Oconee Medical Group

HOW TO QUIT SMOKING J.A. Simon, Archives Intern Med, 2011, helps summarize our present knowledge on treating tobacco addiction. 1. Smoking is common; too many young folks still smoke; everyone else is exposed to the smoker’s waste matter (the analogy I like the most is comparing second hand smoke to having someone drink a keg of beer and then proceed to pee all over social acquaintances). 2. It is our duty as doctors to encourage and help our patients to quit smoking: this ...is the #1 preventable cause of early death, outstripping salt intake, obesity and use of seat belts. 3. Smoking is tough (on the lungs and everywhere else), and quitting is even tougher; most smokers actually want to quit, but can’t do it without help. 4. Follow a tested pathway incorporating the 5 A’s of tobacco use/cessation: Ask (about tobacco use), Advise (on quitting), Assess (willingness to quit), Assist (in quitting), Arrange (follow-up). 5. Set a Quit Date: it helps to use a meaningful date, such as birthdays, anniversaries or emotional milestones involving patient, significant other or progeny. 6. Combination treatment works best: treat smoking just as you would treat sever hypertension or metastatic cancer or HIV. 7. Counseling by qualified specialist is best; other options are MD-delivered counseling or toll-free help-line 800-QUIT-NOW. 8. Drug treatment includes (a)nicotine replacement therapy (stating on quit Date, either as long-acting transdermal patch at 1-21mg/day x 8 weeks, slowly tapering off over 4-8 weeks; consider short acting nicotine inhaler/lozenges/gum PRN for acute cravings; do not use in pregnancy, cardiac arrhythmias or soon after an acute coronary syndrome. (b) Varenicline starting 1 week to 1 month before quit date as 0.5 mg p.o. BID x 4m days, then 1 mg p.o. BID x 12-24 weeks; do not use concurrent with nicotine replacement therapy. (c) Bupropion SR starting 1-2 weeks before quit date as 150 mg p.o. daily x 3 days, and doubling dose to 150 mg p.o. BID 8-12 weeks, do not use in seizure disorders or concurrently with MAOIs. (The Second Opinion, June 2011) Beze Adogu, MD, Ph.D, FACP See more

I miss my dialysis sometimes. Is it harmful to me? Yes, skipping dialysis treatments can be very harmful to you, and can significantly reduce your lifespan. Hemodialysis as is presently given in the United States, usually 3 to 4 hours three times a week, is the barest minimum amount of treatment that keeps you alife. In short, there is no "fluff" or ... "margin of error" in that bare-bones prescription. As one of my favorite teachers would say, "You won't grow fat on thrice weekly dialysis". Therefore, just skipping 1 day means you lost 33% (a third) of your weekly treatment for that week. Next time you come in for treatment, there are more poisons, more fluid, more potassium and more "ash" to clean out of your blood. Missing 1 treatment a week adds up to 4 months of lost treatment a year. Missing just 1 treatment a month equals skipping 1 month of treatment each year. please, remember that. I develop cramps during treatment. What can I do? The exact cause(s) of cramps are unknown, but it tends to be more common amongst patients who are heavy-built or need to have a lot of fluid removed during dialysis. Simple remedies often work: stretch your muscles periodically; try not to gain a lot of fluid between treatments; take off fluids slowly during treatment by not "cutting" your treatment time; apply warm packs to sore muscles; some swear by a half-glass of Tonic Water (it works better if it contains Quinine!) or Apple Vinegar, but make sure you discuss those first with your doctor. I often throw up during dialysis. What can I do? Usually, patients throw up when there is reduced blood flow to the stomach. That usually means that the Blood Pressure has dropped. Consider reducing fluid intake between treatments, so that no more than 1 or 2 liters of fluid is removed during dialysis; do not eat for at least 1 hour before treatment; talk to your Doctor about holding (or only taking half of) your anti-hypertension pills before treatment. If all else fails, there are some medications that might help you control this symptom. How do I reduce fluid gain between treatments? First, be aware that there is a problem with gaining too much fluid- you tend to cramp during treatment, you feel bloated (and sickly), you often feel sick and nauseous at the end of dialysis, and your blood pressures might drop during treatment. Avoid salted foods. Drink no more than a quart of water (32 ounces) of fluid each day. Keep your lips moist with Lip Balm. Suck on a mint. Stay away from the heat (and hot outdoors). Use airconditioning at home. Why does my skin itch? There are many reasons for a dry, itchy skin. Perhaps, the most common cause is loss of moisture: invest in a moisturizing lotion (Vaseline or Eucerin is OK). Check your blood phosphorus levels, and make sure you are using your Phosphate-Binders with each meal. Avoid skin irritants, including perfumes, if you have sensitive skin. Wear long-sleeved clothes when outdoors.

We are excitedly counting down the arrival of Dr. A. Cielo July 1!

Hi Everyone! Happy World Wide Kidney Day! Don't forget to request that your kidneys be evaluated!

Let us help you take care of your kidney's. Make an appointment today! 706-227-2110 Our friendly staff is here to help you!

What is Chronic Kidney Disease? Chronic kidney disease (CKD) is a progressive loss in kidney function over a period of months or years. Each of your kidneys has about a million tiny filters, called nephrons. If nephrons are damaged, they stop working. For a while, healthy nephrons can take on the extra work. But if the damage continues, more and more nephrons shut down. After a certain point, the nephrons that are left cannot filter your blood well enough to keep you healthy.... When kidney function falls below a certain point, it is called kidney failure. Kidney failure affects your whole body, and can make you feel very ill. Untreated kidney failure can be life-threatening. What you should not forget: Early chronic kidney disease has no signs or symptoms. Chronic kidney disease usually does not go away. Kidney disease can be treated. The earlier you know you have it, the better your chances of receiving effective treatment. Blood and urine tests are used to check for kidney disease. Kidney disease can progress to kidney failure. "worldkidneyday.org"

THE 8 GOLDEN RULES What can you do for your kidneys? Kidney diseases are silent killers, which will largely affect your quality of life. There are however several easy ways to reduce the risk of developing kidney disease.... 1. Keep fit and active Keeping fit helps to reduce your blood pressure and therefore reduces the risk of Chronic Kidney Disease. 2. Keep regular control of your blood sugar level About half of people who have diabetes develop kidney damage, so it is important for people with diabetes to have regular tests to check their kidney functions. 3. Monitor your blood pressure Although many people may be aware that high blood pressure can lead to a stroke or heart attack, few know that it is also the most common cause of kidney damage. The normal blood pressure level is 120/80. Between this level and 129/89, you are considered pre-hypertensive and should adopt lifestyle and dietary changes. At 140/90 and above, you should discuss the risks with your doctor and monitor your blood pressure level regularly. High blood pressure is especially likely to cause kidney damage when associated with other factors like diabetes, high cholesterol and Cardio- Vascular Diseases. 4. Eat healthy and keep your weight in check This can help prevent diabetes, heart disease and other conditions associated with Chronic Kidney Disease. 5. Maintain a healthy fluid intake Although clinical studies have not reached an agreement on the ideal quantity of water and other fluids we should consume daily to maintain good health, traditional wisdom has long suggested drinking 1.5 to 2 liters (3 to 4 pints) of water per day. 6. Do not smoke Smoking slows the flow of blood to the kidneys. When less blood reaches the kidneys, it impairs their ability to function properly. Smoking also increases the risk of kidney cancer by about 50 percent. 7. Do not take over-the-counter pills on a regular basis Common drugs such non-steroidal anti-inflammatory drugs like ibuprofen are known to cause kidney damage and disease if taken regularly. 8. Get your kidney function checked if you have one or more of the 'high risk' factors * you have diabetes * you have hypertension * you are obese * one of your parents or other family members suffers from kidney disease * you are of African, Asian, or Aboriginal origin "worldkidneyday.org"

Questions to ask your doctor: What is my GFR? What is my Urine Albumin result? What is my blood pressure? What is my glucose reading?... "worldkidneyday.org"

Did you know? You can loose up to 90% of your kidney function before you have any symptoms!

Hi Everyone! Tomorrow is World Wide Kidney Day! If you haven't already, don't forget to get your kidney health evaluated. Please see other posts for more educational information.

Martine P. Adogu, MD Martine Adogu, MD, was educated at McGill University, Canada and University of Maryland Medical School, where she graduated Cum Laude in 1994. She is board-certified in Ophthalmology, and has an active interest in eye disorders related to Kidney Disease and Diabetes.

A meta-analysis from England, Clark et al, Lancet, 2012, confirms that systolic blood pressure disparity between both arms of 15 mmHg or higher should prod further evaluation for underlying peripheral vascular disease. Such differences in systolic BP were associated with peripheral vascular disease (15% sensitivity and 96% specificity) cerebrovascular disease (8% sensitivity and 93% specificity), as well as higher cardiovascular and all-cause mortality. Some studies report t...hat even trivial systolic BP disparities of only 10 mmHg were linked to peripheral vascular disease with 32% sensitivity and 91% specificity. In an accompanying editorial, McManus & Mant, Lancet, 2011, point out that whilst parallel BP measurements are easier to perform than ankle-brachial indices, the low sensitivity of this maneuver would make it a less than ideal screening tool, but still an actionable clinical finding The Second Opinion, March 2012 Beze Adogu, MD, PhD, FACP See more