From a Book…

I was trying to figure out a new angle from which to write about Chronic Kidney Disease during National Kidney Month and decided that my chapter in the newly released 1in9 just might be the way.

By the way, I really don’t like shopping, but did so for a ‘fancy blouse’ for the fancy book launch. The day of the launch turned out to be the day I unexpectedly had anesthesia and I ended up not being able to go. From the pictures I’ve seen of the event, it was a fun event. Now I need another fun event to wear that ‘fancy blouse’ to.  After all, we can’t let a dreaded shopping trip go to waste, can we?

Without further ado, I present the first part of my 1in9 chapter:

My name is Gail Rae-Garwood. I like to think of myself as an average older woman with two adult daughters, a fairly recent husband, and a very protective dog. But I’m not. What makes me a little different is that I have Chronic Kidney Disease… just like the estimated 30 million or 15% of the adult population in the United States. Unlike 96% of those in the early stages of the disease, I know my kidneys are not functioning well.

Once upon a time, a long, long time ago, before I’d ever heard the word nephrology, I paid no attention to my kidneys. I had just a vague idea of where they were located because I had big brothers. Every time they watched boxing, one or the other of them would yell, “Oh! Right in the kidneys!” when one guy hit the other on the back, sort of near the waist.  My mother attempted to feed us kidney beans once or twice, but three voices chorusing the 1950’s equivalent of “Uh, gross!” was enough to convince her they weren’t that necessary. My father had a friend who’d moved up in the world and had a kidney shaped pool. Of course, I never had a bird’s eye view of that as a child. So, we were a family pretty much ignorant about kidneys.

When I grew up, I never let my children watch boxing; it was too violent. I never even tried to feed them kidney beans, probably due to some residual abhorrence left over from my own childhood. I had no friends with kidney shaped pools, but I had flown in an airplane and could recognize one if we were flying low. That was the sum total of my kidney education. I didn’t even recall if they were covered in high school biology. My daughters, now grown women, said they were, but I didn’t remember anything about that.

I was blindsided over a decade ago. That’s when I started seeing a new doctor solely because she was both on my insurance plan and so much closer to home than the one I’d been seeing. It seems everything is at least half an hour away in Arizona; her office wasn’t. As a diligent primary care physician, she ordered a whole battery of tests to verify what she found in my files which, by the way, contained a kidney function reading (called the GFR) of 39%. That was something I’d never been told about.

39%. I’d been a high school teacher for 35 years at that point. If a student had scored 39% on a test, we would have talked and talked until we had gotten to the root of the problem that caused such a low score. No one talked to me about my low kidney function until I changed doctors.

“That’s not normal,” said my new doctor as she looked at my blood test results.

I made the supreme effort of tearing my eyes away from the height and weight chart to ask, “What’s not normal?”

“Your GFR,” she told me.  I looked at her blankly. (In retrospect, I can understand how hard it probably was for her not to laugh at my empty eyes and a face without a shred of interest showing on it.) I said nothing. She said nothing.

Finally, I asked, “What’s that?”  She gave me a simple explanation with no indication that I should panic in any way, but of course I did.

“It’s what!  It’s below normal?  My kidneys aren’t functioning to full capacity? Why wasn’t I told? What do I do now? How do I fix the problem? I want them at 100%.”

Her voice rose over mine in a steady, sure manner. “This does not mean there is a problem. It means you must go to a specialist to see if there really is a problem.”

“Oh.” I didn’t believe her, but she not only talked, she had me in a nephrologist’s (kidney and hypertension specialist) office the next day. That’s when I started worrying. Who gets an appointment with a specialist the very next day? I was diagnosed at stage 3; there are only 5 stages. I had to start working to slow down the progression in the decline of my kidney function immediately.

I read just about every book I could find concerning this problem. Surprisingly, very few books dealt with the early or moderate stages of the disease.  Yet these are the stages when CKD patients are most shocked, confused, and maybe even depressed—and the stages at which they have a workable chance of doing something to slow down the progression in the decline of their kidney function.

This first nephrologist might have been reassuring, but I’ll never know. I was terrified; he was patriarchal. All I heard was, “I’ll take care of your kidneys. You just do as I say,” or something to that effect.

Nope, wrong doctor for me. I wanted to know how medication, diet, exercise and other lifestyle changes could help. I didn’t want to be told what to do without an explanation as to why… and when I couldn’t get an explanation that was acceptable to me, I started researching. (More about that later.) You see, I’d already had a terrific Dad who’d known better than to ask me to give up control of myself. I didn’t need a doctor assuming his role… especially in a way I resented.

… to be continued. (This will take several weeks. It is a chapter in book, so it’s longer than my usual 1,000 or so word blog.)

Until next week,

Keep living your life!

What a Weird Dream

Part 2I woke up today realizing I’d been dreaming about my bladder.  Sometimes that’s a somatic clue to wake up and empty it, but I’d done that already. Hmmm, was I being told to look into the different aspects of the bladder?  Oh, maybe the dream DIGITAL_BOOK_THUMBNAILwas pointing toward the connection between Chronic Kidney Disease and the bladder. By now, you’ve probably realized everything in my world points to CKD.

To my way of thinking, if I were going to dream of anything CKD related, I should have been dreaming about the photos of you reading one of my books in a weird place that you’ve posted on SlowItDownCKD’s Facebook page to win a free copy of The Book of Blogs: Moderate Stage Chronic Kidney Disease, Part 1. That would make sense, wouldn’t it?

What is it

But, no.  It was the bladder.  Okay, then, let’s take a look at the bladder. As usual, we’ll start at the beginning with a definition. Many thanks to the ever reliable MedicineNet at http://www.medicinenet.com/script/main/art.asp?articlekey=2472 for the following:

A hollow organ in the lower abdomen that stores urine. The kidneys filter waste from the blood and produce urine, which enters the bladder through two tubes, called ureters. Urine leaves the bladder through another tube, the urethra. In women, the urethra is a short tube that opens just in front of the vagina. In men, it is longer, passing through the prostate gland and then the penis. Also known as urinary bladder and vesical.

Notice the mention of the kidneys. Notice also the urine flows from the kidneys to the bladder, not vice versa.  Doesn’t help much to explain the dream.  I wonder if a bladder infection might explain more.

Another standby, WebMD, at http://www.webmd.com/a-to-z-guides/understanding-bladder-infections-basic-information explains:

Bladder infections are known as cystitis or inflammation of the bladder. They are common in women, but very rare in men. More than half of all women get at least one bladder infection at some time in their lives. However, a man’s chance of getting cystitis increases as he ages, due to in part to an increase in prostate size….

Bladder infections are not serious if treated right away. But they tend to come back in some people. Rarely, this can lead to kidney infections, which are more serious and may result in permanent kidney damage. So it’s very important to treat the underlying causes of a bladder infection and to take preventive steps to keep them from coming back.kidney location

Oh, so repeated bladder infections can lead to kidney infections, although rarely.  Maybe we’d better take a look at the symptoms of bladder infections… just in case, you understand.

This was the point in my research that I once again appreciated how user friendly, yet detailed, the Mayo Clinic is. The following information may be found at http://www.mayoclinic.org/diseases-conditions/urinary-tract-infection/basics/symptoms/con-20037892

Part of urinary tract affected      Signs and symptoms

Kidneys (acute pyelonephritis)   Upper back and side (flank) painurinary-tract-infection-uti-picture

High fever

Shaking and chills

Nausea

Vomiting

Bladder (cystitis)                            Pelvic pressure

Lower abdomen discomfort

Frequent, painful urination

Blood in urine

Urethra (urethritis)                        Burning with urination

Let’s change direction here and take a look at pyelonephritis since that involves the kidneys.

at http://www.niddk.nih.gov/health-information/health-topics/kidney-disease/pyelonephritis-kidney-infection/Pages/index.aspx has this information.

Pyelonephritis is caused by a bacterium or virus infecting the kidneys. Though many bacteria and viruses can cause pyelonephritis, the bacterium Escherichia coli is often the cause. Bacteria and viruses can move to the kidneys from the bladder or can be carried through the bloodstream from other parts of the body. A UTI in the bladder that does not move to the kidneys is called cystitis.

However, the site carefully explains that a bladder infection or a structural abnormality that causes urine to flow back into the kidneys are the two most usual causes.  So we’re back to looking at bladder infections after this little detour.

Location of KidneysFor information about what might cause a bladder infection, I shot over to Healthline at http://www.healthline.com/health/bladder-infection#Overview1

Bladder infections are caused by germs or bacteria that enter through the urethra and travel into the bladder. Normally, the body is able to remove the bacteria by clearing it out during urination. Sometimes, however, the bacteria attach to the walls of the bladder and multiply quickly, overwhelming the body’s ability to destroy them, resulting in a bladder infection.

Simple, direct, and to the point. Here we are knowing what a bladder infection is, what the symptoms are, and how we might have developed one.  But, what do we do about it?

UTI OTC testFirst of all, verify that you have UTI or urinary tract infection since the kidneys, the urethra, and the bladder are part of this system. OTC or over the counter test strips for this purpose are available, although I seem to remember they are not effective if you’ve passed menopause.  That was seven years ago when I had my first and last bladder infection, so things may have changed.  You can also make an appointment with your doctor to verify. Usually, a high white blood cell count will indicate you’re fighting some sort of infection.

All right, let’s say you home test and see you’re fighting an infection. Now what? Well, you can try the usual home remedies of cranberry juice and uber hydration, but you have CKD.  You have to act fast before a UTI becomes a bladder infection which may lead to a kidney infection.

My advice?  Call your doctor.  He or she may prescribe an antibiotic which will hopefully clear up the infection in just a few days.  A bladder infection does not have to lead to a kidney infection or be serious… unless you ignore it.

I have spent every day of the last eight years working diligently to protect my kidneys, slow down the progress of Chronic Kidney Disease, and raise GFRmy GFR when I can.  I, for one, am not willing to jeopardize my kidney function because I didn’t jump on what I thought might be a UTI.  Won’t you join me in taking immediate action should you have the symptoms?  Remember the connections between the urethra, the bladder, and the kidneys.

Until next week,

Keep living your life!

What If You Don’t Go?

NYCWe just got back from New York, which included stays in three different places. Only one- my buddy’s pied `a terre in Bay Ridge had a private bath… one bathroom for the two of us.  In my niece’s house on Long Island, we shared two bathrooms with two other adults and four children.  In Manhattan, we shared two baths with twenty other tourists. This didn’t exactly make for instant bathroom use when you needed it.

To add insult to injury, I’ve grown very accustomed to Arizona’s immaculate public bathrooms with automatic faucets, flushes, soap dispensers, and towels. Let’s just say New York has quite a bit of room for improvement in this area. The end result was that I didn’t use the facilities as often as I needed to.

And I started wondering… what’s happens to the urine you don’t void?

toliet First things first: according to National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC), A service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)National Institutes of Health (NIH)  at http://kidney.niddk.nih.gov/kudiseases/pubs/yoururinary/#points,

“The amount of urine a person produces depends on many factors, such as the amounts of liquid and food a person consumes and the amount of fluid lost through sweat and breathing.”

It was New York; it was not only hot, it was humid.  I was drinking my allotted 64 ounces of liquid daily. I was breathing – as usual – and I was sweating (perspiring?) quite a bit. Of course, I was eating, too.

In What Is It And How Did I Get It? Early Stage Kidney Disease, I explained that Book signing

“Ingested food and liquid are digested in the stomach and bowels, and then absorbed in the blood.  A renal artery carries the blood waste and water to the kidneys while a renal vein carries the filtered and sieved waste from the kidneys…..Additional important jobs of the kidneys are removing liquid waste from your body and balancing the minerals in the body. The two liquid waste products are urea which has been broken down from protein by the digestive system and creatinine which is a byproduct of muscle activity.

The problem with unregulated minerals, such as sodium and potassium is that these minerals are needed to remain healthy but too much in the bloodstream becomes toxic. The kidneys remove these toxins and change them into urine that enters the bladder via the ureter.  Look at the picture of a front view of your internal organs …. [You can see]  the kidneys, then the ureter above the bladder.  Below the bladder is the urethra, the passage to the outside of your body. This is, of course, a highly simplified explanation.  The toxins would build up and poison you if the kidneys were damaged.”

This is right at the beginning of the book on pages 2 and 3.

Now that we know how it works, we can go back to my original question: What if you don’t urinate when your bladder is full?urinary

Well, maybe we should explore the bladder a bit more. WebMD at http://www.webmd.com/urinary-incontinence-oab/picture-of-the-bladder tells us the following about the bladder:

“The bladder stores urine, allowing urination to be infrequent and voluntary. The bladder is lined by layers of muscle tissue that stretch to accommodate urine. The normal capacity of the bladder is 400 to 600 mL. During urination, the bladder muscles contract, and two sphincters (valves) open to allow urine to flow out. Urine exits the bladder into the urethra, which carries urine out of the body.”

So, there I was with a full bladder and my body telling me to empty it, but I didn’t.  What happened to the urine?

bladderIt’s time to mention that the ureters don’t have any way to stop the urine flowing back into the kidneys if you don’t void.  There are two sphincters at the bottom of your bladder leading into the urethra, but you can only voluntarily control one of them.

Interesting fact: the urethra is longer in men because it passes through the penis.  Sorry fact: because our urethras are shorter, we women are more prone to urinary tract infections.

Uh-oh, urine was moving back into my poor, already compromised kidneys. This urine flow back could further damage the capillaries and tubules making them even less effective at filtering my blood. The kidney’s pelvis and calyces – their central collection region – might become dilated, causing hydronephrosis.  Or I might end up with a kidney infection from the bacteria forced back in.  This is called pyelonephritis.

Hang on there.  I’m going to use the medical dictionary at http://www.merriam-webster.com/medical  for some definitions here.

CALYX (plural ca·lyx·es or ca·ly·ces  also ca·li·ces): a cuplike division of the renal pelvis surrounding one or more renal papillae

CAPILLARY a: resembling a hair especially in slender elongated form   b: having a very small borekidney interior

HYDRONEPHROSIS: cystic distension of the kidney caused by the accumulation of urine in the renal pelvis as a result of obstruction to outflow and accompanied by atrophy of the kidney structure and cyst formation

RENAL PAPILLA: the apex of a renal pyramid which projects into the lumen of a calyx of the kidney and through which collecting tubules discharge urine

RENAL PELVIS: a funnel-shaped structure in each kidney that is formed at one end by the expanded upper portion of the ureter lying in the renal sinus and at the other end by the union of the calyxes of the kidney  

TUBULE: a small tube; especially: a slender elongated anatomical channel

But, wait before you get all excited about the damage I’ve done to myself – or worse, yourself. You should know it would take a tremendous amount of flow back before any of this happens.  Be aware of your urge to urinate, follow through if you can, and don’t worry if you can’t every once in a while (But remember that I’m not a doctor.) And I wonder why I’ve felt the urge to urinate the whole time I’ve been writing today’s blog.

Many thanks to the oddly informative website http://www.straightdope.com/ for pointing me in the right direction for answers to my question. kidney-book-coverI have a question for all of you:  I am thinking of turning the previous blogs into a book; is that something you’d be interested in?

Until next week,

Keep living your life!