I Feel Like a Heel

I do.  And I have for months.  But I didn’t want to have this checked for months. I’m writing about what turned out to be plantar fasciitis, an inflammation of the connective tissue which supports the arch of the foot and is located between the heel and the ball of the foot. It is caused by small, repetitive trauma to this area.  It almost sounds like carpal tunnel of the foot.  I am being humorous here; don’t take that seriously.

When this first showed up, Bear and I jokingly decided at least one of us should be able to walk. While he’s definitely healing, he’s still wheelchair bound (which is the better than the bed bound that he was for the first GmM8B2ylPUP0lIuKR9OqrzOqFEOtJtRaf2Rpt6ncsBkmonth after surgery… got to look on the bright side) after incurring a non-displaced fracture in the same foot  he had the surgery on.  His three fused joints and torn ligament in that foot were halfway healed at that point. Luckily, the metal in there was not damaged in the fall that caused the broken bone.

I had a referral for a podiatrist from my primary care doctor and I sat on it, until I realized that was what I was doing. I shook my head, took a deep breath, and made the call for an appointment.  I’m glad I did.  My fear had been that I would need surgery on the bone spurs in my heel.  Bear and I may have been joking, but I really did – and do – feel I need to be able to walk until he can.

Plantar fasciitis has nothing, I repeat nothing, to do with the bone spurs in my case  – although they can be a risk factor.

According to Beth Israel Deaconess Medical Center at http://www.bidmc.org/YourHealth/Conditions-AZ/Chronic-kidney-disease.aspx?ChunkID=11621

Plantar fasciitis is most common in people who are 40-60 years old. (How kind of my body to wait the extra seven years.)

Other risk factors that increase your chance of getting plantar fasciitis include:

Physical exertion (like wrestling a wheelchair in and out of the car or pushing it uphill?), especially in sports such as:

Running

Volleyball

Tennisimages (1)

A sudden increase in exercise intensity (Yeah, it’s got to be that Olympic sport of wheelchair wrangling) or duration

Physical activity that stresses the plantar fascia

People who spend a lot of time standing

A sudden increase in activities that affect the feet

Obesity or weight gain (Ummmmm)

Pre-existing foot problems, including an abnormally tight Achilles tendon, flat feet, or an ankle that rolls inward too much

Poor footwear (Ack!  Grew up with that and overcompensated with exactly the wrong kind of shoes as an adult.)

Heel spurs (Luckily for me, not in my case)heel spur

Agave Foot Specialists, the podiatrists I chose, are treating it with rest – one of the hardest things for me to do, even in my ‘retirement.’ When I explained that I needed to exercise at least half an hour daily for the Chronic Kidney Disease, they amended that to using the stationary bike (Well, they gave me a handout that included cross-training.  I wasn’t sure what that was, but I’m good at asking.) It almost felt good to get back on the bike this morning.

They also suggested swimming (Moi?  With my aversion to being in bodies of water?), certain kinds of yoga, and certain kinds of weight training.  I’ll stick with the stationary bike, thanks.

But that, of course, is not all.  I already messed this one up by misreading, but I’ll do it right tonight!  I’m to freeze a sports bottle (still not sure how that’s different from a regular bottle) and roll it over my arch for 20 minutes every evening.  Not bad, I can read while I do that… I think.

I also need to stretch my calf multiple times a day.  That’s not hard to do.  Remembering to do it is the hard part.

Here’s the kicker (ouch!): I have to wear shoes that meet the following criteria:

A firm heel counter.  I had to ask look that up.  I found this definition at http://shoesglossary.com/heel-counters, “A piece of leather forming the back of a shoe or boot. A heel counter may be used to stiffen the material around the heel and to give support to the foot.”  Oh no, that means I just bought two pair of shoes that won’t do since they’re sandals and have no heel counter.

A rigid shank (the part of the shoe between the inner and outer soles).  Now you see why I bought those two pair of shoes.

A flexible toe.  At least I got that part right.

Give me two weeks and I’ll be able to tell you whether I have a handle on the plantar fasciitis or not.

Kidney Book CoverMy dear friend and neighbor, Amy, just came in for our occasional coffee klatch.  While we were talking I told her about SlowItDown’s new website.  That was news to her.  Since she reads the blog religiously, it’s probably news to you, too.  Have a gander.  The address is http://www.gail-rae.com.  Suggestions and comments are welcome, as usual! Don’t forget to tell us which communities you’d like us to contact.

It also came up in conversation that I never told anyone that I’ve had a Certificate of Completion in Perspectives in Adherence from The American Kidney Fund since 11/09/11.  So, I do have some training concerning Chronic Kidney Disease other than my experience as a patient and my research, but I am STILL not a doctor.  Anything you read on the blog, Facebook page, or Twitter that I’ve written STILL needs to be run by your nephrologist before you heed that advice.

I’m taking a class at Landmark. Aren’t I always? At the last class meeting, one of my classmates asked me to tell her the story of how the book came to.  I realized I haven’t discussed the book on the blog in ages. Do take a look on Amazon.com or B&N.com to read the description and order a bunch.  Be wary of textbook companies that offer to rent you the book for most than it costs to buy it ($12.95) and remember the e-book is less expensive at $9.95.  Amazon has a wonderful program by which you can order a print book – or if you have ever ordered a print book – you can order the e-book at a 70% discount.  Another terrific way to save some money is to join with a friend and pool your order for that Amazon discount.

Time to go meet my step-daughter’s sweetie’s family!

Until next week,Book Cover

Keep living your life!

I’m Tired.

baby-shots-5I’m tired.  I’m almost always tired.  That is my most prevalent complaint lately.  And why?  Because I have Chronic Kidney Disease, Stage 3A. I thought I remembered this particular symptom doesn’t appear until dialysis starts – at stage 5 – so I decided to re-research my research… and surprised myself with the results.

Just in case you don’t remember, I retired from teaching at the community college last February (right after my 66th birthday) and from acting a month later. Two careers down and a year older, I’m still tired. True, I do blog every week and work on SlowItDown.  However, it’s still two careers down.

I was becoming concerned.  According to Donna D. Ignatavicius, MS RN, and M. Linda Workman, Ph.D, authors of Medical-Surgical Nursing: Critical Thinking for Collaborative Care, I shouldn’t be.  They explain that patients with early symptoms of chronic renal failure may complain of a general feeling of illness and that lack of energy and fatigue are often reported without any identifiable cause.

By the way, the book is available on Amazon, but I cannot recommend it yet since I just ordered it.  More on that after I read it. Okay, so maybe my CKD hadn’t advanced and maybe I hadn’t developed diabetes. Maybe it was just the stage of CKD I was in.

I wanted to check with my old standby, The Mayo Clinic.  Their website told me: “Signs and symptoms of kidney disease may include:Location of Kidneys

  • Nausea
  • Vomiting
  • Loss of appetite
  • Fatigue and weakness
  • Sleep problems
  • Changes in urine output
  • Decreased mental sharpness
  • Muscle twitches and cramps
  • Hiccups
  • Swelling of feet and ankles
  • Persistent itching
  • Chest pain, if fluid builds up around the lining of the heart
  • Shortness of breath, if fluid builds up in the lungs
  • High blood pressure (hypertension) that’s difficult to control”

You can read more about these symptoms at: http://www.mayoclinic.org/diseases-conditions/kidney-disease/basics/symptoms/con-20026778

Wait a minute!  Where in heaven’s name was loss of appetite when you needed it!  Here I am with CKD, aging, exercising, following the renal diet, and not losing weight. I realize that sounds pretty shallow.  Let me explain.  My weight has always been a problem.  I’m not saying I WANT another symptom of CKD, but since I have CKD anyway, I would have preferred that symptom.

hiccupsI also had never questioned why I have hiccups so often.  Bear thought it was that I ate too fast, so I slowed down. (Hey, almost 45 years of running up to the fourth floor cafeteria, waiting in line, and then bolting down your food so you can get to the restroom and drop off your reports in the office three flights back down before teaching your next class doesn’t dissipate that quickly.  Long term habits….)

And why is fatigue a symptom of CKD in the first place?  I found the following at: http://www.kidneyabc.com/ckd-treatment/991.html (Which looks like it might just be a Chinese herbal site; it wasn’t quite clear.): “Fatigue in CKD (Chronic Kidney Disease) is most often caused by anemia in which the count of red blood cells are lower than normal. As red blood cells distribute oxygen to body tissues and cells, a shortage of oxygen can cause fatigue. Anemia begins in early stage of CKD, and tends to get worse as renal function decreases and less erythropoietin (EPO) is produced by kidneys.”

new blog shotThis is something that I explained in What Is It And How Did I Get It? Early Stage Chronic Kidney Disease. I’ve been diagnosed with non-anemic low iron levels. Well, it’s nice to know I’m not anemic, but the low levels of iron produce the same fatigue. Why?

The National Kidney and Urologic Diseases. Information Clearinghouse at http://kidney.niddk.nih.gov/kudiseases/pubs/anemia/anemia_508.pdf explains: “Healthy kidneys produce a hormone called erythropoietin, or EPO, which stimulates the bone marrow to produce the proper number of red blood cells needed to carry oxygen to vital organs.  Diseased kidney, however, often don’t make enough EPO. As a result, the bone marrow makes fewer red blood cells.”

You can’t correct it by simply taking EPO injections.  It’s just not that simple.  To quote what I wrote in my book, “…EPO can worsen your HBP – which can both cause and be caused by CKD.  Most nephrologists agree it’s better to take the EPO injections and increase your HBP medication to control your hypertension. “

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

So, what can you do for this fatigue?  I went to the same Chinese herbal site because their recommendations were simply so logical.

“Regular exercises have many benefits for stage 3 CKD patients:

Boost your energy.

Improve your immune system.

Alleviate edema.

Lower high blood pressure.

Aerobic exercises such as walking, jogging, dancing, swimming, etc. are preferred. And remember to avoid strenuous exercises.”

How can you argue with that?  I couldn’t, especially since dancing is included!

happy birthdayThank you all for your birthday wishes.  I like to respond to each of you individually and hope I haven’t missed anyone.  Let me know if I have. It was a lovely day with the kids, and neighbors helping me celebrate, as well as my long distance friends emailing, snail mailing, Facebook inboxing, and texting.  I truly feel cherished by those in my communities.

I also believe I’ve gotten across to the French division of Amazon by writing in English and letting them translate it instead of giving in to my own misguided insistence upon using my fractured French.  Take a look for yourself by going to Amazon’s website, scrolling down to the bottom of the page where the different countries of operation are listed, hitting France, and inputting the title of the book – in English.

I’m tired… time to take a rest.

Until next week,

Keep living your life!

Control That Chronic Condition

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

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

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

Patients Can Do More to Control Chronic Conditions

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

By Laura Landro

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

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

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

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

Patients’ Role

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

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

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

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

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

Getting the Word Out                     Book Cover

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

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

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

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

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

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

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

Until next week,

Keep living your life!

Book It!

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Keep living your life!

‘Twas The Night Before The Night Before Christmas

Christmas Tree’Twas the night before the night before Christmas and all through the house…. The night before the night before Christmas?  Where did the time go? Hmmmm, there are no children here to constantly remind us Christmas is coming.  We rarely watch television (although we often watch movies), so we didn’t see the ads that could have reminded us.  Oh, I did know it was coming… just not so quickly.

And that’s often the case when we deal with a chronic illness.  We know that doctor’s appointment is coming up and we’re eager to see the results of our blood tests.  After all, we’ve worked so hard on diet, exercise, sleep, and lack of stress (that’s funny: stressing for lack of stress).  We just didn’t know it was coming so quickly. Did we have enough time to lower our blood pressure?  Was it enough time to lose some weight?  Did we monitor our eating enough in this amount of time that our cholesterol numbers are down?  Time, time, time.  It all comes down to time.

I have a modest proposal (apologies there, Mr. Swift).  What if we ignore time and just always – okay, almost always – watch the diet, exercise, sleep enough, and avoid stress.  Oh right, that’s what we’re supposed to be doing: lifestyle changes.NAFLD

According to an article published in the European Journal of Social Psychology way back in September of 2009, it takes an average of 66 days to form a new habit. The article was written by Phillippa Lally and her colleagues from the Cancer Research UK Health Behaviour Research Centre based at UCL Epidemiology and Public Health, and was based on their research.  You can find more at: http://www.ucl.ac.uk/news/news-articles/0908/09080401

Since it’s habits that form your life style, I had trouble accepting that number so I kept researching.  Ugh, I kept coming up with the same number although one analysis of this same article did mention that it can take as few as 18 or as many as 254 days to form a habit depending upon the individual.  I’ll take the 18 days option, please.

All right, let’s try something else.  How about getting enough sleep.  How much sleep is enough sleep anyway?  According to Dr. Timothy Morgenthaler on the Mayo Clinic site (http://www.mayoclinic.com/health/how-many-hours-of-sleep-are-enough/AN01487), seven to eight hours is what an adult needs, but then he lists mitigating circumstances under which you might need more:

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

Victorian clockThose first two weeks after Bear’s surgery when I was his caretaker, I rarely enjoyed more than two hours of sleep at a time and there seemed to be no difference between day and night.  I’m not saying this would be true for everyone, but we paid for it dearly.  I ended up in the emergency room needing a breathing treatment to relieve the bronchial symptoms that were making it so difficult to breathe and I just may have brought home a virus for Bear who soon started running a high fever. We were both run down from lack of sleep.  Of course, Bear was already in recuperative mode, but we proved to me how very important sleep is.

When I was first diagnosed with Chronic Kidney Disease almost six years ago, the value of exercise was brought home again and again by my nephrologist.  Until I researched for What Is It And How Did I Get It? Early Stage Chronic Kidney Disease, I wasn’t clear about why this was important.  This is what I discovered:

I knew exercise was important to control my weight.  It would also improve my blood pressure and lower my cholesterol and triglyceride levels. The greater your triglycerides, the greater the risk of increasing your creatinine.  There were other benefits, too, although you didn’t have to have CKD to enjoy them: better sleep, and improved muscle function and strength. But, as with everything else you do that might impinge upon your health, check with your doctor before you start exercising.

I researched, researched and researched again.  Each explanation of what exercise does for the body was more complicated than the last one I read.  Keeping it simple, basically, there’s a compound released by voluntary muscle contraction.  It tells the body to repair itself and grow stronger. The idea is to start exercising slowly and then intensity your activity.exercising silhouette

Okay, so we know during that 66 days to form a habit, seven to eight hours a night of sleep is one of the habits we should be forming and half an hour of exercise daily is another.  Might as well throw in following the renal diet and avoiding stress as two other habits to get into.  However, considering how long this blog is already, those are topics for another blog.  Who knows?  Maybe even next week’s blog.

KindleAmazon is offering the book in many different countries as well as ours.  It’s also offering the Kindle MatchBook in each of these countries.  Remember?  That’s the program that allows you to buy the digital edition at a 70% discount if you’ve EVER bought a print copy of the book from them.  Why mention it yet again?  It just occurred to me that you can gift the newly diagnosed, their friends and/or family in many different countries! And for those who asked, yes, the book is available on B&N.com, but their digital reader is The Nook, not the Kindle, so there’s no MatchBook discount program on this site.

May you have a Merry Christmas and a Happy Kwanzaa if those are the holidays you celebrate.  Oh my!  Just one more 2013 blog. I think I’ll go back to the earliest ones from this year to see how varied they are.  I’ll bet there’s more than one about the health benefits of coffee.Book signing

By the way, there has been some controversy about the authorship of the poem from which I played upon for the title of this blog, but I’m more than willing to accept Clement Moore as the author of “ ‘Twas The Night Before Christmas.”

Until next year,

Keep living your life!

A Healthy Diet is Not Necessarily a Renal Healthy Diet

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

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

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

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

So what are the differences you ask?

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

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

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

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

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

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

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

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

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

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

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

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

Until next week,

Keep living your life!

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

Victorian clockYou 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.flu shot

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 sugarapple shaped

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.

heart attackAgain, 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.Dr. Andrew WEil

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.Book Cover

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!blues

A1C! A1C! (Sounds like a Cheer to Me!)

For those of you who don’t know us personally, we do a lot of eating out during celebrations.  (Is Labor Day an eating out kind of holiday?) August is full of birthday celebrations.happy birthday

We started off by celebrating Sean’s August 20th birthday early since he and Kelly were going to be in Michigan with his family on his actual birthday.  I somehow magically found Salute Ristorante Italiano (http://www.saluteaz.com/) in Phoenix which actually had a delicious meal that required no substitutions whatsoever for me… and they didn’t know that I was coming or that I had renal disease.  Hurray for them!  It was Sean’s celebration, but I felt I was the one who’d gotten a present.

Bear’s birthday was the 23rd.  On the spur of the moment, we decided to go to Buca de Beppo’s (www.bucadibeppo.com) for a late lunch/ early dinner since I had a Landmark Worldwide class that night and we wanted to do something to celebrate.  This meal didn’t turn out so well for me.

While Bear ordered a delicious meal, I could taste the salt in the cheese ravioli with meat sauce.  The meatballs weren’t salty, but they were still red meat.  Let’s see:  cheese, red meat, and salt.  Good thing Bear also ordered a salad. Then I completely blew it by having half a chocolate chip cannoli in chocolate sauce while the wait staff sang Happy Birthday to Bear.  Amazing how fast the body lets you know you’re not doing right by it.ravioli

The next day, I’d promised to take Bear to his favorite restaurant for his favorite meal before we went to hear Greg Warren perform at Stand Up Scottsdale (http://standupscottdale.com).  While Greg Warren (www.gregwarrencomedy.com) was an excellent choice, Flo’s (www.madebyflo.com) was a renal diet disaster.  This is in no way a bad review for Flo’s, but rather a bad review for deviating from the renal diet.

Once or twice a year, I indulge myself with their scrumptious house fried rice… even though it’s fried.  But not the day after a meal that did me no good!  To make it worse, they must have changed their recipe for the Vietnamese Spring Roll. It was deeply fried with a very mushy interior. By the time, Bear’s complimentary dessert of chocolate covered wonton surrounding a slice of orange arrived, I was very happy to eat just the orange.

Ah, but we’re not done.  Grown children Abby, Lara, and Lara’s sweetheart joined us for ‘The Mortal Instruments: City of Bones’ (Eh.  Maybe I wasn’t in the mood.) and dinner at Claim Jumpers (www.claimjumper.com/) afterward.  This is a place where Bear usually shares a really tasty renal diet meal with me… but not on his birthday: ribs, mashed potatoes, roasted veggies with sour dough cheese bread and then a taste of the chocolate cake a la mode.  All I have to say is, “What the dickens is wrong with me?!?!?!?!?”

sad faceMy poor beleaguered body could not keep up with so many foods I usually do not eat and I felt physically ill.  To make matters worse, my A1C will be a mess this time around.

Oh, right, A1C.  That’s the topic of today’s blog.  Let’s start the way we usually do with a definition. I picked up Amgen’s Understanding Your Lab Values: A guide for patients with chronic kidney disease. While this is a drug company (and I don’t recommend any drugs; that’s up to your doctor), their informational guides are usually clear and straight to the point.  They define A1C as, “a test that measures your average blood glucose levels over 2 to 3 months.”  Mine is evaluated via my usual quarterly blood draw.

You’ve probably figured out that this has to do with diabetes or pre-diabetes. According to DaVita at http://www.davita.com/kidney-disease/causes/diabetes/the-a1c-test-and-patients-with-chronic-kidney-disease/e/7802, people with Chronic Kidney Disease should keep their A1C readings between 4.0 and 5.9%.  Mine has been rising steadily for the last several years and is presently at 6.1, which is considered pre-diabetic.

Okay, so your glucose levels can be tested for a two to three month average and over a certain percentage is considered pre-diabetic.  What is so important about blood glucose anyway?A1C

Our old friend MedicineNet at http://www.medterms.com/script/main/art.asp?articlekey=32858 tells us blood glucose is:

“The main sugar that the body makes from the food in the diet. Glucose is carried through the bloodstream to provide energy to all cells in the body. Cells cannot use glucose without the help of insulin.

Glucose is a simple sugar (a monosaccharide). The body produces it from protein, fat and, in largest part, carbohydrate. Ingested glucose is absorbed directly into the blood from the intestine and results in a rapid increase in blood glucose. Glucose is also known as dextrose.”

Got it!  We need blood glucose for energy.  And the cells need insulin to provide this energy from glucose. Well, how is this a problem?  Wait a minute – insulin – diabetes.  Oh, my!

I’m getting close to diabetes.  All right, then let’s look at diabetes.  What’s that? Well, we can figure out it’s the body’s inability to handle a surplus of glucose in the body, but what harm is it specifically to you (and me) as a Chronic Kidney Disease patient?

According to Diabetes.co.uk at http://www.diabetes.co.uk/how-does-diabetes-affect-the-body.html, “The kidneys are another organ that is at particular risk of damage as a result of diabetes and the risk is again increased by poorly controlled diabetes, high blood pressure and cholesterol. “

I am not liking this. I’m already being treated for hypertension [high blood pressure] and hyperlipidemia [high cholesterol].  I don’t think I can afford to add diabetes to the list.  And that’s why next week’s blog will be about diabetes.

talkingstickresortThank you for all the support you’ve shown for SlowItDown, the project to bring free CKD education by trained educators to any community that needs it. It was our pleasure to be part of The Fourth Annual Men and Women’s Gathering at Talking Stick Resort this past Thursday.  This was hosted by The Salt River Pima – Maricopa Indian Community and open to all tribes.  Non-tribal members were welcome as well.

Several medical professionals, including nephrologists, have offered to help make this an interactive blog.  Please send your questions in comment form and we will answer them as quickly as possible. I’m enjoying the change of direction for the blog.

And to think this all started when I wrote What Is It And How Did I Get It? Early Stage Chronic Kidney Disease because I needed answers.

Until next week,

Keep living your life!

Spurs in Arizona

Of course there are spurs in Arizona, you may find yourself thinking… and you’re right. Both kinds are in abundance here.  Both kinds?  Sure, the ones you wear on your boots and the ones you wear in your boots, actually inside your foot. cowboy boots

I recently had pain in my heel and figured it was just another sign that I’m growing older (funny, I do that every year).  When I casually mentioned this to my ever vigilant primary care doctor, Helen Zhao of Deer Valley Family Practice, she pounced.  She’s so good at that and since she’s the one who uncovered my Chronic Kidney Disease, I listen when she pounces.

An order for three different foot x-rays revealed a formerly broken little toe (Judo pre-pregnancy 33 years ago), osteoarthritis (that’s like telling a painfully sun burned person they’re sun burned) and a heel bone spur.  A what?  Oh, an osteophyte!  Osteo comes from the Latin osseusos, ossis meaning bone and the Greek osteon, also meaning bone.   (Thank you for the memory, Hunter College of the City University of New York course in Greek and Latin roots taken a zillion years ago).

You know the name of my book about Chronic Kidney Disease is What Is It And How Did I Get It? Early Stage Chronic Kidney Disease.  That’s become my approach to any new ailment that shows up for me.  And there are lots of those lately.

We know from its name that a bone spur has to do with the bone.  We also know what a spur is.  Try to visualize a spur on the end of your heel.  Or, better yet, look at the diagram below. See it?

heel spur

According to MedicineNet.com at http://www.medterms.com/script/main/art.asp?articlekey=7094, this is the definition

Heel spur: A bony spur projecting from the back or underside of the heel that often makes walking painful. Spurs at the back of the heel are associated with inflammation of the Achilles tendon (Achilles tendinitis) and cause tenderness and pain at the back of the heel that is made worse by pushing off the ball of the foot. Spurs under the sole (plantar area) are associated with inflammation of the plantar fascia (the ‘bowstring-like’ tissue stretching from the heel underneath the sole) and cause localized tenderness and pain made worse by stepping down on the heel.”

The latter is my problem.  I’d actually thought that dancing was magic because when I did at Sustainable Blues (https://www.facebook.com/groups/SustainableBluesPhx/), I didn’t feel any pain at all.  Turns out that’s because I was dancing on my toes, not my heels.  I’ve still got bluesto thank daughter, Abby Wegerski, who started the dance as her Self Expression and Leadership Program project at Landmark Worldwide, and her co-instructor, Tyler Robbins, for those two pain free hours a week.

On to how I got it. Webmd.com (http://www.webmd.com/pain-management/heel-spurs-pain-causes-symptoms-treatments) tells us,

“Heel spurs occur when calcium deposits build up on the underside of the heel bone, a process that usually occurs over a period of many months. Heel spurs are often caused by strains on foot muscles and ligaments, stretching of the plantar fascia, and repeated tearing of the membrane that covers the heel bone. Heel spurs are especially common among athletes whose activities include large amounts of running and jumping.”

I don’t run and I don’t jump, but I do pop in a walking tape DVD every other day or so.  Could that be the cause?  I read on only to discover that age, weight, walking gait, worn out shoes (I wear the comfortable ones until they literally fall apart) and “frequent short bursts of physical activity” could be the culprits.  I am pretty sedentary except for those exercise periods each day.

Still not satisfied, I wanted to know what I could do about the heel spur I’d developed. Dr. Andrew Weil, my health hero before I developed Chronic Kidney Disease has quite a lot to say about that at: http://www.drweil.com/drw/u/ART03031/Heel-Spurs.html:

“….Symptomatic treatment involves rest, especially from the activity that is contributing to the condition and making symptoms worse …. Ice is recommended immediately following it…. Stretching exercises that gently lengthen the calm muscle will relax the tissue surrounding the heel and should be done several times a day, especially in the morning and after prolonged sitting. Over-the-counter or prescription-strength anti-inflammatory medications can help temporarily…. Deep tissue massage, taping and other physical therapy modalities can also be helpful. Arch support is highly recommended, either with shoe inserts or custom orthotics made by podiatrists. If pain continues, a steroid injection at the site of pain may be recommended….Sometimes bone spurs can be surgically removed or an operation to loosen the fascia – called a plantar fascia release – can be performed.”

I urge you to read his article for yourself since I omitted many of his warnings due to lack of space.  They are valid.  He also suggests natural remedies that you may find helpful, but be careful about the herbs.  As CKD patients, we need to rely on tested substances and, often, herbal supplements are not.  It was so much easier to deal with my health before CKD (or so I thought). As CKD patients, we cannot take Over The Counter (OTC) pain relievers.  Maybe taking a really close look at some of Dr. Weil’s natural treatments is worth a shot.  Just remember that you do have CKD.

Heel that Pain (love the name!) at http://www.heel-that-pain.com/heel_bone_spurs.php made a common sense point, although they sell the product to follow the common sense.  I am not endorsing their product because I haven’t tried it, but I do use orthotics from several different companies.orthotics

“The heel spur, because it is part of the bone, actually has no feeling in it. The pain that is generated from the heel spur is due to the soft tissue around the heel spur that gets irritated and inflamed and bruised. This is what creates the heel pain from the spur itself. If you can properly support the heel bone so that friction and motion are reduced, it will allow the soft tissue around the area of the heel spur to heal, and have a reduction in the inflammation and tenderness. The goal would be to support the heel bone enough so that the heel spur does not dig into the soft tissue.”

Wait a minute… I think I remember that I have spinal bone spurs too.  Well, there’s next week’s blog.

Kidney Book CoverI have a meeting with Annette, Folmer, the kidney education coordinator for SlowItDown (https://www.facebook.com/NativeAmericanCKDeducation and twitter.com) tomorrow to plan our presentation at the Men’s and Women’s Gathering at Talking Stick Resort on August 29.  I know how important CKD education is, but it hadn’t occurred to me that it would be exciting! By the way, this project emanated from my Landmark Worldwide Self Expression and Leadership Program.

Ah, the book.  I keep forgetting the original purpose of the blog was to publicize the book.  How life transforms! It does well and will continue to do so as long as you remember that every book you buy (Amazon.com and B&N.com) allows me to donate another one.

Until next week,

Keep living your life!

It’s Not Just For Eating

There’s not that much to report on the book, since you already know that sales have been steady.  I’m so close to paying off the costs of printing the book that I can taste it.  Then I’d like to recoup what I paid for having it digitalized and for all the donations I’ve made. This is Book Coveralmost like a game to me because I know I’m just going to take any profits and transform them into books for donation anyway, but it keeps me sharp!

Updates on medical issues here.  I still have macular degeneration – as if it were just going to disappear – and started taking the only two supplements I can with Chronic Kidney Disease.  I’m talking (okay, writing) about the supplements in the comprehensive pill my ophthalmologist offers in an attempt to slow the eye disease down. I’d wanted to take full advantage of the entire 25% chance of slowing the disease that this pill offers, but my kidneys come first.

It turns out Bear CAN wait for the surgery since it’s kind of a last ditch effort to save mobility and he’s not there yet… thank goodness.  Now to find some good pain management for him.  Thank you to Alex Gilmore for showing up to stand for us at the neurosurgeon’s office.  He asked our questions in a form this doctor could understand.  It’s interesting that once Alex was there and we explained why, the doctor started couching his responses to the questions in language that WE could understand.

I’m eager to get into today’s topic: liver, or rather fatty liver disease.  I vaguely remember this showing up on an MRI some time ago and my primary care physician – the ever vigilant Dr. H. Zhao – telling me about it.  That’s when I was obsessed with weight since my nephrologist had just explained I would do better at slowing down the progress of the CKD if I lost weight.  My first response to Dr. Zhao? “That’s fat, too?”

liverOnce she stopped laughing, she explained that many people have fatty livers but you have to be careful about it before you end up with (in my case) NAFLD or Non-Alcoholic Fatty Liver Disease.  Why am I writing about it now?  Beats me, but I dreamed about it so I figured that was enough reason to explore it.

So, we know fat gets deposited in the liver and too much is no good.  The question is how much is too much?  According to WebMD at http://www.webmd.com/hepatitis/fatty-liver-disease,

“Some fat in the liver is normal.  But if fat makes up more than 5%-10% of the weight of your liver, you may have alcoholic or nonalcoholic liver disease.  In some cases, these diseases can lead to serious complications.”

Let’s backtrack a little to find out why the liver is important in the first place.  According to the Mayo Clinic at http://www.mayoclinic.org/liver-disease/?mc_id=comlinkpilot&placement=bottom, these are the functions of the liver:

“Breaking down harmful substances

Removing waste products from the blood

Storing nutrients and vitamins

Moderating chemical levels in the body”

Take a looks at the second function again.  Does it sound familiar?  Yep, that’s one of the functions of your kidneys, your not functioning at capacity kidneys.  You’re already having trouble because one of your organs can’t do its job adequately, you certainly don’t need an additional organ responsible for the same job to be compromised.  Ah, that must be why I’m writing about fatty liver disease on a Chronic Kidney Disease blog.Location of Kidneys

By the way, a liver specialist is called a hepatologist.   That comes from the same word root as hepatitis. Remember I’d urged you to make certain you took the series of hepatitis B inoculations since your kidneys are already comprised? And suggested you might want to be checked for any hepatitis C in your blood work?  Hepatitis is from the same Greek word root, hepa which means liver.  Just in case you’re interested, the University of Hawaii at Manoa has a fairly inclusive list of medical word roots at http://manoa.hawaii.edu/learning/PDFhandouts/StudySkills/Word%20Roots.pdf .  This is right up my alley!

Okay, maybe we need to know a little more about the liver.  It’s a large organ, in fact, the second largest in your body. You’ll find yours under your rib cage on the right side of your body.  My perverse sense of humor found it funny that the kidneys are shaped like – well – kidney beans while your liver is shaped sort of like a football that’s flat on one side. (Can you see the mental image I conjured up of the kidneys tossing the football back and forth?  Can’t really happen but it’s funny… if you’re me, that is.) Oh, yes, weight: three pounds.

Like CKD, NAFLD is mostly a silent disease; it has no symptoms.  When symptoms do occur, it seems to me that they would be hard to pin down as NAFLD since it’s not an array of these symptoms, but any of them. Then again, I’m not a doctor.

“fatigue, weakness, weight loss, loss of appetite, nausea, abdominal pain, spider-like blood vessels (Hey, I have those!), jaundice, itching, edema, ascites {swelling of the abdomen} and mental confusion.”

Thank you to the American Liver Foundation at http://www.liverfoundation.org/abouttheliver/info/nafld/. This is a nifty little fact sheet that is simple to understand.

Then I got to wondering about why this disease could be dangerous.  It’s the possible progression that makes it dangerous.  You’re told you have a fatty liver (AFLD is fatty liver disease caused by alcoholism), you don’t lose weight {if you’re overweight or obese}, lower your cholesterol and triglycerides, control your diabetes {if you have it} or avoid alcohol, and the disease worsens. NAFLD

Your liver swells.  This is called steatohepatitis.  That may cause cirrhosis (Quick!  Go to the University of Hawaii at Manoa’s medical word root site! Or just read on.) or scarring over a long period.  The cirrhosis could eventually cause liver cancer or failure.  The saddest part of all this is that some people develop NAFLD or AFLD for no reason at all.

The good part (There’s a good part?) is that a healthy diet and regular exercise – just like CKD, isn’t it? – may prevent scarring or even reverse it if the disease is caught early enough.  Since there usually aren’t any symptoms, fatty liver disease is most often uncovered by your blood tests.  A high level of liver enzymes could be the tip off.

I almost forgot to mention that Alcoholic Fatty Liver Disease has another name: NASH.  This stands for Nonalcoholic Steatohepatitis.  My parting gift to you today: steat is a word root meaning fat.

Until next week,

Keep living your life!

Eat And Be Well

Here’s hoping all you mothers – and fathers being both mother and father to your children – had a wonderful Mother’s Day. There are just too many such fathers to mention individually here.

I don’t know where the idea originated that you had to give birth to your children to be their mother, but I see examples every day of non-birth mothers being terrific mothers.  That one’s for you, sweet Sharon.

My step-daughter Kelly and her fiancé Sean made a Mother’s Day bar b q and invited her sister Lara, along with Lara’s love, my daughter Abby, and Bear and me.  That’s my kind of Mother’s Day.  The only thing that could have made it better is if my NY daughter, Nima, had been there.download

As usual, Sean asked me first how I needed my chicken seasoned and if the piece he had chosen for me was small enough. That kind of thoughtfulness is a given with this gracious man.  Alex brought the sweetest watermelon… something else I could eat.  Someone brought potato salad which I admit I had a teaspoon of “just to taste,” and someone else brought potato chips.  I had no trouble eating my limited permitted share of those.  Kelly even made a cup of coffee just for me.

I see today’s blog is going to be about food.  Keeping that in mind, I found this general guideline to healthy eating at: http://healthfinder.gov/HealthTopics/Category/health-conditions-and-diseases/diabetes/eat-healthy

The Basics

Your body needs the right vitamins, minerals, and other nutrients to stay healthy. A healthy diet means that you are eating:

  • Vegetables, fruits, whole grains, and fat-free or low-fat milk products
  • Seafood, poultry, lean meats, eggs, beans, peas, seeds, and nuts

Limit foods high in:

  • Cholesterol, sodium (salt), and added sugars
  • Tans fats – Trans fats may be in foods like cakes, cookies, stick margarines, and fried foods.
  • Saturated  fats – These fats come from animal products like cheese, fatty meats, whole milk, and butter.
  • Refined grains – Food products with refined grains include white bread, noodles, white rice, and flour tortillas

 

What I found interesting here is that what the general population is urged to eat is not that much different than what we early stage Chronic Kidney Disease sufferers are told to eat.  We do have to limit the fruits and vegetables to three different sized portions of each.  The portion depends on the particular fruit or vegetable. We also need to cap our limited types of seafood, poultry, lean meats, and eggs to five ounces per day.  As for seeds and nuts, those are no-no’s for us.

Look at the foods the government feels we should avoid.  Look familiar?  Take a look at the renal diet your nutritionist gave you and you’ll find them on that as foods to limit (or avoid), too.glycemic-index

You probably noticed the above information was taken from a website dealing with diabetes.  That’s because diabetes is one of the leading causes of Chronic Kidney Disease and vice-versa. That’s another reason to watch your intake of foods with a high glycemic index – the indicator of how quickly your blood sugar rises after eating the food – which includes not only what we usually consider sweets, but ice cream, too.

P1050446-1024x677You know we need to stay as healthy as possible, including keeping our weight down. One way to do that is NOT skipping breakfast.  Why?  This is how study researcher Dr. Tony Goldstone, M.D., Ph.D. of Imperial College London in the UK explains it:

“Through both the participants’ MRI results and observations of how much they ate at lunch, we found ample evidence that fasting made people hungrier, and increased the appeal of high-calorie foods and the amount people ate.”

You can read more about the study that led him to come to this conclusion at: http://www.medicalnewstoday.com/articles/251709.php

You need to understand that skipping breakfast (literally breaking the fast you incur while you sleep) is a form of fasting.  If you take medication that requires food along with it, you’re also delaying the effects of the medication since you’re not taking it until later in the day.

Here’s an interesting finding on a study publicized in The Journal of Renal Nutrition in 2009:

“Long-term fish consumption was independently associated with improved kidney function among elderly individuals, a finding that extends the current knowledge regarding the benefits of fish intake on human health.”

But we knew that, didn’t we?  Take a look at: http://www.jrnjournal.org/article/S1051-2276(12)00181-1/abstract for more, slightly technical, information on this study.

By the way, are you taking Omega 3 (fish oil) supplements?  There’s a theory it helps retard the progress of CKD. I’ll been taking it all five years since my diagnosis and I’m still at stage 3A.

While that’s something I would suggest – and please remember:  I’m not a doctor.  You need to run my suggestions by your nephrologist before you even think of acting on them! – something I will  caution you  about is grapefruit or grapefruit juice.  Let’s go back to Healthfinder.gov at: http://www.healthfinder.gov/News/Article.aspx?id=670988&source=govdelivery#.ULPppKAFqXI.twitter for the information about this: is

“Even small amounts of grapefruit or grapefruit juice have the potential to cause sudden death, acute kidney failure, respiratory failure, gastrointestinal bleeding and other serious side effects when paired with these medications. Included are certain cholesterol-lowering medications, blood pressure drugs, cancer treatments and antibiotics such as erythromycin, the researchers said.”

And star fruit (carambola)!! Avoid it at ALL costs, because the cost could be your life.  It is toxic to people with Chronic Kidney Disease.  It’s a tropical fruit so chances are you’re not going to run into it too often.  I am so glad I wasn’t adventurous enough to try it in Nigeria all those years ago.  My daughter, Nima, did try it when our Nigerian friends (Remi Okunoye and her children Moriyika, Oliaton, and Benga) were living with us back on Staten Island, but she immediately spit it out.  She was a young child, not used to the taste, and it was too strong for her. Now that she’s at risk for CKD since I have it, I’m glad she did that.is (1)

I took the following quote from an article beguilingly entitled It’s not just what you eat, but when you eat it: “When a species’ typical daily rhythm is thrown off, changes in metabolism also happen. For example, in people, night shift workers have an increased prevalence of obesity and metabolic syndrome, and patients with sleep disorders have a higher risk for developing obesity. Also, less sleep means more weight gain in healthy men and women.”  This is discussed more technically at: http://www.eurekalert.org/pub_releases/2012-11/uops-inj110612.php

Enjoy what you do feel safe eating – and there is quite a bit of that type of food available, you know.

Until next week,

Keep living your life.

Weight A Minute

4weddingWe’ve been married for one week and one day (and no, I don’t feel any different.  Being married to Bear is just as delicious as co-habitating with him).  We just got our pictures back from our future son-in-law and videographer, Sean Rasbury.  They’re beautiful.  We’re beautiful.   Our family is beautiful. Our friends are beautiful. The wedding was beautiful.

But, you know it’s important to keep your weight down when you have Chronic Kidney Disease and the pictures were a rude awakening for me.  I thought I was doing just that.  Hah! I was not the beautiful blushing bride, but the beautiful bountiful bride.

Keeping your weight down is one of the ways to help retard the progression of the disease.  How? By not allowing yourself to become obese. Obiously, if you keep gaining weight, you can become obese.  Obesity is one of the contributing factors for developing diabetes.  Diabetes may lead to, and complicates the treatment of, ckd.

Look at my wedding picture again. Based on my BMI (Body Mass Index) I am obese. This is from What Is It And How Did I Get It? Early Stage Chronic Kidney Disease:

“The BMI formula was something about your weight divided by the sum of your height in inches squared times 703.  I think. I have researched and researched this,

but still do not understand it.  I did discover later on that there are free BMI Calculators online, such as the one on the United States Department of Health and

Human Services’ website [http://www.nhlbisupport.com/bmi/bminojs.htm], so you really only need to know our height and weight. If I’d known that at the time,

I just might not have felt so overwhelmed.”

You can order the book in either print or digital at: http://www.amazon.com/s/ref=nb_sb_noss?url=search-alias%3Daps&field-keywords=What+Is+It+And+How+Did+I+Get+It%3F+Early+Stage+Chronic+Kidney+Disease (which is Amazon) or http://www.barnesandnoble.com/s/What-Is-It-And-How-Did-I-Get-It–Early-Stage-Chronic-Kidney-Disease?keyword=What+Is+It+And+How+Did+I+Get+It%3F+Early+Stage+Chronic+Kidney+Disease&store=allproducts (which is Barnes and Noble).  If you’d like an endorsed print copy, just email me at myckdexperience@gmail.com or call (623) 266-2609.

You can see from the family wedding picture that some of us are naturally thin. They don’t seem to watch their diets or exercise, either. I notice that they need to start doing just that once they approach 30.  I sort of remember that being the case for me, too.  Then again, I danced all the time, studied Judo, ice skated, skied, and basically was moving all the time.  My diet was another story.  I didn’t have ckd at the time and, like any other 20 something, thought that I was immortal.  family

Here’s a chart from Health Travel Guides that offers the other benefits of losing body fat.  You can see it’s an overall positive action to take for your body’s health.

whenyoulosefat

Medical News Today published this information in an article:

“A University of Bristol team, with funding from the British Heart Foundation (BHF), has now identified that a target found to be critical in the brain’s regulation of body weight,

is also crucially involved in the development of obesity-associated conditions. Researchers describe the mechanism behind a key molecule, known as melanocortin-4-receptor (MC4R),

whose mutation or loss in both human and animal models has shown to cause severe obesity with type 2 diabetes.”

The title of the article is Scientists Identify Culprit In Obesity-Associated High Blood Pressure. Hmmm, high blood pressure (hypertension), another contributor to ckd. This is preliminary research so we can’t just pop a pill that will magically control our weight.  We need to do that ourselves. You can read the article for yourself at: http://www.medicalnewstoday.com/releases/255768.php.

If you read another article at: http://news.health.com/2013/02/06/vitamin-d-loss-attributed-to-obesity/, you’ll find that obesity also may lead to a drop in vitamin D, something we can’t afford as ckd patients.  This is the vitamin that regulates calcium and phosphorous blood levels as well as promoting bone formation, among other tasks.  It also affects the immune system. If you’re like me at stage 3A, you’re already taking vitamin D supplements since we need to control phosphorous levels, which means we cannot afford to lose any more of it.

Yet another caution about obesity from Medical News Today is not only for ckd patients but any woman of child bearing age.  The headline says it all: Obese Women Taking Certain Contraceptive May Be At Increased Risk For Type 2 Diabetes.  Keep in mind that diabetes, as mentioned before, may contribute to the development of ckd.  Want to read the entire article?  Here’s the link: http://www.medicalnewstoday.com/releases/256099.php

thAccording to DaVita at http://www.davita.com/kidney-diet-tips/?p=1872

  1.                                        “… people with a BMI 35 or greater had higher death rates than normal weight, overweight and mildly obese patients, so becoming more obese is a concern.
  •                                         Obese people are more likely to have chronic diseases like diabeteshigh blood pressure and heart disease, which could mean they receive more medical care
  •                                                                                                                                                                                                                                       and monitoring compared to normal weight people.
  •                                         Excess weight may be a source of energy during illness or injury—a benefit the lean person does not have.
  •                                        A person can have different degrees of  health and fitness regardless of their BMI or weight. Factors such as nutrition status, diseases, health history, where
  •                                                                                                                                                                         fat is stored (abdominal  vs. lower body), eating habits influence your level of fitness.

The message here is that while excess weight may not affect your general health and may even be of some benefit during times of ill health, we have a chronic disease and cannot afford the luxury of the benefits in being overweight.

We offered no goodies except the wedding cake at our shindig.  Our dinner was all pasta based with plenty of salad and an additional side of string beans.  We had enough champagne for a toast.  That’s it.  We were able to provide the usual wedding dinner with options for those with ckd (ME!). The only thing we each had to control is how much of each we ate.taste the cake

We spent time enjoying instead of gorging.  All our daughters took part in the ceremony:  Abby Wegerski sang Marry Me and Nima Rosensfit sang I Would Love To Be Your Last, Lara Garwood was in charge of the candles for the family blending part of the ceremony, and Kelly Garwood read ‘Corinthians.’  Bear and I wrote our own vows and tailored the officiant’s vows to our beliefs.

Our audience consisted of only Janet Le, my long time buddy from Staten Island; Karla Lodge, my Arizona buddy; and Alex Gilman, Lara’s beau, because I wanted to become Bear’s bride under the palo verde tree in our backyard with only our dearest and nearest in attendance – that, of course, includes Sean Rasbury, who is Kelly’s fiancé, and Michael Payne who was Bear’s best man.  Even Bella, our dog, showed up for the ceremony wearing her new red collar with the red hibiscus the Kurrs and Doris Widmayer had brought back from Hawaii for me.

More pictures next blog and further descriptions for what we did for fun, instead of gorging, at the reception.

Until next week,

Keep living your life.

Timidly Exploring Dialysis

We are a Landmark Education family; that is Nima, Abby, and I are all Landmark Education graduates.  Abby has taken many of their enlightening courses and was candidated as an Introduction Leader.

In other words, she demonstrated her willingness to bring Landmark Education to others and now knew enough about the program to be able to do so.  This is a big deal in the Landmark world and it was celebrated Friday night.

Of course Bear and I went to the celebration to support her.  We even got dressed up a little (this IS Arizona – people go to weddings wearing jeans.).  Since I recently retired – yes, again – from teaching, I went right to my teaching clothes to find something appropriate to wear tonight. landmarkqr

While I’ve only gained a few pounds (no, really), my body has finally decided to show my age.  Out went the tightly fitted dressy tee shirts that accentuated the belly.  Out went the fancy blouses with no room for the droopy bust. Out went the casual dress pants with their tight waistlines. Out went the maxi skirts that now reached the floor since I’ve shrunk.

And it struck me.  I looked something like the peritoneal dialysis patient Walter A. Hunt mentions in his book Kidney Disease: A Guide for Living: “ Peritoneal dialysis also causes weight gain and an increased waistline, which are mostly caused by fluid retention.  It may be difficult to find clothes that fit properly, because your abdomen may become quite large.”

I was reading the book on the recommendation of Mark Rosen from Facebook’s KIDNEY DISEASE AND DIET IDEAS AND HELP 1. Any book he recommends is worth a gander.  I had been looking for a newer book than mine that deals only with early stage chronic kidney disease. (There aren’t any as far as I could research.) What I didn’t realize is that Mr. Hunt wrote about dialysis and transplant in his book.

I began to wonder what else I don’t know about either of these medical procedures and ended up where I always do: MedlinePlus, a service of U.S. National Library of Medicine and National Institutes of Health  at: http://www.nlm.nih.gov/medlineplus/dialysis.html.  This is what I found there:

“When your kidneys are healthy, they clean your blood. They also make hormones that keep your bones strong and your blood healthy. When your kidneys fail, you need treatment to replace the work your kidneys used to do. Unless you have a kidney transplant, you will need a treatment called dialysis.thCAQ0P7T3

There are two main types of dialysis: hemodialysis and peritoneal dialysis. Both types filter your blood to rid your body of harmful wastes, extra salt and water. Hemodialysis  does that with a machine. Peritoneal dialysis uses the lining of your abdomen, called the peritoneal membrane, to filter your blood. Each type has both risks and benefits. They also require that you follow a special diet. Your doctor can help you decide the best type of dialysis for you.”

This may be old news to those of you who are already dealing with renal dialysis and it was to me, too, but what about those people who are still in early stage or who love someone in early stage?  They don’t need to be bewildered when (if) this becomes necessary for them down the road, the way they were when they were first diagnosed with Chronic Kidney Disease.

As much as I deplore the thought of dialysis – I can’t stand anyone fiddling with me, not even for a manicure or a massage – this may become a necessity somewhere down the line for me –  or you.  We all know I intend to be one of the 80% of CKD patients who never progress beyond stage 3… but what if I’m not?  What if you’re not?

I don’t know much about either kind of dialysis, but am learning by forcing myself to research and finish reading Mr. Hunt’s book.  This is something I have studiously avoided in the last five years but I think it’s time to grow up.  I may never need this information, but it doesn’t hurt to have it.

I’ll tell you this, though.  Even though it’s Passover right now and Easter was Sunday, I made the commitment NOT to experiment with foods that are not on my renal diet.  And, since I know these are family heavy holidays, I took time off periodically to sit down and read a book for more than ten minutes at a time so I was at least rested.

While I was the one who invited nine people for Easter dinner (less than a week before our wedding, no less), Bear popped right in and took the stress off me.  He did the meal planning and the shopping.  I just asked each of our guests to make their specialties: Kelly made her creamy mashed potatoes, Lara her grandmother’s recipe cheesecake, Abby the crescent rolls, Sean’s mom Mary Ann the string bean casserole.  Alex brought wine and on and on. easter-dinner

It was pretty clear I needed something I could eat, so Bear brought me turkey, salad, bananas and strawberries.  I didn’t even miss tasting the ham, sweet potatoes, macaroni and cheese or some of the home made food.

I have a confession: I always get the adult children (the youngest is 28 for heaven’s sake!) Peeps and since the adults were disappointed they didn’t get any last year, I got them some this year, too. I know, I know, it’s all sugar and food coloring.

Sometimes, I get glutted by just being with my family.  Maybe that’s why while I might ‘taste’ the foods forbidden to me, I don’t seem to want to eat bunches of them.  Whoa, were the Beatles right when they sang, “All you need is love?”

A nice spring holiday present for me: the book continues to do well in the foreign market.  Let’s see what we can do about moving here at home too.

passoverI hope your Easter and Passover were (and still is in the case of Passover) happy, healthy, and rejuvenating.

Until next week,

Keep living your life!

To Stress Or Not To Stress

I woke up yesterday morning, threw open the windows, and just listened to the birds singing away while the sun shone right in. I was filled with joy that it was Sunday morning, Bear Bearandmewas right next to me, and I could do that.  Then I realized every morning is Sunday morning for me. I live in sunny Arizona and am retired.  The only stress I have is that which I impose upon myself.

I have heard my four grown daughters talk about the stress in their lives and what it seems to be doing to each of them in different ways.  We’re not talking about life or death stress, rather everyday should-I-or-shouldn’t-I stress.  Should I take the new job?  Should I go out with him?  Should I buy a house?  Should I move out of state?  Even (for me) should we have Italian food catered in for our wedding? You know, the usual – and good since so many of them are associated with joyous occasions – life stresses.

Stress?  Hmmm? What does that do to the kidneys? But wait, maybe it would be more prudent to explore just what stress is first.

According to the Free Online Medical Dictionary, “Stress is defined as an organism’s total response to environmental demands or pressures.” The site goes on to explain the description, causes, symptoms, diagnosis, treatment, alternative treatment, prognosis and prevention of stress.  While this was interesting reading, it’s not quite germane to the kidneys.  You can find all this information at: http://medical-dictionary.the freedictionary.com/stress

Alright.  We have those demands or pressures. (I distinctly remember my stress about whether or not to allow my youngest to attend a preforming arts high school across the bay from our Staten Island house in New York City.  It would mean a bus, ferry, and subway ride each way to the tune of an hour and a half… without me!)

But what is our organism’s total response?  You’ve got to remember we respond the same way whether the stress is positive (I always, without fail, experience a few minutes of stress before I go on stage or the cameras start rolling) or negative (like when we were told we need a new air conditioning system and we realized that meant the honeymoon will have to wait).stress

Ready? First you feel the fight or flight syndrome which means you are releasing hormones.  The adrenal glands which secrete these hormones lay right on top of your kidneys. Your blood sugar raises, too, and there’s an increase in both heart rate and blood pressure.  Diabetes (blood sugar) and hypertension (blood pressure) both play a part in chronic kidney disease.

If you still haven’t resolved the stress, additional hormones are secreted for more energy.

Still no resolution?  Not good.  Years, even weeks, of stress can “affect the heart, kidneys  {and doesn’t affecting the heart also affect the kidneys?}, blood pressure  {uh-oh, that also affects the kidneys.} stomach, muscles and joints.”  The comments within the brackets are mine.  Thank you to www.comprehensive-kidney-facts.com/stress-management.html for the rest of the information.

blood pressure 300dpi jpgFor those of you who want more technical explanations, I turned to eHow (I think I’m a little bit of a snob here since I’m surprised when I’m directed there in a medical search). According to www.ehow.com/facts_5929145_effect-stress-hormones-kidney-function.html, “The combination of vasoconstriction {that means ‘the narrowing (constriction) of blood vessels by small muscles in their walls. When blood vessels constrict, the flow of blood is restricted or slowed” http://www.healthscout.com/ency/1/002338.html } and increase in blood volume (because of water retention) raises  blood pressure, which can, over time, translate into chronic hypertension {high blood pressure}.  Persistent water retention as an outcome of prolonged elevations in stress hormones can also produce edema {swelling}.”

And that’s only a part of a total medical explanation.  There’s more that stress does to the kidneys but if you think I explained quite a bit in this part of the explanation, I need to tell you that this was the easiest part of the explanation to understand with some help.

Stress management seems to be part of keeping our already compromised kidneys from deteriorating even more.  Naturally, the next question should be what IS stress management?Book Cover

You’re already exercising half an hour a day (You are, aren’t you?) That’s to control your weight, blood pressure, cholesterol and triglyceride levels. To quote myself from What Is It And How Did I Get It? Early Stage Chronic Kidney Disease, “The greater your triglycerides, the greater the risk of increasing your creatinine.”  Me again: “Keeping it simple, basically, there’s a compound released by voluntary muscle contraction.  It tells the body to repair itself and grow stronger.” So it’s no great surprise that exercise also lowers your blood pressure, even when it’s been raised by stress.

At http://www.holisticonline.com/herb_home.htm, you’ll find dietary suggestions to manage stress.  While I don’t agree with all of them (like caffeine, I am NOT giving up my two allotted cups of coffee a day, no way!  They make me feel far less deprived.) and you need to take your renal diet into account, most of them are well worth adhering to.

Smoking and alcohol (contrary to popular belief) will only increase your stress levels.  I’m wondering if we didn’t get the notion they would decrease stress from the movies or television.

Drinking water, but keeping within your daily fluid limits (mine is 64 ounces, which includes any liquid or frozen liquid such as jello), can also reduce stress as can anything that relaxes you: music, your pet, a warm bath, playing an instrument, etc.

There is stress even with a simple little backyard wedding like ours, which is why I’m so glad to be spending more time than usual with my daughters – a great stress reducer for me – and the new people they’ve been bringing into our lives lately.

Until next week,

Keep living your life!

Whatever Happened To Integrity?

I have been thinking a lot about integrity – or the lack thereof – in today’s society.  I run into it constantly.

Bear spent part of his morning grumbling about it in his shop.  His machinery is well kept and maintained.  However, one of the machines is out of calibration for no apparent reason.  I didn’t understand it all, but it seems to be related to the shoddy way it was made.

I ran into a professional situation that reeks of lack of integrity.  We all know there are procedures to be followed in any job. In this situation, the people involved not only acted as if those procedures didn’t exist, they also caused great discomfort to others who were not part of the situation.

Then there are the people who are always telling you what they are going to do for you… and don’t.  Why bother?  If you’re not going to do it, why say you are?

Since this is a blog about chronic kidney disease, you’re probably asking yourself, “Okay, so what does this have to do with me?” You, or someone you know and love, just might be out of integrity with themselves about taking care of their ckd and keeping that GFR on the rise.    Book Cover

For example, both my nephrologist and my primary care doctor have been telling me for months that my A1c is too high. That’s the blood test that lets you know how your body is handling glucose over a three month period.  I politely nodded and said I’d work on it.

But I didn’t.  I was out of integrity with myself and, if I didn’t get right with myself, I was in for trouble in the form of diabetes. We all know how the combination of ckd and diabetes heightens your chances for some kind of cardiovascular event.

This time, I immediately transformed by ceasing to eat any sweets and cutting down my daily carbohydrate intake to between four and six units a day.  Think of a unit as a slice of bread or 1/3 cup of spaghetti.

Easy enough for her, you say?  Not so!  What I haven’t told you yet is that Bear has an incredible sweet tooth.  While he offered not to bring sweets into the house, I didn’t think that was fair.  He lives here too, and he doesn’t have chronic kidney disease.

The transforming part is that I don’t crave his sweets, even if he’s eating them right in front of me. I don’t think I’ve ever been like this before.

My downfall is usually the carbohydrates (I am the grand-daughter of a miller, you know!).  I have not gone over my limit once since I decided to become in integrity with myself. I’ve thought about it and decided it’s just not worth it. By the way, I got a little reward for this transformation: my weight dropped immediately and continues to drop.

exercisingMaybe it’s exercise for you.  Are you telling yourself that you’ll exercise tomorrow?  To borrow a line from Arthur Miller’s Waiting for Lefty  (which I was in a long, long time ago), “Tomorrow never comes for you.”  Is there some guilt in not doing what you need to for your health?  We don’t just need exercise because we’re human, we especially need exercise because we have chronic kidney disease.

Ah, maybe you’re one of those people who tell yourself you’ll get a good night’s sleep tomorrow night, or after you finish that good book, or another project.  Doesn’t work that way, folks.  You can’t make up for sleep you missed and we, as those who have ckd, need that sleep.

Or stress?  How about stress? I just gave my notice at a job I took because I loved it.  Thank goodness, I didn’t need the money, but I wasn’t ready to retire from this field yet.  The last month or so has been so stressful that even I noticed the black rings under my eyes and my inability to remember things clearly enough.

I had to make this right with myself.  Once I ascertained that another person could slip right into my place and made arrangements to give her the material she needed, I resigned.  Yes, I loved that job but my health is more important.  My supervisor is a person of integrity and completely understood the reasons for my resignation.

It may seem that I am making myself out to be a paragon of integrity, but all I’m really doing is providing you with examples from my life of how you can be in integrity with yourself in dealing with your chronic kidney disease.

On the book front, I remember writing that I had almost recouped the initial outlay to print the book but I forgot something.  This something came to my attention as I prepared my taxes.  I have donated over $1000 worth of books last year alone to doctors’ offices, clinics, nephrology associations, and kidney organizations.

Bear and I are marrying on April 6th of this year. Yay us! I’m going to ask each of you for a wedding present.  2012-12-12 19.41.37-1Buy a book and give it to someone you know can use the information in it or donate it to an organization that needs it. Digital copies are available on both Amazon.com and B&N.com.  Print copies are available on Amazon.com or via an email to me at myckdexperience.com.

What a day!  It’s almost 11 p.m. and the blog is still not finished.

Until next week,

Keep living your life!

 

Good Bye To 2012 And Its Obesity

Today is the last day of 2012.  That means you can start your new year’s resolutions tomorrow.  When you’re done laughing, think about it.  We new-years-eve-celebrations-live-streammake resolutions intending to keep them – at least I do – but something happens right about March something or other.  We tend to forget what they are.

We could look at it another way.  Pollyanna over here likes this way better.  What has become part of your life as a former new year’s resolution?  For me, it’s the renal diet and exercise.  I actually feel bad when I can’t exercise now.

There’s hope for me in the form of a possible cortisone injection to lubricate that hip that has eroded so much that it is bone on bone. I know you were really worried about that [she wrote tongue in cheek].

Sometimes we need motivation to even think of resolutions.  Jody Charnow provided that for me in the Dec. 26th issue of Renal and Urology News:

 

Overweight, Obesity Raise Kidney Disease Risk

A large study conducted in Thailand corroborates previous findings showing that overweight and obesity are associated with an increased likelihood of chronic kidney disease (CKD).

Subjects with CKD had a significantly higher mean BMI than those without CKD (25.36 vs. 24.04), as well as a significantly higher prevalence of abdominal obesity (35.7% vs. 25.3%). The investigators defined abdominal obesity as a waist circumference of 90 cm (That’s 35 7/16 inches for the math challenged like me) or greater for men and greater than 80 cm (This one is about 31 and a half inches) for women.

You can read the rest of the article at http://www.renalandurologynews.com/overweight-obesity-raise-kidney-disease-risk/article/273848/#

IMAG0093My poor dog, Bella, keeps waiting for me to walk with her.  Can’t be done until the hip is taken care of.  Believe me, I tried.  But it’s not just Bella’s disappointment, it’s mine too.  I saw the pictures from Christmas Eve.  Not good, boys and girls.  How am I going to get my BMI under control without exercise?

Just in case you don’t remember, BMI means Body Mass Index or a way of measuring the fat content of your body based on your height and weight.  If you have the fortitude, you can make use of the BMI calculator at http://nhlbisupport.com/bmi/  I just did and I can tell you this is not for the faint of heart. I was a thinner young woman.  I can even prove it!  early headshots (Pardon the cigarette pix.  This was a long, long time ago.) My goal is to lose weight and be healthier.  This picture is another motivation (thank you for finding it, Nima), even though I realize my thinner 65 year old body is not going to look anything like my thinner 25 year old body.

So why all the whining about not being able to exercise, you ask.  Read that article excerpt again.  I already have stage 3 Chronic Kidney Disease.  How much worse do you think a lack of exercise – which leads to weight gain – is going to make my ckd?  Technically (I just had to qualify that), I already am obese.  I’m not that vain, but I want to stay at stage 3 for the rest of my life and avoid dialysis completely.  This is not the way to do it.

Let’s try this another way – for those of you who can walk – untreated hypertension (high blood pressure) may also be one of the causes of ckd.  According to http://www.nydailynews.com/life-style/health/easy-steps-reduce-blood-pressure-article-1.1226714, exercise can lower your blood pressure.  We already know that obesity is another possible cause of ckd.  Here’s the good part: while you’re walking to lower your blood pressure, you’re also exercising which means you’re losing weight if you’re consistent enough. Wow!  Two for one here!

I found surprising information in that article.  Who knew that fructose raises your blood pressure?  The only time I’d heard it mentioned as a medical deficit is at the immunologist’s. According to http://www.immunologist.com, an immunologist is, “A specialist concentrating on allergic diseases and those disease processes that involve the immune system.”  She had warned me that fructose should be avoided if you have allergies.

Potassium may also be a key in lowering your blood pressure.  I’ve been draining my canned fruit and only occasionally having a fresh (oh, all right, HALF a fresh) banana to control my potassium intake.  Guess what.  My blood pressure has gone up.  Maybe I shouldn’t be that surprised.

Oh no! The article also suggests losing weight.  Looks like it always comes back to the same thing.  A thinner body is a healthier body as long as we don’t go past thinner to obscenely thin.

Book CoverAh, I forgot to mention other new year’s resolutions that have become part of my life.  I blog about ckd every week.  This started out as a way to publicize What Is It And How Did I Get It? Early Stage Chronic Kidney Disease (Amazon.com and B&N.com – print and digital), but soon took on a life of its own. Another new year’s resolution that has become a way of life is posting some ckd related news on the facebook page for the book (https://www.facebook.com/WhatHowearlyCKD).  Say, that’s not bad for new year’s resolutions.

You know how some people announce the addition of grand-children?  I do believe we’re going to be announcing our new grand-animals for quite a while before we get to grand-children. Here’s the newest, as yet unnamed, addition to the family, Lara’s new pal. Each of my biological daughters has a cat and my other step-daughter has both a dog and a cat. We are a pet loving family.Lara and Dog

Until next YEAR,

Keep living your life.

Exercising My Options

According to a study published in Diabetes Care this past July, “Weight control through diet and exercise can prevent most cases of type 2 diabetes in American women over age 50…”  I am a woman.  I am an American. I am over the age of 50.  And I have chronic kidney disease which can be a cause of diabetes.  Therefore, I am also confused.  (One place to read about this study is http://www.drugs.com/news/weight-control-can-cut-women-s-diabetes-risk-study-shows-39516.html.)exercising

Why, you ask?  Easy, I’ve just finished reading Dr.Wes Fisher’s November 30th essay in Physician. In this essay, he makes a point in the form of a question: “What if, believe it or not, when it comes to people with Type II diabetes, diet and exercise don’t affect the incidence of heart attack, stroke, or hospital admission for angina or even the incidence of death?” Of course, the quote is taken out of context so you need to read the essay for yourself at: http://www.kevinmd.com/blog/2012/11/reconsider-benefits-exercise-weight-loss.html?utm_medium=twitter&utm_source=twitterfeed.

Okay, so my wildest dream of not having to exercise to avoid illness has finally come true.  Or has it?  I looked over the articles I’d saved about my nemesis. It was a lot easier to force myself to exercise four years ago than it is now.  My knees troubled me a bit then, but that was it. Now it’s the knees, right hip, feet, and shoulders.  I honestly do exercise, but it’s not half as much fun as it used to be. Sure enough, in the articles I’d saved, I ran right into a bunch of reasons to keep up the exercise.

“Statin therapy and physical fitness amounted to a one-two punch for lowering mortality risk in a large cohort of middle-age and older patients with dyslipidemia followed for 10 years.” Damn!  I have dyslipidemia (high cholesterol) and periodically need to pay closer attention to it.  According to this study originally printed in The Lancet, I need to keep exercising – if not to prevent myself from developing the horrors of Type II Diabetes possible outcomes, then to keep the dyslipidemia under control… and I need to keep watching my diet.  You can read the article via Medpage at: http://www.medpagetoday.com/PrimaryCare/GeneralPrimaryCare/36134?utm_source=share&utm_medium=mobile&utm_campaign=medpage%2Biphone%20app.

sore kneeWell, what about my knees and my other hurting parts that make me NOT want to exercise?  The best quote I found came from Dr. Candice Johnstone at the Radiological Society of North America’s press briefing this year when she spoke about exercising in moderation,

“I was not surprised by these results. This is more like common sense,” added Johnstone,

who is from the Medical College of Wisconsin in Milwaukee. “This adds to information

people have to use to design their own exercise program.”

The url for this article is: http://www.medpagetoday.com/MeetingCoverage/RSNA/36117?utm_source=share&utm_medium=mobile&utm_campaign=medpage%2Biphone%20app

Dr. Johnstone’s reference to common sense seems like… well, common sense.  If it hurts, don’t do it.  If you can do it with modification so that no pain is incurred, do it.  You try not to poke at a tooth that hurts, don’t you?  So why poke at a joint that hurts?

All right now, just one more article.  This one just about convinced me I should be happy about exercising. “Most weight loss occurs because of decreased caloric intake. However, evidence shows the only way to maintain weight loss is to be engaged in regular physical activity.” I can accept that.  But what was the convincing part of the article is this:

“Physical activity also helps to–

  • Maintain weight.
  • Reduce high blood pressure.
  • Reduce risk for type 2 diabetes, heart attack,      stroke, and several forms of cancer.
  • Reduce arthritis pain and associated disability.
  • Reduce risk for osteoporosis and falls.
  • Reduce symptoms of depression and anxiety. “

And this from my old friend, Centers for Disease Control and Prevention.  Read it for yourself at: http://www.cdc.gov/healthyweight/physical_activity/index.html?s_cid=tw_ob254

Now I remember why I started exercising.  I love life.  I love avoiding extra medication for ailments I could have handled with life style changes (sorry, Dr. Fisher). I love moving and feeling alive.dogandcatmainpage

Of course today’s blog leaves me thinking that I must continue to exercise.  Am I happy about that?  No, I can’t honestly say I am, but I will do so.  Who knows, maybe it’ll keep me healthy enough that I’ll live long enough to see grand-children instead of just grand-animals.

Announcing the winners of last week’s contest to find the most creative use of the useless garden tub in my master bathroom:

Advocator Peruza – a copy of the book is on its way to her now and it’s personally inscribed to her

Mimi Smiley – all I need is her information to send her a personally inscribed poster for the book

Nima Beckie – who entered just for the fun of it.

Thank you all!  Unfortunately, no one could come up with an answer to the question, “Why is this called a garden tub if it’s in the house?” so I’ll research that myself.

Until next week,

Keep living your life.

Read, Read, Read

I’m a voracious reader.  I read everything: instructions, food labels, medicine bottles, research, fiction, non-fiction and my doctors’ notes.  In What Is It And How Did I Get It? Early Stage Chronic Kidney Disease, I wrote about keeping a file for yourself for each doctor you see. 

                                    

                                     I began requesting copies of my doctor visit reports as well as my blood and urine tests so I could have my own file

                                     at home and stay on top of whatever I needed to. With these copies, my home files would be much more thorough.

                                     I was feeling burned by my previous P.A.’s failure to pick up on the low readings for the estimated GFR and felt I

 

                                     had to be my own case manager. I still do and find both the nephrologist and my primary  care

                                     physician  agree with me.

                                  

                                   Not a single doctor that I’ve seen for a test or a consultation has ever refused or been difficult about

                                   making certain I receive these copies. Most  (The one exception was a rheumotogist I encountered after

                                  the book was published who not only charged for these copies, but had me doing the telephone run

                                  around just to request them.) have encouraged me to keep my own, thorough medical files at home.  I

                                  suspect it may have made life easier for these doctors, too, since there was no calling other doctors to fax

                                  reports or requesting them from labs.  I had them and could fax them over to whichever doctor needed to

                                 see them immediately.

 

 I have been adding quite a bit to these files recently due to the cataract surgery, sleep apnea apparatus, allergies, biopsies, cryosurgery, and an asthma scare.  I have been a bit of a medical mess lately.  

Ever notice that things happen in threes? I’m beginning to think they may happen in sixes. At any rate, I began to doubt my own advice until I read the following articles. 

Opening MDs’ Notes to Patients Wins Support

By David Pittman, Washington Correspondent

Published: October 13, 2012

WASHINGTON — Patients who viewed their doctors’ notes reported feeling more in control of their care and practiced better medication adherence, a study showed.

You can read the rest of this one at:

http://www.medpagetoday.com/PracticeManagement/PracticeManagement/35298?utm_content=&utm_medium=email&utm_campaign=DailyHeadlines&utm_source=WC&xid=NL_DHE_2012-10-15&eun=g596983d0r&userid=596983

I have to agree that I do feel more in control when I read the doctors’ notes. I’m also something of an overachiever, so I want to see my success at whatever was instructed – provided I understand it and agree with it – reflected in my doctors’ notes.

As for my doctors writing more clear and easily understood notes once they realized I would be reading them, well…. maybe it’s because they know I’m going to research that mine don’t do this.

Wait a minute; I used to spend quite a bit of time researching. It seems to me that I spend less and less time researching these days, but am not certain if that’s due to the growth of my knowledge base (Oh no!  I’m using my college instructor vocabulary in a CKD blog.  Talk about needing to write more plainly!) or if doctors really are writing in a way their patients can understand.

The other article that caught my eye was this one:

Medication beliefs strongly affect individuals’ management of chronic diseases, MU expert says

Health practitioners should use behavior-change tactics so patients take medications as prescribed

COLUMBIA, Mo. – Nearly half of patients taking medications for chronic conditions do not strictly follow their prescribed medication regimens. Failure to use medications as directed increases patients’ risk for side effects, hospitalizations, reduced quality of life and shortened lifespans. Now, a University of Missouri gerontological nursing expert says patients’ poor adherence to prescribed medication regimens is connected to their beliefs about the necessity of prescriptions and concerns about long-term effects and dependency.

The entire article is at: http://www.eurekalert.org/pub_releases/2012-10/uom-mbs101512.php

I readily accept that your beliefs dictate your behavior.  For example, my PCP was worried that I might be developing asthma and prescribed a steroid inhaler plus a daily allergy pill until I could see my immunologist.

She was being cautious, but the QVAR could cause oral thrush – a fungal condition – if I didn’t rinse my mouth and teeth carefully enough.  That was scary.  A medication that could cause another condition?

Hmmmm, it did allow me to breathe freely, though.  After a couple of weeks, I became even more uncomfortable since I believed I was developing a dependence on the QVAR. For once in my life, I didn’t research that.  I just stopped taking it.

When I did get to see my immunologist, I suggested stress might be causing the ferocious cough and the difficulty catching my breath afterward.  Not only did I have all these annoying medical problems I mentioned above, but my good buddy and my cousin died in the same week.  It was a rough patch in my life unlike any I’d experienced in the last twenty years.

My immunologist listened to me and suggested breathing exercises that might help since I wasn’t interested in any more pills or other medication.  At my request, she wrote the instructions for yoga breathing in her notes. And, of course, gave me a copy.

As for the article’s mention of mechanical reminders to take your medication, I still wouldn’t take medication if I didn’t agree with the purpose for taking it.  I do think I should have been more responsible and spoken to Dr. Zhao before I just stopped, but who says I was thinking clearly.

Bear uses the reminder on his phone whenever he needs to take a new medication (or cooks or times finish on his woodwork. He’s very clever that way.)  It works for him and he’s found some pretty interesting ring tones. If that method of reminder works for you, use it.  My meds are always meal based, so that triggers me to take the meds.

Here’s a laugh, sometimes I’m just not hungry but I know I have to have something in my stomach before I take my meds so I eat.  Can I blame all this excess weight on that?  Please?????

Until next week,

Keep living your life!

Blue Monday – But Only When It Comes To Sugar

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Until next week,

Keep living your life!

“Fat A**” Doesn’t Sound That Bad Anymore

“Fat A**” used to be a terrible insult.  Nowadays, “Fat Middle” is worse; it’s life threatening.  If you’ve read my book, you know I’m medically obese.  If you’ve seen my picture, you know I look a little chubby.  (Isn’t that called “some extra pounds to love”?)  Now I find out I’m in danger of shortening my life since those extra pounds are all around my middle –  the worst place for my health, especially  since I have Chronic Kidney Disease.  Again, from my book, once you have our disease, it’s going to affect other areas of your heath for the rest of your life.

This article from yesterday’s HeathJockey.com explains:

Kidney patients with higher waistline apparently face doubled risk of death

Kidney disease patients wary of their waist size may be concerned for the good. As per a study led by Loyola University Health System scientists, patients suffering from kidney problems who have a large waist size appear to face a higher risk of death.

Apparently, waist circumference was largely associated to mortality than another common measure of obesity namely body mass index (BMI). BMI is a height-to-weight ratio while waist circumference is simply the measure of the abdominal mass. Investigators observed information from 5,805 kidney patients aged 45 years and older and who enrolled for a study known as Reasons for Geographic and Racial Differences in Stroke (REGARDS). They all faced surveillance for an average of 4 years where it was found that 686 participants died during the course of the study.

The median BMI of the patients who passed away was 29.2 which were seemingly lower than the BMI of the patients who were alive. Contrarily, the mean waist circumference of the patients who faced demise seemed to be 40.1 inches which is apparently higher than the patients who survived and had a waistline of 39.1 inches.

Analysts drew a comparison between kidney disease patients with large waist size to normal waistline counterparts. The BMI and other risk factors were suitably adjusted and it came to fore that those women with a waist size equal to or higher than 42.5 inches and men with 48 inches or larger waist size supposedly faced a higher chance of dying. This was not the case for those who had a slimmer waistline which was almost 31.5 inches for women and 37 inches for men.

The scientists conclude that BMI may not be sufficient to gauge mortality risks linked to fat. This is mainly as BMI is inclusive of many factors like muscle mass and abdominal fat. Paradoxically, waist circumference is the measure of only the abdominal adiposity and may therefore be an essential tool to comprehend death risk linked with obese chronic kidney disease adults specifically when used collectively with BMI.

The study is published in the American Journal of Kidney Diseases.

You can see the article for yourself at:

http://www.healthjockey.com/2011/07/18/kidney-patients-with-higher-waistline-apparently-face-doubled-risk-of-death/

Another thing I discussed in the book is how complicated the formula for measuring BMI is.  As a math repelled person, I had to resort to online BMI calculators.  (These are really a great help; I was just annoyed I couldn’t do it manually.) Now, there seems to be no reason to use this. 

Just grab a tape measure and measure your waistline.  You can even do it without a tape measure if you only have a ruler. Wrap a string, ribbon or cord around your waist and then measure its length wth your ruler. But keep in mind as you’re measuring that this is still a theory – one I like – but one of many.

Until Friday,

Keep living your life!

Published in: on July 19, 2011 at 10:26 am  Leave a Comment  

It’s Not Your Fault

First,  I need to share some exciting news with you: there is now not only a website (www.myckdexperience.com) associated with What Is It And How Did I Get It? Early Stage Chronic Kidney Disease, but also a phone number: (623) 266-2609, AND (thanks to Nima who has worked as a publicist) a twitter address: WhatHowEarlyCKD.  Looks like I’m going to learn how to tweet (or is it twit?).     
 
Back to work now.  I knew it wasn’t all my fault and I resented taking all the blame – although it’s clear I’ll still have to take the responsibility for this.  For what?  Haven’t you read the book? For being obese, of course.
 

I discovered this article (via a tweet? twit?) on today’s New York Times Health Blog.  While it may absolve those of us who are obese from blame, as mentioned, it’s still our responsibility to watch our weight.  Obesity can be a cause of Chronic Kidney Disease, even if indirectly.

 

When Fatty Feasts Are Driven by Automatic Pilot

By TARA PARKER-POPE
Stuart Bradford

“Bet you can’t eat just one” (as the old potato-chip commercials had it) is, of course, a bet most of us end up losing. But why? Is it simple lack of willpower that makes fatty snacks irresistible, or are deeper biological forces at work?

Some intriguing new research suggests the latter. Scientists in California and Italy reported last week that in rats given fatty foods, the body immediately began to release natural marijuanalike chemicals in the gut that kept them
craving more.

The findings are among several recent studies that add new complexity to the obesity debate, suggesting that certain foods set off powerful chemical
reactions in the body and the brain. Yes, it’s still true that people gain weight because they eat more calories than they burn. But those compulsions may stem from biological systems over which the individual has no control.

“I do think some people come into the world, and they are more responsive
to food,” said Susan Carnell, a research associate at the Columbia
University Institute of Human Nutrition. “I think there are many
different routes to obesity.”

In the recent rat studies, by a team from the University of California, Irvine, and the Italian Institute of Technology in Genoa, the goal was to measure how taste alone affects the body’s response to food. Among rats given liquid diets high in fat, sugar or protein, the ones who got the fatty liquid had a striking reaction: As soon as it hit their taste buds, their digestive systems
began producing endocannabinoids, chemicals similar to those produced by
marijuana use.

The compounds serve a variety of functions, including regulation of mood
and stress response, appetite, and movement of food through the intestines. Notably, they were released only when the rats tasted fat, not the sugar or protein. The The findings were published online last week in The proceedings of the National Academy of Sciences.

“The most surprising thing to most people, including me,” said an author of
the study, Daniele Piomelli, director of drug discovery and development
at U.C. Irvine, “is the findings provide a window on how we relate to fatty foods.”

Since fats are essential for cell functioning, Dr. Piomelli continued, “we have this evolutionary drive to recognize fat, and when we have access to it, to consume as much as we possibly can.”

The finding that the signal to eat more fat is released from the gut offers hope for potential new diet drugs. A Food and Drug Administration committee already has rejected one diet drug that blocks endocannabinoids, called Acomplia in Europe, where it was later withdrawn because it had severe psychological side effects, including suicidal thoughts. The new research suggests that the focus might be shifted to endocannabinoids in the gut, which could alleviate side effects in the brain.

In the rat studies, the researchers injected a cannabinoid-blocking drug into the intestines of the rats and found that they lost interest in the fatty food. “The effect is remarkable,” Dr. Piomelli said. “They are no longer interested
in feeding. They stop completely. We were amazed.”

A drug based on the research is still years away, but the findings offer practical advice to consumers about the powerful biological forces at play when they snack on fatty junk foods.

“We think we eat it because we like it, but it’s not just because we like, but because we want it,” said Dr. David Kessler, former head of the F.D.A. and author of the book “The End of Overeating” (Rodale, 2009). “It has a lot more to do with our brains and the feedback mechanism to our brains than we realize.”

Other studies have shown that the body’s brain reward centers are strongly affected by the foods we eat.

For example, when obese women were shown pictures of high-calorie foods,
their brains showed greater activity in regions associated with anticipating reward than did the brains of normal-weight women. “Reward centers were activated just by saying the words ‘chocolate brownie,’” said Dr. Carnell of Columbia.

The question is whether some people are born more responsive to certain foods, or whether a lifetime of overeating leads to brain and body changes that promote a stronger food response. To shed light on that issue, Dr. Carnell is conducting studies looking at normal-weight teenagers who have obese parents, and as a result are at risk for becoming obese themselves. “I’m interested in whether the brain is responding differently even before they become obese,” she said.

Dr. Kessler notes that consumers need to be aware that the body’s natural signals are often overwhelmed by the abundance of choices and messages about food, so they must be extra vigilant about healthful eating.

“The pull is very strong, and there is a biological reason why food has such power over us,” he said. “It’s a real struggle, and it’s not just a question of being lazy or lack of willpower.

“But just because your brain is being hijacked, that doesn’t mean you don’t have a responsibility to protect yourself.”

You can read the article online at: http://well.blogs.nytimes.com/2011/07/11/when-fatty-feasts-are-driven-by-automatic-pilot/?partner=rss&emc=rss

And now, if you’ll excuse me, I’m going to test that theory about not being able to eat just one.

Until Friday,

Keep living your life.

Published in: on July 12, 2011 at 9:57 am  Leave a Comment  

Nutritionist Updates

I got to see the nutritionist yesterday.  I was unaware that you are provided (by the government, no less) one free visit with your renal nutritionist per year.  One of the secretaries at the nephrologist’s office let that slip and I jumped on it making an appointment immediately.  Now why didn’t the nephrologist mention this or the nutritionist when I saw her the first time?

Remember I wrote about being too overwhelmed when you’re first diagnosed to catch everything you’ve being told and that’s why you need to either take notes or bring someone with you?  I think that’s what happened to me here.  In a very early visit to the nephrologist, he probably mentioned this and I didn’t catch it or the nutritionist actually did tell me this during our first visit and I was too busy trying to figure out what she meant by renal diet and food units to hear her fully. Let’s hear it for note taking and/or bringing a friend along.

Crystal, the nutritionist par excellence, gave me some ideas.  As you’ve probably figured out from reading the blog, I have a seemingly permanent battle on my hands: my weight.  When I could thoroughly exercise pushing myself for at least half an hour a day, it didn’t seem so bad.  Once I developed the difficult arthritis problem in my hips, I was stymied.  I continued to exercise anyway, but sometimes could only do it for ten minutes or not at all at a certain time.  I was starting to feel hopeless.  Crystal applied some common sense to my problem: exercise in spurts.  This way if I can only do ten minutes at a time, no big deal: I would keep working on my half hour during the day – even if it meant only minutes at a time – until I achieved my goal of half an hour. This is not the way I like to exercise, but it’s the best I can do with the hip. It’s only been one day, but I certainly don’t feel hopeless about the exercise part of losing weight anymore.

Crystal also told me that not eating until I was hungry is NOT a good idea.  I’ve been having a bit of a problem with blood sugar.  She suspects it may be because I don’t eat until I’m hungry and that causes sugar spikes.  Just as with the exercise, this is common sense, but nothing I thought of in connection with the weight and sugar problem.  Her suggestion was that I eat five or six little meals a day so that my blood sugar stayed constant.  She also mentioned this would help with weight loss because my body would no longer think I was starving and hold on to those extra calories.  Thinking about it, I remember my son-law – Aaron – told me this years ago.  I had simply forgotten and needed to be reminded.

There are days when I just don’t make the minimum 1100-1200 calories I’m allotted.  I was patting myself on the back for being so careful about caloric intake, but Crystal pointed out that going below this number of caloried may mean I’m getting enough nutrition in that particular day.  I do have a good appetite (sometimes too good!) but, especially when I’m writing, forget to eat because I’m just plain deliciously involved in what I’m doing.  I will have to make it a point to eat when I wake to avoid my body thinking I’m starving and holding on to calories, eat five or six small meals a day to ensure even sugar levels and make certain that I eat the minimum number of calories on my renal plan so that I am getting the nutrition I need each day.

The image in this blog – courtesy of National Institute of Diabetes and Digestive and Kidney Disease, National Institutes of Health – demonstrates how all exercising helps to keep your impaired kidneys keep functioning to afford you clean blood.  You can’t see  yourself exercising in the image, of course, but you do get to see how the “blood with wastes” enters glomerulus of your kidney.  The tubules in the nephrons filter the wastes in the blood into your urine and only the clean blood recirculates through your body.

We’re all familiar with the GFR – Glomerulus Filtration Rate.  The diagram shows how different parts of the glomerulus, the tubules in the nephrons, within your kidneys, filter your blood.  Never again will you have to sit there scratching your head when your nephrologist refers to your GFR.  You’ve seen how it works and what the parts of the kidney are.

Published in: on January 25, 2011 at 7:21 pm  Leave a Comment  

The Doctor’s Appointment That Led to a Nephrologist

Let me think!  The doctor is talking about kidney disease and the triglyceride test result is out of range. I was given a pamphlet on triglycerides and told to lower that number within the next month.  This was getting so complicated.  I thought we were looking for kidney disease. The booklet told me that triglyceride was a bad fat, just like LDL cholesterol, which could affect my heart and blood vessel health, and that cardiovascular disease (read heart and arteries) is the number one killer of Americans. Great, now it’s not only the liver and the kidneys I need to worry about, but also the heart and arteries. I mean MY liver, kidneys, heart and arteries.

It was made clear that lifestyle changes just might do the trick as far as the triglyceride number. Other than a little dancing here and there, I no longer did much exercising by now. Okay, I resolved, I would again dance vigorously several times a week.  My doctor agreed, but gently suggested I add some kind of movement every day.  I had unwittingly become a sedentary person – a couch potato.  What could I do? I’d figure it out later. I was not to smoke, drink, or do drugs. That wasn’t going to make any difference because I didn’t do any of that anyway.

Dietary changes were necessary, too.  I was to eat at least five servings of fruit and vegetables daily (You’ll see later that this is not in accordance with the renal diet). Grain products were to be added.  I had no argument with that: my grandfather had been a miller in The Ukraine so my love of bread must have been in the genes. There were other restrictions that didn’t seem to be problematic until I received the renal diet a short time later. Many of the restricted foods on that diet were suggested to help control the triglyceride number.

My head was spinning.  I’d thought it was enough to eat fresh, organic food and rarely ate meat.  It just didn’t taste that good to me. I needed to know about BMI (Body Mass Index) which involved all those numbers – the nemesis of my life – and now they were to be a daily part of my life.

 Come to think of it, it’s a good thing I didn’t know about the weighing and measuring involved with the renal diet at this point. I was already swimming in that foreign sea of numbers.

 Ummm, I may have neglected to mention that according to my BMI at this time, I was obese.  I don’t know which was more of a shock – that I had such serious medical issues or that I was obese.

Trans-fatty acids would have to go, too. I readily agreed thinking it might be nice to know what I just agreed to. The doctor took a look at my eyes wandering around the office and realized I had no clue.  She explained, with the pamphlet’s help, that these are found in fast foods (Damn!  No more McDonald’s drive through breakfasts), cookies and doughnuts (I naively thought it wouldn’t be a problem to cut these out) and deep-fried food (no more calamari or onion rings?) among other things. It’s a good thing that I started cutting these foods out right away because it made adhering to the renal diet a little bit easier later on.

For those of you on the edge of your seat, between the food and exercise changes, I was able to lower the triglyceride number to within the acceptable range within the month. Unfortunately, at the same re-test my GFR was even lower, and my BUN higher – not good – yet my creatinine was within range.  It was time for a nephrologist. I also noticed I’d lost a pound without making any changes yet.  Was I that worried? It doesn’t sound like a lot, but I’d been the same exact obese weight for over two years.

Published in: on September 29, 2010 at 3:34 pm  Leave a Comment