The Nation and the World are Working Together

It’s National Kidney Month and the country is burgeoning with kidney education in one way or another. I’ll be doing my part, too. Tomorrow, I’ll be speaking on eCareDairy. There are two links  to listen in:

https://www.ecarediary.com/EFCRadioShow.aspx and http://www.blogtalkradio.com/ecarediary/2018/03/06/coping-with-chronic-kidney-disease. This is my favorite kind of show – unscripted. If there’s anything you’d like me to include in my talk, leave a comment sometime today.

Of course, some of you are now asking yourselves how National Kidney Month started. Aha! I’ve got that covered. The National Kidney Foundation thought this would be a good way to bring awareness of kidney disease, and how to treat – and even prevent – its complications. Considering the many walks, golf tournaments, dances, free screenings, and other kidney disease education events that are scheduled throughout the year, I’d have to agree with them.

I’ll also be guest blogging on MyTherapyApp at https://www.mytherapyapp.com/blog on World Kidney Day which is Thursday, March 8. (World Kidney Day is always the second Thursday in March.) This is an app to help you remember to take your medications, test your blood glucose, blood pressure, or whatever else you have to test, even to take a walk.

And World Kidney Day? What’s that? This is from The Book of Blogs: Moderate Stage Chronic Kidney Disease, Part 2 (Maybe this year will be the one I finally get to split this book into SlowItDownCKD 2013 and SlowItDownCKD 2014). I’ve updated it to reflect the most current information. The updates are bolded:

“I discovered this is a fairly new designation. It was only twelve years ago that it was initiated.

According to http://worldkidneyday.org, “World Kidney Day is a global awareness campaign aimed at raising awareness of the importance of our kidneys.”

Sound familiar?  That’s where I’m heading with What Is It and How Did I Get It? Early Stage Chronic Kidney Disease; SlowItDownCKD 2011; SlowItDownCKD 2012; The Book of Blogs: Moderate Stage Chronic Kidney Disease, Part 2; SlowItDownCKD 2015; SlowItDownCKD 2016; the daily CKD tidbits on Facebook; and this blog. We may be running along different tracks, but we’re headed in the same direction.

The 58 year old International Society of Nephrology (ISN) – a non-profit group spreading over 155 countries – is one part of the equation for their success.  Another is the International Federation of Kidney Foundations with membership in over 40 countries. Add a steering committee and The World Kidney Day Team and you have the makings of this particular concept….

This year’s theme is Chronic Kidney Disease and Women’s Health.

While there are numerous objectives for this year’s World Kidney Day, the one that lays closest to my heart is this one: ‘Encourage systematic screening of all patients with diabetes and hypertension for CKD.’

Their site offers materials and ideas for events as well as a map of global events. Prepare to be awed at how wide spread World Kidney Day events are.

Before you leave their page, take a detour to Kidney FAQ (Frequently Asked Questions) on the toolbar at the top of the page.  You can learn everything you need to know from what the kidneys do to what the symptoms (or lack thereof) of CKD are, from how to treat CKD to a toolbox full of helpful education about your kidneys to preventative measures.

If only my nurse practitioner had been aware of National Kidney Month or World Kidney Day, she could have warned me immediately that I needed to make lifestyle changes so the decline of my kidney function could have been slowed down earlier. How much more of my kidney function would I still have if I’d known earlier?.. That was a decade ago and this shouldn’t still be happening… but it is.

I received a phone call a few years ago that just about broke my heart.  Someone very dear to me sobbed, “He’s dying.” When I calmed her down, she explained a parent was sent to a nephrologist who told him he has end stage renal disease and needed dialysis or transplantation immediately.

I pried a little trying to get her to admit he’d been diagnosed before end stage, but she simply didn’t know what I was talking about. There had been no diagnose of Chronic Kidney Disease up to this point. There was diabetes, apparently out of control diabetes, but no one impressed upon this man that diabetes is the foremost cause of CKD.

What a waste of the precious time he could have had to do more than stop smoking, which he did (to his credit), the moment he was told it would help with the diabetes.  Would he be where he was then if his medical practitioners had been aware of National Kidney Month or World Kidney Day, especially since this man was high risk due to his age and diabetes?  I fervently believe so.

I have a close friend who was involved in the local senior center where she lives.  She said she didn’t know anyone else but me who had this disease.  Since 1 out of every 7 people does nationally and being over 60 places you in a high risk group, I wonder how many of her friends were included in the 96% of those in the early stage of CKD who don’t know they have CKD or don’t even know they need to be tested.  I’d have rather been mistaken here, but I’m afraid I wasn’t. National Kidney Month or World Kidney Day could have helped them become aware.

For those of you who have forgotten (Easily read explanations of what results of the different items on your tests mean are in What Is It And How Did I Get It? Early Stage Chronic Kidney Disease.), all it takes is a blood test and a urine test to detect CKD.  I have routine blood tests every three months to monitor a medication I’m taking.  It was in this test, a test I took anyway, that my family physician uncovered Chronic Kidney Disease as a problem.

There is so much free education about CKD online. Maybe you can start with the blogroll on the right side of the blog.

Until next week,

Keep living your life!

The Constant Student

Last week, I was excited about a new word and, boy oh boy, did I learn even more about gastroparesis after my blog was posted on Facebook Kidney Disease Support Pages. This week, it’s a new test that a reader asked me about: the Iothalamate clearance test.

This is what the University of Washington at http://www.uwmedicine.org/health-library/Pages/iothalamate-scan.aspx had to say about the test:

“An Iothalamate study is a diagnostic nuclear medicine procedure used to find out your glomerular filtration rate (GFR) for each kidney….

How Does It Work?

A small amount of a radioactive material, called radiotracer, is injected into the muscle of your upper arm. This material is excreted out of your blood, into your urine, by glomerular filtration. By taking samples of your blood and urine over time, we are able to calculate what your GFR is. This gives your doctor information about the health of your kidneys.

How Do I Prepare?

  • Drink 20 ml of water per kilogram of body weight in the 90 minutes before arriving in the department. For most people, this is about 1 to 2 1-liter bottles of water.
  • Drink lots of fluids throughout the 4-hour study. The study may be continued for more time if more urine is needed.
  • You need to be able to empty your bladder completely.
  • Most patients are required to withhold diuretics the day of the test. Check with your doctor if you take diuretics.
  • Do not consume any caffeine the morning of the study.

How is the study performed?

  1. When you arrive at the lab, the technologist will check your blood pressure. You will need to completely empty your bladder into a container. The technologist will also place an IV into one of your veins and take a sample of your blood.
  2. The radioactive tracer will be injected into your upper arm muscle. The technologist will take another blood pressure reading about 10 minutes later.
  3. You will return every hour, for 4 hours. Each hour, the technologist will take a blood sample and ask you to completely empty your bladder into a container. It is very important that you do not go to the bathroom outside of the department.
  4. Throughout the study, you will be required to drink plenty of fluids, and avoid caffeine. You will be allowed to eat.
  5. After 5 urine and blood samples are collected, the IV will be removed and you are free to leave. This urine will be analyzed and measured.

What will I feel during the study?

Most people feel no different than normal during this study. Some people may feel a little shaky after the injection of the radiotracer. This is because a small amount of epinephrine is added to the radiotracer to improve its absorption. You may also have minor discomfort from holding your bladder….

Whoa, baby! Nuclear medicine? Radioactive material? Epinephrine? I understood why no diuretics, but why no caffeine? Any why was there an IV?

I know, I know. Start slowly. According to RadiologyInfo at https://www.radiologyinfo.org/en/info.cfm?pg=gennuclear,

“​Nuclear medicine is a branch of medical imaging that uses small amounts of radioactive material to diagnose and determine the severity of or treat a variety of diseases, including many types of cancers, heart disease, gastrointestinal, endocrine, neurological disorders and other abnormalities within the body. Because nuclear medicine procedures are able to pinpoint molecular activity within the body, they offer the potential to identify disease in its earliest stages as well as a patient’s immediate response to therapeutic interventions.”

Okay, got it. And radioactive?  MedicineNet at https://www.medicinenet.com/script/main/art.asp?articlekey=11952 defines the word this way:

“Radioactive: Emitting energy waves due to decaying atomic nuclei. Radioactive substances are used in medicine as tracers for diagnosis and in treatment to kill cancerous cells.”

As a side note, as far as I could tell this test is not used on pregnant women or those who are breastfeeding since a radioactive substance is involved.

I couldn’t decide if I was feeling better or worse about nuclear medicine to diagnose Chronic Kidney Disease. So I looked… and looked…and looked again before I realized it’s contrast dye that may cause injury in those with CKD, not radioactive material. No wonder some nephrologists have no compunction about ordering this test. By the way, radioactive exposure in this test is less than that in a CT scan.

Hmmm, epinephrine sounds familiar. Of course! My buddy back East carries an epi pen just in case she’s stung by a bee. Epinephrine is also known as adrenaline. Ah, so adrenaline “is added to the radiotracer to improve its absorption.” Makes sense.

Now that we know that epinephrine is adrenaline, we can easily understand why no caffeine. Remember that song, “Fly Me to the Moon”? Between the adrenaline and the caffeine, you’d be flying yourself to the moon.

What also makes sense is no diuretics. You wouldn’t want to be urinating more than necessary if your urine is being evaluated. That might dilute the very small amount of radioactive material that was injected into the muscle of your arm.

So, what’s the IV for you ask.  That’s how the radiotracer is injected and/or how the blood samples are obtained. I know I’d rather have one IV instead of four or five needle sticks for individual blood draws. Apparently, there are variations in how the test is administered.

 

Now the biggie: Why use this test at all? This is from the glossary in What Is It and How Did I Get It? Early Stage Chronic Kidney Disease:

“GFR: Glomerular filtration rate [if there is a lower case “e” before the term, it means estimated glomerular filtration rate] which determines both the stage of kidney disease and how well the kidneys are functioning.”

The Iothalamate clearance test is a measured GRF test. It doesn’t estimate, but actually measures your GFR, sort of like real time videos are not replays but live. Your doctor may doubt the results of your eGFR, the routine test, due to your serum creatinine output or some other variable. Age, race, gender, and muscle mass all affect the eGFR. The Iothalamate clearance test will give him an accurate measurement of your GFR so he will know not only what stage of CKD you are in, but how to treat it.

I hope this is helpful to the reader who asked.

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!

The Nutrition Action Health Letter Article

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

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

 

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

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

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

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

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

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

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

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

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

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

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

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

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

***

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

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

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

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

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

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

My hope is that as a result of this article, more libraries, medical schools, and nephrology practices will IMG_2982order copies of What Is It and How Did I Get It? Early Stage Chronic Kidney FullSizeRender (3)Disease, The Book of Blogs: Moderate Stage Chronic Kidney Disease, Part 1, The Book of Blogs: Moderate Stage Chronic Kidney Disease, Part 2, and SlowItDownCKD 2015. If you have a Kindle, Amazon has two wonderful low cost or free programs that may make it easier for you, your loved ones, and anyone you think could benefit from these books to read them.

This is how Amazon explains these programs:

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

Barnes and Noble doesn’t have any such programs, but they do offer discount deals daily, which you can use to purchase any book.IMG_2980

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

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

Until next week,

Keep living your life!

What’s Your Type?

Every Sunday night, I take a blues dance lesson taught by my daughter, Abby Wegerski, as Sustainable Blues Phoenix at Saint Nick’s Tavern and SlowItDownCKD 2015 Book Cover (76x113)stay to dance to the music of the live band – the Rockets 88s – for a while. Last week, my good buddy, Karla Lodge, organized a fund raiser. I like to support Karla in whatever she does, so I decided to push myself and go to the fundraiser (a half hour drive each way) after dancing.

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

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

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

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

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

4I see a hand raised in the back of the room. (This does remind me of when I was teaching college out here in Arizona.) Why are there four types you ask? Good question. Anyone have the answer? I don’t either, so let’s look it up together. Look! The Smithsonian Institute sums it up in one sentence: “But why humans and apes have these blood types is still a scientific mystery.” Now I don’t feel so uninformed that I couldn’t answer the question. Anyway, you can read more at: http://www.smithsonianmag.com/science-nature/the-mystery-of-human-blood-types-86993838/#JwJKP357AyhDRy4R.99 and, yes, this is THAT Smithsonian Institute.  Where, oh where, is Bones when you need her?Bones-tv-show-f38

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

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

blood-donor-match

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

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

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

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

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

IMG_1398

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

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

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

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

Until next week,

Keep living your life!

It’s Still There

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

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

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

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

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

I’m beginning to wonder just how much time. Although, there was evidently a lot of under the skin bleeding happening here.IMG_1226

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

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

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

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

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

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

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

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

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

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

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

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

Arteries are:

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

Veins are:arteries_and_veins_of_the_arm_l

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

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

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

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

Until next week,

Keep living your life!