Motivation to live

Today my six year old daughter, for no apparent reason, asked me "Daddy, what do you have to do to live a long time?" Delighted that she was asking me something I have been researching so much lately, I cheerfully replied "You have to be happy, always enjoy what you're doing, avoid fighting and being angry, treat everyone as your friend, get lots of sleep, and only eat good things..."

What she said next took me completely by surprise:

"Daddy, I want you to live a long time"

I told her I was going to do everything I could.

Progress

Well, two months have passed since I found out about my condition. 

A week or two after the initial revelation, I decided that to reverse the condition I would have to lead a buddhist monk existance, rising at sunrise every morning for meditation on the beach, living only in the moment, working only a few hours a day and without concern, learning to feel at one with the universe, eating only to satisfy my body and not my mind, getting plenty of rest and plenty of playtime (especially with my children), receiving psychotherapy, etc.

So how am I doing? Pretty poorly really. Here I am at 1am writing my blog and in general I seem to find it a lot easier to spend hours reading about healthy living and meditation than to spend half-an-hour putting it to practice. Although some of my diet changes have been radical, a lot of my consumption is still "comfort" snacks rather than needed nutrition. The psychotherapy is still on the back boiler (I would start if a psychotherapist walked up to me and offered his services...!). I still have trouble getting to myself to sleep at a reasonable time. I am definitely working less and spending more time with my girls but even with them, I'm still checking, and responding to, my mail every few minutes.

I feel that finding out about my condition has been a blessing because it has prompted me to reevaluate my lifestyle and realize that I would like to make lots of changes (and in fact need to make lots of changes if my body is to survive). The question is whether I really have enough desire to make them.

In some ways I feel like it's a battle between me, the Father, who would like to continue his journey for another 30-60 years, and me, the dysfunctional person, who wants to have a chronic, life-threatening, disease. My conscience mind wants the father to win but my subconscience worries me... I´m sure there is a lot of baggage in there that needs to be cast aside if I'm to stop injuring myself.

Learning to be children

This as I sat in my Aikido class, stressing about the noise my young children were making in the "audience" I was struck by a certain irony: 

Here we were, 15 grown men, solomnly listening to an Aikido master talking about importance of being happy and living in the present, while my children, with no instruction, joyously played without the slightest thought of anything beyond that moment. In other words, the mental state that requires years of disciplined training in an adult, exists effortlessly in children. Instead of being embarrassed about my girls disturbing the class, I should probably proudly present them as ideals!

I had always worried that maybe I wasn't teaching my children well (or at all!) but now I find they have much to teach me... I now feel that my main parental responability is to simply be a worthy example. The first step should be learning to love myself and especially my kidneys! (maybe I should keep the ultrasound photos in my wallet...)

Cures in wild animals

Today by pure chance I came across an intestersting book that scientifically documents the impressive healing abilities of wild animals use: Wild Health, By Cindy Engel

I had previously read in a naturopath website that wild animals don't suffer from chronic disease but thought this was probably due to a lack of data than any scientific fact. Now I'm beginning to think that it ties into the theory that all chronic disease starts in the mind... wild animals, as far as I know, don't suffer from the psychological issues that affect man and animals in captivity. 

That almost implies that societal living, which depends on exchange, is a form of captivity because we become dependent on others for our survival. This dependency probably gives rise to expectancies (of reciprocity, of respect, etc.), the unfulfillment of which, seems to me (as my hero, Winnie-the-Pooh would say) to be the primary cause of negative emotions and said psychological issues (which is not to negate the huge benefits of societal living!).

The buddhist goal of "freedom from desire" (which could probably be expressed as "freedom from expectations") seeks to avoid these damaging psychological hang-ups. Perhaps the healthiest option is to learn to live in the trap (of society) without being trapped (psychologically, at least). This is probably what the long-lived communities described in the The Blue Zone acheive.

Of course I'm sure this has all been studied to death but I'm still pretty ignorant. Hopefully the pyschology books I've ordered will help (if only buying a book was the same as understanding its contents!)

Recipes: Guacamole, Carrot and Pineapple Juice

Perhaps too simple to be called recipes, these combinations have worked well for me:

Guacamole

While there must be hundreds of recipes on the web for guacamole, lately I've been enjoying the following as an alternative to plain avocado:

2 Avocados (soft)

Juice of 1 Lime

Mush together with a fork.

You can raw onion, etc. if you like that sort of thing (I don't)

This works well spread on warm corn tortillas, either alone or before filling with fried mushrooms and salad (lettuce, sprouts, grated carrot, etc.)

Carrot and Pineapple Juice

A big surprise for me has been how good fresh carrot juice tastes. I had tried carrot juice years ago and wasn't too impressed, perhaps because it hadn't been made at that moment. Combining it with pineapple (any ratio from 30:70 to 70:30), however, is really delicious to my palate.

What amazes me is that although I would be hard pushed to eat 10 carrots at once, or a whole pineapple, I can happily drink these quantities once they've been juiced. I don't know if juice is better than eating the whole food (it certainly isn't natural!). Maybe it's better because it fills you more easily, reducing cravings for wheat, etc.

Body Care - Life's Priority

Today, feeling great after enjoying an hour or so body-boarding with my six-year-old,  I was struck by a blindingly obvious truth: 

My body is the only thing I can't live without, yet in my 36 years, I have devoted almost no time to looking after it! 

Sure I put in gasoline, touch up the scratches, and ride around in it, but preventive maintenance?Forget about it. I guess the reason is that for the most part it works just fine without me bothering about it... until it breaks. Fortunately, in my case, I became aware of a problem before failure so perhaps I have time to mend my ways, and start investing time and effort in looking after ME (the kind of self-attention that Christian society seems frown upon, perhaps the reason I never learned to do it).

I continue to think that teaching "life skills" really should be a mandatory part of secondary school education. It is probably what most differentiates successful people from the strugglers and what gives some children (with parents capable of teaching these skills) huge advantages over others. And if teaching "life skills" meant postponing differential calculus till university, so be it!

Foamy Urine

I had been quite excited lately to notice that my urine wasn't as foamy as before, possibly indicating less protein in my urine, perhaps indicating that my kidneys were working better. Apparently proteins passing through the kidney nephrons damages them further, so reducing the amount of proteinuria would be a big plus.

Then yesterday afternoon and this morning, I had foamy urine again. As I racked my brains for a possible cause, it became quite obvious. Yesterday I practiced Aikido for the first time in two weeks (and I've also been doing less other exercise due to my girls' easter holiday). I'm not sure why, but apparently exercise causes protein in the urine (though I've never seen it suggested that one shouldn't exercise! On the contrary, I've read that exercise has proved to be good for maintaining kidney function in CKD cases). Will have to ask my nephrologist about it. 

Zyloprim

Today I started taking Zyloprim as indicated by my Nephrologist. I was somewhat hesitant to do so as on a government website it says:

"Start with a low 100mg/day dose, in case of adverse reaction, and only increse if response is inadequate. Exercise extreme caution in cases of insufficient renal function."

The Nephrologist started me on 300mg/day and ordered test in a months time :(  I would like to trust that the Nephrologist knows what he's doing but unfortunately my experience with "professionals" in Mexico in general has been pretty poor (especially accountants and architects)

My other doctor recommended that I take the drug (though he didn't ask about the dose). So here's hoping it doesn't do any harm (like the diuretic that caused me to faint with super low blood pressure)... I've read that high uric acid can cause plenty of problems (crystals forming in joints and things) so I guess it's worth the risk. My reluctance stems from the fact that I feel really good generally, better than ever, and I hate messing with a working machine.

Recipe: Vegetable sushi

This experiment worked really well. I like sushi, and have read good things about eating seaweed.

You need to buy a packet of sushi seaweed. My packet came with instructions for making sushi rolls, or you can surely find them on the web somewhere. If you don't have a bamboo mat, you can use, as we did, a sheet of stiffish plastic or anything else that can be rolled without losing it's form.

Make the filling with boiled rice and your favorite vegetables: Mushrooms, green beans, cucumber, avocado, etc.

Big thank-you to my wife for making this!

Recipe: Fish, sauteed potatoes and green beans.

Today I had my best meal since starting my diet, mainly because I have decided to start eating fish and potatoes. I had stopped eating these mainly based on the recommendations of Ehret (the mucusless eating system), who abstains from animal products and starchy food, but I have since found lots of evidence about the benefits of eating fish. There's probably nothing particularly healthy about eating potatoes but they certainly fill the belly!

Fish
Choose your favorite sea fish fillet.
Marinate with lime juice for one hour.
Fry with olive oil and germinated sprouts until both sides of the fish are slightly browned.

Serve the fish covered with the sprouts.

Potatoes

Boil in water until a butter knife can be inserted into the potatoes (don't leave them too long).

Slice into 1cm thick rounds.

Fry potato rounds in olive oil with your favorite herbs until all pieces are crispy golden-brown on both sides.

Serve next to the fish.

Green beans

Fry frozen green bean segments in olive oil until soft enough to eat (slightly crunchy is good).

Serve next to the fish and potatoes.

Happiness - the key to health

After researching all kinds of theories for treating disease, and trying to reconcile the different points of view, I've come to the conclusion that real "cure for all diseases" is contentment. You can interpret this biologically (endorphins, etc.), spiritually, or pyschologically, but it seems to me that it is the overriding factor in all well-being, and also what explains the people who do all the "wrong" things and yet live healthily into their nineties.

Of course happiness is probably the hardest thing to achieve (especially if you try!) but I believe it is where I should be focussing my efforts.

One study on communities which have above average longetivity (Blue Zones) honed in on four important factors: Exercise, Sense of purpose, Diet, Relationships with others and society at large.

I think all of these factors are contentment related. Two of them directly and I believe the other two (exercise and diet) are manifestations of happiness: Discontentment tends to lead to unhealthy lifestyles.

If anyone reading this knows the secret to contentment, please leave a comment ;)

Watermelon Seed Tea for Kidney Stones

I tried drinking watermelon seed tea for a few days but didn't feel my kidney stones moving. I read one post that says it is just a diuretic and doesn't actually dissolve the stones. I can't imagine passing a 7mm stone without dissolving first, so I need to look for something that will dissolve the stones.

The nephrologist prescribed three medicines and investigating these they seem to act to alkanize the blood (right now I have high uric acid levels, which I guess means my blood is acid). This seems to suggest that he thinks my stones are uric acid stones. However, looking at test results from a month ago, when my stones were discovered, I then had low levels of uric acid in my blood...

The medicines also carry warnings not to use when potassium levels are high (as mine are) as they tend to increase potassium levels (which is apparently dangerous)! It's tough not having much confidence in your doctor, or having the kind of relationship where I could discuss these issues with him (while he seems to be a nice guy, his professional style is "do this and don't ask questions")

Theory of my illness: Apnea

One of my original theories of my illness was that an inability to breath well through my nose was causing night apnea (stopping breathing) and that this was causing my high blood pressure (a proven possibility), which in turn had damaged my kidneys. I later dismissed the theory as I believe the kidney problems predate the high blood pressure.

However, after having a cold symptoms for a few days, I'm beginning to think that breathing may be a factor. While having a slightly stuffy nose, I have been needing to urinate a few times during the night. Apparently this happens to apnea sufferers because attacks cause a toxin to be produced which needs to be eliminated by the kidneys.

After I started my dairy-free diet, one of the first things I noticed was that I was no longer going to the bathroom at night. This may be because I had less mucus in my nose and therefore was able to breath better and therefore avoided apnea periods. My blood pressure also dropped almost immediately and this could also be due to avoiding apnea (lately, with the cold, it has tended to be higher).

It's probably not the whole picture but it could be a very important element, so I think sleeping well is very important. This will probably mean finding a way to avoid our children creeping into our bed every night (or getting a bigger bed) and buying a better mattress. The best I've tried costs about $700 for double size.

Diet

Today I ate my first slice of bread in about a month. It tasted fantastic, so I ate another. The TBM doctor banned wheat from an allergy standpoint. The nephrologist has restricted me to 4 slices a day. I'll probably try and stay off it generally but it's tough. Dairy products, on the other hand, have been very easy to give up and now I really have no desire for them at all (not that they repulse me either).

Both the Nephrologist and the TBM doctor have permitted rice and oats, so I'll try and eat more of those. Potatoes are allowed too. I had kind of been avoiding these as they are starchy foods that are "bad" according to Ehret (The mucus-less eating system) but I think everything in moderation is fine and they certainly eat plenty of rice in asia where people tend to be healthier than in the west.

From a few things I've read, I think it would be good to eat a bit more fish, for the essential fatty acids (omega-3). I'll try and eat a little twice a week.

Doctors' review of the results

After getting my latest results I went to see my two doctors: The Total Body Modification (TBM) doctor and the Nephrologist (kidney expert).

TBM

The TBM doctor seemed a little disappointed with my results but still optimistic that we would be able to solve the problem. He told me about his client who had a creatinine level of 7mg/dL who got it down to 1.5mg/dL in six months. That's a pretty incredible results. Maybe it means that that persons kidneys weren't permanently damaged. Or, more optimistically, perhaps we just need to give it more time.

Nephrologist

The nephrologist was quite upbeat (maybe he was just in a good mood because of the upcoming easter holidays!). He said the results were good and gave me a list of the five important things that need to be controlled (see below). All my results are within target range except for uric acid (whatever that is), and he prescribed a new drug for this (Zyloprim). He also weighed me and it turns out I've only lost 3kg since going on the low protein diet (previously I was a slimish 88kg (1.82m tall). Now I'm a slimmer 85kg).

Targets

The targets the nephrologist gave me (with my current level in parenthesis) are:

Glucose            < 110mg/dL  (86mg/dL)

Triglycerides  < 160mg/dL  (133mg/dL)

Cholesterol      < 200mg/dL (131mg/dL)

Uric Acid         <   7.0mg/dL    (9.2mg/dL)

Hematocrit      >   32%           (36.5%)

"clean" urine

Drugs

Steriods: The nephrologist reduced my dosis of the steroid y prescribed a month ago and which I haven't been taking. He said he would reduce the dose again in a month. The TBM doctor (who is also a medical doctor) recommended not taking it. Even though I was tempted to start taking it after not seeing progress in my results, I think I will hold off for at least another month.

Kidney stones: The nephrologist prescribed three drugs that, taken together, will supposedly disolve my kidney stones in three months. I've read about loads of natural "potions" that supposedly do the same thing but I think it would have occurred to medical researchers to try these things out. Three months is a long time to be taking three medicines (one, every 12 hours, one, once a day, the other every two days - phew - tough to remember!), along with Cozaar, aspirin, and Ketosteril (which I keep forgetting to take despite paying $400 USD for 6 boxes). 

Aspirin: The Nephrologist said that aspirin helps "protect" my kidneys and told me to keep taking it. I haven't read this anywhere but I doubt it will do any harm (and it's cheap) so I guess I'll start taking it again.

Cozaar

Yesterday I started taking Cozaar again. Not so much for the blood pressure (on which it didn't seem to have much effect) but for the possible kidney protection. 

My basic understanding at this point is that when kidney function is reduced, the kidneys work the remaining capacity harder by narrowing the nephron blood vessels (nephrons are the functional parts of the kidneys). This has the effect of damaging the remaining capacity. Cozaar supposedly stops this narrowing, hence reducing kidney function slightly but hopefully slowing new damage.

I don't like taking drugs that react against the body's natural response (as oppose to aiding it) as I don't believe such an approach can solve anything. In this case, however, I feel I need to buy myself time.

Test results

Today I got new test results. Unfortunately they don't show the improvement I was hoping for and in fact seem to show a worsening compared to tests a month ago. 

This is very disappointing and a little depressing. I don't want to passively submit myself to the standard medical prognosis of "gradual decline until failure" but it is disheartening not to see any results after making fairly big changes in my lifestyle. 

Of course I still have many things to try on my "possible solution" list but this condition is taking a lot of my time and energy as it is. More drastic steps might even involve moving to another country for better medical care... but does it make sense to end most of my life's activities just to try and preserve my body? Spending the rest of my life dedicated to trying to stay alive doesn't really appeal to me... maybe it would be better to quit trying to solve the problem and just get on with making the best use of the time I have left?

Creatinine

The main marker for renal (kidney) function is creatinine and my history has been as follows:

23-Feb-09: 2.0mg/dL (start taking Cozaar, which I've read elevates creatinine levels 20%)

06-Mar-09: 2.1mg/dL

12-Mar-09: 2.5mg/dL

17-Mar-09: 2.5mg/dL

07-Apr-09: 2.3mg/dL (about two weeks after stopping Cozaar)

Creatine Clearance Rate

This is an estimate of GFR, the measure used to compare kidney function and categorize it:

06-Mar-09: 42.0 mL/min  (normal is over 61mL/min)

07-Apr-09: 33.0 mL/min

This level is categorized as CKD stage 3 (moderate). Below 30.0 mL/min is stage 4 (severe). Kidney failure is below 15 mL/min. My understanding from the studies I've seen is that the time period for kidney function to halve can be as little as 3 years.

I don't really understand why there has been such an big apparent drop in kidney function in this last month, after all I've probably had the condition for years. I feel it must be related to the changes I've made in that time (drugs and diet) but who knows what? Or maybe a result of thinking about it constantly?!

Urea and  Blood Urea Nitrogen (BUN)

Previously I had slightly high levels of urea in the blood. Now I have slightly low levels. According to Wikipedia this suggests malnutrition (i.e. low protein intake). Apparently urea in the blood isn't toxic but it is marker for other toxins, so lower is better. Some GFR estimatiations take BUN into account, and so these estimate more kidney function than those shown on the lab results.

Protein in urine

The two 24 hour collections of Urine I've done show:

06-Mar-09: Total protein 1,881mg/día (normal: 42 - 225mg/day)

07-Abr-09:  Albumin         1,485mg/día (normal: 42 - 225mg/day)

As one test is total protein and the other is just albumin (the most common protein), I'm not sure if this shows an improvement or not. In any case it's obviously still way to high. This is importante because apparently proteins passing through the kidneys damages them further. How I wish I'd paid more attention to this when protein was first found in my urine 7 years ago! (In my defence the doctor at that time didn't suggest further investigation)

Units serum creatinine

In the UK serum creatinine is measured in µmol/L while in the US (and hence Mexico), it is measured in mg/dL.

To convert µmol/L to mg/dL, you need to divide by 88.4

(source: http://www.vin.com/scripts/labquest/converthtml.pl)

Recipes: Oat mush, vegetable fajitas

Here are some of my more successful recipes that comply with my diet restrictions:

Banana - Chocolate, or Banana - Mango, Oat-Mush

Mash a banana and about half a cup of oats together. Leave about 30 minutes for the oats to soften. 

Alternatives:

• Add a teaspoon of unsweetened cocoa powder for a chocolatey taste.
  
• Add a diced mango (inexpensive mangos are one of the main advantages of living in Mexico).

Portabello Mushroom and Nopal Fajitas

Slice up a couple of Portabello mushrooms and "Nopal" (cactus) pieces. Fry in olive oil for about 5 minutes or until the nopal is soft. Serve on heated corn tortillas, which are wrapped around the vegetables to make a taco.

Proteinuria

It seems like reducing the amount of protein in the urine is also an important goal (along with lower blood pressure) in slowing the progression of reduced kidney function. This very useful article proposes a target of 500mg/24 hours:

http://www.ccjm.org/content/75/10/705.full

My last test shows 1850mg/24 hours, so clearly work to be done here. I feel that my level hasn't changed much so far because my urine continues to create foam, a sign of protein. Tomorrow's test results will tell me.

Progression of CKD

I found a useful explanation of the mechanics of chronic kidney disease and why it tends to worsen over time:

http://www.virtualmedicalcentre.com/diseases.asp?did=204

Mushrooms (Agaricus Bisporus)

A lot of naturist sites say that Mushrooms (Agaricus Bisporus) help people with kidney failure by purifying the blood. By chance one of my staple foods has become portabello mushrooms, which I find to be one of the tastiest foods still on my permitted list.

UpToDate.com

This post is just to recommend a very informative and well-written medical website I've found:

http://www.uptodate.com

Drugs: Cozaar (Losartan)

Here is a decent description of Cozaar, the anti-hypertension drug I stopped taking a couple of weeks ago:

http://www.medicinenet.com/losartan/article.htm

In general my blood pressure has been good without any drug treatment (yesterday as low as 120/75) but occasionally I have peaks of around 140/90 and the day before yesterday I read as high as 145/95 so I have been wondering if I should start taking the drug again because I keep reading that maintaining low blood pressure is the most important factor in slowing the progression of kidney insufficiency (even though the drug really didn't seem to have any effect when I was taking it and I had even higher blood pressure then).

It also seems that the drug, which is an ARB (angiotensin receptor blocker) can specifically help with certain kidney conditions (caused by type II diabetes). Some websites suggest that they are beneficial to retard kidney disease progression of all types and especially when there is proteinuria (which is my case):

http://www.kidneyresearchuk.org/content/view/429/580

http://www.aakp.org/aakp-library/Kidney-disease-progression/

I also read that it is recommended that blood pressure be maintained below 110/80 when there is proteinuria, suggesting I should lower my blood pressure still further.

If my next tests don't show a dramatic improvement, I may start taking Cozaar again, for proteinuria benefits if not for the hypertension.

Reduction in kidney function

I did read that Cozaar can REDUCE kidney function, so this could explain my higher serum creatinine reading (indicating reduced kidney function) two weeks after starting to use the drug. One document said that an increase of 20% of the serum creatinine level should be expected after administering the drug. This is quite a relief as my big jump (from 2.1 to 2.5mg/dL) in serum creatinine had been worrying me. The nephrologist did indicate that it was normal that the serum creatinine level should rise "with the drugs" but I wasn't sure which drugs he was referring to as I am not taking the anti-immune system steriod he prescribed.

Watermelon seed tea

I'm going to try drinking watermelon seed tea. Supposedly it helps get rid of kidney stones and with kidney problems generally (and I have a LOT of watermelon seeds as I'm eating about a kilo of watermelon for breakfast every day).

The recommendation comes from "Edgar Cayce", who it turns out, what was a psychic who discovered cures through psychic readings! Very interesting, though, that I've come across many sources recommending watermelons for kidney problems. I suppose trying the tea is unlikely to cause any harm.

WATERMELON SEED TEA
Watermelon seed tea is a diuretic recommended in the Cayce readings, particularly as a stimulant to cleanse and purify the kidneys and bladder.

INDICATIONS AND USAGE
Watermelon seed tea was specifically recommended by Edgar Cayce for kidney stones. It was also suggested to simulate underactive kidneys.

CONTRAINDICATIONS
No known contraindications.

DOSAGE AND ADMINISTRATION
At least once a day, three days a week, take watermelon seed tea prepared by pouring a pint of boiling water over a tablespoonful of watermelon seed (ground or cut) and allowing it to steep. Let it cool, then strain and drink. If practical, the tea should be made fresh for each use.

Juicers

As an aside, I bought a new juicer: a Moulinex Juice Machine but unfortunately I was a bit disappoionted. I bought it as I thought it would save time because it automatically pushes out the juiced pulp (whereas with my current antiquated juicer, you have to open it every glass, or so, to scrap out the pulp by hand). Also the basket lifts out by hand for cleaning, where with mine you have to unscrew it and then force it out bit by bit.

Unfortunately the Moulinex has so many pieces, and much bigger pieces (allowing you to process more fruit or vegetables at a time), that I'm not really sure there is any time saving at all:

Moulinex: Pusher (about 20cm long), adapter tube (about 20cm), top with input tube (20cm long) plus pulp extraction channels, blade, basket, base piece, pulp collector.

Old juicer: Pusher (about 10cm long), top with input tube (10cm long), blade, basket.

I also felt after that the Moulinex extracted less juice because it generates a moist (sticky - uck) pulp, whereas the old juicer has a dry pulp. However after closer examination, I think the juice output is about the same (but the Moulinex juice has less air in it).

Parasitic causes

Someone suggested Schistosomiasis, a parasitic infection, as a possible cause of my kidney insufficiency (due to the antibodies that the immune system produces to attack the parasite), and reading about it, it is plausible.

http://renalfellow.blogspot.com/2009/02/schistosomiasis-and-renal-disease.html

In any case, this study suggests that anti-parasitic medicine is ineffective at preventing the progression of chronic kidney disease:

http://www.nature.com/ki/journal/v35/n5/abs/ki1989114a.html

Also, I think the fact that my immune system tests were negative (no antibodies in my blood) means that the cause is of my condition is not due to something external to the kidneys.