Neuropathy is a kidney disease that is caused by damaged capillaries (blood vessels) in the kidneys due to excess sugar in the blood. The kidneys are responsible for filtering the blood in the body and regulating blood pressure. When the amount of sugar in the blood exceeds what the kidneys are able to filter, the kidneys become fatigued and eventually be unable to function properly. As a result less blood is filtered causing  increased waste in the blood and fluid accumulates in the body. Hallmarks of early kidney disease: Albuminuria and high GFR. Aluminuria is protein in the urine due to an inability of the kidneys to filter the protein and it spilling into the urine. High GFR or  glomerular filtration rate is the rate in which the kidneys filter blood. Elevated GFR suggesting increased work of the kidneys due to excess sugar in the blood Hallmarks of later kidney disease: Protein in the urine, high serum creatinine, low GFR. A low GFR rate signals the kidneys are failing. Symptoms Symptoms vary based on stage of kidney failure, but include: Swelling of feet, legs, hands due to excess fluid in the body Electrolyte imbalance due to inability to filter blood properly too much potassium can cause heart arrhythmias Nausea Increased urination Shortness of breath due to excess fluid in the body Build up of waste in the blood leads to skin rashes fatigue itching confusion dizziness How to prevent/treat kidney disease Keep blood sugar  in healthy range and blood pressure below <130/70.

Why Nutrition is Important for Osteoarthritis Symptoms While physical therapy and medications are important for treating and managing osteoarthritis , the right diet is also needed. This is because certain foods will feed your muscles and bones and keep them strong, so that they can better support your joints and decrease their continued wear and tear. This can also mean less pain and trauma when you move the joints; in turn, they can rest and heal more easily. In addition keeping a healthy diet can aid in weight loss goals or maintenance; a healthy weight will put less stress on your joints. Foods can help to add moisture and hydration to your system, which will keep those stiff and painful joints supple. Other foods have anti-inflammatory properties, to help tone down that inflammation and soreness around the joints. Because blood brings with it healing oxygen and helpful vitamins, trace minerals, amino acids, and other nutrients, you want to encourage healthy blood circulation when you have osteoarthritis. Certain foods help to feed and nourish your blood cells and also help your body to produce new red blood cells. Foods that build your immune system will also help your body to stay healthier overall so that your muscles and joints won’t become weakened because of not being rebuilt and repaired as they should.

Diabetic Neuropathy is characterized by damage to the nerves due to chronically elevated blood sugar. The nerves are needed to carry signals from the brain to the body and affect all body systems. Therefore, while the most common symptoms of neuropathy involve the small nerves of the hands and feet, symptoms in other areas such as the gi tract, sex organs, and heart can also occur. Neuropathy is a very common condition for diabetic patients, nearly 60% of all people with diabetes will have some form of neuropathy ranging from mild to severe. Symptoms: may begin gradually or have a sudden onset reduced sensation in feet and hands numbness and tingling pain burning sensation weakness sexual dysfunction slowed digestion and constipation carpal tunnel syndrome loss of bladder control Treatment will be individualized based on symptoms, but prevention with tight blood sugar control is key. Treatment of pain Avoid alcohol Physical therapy/ massage Capsaicin and lidocaine patches Antidepressants Anticonvulsants *Tip: Make sure to also check for B-12 deficiency, which can also cause many of these symptoms. Normal B12 range is 200-900. Types of Neuropathy Peripheral Neuropathy Effects the nerves that control movement and sensation in the most distal portion of the body (feet/leg, hands/ arms)The most common form or neuropathySymptoms include numbness, tingling, burning, weakness, and increased sensation of the lower limpsPain occurs in 1 in 4 patientsTypically affects feet first then handsSymptoms are typically worse at night time Autonomic Neuropathy Effects the parasympathetic (relax) and sympathetic (fight or flight response) nerve fibers of the central nervous system May effect any organ in the body Gastric Bloating and feeling of fullness early in meal due to slowed digestion and delayed gastric emptying Nausea Vomiting Constipation Diarrhea Heartburn Genitourinary Loss of bladder control Impotence Cardiovascular Orthostatic (blood pressure that is affected by change in position) Cardiovascular disease

Patients with diabetes are 3 times more likely to develop PVD than non diabetic patients. Peripheral vascular disease is the reduction of blood flow to the muscles due to plaque. Plaque is a buildup of fat and cells that forms on the blood vessel walls, decreasing the space in the vessels for the blood to travel through. This results in a reduced amount of nutrient carrying blood reaching the muscles. Risks Smoking Hypertension High cholesterol Over age 50yr Symptoms Cramping of the leg muscles Muscle weakness and fatigue A sensation of heaviness in the legs Intermittent claudication pain in legs during activity which goes away after activity stops Ulcers open wounds which can lead to infection and limb amputation is not treated properly Treatment Lifestyle changes Stop smoking Low fat, low cholestrol diet Exercise Glucose control BP control Treatment of high cholesterol with statins Medications that inhibit platelt aggregation (prevent clot from forming) Medications that decrease blood thickness Atherectomy: surgical procedure where a catheter is inserted into the artery and then the plaque is removed from the vessel wall using a drill or balloon technique Tests ABI (ankle brachail index) is used to measure the flow of blood in your limbs Blood pressure cuff is placed on your ankle and bicep The highest pressure recorded at the ankle is divided by the highest pressure at arm Normal resting ankle bracial index is >1.0 Abnormal is <0.9 which signifies decreased blood flow Treadmill Test:

Osteoarthritis (OA) is the most common form of arthritis. OA is a chronic disease characterized by the breakdown of joint cartilage and underlying bone. Nearly 15% of the world’s population suffers from this disease. It is most common among joints in the lower extremities such as the knees and hip. The chances of a person developing OA in their lifetime is 40-47%. This risk is even higher in obese populations and athletes. Contrary to common belief, OA is the results of a variety of factors including genetic, metabolic, biomechanical and biochemical factors. OA can occur in virtually any joint. Approximately 7% and 19% of adults with OA experience the disease in their hands or knees. There is a higher prevalence of OA in in women. Pathology of Osteoarthritis OA affects three major components of the joint: the articular cartilage, subchondral bone, and the synovial membrane.  Each of these structures contribute to the integrity of the joint. Articular Cartilage Pathology The articular cartilage covers the ends of the bones where they meet. This cartilage consists of a matrix of proteins and molecules that support the tissue. The matrix components are synthesized and secreted by cells called chondrocytes, which are also embedded in the matrix.