Another New (to me) Kidney Disease

It amazes me that after writing this blog for over a dozen years, I can still happen across something about the kidneys that I didn’t know. This week it’s Acute Tubular Necrosis. Have you ever heard of this before? 

Way back in 2010, I defined acute in What Is It and How Did I Get It? Early Stage Kidney Disease: 

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

I’m going to go back even further back to my college textbook, Latin & Greek in Current Use, Second Edition, for the definition of necrosis: 

“corpse” 

Or, updated for our purposes, dead. 

I think we can handle tubular with my favorite dictionary, the Merriam-Webster Dictionary: 

“having the form of or consisting of a tube. made or provided with tubes.” 

Putting it all together, it’s the sudden onset of dead tubes. It can’t be that simplistic and this definition doesn’t make that much sense. So, I went to Medline for a more comprehensive definition: 

“Acute tubular necrosis (ATN) is a kidney disorder involving damage to the tubule cells of the kidneys, which can lead to acute kidney failure. The tubules are tiny ducts in the kidneys that help filter the blood when it passes through the kidneys. 

Got it. Well, what can cause ATN? The Cleveland Clinic was helpful here: 

“The most frequent causes of acute tubular necrosis are a stroke or a heart attack, conditions that reduce oxygen to the kidneys. 

Chemicals can also damage the tubules. These include X-ray contrast dye, anesthesia drugs, antibiotics and other toxic chemicals.” 

That’s one of the reasons cardiology and nephrology are so connected. Avoid cardiology problems and you’re helping yourself to avoid ATN. One of the three kinds of stroke is hemorrhagic. It’s caused by a burst or blockage of blood vessels in your brain and can be affected by any blood vessel problem. One of the causes of hemorrhagic stroke is high blood pressure which just happens to be one of the causes of chronic kidney disease. It’s also logical; if your blood can’t reach your kidneys due to the blockage, your kidneys will be damaged. 

Well, how do you know if you have ATN? Healthline lists the symptoms for us: 

“The symptoms of ATN vary depending on its severity. You may: 

Photo by Andrea Piacquadio on Pexels.com

feel drowsy even during the day 

feel lethargic or physically drained 

be excessively thirsty or experience dehydration 

urinate very little or not at all 

retain fluid or experience swelling in your body 

have episodes of confusion 

experience nausea or vomiting” 

I’m glad I stumbled across ATN. It sounds like something important all CKD patients should know about. By the way, do you see a cardiologist? Speak with your nephrologist to see if it’s something they’d recommend. 

We know what ATN is, what causes it, and what the symptoms are now, but what do you do about it if you find you have ATN? 

Wait. I have to share this with you. It’s Medscape’s information about ATN that we haven’t come across yet: 

“Acute tubular necrosis (ATN) is the most common cause of acute kidney injury (AKI) in the renal category (that is, AKI in which the pathology lies within the kidney itself). The term ATN is actually a misnomer, as there is minimal cell necrosis and the damage is not limited to tubules.” 

That sounds worse! We’d better get on to what to do about ATN if you find you have it. WebMD had quite a bit of information about treatment: 

“The exact treatment that your doctor recommends will depend on the cause of your acute tubular necrosis.  

If your acute tubular necrosis is caused by some form of poisoning, the most important treatment will be clearing the harmful substance out of your body. Then, you need to make sure that you know how the poison got into your body so it doesn’t happen again.  

Normally, your kidneys will be able to heal on their own. This means that your treatment will be focused on preventing the buildup of fluids and waste products in your body.  

Your treatment phase can last anywhere from a few days to over six weeks. It depends on how badly damaged your kidneys are. Treatment methods can include:  

Dialysis. In some cases, your doctor may decide that you need dialysis, a process that removes waste, salt, and fluids to prevent them from building up in the body while your kidneys are healing. They’ll decide this on a case-by-case basis.  

Dietary changes. Sometimes, you’ll also need to change your diet during your recovery. Helpful changes could include limiting how much fluid and sodium you eat and drink. This way, you don’t add to the fluid build-up that’s caused by the acute tubular necrosis.  

Medications. In some cases, your doctor will prescribe medications to take during your recovery. These include ones to help increase how often you urinate or to control potassium levels in your body.  

If this condition is left untreated, your kidneys could fail. This could mean that you need to make life-long changes to manage the symptoms from the tissue damage.”    

The Merck Manual (Consumer Version) offers us both good and bad news: 

“Outcome depends on correction of the disorder that caused acute tubular necrosis. If that disorder responds rapidly to treatment, kidney function usually returns to normal in 1 to 3 weeks. Prognosis is usually better if people’s urine volume exceeds 400 mL (about 13.5 ounces) every 24 hours. People who are more seriously ill, especially those who require care in an intensive care unit, have a higher risk of death.” 

There’s another reason to take extra good care of both your heart and your kidney health. Should you end up with ATN, you want to be one of those “otherwise healthy patients.” It all sounds bad but be careful rather than afraid. 

Until next week, 

Keep living your life! 

Are You Sure About That?

I just made a neurology appointment for my husband since he has Alzheimer’s. That got me to thinking. What about us? Are chronic kidney disease patients also in need of a neurologist? It may seem an odd question to you, but we are already aware of brain fog caused by ckd. That’s neurological. What else should we know about? 

Wait, I’m rushing again. How about a reminder of what brain fog is? HealthCentral was helpful here: 

Photo by SHVETS production on Pexels.com

“People with kidney disease sometimes describe themselves as feeling like they have ‘brain fog’—a nice-ish way of saying they are muddled in their thinking, have trouble concentrating, and keep forgetting things. These symptoms can have several kidney disease-related causes. For one, ‘low iron levels can lead to cognitive problems or dizziness because you have fewer red blood cells transporting oxygen to your brain,’ …. Confusion may also be a result of high toxin levels in your brain. Elevated protein levels, a hallmark of CKD, can affect brain function as well.” 

I’ve written about brain fog before, and it seems to be accepted by the ckd community. But what else is there that we don’t know in regard to our neurological health when we have ckd? 

verywellhealth has quite a bit of information about neuropathy and ckd:  

“Neuropathy is nerve damage that causes tingling, numbness, pain, and other abnormal nerve sensations in the peripheral nerves (i.e., those of the arms and legs). It can occur for several reasons. Uremic neuropathy is a type that affects patients with advanced kidney disease or end-stage kidney disease patients who are on dialysis…. 

Unfortunately, neuropathy is very common in those with kidney disease. It may be related to nutrient imbalances, aspects of dialysis, or common overlapping conditions. The nerve damage may be permanent and get worse over time…. 

People with advanced kidney disease or those on dialysis have a higher risk for uremic neuropathy…. 

The reason(s) for this are unclear, but it could be that: 

Nerves tend to degenerate in kidney failure. Deficiencies of essential nutrients like thiamine (vitamin B1) or an excess of zinc might contribute…. 

Other diseases common in dialysis patients, like hyperparathyroidism, may be to blame…. 

Certain kinds of neuropathy, like carpal tunnel syndrome, seem to occur more frequently in the arm with dialysis access. A drop in blood supply to the nerves in the hand might be a contributing factor…. 

An increase in pressure due to dialysis access can lead to excess fluid or blood in the surrounding tissues, which might compress a nerve…. 

High phosphorus levels may cause calcium phosphate deposits to form, which could contribute to neuropathy…. 

With objective testing, more than half of dialysis patients could have signs of a nerve problem…. Those who don’t get the minimum prescribed amount of dialysis have a higher risk of developing neuropathy….However, not everyone with neuropathy and kidney disease is on dialysis.” 

Now, we know that I developed neuropathy from having chemotherapy and others have developed neuropathy via their diabetes. Did you know about CKD neuropathy? I must admit that I didn’t. 

I feel compelled to take a moment to remind you that not every CKD patient ends up with these neurological effects and, should they develop one, it can be in varying degrees. For example, my neuropathy is not painful, nor does it curtail my activities, but it is evident. My buddy with neuropathy says she’s barely aware of hers.

 I was sorry to discover that stroke may be one of the neurological side effects of CKD. AHA Journal printed an abstract on June 3 of this year which explains the whys and wherefores of stroke if you have ckd: 

“The global health burden of chronic kidney disease is rapidly rising, and chronic kidney disease is an important risk factor for cerebro-vascular disease. Proposed underlying mechanisms for this relationship include shared traditional risk factors such as hypertension and dia-betes, uremia-related nontraditional risk factors, such as oxidative stress and abnormal calcium-phosphorus metabolism, and dialysis-specific factors such as cerebral hypoperfusion and changes in cardiac structure. Chronic kidney disease frequently complicates routine stroke risk prediction, diagnosis, management, and prevention. It is also associated with worse stroke severity, outcomes and a high burden of silent cerebrovascular disease, and vascular cognitive impairment.” 

I was wondering what else I hadn’t even thought of until I started researching the neurological aspects of ckd. I found this information on Medscape: 

 “Uremic encephalopathy is an organic brain disorder. It develops in patients with acute or chronic renal failure, usually when the estimated glomerular filtration rate (eGFR) falls and remains below 15 mL/min….  

Manifestations of this syndrome vary from mild symptoms (eg, lassitude, fatigue) to severe signs (eg, seizures, coma). Severity and progression depend on the rate of decline in renal function; thus, symptoms are usually worse in patients with acute kidney injury. Prompt identification of uremia as the cause of encephalopathy is essential because symptoms are read-ily reversible following initiation of dialysis….^“ 

Again, not every CKD patient will develop this, nor will all those that do have severe symptoms. The idea of the blog is to educate, not scare. Some of us are in a fragile mindset just from being diagnosed. I’ve been diagnosed for over 13 years and was unaware of everything I wrote about today with the exception of brain fog and neuropathy.  

One more before we end.  

“The incidence of uremic seizures with kidney failure is ∼10%. These seizures are often nonconvulsive and may mimic uremic encephalopathy. Recognition and management of such situations may be challenging for treating physicians who are non-neurologists,” according to PubMed. 

Be aware that ∼ means approximately equal to. Another way to look at this is that ∼90% of kidney failure patients don’t develop uremic seizures. 

While these ckd side effects are considered common, they don’t seem to be discussed very much. I know my nephrologist has only discussed the first two with me. I speak with CKD patients all the time and none of them has ever mentioned the others, either. Is it possible that these are not as common as researchers think they are? Keep in mind that I’m not a doctor nor a professional re-searcher and this is simply my opinion.  

Until next week, 

Keep living your life! 

Is it Blood Sugar or the Pancreas?

We all know diabetes raises your risk of developing Chronic Kidney Disease. But why? What’s the mechanism behind the fact? As far as I’m concerned, it’s time to find out.

Let’s start with diabetes. The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), part of the National Institutes of Health (NIH), which in turn is part of The U.S. Department of Health and Human Services at https://www.niddk.nih.gov/health-information/diabetes/overview/what-is-diabetes offers this explanation.

“Diabetes is a disease that occurs when your blood glucose, also called blood sugar, is too high. Blood glucose is your main source of energy and comes from the food you eat. Insulin, a hormone made by the pancreas, helps glucose from food get into your cells to be used for energy. Sometimes your body doesn’t make enough—or any—insulin or doesn’t use insulin well. Glucose then stays in your blood and doesn’t reach your cells.

Over time, having too much glucose in your blood can cause health problems. Although diabetes has no cure, you can take steps to manage your diabetes and stay healthy.

Sometimes people call diabetes ‘a touch of sugar’ or ‘borderline diabetes.’”

Having just had a tumor removed from my pancreas, I’m well aware that it produces insulin as well as digestive enzymes. Without a pancreas to produce insulin, you would need insulin injections several times a day.

I got what diabetes is, but how it causes CKD was still not clear.

Well, not until I read the following from The American Diabetes Association at https://www.diabetes.org/diabetes/complications/kidney-disease-nephropathy.

“When our bodies digest the protein we eat, the process creates waste products. In the kidneys, millions of tiny blood vessels (capillaries) with even tinier holes in them act as filters. As blood flows through the blood vessels, small molecules such as waste products squeeze through the holes. These waste products become part of the urine. Useful substances, such as protein and red blood cells, are too big to pass through the holes in the filter and stay in the blood.

Diabetes can damage this system. High levels of blood sugar make the kidneys filter too much blood. All this extra work is hard on the filters. After many years, they start to leak and useful protein is lost in the urine. Having small amounts of protein in the urine is called microalbuminuria.

When kidney disease is diagnosed early, during microalbuminuria, several treatments may keep kidney disease from getting worse. Having larger amounts of protein in the urine is called macroalbuminuria. When kidney disease is caught later during macroalbuminuria, end-stage renal disease, or ESRD, usually follows.

In time, the stress of overwork causes the kidneys to lose their filtering ability. Waste products then start to build up in the blood. Finally, the kidneys fail. This failure, ESRD, is very serious. A person with ESRD needs to have a kidney transplant or to have the blood filtered by machine (dialysis).”

Hmmm, now that we know what diabetes is and how it can cause CKD, maybe we need to look at ways to attempt to avoid diabetes.

• “Losing weight and keeping it off. Weight control is an important part of diabetes prevention. You may be able to prevent or delay diabetes by losing 5 to 10 percent of your current weight. For example, if you weigh 200 pounds, your goal would be to lose between 10 to 20 pounds. And once you lose the weight, it is important that you don’t gain it back.
• Following a healthy eating plan. It is important to reduce the amount of calories you eat and drink each day, so you can lose weight and keep it off. To do that, your diet should include smaller portions and less fat and sugar. You should also eat a variety of foods from each food group, including plenty of whole grains, fruits, and vegetables. It’s also a good idea to limit red meat, and avoid processed meats.
• Get regular exercise. Exercise has many health benefits, including helping you to lose weight and lower your blood sugar levels. These both lower your risk of type 2 diabetes. Try to get at least 30 minutes of physical activity 5 days a week. If you have not been active, talk with your health care professional to figure out which types of exercise are best for you. You can start slowly and work up to your goal.
• Don’t smoke. Smoking can contribute to insulin resistance, which can lead to type 2 diabetes. If you already smoke, try to quit.
• Talk to your health care provider to see whether there is anything else you can do to delay or to prevent type 2 diabetes. If you are at high risk, your provider may suggest that you take one of a few types of diabetes medicines.”

This is a list from NIH: National Institute of Diabetes and Digestive and Kidney Diseases posted on MedLinePlus at https://medlineplus.gov/howtopreventdiabetes.html. Notice it’s mentioned that this is for type 2 diabetes.

There are 11 different kinds of diabetes. Types 1 and 2 are the most common. WebMD at https://www.webmd.com/diabetes/guide/types-of-diabetes-mellitus#1 explains what type 1 and 2 are.

“Type 1 diabetes is an autoimmune condition. It’s caused by the body attacking its own pancreas with antibodies. In people with type 1 diabetes, the damaged pancreas doesn’t make insulin…. With Type 2 diabetes, the pancreas usually produces some insulin. But either the amount produced is not enough for the body’s needs, or the body’s cells are resistant to it. Insulin resistance, or lack of sensitivity to insulin, happens primarily in fat, liver, and muscle cells.”

This is all starting to make sense.

Until next week,

Keep living your life!

At the Heart of the Matter

Happy New Year! Here’s wishing you all a very healthy one. I, on the other hand, found myself in the cardiologist’s office the very first week of 2019. That was odd for me.

It all started when I asked my very thorough primary care physician what – if anything – it meant that my blood pressure reading was ten points higher in one arm than the other. By the way, she’s the one that suggested I take my blood pressure on a daily basis. Her nurse always used the left arm to take the reading, so I did too. Then I got curious about what the reading on the other arm would be and how much difference there would be between arms. I expected a point or two, not ten.

Although my readings had always been a bit high, they weren’t high enough to warrant extra attention… until I mentioned the ten point difference to my PCP. BAM! I had an appointment with the cardiologist.

This information in last year’s April 23’s blog will explain why:

“We know that hypertension is the number two cause of CKD. Moderating our blood pressure will (hopefully) slow down the progression of the decline of our kidney function. Kidney & Urology Foundation of America, Inc. at http://www.kidneyurology.org/Library/Kidney_Health/High_Blood_Pressure_and_Kidney_Disease.php explains this succinctly:

‘High blood pressure makes your heart work harder and, over time, can damage blood vessels throughout your body. If the blood vessels in your kidneys are damaged, they may stop removing wastes and extra fluid from your body. The extra fluid in your blood vessels may then raise blood pressure even more. It’s a dangerous cycle.’

And heart rate? The conclusion of a study published in the Journal of Nephrology reads:

‘Heart rate is an independent age-dependent effect modifier for progression to kidney failure in CKD patients.’

You can read the entire study at https://www.researchgate.net/publication/232714804_Heart_rate

So we know that blood pressure and heart rate are important for Chronic Kidney Disease patients. Just in case you’ve forgotten, heart rate is a synonym for pulse which is the number of times your heart beats a minute.

MedicineNet at https://www.medicinenet.com/script/main/art.asp?articlekey=154135 offers more about what the difference between readings from both arms MAY mean:

“People whose systolic blood pressure — the upper number in their reading — is different in their left and right arms may be suffering from a vascular disease that could increase their risk of death, British researchers report.

The arteries under the collarbone supply blood to the arms, legs and brain. Blockage can lead to stroke and other problems, the researchers noted, and measuring blood pressure in both arms should be routine.

‘This is an important [finding] for the general public and for primary care doctors,’ said Dr. William O’Neill, a professor of cardiology and executive dean of clinical affairs at the University of Miami Miller School Of Medicine.

‘Traditionally, most people just check blood pressure in one arm, but if there is a difference, then one of the arteries has disease in it,’ he said.

The arteries that run under the collarbone can get blocked, especially in smokers and diabetics, he noted. ‘If one artery is more blocked than the other, then there is a difference in blood pressure in the arms,’ O’Neill explained.

‘Doctors should, for adults — especially adult smokers and diabetics — at some point check the blood pressure in both arms,’ he said. ‘If there is a difference it should be looked into further.’

The report appears in the Jan. 30 online edition of The Lancet. ”

Notice I capitalized may. That’s because, in my case, there apparently was no blockage. My cardiologist had a different view of things. He felt there wasn’t a problem unless the difference in readings between your two arms is more than 20 points and that your blood pressure would have to be much higher than my slightly elevated blood pressure before this could be considered a problem.

He made note of my diabetes and congratulated me for taking such good care of myself, especially since I’m a caretaker. I must have looked puzzled because he went on to explain that caretakers sometimes have a sort of martyr complex and are convinced they cannot take the time away from the person they’re caring for to care for themselves. And, yes, he did use the oxygen masks in an airplane analogy to point out how important it is for caretakers to care for themselves first.

Now that I’ve wandered on to the subject of caretakers, seemingly continuing the thread from last week’s blog, here’s a health screening from Path to Wellness that may interest you if you live in Arizona. I urge you to take part yourself and bring anyone you think may be affected or has someone in their lives that may have CKD.

What: The National Kidney Foundation of Arizona will host a FREE health screening, aiming to identify chronic diseases in their early stages in those at highest risk.

When: Saturday, January 26, 2019, 8:30am- 12:00pm (appointments highly recommended**)

Where: Betty Fairfax High School (8225 S. 59th Ave., Laveen, AZ 85339)

Individuals who are 18 years or older and have a family member with diabetes, high blood pressure or chronic kidney disease, OR have high blood pressure or diabetes themselves are urged to attend this important event. Early detection means the possibility of preventing further, life-risking damage to the kidneys.

**Appointments may be scheduled by calling the National Kidney Foundation of Arizona at (602) 840-1644 (English) or (602) 845-7905 / (602)845-7912 (Spanish).

OR

Visit https://azkidney.org/pathtowellness and register online!

This medical screening includes immediate onsite results and medical education and is provided at absolutely no cost. The event is staffed with medical professionals, with the ability to screen 200 attendees.

About Path to Wellness: The Path to Wellness program is the product of a community collaboration between the National Kidney Foundation of Arizona and Cardio Renal Society of America. This January screening is provided in partnership with Adelante Healthcare and the Phoenix Metropolitan Alumnae Chapter, Delta Sigma Theta Sorority, Inc. Sorority, Inc., and generously funded by the BHHS Legacy Foundation. Path to Wellness screenings are unique in that they try to target areas of cities where the high demographics of under-insured or at-risk individuals may have an opportunity to detect chronic health problems early on, in a cost-free environment. The screenings also offer the unique advantage of both on-site results, and post-screening education on chronic disease management.

Until next week,

Keep living your life!

All of Me, uh, Us

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

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

“All of me
Why not take all of me?”

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

“All of us

Why not take all of us?”

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

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

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

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

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

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

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

How It Works

Participants Share Data

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

Data Is Protected

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

Researchers Study Data

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

Participants Get Information

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

Researchers Share Discoveries

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

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

Benefits of Taking Part

Joining the All of Us Research Program has its benefits.

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

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

Better Information

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

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

Better Tools

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

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

Better Research

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

Better Ideas

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

Oh, about joining:

Get Started – Sign Up

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

1

Create an Account

You will need to give an email address and password.

2

Fill in the Enrollment and Consent Forms

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

3

Complete Surveys and More

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

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

 

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

Until next week,

Keep living your life!

 

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!

Never Too Old to Learn

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

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

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

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

Abnormal levels of cholesterol, triglyceride or both

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

That’s a pretty big ‘so.’

Until next week,

Enjoy your life!

Blood and Thunder, Without the Thunder

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

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

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

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

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

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

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

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

Albumin:   Water soluble protein in the blood.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Ready for some good news?

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

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

Until next week,

Keep living your life!

Your Thyroid and Chronic Kidney Disease Have Something Going On.

Today’s blog was written at the request of a reader.  The deal is I write a blog about hyperthyroid and its connection to Chronic Kidney Disease and she goes directly to her nephrologist to ask him the same questions she asked me.

While I’m a good researcher, I am not a doctor and that’s who should be asked your CKD questions.  Come to think of it, any time you receive any well-meant advice about this disease, check with your nephrologist first… even if you admire the brain of the person giving the advice.

Let’s do our usual go-back-to-basics-first.  The thyroid, according to WebMD at http://www.webmd.com/women/guide/understanding-thyroid-problems-basics , “… secretes several hormones, collectively called thyroid hormones. The main hormone is thyroxine, also called T4. Thyroid hormones act throughout the body, influencing metabolism, growth and development, and body temperature. During infancy and childhood, adequate thyroid hormone is crucial for brain development.”

There doesn’t seem to be anything alarming there, so let’s go to the T4.  I turned to What Is It And How Did I Get It? Early Stage Chronic Kidney Disease for information about this and found it on page 23 (Usual reminder: digital book owners, use a word search rather than a page).

“What this test is really for is to see if the T3 test comes back abnormal.  If it does, the lab needs to run another thyroid test.  That test, the T4, is a further thyroid test which looks for specific causes of the abnormality.”

Ah, so we need to be tested via a blood draw to see if there is an abnormality in our thyroid function.  Without getting technical, the abnormalities could be hypothyroid or hyperthyroid.  As a former English teacher, I know hypo is a prefix (group of letters added to the beginning of a word that changes its meaning) that means under, while hyper means over.

My reader’s question was about hyperthyroid, but for the safe of completeness, I’ll include the symptoms of hypothyroid. These are the main symptoms – although there are many more – as found on http://thyroid.org.nz/Thyroid_Problems.php

1. Cold hands and feet
2. Chronic fatigue
3. Lethargy and fatigue
4. Emotional instability
5. Depression

Hyperthyroid is not as common as hypothyroid and presents different symptoms:

1. Sweating
2. Anxiety and Excitability
3. Thirst
4. Racing heart
5. Hunger
6. Muscle weakness
7. Shortness of breath
8. High blood pressure
9. Insomnia
10. Weight loss

Numbers 7 & 8 caught my eye immediately since they seem to have something to do with CKD.

The diagnose I was specifically asked about is hyperthyroid, renal.  We already know renal means kidney, so this deals with how the overactive thyroid affects the kidneys.  Remember that hormones travel through the blood and that the thyroid produces a hormone.  Too much of that hormone produces the above symptoms.

As I understand it (and, again, I am not a doctor) – as mentioned –  the thyroid produces a hormone which is released into the blood, while the kidneys filter the blood.  If you have CKD, your kidneys are not functioning as well as they should.  If you have hyperthyroid, you are producing extra thyroid hormone that your compromised kidneys cannot purge from your blood as well as they should.

This quote from Wellness Resources at http://www.wellnessresources.com/health/articles/thyroid_and_kidney_problems_overlap/#ref1  encapsulates the interplay between the kidneys and the thyroid:

“A considerable body of science now links thyroid problems and kidney problems  in a “chicken and egg” manner.”

So yes, Cynthia, the CKD could have caused the hyperthyroid, renal, and vice versa.  However, hypothyroid does seem to be more common than hyperthyroid.

If there are topics you’d like me to research for you, Dear Readers (after Stephen King’s writing), please ask.  You can leave a comment here or inbox me on Facebook via the blog’s page.  I offer you the same deal.  I’ll research for you providing you ask your nephrologist the same question you’re asking me.

It’s clear to me that digital books are not the future of anything, but are what’s more desired right now.  Digital copies of What Is It And How Did I Get It? Early Chronic Kidney Disease consistently outsell the print copy.  That’s fine with me.  While you can pass around a print copy, you can also share the digital copy.  Just keep sharing the Chronic Kidney Disease information.

Another way to share is to send SlowItDown the list of communities in your area that could use CKD education.  It’s free. It’s taught by trained educators. And it’s brought to you.  Could your church use the education as a public service?  What about your local library?  Police station?  Senior citizen center?  Let’s get those phones ringing, folks.  602 509-4965. Don’t feel like talking to me?  Then email: ckded@cox.net.

I am absolutely thrilled that health treatment companies are starting to ask me what it’s like to be a CKD patient, even though I am an early stage patient.  Their interest means the medical profession is looking for new, possibly more effective, ways to slow down the progress of our incurable disease.

On a personal note, we got out for a date day this past Friday.  I once considered a movie and dinner sort of humdrum as a date.  Now that we are still dealing with medical issues, it is wonderful!  Life is definitely a matter of how you look at yours… and mine gets better every day.

We also got out to a party for a bit this weekend.  I’m always amazed that the one person at a social function whose mother has CKD, or whose brother is a nephrologist, or whose roommate works in a doctor’s office, or who is worried about high blood pressure sits right next to me and starts talking.

On another front entirely, sometimes, as (slightly) older people with medical issues, we need help.  So we organized a text group message list.  It includes all our daughters out here in Arizona and two of their significant others.  A third significant other and the woman I consider my niece just asked to be added to the list.

I’d thought it was a burden, but these younger, (thankfully) healthy people WANT to help us out when we need it.  Maybe this would be a good idea for you.

Until next week,

Keep living your life!

The Nos(e) Have It.

My father had a deviated septum.  My daughter has a deviated septum.  Why don’t I have a deviated septum?  Oh right, I’m the lucky one.  I only have Chronic Kidney Disease… not that the two are mutually exclusive… or that it’s lucky to have CKD.

When it was my father’s turn, I was too young to know anything except that my dad was gone over night. I didn’t like that. Now I ask my daughter loads of questions. I don’t like that either.

So here I am very ahead of myself and not giving you a clue as to what a deviated septum is.  Septum comes from the Latin saeptum, which means “a fence, enclosure, partition.” (Thank you my old academia friend Etymology Online at http://www.etymologyonline.com/index.php?term=septum.) We still use that word for the dividing membrane in the nose.

Feel the rigid cartilage under the skin on the outside of your nose.  Inside are two chambers separated by the – what else? – septum.  Deviated means exactly what you think it does: turned aside.  Sometimes you can see the results of a deviated or turned aside septum by looking at a person’s nostrils.  If one is large and the other very small, it’s likely they have a deviated septum.

Sometimes people are born with them, but 80% of the time, they’re caused by accidents of one kind or another, or even growing older.  Sometimes people don’t even know they have a deviated septum.  Sometimes it doesn’t even matter.

But when you start to experience frequent sinusitis and nosebleeds, it does start to matter. According to The Mayo Clinic at: http://www.mayoclinic.org/diseases-conditions/deviated- septum/basics/definition /con-20031537

“When a deviated septum is severe, it can block one side of your nose and reduce airflow, causing difficulty breathing. The additional exposure of a deviated septum to the drying effect of airflow through the nose may sometimes contribute to crusting or bleeding in certain individuals.”

Some of the symptoms are: preferring to sleep on one side since that allows the larger nostril to get the most air, noisy breathing, the above mentioned nosebleeds and frequent bouts of sinusitis.  Wait, sinusitis?  According to Canada.com at http://bodyandhealth.canada.com/channel_section_details.asp?text_id=5694&channel_id=1020&relation_id=70842

“The narrowed nasal passageway caused by a deviated septum can cause mucus to become blocked by preventing the drainage of mucus from a sinus into the nasal cavity. Excess mucus inside the sinuses presents an attractive environment for bacteria, leading to a sinus infection. This in turn causes inflammation of the sinuses (sinusitis), and because it can happen regularly, chronic sinusitis can occur.”

Oh, my poor daughter! Frequent nosebleeds, chronic sinusitis, their accompanying post-nasal drip, and headaches.  Oh yes, headaches. As I understand it, fluid (can’t drain properly due to that deviated septum, remember?) builds up in the sinuses and exerts pressure.  Result: headache.

This sounds pretty bad, but there are ways of dealing with a deviated septum.Keep in mind that some people have a mildly deviated septum so they don’t do anything for it. Others are troubled by the deviated septum and use medications such as decongestants, nasal sprays, or antihistamines. But when the symptoms are affecting your life and health, surgery is usually suggested. The following is from MedicineNet at http://www.medicinenet.com/deviated_septum/page2.htm

“If a person has a deviated septum and it causes breathing problems or sleep apnea and snoring, surgery may be recommended to repair the septum. Surgery to fix a deviated septum is called a septoplasty, submucous resection of the septum, or septal reconstruction.”

Did you notice that this surgery is sometimes necessary so that the sleep apnea  – which may be caused by your deviated septum – can be cured?  That’s how it affects us as CKD patients. We already have enough problems without sleep apnea!  Diabetes, cardiovascular illness, mortality may all be connected to a deviated septum as we know from a recent blog that quoted EurekAlert at http://www.eurekalert.org/pub_releases/2014-04/elf-sal040214.php.

“Sleep apnoea has been linked with elevated blood sugar levels, suggesting people with the condition could be at an increased risk of cardiovascular illness and mortality.

The findings of a new study, published online today (3 April 2014) in the European Respiratory Journal, add to a growing body of evidence that suggests that sleep apnoea is linked with diabetes.”

Your medical condition is simply not as, well, simple as you think with CKD. Deviated septum may lead to sleep apnea, which may lead to diabetes, or any of the other outcomes listed above.

Okay, we’re ready to take a look at the surgery now. I found this at http://deviated-septum.net/deviated-septum-symptoms-diagnosis-and-treatment/ via a simple Yahoo search.

“Septoplasty is the surgical treatment which is preferred by doctors worldwide to correct a deviated septum. The surgery is done entirely through the nostrils, thus no external bruising occurs. During the surgery the portion of the septum which are [sic] extremely deviated will be re-adjusted or realigned or removed completely.”

Sometimes people do have a nose job (rhinoplasty) at the same time.  This completely changes the shape of the nose.  But let’s not judge here; maybe the adjustments made to the deviated septum would make the appearance of the finished product unacceptable to the patient.

I wish my daughter and everyone else who needs this procedure well.  She’s got a pretty nose.  I like the idea that she should be able to adequately breathe through it after her surgery… and may be cured of her headaches, sinusitis, nosebleeds, and sleep apnea.

News: the Medicare monthly magazine has profiled me for an upcoming issue.  I have no idea when it’ll be out, but I’ll tell you as soon as I know.

I’m wondering why, if my advocacy for Chronic Kidney Disease Awareness is so important that I’m being profiled by newspapers, interviewed on radio shows, and have so many readers for the blog, SlowItDown isn’t getting more calls to bring free ckd education by trained educators into the community.  Suggestions for speeding up SlowItDown (love that juxtaposition), anyone?

Thank you all for keeping the book moving out of the stores and into your loved ones’ lives.  After reading about the deviated septum, I donated a copy to the pulmonologist I saw for my own sleep apnea today.

Until next week,

Keep living your life!

Higher and Higher

Today we start off with an announcement:  What Is It And How Did I Get It? Early Stage Chronic Kidney Disease’s profits have offset the cost of 2011’s donations of itself! That is not bragging about earnings, but rather an indication of just how many books were donated that year.

And just why is that important to anyone but Gail, you ask.  Remembering my passion is to get the information about CKD out to the public, you’ll be able to see the connection after reading this:

“That guideline {e.g. providing a common language for communication among providers, patients and their families, investigators, and policy-makers and a framework for developing a public health approach to affect care and improve outcomes of CKD} led to a paradigm change in the approach to CKD, shifting from an uncommon disease often culminating in kidney failure and treatment by nephrologists to a common condition leading to death from cardiovascular disease. As a result, CKD is now accepted as a worldwide public health problem and the global guideline was developed to address this issue.”

This quote is from Andrew S. Levey, MD, co-chair of the NKF KDOQI workgroup that developed the 2002 CKD Guideline and Dr. Gerald J. and Dorothy R. Professor of Medicine at Tufts Medical Center in Boston.

You can probably figure out that NKF is the National Kidney Foundation, but you might need a little help with KDOQI.  That’s the acronym for their Kidney Disease Outcomes Quality Initiative.

2002 was a long time ago, but this statement was issued on December 27^th, 2012, which was the night before the release of Kidney Disease: Improving Global Outcomes (KDIGO).

By the way, many thanks to the National Kidney Foundation for each time they’ve asked me to write for them, suggested my name for articles about kidney disease awareness advocates, or offered me suggestions.

I’ve freely quoted from their page: http://www.kidney.org/news/newsroom/nr/Updated-CKD-Guideline-Enable-Physicians-Predict-More-Accurately.cfm, and yet, there’s even more information there.  Take a look for yourself.

So, CKD is now a common disease. And many people suffering from it die of cardiovascular disease. And hypertension can lead to that… and CKD.  Seems pretty circular.

Back to basics.  Hypertension or high blood pressure is defined on page 132 of What Is It And How Did I Get It? Early Stage Chronic Kidney Disease:

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

Now, about that 140/90…. According to the National Institutes of Health‘s National Heart, Lung, and Blood Institute at http://www.nhlbi.nih.gov/health/health-topics/topics/hbp/printall-index.html, as of January, 2014,

“If you have diabetes or chronic kidney disease, a blood pressure of 130/80 mmHg or higher is considered HBP.”

Not only that, but blood pressure can change depending upon the arm that is being used to measure it, the time of day, whether you’ve just smoked (Just don’t!), had a cup of coffee or eaten just prior to the test, even if you’ve just woken up.  We all know what worry or stress can do to your blood pressure.  It seems even your race can make a difference.

A little less than a year ago, a team at London University College developed a wrist sensor to measure blood pressure as the blood leaves the heart itself. They discovered that blood pressure does not drop as much as thought during the night and that it might be possible to predict heart disease by using this monitoring.

I was particularly interested since I have a wrist monitor that my PCP (primary care physician) prefers I not use, thinking the measurement of the blood passing through the arm arteries more accurate.  I’d originally thought this was a wrist monitor but it doesn’t measure the blood flowing through the wrist.  This was a surprise to me and one I’d like to follow closely.  If you’d like to, also, take a look at http://www.bbc.com/news/health-22812477

The Centers for Disease Control and Prevention provides a chart that makes clear why Blacks (or African Americans as they are referred to in the chart) are at 3.5 times the risk of CKD.  Look at the numbers, ladies and gents.  Hbp {high blood pressure} is the second leading cause of CKD. As usual, there’s so much more information about high blood pressure on their page: http://www.cdc.gov/bloodpressure/facts.htm.

Race of Ethnic Group	Men (%)	Women (%)
African Americans	43.0	45.7
Mexican Americans	27.8	28.9
Whites	33.9	31.3
All	34.1	32.7

 

It’s common knowledge that exercise can lower blood pressure, but how many readers know that it can also make your blood pressure medication more effective? On 4/23 of last year, The American Heart Association issued this statement:

“Alternative therapies such as aerobic exercise, resistance or strength training and isometric hand grip exercises could help people reduce blood pressure. Biofeedback and device-guided slow breathing reduced blood pressure a small amount. Due to their modest effects, alternative therapies can be used with — not as a replacement for — standard treatment.”

Oh, so that’s why I didn’t give away the isometric hand grips when we gave up 1880s competitive shooting.  Good for the trigger finger, just as good for the blood vessels – with proper medication.

Wait a minute.  Both the United Kingdom and the United States have populations with almost a third of the people suffering high blood pressure. Think about this.  What could this mean?

I don’t know if it’s because I’m getting older or not, but life seems to be moving so fast these days.  First there was Passover, then Easter, now Mother’s Day coming up with Father’s Day soon to follow and all those lovely birthdays and anniversaries in between.  How much stress is this?  How much stress is getting ready for your vacation?

No, I’m not saying these occasions should be ignored to lower our blood pressure.  I am saying we are the ones in control of how we treat these occasions.  Are they going to be occasions of stress?  Or gatherings with joint efforts and a relaxed delight in seeing the people involved? {And now you know why our wedding invitation – which I wrote – refers to me as “the Former Wannabe Hippie.”}

Happy Mother’s Day to all those who are mothers, wish they were, have mothers, or ever even remotely considered motherhood – male moms included.  And what better gift for the mom in a family that has a CKD sufferer than…

Until next week,

Keep living your life!

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

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

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

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

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

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

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

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

“1. Abdominal obesity

2. high blood pressure

3. high blood sugar

4. low levels of ‘good’ HDL cholesterol

5. high triglycerides”

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Until next week,

Keep living your life!

Statins: No Easy Decision Here

A reader asked me to write about this topic.  Like me, she is a woman in her middle sixties who takes statins.  Unlike me, she has had adverse side effects.  Who even remembered about these?

Of course, I read the information handout the pharmacy attaches to the bag containing your prescription.  Of course, I researched this drug on the internet when it was first prescribed for me. But that was years ago and, while I periodically re-read the pharmacy’s handout, the dangers of this drug never quite resonated with me.

Dangers?  With statins?  That’s most people’s reaction.

Let’s go back to the beginning with an explanation of what statins are and what they do. According to MedicineNet.com at http://www.medicinenet.com/statins/article.htm,

“’Statins’ is a class of drugs that lowers the level of cholesterol in the blood by reducing the production of cholesterol by the liver. (The other source of cholesterol in the blood is dietary cholesterol.) Statins block the enzyme in the liver that is responsible for making cholesterol.”

Makes sense.  But what’s cholesterol? Medical News Today at http://www.medicalnewstoday.com/articles/9152.php tells us,

“Cholesterol is a lipid (fat) which is produced by the liver. Cholesterol is vital for normal body function. Every cell in our body has cholesterol in its outer layer.”

Okay, so we need this particular lipid but sometimes – between the foods we eat and our body’s functioning – we produce too much of it. Then it may stick to our arteries as plaque, possibly narrowing or even blocking them.  This could lead to CAD or coronary artery disease (heart problems).

Here’s the important part for Chronic Kidney Disease sufferers: it’s the liver – the organ that produces cholesterol – that is affected by the statins. That’s the only other filtering system your body has and your kidneys are already compromised.  TWO compromised filtering systems seems like a really poor idea to me.  Yet, sometimes, we need to take statins.

I went to my favorite, The Mayo Clinic, at http://www.mayoclinic.com/health/statins/CL00010 for information about when you need to be on a statin:

“If you have high cholesterol, meaning your total cholesterol level is 240 milligrams per deciliter (mg/dL) (6.22 millimoles per liter, or mmol/L) or higher, or your low-density lipoprotein cholesterol (LDL, or “bad” cholesterol) level is 130 mg/dL (3.37 mmol/L) or higher, your doctor may recommend you begin to take a statin. But the numbers alone won’t tell you or your doctor the whole story.

If the only risk factor you have is high cholesterol, you may not need medication because your risk of heart attack and stroke could otherwise be low. High cholesterol is only one of a number of risk factors for heart attack and stroke. “

As CKD patients, we already have another risk factor.  If, like me, those numbers mystify you, you can find them on your quarterly blood test reports which will usually have an “H” to indicate high or “L” to indicate low (You won’t find that if you’re on statins.) next to the numbers for your total cholesterol and your low-density lipoprotein levels.

As for how hyperlipidemia (high cholesterol) can affect your body and why statins are prescribed, I took a look at a non-technical explanation at  http://heartdisease.about.com/cs/cholesterol/a/statins.htm:

“Clinical studies have shown that statins significantly reduce the risk of heart attack and death in patients with proven coronary artery disease (CAD), and can also reduce cardiac events in patients with high cholesterol levels who are at increased risk for heart disease. While best known as drugs that lower cholesterol, statins have several other beneficial effects that may also improve cardiac risk, and that may turn out to be even more important than their cholesterol-reducing properties.”

Well, that all sounds good so what’s the problem?  It’s the side effects, ladies and gentlemen.  It’s all the ‘may cause’ that you find on the websites and in your pharmacy handout information.

I went to a new site for me, http://statinseffects.org/, and was staggered by the side effects:

“The risk of liver & kidney damage, muscle damage, increased risk of cancer & other side effects of cholesterol lowering drugs are good reason why exercise & diet should be patient’s first resort for controlling cholesterol levels. For people who must take cholesterol lowering medications, the dose needs to be reduced to minimum by again exercise & diet. The main concern seems to be the overuse or underuse of the medication, despite of the evidence that high cholesterol level itself is not the most important factor of heart disease. It is, however, the ratio between total & HDL cholesterol levels.”

You KNOW what popped out at me: kidney damage.  We already have kidney damage.  Each of these side effects deserves a blog of its own.  But, it is important to remember that these are possible, not definite, side effects.

Am I endorsing statin use for hyperlipidemia? No, I’m not.  I’m not a doctor.  You need to discuss this with your doctor. Mine at the time of my diagnose with hyperlipidemia was amenable to my desire not to take the drugs for a while.

Dr. Susan Bennett, agreed to this in an attempt to demonstrate to me that I needed the medication.  This was about six years before I was diagnosed with CKD.  For three months – the acknowledged honeymoon period – my numbers were great.  And then they started to climb… and climb, despite the dietary changes and exercise.  I am just one of those unlucky ones with naturally high cholesterol. Try this for yourself if your doctor agrees, but keep your health foremost in your mind.

Talking about that, SlowItDown held our first of ten monthly Chronic Kidney Disease education classes on The Salt River Pima – Maricopa Indian Community last Thursday. Talk about a gratifying experience!  In addition, the book is now being used by a spiritual healing and medical care group in the community.

Many thanks to Annette Folmer of DaVita for the ever higher quality of her teaching and to MaryAnn Bennett, the brand new Clinical Services Manager at Salt River Pima-Maricopa Indian Community. Our classroom was even more electronically modern than the ones I’ve taught in here in Arizona’s community colleges!

Until next week,

Keep living your life!

Coffee, The Elixir of The Gods (Or Did I Just Make That Up?)

With all that’s going on in my life and in the world, I awoke today thinking, “Coffee, today’s blog is going to be about coffee!”  First thing I did was make the coffee (my turn today) and then pop back into bed with Bear and check Facebook.

And there it was, right in front of me.  And now, here it is, right in front of you. Mark Rosen shared MedicalPk’s coffee post (http://www.medicopk.com/health-benefits/some-surprising-health-benefits-of-coffee/).  Mark originated The Kidney Disease Ideas and Help Page I follow on Facebook and MedicalPk is a medical blog for students.  Look at all the benefits of coffee mentioned in this chart!  I made that a very large reproduction so you could read it. I wasn’t so sure this could all be true since I remembered the old adage, “If it sounds too good to be true, it probably is.” *Notice, the article also mentions the negatives of coffee so look at the website.

Of course, as Chronic Kidney Disease patients, we can’t run wild in our pursuit of the perfect cup of coffee and how often we can have it. It’s 16 ounces (two cups) maximum for me so I want to have the best taste I can. Coffee Masters’ Jamaican Me Crazy is my favorite.  We discovered it while choosing our wedding cake at Bakery-Wee in Glendale and immediately ordered a ten pound bag.  I sort of, maybe, kind of knew that our wedding guests were not going to drink that much coffee.  Hence, almost two months later, there it is – waiting for me – on the kitchen counter next to the coffee machine everyday.

But it’s become one of those once-in-a-while-heaven-descends treats for me. I haven’t quite figured out how it can have the “richest, sweetest essence of the darkest tropical island rum” without containing alcohol, despite what it says on the package. That’s a topic for another blog.

Going a step further in my coffee research, I found an article at http://www.medicalnewstoday.com/articles/257888.php that explains the benefits of Greek coffee and how that works.  The part that intrigued me was this:

“The endothelium is a layer of cells that lines the blood vessels, which is impacted by lifestyle habits and aging. The researchers focused on coffee because earlier research has proven that moderate coffee intake may decrease the risk of coronary heart disease, they [sic]} wondered whether it could have a positive impact on other areas of endothelial health.”

According to the article based on the findings which were published in Vascular Journal earlier this year, it did. If you look at the chart, you’ll see heart disease mentioned as one the ailments coffee may help prevent there, too.

Another article, this one from Digestive Disease Week, offered more good news about coffee:

“Coffee consumption helped protect against the autoimmune liver disease known as primary sclerosing cholangitis (PSC), a disorder of the bile ducts that causes inflammation and obstruction and that can lead to transplantation or death.”

This one is discussed on MedpageToday at: http://www.medpagetoday.com/MeetingCoverage/DDW/39292.  On the chart, liver cirrhosis is mentioned as another ailment coffee may help prevent.

There’s a wonderful slide show of both the merits and drawbacks of coffee consumption at: http://www.medscape.com/features/slideshow/coffee?src=ptalk#12.  I urge you to see this for yourself. On this slideshow, not only are the benefits mentioned in the chart about Parkinson’s disease, gout, cancer, diabetes, and heart disease also noted, but there are also slides about improving glucose metabolism, promoting weight loss in the overweight (obviously, you need to drink more than the two cups a day I do), lessening of the risk of developing depression, slowing the progress of Hepatitis C, benefitting dry eye syndrome, and preventing MRSA infections (those are the antibiotic resistant ones).

Coffee does initially raise blood pressure, but it also has the potential to lower it long term… one of life’s little dichotomies. Among the other drawbacks of my favorite beverage are the obvious ones: it can contribute to anxiety, insomnia and tremors (so that’s why my mother and her father had these.  Or was it the Parkinson’s disease that seems to run in the family?) Coffee can exacerbate withdrawal symptoms and there is the potential for it increasing the risk of glaucoma.

The article I liked the best during my research is at: http://bodyodd.nbcnews.com/_news/2012/11/20/15309215-coffee-helps-you-see-the-bright-side.  It offers a detailed explanation of how dopamine is elevated by drinking coffee.  In layman’s terms, that means coffee can make you feel good.  As a non-drinker, non-smoker, I can personally attest to the fact that my two cups of coffee per day make me feel great… and not simply in terms of energy.

Talking about coffee, yesterday the Transplant Community Outreach from Facebook invited me to a lunch gathering of people from different parts of Arizona and California. I write KIDNEY MATTERS for the group so they knew I wasn’t a transplant.  I marveled as they ate pretty much whatever they wanted.  The conversations centered on their various transplants and other diseases, but it was so definitely not a pity party.  These people realized they were on their second or third chances and were enjoying life tremendously.  Thank you for inviting me, Janet Peralta.

Kidney educators are waiting to start their kidney education classes on the local Native American reservations.  I am still waiting to get them on the reservations.  If you can think of any access at all, please let me know.  There is nothing like saving a life… even indirectly.

The book has been introduced to British Columbia via Patti Telford and Colorado’s Evans Community Army Hospital via Deanna Leclair.  Thank you both for being the cause of these new avenues for getting the information where it’s needed.  And thank you LandmarkEducation for giving me the opportunity to get this information to places I hadn’t even realized it was needed.

Until next week,

Keep living your life!

Let’s Sleep On It

I have been remiss. Thank you to Rick from RDM Concrete (602.695.1789) for laying the concrete under flooring for the library – and come to think of it –  the pad underneath the spa we moved here from Bear’s house.  AND, tada, to Tom and Mark from Tomark Contracting LLC (623.258.5800) for the library, including the handmade window seat.  I am so lucky to keep running into superior people who have delightful personalities and do excellent work. This includes house painter Felix W. Dukepoo and his crew (623.806.5266).

You simply have to give credit where credit is due.  You see you start, the next  person follows your lead, someone else follows their example  and so on and so forth until everyone in the whole world knows (s)he is appreciated.

Of course you’re wondering what this has to do with chronic kidney disease.  I mean I would be by now. Here’s the tie-in: I’ve been reading quite a bit about the importance of sleep with Chronic Kidney Disease. In addition, one of the first things my nephrologist mentioned – after hearing my schedule – when he discussed lifestyle changes was the importance of a minimum of eight hours of sleep per night.

If I’m crowded (you should have seen the hallways, the living room and the family room overflowing not only with books, but book cases.), worried that the 115 degree heat here is making my house paint chalk (which allows more heat in than normal) or wistfully thinking about the screened in porch I was no longer comfortable using (due to heat? CKD? Age?), I am not going to get a good night’s sleep. By the way, that porch is now the library.

These articles will make clear just how important that is. Keep in mind that you are already at higher risk for having a stroke simply because you have CKD.  Add diabetes and/or hypertension and that risk is heightened.

Lack of sleep increases stroke risk

By Janice Lloyd, USA TODAY [yesterday]

The 30% of working adults who routinely sleep less than six hours a night are four times more likely to suffer a stroke, says a new study.

The findings are the first to link insufficient sleep to stroke; they’re also the first to apply even to adults who keep off extra pounds and have no other risk factors for stroke, says Megan Ruiter, lead author of the report. It will be presented Monday at the 26th annual meeting of the Associated Professional Sleep Societies in Boston.

“People know how important diet and exercise are in preventing strokes,” says Ruiter, of the University of Alabama in Birmingham. “The public is less aware of the impact of insufficient amounts of sleep. Sleep is important — the body is stressed when it doesn’t get the right amount.”

Strokes occur when blood to the brain is restricted or cut off.  Stroke is still the fourth-leading cause of death in the USA. Smoking, being overweight and inactivity are key risk factors.

Notice chart from the Centers for Disease Control and Prevention.  You can read the entire article at: http://www.usatoday.com/news/health/story/2012-06-11/sleep-stroke-risk/55506530/1?csp=34news&utm_source=feedburner&utm_medium=feed&utm_campaign=Feed:+UsatodaycomHealth-TopStories+(News+-+Health+-+Top+Stories)

The American Academy of Sleep Medicine seems to agree as noted in EurekAlert today:

Top risk of stroke for normal-weight adults: Getting under 6 hours of sleep

DARIEN, IL – Habitually sleeping less than six hours a night significantly increases the risk of stroke symptoms among middle-age to older adults who are of normal weight and at low risk for obstructive sleep apnea (OSA), according to a study of 5,666 people followed for up to three years.

After adjusting for body-mass index (BMI), they found a strong association with daily sleep periods of less than six hours and a greater incidence of stroke symptoms for middle-age to older adults, even beyond other risk factors. The study found no association between short sleep periods and stroke symptoms among overweight and obese participants.

“In employed middle-aged to older adults, relatively free of major risk factors for stroke such as obesity and sleep-disordered breathing, short sleep duration may exact its own negative influence on stroke development,” said lead author Megan Ruiter, PhD. “We speculate that short sleep duration is a precursor to other traditional stroke risk factors, and once these traditional stroke risk factors are present, then perhaps they become stronger risk factors than sleep duration alone.”

The entire article can be found at:  http://www.eurekalert.org/pub_releases/2012-06/aaos-tro053112.php.

Arizona Kidney Disease and Hypertension Centers is where I see my nephrologist.  Thanks is due to another  of their nephrologists for his continual outpouring of ideas for me.  That’s you, Dr. Jamal Atala. One of his ideas brought me back to Tamara Jensen at their main office in Phoenix.  Tamara is the person responsible for placing What Is It And How Did I Get It? Early Stage Chronic Kidney Disease at the very top of their patient resource list.  She is also the one responsible for implementing Dr. Atala’s suggestion of fliers in each of their 19 centers.  Thank you both! This is the flier:

What Is It and How Did I Get It? Early Stage Chronic Kidney Disease provides basic information for those diagnosed with kidney disease and their loved ones, covering everything from a glossary of medical terms to what to expect at a doctor’s visit, what tests look for, the need for exercise and renal nutrition. An overview of publications offers resources for further reading. In keeping with the spirit of letting newly diagnosed patients know they are not alone, the book describes other patients’ initial reactions to their diagnosis as well as the author’s own experiences.

Chronic Kidney Disease is not a disease that can be cured at this time. The idea is for the patient to retard the progression of the disease as much as possible. Hence, the renal diet, the need for exercise and all those oh-so-necessary blood and urine tests. Somehow, magically, when you understand something, it doesn’t seem as frightening. Helping you understand your diagnosis or that of a friend, family member or loved one and how the disease is treated is precisely what this book does. Knowing you’re not alone in trying to figure this all out can make it easier for you to understand what is happening to you and – possibly – why.

                                                                                                         

        Available in both print and digital at

    Amazon.com and BarnesandNoble.com

                                  Or

      contact Gail for an autographed copy

 

 

Phone: (623) 266-2609
Twitter: WhatHowEarlyCKD
Blog: https://gailraegarwood.wordpress.com
Email: myckdexperience@gmail.com
Facebook Page: facebook.com/WhatHowEarlyCKD

Until next week,

Keep living your life!