Getting Ready  

As I mentioned last week, I am lucky enough to be cancer free now and have returned to my other specialists. But we are experiencing the Covid-19 pandemic which means most of my doctors are conducting telemedicine appointments.

What are those? Let’s go to my favorite dictionary, The Merriam-Webster Dictionary, and see what we can see. I found this at https://www.merriam-webster.com/dictionary/telemedicine:

“the practice of medicine when the doctor and patient are widely separated using two-way voice and visual communication (as by satellite or computer)”

Surprisingly, I also discovered this has been in use since 1968. Maybe that’s why the phone and/or iPad type devices weren’t mentioned in the definition.

Of course, if you need to be examined physically, you’ll have to go to the doctor’s office. For example, poor Bear needed several mole biopsies last week. Obviously, he had to present himself at his dermatologist’s office to have these procedures carried out.

But I’ve been fortunate to be able to stick with telemedicine. Yet, you’ve got to be prepared for such doctor appointments. Do you have a thermometer? You’ll be asked for your temperature. We use both the DTT (digital temple thermometer) and Target’s talking thermometer (for those days when neither of us can find our glasses… really.) It seems the DTT we use is no longer manufactured, but the updated one is only about $15.00. The talking ear digital thermometer is more expensive. That one runs about double the price of the DTT. I did discover that digital mouth thermometers can be as low as $8.00. Non-digital oral thermometers start at about $6.00 You can compare prices online for the best deal. However, we are apparently old fashioned. The newest form of temperature assessment is the no contact digital scan thermometer. This one starts at about $50.

So, you have your temperature reading ready. What else will you need? I’ve always been asked for my blood pressure and pulse. I use an arm, rather than a wrist, device since my family doctor explained to me that the wrist device takes a reading through two bones. Those are the radius and ulna. The arm device takes your reading through only one bone, the humerus. She feels a reading through only one bone is more accurate. What device do I use? No matter which ones I’ve experimented with, I always return to Omron. It’s easy to use and accurate. These run from about $33 to over $100, depending upon how fancy you want to go. This description is from Amazon’s mid-price Omron:

Platinum (new version)

  • Trusted brand – Omron is the #1 recommended home blood pressure monitor brand by doctors and pharmacists for clinically-accurate home monitoring, and the #1 selling manufacturer of home blood pressure monitors for over 40 years.
  • Unlimited memory and users with the free app – The Omron gold wrist monitor stores 200 total blood pressure readings for 2 users (100 per user, most of any Omron wrist blood pressure monitor). Memory and users are unlimited with the Omron connect free app which works with amazon alexa-enabled devices (on select IOS & android devices).
  • High morning average indicator – Among Omron Amazon-exclusive blood pressure monitors, this feature is unique to the Gold and Platinum monitors. The indicator alerts the user if systolic or diastolic measurements are out of normal range in the morning, when there is a higher risk for heart attack or stroke.
  • Dual display with backlight – The Omron Platinum monitor features a backlit dual-display LCD monitor with easy navigation that allows the user to immediately compare the current reading to the previous reading. The backlight feature is only available with the Platinum Monitor.
  • AC adapter included – The Omron Ac Adapter eliminates the worry of changing batteries in your Omron Blood Pressure Monitor. The convenient AC adapter helps make sure your monitor is ready whenever you are.”

What else now? Let me think for a minute. Of course, if you are prediabetic or diabetic, you’ll be asked for your latest blood sugar readings. Believe it or not, I prefer WalMart’s no nonsense, no frills ReliOn Prime blood glucose monitor. In case you didn’t know, WalMart also operates as Sam’s Club. For my non-U.S.A. readers, according to https://en.wikipedia.org/wiki/Walmart, Walmart International operates in these countries:

Let’s keep in mind that anyone can edit in Wikipedia, so be certain to check before you bank upon going.

My family doctor did prescribe another brand which is a bit fancier in that it has a nicer looking case, lancet ejector, and meter. It was also more expensive and a prescription was needed.

If this is all new to you, you need to know you not only need this kit (which contains the monitor, a lancing device for your lancets, and spaces to store both your test strips and needles), but also the afore mentioned test strips and lancing device. You can buy 100 ultra-thin lancets for under $3.00. I suggest ultra-thin because I’ve found the thinner the lancet, the less the poke to get that one drop of blood needed for testing hurts.

The test strips are another story. These are expensive. They usually cost a little less than $18.00 for 100. And the lancing device? That’s about $6.00. The monitor itself is $9.00. The case comes with your starter kit. I haven’t found one sold separately by Walmart, although Amazon has a few for other brands. The number of times you need to test your blood glucose daily determines the weekly cost of your supplies.

You’ll also be asked for your height and weight. I have to admit I’m partial to digital devices and so have a digital scale from Amazon. Their scales run from $18.00 to $35.00. Of course, non-digital will be less expensive.

As for the height, I guess I cheated. I looked up the most recent height recorded on my last doctor’s appointment and used that.

Conclusion: You’ll need your temperature, blood pressure, height, weight, – if you’re prediabetic or diabetic – your blood glucose, and a phone, iPad sort of device, or computer for your telemedicine appointment.  Now you’re ready.

May you only have good results.

Until next week,

Keep living your life!

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!

Sticking It to Myself

First of all, thanks for your patience in the blog host debacle.  Just goes to show you don’t miss your water until the well runs dry.  Translated that means I love WordPress as the blog host and will not be making any changes from here EVER!  Further translated that means the name of the blog will always be SlowItDownCKD and we’ll always be at https://gailraegarwood.wordpress.com. I do believe I’ve just apologized.  I seem to be doing that a lot this week.

National Kidney MonthHappy third week of National Kidney Month. Seems so odd to place ‘Happy’ and ‘National Kidney Month’ in the same sentence.  Yet, it makes sense. How can we spread awareness of Chronic Kidney Disease if we don’t have a national effort? Hmmm, that sort of makes it happy.

Okay, down to brass tacks (or sharp jabs) now. During the first week of National Kidney Month, my PCP decided it was time to deal with my consistently high A1C test results.  Good timing on her part, huh?

Let’s go back just a bit to remind everyone what the A1C test is for. On page 54 of What Is It and How Did I Get It? Early Stage Chronic Kidney Disease, I wrote the following.

Somewhere along the line, one of your doctors may order an A1C test.  This measures how well your blood sugar has been regulated for the two or three months before the test.  That’s possible because the glucose adheres to the red blood cells.  This is important since quite a few CKD patients develop the disease from diabetes.Book Cover

Ah, so she’s trying to help prevent me from developing diabetes. That is the number one cause of CKD.  But I already have CKD.  Let’s see why it’s important for those with CKD to avoid diabetes, too.

I went directly to The National Kidney Foundation at https://www.kidney.org/atoz/content/diabetes for information.

With diabetes, the small blood vessels in the body are injured. When the blood vessels in the kidneys are injured, your kidneys cannot clean your blood properly. Your body will retain more water and salt than it should, which can result in weight gain and ankle swelling. You may have protein in your urine. Also, waste materials will build up in your blood.

bladderDiabetes also may cause damage to nerves in your body. This can cause difficulty in emptying your bladder. The pressure resulting from your full bladder can back up and injure the kidneys. Also, if urine remains in your bladder for a long time, you can develop an infection from the rapid growth of bacteria in urine that has a high sugar level.

Oh no!  I already have kidney damage. Now I could be exacerbating it. Wait a minute.  How is this happening?  I exercise, watch my renal diet, try to avoid stress, and get enough sleep.  Am I doing something wrong?

In type 2 diabetes, your body does not use insulin properly. This is called insulin resistance. At first, the pancreas makes extra insulin to make up for it. But, over time your pancreas isn’t able to keep up and can’t make enough insulin to keep your blood glucose levels normal. Type 2 is treated it with lifestyle changes, oral medications (pills), and insulin.pancreas

This is from the American Diabetes Association at http://www.diabetes.org/diabetes-basics/type-2/facts-about-type-2.html  A little clarification here: type 1 is the one in which people don’t produce insulin and type 2 is when the body is insulin resistant.

Wow. Just wow.  What’s tickling my mind now is the latest information I’ve read about statins possibly resulting in type 2 diabetes by affecting insulin resistance in a negative way.  Don’t get excited just yet.  Nothing’s been verified and I’m not even sure I understand the research.

All right, jabs next.  Since this is all new to me, I was told to check my blood sugar daily.  I looked dumbly at my PCP.  She caught the look and explained I could get my supplies at the pharmacy and sent over a script.  After four days of running around after my insurance, it was determined Medicare would not pay for the supplies since I didn’t actually have diabetes.  If Medicare doesn’t cover it, my secondary insurance doesn’t. So, I paid out of pocket.diabetes equipment

Off I went to the pharmacy, where the pharmacist explained what I would need. I looked dumbly at my pharmacist.  He caught the look and offered to get the supplies for me.  I’m sure he meant well, but he gave me the pharmacy brand meter which means I can only use their test strips.  It’s sort of a forced income for them.  He also gave me lancets (I used to think that was just the name of an English medical journal. Silly me.), but they weren’t ultra-thin and they hurt.  What he didn’t give me was the lancet device.  I didn’t know that existed until the diabetes counselor provided by my PCP told me about it.

I suspect I over checked because my fingertips are black and blue.  However 2 hours after eating is the norm.  I just took a break and monitored my blood glucose. It’s 121.  While that’s low for me, normal is in the 70-110 range, so even though I took 500 mg. of Metformin this morning, I’m going to have to exercise when I’m done (Doesn’t scare me; I have to exercise for the CKD anyway.) to lower that number.

I can see I’ll be blogging about this again. There is so much to cover here!Part 2

Digital Cover Part 1I keep forgetting to ask.  Would those who you who have read The Book of Blogs: Moderate Stage Chronic Kidney Disease, Part 1 and/or The Book of Blogs: Moderate Stage Chronic Kidney Disease, Part 2 please write a review on Amazon.com. I am interested to hear what you think of these books.

Did you know you can register for the Phoenix Kidney Walk all the way up until that morning, April 19th?  If you’re going to register, why not join Team SlowItDownCKD?  Here’s a link to make that easy: kidneywalk.kintera.org.

Until next week,

Keep living your life.