“Down, Down, Down”: The Slow Decline No One Explains

Opening on the hidden meaning of decline 0:00

A while ago, someone described their A while ago, someone described their decline to me decline to me decline to me >> [music] >> [music] >> [music] >> using three words said slowly, almost >> using three words said slowly, almost >> using three words said slowly, almost like a heartbeat. [music] They said, "He like a heartbeat. [music] They said, "He like a heartbeat. [music] They said, "He went down, down, down." Three downs, and went down, down, down." Three downs, and went down, down, down." Three downs, and in those three words was an entire lost in those three words was an entire lost in those three words was an entire lost year, maybe more.

year, maybe more. year, maybe more. The slow leak of someone's energy, The slow leak of someone's energy, The slow leak of someone's energy, their work, their ability to walk their work, their ability to walk their work, their ability to walk outside and feel like themselves. outside and feel like themselves. outside and feel like themselves. >> Welcome to [music] Wellness Focus with

Show introduction and mission 0:30

>> Welcome to [music] Wellness Focus with >> Welcome to [music] Wellness Focus with Dr. Bisma. I'm Dr. Bisma Irfan, a Dr. Bisma. I'm Dr. Bisma Irfan, a Dr. Bisma. I'm Dr. Bisma Irfan, a physician on a mission [music] to help physician on a mission [music] to help physician on a mission [music] to help you break free from symptom management you break free from symptom management you break free from symptom management and step into a life of [music] thriving and step into a life of [music] thriving and step into a life of [music] thriving health.

health. health. Together, we will uncover simple, Together, we will uncover simple, Together, we will uncover simple, powerful ways to [music] prevent powerful ways to [music] prevent powerful ways to [music] prevent disease, restore energy, and take disease, restore energy, and take disease, restore energy, and take control of your health naturally. Your control of your health naturally. Your control of your health naturally. Your prescription for vitality [music] starts prescription for vitality [music] starts prescription for vitality [music] starts now.

Slow decline and missed warning signs 0:56

>> Here's what I want [music] to ask you. >> Here's what I want [music] to ask you. Have you ever looked back over the last Have you ever looked back over the last Have you ever looked back over the last couple of years and realized couple of years and realized couple of years and realized >> [music] >> [music] >> [music] >> you can't quite point to the day things >> you can't quite point to the day things >> you can't quite point to the day things changed? There was no dramatic event, no changed? There was no dramatic event, no changed? There was no dramatic event, no single diagnosis that explained it, just single diagnosis that explained it, just single diagnosis that explained it, just a slow fading, [music] a slow fading, [music] a slow fading, [music] a little less energy this month than a little less energy this month than a little less energy this month than last, a little more effort to do the last, a little more effort to do the last, a little more effort to do the things that used to be easy.

things that used to be easy. things that used to be easy. >> [music] >> [music] >> [music] >> And when you mentioned it, did anyone >> And when you mentioned it, did anyone >> And when you mentioned it, did anyone treat it like the clue [music] it treat it like the clue [music] it treat it like the clue [music] it actually was? Or did it get filed under actually was? Or did it get filed under actually was? Or did it get filed under stress, under [music] age, under let us stress, under [music] age, under let us stress, under [music] age, under let us keep an eye on it and wait? Because that keep an eye on it and wait? Because that keep an eye on it and wait? Because that phrase, "Let's [music] keep an eye on phrase, "Let's [music] keep an eye on phrase, "Let's [music] keep an eye on it," is one I think about a lot. We say it," is one I think about a lot. We say it," is one I think about a lot. We say it gently and we mean well by it, but it gently and we mean well by it, but it gently and we mean well by it, but for a lot of people, [music] keeping an for a lot of people, [music] keeping an for a lot of people, [music] keeping an eye on it becomes a year of watching eye on it becomes a year of watching eye on it becomes a year of watching something get worse without ever asking something get worse without ever asking something get worse without ever asking [music] [music] [music] why it started.

why it started. why it started. And with kidneys, the why matters And with kidneys, the why matters And with kidneys, the why matters enormously. enormously. enormously. Because the speed of decline is not

Why the cause of kidney decline matters 2:02

Because the speed of decline is not Because the speed of decline is not fixed. It is not destiny. It depends in fixed. It is not destiny. It depends in fixed. It is not destiny. It depends in large part on what's driving it. And if large part on what's driving it. And if large part on what's driving it. And if no one is looking for the driver, no one is looking for the driver, no one is looking for the driver, >> [music] >> [music] >> [music] >> no one can take their foot off the gas. >> no one can take their foot off the gas.

>> no one can take their foot off the gas. So, let me take you into the So, let me take you into the So, let me take you into the investigation because this is where it investigation because this is where it investigation because this is where it gets genuinely interesting. When I see a

Common drivers: infection and stress 2:22

gets genuinely interesting. When I see a gets genuinely interesting. When I see a slow decline, I'm not just asking, slow decline, I'm not just asking, slow decline, I'm not just asking, >> [music] >> [music] >> [music] >> "How far has it dropped?" I'm asking, >> "How far has it dropped?" I'm asking, >> "How far has it dropped?" I'm asking, "What changed in this person's life "What changed in this person's life "What changed in this person's life right before the drop began?" right before the drop began?"

right before the drop began?" And so often, when we trace it back And so often, when we trace it back And so often, when we trace it back together, [music] together, [music] together, [music] we land on one of a few quiet culprits. we land on one of a few quiet culprits. we land on one of a few quiet culprits. The first is infection, and not always a The first is infection, and not always a The first is infection, and not always a dramatic one. I [music] have seen the dramatic one. I [music] have seen the dramatic one. I [music] have seen the story start with a serious illness that story start with a serious illness that story start with a serious illness that a person seemed to recover from [music] a person seemed to recover from [music] a person seemed to recover from [music] on the surface, except their energy on the surface, except their energy on the surface, except their energy never came back.

never came back. never came back. They got better, and then they [music] They got better, and then they [music] They got better, and then they [music] just didn't. The infection passed, but just didn't. The infection passed, but just didn't. The infection passed, but it left the immune system in a state it left the immune system in a state it left the immune system in a state [music] of low-simmering [music] of low-simmering [music] of low-simmering activation. activation. activation. And that ongoing inflammation can And that ongoing inflammation can And that ongoing inflammation can quietly tax the kidneys over time.

quietly tax the kidneys over time. quietly tax the kidneys over time. From the outside, it looks like he's From the outside, it looks like he's From the outside, it looks like he's just tired since he was sick. [music] just tired since he was sick. [music] just tired since he was sick. [music] Underneath the system is still fighting Underneath the system is still fighting Underneath the system is still fighting a war officially ended months ago. a war officially ended months ago. a war officially ended months ago. The second culprit is stress, and I The second culprit is stress, and I The second culprit is stress, and I don't mean that in the soft, [music] don't mean that in the soft, [music] don't mean that in the soft, [music] hand-waving way the word usually gets hand-waving way the word usually gets hand-waving way the word usually gets used. I mean the psychological reality used. I mean the psychological reality used. I mean the psychological reality of a body that has been in survival mode of a body that has been in survival mode of a body that has been in survival mode for too long. A brutal move across the for too long. A brutal move across the for too long. A brutal move across the country, [music] country, [music] country, [music] a demanding new job with 12-hour days.

a demanding new job with 12-hour days. a demanding new job with 12-hour days. When the body perceives relentless When the body perceives relentless When the body perceives relentless threat, it [music] pours out stress threat, it [music] pours out stress threat, it [music] pours out stress hormones. That drives up blood pressure. hormones. That drives up blood pressure. hormones. That drives up blood pressure. It shifts how the kidneys handle fluid It shifts how the kidneys handle fluid It shifts how the kidneys handle fluid and filtration.

and filtration. and filtration. Stress isn't just in your mind. It lands Stress isn't just in your mind. It lands Stress isn't just in your mind. It lands in your arteries and [music] your in your arteries and [music] your in your arteries and [music] your kidneys. And the person living uh kidneys. And the person living uh kidneys. And the person living uh through a genuinely hard chapter of life through a genuinely hard chapter of life through a genuinely hard chapter of life can, without anyone realizing it, be can, without anyone realizing it, be can, without anyone realizing it, be accelerating a decline that everyone accelerating a decline that everyone accelerating a decline that everyone assumes [music] is just the disease assumes [music] is just the disease assumes [music] is just the disease progressing.

When well-intended efforts backfire 4:28

progressing. progressing. And here's the part that often surprises And here's the part that often surprises And here's the part that often surprises [music] people the most. Sometimes the [music] people the most. Sometimes the [music] people the most. Sometimes the decline is sped up [music] by things the decline is sped up [music] by things the decline is sped up [music] by things the person is doing to try to get healthy. person is doing to try to get healthy. person is doing to try to get healthy. I've seen someone pour themselves into a I've seen someone pour themselves into a I've seen someone pour themselves into a very restrictive [music] very restrictive [music] very restrictive [music] diet and a cabinet full of supplements diet and a cabinet full of supplements diet and a cabinet full of supplements with [music] the best intentions, with [music] the best intentions, with [music] the best intentions, genuinely trying to help themselves.

genuinely trying to help themselves. genuinely trying to help themselves. And unknowingly add a burden the kidneys And unknowingly add a burden the kidneys And unknowingly add a burden the kidneys [music] couldn't handle. [music] couldn't handle. [music] couldn't handle. This is the heartbreaking irony I see This is the heartbreaking irony I see This is the heartbreaking irony I see more than I would like. more than I would like. more than I would like. >> [music] >> [music] >> [music] >> Effort in the wrong direction, not >> Effort in the wrong direction, not >> Effort in the wrong direction, not because the person was careless, but because the person was careless, but because the person was careless, but because no one had told them that with because no one had told them that with because no one had told them that with kidney disease, the details [music] kidney disease, the details [music] kidney disease, the details [music] matter enormously.

matter enormously. matter enormously. And more is not always better, which And more is not always better, which And more is not always better, which brings me to [music] the turning point, brings me to [music] the turning point, brings me to [music] the turning point, the insight that changes how you see the insight that changes how you see the insight that changes how you see this whole thing.

Finding the real cause and changing the course 5:29

this whole thing. this whole thing. A slow decline is not a verdict. It is a A slow decline is not a verdict. It is a A slow decline is not a verdict. It is a question that hasn't been answered yet. question that hasn't been answered yet. question that hasn't been answered yet. Why is this happening and why now is not Why is this happening and why now is not Why is this happening and why now is not a philosophical question, it is a a philosophical question, it is a a philosophical question, it is a clinical one with real findable answers.

clinical one with real findable answers. clinical one with real findable answers. An infection that's still smoldering, a An infection that's still smoldering, a An infection that's still smoldering, a blood pressure pattern, blood pressure pattern, blood pressure pattern, >> [music] >> [music] >> [music] >> a source of inflammation, a stress lord, >> a source of inflammation, a stress lord, >> a source of inflammation, a stress lord, sometimes even [music] sometimes even [music] sometimes even [music] a well-meaning routine that's a well-meaning routine that's a well-meaning routine that's backfiring. And every one of those is backfiring. And every one of those is backfiring. And every one of those is something you can actually do something something you can actually do something something you can actually do something about.

about. about. I think about a moment that stays with I think about a moment that stays with I think about a moment that stays with me. me. me. A family member describing A family member describing A family member describing how just a month earlier their loved one how just a month earlier their loved one how just a month earlier their loved one couldn't come outside at all. couldn't come outside at all. couldn't come outside at all. >> [music] >> [music] >> [music] >> An hour of activity was the ceiling. And >> An hour of activity was the ceiling. And >> An hour of activity was the ceiling. And then he'd have to go back in because he then he'd have to go back in because he then he'd have to go back in because he felt so bad. And then after we found and felt so bad. And then after we found and felt so bad. And then after we found and addressed what was actually driving addressed what was actually driving addressed what was actually driving things, that same person was spending things, that same person was spending things, that same person was spending hours outside again, doing [music] hours outside again, doing [music] hours outside again, doing [music] ordinary life. Nobody framed that as a ordinary life. Nobody framed that as a ordinary life. Nobody framed that as a miracle. It wasn't. It was what happens miracle. It wasn't. It was what happens miracle. It wasn't. It was what happens when you stop only watching the decline when you stop only watching the decline when you stop only watching the decline and start asking, [music] and start asking, [music] and start asking, [music] "What's feeding it?"

"What's feeding it?" "What's feeding it?" A slower decline is not a verdict. It is A slower decline is not a verdict. It is A slower decline is not a verdict. It is a question that hasn't been answered a question that hasn't been answered a question that hasn't been answered yet. So, let me leave you with what you yet. So, let me leave you with what you yet. So, let me leave you with what you can actually [music] take from this. can actually [music] take from this. can actually [music] take from this. First, reconstruct your own timeline.

First, reconstruct your own timeline. First, reconstruct your own timeline. >> [music] >> [music] >> [music] >> Sit down and ask yourself honestly, >> Sit down and ask yourself honestly, >> Sit down and ask yourself honestly, "When did I start feeling different? "When did I start feeling different? "When did I start feeling different? What was happening in my life around What was happening in my life around What was happening in my life around [music] then?" [music] then?" [music] then?" An illness, a move, a loss, a season of

Practical takeaways: timeline, why now, and precision care 7:20

An illness, a move, a loss, a season of An illness, a move, a loss, a season of relentless pressure? relentless pressure? relentless pressure? That timeline is some of the most That timeline is some of the most That timeline is some of the most valuable diagnostic information you can valuable diagnostic information you can valuable diagnostic information you can bring to bring to bring to >> [music] >> [music] >> [music] >> anyone trying to help you. >> anyone trying to help you. >> anyone trying to help you. And no test can generate that for you.

And no test can generate that for you. And no test can generate that for you. Only you hold it. Second, [music] Only you hold it. Second, [music] Only you hold it. Second, [music] treat why now as a real question that treat why now as a real question that treat why now as a real question that deserves a real answer. If the only plan deserves a real answer. If the only plan deserves a real answer. If the only plan offered to you is to monitor the numbers offered to you is to monitor the numbers offered to you is to monitor the numbers and wait, it's entirely reasonable to and wait, it's entirely reasonable to and wait, it's entirely reasonable to ask, but what is actually driving this ask, but what is actually driving this ask, but what is actually driving this [music] and are we looking?

[music] and are we looking? [music] and are we looking? Monitoring tells you the speed of the Monitoring tells you the speed of the Monitoring tells you the speed of the car. It doesn't tell you whose foot is car. It doesn't tell you whose foot is car. It doesn't tell you whose foot is on the pedal. on the pedal. on the pedal. And third, And third, And third, >> [music] >> [music] >> [music] >> be gentle with your effort you've >> be gentle with your effort you've >> be gentle with your effort you've already made.

already made. already made. If you have been trying hard to help If you have been trying hard to help If you have been trying hard to help yourself yourself yourself >> [music] >> [music] >> [music] >> and it hasn't worked, that is not a sign >> and it hasn't worked, that is not a sign >> and it hasn't worked, that is not a sign that you have failed. It's very often a that you have failed. It's very often a that you have failed. It's very often a sign that the plan was generic where sign that the plan was generic where sign that the plan was generic where your situation needed to be personal.

your situation needed to be personal. your situation needed to be personal. >> [music] >> [music] >> [music] >> What helps one person's kidneys and what >> What helps one person's kidneys and what >> What helps one person's kidneys and what helps yours can be genuinely different helps yours can be genuinely different helps yours can be genuinely different things because the root cause underneath things because the root cause underneath things because the root cause underneath can be genuinely different. The goal can be genuinely different. The goal can be genuinely different. The goal isn't to try harder, it's to aim more isn't to try harder, it's to aim more isn't to try harder, it's to aim more precisely. Here's what I keep coming precisely. Here's what I keep coming precisely. Here's what I keep coming back to.

back to. back to. Down, down, down is a story almost Down, down, down is a story almost Down, down, down is a story almost everyone tells as if it's a straight everyone tells as if it's a straight everyone tells as if it's a straight line with only one direction, but a line line with only one direction, but a line line with only one direction, but a line only keeps heading down if nothing only keeps heading down if nothing only keeps heading down if nothing interrupts it. interrupts it. interrupts it. The moment you find the why, The moment you find the why, The moment you find the why, the real driver underneath the decline, the real driver underneath the decline, the real driver underneath the decline, you change what's possible. Not always you change what's possible. Not always you change what's possible. Not always all the way back to where you started, all the way back to where you started, all the way back to where you started, but so much further than just keep an but so much further than just keep an but so much further than just keep an eye on it. If you are living with a eye on it. If you are living with a eye on it. If you are living with a decline that no one has fully explained decline that no one has fully explained decline that no one has fully explained to you and you want an approach that to you and you want an approach that to you and you want an approach that asks why it's happening rather than only asks why it's happening rather than only asks why it's happening rather than only how fast, you can learn more about our how fast, you can learn more about our how fast, you can learn more about our approach to precision nephrology where approach to precision nephrology where approach to precision nephrology where finding the root cause is the entire finding the root cause is the entire finding the root cause is the entire point. Whatever you choose, I hope you point. Whatever you choose, I hope you point. Whatever you choose, I hope you walk away from this with one thing.

walk away from this with one thing. walk away from this with one thing. The why is absolutely worth chasing. The why is absolutely worth chasing. The why is absolutely worth chasing. Thank you for being here and listening. Thank you for being here and listening. Thank you for being here and listening. I love you.