The Lamp Post and the Kidneys

disabledThis past week, my car and I tangled with a lamp post. My car got the worst of it. Luckily, I was driving very slowly in a parking lot while looking for the Disabled Parking Spots. (Ironic, isn’t it?) All I got were bruises and stiffness. Or did I?

As usual when confronted with something I didn’t know about, I started wondering:  What happened to my kidneys safely buried in my body while my skin turned black and blue from the seat belt and my hand ended up with tendonitis from gripping the steering wheel so firmly?

Do you remember where the kidneys are? Here’s the drawing from the National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health which was included in What Is It and How Did I Get It? Early Stage Chronic Kidney Disease. You can see that they are internal organs, which means they are not directly under the skin, but protected by layers of fat and muscle (Hmmmm, I usually wish there were more muscle and less fat over them), and other organs.

Location of Kidneys

What is it

According to The University of Michigan Medical School’s Dissector Answers at http://www.med.umich.edu/lrc/coursepages/m1/anatomy2010/html/gastrointestinal_system/kidney_ans.html#a1:

“Besides their peritoneal covering, each is embedded in two layers of fat, with a membrane, the renal fascia, in between the layers. Inside the renal fascia is the perirenal fat, while outside the membrane is the pararenal fat. (The perirenal layer is inside, while the pararenal layer is around the renal fascia.)”

Great! All I needed to know now is what that meant.  We already know from the quote above that perirenal fat is inside the renal fascia, while pararenal fat is outside, but what’s the fascia?

The Medical Dictionary section of the Free Dictionary at http://medical-dictionary.thefreedictionary.com/fascia cleared that up right away:

renal-fascia“a sheet or band of fibrous tissue such as lies deep to the skin or invests muscles and various body organs.”

Wait a minute; what about peritoneal? I had this vague memory of hearing the word before, but not its definition. Just to mix it up a little bit, this time I turned to MedicineNet at http://www.medicinenet.com/script/main/art.asp?articlekey=4842, but for the root word peritoneum since the suffix ‘al’ just means relating to and will only confuse the issue. …

“The membrane that lines the abdominal cavity and covers most of the abdominal organs.”

I needed the information on AnatomyZone at http://www.anatomyzone.com/tutorials/location-and-relations-of-the-kidney/ to find out what lies in front of the kidneys.

“… the colon runs in front of the kidney. …. It runs in front of the lower part of the kidney, the inferior pole of the kidney. That’s the hepatic flexure….. the descending part of the duodenum sits in front of the medial part of the kidney.   The descending part of the duodenum is retroperitoneal as well and it sits right up against the kidney….on top of the kidney. This is the suprarenal gland or the adrenal gland.

…. the other side of the colon sits in front of the left kidney…. the stomach and the spleen sitting in front of it. … the end of the pancreas sitting in colonfront of it as well. “

This reads a bit choppy because it is describing an interactive visualization of the kidneys. If you want to find out more and have a little fun with the site, do click through on the site’s URL. I found this even more entertaining than my Concise Encyclopedia of the Human Body (London: Red Lemon Press, 2015) which I can pore over for hours just marveling at this body of ours.

It seems to me that I’ve ignored whatever is behind the kidneys so let’s find out what’s there. Oh, of course…

“The ribs and muscles of the back protect the kidneys from external damage. Adipose tissue known as perirenal fat surrounds the kidneys and acts as protective padding.” Many thanks to another interactive site, Inner Body at http://www.innerbody.com/image_urinov/dige05-new.html#full-description for this information.

By the way, adipose tissue – or perirenal fat – is an energy storing fat. While necessary, too much of this makes us appear fat and can compromise our health. This is the white, belly fat mentioned in conjunction with kidney disease in The Book of Blogs: Moderate Stage Chronic Kidney FullSizeRender (3)Disease, Part 2:

“Other studies have suggested that once diagnosed with kidney disease, weight loss may slow kidney disease progression, but this is the first research study to support losing belly fat and limiting phosphorus consumption as a possible way to prevent kidney disease from developing.  Dr. Joseph Vassalotti, chief medical officer at the National Kidney Foundation  11/3/13”

It seems I’ve developed a sort of pattern here. We’ve looked in front of the kidneys and behind them. What’s above them, I was beginning to wonder. Then I realized I already knew… and so do you if you’ve been reading my work: They lie below the diaphragm and the right is lower than the left because the liver is on the right side above the kidneys. The adrenal glands which were mentioned above are also on top of your kidneys. According to Reference.com, a new site for me at https://www.reference.com/science/function-adrenal-gland-72cba864e66d8278:

“Adrenal glands are triangular-shaped, measure approximately 1.5 inches high and 3 inches long and are composed of two parts, according to Johns Hopkins Medicine. The outer part is the adrenal cortex, which creates cortisol, aldosterone and androgen hormones. The second part is the adrenal medulla, which creates noradrenaline and adrenaline.adrenal

Cortisol is a hormone that controls metabolism and helps the body react to stress, according to Endocrineweb. It affects the immune system and lowers inflammatory responses in the body. Aldosterone helps regulate sodium and potassium levels, blood volume and blood pressure. Androgen hormones are steroid hormones that are converted to female or male hormones in other parts of the body.

Noradrenaline helps regulate blood pressure, increasing it during times of stress, notes Endocrineweb. Adrenaline is often associated with the adrenal glands, and it increases the heart rate and blood flow to the muscles and the brain.”

It looks like my kidneys and I had nothing to worry about.  They’re well protected from the impact of the accident.  *sigh* If only my car had been as well protected…

IMG_2980IMG_2982

Until next week,

Keep living your life!

 

 

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Statins: No Easy Decision Here

A reader asked me to write about this topic.  Like me, she is a woman in her middle sixties who takes statins.  Unlike me, she has had adverse side effects.  Who even remembered about these?

Of course, I read the information handout the pharmacy attaches to the bag containing your prescription.  Of course, I researched this drug on the internet when it was first prescribed for me. But that was years ago and, while I periodically re-read the pharmacy’s handout, the dangers of this drug never quite resonated with me.

Dangers?  With statins?  That’s most people’s reaction.statins

Let’s go back to the beginning with an explanation of what statins are and what they do. According to MedicineNet.com at http://www.medicinenet.com/statins/article.htm,

“’Statins’ is a class of drugs that lowers the level of cholesterol in the blood by reducing the production of cholesterol by the liver. (The other source of cholesterol in the blood is dietary cholesterol.) Statins block the enzyme in the liver that is responsible for making cholesterol.”

Makes sense.  But what’s cholesterol? Medical News Today at http://www.medicalnewstoday.com/articles/9152.php tells us,

“Cholesterol is a lipid (fat) which is produced by the liver. Cholesterol is vital for normal body function. Every cell in our body has cholesterol in its outer layer.”

Okay, so we need this particular lipid but sometimes – between the foods we eat and our body’s functioning – we produce too much of it. Then it may stick to our arteries as plaque, possibly narrowing or even blocking them.  This could lead to CAD or coronary artery disease (heart problems).

liverHere’s the important part for Chronic Kidney Disease sufferers: it’s the liver – the organ that produces cholesterol – that is affected by the statins. That’s the only other filtering system your body has and your kidneys are already compromised.  TWO compromised filtering systems seems like a really poor idea to me.  Yet, sometimes, we need to take statins.

I went to my favorite, The Mayo Clinic, at http://www.mayoclinic.com/health/statins/CL00010 for information about when you need to be on a statin:

“If you have high cholesterol, meaning your total cholesterol level is 240 milligrams per deciliter (mg/dL) (6.22 millimoles per liter, or mmol/L) or higher, or your low-density lipoprotein cholesterol (LDL, or “bad” cholesterol) level is 130 mg/dL (3.37 mmol/L) or higher, your doctor may recommend you begin to take a statin. But the numbers alone won’t tell you or your doctor the whole story.

If the only risk factor you have is high cholesterol, you may not need medication because your risk of heart attack and stroke could otherwise be low. High cholesterol is only one of a number of risk factors for heart attack and stroke. “

As CKD patients, we already have another risk factor.  If, like me, those numbers mystify you, you can find them on your quarterly blood test reports which will usually have an “H” to indicate high or “L” to indicate low (You won’t find that if you’re on statins.) next to the numbers for your total cholesterol and your low-density lipoprotein levels.

As for how hyperlipidemia (high cholesterol) can affect your body and why statins are prescribed, I took a look at a non-technical explanation at  http://heartdisease.about.com/cs/cholesterol/a/statins.htm:

“Clinical studies have shown that statins significantly reduce the risk of heart attack and death in patients with proven coronary artery disease (CAD), and can also reduce cardiac events in patients with high cholesterol levels who are at increased risk for heart disease. While best known as drugs that lower cholesterol, statins have several other beneficial effects that may also improve cardiac risk, and that may turn out to be even more important than their cholesterol-reducing properties.”

Well, that all sounds good so what’s the problem?  It’s the side effects, ladies and gentlemen.  It’s all the ‘may cause’ that you find on the websites and in your pharmacy handout information.confused

I went to a new site for me, http://statinseffects.org/, and was staggered by the side effects:

“The risk of liver & kidney damage, muscle damage, increased risk of cancer & other side effects of cholesterol lowering drugs are good reason why exercise & diet should be patient’s first resort for controlling cholesterol levels. For people who must take cholesterol lowering medications, the dose needs to be reduced to minimum by again exercise & diet. The main concern seems to be the overuse or underuse of the medication, despite of the evidence that high cholesterol level itself is not the most important factor of heart disease. It is, however, the ratio between total & HDL cholesterol levels.”

You KNOW what popped out at me: kidney damage.  We already have kidney damage.  Each of these side effects deserves a blog of its own.  But, it is important to remember that these are possible, not definite, side effects.

Am I endorsing statin use for hyperlipidemia? No, I’m not.  I’m not a doctor.  You need to discuss this with your doctor. Mine at the time of my diagnose with hyperlipidemia was amenable to my desire not to take the drugs for a while.

Dr. Susan Bennett, agreed to this in an attempt to demonstrate to me that I needed the medication.  This was about six years before I was diagnosed with CKD.  For three months – the acknowledged honeymoon period – my numbers were great.  And then they started to climb… and climb, despite the dietary changes and exercise.  I am just one of those unlucky ones with naturally high cholesterol. Try this for yourself if your doctor agrees, but keep your health foremost in your mind.exercising silhouette

Talking about that, SlowItDown held our first of ten monthly Chronic Kidney Disease education classes on The Salt River Pima – Maricopa Indian Community last Thursday. Talk about a gratifying experience!  In addition, the book is now being used by a spiritual healing and medical care group in the community.

Many thanks to Annette Folmer of DaVita for the ever higher quality of her teaching and to MaryAnn Bennett, the brand new Clinical Services Manager at Salt River Pima-Maricopa Indian Community. Our classroom was even more electronically modern than the ones I’ve taught in here in Arizona’s community colleges!

Until next week,

Keep living your life!Book Cover

It’s Not Just For Eating

There’s not that much to report on the book, since you already know that sales have been steady.  I’m so close to paying off the costs of printing the book that I can taste it.  Then I’d like to recoup what I paid for having it digitalized and for all the donations I’ve made. This is Book Coveralmost like a game to me because I know I’m just going to take any profits and transform them into books for donation anyway, but it keeps me sharp!

Updates on medical issues here.  I still have macular degeneration – as if it were just going to disappear – and started taking the only two supplements I can with Chronic Kidney Disease.  I’m talking (okay, writing) about the supplements in the comprehensive pill my ophthalmologist offers in an attempt to slow the eye disease down. I’d wanted to take full advantage of the entire 25% chance of slowing the disease that this pill offers, but my kidneys come first.

It turns out Bear CAN wait for the surgery since it’s kind of a last ditch effort to save mobility and he’s not there yet… thank goodness.  Now to find some good pain management for him.  Thank you to Alex Gilmore for showing up to stand for us at the neurosurgeon’s office.  He asked our questions in a form this doctor could understand.  It’s interesting that once Alex was there and we explained why, the doctor started couching his responses to the questions in language that WE could understand.

I’m eager to get into today’s topic: liver, or rather fatty liver disease.  I vaguely remember this showing up on an MRI some time ago and my primary care physician – the ever vigilant Dr. H. Zhao – telling me about it.  That’s when I was obsessed with weight since my nephrologist had just explained I would do better at slowing down the progress of the CKD if I lost weight.  My first response to Dr. Zhao? “That’s fat, too?”

liverOnce she stopped laughing, she explained that many people have fatty livers but you have to be careful about it before you end up with (in my case) NAFLD or Non-Alcoholic Fatty Liver Disease.  Why am I writing about it now?  Beats me, but I dreamed about it so I figured that was enough reason to explore it.

So, we know fat gets deposited in the liver and too much is no good.  The question is how much is too much?  According to WebMD at http://www.webmd.com/hepatitis/fatty-liver-disease,

“Some fat in the liver is normal.  But if fat makes up more than 5%-10% of the weight of your liver, you may have alcoholic or nonalcoholic liver disease.  In some cases, these diseases can lead to serious complications.”

Let’s backtrack a little to find out why the liver is important in the first place.  According to the Mayo Clinic at http://www.mayoclinic.org/liver-disease/?mc_id=comlinkpilot&placement=bottom, these are the functions of the liver:

“Breaking down harmful substances

Removing waste products from the blood

Storing nutrients and vitamins

Moderating chemical levels in the body”

Take a looks at the second function again.  Does it sound familiar?  Yep, that’s one of the functions of your kidneys, your not functioning at capacity kidneys.  You’re already having trouble because one of your organs can’t do its job adequately, you certainly don’t need an additional organ responsible for the same job to be compromised.  Ah, that must be why I’m writing about fatty liver disease on a Chronic Kidney Disease blog.Location of Kidneys

By the way, a liver specialist is called a hepatologist.   That comes from the same word root as hepatitis. Remember I’d urged you to make certain you took the series of hepatitis B inoculations since your kidneys are already comprised? And suggested you might want to be checked for any hepatitis C in your blood work?  Hepatitis is from the same Greek word root, hepa which means liver.  Just in case you’re interested, the University of Hawaii at Manoa has a fairly inclusive list of medical word roots at http://manoa.hawaii.edu/learning/PDFhandouts/StudySkills/Word%20Roots.pdf .  This is right up my alley!

Okay, maybe we need to know a little more about the liver.  It’s a large organ, in fact, the second largest in your body. You’ll find yours under your rib cage on the right side of your body.  My perverse sense of humor found it funny that the kidneys are shaped like – well – kidney beans while your liver is shaped sort of like a football that’s flat on one side. (Can you see the mental image I conjured up of the kidneys tossing the football back and forth?  Can’t really happen but it’s funny… if you’re me, that is.) Oh, yes, weight: three pounds.

Like CKD, NAFLD is mostly a silent disease; it has no symptoms.  When symptoms do occur, it seems to me that they would be hard to pin down as NAFLD since it’s not an array of these symptoms, but any of them. Then again, I’m not a doctor.

“fatigue, weakness, weight loss, loss of appetite, nausea, abdominal pain, spider-like blood vessels (Hey, I have those!), jaundice, itching, edema, ascites {swelling of the abdomen} and mental confusion.”

Thank you to the American Liver Foundation at http://www.liverfoundation.org/abouttheliver/info/nafld/. This is a nifty little fact sheet that is simple to understand.

Then I got to wondering about why this disease could be dangerous.  It’s the possible progression that makes it dangerous.  You’re told you have a fatty liver (AFLD is fatty liver disease caused by alcoholism), you don’t lose weight {if you’re overweight or obese}, lower your cholesterol and triglycerides, control your diabetes {if you have it} or avoid alcohol, and the disease worsens. NAFLD

Your liver swells.  This is called steatohepatitis.  That may cause cirrhosis (Quick!  Go to the University of Hawaii at Manoa’s medical word root site! Or just read on.) or scarring over a long period.  The cirrhosis could eventually cause liver cancer or failure.  The saddest part of all this is that some people develop NAFLD or AFLD for no reason at all.

The good part (There’s a good part?) is that a healthy diet and regular exercise – just like CKD, isn’t it? – may prevent scarring or even reverse it if the disease is caught early enough.  Since there usually aren’t any symptoms, fatty liver disease is most often uncovered by your blood tests.  A high level of liver enzymes could be the tip off.

I almost forgot to mention that Alcoholic Fatty Liver Disease has another name: NASH.  This stands for Nonalcoholic Steatohepatitis.  My parting gift to you today: steat is a word root meaning fat.

Until next week,

Keep living your life!