THE HIGH HOPES OF 2014 PARADIGM

Death,

Destruction,

Chaos.

That's just the tip of the iceberg

Well, it's been one heck of a year and, personally, I am glad to see it go. Life always has its challenges and mine is no different than yours. It's when you live with chronic pain and fatigue that it gets a little tricky. Even in the best of times resolutions are a little tough for me. I start out very enthusiastic and then I seem to forget that I had any. I guess goal setting isn't my strong suit. 

I know I'm not big on follow-up, I'm more of the idea man.

But I think this will work.

Here we go.....

First, I resolve to be a little more accepting of me. I know, I make this resolution every year but I think I need to be reminded of this every year.  OK, so I have limitations and pain kind of reminds me on a daily basis that it's there but.........

Next, I need to be a little kinder to my body. I know that if I push I will pay but I still do it. I want to get things DONE! It's that pesky old Type A personality that has plagued me since birth that keeps coming out but..........

Also, I need to be patient and not make myself crazy because I'm frustrated. I need to stop and think "this too shall pass." No, I'm not going to get my wonderful memory back. It falls under the category of "oh well". I'm going to forget words because this is the nature of the fog.......but..........

I need to stay focused on joy. 

I'm not going to go into some sort of nirvana. That just isn't me. I'm not the type of personality that wouldn't recognize stress if it jumped up and bit them. The idea of acceptance of this thing we call Fibromyalgia, to me, means that I climb in bed and pull the covers over my head and then, that's it, life is over. That I can't do and I won't do.

What I mean is that in the worst of times we need to stay thankful and grateful. We need to put one foot in front of the other and keep going. As tough as it is at times; as overwhelming as the pain can get, as tired as we are, as easy as it seems just to give up, we can't. 

I've seen some pretty dark stuff this year. I've seen what happens when the human spirit doesn't have the will to take it any longer. It tends to put things into perspective. I will never minimize what chronic pain can do and I don't want anyone to think that is what I'm doing. Pain is one tough cookie to deal with on a daily basis and it definitely changes you. As bad as it can get and as rough as it is, I'm saying we need to get through it.

As I've always said,

Fibromyalgia isn't for sissies.

My mantra for this year?

IT COULD BE A WHOLE LOT WORSE.

Because it can.

To all my friends, family and followers.....

I wish for a happy, healthy and prosperous 2014.

God Bless every one of you.

Be kind to each other and, most of all....

Be kind to yourself.

Happy New Year!

Rosemary

THE HOSPITAL, CHRISTMAS EVE AND THE DOCTORS TRIANGULATION

What is it about the holidays?

or just the month of December.

It has been a doozy.

And that is an understatement. There was the loss of a family member and the almost-loss of another. I sat in a hospital (which I hate) for hours on end.....for days.....until the crisis was over. Then a funeral.  That, funnily enough, made things a little bit better. While sad for the rest of us left behind, that funeral was truly a celebration of a remarkable man's life. I can only hope when it's my turn that I will be loved as much.

Then shopping for presents.

I know, I know......I could have done this all online but it seems that I'm a glutton for punishment. I just had to go to the mall. No, that's not quite the truth. I just love Nordstroms. Between Nordstroms and Costco, I'm in heaven. Actually, I admire their return policy. So, I brave all of that and start to wrap presents.

For some reason the present wrapping is worse than braving the mall.

The motions of wrapping presents seem to set me off for some reason. Maybe it's the repetitive motions.....I don't know but by the time I was done, I was done. I am now officially sick of shopping and wrapping presents. That, my friends, doesn't happen very often. 

This year has been bad.

Just bad.

I don't mean about the losses. I don't mean to minimize them...that's not my intention at all. I'm talking about the flares and the pain and the overall fatigue. It just hasn't stopped.

And I'm sick and tired of being sick and tired.

It's not just the fibro that's been flaring. I've got quite a few disks from "the accident" that have been acting up. Now the doctor wants to implant a neuro-stimulator that will help mask the pain. I've heard pretty good things about them. The people that do have them think they are the greatest thing since sliced bread. Even the shrink I had to see said they give you a new lease on life.

I know leases and the only ones who win are the landlord. 

And this little baby will surely be the one in charge.

I'm not sure I want a battery operated "thing" surgically implanted. For some reason, it is required to see a psychiatrist before you can be implanted with this device. He found me very well adjusted considering the extent of my back injuries. I mentioned the Fibro and he didn't seem to flinch. Maybe that's a good thing. Well adjusted?? I had to laugh at that one.

But therein lies my problem.

If it was just the back I'd be OK with it, but it's not. It's the Fibromyalgia that concerns me. This will set off a flare. The reason I know this is because every single time I have a procedure done, it takes me months to recover. I have no idea what kind of reaction this will set off. I get poo-pooed by the doctors but it's my body and I know it well. It may help my back but it's going to wreak havoc with the Fibromyalgia.

So what to do?

Oh......and then????

To top it all off?

I got the flu on Christmas.

Let's just add that ol' tiara!

Oh......just one more thing!

I got a flu shot this year.

Oh yeah.....that worked.

WHAT CAME FIRST, THE THYROID OR THE FIBRO?

Oh yay!

Another cure!!

Never mind the research.

Everyone else has been wrong.

It seems that everyone else has been misguided and the cure for Fibromyalgia has been right under our noses all this time.

It's your thyroid that causes the Fibromyalgia.

Sounds simple, huh?

I will agree that a lot of the symptoms sound the same but, at the same time, managing one does not automatically mean the cure of the other. The interesting part? The irrefutable evidence is currently on a website that is offline. 

Hmmmm.......

My doctor gets it. He knows there is a difference between normal and optimum. I don't feel well just being barely normal (OK, don't even go there!!!). I also need T3 and T4. I can't take levothyroxine alone, it just doesn't work for me. Getting my levels in check took some doing but now they seem to be where they need to be. 

I think it's interesting that that a lot of these symptoms are the same. I don't mean to sound flippant. There are a lot of issues with our body and the thyroid may just be one of them. The HPA axis dysfunction has long been a favorite theory of mine. I just think it's suspect when you take the same symptoms and point them to a simple fix.

Don't you think researchers have thought of this?

Maybe there is a problem with the thyroid due to low body temperature and basal metabolism that is common in Fibromyalgia patients, I don't know. Maybe some patients who were diagnosed with Fibromyalgia were actually severely hypothyroid. Maybe it is a problem but, right now, we just don't know. It's a shame that promising studies set themselves up for ridicule.

Why can't they just say, "another piece of the puzzle found."

Or, "study looks promising,

But, no......

Everyone else is stupid

And the cure was right under their noses.

So far, no one has been cured of Fibromyalgia,

But we can!!

(oops, the website with the proof is gone)

Is there any reason this shouldn't be suspect?

The thyroid science study link

IS THE F.D.A. ON D.R.U.G.S UPDATE

Yes, Virginia....

There is a Santa Claus.

All it takes is a little pressure from the Attorney Generals from 28 states and, guess what? 

VOILA!

Now maybe, just maybe the F.D.A. will rethink their approval of Zohydro. 

Believe me, I am not against pain medication. I need it to control the constant pain that I live with, BUT, I keep a tight control on the medication. These drugs, even in low doses, are very powerful and they need to be monitored. I've seen what drugs can do and it isn't pretty. You can take them and not wake up. 

The letter from the attorney generals have asked for the revocation of the approval or to make it conditional and the company must reformulate the product so that it is more difficult to abuse.

What I didn't know?

Zohydro is five to ten times more powerful than the currently available hydrocodone that's on the market. WOW! To my mind? These pills shouldn't be available to everyone. It should be for terminal pain patients. If you're walking around, you shouldn't need Zohydro. It's that simple. 

The company that makes Zohydro declined to comment but the FDA representative said they are reviewing the letter.

Again, pain medication is necessary.

I believe that.

In responsible hands they make one able to enjoy life.

But you don't need an Zohydro if you got a tooth pulled.

The 5 Stages of Kidney Disease

The kidneys are the body's filtering system. They pull waste and extra water from the blood and take it out of the body as urine. The filtering parts of the kidneys are called nephrons. Nephrons have many small blood vessels in them. High blood sugar levels and uncontrolled high blood pressure can damage these small blood vessels.

Damage to the nephrons is called nephropathy. In the early stages of nephropathy, the body doesn't give any warning signs that the damage is happening. The earliest sign of diabetic kidney disease is an increased excretion of albumin in the urine. This is present long before the usual tests done in the doctor's office show evidence of kidney disease, so it is important for diabetics to have this test on a yearly basis. 

As a diabetic's kidneys fail, their blood urea nitrogen (BUN) levels will rise as well as the level of creatinine in the blood. Diabetics may also experience nausea, vomiting, a loss of appetite, weakness, increasing fatigue, itching, muscle cramps (especially in the legs) and anemia (a low blood count). Diabetics may find you need less insulin. This is because diseased kidneys cause less breakdown of insulin. If a diabetic develops any of these signs, they should call their doctor.

Signs of kidney disease in patients with diabetes include but are not limited to the following:
-- Albumin/protein in the urine
-- High blood pressure
-- Ankle and leg swelling, leg cramps
-- Going to the bathroom more often at night
-- High levels of BUN and creatinine in blood
-- Less need for insulin or antidiabetic medications
-- Morning sickness, nausea and vomiting
-- Weakness, paleness and anemia
-- Itching

Stages of Kidney Disease
Diabetes can lead to changes in the kidneys that happen in stages. In the early stages, stages 1 through 3, the kidneys are able to make up for the damage and there aren't any obvious signs that the damage is happening. When enough damage occurs, in stages 4 and 5, the kidneys lose their ability to filter and cleanse the blood.

Stage 1: In this very early stage, the blood flow through the kidneys increases and the kidneys get slightly larger. Good blood pressure and blood sugar control are very important at this stage to help prevent any more changes. Remaining kidney function: 90% or more. Glomerular Filtration Rate(GFR):  90+%

Stage 2: The kidneys start showing damage in stage 2, as small amounts of protein (albumin) begin to leak into the urine. The kidneys will normally try to keep from filtering protein into the urine because protein is such an important building block for the body.

Albumin in the urine in this small amount (200 micrograms or less per milligram of urine) is found by a test called the microalbumin urine test, done at the lab. Remaining kidney function: 60% or more.
Glomerular Filtration Rate (GFR): 60-89%

At this stage, treatment includes quitting all tobacco products, controlling high blood pressure, keeping blood sugar levels as close to normal as possible, and, if really necessary, using an ACE inhibitor or similar drug. Doing these things can protect the kidneys against any further damage. (But, keep in mind that extended drug use can damage the kidneys over a period of years).

Stage 3: The loss of albumin into the urine is more than 200 micrograms per milligram at this stage. This is enough protein to be found by using a urine dipstick test, which can be done at your doctor's office. Treatment will still focus on controlling high blood pressure and keeping blood sugar levels as close to normal as possible. Remaining kidney function: 30% to 59%.
Glomerular Filtration Rate (GFR): 30-59%

Stage 4: By stage 4, also called advanced clinical nephropathy, the kidneys have become badly damaged from poorly controlled diabetes. Large amounts of protein leak out into the urine and signs of kidney damage start to show. These signs can include swelling in the legs and feet, high blood pressure, and high cholesterol and triglyceride levels. Remaining kidney function: 15% to 29%.

Treatment will include supporting remaining kidney function, controlling blood pressure, and keeping blood sugar levels as stable as possible.

Stage 5: By the time a patient gets to this stage, called end stage renal disease, the kidneys have failed. The patient will need expensive therapy and medicine as well as kidney dialysis. When kidneys fail, waste products have to be regularly removed from the blood by a dialysis machine that does the filtering work of the kidneys. Remaining kidney function: Less than 15%.
Glomerular Filtration Rate (GFR): <15 font="">

Some people might benefit from getting a kidney transplant, but most will have to wait years for a donor kidney. After having a kidney transplant, people need to take many different medicines to make sure the body doesn't reject the transplanted kidney. 

Kidney Health Tip: Your kidneys will work better and last longer if you:

• Eat a plant-based diet (such as the Death to Diabetes Diet)
• Control your diabetes and blood sugar (with diet and lifestyle)
• Control high blood pressure (with diet and lifestyle)
• Get treatment for urinary tract infections
• Correct any problems in your urinary system
• Avoid any medicines that may damage the kidneys (especially OTC pain medications)

Note: About 30 percent of patients with Type 1 (juvenile onset) diabetes and 10 to 40 percent of those with Type 2 (adult onset) diabetes eventually will suffer from kidney failure.

The 5 Stages of Kidney Disease Chart

Stage	Description	GFR
1	Kidney damage with normal or raised GFR	≥90
2	Kidney damage with mild decrease in GFR	60-89
3	Moderate decrease in GFR	30-59
4	Severe decrease in GFR	15-29
5	Kidney Failure	<15 span="">

IS THE F.D.A ON D.R.U.G.S???

I'd say....

ARE THEY ON DRUGS?

But I never like to state the obvious.

For those of us in the chronic pain community, we know how difficult it is to receive adequate treatment. If we tell the truth about our pain, we are considered neurotic. If we underplay it, we obviously don't need medication. 

There's no easy way to play it.

On October 25, 2013 the FDA drew huge praises from the addiction community by moving hydrocodone with acetominaphen to a Schedule 2 narcotic. What this means is that instead of going back to your physician every six months for followup, you have to return in three months. In addition, the doctor cannot call in your refills. You must hand the prescription to the pharmacist personally. They have made it harder to get Lortab, Vicodin and other addictive painkillers. They are supposed to make painkillers harder to abuse. For example, they inject Oxycontin with a gel that makes it harder to crushed and snorted. This kind of abuse deterrent is supposed to be a public health priority. 

So what did they do?

They approved Zohydro. 

Zohydro is a long acting opioid. This drug is not intended for as-needed use. This is for patients who need long term, around the clock treatment. Obviously, you wouldn't get this for a tooth extraction. 

This drug is not messing around. You can't drink alcohol. Let's face it, you're not supposed to drink with any pain medication but alcohol with this medication can result in fatal hydrocodone plasma levels in the blood. You even have to be careful taking anything that contains alcohol. This can even mean cough syrup.

You are also instructed by the insert to swallow Zohydro whole otherwise it can be fatal. 

This is their strong stance against substance abuse?

So what that tells me, this drug has the ability to be crushed up and snorted. To be fair, the makers of Zohydro have contracted with a Canadian company to come up with an abuse deterrent formula but who knows how long that will take. This drug was meant for cancer patients but everyone knows it will be on the street soon enough. Pill mills will push these babies out and they can be crushed, snorted and will kill people.

I love the insert on this drug. When addressing who should be prescribed this drug they talk about the opioid "naive." WHAT?? I've never heard that phrase before and I'm not sure I like the way that sounds.

What does this mean to me? It means people will start abusing this powerful drug and many will die. The people who it is intended for will have a hard time getting it after the stats start coming in. People need to be out of pain but because of pill mills and addicts those who truly need opioid therapy will be out of luck.

I thought the difference between Schedule 3 and Schedule 2 narcotics, as far as the refill requirements, was interesting. I live in Nevada and I have to go every 30 days to the doctor for a refill. 

Go every three months?

Not even close.

And you better not take it to a new pharmacy either.

They probably won't fill it.

THE COMFY BED THANKSGIVING CONUNDRUM

The holidays are coming!
Like everyone who writes about chronic issues,
there are hints and tips about getting through the holidays.
So, in the spirit of the day,

I also have helpful hints, observations, and a peek into my day.

Here goes!

First....Make all your grocery lists from bed. Give the list to your kids, spouse or significant other. Send them to the store. Assign the side dishes to the rest of the group.

Stay in bed.

Well, the house needs to be cleaned..so....Put a roomba on the floor. Turn on the ceiling fan and watch the dust will rise to the ceiling. Look around and decide that it doesn't look too bad. Great!! 

Go back to bed.

Get on the phone to your local grocery. Most of the deli departments will make the turkey. Send someone down there to pay for it and make sure the store is open on Thanksgiving. It is? Great! If you're exhausted from making holiday arrangements roll over and put the pillow over your head.

Stay in bed.

It's the big day!! You'll need to get out of bed to get ready to greet guests. You definitely don't want to be stressed today. Since there's plenty of football on, just wear the sweats from your favorite team. This way you're game appropriate and in jammies at the same time! If you want to put on makeup start 5 hours ahead ... that should give you plenty of time. Shower and makeup done?

Get back in bed!

Have the turkey picked up or preferably delivered. This should be done a couple of hours before the guests arrive because the wonderful aroma from that glorious turkey needs to permeate the house.  Just an FYI....place the turkey in a roasting pan and throw the ones from the store in the garbage cans outside. It helps to practice your exhausted-from-cooking look in the mirror. It also helps if you throw a little flour around the kitchen. Hold the cannister tightly otherwise you'll have flour everywhere. I learned this one the hard way. Also, I didn't realize how much my dog Buster loved flour. Yay! It's a game!!! I chased after him and had to clean the little flour paw prints that were throughout the house. After you're done cleaning the flour off the counters and floors....be sure to shake the flour out of your hair too....

Go back to bed.

I don't have to set the table. Why? Because I keep dining room table set year round. This way I don't have to worry about it. Quick tip? Just wipe the dust that has accumulated around the edges of the table. Practice your smile. Oh.....you have an hour before guests arrive?Better not push it...

Go back to bed.

Yay!

Thanksgiving is here! The smells in the house are divine! Guests are arriving and bringing heavenly dishes for tasting! It's time to gather 'round the table grateful for each other and all blessings.....(Don't hold my hands too tight....that hurts!) I'm so thankful for my family and friends.......and my bed.

As we enjoy the glorious food and company, I've been reminded of the times of years past...I sigh wistfully.....or was that a snore? Damn.....I'm starting to go under from the tryptophan. It's the dreaded turkey coma! At least when dinner is over  I can curl up on the couch pretending to be interested in the game. Stay awake.....stay awake.....stay awake....

How many hours till I'm back in bed?

I rise from the table full with bones creaking and stiff. I've been sitting so long that the pain is making me dizzy. Or is that the wine? The couch is calling and the noise from the shouts of the lastest touchdown make my head hurt. Or is it the wine?  Maybe I should head back to the kitchen and help with the dishes. Really? It's all done?? Oh how wonderful!  I'm so thankful that everyone else has cleaned the kitchen! Where did all the time go?? Dishes are washed and glasses sparkling....The dining room table has been reset waiting for next year! Really? It's time to go already? You can't stay? Did I just totally zip on the day?? I don't remember.

So I shuffle back to the bedroom and climb in my comfy bed and cover myself with a nice warm comforter. It's been a long day and I'm ready to close my eyes in glorious slumber. 

Wrong.

Now, I can't sleep.

Happy Thanksgiving!

High Blood Pressure -- The Number 1 Silent Killer

High blood pressure is the Number 1 silent killer disease. This silent killer is characterized by subtle symptoms that often go undetected.

High blood pressure (or hypertension) is a silent killer because it is deadly and has no early significant symptoms.

The American Heart Association estimates that up to one third of people living with high blood pressure are unaware of the fact that their blood pressure is high, and many people are unaware of the risks of high blood pressure.

Some of the statistics associated with high blood pressure and its impact include the following:

• 67 million American adults (31%) have high blood pressure—that’s 1 in every 3 American adults.
• 69% of people who have a first heart attack, 77% of people who have a first stroke, and 74% of people with chronic heart failure have high blood pressure. High blood pressure is also a major risk factor for kidney disease.
• More than 348,000 American deaths in 2009 included high blood pressure as a primary or contributing cause.
• High blood pressure costs the nation $47.5 billion annually in direct medical expenses and $3.5 billion each year in lost productivity.
• About half (47%) of people with high blood pressure have their condition under control.
• Almost 30% of American adults have pre-hypertension—blood pressure numbers that are higher than normal, but not yet in the high blood pressure range. Pre-hypertension raises your risk of developing high blood pressure.
• Reducing average population sodium intake from 3,300 mg to 2,300 mg per day may reduce cases of high blood pressure by 11 million and save 18 billion health care dollars annually.
• About 1 in 5 (20.4%) U.S. adults with high blood pressure don't know that they have it.
• About 7 in 10 U.S. adults (69.9%) with high blood pressure use medications to treat the condition.
• Team-based care that includes the patient, primary care provider, and other health care providers is a recommended strategy to reduce and control blood pressure

The chart below shows normal, at-risk, and high blood pressure levels.

Blood Pressure Levels
Normal	systolic: less than 120 mmHg diastolic: less than 80mmHg
At risk (prehypertension)	systolic: 120–139 mmHg diastolic: 80–89 mmHg
High	systolic: 140 mmHg or higher diastolic: 90 mmHg or higher

The danger from high blood pressure is the extra load on the heart, leading to complications such as hypertensive heart disease, a heart attack, a stroke and congestive heart failure. High blood pressure can also seriously damage the kidneys.

And it does all this silently, without any major symptoms, except when the high blood pressure gets extreme.

Always get your blood pressure checked to rule out hypertension as part of regular medical checkups. 

High blood pressure affects millions of people around the world. This condition goes unnoticed for years unless we have the insurance to receive annual physicals and blood tests from our primary care physician.

For the people who are able to afford insurance and get annual physical exams, they end up "controlling" their blood pressure by taking drugs that mask the real problem and give us the false sense of security that everything is fine. But, over a period of years, we find ourselves having to take more and more medication to 'control" our blood pressure. Until one day, you discover that you have problems with your kidneys, liver, or heart due to taking these medications for so many years.

What to Do
So, what if you have high blood pressure, but you don't know it? We recommend that you visit your primary care physician at least once a year for a complete medical exam. A complete medical exam will uncover a problem such as high blood pressure. At that point, your doctor may recommend one or more medications to help lower your blood pressure.

However, we don't believe that you should rely solely on medications because they don't help to get rid of the disease in your body that is causing your high blood pressure. As a result, you would be required to take high blood pressure meds for the rest of your life.

And since recent studies show that long-term use of these medications can lead to more health problems, we recommend that you make specific lifestyle changes that will return your blood pressure to normal. Those changes include transitioning to a plant-based diet such as the Death to Diabetes Diet avoiding the major "dead" processed foods, and a regular exercise regimen of brisk walking, stretching, and resistance training 4 to 6 times a week.

Please Note: The Death to Diabetes Diet is not just for diabetics! Non-diabetics can also use this diet program.

Warning! More than 87% of people who end up in the hospital because of high blood pressure, do not change their eating habits or lifestyle. As a result, 91% of them return to the hospital or end up in the graveyard.

FYI: Ironically, this top silent killer disease is fueled by what the author calls the "triple-killer foods" along with the 5 "dead" foods. So, make sure that you avoid these foods, especially if this silent killer is stalking you.

References:

1. Kochanek KD, Xu JQ, Murphy SL, Miniño AM, Kung HC. Deaths: final data for 2009. National vital statistics reports. 2011;60(3).
2. CDC. Vital signs: prevalence, treatment, and control of hypertension—United States, 1999-2002 and 2005-2008. MMWR. 2011;60(4):103-8.
3. Roger VL, Go AS, Lloyd-Jones DM, Benjamin EJ, Berry JD, Borden WB, et al. Heart disease and stroke statistics—2012 update: a report from the American Heart Association. Circulation. 2012;125(1):e2–220.
4. Heidenreich PA, Trogdon JG, Khavjou OA, Butler J, Dracup K, Ezekowitz MD, et al. Forecasting the future of cardiovascular disease in the United States: a policy statement from the American Heart Association. Circulation. 2011;123(8):933-44. Epub 2011 Jan 24.
5. Palar K, Sturm R. Potential societal savings from reduced sodium consumption in the U.S. adult population. American Journal of Health Promotion. 2009;24(1):49–57.
6. Hing E, Hall MJ, Ashman JJ, Xu J. National Hospital Ambulatory Medical Care Survey: 2007 Outpatient Department Summary. National health statistics reports. 2012; no 28.
7. Guide to Community Preventive Services. Cardiovascular disease prevention and control: team-based care to improve blood pressure control. 2012. Accessed July 27, 2012.

Kidney Dialysis

When people with diabetes experience kidney failure, they must undergo either dialysis or a kidney transplant. Almost 200,000 people in the United States are living with kidney failure as a result of diabetes.

Dialysis works well in the short run, but, it takes a toll on the person with diabetes -- physically and emotionally. Unfortunately, people with diabetes who receive transplants or dialysis experience higher morbidity and mortality because of coexisting complications of diabetes—such as damage to the heart, eyes, and nerves.

Dialysis is a treatment that removes wastes and excess fluid from your blood. Like healthy kidneys, dialysis keeps your body in balance. You do not need dialysis in the early stages of chronic kidney disease. If your kidneys start to fail, you will need a kidney transplant or dialysis to stay alive.

Your doctor will help you decide when to start dialysis, based on results of lab tests that measure how much kidney function you have left and on your symptoms.

Dialysis is done with a unique liquid called dialysate. This fluid is a combination of pure water and carefully measured chemicals. It removes wastes from your blood without taking out any of the substances you need to stay healthy.

A semi-permeable membrane (having minuscule holes allowing only specific types of particles to pass through) keeps your blood separate from the dialysate. This lets the wastes and fluid in your blood travel into the dialysate. Blood cells and proteins that you need cannot fit through the holes.

In hemodialysis, an artificial kidney (hemodialyzer) is used to remove waste and extra chemicals and fluid from your blood. Your doctor will make an access point into your blood vessels using minor surgery. This access point allows your blood to travel to the hemodialyzer for flushing. Sometimes access is created by joining an artery to a vein under your skin, making a bigger blood vessel or fistula.

If your blood vessels are not the right size for a fistula, the doctor may use a soft plastic tube to join an artery and a vein under your skin. This is called a graft.

Sometimes, access is made using a narrow plastic tube called a catheter, which is inserted into a large vein in your neck. Your blood is then cleaned and returned to your body. This type of treatment needs to be done several times a week and usually lasts about three to four hours.

In peritoneal dialysis, your blood is cleaned right inside your body. Your doctor surgically places a plastic tube called a catheter into your abdomen to create an access point. During your treatment, your abdominal area (or peritoneal cavity) is slowly filled with dialysate through the catheter. Your blood stays in the veins and arteries that line your peritoneal cavity while extra fluid and waste products are drawn out of your blood and into the dialysate. This is a daily form of dialysis, and can sometimes be preformed at your home.

Discussing with your doctor what dialysis option is the best for you will help you manage your chronic kidney disease and keep you feeling as well as possible.

Physical Side Effects of Dialysis and How to Prevent Them
Dialysis is a lifesaving treatment for those with end stage renal disease (ESRD). However, with both peritoneal dialysis (PD) and hemodialysis, there are occasions when a patient may have side effects from the treatment.

These side effects can be mild or severe, depending on the patient’s condition and whether or not they are following their dietary and fluid restrictions. Most of these side effects can be managed if the patient carefully follows their healthcare team’s recommendations regarding diet and fluid intake.

Side Effects of Peritoneal Dialysis (PD)
Infection. PD is a method of home dialysis. All three types of peritoneal dialysis—Continuous Ambulatory Peritoneal Dialysis (CAPD), Continuous Cycler-assisted Peritoneal Dialysis (CCPD) and Nocturnal Intermittent Peritoneal Dialysis (NIPD)—need a small rubber tube called a catheter. The catheter, a soft, straw-like tube is positioned both inside and outside of the body to allow dialysis solution into and out of the abdominal cavity. Exchanges (the process of filling, dwelling and draining dialysis solution) must be done carefully because there is a risk of infection from bacteria on the outside of the body.

The frequent handling of the catheter means greater risk for infection. Specifically, there is a chance of peritonitis, which is an infection of the peritoneum (where the catheter is placed in the abdomen.) This infection is the most common side effect of PD. Peritonitis can cause fever, nausea, vomiting and stomach pain. Patients may notice their dialysis solution looks cloudy. Treating peritonitis quickly is the key to stopping widespread infection. The doctor will likely prescribe antibiotics. 

Skin infections around the catheter insertion site are also common. If the area becomes red or inflamed, a visit to the doctor is recommended.

Preventing infection

To decrease the chance of infection, patients are advised to perform each exchange carefully. Exchange should be performed in a clean area. Keeping the catheter area clean and touching it with washed hands or sterile gloves can minimize the transfer of bacteria. Patients may also be advised to apply an antibiotic preparation at their catheter exit site to prevent infection.

Some patients have problems attaching or detaching the dialysis solution bag, which could put stress on the catheter, causing tiny tears that could allow in germs. If a patient has difficulties handling the bag, a renal nurse can provide tips on how to properly connect the bag to the catheter.

If a patient notices any sign of infection, it’s best to call the doctor immediately.

Hernias. A hernia is another potential side effect of PD. The muscles of the abdominal wall protect the internal organs and keep them in place. The insertion of a catheter can weaken these muscles. When patients do an exchange, the pressure from the dialysis solution in the peritoneum pushes against these already weak muscles. This pressure could cause a tear, and organs from the abdominal cavity could emerge through the opening.

Surgery is the only way to repair a hernia. Patients who have a history of hernias are advised not to exert themselves or participate in activities that could strain the abdominal muscles.

Eating Discomfort. Some PD patients find eating uncomfortable, because of the full feeling from the dialysis solution in their stomach area.  Although eating less feels better, it can lead to malnutrition.

The PD renal diet is designed to meet patients’ nutritional needs. If patients eat less, they may not get enough of the proteins and minerals that are important for good health. Timing exchanges (generally after meals) helps relieve some of the discomfort.

Bloating and weight gain. Bloating and weight gain are common complaints while on PD. Some of the weight gain is fluid bloat from the dialysis solution sitting in the peritoneum. The dialysis solution filters not only the toxins from the bloodstream, but also removes excess fluid. When the dialysis solution is drained, a patient will normally remove more fluid (dialysis solution plus the excess fluid filtered from the blood) than what was originally placed in the peritoneum.

Weight gain not associated with fluid bloat can come from the sugar in the dialysis solution being absorbed by the body. These extra calories could lead to extra pounds. Talking to a renal dietitian and nurse for some insight on how to balance nutritional needs and achieve comfort while on PD is advised.  

Side Effects of Hemodialysis
Low blood pressure. The most common side effect of hemodialysis is low blood pressure (also called hypotension). Low blood pressure occurs when too much fluid is removed from the blood during hemodialysis. This causes pressure to drop, and nausea and dizziness can result. Letting a dialysis team member know about these issue is highly recommended. The dialysis machine can be programmed so that the right amount of fluid is removed.

Medication for high blood pressure should usually not be taken before treatment, unless the doctor prescribes it that way. This could cause further drops in pressure and more discomfort. Watching and limiting fluid intake as recommended by the healthcare team may also prevent low pressure during treatments. Patients who drink more than what is advised usually need to have more fluid removed which can cause nausea and dizziness.

Muscle cramps. Patients sometimes experience muscle cramps while undergoing hemodialysis. These muscle cramps, usually in the legs, can be uncomfortable or sometimes painful. The exact cause of muscle cramps can vary from patient to patient. Sometimes when fluid is taken out of the body at a fast rate during dialysis or too much fluid is removed, the muscles react by cramping. A patient should alert a healthcare team member as soon as a cramp happens to get help in alleviating the discomfort. A doctor may be able to recommend some remedies if muscle cramps are making dialysis treatment uncomfortable.

Infection and clotting. Proper care for the access (either a fistula or a graft) is important in hemodialysis. The access can become infected or inflamed. Pressure on the access (from clothing or from sleeping on the side where the access is located) can cause the site to become irritated. Keeping the area clean can help prevent infection.

An access can become clotted with blood. Clotting prevents blood flow, so that a patient will not be able to get dialysis treatment. Patients are advised to monitor the access daily by checking for the thrill (the pulse feeling in the fistula or graft) to ensure it is working properly.

Itching. Many dialysis patients complain about itchy skin. There may be several causes, but it is commonly thought that high phosphorous levels are responsible for this side effect. Phosphorous is not effectively removed by dialysis. That’s why foods with phosphorus are restricted on the renal diet. Following the dietitian’s guidelines can help prevent this side effect. Remembering to take a phosphorus binder as prescribed (usually before every meal) is another way to help prevent or stop itching.

Dialysis patients are also prone to dry skin, which can be the cause of itching. Using very hot water for showers or baths can dry skin more. Harsh soaps can cause irritation and more itching. Moisturizing creams can alleviate some of the discomfort.

Sexual problems. Dialysis can affect a patient’s sex life. The sexual side effects can include loss of desire, erectile dysfunction and vaginal dryness. Loss of desire can be a psychological side effect. Patients on dialysis may deal with anxiety, depression and a change in self-image. These mental challenges can diminish the sex drive.

Hormone levels while on dialysis can also lead to a loss of desire, as well as physical side effects such as erectile dysfunction and vaginal dryness. Certain blood pressure medications can impair the ability to maintain an erection.

Other Health Problems Associated with Kidney Dialysis

Amyloidosis. Dialysis-related amyloidosis develops when proteins in blood are deposited on joints and tendons, causing pain, stiffness and fluid in the joints. The condition is more common in people who have undergone hemodialysis for more than five years.

 

Anemia. Not having enough red blood cells in your blood (anemia) is a common complication of kidney failure and hemodialysis. Failing kidneys reduce production of a hormone called erythropoietin, which stimulates formation of red blood cells. Diet restrictions, poor absorption of iron, frequent blood tests, or removal of iron and vitamins by hemodialysis also can contribute to anemia.

Bone diseases. If your damaged kidneys are no longer able to process vitamin D, which helps you absorb calcium, your bones may weaken. In addition, overproduction of parathyroid hormone — a common complication of kidney failure — can release calcium from your bones.

 

Fluid overload. Since fluid is removed from your body during hemodialysis, drinking more fluids than recommended between hemodialysis treatments may cause life-threatening complications, such as heart failure or fluid accumulation in your lungs (pulmonary edema).

 

High potassium levels (hyperkalemia). Potassium is a mineral that is normally removed from the body by the kidneys. If you eat more potassium than recommended, your potassium level may become too high. In severe cases, too much potassium can cause your heart to stop.

 

Inflammation of the membrane surrounding the heart (pericarditis). Insufficient hemodialysis can lead to inflammation of the membrane surrounding the heart, which can interfere with your heart's ability to pump blood to the rest of your body.

 

Sleep problems. People receiving hemodialysis often have trouble sleeping, sometimes because of breaks in breathing during sleep (sleep apnea) or because of aching, uncomfortable or restless legs.

Patients should talk to their social workers or doctors if they experience any of these problems.

Keep an open communication with the healthcare team. Let them know about any reactions to treatment so adjustments can be made. Side effects should not discourage a patient from continuing dialysis, especially since many of these side effects can be controlled.

Emotional Effects of Kidney Dialysis

Coping with kidney failure isn't just about managing the physical symptoms with treatment. It is a major life change that can cause a great deal of stress and can give rise to a range of emotional reactions:

Anxiety Depression Anger or a feeling of frustration about the illness Sexual problems

Taking care of your emotional well-being is just as important as looking after your health. Please do not be afraid of discussing emotional or sexual problems with your healthcare team. They will be familiar with the kind of problems you may encounter and will be supportive. They may also be able to offer practical solutions to some of your difficulties.

Coming to Terms with  the Diagnosis

People who are diagnosed with kidney failure are confronted with a range of emotions. Different people react in different ways. Even so, there is a pattern to the way that most people react.

It may help to know about the emotional stages that patients may go through:

• Shock: Often, newly diagnosed patients (and sometimes their family members) go into a state of shock. This is the feeling that life is going on around you but you are not really involved.
  
• Grief: People may feel overwhelmed by grief and loss, as if they have been bereaved. They may feel helpless and have difficulty thinking clearly or dealing with day to day life.
  
• Denial: It's common for people to decide, at this stage, that they "won't think about it." This denial that the disease exists is like a "defense mechanism" that can help patients escape from feeling overwhelmed until they are more able to cope.
  
• Acceptance: Gradually, reality of kidney failure is acknowledged, and people begin to be able to think about the implications and the changes that need to be made. At this point of acceptance, they begin to adjust successfully to their condition.

Stress
One of the main causes of stress is change. All human beings find change stressful - even change that we are looking forward to, like moving house, raises our stress levels.

As a person with renal failure you will have to deal with more change than most people do. Not just the initial change of lifestyle that comes with the diagnosis, but ongoing change as you deal with alterations to your diet, medication and forms of treatment.

All these changes will mean you have to take in a great deal of new information, make decisions, learn new practical skills. You also have to adjust to new ways of doing things, to doing less than you would like to, and to asking for help... This is all extremely stressful - and it comes in addition to coping with the physical effects of kidney failure.

Different people react differently to stress - some get anxious or feel overwhelmed, others may get irritable or hostile, others may deny there is a problem and keep pushing themselves to "cope."

The best way of coping with stress is to recognize that it can be a problem in its own right and that if you are suffering from it, it is with good reason. Accept that you need to actively take time to "de-stress". There are many ways of doing so and they can all contribute to helping you cope with kidney failure.

There are a number of ways of dealing with stress:

• Talking to someone who understands
  
• Doing an activity that you enjoy
  
• Relaxing, perhaps by listening to music
  
• Doing some physical activity (within safe limits)
  
• Take a short break, a day off or a vacation

Anxiety
This can be a specific "worry" related to something in particular, or a more general sense of "being on edge" or "not feeling safe."

Specific anxieties that renal patients may have include:

• Worries about how the illness will affect your relationships,
• Your ability to work,
• Your finances
• Your quality of life
• You may also be anxious about understanding your condition or managing your treatment.

Ways of reducing anxiety include:

• To see if there is something practical you could do to help you feel better. Make that appointment to see the doctor/dietitian/social worker/counsellor about what is worrying you. Ask a nurse about that part of the procedure you don't understand.There will of course be things that worry you that you can do nothing practical about. Most patients will say, however, that they find it helpful simply to talk about their worries to people who understand. Whether it's another patient, a nurse, a family member or a counselor, don't keep yourself alone with your anxiety.
• Generalized anxiety is just as difficult to live with as anxiety that has an obvious cause.
• Feeling generally "unsafe" may have something to do with a sense of "having no control" over your own body and life.
• Many patients find that they can regain a sense of control by learning as much as they can about kidney failure and its treatment. Becoming an "expert" enables them to participate more actively in making decisions and to feel that they are working with the medical staff to control the condition rather than being passive.
• Other people find that setting reasonable goals for themselves, such as going out, exercising, or keeping up certain activities - and achieving them - gives them a feeling of control.

Depression
Like anyone else, you will have times when you feel a bit down and less able to cope with life in general. You may also feel sad and "need a good cry" sometimes. If, however, the sadness turns into a real sense of despair that goes on for some time, this is depression.

You may feel depressed because you are having difficulty coming to terms with some of the changes their condition is imposing on you.

These changes might include:

• The loss of your previous lifestyle
• The loss of independence and self-confidence
• The changes to your body and appearance
• Difficulties with sex or with having children
• Awareness of your own mortality

If you are feeling depressed it may help you feel less isolated if you talk to others who understand. This may be one of the renal unit nurses, the renal social worker, a counselor or even a good friend. Sometimes a short course of anti-depressant medication may be useful to get over these acute problems.

Anger
It seems quite appropriate for people who are going through these experiences to feel angry at times. It can even be energizing, sometimes, to feel angry.

Where problems arise, however, is if you get "locked into" your anger in a way which makes you unhappy and you can't seem to move through it into some degree of acceptance.

Anger is also a problem when it is expressed in destructive or self-destructive ways - when the feelings of anger and frustration lead to rebellion against diet and fluid restrictions, for example, or to aggressive behavior towards friends, relatives and staff. When people are angry, they may tend to "push away" the people who want to support them.

Anger expressed in these ways is self-destructive because it puts your health at risk, and - on an emotional level - leaves you feeling even more isolated.

It can feel like the hardest thing in the world to reach out for support when you are feeling angry. Paradoxically, it may be the one thing you can do to regain a real sense of power and control in your life. 

Sexual Problems
Some kidney patients never have sexual problems, but many do.

The reasons for these problems may include:

• Hormonal problems: The hormones that control sexual urges may be too high or too low.
• Medication: Some of the medication prescribed to renal patients may inhibit sexual desire.
• Tiredness: This can be caused by anemia or by not having dialysis sufficiently.
• Emotional factors: When people feel stressed, depressed or anxious, they often do not feel like having sex.
• Relationship difficulties: The stress of kidney failure on a relationship may affect the couple's sex life.

Sexual problems in men
Impotence (the inability to get or maintain an erection) may be a problem in male kidney patients.

There are various approaches to treating impotence. Initially, doctors will look at possible causes such as anemia, under-dialysis and medication, and consider the treatments for them. There are physical treatments for impotence that can be considered including physical techniques and drugs.

Sexual problems in women
When women patients experience a lack of sexual desire or inability to have orgasms, causes related to anemia, under-dialysis and medication can be investigated.

There may be changes in the menstrual cycle and there is no doubt that the chances of getting pregnant if the kidneys have failed are much reduced. If kidney function is only mildly impaired and the blood pressure is under control before and during pregnancy, it is likely that pregnancy will progress as normal, but there will be a close liaison between the kidney doctor and the obstetrician. Some drugs particularly ACE inhibitors will need to stop before pregnancy and the blood pressure will be checked very carefully.

If you want to know more about the effects of kidney failure on pregnancy then speak to your doctor. And discuss any changes in your periods so that things can be checked out.