And Yet Again

I didn’t think I’d be writing about the flu this year, yet I am. Why? Because, despite thinking I was safe since I didn’t have it in December as usual, I have it now. Actually, I’m in the I-feel-like-an-old-dishrag stage now. Humph, that’s probably why it took me six days to do the laundry (I’m still not done with the putting away) and the dishes. We were lucky enough to have my daughter and new son-in-law do the marketing for us. But it was only then that it became apparent she has it, too.

I have written before about the fact that the flu shot doesn’t guarantee you won’t get the flu, but that if you are one of the unlucky ones to get the flu after the shot, it will not be as virulent. Thank goodness. It’s day seven and I’m just now reaching the stage where I can do something… writing, dishes, laundry…IF I get back into bed for at least an hour between tasks. To be honest, sometimes I have to interrupt those tasks to take that hour rest.

I have read some good murder mysteries and thrillers while listening to silence. Then I could tolerate the television and discovered Dr. Bramwell on Amazon Prime. Terrific for someone who loves Victoriana (I did write Portal in Time and am seriously considering the requests for a sequel.)

But what’s different about the flu and the flu shot this year, I wondered as soon as I felt better enough to wonder about anything. This is the latest information from the Centers for Disease Control and Prevention (CDC) at https://www.cdc.gov/flu/spotlights/flu-season-updates-2018.htm. By the way, they have loads of information about this year’s flu season, but you may have to use the glossary which they so thoughtfully provide.

January 11, 2019 – With the 2018-2019 flu season well underway, CDC today estimated that so far this season, between about 6 million and 7 million people have been sick with flu, up to half of those people have sought medical care for their illness, and between 69,000 and 84,000 people have been hospitalized from flu. CDC expects flu activity to continue for weeks and continues to recommend flu vaccination and appropriate use of antiviral medications.

Flu vaccination is the first line of defense to prevent flu and its potentially serious complications, including death in children. Flu vaccines have been shown to be life-saving in children, in addition to having other benefits.  Flu vaccination has been shown in several studies to reduce severity of illness in people who get vaccinated but still get sick. Antiviral drugs are a second line of defense that can be used to treat flu illness. CDC recommends that people who are very sick or people who are at high risk of serious flu complications who develop flu symptoms should see a health care provider early in their illness for possible treatment with a flu antiviral drug.

CDC’s weekly FluView reports when and where influenza activity is occurring, what influenza viruses are circulating and their properties, and reports the impact influenza is having on hospitalization and deaths in the United States based on data collected from eight different surveillance systems.

So far this season, H1N1 viruses have predominated nationally, however in the southeast, H3N2 viruses have been most commonly reported. The number of states reporting widespread activity increased this week to 30 from 24 states last week. While levels of influenza-like-illness (ILI) declined slightly over the previous week in this week’s report, ILI remains elevated and 15 states and New York City continue to experience high flu activity. There also was a decline in the percent of respiratory specimens testing positive for flu at clinical laboratories however this number remains elevated also.  During some previous seasons, drops in ILI and the percent of specimens testing positive for flu have been observed following the holidays.”

Surprisingly to me, Business Insider at https://www.businessinsider.com/flu-shot-2018-effectiveness-availability-where-to-get-2018-9 answered my question about how the flu shot is different this year.

“The formulation has been changed in two key ways: the nasty H3N2 strain that sickened many people last year has been updated, and the influenza B virus targeted for protection in the vaccine has been changed, too. So far, the revamped vaccines look promising.

‘It appears that the virus is doing a little better job, if we look at what’s gone on in the southern hemisphere season,’ Webby said. [Richard Webby, an infectious disease expert at St Jude Children’s Research Hospital.]

Down south in Australia, for example, it’s been a fairly mild flu season, with flu activity circulating at ‘low’ levels, according to the Australian Department of Health. That may not perfectly translate to an equally mild flu season up north, but what Webby’s seen so far suggests that the shot is also combatting the flu better than it did last year.

Okay, I took the vaccine, am having a less virulent bout of the flu but it’s still here. Now what? The Kidney Foundation of Canada at https://www.kidney.ca/treating-the-common-cold-and-flu—tips-for-kidney-patients offered a succinct answer:

  1. For most people with kidney disease, acetaminophen(Tylenol®) is safe to use for headache, pain and fever.
  2. Cold and flu medications that contain decongestants may increase blood pressure. In addition, avoid cough and cold medications that contain ASA or NSAIDs (Non-steroidal anti-inflammatory medications) such as ibuprofen (Advil®, Motrin®) or naproxen (Aleve®). If you have to use a decongestant, use a nasal spray or nasal drops. (Note: these nasal sprays are habit forming. If you use them more than three days in a row, the blood vessels in your nose can become dependent on the spray.)
  3. Sore throat?Many cough syrups and throat lozenges contain sugar. Make sure you read the label to check the ingredients list, prior to use. Some sugar free or sucrose-free products are available on the market. Gargling with salt water may also be an effective way to soothe a sore throat.
  4. Avoid herbal remedies.Herbal medications and products are not regulated in the same way that pharmaceutical products are. Therefore, the list of ingredients is not always accurate and some herbal medicines have been found to contain pesticides, poisonous plants, hormones, heavy metals and other compounds that are potentially dangerous. Some herbal medications also include diuretics, high levels of potassium, and/or other ingredients that can affect the kidneys or interact with your prescription medications to change their effectiveness.
  5. Vitamin C is not the answer. High doses of vitamin C (500 mg or more) can cause damage to kidneys. There is a specially formulated multivitamin for people with kidney disease that has the right amount of vitamins that your kidneys can handle. Ask your healthcare team about this.

Questions?  Your pharmacist and members of your kidney health team are the best source of information. Ensure you read the label, even on over the counter medications that you’ve taken before, as ingredients do change from time to time. If you have severe symptoms that are lasting longer than 7 days, you should see your doctor.

Until next week,

Keep living your life!

Frustrated and Wondering

You’ve seen it all over the book’s Facebook page and on Twitter.  Yesterday was my birthday, my 66th birthday to be exact.  “I feel good.  I knew that I would,” as James Brown sings when someone calls me.  But what does my, uh, advanced age mean to my kidneys?James Brown

According to my nephrologist, I would lose 1/2 % of my kidney function each year since I was older.  Interesting… and wrong.  I’ve gained between 9 and 21 points on my GFR in the last five years.  It does vary depending on numerous factors: diet, sleep, exercise, stress, illness.

I had my blood drawn two weeks ago and the results told me that my GFR was 52, down from the 64 it had been only three months before. My primary care doctor told me not to worry about this lower number since I had clearly been incubating the flu at the time of the draw.

Here’s something you haven’t heard from me in a while (she wrote tongue in cheek): that got me to thinking.  What do illness – other than chronic kidney disease – and age have to do with your Glomerular Filtration Rate, a widely accepted indication of just how well your kidneys are functioning?

I found the following chart on The National Kidney Foundation’s website at http://www.kidney.org/professionals/kls/pdf/12-10-4004_KBB_FAQs_AboutGFR-1.pdf

      Average Measured GFR by Age in People Without CKD 

AGE  (Years)                   Average Measured GFR (mL/min/1.73 m2)

20-29                                                      116

30-39                                                      107

40-40                                                        99

50-59                                                        93

60-69                                                        85

70+                                                           75

Notice this is for people without CKD.   Now I’m not a mathematician, as we all know, but if those without our disease lose almost ten points of their GFR each decade they age, why am I not surprised that we who do have Chronic Kidney Disease are expected to be lose the same number of points?

By the way, that does take into account the 1/2% a year I would be losing on my GFR – according to my nephrologist – due to age.  But it’s just not happening.

This is a good place to mention that a reader was infuriated that her nephrologist never told her to double her rate to see where she was on the charts.  She previously had a kidney removed due to cancer and was living with one kidney.

Until she was given that information, she thought she should be on par with those living with two kidneys and was aghast as how low her GFR was.  I can see where her ire would rise (as well as her blood pressure from all that unnecessary worry).

I have been researching for hours and the only answers I’ve found to the question of how the flu affected my GFR were on forums or pay-an-expert-for-a-medical-answer sites.

kidney anatomySorry, folks, I just don’t trust them.  I will be seeing my nephrologist this week and will make it a point to ask him.

When I had the flu, my nephrologist told me to go right ahead and take the over the counter medications my primary physician had suggested and in the dosages recommended on the labels.  He did caution that I not take anything with the letter  ‘d’ in the name since that might raise my blood pressure.

Here’s what DaVita at http://www1.davita.com/3617 has to say about that:

When the flu season hits, the use of treatments for cold and flu soars. These medications often include compounds that can intensify

hypertension and salt retention. Should you require a product to treat cold and/or flu symptoms, it is strongly recommended that you

take them as prescribed by your doctor and carefully read the package instructions.

Notice we still don’t know if the flu affects the GFR.  Although, logically, if hypertension (high blood pressure) affects your kidneys and these medications may raise your blood pressure… perhaps that means they lower your GFR?

These are the kinds of questions that sent me running to interview different nephrologists, rather than trying to research my answers on the internet, when I was writing the book.

Attempting to research these questions brought me to this chart on the site of The National Kidney Disease Education Program – which is a part of The U.S. Department Of Health And Human Services – at http://www.nkdep.nih.gov/learn/testing/understand-gfr.shtml.GFR

I have included it here due to its clarity.  Seeing numbers written doesn’t always make it obvious just what the guidelines are, especially for those of us who think we’re not that good at math.

I certainly do not mean to beg the issue, but I’m getting nowhere looking for definitive answers as to how my age and any other illness such as the flu affect CKD.

We can all see how age and illness affect us as far as appearance, physical use of our body, and even shrinkage (Proof: I am ½ inch shorter due to the compression of the discs between my vertebrae), as well as the coughing, sneezing, and body aches of the flu.

Apparently, you have to be a doctor, or have the vocabulary of one, to be able to understand the connection of these conditions to your GFR.

On another note, The Southwest Nephrology Conference is on March 1 & 2 at Wild Horse Pass Hotel and Resort in Chandler.  That is simply too close to ignore.  I am thinking about going to meet all the specialists I’ve corresponded with from different parts of the country in person.

Could I interest any of you in joining me?  You can read more information about the conference at http://swnc.org/

54603_4833997811387_1521243709_o

I keep forgetting to mention the book!  Since I no longer do book signings or book talks, the only way to get the information out there is for you to buy books for your friends and family.

Hey!  I’m donating as fast as I can! (Wait until my accountant hears about that.)

Until next week,

Keep living your life!

The Flu: Part 3, The Last

martin-luther-king-jrToday is such a momentous day.  It is not only Martin Luther King, Jr.  Day, but the second inauguration of President Obama.  2013-01-21T024432Z_1452960950_GM1E91L0TCM01_RTRMADP_3_USA-INAUGURATIONAs I sit at my computer, I ruminate how far we’ve come in a relatively short amount of time.  I remember becoming aware of the Civil Rights Movement and crying when I watched fire hoses being turned on the crowds.  I remember how I wondered as a little girl why my friend’s skin was darker… and assumed she’d just been in the sun longer than I had.  And I remember the prejudice both of us experienced as we traveled in the rural south only forty years ago.  She is Black, but I am a Jew.

And now I wonder how to slide into a blog about chronic kidney disease.  There is no sedge way here. That’s all right, though, because we’re not exactly dealing with ckd today, but the flu instead.  I do promise that this will be the last blog about the flu (this year, that is).

I have just spent four uncomfortable days zapped of energy and not enjoying the movies I watched or books I read while enduring the flu. I was truly surprised at the OTC (over the counter) medications my nephrologist recommended to me.  Tylenol Cold?  A steady regime for four days?  This for a CKD patient who has taken six Tylenol in the last five years?  But that’s what the man said.

Dylsem Cough Suppression was another OTC he recommended.  Then there was the Benedryl that came with a caution not to take it until I was going to sleep. It would knock me out. Oh, and the Mucinex.  The one recommendation I got a kick from was hot tea with lemon and honey (I actually asked him if he knew my mother, but I think he didn’t hear me.) laced with whiskey. This for someone who doesn’t drink?

Now that I’m feeling better – even if I don’t sound better – I’m nervous about all this medication.  I carefully read each and every label.  Not a single one mentioned anything about possible kidney damage.

I think I’ve become accustomed to not taking OTC medication and I think that’s done me well. As I finished each bottle – especially the Tylenol Cold – I noticed I felt more alert, more aware of my body, and less… less what?  Tamped down?  Cocooned?  I don’t know the word, but I certainly feel more here.

Is it that the medications did their job?  Probably.  Is it that I got more sleep and rest than I have in quite a while?  Probably that, too.  But maybe, just maybe, my body doesn’t like more medications.  Sounds a bit hocus-pocus, but this is the same body that has slowly raised its GFR with careful guidance from me.

Would I take the flu shot again even though I got the flu after taking it this season?  Absolutely.  It was my misfortune to take the immunization for the wrong strain of flu this year. flu shot That’s never happened before, but then again, there haven’t usually been this many different strains of flu before in the same season.

Another reason is that this inoculation against  influenza also prevents heart attack and stroke.

“If you’re tempted to skip your flu shot, consider this: Getting vaccinated cuts risk for a heart attack or stroke by up to 50 percent, according to two studies presented at the Canadian Cardiovascular Congress.”  This is the lead sentence in Lisa Collier Cool’s Nov. 26, 2012 Yahoo Health article. You can read the whole article (and I urge you to.  There’s information here that was news to me.) at: http://health.yahoo.net/experts/dayinhealth/shot-prevents-heart-attacks

According to a Reuters’ Jan. 18, 2013 article, the number of flu cases is beginning to taper off but this has been a difficult year. We already know that.  Both Boston and New York State have declared Medical Health Emergencies. Look around you.  Are there people missing from your office?  Your school?  I noticed fewer people in the markets, too.

This same article talks about a dearth of Tamiflu.  Weren’t we told just last week that there was a shortage of the vaccine, too?  Do you see where I’m going with this? If you haven’t gotten your inoculation, get it.  If you have, but can’t find Tamiflu (not that everyone is prescribed Tamiflu), ask your doctor. No reason to panic.  Honestly, I sometimes wonder just how objective our news is.  Oh, the article.  It’s at: http://news.yahoo.com/flu-u-still-widespread-starting-ease-cdc-says-191406674–finance.htmlflu

A MedPage Today article offered some startling information on January 19th of this year: “A resounding 85% of 2,000-plus MedPage Today readers voted “yes” to our survey question asking if media attention promoted a “pseudo epidemic” as patients mistake cold symptoms for flu.” Did I do that?  Did you?  As someone who rarely becomes ill for more than a day at a time, did I simply not recognize a bad cold for what it is?

I couldn’t secure an appointment with my pcp (primary care physician) until this coming Wednesday – fully a week after I started to feel symptoms.  Will it be too late for her to tell the difference?  It’s an interesting article, although I’m not necessarily endorsing it.  Read it for yourself at: http://www.medpagetoday.com/InfectiousDisease/Vaccines/36924?utm_content=&utm_medium=email&utm_campaign=DailyHeadlines&utm_source=WC&xid=NL_DHE_2013-01-21&eun=g596983d0r&userid=596983&email=myckdexperience@gmail.com&mu_id=5721543

As I read a New York Times article about the severe flu season (http://www.nytimes.com/2013/01/19/health/flu-season-worse-than-average-officials-say.html?smid=tw-nytimeshealth&seid=auto&_r=1&) from last Saturday, it occurred to me that when the media refers to the elderly, they mean people over 65.  That means me!  I had not been paying attention to any health warnings for the elderly because they didn’t apply to me.  Hah!  Reality smacks me in the face again.

I could go on and on, but you’ve probably read a great deal yourself about the flu.the flu ends with you

As far as the book, I believe I have come close to paying off the initial cost of publication.  When you buy a book (Amazon.com, B&N.com, or DogEarPublishing.com), my profit goes right back into the book.  That’s what has allowed me to donate books to those who could not afford the book, were just diagnosed, and/or were somehow related to CKD patients.

As soon as I earn enough to pay off turning the book into an e-book , paying for the books I ordered to donate, and then translating it into Spanish (my next project), I intend to order more books to donate.

India, Malaysia, Pakistan, Turkey, Tunisia, the United Arab Emirates, Egypt, Saudi Arabia, Singapore, South Africa, The UK, Canada, Australia, Italy, Ireland, Germany, New Zealand, The Philippines, and Mexico, as well as the USA,  thank you.  Buy a book for yourself and help someone else who needs it.

Until next week,

Keep living your life.Book signing

By Request, Ladies and Gentlemen: The Flu (Redux)

We’re back thanks to the ever willing Sean who pitched right in and picked us up from the airport when we realized Abby, who had taken us to the airport, holds a blues dance just about the time we arrived back in Phoenix. Doctors and medical practices in Apollo Beach, Tampa, Mount Dora and Orlando are now proud owners of office copies of the book.

But while we were on the plane both ways, I heard coughing, sneezing, throat clearing and sniffling… lots of it.  Was this the flu?  All my relatives and friends had seemed healthy enough, but they weren’t traveling on these planes.interior of plane

That got me to thinking more about the flu just as it was requested that I re-run the flu blogs. Before doing so, I thought I’d find out more about this season’s flu.  Sure enough, MedPage Today ran just such an article on January 10th of this new year.  According to Todd Neale, who wrote the article, “Last week, the CDC reported that 41 states had widespread influenza activity, and 29 states and New York City had high influenza-like illness activity in the week ending Dec. 29. Although not unprecedented, that level of activity is not usually seen until later in the season.”

Some of the physicians quoted in the article wondered if it’s the reporting of the illness that’s improved thereby making the flu appear more widespread than it really is.  I don’t think I believe that since there seems to be a shortage of both vaccines and drugs to treat this ailment and Boston’s mayor has declared a public health emergency due to the 700 cases reported in his city. You need only click through to http://www.medpagetoday.com/InfectiousDisease/URItheFlu/36801 to read the article for yourself.

According to Healthfinder.gov, you can protect yourself from the flu by doing the following:

Getting the flu vaccine is the most important step in protecting yourself from the flu. Here are some other things you can do to keep from getting and spreading the flu:

  • Stay away from people who are sick.
  • If you are sick, stay home for at least 24 hours after your fever is gone.
  • Wash your hands often with soap and warm water.
  • Try not to touch your nose, mouth, or eyes.
  • Cover your mouth and nose with a tissue when you cough or sneeze

I wondered how to tell the difference between a cold and the flu.  Since being diagnosed with ckd, I make it a point to take the flu vaccine annually, yet there have been times when I just didn’t feel that well. I found my answer in the following: http://abcnews.go.com/health/t/blogEntry?id=17885194  “ ‘With influenza you might also feel very poorly, with aches and pains in your muscles and joints,’ said Dr. William Schaffner, chair of preventive medicine at Vanderbilt University Medical Center in Nashville, Tenn. ‘There’s often a cough, too, which is much more prolonged and pronounced.’ ”

I’m including part of an article by The National Kidney Foundation so you can feel confidant that your kidneys are being covered here.

Flu Season and Your Kidneys

By Leslie Spry, MD FACP FASN

As flu season approaches, kidney patients need to know what they can do and what they should avoid if they become ill. The first and most important action to take is to get a flu shot. All patients with chronic kidney disease, including those with a kidney transplant should have a flu shot. Transplant patients may not have the nasal mist flu vaccine known as FluMist®. Transplant patients should have the regular injection for their flu vaccine. If you are a new transplant recipient, within the first 6 months, it is advisable to check with your transplant coordinator to make sure your transplant team allows flu shots in the first 6 months after transplant. ALL other kidney patients should receive a flu vaccination.

If the influenza virus is spreading in your community, there are medications that you can take to protect against influenza if you have not been vaccinated, however the dose of these medications may have to be modified for your level of kidney function. This is also true of antibiotics or any medication that you take for colds, bacterial infections or other viral infections. [Me: I have written about this in the book and the blog.  You have to tell the prescribing physician about your CKD and/or remind him of it if (s)he already knows each time a prescription is written for you.] The doses of those medications may have to be modified for your level of kidney function. Even if you are vaccinated, it is still possible to get influenza and pneumonia, but the disease is usually much milder.

You should get plenty of rest and avoid other individuals who are ill, in order to limit the spread of the disease. If you are ill, stay home and rest. You should drink plenty of fluids [me again: remember your limit on fluid intake] to stay well hydrated. You should eat a balanced diet. If you have gastrointestinal illness including nausea, vomiting or diarrhea, you should contact your physician. Immodium® is generally safe to take to control diarrhea. If you become constipated, medications that contain polyethylene glycol, such as Miralax® and Glycolax® are safe to take. You should avoid laxatives that contain magnesium and phosphates. Gastrointestinal illness can lead to dehydration or may keep you from taking your proper medication. If you are on a diuretic, it may not be a good idea to keep taking that diuretic if you are unable to keep liquids down or if you are experiencing diarrhea. You should monitor you temperature and blood pressure carefully and report concerns to your physician. Any medication you take should be reported to your physician. [Me: I’ve gotten other advice about those brands, so check with your nephrologist before you take anything.]

fit the flu

Medications to avoid include all non-steroidal medications including ibuprofen, Motrin®, Advil®, Aleve®, and naproxen. Acetaminophen (Tylenol® and others) and aspirin are generally safe to take with kidney disease. Acetaminophen doses should not exceed 4000 milligrams per day [Me: Nobody ever told me that! Why?] If you take any of the over-the-counter medications, you should always drink plenty of water and stay well hydrated. If you take anti-histamines or decongestants, you should avoid those that contain ephedrine or pseudoephedrine. Over-the-counter cold remedies that are safe to take for patients with high blood pressure are generally designated “HBP”. Any over-the-counter medication that you take for a cold or flu should be approved by your doctor.

You can find the article at: http://www.kidney.org/patients/FluSeasonAndYourKidneys.cfm.  Again, although this a nationally respected doctor, it is not your doctor.  Check everything you plan to take with your nephrologist BEFORE you take it. By the way, Medicare covers the cost of the flu shot.

Here is some of the information England’s Department of Health offered in 2011 :

Seasonal flu vaccination: Who should have it and why

What harm can seasonal flu do?

People sometimes think a bad cold is flu, but having flu can be much worse than a cold and you may need to stay in bed for a few days if you have flu. Some people are more susceptible to the effects of seasonal flu. For them it can increase the risk of developing more serious illnesses such as bronchitis and pneumonia, or can make existing conditions worse. In the worst cases, seasonal flu can result in a stay in hospital, or even death.

Am I at greater risk from the effects of seasonal flu?

Even if you feel healthy, you should definitely consider having the free [me: in England, that is] seasonal flu vaccination if you have:

  • a heart problem
  • a chest complaint or breathing difficulties, including bronchitis or emphysema
  • a kidney disease  [Me: I bolded and italicized this for obvious reasons.]
  • lowered immunity due to disease or treatment (such as steroid medication or cancer treatment)
  • a liver disease
  • had a stroke or a transient ischaemic attack (TIA)
  • diabetes
  • a neurological condition, for example multiple sclerosis (MS) or cerebral palsy
  • a problem with your spleen, for example sickle cell disease, or you have had your spleen removed.

Here’s the URL for this article: http://www.dh.gov.uk/health/2011/10/winter-flu/       Book Cover

This is an usually long blog.  That was necessary for you to understand that you can die from influenza… or you can take preventative measures. I don’t want to scare you and need to remind you that “can” doesn’t mean “will.”

Until next week when I’ll try to remember to tell you about Harry Potter’s World,

Keep living your life!