At the Heart of the Matter

Happy New Year! Here’s wishing you all a very healthy one. I, on the other hand, found myself in the cardiologist’s office the very first week of 2019. That was odd for me.

It all started when I asked my very thorough primary care physician what – if anything – it meant that my blood pressure reading was ten points higher in one arm than the other. By the way, she’s the one that suggested I take my blood pressure on a daily basis. Her nurse always used the left arm to take the reading, so I did too. Then I got curious about what the reading on the other arm would be and how much difference there would be between arms. I expected a point or two, not ten.

Although my readings had always been a bit high, they weren’t high enough to warrant extra attention… until I mentioned the ten point difference to my PCP. BAM! I had an appointment with the cardiologist.

This information in last year’s April 23’s blog will explain why:

“We know that hypertension is the number two cause of CKD. Moderating our blood pressure will (hopefully) slow down the progression of the decline of our kidney function. Kidney & Urology Foundation of America, Inc. at http://www.kidneyurology.org/Library/Kidney_Health/High_Blood_Pressure_and_Kidney_Disease.php explains this succinctly:

‘High blood pressure makes your heart work harder and, over time, can damage blood vessels throughout your body. If the blood vessels in your kidneys are damaged, they may stop removing wastes and extra fluid from your body. The extra fluid in your blood vessels may then raise blood pressure even more. It’s a dangerous cycle.’

And heart rate? The conclusion of a study published in the Journal of Nephrology reads:

‘Heart rate is an independent age-dependent effect modifier for progression to kidney failure in CKD patients.’

You can read the entire study at https://www.researchgate.net/publication/232714804_Heart_rate

So we know that blood pressure and heart rate are important for Chronic Kidney Disease patients. Just in case you’ve forgotten, heart rate is a synonym for pulse which is the number of times your heart beats a minute.

MedicineNet at https://www.medicinenet.com/script/main/art.asp?articlekey=154135 offers more about what the difference between readings from both arms MAY mean:

“People whose systolic blood pressure — the upper number in their reading — is different in their left and right arms may be suffering from a vascular disease that could increase their risk of death, British researchers report.

The arteries under the collarbone supply blood to the arms, legs and brain. Blockage can lead to stroke and other problems, the researchers noted, and measuring blood pressure in both arms should be routine.

‘This is an important [finding] for the general public and for primary care doctors,’ said Dr. William O’Neill, a professor of cardiology and executive dean of clinical affairs at the University of Miami Miller School Of Medicine.

‘Traditionally, most people just check blood pressure in one arm, but if there is a difference, then one of the arteries has disease in it,’ he said.

The arteries that run under the collarbone can get blocked, especially in smokers and diabetics, he noted. ‘If one artery is more blocked than the other, then there is a difference in blood pressure in the arms,’ O’Neill explained.

‘Doctors should, for adults — especially adult smokers and diabetics — at some point check the blood pressure in both arms,’ he said. ‘If there is a difference it should be looked into further.’

The report appears in the Jan. 30 online edition of The Lancet. ”

Notice I capitalized may. That’s because, in my case, there apparently was no blockage. My cardiologist had a different view of things. He felt there wasn’t a problem unless the difference in readings between your two arms is more than 20 points and that your blood pressure would have to be much higher than my slightly elevated blood pressure before this could be considered a problem.

He made note of my diabetes and congratulated me for taking such good care of myself, especially since I’m a caretaker. I must have looked puzzled because he went on to explain that caretakers sometimes have a sort of martyr complex and are convinced they cannot take the time away from the person they’re caring for to care for themselves. And, yes, he did use the oxygen masks in an airplane analogy to point out how important it is for caretakers to care for themselves first.

Now that I’ve wandered on to the subject of caretakers, seemingly continuing the thread from last week’s blog, here’s a health screening from Path to Wellness that may interest you if you live in Arizona. I urge you to take part yourself and bring anyone you think may be affected or has someone in their lives that may have CKD.

What: The National Kidney Foundation of Arizona will host a FREE health screening, aiming to identify chronic diseases in their early stages in those at highest risk.

When: Saturday, January 26, 2019, 8:30am- 12:00pm (appointments highly recommended**)

Where: Betty Fairfax High School (8225 S. 59th Ave., Laveen, AZ 85339)

Individuals who are 18 years or older and have a family member with diabetes, high blood pressure or chronic kidney disease, OR have high blood pressure or diabetes themselves are urged to attend this important event. Early detection means the possibility of preventing further, life-risking damage to the kidneys.

**Appointments may be scheduled by calling the National Kidney Foundation of Arizona at (602) 840-1644 (English) or (602) 845-7905 / (602)845-7912 (Spanish).

OR

Visit https://azkidney.org/pathtowellness and register online!

This medical screening includes immediate onsite results and medical education and is provided at absolutely no cost. The event is staffed with medical professionals, with the ability to screen 200 attendees.

About Path to Wellness: The Path to Wellness program is the product of a community collaboration between the National Kidney Foundation of Arizona and Cardio Renal Society of America. This January screening is provided in partnership with Adelante Healthcare and the Phoenix Metropolitan Alumnae Chapter, Delta Sigma Theta Sorority, Inc. Sorority, Inc., and generously funded by the BHHS Legacy Foundation. Path to Wellness screenings are unique in that they try to target areas of cities where the high demographics of under-insured or at-risk individuals may have an opportunity to detect chronic health problems early on, in a cost-free environment. The screenings also offer the unique advantage of both on-site results, and post-screening education on chronic disease management.

Until next week,

Keep living your life!

The Nation and the World are Working Together

It’s National Kidney Month and the country is burgeoning with kidney education in one way or another. I’ll be doing my part, too. Tomorrow, I’ll be speaking on eCareDairy. There are two links  to listen in:

https://www.ecarediary.com/EFCRadioShow.aspx and http://www.blogtalkradio.com/ecarediary/2018/03/06/coping-with-chronic-kidney-disease. This is my favorite kind of show – unscripted. If there’s anything you’d like me to include in my talk, leave a comment sometime today.

Of course, some of you are now asking yourselves how National Kidney Month started. Aha! I’ve got that covered. The National Kidney Foundation thought this would be a good way to bring awareness of kidney disease, and how to treat – and even prevent – its complications. Considering the many walks, golf tournaments, dances, free screenings, and other kidney disease education events that are scheduled throughout the year, I’d have to agree with them.

I’ll also be guest blogging on MyTherapyApp at https://www.mytherapyapp.com/blog on World Kidney Day which is Thursday, March 8. (World Kidney Day is always the second Thursday in March.) This is an app to help you remember to take your medications, test your blood glucose, blood pressure, or whatever else you have to test, even to take a walk.

And World Kidney Day? What’s that? This is from The Book of Blogs: Moderate Stage Chronic Kidney Disease, Part 2 (Maybe this year will be the one I finally get to split this book into SlowItDownCKD 2013 and SlowItDownCKD 2014). I’ve updated it to reflect the most current information. The updates are bolded:

“I discovered this is a fairly new designation. It was only twelve years ago that it was initiated.

According to http://worldkidneyday.org, “World Kidney Day is a global awareness campaign aimed at raising awareness of the importance of our kidneys.”

Sound familiar?  That’s where I’m heading with What Is It and How Did I Get It? Early Stage Chronic Kidney Disease; SlowItDownCKD 2011; SlowItDownCKD 2012; The Book of Blogs: Moderate Stage Chronic Kidney Disease, Part 2; SlowItDownCKD 2015; SlowItDownCKD 2016; the daily CKD tidbits on Facebook; and this blog. We may be running along different tracks, but we’re headed in the same direction.

The 58 year old International Society of Nephrology (ISN) – a non-profit group spreading over 155 countries – is one part of the equation for their success.  Another is the International Federation of Kidney Foundations with membership in over 40 countries. Add a steering committee and The World Kidney Day Team and you have the makings of this particular concept….

This year’s theme is Chronic Kidney Disease and Women’s Health.

While there are numerous objectives for this year’s World Kidney Day, the one that lays closest to my heart is this one: ‘Encourage systematic screening of all patients with diabetes and hypertension for CKD.’

Their site offers materials and ideas for events as well as a map of global events. Prepare to be awed at how wide spread World Kidney Day events are.

Before you leave their page, take a detour to Kidney FAQ (Frequently Asked Questions) on the toolbar at the top of the page.  You can learn everything you need to know from what the kidneys do to what the symptoms (or lack thereof) of CKD are, from how to treat CKD to a toolbox full of helpful education about your kidneys to preventative measures.

If only my nurse practitioner had been aware of National Kidney Month or World Kidney Day, she could have warned me immediately that I needed to make lifestyle changes so the decline of my kidney function could have been slowed down earlier. How much more of my kidney function would I still have if I’d known earlier?.. That was a decade ago and this shouldn’t still be happening… but it is.

I received a phone call a few years ago that just about broke my heart.  Someone very dear to me sobbed, “He’s dying.” When I calmed her down, she explained a parent was sent to a nephrologist who told him he has end stage renal disease and needed dialysis or transplantation immediately.

I pried a little trying to get her to admit he’d been diagnosed before end stage, but she simply didn’t know what I was talking about. There had been no diagnose of Chronic Kidney Disease up to this point. There was diabetes, apparently out of control diabetes, but no one impressed upon this man that diabetes is the foremost cause of CKD.

What a waste of the precious time he could have had to do more than stop smoking, which he did (to his credit), the moment he was told it would help with the diabetes.  Would he be where he was then if his medical practitioners had been aware of National Kidney Month or World Kidney Day, especially since this man was high risk due to his age and diabetes?  I fervently believe so.

I have a close friend who was involved in the local senior center where she lives.  She said she didn’t know anyone else but me who had this disease.  Since 1 out of every 7 people does nationally and being over 60 places you in a high risk group, I wonder how many of her friends were included in the 96% of those in the early stage of CKD who don’t know they have CKD or don’t even know they need to be tested.  I’d have rather been mistaken here, but I’m afraid I wasn’t. National Kidney Month or World Kidney Day could have helped them become aware.

For those of you who have forgotten (Easily read explanations of what results of the different items on your tests mean are in What Is It And How Did I Get It? Early Stage Chronic Kidney Disease.), all it takes is a blood test and a urine test to detect CKD.  I have routine blood tests every three months to monitor a medication I’m taking.  It was in this test, a test I took anyway, that my family physician uncovered Chronic Kidney Disease as a problem.

There is so much free education about CKD online. Maybe you can start with the blogroll on the right side of the blog.

Until next week,

Keep living your life!

Smoke Gets In Your Hair

Last weekend I was in Las Vegas renewing my vows to Bear as my brother and sister-in-law renewed their vows to each other. It was their 50th year of marriage, our 5th. I listened to what they had to say to each other during the ceremony and realized that was what I would have said to Bear on our 50th, if we were young enough to be able to count on having a 50th. And then I began to wonder how many people do reach this milestone in their lives.

More than the ceremony, it was the smoke in the casinos, the restaurants, the shops, and the cabs that got me to thinking about this. Even our non-smoking rooms had the scent of cigarettes. I know how much harm smoking can do to my kidneys, but what was this second hand smoke doing to them? If it clung to our hair and clothes, what else was it doing to us?

The very minute I was told I have CKD, I stopped the social smoking I had been doing. I would be surprised if I smoked a whole pack of cigarettes each month back then. But I wasn’t taking any chances on not raising my GFR. It was 39% at diagnose, so the smoking had to stop. Yet, it wasn’t until this past weekend that I became concerned about second hand smoke.

It appears that I’m not the only one concerned about second hand smoke. The National Kidney Fund (NKD) at https://www.kidney.org/blog/staying-healthy/second-hand-smoke-may-be-harmful-kidneys offers the following:

“Secondhand smoking was defined as living with at least 1 person who smoked, or having an elevated level of cotinine (a breakdown product of nicotine) in their blood. The researchers found that active smoking was associated with slightly lower kidney function and higher amounts of protein in the urine. Interestingly, secondhand smoke exposure was also associated with slightly lower kidney function in this study even after taking [into] account differences in age, sex, weight, demographics and parental education level. Differences in kidney function observed in the study were relatively small, but these small differences could have important effects on risk of developing hypertension and chronic kidney disease.”

What makes it worse is that hypertension, or high blood pressure, is one of the two leading causes of CKD. So second hand smoke could lead to CKD itself and/or one of the leading causes of CKD. Either way, it sounds like a losing proposition to me.

Of course, I needed to know more about cotinine. The Centers for Disease Control and Prevention (CDC) at https://www.cdc.gov/biomonitoring/Cotinine_FactSheet.html was able to help me out here:

“Cotinine is a product formed after the chemical nicotine enters the body. Nicotine is a chemical found in tobacco products, including cigarettes and chewing tobacco. Measuring cotinine in people’s blood is the most reliable way to determine exposure to nicotine for both smokers and nonsmokers exposed to environmental tobacco smoke (ETS). Measuring cotinine is preferred to measuring nicotine because cotinine remains in the body longer.

How People Are Exposed to Cotinine

Nicotine enters people’s bodies when they smoke or chew tobacco. When exposed to ETS from nearby smokers, smaller amounts of nicotine enter the body of the nonsmoker. Workers who harvest tobacco and produce tobacco products can also be exposed through their skin.”

While I don’t usually write about younger people and Chronic Kidney Disease, this quote from the Johns Hopkins Bloomberg School of Public Health at https://www.jhsph.edu/news/news-releases/2013/navas-acien-smoking-may-impact-kidney-function-among-adolescents.html caught my eye:

“’Tobacco use and exposure to secondhand tobacco smoke are major health problems for adolescents, resulting in short-term and long-term adverse health effects,’ said Ana Navas-Acien, MD, PhD, senior author of the study and an associate professor with the Bloomberg School’s Department of Environmental Health Sciences. ‘In this nationally representative sample of U.S. adolescents, exposure to tobacco, including secondhand smoke and active smoking, was associated with lower estimated glomerular filtration rates—a common measure of how well the kidneys are working. In addition, we found a modest but positive association between serum cotinine concentrations, a biomarker of tobacco exposure, among first-morning albumin to creatinine ratio. These findings further support the conclusion that tobacco smoke may damage the kidneys.’”

Lower estimated glomerular filtration rates???? No, thank you. I rarely go to casinos or any other place that allows smoking for that matter. I just don’t like the odor. Now I have a much more important reason to avoid such places.

Switching topics here. Something else I rarely mention is CKD cookbooks, probably because I don’t cook that often and firmly believe CKD patients need to eat according to their lab results. Months ago I received one such book in the mail and carefully explained to the author’s representatives that I don’t review CKD cookbooks on the blog. It’s an attractive book and always caught my eye just lying there on the kitchen counter for the last several months. During one of those in-the-house-trying-to-recoup-my-energy days after we got back from Las Vegas, I did the logical thing and picked it up to read.

Susan Zogheib, a registered dietitian with a Master’s in Health Science fulfilled my CKD cookbook dreams in her The Renal Diet Cook for the Newly Diagnosed in that she suggested repeatedly that we, as CKD patients, must work on our diets with our doctors and/or renal dietitians, especially if we have high blood pressure or diabetes. I also like that she clearly made the point that you have to take into account the stage of your CKD, your labs, your concurrent medical problems, and more. This, while including fairly easy recipes for some good looking meals. I never thought I’d like a cookbook. Well, there was the Betty Crocker one pre-CKD when I was a young bride still in college.

My 71st birthday is Friday. Naturally that means it’s time for a book giveaway. My birthday equals your gift. Three is my favorite number, so the first three book giveaway virgins (haven’t won a book before) to offer another bit of information about second hand smoke or CKD cookbooks win one of my CKD books. Sounds fair to me.

Until next week,
Keep living your life!

Smokin’!

When I was in college a million years ago, this was a compliment.  I’d wear the new dress my mother bought me, go to a dance or a party, dance my brains out, and find some guys whispering this under their breath as I passed them.early headshots

Not anymore.  True, Mom’s long gone, I’m married, and if anyone whispered this to me now, I’d think they were asking me if I smoked…and that’s a big no-no these days, especially with Chronic Kidney Disease.

We’ve taken for granted for years now that people just don’t smoke anymore. That’s not true, you know.  Other countries still find smoking acceptable, although not all.  There are also people who are so addicted that they just can’t stop.  Today we’ll take a look at what might help.

But first, we need to go back to the basics – as usual. On my very first visit to a nephrologist, I was told to stop smoking, even social smoking.

But why?  DaVita at http://www.davita.com/kidney-disease/overview/living-with-ckd/smoking-and-chronic-kidney-disease/e/4897 offered a succinct answer to my question:

Blood Oxygen Cycle Picture 400dpi jpgHow smoking can harm kidneys

Here are some of the possible ways smoking is thought to harm kidneys:

  • Increases blood pressure and heart rate
  • Reduces blood flow in the kidneys
  • Increases production of angiotensin II (a hormone produced in kidney)
  • Narrows the blood vessels in the kidneys
  • Damages arterioles (branches of arteries)
  • Forms arteriosclerosis (thickening and hardening) of the renal arteries
  • Accelerates loss of kidney function

In addition to tobacco, smoking allows other toxins into the body. And according to the American Association of Kidney Patients (AAKP), studies have shown that smoking is harmful for the kidneys, and can cause kidney disease to progress and increases the risk for proteinuria (excessive amount of protein in the urine).

To make this a little more comprehensive, here are some definitions from What Is It and How Did I Get It? Early Stage Chronic Kidney Disease:The Table

Arteries: Vessels that carry blood from the heart.

Hormones: …chemicals that trigger tissues to do whatever their particular job is.

Protein: Amino acids arranged in chains joined by peptide bonds to form a compound, important    because some proteins are hormones, enzymes, and antibodies.

Renal: Of or about the kidneys

Sounds drastic, doesn’t it?  So, what can be done to help those people who are so addicted they can’t stop smoking on their own?

An Israeli PhD student at Weizmann Institute of Science in Rehovot, Anat Arzi, has a novel idea.  She believes that exposing smokers to the smell of smoke and other unpleasant odors while they sleep can make them less eager to smoke.  In her own words, “”This research stems from recent findings suggesting that novel associations can be learned during human sleep and retrieved upon awakening.”sleepWhile this was only a small study with 76 people, I can’t remember reading about any other cease smoking study that deals with aversive conditioning during REM sleep.  Aversive conditioning is {surprise!} just what it sounds like: using unpleasant stimuli – like the rotten fish Arzi used – to cause some kind of change in behavior.  Quick reminder, REM means Rapid Eye Movement and occurs during the second stage of falling asleep.

You can read about the study yourself at http://www.m.webmd.com/a-to-z-guides/news/20141120/sleep-addiction-cigarettes?page=2

Then, there’s the FDA approved, safe, natural product Smoke Remedy offered on the internet.  You need to remember that FDA approved, safe, and natural does not necessarily mean safe for CKD. I applaud the fact that they list their ingredients, but this is not safe for us.

The homeopathic medicines in Smoke Remedy™ come from several different plant and mineral sources that include:

  • Avena sativa – to help with the addiction to nicotine and tobacco;
  • Caladium seguinum, Daphne Indica, Eugenia jambosa, Ignatia, Calcarea phosphorica, and Plantago major – these help to stop the craving and desire to smoke;
  • Kali phosphoricum, Nux vomica, and Staphysagria – to help prevent the withdrawal symptoms you may experience when quitting;
  • The product also contains purified water, citric acid and potassium sorbate.

For example, that last ingredient, potassium sorbate caught my eye because we know that we, as people with CKD, need to limit our potassium.  It turns out to be a preservative and nothing I’d want in my body whether the FDA approves it or not. The Calcarea Phosphorica made me pause, too.  As CKD patients, we do not need more phosphorous, as you already know.

I’m not saying don’t use homeopathic remedies, but I am saying you need to research each and every ingredient AND bring the list of side effects to your nephrologist before you do. Your doctor may not be familiar with homeopathic medicines, which is why you are doing the research to bring to him or her.Nicotine gum and crossed tobacco.

Of course, there’s always the patch or special gums, but they have their own problems.  Most feed slow doses of nicotine into your body. That’s the element of tobacco that injures your kidneys. This is to address the withdrawal symptoms.

I went to http://www.stopsmoking.net/free-nicotine-patch.html to see if there are side effects. Don’t you just love products with full disclosure? Here’s what I found:

“It’s worth noting that many of the top nicotine patches often produce undesirable side effects. Common side effects include headaches, dizziness, upset stomach, nausea, chest pain, breathing problems, anxiety, and irregular heartbeat. Furthermore, some people have nicotine patch allergies. The skin becomes red, and their body becomes severely irritated by the patch. If this ever happens, you need to contact a doctor right away. Nicotine patch allergies can produce damaging results.”

Now here’s an eye opener I found at http://thechart.blogs.cnn.com/2012/01/09/study-nicotine-gums-patches-only-help-with-withdrawal/:

“The perception of the public using the product is that these are good forever – that these will result in you not smoking in three, five, 10 years,” says Greg Connolly, Director of the Center for Global Tobacco Control at the Harvard School of Public Health. “Well, they were never designed to do that. They were designed to treat withdrawal, which is a symptom that occurs from stopping to probably six months, and then it usually ends.”

I never realized how really hard it is for addicted smokers to stop.  Now I fully appreciate my father who decided there wasn’t enough money 923117_10151599924904491_1034557671_ncoming in for him to waste it on cigarettes when he had three children.  He simply stopped. Or so I thought.  (This was way before 1996 when the patch and gum first made their appearance.) Thank you, Dad; this must have been really hard.

Until next week,

Keep living your life!