Hyperfiltration and eGFR matter?
Been struggling with my creatinine that peaked 1.45 and I manage to lower it to 1.05 by diet (I guess main difference was to avoid whey and read meat). My nefro couldn't explain what I did, but she keep repeating "hyperfiltration", concept which I have a hard time wrapping my head around, but it happens after pregancy and hyperproteic diets. As a great fan of the Podcast I looked around and all I could find is that eventually Peter says creatinine is kind useless because of muscle and diet, but a 40 yo guy with a eGFR of 80 would wave some red flags. I'm a 40 yo that just calculated 70 for eGFR, and now 93 after the diet change. Real questions here: is there a way to eat so much protein I can wreck my kidneys? And could you explain exactly what is Hyperfiltration and how to measure it?
Assessing Metabolic Fitness
Hi there, I recently rewatched Iñigo's PodCast with Peter. First of all, very good. But now I have some questions. If VO2Max is not a good way to assess metabolic fitness, how one could assess it? Is there a number in an VO2Max lab test that can show me my metabolic fitness? For example, if your FatMAX is higher than the previous exam, I would infer that my metabolic fitness has increased right? Or is there a way to measure lactate clearance capacity? For we "mere mortals" how can we measure our metabolic fitness on a more monthly basis? Let's say. 1. One subject runs at 12km/h in Z2 for 45 minutes and the other runs in Z2 at 14km/h for 45'. The second subject in better metabolic shape right? 2. Imagine the same example, but now they run for 2 hours. The first one stays at the same HR at his Z2 speed, but the second one, after 1 hours sees his HR increase and eventually getting into Z3 in the same speed. Which one is at better metabolic health? Asking this because at longer runs and swims at the end I'm seeing my HR increase, but staying at the same speed. I prefer to stay at the same speed, because I think eventually my body will adapt and stay at the same HR. Is this right? Thanks. Hope someone sees this.
Dexcom G6 query
I ordered a Dexcom CGM G6 in Australia. In the app, I note that I can add the macro nutrients on the Events tab, but prefer to free text what I ate to evaluate the glucose response since I don't always know the exact contents of the food. Is there a market for such a software upgrade?
Indications for epidural steroids, indications for urgent back surgery
Great episode with Dr. Stuart McGill. The question of oral steroids or NSAIDS was discussed but no mention was made of epidural injections. It would be helpful to review the indications and risks. Also, Dr. McGill gave a short answer re the indications for surgery. Could you address further what constellation of signs and symptoms would be indications for urgent or non-urgent surgery from a clinician's point of view as opposed to the insurance point of view? Explaining cauda equina syndrome would be helpful as there are patients who do not seek immediate care, potentially leading to irreversible damage. Similarly, Dr. McGill implied that footdrop/loss of sensation or function that is not reversible with physical maneuvers may not be an indication for surgery. Could you discuss the potential for loss of function with or without significant back pain?