What is pneumocystis pneumonia (PCP)?

Pneumocystis pneumonia (PCP) is a kind of pneumonia caused by a fungus called Pneumocystis jirovecior, or P. jiroveci. It used to be called Pneumocystis carinii pneumonia.

Most people exposed to P. jiroveci don’t get pneumonia because their immune systems are healthy and strong. People whose immune systems are weak because of an HIV infection or other medical conditions can get PCP. PCP is less common than it used to be. However, it’s still one of the most common serious infections in people who have advanced HIV disease in the United States.

Others who get PCP are usually taking medicines that lower the body’s ability to fight germs or sickness. They may have other medical conditions, such as:

• Blood cancer
• Inflammatory or autoimmune diseases (for example, lupus or rheumatoid arthritis)
• Organ or stem cell transplant

Symptoms of PCP

See your doctor right away if you have a weakened immune system and have the following symptoms:

• Fever
• Cough
• Trouble breathing (especially with exercise)
• Chest pain
• Chest pain
• Fatigue (extreme tiredness)

Most cases are mild. However, people with severe PCP may die if the infection isn’t treated quickly.

What causes PCP?

Most scientists believe PCP is spread in the air. They don’t know if it lives in the soil or anywhere else. The P. jiroveci fungus is common all over the world. It’s not spread through sexual contact. You can’t prevent being exposed to the fungus.

How is PCP diagnosed?

PCP is diagnosed by lab tests of fluid or tissue from your lungs.

Can PCP be prevented or avoided?

If you’re at risk of PCP because you have HIV, you may be able to lower your risk. A good medicine for preventing PCP is trimethoprim-sulfamethoxazole, or TMP-SMX. TMP-SMX is a combination of two medicines. Ask your doctor if you should be taking this medicine (or another medicine) to prevent illness.

Talk to your doctor about medicines you might be able to take if you have other medical conditions that weaken your immune system.

The pneumonia vaccine does not protect you against PCP. It protects you against a different kind of pneumonia. There is no vaccine for PCP.

PCP Treatment

If you have HIV, your doctor will test your blood regularly to check how strong your immune system is. Your doctor may prescribe TMP-SMX to prevent PCP. Your doctor may also have you start taking the medicine as a preventive therapy if you get certain symptoms. These symptoms may be a temperature above 100°F that lasts for two weeks or longer, or a yeast infection in your mouth or throat (also called “thrush”).

People who have severe cases of PCP are treated in a hospital with IV medicine. The medicine is put into a vein through a tube. As people get better, or if the illness was mild to begin with, the medicine can be taken in as a pill. If you can’t take TMP-SMX, or don’t get better quickly with it, you can take other medicines or combinations of medicines.

Living with PCP

If you have conditions that would make you more likely to get PCP, talk to your doctor about medicines that could lower your risk for getting PCP.

Know that taking TMP-SMX might cause a rash. It might make you feel sick. If you have a mild reaction, you should keep taking TMP-SMX because it works better than any other medicine to prevent PCP.

If you’ve already had PCP, you can get it again. Taking TMP-SMX can prevent second infections with PCP.

Questions to ask your doctor

• Do I have a condition that requires me to take PCP?
• How will I know if my medicine is working to treat my PCP?
• I can’t take TMP-SMX. What other medicines can I take to treat PCP?

Resources

Centers for Disease Control and Prevention: Pneumocystis Pneumonia

National Institutes of Health, MedlinePlus: Pneumocystis jirovecior pneumocystis

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Normal, healthy kidneys remove waste from the blood. If you have chronic kidney disease, your kidneys are not working as well as they should. They have trouble removing the waste. This causes the waste in the blood to build up. This can lead to additional health problems. It also puts extra stress on your kidneys.

Some of the waste in your blood comes from foods you eat. Following a special diet can reduce the buildup. This can reduce stress on your kidneys and slow the progress of kidney disease.

Path to improved health

Some of the waste that can build up in your blood comes from nutrients in the food you eat. Your body needs most of these nutrients for its day-to-day functions. When your kidneys aren’t working well, the following nutrients can become a problem.

Phosphorous. Phosphorous is a mineral that keeps bones healthy and strong. But, even in early stages of chronic kidney disease, the level of phosphorous in your blood can become too high. A high level of phosphorous can cause itchy skin. It can also cause your bones to lose calcium. If this happens, your bones will get weaker and more brittle. You also have a greater risk of developing osteoporosis.

Foods high in phosphorous include:

• Dairy products, such as milk, cheese, yogurt, and ice cream
• Dried beans and peas, such as kidney beans, split peas, and lentils
• Nuts and peanut butter
• Drinks like beer, cola, and hot cocoa

If your phosphorous level is too high even after you change your diet, your doctor may prescribe medicine to lower it.

Calcium. You need calcium to build strong bones. Unfortunately, foods that contain calcium often also contain phosphorous. If you have chronic kidney disease, you may need to take calcium supplements that are phosphorous-free. Your doctor may also prescribe a special type of vitamin D. This will help your body absorb calcium.

Protein. You need protein to build and maintain healthy muscles, bones, skin, and blood. Protein also helps your body fight infection and heal wounds.

Foods that are high in protein include:

• Meats, including beef, pork, chicken, and turkey
• Dairy products, including cheese, milk, and yogurt
• Eggs
• Beans
• Nuts

When protein breaks down, it turns into waste. Kidneys damaged by disease can’t stop this waste from building up in the blood. Many people with early chronic kidney disease should eat a low-protein diet. Talk to your doctor about whether you should reduce your protein.

Potassium. Potassium is a mineral that helps your brain, nerves, muscles, and heart work properly. It is found in foods such as bananas, potatoes, tomatoes, avocados, and melons. Too much or too little potassium can cause serious problems. Your body needs balanced potassium levels. Your doctor will determine whether you need to change the amount of potassium in your diet. This will depend on the stage of your kidney disease and whether you are taking medicine to help lower your potassium level.

Sodium. Too much sodium (salt), may cause you to retain fluid. This extra fluid can raise your blood pressure. This puts stress on your heart and kidneys.

Check food labels for sodium. Packaged and processed foods are high in sodium. You may know that foods such as soy sauce, processed meats, crackers, and potato chips contain a lot of sodium. But you may not realize how much sodium is in foods like bread, canned vegetables, soups, and cheese. Look for sodium-free or low-sodium foods.

Don’t add salt to your food. Try different seasonings, such as lemon juice, hot pepper sauce, and salt-free spices. Avoid salt substitutes. They often contain high levels of potassium.

Fluids. If you have trouble getting rid of fluid from your body, you need to be careful about how much you drink. Too much fluid can put additional strain on your kidneys.

Calories. You need to take in the right amount of calories to maintain a healthy weight and support your body’s functions. This can be challenging for people who have chronic kidney disease. Limiting the amount of protein, dairy, salt, and certain nutrients in your diet reduces your food choices. Foods you used to eat may no longer be healthy options for you. Also, your appetite may be affected by chronic kidney disease. Even if it’s fine to eat certain foods you used to enjoy, they may not have the same appeal.

Your family doctor can help you make a diet plan that supports your kidney health. This is important because your diet may need to change as your kidney disease and the medicines you take change. Your doctor may recommend that you work with a registered dietitian to be sure you get the right amount of calories each day.

To increase your calorie intake, your doctor or dietitian may suggest adding simple carbohydrates or foods with high carbohydrate concentrations. Fats can be a good source of calories. But saturated fats increase your risk of cardiovascular disease. Avoid foods such as fatty cuts of meat, butter, dairy products, baked goods, and fried foods. These often contain saturated fats. Instead, choose monounsaturated or polyunsaturated fats, such as olive oil or canola oil. These good fats are better for your cardiovascular health.

You can track how your diet is affecting your kidneys. Several tests are available to help. The tests can tell you whether your diet is reducing the stress on your kidneys.

To measure how well your kidneys are filtering waste from your blood, your doctor may estimate your glomerular filtration rate (eGFR). This test evaluates the amount of creatinine (a type of waste) in your blood. A declining eGFR indicates that your kidney function is getting worse. Other changes in your diet or medicines may be necessary.

A simple dipstick urine test can reveal whether your kidneys are losing function. This test measures albumin and other protein wastes that build up when the kidneys aren’t working well.

The serum albumin test is a blood test that shows whether you are taking in enough protein and calories. If you’re not, you may be at risk of infections. You may not feel well overall.

The normalized protein nitrogen appearance (nPNA) test measures your protein balance to determine whether you are getting enough protein. This test involves a blood and urine sample.

The blood urea nitrogen (BUN) test measures the level of urea in the blood. Urea is one of the wastes left over when your body breaks down protein. A high BUN level may indicate that you are taking in too much protein.

Your doctor may also do a physical exam. He or she may ask some questions to identify any problems with your diet. They will want to know about any changes in your weight or your body fat and muscle. Your doctor may also ask about the amount of food you eat, as well as your activity and energy levels.

Things to consider

If you are on dialysis, you still need to watch what you eat. Dialysis can filter your blood very effectively. But it can’t remove all the waste your body makes when it processes nutrients. You are at increased risk of waste levels rising between your dialysis sessions.

Questions to ask your doctor

• Why do I need to make changes in my diet?
• What changes do I need to make to my diet?
• Do I need to see a dietician?
• Will I need to reduce the amount of protein I eat?
• Will my diet change when I begin dialysis?

Resources

National Institutes of Health, MedlinePlus: Diet – Chronic Kidney Disease

National Institute of Diabetes and Digestive and Kidney Diseases: Eating Right for Chronic Kidney Disease

National Kidney Foundation: NKF Brochures, Nutrition

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A cardioverter-defibrillator (ICD) is a type of medical implant device. It tracks and treats an irregular heartbeat (arrhythmia). It sends an electric current through your heart when needed. The ICD is smaller than a cell phone. It has two main parts: a pulse generator and a lead (wire). The pulse generator monitors your heartbeat. It is like a small computer that runs on a battery. The lead goes from the pulse generator to the inside of your heart. It sends signals and electric currents between your heart and the pulse generator. Some people need multiple leads with their ICD.

Path to improved well being

Your doctor may recommend an ICD to treat your irregular heartbeat. There are many different types of arrhythmias. Treatment depends on what kind you have. An ICD is one form of treatment. You may need an ICD if you have or are at high risk of a life-threatening ventricular arrhythmia. Examples include ventricular tachycardia and ventricular fibrillation. Having a previous heart attack, heart disease, or cardiac arrest are other reasons you may need an ICD.

Ventricular tachycardia is when the bottom chambers of your heart (the ventricles) beat too fast. When this happens, your heart has a hard time pumping blood. As a result, your body and brain don’t get enough blood. This is life threatening.

Ventricular fibrillation is when the bottom chambers of your heart (the ventricles) beat too fast and unevenly. The heart flutters, and little or no blood is pumped to your body and brain. Someone who has this type of arrhythmia is at risk of passing out. Treatment is required within minutes in order to prevent death.

How is an ICD implanted?

A doctor or surgeon implants an ICD during minor surgery. The pulse generator is placed under your collarbone on the left or right side of your chest, or in your abdomen (stomach area). It can go in a “pocket” under your skin or in a muscle. The doctor inserts one end of the lead (wire) into a vein that goes to your heart. They move the wire through the vein until it reaches the heart. The other end of the wire gets attached to the pulse generator. Once it is implanted, the doctor programs and tests the ICD to treat your heart rhythm problem. The process requires a short hospital stay.

How does an ICD work?

The ICD’s job is to quickly recognize and stop problems. It does this by keeping track of your heart rhythm at all times. If your heartbeat becomes irregular, the ICD delivers the treatment. Your doctor can program the ICD to do several things.

• Pacing: For mild ventricular tachycardia, the ICD can deliver several pacing signals in a row. These signals cause your heart to return to a normal rhythm.
• Cardioversion: This is used if pacing doesn’t work. Cardioversion sends a mild shock to your heart to stop the fast heartbeat.
• Defibrillation: For ventricular fibrillation, the ICD sends a stronger shock. This can stop the fast rhythm and help the heartbeat go back to normal.
• Pacemaker: The ICD can detect when your heart beats too slow. It can act like a pacemaker and bring your heart rate up to normal.

What does treatment with an ICD feel like?

When the ICD delivers pacing or acts as a pacemaker, you may not feel anything. This is because little energy is used. Some people feel fluttering in their chest. However, there is no pain or discomfort. Cardioversion is stronger. It can feel like a thump in your chest.

Defibrillation is the strongest. Most people say it feels like being kicked in the chest. It often happens all of a sudden. It lasts less than a second. It can make you upset or anxious afterward. However, it’s important to remember that it probably saved your life.

Things to consider

An ICD does not cure an arrhythmia or heart disease. It manages your condition(s) and helps prevent cardiac arrest and death. In addition to ICD, your doctor may prescribe medicine. Follow all instructions and tell your doctor what other medicines you take. Ask your doctor for an ICD wallet ID card. It is important that you carry this at all times. You will need this when you travel and in case of an emergency.

How will an ICD affect my lifestyle?

After you get an ICD, you will need to limit activity. This allows your body to adjust and heal properly. You can slowly go back to your regular lifestyle. Ask your doctor when it is safe to drive a car again. It will vary based on your condition and the local laws. You can expect to be back to normal after a month.

You need to stay away from machines that could interfere with your ICD. Do not work near strong magnetic or electrical fields. The ICD is safe around most home power tools and electric appliances, including microwave ovens. However, make sure that all electric items are properly grounded and in good repair. Your doctor can help you understand what to avoid when you have an ICD. Machines, devices, or procedures that may cause interference include:

• Security metal detectors
• Magnets
• Power-generating equipment
• Some power tools and electronic devices
• Electric fences and transformer boxes
• Electronic mattresses or pillows
• Anti-theft systems
• Cell phones
• Magnetic resonance imaging (MRI)
• Therapeutic radiation
• Electrolysis (electric hair removal)

When to see a doctor

Your doctor should test your ICD at regular checkups. Its generator battery can last 5 to 7 years. It can be replaced in outpatient surgery.

Getting an ICD may cause new emotions or depression. Talk to your family and a doctor if this happens to you. The doctor can recommend counseling or a support group.

Questions to ask your doctor

• Once I have an ICD will I always need it?
• How do I care for my wound after ICD surgery?
• How long after getting an ICD can I return to my normal activities?
• Can I drive?
• Can I have sex?
• Can I play video games and use electronics?
• Will I know when a shock is coming?
• How do I know if my ICD is working or not?

Resources

National Institutes of Health, MedlinePlus: Implantable cardioverter-defibrillator

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