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Kidney Screening

share kidney failureKidney disease screening: Screening (looking) for early kidney disease in people who are not already known to have it. Kidney disease is common and is commonly insidious in onset. The burden of kidney disease in its earlier stages lies not only in the risk of progression but in the complications of decreased kidney function and the risk of heart disease.

In 2002 the National Kidney Foundation (NKF) set forth guidelines for kidney disease screening. It recommended that all individuals at increased risk for chronic kidney disease have their blood pressure measured and their blood and urine tested for signs of impaired kidney function. Those at increased risk for chronic kidney disease were defined as people with:

  • Diabetes
  • High blood pressure or a
  • Family history of kidney disease

In the US population, the NKF guidelines also identified older Americans, African-Americans, Hispanics, Asians and Pacific Islanders as being at increased risk for chronic renal disease. The NKF recommended three routine tests be used for kidney disease screening, namely:

  • Blood test for creatinine
  • Urine test for protein and
  • Measurement of blood pressure

The level of creatinine in the blood is then used to estimate the glomerular filtration rate, or GFR. The GRF and checking for persistent protein in the urine (proteinuria) are believed to be the best way to diagnose early kidney damage. The level of GFR and persistent proteinuria can be estimated accurately from blood and urine tests collected during a routine office visit.

The reason for measuring the blood pressure is two-fold. Elevated blood pressure (hypertension) is both a cause and a consequence of chronic kidney disease.

Chronic renal disease is a problem of appreciable proportions. In the US alone, the NKF estimated in 2002 that 20 million people had early chronic kidney disease and did not know it, and another 20 million faced an above average risk of developing it. Screening for chronic kidney disease has been generally neglected and is of inestimable value.

Anaemia Screening

AnemiaAnemia occurs when the amount of hemoglobin (found in the red blood cells) drops below normal. Hemoglobin is necessary for the transport and delivery of oxygen throughout the body. There are many different types of anemia, but we will limit this page to the most common ones. 

Iron and Vitamin Deficiencies 
Iron deficiency anemia is the most common of the anemias and is usually due to bleeding. In women, iron deficiency may be due to heavy menstrual periods, but in older women and in men, the bleeding is usually from disease of the intestines. In children and in pregnant women, the body needs more iron, and iron deficiency may be due simply to not eating enough iron in the diet. Iron deficiency may also result from some extreme diets. Treatment of iron deficiency usually involves iron supplements. In older women and in men, there is usually also some further testing to determine the reasons for the abnormal blood loss. 

Pregnant and nursing women frequently develop this deficiency since the baby requires large amounts of iron for growth. Lack of iron can lead to low birth weight babies and premature delivery. Pre-pregnant and pregnant women are routinely given iron supplements to prevent these complications. Newborns who are nursing from deficient mothers tend to have iron deficiency anemia as well. 

Blood tests may show a normal or low hemoglobin, decreased iron, low ferritin, and abnormal red blood cell indices. The total iron-binding capacity (TIBC) or transferrin will be increased. The ferritin test is considered to be the most specific for identifying iron deficiency anemia, unless infection or inflammation are present. 

Vitamin B12 deficiency is less common than iron deficiency and is usually not due to dietary deficiency of vitamin B12. The most common cause is a disease called pernicious anemia, in which the body stops making a substance (called “intrinsic factor”) that is needed to absorb vitamin B12 from the diet. Vitamin B12 deficiency can also cause nerve problems, often causing numbness and tingling that start first in the hands and feet. Hemoglobin is low, but red blood cells are abnormally large. 

Folic acid deficiency can cause the same pattern of changes in hemoglobin and red cell indices as does vitamin B12 deficiency. Folic acid is found in many foods, especially in green, leafy vegetables. Folic acid is also added to most grain products in the United States so that deficiency in folic acid is rarely seen in the U.S. today. During pregnancy, however, there is an increased need for folic acid so deficiency can develop during this time. This is especially dangerous because deficiency in folic acid can cause problems in the development of the brain and spinal cord of the baby. Pregnant women usually need folic acid supplements. 

Aplastic Anemias
Aplastic anemia is a rare disease, caused by a decrease in the number of blood cells produced due to bone marrow failure. Symptoms of aplastic anemia include prolonged bleeding and the frequent appearance of bruises due to decreased platelets, pale skin color and fatigue from decreased hemoglobin, and increased number and severity of infections due to a low white blood cell count. The differential white blood count shows a decrease in all types of cells (pancytopenia). A bone marrow aspiration will show a decrease in the number of mature cells. Treatment depends on the cause. Blood transfusions and a bone marrow transplant may be needed in severe cases.

anemia symptoms

Wound Dressing

Scrapes, cuts, burns, stings and serious wounds can cause panic, but if you know how to properly care for wounds you will be able to stay calm, assess the situation, clean the wound, prevent infection and practice good wound care maintenance. It is always recommended that you discuss wound care with a health care provider but here are some tips to keep in mind the next time you are faced with scrapes, cuts, blisters or other wounds.

7 Steps For Natural Wound Care

Step 1 – Stop the Bleeding

The most important thing to do when confronted with an open wound is to control the bleeding. If you are not the victim, remember to follow the universal precautions and use personal protective gear such as A1 latex examination gloves if available. Apply pressure to the wound until the bleeding stops before evaluating, cleaning and dressing the wound.

Step 2 – Evaluate the Wound

Generally wounds fall into two main categories namely: Closed wounds which do not break the skin but can be identified by bruising and swelling, and open wounds which include lacerations, incisions, punctures, avulsions and abrasions.

Lacerations are simple breaks or tears in the skin.
Incisions are surgical wounds, similar to lacerations but have smooth edges.
Punctures are also similar to lacerations but are caused by objects moving in and out rather than tearing through the skin.
Avulsions are torn sections of skin, either flaps or missing completely.
Abrasions are scrapes or scratches, similar to avulsions but not as deep.
When you have determined how severe the wound is, decide on a course of action. You should consider visiting a doctor for 1.5 cm lacerations or incisions with visible fat, bone or muscle, blood spurting or uncontrollable bleeding, deep puncture wounds or if dirt remains in the wound. Animal and human bites should also be cared for by a doctor. A serious complication that can result from wounds or bites is tetanus. Tetanus, commonly called lockjaw, is a serious condition that causes jaw spasms and possibly death. If the injured person has not had a tetanus vaccination in the last 5 years you should consult a doctor.

Step 3 – Clean the Wound

Your skin covers and protects your body against bacterial and viral infections but becomes susceptible when broken. Carefully and gently clean the wound with a mild liquid soap to help prevent infections. You don’t need antibacterial soap, an all-natural liquid soap or saline solution is easier on tender skin. Rinse the wound with clean water and dry with cotton wool swabs or gauze pads. If the bleeding returns it should be minor, apply pressure again with the gauze until the bleeding stops.

Step 4 – Protect the Wound from Infection

Once the wound is cleaned you need to protect the wound from infections. Antibiotic ointments can cause bacterial resistance, inflammation from allergens and contact dermatitis. Instead use an antiseptic cream, gel or solution, apply it with cotton wool swabs anddry the excess antiseptic from around the wound area.

Step 5 – Dress the Wound
Once the bleeding has been controlled and the wound is clean you need to make sure it stays clean. Small lacerations, incisions and avulsions may require butterfly closures in place of surgical sutures to pull the skin on either side of the wound together. Use clean sterile dressing such as plasters or gauze to cover superficial wounds that are not deep enough to see subcutaneous (fatty) tissue. Lightly cover the butterfly closure, plaster or gauze with a bandage or adhesive dressing if required. This will absorb fluids, protect the wound from infections and allow optimal healing time.

Step 6 – Practice Good Wound Care Maintenance

Most antiseptic protection against bacteria lasts from 5 to 12 hours, so it is essential to periodically clean the wound. Gently remove the dressing and inspect the wound for infection. These are signs you should consult a doctor:

Tenderness or inflammation around the wound.Cloudy or yellow/green coloured drainage from the wound.Fever.Swelling around the wound.Numbness around the wound.Red streaks around the wound.

Step 7 – Boost You Immune System

A strong immune system helps keep your body and wounds infection free. A natural way to boost your immune system and the body’s capacity to deal with infections and wound repair is to eat and drink fermented foodstuffs such as probiotic liquids and cultured foods.

There is no need to panic if you have a basic understanding of adequate wound care, you can take care of most cuts, scrapes and bumps that are part of life. However, it is still important to identify when you require medical help and consult with a medical professional. Your body has an amazing ability to heal but it is always good to help where you can. Cleanliness is important in wound care, so remember to wash your hands before and after the treatment of any wound to prevent the spread of bacteria or infections.

Feet & Nail Care (Diabetics)

Why is foot care important?
If you have diabetes, nerve damage, circulation problems, and infections can lead to serious foot problems. However, you can take precautions to maintain healthy feet.

Managing your diabetes and maintaining a healthy lifestyle helps keep your feet healthy. This should include:

regular medical exams, including foot checks at every visit and checking your ABCs (A1c, blood pressure, and cholesterol)
monitoring your blood sugar daily
regular exercise
eating a balanced diet rich in fruits and vegetables
You can help prevent serious foot problems by following a good foot care regimen.

Daily foot care
Here are a few foot care habits you can adopt and try to do every day.

1. Inspect your feet
Check your feet and toes, inspecting the tops, sides, soles, heels, and the area in between the toes. If you’re physically unable to inspect your own feet, use a mirror or ask someone to help. Contact your doctor immediately if you discover any sores, redness, cuts, blisters, or bruises.

2. Wash your feet

Wash your feet every day in warm water with mild soap. Hot water and harsh soaps can damage your skin. Check the water temperature with your fingers or elbow before putting your feet in. Your diabetes may make it difficult to sense water temperature with your feet.

3. Dry your feet

Pat your feet to dry them and make sure to dry well. Infections tend to develop in moist areas, so make sure you dry the area between your toes well.

4. Moisturize dry skin

If the skin on your feet feels rough or dry, use lotion or oil. Do not use lotion between your toes.

Healthy foot habits

Following good foot care habits will go a long way toward keeping your feet healthy. Here are a few helpful tips.

Antiseptic solutions can burn your skin. Never use them on your feet without your doctor’s approval.Never use a heating pad, hot water bottle, or electric blanket on your feet.Avoid walking barefoot. Most people know to avoid hot pavement or sandy beaches, but even walking barefoot around the house can cause sores or injuries that can get infected.Protect your feet from heat and cold.Never attempt to remove corns, calluses, warts, or other foot lesions yourself. Don’t use chemical wart removers, razor blades, corn plasters, or liquid corn or callus removers. See your doctor or podiatrist.Don’t sit with your legs crossed or stand in one position for long periods of time.

Toenail care

It’s possible for people with diabetes to perform routine toenail care. But visual difficulty, nerve problems, or circulatory changes in the legs or feet can make this unsafe.

If you’re able to safely trim your toenails yourself, doing so properly will help you avoid getting an ulcer or foot sore. Make sure to consult with your healthcare provider to see if it’s safe for you to perform routine toenail care. Ask them to show you the correct way.

Here are a few tips for proper toenail care:

Trim your toenails after washing your feet, when your nails are soft.Cut straight across rather than in a curved fashion to help prevent ingrown toenails.Don’t cut into the corners. Use an emery board to smooth the edges.Be careful not to cut toenails too short.Have your toenails trimmed by a foot doctor or another healthcare provider if you can’t see well, or if your nails are thick or yellowed.

Footwear: Shoes and socks

If you have neuropathy, or nerve damage that has affected foot sensitivity, you may overlook cuts or bumps. You can help protect your feet by wearing shoes at all times.

Shoes

Choose comfortable, well-fitting shoes with plenty of room, especially in the toe box. Never buy tight shoes hoping they will stretch.Do not wear shoes made out of plastic or other materials that do not breathe. Choose leather, canvas, or suede.Avoid thong sandals, flip-flops, pointed-toe and open-toe shoes, and very high heels.Wear shoes that can be adjusted with laces, buckles, or Velcro.Inspect the inside of your shoes every day for tears or bumps that may cause pressure or irritation.If you have nerve damage, give your feet a break or change shoes after five hours to change the pressure points on different areas of your feet.If you experience repeated problems with your feet, ask your doctor if special shoes would help.Socks can provide an extra layer of soft protection between your foot and your shoe.Wear clean, dry socks, or non-binding pantyhose. Avoid socks or hosiery with seams that can cause additional pressure points or are too tight on the leg.Wear socks to bed if your feet are cold.

Signs and symptoms of foot problems

It’s important to recognize early warning signs of foot problems, such as:

burning, tingling, or painful feetloss of sensation to heat, cold, or touchchanges to the color or shape of your feetloss of hair on the toes, feet, and lower legsthickening and yellowing of the toenailsonset of red spots, blisters, sores, ulcers, infected corns, or ingrown toenails

If you have any of these symptoms, call your doctor immediately. Delay may result in serious health complications.

Potential complications

Following the tips above can help you to avoid foot problems. As stated above, high blood sugar levels over time can cause nerve damage and circulation problems. These problems can cause or contribute to foot problems. Left unnoticed or untreated, sores, ingrown toenails, and other problems can lead to infection. Poor circulation makes healing an infection difficult. So it’s best to avoid them if possible.

Infections that do not heal can cause skin and tissue to die and turn black. This is called gangrene. Treatment can involve surgery to amputate a toe, foot, or part of a leg.

Visiting the doctor

A doctor should examine your feet at every visit and do a thorough foot exam once a year. If you have a history of foot problems, you should be checked more often. Your health care provider should also give you information on foot care and answer all your questions. Report any corns, calluses, sores, cuts, bruises, infections, or foot pain.

If necessary, your doctor can recommend a podiatrist who specializes in diabetic foot care or give you information about special shoes that may help.

Remember: Diabetes-related foot problems can worsen very quickly and are difficult to treat, so it’s important to seek prompt medical attention.

Cholesterol Test

A complete cholesterol test is also called a lipid panel or lipid profile. Your doctor can use it to measure the amount of “good” and “bad” cholesterol and triglycerides, a type of fat, in your blood.

Cholesterol is a soft, waxy fat that your body needs to function properly. However, too much cholesterol can lead to:

  • heart disease
  • stroke
  • atherosclerosis, a clogging or hardening of your arteries

If you’re a man, you should get your cholesterol levels checked regularly, starting by age 35 or younger. If you’re a woman, you should begin routine cholesterol screening by age 45 or younger. To be on the safe side, you may want to get your cholesterol tested every five years beginning as early as age 20. If you’ve been diagnosed with diabetes, heart disease, stroke, or high blood pressure, or if you’re taking medication to control your cholesterol levels, you should check your cholesterol every year.

Who Is at Risk of High Cholesterol?

Risk Factors
 

Cholesterol testing is very important if you:

 
  • have a family history of high cholesterol or heart disease
  • are overweight or obese
  • drink alcohol frequently
  • smoke cigarettes
  • lead an inactive lifestyle
  • have diabetes, kidney disease, polycystic ovary syndrome, or an underactive thyroid gland

All of these things can increase your risk of developing high cholesterol.

What Does a Cholesterol Test Measure?

purpose
 

A complete cholesterol test measures four types of lipids, or fats, in your blood:

  • Total cholesterol: This is the total amount of cholesterol in your blood.
  • Low-density lipoprotein (LDL) cholesterol: This is referred to as “bad” cholesterol. Too much of it raises your risk of heart attack, stroke, and atherosclerosis.
  • High-density lipoprotein (HDL) cholesterol: This is referred to as “good” cholesterol because it helps remove LDL cholesterol from your blood.
  • Triglycerides: When you eat, your body converts the calories it doesn’t need into triglycerides, which are stored in your fat cells. People who are overweight, diabetic, eat too many sweets, or drink too much alcohol can have high triglyceride levels.

Preparation for a Cholesterol Test

Diagnosis
 

In some cases, your doctor may ask you to fast before having your cholesterol levels tested. If you’re only getting your HDL and total cholesterol levels checked, you may be able to eat beforehand. However, if you’re having a complete lipid profile done, you should avoid eating or drinking anything other than water for nine to 12 hours before your test.

Before your test, you should also tell your doctor about:

  • any symptoms or health problems you’re experiencing
  • your family history of heart health
  • all medications and supplements that you’re currently taking

If you’re taking medications that could increase your cholesterol levels, such as birth control pills, your doctor may ask you to stop taking them a few days before your test.

How Is a Cholesterol Test Performed?

process
 

To check your cholesterol levels, your doctor will need to get a sample of your blood. You will probably have your blood drawn in the morning, sometimes after fasting since the night before.

A blood test is an outpatient procedure. It takes only a few minutes and is relatively painless. It’s usually performed at a diagnostic lab. In some cases, it can also be performed during a regular doctor visit, at a local pharmacy, or even at home.

There are very few risks associated with having your blood drawn for a cholesterol test. You may feel slightly faint or have some soreness or pain at the site where your blood was drawn. There’s also a very slight risk of infection at the puncture site.

What Do the Test Results Mean?

Results/Exams
 

Cholesterol levels are measured in milligrams (mg) of cholesterol per deciliter (dL) of blood. Ideal results for most adults are:

  • LDL: 70 to 130 mg/dL (the lower the number, the better)
  • HDL: more than 40 to 60 mg/dL (the higher the number, the better)
  • total cholesterol: less than 200 mg/dL (the lower the number, the better)
  • triglycerides: 10 to 150 mg/dL (the lower the number, the better)

If your cholesterol numbers are outside of the normal range, you may be at a higher risk of heart disease, stroke, and atherosclerosis. If your test results are abnormal, your doctor may order a blood glucose test to check for diabetes. Your doctor might also order a thyroid function test to determine if your thyroid is underactive.

Next Steps and Treatment

Treatment
 

High cholesterol can be treated with lifestyle changes and medication. Lowering high levels of LDL in your blood can help you avoid problems with your heart and blood vessels.

To help lower your cholesterol levels:

  • Quit smoking tobacco and limit your alcohol consumption.
  • Avoid high-fat and high-sodium foods, while maintaining a well-balanced diet. Eat a wide variety of vegetables, fruits, whole-grain products, low-fat dairy products, and lean sources of protein.
  • Exercise regularly. Try to do 150 minutes of moderate intensity aerobic activity per week, as well as two sessions of muscle strengthening activities.

Your doctor may put you on a “therapeutic lifestyle changes” or TLC diet. Under this meal plan, only 7 percent of your daily calories should come from saturated fat. It also requires you to get less than 200 mg of cholesterol from your food each day.

Some foods help your digestive tract absorb less cholesterol. For example, your doctor may encourage you to eat more:

  • oats, barley, and other whole grains
  • fruits such as apples, pears, bananas, and oranges
  • vegetables such as eggplant and okra
  • beans and legumes, such as kidney beans, chickpeas, and lentils

Obesity is also a common risk factor for high cholesterol and heart disease. Your doctor may encourage you to lose weight by cutting calories from your diet and exercising more.

Taking medications such as statins can also help keep your cholesterol in check. These medications help lower your LDL levels.

Outlook

Outlook
 

Overall, high cholesterol is very manageable. Ask your doctor to help you create a treatment plan that you can maintain. It may include changes to your diet, exercise routine, and other daily habits. It may also include cholesterol-lowering medications. The more proactive you are in making lifestyle changes and taking prescribed medications, the better results you will have.