Thursday, March 27, 2014

Lowering Blood Pressure Without Medication

If you have high blood pressure or in danger of doing so, there are a number of things you can do to lower blood pressure without medication.

While taking BP medicine is a fast and simple way to go about it they aren't always the best way to go about it since they do some with side effects. In fact, most doctors will only put you on BP medication when natural ways aren't effective. Here are some ways. You can also read more here.

1. Exercise


One of the most effective ways of lowering your blood pressure is exercising. This means physical activity and movement. The goal is to try to get 30 minutes of exercise daily or three and a half hours a week.

Cardiovascular exercise is one of the best ways for lowering blood pressure. This includes walking and jogging or using workout equipment like treadmills, ellipticals, spinning bikes or step machines.

If you have knee or back problems be sure to choose non-impact machines like elliptical machines, rowers, or even recumbent exercise bikes.
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Kidney Disease Stages

The stages of kidney disease is one of the simplest ways to figure out how far the disease has gone. It is also a way wherein doctors can assess their patients and set up some guidelines, including dietary, lifestyle and medicine based to stop the progression.

There are two very important things you want to understand about kidney disease and its stages. One, kidney disease is often silent and you don't experience any symptoms until it has progressed a bit. For this reason it is important to have your annual checkups done specially if you have a family history of kidney issues.

The second important thing you need to be aware of is kidney disease is irreversible. It doesn't go away once it's there. But the one thing you want to do is keep it from progressing any further. Read more...

Monday, March 24, 2014

Physical Activity After Transplant

After transplantation, be it kidney, liver or heart you doctors will advise you to take up some form of physical exercise. The more routine and regular the exercise the better. This is not to say that you're out to train or be an athlete but that doesn't hurt either if you want to do that. In fact, there's the Transplant Games which is held regularly that promotes camaraderie among fellow transplant patients and is made to inspire everyone to get in shape and show that being a transplant patient doesn't mean you can't get involved in sports.

Going back to physical activity. The reasons doctors want transplant patients to be active is that it is healthy. It is for regular people, but more important for those who've had transplants. This is due to the fact that most of us are on prednisone.

Prednisone is a drug used to combat rejection. But it has a lot of side effects, one of which is, with long term use will make bones weak and brittle. This makes patients, not just transplantees, who are on the drug susceptible to weaker bones that could be more prone to fractures. And in the longer term, osteoporosis.

Two trains of thought come into play with regard to physical activity. One is cardiovascular or aerobic, and other other is resistance training. For most people one or the other may work. But for transplant patients, a combination of the two is much better because you want to get the bone and muscle building effects of resistance training to battle the effects of prednisone, which not only weakens the bones, but with prolong use at sufficient doses also wastes away muscles.

Cardiovascular exercise on the other hand is there for heart health and better blood circulation. This is important because it is one of the best ways to ward off high blood pressure which is the main enemy of the kidney. It also helps keep down your lipid levels (cholesterol, triglycerides and other) to normal ranges. The one last thing it does very well is regulate blood sugar. This is vital since you diabetes is one of the leading causes of high blood pressure that also leads many to kidney disease. For those on prednisone, you'll want to add aerobic exercise to your routine since prednisone also does a number on our blood sugar levels. So if you can get off the drug or find a transplant center that follows a no prednisone protocol this would be a good way to avoid the serious side effects of the drug.

Cardiovascular Workouts


The simplest way for anyone to get a cardio workout is to walk. It's that simple. You see treadmills, exercise bikes and elliptical machines all around. These do the job very well but if you don't have or want to spend extra cash then a good quick way to get yourself into any aerobic workout is to walk.

You can walk, jog or run. Your choice. But when starting out walking is the easiest. Start by taking a leisurely 5 minute walk. Then increase that by 5 minutes every week until you get 30 minutes a day, and increase the intensity until you're brisk walking. The great thing about walking is you can squeeze it in anywhere.

Take the stairs each time instead of the escalator or elevator. Walk the dog or just stroll around the a few blocks after you get home. The keys are get to 30 minutes a day and walk a good speed. This means you want to walk at least 3 MPH. Some people can go faster between 4 to 6 MPH, but 3 MPH is enough and just adjust to a pace that you feel is right when you achieve that.

If you prefer exercise equipment, a good exercise bike works very well. Other good choices would be treadmills, mini step machines and elliptical trainers.

The key to cardiovascular exercise is movement.

Resistance Training at Home


In contrast to aerobic/cardiovascular exercise, resistance training is more focused on working the muscles. This is done by lifting objects to work specific muscles. While cardio builds stamina, resistance workouts are more focused on strength.

Know that were not after size in this case. Though if you like looking buff (for the guys), and toned (for the ladies) you can go that route too.

The main goal of resistance training in this case to to build the muscles so they're strong. A strong muscular system protects your bones from carrying the load. It also reduces chances of injury in day to day activities. Lastly, they keep your bones strong.

While the goal in the aerobic workouts mentioned earlier was length of exercise and speed, the focus here is to challenge the muscles. Resistance training only works if you are challenged. So it isn't worth much if you lift something you can easily carry 50 times. What you want is to lift something that is about 70 to 80% of what you can carry at full strength for about 5 to 12 repetitions.

Working the right muscles is likewise important. And for transplant patients, this often prioritizes the spine and hips. So you'll need to work your legs.

Going to the gym and hiring a trainer is great, but a cheaper way would be to get adjustable dumbbells. Take note of the word adjustable. There are many dumbbells that are fixed in weight, you don't want that since you'll need heavier weights for the legs and lighter ones for the arms. Also when you get stronger you need to increase weight to get any lasting effects. You won't want to keep buying new sets of weights.

Including the Two Exercise Types in Your Regimen


Combining resistance training and cardiovascular exercise isn't difficult. If you want something that's very structured an easy way to go about it would be to take every other day. Or you could also insert the cardio workout as the warm up before every resistance training workout.

An alternative would be to try a rowing machine. This is an indoor rowing equipment that mimics rowing a boat on water. What you do is row for a specific amount of time at a specified pace. This gives you the cardiovascular portion of the workout. The rowing motion, which starts with the legs pushing then the back pulling along with the arms works the legs, hips and back the most which are the most important body parts transplant patients want to work on.

There are a lot of rowing machines around and you don't have to get the high end Concept2 rowers which are expensive. Though they're awesome. There are a lot of affordable home rowing machines that work really well.

If you don't believe me, take a look at the world class rowers in the Olympics. These guys are tested for their lung capacity and breathing ability. And if you look at their stature, they're built solid from head to toe with the strongest muscles being the legs/thighs and back.
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Sunday, August 30, 2009

Post Transplant Watch: Bone Disease

Bone disease is something that kidney disease often brings with it. The reason for this is that our kidneys play a major role in building our bones and keeping them strong.

One other issue is steroids. Most kidney transplant centers have used steroids as part of their immunosuppression protocols. Over the years, great strides in the post kidney transplant medication management have allowed doctors to minimize the doses of steroids we have to take in order to keep our transplants. In fact, there a already a number of transplant centers that have moved to a steroid-free immunosuppression protocol with great success rates.

But for most of us, whose transplant centers regimens include steroids, and for those who require steroids otherwise experience rejection, the consequences of steroids is something we have to deal with.

Here are some steps that doctors will monitor closely in order to minimize the problems caused by steroids with respect to bone disease.

RISK FOR OSTEOPEROSIS

Osteopenia and osteoperosis are two situations that everyone looks to avoid. They are signs that our bones are weaker that should be and in many cases more brittle and thinner also. Having weaker bones makes us more susceptible to fractures and other bone injuries as well as unwanted changes in our stature that make it more difficult to function normally.

For patients at risk of osteoperosis, the following guidelines will help in preventing it from happening and keep a close watch so that more aggressive treatment can be made when there are possible signs of moving towards it.

Being in any of following situations may put you in greater risk of osteoperosis

  • Women
  • Menopause or above 45 years
  • Personal or family history of low-trauma fractures
  • Amenorrhoea (absence of menstrual bleeding)
  • Slender build (BMI <>
STEP 1: Weight bearing exercises
I learned that weight bearing exercises are very important in keeping our bones strong. They also help build bone density. The logic sounds contrary to what we'd normally think. Common thinking would be, by not pushing or handling weight, we preserve our bones. But ironically, forcing our bones against heavier objects and making them 'work', actually improves their health, similar to how our muscles react to exercise. While being sedentary makes our bones deteriorate faster.

Not all exercises, however, are created equal. Some help in increasing bone mass and strength, while others don't. For example, exercises like lifting weights, brisk walking, climbing stairs strengthen bones, while swimming, rowing, cycling have been shown not to be as effective.

Also, different exercises affect different bones. Activities like climbing stairs, jumping and brisk walking help increase bone density in the hips and spine, whereas push-ups, for example, strengthen the bones in with wrist, arms and shoulders.
STEP 2: If you smoke, stop
Studies have shown that smoking is detrimental to bone health and bone healing.

The reason? Cigarettes and tobacco contain nicotine, which constricts blood vessels of their normal diameter. Because of the constriction of the vessels, the amount of nutrients that are supplied to the bones are less than they should be.
STEP 3:Calcium carbonate
Taking calcium carbonate is often needed in order to make sure that you get sufficient calcium that may otherwise be lacking from diet.
STEP 4:Vitamin D if or other activated forms of Vitamin D
Along with calcium, vitamin D is needed in order to build bones. With lessened function, the kidney isn't able to produce the same amount of vitamin D that it used to. Thus, supplementation with vitamin D is often required.

Depending on how well kidney function is, however, the type of vitamin D matters. If kidney function is good, meaning a GFR of 50ml/min or higher, then the vitamin D3 supplements are often given.

But in cases where there is decreased kidney function, like when creatinine is above 200 ╬╝mol/L or 2.3 mg/dL, your doctor may prescribe an activated form of vitamin D formulation like, alfacalcidol.

In doing this, it effectively side steps the need for the kidney to work in order to convert the vitamin D that comes in oral form or sunlight into the activated form which is what the body can use.
STEP 5: DEXA scan
A DEXA scan can be compared to other imaging machines like x-rays, and MRI machines. What they do is to scan through our bones and provide us an indication of how strong our bones are, in terms of bone mass density.

This is something that isn't always done by physicians but something I've learned to be quite important in gauging how well our bones have done over time (if they are improving or weakening) and if the current treatments being prescribed are working.

It is a good idea to get one before transplantation and yearly thereafter for comparison.
In an upcoming post, we will take a look at how the steps may differ when a diagnosis of osteopenia or osteoperosis has been determined.

Read more...

Saturday, August 29, 2009

Kindess From A Stranger

When we look at the world we live in, we often see a lot of harsh and sad events that lead us to look at the world we live in with a negative perspective. The thing is, often enough, just when we're ready to give up on believing that man is still capable of great kindness and compassions, it never fails to pull out a surprise.

Here's a great inspirational story that reminds us of the wonders and generosity we are all capable of. In this instance, a cab driver offers to donate his kidney to a passenger whom he knows needs it.

PHOENIX — Rita Van Loenen had no idea that a trip in Thomas Chappell's taxi cab could end up being the ride that saves her life.

"There are better odds of getting struck by lightning," Van Loenen said. "A random taxi driver offering to give me his kidney and all these pieces match. There has to be something behind this. How can this be?"

Chappell, who has been driving Van Loenen to dialysis appointments, shocked the Gilbert, Ariz. woman a month ago by offering to donate his kidney. But even more shocking to her was that doctors found they had the same blood type, that they were compatible.

"He calls me all excited. If we were a closer match, we would've been siblings. I was ready to fall off the floor," Van Loenen said.

The Phoenix taxi driver said he was a man of faith and that a higher power wanted him to step in.

"By then, me and the good Lord already had a talk. He said 'Tom, you go give her one. It will work," Chappell said.

Last year, Van Loenen, an instructor in special education methods, began feeling ill and experiencing water retention in her legs. She went to see a doctor and was diagnosed with kidney disease. With kidney failure setting in, friends and family were tested but there was no match.

In February, she received her cousin's kidney but that transplant failed. One day, Van Loenen, 63, found herself telling Chappell, 56, about how her son was now going to get tested. Chappell decided to add his name to the list.

"I said 'Rita, your son's a whole lot younger than me. He's got a lot more years. I'm gonna go down and go through the process and see if it will work.' I don't think she really believed I was going to."

The gesture evoked tears of gratitude from Loenen but she was still skeptical.

"A little bit in my heart I didn't believe it. He said 'give me the number' and I have transplant number at Mayo (Clinic in Scottsdale) memorized."

The two first met more than three months ago. It wasn't an auspicious beginning.

Chappell was half an hour late picking Van Loenen up for a dialysis appointment.

"When I got there she was not happy," Chappell said. "And I can understand it now. She's sick and all these things she goes through ... The next day, it just so happens I got her again."

Since then he has — and he insists it is by happenstance — been her taxi driver three to four times a month. For the last month, Chappell has started undergoing the arduous process of donor screening, undergoing numerous tests and exams. But none of it has brought second thoughts.

"This has put a whole new kind of lift in my boots. I never knew what it felt like to give somebody life and that's what I'm doing," Chappell said.

Van Loenen said Chappell never asked for any compensation. She still can't quite believe his level of commitment.

"I've never known anybody so enthusiastic to get a body part removed," Van Loenen said.

After the transplant, which hasn't been scheduled yet, Chappell will need to tread carefully. He will have to rest between four and six weeks but his work has promised to cover his lost wages.

"I've had drivers do some pretty incredibly amazing things for no charge. But this is just over the top," said Jim Hickey, national sales and marketing director for the company that owns VIP Taxi. "We're just so proud of him."

Van Loenen said that, thanks to Chappell, she can actually make plans for the future.

"Whenever I tell my friends or my family, they just find it so incredible," Van Loenen said. "They do call him an angel. My friend says there's angels everywhere. That's the right way to capture it."


Read more...

Friday, August 21, 2009

Night Hemodialysis Just as Effective as Kidney Transplant

In the first study of its kind, it has been shown that night time home hemodialysis, which is done for 6 to 8 hours nightly, up to 7 days a week, is as effective as receiving a transplant. The long term study focused on comparing the survival rates and how this particular type of dialysis compares with both cadaver and living donor transplantation.

For the first time, it has been shown that patients who receive night home hemodialysis live just as long as those who receive kidney transplants from deceased donors.

[...]

a total of 1,239 patients were followed for up to 12 years. Night home hemodialysis patients were compared to patients who received either a deceased donor kidney transplant or a living donor kidney transplant. The study found that the survival between night home dialysis patients and those who received kidney transplants from deceased donors was comparable, while the survival of the patients who received a transplant from a living kidney donor was better than both the other groups.
These results are encouraging considering the shortage of organs. It provides a means for those waiting for a transplant to maintain good health and good quality of life. In certain situations, it may also be a good alternative to high risk patients that aren't approved for transplants and those who aren't able to get a kidney transplant.

The full article can be found here.
Read more...

Single Kidney Transplants from Young Donors Effective

In the August publication of The Clinical Journal of the American Society of Nephrology, researchers reported that transplanting a single kidney from a young deceased donor is sufficient in maintaining health in an adult with kidney failure.

In most transplant centers, the kidneys of very young deceased donors are transplanted together into one patient. According to a study appearing in an upcoming issue of the Clinical Journal of the American Society of Nephrology (CJASN), a single kidney from a very young deceased donor maintains the health of an adult with kidney failure.

[...]

The researchers' study included all 79 adults who were transplanted at the Tulane Abdominal Transplant Institute with single pediatric kidneys from deceased donors aged 10 years or less between January 1996 and June 2007. Physicians transplanted a single pediatric kidney if it was healthy enough for splitting and the recipient consented. Half of the adults received single pediatric kidneys from donors less than five years of age. The other half received single kidneys from donors aged five to 10 years.

[...]

Patients in the two groups experienced similar rates of kidney rejection and delayed kidney function. In both groups, kidney function improved dramatically in the first year after transplant, and it continued to improve into the third year. Furthermore, patients in the two groups lived a similar length of time. The youngest donor in the study was a nine-month old female; both of her donated kidneys remain healthy more than six years post-transplantation into two different recipients.
The article is saying that based on their findings, using a single kidney from very young diseased donors are able to sustain good health in adults. Often, when the donor is of very young age, both kidneys are transplanted into adult recipients.

This report contradicts previous studies where it has been noticed that adults given single kidneys from very young donors produce more complications compared the those from adult donors.

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Thursday, August 20, 2009

Wearable Artificial Kidney

The wearable artificial kidney that is being developed has been successful in preliminary trials. It looks promising with the ability to allow patients to strap on their 'portable dialysis' machines and receive dialysis 24 hours a day, 7 days a week.

While it is still going through tests, things look promising.

"Our vision of a technological breakthrough has materialized in the form of a Wearable Artificial Kidney, which provides continuous dialysis 24 hours a day, seven days a week,"

[...]

The device—essentially a miniaturized dialysis machine, worn as a belt—weighs about 10 pounds and is powered by two nine-volt batteries. Because patients don't need to be hooked up to a full-size dialysis machine, they are free to walk, work, or sleep while undergoing continuous, gentle dialysis that more closely approximates normal kidney function.

[...]

The Wearable Artificial Kidney is successful in preliminary tests, including two studies in dialysis patients. The new study provides important information on the technical details that made these promising results possible.
This will be a great innovation that will allow dialysis patients not only avoid having to sit around the dialysis machine during dialysis sessions, but also allow continuous filtering of the toxins from the body, resulting in better health and quality of life.
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Wednesday, August 19, 2009

Pros and Cons of Kidney Biopsies

Although the kidney biopsy is a very thorough test that is able to provide a good assessment of kidney function, it isn't always the first option doctors go to in diagnosing kidney issues. Other procedures such as blood tests, urine sampling, ultrasound and CT scans are often done first. Only when these have been exhausted and there are still some unanswered questions, or the need to get a more definitive answer to a lingering unknown does the biopsy come into play.

Knowing the pros and cons of having a kidney biopsy should help explain why physicians often take this route.

PROS

  • Gives a clear cut picture of what is happening, what is affecting the kidney, how much is functioning, amount of renal mass that is still working and any infection or malignancy, if present.
  • It can find the cause of the kidney problem and tell what the best treatment will be.
  • Biopsies enable you to avoid being given unnecessary treatment which could have side effects.
CONS
  • The procedure is invasive, because there is penetration of the skin more risk is involved. The most common complication is bleeding. Another complication is possible damage to the kidney or other parts near it, if the kidney biopsy is done incorrectly. Though complications especially the latter one are very rare.
  • A kidney biopsy is expensive. The procedure itself which uses an imaging machine, like an x-ray or CT scan, along with the testing and doctors' fees cost significantly more than regular blood tests.
  • In a biopsy, the doctor will take a part of the kidney, so the sample may not be a complete representation of the health of all the tissues in the kidney. For this reason, some doctors may get elect to take a number of samples from different areas of the kidney during the procedure.

Read more...

Monday, August 17, 2009

Warning Signs of Infection

A common side effect of immunosuppressive agents is increased susceptibility to infection. These drugs, such as kidney transplant medications, weaken the immune system to prevent rejection. Therefore, you must take precautions to avoid infection.

If you experience any of the following signs of infection and or rejection as mentioned here, you should notify your transplant coordinator immediately. They will be able to give you the proper instructions on what to do.

Here are common warning signs of infection.

1. Sore throat
2. Cough, cold or shortness of breath
3. Flu symptoms
4. Fever over 100°F or 37.8°C
5. Pain over transplant area
6. Gastrointestinal discomfort, diarrhea, nausea and vomiting
7. Skin irregularities like sores, redness, swelling, or wounds that don't heal
Looking after yourself and being careful often reduces the possiblity of getting infections. I remember my doc telling me what to watch out for. But the most important things that came out of his lips then was “use common sense.”

As transplantees, we should be wary of infections because when they occur, our body's immune system becomes active and sends out its soldiers to knock out that infection. During this process, our immune system goes into attack mode and is more vigilant to foreign substance, including our kidney, increasing the possibility of causing a rejection episode.

It is important to inform your transplant center when you notice these symptoms and not to just take any over-the-counter drug that other people take. Many over-the-counter drugs can harm our transplanted kidney.

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