Category Archives: Kidney & Urinary System

Women’s Health – Week 36: Pelvic Floor Disorders

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tacuin womenFrom the Office of Research on Women’s Health

The term pelvic floor refers to the group of muscles and connective tissue that form a sling or hammock across the opening of a woman’s pelvis.

These muscles and tissues keep all of your pelvic organs in place so that the organs can function correctly.

A pelvic floor disorder occurs when your pelvic muscles and connective tissue in the pelvis is weak due to factors such as genetics, injury, or aging. Continue reading

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Women’s Health — Week 30: Urinary Incontinence

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tacuin womenFrom the Office of Research on Women’s Health

Urinary incontinence, or loss of bladder control, can range from mild leaking to uncontrollable wetting.

For some women, the risk of public embarrassment prevents them from enjoying many activities with their family and friends.

Urine loss can also occur during sexual activity and cause tremendous emotional distress. Under a health care provider’s care, incontinence can be treated and often cured.  Continue reading

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Check your blood pressure, give your contact info away

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By April Dembosky, KQED

Health insurance companies are on the prowl for more customers. There are still three months to go for people to enroll in health plans under the Affordable Care Act, but insurers don’t want to rely solely on state or federal websites to find them.

solohealthSome are finding a path to new customers by partnering with companies that operate health-screening kiosks –- those machines in supermarkets and drug stores where people check their blood pressure or weight.

One of these kiosks sits in aisle 10 of a Safeway grocery store in a city near San Francisco. Sitting down at the machine is like slipping into the cockpit of a 1980s arcade game. Continue reading

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Women’s Health – Week 17: Complications of Diabetes

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From the Office of Research on Women’s Health

Complications of diabetes

If you have diabetes, you may be at greater risk for many serious health problems. But if you follow your treatment plan and make lifestyle changes, you may be able to prevent or delay serious health problems. Some common complications of diabetes are below.

Eye disease

Damage to the eyes can lead to severe vision loss or even blindness. Eye problems may include:

  • Retinopathy: damage to the blood vessels in the retina. Diabetic retinopathy gets worse with time. You may not notice vision changes at first. Timely treatment and follow-up care help prevent serious vision loss. Diabetic retinopathy usually affects both eyes and is a leading cause of blindness in adults.
  • Cataract: clouding of the eye’s lens. Cataracts develop at an earlier age in people with diabetes.
  • Glaucoma: increase in fluid pressure inside the eye, which leads to optic nerve damage and loss of vision. A person with diabetes is nearly twice as likely to get glaucoma as other adults.

Kidney failure

Diabetes is the most common cause of chronic kidney disease (CKD) and kidney failure, though most people with diabetes do not develop CKD that is severe enough to progress to kidney failure.

People with kidney failure undergo dialysis, an artificial blood-cleaning process, ortransplantation to receive a healthy kidney from a donor.

Researchers have found that high blood pressure and high levels of blood sugar increase the risk that a person with diabetes will develop kidney failure. Controlling your blood pressure and blood sugar may reduce your risk.

Nerve disease

Diabetes can cause serious nerve problems, or neuropathies. People with diabetes can develop nerve damage throughout their body. Some people with nerve damage have no symptoms. Others may experience pain, tingling, or numbness – loss of feeling – in the hands, arms, feet, and legs. Nerve problems can occur in every organ system, including the digestive tract, heart, and sex organs. People with diabetes can develop nerve problems at any time, but risk rises with age and the longer a person has diabetes. Neuropathies also appear to be more common in people who have problems controlling their blood sugar as well as those who are overweight or who have high blood pressure or high levels of blood fat.

Foot ulcers and amputations

People with diabetes need to take special care of their feet. The nerves to the feet, the longest in the body, are most often affected in diabetes. Loss of sensation in the feet means that sores or injuries may go unnoticed and may become ulcerated or infected.

Circulation problems also increase the risk of foot ulcers. More than half of all lower-limb amputations in the United States occur in people with diabetes – 86,000 amputations per year.

Health care providers estimate that nearly half of the amputations caused by neuropathy and poor circulation could have been prevented by careful foot care.

Periodontal disease

People with diabetes are at higher risk for developing infections, including periodontal, or gum disease. For more information on dental health, please see Week 13.

For more information: www.ndep.nih.gov

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Kidney Health Fest for African American Families – June 22nd

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Northwest Kidney Center LogoOn Saturday, June 22, 2013, Northwest Kidney Centers will hold its 11th annual Kidney Health Fest for African American Families, featuring free health screenings, education, entertainment and healthy food made by local celebrity chefs.

The free event runs from 9 a.m. to 2 p.m. at Van Asselt Elementary (formerly the African American Academy), 8311 Beacon Ave. S., in Seattle, on Metro bus line 106. About 750 people attended last year.

Free health screenings. From 9 a.m. to 1 p.m., participants can receive a free kidney health screening and private consultation with a doctor about the results.

The screening includes a finger stick for a blood sample, urinalysis, blood pressure and weight check. Diabetes, high blood pressure and obesity all contribute to the current epidemic of kidney disease.

Educational presentations. A health education program from 10 a.m. to noon will be hosted by Chris B. Bennett, publisher ofThe Seattle Medium newspaper and talk show host on KRIZ/KYIZ/KZIZ Radio.

Dr. Jonathan Himmelfarb, director of the Kidney Research Institute in Seattle, will be among the speakers. Himmelfarb is an international authority who can explain up-to-the-minute science in terms lay people can understand.

He will talk about the reasons why kidney disease is more common in African Americans than in Caucasians, and the latest thinking about ways to prevent and treat it.

Healthy, tasty lunch. At noon, noted local chefs will serve a free lunch. Donating their services are Jemil Johnson of Jemil’s Big Easy, Mulugeta Abate of Pan Africa, Theo Martin of Island Soul, Anthony Davis of AMD’s Catering, and Kristi Brown-Wokoma of That Brown Girl Catering.

Entertainment. The award-winning Pacific Northwest Drumline Association will kick off the day, and the energy will stay high with performances by electric fusion band Comfort Food, rapper Willa Scrilla, singers and musicians from the NAACP ACT-SO program, spoken word artists, the Liberation United Church of Christ choir, and more.

Special activities for children include an obstacle course and a visit from the Black Firefighters Association truck.

Focus on fitness. Edna Daigre from Ewajo Center, Ajene Bomani-Robertson from the Austin Foundation, and Jannine Young from Core Power Yoga will speak and get the audience moving with fitness demonstrations.

This year’s Fest is dedicated to the memory of Willie Austin, former University of Washington football player and power lifting champion. His Austin Foundation provides youth with vital access to fitness and nutrition. A regular and popular presenter at the Fest, he died unexpectedly April 24,2013.

Local churches are co-hosts, providing volunteers and encouraging attendance. They include Damascus Baptist, First AME, Freedom Church of Seattle, Goodwill Missionary Baptist, Immaculate Conception, Liberation United Church of Christ, Madison Park Church of Christ, Mt. Zion Baptist, New Beginnings Christian Fellowship, New Hope Missionary Baptist, Pentecostal Covenant Church, Southside Church of Christ, St. Mary’s, Tabernacle Missionary Baptist, and Walker Chapel AME.

Community partner organizations. More than 30 exhibitors will be on hand to share resources for healthy living.

“Everyone is welcome to attend the Fest, have fun and learn about kidney disease and healthy living – and it’s completely free!” said Dr. Bessie Young, a Seattle kidney specialist who has chaired the community organizing committee since the Fest began. “Bring your friends and family and make a day of it. People of every age can have fun while they learn how to keep their families healthy.”

One in seven American adults has kidney disease. In the African American community, the number increases four-fold. Although African Americans make up 12 percent of the U.S. population, 35 percent of individuals with kidney failure on dialysis are African American. In addition, African American men are 10 to 14 times more likely to develop kidney failure due to high blood pressure than Caucasian men in the same age group.

Participants in the Kidney Health Fest will learn how to improve their lives to avoid kidney disease. This includes:

  • Treating high blood pressure and diabetes, two of the leading causes of kidney failure.
  • Quitting smoking.
  • Reducing added salt and processed, packaged and fast food.
  • Eating healthy to avoid obesity.
  • Exercising at least 30 minutes a day, five days a week.
  • Avoiding the overuse of pain relievers such as ibuprofen and naproxen, which can damage kidneys.

For more information about the event or to pre-register, visit www.nwkidney.org/fest. The Twitter hashtag for the Fest is #healthfest.

 

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Americans living longer but less healthy lives, UW-led research finds

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Change in leading cause of death in high-income North America 1990-2010

Americans are living longer lives, but we are living out these longer lives with chronic illnesses in large part due to our lifestyle choices, including eating unhealthy diets, failing to exercise, smoking, and using alcohol and drugs, according to research led by researchers at the University of Washington.

In the analysis, the researchers looked the causes of death and disability in 187 countries around the world. The study was led by the University of Washington’s Institute for Health Metrics and Evaluation (IHME) and funded by the Bill & Melinda Gates Foundation.

A live webcast will be held tomorrow, March 5 from 9 am to 10:30 am PST, in which Microsoft founder Bill Gates, UW President Michael Young, and and IHME Director Dr. Chris Murray help launch a new suite of online data visualization tools.

The webcast can be viewed at http://www.healthmetricsandevaluation.org/gbd/live.

Researchers from more than 303 institutions and 50 countries contributed to the project, called the Global Burden of Diseases, Injuries, and Risk Factors Study 2010.

US: a “mixed picture”

Analysis of the US health data revealed a “mixed picture” the researchers said: we are living longer but many of us are not enjoying a healthy old age.

The average life expectancy of American women, for example, increased from 78.6 years in 1990 to 80.5 years in 2010, yet only 69.5 of those 80.5 years were lived in good health.

The picture was the same for American men who in 2010 lived, on average, to be 75.9 years old – up from 71.7 in 1990 – but only 66.2 of those years are healthy.

Most of the illness and death in the US is caused by relatively few conditions. The top causes of death and disability were ischemic heart disease, followed by chronic obstructive pulmonary disease, low back pain, lung cancer, and major depressive disorders.

The analysis also found that the leading causes of death had changed over the past 20 years. Over those two decades,

  • ischemic heart disease, stroke, and lung cancer remained the top three causes of death;
  • chronic obstructive pulmonary disease, lower respiratory infection, and colorectal and breast cancers had moved down;
  • and diseases like diabetes, chronic kidney disease, and Alzheimer’s disease moved up.

US: Lagging behind

The study found that the US also lagged behind many wealthy and middle-income countries with Americans living shorter lives — and shorter healthy lives — than the residents of many other nations.

For example, men in 39 other countries – including Greece, Lebanon, and South Korea – live longer, and men in 30 other countries – such as Costa Rica, New Zealand, and Portugal – enjoy more years of good health.

American women fare about the same; in terms of life expectancy they are ranked 36th in the world, and in terms of healthy life expectancy they are ranked 35th, the analysis found.

We are doing so poorly because of our lifestyle choices:

  • The number one culprit: a diet that puts us at risk for such obesity-related illnesses such as heart disease and diabetes.
  • Number two: smoking, which leads to lung cancer, chronic obstructive pulmonary disorder, heart disease and stroke.

To learn more:

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Seattle’s contribution to kidney-failure research reflected in one woman’s story

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Nancy Spaeth at the Northwest Kidney Centers new museum explaining how this vintage dialysis machine worked when she used it in the 1960s / Photo Credit: Mali Main

By Mali Main

In 1959, Nancy Spaeth suddenly felt too tired to brush her own hair. The 12-year-old also noticed that her urine had turned a murky, mud color. Her doctor told her she had Bright’s disease, now called glomerulonephritis.

But no one told her that she had chronic kidney failure, that her kidneys were slowly deteriorating inside her, or that there was no known effective treatment.

“It was the custom in those days not to tell the patient what was going on,” recalls Spaeth, now a semi-retired nurse and teacher and grandmother of two.

It took seven years for her kidneys to completely shut down. “Kidney disease is insidious,” Spaeth says. By that time, Spaeth was a freshman at the University of Arizona. She lost her appetite, and the food she did eat would not stay down. She threw up her breakfast in the plants outside her early morning physics class. By the time the doctors sent her home to Seattle she weighed 88 pounds.

Fortunately, Spaeth returned home just when researchers in Seattle were making advances in kidney dialysis that would revolutionize the treatment of kidney failure. Many of those advances were made by researchers working at the Seattle Artificial Kidney Center, the world’s first artificial kidney clinic. The center, now known as the Northwest Kidney Centers, commemorates its 50th anniversary this year.

Spaeth would be among the first patients to be treated at the new center, and, today, she is one of the longest living chronic kidney failure patients in the world, says Christopher Blagg, former executive director of the Northwest Kidney Centers, a retired nephrologist who is writing a book on the history of the center. “She’s probably the only one who’s had every possible treatment during the course of their illness,” he adds.

Spaeth’s physician, Belding Scribner, wanted her on dialysis. Scribner had helped found the Seattle Artificial Kidney Center, but dialysis was an expensive, lifelong treatment and the Center could not accommodate more than a dozen or so patients at a time.

The Center set rigid medical guidelines for patient selection: well-adjusted adults between the ages of 18 and 45 whose kidney disease was uncomplicated by additional health problems.

But with more applicants to the Center than they could treat, anyone who wanted treatment also had to be approved by the anonymous seven-member Admissions and Policy Committee appointed by the King County Medical Society.

Spaeth, standing in the new dialysis museum at the Northwest Kidney Centers’ 700 Broadway, clinic points at a photograph on the wall. It’s a silhouette of a woman and six men sitting behind a long table, their faces obscured by shadow.

“We called them the Life & Death Committee,” Spaeth says. “They were supposed to be unbiased. But Dr. Scribner told me, years later, that he was sometimes able to get his two cents in.”

The Committee considered a variety of factors in making its life and death decision, including the applicant’s profession, whom they might leave behind and whether those left behind would be well-provided for or become a social burden.

Life Magazine and an NBC news documentary publicized their activities, inspiring the field of bioethics.

The committee sent a social worker to interview Spaeth’s family. Spaeth went through two days of psychological testing – during which she remembers they asked multiple variations of the question “Do you love your mother and father?” – before she was approved for dialysis treatment, which she began in 1966.

The Shunt

Spaeth pulls back her sleeve. Her arm is a tangle of scars from the wrist to the elbow. The divot on the inside of her left wrist is the 46-year old scar from the device that changed chronic kidney disease from a deadly illness to a treatable one: the Scribner shunt, an apparatus developed by her physician.

The scars on Nancy Spaeth’s forearm tell the evolution of dialysis technologies, how the techniques for coaxing blood from the arteries has changed over time / Photo Credit: Mali Main

The scars on Nancy Spaeth’s forearm tell the evolution of dialysis technologies, how the techniques for coaxing blood from the arteries has changed over time / Photo Credit: Mali Main

Blagg explains that before 1960 dialysis was only used to treat patients with acute, meaning temporary, kidney failure. Patients had to undergo surgery to be attached to the machine, a process that could only be done a few times. “If they had chronic kidney failure we would stop treatment there and the patient would go home and die,” Blagg says.

The shunt was a semi-permanent installation in the patient’s forearm made of three Teflon tubes.

One was inserted in an artery and the other into a vein, they were connected by a third u-shaped tube. During dialysis this u-shaped tube was removed so the arterial and venous tubes could connect to the artificial kidney.

“It didn’t hurt,” says Spaeth, “Not really. But it got infected a lot.” So she kept her shunt-embedded forearm wrapped in white gauze during the day while she studied for her BA in Education at Seattle University.

Then three nights a week she walked the three blocks to the Center, where the nurses unwrapped her shunt, unscrewed the u-shaped end piece, and connected her to the artificial kidney next to her bed.

While she slept, the device filtered excess salt and fluid from her blood and cleansed it of harmful wastes. In the morning, she would be disconnected and go back to school.

By 1968, Spaeth was able to have her dialysis done at home. She spent the summer of that year at the Coach House, an old motel near the campus where the University of Washington had set up a home-dialysis training program.

Nancy Spaeth on home dialysis, 1968 / Photo courtesy of Nancy Spaeth

Nancy Spaeth on home dialysis, 1968 / Photo courtesy of Nancy Spaeth

“I was always willing to try anything [the Center] was doing,” Spaeth says. “I learned how to run the machine, take it apart, clean it, and put it back together.”

Spaeth pulls back her sleeve further and slides her watch down to her palm. The scars tell the story of the changes in dialysis technology.

The different techniques for coaxing blood from her arteries is evident in the puffy overlapping grafts and the white sinusoidal scar near the soft bend in her elbow.

Transplantation:

In 1972, Spaeth had a renal transplant, a gift from her younger brother, Charlie. “He came home from Stanford on his spring break, gave me a kidney and went back to school.”

Charlie’s kidney lasted seven years. Enough time for Spaeth to get married and have two children, a boy and a girl.

Then in 1979, she contracted an infection that caused her to lose the transplant. Her next three transplants were from strangers: a young woman who fell from the ladder of a fishing barge in Alaska, a motorcyclist who died in an accident in Bellevue, and in 2000, she received the kidney she still has today. “It was from a man who was in a car accident near Spokane,” she says.

Peritoneal Dialysis

Sometime between her third and fourth kidney transplant, Spaeth was able to try another kind of dialysis, called peritoneal dialysis, that freed her from the machine. Instead the dialysis fluid, the dialysate, runs into the abdominal cavity through a catheter implanted in her abdominal wall.

To begin the process, she only had to have a place to hang the bag of dialysate. Once connected to the catheter, the fluid from the bag would flow into her abdomen, where the water, salts and wastes would be exchanged through a thin sheet of cells, called the peritoneal lining. When it was time to drain the dialysate, she set the bag on the floor and the fluid would run out.

She lifts her shirt and points to the pinch of flesh on her lower abdomen where the catheter was installed when she switched to peritoneal dialysis. “I liked it,” she says. “It gave me a huge amount of freedom.”

“I could travel, I could do it on the airplanes,” says Spaeth. “I would just find a restaurant in the airport and they would warm [the bag of dialysate] in the microwave for me.”

“I could do it in my brother’s kitchen,” she says with a laugh. “Just hang the bag from a knob on the cabinet and sit there and have a glass of wine.

Drug trials

In the late 1980s, after Spaeth lost her second transplant, she volunteered to be part of a clinical trial of a drug that changed the lives of kidney disease patients.

She and an architect friend had just finished building her new three-story house next to a gully on Mercer Island. “I was extremely anemic,” she says. “I was crawling on my hands and knees up the stairs in that house,” she explains.

Healthy kidneys, in addition to filtering waste from the blood, also secrete the hormone erythropoietin, EPO for short.

The Northwest Kidney Centers' new Haviland Pavilion clinic at 700 Broadway houses a museum and gallery that showcase advances in kidney disease treatment.

The Northwest Kidney Centers’ new Haviland Pavilion clinic at 700 Broadway houses a museum and gallery that showcase Seattle’s contributions to kidney disease research.

“It regulates how many red blood cells we have, and therefore, how much hemoglobin we have,” says Stuart Shankland, who heads the Division of Nephrology at the University of Washington. Hemoglobin colors blood red and infuses the organs with oxygen. “So when a kidney fails, it stops making EPO and you get anemic.”

Without hemoglobin, Spaeth’s cells and tissues were essentially being starved of oxygen.

The pharmaceutical company Amgen chose the late Joseph Eschbach, a senior research advisor at the Northwest Kidney Centers, to run the first human trials of their synthetic EPO.

“Dr. Eschbach had worked on anemia in patients with kidney failure since 1963,” says Blagg. “He was Mr. EPO at that time.”

The Food and Drug Administration approved EPOGEN in 1989. “It was a miracle,” says Spaeth. “After a few weeks, I could run up those stairs.”

Today

Today, Spaeth serves on the board of the Northwest Kidney Centers and travels around the country telling about her experience to the dialysis community. Lyle Smith, continuing education director at the Board of Nephrology Examiners Nursing and Technology, who has arranged for her to speak at professional conferences, says Spaeth is an inspiring speaker.

“In dialysis, we see so many patients who are devastated,” says Smith. “Nancy’s story gives staff hope that their patients can succeed.”

 Mali Main is studying Journalism and Quantitative Science at the University of Washington. She is the Newsletter Intern at the Division of Occupational Therapy in the UW Department of Rehabilitation Medicine and works as the Development Assistant at the St. James ESL Program. She has also covered art, astrophysics and healthcare reform.

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Northwest Kidney Centers opens extensively remodeled facility at 700 Broadway

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Northwest Kidney Centers has completed an extensive remodel its facility at 700 Broadway.

The $8 million remodel of the building, known as Haviland Pavilion, includes:

  • An updated 15-station dialysis clinic.
  • Surge capacity for emergency dialysis in case a disaster makes services impossible at another dialysis facility in the region.
  • An expanded pharmacy that serves the special needs of people with chronic kidney disease, on dialysis or with a kidney transplant. Compared to the old pharmacy, capacity is now tripled.
  • A clinical research center to allow Kidney Research Institute investigators to work with Northwest Kidney Centers patients on studies and advance research.
  • New space and increased capacity for physician and clinical staff training and community and patient education, including a demonstration kitchen to show patients and their families to prepare tasty, healthy food.
  • A museum and gallery that showcase important artifacts of the medical history made at Northwest Kidney Centers.

Northwest Kidney Centers purchased the 40,000-square-foot building in 1978. The building is named for Dr. James Haviland, a founding father of Northwest Kidney Centers.

Dr. Haviland was president of the King County Medical Society in the early 1960s, at the time Dr. Belding Scribner at the University of Washington was developing technology to enable people to live indefinitely with kidney failure.

The two are credited with marshaling the community resources to create the world’s first dialysis organization 50 years ago.

The facility, which provides dialysis for some of Northwest Kidney Centers’ poorest and most at-risk patients, is one of three dialysis facilities on First Hill. The other two are located at 548 15th Ave. and at 600 Broadway.

$1.7 million of the $8 million construction cost was raised via Northwest Kidney Centers’ Transforming 700 Broadway capital campaign. More than 100 donors made gifts to the campaign

Northwest Kidney Centers provides 234,000 treatments per year to nearly 1,500 patients in its 14 dialysis centers, in 11 hospitals and in homes.

It is the largest provider of dialysis services in King and Clallam counties, and it offers one of the largest home hemodialysis programs in the United States.

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The ups & downs of blood pressure

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Anusha Iyer, MD

By Anusha Iyer, MD
Valley Medical Center Fairwood Clinic

Is my blood pressure high?

I get asked this question time and again: what is considered normal blood pressure and what is high?

Generally speaking, in healthy adults a normal blood pressure (BP) is less than 120 systolic (the pressure on the arteries as the heart contracts (squeezes)), and less than 90 diastolic (the pressure on the vessels as the heart relaxes).

In common terms this BP would be expressed as 120 over 90. We call it high blood pressure or hypertension if the BP is greater than 140 systolic and greater than 90 diastolic.

What causes high blood pressure?

Genetics plays an important role. Obesity, weight gain, excessive alcohol use, high cholesterol, excessive use of salt (sodium), not enough activity and a sedentary lifestyle, and type A or having an aggressive personality have all been linked to high blood pressure.

Medications such as oral contraceptive pills, certain cold remedies, anti-inflammatory drugs and many other common medications can increase blood pressure.

Also certain medical conditions such as kidney disease, thyroid and adrenal gland disorders, and sleep apnea can lead to secondary hypertension.

Why is knowing my blood pressure important?

High blood pressure is a major risk factor for heart disease and stroke. Also, untreated hypertension can lead to damage to the eyes and kidneys.

What should I do if my blood pressure is high?

Eat less salt. Most patients don’t realize the high salt content of common foods like certain types of breads and canned soups. Be sure to read labels and choose items with lower sodium content.

Eat more servings of vegetables and fruits. Limit the amount of alcohol you consume. Try to get some cardio-exercise into your weekly schedule. And try to decrease your stress level. (Yeah right! That’s easier said than done!)

If you can you set aside 15 minutes in your day here is a simple meditation exercise to relax your mind and reduce your stress: sit in a quiet place, close your eyes and take slow deep breaths in and out; meditate on peace (choose a person, place or object that makes you feel calm and happy).

I believe that a peaceful and strong internal environment is as essential to a woman’s survival and success as is her external environment.

Keep track of your BP numbers and follow your doctor’s recommendations. You can check your BP with your own blood pressure cuff if you have one, or you can check it by using the free automatic blood pressure monitor available at many large pharmacies. Write down your numbers in a log book and show it to your doctor when you go for your appointment.

Discuss your blood pressure goals with your doctor and write it down. If you are taking medication to lower your BP, don’t forget to take your medication and report any side effects or concerns to your doctor.

Almost 30% of the US population is reported to have high blood pressure. Take control of your blood pressure and work towards a healthier you by adopting healthy habits and setting the right goals.

Dr. Iyer is a Internal Medicine physician in VMC’s Kent Clinic, located at 24920 104th Ave SE in Kent. Phone: 253.395.2000.

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What you need to know about your kidneys, chronic kidney disease and its prevention

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By Vilma Quijada, MD
Valley Medical Center, Nephrology Services

The incidence of chronic kidney disease (CKD) in our country has increased significantly over the past 20 years.

In analyzing national data from NHANES (National Health and Nutritional Examination Survey), the Centers for Disease Control (CDC) indicates that 16.4% of the population age 20 years and older have this condition.

The incidence of obesity and diabetes has also increased in what seems to be epidemic proportions during this same period. Is there a connection?

First: What is the function of our kidneys?

Before I discuss CKD it’s important to understand what our kidneys do in our bodies. You might know that kidneys filter waste products and excess fluid out of our blood and eliminate them as urine.

What you probably don’t know is that our kidneys filter 172 liters (over 45 gallons) of blood each day. Our bodies contain about 5 liters (1.3 gallons) of blood that circulates through the kidneys at a rate of 120 ml (about ½ cup) per minute.

Another important function of the kidneys is they help to regulate our electrolyte* levels by filtering out excess minerals and keeping a very tight balance of the most important ones, including potassium and sodium.

In addition, the kidneys produce several very important hormones, including erythropoietin (also called EPO), that stimulate your bone marrow to produce red blood cells** and calcitriol, the most active form of vitamin D.

What is chronic kidney disease and what causes it?

When our kidneys become damaged as a consequence of chronic inflammation, infections, exposure to toxins, excessive use of non-steroidal anti-inflammatory drugs (over the counter pain medications), illicit drug use, or from a genetic condition, we call this chronic kidney disease.

The two most prevalent causes of CKD are thought to be diabetes (Type I and Type II) and high blood pressure. CKD can also be a strong indicator of vascular disease.

It has been reported that amongst people with kidney disease, it’s likely that more than 80% may die of serious complications such as stroke or heart attack without even knowing their kidneys are damaged.

This is unfortunate because the diagnosis is relatively simple:  A blood test for creatinine (a naturally occurring substance in our blood) and a urine test to detect proteins is all that is needed to evaluate the presence and severity of kidney disease.

You’ve been diagnosed with chronic kidney disease – how can you prevent its progression?

When faced with a diagnosis of CKD, people often and understandably feel overwhelmed because it can lead to end-stage renal failure requiring dialysis or a kidney transplant for the patient to survive.

But it’s very important to remember that there are ways to prevent the progression of CKD once an initial diagnosis has been made:

  • Maintain a healthy weight to avoid obesity-related diabetes (Type II)
  • Treat hypertension (high blood pressure)
  • Avoid cigarette smoking
  • Avoid excessive use of anti-inflammatory drugs (over-the-counter drugs with analgesic and fever-reducing effects such as aspirin, ibuprofen and naproxen)
  • Avoid excessive use of alcohol
  • Avoid using illicit drugs
  • Keep your cholesterol low
  • Stay physically active and well hydrated

It’s important to note that no matter what stage your CKD has progressed to, short of renal failure, these simple preventive steps can help significantly.

Genetic kidney disease

Some causes of CKD, such as genetic or familial causes, we unfortunately cannot control. However, keeping healthy habits will make a big difference between a rapid or slow decline of kidney function.

If you have a family history of kidney disease, diabetes or hypertension, consult with your doctor. They can order tests that will gauge whether or not you have healthy kidneys. Use this information as a platform to educate yourself and to take charge of the long-term health of your kidneys.

*Electrolytes are essential minerals in your body that are necessary for nerve and muscle function, the body-fluid balance, and other critical processes.

**A single drop of blood contains millions of red blood cells which are constantly traveling through your body delivering oxygen and removing waste. Without red blood cells performing this function, your body would slowly die. 

About Dr. Quijada

Dr. Vilma Quijada is board certified in both Nephrology and Internal Medicine, and practices in VMC’s Nephrology Clinic in Kent (nephrology concerns the diagnosis and treatment of kidney diseases). She is also the Medical Director of the Renton Kidney Center. Originally from Panama, Dr. Quijada graduated from the University of Panama in 1977 and has been practicing in Nephrology since 1983. When she came to the U.S. in the late 1980s she trained in Internal Medicine and Nephrology at Georgetown University in Washington DC. Dr. Quijada is a Fellow of the American Society of Nephrology (FASN) and also holds “Hypertension Specialist” certification from the American Society of Hypertension. Passionate about helping people, Dr. Quijada truly loves educating her patients in a way that is meaningful to them. Married with two children and one grand-daughter that she is crazy about, Dr. Quijada enjoys hiking, sailing, and reading mysteries. And, she says, “I just love the rain.”

Nephrology Services is located at 24920 104th Ave SE in Kent. Phone: 425.227.0231

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Dr. Ruth McDonald

Ruth McDonald has been appointed pediatrician-in-chief at Seattle Children’s

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Dr. Ruth McDonald has been appointed pediatrician-in-chief at Seattle Children’s Hospital.

Dr. McDonald, a pediatric nephrologist, has been with Seattle Children’s for 19 years, most recently as medical director of Ambulatory Services where she focused on improving communications and aligning hospital and clinic needs with the needs of referring physicians.

Continuing to enhance such communications will become part of Dr. McDonald’s responsibilities in her new pediatrician-in-chief role, hospital officials said.

Dr. McDonald is also an at-large member of the Children’s University Medical Group Board of Directors and chairs the group’s Clinical Practice Committee.

Dr. McDonald also serves as principal investigator in many multicenter research studies on pediatric renal transplantation. Additionally, she serves on the pediatric nephrology sub-board of the American Board of Pediatrics.

Dr. Mark Del Beccaro, former pediatrician-in-chief, has moved into his new position as vice president of medical affairs at Seattle Children’s.

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Diagram showing how a donated kidney is implanted in the human body

Living kidney donation: Free seminar, April 24

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Diagram showing how a donated kidney is implanted in the human bodySeminar Living Kidney Donation April 24 at First Hill Campus

A free educational seminar about living kidney donation will be held Tuesday, April 24 from 6:30-8:30 p.m. in Glaser Auditorium on Swedish Medical Center’s First Hill campus (747 Broadway, first floor).

At the two-hour seminar Swedish Organ Transplant’s living kidney donor team will talk about the living kidney donor process.

Speakers will include:

  • Phillip Chapman, M.D. – Living kidney donor surgeon
  • Nelson Goes, M.D. – Nephrologist
  • Diane Gould, R.N. – Living donor clinical transplant coordinator
  • Kathy Otis, M.S.W. – Medical social worker
  • A living donor
  • Moderator Marquis Hart, M.D. – Organ transplant surgeon and medical director of Swedish Organ Transplant

After the team members speak, a panel of two or three living kidney donors will discuss their personal experience with being a living donor, followed by a question-and-answer period.

Light refreshments will be served.

Registration for this free seminar is required.

To RSVP, contact Dwayne Biles at 206-215-2913 or via dwayne.biles@swedish.org.

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pizza

10 foods account for 40% of salt in your diet

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Nine in 10 U.S. adults get too much sodium every day

Main sources of sodium include many common foods

From the CDC

Nearly all Americans consume much more sodium than they should, according to a report from the Centers for Disease Control and Prevention.  Most of the sodium comes from common restaurant or grocery store items.

The latest Vital Signs report finds that 10 types of foods are responsible for more than 40 percent of people’s sodium intake.

The most common sources are breads and rolls, luncheon meat such as deli ham or turkey, pizza, poultry, soups, cheeseburgers and other sandwiches, cheese, pasta dishes, meat dishes such as meat loaf, and snack foods such as potato chips, pretzels and popcorn.

Some foods that are consumed several times a day, such as bread, add up to a lot of sodium even though each serving is not high in sodium.

“Too much sodium raises blood pressure, which is a major risk factor for heart disease and stroke,” said CDC Director Thomas R. Frieden, M.D., M.P.H. “These diseases kill more than 800,000 Americans each year and contribute an estimated $273 billion in health care costs.”

The report notes that the average person consumes about 3,300 milligrams of sodium per day, not including any salt added at the table, which is more than twice the recommended limit for about half of Americans and 6 of every 10 adults.

Top Sources of Sodium in Our Diet

  • Breads and rolls
  • Cold cuts and cured meats
  • Pizza
  • Poultry
  • Soups
  • Sandwiches
  • Cheese
  • Pasta dishes
  • Meat dishes
  • Snacks

The U.S. Dietary Guidelines recommend limiting sodium intake to less than 2,300 milligrams per day.  The recommendation is 1,500 milligrams per day for people aged 51 and older, and anyone with high blood pressure, diabetes, and chronic kidney disease, and African Americans.

Key points in the Vital Signs Report:

  • Ten types of foods account for 44 percent of dietary sodium consumed each day.
  • 65 percent of sodium comes from food sold in stores.
  • 25 percent of sodium comes from meals purchased in restaurants.
  • Reducing the sodium content of the 10 leading sodium sources by 25 percent would lower total dietary sodium by more than 10 percent and could play a role in preventing up to an estimated 28,000 deaths per year.

Reducing daily sodium consumption is difficult since it is in so many of the foods we eat.  People can lower their sodium intake by eating a diet rich in fresh or frozen fruits and vegetables without sauce, while limiting the amount of processed foods with added sodium.

Individuals can also check grocery food labels and choose the products lowest in sodium.  CDC supports recommendations for food manufacturers and restaurants to reduce the amount of sodium added to foods.

“We’re encouraged that some food manufacturers are already taking steps to reduce sodium,” said Dr. Frieden. “Kraft Foods has committed to an average 10 percent reduction of sodium in their products over a two year period, and dozens of companies have joined a national initiative to reduce sodium.

The leading supplier of cheese for pizza, Leprino Foods, is actively working on providing customers and consumers with healthier options.  We are confident that more manufacturers will do the same.”

To learn more:

  • Reducing sodium is also a key component of the Million Hearts™ initiative to prevent a million heart attacks and strokes over the next five years.
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New Northwest Kidney Centers Renton to host community open house Feb. 23

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Northwest Kidney Centers’ new dialysis center in Renton will host a community open house from 12:30 to 2 p.m. Thursday, Feb. 23.

The public is invited to attend the free event, which will feature tours, refreshments, healthy cooking demonstrations and a short program that begins at 1 p.m.

The 21,000-square-foot center includes a clinic that administers dialysis treatments and an area to train patients who prefer to give themselves dialysis at home.

Located in an area of King County where kidney disease is growing fast, the facility is at 602 Oakesdale Ave. SW in Renton’s Oakesdale Center business park.

The $4 million center is licensed to serve up to 168 patients, but large enough to serve up to 246 in the future. It employs 34 people. A generator on site provides continuous power so that life-saving dialysis can continue even if regular power is out.

Dialysis center patients and staff members moved from a former treatment center at 4242 East Valley Rd. Northwest Kidney Centers now uses that building as a dispatch center for its team of nurses who provide dialysis in hospitals. They were formerly based in downtown Seattle.

When:

Thursday, Feb. 23rd.

12:30 to 2 p.m.

Where:

602 Oakesdale Ave. SW

Renton’s (in the Oakesdale Center business park).

To learn more:

  • Go to the Northwest Kidney Centers website.
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