TO YOUR GOOD HEALTH By Keith Roach, M.D.
DEAR DR. ROACH: How can I find the most successful, experienced kidney doctor? Would I be better off with a doctor who has his or her own practice, or one who works in a hospital? My kidney function is at 32 percent, down from 44 percent four years ago due to hypertension. – J.A.
ANSWER: I often have tried to point out when a teaching hospital or special expertise is critical to having the best chance for a good outcome. For chronic kidney disease, the expertise of the kidney specialist is seldom at issue, because virtually all kidney doctors are very experienced and are expert at taking care of this condition. The main goal will be to slow down the decline of kidney function, but many people in your situation eventually will need dialysis.
In my opinion, what you want to look at carefully is the dialysis facility. They vary greatly in quality. I found a watchdog group with an interesting look at dialysis centers at projects.propublica.org/dialysis. This uses Medicare data to evaluate hospitalization, infection and even mortality. It’s not a perfect tool, but it gives you some information on which to base your decision. Find a doctor affiliated with the best dialysis facility around.
DEAR DR. ROACH: I am a generally healthy 81-year-old lady. I retired from teaching two years ago. I had a very strange situation about a month ago. I was sitting on the toilet and suddenly had pain in both my legs, and I could not move my feet, toes or any other parts. My husband gave me two aspirin, which did not help the pain. He then gave me an oxycodone 5 mg from our son, who was recovering from a badly broken arm. The oxycodone worked after about an hour and a half, and I was able to get up and walk. My husband thought it was probably a leg cramp.
I went to see my regular doctor the next day. He thought that I might have a blood clot in the leg and sent me to the hospital for more testing. After ultrasound testing, they did not find anything abnormal.
I am now afraid to drive by myself or even to be at home alone. Do you have any idea what this might have been, or what I should do at this point?
ANSWER: Sudden onset of pain and weakness does not sound like a blood clot to me. It sounds like a neurological event, such as a pressed nerve (actually nerves, since it was both sides). It is possibly in the brain or the spinal cord, but that seems less likely. A leg cramp usually would not be on both sides and usually does not cause weakness.
I don’t agree with you taking your son’s oxycodone. It’s a very powerful and dangerous narcotic. Five mg is a relatively small dose, but people can be very sensitive to narcotics, and deaths have occurred from people using a friend’s or family member’s drugs.
If your symptoms don’t occur again, I would suspect that this was caused by too much pressure put on the nerves.
Dr. Roach regrets he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu. To view and order health pamphlets, visit www.rbmamall.com, or write to Good Health, 628 Virginia Drive, Orlando, FL 32803.
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