This Shouldn’t Hurt

Today is our second wedding anniversary, so I took a picture of me in my wedding dress.  While it is a one of a kind, handmade dress, it was far too2 year anniversary small when I bought it.  No problem, I figured.  I’ll just wear those slimming garments underneath.

That worked.  But I think they’re really torture garments. This year, after two years of exercising, renal dieting, and the new addition of high blood sugar dieting (oh, and blissful marriage), I was able to wear the dress without the torture garments.

What’s my point, you ask.  Simply, that there is hope, that exercise and following the correct diet for your health do pay off.  Since I only wear my wedding dress once a year on our anniversary, I got the chance to really see the difference in my body since last year…and, for once, I was pleased.

You know what pleases me. Now here’s what displeases me.  I didn’t know that lancets for testing blood glucose come in sizes.  Actually, I would have laughed had you told me that before I needed them and made some lewd comparison to a personal product that also comes in sizes.

I was working blind.  Now that my informative diabetes counselor told me about ultra-thin lancets, I’m a bit more comfortable sticking myself with them several times a day. But that doesn’t mean I understand the whole deal.  So today’s blog is pretty much about the mechanics of testing your own blood.

As usual, let’s start at the beginning.  Lancet is defined by The Medical Dictionary at http://medical-dictionary.thefreedictionary.com/lancet as

A surgical knife with a short, wide, pointed double-edged blade, used especially for making punctures and small incisions.

lancetsMine is a little different since it has a cylindrical stem with a detachable, disposable cap.  Under the cap is a sharp, needle looking device that is what pierces my skin. The first few days I used one, I cried. It hurt. Bear was not going to put up with that and went to the pharmacy to find something better for me.  No one had told me these little guys came in ‘ultra-thin.’ I gather my PCP thought my pharmacist would tell me and my pharmacist thought my PCP told me.  Wrong on both accounts.

So, what are the mechanics that allowed the ultra-thin lancets to hurt less than the regular (for lack of a better word)? According to Diabetics Answers at http://diabetes.answers.com/management/blood-glucose-monitoring-how-to-test-your-blood-sugar-at-home

Blood sugar is tested by obtaining a very small blood sample from tiny capillaries under the skin. You do not use a vein to obtain the blood sample. The test is sometimes referred to as a finger stick because the sample is most often obtained from the fingertip with the help of a lancet.

In other words, you’re not creating a deep puncture at all.  That also explains why I can use the ultra-thin lancets; you only need a small drop of blood from the capillaries just under the skin.  Because I can use these, however, doesn’t mean you can.  Each of us is different. The MedSupplyGuide at http://www.themedsupplyguide.com/lancets/ tells us

The higher the gauge, the smaller the perforation the lancet makes. Usually a higher-gauge lancet is less painful to use, but it may be harder to get an adequate amount of blood with a higher-gauge lancet.layers of skin

Okay then, if you can’t get enough blood for the testing with the higher gauge lancet, you’ve got to experiment with lower gauges until you find the right one for you. The lower gauge hurt more for me, but that could be because I didn’t know about the lancet device.

While I was no longer crying with each prick, I was still tearing up.  My loving husband (You don’t need one of these; you can go to the pharmacy yourself which is what I was going to do before he beat me to it.) still wasn’t pleased with my everyday experience, so back to the pharmacy he went and discovered the lancet device. I can only imagine I wasn’t told about this for the same reason I didn’t know about ultra-thin lancets: miscommunication.

lancet devicesThese, my friends, are just plain wonderful. I went to Diabetic Live at https://www.diabeticlive.com/diabetes-101/how-to-use-a-lancet-and-lancing-device/ for help in explaining this one.

This instrument has a spring inside those {sic} forces the lancet to prick or make an incision on your finger. Then it draws back quickly. With a lancing device, you can change how deep or shallow you want the incision to be. Depending on what measurement you choose, it can alleviate additional pain and discomfort.

No more crying; no more tearing up, just the prick I was told I would feel.  Mine has depth settings from 1 to 5.  I’m still on 1 which is the shallowest piercing.  As my device ages and the spring wears out, I may have to use a higher setting to pierce at the same depth.

When you think about it, this is really simple. But who thinks about it if you don’t have to?  For the last month, since I’ve started treatment for the high blood glucose, I have felt like I was in a foreign land and didn’t know the customs. I’m still learning, but am so much more comfortable with the physical part of it.t-shirt

Aha! Talk about being physical… you are joining us for the Kidney Walk in Phoenix, aren’t you?  It’s at Chase Stadium on Sunday,tshirt pix the 19th and you can register there from 7:30 in the morning.  Or, if you’re like me and don’t like to wait for the last minute, you can register early by going to Kidneywalk.kintera.org.  We’re Team SlowItDownCKD.  Can’t make it but want to support us?  You can donate at the same address.  Above are the pictures of the t-shirt I’ve been promising.

Digital Cover Part 1

Many thanks if you wrote reviews for The Book of Blogs: Moderate Stage Chronic Kidney Disease, Part 1 and The Book of Blogs: Part 2Moderate Stage Chronic Kidney Disease, Part 2. I am asking for an anniversary present: please write a review.  Some people mentioned they don’t want their name posted anywhere; well, you can use a nickname or post a review anonymously.

Until next week,Book Cover

Keep living your life!

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Stressed? You Must Be Kidding.

You’re reading this and I’m recovering from my first cataract surgery.  Only one eye is operated on at a time, so the next one is September 4th.  Part of the post operation plan is not driving for a week, which I’m sure I’ll be chaffing at before that week is over.  Another part is reading (and computing) for only ten minutes at a time which is why I’m writing this particular blog a week ahead of time, even though it will be published August 21st.

If you’re following us on Facebook or Twitter, you know I had a cardiovascular scare during my pre-op testing.  While talking to the ever reassuring Dr. Waram at Southwest Desert Cardiology, he mentioned the stellar reviews for What Is It And How Did I Get It? Early Stage Chronic Kidney Disease on Amazon. That got me to thinking I hadn’t looked at them so months, so I did.  I found two new ones I want to share with you:

5.0 out of 5 stars very helpful for calming down and getting to work on controlJune 23, 2012

By R. Sass

Format:Paperback|Amazon Verified Purchase

This is not a medical book, but it is the ONLY book I could find discussing the issue of early stage CKD. My twenty month old son was diagnosed on thursday, almost in passing by his nephrologist. I did not ask any questions on CKD, I was not handed any pamplets – I went into schock and reacted like I always do to bad news I can not process. I asked questions about my infant son’s high blood pressure (the reason for the appointment). Tried to pay attention, remained calm so as not to upset my children who were with us in the room, and then began to research like crazy. I also went back to the doctor and confirmed that she had in fact diagnosed my son with CKD (stage 1). So for me this book has been very helpful, but again I am still in a schock like state and just want to know how to slow the progression of the disease so that my son can have a mostly normal childhood. Best I can tell there is no treatment for the early stages and at least my son’s nephrologist (who is an expert in the area) does not appear to be at all concerned or worried. So I appreciate this book because it remined me to take the reigns (no one else will or can) and I plan to speak to my son’s pharmacist today about his other daily perscriptions, just to make sure that its okay to take… I plan to get more knowledgeable about nutrition (just like the author did) but most of all I plan to let my son play the sports he loves because activity is so important (the author loves to dance, my son loves to try and ice skate like his big sister).

This book is a very quick read, its almost like you are having a conversation with a friend over coffee. It calmed me down, it gave me direction and it was available on my kindle in seconds. THANK YOU!!!!

5.0 out of 5 stars great down to earth read. May 31, 2012

By HELEN A. VIOLA

Format:Kindle Edition|Amazon Verified Purchase

This book and the author was very informative and so close to my situation that I felt at timess, I wrote it myself. There is so much information included, along with so many web sites to continue my own research. I want to thank this author for her down to earth style of writing!

Back to the cardiovascular scare.  There is no, zero, zilch history of heart disease in my family BUT (as we all know), I do have Chronic Kidney Disease. That moves me up a notch for developing heart problems. According to the U.S. National Library of Medicine, ckd may be the cause of the following heart and blood vessel complications:

(Diagram  by  Nucleus Medical Art, Inc./Getty Images)

I was worried, but keeping my fear under control thanks to Bear and my good buddy, Joanne Melnick. – one with hugs and kisses, one with common sense (e.g.  Are you in the hospital?  No? Then it’s not an emergency.)

By the way, you can read more about ckd at: http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001503/

Here’s what happened.  I needed pre-op clearance for the cataract surgery. My trustworthy primary care doctor was unavailable, so her lovely and efficient physician assistant made an appointment for me with the nurse practitioner in the practice.  This woman asked her own physician assistant to perform an EKG on me – twice since she didn’t like the results of the first one.

I didn’t know the np., but was more than a bit disconcerted that she arrived late and had not looked at the notes, did not believe me when I pointed out on the ophthalmologist’s request that I needed an EKG and asked my pcp’s p.a. to verify, and – here’s the worst one – was visibly shaken at the EKG results.  Okay, maybe I was annoyed when I walked in (none of this was taken care of in a timely fashion despite my phone calls so it ended up being a terrific rush), but if anyone should be upset at the results, shouldn’t it be the patient?

The practice provided cardiology recommendations since it was clear seeing one was my next step. I called the closest one hoping they could get me in before my scheduled surgery. Southwest Desert Cardiology’s Brittany had me in the next day.  Their Dr. Kethes C. Waram answered every single one of my numerous questions (Hey, this is me.) and scheduled a stress test for the next day after reading the results of the EKG I’d been given in this office.  Dr. Duong wandered into the examining room while I was there and explained that EKGs can be interpreted from different aspects. While the np. used electrodes on many different parts of my body, the cardiologist concentrated on those areas nearer the heart. These EKG results were far less worrisome, but there still was an abnormality in one part of my heart function they wanted to explore.  Hence, the stress test. (The photo to the left is not my EKG and is for demonstration purposes only. Courtesy of Pharmacotherapy Publications via Medscape.com)

Dave made me very comfortable during that test. He even supplied a blanket since nuclear medicine rooms need to be kept very cold. I was injected with a slightly radioactive dye, but was assured this went nowhere near the kidneys and was so safe that I didn’t even have to check with the nephrologist about its use.

The test results came back normal. According to Dr. Waram, an EKG may be too sensitive to female hearts.  I’m having trouble verifying that via research, but I have to admit I had no symptoms and no results. I wonder why the np. didn’t explain that so I wouldn’t worry about the possible diagnoses (infarction, which mean heart attack, was one of them) on the EKG print out she gave me.

Moral: Go to doctors you know or have an immediate affinity with.  I didn’t know any of these doctors, but was immediately frustrated with the np, while I immediately felt comfortable with Dr. Waram.  Is this sound medical advice?  Hardly, but it makes me feel better should I have to see that doctor again.

Of course, if you have no affinity with someone who is the best doctor for you, ignore my advice.  I’ve done that myself.  The nice thing about advice is that you don’t have to take it.

Until next week,

Keep living your life!

You ARE Part Of The Process

Readers of the blog have repeatedly asked me to include reviews of the book and I have repeatedly forgotten.  Ignoring what that might say about me as a person, I’ve included the Amazon reviews today.  We’ll have to wait for another blog to include the B & N reviews or the blog would be more than double the length of the longest one so far. You can order the book on Amazon or B & N in both print and Kindle, but only print at myckdexperience.com. If you’d like a print book, I can mail you one at the discounted price of $10.00 and you can have me personalize it, too.  Enough selling!
Now, about being involved.  The article I’ve included today has to do with  the idea that the patient must have a say in determining which tests (s)he takes and is written from a physician’s point of view.  I discuss this in What Is It And How Did I Get It? Early Stage Chronic Kidney Disease and you’ll notice that some of the reviews mention it, too.  This is your body, your life. Certainly you should seek the advice of medical experts, but the decision whether or not to take (insert name of medical test) is ultimately yours. This post is from KevinMD.com.  The URL is:  http://www.kevinmd.com/blog/2012/05/test-test-include-patient.html. As usual, the comments in brackets are my own and not part of that post.
 Shannon Brownlee’s recent post, “Don’t discard shared decision making on the basis of PSA testing,” [that was a previous post on the same blog] couldn’t ring more true. The crux of shared decision making is that the patient must decide, with his or her physician, which tests or procedures make sense, given the various risks, tradeoffs and outcomes. Discarding the construct on the basis of one test (PSA testing) [in that previous posting] is not only poor form in that it is a sample of one, but also what might not seem like much of a choice to some may be the biggest choice of all to someone else.Choice is the operative word in this debate. Patients need to know their options, regardless of physician opinion or what research says would probably happen (i.e. a false positive). It is up to the patient to choose whether the odds are worth it to them. And while PSA testing [again, this post refers to all medical testing, not just PSA]  may not be strong in validity (though the research does conflict), causing some doctors to (erroneously, in my opinion) consider it non-elective, there are certainly other common medical tests that warrant shared decision making, such as colon cancer screening, for example. In addition to the decision of whether or not to be tested there are several choices about how to get tested and then after that several choices about what to do in the event that a polyp is found. When medical evidence supports more than one approach to testing, patients should be informed about their choices and providers should respect their preferences.Shared decision making is not just the right thing to do, it is one of the most effective ways to combat the myriad health issues affecting us today – quality, cost, satisfaction. Shared decision making is not meant to encourage or discourage certain tests or procedures – it is meant to involve and educate each patient so that no medical choice is made without them.  And that makes patients happy – exercising the right to be involved in decisions about their care. Once educated, patients do tend to select less invasive procedures on average, as Shannon notes, and costs thereby go down as does the risk of medical error or unwanted care. A randomized controlled trial in the New England Journal of Medicine also produced these effects: a shared decision making intervention produced 9.8% fewer inpatient and outpatient surgeries and 11.5% fewer hospital admissions.

Shared decision making makes healthcare better. To my fellow physicians trying to determine whether to test or not to test – include the patient first. Is the patient involved? That is the real first question.

Peter Goldbach is Chief Medical Officer, Health Dialog.

So, read the reviews below and then get involved in your own life.  Ask questions, weigh the options and let your medical expert help you make YOUR decision. 

 

This book includes TONS of definitions and images and is a good read for anyone looking to learn more about kidney disease — whether your a doctor or a recently diagnosed patient. Her perspective is real and her stories will relate with many. The book touches on many topics from related health complications to dealing with nephrologists and maintaining a kidney-friendly diet. If you or someone you know is facing CKD, I highly recommend reading this book. Take experiences from those who have already gone through it and are looking to help.
Gail Rae’s story and book are a terrific resource for anyone facing the challenges of CKD.  “What Is It and How Did I Get It?” is an honest, personal, forthcoming account of what it takes to stay on top of your own health. It’s great that Gail empowered herself by education and learning — resulting in trusting herself.  Hopefully, her story will teach others to take control of their own health by eating the right diet, exercising, and taking the time to understand the myriad of information that comes from the medical world.  She does an excellent job of explaining what happens once someone learns they have kidney disease.  From what happens with every medical exam, test, visit to a doctor, researching medicines, nutrients, causes, body functions, physiology, etc…touching on every aspect in a very helpful way.  This book is a must read for anyone who has any questions about kidney disease, whether it’s personal or for a loved one.
This is a must read for anyone who has kidney disease. I had the privilege of reading Gail’s book and  interviewing her on the radio. For anyone with kidney disease, this is one of the best books around written by someone who has kidney disease. I recommend this book highly!!!!!!!
Gail Rae’s book, What Is it and How Did I Get it?: Early Chronic Kidney Disease provides information about this disease from the patient’s viewpoint. Having dealt with many doctors while dealing with a different health issue, I have learned how important it is to understand what all the tests and procedures mean. From my viewpoint, it’s also important to know how to talk with your doctor and even more importantly in my opinion to know how to get the doctor to talk with you about prognosis, treatments, and any questions you have. Her book gives you the basic understanding about chronic kidney disease and addresses issues that can puzzle and frighten patients. She gives you her experience as a patient as well as information she’s researched trying to find her own answers. A useful resource for anyone dealing with Chronic Kidney Disease.
 This book is wonderful because it explains all you need to know for early stages of ckd and not in medical terms, but in terms that everyone can understand. The author was so passionate about getting the information to others who are going through what she went through as this information was not avaialble to her. Her altruistic motive for this book is also what makes it wonderful. I would definately buy a copy if I were you.
Having lived with autoimmune diseases since my late 20’s, and I know first hand what it’s like to get a new diagnosis.  Even with the internet, it’s hard to get solid, reliable and empathic information.  This book does it all in an easy to read format.  I think this is useful for a person with any new diagnosis because it highlights the issues people wonder and worry about.
 As the daughter of a mother who has early stage CKD, I have to admit at first I panicked at the diagnosis. What exactly did it mean? I was relieved to find this book and even more so relieved to find that it was written in plain English and not Medical-ese. Author Gail Rae has written an easy to follow book not just for the newly diagnosed early stage CKD patient, but, also for their family members and friends. There’s even an entire chapter dedicated to questions raised by friends and family. I highly recommend this book for both the newly diagnosed early CKD AND their family/friends.
 This is an incredibly well-researched, well-written book written by a woman who herself developed kidney disease. Her book provides clear and comprehensive information for all about the care patients need to have, and responds to the fears and concerns of all involved with coping with kidney disease. It is an honest, very personal accounting of her experience, and I found it to be written clearly, providing tons of pertinent information about every facet of how to cope with this illness.
I think Ms. Rae wrote this book for the ordinary person who learns that they will be living with kidney disease from the moment of diagnosis, on. But after reading, I believe that it is also a book that every family member, every friend of someone who has developed kidney disease ought to read as well, in order to better understand what their loved ones are going through. I also believe that this book will benefit every professional in the medical community who deals with patients coping with Kidney Disease. It has helped me, and will help everyone involved with the patient on any level to be better able to understand their patient’s concerns, anxieties, needs and limitations.  For these reasons I think it is a great guide for the medical community as well as for the patient/family/friends, as it can help professionals understand the kind of information their patients need to have in order to take good care of themselves. Don’t pass this book up!
This book is especially good for the newly diagnosed with CKD. So much information in a well written format. The author, a teacher and a writer uses her excellent skills to make this disease easier to understand and “navigate”. Highly recommended. Medical specialists should give this to all of their kidney disease patients.
Thanks for the chance to let you know how others view the book.
Until next week,
Keep living your life!