Tuesday, 7 August 2018

A belated update - Summer 2018


I've been too busy with work, family life and other projects to do any blogging recently. I had my Nephrologist appointment in early June and my stats were largely unchanged, the consultant believes they look a little better when I lose weight and a little worse when I gain it.
At 115kg I was slightly heavier than the previous appointment, which was no surprise. My recent weight seems to have settled around the 115kg mark, which is one or two kilos above where it has been for most of the past two years. It's a little disappointing in that I did get down to around 112kg 18 months ago, so I know it's possible to get there.
My potassium levels were largely unchanged despite some efforts I made to reduce potential intake; suggesting it's one of those things that’s hard to shift the dial on. She did suggest increasing my sodium bicarbonate from 0.5g in the evening to 1g (I already take 1g in the morning), which cleared up the reason I take it in the first place. Sodium bicarbonate apparently helps flush potassium out of the kidneys, it also counteracts acidosis, where the kidneys fail to excrete acids (excess uric acid is the cause of dreaded gout). The flip side is that sodium bicarbonate is linked to higher blood pressure, resulting in a balancing act.
As it happens she never passed on these instructions to my GP, so my script is yet to change. My potassium levels are the probable culprit for the leg and calf cramps I suffer daily, particularly when in bed. I've trained myself to recognise warning signs and possible triggers such as the natural urge to stretch too quickly when waking in a morning, and to react fast when cramps do occur e.g. jumping out of bed and immediately stretching the relevant limb results in a short sharp pain, whereas letting it recede naturally takes longer and leaves residual soreness that can last all day.
The week following week the Nephrologist I had my annual medical at the GP surgery. My cholesterol levels have got worse, but this is more down to my 'good' HDL cholesterol being low relative to my 'bad' LDL cholesterol, rather than the LDL shooting up. Of more concern my HbA1c level had increased, putting me back in 'prediabetic' range again. Two years ago I was in this range, then I lost some weight and dropped out of it, now my weight has gone up a bit I'm back in it again (I'm still 10kg lighter than first time round). To shine a bit of perspective on this prediabetic reading, my HbA1c has gone from 5.9% to 6.0% which, that 0.1% putting me back in range. I got out of it before, I'll do it again.
These prediabetes readings also explain what happened with my referral to the 'Healthier You' diabetes prevention programme. This NHS programme is intended to intervene early with high risk patients, the premise being that prevention is better (and definitely much cheaper) than cure. My GP referred me late last year on the basis of my medical history including my weight management issues, my chronic kidney disease and my previous prediabetes reading, but because my then most recent HbA1c test just dropped me out of range I was rejected! Time permitting I'll write a more comprehensive post on this subject, but it’s a good demonstration of arbitrary rules being applied to clinical decision making, in this case a 0.1% variance in HbA1c led to an eight month delay in getting me on a programme that offers significant benefits to my health and the cost of my future treatment!

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