The Breath of Life

Valentinr'sHere’s hoping you had a wonderful Valentine’s Day whether your Valentine was someone else or yourself.  I spent years celebrating myself in various ways: an afternoon at the bookstore, an evening dancing at a new dance hall, even simply coffee with a friend I hadn’t seen in a while, and enjoyed all of it.

This year I decided to celebrate with a book giveaway contest and was thrilled when one of the winners told me she’d never won anything before.  What better gift could I give her than a new experience? So that you can see SlowItDownCKD is a family affair,  the link for the video of the ‘drawing’ is http://www.youtube.com/watch?v=oQZSou8-Nc8. Our wondrous cancer free dog, sweet Ms. Bella, chose the winners while my even sweeter husband, Bear, did the videoing and helped me see what I couldn’t.2015-04-18 21.39.40

I was a bit sad to discover my Kidney Walk days are over (Thanks, neuropathy, you meanie you.), but I’ll be celebrating National Kidney Month in a different way this year and hope you’d like to join me.  The National Kidney Foundation of Arizona at https://azkidney.org/ will be hosting their joint conference with The Cardio-Renal Society on March 11 & 12.  I’ll be attending on the 11th.

Kidney ArizonaSome of you have already asked if you can accompany me.  Of course you can!  Here’s the address for the conference: http://www.swnc.org/. Register there and then contact me at SlowItDownCKD@gmail.com or via a comment on the blog and we can arrange to meet there.

There have been so many medical issues since last week that I wasn’t quite sure which one to use as the topic of today’s blog, so I decided to use the first one that came up chronologically.  That was the pulmonologist. When I was in New York back in October, I experienced some shortness of breath and a burning sensation in my chest while walking at the typical New Yorker’s pace (Oh, how I have forgotten what that’s like.) and climbing stairs to the subway and elevated train two, three, or four times a day.NYC

When I told the pulmonologist, who I was originally seeing for sleep apnea problems, he ordered a lung x-ray be completed two weeks before my appointment.  My lungs were perfectly clear. Yay! Hurdle number one passed.

Next, a breathing test.  While I wouldn’t exactly call this fascinating, it was interesting… and the technician administering it made it even more so as she explained what we were doing each step of the way and, more importantly to me, why we were doing it. I sat in a glass box while she alternately fed oxygen into my lungs or asked me to empty my lungs of the same by forcibly exhaling into a tube.

WebMd at http://www.webmd.com/lung/copd/diagnostic-tests?page=3 has an easy to understand explanation – the kind I like best – of these tests.glass booth

  • Nitrogen Washout: You breathe pure oxygen, and the air you breathe out is collected and analyzed for nitrogen content.
  • Helium Dilution: You breathe a gas mixture of helium and oxygen.
  • Body Box: This is the most accurate of these types of tests. You sit in an enclosed chamber, made of glass or clear plastic and perform a series of small panting breaths. While very accurate, the equipment requires specially-trained technicians to operate it.

My results were not perfect, but my lung capacity was 97% which was just fine for my age.  There goes that qualifier again: for my age. It’s hard for me to accept that time will have an effect on your body, although it’s perfectly logical. Although this is not something terrible, there have been so many borderline issues lately due to my age.

What is itOf course you’re wondering why I’m even writing about this in a Chronic Kidney Disease blog, right? To that end, I took a little jaunt into What Is It and How Did I Get it? Early Stage Chronic Kidney Disease to clarify the issue for us. The first mention of the lungs was in an explanation of your nephrologist’s ROS.

“Then came the Review of Systems [ROS]. My primary care physician asked me questions about my constitution, the functional habits of my body such as weight changes, fever or chills. The cardiac part of my health was covered with questions about chest pain or palpitations. Finally, the lungs were referred to with questions about coughs, shortness of breath and dyspnea.”

That does still leave us with the question of why the lungs were covered at all in this examination for CKD. I found my answer in The Book of Blogs: Moderate Stage Chronic Kidney Disease, Part 2, in an inquiry into erythropoietin, or EPO.Digital Cover Part 2 redone - Copy

“The National Kidney and Urologic Diseases Information Clearinghouse at http://kidney.niddk.nih.gov/kudiseases/pubs/anemia/anemia_508.pdf explains.

Healthy kidneys produce a hormone called erythropoietin, or EPO, which stimulates the bone marrow to produce the proper number of red blood cells needed to carry oxygen to vital organs.  Diseased kidneys, however, often don’t make enough EPO. As a result, the bone marrow makes fewer red blood cells.”

If you have fewer red blood cells, you are carrying less oxygen to your vital organs… which are the following according to livescience at http://www.livescience.com/37009-human-body.html

“The human brain….The human heart…. The job of the kidneys is to remove waste and extra fluid from the blood. The kidneys take urea out of the blood and combine it with water and other substances to make urine. The liver….The lungs are responsible for removing oxygen from the air we breathe and transferring it to our blood where it can be sent to our cells. The lungs also remove carbon dioxide, which we exhale.”

Okay, so the lungs are responsible for gathering oxygen from the air (for one thing) and healthy kidneys produce red blood cells to carry oxygen to your vital organs (again, for one thing). CKD reduces the oxygen you have since it reduces your red blood cell production. Add unhealthy lungs that gather less oxygen and you’re in for a very tired time.

Keep breathing, keep enjoying, and keep on top of your health.DIGITAL_BOOK_THUMBNAIL

Until next week,

Keep living your life!

To Sleep: Perchance to Dream

First: credit where credit is due.  Thanks to the Bard, William Shakespeare, for providing the title for today’s blog.  Anyone recognize it from Hamlet’s soliloquy?

Although I’d planned to write about my odd experience with the threat of heart disease in next week’s blog, people have already started asking what heart disease has to do with Chronic Kidney Disease. The American Association of Kidney Patients has an easily understood, comprehensive article about just that. In a nutshell, “Individuals with kidney disease are at a high risk of developing hardening of the arteries resulting in heart attacks, heart failure and strokes.” I’d recommend reading the entire article at: http://www.aakp.org/aakp-library/heart-disease-and-kidney-disease/

In addition, although I am not astute enough to completely understand the studies I read about women and EKG testing, there does seem to be conclusive evidence that the female heart IS more sensitive to the EKG (just as Dr. Waram told me) and could provide a false positive for heart disease. Phew!  I feel like I dodged a bullet on that one.

So, what is today’s blog topic? Sleep!  If you remember, I’d had a sleep study just before the EKG panic but never got to write about sleep apnea and CKD.  You should know that I’d spent over four years trying to convince my nephrologist that I was tired because the CKD prevented me from producing enough red blood cells and he spent the same amount of time trying to convince me that wasn’t why I was always so tired.

In retrospect, it’s surprising that neither one of us ever considered sleep apnea.  It wasn’t until one of my many daughters was diagnosed with OSA that I started wondering if I could have it.  Of course, then I spent some time wondering if I were going to consider myself a victim of whatever health problem anyone I knew had. Once I got beyond that, help was on the way.

I found a study at http://www.medscape.com/viewarticle/538872 which clearly links sleep apnea and hypertension. Dr. John J. Sim makes the connection very clear:

“We think there may be a causative factor here; that sleep apnea may be causing direct glomerular injury,” Dr John J Sim (Kaiser Permanente, Los Angeles, CA) told renalwire . “We already know that sleep apnea causes hypertension and that hypertension causes kidney disease.”

If some degree of causality can be shown, it’s possible that treating sleep apnea may slow the progression of kidney disease, the authors speculate.

This is an older study from 2005, but it seems to lead the way to further proof that sleep apnea  does affect CKD. It’s also the only one I could understand {sometimes I do wish I were a doctor} which even mentions glomerular injury.

I think we need a definition of sleep apnea – also called obstructive sleep apnea or OSA – before we go any further, preferably a non-medicalese one. The simplest definition I could locate is from Yahoo! Health: “Obstructive sleep apnea is a condition in which a person has episodes of blocked breathing during sleep.” I should add the episodes usually last 10 seconds or longer.

During those episodes, you wake yourself up by gasping or snorting in an effort to start breathing again.  Now that I understand exactly what is happening, it’s sort of scary.  I hadn’t realized this could be serious.  But, being me, I’m not going to let it.  Hence, the sleep study. 

You don’t just walk into a sleep center to request one of these.  My family doctor, the ever vigilant Dr. H. Zhao of Deer Valley Family Practice, referred me to several pulmonologists – lung and respiratory tract specialists. I chose Dr. Loreman of Central Arizona Medical Associates and was glad I did since I found her personable, informative and easy to engage in a specific discussion about my health. Her suggestion?  A sleep study.  Off I went to make my appointment with Valley Sleep Center.

While they did a terrific job of monitoring my sleep patterns during different sleep states, I was unimpressed.  I don’t know what I expected, but they hooked me up, sent me to sleep, then woke me up to put on a CPAP and sent me back to sleep.

According to WiseGeek.com, “A CPAP machine has a small box connected to tubes through which air flows. The tubes are connected to a mask worn on the face. Straps around the mask fit it to the face over the mouth and nose. For those with sleep apnea, the CPAP is used at night during normal sleep.”

A CPAP was recommended for me. I am not thrilled and made it clear I’d like to try an oral {sometimes called dental} device to see how effective that is before I agreed to the CPAP.  I have reservations about being hooked up to a machine.  Those are my personal reservations.  Many, many people are perfectly comfortable with the CPAP.

There are several different types of dental appliances, so I’ll have to tell you about them at another time.  I don’t know anything about them yet. I had to postpone my appointment with this dental specialist since I had the emergency appointment with the cardiologist at the same time {see next week’s blog}. But before this appointment, there is one of   the two cataract surgeries.

Looks like my body is catching up to my chronological age.  It was bound to happen.  I just didn’t expect it all to happen in one month!!!!

Until next week,

Keep living your life!