Re: Sick kids, coworkers, & working in a hospital etc....Dave

[Guest guest]

Hi Dave, I no longer have little ones at home, my kids are now grown and 1st

grandbaby to come soon. I also work in Internal Medicine, (senior clinic at a

fairly large hospital). I'm the only full time provider (CNS/NP), as the doc I

work with is only part time. I share in your " alertness " regarding sharing

germs from patients especially since I'm taking CellCept 1000 mg bid. (at least

my neph and research coordinator think I'm on the real stuff, and not placebo)

I also have tried to go part time, but unfortunately to no avail. I wear a mask

with all ill respiratory patients. Keep a box of masks in each exam room. I

can't get a flu shot because I'm allergic to eggs. As Pierre says, just try to

take it in stride and not get too nervous about everything, but I do try and

take special precautions. I am up front with my patients, and tell them that

I'm on " special medication " so can't take the chance of sharing anyone's germs.

They are actually very accommodating and they pay

special attention (at least so far) to do the simple things like turn their

head away from me when I am assessing them and to cover their mouth when they

cough etc. All the little things that we hope and pray everyone will do, but

many times people forget, especially when they are just feeling poorly and

forget.

I'm glad you have been able to combine seeing patients, teach and do research,

especially during the winter season. Best of luck to you. I've got a quick

question for you also, (although a bit off topic), do you know anything about

diastolic dysfunction? I had an echo done for workup for Fabry's and showed

RVId at 3.0 cm, our norm at

0.9 - 2.6) IVSd and LVPWd both at 1.1 (norm 0.7 - 1.1). I don't mean to put

you on the spot, but just curious as it looks like to me, mild diastolic

dysfunction and borderline PA pressure. Valves only trivial regurg. EF fine. I

understand most cardiology " stuff " but knowledge of diastolic dysfunction is

lacking. I'm 48 years old. Ig A with GFR at about 59%, moderate proteinuria (3

grams now down to 1.2), HTN, and sclerosis by biopsy. The Fabry's thread came

about d/t multiple angiokeratomas of abd and thighs and very low

alphagalactosidase level (0.8 with norms being 0.6 - 3.6), lipiduria,

proteinuria etc. which are markers for women with Fabry's. My doc at Mayo said

" highly suggestive of Fabry's) I just got through faxing to Mount Sinai,

(referred to them by Mayo, cause they are the guru for Fabry's, Dr. Desnick) for

their review etc. They repeat my alphagalactosidase level and put all the

" pieces " together, then based on this, continue onward with DNA assay and

Lymphoid cell

line. But just curious what you think. When I try to look up values etc in

on's they just are not specific regarding parameters, and our Echo techs

have gone home for the day. What's your gut? Here's an early thank you for your

opinion, and I obviously will appreciate any info or thoughts just as they are.

Thanks again. Bonnie

Dave Arterburn wrote:

OK, so I've been seeing a few posts about sick co-workers, and I

thought I would offer up this rant and see what others have to say.

I think one of the toughest parts of having IGAN is avoiding sick

people. Anytime someone coughs, I pretty much hold my breath until

I'm as far from them as I can get before I turn blue.

One big problem is that I have two boys at home (3 yrs and 1 yr) who

are in day-care and preschool and bring home all sorts of nasty

little bugs every week or so. It's hard to know what to do with that

as a dad! I feel sorry for them and want to care for them, but I

have this innate self-protection mechanism that kicks in and

says, " I need to go out for a while. " Luckily my wife and family are

understanding, and I have worked it out that I can stay with my

brother and his wife whenever the kids (or my wife) get really sick.

Before you think too poorly about me, I take the kids with me to my

brother's when my wife is the one that is sick.

Finally, I'm also an internal medicine doctor, and I have continued

seeing patients throughout this thing. I'm sure that I have gotten

sick as a result of this contact, and it probably affects the way I

practice. I've recently decided to cut back on my patient contact

and do more research and teaching -- I luckily have the option of

doing this because of my training.

I wonder how you all have been handling all this stuff... any ideas

or thoughts would be appreciated.

Thanks,

--Dave

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Thank you

[Guest guest]

Hey Bonnie:

Thanks for your response and your suggestions. Unfortunately, I

don't know a lot about Fabry's and interpreting echos. I have sent

you two articles from my favorite clinical medical reference --

UpToDate. I hope they answer some of your questions. I usually find

their articles to be helpful, also a guest pass comes with the

article.

Anyway, diastolic dysfunction itself can be controlled and actually

improved with blood pressure medications. So if it turns out you

don't have Fabry's, it's most likely a result of high blood

pressure, which can be treated.

I wish you all the best with this. It sucks getting diagnosed with

something in addition to IGAN. That's how I felt when I got panic

disorder and viral meningitis diagnoses this year. I mean, how much

should we have to bear? Of course, there's really no answer to that

question -- in fact, I don't want to know the answer. It might be

depressing

Keep your chin up and thanks for your post.

--Dave

[Guest guest]

Hi Dave,

Thanks so much for the articles on Up to Date. That is my favorite reference

also. Unfortunately I do not have access to it where I work now, but for the

past 4 years was my " bible " . I really appreciate the articles. I skimmed them

a couple of minutes ago, but will need to study them a lot more when I get home

tonight. (Dictations, dictations, dictations tonight, they are ongoing, know

what I mean? My pitfall in life ....

I'm so sorry you were faced with viral meningitis with Ig A and panic attacks to

boot. Double uggh. How's your kidney function now? Proteinuria? Mine is

mighty stable. I love the word STABLE, it is taking on a new dimension in my

life. B/P doing pretty well, went up again after the CellCept, but that is an

expected side effect, and with the edema of course B/P would rise also. I was

on Altace 20mg + Avapro 150 mg and was doing great. B/P was running about 120 -

low 130/70, quite a switch for me, cause I was running about 186/100 in Jan/Feb

this year. But with the Mayo research study for CellCept, had to d/c the Altace

and Avapro and switch to Lisinopril. They are VERY hesitant to switch any of my

meds including diuretics (even with the pitting edema) due to the research

protocol. I'm sure if I crashed and burned they would treat, but " if it ain't

broke, don't fix it " principle. I'm sure their biggest concern is certainly not

the edema, compared to possibly worsening my

renal function with more diuretics. I can deal with the extra fluid but my

weight was up as much as 16 #, so tighter control with the salt, etc. It's a bit

better now. I just feel like a blimp ((((smile)))) and look like one too. Have

a really hard time exercising due to my work schedule (and 45 minute commute to

and from the hospital). Anyway I'm rambling.... Thanks again for the articles.

What are you teaching? Research? (or is it hush, hush?) Where are you

located? Unfortunately I don't have time to read all the posts, so I apologize

if you have stated this before. Take good care and hope those precious kids of

yours are doing well. Bonnie

Dave Arterburn wrote:

Hey Bonnie:

Thanks for your response and your suggestions. Unfortunately, I

don't know a lot about Fabry's and interpreting echos. I have sent

you two articles from my favorite clinical medical reference --

UpToDate. I hope they answer some of your questions. I usually find

their articles to be helpful, also a guest pass comes with the

article.

Anyway, diastolic dysfunction itself can be controlled and actually

improved with blood pressure medications. So if it turns out you

don't have Fabry's, it's most likely a result of high blood

pressure, which can be treated.

I wish you all the best with this. It sucks getting diagnosed with

something in addition to IGAN. That's how I felt when I got panic

disorder and viral meningitis diagnoses this year. I mean, how much

should we have to bear? Of course, there's really no answer to that

question -- in fact, I don't want to know the answer. It might be

depressing

Keep your chin up and thanks for your post.

--Dave

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home page:

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iga-nephropathy-unsubscribe

Visit our companion website at www.igan.ca. The site is entirely supported by

donations. If you would like to help, go to:

http://www.igan.ca/id62.htm

Thank you

[Guest guest]

That is very important work given the epidemic numbers of people battling

obesity now days!

Good luck on your labs next month. I hope you find you continue to be stable

with such good numbers.

In a message dated 10/29/2004 7:21:15 AM Pacific Daylight Time,

.Arterburn@... writes:

> I'm on the Internal Medicine faculty at the University of

> Cincinnati, and I see patients and teach with residents and students

> in the outpatient clinic and VA inpatient ward. Most of my time is

> spent doing research on obesity. My expertise is in drug and

> surgical weight loss. I'm doing studies currently on cardiovascular

> risk, quality of life, healthcare costs, and I'm also developing a

> video-based decision aid for patients who are considering weight

> loss surgery. Thanks for asking...

>

> --Dave

>

[Guest guest]

Bonnie:

I've had presumed IGAN for over a year now, and my neph still

doesn't think I need a biopsy yet because my numbers have been good:

Protein 200 mcg, Cr 0.9, BP 120/80. I'm the type who gets dark brown

urine and flank pain with each URI, and that's what led me to get a

neph. I love my neph, and I agree with his plan to hold off on my

biopsy at this point. The list of kidney diseases that present like

this is pretty short: IGAN and nothing else. So, I'm taking fish

oil, Vit A, and baby ASA right now, and I'm seeing my neph again

next month for a check-up. Fingers are crossed.

I'm on the Internal Medicine faculty at the University of

Cincinnati, and I see patients and teach with residents and students

in the outpatient clinic and VA inpatient ward. Most of my time is

spent doing research on obesity. My expertise is in drug and

surgical weight loss. I'm doing studies currently on cardiovascular

risk, quality of life, healthcare costs, and I'm also developing a

video-based decision aid for patients who are considering weight

loss surgery. Thanks for asking...

--Dave