WWII vet with renal failure plagued with gout

October 17, 2012 By

DEAR DR. GOTT: I am an 86 year-old WWII vet in very good health. In the early part of last year I developed a bad case of gout for the first time. Several months later I slipped getting out of the shower and fractured my pelvis. I made a very good recovery from the fracture but my gout has persisted to this day. I have edema in both legs. I’m on Lasix 40 mg twice daily and allopurinol 100 mg. Most recently I started wearing compression stockings. My kidneys are functioning at 40% and have been stable for the last four years. PCM, nephrology and cardiology doctors don’t seem concerned but I am very worried since this condition has lasted so long.

I would appreciate your opinion regarding this condition and or any suggestions regarding my affliction. Sign me yours with gratitude.
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Hypertensive drug to blame for weight gain

August 7, 2012 By

DEAR DR. GOTT: I am a female with ESRD, stage 4. My doctor prescribed 100 mg metoprolol approximately 2 ½ years ago. Before that he had prescribed another high blood pressure medicine. My problem is that I am slowly gaining weight, over 20 pounds in two years, and lately I have frequent diarrhea. I am also tired most of the time. I am an older woman and realize that my metabolism is slower and may be contributing to my weight gain. However, I try to stay away from fried foods and processed foods. I exercise about three to four times a week for 30 minutes. Could the metoprolol be causing weight gain and is there a better blood pressure medicine that my doctor could prescribe? Thank you.

DEAR READER: For other readers who may be unaware, ESRD stands for end-stage renal disease, a condition that signifies the almost complete failure of the kidneys to work efficiently. It is likely your kidneys may have begun slowing down 10 or even 20 years before you entered this stage. [Read more...]

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When blood levels aren’t normal

April 20, 2012 By

DEAR DR. GOTT: This is being written with the hope you will help me to understand a medical issue. For the past 2 ½ years I have had quarterly blood tests to monitor my liver enzymes and cholesterol levels. In November 2010 these tests also showed my creatinine level was 1.3 and there was a notation from the lab that such was high. When talking with my doctor, he agreed and said we should monitor it. The test in February 2011 was 1.4 but in May it was down to 1.3 again. Then in the August test, it had jumped to 1.8. At first I was told this indicated something serious was going on with my kidneys and my doctor ordered additional blood work to rule out a lab error and help determine the cause. Then those tests were canceled and I’ve been told it’s nothing to worry about. Should I be worried?

DEAR READER: When creatine (important for the production of muscle energy) is metabolized, it produces a waste product known as creatinine, a compound that is produced in the liver. [Read more...]

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Kidney-failure diagnosis can be tricky

September 18, 2010 By

DEAR DR. GOTT: I am an 86-year-old doctor’s daughter concerned that both my parents died of kidney failure, although I never knew how it happened.

Perhaps you could tell me what steps I should take first to deal with it, as I just got a report from my doctor indicating that I have chronic kidney disease that has stabilized. What does that mean?

DEAR READER: The kidneys are fist-sized, bean-shaped organs located at the back of the upper abdomen. Their purpose is to filter and clean blood. When the kidneys lose their ability to perform as intended, the condition is known as kidney failure. Stabilized failure simply means that your kidneys have lost some function but are no longer deteriorating.
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Chronic kidney disease carries dietary restrictions

July 10, 2010 By

DEAR DR. GOTT: I have been diagnosed with chronic kidney disease. I was shocked when the nephrologist told me this, as I have no symptoms. I decided I would get a second opinion. The second doctor said my first diagnosis was correct and put me on a strict low-sodium, low-phosphorus, low-protein diet with very few things I could eat. I went back to the first nephrologists, who said, with all the trials done on the kidneys, it was found that I wouldn’t live one day longer on the diet. She said instead to limit my protein somewhat and to watch my sodium. What is your feeling on this strict diet? I’m a 76-year-old woman. I am having surgery soon to provide an access, as it takes six months for it to heal so I can have dialysis.

DEAR READER: Chronic kidney disease is the gradual loss of kidney function. Conditions such as diabetes, kidney stones, enlarged prostate, vasculitis and hypertension are often associated with the disorder.
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Daily Column

May 3, 2008 By

DEAR DR. GOTT:
Your recently wrote a column about a gentleman who was taking 16 medications. My husband, who is 82, is taking 19.

He has survived Hodgkin’s Lymphoma (1988), a 5 way by-pass surgery (1991), stroke (1997), and two carotid artery surgeries (1997 and 1998). He has type two diabetes as a result of his lymphoma chemotherapy. He is in kidney failure, was diagnosed with bladder cancer in 2005 and myelodysplasia.
He regularly sees an oncologist, endocrinologist, nephrologist, urologist and cardiologist. His medications include pain relievers, blood thinners, cholesterol reducers, calcium, vitamins, water pills, and many more.

I would like your opinion. We have insurance which I am very thankful for. I respect his doctors and their opinions as I do yours. I am worried, though, that he is over medicated. I also am worried that if he stops any of these, it would be his end. He leads a fairly normal life other than sleeping a lot, but given the situation, I would expect this. He does not do much, cannot play golf and is no longer sexually active (even though he would like to be). It is just not possible for him to do the things he wants and enjoys the way he used to.

DEAR READER:
Your husband has several serious medical ailments for which he is taking various (and mostly appropriate) medications. In your list, I do see two medications that I believe could be safely stopped. Valtrex is given to individuals with genital herpes as an outbreak preventive or treatment. Because your husband is not sexually active, there is little risk of him passing this condition on to you. You also state that your husband sleeps a lot. I note that he is taking Lunesta which is a sleep aid. If he is getting more than adequate sleep (7-8 hours) I don’t believe he needs this. If he is taking it because he cannot fall asleep at night, perhaps this is a result of him sleeping too much during the day. Try to keep your husband as active as possible during the day and he should have no problem sleeping at night.

Before making any modifications, I suggest you discuss your concerns with his physicians. Perhaps they would be willing to set up a conference call or meeting at which you and your husband can discuss the necessity of his medications and whether or not any can be modified, reduced or stopped. It is important, given his various ailments, that all his physicians agree on medication modifications. Perhaps now is also the time to involve a primary care physician who can help you sort out his medications and treatments. This will also help in the future if his situation becomes worse. At that time he may wish only to have medication to make him comfortable. Your husband’s quality of life should be of the utmost importance and if he is not enjoying his life and is missing out on the things he loves, his is, in my opinion, suffering. This can also lead to depression.

To give you related information, I am sending you a copy of my Health Report “Consumer Tips on Medicine”. Other readers who would like a copy should send a self-addressed, stamped envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.

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Daily Column

March 14, 2008 By

DEAR DR. GOTT:
I am a 73-year-old male with heart and kidney failure. I am not on dialysis. I take Lasix. I was taking three 80 mg pills every day for quite some time. One day I suddenly could not urinate. The following day, the same thing so I went to the emergency room at my local hospital where I was catheterized. The doctor then told me I did not have a blockage and that he could find nothing wrong with my blood and urine tests. He told me upon release to reduce my Lasix to one and a half pills per day. A few days later, my ankles began to swell, so my kidney doctor put me back on two pills a day.

I am still unsure about what happened. Could taking three Lasix a day have caused this?

DEAR READER:
I do not believe that the Lasix was the cause of your unpleasant experience. More likely, you had bladder dysfunction due to urinary tract muscle contraction.

I assume that your “kidney doctor” is a nephrologist. You should review your problem with him or her. I would hope that the specialist can suggest ways of over coming the spasm if it occurs again.

To give you related information, I am sending you copies of my Health Reports “Bladder and Urinary Tract Infections” and “Kidney Disorders”. Other readers who would like copies should send a self-addressed, stamped number 10 envelope and $2 FOR EACH report to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title(s).

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