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Clinical Depression. You Can Defeat Your Demons!


By Bob Aronson

loneliness cartoonDepression, what is it? Why can’t you just snap out of it? Many people including family and friends who have not experienced depression have great difficulty understanding it much like people who are not addicts can’t understand addiction. In both cases we often hear advice like, “Snap out of it, you’ve got things pretty good. There’s no reason to be depressed.” Or, “You made the choice to start drinking or using drugs so choose to stop.” Oh, if it were that simple.

Here’s a cold slap in the face to bring us into reality. Depression is a mental illness, like the common cold is a physical illness. There has long been a stigma associated with mental illness held over from the days of Insane Asylums and “Crazy” people. That stigma is rapidly disappearing because so many people suffer from depression which is often a chemical imbalance that is quite treatable. Your mental health is every bit as important as your physical health and one can affect the other.

Here are some shocking statistics from the National Institutes of Mental Health (NIMH).

Major Depressive Disorder

  • Major Depressive Disorder is the leading cause of disability in the U.S. for ages 15-44.3
  • Major depressive disorder affects approximately 14.8 million American adults, or about 6.7 percent of the U.S. population age 18 and older in a given year.1, 2
  • While major depressive disorder can develop at any age, the median age at onset is 32.5
  • Major depressive disorder is more prevalent in women than in men

Major or clinical depression is an awful feeling. It is a gnawing at the pit of your stomach, in your gut that makes you feel hopeless, helpless and alone. It is as though someone locked up your ability to reason, your sense of humor and your will to live in a windowless, dark, solitary confinement jail cell from which there is no escape. It is a constant feeling of impending doom combined with a profound sadness and even fear. It can steal your energy, memory, concentration, sex drive, interest in activities you used to love and…it can even destroy your will to live. Depression may not be as common as the common cold but it is much more common than ever before. Nearly 20 percent of Americans suffer from it at one time or another.

Logic says that you should be able to “Will” yourself out of this mood, but will power alone cannot give you tStop being sadhe boost you need to get your life’s engine started again. Mental illness is not unlike physical illness. You cannot use will power to eliminate depression any more than you could use it to stop cancer. No one wants to be depressed, no one,. Think about it. If will power would work as an anti-depressant there would be no depression because again, no one wants to feel like what I described.

Let’s get to the medical description and symptoms as offered by the Mayo Clinic. http://www.mayoclinic.org/diseases-conditions/depression/expert-answers/clinical-depression/faq-20057770

“To be diagnosed with clinical depression, you must have five or more of the following symptoms over a two-week period, most of the day, nearly every day. At least one of the symptoms must be either a depressed mood or a loss of interest or pleasure. Signs and symptoms may include:
• Depressed mood, such as feeling sad, empty or tearful (in children and teens, depressed mood can appear as constant irritability)
• Significantly reduced interest or feeling no pleasure in all or most activities
• Significant weight loss when not dieting, weight gain, or decrease or increase in appetite (in children, failure to gain weight as expected)
• Insomnia or increased desire to sleep
• Either restlessness or slowed behavior that can be observed by others
• Fatigue or loss of energy
• Feelings of worthlessness, or excessive or inappropriate guilt
• Trouble making decisions, or trouble thinking or concentrating
• Recurrent thoughts of death or suicide, or a suicide attempt
Your symptoms must be severe enough to cause noticeable problems in relationships with others or in day-to-day activities, such as work, school or social activities. Symptoms may be based on your own feelings or on the observations of someone else.
Clinical depression can affect people of any age, including children. However, clinical depression symptoms, even if severe, usually improve with psychological counseling, antidepressant medications or a combination of the two.”

The National Institutes of Health (NIH) has this to say about depression.

What causes depression?

Several factors, or a combination of factors, may contribute to depression.
• Genes—people with a family history of depression may be more likely to develop it than those whose families do not have the illness.
• Brain chemistry—people with depression have different brain chemistry than those without the illness.
• Stress—loss of a loved one, a difficult relationship, or any stressful situation may trigger depression.
Depression affects different people in different ways.
• Women experience depression more often than men. Biological, life cycle, and hormonal factors that are unique to women may be linked to women’s higher depression rate. Women with depression typically have symptoms of sadness, worthlessness, and guilt.
• Men with depression are more likely to be very tired, irritable, and sometimes even angry. They may lose interest in work or activities they once enjoyed, and have sleep problems.
• Older adults with depression may have less obvious symptoms, or they may be less likely to admit to feelings of sadness or grief. They also are more likely to have medical conditions like heart disease or stroke, which may cause or contribute to depression. Certain medications also can have side effects that contribute to depression.
• Children with depression may pretend to be sick, refuse to go to school, cling to a parent, or worry that a parent may die. Older children or teens may get into trouble at school and be irritable. Because these signs can also be part of normal mood swings associated with certain childhood stages, it may be difficult to accurately diagnose a young person with depression.

get out of bedOk we’ve defined the malady and we know how clinicians determine if patients have it so the next logical question is, “What can you do about it.” Well, the answer is simple, but it will take a major commitment on your part to make the answer work for you, we can start by identifying some hazards, potholes on the road to good mental health.

Depression: Ten Traps to Avoid

Dr. Stephen Ilardi, author of “The Depression Cure,” has identified several things that can make depression worse. First, know this. Depression is a serious medical condition and should be treated by a doctor or licensed therapist. Having said that, here”s what Dr. Ilardi suggests.

Trap 1: Being a Couch Potato

When you’re feeling down, it’s tempting to hole up in your bed or on the couch. Yet exercise – Even moderate activityclinical depression image like brisk walking – has been shown to be at least as effective against depression as antidepressant medication. It works by boosting the activity of the “feel-good” neurochemicals dopamine and serotonin.
For an “antidepressant dose” of exercise, try at least 40 minutes of brisk walking or other aerobic activity three times a week.

Trap 2: Not Eating “Brain Food”

Omega-3 fats are key building blocks of brain tissue. But the body can’t make omega-3s; they have to come from our diets. Unfortunately, most Americans don’t consume nearly enough Omega-3s, and a deficiency leaves the brain vulnerable to depression. Omega-3s are found in wild game, cold-water fish and other seafood, but the most convenient source is a fish oil supplement. Ask your doctor about taking a daily dose of 1,000 mg of EPA, the most anti-inflammatory form of omega-3.

Trap 3: Avoiding Sunlight

Sunlight exposure is a natural mood booster. It triggers the brain’s production of serotonin, decreasing anxiety and giving a sense of well-being. Sunlight also helps reset the body clock each day, keeping sleep and other biological rhythms in sync.

During the short, cold, cloudy days of winter, an artificial light box can substitute effectively for missing sunlight. In fact, 30 minutes in front of a bright light box each day can help drive away the winter blues.

Trap 4: Not Getting Enough Vitamin D

Most people know vitamin D is needed to build strong bones. But it’s also essential for brain health. Unfortunately, more than 80 percent of Americans are vitamin D deficient. From March through October, midday sunlight exposure stimulates vitamin D production in the skin – experts advise five to 15 minutes of daily exposure (without sunscreen). For the rest of the year, ask your doctor about taking a vitamin D supplement.

Trap 5: Having Poor Sleep Habits

sleepChronic sleep deprivation is a major trigger of clinical depression, and many Americans fail to get the recommended seven to eight hours a night. How can you get better sleep?

Use the bed only for sleep and sex – not for watching TV, reading, or using a laptop. Turn in for bed and get up at the same time each day. Avoid caffeine and other stimulants after midday. Finally, turn off all overhead lights

Trap 6: Avoiding Friends and Family

When life becomes stressful, people often cut themselves off from others. That’s exactly the wrong thing to do, as research has shown that contact with supportive friends and family members can dramatically cut the risk of depression. Proximity to those who care about us actually changes our brain chemistry, slamming the brakes on the brain’s runaway stress circuits.

Trap 7: Mulling Things Over

When we’re depressed or anxious, we’re prone to dwelling at length on negative thoughts – rehashing themes of rejection, loss, failure, and threat, often for hours on end. Such rumination on negative thoughts is a major trigger for depression – and taking steps to avoid rumination has proven to be highly effective against depression.

How can you avoid rumination? Redirect attention away from your thoughts and toward interaction with others, or shift your focus to an absorbing activity. Alternatively, spend 10 minutes writing down the troubling thoughts, as a prelude to walking away from them.

Trap 8: Running with the Wrong Crowd

Scientists have discovered that moods are highly contagious: we “catch” them from the people around us, the result of specialized mirror neurons in the brain. If you’re feeling blue, spending time with upbeat, optimistic people might help you “light up” your brain’s positive emotion circuits.

Trap 9: Eating Sugar and Simple Carbs

Researchers now know that a depressed brain is an inflamed brain. And what we eat largely determines simple carbsour level of inflammation. Sugar and simple carbs are highly inflammatory: they’re best consumed sparingly, if at all.

In contrast, colorful fruits and veggies are chockablock with natural antioxidants. Eating them can protect the body’s omega-3s, providing yet another nice antidepressant boost.

Trap 10: Failing to Get Help

Depression can be a life-threatening illness, and it’s not one you should try to “tough out” or battle on your own. People experiencing depression can benefit from the guidance of a trained behavior therapist to help them put into action depression-fighting strategies like exercise, sunlight exposure, omega-3 supplementation, anti-ruminative activity, enhanced social connection, and healthy sleep habits.

So you think you’ve avoided all the traps, but you are still depressed, now what? According to the National Alliance on Mental Illness (NAMI) here are the options. (http://www.nami.org/Content/NavigationMenu/Mental_Illnesses/Depression/Depression_Treatment,_Services_and_Supports.htm)

Treating Major Depression

pillsAlthough depression can be a devastating illness, it often responds to treatment. The key is to get a specific evaluation and a treatment plan. Today, there are a variety of treatment options available for depression. There are three well-established types of treatment: medications, psychotherapy and electroconvulsive therapy (ECT). A new treatment called transcranial magnetic stimulation (rTMS), has recently been cleared by the FDA for individuals who have not done well on one trial of an antidepressant. For some people who have a seasonal component to their depression, light therapy may be useful. In addition, many people like to manage their illness through alternative therapies or holistic approaches, such as acupuncture, meditation, and nutrition. These treatments may be used alone or in combination. However, depression does not always respond to medication. Treatment resistant depression (TRD) may require a more extensive treatment regimen involving a combination of therapies.

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Bob Aronson of Bob’s Newheart is a 2007 heart transplant recipient, the founder of Facebook’s nearly 4,000 mmagic kindom in backgroundember Organ Transplant Initiative (OTI) and the author of most of these donation/transplantation blogs. You may comment in the space provided or email your thoughts to me at bob@baronson.org. And – please spread the word about the immediate need for more organ donors. There is nothing you can do that is of greater importance. If you convince one person to be an organ and tissue donor you may save or positively affect over 60 lives. Some of those lives may be people you know and love.

Kidney Disease — A Quiet, Sneaky Epidemic. Are You At Risk?


By Bob Aronson

You are what you eatAs I did the research for this blog, I “Cherry Picked” information from a great many sources.  I am not a medical professional, but made every effort to ensure that the information I used came from experts.  I have identified sources where possible. 

This is a blog, it is made up of a good many opinions.  You should not make decisions about your health based on this or any other posting or even your own research. Only a highly skilled, educated and experienced physician can do that.  Blogs like this can only offer you general information.  As you read this remember that no two people are exactly alike.  What works for one person may cause serious damage to another even though they share similar characteristics.  Your health is too important to be left to chance.  It should be managed by a qualified physician who can focus on your specific condition, examine you, call for appropriate tests, diagnose and then develop a treatment program to meet your unique needs.

Kidney disease is disabling and killing us and no one seems to be paying attention.   To get yours I am going to start this post with some startling, even shocking facts.

  • Chronic kidney disease can lead to kidney failure, heart attack, stroke and death. In factkidney graphic, kidney disease is the nation’s ninth leading cause of death
  • 26 million Americans have kidney disease (many of whom don’t yet know it) and an additional 76 million are at high risk of developing it.
  • Of the 122,000 people on the national organ transplant waiting list about 100,000 are waiting for kidneys and there are not enough to go around.
  • Nearly a half million Americans are getting dialysis and the number is growing rapidly.
  • Diabetics are in the greatest danger of developing kidney disease and The American Diabetes Association says 25.8 million of us have it, that’s 8.3 percent of the U.S. population. Of these, 7 million do not know they are diabetic.
  • And – a final startling fact.  Kidney disease kills 100 thousand Americans a year, that’s more than prostate and breast cancer combined, but kidney disease gets nowhere near the publicity or concern of those two malignancies.

 

Got your attention?  Ok…there’s a lot more to come but first let’s define the topic. – just exactly what do kidneys do and what is kidney disease?  Here’s what the National Kidney Foundation says:

The kidneys are bean-shaped organs, each about the size of a fist. They are located just below the rib cage, one on each side of the spine. The kidneys are sophisticated reprocessing machines. Every day, a person’s kidneys filter about 120 to 150 quarts of blood to produce about 1 to 2 quarts of waste products and extra fluid. The wastes and extra fluid become urine, which flows to the bladder through tubes called ureters. The bladder stores urine until releasing it through urination.”

 So what is kidney disease?  The Mayo Clinic offers this explanation:

Chronic kidney disease, also called chronic kidney failure, describes the gradual loss of kidney function. Your kidneys filter wastes and excess fluids from your blood, which are then excreted in your urine. When chronic kidney disease reaches an advanced stage, dangerous levels of fluid, electrolytes and wastes can build up in your body.

In the early stages of chronic kidney disease, you may have few signs or symptoms. Chronic kidney disease may not become apparent until your kidney function is significantly impaired.

Treatment for chronic kidney disease focuses on slowing the progression of the kidney damage, usually by controlling the underlying cause. Chronic kidney disease can progress to end-stage kidney failure, which is fatal without artificial filtering (dialysis) or a kidney transplant.”

Causes of Kidney Disease

What causes Kidney disease?  First let’s define terms.  There’s ESRD (End Stage Renal Disease or Kidney failure), where the organs just quit working and there is CKD (Chronic Kidney Disease) which can lead to kidney failure.  The causes could be many but the most common are diabetesDiabetes and High blood pressure.  There are concerns, too, that some environmental factors may also contribute to both CKD and ESRD.  Sri Lanka, for example, has banned Monsanto Corporation’s “Roundup” herbicide on the grounds that it causes both kidney maladies.  Monsanto says its studies offer convincing evidence that the charges are not true.

What to do about it

Much is known about who faces the greatest risks of developing chronic kidney disease and how it can be prevented, detected in its early stages, and treated to slow or halt its progression. But unless people at risk are tested, they are unlikely to know they have kidney disease; it produces no symptoms until it is quite advanced.

Even when it is not fatal, the cost of treating end-stage kidney disease through dialysis or a kidney transplant is astronomical, more than fivefold what Medicare pays annually for the average patient over age 65. The charges do not include the inestimable costs to quality of life among patients with advanced kidney disease.

Much is known about who faces the greatest risks of developing chronic kidney disease and how it can be prevented, detected in its early stages, and treated to slow or halt its progression. But unless people at risk are tested, they are unlikely to know they have kidney disease; it produces no symptoms until it is quite advanced.  And…it appears as though it is quite common that many physicians overlook simple tests that could save lives.  For example, high blood pressure, is a leading cause of kidney failure yet many physicians don’t check to see how well vital organs are functioning.  Patients, then, have to be their own advocates and insist on tests to see what effect diabetes and/or high blood pressure are affecting their organs. For some reason kidney disease often is not on the medical radar, and in as many as three-fourths of patients with risk factors for poor kidney function, physicians fail to use a simple, inexpensive test to check for urinary protein.  So, our message to you is simple…make sure your doctor checks the amount of protein in your urine at least once a year.

A study published in April online in The American Journal of Kidney Disease demonstrated how common lifestyle factors can harm the kidneys. Researchers led by Dr. Alex Chang of Johns Hopkins University followed more than 2,300 young adults for 15 years. ParticipantJohns Hopkinss were more likely to develop kidney disease if they smoked, were obese or had diets high in red and processed meats, sugar-sweetened drinks and sodium, but low in fruit, legumes, nuts, whole grains and low-fat dairy.

Only 1 percent of participants with no lifestyle-related risk factors developed protein in their urine, an early indicator of kidney damage, while 13 percent of those with three unhealthy factors developed the condition, known medically as proteinuria. Obesity alone doubled a person’s risk of developing kidney disease; an unhealthy diet raised the risk even when weight and other lifestyle factors were taken into account.

Overall, the risk was highest among African-Americans; those with diabetes, high blood pressure or a family history of kidney disease; and those who consumed more soft drinks, red meat and fast food.

Dr. Beth Piraino, president of the National Kidney Foundation, said, “We need to shift the focus from managing chronic kidney disease to preventing it in the first place.”  And one of the ways to prevent kidney disease is to live healthier.  I know, no one wants to hear those words, “Live Healthier.”  Ok, I won’t use them again, but if you eat right and get the right kind and amount of exercise you can avoid kidney problems.  Want some good recipes and ideas for weight control?  Try this link  http://www.kidney.org/patients/kidneykitchen/FriendlyCooking.cfm

You are at greater risk of having kidney disease if others in your family have it or had it, genetic factors are important, but in addition you should know that African-Americans, Hispanic Americans, Asian-Americans and American Indians are more likely than white Americans to develop kidney disease.  I have been unable to find out why.  One Doctor said that prevention is the key and that it is not very complicated.  “I wouldn’t have to work so hard if they didn’t smoke, reduced their salt intake, ate more fresh fruits and vegetables, and increased their physical activity. These are things people can do for themselves. They involve no medication.”

Physicians also urge patients with any risk factor for kidney disease to be screened annually with inexpensive urine and blood tests. That includes seniors 65 and above, for whom the cost is covered by Medicare. Free testing is also provided by the National Kidney Foundation for people with diabetes.

The urine test can pick up abnormal levels of protein, which is supposed to stay in the body, compared with the amount of creatinine, a waste product that should be excreted. The blood tUrine testest, called an eGFR (for estimated glomerular filtration rate), measures how much blood the kidneys filter each minute, indicating how effectively they are functioning.

If it is determined that you have kidney disease you should be referred to a nephrologist.  If you are not referred, ask for a referral.  The Nephrologist will work closely with your family physician to help control the disease.

There are two medications commonly used to treat high blood pressure that often halt or delay the progression of kidney disease in people with diabetes: ACE inhibitors and ARB’s (angiotensin receptor blockers). Careful control of blood sugar levels also protects the kidneys from further damage.

As I conducted the research for this blog I found that one of the most comprehensive websites for factual, understandable information about Kidney Disease is India’s “The Health Site.” It also contains a good deal of advertising and other questionable material, but its information on the kidneys and kidney disease is backed up by solid research.  What follows is some of it.  http://www.thehealthsite.com/

12 Possible Kidney Disease Symptoms

Even an unhealthy lifestyle with a high calorie diet, certain medicines. lots of soft drinks and sugar consumption can also cause kidney damage. Here is a list of twelve symptoms which could indicate something is wrong with your kidney:

  1. Changes in your urinary function: The first symptom of kidney disease is changes in the amount and frequency of your urination. There may be an increase or decrease in amount and/or its frequency, especially at night. It may also look more dark coloured. You may feel the urge to urinate but are unable to do so when you get to the restroom.
  2. Difficulty or pain during voiding: Sometimes you have difficulty or feel pressure or pain while voiding. Urinary tract infections may cause symptoms such as pain or burning during urination. When these infections spread to the kidneys they may cause fever and pain in your back.
  3. Blood in the urine: This is a symptom of kidney disease which is a definite cause for concern. There may be other reasons, but it is advisable to visit your doctor in case you notice it.
  4. Swelling: Kidneys remove wastes and extra fluid from the body. When they are unable to do so, this extra fluid will build up causing swelling in your hands, feet, ankles and/or your face. Read more about swelling in the feet.
  5. Extreme fatigue and generalised weakness: Your kidneys produce a hormone called erythropoietin which helps make red blood cells that carry oxygen. In kidney disease lower levels of erythropoietin causes decreased red blood cells in your body resulting in anaemia.  There is decreased oxygen delivery to cells causing generalised weakness and extreme fatigue. Read more about the reasons for fatigue.
  6. Dizziness & Inability to concentrate: Anaemia associated with kidney disease also depletes your brain of oxygen which may cause dizziness, trouble with concentration, etc.
  7. Feeling cold all the time: If you have kidney disease you may feel cold even when in a warm surrounding due to anaemia. Pyelonephritis (kidney infection) may cause fever with chills.
  8. Skin rashes and itching: Kidney failure causes waste build-up in your blood. This can causes severe itching and skin rashes.
  9. Ammonia breath and metallic taste: Kidney failure increases level of urea in the blood (uraemia). This urea is broken down to ammonia in the saliva causing urine-like bad breath called ammonia breath. It is also usually associated with an unpleasant metallic taste (dysgeusia) in the mouth.

10. Nausea and vomiting: The build-up of waste products in your blood in kidney disease can also cause nausea and vomiting. Read 13 causes for nausea.

11. Shortness of breath: Kidney disease causes fluid to build up in the lungs. And also, anaemia, a common side-effect of kidney disease, starves your body of oxygen. You may have trouble catching your breath due to these factors.

12. Pain in the back or sides: Some cases of kidney disease may cause pain. You may feel a severe cramping pain that spreads from the lower back into the groin if there is a kidney stone in the ureter. Pain may also be related to polycystic kidney disease, an inherited kidney disorder, which causes many fluid-filled cysts in the kidneys. Interstitial cystitis, a chronic inflammation of the bladder wall, causes chronic pain and discomfort.

It is important to identify kidney disease early because in most cases the damage in the kidneys can’t be undone. To reduce your chances of getting severe kidney problems, see your doctor when you observe one or more of the above symptoms. If caught early, kidney disease can be treated very effectively.

http://www.thehealthsite.com/diseases-conditions/12-symptoms-of-kidney-disease-you-shoulnt-ignore-world-kidney-day-special/

Kidney Disease Prevention

Ten Steps you can take

 Our kidneys are designed such that their filtration capacity naturally declines after the age of 30-40 years. With every decade after your 30s, your kidney function is going to reduce by 10%. But, if you’re going to increase the load on your kidneys right from the beginning, your risk of developing kidney disease later in life will definitely be higher. To be on the safe side, follow these few tips and take good care of your kidneys to prevent the risk of developing kidney problems.

1. Manage diabetes, high blood pressure and heart disease: In most of the cases, kidney disease is a secondary illness that results from a primary disease or condition such as diabetes, heart diseases or high blood pressure. Therefore, controlling sugar levels, cholesterol and blood pressure by following a healthy diet, exercise regimen and medication guidelines is essential to keep kidney disease at bay.

2. Reduce the intake of salt: Salt increases the amount of sodium in diet. It not only increases blood pressure but also triggers the formation of kidney stones. Here are a few tips to actually cut down your salt intake.

3. Drink lots of water every day:  Water keeps you hydrated and helps the kidneys to remove all the toxins from your body. It helps the body to maintain blood volume and concentration. It also helps in digestion and controls the body temperature. At least 8-10 glasses of water a day is a must.

4. Don’t resist the urge to urinate: Filtration of blood is a key function that your kidneys perform. When the process of filtration is done, extra amount of wastes and water is stored in the urinary bladder that needs to be excreted. Although your bladder can only hold a lot of urine, the urge to urinate is felt when the bladder is filled with 120-150 ml of urine.

So, if start ignoring the urge to go to the restroom, the urinary bladder stretches more than its capacity. This affects the filtration process of the kidney.

5. Eat right:  Nearly all processes taking place inside your body are affected by what you choose to eat and how you eat. If you eat more unhealthy, junk and fast food, then your organs have to face the consequences, including the kidneys. Here’s more information on the relation between unhealthy diet and kidney damage.

You should include right foods in your diet. Especially foods that can strengthen your kidneys like fish, asparagus, cereals, garlic and parsley. Fruits like watermelon, oranges and lemons are also good for kidney health. 

6. Drink healthy beverages: Including fresh juices is another way of drinking more fluids and keeping your kidneys healthy. Juices help the digestive system to extract more water and flush out wastes from the body. Avoid drinking coffee and tea. They contain caffeine which reduces the amount of fluids in the body. So, the kidneys have to work harder to get rid of them.

If you’re already suffering from kidney problems, you should avoid juices made from vegetables such as spinach and beets. These foods are rich in oxalic acid and they help in the formation of kidney stones. But you can definitely have coconut water.

7. Avoid alcohol and smoking: Excess intake of alcohol can disturb the electrolyte balance of the body and hormonal control that influences the kidney function. Smoking is not directly related to kidney problems but it reduces kidney function significantly. It also has an adverse effect on heart health which can further worsen kidney problems.

8. Exercise daily: Researchers believe that obesity is closely linked to kidney related problems. Being overweight doubles the chances of developing kidney problems. Exercising, eating healthy and controlling portion size can surely help you to lose extra weight and enhance kidney health. Besides, you will always feel fresh and active. Here’s more about how obesity and kidney disease are linked.

9. Avoid self-medication: All the medicines you take have to pass through the kidney for filtration. Increased dosage or taking medicines that you are not aware of can increase the toxin load on your kidneys. That’s why you should always follow dosage recommendations and avoid self-medication. Read more about how drugs affect the kidneys. 

10. Think before you take supplements and herbal medicine: If you’re on vitamin supplements or if you’re taking some herbal supplements, you should reconsider your dosage requirement. Excessive amount of vitamins and certain plant extracts are linked to kidney damage. You should talk to your doctor about the risk of kidney disease before taking them.

Dialysis and Transplantation

By Ed Bryant

(I could find no additional information about Mr. Bryant other than the following website.  His information, though, is sound).

https://nfb.org/images/nfb/publications/vod/vow0006.htm

Dialysis

Dialysis is not an “artificial kidney.” A person undergoing hemodialysis must be hooked up to a machine three times a week, three to four hours per session. A normal vein cannot tolerate the 16–gauge needles that must be inserted into the arm during hemodialysis, so the doctor must surgically connect a vein in the wrist with an artery, forming a bulging fistula that will better accommodate the large needles needed for treatment.dialysis

Like the kidney, a hemodialysis machine is a filter. Where it uses tubes and chemicals, the kidney uses millions of microscopic blood vessels, fine enough to pass urine while retaining suspended proteins. Long–term high blood glucose can significantly damage the kidney’s filters, leading to scarring, blockage, and diminished renal function. Diabetes is the leading cause of kidney disease. Long–term diabetics often have cardiovascular and blood pressure problems, and the added strain of hemodialysis, with its rise in blood pressure straining eyes and heart function, can be too much for some. The diabetic dialysis patient spends, on the average, 33% more time in the hospital than does the non–diabetic dialysis patient, according to 1999 USRDS figures.

Some patients choose CAPD (continuous ambulatory peritoneal dialysis) or its variant, CCPD (continuous cycling peritoneal dialysis), both of which can be carried out at home, without an assistant. Unlike hemodialysis, which uses a big machine to remove toxic impurities from the blood, peritoneal dialysis works inside the body, making use of the peritoneal membrane to retain a reservoir of dialysis solution, which is exchanged for fresh solution, via catheter, every four to eight hours. CAPD is carried out by the patient, who simply exchanges spent for fresh solution, every four to eight hours, at home, at work, or while travelling. CCPD, its variant, makes use of an automated cycler, which performs the exchanges while the patient is asleep. Although more complicated and machine–dependent, it does allow daytime freedom from exchanges, and may be the appropriate choice for some. Though the risk of infections is heightened (as it is with any permanent catheterization), these two processes have advantages, one being that insulin can be added to the dialysis solution, freeing the patient from the need to inject, and giving good blood sugar control.

Transplantation

Kidney transplantation is a logical alternative for many. It substantially improves a patient’s kidney transplantquality of life. Although the transplant recipient must be on anti–rejection/ immunosuppressive therapy for life, with the inherent risk from otherwise nuisance infections, a transplant frees the patient from the many hours spent on hemodialysis procedures each week, or from the periodic “exchanges” and open catheter of CAPD, allowing a nearly normal lifestyle. For those ESRD patients who can handle the stresses of transplant surgery, the resulting gains in physical well–being add up to real improvement in quality of life and overall longevity.

“Fifty percent of all kidney transplantations taking place today are into diabetics,” states Giacomo Basadonna, MD, PhD, a transplant surgeon at Yale University School of Medicine, in New Haven, Connecticut. He reports that success rates are identical with kidney transplants performed on non–diabetic ESRD patients. “Today,” he advises, “average kidney survival, from a living donor, is greater than 15 years.”

One of the areas where we are seeing rapid improvement is immunosuppressive medication. The traditional mix of immunosuppressants: cyclosporine, prednisone, imuran, is giving way to more targeted medications that may have fewer side effects. Cellcept, by Roche/Syntex, and Rapamycin (Rapamune), by Wyeth/Ayerst, have been approved by the FDA, and others are being tested. The risk of organ rejection is always present, but each new development increases the chances of success.

I and others knowledgeable in kidney transplantation advise you to pick the best transplant center possible. Once you have read their statistics, ask your prospective center the following questions. If they don’t answer to your satisfaction, you should consider going to another center.

1. Do you have an information packet for prospective donors and recipients?

2. Can you put me in touch with someone who has had a transplant at your center?

3. What is your “graft survival” (success) rate?

4. Who will my transplant surgeon be? If a fellow or resident, will he/she be supervised by a practicing transplant surgeon?

5. How long have your current surgeons been doing kidney transplants? How many have they done? That your center has 35 years experience with kidney transplants is of little consequence if my surgeon has only done ten in his or her career.

6. What is the average post–operative stay in your hospital?

7. When I come for my transplant, or come back for follow–ups, will there be any affordable housing for me and/or my family? (Ronald McDonald House, or other lodging with discount rates…) or will I get stuck in a luxury hotel for $125 a night?

8. How often will I need to come back to the center for follow–ups? Can my nephrologist do the blood tests and send you the results?

9. Can you recommend a nephrologist in my area?

10. Do you have a toll–free number to call for after–transplant information?

11. What is your policy on people with insufficient health insurance? Will you work with an uninsured patient? What will it cost?

12. Are you prepared to satisfy my doubts? Will you show me the documents that answer my questions? Will you guarantee the price quoted?

Conclusion

Kidney disease can be manageable if caught early and treated appropriately.  The information contained in this blog should allow you to make good decisions that can provide you with the quality of life you seek and deserve.  For more information about kidney disease and treatment here are some additional sources.

  • The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)

http://tinyurl.com/qfna7f2

 

 

 

 


My new hat April 10 2014Bob Aronson of Bob’s Newheart is a 2007 heart transplant recipient,
 the founder of Facebook’s nearly 4,000 member Organ Transplant Initiative (OTI) and the author of most of these donation/transplantation blogs. You may comment in the space provided or email your thoughts to me at bob@baronson.org. And – please spread the word about the immediate need for more organ donors. There is nothing you can do that is of greater importance. If you convince one person to be an organ and tissue donor you may save or positively affect over 60 lives. Some of those lives may be people you know and love.

Post Transplant Depression. You Don’t Have To Feel That Way!


depression cartoon

By Bob Aronson

The very first thing you should know is that depression is common after an organ transplant – very common and no one is immune.  You should also know that there is help available.  You don’t have to feel that way!   I know because I suffer from it.  As of this writing I am six years post transplant and my depression is under control because I found help but it still rears its ugly head from time to time.

For two years following my 2007 heart transplant I wallowed in emotional pain, I felt useless, worthless, without value, guilty and empty.  I looked at myself as one might look at a car you’ve owned for many years.  It was useful and desirable once but now it is old and things keep going wrong and need fixing.   To keep it running just costs too much and sad as it is we are probably better off without it.  It is costing more than it is worth.   That’s pretty much how I felt about myself.

Depression, I think, is compounded by the patient’s inner battle between the armies of logical thought and those of emotion.  Your logical mind asks, “How can you be depressed when you just got a new heart that saved your life?”   But, your emotions say, “I don’t know but I feel awful and sometimes I wish I was dead.”  That is a horrible battle to have to fight alone…but you don’t have to, there’s help and you can win.

For a quarter of a century 228642_8263187420_1503_nI had been a communications consultant with a stable of highly respected internationally known clients many of which were based in Minnesota where I lived.  I needed a heart transplant and discovered that I stood a better chance of getting one if I moved to Jacksonville, Florida.  I learned that the Mayo Clinic there had an excellent record of obtaining and transplanting organs and data indicated I stood a better chance of getting a heart there than in Minnesota.  Furthermore, Jacksonville was my wife Robin’s home town and her son, parents and extended family lived there.  It made sense to move…but it also meant giving up a lion’s share of my business.

To shorten a long story we moved to Jacksonville and I got my new heart after only a 13 day wait but recovery took longer than expected.  There were complications…many of them. I got pneumonia, suffered two torn rotator cuffs which resulted in an extended period of excruciating pain and I became very, very depressed.  I could hardly function day to day never mind think of working again.  But, because I could not work I felt guilty and my depression got worse.

I sat in a dark corner of our family room every day watching the TV’s flickering light change the shadows in the room.  The set was on but rarely was I involved in what was playing…my mind was somewhere else.  I felt totally and utterly useless and guilty that I had taken an organ but couldn’t do anything to show that I was worthy of it. I felt that way for two years.  Each day I went through the motions of living, trying to be useful, trying to help my wife with her fledgling business but feeling totally inadequate and unnecessary.

You’ve seen the Roadrunner TV cartoon I’m sure where the poor coyote just can’t win against his fleet footed foe.  wiley hanging from a limbOften the canine victim is seen hanging by one hand from a branch on the side of a mountain…then the branch gives way and he falls the 5,000 feet  to the ground below which flattens him.  I felt like Wylie, like I was hanging from that branch waiting to fall and sometimes I wished the branch would break.

Two things kept me from giving up,  Robin’s constant encouragement and this blog along with my Facebook Group Organ Transplant Initiative (OTI).  Both were started two months after my transplant at the urging of my friends at Mayo.  These social media activities weren’t meant to be anti depressants but they turned out to be just that.   Thank God for both of them.

Then, one day, it occurred to me that maybe, just maybe I could get help and for the first time I mentioned depression as a problem to my Mayo Clinic transplant coordinator.  With virtually no delay I was seen by a physician who determined that anti depressants might help.  There were several false starts before we found one that worked but we did

At about the same time Robin asked me if I could make some wood fixtures for her art show booth; shelving, pedestals and other display items.  I soon found I loved woodwork and a new hobby was born, one that ensured my not returning to that dark corner in which I used to reside.

As I did the research for this blog I found a good deal of information about depression,  most of it clinical in nature and not real helpful.  From personal experience I know that fighting depression isn’t easy.  I know that it can last a long time, it can take even more time to find the right solution and sometime the solutions have a short life and the depression returns which forces you to find another solution.   It is a never ending battle but oh so worth it.

In a document titled “Issues for Today’s transplant Patients….A guide” published by the National Kidney Foundation (NKF) http://www.kidney.org/transplantation/transAction/pdf/UnderstandingDepression.pdf   there is an excellent section on post transplant depression, “Understanding Depression” I won’t re-print all of it but here’s some of it.

NKF LOGL

Depression is extremely common in the United States, and it can have a unique impact on transplant recipients. Practically every transplant recipient has likely felt—or fought off—depression at some time or another.

 Living with a new organ has daily challenges. These include medical bills and getting used to a new body. Some transplant recipients may also feel they are burdening their loved ones with constant doctors’ visits and a general need for extra help. All of this comes on top of the trials and tribulations that arise for everyone, transplant recipient or not.

It’s normal to have a range of feelings after a transplant.  We at the NKF believe that depression is one of the biggest issues people face, and something a lot of health care workers ignore.  Research shows that, in any given year, almost 10 percent of theU.S. population is depressed. That’s 19 million adults, with and without transplants.  And in people with chronic illness, the incidence of depression is much higher . Some research suggests that up to 25 percent of people with illnesses become depressed at some point in their lives. So, if you are a transplant recipient and you feel depressed, you are definitely not alone. 

Depression is different. It’s not just a bad mood, which is something everybody feels. Being depressed means that people feel at least five symptoms of depression for two weeks or longer. A bad mood should only last a couple of days. Depression is also more intense than a bad mood, even how the body feels.

 Nine symptoms of depression:

  1. Feeling depressed for most of the day, almost every day
  2. Lack of enjoyment of activities you once enjoyed, such as going to work or visiting friends.
  3. Weight changes (gaining or losing).
  4. Sleep problems (too much or too little).
  5. Feeling restless.
  6. Lacking energy, feeling easily fatigued.
  7. Feeling worthless or guilty.
  8. Trouble concentrating.
  9. Frequent thoughts of suicide.

 Remember that people have to have at least five of these nine symptoms for at least two weeks before doctors will diagnose depression. This is to make sure that people who have bad days here and there are not misdiagnosed.

The stress of having a transplant can trigger depression.  Having a transplant is a life-altering experience. The range of emotions people feel as a result of the procedure can definitely trigger depression in those who are susceptible to it.   It can be incredibly difficult for people to accept that one of the organs they were born with no longer works. For many, organ failure can feel like a profound loss. Some really grieve over it, which is totally under-standable. Unfortunately, this grief can also lead to depression.

 Having a transplant can create another loss, by changing recipients’ lives in an irreversible way. They may grieve that they can no longer lead the same life as before, now having to rely on doctors and medications to stay well. That can be hard to accept.

 Some recipients may also find it hard to accept that they are more dependent on their families. They may feel like their illness disrupts their families’ lives, and they are dependent on them emotionally and sometimes financially.

For recipients who are used to being the sole providers for their families, that can be really tough.  Financially, many transplant recipients also worry about their futures and how to afford the medicines they’ll need for the rest of their lives.  People with kidney transplants often worry about their health insurance,   knowing that they lose Medicare after three years.   

 Ok, all of that explanation makes a lot of sense but if you are depressed what can you do about it?  There’s much that can be done and you can start by talking to your transplant coordinator.  You can be sure they’ll have some resources for you to investigate or they can arrange for you for appointments.

While treatments abound there are two that are most common.  They are talk therapy and medication.  The most common type of therapy cognitive behavior therapy,  or CBT.  A highly skilled therapist can help you correct the negative thought patterns behind your depression. For instance, if people are constantly feeling hopeless, or that there’s no point in living, There is also a behavioral aspect to cognitive behavior therapy.  It focuses on how helping you avoid behaviors that cause or invite depression…behaviors like staying in bed all day or avoiding activities that had been enjoyable.  This kind of therapy can be done in a one on one or group setting, whichever makes you more comfortable and is most effective.

Another form of therapy is medication.  Sometimes both therapies are applied simultaneously but experts in depression can advise you best on when that is appropriate.

In my case it was medication that worked.  But it took time, there were months of trial and error.  It usually takes four to six weeks for an anti depression medication to work.  Sometimes it did but only for a short while and on other occasions there was no effect at all and we’d have to start all over again.  Different people react differently to the same medication.  What may work for your neighbor may not work for you at all but withy patience and the aid of a professional it is likely you will find the right one.

A word of caution: AVOID ST. JOHN’S WORT

st. John's wort

A lot of people use herbal medicines to treat a variety of conditions. One very popular herbal medicine is St. John’s Wort which has achieved some popularity in treating depression.  Transplant patients should avoid using it because medical evidence clearly indicates that St. John’s Wort interferes with other drugs like Cyclosporin, which people take to prevent transplant rejection.  There is documented evidence that some transplant recipients have lost their organs after taking St. John’s Wort.

Still another way to address depression is activity, a hobby, a business, a project.  The combination of medication and activity is what got me out of depression and keeps me there.  I rarely sit still and when I do it’s because I’m exhausted from all the activity.   I will be writing more about activities but woodwork, music, art, nature studies or astronomy can be of immense help in chasing away your demons.  There’s one for you…you just have to find it.

One way of beating depression is…not to get it.  Not long ago CBS TV news did an interesting story on the subject called, “Depression: Ten Traps to Avoid”  You can watch it on this link…or read it below.

http://www.cbsnews.com/2300-204_162-10004447.html

Clinical depression is a devastating illness, and profound sadness is just the beginning. Depression can rob people of their energy, memory, concentration, sex drive, interest in usual activities – and in severe cases, even the will to live. Seventy million Americans will be afflicted at some point.

Dr. Stephen Ilardi, author of “The Depression Cure,” has identified several things that can make depression worse.

Depression is a serious medical condition and should be treated by a doctor or licensed therapist.

Trap 1: Being a Couch Potato

couch potato

When you’re feeling down, it’s tempting to hole up in your bed or on the couch. Yet exercise –

Even moderate activity like brisk walking – has been shown to be at least as effective against depression as antidepressant medication. It works by boosting the activity of the “feel-good” neurochemicals dopamine and serotonin.

For an “antidepressant dose” of exercise, try at least 40 minutes of brisk walking or other aerobic activity three times a week.

Trap 2: Not Eating “Brain Food”

junk food

Omega-3 fats are key building blocks of brain tissue. But the body can’t make omega-3s; they have to come from our diets. Unfortunately, most Americans don’t consume nearly enough Omega-3s, and a deficiency leaves the brain vulnerable to depression. Omega-3s are found in wild game, cold-water fish and other seafood, but the most convenient source is a fish oil supplement. Ask your doctor about taking a daily dose of 1,000 mg of EPA, the most anti-inflammatory form of omega-3.

Trap 3: Avoiding Sunlight

alone in the dark

Sunlight exposure is a natural mood booster. It triggers the brain’s production of serotonin, decreasing anxiety and giving a sense of well-being. Sunlight also helps reset the body clock each day, keeping sleep and other biological rhythms in sync.

During the short, cold, cloudy days of winter, an artificial light box can substitute effectively for missing sunlight. In fact, 30 minutes in front of a bright light box each day can help drive away the winter blues.

Trap 4: Not Getting Enough Vitamin D

vitamin D from the sun

Most people know vitamin D is needed to build strong bones. But it’s also essential for brain health. Unfortunately, more than 80 percent of Americans are vitamin D deficient. From March through October, midday sunlight exposure stimulates vitamin D production in the skin – experts advise five to 15 minutes of daily exposure (without sunscreen). For the rest of the year, ask your doctor about taking a vitamin D supplement.

Trap 5: Having Poor Sleep Habits

bad sleep habit

Chronic sleep deprivation is a major trigger of clinical depression, and many Americans fail to get the recommended seven to eight hours a night. How can you get better sleep?

Use the bed only for sleep and sex – not for watching TV, reading, or using a laptop. Turn in for bed and get up at the same time each day. Avoid caffeine and other stimulants after midday. Finally, turn off all overhead lights

Trap 6: Avoiding Friends and Family

depressed person

When life becomes stressful, people often cut themselves off from others. That’s exactly the wrong thing to do, as research has shown that contact with supportive friends and family members can dramatically cut the risk of depression. Proximity to those who care about us actually changes our brain chemistry, slamming the brakes on the brain’s runaway stress circuits.

Trap 7: Mulling Things Over

mulling

When we’re depressed or anxious, we’re prone to dwelling at length on negative thoughts – rehashing themes of rejection, loss, failure, and threat, often for hours on end. Such rumination on negative thoughts is a major trigger for depression – and taking steps to avoid rumination has proven to be highly effective against depression.

How can you avoid rumination? Redirect attention away from your thoughts and toward interaction with others, or shift your focus to an absorbing activity. Alternatively, spend 10 minutes writing down the troubling thoughts, as a prelude to walking away from them.

Trap 8: Running with the Wrong Crowd

bad person

Scientists have discovered that moods are highly contagious: we “catch” them from the people around us, the result of specialized mirror neurons in the brain. If you’re feeling blue, spending time with upbeat, optimistic people might help you “light up” your brain’s positive emotion circuits.

Trap 9: Eating Sugar and Simple Carbs

sugar donuts

Researchers now know that a depressed brain is an inflamed brain. And what we eat largely determines our level of inflammation. Sugar and simple carbs are highly inflammatory: they’re best consumed sparingly, if at all.

In contrast, colorful fruits and veggies are chockablock with natural antioxidants. fruit and veggie plateEating them can protect the body’s omega-3s, providing yet another nice antidepressant boost.

Trap 10: Failing to Get Help

hopelessness

Depression can be a life-threatening illness, and it’s not one you should try to “tough out” or battle on your own. People experiencing depression can benefit from the guidance of a trained behavior therapist to help them put into action depression-fighting strategies like exercise, sunlight exposure, omega-3 supplementation, anti-ruminative activity, enhanced social connection, and healthy sleep habits.

We hope this blog has helped.  If you feel depressed or even if you are not sure talk to your transplant coordinator or any mental health professional. There is help. You don’t have to feel the way you do.

                                                                    

Bob informal 3

Bob Aronson of Bob’s Newheart is a 2007 heart transplant recipient, the founder of Facebook’s nearly 3,000 member Organ Transplant Initiative and the author of most of these donation/transplantation blogs.

You may comment in the space provided or email your thoughts to me at bob@baronson.org. And – please spread the word about the immediate need for more organ donors. There is nothing you can do that is of greater importance. If you convince one person to be an organ and tissue donor you may save or positively affect over 60 lives. Some of those lives may be people you know and love.

Please view our music video “Dawn Anita The Gift of Life” on YouTube https://www.youtube.com/watch?v=eYFFJoHJwHs.  This video is free to anyone who wants to use it and no permission is needed.

If you want to spread the word personally about organ donation, we have another PowerPoint slide show for your use free and without permission. JAgain, write to me and ask for “Life Pass It On.”  I will email it to you immediately.  This is NOT a stand-alone show; it needs a presenter but is professionally produced and factually sound.  If you decide to use the show I will  also send you a free copy of my e-book, “How to Get a Standing “O” that will help you with presentation skills. Just write to bob@baronson.org and I will send the show and book ASAP.

Also…there is more information on this blog site about other donation/transplantation issues. Additionally we would love to have you join our Facebook group, Organ Transplant Initiative  (OTI).  The more members we get the greater our clout with decision makers.

En Espanol

Bob Aronson de Newheart de Bob es un centro receptor de trasplante 2007, el fundador de la Iniciativa de Facebook cerca de 3.000 miembros de trasplantes de órganos y el autor de la mayoría de estos blogs de donación / trasplante.

Usted puede dejar un comentario en el espacio proporcionado o por correo electrónico a sus pensamientos a mí en bob@baronson.org. Y – por favor difundir la palabra acerca de la necesidad inmediata de más donantes de órganos. No hay nada que puedas hacer lo que es de mayor importancia. Si se convence a una persona para ser un donante de órganos y tejidos puede salvar o positivamente afectará a más de 60 vidas. Algunas de esas vidas puede haber gente que conoces y amas.

Por favor, vea nuestro video musical “Dawn Anita The Gift of Life” en YouTube https://www.youtube.com/watch?v=eYFFJoHJwHs. Este video es libre para cualquier persona que quiera usarlo y no se necesita permiso.

Si quieres correr la voz personal sobre la donación de órganos, tenemos otra presentación de PowerPoint para su uso gratuito y sin permiso. JAgain, escribir a mí y pedir “Life Pass It On.” Voy a enviar por correo electrónico a usted inmediatamente Esto no es un espectáculo independiente,. Necesita un presentador, pero es producido profesionalmente y objetivamente sonido Si usted decide utilizar el archivo. demuestro que también le enviará una copia gratuita de mi libro electrónico, Cómo obtener un Standing” O “que le ayudará con habilidades de presentación. Sólo escribo bob@baronson.org y enviaré el programa y el libro lo antes posible.

Además … hay más información sobre este sitio de blogs de otros temas de donación / trasplante. Además, nos encantaría que te unas a nuestro grupo de Facebook, la Iniciativa de Trasplante de Órganos (OTI). Cuantos más miembros que tienen la mayor influencia en nuestra toma de decisiones.

Post-Transplant Depression — What It Is and What To Do.


This is a compilation of information from various sources.  It does not constitute medical advice.  Please consult your physician about your condition and base your treatment decision on his or her advice, not on what you read here.

Post-transplant depression is real.  There are no statistics of which I am aware that indicate the percentage of organ recipients that suffer from the malady but there are enough reports of the problem to suggest it is no small number.

The extent to which your emotional health is affected by a transplant depends on a complex interplay of your health status and personality, genetic factors, social support, financial situation, and other concerns.

For most people, emotions about their experience change and evolve over time. Typically, feelings of sadness or anxiety are transient. For some, however, these feelings may persist and interfere with daily life.

According to the Mayo Clinic Depression is more than just a bout of the blues.  It isn’t a weakness, nor is it something that you can simply “snap out” of. Depression is a chronic illness that usually requires long-term treatment, like diabetes or high blood pressure. http://www.mayoclinic.com/health/depression/DS00175

Depression is a complex disease and sometimes it is difficult if not impossible to find a reason for the problem.  One that I hear most often is guilt.  Some recipients feel guilt because, they say, someone had to die in order for them to live. Others feel guilt because they are doing well while other transplant recipients may not be so fortunate.  Those feelings sometimes proves to be a very heavy burden for many transplant recipients but it may be only one potential cause of their feelings. There are some other factors that may contribute to post transplant depression as well:

  • Anger or depression, because they don’t feel better as soon as they expected.
  • Frustration, because of chronic or lingering fatigue that keeps them from things they want to do or accomplish.
  • Mood changes caused by the drugs that must be taken following a transplant.
  • Dissatisfaction with old plans and goals. Identifying new priorities and making lifestyle changes may feel good, but can also be stressful.
  • Fear that the old illness might return and affect the new organ

Symptoms of depression include:

  • Persistent sad, anxious, or “empty” feelings
  • Feelings of hopelessness or pessimism
  • Feelings of guilt, worthlessness, or helplessness
  • Irritability, restlessness
  • Loss of interest in activities or hobbies once pleasurable, including sex
  • Fatigue and decreased energy
  • Difficulty concentrating, remembering details, and making decisions
  • Insomnia, early-morning wakefulness, or excessive sleeping
  • Overeating, or appetite loss
  • Thoughts of suicide, suicide attempts
  • Aches or pains, headaches, cramps, or digestive problems that do not ease even with treatment.

Despite the feelings of gloom and doom, though, there is reason to be optimistic because most people with depression will eventually  feel better with medication, psychological counseling or other treatment.

Still another reason for post-transplant depression is Post Traumatic Stress Disorder (PTSD).  Post-traumatic stress disorder is a type of anxiety disorder. It can occur after you’ve seen or experienced a traumatic event that involved the threat of injury or death.  Obviously getting an organ transplant falls into that definition. http://health.nytimes.com/health/guides/disease/post-traumatic-stress-disorder/overview.html

Symptoms of PTSD fall into three main categories:

1. “Reliving” the event, which upsets day-to-day activity

  • Flashback episodes, where you re-live the event so it seems to be happening again and again
  • Repeated traumatic memories of the event
  • Frequent nightmares of the event
  • Strong, uncomfortable reactions to reminders of the situation

2. Avoidance

  • Emotional “numbing,” or feeling as though you don’t care about anything
  • Feeling detached
  • Being unable to remember important aspects of the trauma
  • Lack of interest in normal activities
  • Hiding your moods
  • Avoiding places, people, thoughts or things that remind you of the trauma
  • Feeling as though you have no future

3. Arousal

  • Difficulty concentrating
  • Startling easily
  • An exaggerated response to things that startle you
  • Feeling more aware of negative things
  • Irritability and angry outbursts
  • Difficulty falling or staying asleep

If you have severe depression, a doctor, loved one or guardian may need to guide your care until you’re well enough to participate in decision making. You may need a hospital stay, or you may need to participate in an outpatient treatment program until your symptoms improve. http://www.mayoclinic.com/health/depression/DS00175/DSECTION=treatments-and-drugs

Here’s a closer look at your depression treatment options.

Medications
A number of antidepressant medications are available to treat depression. There are several different types of antidepressants. Antidepressants are generally categorized by how they affect the naturally occurring chemicals in your brain to change your mood. You can view the entire section on medications by following the above link to the Mayo clinic.

Types of antidepressants include:

  • Selective serotonin reuptake inhibitors (SSRIs). These medications are safer and generally cause fewer bothersome side effects than do other types of antidepressants. SSRIs include fluoxetine (Prozac), paroxetine (Paxil), sertraline (Zoloft), citalopram (Celexa) and escitalopram (Lexapro). The most common side effects include decreased sexual desire and delayed orgasm.
  • Serotonin and norepinephrine reuptake inhibitors (SNRIs). These medications include duloxetine (Cymbalta), venlafaxine (Effexor XR) and desvenlafaxine (Pristiq). Side effects are similar to those caused by SSRIs.
  • Norepinephrine and dopamine reuptake inhibitors (NDRIs). Bupropion (Wellbutrin) falls into this category. It’s one of the few antidepressants that doesn’t cause sexual side effects.
  • Atypical antidepressants. These medications are called atypical because they don’t fit neatly into another antidepressant category. They include trazodone (Oleptro) and mirtazapine (Remeron). Both of these antidepressants are sedating and are usually taken in the evening. In some cases, one of these medications is added to other antidepressants to help with sleep. The newest medication in this class of drugs is vilazodone (Viibryd).
  • Tricyclic antidepressants. These antidepressants have been used for years and are generally as effective as newer medications. But because they tend to have more numerous and more-severe side effects, a tricyclic antidepressant generally isn’t prescribed unless you’ve tried an SSRI first without an improvement in your depression.
  • Monoamine oxidase inhibitors (MAOIs). MAOIs — such as tranylcypromine (Parnate) and phenelzine (Nardil) — are usually prescribed as a last resort, when other medications haven’t worked. That’s because MAOIs can have serious harmful side effects. They require a strict diet because of dangerous (or even deadly) interactions with foods, such as certain cheeses, pickles and wines, and some medications including decongestants. Selegiline (Emsam) is a newer MAOI that you stick on your skin as a patch rather than swallowing. It may cause fewer side effects than other MAOIs.
  • Other medication strategies. Your doctor may suggest other medications to treat your depression. These may include stimulants, mood-stabilizing medications, anti-anxiety medications or antipsychotic medications. In some cases, your doctor may recommend combining two or more antidepressants or other medications for better effect. This strategy is known as augmentation.

Finding the right medication
everyone’s different, so finding the right medication or medications for you will likely take some trial and error. This requires patience, as some medications need eight weeks or longer to take full effect and for side effects to ease as your body adjusts. If you have bothersome side effects, don’t stop taking an antidepressant without talking to your doctor first.

Antidepressants and pregnancy
If you’re pregnant or breast-feeding, some antidepressants may pose an increased health risk to your unborn child or nursing child. Talk to your doctor if you become pregnant or are planning on becoming pregnant.

Antidepressants and increased suicide risk
Although most antidepressants are generally safe, be careful when taking them. The Food and Drug Administration (FDA) now requires that all antidepressant medications carry black box warnings. These are the strictest warnings that the FDA can issue for prescription medications.

The antidepressant warnings note that in some cases, children, adolescents and young adults under 25 may have an increase in suicidal thoughts or behavior when taking antidepressants, especially in the first few weeks after starting an antidepressant or when the dose is changed. Because of this risk, people in these age groups must be closely monitored by loved ones, caregivers and health care providers while taking antidepressants. If you — or someone you know — have suicidal thoughts when taking an antidepressant, immediately contact your doctor or get emergency help.

Psychotherapy
Psychological counseling is another key depression treatment. Psychotherapy is a general term for a way of treating depression by talking about your condition and related issues with a mental health provider.

Through these talk sessions, you learn about the causes of depression so that you can better understand it. You also learn how to identify and make changes in unhealthy behavior or thoughts, explore relationships and experiences, find better ways to cope and solve problems, and set realistic goals for your life.

Hospitalization and residential treatment programs
In some people, depression is so severe that a hospital stay is needed. Inpatient hospitalization may be necessary if you aren’t able to care for yourself properly or when you’re in immediate danger of harming yourself or someone else. Getting psychiatric treatment at a hospital can help keep you calm and safe until your mood improves.

In this blog we have attempted to give you an overview of depression and its causes along with known effective treatment options.  Please remember, this is only a blog, it is not medical advice and we strongly suggest that you take no action based on what you read here.  See a qualified physician, ask a lot of questions and then make a decision.

Bob Aronson of Bob’s Newheart is a 2007 heart transplant recipient, the founder of Facebook’s nearly 2,500 member Organ Transplant Initiative and the author of most of these donation/transplantation blogs.

You may comment in the space provided or email your thoughts to me at bob@baronson.org. And – please spread the word about the immediate need for more organ donors. There is nothing you can do that is of greater importance. If you convince one person to be an organ and tissue donor you may save or positively affect over 60 lives. Some of those lives may be people you know and love.

Please view our video “Thank You From the Bottom of my Donor’s heart” on http://www.organti.org This video was produced to promote organ donation so it is free and no permission is needed for its use.

If you want to spread the word personally about organ donation, we have another PowerPoint slide show for your use free and without permission. Just go to http://www.organti.org and click on “Life Pass It On” on the left side of the screen and then just follow the directions. This is NOT a stand-alone show; it needs a presenter but is professionally produced and factually sound. If you decide to use the show I will send you a free copy of my e-book, “How to Get a Standing “O” that will help you with presentation skills. Just write to bob@baronson.org and usually you will get a copy the same day.

Also…there is more information on this blog site about other donation/transplantation issues. Additionally we would love to have you join our Facebook group, Organ Transplant Initiative The more members we get the greater our clout with decision makers.

Hepatitis C — What You Need to Know


More people in the United States now die from hepatitis C each year than from AIDS, according to a new report from the Centers for Disease Control and Prevention. More than 3.2 million Americans are currently infected with hepatitis C and the really bad news is that most people who have it don’t’ know it.

Let’s start with a definition.

According to the Mayo Clinic Hepatitis C is an infection caused by a virus that attacks the liver and leads to inflammation. Most people infected with the hepatitis C virus (HCV) have no symptoms. In fact, most people don’t know they have the hepatitis C infection until liver damage shows up, decades later, during routine medical tests.

Hepatitis C is one of several hepatitis viruses and is generally considered to be among the most serious of these viruses. Hepatitis C is passed through contact with contaminated blood. http://www.mayoclinic.com/health/hepatitis-c/DS00097

According to the U.S. Centers For Disease Control (CDC) http://www.cdc.gov/hepatitis/c/cfaq.htm Hepatitis C is most commonly spread through the use of infected needles. Before 1992, when widespread screening of the blood supply began in the United States, Hepatitis C was also commonly spread through blood transfusions and organ transplants. Now we know that people can become infected with the Hepatitis C virus during such activities as

  • Sharing needles, syringes, or other equipment to inject drugs
  • Needlestick injuries in health care settings
  • Being born to a mother who has Hepatitis C

Less commonly, a person can also get Hepatitis C virus infection through

  • Sharing personal care items that may have come in contact with another person’s blood, such as razors or toothbrushes
  • Having sexual contact with a person infected with the Hepatitis C virus

***Note, the Executive Director at HCVets.com, Tricia Lupole, indicates that the CDC information may be incorrect. She made this comment on our Facebook page.

“HCV by sex is a risk if both partners experience trauma and exchange blood…. the only cells found is seminal fluids are dead cells…. confirmed by many microbiologist. http://www.ncbi.nlm.nih.gov/pubmed/15128350 There are 100s of studies that show this is the case but it is junk science that reins control of the message to control the funding. Lots of plans to make HCV the fall guy for bad behavior.“

In a second post she went on to say, “Yes, the CDC has quoted the same statement for about 15-20 years now. The study I posted is based on the CDC National Survey. Another sad point, last I checked. Even though we all know better the CDC says that there is not enough evidence to show tattoos are a risk factor.

AMA does not want to regulate tattoo parlors as medical procedures because they are responsible for guidance/ prevention. (The task has been given to OSHA).

Today Ms. Lupole issued this statement:

The Centers for Disease Control federal funding has decreased in recent decades, while there’s been increased demands for vaccination programs; resulting in limited resources for at-risk adults and other mandated priorities. The categorical nature of federal funding for HIV, STD, and viral hepatitis prevention limits the shifting of funds across program lines. In response to these funding woes, the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention’s (NCHHSTP) captured HCV disease and redesign public health services to fit HIV programs, instead of critical public health needs. It’s important to note that HCV disease was previously integrated into federal research that included its viral family called Flaviviridae, whose members are Yellow Fever and Dengue viruses and transmit disease through mosquitoes. The HCV genome is almost identical to Dengue virus.


NCHHSTP’s Federal mandate is an integration of existing programs with new programs, like Viral Hepatitis, developed to mirror HIV/AIDS management model based on specific risks and disease pathology. STD and Substance Abuse programs associated with the spread of HIV/AIDS received increased attention and funding, blurring the other components of these programs.

Needless to say, NCHHSTP has meet with resistance from advocates and congressional leaders, because of this effort by public health agencies to narrowly define HCV’s pathology.


Today, NCHHSTP spends half the federal resources acquired for HCV to vaccinate patients with both Hepatitis A & B vaccines. The majority of remaining resources are directed at drug and STD intervention and prevention. The STD division must qualify for its share of funding by defining HCV a sexually transmitted disease.


Despite scientific proof that HCV is not an STD, NCHHSTP promotes HCV as an STD based on a handful of studies that bring about scientific uncertainty, working against broader public health threats. Research excluded several methods by which the virus transmits to insure standard elements comply with CDC corporate agreement requirements. Thus… junk science.
Such actions suggests this poor public health response to the HCV Disease epidemic, may be the direct result of a system in disarray – seemingly captured by special interest with legal and political agendas that have negatively influenced the response. The integration approach has created disparities in access to health care and created “social labels” that have fostered discrimination, responsible for the reduction in quality of life.

The enduring legacy of “junk science” and indifference of governments, nonprofits, advocates, political parties or economic elites, have grave and global consequences given the propensity for viral transmission in provider settings as seen in current headlines.

FY 2012 Hepatitis C transmission and prevention: latest news. Massive increase of hepatitis C incidence in HIV-positive gay men in Switzerland 30 August 2012 …http://www.aidsmap.com/Hepatitis-C-transmission-and-prevention/cat/1628/

• FY 2008- No evidence of a HCV epidemic in HIV negative gay men
Dr Turner et al. Data from attendees at a London GUM clinic suggest that there is no increase in HCV infections amongst HIV negative gay men.

• FY 2007- Injection Behavior, Not Sexual Contact, Accounts for Couples’ HCV Risk NEW YORK (Reuters Health) – Injection behavior, rather than sexual contact, accounts for the clustering of HCV virus (HCV) infection in heterosexual couples, according to a report in the June 1st issue of The Journal of Infectious Diseases.

• FY 2004 No Evidence of Sexual Transmission of HCV among Monogamous Couples: Results of a 10-Year Prospective Study The risk of sexual transmission of HCV virus (HCV) infection was evaluated among 895 monogamous heterosexual partners of HCV chronically infected individuals in a long-term prospective study, which provided a follow-up period of 8,060 person-years.

Either way, CDC or not…. junk science remains junk science. Wish the outcry would focus on piercing jewelry or the reuse of razors and personal care items verses a national message about a method that is least as likely as not. This battle over CDC junk science, goes way back and is in memory of many who passed HCV on to family members, while sacrificing pleasures of the mind, body, and soul. As you can imagine, sexual transmission is a constant worry for some. Their partner may catch/transmit this deadly virus through sex, protection or not….. yet… turn right around and share razors and other items as such.  Especially the economically depressed populations.”

Most recently, though, we’ve identified another way people may become infected and through no fault of their own. Recently in a New Hampshire hospital an employee who was a drug addict and who also had Hepatitis C was found to be injecting himself with filled syringes meant for patients, refilling the syringes with a harmless liquid non-pain killer and then replacing the needles and syringes on the tray to be used again. Below is one of the original stories on this 2012 incident.

‘Serial infector’ accused of spreading hepatitis at NH hospital

U.S. Attorney’s Office | ASSOCIATED PRESS

CONCORD, N.H. — Authorities in at least six states are investigating whether a traveling hospital technician accused of infecting 30 people with hepatitis C in New Hampshire also exposed earlier patients to the liver-destroying disease.

David Kwiatkowski, a former technician at Exeter Hospital, was arrested Thursday morning at a Massachusetts hospital where he was receiving treatment. Once he is well enough to be released, he will be transferred to New Hampshire to face federal drug charges, said U.S. Attorney John Kacavas, who called Kwiatkowski, 33, a “serial infector” who worked in at least half a dozen states.

Authorities believe Kwiatkowski stole drugs from a hospital operating room in another state, but they declined to name any of the other states, saying only that they are not clustered in one part of the country. They would not say in what hospital Kwiatkowski was being treated at so he couldn’t be contacted for comment.

This story brought new attention to hospital policies on infection control, narcotics control and patient safety and has had ripple effects across the nation if not around the world.

So…the next question is, how serious is hepatitis C? Chronic Hepatitis C is a serious disease that can result in long-term health problems, including liver damage, liver failure, liver cancer, or even death. It is the leading cause of cirrhosis and liver cancer and the most common reason for liver transplantation in the United States. Approximately 15,000 people die every year from Hepatitis C related liver disease.

What are the long-term effects of Hepatitis C?

Of every 100 people infected with the Hepatitis C virus, about

  • 75–85 people will develop chronic Hepatitis C virus infection; of those,
    • 60–70 people will go on to develop chronic liver disease
    • 5–20 people will go on to develop cirrhosis over a period of 20–30 years
    • 1–5 people will die from cirrhosis or liver cancer

The CDC strongly suggests that all baby boomers born since 1945 should get tested for Hepatitis C. http://tinyurl.com/8tg28x6Baby boomers account for 2 million of the 3.2 million Americans infected with the blood-borne liver-destroying virus. CDC officials believe the new measure could lead 800,000 more boomers to get treatment and could save more than 120,000 lives.

“The CDC views hepatitis C as an unrecognized health crisis for the country, and we believe the time is now for a bold response,” said Dr. John W. Ward, the CDC’s hepatitis chief.

Several developments drove the CDC’s push for wider testing, he said. Recent data has shown that from 1999 and 2007, there was a 50 percent increase in the number of Americans dying from hepatitis C-related diseases. Also, two drugs hit the market last year that promise to cure many more people than was previously possible.

What are the Symptoms of Hepatitis C?

Here’s what WEBMD says. http://www.webmd.com/hepatitis/hepc-guide/hepatitis-c-symptoms

Most people who are infected with hepatitis C-even people who have been infected for a while-usually don’t have symptoms.

If symptoms do develop, they may include:

  • Fatigue.
  • Joint pain.
  • Belly pain.
  • Itchy skin.
  • Sore muscles.
  • Dark urine.
  • Jaundice, a condition in which the skin and the whites of the eyes look yellow.

A hepatitis C infection can cause damage to your liver (cirrhosis). If you develop cirrhosis, you may have:

  • Redness on the palms of your hands caused by expanded small blood vessels.
  • Clusters of blood vessels just below the skin that look like tiny red spiders and usually appear on your chest, shoulders, and face.
  • Swelling of your belly, legs, and feet.
  • Shrinking of the muscles.
  • Bleeding from enlarged veins in your digestive tract, which is called variceal bleeding.
  • Damage to your brain and nervous system, which is called encephalopathy. This damage can cause symptoms such as confusion and memory and concentration problems.

What Treatment is Available?

So if you have Hepatitis C, then what? There are a number of options and there might even be a cure before too long. Standard state of the art treatment today for Hepatitis C is with Peginterferon and Ribavirin which achieves a “sustained response” up to 54% of people, which means that the virus has been eliminated from their blood after stopping treatment. People with hepatitis C types 2 and 3 have sustained response rates of about 80%; people with type 1 have rates of up to 50%.

While hepatitis C treatment has come a long way, there are still drawbacks. For a person who’s newly diagnosed, a 54% cure rate may not sound great. After all, it means that about one out of two people won’t respond to treatment.

Also, hepatitis C treatment is less effective in some populations. For reasons that no one understands yet, African-Americans are less likely to benefit from treatment. And the treatments may not be safe for people with other medical conditions — such as kidney failure, heart disease, or pregnancy. Interferon can also be expensive; according to the American Academy of Family Physicians, it can cost $6,000 per year. http://www.medicinenet.com/script/main/art.asp?articlekey=52451

It is important to note again, that while liver transplants can be very helpful to Hepatitis C patients, the procedure is not a cure but rather a delaying action and an effective one. There is some evidence that a transplant from a living donor to a patient who has been receiving the Interferon treatment could represent a cure. http://www.youtube.com/watch?v=3kOElXz0vVg

A Possible Medicinal Cure

Gilead Science is performing multiple studies to test an experimental drug, but the trial that is possibly the most intriguing looks at a combination therapy that rolls two medicines into a single pill. Gilead hopes to advance tests of its lead hepatitis drug GS-7977 in a combination with another company medicine, GS-5885.

Bristol Myers Squibb had a promising drug but clinical trials resulted in some negative results so the company has sent the project back to the drawing board. http://www.nytimes.com/2012/08/24/business/bristol-myers-ends-work-on-hepatitis-c-drug.html?_r=2&

Finally, Gilead Sciences, mentioned earlier, has a drug that combined with another from Bristol Myers Squibb could be a cure, at least clinical trials seem to offer that indication but the two companies, according to Hepatitis C activist Margaret Dudley can’t seem to cooperate. She is circulating a petition to get the “cure” on the market. http://hepc-cured.com/

October is National Liver Awareness month. We hope you have found these blogs helpful and offer these links for further information.

http://www.liverfoundation.org/

http://www.nlfindia.com/index.asp

http://www.mayoclinic.com/health/liver-problems/DS01133

http://tinyurl.com/92bjlup U.S. Government Link

Bob Aronson of Bob’s Newheart is a 2007 heart transplant recipient, the founder of Facebook’s nearly 2,500 member Organ Transplant Initiative and the author of most of these donation/transplantation blogs.

You may comment in the space provided or email your thoughts to me at bob@baronson.org. And – please spread the word about the immediate need for more organ donors. There is nothing you can do that is of greater importance. If you convince one person to be an organ and tissue donor you may save or positively affect over 60 lives. Some of those lives may be people you know and love.

Please view our video “Thank You From the Bottom of my Donor’s heart” on http://www.organti.org This video was produced to promote organ donation so it is free and no permission is needed for its use.

If you want to spread the word personally about organ donation, we have another PowerPoint slide show for your use free and without permission. Just go to http://www.organti.org and click on “Life Pass It On” on the left side of the screen and then just follow the directions. This is NOT a stand-alone show; it needs a presenter but is professionally produced and factually sound. If you decide to use the show I will send you a free copy of my e-book, “How to Get a Standing “O” that will help you with presentation skills. Just write to bob@baronson.org and usually you will get a copy the same day.

Also…there is more information on this blog site about other donation/transplantation issues. Additionally we would love to have you join our Facebook group, Organ Transplant Initiative The more members we get the greater our clout with decision makers.

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