IN LOVING MEMORY OF MY FRIEND

Death leaves a heartache nobody can heal and love leaves a memory nobody will steal.

These past few weeks have been heavy. Not only for me but for all those knew and interacted with Eric, my little best friend who passed on after battling kidney failure. He was twelve years confidently and surely. Though the misery of poverty and illness had died a thousand deaths in his spirit, the reality of Alport Syndrome lingered on in his little body like a vengeful zombie. For him and other children, let us demystify this rare and genetic disease called ALPORT SYNDROME.

If you are new to these #KidneyWednesday sections, let me welcome you. The message on health and particularly Kidney health is one I do my very best to speak of in the simplest of terms. My target audience is not the specialists but every other Kenyan without any form of medical knowledge. I hope to speak to you in a language that you can identify with. However, some terms will be highly technical and if you do not understand I really encourage you to interact with me in the comments section. Feel free to contact me on www.facebook.com/catemimi and let me know your concern. @catemimi1772 is another way to talk to me on Twitter.

I do not have all the answers. You letting me know your concerns and questions will help me to seek for the answers from the great nurses that mentor me and doctors and other professionals. In return I will package that information in the simplest terms possible. Deal? Thank you.

ALPORT SYNDROME

This is a genetic condition characterized by kidney disease, hearing loss and eye anomalies. That means the patient will present with some degree of eyesight loss, some degree of deafness and some degree of kidney failure. These symptoms occur in childhood or adolescence for most of the patients. Alport syndrome being genetic means you are born with it. Not everyone gets it though. Let me explain a bit. Alport syndrome is inherited through the X-linked recessive pattern. Wachana na hiyo kiasi…Anyone up for a biology refresher course? Ha ha

X’s AND Y’s.

Males have an X and a Y sex Chromosome while females have an X and another X as their sex Chromosomes. That tells you all Kenyan men, it is not that your wife isn’t giving you sons; it is you who has the chromosome that can result to a son and you need to research more on how to make a baby boy. I digress.

Mutations (changes) of specific genes in the X chromosome lead to manifestation of this disease. There are specific materials needed to make each and every tissue in our body. All the information is contained in genes. There are genes for every part of our body. That explains why my cheeks and those of my siblings will always be full. It is because our parents’ genes decided to carry that information and use it while manufacturing our chubby cheeks. That is why your nose is the way it is. What I don’t know is whether genes are to also blame for my never growing hair.

It has been ten years now and every girl and their cat have long hair. Mine arrived came to the land of menopause and fell in love with the place. Oh the pains of kinky curls!

To filter urine, kidneys are comprised of millions of small structures called nephrons. Within the nephrons, there is a sieve-like membrane that allows waste products to pass through and come out as urine. We already said what urine contains. Right? Eti left? Hehehe you are funny. This membrane is interspersed with a fine network capillaries and together we call it the glomerulus. That is singular. Plural is glomeruli. I would go further and discuss the glomerular basement membrane but we are not here to get medical. We are here to at least get the basics.

Think of a regular kitchen sieve and a handle. The sieve is your glomerulus and the handle is your tube which will allow urine to pass through. Fair enough.

There is a specific protein that is needed in the formation of this glomeruli. This is the type IV collagen protein. Mutations in the genes specific in making type IV collagen cause abnormalities in the glomeruli and subsequent inability of kidneys to properly filter the blood. Type IV collagen is also needed in the making of Organ of Corti in the inner ear. This is an epithelium (membrane or lining) involved in the transformation of sound into nerve impulses for the brain to interpret.

Therefore, abnormalities in type IV collagen will cause hearing loss. Okay medics, it will cause sensorineural hearing loss. Sijawasahau hehehe.

Type IV collagen helps maintain shape of the lens and cells of the retina of the eye. That tells you changes in how this protein looks like will mean changes in the eye lens and retina. The retina is where we find the cells of sight and this will mean different degrees of blindness.

I am now biting my nails in the corner of my room eating last night’s disappointments hoping to my ancestors that you #TeamPhoenix do understand the three relationships. That is, this is not witchcraft like I saw some of you allude to in Eric’s case or a curse from the gods. That it is a genetic condition and the village witches had nothing to do with it. Sorry you alumni of Hogwarts school of witchcraft and wizardry, this isn’t on you.

INHERITANCE

The genes needed to make type IV collagen are within the X sex chromosome. It follows then that women will most likely pass the disease to their offspring while themselves are not affected.

Hold that thought please.

If a man has the mutations in these particular genes in the X chromosome. He too will pass it along and most likely he will already be exhibiting the signs and symptoms we have discussed. This is because, again, women have two X sex chromosomes while men have an X and a Y as their sex chromosomes.

 Dear God, show me a sign that kinaeleweka…

In males (XY) who have one altered copy of COL4A5 (the gene in question) in each cell, it is enough to cause kidney failure and other severe symptoms. In females (XX) who have a mutation in only one copy of the COL4A5 gene, it usually only results in hematuria.

However in some cases, it is inherited in an autosomal recessive pattern. Simply put, parents of this individual have one copy each of the mutated gene (carriers). In this case males and females are affected alike.

DIAGNOSIS

I would be very happy to write text book procedures. However, that would reduce this blog to a site of plagiarism with intelligent insults. See, in the Kenyan set up, such diseases get diagnosed by accident. It means that the parents have time and again presented the child to the hospital with either blood in urine, hearing loss or blindness. These are usually picked by the teachers who notice change of behavior with a child more intimately than parents do.

Sometimes the child will start speaking loudly and saying too many ‘repeat what you said.’

That is just but a clue to what could be happening. Thinking about the above, so many reasons can be attributed to them. It goes to show you that there is no walk in the bright sunny park as far as diagnosis of Alport Syndrome goes. It may take a few months if not years for the doctors to know what they are dealing with. By this time the kidneys will be damaged beyond repair.

A kidney biopsy will indeed detect the scarring of the glomeruli. Specifically it allows for testing of type IV collagen which will be absent in people with Alport syndrome. Genetic testing will confirm the diagnosis and help in determining the inheritance pattern so as to help other family members.

TREATMENT OR IS IT?

You will not treat Alport Syndrome. I wish we could. What management involves is monitoring and deterring progression of the disease as well as supporting the individual in different life skills. Patients will need hearing aids and in the case of blindness, ophthalmic support.

With regards to the inevitable end stage renal failure, dialysis and Kidney transplantation is the way to go.

PREVENTION

It really would be grand if we had some sort of genetic counseling centers in Kenya. That would allow us to seek information regarding our different health conditions. That would inform our decisions on what to do or not do. This is a tentative area pregnant with misinformation so I will shamelessly let it hang in the air like unclaimed Valentine’s roses.

Alport syndrome when detected early will be slowed down in its progression. Management of high blood pressure will be key. There are a wide range of drugs safe in the management of high blood pressure. There is, specifically, a cluster of medications concerned with preventing proteins from leaking through the glomeruli into the urine. These are the ones that the nephrologist will go for.

OUTRO

Funds were available through numerous fund drives for Eric to undergo kidney transplant but he passed on before that could be actualized.

Thank you all of you that empathized with his story and to all the parents, guardians and families and friends dealing with this horrendous illness, from my heart is a warmth of understanding, love and unconditional support.

Till we meet again Eric, Rest in peace.

COLORLESS VIOLENCE

We have no future as a people if we do not stop having violence (paraphrased from Edward Bond)

There are many things I have believed all my life. Like If it rains while still sunny, monkeys and hyenas are getting married in a beautiful jungle wedding.  If you cross the outstretched legs of your elders as they warm around the fireplace, you will never give birth. They are truths I held dear until I grew up and realized my clan and their clans played me. I however hold grudges against my elder sister Immaculate. That lassie told me that I have large-sized feet because I hated washing them. Who lies to their baby sisters like that? I am yet to execute a revenge.

I have been enlisting the services of the committee of experts in my head for most of my adulting and they are yet to give me a befitting course of action. I called her out to my whole family in the last get together. I wanted them to realize that behind that calm demeanor lay a not-so-immaculate wicked heart. They did not. They all burst out in peals of laughter that would put excited teenagers to shame. Labelled her creative. She even told dad that she had said so to help me love water because for most part of my childhood, bathing and I were sworn enemies.

I will tell ogre stories to her children you wait and see. They will hear it from me.

When dating and love and the whatnots of restless hearts came in, we were told that there are certain calibers of men that treated their women well. We were not taught to find them or to be found by them on the basis of their characters, no. We were to base this elusive gold through tribes, sub tribes, clans and race.

Stereotypes were painted in our hearts and agile minds that a man was indeed as good as their surname or lack thereof. Coupled with happily-ever-after-infused telenovelas, the reality of pain and pleasure of love was lost on us.

I had been mulling over how untrue all these things have been when I knocked on the Duty Room’s door to meet Mildred*. Mildred is a nurse in my new work station. It was New Year’s Day and normal people were either making resolutions or having their time with families. Nursing is not a job that allows anyone to be normal. We were therefore being on duty.

I had spent the New Year’s Eve at a street party and there ensued a stampede which saw my ankle half sprained. I wanted Mildred to please take my shift as I went home to cool my heels down.

That is when I saw her. Her milky white skin was flushed on both cheeks. Her lower eyelids colored in tiny dark streaks of the mascara she wore. Her lips smudged and minute traces of purple lipstick clung on. Her eyes, though winning at a smile were worn out like a tired headline. Verdict; she has been crying. In comes Catherine, deducer of the obvious and master of apparent observations.

Tenderly placing the stethoscope I held in my hand on the table, I asked Mildred what was happening. She ignored me and went back to furiously write a letter she was engrossed on. I felt pity for that piece of paper because the strength with which she wrote made me conclude, again that that paper had hurt her.

After realizing I was not going anywhere, she looked at me and said, “Catherine I can’t take your shift because I must go home to see my children before something happens to them.”

She said it with such a finality that my curiosity was piqued. She opened up.

Mildred has been living with her partner and father of her children for the past five years. He has been beating the living lights out of her as well as being an emotional, sexual and the in-betweens abuser. He is the most charismatic man to the rest of the world but a jerk at home. He makes her go on diets to be plump or slim depending on his present fantasy. This man had been arrested and charged over five times in the period they stayed together due to battery in its different forms. Restraining orders had been broken time and again. Twice he has been in remand but Mildred went and bailed him out. You read that right. He beat her, got arrested, she bails him out. That has been the cycle she had been through.

Why you ask? Because of the same reason every victim defends their abusers –control.

She showed me copies of doctor’s assessments after she was sexually abused by this same guy. She hoped, with time, that she will make herself good enough for him but in the meantime she wanted time off to go be with her children. She was drafting a letter, therefore, to the manager asking for an emergency leave.

I was perplexed. Not because she had bailed him out but because she is a White woman in a White country which is thousand degrees up on the civilization thermometer. With coercive control being a crime in this country of the Queen, I was appalled by the presence of such inhumane treatment and silenced intimate partner violence. Gobsmacked because my truth of White men treat women betterthan my African brothers was shattered right there in my eyes.

My truth that White men only mistreat Black women was ripped at the centre. She showed me scars on her back from whips this man has used on her when he felt that she needed ‘disciplining.’ A cold chill that had nothing to do with the wintry weather outside made its way down my back.

That first day of 2020 taught me how tasteless and utterly colorless violence against intimate partners is. I went back to the many taunts from a few friends that I am better off marrying a Mzungu as they treat people well. How ignorant that statement is.

Treating your partner right, respecting them, wishing them well has nothing to do with race. Take that and run with it. Race is what we see on the outside. Perhaps the westernization of most of our television love stories has made us assume that the rain of abuse only pours in Africa. N to the O.

Violence is a torrential storm sweeping across all colors, shapes and forms. Violence knows not your surname. Abuse does not respect melanin or lack of it. At this juncture, Mildred is just another sister girl going through the patches I have had to go through. Mildred is a girl held mentally captive by her abuser just like many victims are. She is a girl not taught and not able to be taught by her current system, how to value herself and move out of a potentially fatal situation. I cry for her. Not because he will be back in her life but because she will let him in.

She is a girl whose story stings my heart in different new ways. It is not about where one comes from ethnically speaking. This is all about one’s virtues as a level-headed human being. An evil person is evil whether they come deeply spiced and tenderly marinated from an island in the Caribbean or Canada. A good person is good whether Taiwanese or Togolese. Goodness and evil transverse the globe in varying shades of melanin. It is your happy day to accept this plain truth. Actually, use this as your New Year’s entrance song. Wrap it on your elegant neck. Cuddle it to sleep. That, #TeamPhoenix is all the motivation speech I will throw at you this year. No promises though. Ha ha.

 I no longer wonder why victims stick with their abusers. The element of control by the perpetrators is played with surgical precision. Abuse, essentially, is not so much the physical as the mental hemisphere from which it emanates. Violence is about control. The battery, insults and assaults serve to buttress the emotional and mental regime of captivity.

There must be something more than the physical walking out of an abusive relationship. If not there, one tends to keep stumbling over the same outgrowths of misery then blame it on life being thoroughly unfair to them.

Like Mark Manson I pose, how special do you think you are that life suddenly decides to focus on making you sad all the time?

#TeamPhoenix, Tweni tweni has not even had a cuppa tea so here is my Beautiful New Year Wishes to you!

KIDNEY HOLIDAYS

I am a good cook. At least that is what I tell myself every day before I go to bed. In fact, if you wanted me to fall asleep quickly, remind me how excellent my culinary skills are. I know this sounds like something a horrible cook would say but horrible is not a word I love.

The intention, as I set out to this artistic mission of cooking, is always right. I have my ingredients figured out and my appetite just right. What I conjure up later is always a mystery. My final cuisine taste like Kenyan rainfall in December. What I was to cook this holiday season is good old Chapattis. What I served everyone was something that you could comfortably rekindle a fire with. Crackling dry and impossibly hard.

Forget about ingredients and lectures on how to make the dough. I do all that and just like the main course, my Chapattis always disappoint.

For most Kenyan homes, holidays are tantamount to chapatti, pilau and nyam chom (grilled goat meat) with a crate or two of beer to drown in. It is a tradition passed down from generations. We can’t escape it. Chapatti do get cooked at any other day of the year but it is never really Christmas if you haven’t rolled and unrolled dough and flattened it into different shapes of the African map.

This diet has helped many have sizzling New Year resolutions of losing weight which rightfully belong where they should be–on paper. Friends argue that weight is a state of the mind just like poverty. I differ because I have touched those two things. Obesity and Poverty. Perhaps not in that order but I can tell you they are not in anyone’s mind. They are as real as inflated power bills and disconnected water supply.

Being overweight is a blow to your kidneys. They suffer when elevated cholesterol and blood pressure if not Diabetes Mellitus kick in. We have established that high blood pressure and Diabetes are the two leading causes of chronic kidney disease. If we can do something to run away from these two then we sure should do it and do it now.

Poor dietary intake like I have highlighted will not only give you rumors of New Year’s resolutions but add more wastes to your body for your kidneys. Let me explain.

Red meat must be broken down into proteins whose by product is urea. You are overwhelming the kidneys by increasing the amount of waste without increasing the filtration rate. More to that, alcohol causes you to pass urine more times and this will dehydrate your body. Some may tell me that that in itself is a balance because the more you urinate the more you are filtering the waste. If you are in this WhatsApp group raise your hand up…

Thank you for your honesty class. You are wrong. Now put your hands down.

Alcohol pulls out the water you already have in your body into the nephron tubules hence making you urinate more. It is a case of drawing water from the bloodstream into urine. This explains your morning hangovers to a great extent. What you pass at those urinals will not be well made urine (with all the wastes we have outlined before) but the largest percentage shall be water.

Less water in the bloodstream means we will have less blood (both volume and rate) circulating within the kidney tissues causing low blood pressure within the kidneys which will initiate the process of raising the blood pressure. Are you then surprised why some people must have headaches during or after a drinking spree?

What then is the solution since we must eat and celebrate and drink and have irresponsible sex and such other things? Thank you for asking.

Value the company more than the food. Eat, not to finish but to be full. I must vehemently condemn the conspiracy of all Kenyan mums. You feed us as if the Armageddon is nigh. You create small hills and mountains on the plate and if we decline you get offended. This has been so since eons ago. Please desist from these guilt-evoking love acts. Food served on a plate must not be overwhelming. Let us enjoy the first helping and if we want more we can always get a second helping. After all, we eat that heap of food to finish it and not offend your darling feelings. Please resist this strategy. Ha ha.

Talking about food, potatoes are very high in their glycemic index. Especially because we rarely bake them. Baking does reduce the glycemic index but I am not a Nutritionist now, right? *wink*

That means we can eat them, not as part of stew but part of the main meal. Central Province, am I telling you something? Yes I am smiling…

We have learnt to joke about adding potatoes in everything we cook but the truth should be told with the scathing nakedness it deserves. You can comfortably eat your starch without adding potatoes in them. I mean, do not serve chapos or pilau with a stew of potatoes. Both are starch and will contribute to weight gain. I need an emoji here…

Potatoes with garden peas and highlights of meat (red or white) is a meal by itself. Yes highlights ha ha. Stop calling it a stew with which to serve rice or chapatti.STOP.IT.Thank you. That explains the high cases of lifestyle diseases in Central Kenya and the Coast region. Coast shida yenu ni sukari. You people add sugar to everything!

This should not mean that thin folks are safe. I am concerned about our diet whether thin as rail or thick as the train that passes on it. Desist from horrible diets. Value the company, the laughs, the sharing, more than the heaps upon heaps of food you will eat this festive season.

Protect your kidneys for me if you won’t do it for you.

When you go out drinking, have some water and drink it. I had three Zambian classmates pale School of Nephrology Nursing. When we went out, I noted with astonishment something that not any of us Kenyans had. They drunk gallons of water before we touched any alcohol. I managed to ask one of them why. She replied with the very simple physiology we were learning in class but were too daft to apply it to ourselves. Drink water to cater for the resultant dehydration.

Miguel is a Rotarian friend who has globe-trotted because of his work. He told me in all his wine tasting years, it is only in Kenya where we serve beer at room temperature (pombe moto…very funny) and drink like the alcohol hurt us. My concern is not your fun but your kidneys. Those two organs must remain in top form if we can.

Excessive alcohol damages the liver. We all know this. What they did not tell you is that a damaged liver affects the kidneys and causes what we call a hepatorenal syndrome. Not once or twice have we have to start permanent dialysis on a young man whose alcohol overpowered his kidneys.

Friends, we have very few renal units in Kenya. Furthermore sustaining one is expensive to the family. Adequate dialysis should be thrice a week but we only manage twice a week. The number of patients on the waiting list keep growing in exponential proportions. #TeamPhoenix, if I can have one freer machine, then I can use it on a dire case.

As I talked about alcohol at the Rotary Club of Hurligham sometimes in June this year, I remember mentioning that it is wise to have a salty snack if you must waste yourself at the brewery. Salt retains water and will, though to a very small degree, pull some water from the tubules back into the bloodstream. However, I ask, how much salt would you need to lick for every bottle of Tusker or Guinness? Hehehe…

Protect your kidneys this festive season because I asked you to.

As always, thank you for coming.

SCRATCH THE SURFACE

I held the sun in my hand,
but it felt cold.
Not like the flaming ball of Orange in the sky
but like a globe of ice.

It is a little past noon and the meeting has just been called to order. Scott is the facilitator.  We do not know his surname. Nobody knows anyone’s surname here.  I even doubt his name is Scott. People are comfortable not knowing much about one another in this group. It is my third time here and everyone is looking expectantly at me. I had to attend this group therapy because my supervisor said I either attend it or I face the sack. I do not want to be jobless so here I am.

“Hello, I am Catherine and I am an angry person,” I unreservedly declare.

“Hi Catherine,’’ the six people in the humid room reply in a boring monotone.

They are; three almost-gentlemen whose names I can’t recall, two ladies and a ferret. The animal is owned by Scott. He says it helps him focus. I think he just loves animals but won’t admit it. He excitedly talks about anger. He is not angry. I am confusion itself.

He starts preaching about how antisocial we are. Not because of the anger but because we are too passionate. What a paradox. We have always been that way even before the discovery of the global village. Hello mother, I am not angry, I am very passionate. Ha ha.

Everyone nods in agreement but I couldn’t be bothered. I am pissed off. I miss my phone and a strong Wi-Fi connection. I want to tell my hundreds of followers how boring this meeting is. I am not ready to form friendships or any real life connections as Scottie is suggesting. I call him Scottie. Not to his face but on my mind he is Scottie the Ferretie.

I hate when I have to talk about my feelings. I am a bubbly person but below the surface that Scottie and his band of feel-Happy artists want to scratch is a cauldron of smoldering anger. And a deep desire for release.

There are many things I am angry about. Today, I am mad at Mary and her malicious self. Mary is a girl I should not have called. But I did. Follow me.

It had been a normal Friday evening. The traffic in Nairobi city coughed like and sputtered. The touts slapped the thighs of the loud Matatus and Facebook was still Instagram for old people. I am old-ish. As I scrolled through photos of extremely good-looking men on Facebook, my notifications badge blinked red with a message. I have always replied to them and so I decided why not.

It was a lady asking for my phone number because well, she had something very important to tell me. I encouraged her to share in my inbox but I think she thought I am part of those Russian spies or something. She wouldn’t. She was adamant too that all it took was her talking to me on the phone. She graciously gave me her number.

A few days later, after twiddling and doodling with the number, I decided to give it a buzz. A buzz. Mm, I admire people who speak like that.

“Yo Boris, give me a buzz later. Cheers.”

“Cheers, mate”, Johnson tells Boris.

So I buzzed. I was ready with a wise-ass line. I wanted to tell the owner of the meek “Hello” at the end of the line that it still wasn’t safe to talk. That we could go to the heart of Chalbi desert with my eyes blindfolded and after using three planes, one rickety Chevy and a camel to throw off anyone keen enough to follow me.

That or maybe, it is time we met in a Library on the same aisle and talk to each other while reading different books and never eyeing each other because spies might be listening in on our little chat. We may have to run for our lives soon.

I did not do it. After introductions and her vote of thanks for my auspicious call to her, she dropped the bombshell. Literally.

“How is Jim? Do you think I can trust him?” She eagerly waited.

Now, Jim and I had been married for a while before I realized the trouble I was enshrouded in and walked away. This was when I was waiting and praying to the gods of marriages to touch my husband and return him to me.

It was one of my most vulnerable points in life. Maybe not quite because no good deed goes unpunished but this was it. I was hurting and a new girl was asking me how to handle my soon to be ex-husband. Satan is not short of surprises and innuendos.

Mary laughed in my silence. She giggled. I realized the meek voice was meant to throw me off-balance because instead of a bird learning to fly, I heard the chirp of a vulture used to the hunt.

“Catherine, I want you to know I came to your wedding and I have your man. He has even visited me and I love him very much,” She cheerfully announced. After the dark angel on my left shoulder finished laughing at the white angel on my right shoulder, I replied in the most honorable ways.

“Jim is a great man and you can trust him. Also thanks for letting me know about your plans. If there is nothing else, I wish you a good day.” I hung up before that maniacal laugh from Mary the hunky dory got the better of me. I needed to hung up and block her on all platforms. It was nauseating.

I was angry. Angry that my dear husband had gone to such great extents to make sure that I was not only hurt but shattered.

I should have shared with the group. I should have told them how agonizing It felt to be replaced that fast. But I did not. I kept telling myself stories as the group members spilled their guts out. All I wanted to do was sign the attendance register then grab my phone and start interacting with hollow profile holders on social media.

My new found drug was sunshine laced posts and comments on social media. I liked how it used to numb the pain.

This meeting was outliving its usefulness. Scottie the Ferretie wanted us to recite the 12 steps heavily borrowed from Alcoholic Anonymous. I was not amused. Nothing in this room was a source of amusement apart from that brown ferret with piercing eyes.

I have been thinking lately about why women hurt other women. I have asked myself that question a million and one times. I have been wondering what Mary hoped to achieve or did achieve by hitting below the belt with me. Was it all worth it at the end? I would be disappointed for her sake if it wasn’t.

I have learnt to sell nothing short of happiness in spite of a cloud of dark. My journey, like that of many other men and women may have been scribbled with the right amount of agony but we triumphed. We faced our fears and did something anyway. Scared of the rising sun but opening the curtains nonetheless.

People, in a nutshell, will always do whatever they want to do and there is nothing we can do to stop them. I could hate people if I wanted to. Maybe label them in colorful words It is in your best interest to know that sometimes when it rains it pours. You may think you have seen it all and then boom! It gets worse. But It gets better too. It does. As soon as the storm passes, we will safely anchor the ship and have a party.

IT HURTS STILL

Light at the end of the tunnel can simply mean an oncoming train.

Life will not always make sense. It is there to be lived either way. Not the chirping of the birds or the aroma of good food will have hidden meaning. It is all part of this maze we live in. Life, painful as it may be for some or pleasurable for the others, is not what you make it as some would want us to believe. Life just is. It does not care about your perspective. It will happen because that is what life does–happen.

I would love to stand in front of an eager crowd and feed them hope. I would love to stand and punch the air with fists of victory over every little and big fight I have allegedly won in my life. Maybe be this iron lady who prances like a foal in a paddock because she was there,saw and conquered. Probably sing songs of freedom to a wild audience that will sway to my tune like a tribe of over-caffeinated monkeys.

However I will not because I am not a very good liar. I suffer short term memory loss and I would have to write down every lie I bellow through the microphones so that I may remember them all.

Truth is, it still hurts. It hurts that I invested so much of my time and resources trying to build a marriage that was authored on some sinking sand. It breaks my heart. Every. Single. Day. Well, there is a hint of hyperbole there but it is the truth nonetheless. It may not bother me all the time because I am busy being a nurse and a semi-manager of some sorts. You do get what I mean, however,don’t you?

Time and again I hate myself. I look at all I may have done had I not willingly entered a pit that I knew was too deep for me to climb out of. I knew it. That is the problem with most abusive relationships. The victim always, always know what the perpetrator is capable of but they somehow go ahead with it.

It is what I constantly call the impeccable art of self-destruction. My issues, to bore you, were not to do with my marriage per se. I like that phrase “per se.” It is a very Kenyan phrase. We use it in all situations and subsequently murder the Queen’s language. We are amazing. Not amazing Per se but… ha ha see what I did there? You are welcome!

I am deflecting , thank you for stating that. My issues stemmed from anger against those who took my childhood away from me. That was the most simple, perhaps too simple, an explanation I got from my shrink when I asked her why I was so good at screwing myself. I chose a man who I knew would hurt me so that I could continue with my incessant fights with this thing called life. I have always had to fight for things and I thought, albeit unconsciously, that even with marriage, I could fight and change, ergo, my man. When that did not work as I had envisioned, I had to go back to the drawing board.

Some people tell me I was extremely lucky to walk away and finalize the divorce. Others say I was very lucky to move on. These are opinions of people who are not me so allow me to tell you what I think. Fortunate to not have had a baby. By default or by design.

It is all well-preserved hogwash. Balderdash. Shut up world.

I do not feel lucky. I did not, for Chrissake, walk down the aisle so that I could walk right up. We all accept that marriages end but no girl wishes hers to be the one that does. So yes, I may not feel as jammy as I get labelled.

Do not get this twisted, given another chance, I would definitely get that divorce and sooner than I did. I would still look at the man I once called mine and say enough is enough. I am alluding to the fact that fortunate is not how I see myself. Stories of picture-perfect couples I call friends do not help the matter. It is not strange to find myself sad at weddings and crying at christenings. I remember what I do not have. I must say it. Oh I am sorry if you expected a shell of a woman. No. I see things. I think about them and I definitely wish many things would not be or would be and such other self-tormenting thoughts.

Turns out I still succeed at breaking my own heart. I should now get an award . ha ha.

The truth still, is that I let all these feelings of unfulfilled wishes wash over me. I let every dark emotion course through my veins like the poison it is. I have allowed hard times to weigh me down properly until they can’t anymore.

As a matter of fact I remember crying the other day and naming every drop of tear that fell from my eyes. I called one strength, the other wisdom, another compassion, understanding, one more discernment. I had a love tear, a hope tear and a better-day tear. I also allowed the river of anger to stream freely from my eyes . Anger pulled with it fear and fear balanced its legs on my lower eyelids before making small rivulets down my chubby cheeks. The session lasted shorter than I had hoped for.

if you try to gloss over the truth or massage it, more often than not you arrive at erroneous conclusions. That is my truth. I have learnt to wear my unspoken with aplomb. I have learnt that I will hurt even years from today. I will hurt even when IO get married again and even if that marriage will turn out to be what God authored, hurt I will.

Hurting will not escape me when friends seem to be so happy in their marriages, whether on camera or privately. Pain, Like a ghost in the night, will visit me when I remember some four years I spent teaching a fish how to climb a tree. Misery will engulf me when friends post photos of their babies and I am left to wonder kwani what did I do wrong? Yeah, I will ask God many questions too. God and myself.

Mostly myself because well, Papa God answers to no man.

I will want to deactivate all my social media accounts or perhaps go and live in the heart of China where social media is rumors and suggestions. I will feel all these and more.

However, I will still chart my way forward. I will believe that I am human and to not make dumb moves is to be robotic. I am not. To be low is human as Christ had a moment where He too wished to not drink from the cup that was his shameful death by crucifixion. this is where most of us go wrong. The journey to love is both pain and pleasure. You have no choice but to take them both.

We must learn to accept that life does not owe us happiness.

If that is so then, we must allow life to happen and appreciate the good with the bad. God, after creating people, He handed everyone their own small hell to handle. You will never outrun your hell. You will not out-smoke or out-drink or out-whatever-terrible-things-you-do. In fact, you won’t out-sex your hell.

Have fun with it. Embrace it because that is the only way to be human. You will appreciate your journey once you have faced that little piece of pain and risen in spite of it. Like demons, which i will address in the next Lifestyle topic, create a circus for your pain and join in. Control the strings and let the pain dance to your tune.

You own the pain. It does not own you.

Thank you for passing by.

WHY KIDNEYS MATTER

The heart may Stop, The brain may sleep but the kidneys never give up. However when the kidneys give up, not even the heart can stand it.

I may have touched on the work of these two bean-shaped organs in our bodies but I will go back to them yet again. I have received diversified questions and I thought if I took you all back to some basic physiology class we may be able to answer these (un)asked questions.

The kidneys are located towards the back of your body.They are on each side on the lower aspect of your ribcage. This is as far as I can make it sound non-medical. We agreed that these articles will not be written in medical jargon,no? Wait,you did not attend that meeting? Surely you had a representative? hehe.

Kidneys contain millions of tiny sieve like cells called nephrons. These small,intricate systems are key in filtering wastes and excess water from the blood.Waste in this case includes in part Urea and Creatinine. Urea is an end product of protein metabolism. It needs to be taken out of the body because excess content interferes with the normal working of the other systems in the body. Actually we get the word ‘urine’ in part from Urea.Creatinine is as a result of muscle breakdown. So, ladies will have less Creatinine in blood than men, got it ?

In addition, the medicines we take need to be removed from the body after they have done what they were meant to do in the body. Majority of these drug metabolites are excreted through the kidneys. #TeamPhoenix, some drugs get converted into inactive forms in the liver and we need to get this ‘inactive’ metabolite out.

Sometimes it is the poisons we ingest in the name of fun. Alcohol is a good example. Alcohol exits the body largely through the kidneys and that explains (albeit vaguely) the numerous trips you take to the washroom after your second beer or so. Imbibe on alcohol and you overload not only the liver but the kidneys too. By and by a hepatorenal syndrome with subsequent kidney failure will be apropos to you.

Kidneys also regulate the amount of salts and electrolytes in the body. We need these salts and electrolytes for muscle coordination, brain cell excitation, heart contraction to highlight but a few of the functions. Kidneys keep these elements within the normal range so that the internal working system of the body stays in some equilibrium.

Potassium is a cation worth mentioning because of its high relevance to renal patients. While normally we evade any catastrophes whether the Potassium in our diet is present or not, renal patients do not afford such a luxury. Kidneys retain and remove potassium from the blood with surgical precision. Too low or too high potassium is enough to cause a cardiac arrhythmia (heart beating abnormally). That explains the stringent dietary Potassium restrictions that renal patients have.

The blood’s PH is neither acidic nor basic and must be maintained within that range of 7.35-7.45. This happens via an acid-base mechanism that primarily is the role of the kidneys. Hormones and blood cells get denatured and destroyed if the PH is altered. This will manifest in various ways.

Kidneys produce an important hormone called Erythropoietin. This hormone stimulates the production of red blood cells in the bone marrow. That is why, when kidney failure sets in, one of the manifestation is anemia which means low blood levels. This hormone is so important that we inject it to the patients on dialysis. Dialysis attempts to replace the functions of the kidneys but this is one function that it can not replace–yet; because who knows the future?

Kidneys also control blood pressure. That means very high or very low blood pressure will have detrimental effects to the kidneys. Note too that high blood pressure can also be as a result of damage to the kidneys from other factors. I hope I have not lost you there.

It automatically follows then that any elevation or decrease in blood pressure is worth looking into. The kidneys play a vital role in activation of vitamin D which we need for strong, healthy bones. Talking of bones, the kidneys maintain Calcium metabolism,a key element in maintaining healthy bones.

In a nut shell, urine is of immense value as it tells us how your kidney health is. Urine is a mixture of excess water, electrolytes, Salts and a horde other waste materials. When other substances like glucose are present in urine, It guides the physician towards a correct diagnosis and management.

I hope these functions are palatable to your non-medical taste buds.

Till next week,cheers.

KIDNEY HEALTH DISCUSSION

More powerful than the best artillery is information in the hands of those who want to use it.

Despite it being among the top ten non-communicable disease killer in our country, kidney disease has continued to receive a wide berth as far as resource allocations go. There is so much the government, present and future could do to make sure that this is rectified. However I believe that the steering wheel of your health, #TeamPhoenix is not one you carelessly leave to other people. It must be your vehicle, your wheel.

The goal of many of these #KidneyWednesday articles are to make you feel empowered enough to approach Kidney Disease from a point of some sort of know-how. There is a need to perceive Kidney Disease as a primary ailment rather than a cause-effect phenomenon. That means we can talk about kidney disease and the disparaging misery it has brought to many households. That means we can now include Urine analysis as a mandatory baseline test for anyone visiting our health facilities.

#TeamPhoenix, my desire is for you to be informed. Shall we start some information therefore?

Basics

I know I have said it before but shall I repeat anyway. There is a major difference between Acute Kidney Injury and Chronic Kidney Disease. Now, the former is easily reversed if the right measures are put in place and I have a thousand and one words to say on this topic on my Facebook Wall before we gave birth to this blog. Most of the patients we handle , however, are suffering chronic kidney disease and unfortunately are in the fifth stage of the illness called End Stage Renal (Kidney) Disease.

Diabetes Mellitus and Hypertension are the two leading causes of this disease and I can’t overemphasize that point. There is however, a rather little known disease called Polycystic Kidney Disease. More often than not this is discovered while one is being treated for a totally different condition. It is a situation where the kidneys develop cysts (water -filled growths). These tiny little monsters compress the normal tissue of the kidneys. The result is reduced surface area for the kidneys to do their work. That increases the blood pressure in the kidneys and the general systemic circulation leading to a further damage to the kidneys.

A feedback cycle from hell you could call it.

That usually presents in the early thirties. I must say I never thought much about it until I went to the Renal Clinic at Kenyatta National Hospital during my training. I encountered so many young people on management for Polycystic Kidney disease, the reality was staggering for me.

It presents with very high blood pressure. Time and again a patient can be mismanaged–albeit genuinely, as having a migraine. Wait, now that I have written that down, I think I need to make some calls…funny how real things appear when one writes them down!

Where were we?

Polycystic kidney disease detected early is managed and the disease progression slowed. We may do little to reverse it as it has everything to do with our genetic make up. The reason I am highlighting this is to make you realize the need for this conversation surrounding Kidney failure.

We need early screening and staging of the disease so as to inform management. Last time I told you a story of a Patient we are dialysing who we shouldn’t be, at least not yet, had the attending consultant identified the staging early enough and referred the patient to a Nephrologist.

See, there is a culture of indomitability within medics circles, and Kenya has not been spared, that really needs to come to an end. This is where a consultant or doctor or another medic delays a referral to specialists in the name of figuring it out. I daresay medicine is dynamic and nobody will have all the answers. What you do is put these patients at risk as you focus on what to do or not do. As you become too afraid to be labelled incompetent just because you referred a patient. This is why we have so many cases of terminally ill patients whose stories look like they were scripted by the same writer.

That is how patients start dialysis and they tell us that they have been undergoing treatment for stomach ulcers, Malaria, Typhoid and a horde of other illnesses which if we take a proper history, were all related to the failing kidneys. The Chronic nature of this type of kidney disease means that it does not befall us as a thief in the night. Surely there are signs.

If your patient isn’t responding to particular management after a set timeline, why on God’s green earth do you want to keep treating them for that same condition till Jesus comes? What happened to effective referrals being part and parcel of management?

Sigh…

#TeamPhoenix, do find out the type of Kidney disease you are dealing with. I always say sometimes you do not know because you do not ask. Please ask the medical team handling your loved one, you or a friend or a neighbor what type of Kidney disease they are dealing with.

If it is Chronic, I want you to be part of the team that supports these families. Please encourage them to attend dialysis sessions because if the kidneys are failing, we are accumulating wastes in the blood and excess water which by and by will lead to complications.

Drop them at the renal unit, provide some eggs for them, ask about their next session, talk about the need for kidney transplant, link them to people who have undergone transplant and are doing well. Link them to people who have been on dialysis for a couple of years. Be there. Be available. If a village brings up a child, then the village should indeed help one to be well again. Let us put to action those community values we boast of as an African village.

It doesn’t need a title but here we are

Let us have conversations about Kidneys and how to keep them healthy. As well as how to manage the disease if it comes to that. End stage renal disease is a terminal illness in itself but it should not be the way life comes to an abrupt halt.

People can dialyse and still attend school, work and be productive. People can undergo kidney transplant and change the whole ballgame altogether. However this is a multi-pronged team effort. I keep saying that the most important player of the medical team is you, #TeamPhoenix–the patient/client.

Ask questions. Seek simple explanations. If not for anything else, for the sake of your consultation fees. That is what you pay for, right? Consultation. Then by all means , Consult.

Next week , we shall talk about functions of the kidneys. I know we had talked about it on my Facebook wall but I have this unsettling need of going through them again.

It has been a pleasure having you today.