“The 10th leading cause in America is Suicide.  Each year 44,965 Americans die by suicide. Know for every suicide 25 attempts.  Suicide costs the US $ 69  Billion annually.”

American Foundation for Suicide Prevention

Suicide is a major public health problem and a leading cause of death in the United States. The effects of suicide go beyond the person who acts to take his or her life: it can have a lasting effect on family, friends, and communities. This fact sheet, developed by the National Institute of Mental Health (NIMH), can help you, a friend, or a family member learn about the signs and symptoms, risk factors and warning signs, and ongoing research about suicide and suicide prevention.

What Is Suicide?

Suicide is when people direct violence at themselves with the intent to end their lives, and they die because of their actions. It’s best to avoid the use of terms like “committing suicide” or a “successful suicide” when referring to a death by suicide as these terms often carry negative connotations.

A suicide attempt is when people harm themselves with the intent to end their lives, but they do not die because of their actions.

Who Is at Risk for Suicide?

Suicide does not discriminate. People of all genders, ages, and ethnicities can be at risk.

The main risk factors for suicide are:

• A prior suicide attempt
• Depression and other mental health disorders
• Substance abuse disorder
• Family history of a mental health or substance abuse disorder
• Family history of suicide
• Family violence, including physical or sexual abuse
• Having guns or other firearms in the home
• Being in prison or jail
• Being exposed to others’ suicidal behavior, such as a family member, peer, or media figure
• Medical illness
• Being between the ages of 15 and 24 years or over age 60

Even among people who have risk factors for suicide, most do not attempt suicide. It remains difficult to predict who will act on suicidal thoughts.

Are certain groups of people at higher risk than others?

According to the Centers for Disease Control and Prevention (CDC), men are more likely to die by suicide than women, but women are more likely to attempt suicide. Men are more likely to use more lethal methods, such as firearms or suffocation. Women are more likely than men to attempt suicide by poisoning.

Also per the CDC, certain demographic subgroups are at higher risk. For example, American Indian and Alaska Native youth and middle-aged persons have the highest rate of suicide, followed by non-Hispanic White middle-aged and older adult males. African Americans have the lowest suicide rate, while Hispanics have the second lowest rate. The exception to this is younger children. African American children under the age of 12 have a higher rate of suicide than White children. While younger preteens and teens have a lower rate of suicide than older adolescents, there has been a significant rise in the suicide rate among youth ages 10 to 14. Suicide ranks as the second leading cause of death for this age group, accounting for 425 deaths per year and surpassing the death rate for traffic accidents, which is the most common cause of death for young people.

Why do some people become suicidal while others with similar risk factors do not?

Most people who have the risk factors for suicide will not kill themselves. However, the risk for suicidal behavior is complex. Research suggests that people who attempt suicide may react to events, think, and make decisions differently than those who do not attempt suicide. These differences happen more often if a person also has a disorder such as depression, substance abuse, anxiety, borderline personality disorder, and psychosis. Risk factors are important to keep in mind; however, someone who has warning signs of suicide may be in more danger and require immediate attention.

What Are the Warning Signs of Suicide?

The behaviors listed below may be signs that someone is thinking about suicide.

• Talking about wanting to die or wanting to kill themselves
• Talking about feeling empty, hopeless, or having no reason to live
• Planning or looking for a way to kill themselves, such as searching online, stockpiling pills, or newly acquiring potentially lethal items (e.g., firearms, ropes)
• Talking about great guilt or shame
• Talking about feeling trapped or feeling that there are no solutions
• Feeling unbearable pain, both physical or emotional
• Talking about being a burden to others
• Using alcohol or drugs more often
• Acting anxious or agitated
• Withdrawing from family and friends
• Changing eating and/or sleeping habits
• Showing rage or talking about seeking revenge
• Taking risks that could lead to death, such as reckless driving
• Talking or thinking about death often
• Displaying extreme mood swings, suddenly changing from very sad to very calm or happy
• Giving away important possessions
• Saying goodbye to friends and family
• Putting affairs in order, making a will

Do People Threaten Suicide to Get Attention?

Suicidal thoughts or actions are a sign of extreme distress and an alert that someone needs help. Any warning sign or symptom of suicide should not be ignored. All talk of suicide should be taken seriously and requires attention. Threatening to die by suicide is not a normal response to stress and should not be taken lightly.

If You Ask Someone About Suicide, Does It Put the Idea Into Their Head?

Asking someone about suicide is not harmful. There is a common myth that asking someone about suicide can put the idea into their head. This is not true. Several studies examining this concern have demonstrated that asking people about suicidal thoughts and behavior does not induce or increase such thoughts and experiences. In fact, asking someone directly, “Are you thinking of killing yourself,” can be the best way to identify someone at risk for suicide.

What Should I Do if I Am in Crisis or Someone I Know Is Considering Suicide?

If you or someone you know has warning signs or symptoms of suicide, particularly if there is a change in the behavior or a new behavior, get help as soon as possible.

Often, family and friends are the first to recognize the warning signs of suicide and can take the first step toward helping an at-risk individual find treatment with someone who specializes in diagnosing and treating mental health conditions. If someone is telling you that they are going to kill themselves, do not leave them alone. Do not promise anyone that you will keep their suicidal thoughts a secret. Make sure to tell a trusted friend or family member, or if you are a student, an adult with whom you feel comfortable. You can also contact the resources noted below.

“Sigmund Freud used to refer to depression as anger turned inward. While many people may regard this as an overly simplistic approach to the most common mental health disorder in the world, there is no doubt that anger plays a significant role in depression.”

Depression Vs. Anger — What does it all mean and What do I do?

Getting the blues  or down in the dumps now and than in one thing but staying in the blues or down in the dumps just sinking deeper over a long period of time can be diagnosed as clinical depression. Clinical depression presents many forms and symptoms. It is not something just to be brushed off, assuming it will rectify itself in a while. One of the most common symptoms noted when a person suffers from clinical depression is anger. Whether it’s uncontrollable anger toward oneself or outward aggression toward others, it’s clinically proven that depression and anger run hand in hand.

Do you find yourself feeling angry more often than usual, or more often than not, depression could be to blame. Anger is a common symptom of depression, which can lurk beneath the surface of any man, woman, or child as well.

Depressive disorders come in many different types, but each type has its own unique symptoms and treatments. Major depression, the most common type of a depressive disorder, is characterized by a combination of symptoms (see symptom list) that interfere with the ability to work, study, sleep, eat, and enjoy once pleasurable activities. Such a disabling episode of depression may occur only once but more commonly occurs several times in a lifetime. Mental health professionals use this checklist of specific symptoms to determine whether major depression exists or not. Depression is also rated by your diagnosing physician or mental health professional in terms of its severity — mild, moderate, or severe. Severe depression is the most serious type. A less severe type of depression, dysthymia, involves long-term, chronic symptoms that do not disable, but keep one from functioning well or from feeling good. Many people with dysthymia also experience major depressive episodes at some time in their lives. Another type of depression is experienced as a part of bipolar disorder, also called manic-depressive illness. Not nearly as prevalent as other forms of depressive disorders, bipolar disorder is characterized by cycling mood changes: severe highs (mania) and lows (depression). Sometimes the mood switches are dramatic and rapid, but most often they are gradual. When in the depressed cycle, an individual can have any or all of the symptoms of a depressive disorder. When in the manic cycle, the individual may be overactive, overtalkative, and have a great deal of energy. Mania often affects thinking, judgment, and social behavior in ways that cause serious problems and embarrassment. For example, the individual in a manic phase may feel elated, full of grand schemes that might range from unwise business decisions to romantic sprees

Risk Factors

Numerous risk factors can lead to feelings of depression and anger in an individual. Some of these risk factors include but are not limited to: loneliness, financial strain, unemployment, alcohol or drug abuse, marital or family problems, or lack of a social support network. Depression and anger can also be influenced by childhood trauma, or it can be hereditary.

Symptoms

Anger manifested with depression is no ordinary anger. It can be all-consuming feelings of anger and hatred against one’s self, others or the situation that is causing the depression. One of the first signs of depression in a teenager may be a sudden onset of uncontrollable anger. In turn, constant feelings of anger can also trigger a response of depression. Also noted with depression are a tendency to turn away from family and friends, poor performance at work or school, lack of motivation, feelings of guilt, insomnia and hopelessness

Symptoms of Depression

Not everyone who is depressed or manic experiences every symptom. Some people experience a few symptoms, some many. Severity of symptoms varies with individuals and also varies over time.

Depression

• Persistent sad, anxious, or “empty” mood
• Feelings of hopelessness, pessimism
• Feelings of guilt, worthlessness, helplessness
• Loss of interest or pleasure in hobbies and activities that were once enjoyed, including sex
• Decreased energy, fatigue, being “slowed down”
• Difficulty concentrating, remembering, or making decisions
• Insomnia, early-morning awakening, or oversleeping
• Appetite and/or weight loss or overeating and weight gain
• Thoughts of death or suicide; suicide attempts
• Restlessness, irritability
• Persistent physical symptoms that do not respond to treatment, such as headaches, digestive disorders, and chronic painMania
• Symptoms of Mania (for Bipolar Disorder)

• Abnormal or excessive elation
• Unusual irritability
• Decreased need for sleep
• Grandiose notions
• Increased talking
• Racing thoughts
• Increased sexual desire
• Markedly increased energy
• Poor judgment
• Inappropriate social behavior

“Dog lovers know how much warmth and comfort their canine companions add to their lives. But they might not know that a growing body of evidence suggests that having a dog may help improve heart health.”

Harvard Medical School – Harvard Health Publishing (www.health.harvard.edu)

“When kidneys fail, your body may have difficulty filtering your blood and keeping your body chemically balanced. Dialysis is a treatment process that cleans the body of unwanted toxins, waste products and excess fluids.”

Fresenius Kidney Care (freseniuskidneycare.com)

PERITONEAL DIALYSIS    VERSUS                 HEMODIALYSIS

There is not always a simple easy answer for a patient that has chronic renal disease regarding which choice or option of dialysis that is best for him or her ; so let’s investigate the options & know you can always change the choice of dialysis you initially go on.  But remember you are going from a tube placed in your circulatory system to a tube now in your abdomen or visa versa (depending on what your first choice of dialysis was) and that both tubes take time to be ideally ready and final for dialysis after inserted.  So definitely take consideration in your choice both for your body and time it takes to allow the tube (especially in hemodialysis) in getting at its optimal level or state in being used:

More than 1/2 a million patients in USA suffer from stage V CKD commonly referred to as Renal Failure (or End Stage Renal Disease (ESRD)) with nearly similar number of patients suffering with the pre-dialysis, stage IV CKD. The management of ESRD involves either replacement of the lost kidney function through the kidney transplantation, or clearing body of the accumulating toxins through maintenance dialysis. Unfortunately, kidney transplantation is not a viable option for a majority of ESRD patients due to a limited availability of donor organs, further compounded by the fact that many of the dialysis patients are medically unsuitable for transplantation. Thus, maintenance dialysis forms mainstay of the treatment for this large majority of the ESRD patients.

1.  Peritoneal Dialysis (PD): This has been argued as one of the simplest form of dialysis with limited life style interruptions and high degree of freedom. In this form of dialysis a synthetic tube is placed in the abdominal cavity which then allows dialysis by exchange of dialysis fluid at regular intervals. It can be tailored to individual needs so that the patient can perform this at night while asleep with the help of a small machine called “Cycler” or during daytime by performing around four manual exchanges, each lasting around 15-30 minutes. Because of its simplicity, PD is many times a chosen modality for persons with busy lifestyle, active family responsibilities and significant time constraints.
2. Home Hemodialysis (HHD): Advances in dialysis technologies in recent times has highly simplified the above-mentioned form of hemodialysis allowing it to be performed in the comforts of patients’ home. Development of smaller dialysis machine that can be placed on a nightstand; and simpler blood tubing and dialyzer connections, has resulted in increasing number of patients choosing this modality of dialysis to preserve their independence and high functional status. Though the typical duration for individual patient varies, these form of dialysis can be tailored for an individual’s needs with 5-6 times a week frequency for dialysis with each individual session duration ranging from 3-6 hours. The shorter versions called short daily hemodialysis (SDHD) whereas the longer versions are typically performed at night and thus called nocturnal hemodialysis (NHD). The typical home hemodialysis allows a much higher clearance compared to other forms of dialysis and thus gives greater freedom in terms of dietary restriction and life style choice.
3. In Center Hemodialysis (HD): Where blood is taken out of the body through a complex set of tubes, run through a filter called dialyzer, cleaned off various impurities, and returned back to the patient. During its passage through the filter, the blood comes in contact with dialysate, which mirrors the body fluid except for the presence of impurities.  This is conventionally performed in dialysis centers across various medical and commercial facilities and typically involves patients receiving dialysis three times a week (either on Monday, Wednesday and Friday OR Tuesday, Thursday and Saturday) with four hour session each time. This is a relatively complex form of dialysis with rigid treatment structure and limited flexibility in terms of patients’ time, mobility and transportation. Additionally, this involves creation and maintenance of vascular access such as dialysis catheter or creation of AV fistula or graft, in either arm or groin to access high flows of blood needed to perform dialysis.

It is uniformly agreed that no single type of dialysis (home Vs In-center dialysis, or Hemo Vs peritoneal dialysis) is superior to others in terms of hard clinical endpoints e.g. mortality or cardiovascular deaths.  However, home dialysis modalities (both PD and HHD) provide significant advantages in multiple outcome parameters important to the management of patients with ESRD namely quality of life, freedom of travel, greater liberty from dietary restrictions, preservation of residual kidney function etc.

Historically, analyses of various patient cohorts in US have consistently revealed that; a privileged patient cohort more frequently chooses a home dialysis. This in many circumstances have been reflected by higher use of peritoneal dialysis in patients that are Caucasians, patients with higher education, patient under the care of nephrologists during the pre-ESRD period, patients receiving pre-dialysis education etc. In fact, nearly half of the patients when provided with a comprehensive pre-dialysis education (CPE) opt for home dialysis. Additionally both individual kidney physician surveys and recommendations of various professional medical societies now recommend a higher utilization of home dialysis. Despite these, only a minority of ESRD patients in US are on Home dialysis modalities. Lack of patient awareness due to lack of pre-dialysis education and scarcity of medical experts performing the home dialysis therapies are the two principle reasons for this underutilization of Home dialysis therapies.

Considering these facts, University of Florida and DCI have established a specialized clinic and education set up where a comprehensive pre-dialysis education (CPE) will be provided to the patients with stage IV (pre-dialysis) CKD along with their multispecialty care for various ailments of CKD. This clinic will put a special emphasis on the comprehensive care of CKD patients with special attention towards their dietary needs, their social and pharmacological concerns and their awareness and needs for decision making for their eventual dialysis or transplant therapies.

In conclusion of renal failure and if you are chronic, it’s not always easy to decide which type of treatment is best for you. Your decision depends on your medical condition, lifestyle, and personal likes and dislikes.

**Discuss the pros and cons of each with your health care team. If you start one form of treatment and decide you’d like to try another, talk it over with your doctor. The key is to learn as much as you can about your choices. With that knowledge, you and your doctor will choose a treatment that suits you best.**

I hope this article help you in some small way or more in dealing with your chronic renal failure.  Know your not alone and have many sites and places in giving you direction and support!

” “Transplant tourists” are traveling to established destinations to obtain readily accessible organs for transplantation, available from the poor of that destination country who sell mostly kidneys, but in some instances, a lobe of the liver or a cornea. These practices have been well known for more than a decade.”

Francis L. Delmonico

“Whether you’re ready or not, cold and flu season is right around the corner. But fortunately, you don’t have to settle for the inevitable. With a small amount of preparation and prevention, you can be ready.  There are no guarantees when it comes to colds and the flu.  The vaccine for the flu is great for prevention.”

Inter-mountain Healthcare

Winter is now around, so is the flu!  While many people look forward to the cold weather for skiing and other outdoor activities, others heads have gone indoors until spring, cutting down on their opportunities for the exercise they need.  Staying indoors with someone who has the flu you keep inhaling that air which will prone you in getting the flu as opposed to getting outside.  Remember in a hospital your put on Droplet precaution, in a isolated room and droplet means you can catch the Flu within arm’s length of the pt; so you wear a mask when visiting the patient with the flu in a hospital.

So get outside in warmer or when the temp gets colder.  Whether it’s spending an afternoon at the local sled hill with the kids or skiing down the Alps, you can help your clients and patients – not to mention yourself – maintain an active lifestyle in the wintertime while it still lasts.

Shoveling snow, building a snowman or going on a deep-snow hike all increase a person’s heart rate, oxygen consumption and energy expenditure. Skiing, snowboarding or ice skating strengthen the musculoskeletal system and improve balance and skill. Cross-country skiing, with its whole-body challenge, improves cardiovascular fitness and muscular endurance. And all winter sports connect us with the elements: wind, snow and, for some, the sublime beauty of the mountains.

Winter Nutrition Needs

Participating in winter activities may increase energy and fluid needs, especially if the person is engaging in vigorous and demanding activities. High altitude and cold temperatures can also increase energy expenditures — as much as two- or three-fold if you’re shivering. With winter activities, it is easy to forget to stay hydrated and fueled all day, so it’s imperative to take breaks to fuel up.

Fluid Balance

Exercising in the cold and at altitude exacerbates fluid loss in the body. A significant amount of fluid is lost through increased respiration and the body’s need to humidify dry, cold mountain air. In addition, cold-induced diuresis will lead to increased urinary volume and fluid loss. And cold reduces the body’s thirst response, making it a challenge to maintain fluid balance in the cold. However, dehydration in the cold has serious consequences; it impairs thermo-regulation and increases the risk of hypothermia.

With this in mind, it is best to begin exercise well-hydrated with water breaks (3 to 8 ounces) every 15 to 20 minutes if going out on the slopes for less than 60 minutes. For any time longer than an hour, consider recommending a sports beverage.

The Air Up There

Altitude may increase the body’s need for vitamins and minerals. Adequate iron stores are necessary to increase red cell mass if exposure to altitude occurs on a regular basis. In other words, iron depletion interferes with the positive adaptation of the blood’s oxygen carrying capacity that typically occurs in response to exercise at altitude. Furthermore, altitude exposure increases the generation of reactive oxygen species. However, it remains debatable whether antioxidants such as vitamin E and C are needed in higher amounts to protect cells from damage when participating in exercise at altitude.

This topic is largely understudied in winter sports, and may be more concerning for elite athletes training at altitude. A balanced diet including a hearty vegetable soup with herbs and spices, a handful of nuts, an orange and a cup of green tea may be plenty to protect the cells from occasional winter outings.

Be Prepared

Engaging in any type of cold-weather sports, especially at higher elevations, requires appropriate preparation in terms of clothing, shelter and the foods and fluids a person consumes before, during and after the activity. Recommend that your clients and patients take breaks throughout the day and listen to their bodies to ensure that they are feeling well and ready for another round of winter activity.  Staying active outside can possibly help with keeping the Flu away especially if your exposed to someone in the house with the flu your not breathing the same air in the house which will prone you to getting the flu as opposed to staying active outdoors.  Best thing in prevention of the flu is the vaccine but always check with your doctor.