CKD and the VA or It’s Not Alphabet Soup at All

Today is Memorial Day in the United States. It is not a day to say Happy Memorial Day since it is a day commemorating those who gave their lives for our freedom. Lots of us have bar-b-ques or go to the park or the beach to celebrate. No problem there as long as we remember WHO we are celebrating. I promise: no political rant here, just plain appreciation of those who serve(d) us both living and dead. Personally, I am honoring my husband, my step son-in-law, and all those cousins who just never came home again.

I explained the origins of this day in SlowItDownCKD 2015 (May 25), so won’t re-explain it here. You can go to the blog and just scroll down to that month and year in the drop down menu on the right side of the page under Archives. I was surprised to read about the origins myself.

We already know that Chronic Kidney Disease will prevent you from serving your country in the military, although there are so many other ways to serve our country. This is from The Book of Blogs: Moderate Stage Chronic Kidney Disease, Part 2:

‘The Department of Defense’s Instruction for Medical Standards for Appointment, Enlistment, or Induction in the Military Services establishes medical standards, which, if not met, are grounds for rejection for military service. Other standards may be prescribed for a mobilization for a national emergency.

As of September 13, 2011, according to Change 1 of this Instruction, the following was included.

‘Current or history of acute (580) nephritis or chronic (582) Chronic Kidney Disease of any type.’

Until this date, Chronic Kidney Disease was not mentioned.”

You can read the entire list of The Department of Defense’s Instruction for Medical Standards for Appointment, Enlistment, or Induction in the Military Services at http://dtic.mil/whs/directives/corres/pdf/613003p.pdf. You’ll also find information there about metabolic syndrome, high blood pressure, high cholesterol, diabetes, and pre-diabetes as conditions for non-enlistment.

This got me to thinking. What if you were had already enlisted when you developed CKD. Yes, you would be discharged as medically unfit, but could you get help as a veteran?

According to the Veterans Administration at https://www.research.va.gov/topics/Kidney_disease.cfm#research4,

“In 2012, VA and the University of Michigan began the work of creating a national kidney disease registry to monitor kidney disease among Veterans. The registry will provide accurate and timely information about the burden and trends related to kidney disease among Veterans and identify Veterans at risk for kidney disease.

VA hopes the kidney disease registry will lead to improvements in access to care, such as kidney transplants. The department also expects the registry will allow VA clinicians to better monitor and prevent kidney disease, and will reduce costs related to kidney disease.”

That’s what was hoped for five years ago. Let’s see if it really came to fruition.

Oh, this is promising and taken directly from The U.S. Department of Veterans Affairs.

“VA eKidney Clinic

The VA eKidney Clinic is now available! The eKidney Clinic offers patient education through interactive virtual classrooms where Veterans can learn how to take care of their kidneys and live a good life with kidney disease. Please visit the VA eKidney Clinic website or click on the picture below. For additional information see the eKidney Clinic Patient Information Brochure.”

The Veterans Health Administration doesn’t just provide information, although I must say I was delighted to see the offer of Social Work Services. There is also treatment available. Notice dialysis mentioned in their mission statement.

Mission: The VHA Kidney Program’s mission is to improve the quality and consistency of healthcare services delivered to Veterans with kidney disease nationwide. The VHA Kidney Program provides kidney-related services to dialysis centers throughout VA’s medical centers. Professional guidance and services are available in the form of consultation and policies developed by VA kidney experts. These experts are dedicated to furthering the understanding of kidney disease, its impact on Veterans, and developing treatments to help patients manage disease symptoms. In addition, the VHA Kidney Program provides VA healthcare professionals with clinical care, education, research, and informatics resources to improve healthcare at local VA dialysis facilities.”

I did find it strange that there was a cravat on the Veterans Administration site that they do not necessarily endorse the VHA Kidney Program, especially since it is so helpful.

 

 

 

How involved is the VA with CKD patients? Take a look for yourself at this 2015 statistics by going to https://www.va.gov/HEALTH/services/renal/documents/Kidney_Disease_and_Dialysis_Services_Fact%20Sheet_April_2015.pdf

  • All Veterans enrolled in VA are eligible for services, regardless of service connection status
  • Enrolled Veterans can receive services from the VA or from community providers under the Non-VA Care Program if VA services are unavailable
  • 49 VA health care facilities offer kidney disease specialty care (nephrology services)
  • 96 VA facilities offer inpatient and/or outpatient dialysis; 25 centers are inpatient-only. Of the 71 VA outpatient dialysis centers, 64 are hospital based units, 2 are joint VA/DoD units, 4 are freestanding units, and one is within a community based outpatient clinic (CBOC)
  • VA enrollees must be offered the option of home dialysis provided either directly by the VA or through the Non-VA Care Program
  • 36 outpatient hemodialysis centers offer home dialysis care directly.
  • 5 VA medical centers host kidney transplantation programs.
  • VA Delivered Kidney Care (Calendar Year 2013) 13,794 Unique Veterans receiving dialysis paid for by VA; representing an annual increase of 13% since 2008. 794 Veterans received home dialysis; 55percent (434) by VA facilities and 45percent (360) under the Non-VA Care Program.
  • Increasing use of telehealth services to increase Veteran access to kidney specialty care Secure messaging: 7,319 messages, Clinical video telehealth: 4,977 encounters
  • VA Kidney Research (FY ’14) the research budget for the study of kidney disease has been $18.5 million per year for the past 5 years (FY ’10-FY ’14). The VA Cooperative Studies Program has supported national clinical trials addressing the best treatment of Veterans with CKD since at least 1998.

It seems to me our veterans are covered. Now if we could only make sure the rest of us stay covered no matter what bills the current administration signs into law.

Until next week,

Keep living your life!

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Bridging the Gap…

Which gap? The anion. What’s that, you say.

“The anion gap deals with the body’s acidity. A high reading for the anion gap could indicate renal failure.”

Book CoverThat’s what I wrote in What Is It and How Did I Get It? Early Stage Chronic Kidney Disease. But you know what? It’s just not enough information any more. Why? I’m glad you asked.  Oh, by the way, if you want to check your own reading look in the Comprehensive Metabolic Panel part of your blood tests, but only if your doctor requested it be tested.

I mentioned a few blogs back that I returned to a rheumatologist I hadn’t seen in years and she chose to treat me as a new patient. Considering how much had happened medically since I’d last seen her, that made sense to me and I agreed to blood tests, an MRI, and a bone density test.

The only reading that surprised me was an abnormally high one for anion gap. The acceptable range is 4 – 18. My reading was 19.  While I have Chronic Kidney Disease, my kidneys have not failed (Thank goodness and my hard work.) In addition, I’ve become quite aware of just how important acidity and alkaline states are and have been dealing with this, although apparently not effectively.

MedFriendly at http://www.medfriendly.com/anion-gap.html – a new site for me written by Dr. Dominic Carone for the express purpose of simplifying complex medical terms for the lay person – explains it this way:diabetes equipment

“…. Too high of an anion gap level can mean that there is acidosis (too much acid in the blood) due to diabetes mellitus. The high anion gap level can also be due to lactic acidosis, in which the high level of acid is due a buildup of a substance called lactic acid. … A high anion gap can also be due to drug poisoning or kidney failure. …When the anion gap is high, further tests are usually needed to diagnose the cause of the problem.”

Ah, I remember writing a bit about acidosis in The Book of Blogs: Moderate Stage Chronic Kidney Disease, Part 1. It had to do with DIGITAL_BOOK_THUMBNAILfruits and vegetables.

“’After three years, consuming fruits and vegetables or taking the oral medication reduced a marker of metabolic acidosis and preserved kidney function to similar extents. Our findings suggest that an apple a day keeps the nephrologist away,’ study author Dr. Nimrit Goraya, of Texas A&M College of Medicine, said in a university news release.

Apparently, some CKD suffers have metabolic systems that are severely acidic. Fruits and vegetables are highly alkaline.  This may counteract the acidity in the patients mentioned above AND those that have less metabolic acidosis (acid in the body).

You can find the complete article at http://kidneygroup.blogspot.com/2012/11/eating-fruits-and-vegetables-may-help.html

Okay, I like fruit and I like vegetables. Ummm, will my limitation of three servings of each within the kidney friendly fruit and vegetable lists do the trick, I wonder. Looks like I’ll be questioning both the rheumatologist and the renal dietician about that.

Recently I’ve written about alkaline being the preferred state of a CKD patient’s body. That is the antithesis of an acid body state. Years ago, Dr. Richard Synder was a guest blogger here and also interviewed me on his radio show. He is the author of What You Must Know about Kidney Disease and a huge proponent of alkaline water.  Here’s what he had to say about that (also from Part 1):

“I have taken alkaline water myself and I notice a difference in how I feel. Our bodies are sixty percent water. Why would I not want to put the best517GaXFXNPL._SL160_PIsitb-sticker-arrow-dp,TopRight,12,-18_SH30_OU01_AA160_ type of water into it? Mineralized water helps with bone health.  In alkalinized water, the hydroxyl ions produced from the reaction of the bicarbonate and the gastric acid with a low pH produce more hydroxyl ions which help buffer the acidity we produce on a daily basis. (Me interrupting here: During our visit last Monday, I noticed that my extremely health conscious, non-CKD, Florida friend drinks this.)

Where are these buffers? In the bones and in the cells, as well as some extracellular  buffers. You  are  helping lower  the  total  body  acidity  and decreasing the inflammation brought on by it. You do this early on so that you don’t have a problem with advanced acidosis later. Why wait until you are acidotic before doing something?”

Notice his comment about lowering body acidity and decreasing inflammation.  We already know CKD is an inflammatory disease.  There was Digital Cover Part 2 redone - Copysomething to this. I went back to The Book of Blogs: Moderate Stage Chronic Kidney Disease, Part 2 to tease it out.

“‘Belly fat is also much more inflammatory than fat located elsewhere in the body and can create its own inflammatory chemicals (as a tumor would).’

You can read the entire article at http://www.huffingtonpost.com/2013/03/21/body-fat-facts_n_2902867.html

Inflammatory?  Isn’t CKD an inflammatory disease? I went to The National Center for Biotechnology Information, which took me to the National Library of Medicine and finally to a National Institute of Health study at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3332073/   for the answer.

‘The persistent inflammatory state is common in diabetes and Chronic Kidney Disease (CKD).

This is a lot to take in at once.  What it amounts to is that another way to possibility prevent the onset of CKD is to lower your phosphorous intake so that you don’t accumulate belly fat.’”

Phosphorous? Once we have CKD, we do have phosphorous restrictions. But I have never had high phosphorous readings.  Maybe I should be exploring an abundance of lactic acid as a cause of the high anion gap reading instead.

According to Heathline.com,

adam_liver_8850_jpg“Lactic acidosis occurs when there’s too much lactic acid in your body. Many things can cause a buildup of lactic acid. These include chronic alcohol use, heart failure, cancer, seizures, liver failure, prolonged lack of oxygen, and low blood sugar. Even prolonged exercise can lead to lactic acid buildup.”

I’m definitely barking up the wrong tree here.

Wait a minute. I recently started using a BiPAP since I have sleep apnea and wasn’t exhaling enough CO2. That could cause acidosis, but it would be respiratory acidosis. Say, a basic metabolic panel would expose that. Nope, that’s not it either since my CO2 levels were normal.

It looks like this is going to be one of those blogs that asks more questions than it answers. I do have an appointment with the rheumatologist on the 20th and will ask for answers then.

Until next week,

Keep living your life!SlowItDownCKD 2015 Book Cover (76x113)

Proof Positive

Name

Standard Range

 5/29/15  9/4/15
TSH

0.450 – 4.500 uIU/mL

 1.900  3.480

diabetes

Name

Standard Range

5/29/15 9/4/15
Microalbumin, Urine

0.0 – 17.0 ug/mL

29.7 38.9

Glomerulus-Nephron 300 dpi jpg

How’s that for proof positive of what stress can do to you?  Other values also shot up, some past the normal range. While .57 to 1.00 mg/dL is within range for creatinine, I knew mine was a bit beyond this range. Now it’s shot up from 1.02 to 1.12.

My glucose – which I’ve spent over a year getting and keeping in range – went up from 94 to 117 mg/dL. The normal range is 65-99.

And my GFR? Oh no, down to 51 from 56.  So now I’m a stressed, sicker person.

Mind you, this was unavoidable stress. There was a medical emergency in the family (No, it’s not me.) and, by default, I was the one handling it. There simply wasn’t anyone else to do it at the time and it had to be dealt with immediately.  It was that kind of emergency.

There went the carefully orchestrated seven hours of sleep a night.  A 36 hour round trip to New Jersey with snatches of sleep here and there killed that.

There went the carefully orchestrated daily exercise. I couldn’t leave the patient alone long enough to even walk the airports… and the patient was incapable of doing it, anyway.

There went the carefully orchestrated ingestion of 64 fluid oz. It was catch as catch can since you can’t bring water into the gate area and they only had flavored or mineral infused water for sale once you passed the entry area.

There went the carefully orchestrated renal diet.  No, wait, that one I was very, very careful about.  I just drove the restaurant servers nuts with all my modifications. I figured if I could hold on to that, maybe I wouldn’t do as much damage to my kidneys and sugar levels as I feared I might.

Now that I’ve started in medias res (Latin for in the midst of things. Something I remember from long, long ago at Hunter College…even in an emergency.), let’s backtrack a little.  The obvious mystery is mg/dL. I have responded ‘huh?’ to this before. It means milligrams per deciliter.

Convert Deciliters To Fluid Ounces

Quantity Deciliters Fluid Ounces

(Courtesy of http://www.csgnetwork.com/directvolcvtdl2fo.html)

You’re probably familiar with mg. if you take any prescription medication.  As for deciliter? (I love that I remember so much from college almost 45 years ago.) That means 1/10 of a liter or 3.8 ounces. For the sake of full disclosure, I did have to look up the equivalent in ounces. So you see, there wasn’t that much change in my values, but enough for me – and my PCP – to notice.

Book CoverTo be perfectly honest, I had to use What Is It and How Did I Get It? Early Stage Chronic Kidney Disease as my bible to even understand these results.  Odd how you forget what you spent so much time learning… especially during an emergency.

TSH means Thyroid Stimulating Hormone. This is what I wrote about it.

“Part of the CBC [comprehensive blood test] which measures your triiodothyronine, which is a thyroid hormone that plays an important role in controlling your metabolism.  If the T3 reading is abnormal, then the T4 test is ordered to find out what the problem might be.

So it’s really a test to see if you need another test to check your thyroid function.  Notice how much closer I came to needing that secondary test while I was under stress. Although I was still within normal range, that was a significant jump.  No wonder my metabolism is screwed up. That is governed by your thyroid.

As for the Microalbumin, Urine, I was out of bounds there and, frankly, that worries me. This

“tests for micro, or very small amounts, of albumin in the urine. Ur stands for urine. Albumin is a form of protein that is water soluble. Urine is a liquid, a form of water, so the albumin should have been dissolved. Protein in the urine may be an indication of kidney disease.”

Well, I know I have Chronic Kidney Disease and I don’t like this indication that stress is making it worse. I’ve worked too hard for the last eight years to let this happen.

I’m hoping the renal dietician can help me get back on track when I see her later today. I follow the renal diet that was designed for me, but now I believe it needs some tweaking.food label

I’ve also been declared pre-diabetic since the last time I saw her.  Although I’ve been to see a diabetes counselor for several months, I’m wondering if today’s appointment with the renal nutritionist will give me ideas about how to include the pre-diabetes diet in the kidney disease diet.

I was down at my Primary Care Doctor’s appointment this past week; I won’t deny it. Add these test results to the family medical emergency plus 9/11 (I watched the buildings from my classroom window and went to more memorials that week than any 10 people should have to go to in a year.) and  unexpected death of a neighbor and I really wasn’t myself.  I finally asked her, “What’s the point of all my hard work if I end up with these results?”

Being the kind of person she is and the kind of doctor she is, she reminded me it was my hard work that kept my rising values from rising even more. Funny, but that got me right back on track.  Thank you to my PCP and other concerned doctors like her.

Talking about testing, here’s something locals should know about and it’s this Saturday, folks.

11990439_10204944411870363_4775265224050810062_n

Call me crazy, but I’m having quite a bit of fun indexing The Book of Blogs: Moderate Stage Chronic Kidney Disease, Part 1 and The Book of Blogs: Moderate Stage Chronic Kidney Disease, Part 2. It seems to me that I’d rather be doing that or researching than working on my fiction.  Hmmmm, what am I telling myself?

IMG_1398

 

Until next week,

Keep living your life!

Water, Water Everywhere

11194487_10206480685479477_4614482644786730988_oYesterday was Mother’s Day here in the U.S.  Here’s what I posted on that day:

When I grew up, mothers were all married women. Not anymore! Happy Mother’s Day to the moms who are moms in a lesbian relationship, the dads who are moms in a gay relationship, the single dads who are both mother and father, the moms in straight relationships, the older siblings bringing up their brothers and sisters, the single moms and those who have lost their child. You’re all still mothers and I relish enjoying this day with you.

I hope yours was a very happy one, even if your children are far away like my Nima who is in New York. Nima

This mother (two biological daughters, two step-daughters, two significant others) has been writing about sea sickness remedies, both medical and natural, for the past two weeks.  That got me to thinking about another kind of water and why we need it.

I’ve mentioned that I see a nutritional counselor to help me prevent my pre-diabetes from becoming diabetes. We all know I need 64 oz. of fluid intake a day as a Chronic Kidney Disease patient, but it’s not all water.  There’s my beloved 16 ounces – or two cups – of coffee a day plus any solid that turns to a liquid when melted (think ices) and the liquid in fruits such as watermelon.  By the way, did you know that our bodies are 50-75% water depending upon our health and age?diabetes equipment

Debbie, my nutritional counselor, kept hitting the need to hydrate.  Until she realized I already take this into account daily, she asked me to keep count of the number of eight ounce glass of water I drank each day.  That’s how important she felt it was.  We know that; we’re CKD patients.

But, have you ever wondered why it’s so important that we keep hydrated?  That’s one of those questions that was answered when I was first diagnosed, but – being who I am – I don’t remember the answer.  And that got me to wondering if you did.

The most obvious answer is that we need water so that our metabolism can function at its best. This is important so we have energy and build new cell materials. Let’s explore this a bit more.

The Oxford Dictionary defines catabolism (love that name) as

the breakdown of complex molecules in living organisms to form simpler ones, together with the release of energy; destructive metabolism.

In this case, ‘destructive’ is a positive.  No destruction of complex molecules = no release of energy.  Heaven knows we already have enough problems with energy as CKDers.

I used the Medical-Dictionary at http://medical-dictionary.thefreedictionary.com/anabolism for an explanation of anabolism.

The phase of metabolism in which simple substances are synthesized into the complex materials of living tissue.

So catabolism is the function of metabolism which breaks down complex molecules for energy and anabolism is the function that builds up cell material.metabolism

Oh, almost forgot – metabolism simply means change. How can I remember a college etymology lesson from fifty years ago, but not remember what my nephrologist told me seven years ago????

All right, but why the need to hydrate? While a commercial site, Nestle Waters at http://www.nestle-waters.com/healthy-hydration/water-fonctions-in-human-body (I did wonder about that ‘o’ in fonctions.) lists the five reasons we need water.  Notice number five and remember that toxins need to be eliminated, too.  That’s the job of the kidneys… and they need water to do it.water to cells

  1. Cell life
  2. Chemical and metabolic reactions
  3. Transport of nutrients
  4. Body temperature regulation
  5. Elimination of waste

As I researched, I hit medical sites, sports sites, pregnancy sites, elder care sites, and even pediatric sites.  All included hydration in their how-to-stay-healthy advice.

As CKDers, we know that an excess of sodium, phosphorous, potassium, and protein is not good for us.  Guess what flushes out the excess.  That’s right.  Your kidneys filter it from your blood, it’s converted to urine, and leaves your system.  Of course, you don’t want to overtax your already compromised nephrons by going over your daily limits of each of the above.

We’ll pause for a moment here while you go get a drink of water.

409px-Glass-of-waterRefreshed?  Okay.

Did you know there are different types of water? Many thanks to Consumer Reports for the following chart.

Artesian

Water obtained from a well that taps a confined aquifer, an underground layer of rock or sand that contains water. Example: Fiji Natural Artesian Water.

Distilled

Water that has been boiled and then recondensed from the steam that the boiling produces. Distillation kills microbes and removes minerals, giving water a flat taste. Example: Glacéau Smartwater.

Mineral

Groundwater that naturally contains at least 250 parts per million of dissolved solids. All minerals and other trace elements must be present in the water when it emerges at the source. Example: Calistoga.

P.W.S.

Public water source, also known as municipal water supply, or tap water. Fun fact: Aquafina, one of the top 10 selling domestic brands, used to say “P.W.S.” on its label—but changed that in 2007 under pressure from Corporate Accountability International to make clear that the water came from a public supply and not some pristine mountain spring called P.W.S.

Purified

Water from any source that has been treated to remove chemicals and pathogens according to standards set by the U.S. Pharmacopoeia. Must contain no more than 10 parts per million of dissolved solids. Distillation, deionization, and reverse osmosis are all purification methods. Examples: Aquafina, Dasani. (Note from me: recently, Dasani has started added minerals to their water.)

Sparklingbottled water

Water that contains carbon dioxide at an amount equal to what it contained when it emerged from its source. Carbon dioxide lost during the treatment process may be added back. (Carbonated waters such as soda water and seltzer are considered soft drinks, not bottled waters.) Example: Perrier.

Spring

Water derived from an underground formation from which water flows naturally to the Earth’s surface. Spring water must be collected at the spring or through a borehole tapping the underground formation (aquifer) feeding the spring. Examples: Arrowhead Mountain Spring Water (Nestlé), Evian. (Hmmm, Nestle also has minerals added now.)

I stick to either spring water or osmosis filtered water.  Be wary of any water with minerals added. You don’t really need more of those.

Digital Cover Part 1

 

Book Cover

It’s contest time.  Post a picture of you reading any of my three books in the most unusual place you can think of and win a copy of Part 2The Book of Blogs: Moderate Stage Chronic Kidney Disease, Part 1.  You can post your pictures at https://www.facebook.com/WhatHowearlyCKD which is SlowItDownCKD’s Facebook page.  Make sure the title and your face are clearly visible. Keep it clean and keep them coming!  The contest ends on May 31.  Thank you to inspired reader, Geo De Angelo, for sparking the idea in my mind. I’m eager to see how creative you can get.

Until next week,

Keep living your life!

But What Does That Mean?

11164740_10206320086664607_5860553690846776933_oI have to start off with gratitude to Team SlowItDownCKD for their willing participation in yesterday’s National Kidney Foundation of Arizona Kidney Walk. Abby Wegerski, Lara Garwood (and their ‘others’), Keith Harris, Patti DuBois, and Amy Vlasity with her children – Olivia, Willie, and Adam – all showed up bright and early.  I was so busy passing out book cards, speaking to others, and enjoying the dancing my team did that I neglected to notice which radio and TV stations were there.  Let me know if you can help out here.

Funny anecdote: when I presented Dr. Ivie of NKF of Az. with a copy of The Book of Blogs: Moderate Stage Chronic Kidney Disease, Part 1, he looked at it quizzically and said something to the effect that it looked thicker than the other one I’d given him.  He was actually referring to What Is It and How Did I Get It? Early Stage Chronic Kidney Disease.  Thank you, Dr. Ivie, for proving to me that I got the cover just right for everyone to know this is a series.Book Cover

I’m glad to report there are loads of questions about last week’s blog.  These are questions I was going to answer when I got the results, hopefully for next week’s blog.  However, I’ll happily yield to public demand.

To refresh your memory, the test in question is NutrEval (FMV Amino Acids) with Nutrient & Toxic Elements. Below is a scan of the orders.  Lots of different elements being tested here.  I could think of several ways to explain them, but turned to the CPT codes as what seemed to be the easiest way of doing so.

Notice there are CPT codes to the right of the profile components.  CPT means ‘Current Procedural Terminology” according to The American Medical Association (AMA) at http://www.ama-assn.org/ama/pub/physician-resources/solutions-managing-your-practice/coding-billing-insurance/cpt.page

I attempted to use the AMA code manager at https://ocm.ama-assn.org/OCM/CPTRelativeValueSearch.do?submitbutton=accept  where you can enter any CPT code. No go, it turned out the site required registration and payment. I also wonder if this is not a billing site.

Back to figuring this out.  Next I did a simple Google search. I did come up with a few sites, but they all seemed to be for billing purposes. Well, maybe I shouldn’t be using those codes.  Maybe they were codes used solely for billing.

Oh! Mental head slap!  That’s exactly why CPT coding was developed and what it’s used for. (Do you think I can get away with saying I’m still tired from yesterday’s walk as my excuse for not catching that immediately?)

IMG_0070Think!  What else could I do? I could do a simple search for the name of the test, couldn’t I?  I decided to find out. I looked for the most esoteric name I could find and settled upon 8-OHdG.  Anyone ever hear of it?  Me, neither. But Farley’s Free Medical Dictionary has.  This is at http://medical-dictionary.thefreedictionary.com/8-OHdG 8-OHdG 8-hydroxy-2’-deoxyguanosine.

A modified DNA nucleoside product generated by reactive oxygen species (ROS), which is elevated in colorectal carcinoma, but not in adenomas. 8-OHdG is also elevated in ulcerative colitis (UC) and increases with disease duration and dysplasia. MUTYH, the human mutY homologue, is responsible for excising misincorporated adenine and for suppressing mutations caused by ROS. Nuclear expression of MUTYH is attenuated in UC.

We have a choice here: wait for the nutrition counselor prescribing the test to explain this in detail IF the value is unacceptable upon testing or define each unknown separately.  I’m willing to wait until the test results are in.  Do tell me if you’re not and we’ll explore these terms together.

Maybe we’ll have more luck with another term.  Which one, though?  Ummmm, okay, let’s take a look at Pyruvic Acid. The same dictionary tell us this is

CH3COCOOH, an intermediate in carbohydrate, lipid, and protein metabolism.

Now we could look up CH3COCOOH but what good would it do?  We have what we need. We know carbohydrates, lipids (fats), and protein have to be metabolized in order to be of any use to us.  This acid helps to do that.  We can understand how a lack of or surplus of this could affect us. I’d pay special attention to this component since it’s the metabolism of these components that give us energy… or in my case, seemingly not enough energy.

Let’s try another one.  How about Behenic Acid this time?  I found this definition at Dictionary.com (http://dictionary.reference.com/browse/behenic+acid?s=ts).

a crystalline, saturated fatty acid, C 22 H 44 O 2, obtained from plant sources, used chiefly in the manufacture of cosmetics, waxes, and plasticizers.

Frankly, the definition left me scratching my head and wondering why I would be tested for that.  Wait! I’ve got it, but it’s supposition. Maybe too coxemeticsmuch of that seeping into my system would cause a problem.  Clogging?  If so, clogging what?

Drugs.com at http://www.drugs.com/dict/behenic-acid.html told me it’s

A constituent of most fats and fish oils; large amounts are found in jamba, mustard seed, rapeseed oils, and cerebrosides.

And that it has a synonym:  N-docosanoic acid. This is getting frustrating.  It’s at times like these that I wish I did have all the answers, but – as I keep saying – I’m not a doctor.

Okay, one more shot – this time at the synonym. Oh boy, the information about this is written in deep chemistry terms.  That’s a foreign language to me.  I will have the same questions for my nutrition counselor when the test results are in as you probably have reading this blog.

Hey, maybe I could work with a word I know – like manganese. Oh, sorry, that means

manganesea mineral that is found in several foods including nuts, legumes, seeds, tea, whole grains, and leafy green vegetables. It is considered an essential nutrient, because the body requires it to function properly.

Thank you to WebMD at http://www.webmd.com/vitamins-supplements/ingredientmono-182-manganese.aspx?activeingredientid=182&activeingredientname=manganese for information we could all finally understand.  It doesn’t help to have loads of information about a component if the information doesn’t make sense to you.  I’m the one who’s meant to simplify explanations and I couldn’t understand enough to explain to you.

On a happy note, I am more than willing to share both my results and the explanations the nutritional counselor offers me when they arrive.  You know that saying about sometimes it just doesn’t pay to even get out of bed….Part 2Digital Cover Part 1

 

Until next week,

Keep living your life!

Metabolic Syndrome doesn’t Sit Well with Me

I have been dismayed by this spare tire around my middle for a while.  I looked around and noticed some of my female friends have it, too.  For some reason, I didn’t look at my men friends’ middles.tire

Was it a post-menopausal thing? No, not with these young women friends having it, too.  So I asked and more than one told me she had Diabetes.

Whatever could that have to do with my spare tire, I wondered.  I may be pre-diabetic, but I don’t have diabetes.  No, I think it’s something else.  So I researched and found I’d been in denial about having (self-diagnosed) Metabolic Syndrome. Certainly I’ll speak with my primary care physician, but meanwhile I decided to tell you about it.

Did you know that one out of every three United States citizens and Canadian citizens suffer from Metabolic Syndrome?  While the title sounds exotic, it’s not. Okay, with those kinds of numbers, this isn’t a case of Metabolic Syndrome being the disease – or syndrome – of the day.  You know, when all of a sudden, everyone you know thinks (s)he has whatever it is… like me.

Okay, so what is it? This is what the Mayo Clinic at http://www.mayoclinic.org/diseases-conditions/metabolic-syndrome/basics/definition/con-20027243 had to say about it:

“Metabolic syndrome is a cluster of conditions — increased blood pressure, a high blood sugar level, excess body fat around the waist and abnormal cholesterol levels — that occur together, increasing your risk of heart disease, stroke and diabetes.”

Busted!  On my August blood draw report, my blood sugar level was high at 6.2 via the A1C.  That’s what it’s been for a year. Normal is between 4.8 and 5.6. A reading of 5.7 – 6.4 indicates increased risk for diabetes.  Just in case you don’t remember, the Hemoglobin A1C measures how well your body handles blood sugar over a three month period. This is important for Chronic Kidney Disease patients because, as defined in What Is It and How Did I Get It? Early Stage Chronic Kidney Disease (page 132 for those with the book), hemoglobin:

“Transports oxygen in the blood via red blood cells and give the red blood cells their color.”Book Cover

Awk!  I almost, but not quite, hesitated to check just how abnormal my cholesterol level was and for how long. I snuck at a quite peek at my book (page 130) before I did that just to be sure I knew what I was checking. The definition of cholesterol was:

“While the basis for both sex hormones and bile, can cause blockages if it accumulated in the lining of a blood vessel.”

So cholesterol is a good thing unless there’s a buildup.  Wait a minute; I need a refresher about bile.

MedlinePlus at http://www.nlm.nih.gov/medlineplus/ency/article/002237.htm cleared this up for me:

“Bile is a fluid that is made and released by the liver and stored in the gallbladder.

Bile helps with digestion. It breaks down fats into fatty acids, which can be taken into the body by the digestive tract.”

My latest cholesterol reading (with medication to keep it low) for Total Cholesterol were in range (100 – 199) at 165, as were my HDL Cholesterol reading at 49 (greater than 39 is acceptable), my VLDL Cholesterol reading at 23 (5-40 is considered normal), and my LDL Cholesterol reading (anywhere from 0 – 99 is normal).

Let’s backtrack just a bit.  HDL is High Density Lipoprotein, the cholesterol that keeps your arteries clear or – as it’s commonly called – the good cholesterol.  VDL is Low Density Lipoprotein or the ‘bad’ kind that can clog your arteries. VLDL is Very Low Density Lipoprotein and one of the bad guys, too. It contains more triglycerides than protein and is big on clogging those arteries.

Hmmm, this is part of Metabolic Syndrome, but I didn’t have it.  Did I ever have a cholesterol problem?  I looked back over the past year and noticed my Total Cholesterol had been out of whack by a point or two once or twice.

blood pressure 300dpi jpgWhat about increased blood pressure?  Well, I do have Chronic Kidney Disease and usually ran about 130/80.  The 130 was the systolic part of the reading; it measured the pressure when the heart is beating.  The lower part of the reading, or diastolic (the 80 in my case) was when the heart was at rest between beats. A normal blood pressure for a person my age (67) with CKD according to the new Eighth Joint National Committee is 150/90. Uh-oh, that’s under control, too.

Having both your cholesterol and your blood pressure under control were good things, and in this case, they pointed out the folly of self-diagnose.  Mea culpa!

By the way, this was important for CKD patients because we’re already at risk for heart disease simply by being CKD patients.  Why add to that risk with hypertension (high blood pressure) and/or hyperlipidemia (high cholesterol)?

Okay, so I didn’t have Metabolic Syndrome despite the spare tire I carried. But maybe you do.  Let’s see what you can do about it.

According to MedicineNet at http://www.medicinenet.com/metabolic_syndrome/page4.htm#what_is_the_treatment_for_metabolic_syndrome, the treatment is – you guessed it – diet, exercise, and no smoking.  Medication is used if the syndrome is severe enough, but life style changes are the first line of treatment.

Tonight, my brother and sister-in-law arrive from Florida.  By the time I blog next week, we will have spent time in Prescott, Sedona, and Jerome.  For those of you who don’t know these cities in Arizona, each has its own, distinct personality.  We will also have had an early birthday party for my brother so they can meet my family here, all the step-daughters and almost son-in-laws.  Ladies and gentlemen: this is the best medicine for whatever bothers me.firworks

I am so excited I almost forgot to tell you about the book.  I want to make sure none of you students is renting it for a semester.  Even if you don’t use Amazon’s Kindle Match Book Program, buying the book is LESS EXPENSIVE than renting it, especially the digital copy.  I’m sorry if you’ve been duped into renting.  Periodically I write reminders in the blog about this.

Until next week,

Keep living your life!

You Mean it’s Really The Carbs?

sugarWhen I think of diabetes, or pre-diabetes, I think of sugar.  Your A1C measures the percentage of blood glucose (think sugar) in you, so I just presumed that’s why it was used to determine if you have diabetes. Last week, when I was researching this test, I came across material suggesting it was carbohydrates – not the sugar I had assumed – that needs to be cut down in an effort to slow down the disease.

As usual, I’m getting a little ahead of myself.  I think I’ve discovered a formula that works when explaining… and it starts with a definition. According to Medical News Today at http://www.medicalnewstoday.com/info/diabetes/,

“Diabetes, often referred to by doctors as diabetes mellitus, describes a group of metabolic diseases in which the person has high blood glucose (blood sugar), either because insulin production is inadequate, or because the body’s cells do not respond properly to insulin, or both. Patients with high blood sugar will typically experience polyuria (frequent urination), they will become increasingly thirsty (polydipsia) and hungry (polyphagia).”

Mellitus comes from the Latin and refers to sugar sweetened. Notice that diabetes is often called Diabetes Mellitus.  Hmmmm, another reason I thought it was ingested sugar that causes the disease.  Yet, it is described as a metabolic disease; that is, a disease that deals with our metabolism – the way we process the foods we eat to gain energy.

Well then, where does insulin come in?  Just in case you forgot, insulin is “A natural hormone made by the pancreas that controls the level of the sugar glucose in the blood. Insulin permits cells to use glucose for energy. Cells cannot utilize glucose without insulin,” accordinginsulin to MedicineNet.com at http://www.medterms.com/script/main/art.asp?articlekey=3989.

Oh, so if your body is not producing enough insulin or none at all or the cells can’t respond to the insulin produced in the usual way, the energy from the blood glucose can’t be used to provide energy for your cells.  Accepted.  But isn’t blood sugar still sugar, say from candy, cake, cookies and the like?  You know, the things we don’t eat as Chronic Kidney Disease patients.

Well… yes and no. Certainly these food items contain sugar.  That’s part of what makes them so delicious.  But they are also carbohydrates, a word I usually associate with bread and pasta. MedicineNet’s definition of carbohydrate at http://www.medterms.com/script/main/art.asp?articlekey=6553 cleared up my confusion:

“One of the three nutrient compounds, along with fat and protein, used as energy sources (calories) by the body. Carbohydrates take the form of simple sugars or of more complex forms, such as starches and fiber. Complex carbohydrates come naturally from plants. Intake of complex carbohydrates, when they are substituted for saturated fat, can lower blood cholesterol. Carbohydrates produce 4 calories of energy per gram. When eaten, all carbohydrates are broken down into the sugar glucose.” cookies

Ahh! So all carbohydrates, whether from starches or sugars break down into sugar glucose.  This is starting to sound familiar. When I brought my pre-diabetes to the nutritionist at my nephrologist’s office, she gave me quite a bit of information and a handout from DCE, a dietetic practice group of the American Dietetic Association.  Did you know that starchy vegetables, fruits, juices and milk also contain carbohydrates?  It hadn’t occurred to me.

Remember the way to measure a half cup or a whole cup when you don’t have measuring cups but want to stay on the renal diet, including portion control?  It’s the size of your palm for half a cup and the size of a clenched fist for a whole cup.  The same measurements are used to measure a portion of carbohydrates.  Good for us, one less thing to learn.  You know measuring cups are better, but to be honest, I got a little tired of dragging them around with me in only a few weeks. measuring cups

You can also buy portion control plates on the internet, but frankly, it’s just as easy to measure it (whatever it is) out once and then know what that size portion is. For example, we needed glasses so when I first used one, I measured the water it held and now know the new glasses hold 15 oz. unlike the blue ones which hold 8 oz.

When we moved in together, we had two sets of plates (Ahem, of course mine were more attractive.)Bear’s set had only large dinner plates whereas mine had both large and smaller dinner plates.  Since we were both trying to lose weight, it made sense to use the smaller ones.  Now I can see a portion on the plate without having to measure it.  I do measure periodically just to make sure I haven’t allowed my assessment of a portion to grow bigger.  Funny how that happens over time.

The Mayo Clinic has a good diet plan for diabetes at http://www.mayoclinic.com/health/diabetes-diet/DA00027/NSECTIONGROUP=2, but it won’t work for Chronic Kidney Disease patients as it is.  For example, whole wheat flour raises your blood glucose less than white flour, but has too much phosphorous for us, so we are warned to avoid it. Yoghurt, cheese, beans, and nuts are no-nos on my renal diet, but are often recommended in diabetes diets.

You need to know what you can and cannot eat on your renal diet before you look at the diabetes diet so you know what to cross out immediately.  This is what makes it easier for me to plan what I’ll be eating that day.

black breadYou also need to space out your carbohydrates.  This grand-daughter of a Jewish miller from Russia really did miss sitting down to eat a whole loaf of fresh black bread at one sitting… with butter, no less.  The diabetic diet’s not that bad, though: for me it’s 2 to 3 carbohydrate portions at breakfast, lunch and dinner with a one carbohydrate portion at three snacks – one after each meal. As I understand it, each carbohydrate portion is 15 grams. You can find a comprehensive list of these foods at http://www.diabetesdaily.com/forum/food-diet/25848-15g-carbs-snack-list/

I never told you about The Men’s And Women’s Gathering hosted by The Salt River Pima-Maricopa Indian Community and open to all tribes as well as non-tribal members.  SlowItDown’s kidney education coordinator, Annette Folmer (left), and nurse CherylVietri (right) did a great job of answering all the questions asked..  The three of us were delighted at how interactive the session was.  We had a plan, but a better one presented itself during the education.  As a result, I ended up gladly donating 15 books to visiting tribal members.  What a way to start off SlowItDown’s career of bringing free ckd education to any community that needs it! IMG_0189

Until next week,

Keep living your life!

Exercising My Options

According to a study published in Diabetes Care this past July, “Weight control through diet and exercise can prevent most cases of type 2 diabetes in American women over age 50…”  I am a woman.  I am an American. I am over the age of 50.  And I have chronic kidney disease which can be a cause of diabetes.  Therefore, I am also confused.  (One place to read about this study is http://www.drugs.com/news/weight-control-can-cut-women-s-diabetes-risk-study-shows-39516.html.)exercising

Why, you ask?  Easy, I’ve just finished reading Dr.Wes Fisher’s November 30th essay in Physician. In this essay, he makes a point in the form of a question: “What if, believe it or not, when it comes to people with Type II diabetes, diet and exercise don’t affect the incidence of heart attack, stroke, or hospital admission for angina or even the incidence of death?” Of course, the quote is taken out of context so you need to read the essay for yourself at: http://www.kevinmd.com/blog/2012/11/reconsider-benefits-exercise-weight-loss.html?utm_medium=twitter&utm_source=twitterfeed.

Okay, so my wildest dream of not having to exercise to avoid illness has finally come true.  Or has it?  I looked over the articles I’d saved about my nemesis. It was a lot easier to force myself to exercise four years ago than it is now.  My knees troubled me a bit then, but that was it. Now it’s the knees, right hip, feet, and shoulders.  I honestly do exercise, but it’s not half as much fun as it used to be. Sure enough, in the articles I’d saved, I ran right into a bunch of reasons to keep up the exercise.

“Statin therapy and physical fitness amounted to a one-two punch for lowering mortality risk in a large cohort of middle-age and older patients with dyslipidemia followed for 10 years.” Damn!  I have dyslipidemia (high cholesterol) and periodically need to pay closer attention to it.  According to this study originally printed in The Lancet, I need to keep exercising – if not to prevent myself from developing the horrors of Type II Diabetes possible outcomes, then to keep the dyslipidemia under control… and I need to keep watching my diet.  You can read the article via Medpage at: http://www.medpagetoday.com/PrimaryCare/GeneralPrimaryCare/36134?utm_source=share&utm_medium=mobile&utm_campaign=medpage%2Biphone%20app.

sore kneeWell, what about my knees and my other hurting parts that make me NOT want to exercise?  The best quote I found came from Dr. Candice Johnstone at the Radiological Society of North America’s press briefing this year when she spoke about exercising in moderation,

“I was not surprised by these results. This is more like common sense,” added Johnstone,

who is from the Medical College of Wisconsin in Milwaukee. “This adds to information

people have to use to design their own exercise program.”

The url for this article is: http://www.medpagetoday.com/MeetingCoverage/RSNA/36117?utm_source=share&utm_medium=mobile&utm_campaign=medpage%2Biphone%20app

Dr. Johnstone’s reference to common sense seems like… well, common sense.  If it hurts, don’t do it.  If you can do it with modification so that no pain is incurred, do it.  You try not to poke at a tooth that hurts, don’t you?  So why poke at a joint that hurts?

All right now, just one more article.  This one just about convinced me I should be happy about exercising. “Most weight loss occurs because of decreased caloric intake. However, evidence shows the only way to maintain weight loss is to be engaged in regular physical activity.” I can accept that.  But what was the convincing part of the article is this:

“Physical activity also helps to–

  • Maintain weight.
  • Reduce high blood pressure.
  • Reduce risk for type 2 diabetes, heart attack,      stroke, and several forms of cancer.
  • Reduce arthritis pain and associated disability.
  • Reduce risk for osteoporosis and falls.
  • Reduce symptoms of depression and anxiety. “

And this from my old friend, Centers for Disease Control and Prevention.  Read it for yourself at: http://www.cdc.gov/healthyweight/physical_activity/index.html?s_cid=tw_ob254

Now I remember why I started exercising.  I love life.  I love avoiding extra medication for ailments I could have handled with life style changes (sorry, Dr. Fisher). I love moving and feeling alive.dogandcatmainpage

Of course today’s blog leaves me thinking that I must continue to exercise.  Am I happy about that?  No, I can’t honestly say I am, but I will do so.  Who knows, maybe it’ll keep me healthy enough that I’ll live long enough to see grand-children instead of just grand-animals.

Announcing the winners of last week’s contest to find the most creative use of the useless garden tub in my master bathroom:

Advocator Peruza – a copy of the book is on its way to her now and it’s personally inscribed to her

Mimi Smiley – all I need is her information to send her a personally inscribed poster for the book

Nima Beckie – who entered just for the fun of it.

Thank you all!  Unfortunately, no one could come up with an answer to the question, “Why is this called a garden tub if it’s in the house?” so I’ll research that myself.

Until next week,

Keep living your life.

Fruits, Vegetables, and Staten Island.

I brought up my daughters on Staten Island which is still part of New York City.  Staten Islanders often call themselves “the forgotten borough.”

I have been riveted to my computer for news of friends and family and to pass information about them to others even further away than I am.  Hurricane Sandy has not been kind to the island.

Now that people have electricity, phone service and cell service (for the most part), I wonder if those with early stage chronic kidney disease are able to get the food on their diet.

Nima, my Staten Island daughter, and I talked last night about how the food that defrosted in the freezer during the no electricity time has refrozen now that the power is back on. Sometimes, people don’t realize that defrosted frozen food must be tossed, not refrozen; it’s no longer safe to eat.

You can see (and smell) that most of the refrigerator food is no longer edible after five days without electricity.  I wouldn’t trust the rest of it.  There’s a reason we refrigerate food.

According to the United States Department of Agriculture’s Food Safety And Inspection Service, these are guidelines to follow:

“Always keep meat, poultry, fish, and eggs refrigerated at or below 40 °F and frozen food at or below 0 °F. This may be difficult when the power is out. [This is me here: Or impossible with five days of no electricity even if you’ve kept the refrigerator and freezer doors closed.  Please, take no chances.]

Keep the refrigerator and freezer doors closed as much as possible to maintain the cold temperature. The refrigerator will keep food safely cold for about 4 hours if it is unopened. A full freezer will hold the temperature for approximately 48 hours (24 hours if it is half full) if the door remains closed.”

You can find food safety charts on their website at: http://www.fsis.usda.gov/Fact_Sheets/Keeping_Food_Safe_During_an_Emergency/index.asp

There’s been new research that indicates fruits and vegetables are more important to ckd patients than originally thought.  Keep this in mind when you restock your refrigerator.

This article appeared in The Kidney Group of South Florida’s blog a few days ago. They originally located the article in HealthDay News. (San Diego hosted the American Society of Nephrology’s annual meeting this past weekend, which was the source of quite a bit of new information.)

“After three years, consuming fruits and vegetables or taking the oral medication reduced a marker of metabolic acidosis and preserved kidney function to similar extents. “Our findings suggest that an apple a day keeps the nephrologist away,” study author Dr. Nimrit Goraya, of Texas A&M College of Medicine, said in a university news release.”

Apparently, some ckd suffers have metabolic systems that are severely acidic. Fruits and vegetables are highly alkaline.  This may counteract the acidity in the patients mentioned above AND those that have less metabolic acidosis (acid in the body).

You can find the complete article at: http://kidneygroup.blogspot.com/2012/11/eating-fruits-and-vegetables-may-help.html

What is not mentioned in the findings of the study is whether or not the ckd patients adhered to their fruit and vegetable restrictions.  I am limited to three servings of each daily with their serving sizes limited according to the fruit or vegetable.  For instance, I can consume three apricot halves during the same day, but only two peach halves. In addition, the fruit is usually canned so I can drain away the potassium in its juices.

I’ve written repeatedly about the prevalence of chronic kidney disease.  Now the public is beginning to understand.  Hmmm, I don’t mean my writing alone did that.  Consumer Reports, a magazine you should know if you’ve ever bought a car, an electronic device or anything else you need information about before buying now has a Chronic Kidney Disease Site.  Take a look for yourself.  The address is:

http://consumerhealthchoices.org/wp-content/uploads/2012/10/ChoosingWiselyKidneyDiseaseASN.pdf

While my biopsy stitches are healing nicely, I did have to return to the ophthalmologist for a secondary membrane procedure.  I had read about it before the original cataract surgery, but hadn’t taken it into account until I realized I was having trouble seeing in one eye despite the surgery.  I found it fascinating to see what medical science can do with the human body these days.

According to the University of Wisconsin – Madison’s School of Medicine and Public Health, “The natural lens of the eye is enclosed in a clear, cellophane-like membrane called the capsule. During cataract surgery the front of the capsule is opened. The cloudy lens inside the capsule is removed. In most cases, the back of the capsule is left in one piece, and a plastic lens implant is put in place in front of the capsule. In some patients, the capsule can become thickened and cloudy over time…”

Their address is: http://www.uwhealth.org/healthfacts/B_EXTRANET_HEALTH_INFORMATION-FlexMember-Show_Public_HFFY_1126651607431.html

Wouldn’t you know I was one of those whose “over time” was only three months.  A laser was used to make a hole in the back of the capsule and I’m already beginning to see just as well out of that eye as the other one.

One last note, Libre Clothing (makers of dialysis clothing) who has been such a good friend to What Is It And How Did I Get It? Early Stage Chronic Kidney Disease, is holding a contest on Pininterest from Nov.12-16. I’d suggest you take a look!

Until next week,

Keep living your life.

Fat Day

I am being thrust into the 21st century whether I like it or not.  Thank goodness, Bear gave me an iPad for my 65th birthday because my laptop is not so functional these days and my big guy needs all kinds of things installed on it now that it’s fixed. This is a first for me, but I’m one paragraph in and so far, so good. Welcome to iPad blog (#1?).

I feel fat and frustrated today, sort of like this picture: Image  I could do the analyzing thing and decide that the frustration is displaced from not being able to do anything about my buddy’s decision to end her life or my cousin’s running out of options to save hers, but I know I have no control over these tragedies.

I feel fat and frustrated because I know what to do to lose weight, do it and still gain.  It got so that I started to wonder if exercise were worth it.  And counting calories?  That went out the window.  I never did get to the point of abandoning the renal diet, though.  That’s become sacrosanct, the way I wish losing weight was.

Following my usual method when I have a problem, I started researching.  I remembered blogging about brown fat cells, but these were only recently discovered and no one knows how to access them yet.  In case you forgot, brown fat cells gobble up other fat cells or something like that.  I’d have to revisit the blog about them to be more specific, but I fear if I leave this page it will disappear.  This is all so new to me.  You should be able to find it quickly since the computer savvy Ms. Nima Beckie categorized the blogs.  How nice for me to have family who can freelance on the payroll.

I found some information that won’t help me lose weight but makes the frustration lessen.  Lucky for me that I just bought a Groupon for dance lessons and that my youngest daughter, Abby Wegerski, runs Sustainable Blues at The Blooze Bar on 32 Street  ( Sunday nights free lesson at 5 with live band after).  There’s exercise I at least adore and it’s clear to me despite all my belly aching, exercise is very much in my future.

EurekAlert’s article about long term weight loss after menopause gave me pause (sorry, I couldn’t resist.  I think I’m feeling better already.) Obviously I’ve been through menopause, but not so obviously had no idea that because of that my resting metabolism has decreased, so has my losing weight and keeping it off ability despite having no sugary drinks, fried food or desserts.  Well, drastically cutting down on desserts. It helps that I know I’m lactose intolerant, but I certainly am having trouble working gluten sensitivity into my renal diet. You can find this article at: http://www.eurkalert.org/pub_releases/2012-08/ehs-ilw082212.php.

That wasn’t enough for me though.  I wanted to feel that I was like everyone else so I searched some more.  I should mention here that belly fat holds a great deal of my excess weight or, at least it looks that way to me. Why Medical News Today’s article “Belly Fat Increases Risk Of Death Even In People Of Normal Weight” should be comforting is beyond me, but it was and actually lessened my frustration a bit. The article cites a Mayo Clinic study in which it was suggested, “that people of average weight who have extra fat in their stomach have a higher risk of dying than obese people.” Am I interpreting this to mean it’s better to be obese?  I sure hope that is not the case.  The address for this article is: http://www.medicalnewstoday.com/articles/249506.php.

A few things became clear while writing this blog.  I am trying to combine the renal diet with those for high cholesterol, lactose intolerance, and gluten sensitivity. I am not succeeding.  My failure here is probably the cause of my weight gain so I’ll see my renal nutritionist for help, keep on exercising (see you there, Abby) and go right back to counting calories.  Problem solved.

Did you know the book is available in India?  I didn’t. I thought it was only available here and in Europe.  Great work on Amazon’s part.  It’s also available on B&N.com, should you have a Nook.

Until next week,

Keep living your life!Image

It’s a Weighty Question

There’s a new addition to our family.  Oh, no, no!  Of course, with all our daughters, it’s natural to think it’s a grand child, but it’s actually a “grand” cat.  Let’s see now, we’re up to two grand dogs and three grand cats, plus our own Bella dog.  Little miss Annabelle is just twelve weeks old and cute as a button.  Thinking about cats led me to wonder if you knew that cats can also have CKD. And if you knew that some of the same treatments are used for feline CKD as for human CKD. That’s why you’ve got to be careful when you do your own research that what you’re reading deals with human, not feline, CKD.    

My daughter, Abby, brought Annabelle to the bar-b-q my fiance – Bear – threw to celebrate my 65th birthday yesterday (The bar-b-q was yesterday; my birthday was February 2 – Ground Hog’s Day – just in case you were wondering.) so everyone could meet the little cutie.

Being human, we overate, which got me to wondering about how hard it’s become for me to lose weight, much less maintain a healthy weight.  I remembered a blog I’d read on NPR way back in November and decided to share it with you.  I can’t be the ONLY one concerned with my weight, can I?

Hormones And Metabolism Conspire Against Dieters

by

There are some fresh insights from Australia that help explain why it’s so difficult for dieters to keep off the weight they lose.

Willpower will only take you so far, in case you haven’t run that experiment yourself. Turns out our bodies have a fuel gauge, not entirely unlike the gas gauge on our cars, that tell us when it’s time to tank up on food.

The gauge relies on hormones that signal to the brain when and how much to eat. But as Dr. Louis Aronne, who directs the comprehensive weight control program at Weill Cornell Medical College in New York, explains, the human fuel gauge can sometimes be way off the mark — especially for dieters.

A study just published in the New England Journal of Medicinedocuments a pretty extreme diet regimen that limited 50 overweight and obese Australian volunteers to about 550 calories a day for 10 weeks.

Most of them, though not all, actually stuck with the diet, and, not surprisingly, lost a lot of weight. While dieting they shed an average of nearly 30 pounds, or 14 percent of their body weight. At a year, they’d still kept a lot of the weight off, but, on average, their loss was down to 8 percent 15 months after the start of the study.

What happened to their hormones? The researchers measured a whole bunch of them, including insulin, leptin (an appetite suppressant) and ghrelin (a hunger stimulator) and found that more than year after the weight loss, the hormones were telling the people to keep eating — a lot.

As Aronne puts it, their internal gas gauges went down 65 percent instead of the 10 percent or so that would have been more in line with the weight lost. In essence, “they think they’re going to run out of gas  very, very soon.”

So it’s not just a lack of willpower that’s tripping people up. Their hormones are sending a strong, confounding signal to chow down.

What’s more, the study found that the metabolic  rate of the dieters remained low a year after the low-calorie diet  ended, making it even harder to burn off those calories.

While this might be a plausible explanation, I don’t find it all that comforting.  Yes, I do understand better why I’m having such a hard time with the weight, but I also know this means more exercise to burn off some of those calories my body is holding on to.  Guess I’d better learn to love exercise all over again, only exercise that accommodates arthritis this time.

You can find the blog at: http://www.npr.org/blogs/health/2011/11/03/141769832/hormones-and-metabolism-conspire-against-dieters?sc=fb&cc=fp

On another note, the lovely Aaron Milton of the FB page P2P for sufferers of any chronic illness posted an “Add to cart” button for the book there.  I’d like to do that to the blog and the book’s FB page, as well as my person website (www.gail-rae.com) but Aaron’s forgotten how he did it.  Anyone know how to do this?

Until next week,

Keep living your life!

Published in: on February 6, 2012 at 12:20 pm  Leave a Comment  
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