Book It!

Every once in a great while, I’ll come across a Chronic Kidney Disease book that I want to share. I think there were only three or four of these in the last six years. Today, I add another one. Dr. Kang, the author, is a local doctor. That was the first thing that caught my eye.

I thought I would be reading the usual information … and I did, but it was written with verve and included some information I hadn’t known. So I did the obvious. I contacted the good doctor to see if he’d be interested in sharing his knowledge with us on the blog. I’m so very glad he agreed.

Dr. Mandip S.Kang, is not only a senior partner in Southwest Kidney Institute right here in Phoenix, but he is also a Fellow in the American Society of Nephrologists I like so much. Just last week, I gleefully accepted their invitation to join the Twitter chat (#AskASN) about staging in CKD and often refer to them in both my blogs and books. He is also the author of the IBPA Gold Award winning book: The Doctor’s Kidney Diets……A Nutritional Guide to Managing and Slowing The Progression of Chronic Kidney Disease, the book that caught my eye.

This is what he wrote for us:

Receiving a diagnosis of kidney disease is not a death sentence for patients, but is often overwhelming and a life changing event. Patients are often confused and the information they receive from different healthcare providers may not be the same. Patients often ask, “What should I do?”

Having experience as a former Assistant Clinical Professor of Medicine at University of Utah School of Medicine and currently as a Senior Nephrologist (kidney specialist), I have gained some insight into how to alleviate my patients’ fears and I have come up with a four point plan that I try to teach my kidney patients. I believe that the role of the physician is to be a teacher and a coach as patients navigate their way into the complexities of a Chronic Kidney Disease diagnosis. I believe that every kidney specialist should have a chalk board in the patient exam rooms and lay out the plan for his or her approach to their patients just like we were taught in schools.

Here is a four point plan that all kidney patients should remember as they visit their kidney specialists and at home. The acronym for the plan is very simple: D.A.M.E.

1. ‘D’ in the acronym stands for diet. The reason I chose diet first comes from the Chinese wisdom in treating any disease: ‘He that takes medicine and neglects diet, wastes the skills of the physician.’ Patients must be taught what the kidney diet is and why they need to follow it for the rest of their lives. Since the kidney diet is complex, they must be provided with educational materials that outline the diet and be strongly encouraged to visit a kidney dietitian who will tell them what and how much to eat.

Dietitians and kidney doctors will teach them about the benefits of eating fresh foods and avoiding processed foods. Patients should remember that the ‘p’ in ‘p’rocessed foods is akin to ‘p’acked with calories. Learning to read a Nutrition Facts label is a must if the doctor wants to do all he or she can to help the patient slow down – and sometimes halt – the progression of kidney disease. It is important to remember that in the earlier stages of kidney disease, the diet may not be as strict – but if progression of the disease is noted, then dietary modifications are more stringent and frequent laboratory tests may need to be performed to assess progress.

2. ‘A’ in the four point CKD plan stands for activity. “What is activity?” you might say. It could mean walking more, taking more steps daily, joining a gym, hiking, biking or any activity that keeps you on your feet. As most Americans already know, the obesity rates in the USA are skyrocketing leading to most chronic health conditions such as Chronic Kidney Disease, Coronary Artery Disease, Stroke, Arthritis, Lung Disease, etc. These chronic health conditions stem from lack of activity and consuming excessive calories. Many patients lead a sedentary lifestyle such as watching TV for long hours which leads to worsening of their health issues. Patients should be encouraged to do the activities they enjoy the most such as dancing, or walking in a park or on a beach. Patients should weigh themselves on a weekly basis to monitor their weight.

3. ‘M’ in the acronym stands for medications that your doctor prescribes. Your doctor may also tell you not to take certain over the counter medications that may harm your kidneys such as Advil, Motrin, Aleve, Ibuprofen, Celebrex, Prilosec, herbal remedies, etc. I encourage all patients to memorize their medications and keep a list with them at all times. Remember that all medications are prescribed because the benefit to the patient outweighs the risk and no medication is entirely safe; therefore, it should be taken as prescribed and any side effects reported to your doctor. You should not take any new medicine unless it has been cleared by your kidney specialist.

4. ‘E’ in the above acronym stands for education. This is the key element in the D.A.M.E plan to treat patients with CKD. Unless the patient has a clear understanding of their disease process, labs, treatment plan, and the role of diet, activity, and medications, they will not be successful in managing and slowing the progression of Chronic Kidney Disease. How well a patient does will depend on their knowledge of their disease and if they comply with the instructions given to them by the kidney doctors.

I hope that all kidney doctors and patients keep the D.A.M.E. acronym in mind. Patients who are active participants in their care lead healthier and productive lives. I wish all of the readers well.

I hadn’t heard of the D.A.M.E. method before but I like it, especially “the ‘p’ in ‘p’rocessed foods is akin to ‘p’acked with calories.” Many thanks, Dr. Kang, for introducing this common sense theme to us.

Until next week,
Keep living your life!

Deodorant Doubts

I’ve been playing around with the idea of a newsletter concerning which beauty and hygiene products are safe for Chronic Kidney Disease patients. (Free feel to ‘steal’ the idea.)  Here’s why: every day I use deodorant and every time I pick up the container I’m reminded of the warning on it, “Ask a doctor before use if you have kidney disease.”warning

I did just that about three years ago. At first, my nephrologist was seemingly annoyed at the question, almost as if no one had ever asked him that before. (Is that possible?) I imagine he had his P.A. check a deodorant container because he did have her call me back to say that was only for late stage CKD.  Notice there’s no explanation in that message and, yep, this is the nephrologist I no longer see.

Last week, I did the marketing as I usually do lately since Bear is waiting for surgery on his foot and having a hard time walking much less carrying.  Deodorant was on the list I’d written. I picked up one brand, then another, and a third.  I decided to look at all the brands available and they all had that same warning. Why had I never researched this before?

Good question.  I’m a firm believer in it’s never too late.  Rather than a discussion of which brands are safe for those of us with kidney disease, I’ll be going into the mechanics (if that’s the right word) of deodorant and kidney disease.

exercisingI found a clear explanation of just what function deodorant serves. “Contrary to popular opinion, most deodorants do not just cover up odor with fragrance. They actually have antiseptic properties that work to kill bacteria, which is what causes odor to begin with.” Thank you

According to Dr. Nathalie Beauchamp in a January, 2010, article at, the culprit is, “Propylene Glycol – found in thousands of cosmetic products – to help moisturize. It is also an ingredient used in anti-freeze and brake fluid, so it’s no surprise that it could cause liver abnormalities and kidney damage.”

I was surprised since I’d always assumed it was the aluminum in the deodorant that was the problem.  It made sense to me that, since American women tend to shave their underarms, ingredients are more easily absorbed into the skin, build up in the body, and then cannot be easily excreted by already compromised kidneys.  Although, according to the article above, aluminum may contribute to Alzheimer’s. Apparently, it builds up in the brain. Shows you what I know… or thought I know!

But then I found The American Association of Kidney Patients post from a 2008 article by Dr. Nathan Levin in RENALIFE, “Most of the antiperspirants and some deodorants contain aluminium (Al), which is absorbed by the skin (Flarend et al – Food Chem Toxicol, 2001). In healthy people, it gets eliminated by the kidney, but for people with reduced function, Al will accumulate in the body. Albeit unusual, this could lead to dementia (Carpenter et al. – Int J Occup Med Environ Health, 2001), anemia and bone disease (Jeffery et al. – J Toxicol Environ Health 1996).”aluminum

So now we know the build-up of aluminium is also a problem.  This goes right back to compromised kidneys not being able to eliminate the chemical that enters our bodies via the skin.  As mentioned earlier in this blog, women are at risk since they shave their underarms (leaving very small cuts in the skin), but men are also at risk.  The chemical is applied to the skin, is absorbed, and builds up.

I did find a reason for the warning against antiperspirants, but keep in mind that these actually close the pores through which sweat is exuded and are not quite the same as deodorants which work on bacteria once the sweat has already been exuded.

In general, the new warning statement is meant for patients with kidney disease who may not be able to excrete the low levels of aluminum in the body that may result from antiperspirant use. This would be individuals with advanced chronic kidney disease (corresponding clinically to stage 4 or stage 5 chronic kidney disease1). Such individuals have approximately 30% or less of their original normal kidney function.  If you have any questions about whether you have such a chronic reduction in your kidney function, you should discuss it with your doctor.”

The entire warning and discussion of it can be found at: which is on the website of the American Society of Nephrology.

If you’d like to do more research yourself, take note that I got very few hits when I used ‘Chronic Kidney Disease and deodorant,’ but quite a few with ‘CKD and deodorant.’

On another note entirely, I’ve been talking quite a bit about SlowItDown, my project to bring CKD education by trained educators on a monthly basis for free to any community that needs it.  This is all part of my passion to spread this information, as are the Facebook pages and twitter accounts for SlowItDown and What Is It and How Did I Get It? Early Stage Chronic Kidney Disease. Come to think of it, so is this blog.Book Cover

I did tell you that when I researched inexpensive CKD information for readers in Germany and India who requested it, my book was the first item on both lists, right?  I’m pretty sure I told you that when a nephrologist from India contacted me for ways to get the information into his destitute patients hands, I figured out I could send him the first issues of the blog – which were the book – for him to translate and leave in nephrology offices and clinics for the patients to read or have read to them.

Amazon is starting a really helpful program for their Kindle. (By the way, although I am an aficionado of REAL books, I also have already worn out one Kindle.) If an author chooses, you can buy a greatly reduced in price edition of the digital book when you purchase a print copy of the book.  I chose it. As it stands now, the print book is $12.95 and the digital edition is $9.95.  Once the program is in place, the print book will still be $12.95, but the digital edition you can buy when you purchase the print book is only $2.95.  Many thanks to Amazon for yet another way to get the word about CKD out to the people who need it.Kindle

Until next week,

Keep living your life!

A Simple Dip Stick Urine Test?

Those of you on Facebook (Why not like our page “What Is It And How Did I Get It? Early Stage Chronic Kidney Disease” on Facebook now that I’ve brought it up?) and Twitter probably already know why last week’s Tuesday and Friday blogs weren’t posted.  In addition to learning I need ALL the equipment in my office to post – instead of just the little notebook I had with me when I took off to Providence for the wedding of the now Mr. & Mrs. G. Scherban – I also learned that the world doesn’t stop if I don’t blog twice a week.  Considering all the extra work for radio shows, book talks and public relations the book has produced, I’ll be cutting down the blogs to once a week – on Monday.  I don’t think this will cause a problem for anyone, but if it does, just let me know.  My decision is not written in stone.

Today’s article is a bit technical but basically it explains how a simple, non-invasive test can detect chronic kidney disease. It’s as easy as urinating into a cup and allowing your doctor to place a dip stick in your urine sample. You know I’m not a doctor, but I sincerely feel that if I’d been diagnosed earlier, I might have been able to do more to preserve more of my kidney function.  I’m excited that this is becoming such a simple process.

DGNews  (note: DG = Doctor’s Guide)

Simple Urine Test Detects Silent Kidney Disease

Washington, DC — July 29, 2011 — A simple and inexpensive urine test routinely done in family doctors’ offices may be the key to identifying individuals who are silently undergoing rapid kidney function decline, according to a study appearing in an upcoming issue of the Journal of the American Society Nephrology (JASN). Using this test could lead to potentially earlier and more effective treatments, lowering patients’ risks for renal failure and premature death.

Approximately 60 million people globally have chronic kidney disease. Early detection and prevention of kidney disease is the only way to prevent renal failure, but individuals with
kidney disease often do not experience symptoms until later stages of the disease. Serial monitoring of kidney function in the general population would likely catch such silently progressing kidney disease early, but it would be too expensive.

William Clark, MD, The University of Western Ontario and London Health Sciences Centre, both in London, and Ontario, Canada, and his colleagues evaluated whether simple and routine screening tests for urine protein could be used to identify individuals at highest risk of rapid kidney function decline. These patients would benefit the most from serial kidney function monitoring and early treatments to prevent kidney failure.

The investigators followed 2,574 participants in a community-based clinic for an average of 7 years. They found that a positive dipstick urine test (a protein concentration of
>=1g/L) was a strong predictor of rapid kidney function decline. Overall, 2.5% of participants in the study had a urinary protein concentration of >=1g/L at the start of the study. If all of them were followed with serial monitoring of kidney function, one case of rapid kidney function decline would be identified for every 2.6 patients who were followed.

The test correctly identified whether or not individuals had rapid kidney function decline in 90.8% of participants, mislabelled 1.5% as having the condition, and missed 7.7% who were later identified as having the condition. Among those with certain risk factors, such as cardiovascular disease, age >60 years, diabetes, or hypertension, the probability of identifying rapid kidney function decline from serial kidney function measurements increased from 13% to 44% after incorporating a positive dipstick test.

“We showed that routine inexpensive urine dipstick screening in a population with and without risk factors will allow primary clinicians to follow fewer patients with serial monitoring to identify those with rapid kidney function decline that will potentially benefit from earlier referral and therapeutic intervention,” said Dr. Clark.

This study was funded by peer-review grants from Kidney Foundation of Canada and the Ontario Ministry of Health.

The URL for this article is:

This advance notice of the Journal of The American Society of Nephrology was provided by P\S\L Group, (The following is taken from their website.) a global organisation dedicated to putting information at the service of medicine. The companies and people of the P\S\L Group aim to improve medical care by serving those who need it, those who provide it and those who seek to improve it.

I wish it was realized when I first started this CKD journey how easily doctors can detect the disease, but I’m really happy about those who are going to find out they have this problem earlier than I did so they can start slowing down the progression of the disease right away.

So, until next Monday – a week from today,

Keep living your life!