I’ll be Glowing!

Not really, but that was my first thought when a nuclear medicine (NM) test was ordered for me. It required radioactive material to be injected into my veins. The test is called NM Hepatobiliary Scan with Pharmacologic Intervention.

Let’s get a definition of hepatobiliary before we do anything else. Thank you MedicineNet at https://www.medicinenet.com/script/main/art.asp?articlekey=19515 for this one:

“Hepatobiliary: Having to do with the liver plus the gallbladder, bile ducts, or bile. For example, MRI (magnetic resonance imaging) can be applied to the hepatobiliary system. Hepatobiliary makes sense since “hepato-” refers to the liver and “-biliary” refers to the gallbladder, bile ducts, or bile.”

That’s my kind of definition. Clear and easy for those of us who are not doctors to understand. It makes sense, too, since we were exploring what I called discomfort and my PCP called pain just under the lowest rib on my right side… very close to the gall bladder. The more than occasional nausea helped her to decide this test was necessary.

According to the test report, this is how it works:

“TECHNIQUE:

Frontal standing images of the abdomen and pelvis were obtained immediately and 30 minutes following the intravenous administration of Tc99m IDA. Pharmacologic intervention with CCK (or equivalent) and/or morphine with additional dynamic imaging was also performed.”

I didn’t know what Tc99mIDA or CCK was, so I’m guessing you don’t either.  Wikipedia at

https://en.wikipedia.org/wiki/Technetium_(99mTc)_mebrofenin  tells us,

“Technetium (99mTc) mebrofenin is a diagnostic radiopharmaceutical used for imaging of the liver and the gallbladder.”

Hmmm, we could have figured that out from the way the term is used in the context of the technique.

Let’s try CCK. This is also from Wikipedia but this time at https://en.wikipedia.org/wiki/Cholecystokinin.

“Cholecystokinin (CCK or CCK-PZ; from Greek chole, “bile”; cysto, “sac”; kinin, “move”; hence, move the bile-sac (gallbladder)) is a peptide hormone of the gastrointestinal system responsible for stimulating the digestion of fat and protein. Cholecystokinin, officially called pancreozymin, is synthesized and secreted by enteroendocrine cells in the duodenum, the first segment of the small intestine.” 

Well, that’s fairly explanatory, but keep in mind that Wikipedia entries can be edited by anyone.

I know, now you want to know the results. Back to the test report:

“HIDA scan:

Gallbladder clearly visualized. Gallbladder ejection fraction calculated at 37% at 30 minutes. Greater than 35% is normal.

Study Result Impression:

Gallbladder clearly visualized. Borderline abnormal gallbladder response to cholecystokinin challenge.”

Here’s where I got lost. If my gall bladder ejection fraction is normal, how can I have a borderline abnormal gall bladder response to cholecystokinin challenge? Yep, it’s time to make an appointment with my family doctor since she ordered these tests and, being who she is, can probably explain that in terms I can understand.  More on that after next week’s liver MRI and an appointment with her to discuss the findings of both tests.

While this is all interesting, what does it have to do with the kidneys? I went back to SlowItDownCKD 2013 to find out what I’d written about that after my New York daughter’s gall bladder was removed.

“After speaking with my daughter, I still wondered what gallstones have to do with Chronic Kidney Disease.  Searching the web only garnered this one article from January, 2009 … and the study only covered Taiwan. Of course, I found it at the National Institutes of Health at https://www.ncbi.nlm.nih.gov/pubmed/19352299.

‘The prevalence of gallbladder stones in patients with Chronic Kidney Disease is significantly higher than in those without Chronic Kidney Disease. Our findings suggest that increasing age, Chronic Kidney Disease, body mass index > or =27 kg/m {greater than 59 pounds}, metabolic syndrome, and cirrhosis are the related factors for gallbladder stone formation.’

Now think about it another way: you already have a compromised immune system because you have CKD.  Gallstones can cause infection of the gallbladder. As in Nima’s experience, infection causes white blood cell elevation. So you know you have an infection, you might even realize it could be in the bile ducts, too.  But did you check to see if there’s infection in other areas of your body? That would mean you can read your own test results or have the kind of relationship with your doctors – especially your nephrologist – to freely ask questions.

As for what this organ does, this is what MedlinePlus at https://vsearch.nlm.nih.gov/vivisimo/cgi-bin/query-meta?v%3Aproject=medlineplus&v%3Asources=medlineplus-bundle&query=gall+bladder&_ga=2.56082859.126205281.1548540376-1108406265.1544652518 had to say.

‘Your gallbladder is a pear-shaped organ under your liver. It stores bile, a fluid made by your liver to digest fat. As your stomach and intestines digest food, your gallbladder releases bile through a tube called the common bile duct. The duct connects your gallbladder and liver to your small intestine.’

Keep in mind that your liver, the largest organ in your body {The skin is actually the largest organ, but it’s external.} is the other organ that filters your blood.  Since your CKD has been diagnosed, your liver is already working harder. Add losing your gallbladder and you’ve got one very hard working – possibly overworked – liver.”

Needless to say, while I was taking this in stride, especially since my kidney function is the best it’s been in the over a decade since I’ve been diagnosed with CKD, I am now eager to have the liver MRI and get back to my primary care doctor (PCP) so she can explain what a lay person can’t understand from reading the results-  even with further researching.

A few announcements, if you please:

Our friends at @antidote_me are hosting the first of their new free monthly patient focused webinars. This one is about how medical research really works and is this Wednesday, January 30th. It’s a 15 minute webinar.  Register now: https://hubs.ly/H0gc_KV0.

Also, I write the blogs from a U.S. angle since that’s where I live. There is a new Facebook CKD support group which is from the British angle. It’s Chronic Kidney Disease Support Group for UK! Another is CKD Support UK. These are only two of several from across the sea. If you’d like to find the others, go to Facebook and in the search bar on top, enter CKD Support in UK. That little word “in” is what makes it searchable.

Until next week,

Keep living your life!

Stressed? You Must Be Kidding.

You’re reading this and I’m recovering from my first cataract surgery.  Only one eye is operated on at a time, so the next one is September 4th.  Part of the post operation plan is not driving for a week, which I’m sure I’ll be chaffing at before that week is over.  Another part is reading (and computing) for only ten minutes at a time which is why I’m writing this particular blog a week ahead of time, even though it will be published August 21st.

If you’re following us on Facebook or Twitter, you know I had a cardiovascular scare during my pre-op testing.  While talking to the ever reassuring Dr. Waram at Southwest Desert Cardiology, he mentioned the stellar reviews for What Is It And How Did I Get It? Early Stage Chronic Kidney Disease on Amazon. That got me to thinking I hadn’t looked at them so months, so I did.  I found two new ones I want to share with you:

5.0 out of 5 stars very helpful for calming down and getting to work on controlJune 23, 2012

By R. Sass

Format:Paperback|Amazon Verified Purchase

This is not a medical book, but it is the ONLY book I could find discussing the issue of early stage CKD. My twenty month old son was diagnosed on thursday, almost in passing by his nephrologist. I did not ask any questions on CKD, I was not handed any pamplets – I went into schock and reacted like I always do to bad news I can not process. I asked questions about my infant son’s high blood pressure (the reason for the appointment). Tried to pay attention, remained calm so as not to upset my children who were with us in the room, and then began to research like crazy. I also went back to the doctor and confirmed that she had in fact diagnosed my son with CKD (stage 1). So for me this book has been very helpful, but again I am still in a schock like state and just want to know how to slow the progression of the disease so that my son can have a mostly normal childhood. Best I can tell there is no treatment for the early stages and at least my son’s nephrologist (who is an expert in the area) does not appear to be at all concerned or worried. So I appreciate this book because it remined me to take the reigns (no one else will or can) and I plan to speak to my son’s pharmacist today about his other daily perscriptions, just to make sure that its okay to take… I plan to get more knowledgeable about nutrition (just like the author did) but most of all I plan to let my son play the sports he loves because activity is so important (the author loves to dance, my son loves to try and ice skate like his big sister).

This book is a very quick read, its almost like you are having a conversation with a friend over coffee. It calmed me down, it gave me direction and it was available on my kindle in seconds. THANK YOU!!!!

5.0 out of 5 stars great down to earth read. May 31, 2012

By HELEN A. VIOLA

Format:Kindle Edition|Amazon Verified Purchase

This book and the author was very informative and so close to my situation that I felt at timess, I wrote it myself. There is so much information included, along with so many web sites to continue my own research. I want to thank this author for her down to earth style of writing!

Back to the cardiovascular scare.  There is no, zero, zilch history of heart disease in my family BUT (as we all know), I do have Chronic Kidney Disease. That moves me up a notch for developing heart problems. According to the U.S. National Library of Medicine, ckd may be the cause of the following heart and blood vessel complications:

(Diagram  by  Nucleus Medical Art, Inc./Getty Images)

I was worried, but keeping my fear under control thanks to Bear and my good buddy, Joanne Melnick. – one with hugs and kisses, one with common sense (e.g.  Are you in the hospital?  No? Then it’s not an emergency.)

By the way, you can read more about ckd at: http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001503/

Here’s what happened.  I needed pre-op clearance for the cataract surgery. My trustworthy primary care doctor was unavailable, so her lovely and efficient physician assistant made an appointment for me with the nurse practitioner in the practice.  This woman asked her own physician assistant to perform an EKG on me – twice since she didn’t like the results of the first one.

I didn’t know the np., but was more than a bit disconcerted that she arrived late and had not looked at the notes, did not believe me when I pointed out on the ophthalmologist’s request that I needed an EKG and asked my pcp’s p.a. to verify, and – here’s the worst one – was visibly shaken at the EKG results.  Okay, maybe I was annoyed when I walked in (none of this was taken care of in a timely fashion despite my phone calls so it ended up being a terrific rush), but if anyone should be upset at the results, shouldn’t it be the patient?

The practice provided cardiology recommendations since it was clear seeing one was my next step. I called the closest one hoping they could get me in before my scheduled surgery. Southwest Desert Cardiology’s Brittany had me in the next day.  Their Dr. Kethes C. Waram answered every single one of my numerous questions (Hey, this is me.) and scheduled a stress test for the next day after reading the results of the EKG I’d been given in this office.  Dr. Duong wandered into the examining room while I was there and explained that EKGs can be interpreted from different aspects. While the np. used electrodes on many different parts of my body, the cardiologist concentrated on those areas nearer the heart. These EKG results were far less worrisome, but there still was an abnormality in one part of my heart function they wanted to explore.  Hence, the stress test. (The photo to the left is not my EKG and is for demonstration purposes only. Courtesy of Pharmacotherapy Publications via Medscape.com)

Dave made me very comfortable during that test. He even supplied a blanket since nuclear medicine rooms need to be kept very cold. I was injected with a slightly radioactive dye, but was assured this went nowhere near the kidneys and was so safe that I didn’t even have to check with the nephrologist about its use.

The test results came back normal. According to Dr. Waram, an EKG may be too sensitive to female hearts.  I’m having trouble verifying that via research, but I have to admit I had no symptoms and no results. I wonder why the np. didn’t explain that so I wouldn’t worry about the possible diagnoses (infarction, which mean heart attack, was one of them) on the EKG print out she gave me.

Moral: Go to doctors you know or have an immediate affinity with.  I didn’t know any of these doctors, but was immediately frustrated with the np, while I immediately felt comfortable with Dr. Waram.  Is this sound medical advice?  Hardly, but it makes me feel better should I have to see that doctor again.

Of course, if you have no affinity with someone who is the best doctor for you, ignore my advice.  I’ve done that myself.  The nice thing about advice is that you don’t have to take it.

Until next week,

Keep living your life!