March 2009

March is Help Fight Liver Disease Month: What You Need to Know

JH: March is almost over, and we haven’t finished going through all the highlighted diseases like we promised at the first of the month. We do have time this month to talk about one more – liver disease – but will have to do Chronic Fatigue Syndrome in April.

RM: Sounds good. One thing though. We should say that March is the month that liver disease is highlighted in Canada, while October is Liver Awareness Month in the US. 

JH: But since it’s so important to us all year round, we’ll talk about it now, and again in October.  First question: is there anything that women our age especially need to know about the liver?

RM:  One thing that I think is important to know is that alcohol is not the only thing that can cause liver disease.

JH: Good point. Many of my patients who don’t drink heavily are surprised when they are found to have a problem with the liver.  I then tell them that many other things can harm the liver in the same way that alcohol does.

RM: Like what?

JH:  There’s a condition known as “fatty liver” in which fat accumulates within the liver.

RM: Yes – and isn’t it also called “nonalcoholic fatty liver disease” ?

JH: That’s right. What’s frightening about it is that the fat may cause no damage to the liver, but the condition can progress to cause inflammation, and even go on to cirrhosis, just like liver disease caused by excess alcohol.

RM: That is frightening because cirrhosis – a term that means hardening or scarring of the liver in which the normal functioning liver cells are replaced with scar tissue – can lead to liver failure. 

JH: Then, one would eventually need a liver transplant because we can’t survive without a functioning liver.  So, alcohol is definitely not the only cause of cirrhosis and liver failure.

RM: Back up just a minute. Why can’t we survive when the liver no longer functions?

JH:  I had a professor in medical school who described the liver’s function in our bodies in an easy-to-remember short phrase: “The liver is the metabolic brain of the body.”  It metabolizes, or breaks down, most of the substances that come through the body so that the useful parts can be used, and the toxic parts can be eliminated.

RM: So if the liver isn’t functioning, all the toxins and waste build up somewhat similar to what happens when both kidneys fail. The difference is that dialysis can sustain us when we have kidney failure, and there’s no similar treatment for liver failure.

JH: What are some of the things that can lead to fatty liver?

RM:  High cholesterol, high triglycerides in the blood, obesity, malnutrition, gastric bypass surgery, rapid weight loss, and Type 2 diabetes are some risk factors, just to mention a few. But important to remember is that not everyone with one of these abnormalities or diseases gets fatty liver. The cause of fatty liver is not fully understood yet.

JH:  The other thing that some people don’t realize is that some medications can cause liver damage, and even liver failure.  This is called “drug-induced liver disease”. 

RM:  What are some of those drugs?

JH: There are many: isoniazid – a drug used to treat tuberculosis; niacin – used to treat high cholesterol; nitrofurantoin – an antibiotic often used to treat urinary infections; and acetaminophen – that’s the generic name of Tylenol.

RM: Tylenol? You mean that if we take that routinely for a headache, we can get liver disease?

JH:  No – not if it’s taken as directed on the bottle which says that we shouldn’t take more than  8 Extra-Strength pills  in a twenty-four hour period.  Most of us don’t do that, so it’s not so much of a worry.

RM: But what if we take some Tylenol and take a few drinks of alcohol, which we know can damage the liver. Can both of those together in smaller doses add up to cause liver damage?

JH: Absolutely. Great point.  Someone who drinks more than two alcoholic beverages a day should not take more than 4 Extra-Strength pills in a day.  Taking more Tylenol than that, in addition to the alcohol, can hurt the liver.

RM: So, to keep our livers healthy, we shouldn’t be taking in lots of different substances?

JH: Exactly right. Which makes it so important that we always follow the directions on pill bottles, and that we educate ourselves as to which common substances we put in our bodies can hurt the liver.

RM:  I’m getting tired here, so I know our readers are too. Quickly, what are the other things that can cause liver damage?

JH: The different types of viral hepatitis – Hepatitis B and Hepatitis C can lead to chronic liver damage, but do not always do that.  In addition, certain hereditary diseases, like Wilson’s disease, can lead to liver damage.

RM: So, to keep our liver healthy, we need to be aware of : 1) a family history of liver disease; 2)  exposure to one of the hepatitis viruses; 3) the medications we take  and whether they can damage the liver; 4) our weight and cholesterol level in order to be checked for fatty liver if they are high; 5) how much alcohol we are drinking per day.

JH: Right. And, we need to be able to tell our healthcare provider all of that. We need to know that early in its course, liver disease may cause no symptoms at all, or may just cause severe fatigue or itching. By the time other symptoms appear, such as swelling in the legs or abdomen, the disease is advanced.

RM: And that liver disease can be diagnosed through simple blood tests, known as the liver function tests.

JH: And that a diet of nutritious foods, maintaining a healthy weight, and drinking alcohol in moderation will go a long way in keeping the liver healthy.

RM: Whew! Huge topic, and we could talk about it for an even longer time.

JH: But we’ll table this discussion for now. It’s very appropriate that next we’ll talk about Chronic Fatigue Syndrome because that’s almost where I am right now!

 

To learn more about your liver and how to take care of it, go to:

http://www.liverfoundation.org/

http://www.cdc.gov/hepatitis/index.htm

March Is National Kidney Disease Month: What You Need to Know

RM: Hey there! Long time no chat!

JH: You’re so right – we haven’t chatted on our blog in ages. That’s because of all those “disease-a-month” topics we’ve had to cover.

RM: But aren’t we doing that with today’s blog anyway?

JH: Sure are. We’re talking about kidney disease in older women. But I thought it might be more fun for both of us to chat about it.

RM: Ok, then. What do we older but cooler ladies need to know about kidney disease?  Are you going to start by telling us how to stay leak-free?

JH:  That’s a big one at this age, but no, we’re not talking about urinary incontinence today.  (We do have an entire chapter on it and its treatment in our book though). We’re going to move higher up the urinary tract and talk about the main organs of that system – the kidneys.

RM:  You mean, the mothers of the urinary system?

JH:  Good analogy! The kidneys in fact do create the urine, by removing the toxins and waste matter from our blood, while maintaining the body’s fluid and electrolyte balance, and then send that urine on down the rest of the urinary tract and out into the world. So, they do the same type of work, and every bit as important, as mothers do.

RM:  Cool. So at this age, what are the main things that can go wrong with the kidneys?

JH: At our age, and as we continue to get older, the most common of the kidney diseases are chronic kidney disease and kidney failure. 

RM:  And exactly what do you mean by chronic kidney disease and failure?

JH:  Exactly as they sound. Chronic disease of the kidneys is a term indicating that the kidneys are not functioning as well at their job of removing toxins and waste products, and maintaining the body’s fluid and electrolyte balance.  Kidney failure occurs when neither kidney is functioning at all.  When someone has kidney failure, the next step is dialysis to, in essence, perform the job of the kidneys. And eventually, many people on dialysis can get kidney transplants.

RM:  Then those kidneys just get pooped out after all those years of disease?

JH:  That’s right.  What’s even more frightening about chronic kidney disease is that it is silent, or has no symptoms; so most people with it don’t know they have it.   There are an estimated 26 million people in this country with it, and most are unaware of it.  Also, it is the 9th leading cause of death in this country.

RM: Do we know of any risk factors for kidney disease, since we know risk factors for heart disease and many other diseases?

JH:  This may surprise our readers, but the three major risk factors for kidney disease  are also risk factors for heart disease and stroke:  high blood pressure, diabetes, and a family history of the disease in question, in this case – kidney disease.   In addition, smoking cigarettes and weight gain may increase the risk for chronic kidney disease.

RM:  Is there are a difference between men and women in how often they get it?

JH:  Great question.  Yes there is.  Women have what’s been called “the female advantage” regarding chronic kidney disease; that is, they get it much less frequently than men do.  The only group of women who do not have this advantage are diabetics.

RM:  So, are you saying that our not getting kidney disease has something to do with our hormones?

JH:  It’s a real possibility since postmenopausal women tend to be diagnosed more frequently with chronic kidney disease than are younger women, but still less than men.  But that needs to be studied further.

RM: Any difference between ethnic groups as to who gets chronic kidney disease?

JH:  Yes. African Americans, Hispanic Americans, and American Indians are more than twice as likely to develop this disease than are CaucasianAmericans.

RM: So, what can we do to prevent kidney disease?

JH:  The better our high blood pressure and diabetes are controlled, the less likely it is that we will get chronic kidney disease and kidney failure.  For those of us with a family history, the best thing we can do is to be proactive: take good care of ourselves, and make sure our clinician knows there is a family history of kidney disease, so we can be screened for it regularly.  Since diabetes and high blood pressure can often have no symptoms, we should have our healthcare provider check us regularly for those diseases.  And I know I’ll sound like a broken record here, but women who smoke need to stop!  Also, we need to try to maintain a healthy body weight.

RM:  Aren’t those tests you just mentioned checked for routinely anyway? And, another question, how is kidney disease diagnosed?

JH:  Easy – kidney disease can be diagnosed most often by labwork done on the blood – specifically, the creatinine and BUN levels. In addition, oftentimes, a urinalysis can help with the diagnosis. And yes – both of these studies, as well as a test for blood sugar and checking the blood pressure and weight should be a routine part of health screening.

RM:  Ok then, so we need to get a check up regularly, keep our blood pressure and blood sugar under control, stop smoking, and try to maintain a healthy weight. Nothing really new here!

JH: You got it.

RM: Oh yeah – and one other thing: be good to our mothers!

JH: And our kidneys!

For more information, go to:http://kidney.niddk.nih.gov/kudiseases/pubs/chronickidneydiseases/

 

March is National Colorectal Awareness Month: What You Need to Know

Colon cancer is the third leading cause of cancer death in both men and women in the U.S. Of all women in the U.S., African American women have the greatest chance of developing it, followed by Caucasian women, then Native American and Asian American women. Hispanic women have the lowest incidence of colon cancer.

That’s the bad news. The good news is that this cancer can not only be detected early – increasing the chance of a cure – but also may be completely prevented in many cases. Why and how can that be done? Because nearly all colon cancers start as polyps, and most polyps can be detected by colonoscopy, a procedure that is done using a scope or tube that has a camera on one end and the doctor on the other end. When this tube, which is nearly 6 feet long, is pushed up into the colon while the patient is sedated or under anesthesia, the doctor is able to see the colon directly. If she/he sees a polyp or growth, it can be removed at that time. Removing polyps and growths before they become cancerous is the goal. Not all polyps are cancerous, but again, nearly all cancers of the colon start as polyps.

Who should get a colonoscopy? Since the odds of getting colon cancer is greatest in people who are 50 and older, and increases with age, a screening colonoscopy is recommended when you turn 50 years old or soon after. If you have a first degree relative who has had colon cancer, then you are greater risk of getting it, and colonoscopy should be done 10 years prior to the age that that first degree relative was diagnosed with colon cancer.  For instance, if your father had a colon cancer diagnosed at age 45 then you would need your first colonoscopy done at age 35. After your first colonoscopy, you will need to have one every five to ten years thereafter as recommended by your doctor.

The “bottom” line is that if you haven’t had your colonoscopy yet, it is time to arrange it now.  Think of it as the ultimate spring cleaning! It can save your life.

In our book, there is a lengthy discussion of colon cancer, all the risk factors – including diet, and how both of us prepare for our colonoscopies in the most “pleasant” way possible (if that is possible at all!) Also for more information, go to:
http://nihseniorhealth.gov/colorectalcancer/toc.html

Since March is also National Kidney Month, the next blog will discuss kidney disease and how to prevent it at this age.

March Is . . . National Colorectal Awareness Month; National Kidney Month; National Chronic Fatigue Syndrome Awareness Month; and National Help Fight Liver Disease Month

When we first started this blog – and even before, when we were thinking on what we’d write about – we never dreamed that our topics would be chosen for us each and every month by the Disease-a-Month club! Of course, there’s no such thing, but it surely seems that each and every month now has a specific disease (and this month, a first – FOUR diseases) associated with it.  I knew about the longstanding ones, February as Heart Disease month, and October as Breast Cancer Awareness month. but imagine my surprise when, for fun, I googled March, and came up with the above diseases as being highlighted this month!

So, this month, we will be talking about each of the above, but also will discuss topics that we want to talk about like:  diets (which ones work best – there are new studies on this); Salmonella (are you safe from it by just avoiding peanuts and peanut butter? No!); resveratrol (is it really anti-aging?); and a few more.

So stay tuned.

 

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