Chemo isnt just for Cancer

When someone hears the word Chemo it is automatically associated with Cancer patients. Well, I have learned that Chemo helps a lot more issues than cancer. With Tim the Chemo meds help suppress his autoiummune system which is what is killing his insides. Tim diseaes Lupus triggered his kidneys so taking this drug once a month will kill the immune system and force to start all over again without previous knowledge of the damage. Although the chances of him getting lupus flares again is against him, this will help with his new kidney and now that we have information about his disease we can catch it first hand instead of finding out he has stage 5 kidney failure. Chemotherapy is treated for a lot of autoimmue diseases such as lupus, wegeners, Arthritis, and I found out today it is also helping someone with MS (multiple scelerosis) Just thought it was interesting. Here is some information on the type of Chemo Tim is taking to give you a better understanding.

-Jackie & Tim

The main use of cyclophosphamide is together with other chemotherapy agents in the treatment of lymphomas, some forms of leukemia^[3] and some solid tumors.^[4] It is a chemotherapy drug that works by slowing or stopping cell growth.

Cyclophosphamide IV drip

Cyclophosphamide also decreases the immune system's response to various diseases and conditions. Therefore, it has been used in various non-neoplastic autoimmune diseases where disease-modifying antirheumatic drugs (DMARDs) have been ineffective. For example, systemic lupus erythematosus (SLE) with severe lupus nephritis^[5] may respond to pulsed cyclophosphamide (in 2005, however, standard treatment for lupus nephritis changed to mycophenolic acid (MMF) from cyclophosphamide). Cyclophosphamide is also used to treat minimal change disease,^[6] severe rheumatoid arthritis,^[7] Wegener's granulomatosis^[8] (with trade name Cytoxan), and multiple sclerosis^[9] (with trade name Revimmune).
A 2004 study^[10] showed that the biological actions of cyclophosphamide are dose-dependent. At higher doses, it is associated with increased cytotoxicity and immunosuppression, while at low continuous dosage it shows immunostimulatory and antiangiogenic properties. A 2009 study of 17 patients with docetaxel-resistant metastatic hormone refractory prostate cancer showed a Prostate-specific antigen (PSA) decrease in 9 of the 17 patients. Median survival was 24 months for the entire group, and 60 months for those with a PSA response. The study concluded that low-dose cyclophosphamide "might be a viable alternative" treatment for docetaxel-resistant MHRPC and "is an interesting candidate for combination therapies, e.g., immunotherapy, tyrosine kinase inhibitors, and antiangiogenisis

Many people taking cyclophosphamide do have serious side effects. Side-effects include chemotherapy-induced nausea and vomiting (CINV), bone marrow suppression, stomach ache, diarrhea, darkening of the skin/nails, alopecia (hair loss) or thinning of hair, changes in color and texture of the hair, and lethargy. Hemorrhagic cystitis is a frequent complication, but this is prevented by adequate fluid intake and Mesna (sodium 2-mercaptoethane sulfonate). Mesna is a sulfhydryl donor and binds acrolein.
Cyclophosphamide is itself carcinogenic, potentially causing transitional cell carcinoma of the bladder as a long-term complication. It can lower the body's ability to fight an infection. It can cause temporary or (rarely) permanent sterility. A serious potential side-effect is Acute Myeloid Leukemia, referred to as secondary AML, due to it occurring secondarily to the primary disease being treated. The risk may be dependent on dose and a number of other factors, including the condition being treated, other agents or treatment modalities used (including radiotherapy), treatment intensity and length of treatment. For some regimens it is a very rare occurrence. For instance, CMF-therapy for breast cancer (where the cumulative dose is typically less than 20 grams of cyclophosphamide) seems to carry an AML risk of less than 1/2000th, with some studies even finding no increased risk compared to the background population. Other treatment regimens involving higher doses may carry risks of 1-2% or higher, depending on regimen. Cyclophosphamide-induced AML, when it happens, typically presents some years after treatment, with incidence peaking around 3–9 years. After 9 years, the risk has fallen to the level of the regular population. When AML occurs, it is often preceded by a Myelodysplastic syndrome phase, before developing into overt acute leukemia. Cyclophosphamide-induced leukemia will often involve complex cytogenetics, which carries a worse prognosis than de novo AML.
Other (serious) side effects include:

• gross and microscopic hematuria,
• unusual decrease in the amount of urine,
• mouth sores,
• unusual tiredness or weakness,
• joint pain,
• easy bruising/bleeding,
• existing wounds that are slow healing.

Diabetes and it's association with CKD (chronic kidney disease)

-Jackie and Tim

Check your blood sugar

High blood sugar can damage the kidneys.  Keeping your blood sugar in a healthy range can help protect your kidneys and prevent or slow diabetic kidney disease.  A special diabetic diet, exercise and medicines can help you keep a healthy blood sugar level.
 
You will need to check your blood sugar on a regular basis to know how you’re doing.

Checking your blood sugar level at home

Your doctor may suggest that you check your blood sugar at home.  You can do this using a blood glucose meter (also called a glucometer).  You can get a meter at your local drug store, hospital, clinic or online.  Your doctor can help you find a meter that is right for you.

Your meter will come with directions for how to check your blood sugar.  For most meters,

1. You use a tiny pin (called a lancet) to prick the side of your finger.  This makes a tiny drop of blood.
2. You put the tiny drop of blood on a test strip that comes with your meter.
3. You put the test strip in the meter.
4. The meter will show a number.  This is your blood sugar level.

Take your meter to your next doctor visit so that your doctor can make sure you are using it correctly.

Checking your blood sugar level with your doctor

Another test your doctor might suggest is called the hemoglobin A1c or “A1c” for short.  This is a blood test tells how your blood sugar has been over the last 2 or 3 months.
Ask your doctor what your A1c result should be.  The goal for most people with diabetes is an A1c less than 7%.

Follow a diabetic diet

What you eat affects your blood sugar.  Ask a diabetes educator or dietitian about:

• What to eat
• How much to eat
• How often to eat

Picking healthy foods, eating smaller meals and eating more often can help you control your diabetes and prevent problems.
A dietitian or diabetes educator can help you plan your meals and learn more about a healthy diabetic diet.  Medicare and many insurance plans will even help pay for sessions with a dietitian.

Keep a healthy blood pressure

High blood pressure can also harm your kidneys.  In fact, high blood pressure is the #2 cause of kidney failure.  (Remember, diabetes is the #1 cause.)  Having both diabetes and high blood pressure puts you more at risk for kidney disease and heart disease.
For most people with diabetes, a normal blood pressure is less than 130/80.  Ask your doctor how often you should get your blood pressure checked.  If your blood pressure is high, ask your doctor what you can do to lower it.

Live a healthy lifestyle

Managing your diabetes is key to keeping your kidneys healthy.  You can also help protect your kidneys by following other healthy habits.  Try to:

• Be physically active
• Keep a healthy weight
• Control your cholesterol
• Avoid tobacco
• Limit alcohol

Donate Life- Be a living donor!

I found this website when doing research on being a live donor for Tim. Did you know that you don't have to be the same blood type to donate life? There is a system in the United States that puts you into a registry where you can swap your kidney for a match for your spouse or family member. It has been going on for about 5 years. The average wait time for a kidney these days on the transplant list is about 6 years. That is because last year there were 8000 donors between live and cadaver donations and 108,000 people who needed them. The number of Chronic Kidney Disease patients are on the rise and doesn't look like it is going down. To prevent someone from going on Dialysis you can donate your kidney and help increase the chances of a transplant to go quicker and also last longer. The average kidney lasts 8-10 years before it starts to reject in your body. Some people can last up to 40 years, others it rejects immediatly. The best cadidate is someone in relation to you like a brother/sister/mom/dad.. If you have a twin that is fantastic because you wouldnt need to be on resistant drugs the rest of your life. The next you can do the swap if you have a spouse who has CKD and needs one but you aren't a match. Its like a wife swap.. and amazing thing.. then you can also be placed on the transplant list.

Hope this helps! There are also other ways to donate life on this website.. blood, tissue, bone marrow!
-Jackie and Tim

Thinking about donating to anyone who needs it?

(Anonymous or non–directed donation)

Living donation takes place when a living person donates an organ (or part of an organ) for transplantation to another person. The living donor is usually a family member or friend of the recipient.
In some cases, living donation may be from a stranger, which is called non–directed donation (because the donation isn’t “directed” towards a specific recipient).
If you are thinking about being a non–directed living donor, you should follow these steps:

1. Educate Yourself To begin, you should first read everything you can about living donation, outcomes, risks, and benefits. The NKF has information on living donation available at www.livingdonors.org, which can answer many of your questions. This includes:
   Q&A on living donation: Read the Q&A carefully to ensure that you understand the risks and benefits, the evaluation process, surgery process, and possible outcomes.
   Consensus Statement on the Live Organ Donor: The Consensus Statement was published in the December 13, 2000 issue of the Journal of the American Medical Association (JAMA). Table 1 lists elements of disclosure for potential living donors – meaning, these are all the things you should ask the transplant center prior to donation. That way you can make an informed decision.
2. Consider Your Reasons
   Make sure you understand the risks and benefits of donation. Think about your reasons for wanting to donate, and the impact of the donation on you and your family – emotionally, physically, and financially.
3. Important Note
   Living donation is a gift made from the donor to the recipient with no expectation of material compensation. Under U.S. law, it is illegal to buy or sell organs.
   Donors are never financially compensated. Under federal law, it is illegal to receive money or gifts in exchange for an organ donation. In addition, donors are often responsible for their own travel expenses and any time lost from work.
4. Request Information
   If you decide to pursue donation, you will need to contact transplant centers (hospitals that perform transplant operations) in your area about the possibility of being a living donor. Or, you can contact other organizations that help facilitate living donation.
   
   • You can find a list of all U.S. transplant centers by state online at http://optn.transplant.hrsa.gov/members/search.asp
     • Under Step 1, select a Member Type: choose "Transplant Centers"
     • Under Step 2, choose the state of residence (or surrounding states)
     • Call and ask for the "Kidney Transplant Coordinator", who will be a registered nurse who can help.
     • If the center accepts non–directed donors, you will undergo rigorous physical and psychological testing to ensure that you are a suitable candidate for donation. This process is not easy, and does take time. You can find out more about the evaluation process in the NKF's Q&A on living donation.
   • You can also try contacting one of the following organizations for help. (Note: these organizations and their websites are not under the control of the NKF, and NKF assumes no responsibility for their content or services. These links are provided for information purposes only, and should not be considered an endorsement or recommendation by the National Kidney Foundation.)
     • Alliance for Paired Donation: The mission of the Alliance for Paired Donation™ is to save lives by significantly reducing the wait time for a kidney transplant through kidney paired donation. For more information, visit www.paireddonation.org.
     • National Kidney Registry: The mission of the National Kidney Registry is to save and improve the lives of people facing kidney failure by increasing the quality, speed, and number of living donor transplants in the world. For more information, visit www.kidneyregistry.org.
     • Paired Donation Network: The Paired Donation Network is dedicated to making living donor kidney transplantation possible for all patients with kidney failure. It includes over 80 kidney transplant programs in 23 states. For more information, visit www.paireddonationnetwork.org.
   You may also want to meet with a financial counselor at the hospital to discuss your situation as it relates to lost work time, testing expenses, etc. Most transplant centers have a financial counselor who can help you.
5. What Else Can I Do?
   You may not be able to be a living donor – or you may decide that living donation isn’t right for you. You can still help those awaiting life–saving organ transplants. Here are a few ways you can make a difference.
   Be a Donor after your death. Click here for more information.
   Donate blood, which also saves lives every day. For more information about blood donation, call the American Red Cross at (800) GIVE–LIFE or visit www.redcross.org/donate/give/.
   Join the bone marrow registry. For more information about bone marrow or blood stem cell donation, contact the National Marrow Donor Program at (800) MARROW2 or visit www.marrow.org/DONOR/donor_information.idx.html.
   Volunteer or make a financial contribution. For more information about other creative ways to help, visit www.kidney.org/support and www.shareyourlife.org/promote.html.

Look into my eyes

The eye doctor was the one who said to us.. GO to the emergency room. You can see everything from the eye. People don't think having your eyes checked is important.. well it was important to Tim and it could be important to you!

"Look into my eyes my dear " is a popular and seductive quote based on the romantic notion that the "eyes are the window to the soul". It is well known that certain emotional states such as stress, sexual stimulation, and intoxication with certain substances can cause characteristic changes in pupil size.

Iridology is an entirely different concept that claims actual disease, both physical and emotional, can be diagnosed by visible changes in the pattern of the Iris.

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Tutorial

Parts of the eye visible without special equipment include:

• Sclera (white part)
• Iris (colored part)
• Pupil (black opening in the center of the Iris that lets light to be passed to the retina)
• Cornea ( clear covering over the iris and pupil)

The iris contracts or relaxes, thus changing pupil change size, depending on the amount of light present. Under conditions of bright light contraction of ciliary muscles attached to the Iris causes constriction of the pupil, thus filtering out excessive light ( Iris is more noticeable). In darkness the pupil dilates (widens) to allow as much available light as possible to reach the retina- less of the Iris is visible.

The Iris of each person is fixed in that its' markings do not change. A persons Iris may appear different based on amount of pupil dilation or constriction at a given time. An analogy is that although a person's palm or finger prints always contain the same markings (do not change), they will appear different when the palm and fingers are straight compared to when they are clenched.

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What can examining the Eye tell?

Examination of the eye, including the iris, by a trained physician can sometimes tell a lot about disease processes (trauma, inflammation or infection) affecting the eye.

In certain circumstances examination can reveal disease affecting other parts of the body or the entire body.

Retinal exam can sometimes show evidence of high blood, high cholesterol, diabetes, certain protozoan and parasitic infections, retinoblastoma (a rare eye & brain tumor) and/or elevated intracranial pressure.
Corneal exam, in extremely rare circumstances, may detect very rare diseases involving excess deposit of minerals (iron, copper) in various body organs.
Sceral exam may detect Grave's disease, a component of hyperthyroidism
Pupillary exam, when abnormal, may indicate a number of conditions including drug intoxication, neurologic disease, diabetes, vascular disease, or infectious disease (neurosyphylis).

The list of conditions that might be detectable by ophthalmologic exam is by no means complete. An ophthalmologist is a physician with special training in the diagnosis and treatment of eye conditions. Other physicians having some training in Ophthalmologic exam as part of their training include Internists, Family Physicians, and Emergency Medicine specialists.

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How is Iridology supposed to work? [1]

Iridology , also called iris diagnosis, is based on the belief that each area of the body is represented by a corresponding area in the iris. According to this theory, a person's state of health and disease can be diagnosed from the color, texture, and location of various pigment flecks in the eye.

Iridology practitioners claim to diagnose "imbalances" that can be treated with vitamins, minerals, herbs, and similar products. Some also claim that the eye markings can reveal a complete history of past illnesses as well as previous treatment. One textbook, for example, states that a white triangle in the appropriate area indicates appendicitis, but a black speck indicates that the appendix had been removed by surgery.

Iridology charts vary somewhat in the location and interpretation of their iris signs. Sclerology is similar to iridology but interprets the shape and condition of blood vessels on the white portion (sclera) of the eyeball.

Can examining the Iris diagnose disease in other parts of the body?

Examination of Iris patterns has no clinical use in detecting problems not related to the eye. No correlation has ever been proven between patterns on specific areas of the Iris and the presence or absence of disease.

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Results from studies with "Experienced Iridologists"

There three controlled studies [2, 3, 4]in which trained iridologists were asked to look at eye photographs of well patients and those with certain disease conditions such as gallbladder and kidney disease. In no case could the iridologists reliably differentiate well patients from disease conditions nor could they tell when the same person was ill or well by examining eye photographs.

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Bottom line

Iridology has no diagnostic value. Successful therapies occur either due to placebo or self limited illness. Some multilevel distributors are using iridology as a basis recommending dietary supplements and/or herbs.

Some practitioners of Iridology are well intended but misinformed while others may indeed by using intentional deception.

Coping as a spouse of some with a Chronic Illness

Sometimes I am outright down in the dumps. I get flustered, angry, and depressed. I thought this might be helpful for those who have a significant other with a chronic disease whether it is diabetes, depression, kidney disease, cancer etc... This should help.. Through sickness and in health

It's natural to enter a long-term relationship with expectations. And one expectation most of us have is that our spouse or partner will remain relatively healthy. Although wedding vows ask us to consider the possibility of sickness, we don't automatically assume our loved ones will suffer a serious illness.

When Illness hits home-The reality is that many couples must learn to cope and adjust to a life-altering illness. Understanding the impact this can have on your relationship can help you adjust and adapt to such an enormous challenge.

Coping with a Sense of Loss

Depending on the nature of the illness, the sick partner may change in subtle and, sometimes, profound ways. The relationship that you once relied upon may no longer feel accessible to you.

Adjusting to such a major change can take time, and you may find yourself struggling with feelings of anger, despair and depression. It's common to feel anger toward the person who has the illness (which then may cause you to feel guilty). This is all part of grieving the loss of what once was the foundation of your relationship and life.
The Impact of Shifting Roles

We all play different roles in our relationships. And very often we end up with someone whose preferred role complements our own. For instance, someone who is timid and insecure may find him/herself with a partner who exudes confidence; someone who is highly emotional and spontaneous might be drawn to a more rational-minded planner; the natural caregiver may feel most at home with a partner who longs for this type of attention; and so on.

An illness can abruptly alter these roles and tip the balance that once grounded your relationship. The confident, take-charge person may now find him/herself in an overly dependent position; the rational-minded planner may have to relinquish control; and the caregiver may now need to be cared for. Such changes can rock the foundation of your union by forcing you to assume roles that are alien to what you've known most of your life.

Coping with Uncertainty

We all like to believe we're in control of our lives. When faced with a significant illness, however, the idea of absolute control is revealed as an illusion. Questions you never before considered now become routine: Is s/he going to be OK? What's going to happen to us? What should I do?

And when an illness interferes with one's ability to work, financial uncertainty can now take center stage—fear and anxiety are common as the once secure areas of your life give way to uncertainty.
Letting Go of Guilt

Sam began feeling guilty when he finally started spending time with friends and found himself enjoying time away from his wife more than a year and a half after she became ill. During his wife's rehabilitation, Sam rarely did anything for himself. As he described, "I had to come to grips with the fact that she's sick and I'm healthy. This wasn't easy. She's slowed down considerably and I felt bad because I've always been so full of life."

Sam continues to care for his wife when needed, but he has also begun taking care of himself. For a period of time, guilt-inducing thoughts flooded his mind ("How dare you have fun while your wife's sick?"; "You should be home with her"), but Sam was slowly able to realize that his guilt served no useful purpose. With the support of his minister, Sam was able to let go of his guilt as he began embracing life again.
Understanding the sick partner's emotional reactions

The person struggling with a serious illness is on an emotional rollercoaster. In one moment s/he may be grateful for your help and a moment later s/he may seem to act irrationally, no longer able to keep the fear, anger and despair in check. At times you may end up feeling berated, blamed, pushed away, and marginalized—despite your best efforts to comfort your partner. It's difficult not to take this personally. For your own sanity, it will be important to remember that you are not responsible for your partner's reactions and you will need to repeatedly remind yourself of this truth.

Remember that the partner struggling with the illness is adjusting to this traumatic life change and is trying to cope with fear and uncertainty. S/he may not even realize the impact his/her behavior is having on others, including his/her healthy partner. It's important for you to seek ways to understand your partner's unpredictable, tumultuous reactions; and it is just as important that you protect yourself from any emotional onslaughts directed at you.

The impact of a significant illness can have a dramatic and unexpected impact on your marriage or relationship. Some couples report that their relationship has become stronger because of an illness, whereas others continue to stumble under considerable stress. Having an understanding of the different ways in which an illness can impact you, your partner and your relationship is an important step in adapting to these painful events.

Anemia- Number one difficency in people.

I write about this because Tim has been struggling with this due to his Kidney Failure. I too have issues with Anemia due to my weight loss and have found that it the number one difficency people have. Hope you find this useful. I have.
I recently have found that I am struggling with a little low blood pressure. The machine at home ranged from 98/57 back up to 123/69.. Normal blood pressure ranges are from 120/80 and below.. some people have blood pressure as low as 90/50 and it is still considered normal. If you are experiencing, Dizziness, Tingling, problems concentrating, headaches, chest pain, or shortness of breath. You may also experience Black Stool or blood in your stool. Kind of Tar like.  Check your blood pressure. If it is low you may need to increase your Iron and B-12. There are different ways to handle anemia.. water, pills, blood transfusions and steroids to help supress the immune system. Very important to check you blood pressure regularly.. after all. This is one of the signs that helped us get Tim some help to begin with. I am going to paste an article from PubMED Health.

Jackie-

Anemia

Last reviewed: February 28, 2011.

Anemia is a condition in which the body does not have enough healthy red blood cells. Red blood cells provide oxygen to body tissues.
See also:

• Anemia due to B12 deficiency
• Anemia due to folate deficiency
• Anemia due to iron deficiency
• Anemia of chronic disease
• Hemolytic anemia
• Idiopathic aplastic anemia
• Megaloblastic anemia
• Pernicious anemia
• Secondary aplastic anemia
• Sickle cell anemia
• Thalassemia

Causes, incidence, and risk factors

While many parts of the body help make red blood cells, most of the work is done in the bone marrow. Bone marrow is the soft tissue in the center of bones that helps form blood cells.
Healthy red blood cells last between 90 and 120 days. Parts of your body then remove old blood cells. A hormone called erythropoietin made in your kidneys signals your bone marrow to make more red blood cells.
Hemoglobin is the oxygen-carrying protein inside red blood cells. It gives red blood cells their red color. People with anemia do not have enough hemoglobin.
Possible causes of anemia include:

• Certain medications
• Chronic diseases such as cancer, ulcerative colitis, or rheumatoid arthritis
• Genetis: Some forms of anemia, such as thalassemia, can be inherited
• Kidney failure
• Blood loss (for example, from heavy menstrual periods or stomach ulcers)
• Poor diet
• Pregnancy
• Problems with bone marrow such as lymphoma, leukemia, or multiple myeloma
• Problems with the immune system that cause the destruction of blood cells (hemolytic anemia)
• Surgery to the stomach or intestines that reduces the absorption of iron, vitamin B12, or folic acid
• Too little thyroid hormone (underactive thyroid, or hypothyroidism)
• Testosterone deficiency

Symptoms

Possible symptoms include:

• Chest pain
• Dizziness or light-headedness (especially when standing up or with activity)
• Fatigue or lack of energy
• Headaches
• Problems concentrating
• Shortness of breath (especially during exercise)

Some types of anemia may have other symptoms, such as:

• Constipation
• Problems thinking
• Tingling

Signs and tests

The doctor will perform a physical examination, and may find:

• Pale skin
• Rapid heart rate
• Heart murmur

Some types of anemia may cause other findings on a physical exam.
Blood tests used to diagnose some common types of anemia may include:

• Blood levels of vitamin B12, folic acid, and other vitamins and minerals
• Red blood count and hemoglobin level
• Reticulocyte count
• Ferritin level
• Iron level

Other tests may be done to identify medical problems that can cause anemia.

Treatment

Treatment should be directed at the cause of the anemia, and may include:

• Blood transfusions
• Corticosteroids or other medicines that suppress the immune system
• Erythropoietin, a medicine that helps your bone marrow make more blood cells
• Supplements of iron, vitamin B12, folic acid, or other vitamins and minerals

Expectations (prognosis)

The outlook depends on the cause.

Complications

Severe anemia can cause low oxygen levels in vital organs such as the heart, and can lead to a heart attack.

Calling your health care provider

Call your health provider if you have any symptoms of anemia, or any unusual bleeding.

women and CKD *Chronic Kidney Disease

Chronic kidney disease (CKD) is on the rise. One population group that has seen an increase in occurrences of kidney failure is women who are older (50+ years old) and African American.
In 2001, of all new patients diagnosed with kidney failure in Canada , 55% were 65 and older. Men made up 58% of the cases, and are still the majority of CKD patients. However, in a five-year period there was a 23% increase in the number of men diagnosed with kidney failure, compared to a 45% increase in the number of women.
A Journal of the American Society of Nephrology study done in 2002 using computer simulation, took into account factors for race (black, white) and gender to calculate lifetime risk of ESRD based on a group of 20-year-olds. In this model, the likelihood that an African American woman would need dialysis or a kidney transplant in her lifetime was almost 8%.
Type-2 diabetes was the main factor attributed to more African American women experiencing kidney failure. Usually brought on by obesity, diabetes is the number one risk factor for chronic kidney disease. High blood pressure is the second most common risk factor for kidney disease. Making women aware of the risks of chronic kidney disease and the measures to prevent CKD will hopefully reverse this upward trend. Women are encouraged to talk to their doctor about chronic kidney disease and find out if they are at risk.

1. J Am Soc Nephrol. 2002 Oct;13 (10):2617
2. Canadian Institutes for Health Information. January 21, 2004

Special issues for women with chronic kidney disease (CKD)

When researching information about kidney disease and dialysis treatments, there is rarely any differentiation between treatments for men and women. There are, however, several unique issues a woman will deal with in her health care that should be discussed, such as menstrual periods, sexuality, pregnancy and menopause. The following sections will discuss these issues.

Periods and CKD

 When a woman has chronic kidney disease her periods tend to be irregular. Once she begins dialysis her periods may even stop altogether. As kidney function drops below 20% of normal, a woman is less likely to conceive because dialysis doesn't perform all of the tasks of the kidneys. The body retains a higher level of waste products than it would with a normal kidney, which can prevent egg production and affect menstruation.
Erythropoietin treatments will cause about 50% of woman on dialysis to get their periods again. This is attributed to the improved hormone levels and the treatment of anemia. Therefore, erythropoietin treatments can increase a woman's fertility, so birth control should be used if a woman is sexually active and does not want to become pregnant.

Sexuality and CKD

Most chronic kidney disease patients find they don't have the same interest in sex. There are emotional, physical and psychological factors at play that can diminish the sex drive. Getting used to life with a chronic illness and the lifestyle changes that come with it takes time. There can also be stresses related to job, income and family life that a woman will have to adjust to.
Physically, lower hormone levels may cause some women to experience vaginal dryness or painful intercourse. A water-soluble vaginal lubricant can be used to remedy these situations. Side effects of certain medicines and complications from uremia can cause fatigue, menstrual irregularities and decreased sexual desire. Some medications may also cause hormonal changes making it difficult for a woman to become aroused or experience an orgasm. A woman should discuss these issues with her doctor, as changes in blood pressure medication or taking extra hormones may help the situation. Anemia can also be treated with erythropoietin, however, sometimes the actual dialysis treatment is the cause of fatigue.
Some women become anxious about changes in their appearance, such as weight loss, or in the case of some PD patients, weight gain from the sugar in the dialysate. The catheter in the abdomen or fistula in the arm may also create anxiety either because a woman believes it is unattractive or is afraid it could be damaged. Sharing these feelings with a partner is often the best way to overcome them. It is also rare that anything will happen to an access in the process of lovemaking.
Most women need a little time to adjust to dialysis. They may find their sex drive returns as their energy level increases. It is best to use contraception when being intimate. Even if a woman isn't having a regular period, she may still be ovulating, making her able to get pregnant. Condoms are a safe and easy choice. There are other options, but a health care professional should be consulted due to hormonal effects of some birth control methods.

Pregnancy and CKD

While it is uncommon for a woman on dialysis to become pregnant, studies indicated that between 1992 and 2003 from 1% to 7% of patients did. A national Registry of Pregnancy in Dialysis Patients is maintained to track and study these events and outcomes. About 50% of the babies born to women on dialysis survived. There was evidence that longer dialysis time (16-24 hours per week) helped improve infant survival. Many of the babies were born premature, which was attributed to high blood pressure. Many chronic kidney disease patients have high blood pressure, which tends to get worse during pregnancy.
A survey of dialysis units listed by the Health Care Finance Administration regarding pregnancy in dialysis patients showed that infant survival for a woman on dialysis was higher than previously thought. The survey yielded the following results:
During a four-year period two percent of woman in their childbearing years became pregnant (2.4% were hemodialysis patients, 1.1% were peritoneal dialysis patients)

• Of those who were on dialysis before they became pregnant, 40.2% (out of 184 pregnancies) of the infants survived
• Of those who started dialysis after they became pregnant 73.6% (out of 57 pregnancies) of the infants survived
• Infant survival was greater for women who received dialysis more than 20 hours per week
• Complications for the women included: high blood pressure in 79% of pregnancies, hypertensive crisis in five women, hematocrit lower than 30 for 93.1% of patients, transfusions for 26% of those treated with erythropoietin and 77% of those not treated and, in two cases, death
• Complications for the surviving infants included: premature birth in 84% of women who conceived after beginning dialysis, congenital anomalies in 11 infants and long-term medical problems for 11 infants

Menopause and CKD

When kidney failure occurs, dialysis helps to remove wastes from the blood, however, it does not replace all of the functions of the kidneys, such as producing hormones. While all menopausal women are encouraged to take calcium to prevent osteoporosis, it is even more important for those on dialysis or who have a kidney transplant. When hormone production decreases in menopause, this puts women at risk for osteoporosis and cardiovascular disease. Because many women on dialysis tend not to have regular periods, their hormone levels may already be compromised. To help combat osteoporosis, additional calcium in the diet, or in the form of supplements, can help prevent bone loss. Osteoporosis is frequently a complication for those who have a kidney transplant due to the anti-rejection drugs that must be taken.
In addition to osteoporosis, lower hormone levels put women at increased risk for heart disease. A hysterectomy creates early menopause, which puts women at risk for a longer period of time. Women are advised to approach their health care team with questions regarding how to preserve bone and heart health.
Creating awareness is the best way to help women feel comfortable about bringing up issues to discuss with their health care team. Knowing they are not alone can lead to more openness to help women become more proactive in seeking the special care they need.

Resources

1. Biff F. Palmer. Sexual dysfunction in men and women with chronic kidney disease and end-stage kidney disease. Am J Kidney Dis. 2003 January Vol10 N1
2. D. Shemin, et al. Dialysis in pregnant women with chronic kidney disease. Semin Dial, 2003;16(5):379-383
3. Okundaye I, Abrinko P, Hou S. Registry of pregnancy in dialysis patients.
4. Am J Kidney Dis. 1998 May;31(5):766-73
5. Bagon JA, Vernaeve H, De Muylder X, Lafontaine JJ, Martens J, Van Roost G. Pregnancy and dialysis. Am J Kidney Dis. 1998 May;31(5):756-65.
6. Susan Hou, MD Pregnancy in chronic renal insufficiency and end-stage renal disease. Am J Kidney Dis. 1999 Feb Vol33 N2
7. Holly Mattix Kramer, MD, Gary C. Curhan, MD, ScD, Ajay Singh , MD ,
8. HELP Study Group. Permanent cessation of menses and postmenopausal hormone use in dialysis-dependent women: The HELP study. Am J Kidney Dis. 2003 March Vol41 N3
9. Holly Mattix Kramer, MD, Gary C. Curhan, MD, ScD, Ajay Singh , MD ,
10. HELP Study Group. Hemodialysis and estrogen levels in postmenopausal (HELP) patients: The multicenter HELP study. Am J Kidney Dis. 2003 June Vol41 N6
11. Kramer HM, Curhan G, Singh A; HELP Study Group. Hemodialysis and estrogen levels in postmenopausal (HELP) patients: The multicenter HELP study. Am J Kidney Dis. 2003 Jun;41(6):1240-6.

How could things change so much after a Diagnosis?

Haven't written much on here lately. Mostly because we have just been adjusting to a new lifestyle that none of us ever thought would happen. 12 Doctors appointments a month,  12 different types of medicine, Chemo therapy once a month.. food and water restrictions it is just a huge change. On a good note Tim's Kidney function seemed to improve since we saw the nephrologist last and that rarely happens when there is scar tissue around an organ. The Chemo went like a normal chemo treatment went... 8 hours at Smillow Cancer Hospital.. pumped with fluid Tim shouldnt have and waiting anxiously for the bag of medicine to get mixed together. Followed by three days of not knowing whether he is sick to his stomach or hungry, hot or cold.. and feeling weak to the knees. After that he gradually has gotten back to normal but complications always find its way to show face. The antibiotics caused a new reaction and so it was stopped plus a few other glitches here and there with his blood pressure, but everything seems to be under control today. I just don't understand how all of this can come out after a diagnosis... His legs were swollen a TINY bit before he was hospitalized and now they are always swollen, and he was drinking a LOT more water than a liter... They tell us he has Lupus and to watch for skin irritation and all of a sudden he starts getting skin irritation... It is just akward and still feels funny about this whole thing. I don't want to say the wrong thing but I don't think their diagnosis is 100% accurate and I haven't since he was admitted. I continue to pray every single day for Tim and ask for continued strengeth and support. I ask for Blessing to each and every member of the associated Teams working with Tim which is over 150 doctors as well as any nurse staff and staff helping with his treatment. I thank God for the opportunity to work at night and have the freedom during the day to be there for Tim with his specialist appointments and the support of his family as well as mine who have asked and constantly been there by our side while times have been tough.