Cellulitis, CKD, and Diabetes

My uncle-in-law had it. My children’s father had it. My husband had it. Now the question is what is cellulitis? 

WebMd at https://www.webmd.com/skin-problems-and-treatments/guide/cellulitis#1 answers: 

“Cellulitis is a common infection of the skin and the soft tissues underneath. It happens when bacteria enter a break in the skin and spread. The result is infection, which may cause swelling, redness, pain, or warmth.” 

Alright, but what does that have to do with Chronic Kidney Disease. By the way, only one of the men mentioned in the first paragraph has CKD.  

According to the NHS (National Health Service) in the United Kingdom at https://bit.ly/2IJJrbT: 

“You’re more at risk of cellulitis if you: 

  • have poor circulation in your arms, legs, hands or feet – for example, because you’re overweight 
  • find it difficult to move around 
  • have a weakened immune system because of chemotherapy treatment or diabetes [Gail here: I bolded that.] 
  • have bedsores (pressure ulcers) 
  • have lymphoedema, which causes fluid build-up under the skin 
  • inject drugs 
  • have a wound from surgery 
  • have had cellulitis before” 

Two of the men above were overweight, but one of these did not have CKD. The overweight man who had CKD also had diabetes. One had a wound from surgery which was the cause of his cellulitis. Another had had cellulitis before. (Does this sound like one of those crazy math word questions?) 

CKD is not a cause? Whoa! Whoa! Whoa! Wait just a minute here. Let’s remember that CKD gives you the lovely present of a compromised immune system. A compromised immune system means it doesn’t do such a great job of preventing illnesses and infections. 

Also remember that diabetes is the leading cause of CKD and diabetes can also weaken your immune system. I needed more information about diabetes doing that and I got it from The University of Michigan’s Michigan Medicine at https://www.uofmhealth.org/health-library/uq1148abc:    

“High blood sugar from diabetes can affect the body’s immune system, impairing the ability of white blood cells to come to the site of an infection, stay in the infected area, and kill microorganisms. Because of the buildup of plaque in blood vessels associated with diabetes, areas of infection may receive a poor blood supply, further lowering the body’s ability to fight infections and heal wounds.” 

Remember that cellulitis is an infection. Reading the above, I became aware that I didn’t know anything about plague in the blood vessels and diabetes, so I went right to what I consider the source for vascular information, Vascular.org. This time at https://bit.ly/31dZ0yI:  

“Peripheral artery (or arterial) disease, also known as PAD, occurs when plaque builds up in the arteries and reduces blood flow to the feet and legs. Fairly common among elderly Americans, PAD is even more likely among those with diabetes, which increases plaque buildup.” 

All three of these men were elderly, if you consider in your 70s elderly. Of course, I don’t since I’m in my 70s, but we are talking science here. 

Hmmm, we don’t know yet how cellulitis is treated, do we? Let’s find out. I turned to my old buddy, The MayoClinic at https://www.mayoclinic.org/diseases-conditions/cellulitis/diagnosis-treatment/drc-20370766:  

“Cellulitis treatment usually includes a prescription oral antibiotic. Within three days of starting an antibiotic, let your doctor know whether the infection is responding to treatment. You’ll need to take the antibiotic for as long as your doctor directs, usually five to 10 days but possibly as long as 14 days. 

In most cases, signs and symptoms of cellulitis disappear after a few days. You may need to be hospitalized and receive antibiotics through your veins (intravenously) if: 

Signs and symptoms don’t respond to oral antibiotics 

Signs and symptoms are extensive 

You have a high fever 

Usually, doctors prescribe a drug that’s effective against both streptococci and staphylococci. It’s important that you take the medication as directed and finish the entire course of medication, even after you feel better. 

Your doctor also might recommend elevating the affected area, which may speed recovery…. 

Try these steps to help ease any pain and swelling: 

Place a cool, damp cloth on the affected area as often as needed for your comfort. 

Ask your doctor to suggest an over-the-counter pain medication to treat pain. [Gail again: no NSAIDS, you have CKD.] 

Elevate the affected part of your body.” 

Now the obvious question is how, as CKD patients and possibly diabetics, do we avoid that infection in the first place? 

“Cellulitis cannot always be prevented, but the risk of developing cellulitis can be minimised by avoiding injury to the skin, maintain [sic] good hygiene and by managing skin conditions like tinea and eczema. 

A common cause of infection to the skin is via the fingernails. Handwashing is very important as well as keeping good care of your nails by trimming and cleaning them. Generally maintaining good hygiene such as daily showering and wearing clean clothes may help reduce the skin’s contact with bacteria. 

If you have broken skin, keep the wound clean by washing daily with soap and water or antiseptic. Cover the wound with a gauze dressing or bandaid every day and watch for signs of infection. 

People who are susceptible to cellulitis, for example people with diabetes or with poor circulation, should take care to protect themselves with appropriate footwear, gloves and long pants when gardening or bushwalking, when it’s easy to get scratched or bitten. Look after your skin by regularly checking your feet for signs of injury, moisturising the skin and trimming fingernails and toenails regularly.” 

Thank you to Australia’s HealthDirect at https://www.healthdirect.gov.au/cellulitis-prevention for these common sense reminders. Actually, we need to keep washing our hands while Covid-19 is at our door anyway, so we’ve already got that part of the prevention covered. I suspect that many of us don’t bother to deal with small wounds, but it looks like we’d better start. 

What if you do develop cellulitis? How will you be treated? My old buddy, The Mayo Clinic at https://mayocl.in/2FDxUtf tells us: 

“Cellulitis treatment usually includes a prescription oral antibiotic. Within three days of starting an antibiotic, let your doctor know whether the infection is responding to treatment. You’ll need to take the antibiotic for as long as your doctor directs, usually five to 10 days but possibly as long as 14 days. 

In most cases, signs and symptoms of cellulitis disappear after a few days. You may need to be hospitalized and receive antibiotics through your veins (intravenously) if: 

Signs and symptoms don’t respond to oral antibiotics 

Signs and symptoms are extensive 

You have a high fever 

Usually, doctors prescribe a drug that’s effective against both streptococci and staphylococci. It’s important that you take the medication as directed and finish the entire course of medication, even after you feel better. 

Your doctor also might recommend elevating the affected area, which may speed recovery.” 

Until next week, 

Keep living your life! (Safely, please) 

 

Inked

tattooThere’s a woman I know, younger than I by three and a half decades, who is inked… and I mean inked. She has sleeves on both arms and (almost) a body suit.  Don’t know what I’m talking about? Take a look at http://www.inkedmag.com/tattoo-lingo/. Unfortunately she’s lost a job or two when narrow minded employers saw her arms, but that’s not what I’m writing about today.

Oh, all right. Here are the definitions of the jargon above: inked = tattooed; sleeve= fully tattooed on the arm; body suit= tattoos on the majority of the body.

I was thinking about her the other day and that got me to thinking about tattoos and whether or not they’re safe for us since we have Chronic Kidney Disease. Let’s take a look at the tattooing process itself to see if there’s anything there to worry about.

I turned to The Mayo Clinic at http://www.mayoclinic.org/healthy-lifestyle/adult-health/in-depth/tattoos-and-piercings/art-20045067 for this information.

“A tattoo is a permanent mark or design made on your skin with pigments inserted through pricks into the skin’s top layer. Typically, the tattoo tattoo machineartist uses a hand-held machine that acts much like a sewing machine, with one or more needles piercing the skin repeatedly. With every puncture, the needles insert tiny ink droplets.

The process — which is done without anesthetics — causes a small amount of bleeding and slight to potentially significant pain.”

Personally, I’m too much of a scaredy cat to give tattooing a try now that I know about the possibility of pain. There’s enough of that in my life already… like the endometrial biopsy a few months ago. Ugh! But maybe you’re not…

Well, why might you want a tattoo in the first place? Maybe it’s an artistic requirement for your soul.  Maybe it’s to remind yourself of some life lesson like my New York daughter, Nima’s. Or maybe it’s a medical tattoo to wear rather than a medical alert bracelet.

What is itHmmm, I’d think again. As CKD patients, our blood is already not that pure. Remember, as I explained in What Is It and How Did I Get It? Early Stage Chronic Kidney Disease,

“The kidneys remove these toxins (e.g. from the blood) and change them into urine ….”

Our kidneys are not functioning at the top of their game. With my current GFR of 51, my kidneys are only functioning at a teeny bit more than half capacity while still trying to filter the blood as kidneys with a GFR of 100% would. Oh, right, GFR. In The Book of Blogs: Moderate Stage Chronic Kidney Disease, Part 1 that’s explained according to the NKDED:

“The National Kidney Disease Education Program at The U.S. Department of Health and Human Services provides the following information.DIGITAL_BOOK_THUMBNAIL

  1. A blood test checks your GFR, which tells how well your kidneys are filtering. GFR stands for glomerular filtration rate. …”

Here’s what I found on Health Impact News at http://healthimpactnews.com/2015/think-before-you-ink-the-little-known-risks-of-tattoos/ that makes me so leery of tattoos.

“In 2011, a study in The British Journal of Dermatology revealed that nanoparticles are indeed found in tattoo inks, with black pigments containing the smallest particles (white pigments had the largest particles and colored pigments were in between).

Nanoparticles are ultramicroscopic in size, making them able to readily penetrate your skin and travel to underlying blood vessels and your bloodstream. Evidence suggests that some nanoparticles may induce toxic effects in your brain and cause nerve damage, and some may also be carcinogenic.”Healthy%20Kidney

Whenever I speak to someone who has a tattoo, they tell me the ink only goes as far as the dermis (the second layer of skin) and nowhere near the blood.  I often wondered about that since the dermis is rife with blood vessels. I guess I just learned that the tattoo owners were misinformed. And why we as CKD patients should not be allowing even the possibility of more toxins entering our blood streams for our already overworked kidneys to eliminate.

Are tattos pretty? I think so.  Are they spiritual? Sometimes they are. Are they worth the risk? It’s your decision, but I can’t agree that they are. I found even more evidence to the contrary on WebMd at http://www.webmd.com/skin-problems-and-treatments/laser-tattoo-removal?page=2

“There are minimal side effects to laser tattoo removal. However, you should consider these factors in your decision:

tattoo removalThe tattoo removal site is at risk for infection. You may also risk lack of complete pigment removal, and there is a slight chance that the treatment can leave you with a permanent scar….”

I’d also read on various sites that simply being tattooed may leave you open for infection if the autoclave (instrument steaming machine) or needles are not clean enough. I don’t know of any sites to rate the cleanliness of tattoo parlors, but I do know infection opportunities are far more common for us as CKD patients…and they are more dangerous for us.

This paragraph from The Book of Blogs: Moderate Stage Chronic Kidney Disease, Part 2 should clarify the why of avoiding infection possibilities.

Digital Cover Part 2 redone - Copy“Think about it: your liver and your kidneys are the two most important blood filters you have. We already know we need to maintain as steady a blood pressure in the kidneys as we can to do no more damage to them.  The liver does this by releasing angiotensin which constricts your blood vessels. Don’t forget the liver helps maintain your blood sugars.  If it can’t do that due to infection, kidney function can be further reduced. The liver also filters toxins and drugs from the blood.”

I wondered if I’d find enough information for a blog about CKD patients and tattoos. On the contrary, I find I could go on and on.

Tuesday is the beginning of National Kidney Month. While I won’t be leading my team in the kidney walk this year (Damn neuropathy!), I’ve got another surprise up my sleeve to celebrate. I may be able to announce that next week.2015-04-18 22.09.45

Don’t forget about the National Kidney Fund of Arizona’s annual conference on March 11th and 12th. I’ll be there on the 11th. You can register at www.SWNC.org.

Until next week,

Keep living your life!

Another Infection? 

I noticed I often develop an infection at the site of a simple cut, one I treated with antibiotic when I first received it. You know I’m a writer, but did you know I like to write long hand sometimes?  I think those yellow legal pads have extra thin paper made purposely for paper cuts.

There are times I am hopeless in the kitchen, too.  That’s usually when I have my mind on my writing or the Victorian murder mystery I’m reading.  firworksWell, lately I’ve had my mind on my daughter’s new career, my step-daughter’s promotion to first female head instructor for Krav Maga here in Phoenix, the publication of my new book and getting the third one ready for print, my almost son-in-law’s new career {another new career!}, or our trip to Meteor Crater.

I digress.  Back to infections. This made no sense… until I remembered that my immune system was already compromised by my Chronic Kidney Disease.  OMG!  As if we didn’t have enough to deal with concentrating on diet, exercise, sleep, rest, inoculations, creatinine and GFR monitoring. Might as well take a deep breath and explore this one, too.

So, just what is an infection anyway?  According to the Free Dictionary (Medical) at http://medical-dictionary.thefreedictionary.com/, it’s

 invasion and multiplication of microorganisms in body tissues, especially that causing local cellular injury due to competitive metabolism, toxins, intracellular replication, or antigen-antibody response.

downloadUhhh, this definition may have exacerbated our confusion so we’ll need a few more definitions. I’d say we all know that toxins are poisons, and microorganisms are those teeny, weeny little living things you can’t see with the naked eye.

As for intra – Hunter College Latin and Greek roots class a million years ago to the rescue – that means within. Add cellular and you have within the cells. Add replication and you end up with bacteria making copies {replication} of itself within the cells to the best of my knowledge.

Undergoing immunology treatments myself, I remember the phlebotomist in the office telling me that the layman’s term for antigen-antibody reaction is allergic reaction.

And now?  Oh right.  What do frequent infections have to do with our already compromised immune system.

This is what I found on DaVita’s site at http://www.davita.com/kidney-disease/overview/symptoms-and-diagnosis/infections-and-chronic-kidney-disease/e/4734

People with kidney disease  can be more prone to infection because of related conditions such as diabetesinadequate calorie and protein intake, and the access site can be vulnerable to infection.

Now, we all know I’ve been successfully fighting to stay pre-diabetic for years, so I’m not a diabetic.  And we all know I’m at stage 3A, so I have no access site.  That’s something you encounter when you start dialysis at stage 5.

Ahhhh, but I am restricted to five ounces of protein a day and 1200 calories. Neither of these is inadequate for a woman my age and weight.  Or are they?ham

I didn’t know, really. But a site with the unlikely name of Breaking Muscle seemed to.  I found them at http://breakingmuscle.com/nutrition/how-much-protein-do-you-need-science-weighs. Their answer? .36 grams/pound/day.

Apparently, you just multiply what you weight by .36.  Let’s say I weighed 125 pounds {Will you please get up off the floor and stop laughing?}. I’d need to eat a minimum of 45 grams of protein. That’s less than two ounces.

What about the days I just don’t feel like eating any protein?  It’s surprising how you can lose your taste for it.  Or maybe I’m just not bothering to consume enough calories each day.  Considering that I’m not underweight {hah!}, these are both hypothetic situations.

Kidney Service China at http://www.kidneyservicechina.com/ckd-basics/1546.html explained the connection between CKD and infection this way.

Besides {proteinuria}, damaged kidney can cause lots of toxins and wastes’ accumulation in blood, while these substances will be transplanted to everywhere of our body. Many of them are harmful to the organs and tissues of our body, and they can cause damage to our immunity. For example, marrow is a major organ of our immune system, while some toxins can inhibit its function of producing cells.Blood Oxygen Cycle Picture 400dpi jpg

This makes sense to me. I visualize it as bacteria streaming into your cut from the outside, while the already overloaded blood is doing its darnedest to keep them out… and not succeeding in its sluggish, polluted state.  Hope that’s not too violent an image for you.

Most of the other information I was able to dig up had to do with ESRD {end state renal disease} and the inflammatory state of your body at this stage.  I did find it interesting, but we’re not quite there yet – thank goodness.

The_Book_of_Blogs-_M_Cover_for_KindleChanging the subject: the digital version of The Book of Blogs: Moderate Stage Chronic Kidney Disease, Part 1 is free today.  That’s right; the digital version of the book is free today. Why?  As a reward for reading the entire blog instead of just the first few paragraphs.  Got you!  It’s because today is my birthday and I wanted to give you a present.  Also because I couldn’t think of a better way to get the word about moderate stage chronic kidney disease out there.  Thank you for celebrating with me.

Oh, the print copy of the book is being released today, too.  Now that’s a present for me.  Both are available on Amazon.com.  Do let me know what you think of the cover.

And, please, write a review after you’ve read the book. I’ve had some of my 17, 000 readers in 109 countries tell me they aren’t writing a review because they don’t want their name in plain view for the entire world to see.  Guess what? You can sign as anonymous, or use your nickname,  or make up an alter ego name and use that.

Until next week,

Keep living your life!