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Posted March 10, 2009 | Copyright © The Northern Virginia Daily
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Managing chronic illness: An education, screening event set in Winchester
By Sally Voth
WINCHESTER -- Gary Lambert is once again full of vim.
Chronic kidney disease had robbed the Air Force veteran from Frederick County of his pep.
A long-time Type 2 diabetic, Lambert took a diabetes class several years ago.
"They got to talking about things like how diabetes affects your heart and your kidneys and your liver ... your eyesight," he said. "The doctors -- bless their hearts -- they started looking at some of these things."
A nephrologist -- a doctor specializing in kidneys -- had some blood work done on Lambert, which revealed his red blood cell count was low, meaning he had anemia.
Since then, the U.S. Postal Service employee has been making regular visits to the Valley Health Outpatient EPO Clinic located in the former hospital at 333 W. Cork St.
There, his red blood cell count is monitored, and if necessary, he receives a shot of erythropoietin, which is where the clinic gets the term "EPO." EPO shots are also available in Front Royal and Woodstock.
While the kidney's main job is to maintain the balance of various chemicals, remove waste products, maintain electrolytes and remove extra fluids from the system, a lesser-known function of the kidney is to create a hormone, called erythropoietin, that stimulates the production of red blood cells, said Winchester nephrologist Dr. Archana Shyamsunder.
When that count gets too low, a patient becomes anemic and will be fatigued, she said.
"It has also shown in studies in the long run to actually promote cardiovascular disease," Shyamsunder said.
It is thought that more than 10 percent of the population likely has some form of chronic kidney disease without even realizing it, she said.
Hoping to detect and treat this "silent" disease, Winchester Medical Center is hosting a kidney education and screening program from 8 a.m. to noon and 1:30 to 5 p.m. on Thursday in the Winchester Medical Center Conference Center as part of World Kidney Day, according to a news release from the hospital.
Medical Center nephrologist Dr. Donna Michel will speak at 2 p.m., and a limited number of free kidney screenings will be offered, the release says. There also will be exhibits and information offered about treating and preventing chronic kidney disease, and treating kidney failure, the release says.
According to Shyamsunder, kidneys appear "to have a lot of reserve function," meaning kidney disease can go undetected for long periods of time.
"Most of the time, by the time they have symptoms, they probably already have advanced, irreversible kidney failure," Shyamsunder said. "It's completely asymptomatic until the end."
Often, after learning they have mild kidney disease, patients will report they had been feeling well.
"That makes it a little more challenging in terms of communicating the importance of this to the public and the patient," Shyamsunder said. "The No. 1 risk factor for kidney disease is type 2 diabetes. A close second is probably hypertension. These two medical problems are only growing in our population.
"There's a lot of studies now that show in fact the biggest reason for morbidity and mortality with people with kidney disease is the associated heart disease they have. A lot of these conditions do go hand in hand. That is an important thing that we are recognizing now."
There are several other conditions that can cause kidney disease, including polycystic kidney disease, she said.
Screenings -- which can be done through blood and urine tests -- should be performed on those who have a family history of kidney disease, are older than 50, smoke, have high cholesterol, have high blood pressure, are diabetic or are obese, Shyamsunder said.
"Our kidneys are filters to the blood," she said. "A filter is supposed to retain the good things and get rid of the waste products."
Since the body is supposed to retain protein, its presence in the urine is a red flag.
EPO therapy has been around for 15 to 20 years, Shyamsunder said.
"Now that we're able to give that hormone, it has improved the quality of life of kidney patients enormously," Shyamsunder said.
Lambert is proof of that.
"It kind of gave me my life back," he said of the EPO clinic. "I consider myself pretty peppy now."
The fatigue he felt from being anemic was comparable to what a marathoner would feel at the end of a race, he said.
A kidney transplant is the end result of his disease, Lambert said.
"I'm not on dialysis," he said. "I don't think I will ever go on dialysis. I have a perfect match kidney donor waiting in the wings."
That's Lambert's daughter, but the thought of her giving up a kidney gives him pause.
"The odds of her having diabetes or having kidney failure later on are greater because of the family link," he said. "I'm a little hesitant about doing that. I guess that's an avenue of last resort. By the same token, knowing there's an avenue of last resort makes it bearable. I would go through dialysis, but I would rather bypass that step if I can. I've known a lot of people who've gone through dialysis. They're miserable, most of them."
The EPO shot isn't without side effects.
Because it "irritates" the bone marrow, there is bone pain for a day or so after the jab, Lambert said. It's pain Lambert, who gives himself insulin injections five times a day, can live with.
"It's helping me live better," he said of the shot. "With the complications of diabetes, tomorrow is not given to anybody. I might wake up in the morning not waking up, but the quality of life is better."
Lambert's diabetes' complications have made his wife and children -- he has three, along with two grandchildren -- smart about the disease. In fact, his wife recently lost 40 pounds.
"She said, 'Gary, I love you, but I don't want to go through what you're going through,'" Lambert said.
For more information about the World Kidney Day events, call 536-7448.
More information about kidneys:
• Kidneys filter 200 liters of blood every day. They filter the body's entire blood supply 12 times a day.
• As many as one in nine Americans have kidney disease, but don't realize it.
• While there were 6,000 heart transplants and 21,000 liver transplants in 2005, according to the World Health Organization, 66,000 kidney transplants were performed. However, an estimated 90 percent of the need for kidney transplants went unmet.
Those who should have a kidney screening include those who:
• Have a family history of renal disease.
• Are older than 50.
• Are diabetic.
• Are hypertensive.
• Have high cholesterol.
• Are obese.
Kidney disease prevention strategies:
• Annual checks for diabetes and hypertension.
• Regular exercise.
• Regulate weight.
• Maintain as normal a level of blood pressure and blood sugar as possible even if you are hypertensive or diabetic.
-- Source: Nephrologist Dr. Archana Shyamsunder
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