Causes Of Liver Failure

>>> hello.i'm terrance afer-anderson and this is healthwatch.just so you know, i have really been trying to reduce mywaistline and getting in some exercise.i've only lost three pounds so far, but it looks really good onme, don't you think? i really enjoyed myself when yousaw me working up a serious sweat on the last edition.to be honest, i may not have looked like it, but it trulyfelt good to be working out again.so much so, that i am now

developing an inventive programin which i think many of you will be interested.i should have more information on the next edition ofhealthwatch. again, stay tuned.but right now, i have some guests that i am very anxious tointroduce. our topic for today's show ischronic kidney disease. first up is wallace green, alsoknown as ace, a u.s. navy retiree, the founder and ceo ofhealth and wellness, inc., and someone who has an inspiringpersonal story to share about

kidney disease.next up is denise lundy, a dietitian with fresenius medicalcare. finally, we have nephrologistdr. maxim mirovski, m.d. guys, welcome to healthwatch.>> thank you. >> thank you.>> i'm really excited to have you on board and delighted aswell. you know, i lose a little bit ofweight, some pounds, and my brain goes to jelly.but anyway, max, i want to -- now i'm calling you max.ace.

okay, i'll get it together in asecond. >> all right.>> ace, i want to really know more about your own situation,being diagnosed with kidney disease.tell us your journey, it's been an interesting journey for you.>> oh, very interesting. in my case, with kidney disease,of course, there is no symptoms or at least no notable symptomsunless you know what you're looking for.being a jock, i played ball, played sports, pretty much aworkaholic and i was able to go

about my normal business withoutrealizing any symptoms or anything going on.i took my physicals and everything, like the averageperson would, but during the whole period, there was nochanges in my life, so it was like a normal day at work.>> now, from what i gathered about you, you're someone thatdoes a lot of research, so when you got that diagnosis, you didsome research. what did you learn about kidneydisease? >> well, funny you mentionresearch because, like the

average person, you know, yourmechanic will do a lot of publication on fixing a car andbeing a military personnel, i did a lot of reading,publications on my job and things of that nature, but whenit came to self, that's where i was lacking.the signs and symptoms of having kidney disease was there, but,of course, i didn't concentrate on those.i didn't really take too much -- pay any attention to it.my role was to go to the doctor, put it in his hands, and, ofcourse, i was letting the doctor

live for me.i wasn't really taking that active role in finding out whatthose results were that he was giving to me when i take thatblood test that he tells me to take and we sit down and we talkabout it. as long as he were able to tellme that i was going to continue to live, i just went on about mybusiness. so at that diagnose stage,which, of course, when i finally got the shocking news that mykidney had failed and i started doing my research at that point,which was a little backwards,

and i started realizing thatthere was signs of kidney declining as early as 20 yearsold, but as i mentioned, i didn't pay any attention tothat. my different blood tests, urinetests and everything that i took, medication they gave meand things of that nature, why i was taking it, just didn't askthe questions. so i didn't take the active roleof finding out exactly what i needed to do to control it.i was still giving it and leaving it up to the doctor.>> we're going to talk a little

bit later about symptoms, butyou said that you noticed that there was something differentabout what was going on with your body, but you were kind ofdismissive of it. is that correct?>> there was things that the doctor was telling me, but idismissed them. >> i see.>> like when i would visit the doctor and i would give bloodwork -- >> right.>> -- of course, they would do creatinine, albuterol, theywould rate my gfr, which is a --

i have a problem pronouncingthis word, but it's the -- >> globulomerol associationrate. >> that's right.>> that sounds like a constellation.>> gfr is what it is for short, so if i continue to use that,that's what it is. it shows how well your kidney isfunctioning and when i would visit the doctor and get thoseresults, i would basically dismiss them because i was okay.>> felt okay. >> i felt okay, that's correct.and i just continued to go, and

once my kidney failed and i wason dialysis and i compared these notes, i could see where theywere actually declining. i could see the increase in theprotein in my urine and things of that nature, which of course,is not layman terms for the average individual, somethingthat we don't look for every day.>> right. >> so include the lab report,when you have the codes and things in there, i didn't takethe time to say what is this, what is it for, and things ofthat nature.

so i was diagnosed what i didn'ttake as an active role in finding exactly what it was.i just... >> so the lesson here is thatyou learn to be proactive in your own healthcare.>> by all means and with health and awareness, that's one of themain things that we try to educate people on is take thatactive role. >> and thus the company that yourun, health and wellness, inc. >> that is correct.>> when were you diagnosed, how long ago?>> i was diagnosed, as i

mentioned, as early as 18 yearsold. >> oh, i see.>> but i didn't take the active role on it and i didn't realizeit was that far back until my kidney failed in 2006.so the signs was there. >> okay.>> but i didn't take it serious. >> i'm sorry, you're saying thatyou got an actual diagnosis of kidney disease when you were -->> through my medical records and i'm calling that a diagnosisbecause individuals with a risk factor of kidney disease isactually diagnosed with kidney

disease.for example, if an individual have high blood pressure,diabetes, they're actually at risk for kidney disease.which is a diagnosis to actually start getting kidney screeningand things of that nature to monitor your kidneys and see howwell they're functioning. >> that's something i'm gladthat you explained because as i was doing research, as i waswriting the script and so forth, i saw that and i wasn't certainabout the distinction between the symptoms being manifestedand an actual clinical

diagnosis.>> yeah, because there's a lot of people that actually havekidney disease and if in fact they're following thecompliance, doctor's orders and things of that nature, they cancontinue to live with it, slowing down the process, andthey never have kidney failure. >> what kind of treatments didyou have? i get the impression that thetreatments changed over a period of time or -->> yes, they did. >> okay.>> because from the very

beginning, i was actually seeingthe nephrologist once a year, and that was a part of what iunderstand as being the kidney screening where they took theblood tests and the urine. >> okay.>> and, of course, here again, i dismissed those in terms of theserious nature of them, how well my kidneys are functioning.as long as the doctor said okay, you can go back out and playball, you're okay, and things of that nature, i didn't take theextra step that i share with individuals now and especiallytalk to your dietician and

things of that nature to findout those things that we can take an active role in takingcare of our bodies. being a steaming sailor, icontinued to drink. i was a smoker.there was a lot of things i could have actually stopped thati feel today could have prevented that kidney fromactually failing and continued to live with kidney disease.>> that makes for a great segue to my next question.we can talk some more about treatments here, but what wouldyou suggest to someone that has

been diagnosed, how they canslow down -- how they can retard the progression of kidneydisease? >> one of the first things isuggest to everyone to do is when they're at family reunionsand things like that is find out the family history.if in fact high blood pressure, diabetes and things of thatnature, someone may have passed because of kidney disease intheir family, it's inherited, so therefore, they should actuallytake a kidney screening themselves.that's one of the major things

that i tell them.the second thing is take an active role, become aware ofyour condition and taking that active role doesn't necessarilyjust apply to kidney disease. that's for any of the health andthings of that nature because diabetes, high blood pressure,and things of that nature can actually -- if an individual isliving with compliance and things like that, get it undercontrol, a lot of times where they're actually ignoring that.so the second thing would be to actually take an active controlin compliance and follow those

guidelines instead of allowingthe doctors to live for you. listen to your body and takecharge yourself. >> max, in the notes that acesent me, i'm going to quote you verbatim here, he said he haddropped the ball in terms of patient compliance.how important -- i gather it probably is pretty important,but you can elaborate. how important is patientcompliance to the treatment of kidney disease?>> well, compliance is critical. it is really critical, and we'retalking about day in/day out

type of compliance.it's a funny disease. in fact, compliance is necessaryfor life and my heart goes out to our patients.some of them have to take ten -- more than ten pills a day, andthat's hard. some of those pills may haveside effects, unpleasant side effects.it is difficult, very difficult. on the other hand, patients who,you know, are compliant with doctor's visits, they'recompliant with their blood work, you know, blood work we order,compliant with their

medications, those patientscertainly do better. they live longer, their kidneyslast longer, and they live healthier.mr. green may have not been perfectly compliant at somepoint, but he is a perfect example of the most compliantpatient we have at this time or one of the most and it'scertainly paying off. right, mr. green?>> yes, it is. >> with such an intensiveregimen of medications, you mentioned as many as 10 to 12pills a day, that kind of

demands compliance.>> absolutely. >> major step too.>> hard, hard. >> there are no symptoms.what do you look for? what does one look for?what kind of testing is done? ace referred to a few.can you elaborate? >> mr. green was absolutelyright. frequently there may be nosymptoms or few symptoms. some patients may have someankle swelling, sometimes swelling behind the eyes whenthey wake up.

>> behind the eyes?>> well, around the eyes. sometimes some patients may seeblood in their urine. when they go to the doctor, theyare told that their blood pressure is getting high, thatmay be the result of significant kidney disease.but frequently there are no symptoms and, you know, thatcertainly is a problem. >> someone may well begenetically predisposed to have kidney failure or to have kidneydisease. who is at the greatest risk, andhow often is the testing done?

ace made a reference to anannual monitoring, an annual screening.>> right. well, as mr. green said, youknow, he might have done his work, but -- homework, butpatients with diabetes clearly, patients with hypertension,african americans have four times higher risk of kidneydisease than caucasians. you know, that's a -- that's oneof the genetic factors you mentioned.and -- >> you -- i'm sorry, go rightahead.

>> and as mr. green as pointedout, family history is very, very important.kidney disease does run in the families, very important.>> you mentioned one of the things that's a potentialindicator is blood in the urine, hematuria, i guess it's called,and as i mentioned something about protein in the urine.the blood is easily seen, but protein, how -- what does onelook for? >> that's a very good point.blood sometimes can be seen, sometimes cannot be seen,depending upon the degree of

hematuria.the protein in the urine, some patients may notice the cloudyurine, and that usually signifies that there's a verysignificant amount of protein in the urine.frequently the amount of protein in the urine is moderate and youdon't see anything and that's when the lab, the blood workcomes in and lab tests. so there are basically twosimple tests to screen for kidney disease.one is the blood work to look for the creatinine, the gfr, thekidney function, and the second

test is the urine to look forprotein. so that's a special test.both tests are very simple and readily available, though.>> any idea on the incidence of kidney disease in virginia, thenumbers? >> well, the number is actuallyquite high. up to 500,000 virginians do havea kidney disease. fortunately the majority of itis fairly mild kidney disease, so initial stages of kidneydisease, and with proper care, those patients would not, youknow, progress to more

significant disease.>> 500? >> 500,000.many of those patients are not doing the work and that's notokay. those patients do need to beidentified and they need to go to their doctors to, you know,to take care of their kidneys. their kidney disease has to bemanaged. there are about 10,000virginians who are on dialysis and about 4,000 live with afunctioning kidney transplant. those patients who were ondialysis or had advanced kidney

disease and received a kidney.>> so someone's situation before they get a transplant has toapparently deteriorate to not necessarily critical point, buta very serious point. >> well, dialysis is typicallyinitiated when the kidneys fail completely or almost completelywhen patients develop significant symptoms.>> okay. denise, i've saved the best forlast. we're going to talk about foodafter i just said that i lost some weight, right?>> okay.

>> what as dietician's role inmaintenance, health maintenance of someone diagnosed with kidneydisease? >> basically, i'd like to pointout first, there are differences with the renal diet plans whenit comes to kidney disease. for you're patients ondialysis -- for your patients that are on dialysis and thenyou have patients that aren't on dialysis.you can follow a renal diet plan that will help slow theprogression, just as as i mentioned a few minutes ago,slow the progression of kidney

disease, but again, you have adiet plan for your patients that are on dialysis.for those that are on dialysis, you definitely want to make surethat you are increasing your protein intake, so there aresome key nutrients that you need to look at when you're eating.one is your protein. increase your protein intake,basically because your protein is being pulled off while you'rebeing dialalyzed, and that has a great effect on your treatment.it has a great effect on the success of your dialysis withyour protein, building that

albumin number is what we callit. we talked about the lab work,and the albumin lab number is an indicator of your proteinstatus. so that's very important withthe dialysis patients. the second, i would say, wouldbe sodium. we definitely want to make surethat your sodium, your salt intake is limited because, ofcourse, if you're having excess of salt in your system, you'regoing to have fluid reextension which is bad for your --retention which is bad for your

kidneys and heart as well.and you want to look at your potassium and your foreforeruss.you want to -- phosphorus. you want to look at that becausethat determines your harlt health as well in preventingcardiovascular risk disease as well as salt.>> potassium, sodium chloride and i guess -- well, i guesssodium chloride is -- >> protein, sodium, potassiumand phosphorus. >> do you get many requests forfolks seeking assistance with maintaining their diet?>> that's not too often.

because i work in a dialysiscenter, i may receive a phone call from a patient stating thatmy physician has told me i have to start dialysis now or i havekidney disease and they're looking for further informationor more resource. most of our patients come fromthe nephrologist referrals when we're in the dialysis center.>> you touched upon this a little bit, but can you talkabout the types of foods that are really good?>> oh, sure, sure. i didn't mean to jump ahead.>> oh, no, no, no, that's fine.

you didn't jump ahead.i probably was staggering. >> okay.again, going back to the four key nutrients, when you have apatient that is not yet on dialysis and you want to helpslow the progression of kidney disease, you want to limitprotein, you want to limit your protein intake, and thosesources of protein are basically coming from your animalproducts, your meat, your cheese, your milk, your eggs,your fish. now, you definitely want to makesure you limit that sodium

intake, that salt intake, andyour high salty foods are those that you want to avoid as muchas possible. you're talking about your cannedfoods, your processed foods, your fast foods, your smoked andcured meats. even your seasonings that youhave in your pantry at home that have added salt.you need to read the food label to those seasonings so see whereyour added salt is. your potassium foods.most of your high potassium foods are your fruits, forinstance, your oranges, your

tomatoes, your bananas, yourmelons. very high in potassium.your potatoes are very high in potassium.again, the phosphorus foods is the last key nutrient there andthat's sort of tricky because you have phosphorus in almostall of your foods. your dairy products are highphosphorus, your chocolate, your breads and your cereal items arehigh phosphorus and most of your packaged foods, not only arethey typically high in sodium, they have a lot of phosphorusadded to them for preserving.

>> so your role then as adietician is pretty important in helping people select the foodsto eat. >> it really is and i would saythat is very difficult, one of the hardest diets to follow is arenal diet so we have to work with the patients, monthlybasis, weekly basis. it's a complete lifestylechange. >> probably an issue withcompliance there as well because people like to eat.they really, truly do. >> they do, they do, and we haveto be very creative in just

educating, having people to goback into the kitchens and cook, and just taking note of what --everything they're taking in, everything they're eating, andlistening to their body, just as as i mentioned earlier.>> and around the holidays -- >> yes, very high phosphorus, wesee that in patients' lab work particularly during theholidays. >> my numbers went up over theholidays because of macaroni and cheese.couldn't get over it. >> that's a very difficult thingto resist.

>> yes, sir, it is.>> you have an event -- well, tell us, we're going to run outof time here pretty quickly, but if you can tell us a little bitabout health and wellness, inc., and about the event that youhave coming up. >> sure.march the 13th, we're actually celebrating caregiver month withthe national kidney month. now, sounds kind of strange, butwith caregiver month being in november, the reason we do thisis because of this increase in the need for dialysis patients,which also increased the need

for caregivers.so to try to bring some attention to this, we kind ofcombined the two and we're holding this at norfolk state,6:00 until 11:00. we've got some caregiverspeakers that's going to be there.it's an educating event, but in a relaxed atmosphere.health and awareness does not walk or run to raise funds.we dance. so we've got an excellent bandthat's going to be there, the education going, and individualsbe able to relax while they

stalk to the individuals that'sthere because -- talk to the individuals that's there becausethe educators will still be there talking to the individualsas they go through, so we're trying to go at it a differentway to actually educate individuals where they wouldn'tordinary come out and speak to someone, but in that atmosphere,they feel a little more relaxed. >> it's at norfolk state, whatday? >> that's a friday evening 6:00until 11:00. >> what day is that?>> that's a friday.

>> march the 13th.>> yes. >> i just wanted to repite itagain. >>.>> and we're still looking for caregivers.there's a few spots open. 15th is the deadline for that.>> and dozer hall, is that where it is?>> that's correct. >> and les smith is going tospeak? >> it's not going to bespeaking. >> he's presenting an award.>> he's going to be presenting

the awards and the illustriousterrance is going to be our speaker!>> oh, really? i thought i was going to be theemcee. i'm going to speak, okay.>> you're not going to be the guest speaker, you're going tobe the actual emcee, that's correct.we have a caregiver that's going to be our speaker from newportnews. >> okay.>> but we got a pretty powerhouse this year in speakersand presenters and all, and

we're very, very honored to haveyou on board. >> i'm delighted to be there.>> to join us this year. >> i'm very delighted.i feel honored that you asked me to do so and i had forgottenthat there was some dancing involved.the last time i did a little dancing, i put it on facebookand got 2500 hits. >> that's great because we'relooking for publicity. >> well, we won't use thatagain. how can someone get informationabout this?

where do they call?>> if they reach our website, which iswww.healthandawarenesskidney dance.com or give us an all at757-376-7645. >> let's repeat the number.>> 757-376-7645. >> and health and awarenesskidney dance -- >> dot-com, yes.>> okay. >> we don't walk, we don't run,we dance. >> i like that.i have to remember that. i want to thank all of you forcoming on board and talking

today and talking about how wecan approach kidney disease from the different angles withdietician, with the nutrition, and diet and with the healthmaintenance through screenings, the annual screenings, and theimportance of being proactive and patient compliance.that's a very important thing to all of you, and each role thatyou play. again, thank you so very much.>> thank you for having us. >> thank you.>> and it's ace and max and denise.someone said earlier, a rose

between two thorns.>> there we go. >> guys, thank you again so verymuch. and of course, we want to thankyou for joining us today. remember, you can watch previouseditions of healthwatch online at www.norfolk.gov/healthwatch.if you'd like to drop me a line, you can e-mail me atterrance.afer-anderson@vdh. virginia.gov.please also feel free to give me a call at 757-683-8836.that's 757-683-8836. for the norfolk department ofpublic health, i'm terrance

afer-anderson and this has beenhealthwatch.