Let me start with I'm a diabetic. I developedneuropathy, which basically you lose all sensationthe feet, but it's over a period of time.It was very painful. I would have sensationsmy feet like I was standing on fire, walkingon glass. Last October it got so bad that I couldn't sleep at night. Then I met Bullard, because he's just a great physician. I wouldn't think twice, I'd recommendhim to anybody. Very compassionate, very thorough, I can't say enough about Bullard. He'sjust a great physician and I don't know if there's anything he couldn't do hecould probably move mountains if he wanted to!Glen, probably one of the biggest questions
people are asking you is what'd we do, what'shappened. Of course, you had a tremendous improvementyour pain and the tinglingand the numbness. Easiest explanation is, to tell everybody, that this big nerve here,which is on the inside part of your left foot, was getting strangled. There was a noose aroundit. What we did is we wentand loosened the noose, and that allows that nerve to beginto function and work like it's supposed to.Now, the sensation is coming back, it's something that's going to take time butI can feel more. My quality of life has greatly improved since I had the procedure done by Bullard. There's no other physician
that I would recommend.Glen,the next couple weeks, what we're going to do is make sure that the swellingis improving, hopefully begin to transition you out of your compression socks, becauseI know it's kind of hot right now, and then look at making sure that your shoe gear andthings like that are where they're supposed to be, fitting you well, protecting your feetand stuff. Ok? Very good. Thank you, I appreciate it, havea good weekend! You do the same. Alright, see ya.
Diabetic nephropathyis one of the most common and serious chronic compliions associated with diabetes mellitus. In this tutorial, let'sdiscuss how the mechanisms underlying diabetic nephropathy correlate with the al presentation as well as the treatment of the disease. Now fortunately the mechanisms
underlying diabetic nephropathy, directly correlate withthe al presentation. And the first alfinding of the disease is somewhat paradoxicallyan increased kidney filtration rate orglomerular filtration rate. So, diabetic nephropathy,if you break down the term into nephro and pathy literally means kidneydisease caused by diabetes.
Now typically kidney disease is marked by a decreased filtration rate, so why is it that the first al stage of diabetic nephropathy is that of an increased glomerularfiltration rate? Well recall that the earliest mechanism contributing to diabetic nephropathy is an increased pressurestate, over hereblue.
And this is due to hypertension and efferent vasoconstriction. So let's use a common garden hose to help illustrate how thisincreased pressure state will ultimately resultan increased glomerular filtration rate. So, imagine you have this garden hose and it has a small holein the middle of it.
So first you're gonna open up the spigot and increase the pressureand flow through the hose. Intuitively, this isgoing to increase the rate at which water is leakingfrom the holethe hose. Next, you partially kink off the end of the hose distal to the hole, and once again this isgonna further increase the rate at which waterleaks from the hose.
This is essentially what'soccurringthe glomerulus with the hypertension representing the opening up of the spigot and increasing the pressurebefore the glomerulus,front of the glomerulus, and the efferent vasoconstriction representing the kinking off of the hose, which causes this back pressure.
One of the most seriouschronic compliions of diabetes mellitus is a condition known as diabetic nephropathy. Which, if you break down the term into nephro and pathy literally means kidney disease that occurssecondary to diabetes. And it's actually pretty common as it eventually affects about20% to 40% of all individuals
with diabetes, includingboth type I and type II. In this tutorial, let'stalk about the mechanism underlying the causeof diabetic nephropathy and how individuals withdiabetes develop the condition. So diabetic nephropathyis a chronic compliion of diabetes mellitus. Meaning, it usually has aslow progression over decades after the initial diagnosis of diabetes.
And to give you anoverview of what happens, an insulin deficiency due to the diabetes resultshyperglycemia, which then causes hypertensionand kidney dysfunction. This kidney function isactually then further worsened by the hypertension. And ultimately, all of thisresultskidney failure, which can have very severeand potentially even
life threateningcompliions, such as anemia, electrolyte imbalances,such as metabolic acidosis, and heart arrhythmias. Now, before we dive into the mechanism of diabetic nephropathy, let'sbriefly the structure of the glomerulusthe kidney, by bringinga diagram here. So, the glomerulus isthe portion of the kidney
where blood is initially filtered. So blood enters the glomerulus over here, through this afferent arterial, and then leaves the glomerulus throughthe efferent arterial. And you can remember this, that it leaves throughthe efferent arterial for E for exit, or efferent. And while the blood iswithin the glomerulus,
there's this advanced filtration system, which we'll talk about morea minute. And the filtered fluidthat exits the blood is known as a filtrate and it collectsBowman's space before it enters into thetubules of the nephron where further reabsorptionand secretion occurs before it exits the kidneyinto the ureters as urine.