time you usually spend reading my posts clicking through to other articles on kidney health or researching the information that’s been made available to you via these posts.  March is the month of renewal – about our current kidney information anyway.

Enjoy the researching and clicking through.  Until Friday,

Keep living your life!

Not Again!

In one of those little flukes during which I didn’t receive my nephrologist’s report until a few weeks after the doctor visit and didn’t catch everything he said during the visit (yes, even after almost three years), I noticed a colonoscopy was recommended.  But I had one only eight years ago! When I called the nephrologist’s office to speak to his M.A. in an effort to find out why I needed this test, it was explained to me that the fatigue I’d been experiencing just might be from polyps.

That didn’t sound right to me so I dutifully made an appointment with the gastroenterologist, and while there, had a long, involved discussion with him.  He wisely allowed me to do most of the talking to see if he could get a handle on the nephrologist’s reason for wanting this test performed, but couldn’t.

Was it my failure to understand the M.A.?  Could be, but just to be certain AND to find out which drugs I would be allowed since I now have CKD  and was going to be “put out” – oh, Lord, I hope that’s nothing akin to being “put down” – for the experience , this specialist agreed to call the other specialist.

Here it is almost two weeks later and I’ve heard nothing from either of them.  Apparently, my nephrologist is on vacation and we’re waiting for his return. So, of course, I started researching on my own.  I still can’t quite figure out why I’m having the test since I couldn’t find anything about polyps contributing to fatigue in CKD patients (which doesn’t mean the information isn’t there – it may have been too technical for me to understand), but I did discover the following warning on the National Kidney Foundation’s site:

Oral Sodium Phosphate Safety Alerts

Patients with chronic kidney disease (CKD) who use bowel cleansing products should be aware of a recent warning issued by the FDA for a type of sudden loss of kidney function or acute kidney injury, as well as, blood mineral disturbances. Phosphate crystal deposition in the kidneys causes the loss of kidney function, which can lead to kidney failure. The medical term for this condition is acute phosphate nephropathy.

The warning relates to the use of bowel cleansing agents, called sodium phosphate (OSP) products as laxatives or in preparation for colonoscopy. OSPs are available both with and without a prescription and are taken by mouth. These products can cause phosphate nephropathy.

Oral sodium phosphates clear the bowel by making bowel movements frequent, loose and runny. These agents work by causing fluid loss so it is recommended to patients that they drink large quantities of clear liquids as part of the bowel preparation.
Symptoms of acute phosphate nephropathy are:

  • Lethargy
  • Drowsiness
  • Decreased urination
  • Swelling of ankles, feet and legs

Early on, people may not have any symptoms at all. Anyone at high risk for this condition should have their kidney function monitored by their doctor.

Visicol® and OsmoPrep® are available by prescription only. Other similar OSP products are non-prescription, and can be used as a laxative at low doses.

Children under 18 years should not use these products alone or in combination with other laxatives containing sodium phosphate. Others groups who are at risk for acute phosphate nephropathy are:

  • People over 55
  • CKD patients
  • People who are dehydrated
  • People who have bowel obstruction, delayed bowel emptying or active colitis
  • People taking medications such as diuretics, angiotensin converting enzyme [ACE] inhibitors, angiotensin receptor blockers [ARBs], and inflammation and pain relief medications such as nonsteroidal anti-inflammatory drugs [NSAIDs])

The FDA requested that the manufacturer of Visicol® and OsmoPrep®, Salix Pharmaceuticals;

  • Add a black boxed warning to the pharmacy package insert for these products
  • Develop and distribute a medication guide for patients that is easier for most patients to understand than package inserts
  • Arrange a post-marketing trial to assess the risks to patients taking OSP products

Non-prescription OSP products have a long history of safety when used as laxatives and will still be available over the counter. However, because of the recent warning by the FDA, those OSP products should only be used as laxatives and not for bowel cleansing. The FDA suggests consumers should get a prescription from a health care professional when thinking about having a bowel cleansing.

The U.S. Preventive Services Task Force (USPSTF) strongly recommends that clinicians screen men and women 50 years of age or older for colorectal cancer with one of several tests, including colonoscopy. If your doctor recommends colonoscopy, concerns about bowel cleansing should not prevent you from undergoing colon cancer screening. Colon cancer is treatable when the disease is caught early and the best treatment is to identify and remove precancerous polyps before they progress to cancer.

A high-quality and safe colon cleansing preparation is important for colon cancer screening using colonoscopy. There are other FDA-approved alternatives to OSP for bowel preparation prior to colonoscopy that may be safer for some patients, but may not always clean the bowel adequately. Patients should discuss the risks of the preparation and procedure, versus the benefits of the screening to determine the best bowel cleaning agent for their age, and risk conditions noted above.
More than 26 million American adults and thousands of American children have Chronic Kidney Disease. Most do not know they have this condition.

Date Reviewed: July 2009″

July, 2009, was 18 months ago yet I’ve found no updates anywhere on the internet.  Whether or not I’m satisfied with what my nephrologist tells the gastroenterologist or what the gastroenterologist tells me, I intend to bring this information with me to the gastroenterologist BEFORE the procedure and certainly bring it to the attention of the nephrologist.  After all, I am responsible for managing my own health issues.

Until Tuesday,

Keep living your life.

Published in: on February 18, 2011 at 9:59 am  Comments (6)  

Back to the Notebook Entries

Finally! The publisher tells me the book this blog is based upon is going to be out by late March.  It’s later than I’d wanted, but I’ll wait to make sure it’s done right.  Just had to share that with you.  I’m really excited, so I think I wanted you to be, too.  Good news before the holidays can be a real stress releaser to my way of thinking – even if it’s someone else’s good news.

Here’s the notebook entry again so you don’t have to flip back to Friday’s blog while I explain it. I hate to admit it, but I have to: while I lined up the columns perfectly last week, I just can’t seem to do it this week. Maybe that’s not such a bad thing because now the entries look a little bit more realistic.

Sample (Unrealistically Neat) Page from An Earlier Notebook Entry

Monday                                              Tuesday

2 coffee      458    1500NA        2 coffee       30

3 fruit           757     3050K          6 starch      383

2 veg.           150        612 P          5 protein   20

5 protein  987      750 PRO       dairy        134

1 starch                                            2 veg.         134

dairy                                               1 fruit           34

3

121

8

19

 154

1040

The second column is a calorie count.  You can see that on Monday, I was neither rushed nor tired so I could mentally add quite a few of the individual calorie counts of the food I ate and you only see a few numbers with the grand total on the bottom [458, 757, 150 = 987].  Tuesday, a teaching day, was far busier for me so I needed to write down even the three calories of a bite of something or other.  It was easier to write it down as soon as I could and total it later. Naturally, as you can see from the length of the calorie count column, the number next to the food does not necessarily correspond to that food.

I needed to take into account my limitations on protein, potassium, phosphorous, and sodium – three peas with salt.  On Monday, you see 1500NA.  That’s sodium.  My limit for this was 200o mg. per day, so I did all right on Monday.  K is potassium which is limited to 3000 mg. daily for me.  Uh-oh, I didn’t do so well with potassium that day.  P equals phosphorous of which I could have 800 mg. per day, so those 612 mg. were not a problem.  Although protein is one of the food groups, there are also grams of protein in other foods, so you need to keep account of how many mg. you have a day in addition to how many units of the protein food group you eat each day.  Since my limit for protein is five ounces a day which equals 35 grams [one ounce of meat is about seven grams], my 60 gram limit on protein is fairly generous.  By the way, all these different limits are based on your individual weight and nutritional needs.

You can see that I didn’t fill in the elements for Tuesday.  I kept a running list of the foods I ate on the back of my notebook intending to figure out the amounts of each element in those foods when I got home.  That was not a good idea since I forgot to do it.  That was also the last time I tried that, and I do not suggest you try it.

Not only is my sample notebook page unrealistically neat, but it took much more room to type it out neatly than it actually takes when handwritten. That’s why you can fit an entire week’s worth of this sort of accounting on the front and back of one index card of your notebook.

I kept refining the way I kept the notebook and playing around with different options, but this straight forward method was the one that worked the best for me.  Depending upon your mathematical ability, you may just choose to run all the totals in your head. Or, conversely, you may choose not to keep a single tally mentally.  The choice is yours.

If you come up with a different way of keeping your counts, why not share it with us via the blog comments?

Until Friday,

Keep loving your life!

Published in: on December 21, 2010 at 5:09 pm  Leave a Comment  

More Liquids and an Idea

Ready for the quandry?  Here it is:

My sweetheart made us a treat today: strawberry smoothies which consisted of the ½ cup of strawberries that can comprise one of my three fruit units today and four ounces of vanilla ice cream or my one and only dairy unit for the day.  I count this as a fruit and a dairy, but should it also be considered part of my remaining 48 ounces of liquid?  This is the type of quandary I run into in one form or another on a daily basis. As already mentioned, dairy is, indeed, taken into account as part of your fluids.

As a non-drinker and someone who doesn’t care for soda, I had no problem eliminating those from my diet, but my beloved hot chocolate is something I now have maybe once a year. Vitamin and flavored water were just becoming popular when I was diagnosed and, I was surprised to note they are high in sodium, potassium and/or phosphorous.

The list of what to avoid included so many surprises (to me) and the list of beverages that was permitted was so unappealing to me that I’m perfectly content sticking to filtered, non-iced water and coffee.  When I go out to dinner unexpectedly, if I’ve already had my two cups of coffee, I just order hot water and lemon. In over two years, maybe one waiter has asked me to repeat that order.

I was having a dismal time adding up how much sodium, potassium, protein and phosphorous I eat each day although I’d pretty much memorized my allotted food units and the calorie counts of each of my usual foods. I don’t know if this is a subconscious revolt against all the bookkeeping or if I truly was incapable of keeping this all straight. My son-in-law told me that eventually food packages will have bar codes containing how much of each of these is in it and our phones will be able to read these labels for us.  I sure hope he wasn’t kidding.

I devised a little notebook as the CKD patient’s food helper.  My nephrologist gave me a printed copy of the AAKP Nutrition Counter.  This can also be downloaded from their website, but this one was already printed and collated.  It measured four inches high by five and a half inches wide. At about the same time, I found a notebook of three by five inch ruled index cards.  That was a close enough match for me to realize I could tape the nutrition counter in the back of the notebook and make life easier for myself.  I managed to get a week’s worth of counting calories, food units, and elements on the front and back of one index card.

I listed each food unit I ate that day and circled the unit [e.g. dairy, protein, etc.] when I reached my limit for the day.  Each time I ate something, I used the nutrition counter in which food is listed alphabetically and contains portion size for the elements and calories.  I just now am beginning to be able to quickly tabulate the amount of each element and calories in the food and keep a running total until I’d reached my limit for the day.  It is cumbersome, but I hope to get it down to a science. Then it will become second nature, just as counting food units and calories has become. If I don’t routinely pull this little helper out at the start of a meal, my daughter automatically asks me where it is.  It’s actually becoming part of who I am. I have high hopes for this helper.

Sample (Unrealistically Neat) Page from An Earlier Notebook Entry

Monday                                              Tuesday                           Wednesday

2 coffee      458    1500NA        2 coffee       30

3 fruit         757     3050K          6 starch      383

2 veg.         150     612 P            5 protein     20

5 protein    987    750 PRO      dairy          134

1 starch                                      2 veg.         134

dairy                                         1 fruit           34

3

121

8

19

 154

1040

The first column for the day (shaded) is the food group column in which I recorded the number of units of the food I’d eaten from each group.  I’ve shaded these lists so you can easily locate them. In order to make this neat enough to read, I’ve used bold lettering [rather than the circles I actually used in my notebook] to indicate when I’d reached my daily limit for that food group. The groups are listed in the order I ate the first food in that group that particular day.  On each day, coffee – not a food group but limited, so included – was the first thing I had.  Then I ate fruit next on Monday, but starch next on Tuesday.  By looking at the food unit column, I could also see where I was falling down.  For example, I ate only two portions of vegetables each day.  I knew I needed to increase that number to three on the following days.

There’s more to explain about this, but it contains NUMBERS and it’s Friday night – the start of the weekend – so I’ll explain the rest on Tuesday.

Until then,

Keep loving your life.

Published in: on December 17, 2010 at 8:58 pm  Leave a Comment  

Food and Drink Items You Might Not Have Thought About

Did you ever consider herbal supplements?  They can be a problem when you have CKD since only a few have been studied with CKD patients.  Keeping in mind that my kidneys were not functioning up to snuff, I decided to abandon them completely.  This was quite a departure from the way I usually dealt with illness, but I was frightened enough to just stop using them. I also didn’t know if any of them contained “the three peas with salt” or phosphorous, protein, potassium or sodium. I wasn’t willing to accidentally further damage my precious kidneys.

While none of this is established, the following might be toxic to the kidneys -wormwood, periwinkle, sassafras (I remember drinking sassafras tea as a child.  Did that have any effect on my kidneys?) and horse chestnut just to name a few. Then there are other  herbal supplements that might be harmful to CKD patients: alfalfa, aloe, bayberry, capsicum, dandelion, ginger, ginseng, licorice, rhubarb and senna.  There are even more, but they seemed too esoteric to include. I found I was continuing to learn information that had nothing to do with CKD, but was surprising none the less.  For instance, I’d always used a broken open aloe stalk to treat burns never once realizing it was ingestible.

While I urge you to speak with your nephrologists before eating any of these, there are several websites that may be helpful. They are http://www.herbalgram.org and http://www.nccam.nih.gov. And, as my nutritionist kept mentioning, star fruit is toxic for CKD patients.  Gulp!  I ate that, too, when I was in Nigeria.  Again, I feel like the medical student who was convinced she suffered from every illness she studied, except in my case, I think everything I ate that’s not good for CKD patients was the cause of my disease.

Most of the renal diets limit liquid intake daily, despite the fact that humans lose one liter of water through our skin daily via evaporation. We also lose fluid through breathing, sweating and feces. Men are 60% fluid, which includes not only water but blood and salvia while females are 55% fluid.  The kidneys are the organs responsible for regulating the fluids in our bodies.

As CKD patients, we do not internally control the amount of liquid in our bodies, so we have to do it externally.  If we drink too little or sweat too much, we become dehydrated.  Severe dehydration can cause sweating, diarrhea, vomiting and usually the low blood pressure that makes you feel weak and dizzy when you stand up.  On the other hand, if we drink too much, we suffer fluid overload.

It’s thirst that makes us drink in order to dilute the concentration of dissolved solids in our bodies so we can bring them back to the proper level. Unfortunately, the brain concurrently releases vasopressin, which is an anti-diuretic hormone that causes the kidneys to conserve water.  What this means is that those of us with CKD drink when we’ve thirsty as does everyone else, but we don’t produce much concentrated urine.

If you fall below the proper concentration of dissolved fluids, normally you lose interest in drinking while your urine becomes diluted and you void a great deal of it.  However, if you suffer from CKD, there’s little increase in urine flow and the urine doesn’t become diluted.   In other words, a person with CKD – like you or me – has a low concentration of dissoluble solids.

I’ve already mentioned that my fluid intake restriction is 64 ounces and that I drink two eight ounces cups of coffee daily (I think they help to keep me from feeling deprived), so I’m left with only 48 ounces of liquid. In researching for this book, I discovered that the organic soy milk I sometimes have with cold cereal in the morning and the ice cream I sometimes have are considered fluids as well as being considered dairy.

I don’t have both on the same day since my allotment is only four ounces of dairy.  That’s only half a cup.  Have you ever tried to enjoy a quarter cup of ice cream?  That’s what I’d have to do as well as limit myself to two ounces of that soy milk to enjoy (hah!) them both on the same day.

Going back to the fluid intake, between the coffee and the dairy, I only have 44 ounces of fluid left per day.  I live in Arizona where the summer temperatures go up to 115 degrees.  I’ve learned to plan when I’m going to have water and how little to have each time.  You’ll have to do the same depending upon the climate. This is one time when that old dieting adage which recommends drinking water instead of eating whenever you think you’re hungry is not apt, and it’s certainly not necessary to drink when others do just to be social.

You might need to be reminded that popsicles, sherbet and gelatin are also fluids, though in solid form.  You might need to be reminded, but I needed to learn that.  To me, a solid was a solid and a liquid was a liquid. But that’s not true for CKD patients.  Think about it. Popsicles and sherbet are frozen water with flavoring (I know I’m being too simplistic here.) and gelatin is boiled water with a powder added.  This certainly made me curious about what else I didn’t know about what I always thought I knew.

I’ve got a little quandry ready for you to solve on Friday.

Until then,

Keep loving your life!

Published in: on December 14, 2010 at 10:00 am  Leave a Comment  

News Before Dietary Restricitons

I am flabbergasted!  This month, I am the featured writer on the front (home) page of both www.KidneyTimes.com and www.RSNHope.org. Not only that, but the book this blog is based upon, “What Is It and How Did I Get It? Early Stage Kidney Disease” is now ready for print.  Hmmm, I wouldn’t mind a little help here if you know people in the right places to help expedite the process.  Anyone out there a publisher?  Agent?  Have a friend who is one?  Point me to them!

I’m laughing out loud as I re-read what I just wrote.  A little full of myself today, aren’t I?  Okay, enough of that – let’s get back to the business at hand, the renal diet.

Another potential problem concerns both salt and water.  If these are retained, you develop edema of the soft tissues of the body.  Due to gravity, this occurs in the ankles and feet during the day and the back at night.  Edema is dangerous if it occurs in the lungs.  Restricting salt [sodium] and making use of a diuretic to cause the kidneys to increase their output of both sodium and water can cure the problem, but as a CKD patient, consult your nephrologist before you take action.

Too much sodium can also increase your need for potassium. Potassium is something you need to limit when you have CKD despite the fact that potassium not only dumps waste from your cells but also helps the kidneys, heart and muscles to function normally. Too much potassium can cause irregular heartbeat and even heart attack. This can be the most immediate danger of not limiting your potassium.  Some of the highly limited foods are my favorites such as chocolate, caffeine, and chips.

Keep in mind that as you age (you already know I’m in my 60s), your kidneys don’t do such a great job of eliminating potassium. So, just by aging, you may have an abundance of potassium. Check your blood tests. 3.5-5 is considered a safe level of potassium. You may have a problem if your blood level of potassium is 5.1-6, and you definitely need to attend to it if it’s above 6.  Speak to your nephrologist (although he or she will probably bring it up before you do).

The National Kidney Foundation is one of the many places that offer a list of the amounts of potassium in certain foods.  Here’s a little piece of information you might enjoy: neither gin nor whiskey is high in potassium, but wine is. Not being a drinker, I don’t see this as important, but then again, alcohol is something CKD patients are supposed to avoid, not totally eliminate.

I found myself in exactly the opposite position: too little potassium with no reasoning behind it.  Maybe I’d been a bit too conscientious about draining the liquid from the canned fruits and vegetables I ate which is one way of avoiding potassium. I’d also been really careful about not having lots of low potassium foods at one time since that increases the amount of potassium you’re ingesting even though they are low potassium foods.

The nephrologist handed me a list of low, medium and high potassium foods and simply told me to eat more foods on the medium list.  I did, drank some of the liquid from the canned fruits I ate and served myself larger portions of low potassium foods. That seemed to solve the problem.  Had I been doing too good a job of limiting potassium rich foods?  Before this, I’d been missing bananas, the one food I craved during both my pregnancies.  When I needed to raise my potassium, I ate one and was surprised to discover it was the aroma, not the taste, which I had missed.

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.

Milk and diary products contain phosphorous, which is why I’m limited to 4 ounces daily.  Other foods that I, for one, need to limit or avoid due to their high phosphorous level are colas, peanut butter (which I, unfortunately, had just discovered much to my delight before being diagnosed), nuts, and cheeses.  To give you an idea why, my phosphorous limit per day is 800 mg. Two pancakes contain 476 mg. or well over half my daily allotment.  Although both IHOP and Village Inn now make their pancakes from scratch, it’s very rarely that I spend so much of my phosphorous allotment on them.

On Tuesday, we’ll take a look at our protein restrictions.  Enjoy your weekend and  keep loving your life!

Published in: on December 3, 2010 at 12:13 pm  Leave a Comment  

The Renal Diet, as Promised

In my research, I found information that amazed me.  Apparently, the majority of the U.S. population over 50 suffers from hypertension which may lead to CKD.  How are all these people paying for their nutritionist if they do develop CKD, I wondered.  Most people think of a nutritionist as a luxury even if they do have a chronic disease.  When I pulled out my checkbook to pay my renal dietitian [RD], I was told the government will pay for her services.  That made sense.  Especially in the current economic atmosphere and for older people, the government needs to help pay our medical bills.

Crystal Barraza, the RD in my nephrologist’s Arizona Kidney Disease & Hypertension Center practice, clarified the reasoning behind the diet with the following:

“One of the most obvious messages [I’ve heard] is that when people are sick, the last thing they want to hear is what they can and cannot eat.  It makes sense.  I feel that this is also true for many who have many chronic illnesses.  I have heard, time and time again from patients like you, ‘I am not going to be able to eat anything!’ My goal for any session is to help destress people about the diet and help with better food choices.  The main goal is to help protect your kidney(s). My favorite word is moderation.  I don’t feel that eliminating favorite food from anyone’s diet is going to help anyone.  It has to be realistic for all.  So, I have learned that the best approach is to meet you where you are.”

In order to fully understand the renal diet, you need to know a little something about electrolytes. There are the sodium, potassium, and phosphate you’ve been told about and also calcium, magnesium, chloride and bicarbonate. They maintain balance in your body.  This is not the kind of balance that helps you stand upright, but the kind that keeps your body healthy.  Too much or too little of a certain electrolyte presents different problems.  Eating a larger portion than suggested in the renal diet of a low sodium, phosphate, protein or potassium food is the equivalent of eating a high sodium, phosphate, protein or potassium food.  This simply did not occur to me until I read it in one of my sources.

Sodium is pretty well known since news articles about its effects have produced an influx of low sodium foods in supermarkets.  Too little sodium can be a problem. Since most adults easily consume the estimated required minimum daily 500 mg. without adding salt to food, it’s not a common problem.  However, excessive sodium intake is.  It can lead to hypertension which can be a cause of CKD.  It also may lead to edema, or swelling, another possible problem with CKD.

What makes it worse is that there is no internal mechanism that tells us if we need more or less salt.  CKD sufferers are in a spot because the kidneys are the only route by which to eliminate excess salt.

Basically, sodium balances fluid levels outside your cells.  You need it because it is responsible for watering your cells. This watering is the prompt for potassium to dump waste [cell process by-products] from your cells.  Sodium does deal with other functions of the body, but this is a pretty important one.

If you have damaged kidneys and cannot excrete most of the sodium you ingest, you’re up against higher blood pressure which may worsen your CKD which may further cut down on your elimination of sodium and so on and so forth in an ever spiraling cycle. In addition, for CKD patients, too much sodium causes fluid retention, thereby causing swelling, further resulting in weight gain, leading to shortness of breath.  That’s why your nephrologist asks if you’ve experienced shortness of breath.

That’s also why the following are not on the renal diet or, if they are, it is suggested they be eaten  in severely limited quantities once in a great while: pizza, frankfurters, canned soup, frozen dinners, luncheon meats, cheese and smoked or cured food. There are low sodium cheeses but you have to search for them.  The most common are Swiss and provolone. I had mistakenly thought nitrates were the problem with frankfurters.  Although there are now no nitrate brands, they are still too high in sodium.

It’s also become possible to buy reduced or no sodium mayonnaise, baking powder, butter, margarine, seasonings and snacks such as crackers, cookies, pretzels and chips. Don’t go too far and use salt substitutes.  Rather than help, they’ll hurt. They contain potassium chloride which could raise your potassium levels.

This information about food seems to interest people with or without CKD the most.  It makes sense.  We are a nation of people who love to eat and can.  We have supermarkets laden with food that is readily available.  There is so much more to learn about how to make appropriate choices as CKD patients.  Especially since our healthy choices are not the same as those without CKD.  There will be at least one more post on this topic.

Until Friday,

Keep loving your life!

Published in: on November 30, 2010 at 4:56 pm  Leave a Comment  

Where It All Started

My new primary care physician – a term I use interchangeably with family doctor or simply physician in this blog – was looking at the results of current blood and urine tests when she started asking me those questions I couldn’t answer. I’d always accepted that copies of my quarterly blood tests were in my file at the doctor’s office and I’d be informed if there was a liver problem since I was taking these tests to monitor how my medication was affecting my liver function in the first place.

Pretend you are looking at my test results. On top, above the results section, was all the information needed to identify these as my tests and the information that this was a fasting test, no eating or drinking after midnight the day before the blood and urine were collected.  Following are explanations of the different parts of these tests, including what is measured in each part.

The CBC, with Diff,/with Plt:

In plain English, this test measures the concentration of white blood cells (WBC), red blood cells (RBC), and platelets (PLAT) in the blood.  All are important since the white blood cells make up your immune system, the red ones carry oxygen to the other cells in your body – so the higher the number here the better – and wastes such as carbon dioxide from them, and the platelets deal with the blood’s clotting ability by repairing leaks in your blood vessels.

Something I found interesting: white blood cells are the largest, red ones smaller and platelets the smallest and that there are five billion red blood cells – the mid sized cells – in a single drop of your blood .  Your blood is 60% plasma, which is a fluid, and 40% blood cells.  Remember the kidneys should control the amount of fluid in your body, but with CKD doesn’t do this effectively.

Furthermore, red blood cells usually live 120 days, but not with CKD so they need to be replaced more often.  You may not yet have heard of EPO (erythropoietin). This is the substance that travels via the blood from the kidneys to the bone marrow to trigger the manufacture of red blood cells.  With CKD, less EPO is produced so the bone marrow makes fewer red blood cells.  That translates into anemia. 

“DIFF.” indicates that your doctor wants the lab to describe each type of white blood cell and list how many of each type of cell is present since each performs a different function. Lymphocytes, monocytes, basophils, eosinophils and neutrophils (segmented means mature) are different types of white blood cells. Absolute means that a formula has been used to count each type of white blood cell.

Hemoglobin is the protein in red blood cells that carries oxygen from the lungs to the rest of the body.  I didn’t know it then, but hemoglobin is important for CKD patients. Hematocrit reflects the percentage of blood volume that is made up of red blood cells (erythrocytes), something else that is important to CKD patients.

MCV, or Mean Corpuscular Volume, measures the average volume or size of individual red blood cells. MCH, or Mean Corpuscular Hemoglobin, measures the hemoglobin content of red blood cells. MCHC, or Mean Corpuscular Hemoglobin Concentration, measures the concentration of hemoglobin in the average red blood cell. MPV, or Mean Platelet Volume, describes the size of the platelets. RDW is the red cell distribution width, also important for CKD patients since it deals with different kinds of anemia.

My explanation of the tests is a bit simplistic, but for me on this blood test, none of the results (column 2) were out of range (column 3) according to the reference ranges (column 4). This was good news for me.

 Most labs set up their reports using this four column system.  Column 1 was the name of the test.  I’ve learned to watch hemoglobin and hematocrit. It’ll be a little vague now, (all right, so it’s a little boring, too) but both have to do with anemia which can be common in people with our disease.

Amylase, Lipase

I glossed over the next section, since all was all right in my amylase – lipase world. Naturally, I had no idea what they were and didn’t care since they weren’t causing a problem for me.  But then curiosity got the better of me, so I looked them up: amylase is an enzyme that breaks starch down into sugar. Were we looking for diabetes, another cause of Chronic Kidney Disease, here?

 Lipase is an enzyme necessary for the absorption and digestion of nutrients in the intestines. I wasn’t sure why that was being tested until I researched a bit more and discovered that, even though an elevated level of this indicates a pancreatic problem, a mild increase of lipase in the blood could be an indication of kidney disease. Both tests were within range.  More good news for me.

Lipid Panel

Then I hit the Lipid Panel. Uh-oh, all these years of taking medication to successfully control my cholesterol level and the triglyceride number was out of range. These quarterly blood tests were to monitor the cholesterol lowering medication’s affect on my liver. I’d never had such a result before.  The triglycerides are one of the “bad” cholesterols like LDL cholesterol and could affect the heart and blood vessels. I was a little confused as to what this had to do with CDK.

Cholesterol, as you probably already know, is a natural substance in the body which is actually helpful – unless you have too much.  Then it threatens your heart health. Triglycerides, another natural substance in the body, can also threaten your heart health, this time via your coronary arteries. To be blunt, triglycerides are fat.

 I recognized HDL cholesterol as the “good” cholesterol and LDL as the “bad,” but what was VLDL Cholesterol? I discovered it’s “very low density lipoprotein,” a transporter of cholesterol within the body just like HDL and LDL cholesterol. I didn’t bother with ratios and percentages thinking (hoping?) they were self explanatory.

 

Comprehensive Metabolic Panel

It got worse: while my glucose (sugar in the blood), urea nitrogen (BUN) – which could indicate some kind of kidney disorder – and creatinine (a higher result could mean the kidneys were not adequately filtering this from the blood) were within range, the estimated GFR or Glomerular Filtration Rate was certainly not above 60 as it should be. The GFR is considered the best method measuring kidney function and staging of kidney disease. 

It is also important since the dosage of any medication you may be taking may have to be adjusted for this level of kidney function. Many drugs exit via the kidneys.  That means if your kidney function is reduced, these drugs are going further than they need to and you may need to take less of them.

 The percentage of kidney function is measured by comparing the amount of waste produced in your urine to the amount of waste found in your blood stream. To be perfectly clear, this test showed that my kidneys were functioning at a Stage 2 Kidney Disease Level.  Panic time for me!

Sodium, potassium, chloride, phosphate, calcium, magnesium and carbon dioxide are all electrolytes that the kidneys help keep in balance… and, according to this blood test, were. Suffice it to say, the anion gap deals with the body’s acidity. At this point, I decided the rest of the Comprehensive Metabolic Panel was just too technical for me. But the not knowing was probably worse than the knowing, so I forced myself to investigate them.

Protein, Total looks for an indication of kidney (I was right to research this) or liver function. Albumin, produced in the liver, deals with a certain pressure between blood and tissue fluids. Globulin was being tested for any degenerative, inflammatory and infectious processes (like CKD?).

I was beginning to feel I was re-inventing the wheel, but knew I was still a little too fragile to understand what the doctor was explaining, even if I did take notes. Again, I ignored ratios, deciding I could always get to that on the next round of tests if they turned out to be important, in range or not.

Calcium is more than we were told it is as children.  Yes, it does relate to bone metabolism, but it also deals with muscle contraction to name only one of its several jobs. It helps with trauma, infection and stress, too.

Alkaline phosphatase, if elevated, indicates a liver, bone or intestinal problem, possibly cancer. Alt and Ast meant nothing to me but, again, were tests to indicate liver damage or dysfunction. Bilirubin, Total is the test to see just how much of it from damaged or old, dead red cells remained in the blood when the hemoglobin broke down.

There’s far more to explain about this blood test even before we get to the urine test, but it will have to wait.  The material, while simplified, is too technical to absorb too much at one reading, so: more next time.  Have a fun, healthy weekend!