Archive

Posts Tagged ‘vitamin d’

February 2011 Transplant Labs

March 9, 2011 1 comment

The level of BK virus in my urine is down again; from 11,300 to 9600. Fortunately, my creatinine is still stable at 1.1.  All of my other labs are stable as well. I’m a little late posting this month, mainly because it took me over a week to get my results, and also with being busy with other things going on.

Last week, I had the first major infection since my transplant in May, 2008.  I had a very small break in the skin of my left shin, and a scab formed over it (about 2-3 mm).  My leg started hurting on Thursday, and I thought it was a combination of my orthotic being too tight, and possibly a recurrence of phlebitis.  I was in class that day at orientation, so I took off my orthotic at lunch, and continued on.  It was a little bit red by Thursday night, so I had planned on getting an appointment with my PCP for Friday.  I texted my friend the next day, and she got me an appointment. I went in to work, and then left for my appointment, expecting to be gone for only an hour or so. However, my leg had gotten worse in just 2 hours, and by the time I got there, my leg was angry red, hot, and painful from my foot to halfway up to the knee-I had cellulitis of my foot and leg.  I was given IV Ceftriaxone in the office (an antibiotic), and a prescription of Keflex to start the next day. I went back to work, but my co workers told me to go home and rest my leg (it was my first day off of orientation. I rested it all weekend, and by today, I still have some pale redness and minimal swelling, so it’s definitely much better.  Given my immunosuppression, I’m lucky I sought treatment when I did.

My new job is going very well. There is still a lot to learn, but I’m positive I made the right decision.  I figure it will take a good 6-12 months until I’m comfortable doing it, but I expected that going in.

I miss my co workers at my old job, but still get to see them on occasion.

As I sit here typing, my wife is on the couch sick with a sinus infection and probably a cold on top of it.  It made me think back to when I had a cold last, and I can’t remember when I did.  When my kidney function began worsening and I started Calcitriol, I began researching Vitamin D.  I’ve found several articles (although not much research to back it up) that suggest that Vitamin D has an antibiotic type effect.  I started taking Vitamin D supplements after my transplant (2000 IU daily, plus another 800 IU in my calcium and multivitamin). Could this be the reason I don’t get colds?  Having worked in Pediatrics as an RN for the past 22 years, plus 3 years prior to that working with children on an inpatient psychiatric unit, I surely have been exposed to much more than the average person, but yet my immune system is suppressed by the meds for my transplant. And yet, I don’t get colds (I do, however, get sinusitis).  Could it be the Vitamin D?  I’ve had my level checked, and it’s in the low 30 range (normal), so my supplementation is appropriate.

That’s all until next month.  Stay healthy, and Happy St Patrick’s Day!

Advertisements

Medical Article Scan for August 2008

September 3, 2008 Leave a comment

I know; it’s September. Better late than never…

Anemia of Chronic Disease: An Adaptive Response?  The authors argue that anemia may be beneficial to patients with inflammatory disease, and advocate restraint in treating mild to moderate forms of anemia. This may be proven someday, as they are now finding that too much injected erythropoietin (Procrit, Epogen, etc) can have adverse effects if used to bring hemoglobin up past 12.

CMV Infections Affect More Than Just Patients With Compromised Immune Systems – researchers have discovered that Cytomegalovirus, which is particularly dangerous to those with suppressed immune systems, can also be reactivated in those with normal

Want A Reason To Love Your Lower Belly Fat?….     Fat in the lower abdomen and thighs is rich in adult stem cells.  Maybe they can set up a plan for those having gastric bypass to donate their extra fat after weight loss to cover the cost of cosmetic surgery?

Does Too Much Sun Cause Melanoma? You’ll notice in the past that I’ve had articles on Vitamin D. This article reports that sun can cause the more “benign” skin cancers, but not melanoma, and that we must strike a balance between the need to protect the skin from cancer and the need to get Vitamin D.

Long Term Weight Loss… – study of women which shows that in order to maintain a 10% weight loss, there needed to be 5 days a week of 55 minutes of exercise. On the bright side, small changes throughout the day can be partially substituted, such as moving around more, less TV, etc.

Total Calories More Important Than Dietary Fat In Diabetes Risk – decreased risk of diabetes is linked to weight loss, and not to specific nutrient content. There are other conclusions in this study, such as consumption of soft drinks was associated to unhealthy behaviors and consumption of fruit juices to healthy behaviors “to some extent”.

Stem Cell Scientist Predicts Health Revolution – immature adult stem cells are predicted to be as important a revolution in the 21st century as antibiotics were in the 20th century.

World’s First Transplant of Both Arms – Last month, a surgery team in Germany transplanted bilateral arms onto a 54 year old farmer who lost his in an accident. The 2 things of interest are the actual procedure and what was involved, as well as the hurdles afterwards, such as immunosuppression and the lack of a blood test to catch rejection.

Positive Thinking May Protect Against Breast Cancer – Yet another study affirming feelings of happiness and optimism as providing a “protective role” against disease (in this case, breast cancer).

Work, Vitamin D

September 2, 2008 Leave a comment

Work has been extremely busy lately, especially the last 2 weeks. Part of it is the fact that school is back in, but a lot of it is just that there is a lot of work (I’m not complaining; job security).  I don’t do any direct patient care at my full time job (at least for now, due to my immunosuppression); it’s all taking care of phone messages, authorizations for meds, advice calls and emails, and many other things.

The job is rarely boring, and although I’ve been fielding phone calls from parents, patients, pharmacists, home medical suppliers, nurses, and many others, I never run out of new situations.

A parent recently contacted me about her child, who apparently is just entering college for the first time. One of the classes involves the students going out “in the field” to catch wild bats, so the students need pre-exposure vaccination with Rabies vaccine (which differs from Post Exposure Prophylaxis, which is given after exposure to a potential rabies contact).

Well, there is a serious nationwide shortage of Rabies vaccine. In Pennsylvania, the Department of Health is now overseeing the distribution of Rabies Vaccine/Rabies Immune Globulin. In order for a provider to get the vaccine to administer to patients, they must call the DOH, provide the history and rationale for giving the vaccine, and if approved, they will be given an authorization number. The provider must then contact the manufacturer, and they will ship the vaccine overnight.

Back to the parent. The parent is a RN, and I explained to this person that there is a shortage, and the PA Department of Health will not release vaccine for pre-exposure prophylaxis . As the conversation progressed, she stopped short of calling me a liar, and insisted on speaking with the doctor. I forwarded the message to the doc, and she called the parent.

I’m not sure what happened with the phone call (but can pretty much guess), but I was annoyed not so much at the mother, but more at the professor who reportedly was having untrained Freshmen college students go into the wild and risk death for a class (except in 1 case, Rabies is nearly 100% fatal if not given post-exposure prophylaxis, and bat bites can very easily go unnoticed).

I called the Health Department office in the county of the University, and explained the situation to the nurse. She basically couldn’t believe it, especially knowing that there is a severe shortage of vaccine.  She was going to call the University and speak with someone there.

This is proof that having an advanced degree does not necessarily equate to common sense. Why do these untrained students need to catch wild bats? I’m sure there is a wealth of information out there obtained by trained professionals who have caught bats, that these students don’t need to do it, but can read about it on the internet or in books. End rant.

My Vitamin D level is finally back. I can’t compare the previous level back in January, because they checked different labs. The one I had this time is probably the one that is appropriate (although the January test, Vitamin D1,23 Hydroxy, was probably appropriate back then, as I was on dialysis at the time).  Anyway, my Vitamin D 25 Total was 41 (norm 20-100), my Vitamin D 25 OH D3 was 21, and my Vitamin D 25 OH D2 was 20.

Vitamin D 25 OH D3 indicates both endogenous production and supplememtation.

Vitamin D 25 OH D2 in an indicator of exogenous sources such as diet or supplementation.

Therapy is based on measurement of Total Vitamin D 25 OH, with levels below 20 indicating defiency, 20 to 30 indicating insufficiency, and optimal levels being over 30 (again, mine is 41).

I had been taking 50,000 units of Ergocalciferol per month (prescription), although I’ve read that Cholecalciferol is the preferable form. I think I’ll ask the Nephrologist if I can just switch to Citracal + D.

Medical Article Scan June 2008

July 7, 2008 3 comments

Stowers Institute discovers possible cause of polycystic kidney disease – I’ve heard several theories about the cause of PKD, which is currently known as a hereditary disease. One such theory is that it is caused by an infectious disease. Now, a researcher postulates that a gene mutation occurs from being disrupted by Tumor Necrosis Factor, and that Enbrel may be a treatment.

Low Vitamin D, Anemia Linked – more interesting research on Vitamin D. The study compared those with impaired renal function to those with normal renal function, and found that those with impaired renal function and low Vitamin D levels were at a much higher risk for anemia. “Data show that supplementation with 25 (OH) D is associated with reductions in pro-inflammatory cytokines”  It’s also interesting to note that a study of over 16,000 participants (not necessarily renal patients) showed that Vitamin D deficiency was significantly associated with increasing prevalence of CVD (cardio vascular disease) in the entire study population.

10 Surprising Places Where Germs Lurk – I found this article personally interesting, since I am currently immunosupressed.   Of course, some of the places are well known, such as grocery cart handles, gym equipment, and the shower curtain. But did you ever consider your vacuum, the lemon wedge in your drink, or the menu in a restuarant?  (hat tip to WhiteCoat Rants) 

Weight Gain Increases Risks To Kidneys – gaining weight while remaining within normal range increases risk of chronic kidney disease.

Bariatric Surgery May Help Prevent Infections – interesting study. Roux-en-Y Gastric Bypass may not only help prevent infections, but also prevent cancer.

Transplant Day 39

June 11, 2008 5 comments

Kevin and I just got back from my bi-weekly appointments with the Transplant Surgeon and Transplant Nephrologist.

I started out having labs drawn, we then went to breakfast, and then up to see the nurse and doctors. Everything is going GREAT. My creatinine is 1.2, and my kidney function is above 60%! (they don’t quantify above that; anything over 60% is considered normal)  I looked back at my labs, and was able to track my creatinine back to April 2000; at that point, it was 1.6. They didn’t start reporting GFR until 2004, and in March of that year, it was 29.2.  This was the first BMP (basic metabolic panel) since the mid-late 1990’s that ALL values were normal.  Dr. Varma, the Transplant Surgeon, had a huge smile, and said that I couldn’t have asked for a better kidney. My Prograf level (FK-506), CMV level (to determine if I have the virus active in my body), and BK Virus screening were not back yet.

Other highlights: I don’t have to return for another 2 weeks (I was told initially I would have appointments WEEKLY for 3 months), I am cleared to drive (WHOPPEE!), and I can return to work sooner than planned (tentatively set for July 7).

The Transplant Nephrologist was also pleased with my progress. I asked about still taking Vitamin D, and he said it was OK, and that he will check a Vitamin D level and PTH in several months.  Also, he will recheck my iron studies to see if I need another IV dose of Venofer.

The Transplant Nurse explained my immunosuppression regime in a little more detail. I follow a kidney transplant group online, and many of the patients report a dose of CellCept of 1000 mg twice daily; mine is 500 mg twice daily. The reason for the lower dose is because they hit me with Campath prior to surgery, which basically wiped out my T cells, and decreases the need for more heavy immunosuppression. I guess it’s a case of a synergistic effect. Using smaller doses of more meds is better than larger doses of less meds.

As things are pretty much stable, I probably won’t blog every day, at least about my transplant. However, I will update my “Vital Signs…” page daily.

I’ve come upon some useful browser add-ons, as well as other software. First, there’s “Slimbrowser”It incorporates a large collection of wonderful features like recoverable popup killer, form filler, site group, quick-search, auto login, hidden sites, built-in commands and scripting, online translation, script error suppression, blacklist/whitelist filtering. In plain English, it’s a lean, mean alternative to Internet Explorer, and more secure.

There are several add-ons to it as well. First, there’s Roboform, which incorporates into ALL of your web browsers, and fills in passwords and forms. It’s safe, because you have to log on with a master password to use it. Another worthwhile add-on is Blaze-FTP, which is a free FTP client.

Another add-on that I now use is BlogRovR. It is an online website/application that allows you to centralize the blogs that you read on a regular basis. Unfortunately, it’s only available for Firefox.

Medical Article Scan May 2008

May 27, 2008 2 comments

Here are some interesting articles from this past month:

Supplement Your Knowledge of Vitamin D – While looking up some information on one of my meds, I found this article. It’s actually directed at a general audience (as opposed to those with kidney disease).

Bye Bye Biopsy – there is now an alternative for those of us with transplants who may face a biopsy; a genetic test that is done from a blood sample. This test can also be used for a variety of other biopsy related situations.

New York Planning Special Ambulance To Recover Organs – on the surface, this looks like a great idea, but I think it will do more harm than good. To quote from the article: “People are going to worry when the ambulance comes out to their house whether they are there to care for them or to take their organs.”  And this is where the problem lies; there are a good amount of people who will not sign the donor card for fear that they will be in an ED, and the doctor will pronounce them brain dead in order to get their organs, when they may not be brain dead. I don’t believe this to be true, but the thought is still out there, and this plan could potentially make things worse.

Daily Doses of Bach and Breathing Lower Blood Pressure – The title is a bit misleading, as it’s not only music by Bach that had an effect. Being a former music teacher, this is right up my alley (although one physician interviewed felt that it was primarily the breathing that had an effect). And even though it only had an effect on systolic pressure, it’s a treatment that has no side effects, so what can it hurt?

 Early Insulin Hit Leads To Diabetes Remission – This is a very interesting study of using intensive insulin treatment for newly diagnosed Type 2 diabetics (non-insulin dependant aka “adult onset diabetes), although the study is limited.

Home Monitors Advised For Hypertensive Patients – in my opinion, this is an excellent proposal. It seems odd that physicians will base anti-hypertensives on bp readings limited to when to when the patient is in the office. There are far to many variables to depend on this. If bp is taken at home, it can be done once or twice a day, and it will be easier to spot trends. Also, I’ve found that the electronic machines are a waste. I bought a cuff that has a stethoscope attached, and it is much more accurate. And for those not trained to take a bp, as long as you can hear well, it’s easy to learn.

Experts Question Placebo Pill For Children – I don’t think this is a good idea. After all, a parent needs to build trust with their child/children; once the child finds out that the parent has tricked them, what does that do to their sense of trust?

 

Medical News

May 13, 2008 4 comments

Protecting the Heart in Muscular Dystrophy Patients wait until you see which med they studied….

Perfecting an Artificial Pancreas misleading title; this is about producing insulin (the pancreas has other functions as well). Nonetheless, this is potential big news on the diabetes front.

Tobacco as a Self-Medication and Wellness opinion piece on how people self-medicate with tobacco, yet are being financially punished for this.

Vitamin D Linked To Reduced Mortality Rate In Chronic Kidney Disease the docs tested all of us on dialysis a few months ago, and I started on Vitamin D (ergocalciferol, which is non-activated), in addition to Zemplar (the activated form). I think you’ll be seeing a lot more on Vitamin D, even in “healthy” patients.

Microsoft Envisions Smarter EMR Interfaces this is interesting to me, as my employer is 100% EMR based (electronic medical record)