There’s Always the Exception

And this is one of them. We all know I don’t write about dialysis, but I’ve been receiving bunches of emails lately asking if I would consider including this product, that book, or the other social media kidney disease awareness item. My response is usually thank you, but I don’t allow advertising or product promotion on the blog. When Dr. Bruce Greenfield, a Los Angeles nephrologist with 37 years experience, sent me a link to his dialysis rap with the following message, I was forced to think twice: “My goal is to reach every dialysis patient in America, in part to make people more informed, in part to shed a little light into their world in a fun way, and of course- to make them smile!”

But why? Are smiles and laughter necessary in the treatment of illness? According to Dr. Jordan Knox, a resident in family medicine, they are. This is how he summarized the need for physicians to use humor in his essay on KevinMD.com at http://www.kevinmd.com/blog/2017/10/theres-place-humor-medicine.html last Friday: “Patch Adams, MD is one of the best-known physicians to use humor in healing. He focuses more on silliness to reach pure joy, nourishing the soul as much as the body. There is something about the contrast, when silliness uproots the expectation of seriousness, that is more powerful than pure humor alone. I think that’s why humor can be so powerful in the doctor’s office; because the expectation is all business, seriousness, and authority. Humor can break down those rigid roles of “patient” and “doctor,” or “team leader” and “team member.” It can level the playing field and align people on the same side, working toward a shared goal.”

Being a Groucho Marx fan, I keep thinking of his one liner, “A clown is like an aspirin, only he works twice as fast.” Hey, CKD patients can’t take aspirin (if they’re NSAIDS or nonsteroidal anti-inflammatory drugs), so why not take humor instead?

But what happens to us physically when we laugh? I checked in with my old standby, The Mayo Clinic, at https://www.mayoclinic.org/healthy-lifestyle/stress-management/in-depth/stress-relief/art-20044456?pg=1 and found the following information about laughter and your body.

Short-term benefits

Laughter can:

Stimulate many organs. Laughter enhances your intake of oxygen-rich air, stimulates your heart, lungs and muscles, and increases the endorphins that are released by your brain.

Activate and relieve your stress response. A rollicking laugh fires up and then cools down your stress response, and it can increase your heart rate and blood pressure. The result? A good, relaxed feeling.

Soothe tension. Laughter can also stimulate circulation and aid muscle relaxation, both of which can help reduce some of the physical symptoms of stress.

Keep in mind that I am not a dialysis patient but hope that this rap is helpful to those who are. Sit back, turn up the speakers, and have some short term benefits courtesy of Dr. Greenfield.

I laughed… and I learned, but I was really interested in the effects of laughter that could help Chronic Kidney Disease patients in the early and moderate stages. WebMD at https://www.webmd.com/balance/features/give-your-body-boost-with-laughter#2 had a bit more information about that. Mind you, these results are observational or the results of very small studies.

Blood flow. Researchers at the University of Maryland studied the effects on blood vessels when people were shown either comedies or dramas. After the screening, the blood vessels of the group who watched the comedy behaved normally — expanding and contracting easily. But the blood vessels in people who watched the drama tended to tense up, restricting blood flow.

Immune response. Increased stress is associated with decreased immune system response, says Provine. (He’s a professor of psychology and neuroscience at the University of Maryland, Baltimore County and author of Laughter: A Scientific Investigation.) Some studies have shown that the ability to use humor may raise the level of infection-fighting antibodies in the body and boost the levels of immune cells, as well.

Blood sugar levels. One study of 19 people with diabetes looked at the effects of laughter on blood sugar levels. After eating, the group attended a tedious lecture. On the next day, the group ate the same meal and then watched a comedy. After the comedy, the group had lower blood sugar levels than they did after the lecture.

Reminder: Diabetes is the number one cause of CKD. CKD means a compromised immune system. Healthy blood flow is necessary for healthy kidneys.

Tomorrow is Halloween (Happy birthday to my brother Paul!), so I wanted to try my hand at some macabre humor.

 

Obituary –

The Book of Blogs: Moderate Stage Chronic Kidney Disease, Part 1 died peacefully on October 20th, 2017, on Amazon.com and B & N.com at the age of three. The Book of Blogs: Moderate Stage Chronic Kidney Disease, Part 1 is survived by SlowItDownCKD 2011 & SlowItDownCKD 2012, which were both born of a need for larger print, more comprehensive indexes, and a less wieldy book to hold. The Book of Blogs: Moderate Stage Chronic Kidney Disease, Part 1 was preceded by What Is It and How Did I Get It? Early Stage Chronic Kidney DiseaseThe Book of Blogs: Moderate Stage Chronic Kidney Disease, Part 1 gave birth to The Book of Blogs: Moderate Stage Chronic Kidney Disease, Part 2, SlowItDownCKD 2015 and SlowItDownCKD 2016. Flowers and condolences in the form of Chronic Kidney Disease Awareness may be sent to any and all vehicles for spreading awareness of this disease.

Researching laughter and CKD led to only laughter and dialysis sites. I wasn’t satisfied with that and kept looking only to find this generalized, but easily understood, image from The Huffington Post Partners at .

I don’t think we can forget that anything that’s good for your heart will benefit the kidneys. Since CKD is an inflammatory disease, reducing inflammation of any kind in the body can only be a good thing. Look at that! Both bad cholesterol and systolic blood will be lowered. These are all kidney related. Hypertension is the second most common cause of CKD. Cholesterol makes the heart work harder, which can raise your blood pressure. Uh-oh.

Another thing I realized is that if I find something wrong, you know like the termite invasion or the a/c breaking in 100 degree weather, my first response is laughter. I never knew why. Hmmm, maybe I’ve been protecting my body all along.

Until next week,

Keep living your life!

This Former Hippy Wannabe Likes HIPAA

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Until next week,
Keep living your life!

Stressed? You Must Be Kidding.

You’re reading this and I’m recovering from my first cataract surgery.  Only one eye is operated on at a time, so the next one is September 4th.  Part of the post operation plan is not driving for a week, which I’m sure I’ll be chaffing at before that week is over.  Another part is reading (and computing) for only ten minutes at a time which is why I’m writing this particular blog a week ahead of time, even though it will be published August 21st.

If you’re following us on Facebook or Twitter, you know I had a cardiovascular scare during my pre-op testing.  While talking to the ever reassuring Dr. Waram at Southwest Desert Cardiology, he mentioned the stellar reviews for What Is It And How Did I Get It? Early Stage Chronic Kidney Disease on Amazon. That got me to thinking I hadn’t looked at them so months, so I did.  I found two new ones I want to share with you:

5.0 out of 5 stars very helpful for calming down and getting to work on controlJune 23, 2012

By R. Sass

Format:Paperback|Amazon Verified Purchase

This is not a medical book, but it is the ONLY book I could find discussing the issue of early stage CKD. My twenty month old son was diagnosed on thursday, almost in passing by his nephrologist. I did not ask any questions on CKD, I was not handed any pamplets – I went into schock and reacted like I always do to bad news I can not process. I asked questions about my infant son’s high blood pressure (the reason for the appointment). Tried to pay attention, remained calm so as not to upset my children who were with us in the room, and then began to research like crazy. I also went back to the doctor and confirmed that she had in fact diagnosed my son with CKD (stage 1). So for me this book has been very helpful, but again I am still in a schock like state and just want to know how to slow the progression of the disease so that my son can have a mostly normal childhood. Best I can tell there is no treatment for the early stages and at least my son’s nephrologist (who is an expert in the area) does not appear to be at all concerned or worried. So I appreciate this book because it remined me to take the reigns (no one else will or can) and I plan to speak to my son’s pharmacist today about his other daily perscriptions, just to make sure that its okay to take… I plan to get more knowledgeable about nutrition (just like the author did) but most of all I plan to let my son play the sports he loves because activity is so important (the author loves to dance, my son loves to try and ice skate like his big sister).

This book is a very quick read, its almost like you are having a conversation with a friend over coffee. It calmed me down, it gave me direction and it was available on my kindle in seconds. THANK YOU!!!!

5.0 out of 5 stars great down to earth read. May 31, 2012

By HELEN A. VIOLA

Format:Kindle Edition|Amazon Verified Purchase

This book and the author was very informative and so close to my situation that I felt at timess, I wrote it myself. There is so much information included, along with so many web sites to continue my own research. I want to thank this author for her down to earth style of writing!

Back to the cardiovascular scare.  There is no, zero, zilch history of heart disease in my family BUT (as we all know), I do have Chronic Kidney Disease. That moves me up a notch for developing heart problems. According to the U.S. National Library of Medicine, ckd may be the cause of the following heart and blood vessel complications:

(Diagram  by  Nucleus Medical Art, Inc./Getty Images)

I was worried, but keeping my fear under control thanks to Bear and my good buddy, Joanne Melnick. – one with hugs and kisses, one with common sense (e.g.  Are you in the hospital?  No? Then it’s not an emergency.)

By the way, you can read more about ckd at: http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001503/

Here’s what happened.  I needed pre-op clearance for the cataract surgery. My trustworthy primary care doctor was unavailable, so her lovely and efficient physician assistant made an appointment for me with the nurse practitioner in the practice.  This woman asked her own physician assistant to perform an EKG on me – twice since she didn’t like the results of the first one.

I didn’t know the np., but was more than a bit disconcerted that she arrived late and had not looked at the notes, did not believe me when I pointed out on the ophthalmologist’s request that I needed an EKG and asked my pcp’s p.a. to verify, and – here’s the worst one – was visibly shaken at the EKG results.  Okay, maybe I was annoyed when I walked in (none of this was taken care of in a timely fashion despite my phone calls so it ended up being a terrific rush), but if anyone should be upset at the results, shouldn’t it be the patient?

The practice provided cardiology recommendations since it was clear seeing one was my next step. I called the closest one hoping they could get me in before my scheduled surgery. Southwest Desert Cardiology’s Brittany had me in the next day.  Their Dr. Kethes C. Waram answered every single one of my numerous questions (Hey, this is me.) and scheduled a stress test for the next day after reading the results of the EKG I’d been given in this office.  Dr. Duong wandered into the examining room while I was there and explained that EKGs can be interpreted from different aspects. While the np. used electrodes on many different parts of my body, the cardiologist concentrated on those areas nearer the heart. These EKG results were far less worrisome, but there still was an abnormality in one part of my heart function they wanted to explore.  Hence, the stress test. (The photo to the left is not my EKG and is for demonstration purposes only. Courtesy of Pharmacotherapy Publications via Medscape.com)

Dave made me very comfortable during that test. He even supplied a blanket since nuclear medicine rooms need to be kept very cold. I was injected with a slightly radioactive dye, but was assured this went nowhere near the kidneys and was so safe that I didn’t even have to check with the nephrologist about its use.

The test results came back normal. According to Dr. Waram, an EKG may be too sensitive to female hearts.  I’m having trouble verifying that via research, but I have to admit I had no symptoms and no results. I wonder why the np. didn’t explain that so I wouldn’t worry about the possible diagnoses (infarction, which mean heart attack, was one of them) on the EKG print out she gave me.

Moral: Go to doctors you know or have an immediate affinity with.  I didn’t know any of these doctors, but was immediately frustrated with the np, while I immediately felt comfortable with Dr. Waram.  Is this sound medical advice?  Hardly, but it makes me feel better should I have to see that doctor again.

Of course, if you have no affinity with someone who is the best doctor for you, ignore my advice.  I’ve done that myself.  The nice thing about advice is that you don’t have to take it.

Until next week,

Keep living your life!