They’re Not Two Separate Things

I know someone who is mentally ill.  You do, too, although you may not be aware of it. PTSD, bipolar, personality disorder, poor impulse control, schizophrenia, braindepression, anxiety disorders, obsessive-compulsion, even eating disorders. I could go on and on with diagnoses we know nothing about when we meet the person. (Well, maybe we would with an eating disorder.) And why should we?

With medication, this person can function in the world… and function well. For those of you who are successfully treating your psychiatric illness holistically, whatever it is you are taking or doing that works for you will be included in the category of medication for the purposes of this blog.

But what if the person is not taking the medication necessary? What if they’re not and they have CKD? What if they are and have CKD? How does that affect their kidneys?

I came across a 2002 grant proposal on the National Institutes of Health site at http://grants.nih.gov/grants/guide/rfa-files/RFA-DK-02-009.html which made clear that there is a correlation.

“There is substantial evidence that severe chronic illness may be associated with and exacerbated by co-existent mental disorders such as depression, anxiety NIHdisorders, schizophrenia, and eating disorders.  Nonetheless, few studies have addressed the natural history and consequences of co-existent mental disorders on chronic diseases of interest to the NIDDK, such as diabetes mellitus, chronic renal disease and obesity and eating disorders.”

The person I know has two parents with CKD. That means he has to be extra vigilant about preventing CKD. But can he with the impulsive, irrational thinking he occasionally experiences?

One of the many complications of Chronic Kidney Disease according to The Mayo Clinic at http://www.mayoclinic.org/diseases-conditions/kidney-disease/basics/complications/con-20026778 is

“Damage to your central nervous system, which can cause difficulty concentrating, personality changes or seizures”

Difficulty concentrating.  Personality changes. Just as in mental illness.

Let me talk about that term a bit. By mental illness, I mean a psychiatric condition rather than a physical one, but one that requires daily treatment, just as diabetes or CKD does. You watch your diet, don’t you? And try to stay away from stress? There’s another kind of daily attention psychiatric patients need to adhere to.

And here’s where it gets muddled. Just as CKD, a physical condition, can cause mental problems, a psychiatric condition can cause physical conditions.  The two are wrapped up in each other. You can’t divorce the physical from the mental or vice-versa. You are one person with all these interrelated parts.

Mental illness is far more prevalent than you think… and that’s with its being ‘out of the closet,’ so to speak, in recent years. The Centers for Disease Control’s Fact Sheet about mental health surveillance at http://www.cdc.gov/mentalhealthsurveillance/fact_sheet.html  contains the following statement.CDC

“According to the World Health Organization, mental illness results in more disability in developed countries than any other group of illnesses, including cancer and heart disease. Other published studies report that about 25% of all U.S. adults have a mental illness and that nearly 50% of U.S. adults will develop at least one mental illness during their lifetime.”

Let me make it worse.  This was in 2002, 13 years ago.

In 2012, the CDC had this to say about mental illness and chronic disease:

“One common finding is that people who suffer from a chronic disease are more likely to also suffer from depression. Scientists have yet to determine if having a chronic disease increases the prevalence of depression or depression increases the risk of obtaining a chronic disease.”

This is from a study about chronic disease and mental health in the workplace. You can read more about that at http://www.cdc.gov/nationalhealthyworksite/docs/Issue-Brief-No-2-Mental-Health-and-Chronic-Disease.pdf

I know little about medications for mental illness except for those prescribed for my friend.  As an example of how drugs for psychiatric conditions may or may not interact with your physical ailments, let’s talk a bit about his drugs.

zyprexaWhen my bipolar friend has a manic episode, an anti-psychotic – Zyprexa (generic name Olanzapine) – is prescribed. WebMD at http://www.webmd.com/drugs/2/drug-1699/zyprexa-oral/details# tells us

“This medication can help to decrease hallucinations and help you to think more clearly and positively about yourself, feel less agitated, and take a more active part in everyday life.”

Okay, sometimes my friend needs that, but there are also things he doesn’t need.

glucose“This drug may infrequently make your blood sugar level rise, which can cause or worsen diabetes. Tell your doctor immediately if you develop symptoms of high blood sugar, such as increased thirst and urination. If you already have diabetes, be sure to check your blood sugars regularly. Your doctor may need to adjust your diabetes medication, exercise program, or diet.

This drug may also cause significant weight gain and a rise in your blood cholesterol (or triglyceride) levels…. These effects, along with diabetes, may increase your risk for developing heart disease. “

Not so great for someone that has two parents with CKD, one with CKD caused by diabetes. As for the cholesterol or triglyceride levels,  we could be getting pretty close to heart disease here, as mentioned above. Nothing about the kidneys, yet diabetes is the leading cause of CKD.

What else was he recently prescribed? Oh, yes, lithium.  He’s been taking that off and on since he was 14 and first diagnosed with bipolar disorder. Drugs.com at http://www.drugs.com/sfx/lithium-side-effects.html made me weep – not that this was going to help anything. I keep reminding myself that this is not usual when taking the drug, but my mind keeps placing the image of his two CKD parents before me.

“Moderate reversible increases in blood urea nitrogen and serum creatinine as well as proteinuria have been observed in patients with lithium toxicity. Rarely the decreases in glomerular filtration have been persistent. A variety of renal effects have been reported and include glomerular sclerosis, interstitial fibrosis, chronic interstitial nephritis, nephrotic syndrome, renal tubular acidosis and tubular atrophy.”Glomerulus-Nephron 300 dpi jpg

Sometimes you need to take a risk to save your life. I’m sure that’s what my friend’s doctors are doing here. I’ve known him all his life. I hope they’re doing the right thing.

On a more positive note, Amazon tells me all three books are now available in the Japanese market as well as being available in Europe and other areas.  Nothing like getting the word about CKD Awareness out to the entire world.IMG_1398What is it

Today is Labor Day. Thank you to all those union organizers that were jailed repeatedly- like Benjamin Binenbaum, my maternal grandfather – for the advantages they won for us.

Until next week,

Keep living your life!labor day

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It Is Not All In Your Mind; It’s In Your Organs, Too.

It’s National Kidney Month and National Kidney Day on March 13th is coming up fast, so – naturally – the Southwest Nephrology Conference was this past weekend.  It was the usual   Az. Kid Walk pleasure to see Dr. James Ivie, Director of Patient Services at The National Kidney Foundation of Arizona.  The man is wonderfully generous and will be distributing business cards for the book and blog at the Arizona Kidney Walk on April 7th at Chase Field as he allowed Dr. Jamal Atalla from Arizona Kidney Disease and Hypertension Center (AKDHC) to do at the last KEEP (Kidney Early Evaluation Program) event here.

I am up to my elbows in wedding preparations and had to push to make the time to attend the conference and, other than the non-renal diet food (geared to nephrology related practitioners, not patients), I was glad I did.

So much of the material was right up my alley, even though I’m what’s called ‘Allied Health’ rather than medical practitioner. True, I couldn’t quite understand the very technical medical issues, but what I did understand is worth sharing here.

There’s so much to share that I wasn’t sure what to concentrate on this week… until I spoke with Nima. We went from discussing my great-niece’s first birthday party to Nima’s god-mother’s youngest granddaughter’s Bat Mitzvah to lithium. That part of that family has a number of male members who have taken lithium for extended periods for bipolar disorder years ago.

According to Wikipedia, “Trace amounts of lithium are present in all organisms. The element serves no apparent vital biological function, since animals and plants survive in good health without it. Nonvital functions have not been ruled out. The lithium ion Li+ administered as any of several lithium salts has proved to be useful as a mood-stabilizing drug in the treatment of bipolar disorder, due to neurological effects of the ion in the human body.” The operant word in this definition is SALTS.  You can read more about lithium at:   http://en.wikipedia.org/wiki/Lithium.

There were two Plenary Sessions.  It was at the second one, “Psychiatric issues in kidney patients” presented by Dr. Christian Cornelius from Phoenix’s own Banner Good Samaritan Medical Center (where two of Cheryl’s grandchildren were born and also where she was diagnosed with the colorectal cancer that ended her life) that I suddenly sprang into attention again.

Hey, it had been a long morning and lunch was coming up soon.  I hadn’t been able to eat the mid-morning snack of cookies, soda, or coffee. I was tired from getting up at 5:30 to get to the conference down in Chandler in time. Tired and hungry – not the greatest combination.

cookiesWhat was this man saying?  Something about lithium doubling the risk for Chronic Kidney Disease?  And I was off… how many psychiatric patients knew that fact?  How many of their caretakers knew that just in case the patient was not responsible at the time of treatment?  What about children?  Did their parents know?  Was a screening for CKD performed BEFORE lithium was prescribed?

26 million Americans have kidney disease that is not yet diagnosed.  What if one of these psychiatric patients belongs to that group?  What if they all do?  Currently, kidney disease is the ninth leading cause of death in the United States.  Ninth!!!  Are these undiagnosed psychiatric patients moving it to the eighth?  And what about the 73 million at risk for kidney disease due to high blood pressure, diabetes, or family history?  Are they being given lithium without screening?  (You can read more facts about kidney disease at: http://www.kidney.org/news/newsroom/factsheets/FastFacts.cfm.)

I decided to dig deeper, as I often do.  Again and again on different sites about side effects of different psychiatric drugs, I found warnings that patients need to have a complete medical exam before starting the drug and then periodical exams to check whether or not the patient has developed some damage from taking the drug.  Here’s my question: do these exams include kidney screening?lithum

First I looked at my Twitter feed and found this at: http://www.winnipegfreepress.com/local/screening-for-kidney-disease-on-first-nations-193767521.html

“The $1.6-million federally funded project — First Nations Community Based Screening to Improve Kidney Health and Dialysis — will launch in March.

The project, co-led by Manitoba First Nations’ Diabetes Integration Project and Manitoba Health’s Manitoba Renal Program, provides early detection and treatment to several First Nations communities.

Detection of the disease in people as young as eight can take less than 15 minutes.”

The article deals with a KEEP type program for some Canadian First Nations and is included here to demonstrate the growing awareness of the need to screen for kidney disease, not to infer that First Nations have psychiatric disorders.

Other than that article, there is nothing about screening for kidney disease.  If medical practitioners aren’t aware of the prevalence of CKD – and, obviously, I am not referring to the entire medical professions – how can psychiatric practitioners be expected to know to do this?

I am not a psychiatric patient, not even for minor psychiatric issues, so I don’t know what the screening process is first hand.  However, I do know people who have confided in me (no names for privacy’s sake) that they are taking drugs for some psychiatric condition.  Big mouth here always asks what effect that drug might have on their kidneys… or liver for that matter since such drugs may hit the liver negatively.

That is not enough.  We need a lot more big mouths to ask the right question about drugs: How will this affect my kidneys?

I’m asking for one, no two, wedding presents from each and every one of you.

  1. Have yourself tested for kidney disease
  2.  Before you take any drug for any reason, ask how it will affect your kidneys.

Wow!  You have it in your power to make me a happy bride.  Please do it for your sake and mine.  wedding dress

Until next week,

Keep living your life!

Why The Book?

Some of you are already aware of the severe, non-renal, medical emergencies which have occurred in my family during the last two weeks.  For those of you who aren’t, one of the emergencies deals with diabetes-hypertension-possible cancer-mental health.  The other is purely mental health. Before I got the chance to try to calm my loved ones a little by reminding each of them that everything happens for a reason, whether or not we know the reason, they reminded me. And, as usual, that got me to thinking….

I have been asked repeatedly why I wrote What Is It And How Did I Get It? Early Stage Chronic. Kidney Disease. You’d expect that question on the radio health shows I guested on and it was there.  You’d also expect that question at the renal symposium, book signings and book talks I was involved with and, yes, it was there too. But when I most often hear the question is when I’m just chatting with friends, theirs friends, someone’s family – you know, ordinary, everyday people like you or me.

I’ve carefully explained each time I’m asked. Then I happened upon an article at DaVita that said the same thing with more authority than I could ever muster. I know we usually think of DaVita in association with End Stage Renal Disease, but they have a wonderfully comforting educational unit to their website as well. It’s Your Kidneys.com. I kept running into this article whenever I was researching. Since I do believe everything happens for a reason, whether or not we know the reason, I figured that I was meant to share it with you via the blog.

These are the parts of the article that hit home for me as far as why I wrote the book.

“It can be overwhelming to discover you have chronic kidney disease. Sometimes the amount of new information seems mind-boggling, but it’s important for you to remain calm. You may feel like you’re losing control, but in fact, you are the key to maintaining your health. You, above any doctor, nurse or dietitian, are the head of your kidney disease health care team. {Me: The book was written from my feeling overwhelmed and not wanting any other CKD patient to feel that way.}

The one person who has been an intimate part of your health care since day one is you. You know how you feel when you get the flu, you know how your body responds to medicine, you know if you’re allergic to something, and you’ve known yourself your whole life. Now that you are dealing with kidney disease, your job has become even more important. {Me again: To abdicate that job because you are overwhelmed is to give up control over your own life as I see it. You are wise as the owl, you know, especially when it comes to your own body.}

……….

If you feel confident being your own kidney disease health care advocate, be sure to cover all your questions and concerns by making a checklist. The best way to tackle issues is to keep a pad of paper handy and when you think of things you want to discuss with your doctor, jot them down. On your next doctor’s visit take out your pad and cross each item off after you address it. Your medical team will be impressed, and you will also get more out of your visit. {Me: Sorry for another interruption: I’m not at all sure it’s necessary to impress your medical team, but it is to get those answers. The book will help you formulate the questions.  That was my problem.  I wanted answers, but I didn’t know the questions to ask.}

If you have a pressing concern that won’t wait until your next doctor’s appointment, feel free to call your doctor, nurse practitioner or renal dietitian. You can also start researching your question on www.davita.com. DaVita offers a comprehensive and easy to use website that specializes in renal (kidney) education.

……….

It’s always a good idea to follow your kidney doctor’s advice. {Me: Last interruption, I promise – But ask WHY they’ve given you this advice and make sure you understand it rather than blindly doing as you’re told.  It’s quite an unfair burden on your doctor, too, when you do as you’re told without taking any responsibility.} They have gone to medical school, seen many patients and chosen a career to help people with kidney disease. While doctors are loaded with medical information, they are people first. Doctors may assume you understand everything when you don’t, they may not be aware of personal situations, and sometimes they don’t have all the answers. {Me: Bingo! There’s my reason in a nutshell – even though I promised no more interruptions.}

That’s why you need to be the head of your kidney disease health care team. The kidney doctors, nurses and renal dietitians are on your health care team, and you are a key player in that team. If something’s not right, you must consult your health care team to find a solution. If you’re unclear on anything regarding your treatment or kidney disease care, ask again. Your health is the priority of your team and when you succeed, so do they.”

It’s worth reading the entire article at: http://www.yourkidneys.com/kidney-education/Treatments/Heading-your-kidney-disease-health-care-team/2944. Take a look at the others they have to offer, too. Sure it’s scary to take responsibility for something you don’t understand, but you can do it and look at all the help you have.  Now that’s why I wrote the book.

I don’t exactly know why (Could it be the flier campaign headed by AKDHC’s Tamara Jansen? But how could that explain the England sales?), but sales are spiking as are the likes and comments on the Facebook page. Thank you all. If you want to order the book, but haven’t yet, here are the direct links to Amazon:  http://www.amazon.com/What-How-Did-Get-Chronic/dp/1457502143/ref=sr_1_1?ie=UTF8&qid=1321474094&sr=8-1  and     

Barnes and Noble: http://www.barnesandnoble.com/w/what-is-it-and-how-did-i-get-it-gail-rae/1103363592?ean=9781457502149&itm=1&usri=what2bis2bit2band2bhow2bdid2bi2bget2bit253f#CustomerReviews   where the book is available in both print and digital.  By the way, thank you for all the reviews I’ve discovered on both sites.

If you’d rather have a personalized, discounted (love that word) copy of the book, email me at: myckdexperience@gmail.com and that can be arranged.

Until next week,

Keep living your life!