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Kidney failure too extreme a diagnosis for many
DEAR DRS. DONOHUE AND ROACH: I am a 60-year-old woman. I am 5 feet 6 inches tall and weigh 118 pounds. I exercise four to five times a week, and I work with kids every day in the afternoon. For my 60th birthday I went skydiving. I always have been extremely healthy, but I decided to get a 60-year checkup. I did have a high cholesterol level, and the doctor called in a prescription for that. What I wasn't expecting to hear was the doctor saying I am in stage 3 kidney failure. I have never heard of anyone being told this after having only blood work done. What can I do to prevent further damage? Am I destined for dialysis or a kidney transplant? -- M.L.
ANSWER: Kidney damage is estimated by blood tests done on a routine physical examination. The estimate is only that -- an estimate. It's based on what your creatinine level is. Five stages of kidney function are designated.
Stage 1 is normal, and says that your kidneys are cleaning 90 milliliters (about 3 ounces) or more of blood every minute. Stage 3a indicates that your kidneys are cleaning between 45 and 59 ml of blood a minute. The designation "chronic kidney failure" has been changed to "kidney disease." "Failure" is too harsh a word to describe kidneys in stage 3, and "failure" unhinges people. Many older people fall into this stage, and most of them stay there, without progressing to stage 5, which calls for dialysis or a kidney transplant.
The positive factors for you are the total lack of any symptoms, like sluggishness, weight loss or loss of appetite. No other signs of kidney disease are present. You don't have high blood pressure. You aren't anemic, as many with serious kidney illness are. There's no protein in your urine, another sign of kidney health.
You need not do anything other than what you are presently doing: enjoying your life to the fullest. Your doctor will periodically check on your kidneys. You're not likely ever to need dialysis or a kidney transplant.
DEAR DRS. DONOHUE AND ROACH: Please write about the difference between a nurse practitioner and a physician assistant. -- M.S.
ANSWER: One obvious difference is that a nurse practitioner is a registered nurse. To become a nurse practitioner, the nurse takes further academic medical training to obtain a master's degree obtained mostly from university-associated programs. After that training, the nurse is eligible to take exams that provide licensing and certification in this field. The nurse practitioner can take further training in specialty fields like pediatrics and cardiology. Such a person can work in hospitals, in doctors' offices or in their own office. They diagnose and treat illnesses. They write prescriptions. They assist in surgery.
A physician assistant earns a bachelor's degree from a university in basic medical sciences and in learning the treatment of illnesses. The candidate then takes extra university training that qualifies him or her for a master's degree. Such a person can take additional education in a medical specialty. He or she treats patients, prescribes medicines and assists in surgical procedures. Physician assistants take exams that qualify them for licensing and certification. They, too, work in hospitals or doctors' offices. A doctor supervises their work. They do not open their own offices.
Both are well-educated, highly trained medical personnel who provide needed medical services for the public.
DEAR DRS. DONOHUE AND ROACH: My daughter has a hernia in her stomach area, and it's as big as a softball. They told her surgery will not help, because the hernia will come back. She can't lift. It bothers her to wear anything tight around the waist. Do you have any advice? -- V.W.
ANSWER: Your daughter needs a second or third opinion. A baseball-size abdominal hernia is treatable with surgery. If she's much overweight, weight loss improves her chances for successful repair.
If she can't find a local surgeon who will do the job, she ought to go to a university medical center for an examination and evaluation of her hernia.
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Drs. Donohue and Roach regret that they are unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may write the doctors or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers also may order health newsletters from www.rbmamall.com.
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