It’s Still There

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Arteries are:

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

Veins are:arteries_and_veins_of_the_arm_l

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

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

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

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

Until next week,

Keep living your life!

They’re Not Twins

Kidney ArizonaMarch is National Kidney Month here in the United States.  That makes it an even better time to have yourself screened for Chronic Kidney Disease. 28 million people have it and quite a few of them don’t know it.  Don’t be one of them.  All it takes is a simple blood test and a simple urine test.

Talking about blood and urine tests, I mentioned in passing on one or two of my blogs that your values and the reference range values on your lab tests may differ according to the lab you use, and loads of physical factors such as: being adequately hydrated, having voided your bladder, having gotten enough sleep, even how the specimens were handled.

I was in the unique position of taking these two tests once and then again two weeks later. Had the due date of the tests for each doctor been closer, I might have combined them and had the results of the one set of tests sent to each doctor. But my nephrologist needed his tests two weeks before my appointment, and my primary care physician {pcp} needed hers no less and no more than every three months since she was monitoring my bmpliver for the effect of a medication.

She was checking primarily for my cholesterol levels {which are better than ever and finally all within range, thank you very much!} and included the other tests because she is one thorough doctor. He, my nephrologist, was much more concerned with my kidney function.

The reference range values from the two different labs I used were not twins. For example, Sonora Quest, the lab my nephrologist uses, has the acceptable range for creatinine as 0.60 – 1.40.  But my pcp uses LabCorp. which states that it is 0.57 – 1.00 mg/dL. If you look to the right, you’ll see an older test result using mg/dL.

I wasn’t really sure what mg/dL meant, so I looked it up. According to the Free Dictionary at http://acronyms.thefreedictionary.com/mg%2fdL, this means

Milligrams per Deciliter

That was my reaction, too, so I used the same dictionary for both words used in the definition.  Milligrams means

A unit of mass equal to one thousandth (10-3) of a gram

while deciliter means

100 cubic centimeters

We are talking small here!Book Cover

The results for this test were a little different, too.  On February 10th, it was 1.11, which was not out of range for Sonora Quest.  But two weeks later, it was 1.1 – ever so slightly lower – which was out of range for LabCorp. This is a bit confusing.

Let’s go back to What Is It and How Did I Get It? Early Stage Chronic Kidney Disease to see if we can shed some light on this. On page 21 {Use the word search if you’re using the digital version of the book.}, I wrote

A higher creatinine result could mean the kidneys were not adequately filtering this element from the blood.

By the way,

Creatinine is a chemical waste product that’s produced by your muscle metabolism and to a smaller extent by eating meat.

Thank you to The Mayo Clinic at http://www.mayoclinic.org/tests-procedures/creatinine/basics/definition/prc-20014534 for this clarification.

All I can say is that seemed like earth shattering information when I was first diagnosed with CKD.  Now that it’s seven years late, it just means I have CKD.  It’s sort of like reiterating I have this slow decline in the deterioration of my kidney function no matter which acceptable range we use.

Another difference in value ranges was BUN.  This is your urea nitrogen. Medline Plus at blood drawhttp://www.nlm.nih.gov/medlineplus/ency/article/003474.htm explains

BUN stands for blood urea nitrogen. Urea nitrogen is what forms when protein breaks down.

This could be a ‘Who cares?’  statement except that the BUN is used to measure your kidney health. Sonora Quest’s acceptable range is 8-25 mg/dL, while my LabCorp’s is 8-27. At the first lab, my value was 22 and at the other, two weeks later, it was 17. Both were in range, but let’s say – just for argument’s sake – my value had been 26.  Would that mean I was out of range?  It would at one lab, but not the other.  I think I just answered my own question as to why I need to have my doctor interpret my lab results even though I can read them myself.

Well, what makes these levels go up or down? Thank you WebMD for this simple to understand answer.

If your kidneys are not able to remove urea from the blood normally, your BUN level rises. Heart failure, dehydration, or a diet high in protein can also make your BUN level higher. Liver disease or damage can lower your BUN level. A low BUN level can occur normally in the second or third trimester of pregnancy.

Aha!  We know that as CKD patients we are restricted to five ounces of protein a day. Why combine an inability to “remove urea from the blood normally” with an overabundance of protein?

Hopefully, some of the questions you didn’t even know you had were answered today.

Part 2I’m sorry if you missed out on your free copy of The Book of Blogs: Moderate Stage Chronic Kidney Disease, Part 1  by being the third buyer during the last part of February. While I’ve used up my freebies for that book, I’m now working on a free day for The Book of Blogs: Moderate Stage Chronic Kidney Disease, Part 2 on World Kidney Day, March 12.  Keep watching for more news about this as Amazon and I keep working on it.

Again, if you’d like to join us for the Kidney Walk on April 19 at Chase Stadium in Phoenix, why not go to the Walk’s website at http://kidneywalk.kintera.org/faf/home/default.asp?ievent=1125145 and join our team, Team SlowItDown. We’ll be looking forward to seeing you there.

Until next week,

Keep living your life!

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!