The Get Healthy Tampa Bay Podcast

E38: Protecting Your Kidneys: Awareness, Prevention, and Maintenance with Dr. Ndidiamaka Obadan

• Kerry Reller • Episode 30

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Welcome to the Get Healthy Tampa Bay Podcast with Dr. Kerry Reller! This week I am joined by Dr. Ndidiamaka Obadan to dicuss the importance of protecting your kidneys.

Dr Ndidiamaka Obadan, fondly known as Dr DD. She is board certified in internal medicine and nephrology. She is a certified hypertension specialist and an affiliate assistant professor. She graduated from the University of Benin, Completed her Masters in International Health Policy and Management at the Heller School of Public Health, Brandeis, Massachusetts. Residency in Harlem/Columbia University in New York and Nephrology fellowship in the Medical University of South Carolina, Charleston SC.

Dr. DD is the CEO of youngerselfmd which is a medical practice specializing in preventing and treating chronic medical conditions like hypertension, diabetes, and chronic kidney disease. Her practice is located in Kennesaw/Acworth, Georgia. Dr. Obadan serves her patients/clients by providing primary care and nephrology services to her local community and beyond, through in-person and telemedicine visits. She is a wife and mom of 3 beautiful kids.

0:00 Welcome back to the Get Healthy, Tampa Bay Podcast!
0:46 Meet Dr. DD
5:43 Back to the kidneys, how important are they?
8:39 Chronic Kidney Disease (CKD)
11:49 What kind of medications are harmful to your kidneys
15:07 Supplements
18:55 Comorbidities and how they affect your kidneys
22:05 Having a good PCP
22:47 What kind of lifestyle choices can positively affect our kidneys?
25:22 General Broad Recommendations
28:39 The Goal
29:44 Where to find Dr. DD?

Connect with Dr. Ndidiamaka Obadan a.k.a Dr. DD
Connect with Dr. Ndidiamaka Obadan a.k.a Dr. DD
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LinkedIn: https://www.linkedin.com/in/dr-ndidiamaka-obadan-md-ms-fasn/
Website: https://www.youngerselfmd.com/

Connect with Dr. Kerry Reller
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kerry:

Hi everybody. Welcome back to the Get Healthy Tampa Bay podcast. I'm your host, Dr. Kerry Reller, and today we have a very special guest. Goes by Dr. DD. Right?

Ndidiamaka:

Yes, yes.

kerry:

Why don't you introduce yourself and tell everybody a little bit about who you are and what you do.

Ndidiamaka:

Hi everyone. My name is Dr. Ndidiamaka Obadan Also known as Dr. DD for short. I'm the c e o and founder of YoungerSelf MD Medical Health and Wellness. It's located in Kennesaw, GA. And identify as the physician educator. I'm an adjunct professor with the Morehouse School of Medicine, and I'm an international speaker. I have a nice TEDx talk that you should all go and watch. You'll be highly educated.

kerry:

And blown away. I think your TEDx talk was awesome, so please look her up

Ndidiamaka:

Thank you. Thank you for having me on the podcast. And I'm a nephrologist. So that's a kidney physician. We'll be talking more about that shortly.

kerry:

Yeah, I did not know that you were professor at Morehouse, so that's really neat. Cool

Ndidiamaka:

Assistant professor.

kerry:

okay?

Ndidiamaka:

the adjunct there. There's so many, steps in the academic world and I, yeah, so,

kerry:

Well, awesome. So nephrology, can you tell our listeners basically what a nephrologist is and what you do?

Ndidiamaka:

a nephrologist is a kidney physician. So generally people go to med school, they go into residency, and then they become general medical physicians after their residency in either internal medicine or family medicine or whatever other specialty they choose. They have surgical specialties and you can decide from internal medicine that you want to go on to sub-specialize. Okay? They make it easy for you to keep training and keep training and spend all your years training and getting more and you get an extra two years or three. Sometimes four of fellowship to become specialized in just the kidneys and so that's what I did to become a nephrologist. And there's some other people who go on further to subspecialize and become transplant nephrologist because they only want to focus on a specific part on people who have already received a transplanted kidney.

kerry:

I didn't even know that was a secondary thing.

Ndidiamaka:

Oh yes. Oh, they have so many. And then you can become an interventional nephrologist and it just keeps going on. Like I said, they make you stay in the pathway if you choose to, and then at some point to decide. Okay. Yeah. So I wanna, and that's fine, I mean, to each his own. It actually took the intervention of one of my friends'cause. She called me one day. She's family medicine. I dunno if I should be spilling this but I mean, well she probably, I dunno, she's probably never gonna hear this but if s he does that's okay, because I'm not lying. It's true. Right. So she called me one day and she said Didi, you have been in training for so many years. When are you gonna actually stop? Like, are you ever gonna stop this? And I'm like, oh, this is the worst friend ever. I've never, this was, I said, this is a bad friend. How can she tell me to stop training? You know?'cause I come from a background where education is very important and I'm Nigerian originally, and so we as Nigerians really value education. The more educated you are. The better. And I don't think there's anything wrong with that. It's just that at some point you did definitely need to figure out this balance. You know, her point was at the time, there are other aspects to life, right? And'cause a lot of. I don't know if you want us to go this deep on your podcast. Okay, so let's stay, let's stay on track here. But the point is, with all those excessive intensive training, they come at a cost. There's an opportunity cost to all that, especially as a female immigrant. All the other titles that we may wanna have on ourselves. And then if it's your priority to be an priority, to be an all rounder and what I mean by that is, If you wanna have a family, if you wanna have kids, and there are some people that don't want to believe me. I've seen a lot of women

kerry:

Yeah.

Ndidiamaka:

who don't wanna have any of those things. They just never wanna get kids. And that's fine. So those people can definitely get as many degrees and certifications and just stay focused on whatever goals it is that they want to achieve.

kerry:

Even just being in medicine, we're a lifelong learner, so whether you're getting an official certificate or something like that, we're constantly learning and training, I would say.

Ndidiamaka:

Right. Yes, I agree totally. Well, lifelong learners and how much emphasis you place on the certification at the end of the day. While some school of thought really wants to get the certified, the certificate as evidence to prove that they actually got that training, I mean, that's a totally different conversation. Okay. Because I was just having outta the scope of this podcast.

kerry:

Well, anyway, let's bring it back to the kidneys. So why are the kidneys important? Why do they devote such a long training and specialty to this field?

Ndidiamaka:

So the kidneys? Yeah, that's a very good question. I say, I often say they're like two small bean shaped kidneys located at the back, and they tend to be overlooked. They're really small, but mighty and resilient. When you have a heart problem, you have severe heart pain. Not able to walk you, boom. Everyone knows usually, and they rush you to the hospital. It's very dramatic in presentation, right? Whereas the kidneys, they're so strong. They're like, before you kill me, it's gonna take years for some people I mean, there are some things that can cause you to have immediate kidney shut down, we're not talking about those things. The more common things are the things that cause chronic kidney disease, which we define as impaired kidney function over three months, when your kidney function stays, decreased, right? And so the insult occurs. Usually over a period of time and starts to prevent the kidneys from doing its function. So they help with a lot of things in the body. Most importantly, excrete toxins, they filter out all the blood and they get rid of all the toxins in the form of urine. So you produce urine as a result of the expiration of those toxins. They keep the blood volume, your blood pressure in check. They help to regulate those things. They also help with maintaining your electrolyte balance. So like your sodium, potassium, calcium, magnesium, phosphorous. So they help with regulating all those things. And those are important because, they all help with a lot of functions. All those electrolytes help with a lot of functions with electrical parts of the heart and keeping the body functioning properly. So we say they maintain the body homeostasis essentially. The kidneys also have a hormonal role. They produce erthropoietin, which helps to keep the red blood cells in check. And that's why when you've seen people who have really severe kidney disease, they may tend to become anemic because now the kidneys are not able to produce the erthropoietin. And, surprisingly enough, you know, we talk about calcium and vitamin D functions, the kidneys help to regulate that as well. And so when people have problems with those, they can start to have problems with bones. And so yeah, they're small organs, but you see they're involved in almost everything the body and so they're very important. And I think, as I said earlier, they're very like resilient. So when things start to happen, unless it's really something major, you know, sometimes let's talk about chronic kidney disease, it takes years for the symptoms to manifest. And so a lot of people are walking around with impaired kidney function for many years and they don't know about it. The study showed that more than 90% of people have problems with their kidneys and are not aware. And to me that's a, a huge opportunity to intervene because, My personal experience when I was working in the hospital was a lot of hatred towards Nephrologists and the reason, yeah, I talked about this a lot in my TEDx talk, and the reason is because people generally are not aware that they have kidney disease and present when it's far too advanced and kind of late. And so when they come into the hospital and the nephrologist appears to be the Bear of Bad News, because now they're telling them that your kidneys are no longer doing all this stuff that they normally do. That's why you're having all these symptoms, and so now we have to place you on dialysis or start, working you up for a kidney transplant. Most of the patients are surprised they've never heard this before. I can't count how many times, you know, doc, you must be mistaken. I've not heard this before and how come no one has ever told me? I have my doctors, I've been seeing all my doctors and no, it's just like you're making up stuff or you're trying to actually tell them that they have to be on dialysis and be mean to them when in fact, we as a health system missed the opportunity to educate and inform them earlier on about the problems that they may have been predisposed to.

kerry:

So what kind of problems are you talking about? Like what kind of things hurt the kidneys?

Ndidiamaka:

Well, the most common thing are drugs and over the counter medication. These are the things that we can modify. So the most common causes of kidney disease, Are uncontrolled diabetes, and high blood pressure. And then I put the drugs there because a lot of the time we do those things to ourselves. The medications we take over the counter medications, that may hurt us, you know, or we overdose, we self-medicate. So we take it a lot more then it's prescribed or recommended because we're chasing something, some other secondary gain. So for me, medication is a big bucket. However, the most common causes are diabetes and depression.

kerry:

Yeah, I had recently done a video on, why am I checking your kidneys? Why am I doing all these labs? And I think obviously focusing on something that we don't wanna miss, like you were saying, you have all these people that approach to the end up in the hospital and then obviously it's too late for them. So I think making sure you are seeing your physician, especially if you have high blood pressure and diabetes. To make sure they're these doing these kidney tests too, catch this before it gets to be a problem where you're, hey, now you're on dialysis. Right? So I think that's super important. You mentioned medications too, so what kind of medications are the most common problems that you see?

Ndidiamaka:

Most of the time it's pain medications. A lot of people are dealing with all sorts of pain and they go on and they start self medicating on. The biggest group bucket category are the the non-steroid anti-inflammatory agents because they're commonly prescribed for a lot of the pain that we have. The joint pains, arthritis pains, and even, headaches. People who have a menstrual issue pain, so people just pop these medications. Now those medicines are good. People with gout and everything they're good for short periods of time, pain control. But I've found that you'll see a lot of of my patients who've been on them for years. They just take them routinely as one of the medications that they just pop in with their diabetes and their high blood pressure medications. Not only are they not made for us to take for high doses or excessively long periods of time. Not only do they affect the kidneys, they also have other side effects like, the gastric mucosa, GI bleeding. If you already have high blood pressure and you're taking medications that can increase your blood pressure, like the non-steroid inflammation, anti steroid NSAIDs, non-steroid anti drugs, they tend to increase your blood pressure as well. So you definitely don't want to be on those drugs for excessive periods of time because they can affect your kidneys.

kerry:

Yeah, I think it's hard because all these medicines are over the counter and anybody can go pick'em up and they don't think they're doing any harm to themselves. Right? Because, oh, it's over the counter, like obviously it's gonna be fine, and then they don't notice anything, until much later. So it's really good to be at least following with a doctor that's doing some labs every year.

Ndidiamaka:

Yes, definitely. You wanna make sure you keep your appointments, your doctors don't set Medicaid, don't adjust the drugs when they, adjust for blood pressure. So you don't want the extremes. You don't want your blood pressure to be too high or too low. And one of the things I've seen, or even your heart rate as well, so people who are on medications that control their heart rate or control their blood pressure, missing doses, increasing adjusting can affect your kidneys because your kidney does not want you to have excessively high or excessively low blood pressures. Can damage the kidneys chemotherapeutic agents. So, you know, sometimes these are other drugs. So I'm just thinking about other drug categories. Usually. I mean, at that point, if by the time you're on chemotherapy, you and your specialized physicians for cancers, the oncologist who have probably discussed with you the risks and benefits. So at that point it's just for us to keep in mind these are other drug classes that can affect the kidneys. So the chemo drugs, the NSAIDs we talked about and over the, you know, we talked about blood pressure meds, excessive or, yeah. And then the heart rhythm control meds. Another category that you wanna monitor, I find are the supplements. There's a lot of supplements and there's so many of them. It is always important, I feel, I always recommend all my patients to bring in the bottles of their medications when they're coming in because many times those compounds have different things that they've included in them. may not exactly be good for people who have slight impairment of kidney function or overt advanced kidney disease.

kerry:

Yeah. Are there any specific supplements that you're thinking of?

Ndidiamaka:

I generally don't like say names of any specific ones because, you know, But it's good to have this conversation with your doctor, speak with your physicians or your nephrologist and show it to them and say, Hey, you know, I've been told in the past that I've had and you know, especially if you've had acute kidney injury, which resolves. Okay. So the difference between acute and chronic is that the chronic stays on for more than three months, but the person may recover function. Sometimes they recover function back to normal. Sometimes they recover function back to what we call their new baseline. So not quite normal. so when you have any form of injury, whether it's been accurate or whether it's chronic, you are at a higher risk of getting more of those injuries. Think about scarring of the skin when you have an injury to your skin. The wound heals. Now you're left with that scar. It doesn't quite feel the same as your original skin or the surrounding area. So that's how it is when you have multiple injuries, multiple acute injuries to your kidneys. Over time, now of a sudden everything is becoming all fibrosis. You know, it's full of scar tissue and that's where the kidneys start to have a lot of issues. By the time you have a lot of those insults over time, now you have just your kidneys are now all this scar tissue. Does that make sense? You see what I'm trying to say? Yeah. So,

kerry:

I know you didn't wanna mention names, but going back to the NSAIDs, in case listeners don't know, we're talking about like ibuprofen,

Ndidiamaka:

Motrin,

kerry:

aspirin.

Ndidiamaka:

Yeah Goody powder is a very-

kerry:

Oh yes, actually that's funny you bring that up because I had a patient who was taking lots of goody powder and I didn't know what it was, but I looked it up and I was like, whoa. And I definitely discovered that her kidney function was probably impaired due to that, and it did recover a little bit, but she actually Has worsened kidney function since then, and that is not related to the goodie power. Mostly I think from chemotherapy agents now, but, so unfortunately she, like you said, she injured her kidneys. They might've recovered a little bit, but she had a new baseline and then she had to undergo chemotherapy, and that I definitely think contributed to her worsening kidney function, and that's why I had to send her to nephrology. Yeah.

Ndidiamaka:

Yes, and that's good. Yeah. So Meloxicam they come in different names. And the thing that is difficult is that the names vary by country. So if you're one of those, or you know, by different location, I mean even me, I've worked in, even in the United States, I started my training and working in the Boston area. And then when I moved to South Carolina, the names of the drugs were so different, the trade names. So that's even within the United States. So talk about when you're now trying to practice across different countries. Yeah, so a look on the bottle of the medication. If you see N S A I D s NSAIDs, you should be wary of it if you have problems with your kidneys.

kerry:

Yeah, absolutely. So you mentioned like diabetes and high blood pressure or hypertension also are affecting the kidneys. Can you explain that a little bit more?

Ndidiamaka:

Make sure you work closely with your primary care physician and your specialist for diabetes. It depends if you're type one, type two and how you know all the different other mod, you know, we have Moody and yeah. So you definitely wanna be in touch with them and make sure that it's being controlled. Typically, they recommend A1c of less than seven. It's how they're monitoring it. You might be on a variety of different medications to get those under control. So that's the goal. You really wanna get them under control. You want your blood pressure to, depending on all the other comorbidities that you have- so what I like to say is this, I think what is important for this podcast is that it is individualized care. One threshold or one recommendation might work for one group, one person who just has one risk factor and one comorbidity. Whereas a different set of recommendations may be perfect for another person who not has, you know, they're really old or really young and then have other comorbidities like heart failure and all that. So it's very important for you to make sure that you are keeping your appointments and having these conversations. I would say ask the questions. They're on terms that you don't understand, go with notebook and write them down'cause usually the doctors may not have the time to just download all the 25 years of knowledge to you in just one visit, right? Especially if your visit is for 15 minutes or 30 minutes, or even if it's two hours, it's still gonna take a lot of time for them to give you all the information you need. So going in with the expectation that you're going to leave there with everything, might not be quite realistic. So take the notepad, do some research, ask questions, build your rapport. Rapport. Don't bully. I always say don't bully your physicians'cause this is for me very personal. I've experienced that in the past. And you have to understand that they're trying their best to help you. So work with them to provide you the best care.

kerry:

Yeah. I also think that's really important and being an advocate for yourself as well, because there are some medications, like if you're having high blood pressure or diabetes that we may put you on that actually help protect kidneys. Right. So being aware of kind of the medications that you are taking and discussing those with your provider is really important.

Ndidiamaka:

Very, very important, so this happens all the time. People don't like this physician. They go to this other one. Or they get admitted and while they're in the hospital, there's certain changes that are done. And now they have this updated list. And now you don't take your updated list to your other physician, especially if you just switched. So what you just said is, is really important. Definitely try to keep them in the loop up to date, and that's why it's important to have a primary care. Usually if you have a good primary care physician. They're the ones, they're the gatekeepers, they're the ones coordinating your care amongst all these different specialists that you may be seeing. Some people have endocrinologists, cardiologists for their hearts issues, they may have podiatrists, dentists, and sometimes these people may want to alter some of your medications. They may have ophthalmologist as well, right? So you need a primary care physician who will c oordinate your care and always make sure that they're staying on top of everything,

kerry:

Absolutely. I totally agree with that one. So let's change gears a little bit. What kind of lifestyle choices can basically positively impact kidney health and prevent kidney disease?

Ndidiamaka:

lifestyle choices. Hmm. So for me, these are very important things here because obesity is also one of the risk factors for chronic kidney disease. So we didn't add that, but we definitely want to maintain a healthy lifestyle, avoid processed foods, limit salt intake for sure. The sodium is definitely one of the risk factors for all things kidney impairment. So wanna limit those. We definitely wanna drink water. I always say stay hydrated. Leave the sodas and those energy drinks. Oh my gosh, that's a big one. But, you know, yeah, because I've been having all like, yeah. I mean, it's a struggle. So we don't have to Reveal everything here, but you know, it's really a challenge. so try to cut back, limit those things and water is your best friend. If you don't have any contraindication to drinking water, like if you have heart failure, you don't wanna go choke down a whole liter. Nobody's planning to do that. But in kidney, you know, the other day I was having a conversation and it seemed like I was having dinner. There were like 10 people, almost all of them had stories about their kidney stones. It was like we were in a kidney stone conference. You know, I've had a kidney. Somebody even had a picture and showed me the picture of their stone that they extracted. It was very interesting. I don't know if they set me up with all the kidney stone people'cause they knew I was a nephrologist. But drink water, stay hydrated. If you have kidney stones, make at least 2.5 liters of urine drip. Stay hydrated enough so that you are peeing, flushing out the kidneys essentially.

kerry:

Do you kind of say, drink enough water to have the urine clear, or what do you

Ndidiamaka:

Yeah. That's easier, right. To clear it up a little bit. And in people who have kidney stones, they should try to at least aim to get two liters of pee out. So you really want to be flushing out the kidneys more, and it also depends on the, but that's a different whole topic. Okay. But it depends on the kind of stones you have because there's so many different kinds. In general, we're talking about generally, again, this is individualized care, so you have to get the patient in. We've gotta ask you all the questions and figure out which of the buckets we need to place you in. Identify the root cause. For me, I'm big about, Identifying what the root cause is, and then we'll make the recommendations, but we're talking now general broad recommendations, exercise is your best friend to maintain a healthy weight. Definitely move. I went on a campaign recently to save the kidneys and it's being mad. Mad, being mad about taking the kidneys. M a d and the M stands for movement. And that's where I talk about how much to exercise and we'll go into detail about that. And accountability is the a and, and sometimes you might need external accountability, and sometimes it's internal. And by that I mean you. So knowing yourself is important. You might need the external for coaches or you know, a FitnessPal or family members, spouses, whoever it is that you may need to keep you accountable. Or if you're the kind of person who has discipline to be your own accountability partner, that's great too. And you know, we've been talking about diet, the d and m A D is for diets, and we kind of went in a little bit about all the different things we talk about, which is avoiding the processed foods, stay hydrated and stuff like that. So that's my campaign to become mad about saving your kidneys.

kerry:

I like that, and I do remember that from your TED Talk too, right?

Ndidiamaka:

I don't think I mentioned that campaign in the TED Talk. No, this

kerry:

The mad I remember that.

Ndidiamaka:

Really. Oh, okay. Maybe you've watched some other talk, the one on the TED Talk was for prevention. So there I was saying that we needed to be curious about the health of our health. The title was the Healing power of Curiosity, focus on prevention yeah, I don't want to tell people everything they need to go watch it, just Google my name and, and go watch it. But the idea was when you take control of your own health, And become curious about learning and that's when you learn, all these things instead of just waiting.'cause you know, when I was deep in the academic world pursuing my professorial titles I had some some publications on chronic kidney disease awareness after I discovered that the awareness was so low. As I mentioned earlier, people are coming in at the end. And when there's a lot more that they can do so if you become curious and you identify, this is going on earlier on, you can put interventions in place to stop the kidney. You don't have to wait you can do stuff on your own, like not buy the NSAIDs as we're talking about. At least sending a text message to your physician to ask if they prescribe this new medication. Is this okay for my kidneys? Is this gonna hurt my kidneys if you wanna start new supplements, and the vitamins. Again, it's all individualized care, so it's really difficult to give broad strokes because one recommendation might not be good for the other person. But we try to keep general ideas on the podcast just so people know all the different things that they can even know to ask. To start to have the conversation with their doctors.

kerry:

I mean, I think you've given a lot of great advice of how people can be aware and what they can bring back to their primary care or other doctors to ask about. Is there anything else that you'd like to add or tell anybody?

Ndidiamaka:

I mean, good sleep is important. Stay away from the alcohol, excessive behaviors, you know? Alcoholic beverages and intoxication, try to do things in moderation and I'm a physician health coach and my goal, when I say I help prevent kidney disease to patients, I say I help adults at risk prevent kidney disease and at little as a 30 minute consultation so they can go on to live healthier, happier, and longer lives. I really want us to enjoy our life, right? Definitely, for me, quality of life is important. So that's gonna be my take home message. At the end of the day, whatever you're doing, try to maximize the enjoyment of it and, and do things in moderation. Get good sleep and, and just make sure that you're trying to enjoy the best of it.

kerry:

Protect the kidneys. Be mad about it. Right.

Ndidiamaka:

Be mad about saving your kidneys in the process. Yes,

kerry:

I like that. Awesome. Well, where can people find you?

Ndidiamaka:

Yeah. Yeah. So I'm on youngerselfmd.com. That's my website, and I'm on Instagram at Younger Self md. I have a YouTube channel. And you can also find me on Facebook at Younger Self md. So yes reach out to us. Phone number is 404-566-4623. Would love to speak with you. We can help you in way. Feel free to call to ask questions. Also for primary physicians. Ask any questions that you may have.

kerry:

All right. Well thank you so much for coming on the podcast. We'll put all that in the show notes and well tune in next week for next episode. Thank you!

Ndidiamaka:

Thank you for having us. Thank.

kerry:

all.

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