Tag Archives: Fatigue

THE DOCTORS 101 CHRONIC SYMPTOMS & CONDITIONS #20: KIDNEY FAILURE (ESRD)

Our Kidneys and Liver have a lot in common. They are not dramatic, take-care-of-me-now organs like our Hearts and Brain, but usually do their job quietly until they lose almost all of their function. They have lots of reserve; you can donate one of your kidneys or a piece of your liver and notice no change. They are both vital organs, and you will die without them.

Since they both help clear wastes and toxins from the bloodstream and produce hormones, they SHARE SYMPTOMS such as nausea, vomiting, fatigue, and mental changes.Their performance can be checked by blood tests. Healthy habits will protect their -and your- survival.

Certain Drugs impair their operation. They are both composed of many identical functional units, the nephron in the kidney, and the hepatic lobule in the liver.

The GLOMERULUS of the Nephron is a tuft or ball of capillaries and associated kidney cells that allow the fluid and dissolved molecules of the blood to come through, while restraining the larger proteins and cells of the blood, keeping them in the vascular system. The smaller molecules of sodium, potassium, urea and other waste products leak through the glomerulus.

This filtered liquid travels through the long, folded kidney tubules, where the RIGHT AMOUNT of salt and water are REABSORBED. This keeps the vascular fluids, the internal environment, the MILIEU INTERIOR, perfectly well adjusted for proper cell function. It is when the chemical environment of the body falls out of adjustment, when the kidneys FAIL to do their job, that the cells of the body cannot function properly, and Symptoms-fatigue, lethargy etc. – develop.

BLOOD PRESSURE is intimately involved with the KIDNEYS, which has an Endocrine function. The Renin( Renal=kidneys) Angiotensin system is a major regulator of blood pressure.

You may have heard of the ACE-2 receptor as the binding site of th COVID Virus. This Angiotensin Converting Enzyme receptor is on the surface of cells all over the body and normally functions to control blood pressure.

DIABETES is the most common cause of end stage renal disease (ESRD), bringing our healthy triad of SLEEP DIET and EXERCISE to our attention once again.

POLYCYSTIC KIDNEY DISEASE is an inherited condition where many nephrons fail to hook up to the urine collecting system, and the fluid builds up into cysts, which then eventually replace the rest of the kidney. Pressure from urine blockage by an enlarged prostate, or even lack of ureteral valves can also back up into the kidneys and eventually cause ESRD.

Infections and autoimmune diseases can result in ESRD. Treatment of ESRD is usually a Kidney transplant or Dialysis. There is a waiting list for the former and the latter is life-altering. You can’t beat a healthy lifestyle.

–Dr. C.

Dr. C’s Journal: A Little Bit About “Energy & Fatigue”

Sometimes I wake up in the morning with a feeling of RELAXED ENERGY. My mind is clear, I have no fatigue, and believe once more that the world is wonderful, and it’s great to be alive.

I St-re-tch, exercise my hands (I have Osteoarthritis, and they are stiff), take out my Nite guard ( I grind my teeth at night and would otherwise wear them away), take my beta blocker eye drops ( to lower my intraocular pressure) and wash down my Eliquis ( an anticoagulant to prevent stroke from my Atrial Fibrillation) with 16 oz. of water, while thinking about all of the delights awaiting me.

Yes, my body was in better shape 60 years ago; but I had much more responsibility then, and much less discretionary time. All things considered, I like to believe that I am happier now.

The KEY is to stay in GOOD HEALTH. GOOD SLEEP is critical, but it cannot be had by willpower alone. As I have discussed previously, you need a bedtime routine, good SLEEP HYGIENE.

You also need a…….. GOOD DIET. with lots of fruits, vegetables and whole grains. Fatty, spicy foods will stay in your stomach and bother you at night, particularly if you eat Late. I like to finish eating by 5 PM. Late dinner is also likely to produce GERD, and maybe Sleep Apnea.

GOOD EXERCISE is also critical. If you are not tired at the end of the day, it is hard to get good sleep. I always seem to sleep better on the day when I walk the hills for an hour, which is 3 days a week. Try not to exercise within 2 hours of bedtime. Assuming that you have a good base of SLEEP, DIET and EXERCISE, there are other mechanisms that can foul things up. INFLAMMATORY conditions often cause fatigue.

The most common inflammatory diseases are OBESITY, METABOLIC SYNDROME and DIABETES. OBESITY is the defining disease of our EXCESSIVE SOCIETY, where there is too much of everything, and excessive consumption is relentlessly advertised everywhere.

External correction is probably a pipe dream, since there is no will even to Tax Sugar-containing Beverages, the “low hanging fruit” of dietary excess. Internal correction is all that is left, and that takes WILL POWER, also in short supply.

INFECTIOUS DISEASES are a subset of inflammatory conditions. COVID 19 is the poster child of infection, and FATIGUE is one of the hallmarks of the disease. Interleukins, like TNF-alpha, IL-1, andIL-6 are some of the defense factors which cause the fatigue. AUTOIMMUNE Diseases like Rheumatoid Arthritis and Lupus are also associated with fatigue-producing interleukins.

Fatigue even has its own flagship disease, CHRONIC FATIGUE SYNDROME. Chronic viral disease has been suspected as the cause of this condition, and inflammatory cytokines may be elevated. This condition, and the similar GULF WAR SYNDROME are still poorly understood. Several CFS patients were sent to me when I was in practice, and I had some success in getting them to exercise regularly, which seemed to help. CANCER is another category of diseases where Fatigue is prominent.

Inflammation plays a role in these diseases, which also drain energy substrates from the Patients body; Cancer cells have a high metabolic requirement. MEDICATIONS, Cancer meds especially, but a variety of other Drugs are associated with FATIGUE. I went through MY MEDICATION LIST. Lo and behold, 3 of them are associated with fatigue.

Finasteride is a relic of my prostate operation, recommended to keep it from growing back. It causes fatigue, probably because of its ANTITESTOSTERONE effect. At least I can still pee, and am not bald. I take METFORMIN because of its fame in prolonging life. Its mechanism is that of interacting with the Sirtuin system, and increasing the inefficiency of mitochondria. Isn’t this surprising?

Like many other things in physiology, you place a stress on the body, and the body responds by improving its performance. If you are fatigued, you exercise. Respecting the body works with drugs as well. If you are drinking a ton of coffee and stop it, after a few weeks you will feel less fatigued.

And when you ARE FATIGUED, you drink a LITTLE coffee, and it wakes you right up. Caffeine works by displacing ADENOSINE, which causes Fatigue as it increases through the morning, peaking at SIESTA (or tea) time,at about 2 PM. OMEPRAZOLE, which I take to prevent HEARTBURN, also is related to fatigue especially if it blocks MAGNESIUM for long enough. DEPRESSION overlaps with fatigue, as does SLEEPINESS, to increase the complexity of the situation.

Many chronic LUNG, KIDNEY and LIVER diseases are associated with fatigue as a secondary concern. STAY HEALTHY!

–Dr. C

BLOOD TESTS: THE BENEFITS THAT “COMPREHENSIVE METABOLIC PANELS” REVEAL

One of my nurses who was usually in good health developed chronic complaints. She felt tired all the time and had a variety of aches and pains. She has been going through menopause for a long time but this set of problems seem different. Then she broke her arm after sustaining a minor fall. An investigation was in order. I should order some tests, but which ones?

Anemia would explain the fatigue so a CBC was a no brainer. With the surprise fracture, I wanted to cast the net wider, so I ordered a comprehensive metabolic panel.

This is an automated test that was a good value for the amount of information provided, I thought.

Nobody was more surprised than I when the test provided results that were the key to her very rare diagnosis. Her serum CALCIUM was very high, and her alkaline phosphatase was also elevated.

Further evaluation showed her diagnosis to be PRIMARY HYPERPARATHYROIDISM.

Removal of her abnormal parathyroid gland was curative. I have been a big fan of the Comprehensive Metabolic  Panel ever since.

The Panel of 14 tests includes:

  • Glucose – an essential test to check in Diabetes, Seizures and Coma.
  • Sodium, Potassium, Chloride, and CO2 and the associated Anion Gap – can be abnormal in a variety of accidents, and other conditions.
  • BUN and Creatinine – cleared by the kidneys, and become elevated in Renal, or Kidney conditions.
  • Calcium and alkaline phosphatase – reflect bone metabolism, and are sensitive to Vitamin D and parathyroid hormone, as in my nurses case.
  • Albumin and Globulin – important blood proteins. Globulins contain the   important immunoglobulins. A variety of conditions will influence their values.
  • AST (SGOT) and ALT – elevated in liver disease

Type in “Comprehensive Metabolic Panel” in google, and choose from the variety of “hits” to get more information about this “ Sherlock Holmes’ Magnifying Glass” for Physicians.

Medicine would be hard pressed to do without it!

Dr. C.