Living with CKD - Chronic Kidney Disease

Approximately 30 million Americans have Chronic Kidney Disease (CKD) and only about 10 percent of them know it.  This is especially unfortunate because the earlier it is detected, the more time the patient will have to make lifestyle changes which could dramatically postpone dialysis and an early death.  My husband is one of the millions of people in our country who has CKD.  He was diagnosed with Stage 4 kidney disease in 2009.  This diagnosis caused us to spend nearly a decade learning everything we could about the disease.  Because of what we learned, the lifestyle changes we made, and a trial medication, he has managed to avoid dialysis years past the time when he was expected to need it.

 Facts About Chronic Kidney Disease

*  People who are at the highest risk of developing CKD are those with diabetes, hypertension (high blood pressure) or a family history of kidney disease.  However, there are other reasons you may develop it, too.  In fact, one-third of adults are considered at risk for kidney disease.
*  There is a high correlation between kidney disease and heart disease.  Most of the people who die after a kidney disease diagnosis will actually die from heart disease. This makes it essential that you take care of  both your kidneys and your heart.
*  Hispanics, Pacific Islanders, African Americans, American Indians and senior citizens (anyone over the age of 60) have the highest risk.  As a result of this last category, Baby Boomers and older retirees need to have their kidney function tested so they can make appropriate lifestyle changes, if necessary.
*  There are simple tests which can detect CKD:  high blood pressure, urine albumin and serum creatinine.  The last one is often included in your routine blood lab tests, so you do not have to do anything special, other than ask that your doctor use your test result to estimate your kidney function.
*  Your doctor can easily estimate your GFR or glomerular filtration rate, which is a test of your kidney function.  It is calculated from your blood creatinine test, combined with your age, race, gender and other factors. If you know your creatinine, you can even find online sites which will do the calculation for you.  Your doctor may also want to perform an ultrasound or CT scan on the kidneys or do a kidney biopsy.

What to do if You are Diagnosed with Kidney Disease

It can be terrifying to be told that you have CKD and may eventually have to go on dialysis or get a transplant.  If that happens to you, you should immediately do the following:

*  Find out your glomerular filtration rate (GFR) and keep track of it over the years.  It is a good indication of how well you are slowing the progression of the disease ... which you can actually do by making simple changes to your diet. 
*  Know what stage of kidney disease you have.  The five stages are listed below.
*  Get your blood pressure checked frequently.  High blood pressure damages the kidneys.
*  Ask for a referral to a nephrologist (kidney doctor) and a dietician who can help you understand the diet.  The nephrologist will also review all your medications, including over-the-counter ones, and take you off or reduce those which put stress on your kidneys.  Make sure your other doctors are aware of your kidney disease and take it into consideration when they perform any imaging tests or other procedures, because they may have to take special precautions.
*  Find out what you can do to reduce your risk of heart disease, including keeping your blood pressure and cholesterol in check.
*  Stop smoking and get exercise.

Stages of Chronic Kidney Disease

Despite the fact that as many as 10 percent of Americans will develop CKD, most people have no idea whether or not they are at risk or if they are in the early stages of the disease.  The most common way to find out the condition of your kidneys is to ask your doctor to perform a routine blood test and estimate your GFR (referred to as your eGFR). Once you have that information, you can determine whether or not you have kidney disease and how serious it is.

The various stages of CKD are:

Stage 1 - GFR of 90 to 120
Stage 2 - GFR of 60 to 89
Stage 3 - GFR of 30 to 59
Stage 4 - GFR of 16 to 29
Stage 5 - GFR of 15 or less (this is also known as End Stage Renal Disease)

Anyone with a GFR under 60 should talk to their doctor about changing their diet and taking whatever other steps their physician deems important to slow down the progression of the disease.  Your goal is to postpone dialysis as long as possible and many people have been able to go years without dialysis, but only if they make the necessary lifestyle changes.

The Kidney Disease Diet

The CKD diet is restrictive, but it can make a significant difference in your ability to slow down the progression of the disease.  Most people with kidney disease realize they need to reduce their intake of salt.  However, sodium is not the only nutrient which should concern you.  You also want to control your protein, potassium and phosphorous.   The entire diet is quite lengthy, which is why it may benefit you to talk to a dietician, but the information below will help you get started.

Protein - You do not want to eat too much protein, especially from red meat or processed meat.  Avoid sausage and lunch meats.  Limit yourself to only two to four ounces of protein at a meal, primarily from chicken, turkey, and fish.

Salt - Limit your sodium to a maximum of 1800 mg. a day.  This can be difficult to determine, since it is hidden in so many foods.  Do not add salt to your food when cooking and read labels carefully to make sure you are not eating more than about 400 to 500 mg. in a meal.

Potassium - Too much potassium can be very dangerous for someone with kidney disease. Avoid potatoes, tomatoes, avocados, bananas, artichokes, bran, granola, beans, brown rice, spinach (and most other dark green leafy vegetables).  Instead, eat white rice, white bread, tortillas, cauliflower, peppers, lettuce, apples, grapes, pineapples, blueberries and strawberries.

Phosphorus - Avoid whole grain bread, bran, oatmeal, nuts, sunflower seeds, and dark colored soda.  Instead, eat white or sourdough bread, corn or rice cereals, cream of wheat, unsalted popcorn, and lemonade.

You also want to minimize your consumption of milk, cheese, butter and other dairy products. In addition, you should avoid chocolate and limit your consumption of caffeine.  If you regularly take NSAIDs such as aspirin, Tylenol or Motrin, you will want to discuss this with your doctor.  These over-the-counter medications can put additional stress on your kidneys. If you also have diabetes, your diet will be even more complicated, because you will have to monitor your consumption of sugar.

A registered dietician who specializes in kidney disease should be able to give you a complete list of the foods which are good and poor choices.  If you eventually go on dialysis, your dietary restrictions may change to meet your new nutritional needs. You may also want to buy a kidney disease diet book, such as the "Renal Diet Cookbook."


Treatment Options for Renal Failure

Once you are in late Stage 4 or early Stage 5, you will have to decide what type of treatment you would like to receive as you approach end-stage renal failure.  There are advantages and disadvantages to each of your choices, so you need to research them carefully and decide which one seems to be the best choice for you during the remaining years you have left.

Transplant:  In most cases, this involves a long wait, during which time you will probably be on dialysis.  After the transplant, especially if you are an older adult, you will be at an increased risk for problems and possible death from a variety of causes, including heart disease and sepsis.  You will need to take a large number of anti-rejection drugs every day, or the transplant will fail. The anti-rejection drugs can pose health problems of their own. Many people are not aware that transplants do not last forever.  Depending on your age at the time of the transplant and whether the donated kidney came from a living or deceased donor, your transplant may last only a couple of years, or up to a dozen or so years.  In rare cases, they have lasted longer.  The older you are when you get a transplant, the riskier it is.

Dialysis:  You can get dialysis either at home or in a dialysis center.  There are a variety of types available in both locations.  You can do your dialysis while awake or while sleeping, including staying overnight at some dialysis centers.  You will need to have surgery in advance to insert a port or fistula.  The type you will need depends on the type of dialysis you decide to have.  You will want to thoroughly discuss the options with your nephrologist and a dialysis nurse before choosing a type of dialysis.  Ask for a complete explanation of the choices as well as both the advantages and disadvantages of each type of dialysis you are considering.

No treatment:  Some people choose not to go on dialysis or get a transplant.  Others stop dialysis after a few months.  This is a personal decision and it is entirely up to you.


Consider Trying a Trial Medication

My husband and I believe there are two reasons why he has lived as long as he has without needing to go on dialysis.

First, he has followed the dietary restrictions carefully, and used frequent blood tests to make sure he was controlling the levels of protein, potassium and phosphorus in his blood.  He has also followed a very low sodium diet.

Second, within months of his diagnosis he went on a trial medication to counteract the severe anemia which is common with CKD patients.  This medication has helped him maintain a normal hemoglobin level in his blood and, in turn, helped him slow the progression of his disease. 

Sources of More Information:

If you or someone you love has been diagnosed with CKD, you will want to keep up with all the research available, in order to postpone dialysis or a transplant as long as possible.  Two of the best sites are:

National Kidney Foundation (which has a wealth of information on its website)
American Kidney Fund

If you are interested in learning more about common medical problems as you age, financial planning, Medicare, Social Security, where to retire and more, use the tabs or pull down menu at the top of the page to find links to hundreds of additional helpful articles.

You are reading from the blog:  http://www.baby-boomer-retirement.com

Photo credit:  Google images - NDTV

College Scholarship Tips for Grandchildren

At nearly the same time millions of Baby Boomers are reaching retirement age, they may also have grandchildren in elementary or high school who hope to go to college someday.  While they may want to do everything they can to make the college dreams of their grandchildren a reality, the truth is that the vast majority of Baby Boomers will be lucky to finance their own retirement, let alone help pay for the college education of their grandchildren.  Despite the risk to their own financial future, according to AARP, approximately 53 percent of grandparents help their grandchildren with their educational expenses.

The generosity of the grandparents is probably because most of us hate to see our grandchildren assume $50,000 to $100,000 or more in college debt which could take them decades to pay off.  This staggering amount of college debt could also make it difficult for our grandchildren to ever become financially independent and able to buy a home or save for their own retirement.

Because of this dilemma, I have invited the author of "Free College" to give a preview of her book, which has the goal of helping young people pay for college through the use of grants and scholarships.  By sharing this information with your children and grandchildren, you could help your grandchildren afford a college education without the need for you to dip into your retirement funds.   Her guest post is below.

How to Help Your Grandkids Pay for College without Touching Your Retirement Funds

There are no scholarships or grants in the United States to subsidize retirement. That’s zero, none, nada, zilch. There are, however, billions of dollars in both categories to pay for college for your grandchildren. In 2017, there was more than $46 billion in grants and scholarships available. Sadly, more than $2.9 billion in free college federal grant money went unclaimed.  At the same time, grandparents were pilfering their retirement accounts to help their children and grandchildren pay college tuition. This is tragic.

I was a high school German and French teacher for most of my teaching career. When you teach an academic elective, as I did, you need to do something extra to encourage students to sign up for classes they perceive as more difficult. What I did, while helping them become proficient in their chosen language, was teach students what to do in order to be accepted by the college of their choice. I showed them how to stand out from the crowd of applicants. We also discussed scholarships and grants.

One day while I was chatting with some of my high school students about the importance of applying for several college scholarships, a boy spoke up, "I don’t need to do that. My parents will pay.” When I asked if they spent their retirement money on him, would it be okay if they moved into his house when they were old, he paled. Most of the other students who were listening groaned. One girl said she would like her parents to live with her. I asked if she would prefer them to do so broke or with money in their pockets. They all came to understand the importance of applying for lots of scholarships and grants.

We all want our children and grandchildren to do well. We realize 90% of the jobs in the future will require a college education. We don’t want our loved ones to join the more than 40 million Americans who presently owe student loans. I wrote my new book, "Free College," to help families learn from successful graduates who earn the most scholarship and grant money. If their children can earn full-ride scholarships, why can’t your grandchildren?

I am against taking out student loans, whether federal or private. The student loan monster devours the futures of many. Families with such debt aren’t able to take vacations, buy new cars or homes. There has been a decline of over 35% in home ownership because of student loan debt. Many families are even putting off having children. Student loans cannot be discharged in bankruptcy, so they follow people into their senior years. If loans and diverting money from retirement are so bad, and they are, what can you do to help your grandkids?

Grandparents do not need to dip into their retirement accounts to pass on the tips contained in my new book. If you have one child, who has three kids, you only need to buy one copy of "Free College." I designed it to be used by one family for all of their preschool through high school children. If you, the grandparent, have three adult children, and they all have kids in this age range, then you’ll need to buy three copies, one for each family of your adult children. I set the price low enough so it is affordable.

Students who earn massive amounts of scholarship money do not do so simply because they are smart. While that certainly helps, it’s impossible to outsmart lazy. Those who develop good work habits early are more likely to do the right things. Families who encourage college readiness are also encouraging scholarship readiness. Colleges know what they’re looking for when they read applications. So do those who are awarding scholarships. Students need to do more of what colleges want to see, and become more of what colleges want them to become in order to be given a full-ride.

I divided "Free College" into chapters, each devoted to one habit I saw in the most successful scholarship winners. Those who earned the most money were the ones who had acquired all of these behaviors. Those who didn’t quite adopt them all, earned far less when it came time for scholarships. The largest scholarship given to any of my own students was the Bill and Melinda Gates Millennium Scholarship. It covered tuition, books, fees, room, board, and a mentor for the life of the recipient. Several of my students won this scholarship. But they were not the brightest students I ever had. They had, however, practiced all of the strategies that are now in my book.

"Free College" should not be the only book grandparents give their grandchildren. I send mine books on their birthdays and for Christmas. I find series they enjoy, or subjects they’re interested in and buy those books. In the minds of my grandsons, I’m the “book” grandparent. They love my book gifts and after reading them, display them in a place of honor. I autograph each book and write something sweet inside. My daughter told me once when I forgot to include a message, the boys were upset. I haven’t forgotten since.

My book will help your children raise your grandkids in a way that should result in more college scholarships. It does not, however, include the detailed steps high school students should take to apply for scholarships and grants. Those change too often to include in my book. I do, however, tell the reader where they can find this important information. The best place is in the office of a high school’s resident college expert. Most high schools have one. I’ve included other places to find this information if your grandchildren are unlucky and do not go to a high school with a resident expert.

Finally, while reading my book, and following the step-by-step guide it contains, you will find my Twitter handle and blog address. I regularly share information about education as well as college and scholarship readiness in both places. Remember, spend time with your grandchildren, but don’t spend your retirement money on their education. Help them earn enough scholarships and grants to pay their own their way. They’ll be proud, and you’ll be glad they did.

If you are a Baby Boomer or senior citizen who is interested in learning more about financial planning, Social Security, Medicare, where to retire, common medical problems and more, use the tabs or pull down menu at the top of the page to find links to hundreds of additional helpful articles.

You are reading from the blog:  http://www.baby-boomer-retirement.com

Photo credit:  Photo courtesy of the author of "Free College"

Medicare, Substance Abuse, Addiction and Alcoholism

Our nation currently faces serious problems as the result of the large number of people who have become addicted to opioid painkillers.  Among those who are currently struggling with addiction problems are senior citizens, many of whom are on Medicare.  In addition to opioid addiction, the elderly may also struggle with other substance abuse problems, including alcoholism.  While it may be difficult to admit you have a problem with substance abuse, addiction or alcoholism, getting help for these issues can save your life.  

Many people worry about the financial hardship which could result from seeking help for their substance abuse problem.  Those who worry about the high cost of treatment may be relieved to know that Medicare does provide some coverage for these issues.  The amount of help you get can depend to some extent on the type of Medicare Supplement or Advantage plan you have.  As a result, this month I reached out to Medicare expert, Danielle K. Roberts with Boomer Benefits, to learn more about the insurance coverage which is available from Medicare for substance abuse problems.  You'll find her informative and helpful guest post below:

How Medicare Covers Substance Abuse

Today in America there is a growing struggle with opioid abuse among senior citizens. Opioid drugs are commonly prescribed to seniors for chronic pain and it is all too easy to get hooked because of the addictive nature of these medications.

Overcoming any drug addiction can be a lengthy process and a costly one as well. For many years, health insurance in general did not provide mental health coverage which was on par with other medical coverage. The passage of the Affordable Care Act in 2010 changed this for the better. 

Today it is mandated that treatment for mental health and substance abuse disorders be the same as any other form of medical treatment. This kind of parity for people under age 65 has been welcome news for both addicts and treatment providers alike. 

As people age into Medicare, they often have concerns about their upcoming coverage. Will they still be able to obtain good access to care for mental health and substance abuse once they enroll on Medicare?

Here’s a quick rundown on how Medicare provides benefits and treatment for substance abuse.

Medicare Benefits for Substance Abuse

Medicare is our nation’s healthcare program for people aged 65 and older. It also covers people under age 65 with certain disabilities or health conditions.

  

Medicare benefits are modeled after the old Blue Cross and Blue Shield style of coverage, with hospital and outpatient medical benefits falling into two separate parts.

Part A

Medicare Part A pays for your inpatient hospital coverage. If you have a stay in the hospital, it will provide you with a semi-private room and three meals per day. Part A also covers blood transfusions, care received in a short-term skilled nursing facility and hospice benefits for the terminally ill.

For individuals obtaining substance abuse care or mental healthcare, Part A provides a lifetime benefit of up to 190 days in a specialty psychiatric facility.  The patient or Medicare beneficiary is responsible to pay their own Part A deductible, which in 2018 is $1340 per benefit period.

When you enter a hospital, you start a benefit period with Day 1. When you leave the hospital, you must be out for 60 days to reset that. If you re-enter the hospital before 60 days are up, you continue with the original benefit period.

This provides the first 60 days of care in an inpatient facility. Thereafter, the patient begins paying a daily hospital copay which becomes larger over time.

If the beneficiary leaves inpatient care and remains outside of the hospital for 60 days or more, the benefit period closes. When the patient re-enters the hospital, a new benefit period will begin.

Every person has their own journey with substance abuse care. It is possible that some beneficiaries may need more care than the lifetime limit allows. In that scenario, Medicare may offer some additional coverage if those services are provided in a regular hospital.

Sometimes Medicare will cover treatment for substance abuse in a partial hospitalization program. This would occur if your physician certifies that you would benefit from 20 or more hours of therapeutic services each week. 

Your Medicare doctor must put together and submit an individualized care plan for you which will be under his supervision. He must also re-certify you for the program on a regular basis so that Medicare will keep paying for that care.

Part B

Medicare Part B provides outpatient medical care. This includes ordinary outpatient services like consultations with your doctor and lab-testing and preventive care, as well as more expensive procedures like surgeries.

However, it also provides for substance abuse counseling, psychotherapy in an outpatient clinic, screenings for drug or alcohol addiction and drugs like methadone which are administered in a clinical setting.

Part B will also cover Structured Assessment and Brief Intervention, if services are provided by a Medicare doctor or outpatient hospital. If a person shows signs of substance abuse, this treatment includes screening to determine the appropriate level of care, a brief intervention to encourage the patient to make changes, and a referral to access specialty care if necessary.

Just like Part A, Part B has cost-sharing which you are responsible for when you are using these services. You will owe an annual deductible upon your first Part B service of the year. After that, your benefits will pay for 80% of all Part B services, while you pay the other 20%. 

There is no cap on out-of-pocket maximum to this 20%, so you will continue to owe this for each service unless you have other supplemental coverage.

Part D

For over four decades, Medicare beneficiaries had no access to suitable outpatient drug coverage.  They would often be faced with paying full price for medications, and sometimes they would have to decide between food or medications. 

Fortunately, this problem was solved with the Medicare Modernization Act of 2003, which created the Medicare Part D program. In May of 2006, all current beneficiaries were given an opportunity to enroll, and now new beneficiaries are also given an initial enrollment period when they age into Medicare to sign up for drug coverage.

  

Medicare Part D is optional.  You are not required to enroll. Congress made the coverage voluntary because some people have access to drug coverage already.

For example, some veterans can get their medications at the VA clinic, so they may decide not to enroll in Part D.  However, if you do not have access to other creditable coverage for prescription drugs, it is important to enroll when you are first eligible or else you may be subject to a late enrollment penalty.

Plans are provided by private insurance carriers in each state, and this coverage is important in helping beneficiaries pay for medications which may help treat substance abuse disorders. 

All plans have minimum coverage rules. For example, drug formularies must include antidepressants and antipsychotic drugs, as well as drugs which are considered medically necessary to treat substance abuse. 

Beyond those minimum coverage rules, though, each carrier develops its own formulary of covered medications. Beneficiaries should carefully review a plan’s drug formulary before enrolling to confirm that their necessary medications are included.

Covering the Gaps in Medicare

While everyone would like it if Medicare covered 100% of medical expenses, it doesn’t work that way. In fact, Medicare is very similar to other health insurance in that it covers a share, and the member is also responsible for a share in their own medical costs. 

Beneficiaries must pay for their own deductibles, copays and coinsurance. To plan ahead for these expenses, beneficiaries can purchase supplemental coverage. There are traditional Medigap plans available in all 50 states and in most areas, there are also Medicare Advantage plan choices.

Medigap plans can be purchased from private insurance companies, and the plans' designs are standardized by the government. There are several standardized plans to choose from and these each cover a certain set of benefits.

Although 10 plans are outlined, a few plans have become more popular than others.  The most comprehensive plans are Medigap Plan F and Plan G.  These plans cover most of the gaps and leave very little for you to pay out-of-pocket. Some people prefer plans with lower premiums where they pay more of their own cost-sharing. Plan K and Plan N are popular choices for that.

Aside from Medigap plans, the other type of coverage available is Medicare Advantage. In this type of coverage, you choose to get your benefits from a private insurance company instead of from Original Medicare. In some areas, there are Medicare Advantage plans called Special Needs Plans which are created specifically for people with chronic diseases, and this may include mental health or substance abuse disorders.

When enrolling in a Medicare Advantage plan, you will agree to see the plan’s network of doctors for your care, so if you are seeing a psychologist or psychiatrist for substance abuse counseling, you will want to make sure that he or she is in the plan’s network. Premiums are usually lower with a Medicare Advantage plan than for a Medigap plan, but you will pay copays for your medical care as you go. 

All Medicare Advantage plans must cover the same services that Part A and B cover, so if you enroll in one, you will have access to substance abuse benefits through your plan. Just consult the plan’s Summary of Benefits to see what your cost-sharing is for counseling and other benefits.

About the author:  Danielle K Roberts is a Medicare insurance expert who helps baby boomers navigate Medicare. You can learn more about her and her team at https://boomerbenefits.com 

(Note:  The numbers cited in this post are subject to change if the federal government makes changes to the Medicare program.  Check with your insurance carrier to confirm the specific benefits you are eligible to receive.)

If you are interested in learning more about common medical issues as you age, Medicare, Social Security, financial planning, where to retire and more, use the tabs or pull down menu at the top of the page to find links to hundreds of additional articles.

You are reading from the blog:  http://www.baby-boomer-retirement.com

Photo credit:  morguefile.com