- Published on Wednesday, 08 June 2011 08:36
Got a kidney-related question this morning? Text your questions to OhOhOh (646464).
This morning's "Get Well Wednesday" questions will be answered by kidney transplant surgeon and board-certified urologist Dr. Charles Modlin, founder and director the Cleveland Clinic Minority Men’s Health Center and executive director for Minority Health at Cleveland Clinic.
Dr. Modlin is the sole African-American transplant surgeon in Ohio, one of only roughly 20 black transplant surgeons in the United States and a recognized national leader in the effort to eliminate minority health disparities.
A graduate of Northwestern University in 1983 and Northwestern University Medical School in 1987, Dr. Modlin was inducted into the Alpha Omega Alpha National Medical Honor Society. He completed a six-year residency in urological surgery at New York University in 1993, a three-year fellowship in kidney transplantation in 1996 (Cleveland Clinic), then joined the Cleveland Clinic Staff.
Dr. Modlin is an associate professor of surgery at the Cleveland Clinic Lerner College of Medicine, also serving as an advisor and lecturer, and is on several boards at Northwestern University Medical School and Northwestern University in Evanston, Illinois. He is the author of several scientific publications and book chapters on kidney transplantation and health disparities.
In 2003, Dr. Modlin established a dedicated Cleveland Clinic Minority Men’s Health Center to address the specific health care needs of minority men. The center provides direct hands-on patient care, patient education, outreach, conducts research into the elimination of minority healthcare disparities and provides mentorship to students in order to promote the health professions as career options. The annual MMHC Health Fair provides free health screenings for thousands of minority men.
Because of his work, Dr. Modlin was appointed to the Ohio Commission on African-American Males and the Ohio Commission on Minority Health. He chairs the health committees of the Cleveland NAACP and the Cleveland 100 Black Men and is on several boards, including the Urban League.
I donated a kidney to my brother in 1982. What health concerns should I have now?
Thank you for donating your kidney. Living kidney donation is very important, especially in African-Americans, because of the increased need for kidney transplantation in African-Americans and the shortage of available kidneys. Kidneys from living donors also last longer and function better compared to those from deceased donors.
Living kidney donation has been around now for nearly 50 years, and we know that people who donate kidneys do well and suffer no increased risks for developing any medical problems more than anyone else. However, the major things that you as a donor should now do to ensure your continued good health is to get routine blood pressure checkups and to establish routine physical examinations with a primary care doctor. Also, please have your doctor dip your urine yearly to check for protein in the urine. Every adult - whether or not they have donated - should have this.
My cousin has lupus and needs a kidney transplant. She wants me to get tested to see if I would be a match. What does testing involve?
The initial testing is to determine if you have a compatible blood type with your cousin. Generally speaking, if you are Type O, you can donate to anyone. If you are Type AB, you can only donate to another AB, but there are exceptions that your transplant team can discuss with you and your cousin. Second, they have to give you a general medical exam to make sure you are in good health; people with diabetes or significant hypertension are not able to be donors. Also, generally, people who smoke are not candidates to donate. Of course, also, they will be checking to make sure you have normal kidney function, and they will check your blood tests and urine to make sure there are no problems. Then X-rays will be done to ensure that you have two normal kidneys.
My uncle has been diagnosed with renal insufficiency. Is this the same as kidney failure?
Renal insufficiency is the same as kidney disease. There are different stages of renal insufficiency; early stages are not kidney failure but can advance to kidney failure. Early stages of renal insufficiency, if treated by controlling blood pressure and diabetes (if they have it), can help prevent that from resulting in kidney failure.
Do more ejaculations decrease a man's risk for prostate cancer?
No, there have not been conclusive studies showing that ejaculation decreases risks for developing prostate cancer. There is a huge hereditary component to prostate cancer.
At what age should men start getting their prostate checked?
Black men need to start getting checked for prostate cancer at age 40, whereas white men at age 50 and then annually or more often depending on the results of the examination and PSA blood test.
My husband was diagnosed with Stage Four kidney disease. Will he need dialysis or a kidney transplant?
With Stage Four kidney disease, there is a great probability that it may progress to Stage Five (kidney failurre), requiring a kidney transplant or dialysis. If he is otherwise healthy and depending on his age, a kidney transplant would be preferable.
I know someone who needs a kidney transplant who has no insurance. Any ideas on how to get assistance?
Most transplant centers employee social workers and financial counselors who can counsel patients without insurance about access to kidney transplantation. Many patients don't have insurance, but counselors have knowledge about how to enroll patients for financial assistance programs. All patients with kidney failure who are on dialysis qualify for Medicare coverage. Your friend can contact my office at the Cleveland Clinic - (216) 445-7550 - and we'll help them the best we can with answers.
I was just diagnosed with Stage Three kidney disease. What should I know about it?
Stage Three kidney disease can progress to kidney failure. The main things you need to do is to get a good nephrologist (medical kidney doctor specialist) and maintain strict and tight control of your blood pressure, diabetes and weight.
How often should you have your blood checked for everything?
It depends on your age and overall health. In general, you should have a yearly physical examination, including blood tests and urine test to check your kidney function, cholesterol, fasting blood sugar or hemoglobin A1C (for diabetes screening) and urine dip for blood and protein. Check your BMI (body mass index), which should be 30 or less ideally.
How important is it for men to drink lots of water?
Adequate hydration is important for both men and women. It's very important and healthy for the kidneys.
In what range is your PSA supposed to be?
The level of a normal PSA depends on your race and your age.
In black men ages 40-49, at Cleveand Clinic Minority Men's Health Center, we consider a normal PSA to be 2.5 or less. For ages 50-59, it should be 2.5 to 3.5 or less; for ages 60-69, it should be between 3.5 and 4.0 or less, and for ages 70-79, it should be 4.0 or less.
I have been exhausted lately. I thought it was because I had stopped taking my vitamins, so I started taking them again. Now, the exhaustion is worse. I have been blaming it on the Mississippi heat. Should I be concerned?
Thanks for your question. There are a number of possible causes here. You should see your primary care doctor and get your blood pressure checked and your blood count and kidney function checked. It could be concerning.
If your OSA test is negative, do you need a rectal exam?
As urologists, we prefer to perform both the PSA blood exam and rectal exam to increase the detection rates for prostate cancer; however, if the PSA is normal, we are beginning to feel that the rectal exam is not as important. But remember that you can still have prostate cancer with a normal PSA; the rectal exam may be what is abnormal. So for now, we still recommend both tests.
If I don't have a personal physician. Can I go to the emergency room to be checked?
You can go to the emergency room, but that is not the best place to go. It is costly, and you won't have the continuity of having the same doctor. The ER is primarily reserved for emergency visits. The best thing to do is to call your local hospital or find a primary care doctor in your area. We welcome patients from all parts of the nation here at Cleveland Clinic and would be happy to take care of you.
I am a truck driver, and my legs and feet have a tingling and I hurt from the waist down to my feet. Do u hav any idea what my problem is?
If may be vascular insufficiency or it could be lumbar disc prolapse causing your pains. You definitely need to get it checked out.
My son is 27 years old and has no health insurance. What screenings should a man of that age be taking?
Blood pressure, blood pressure, blood pressure! Also, cholesterol, fasting blood sugar or Hemoglobin A1C for diabetes and body mass index are the most important tests for him at age 27. I would add also a dental exam and eye exam to screen for glucoma, especially if there is a family history of blindness.
My two-year-old has hydronephrosis. Will he be at a higher risk for cancer? He is literally at his kidney doctor every three months. Will his kidneys ever be normal?
Hydronephrosis is not a risk factor for kidney cancer in most cases, but it can lead to irreversible kidney damage of the involved kidney and kidney failure if his opposite kidney is not normal. There are ways to treat this. He needs to see a urologist. You can contact my office if you wish: (216) 445-7550.
My kidney enlarged while I was pregnant. The doctor told me it was normal to have some inflammation, but the pain and inability to use it was an issue. My mom now has a cyst in one of her kidneys. Can I expect to have problems with mine as well?
This is hydronephrosis of pregnancy and usually resolves following delivery of the child, but it can persist, and you should have a followup ultrasound. Just because your mom had it does not mean that you will.
What are the warning signs of a kidney problem, and is the test numbered like diabetics tests?
Often times, there are no signs of kidney disease until at late stages, so everyone should see their doctor yearly and sometimes more often and control their blood pressure. The best tests to detect diabetes are the fasting blood sugar and/or hemoglobin A1C blood test.
Is Cellcept strictly a drug used for kidney transplant? Would there be any indicationt to use the drug in a teen with lupus and no kidney damage?
Yes, Cellcept is a medication used for lupus, even in those without kidney damage. It reduces the autoimmune response of lupus. We use it to treat kidney transplant patients also to prevent rejection.
Is an ostomy reversible?
Yes. It depends on the circumstances, but yes, it is usually reversible.
I'm a 29-year-old, 350-lb male in great shape - a pro MMA fighter - but I can't stay awake more than 10 to 12 hours at a time without dozing off. Is there anything major, besides sleep apnea, I should be worried about?
Yes, you have to be concerned about your blood pressure, your body mass index (depends on your weight and height), cholesterol and heart.
My son is black and 18. What is a good blood pressure for him? He is normally 124/70 something. Some doctors say he doesn't have high pressure; his cardiologist mentioned HCTZ, but he doesn't go to her now.
BP of 124/70 is a single reading, but is generally considered normal. It is important for him to check his pressure at several different times during the day and keep a record because it may be higher at times. HCTZ is a mild diuretic and is good to treat early stages of hypertension.
Can a man get off ED meds ever?
Yes. Often times, men will take Viagra, Cialis or Levitra or other ED medications and have a good response and later not need them, especially if he controls his weight, diabetes and blood pressure. Also, men with ED who get kidney transplants often no longer have ED once they get their transplant. Some BP medications cause ED, and you should talk to your doctor about changing your BP meds to see if your ED resolves.
Is there a such thing as borderline diabetes? I have elevated sugar levels sometime and other issues that that sometimes points to diabetes.
Yes, you can have pre-diabetes or borderline diabetes, which can progress to diabetes. Check your fasting blood sugar and hemoglobin A1C, which should be 6 or less.
Would you say it's a good idea to have my 19-year-old son's prostate and colon checked?
Men generally don't need a prostate check until age 40 or colon cancer check until age 50 (but a colon check at age 40 if there is a strong family history of colon cancer). If your son is having pelvic pains, he may need a prostate check or if he is having blood in his stool or abdominal pains, etc., he may need a colon check.