Dear Ann Landers,
am a 20- year-old male with a very embarrass-ing problem. It is also depressing be-cause I can't talk to anyone about it. Please don't tell me to go to my doctor because it is not medical. And I hope you won't suggest a shrink. Even though I know the problem is all in my head, I don't think it warrants psychi-atric treatment. I have what is commonly referred to as "a bashful kidney." I simply cannot urinate unless I have complete privacy. Is there anything I can do about this? Can I cure myself? I'd appreciate some advice. B.K. IN MINNESOTA

DEAR B.K.,
My consultants tell me that the harder you try, the more difficulty you'll have. Unless you can suddenly surprise yourself and relax, your best bet is to use a private stall and accept that which you cannot change. (P.S. There are worse things in life than not being able to urinate before an audience.) When the above letter and answer appeared in print I heard from several hundred males whose ages ranged from the early teens through the sev-enties, expressing relief that someone else in the world had the same prob-lem. I believe one of the most valuable aspects of my column is that it lets the person who has an embarrassing prob-lem know he isn't alone. Misery does, indeed, love company. Many men who wrote said they had "bashful kidneys" until World War II, Korea or Vietnam. "Circumstances," confessed a former corporal from Rochester, New York, "made it impos-sible for me to continue living with that hang-up. When I had no choice- the problem solved itself. Kidney Disease More than eight million Americans suffer from kidney and other diseases of the urinary tract. About 54,000 Americans die each year because of kidney disease, and more than 35,000 need the help of the kidney machine to stay alive. At least 8,000 patients are waiting for a kidney transplant but only ap-proximately 2,000 will receive one this year because of a shortage of suitable organ donors. The kidneys are two bean-shaped organs, each slightly larger than the palm of your hand. The vast majority of people have two kidneys, but ap-proximately one person in four thousand is born with only one. This need be no cause of concern since one healthy kidney can carry an individual through life. This, of course, is the reason doctors can remove a healthy kidney and transplant it to a person whose kidneys have failed. "Functioning kidneys (or their equivalent) are essential to survival. Bones can break, muscles can atrophy, glands can loaf, even the brain can go to sleep without immediate danger to survival, but should the kidneys fail, nei-ther bone, muscle, gland nor brain could carry on." So stated Dr. Homer W. Smith, of New York University, the foremost pioneer in kidney physiology. The function of the kidneys is to eliminate body waste which can be poi-sonous if retained. These wastes result from the burning of body fuel-just as gasoline in your car produces toxic fumes which must be eliminated by ex-haust. If for some reason there is failure of the exhaust system (in this case the kidneys) and the toxic products remain in the body, kidney failure occurs. A second function of the kidneys is to regulate the excretion of salt and water. In some instances, failure of the kidney to do this properly may result in retention of fluid, swelling of the ankles and marked bloating of the belly. In recent years it has become apparent that the kidney is not only a filter for the elimination of body poison but plays a major role in the regulation of blood pressure. Many doctors believe that most, if not all, high blood pres-sure problems involve failure of normal function of the kidney. In addition, the kidney is critically important in producing substances which control the formation of red blood cells and vitamin D. Many kinds of kidney disease, if discovered early, can be cured. These in-clude infection, birth defects of the kidney or bladder and obstruction by en-largement of the prostate in men, or by kidney stones in either sex. Pain and burning on urination or frequent small voidings, blood in the urine and difficulty in starting urination are all symptoms which should be quickly investigated by a doctor. The appearance of blood in the urine, which frequently may cause the urine to look "smoky" or "coffee-colored," may also be due to tumors of the kidney or occasionally to disease formally known as Bright's disease but more properly called nephritis. Nephritis is the inflammation of the kidney's filtering apparatus, and in some instances, this inflammation may create scarring, much the same as a scar that is left on the skin after an injury. However, in the case of the kid-ney, these little scars destroy the filters and if enough of them are destroyed, the result is kidney failure, and eventually uremic poisoning. This scarring ac-counts for two thirds of the cases of kidney failure. It is estimated that more than thirty thousand people die of this disease every year. One of the insidious forms of nephritis is called nephrosis or nephrotic syndrome. Here the filtering apparatus of the kidney becomes damaged so that protein leaks from the blood into the urine, thus decreasing the amount of protein in the blood. When this occurs, salt and water are retained and produce swelling. This is usually first noticed by puffiness of the eyes in the morning and later by swelling of the ankles as the day wears on. It is easily diagnosed by examination of the urine, which shows large amounts of pro-tein. Many kinds of nephrosis in the early stages are treatable. Another form of kidney disease which is treatable, or at least preventable, is caused by taking too many headache pills or pain-killers which contain phenacetin. Large amounts of aspirin and phenacetin taken over a period of years may cause kidney disease and kidney failure. At least seven hundred cases of this disease were reported in the United States last year. This kidney disease is particularly difficult to diagnose since it may give very little in the way of signs or symptoms even on examination of the urine until failure of the kidneys is already apparent. The problem of kidney failure is one which has become increasingly im-portant in the past twenty-five years since there are now specific methods for keeping the patient with kidney failure alive and well. Twenty-five years ago, kidney failure led to death. Today, however, the use of an artificial kidney machine or transplantation of the kidney can mean a useful, relatively normal life even in patients who have no kidney function whatever. The artificial kidney is perhaps the most widely used form of treatment. It can be utilized in the hospital or in ambulatory centers where people can walk in, be treated and go back to work or home. The machine can also be used at home if there is a co-operative relative or friend. In some instances, even the patient himself can be trained to use this machine. Although the treatment is expensive and must usually be done three times a week, a federal law passed in 1973 provided that anyone eligible for Social Security will have such treatment paid for with Medicare funds. At the present time, there are more than thirty thousand patients being treated with artificial kidneys. Transplantation of a normal kidney, however, is the treatment of choice when this is possible. The major problem is that transplanting a kidney from one individual to another is, in essence, transplanting a foreign substance. We know that if a bacteria such as typhoid is injected under the skin, the body of the person who receives the bacteria develops a response which rejects the bacteria. The same thing is true to a lesser extent of human kidneys when transplanted from one person to another. Some kidneys are more suitable for certain patients than others. For exam-ple, a kidney taken from a brother or sister does much better than a kidney from an unrelated person. Brother and sister transplants, for example, show a 95 percent survival for a two-year period. Many of these have survived for ten to twelve years. Our oldest survivor received a transplant from his brother and is now in his eighteenth year of survival and in good health. PRACTICAL HINTS ABOUT KIDNEY DISEASE "Floating kidney" is a medical myth. Kidneys do not float. A kidney that is loosely attached may drop when the patient stands up and may be cause for concern. Surgery to "tack the kidneys back up" may be performed but usu-ally this is not necessary. Pain from such kidneys is unusual although some patients who know they have "floating kidneys" may worry about it and imagine they have pain. Many patients are told that they have three kidneys and this may be dis-turbing. The common explanation is that one kidney is divided somewhat more than normal but only in rare instances does this create any difficulty. Infection of the urine may come from the kidneys or the bladder. In severe cases, high fever, chills and back pain may indicate a need for immediate in-vestigation. In many cases, the symptoms are burning on urination and fre-quency of urination. Many bladder infections are caused by bacteria getting into the bladder during sexual intercourse. Therefore, careful cleansing of the female genitals should be done before and after sexual relations. Bedwetting, particularly after the age of five, should be evaluated by a kid-ney specialist. Although most bedwetting is caused by emotional problems it is possible that there may be an organic problem. If there is an organic prob-lem it should be corrected promptly. Such problems not attended to may lead to total kidney failure in further adult life. "Foul-smelling urine" may mean simply that the normal urine is highly concentrated and therefore gives off a stronger odor and is of a darker color. On occasion, it may be due to the fact that the urine sample has been left out unrefrigerated and the bacteria have gone to work. Kidney stones remain a problem for both the doctor and the patient. In sit-uations where the kidney stone is formed in the kidney and remains there, the patient may have no symptoms and the stone is discovered on X-ray ex-amination. In other instances, blood in the urine may be a clue to the stone and frequently the passage of the stone from the kidney to the bladder may produce severe pain in the back and also in the groin. Many such stones are passed in the urine but others must be removed by surgery. What can one do to keep the kidneys in good condition? Prompt attention to symptoms of infection or obstruction may reveal preventable kidney dis-ease. Unfortunately, most forms of nephritis are not "curable" at the present time. However, more and more of these patients are being treated success-fully each year and many heal with no medical attention, particularly chil-dren. One important thing to remember about chronic nephritis is that good re-sults can be obtained if it is diagnosed and arrested before too much of the kidney has been destroyed. Thus, the patient whose kidneys have been 50 percent destroyed still has the equivalent of one normal kidney. A healthy life is perfectly compatible with one normal kidney. In the past few years, progress in medical science has been such that more and more of these cases are being successfully treated before they reach the stage of failure requiring transplantation or treatment with an artificial kidney. credit: John P. Merrill, M.D., Professor of Medicine, Harvard Medical School; Director of Kidney Section, Peter Bent Brigham Hospital. Dr. Merrill perfected the kidney machine in 1948 and did the first successful human dialysis in the United States. He also directed the team that performed the first successful kidney transplant in 1954. Kidney Donor Plan If you needed a kidney or other vital organ to live . . . would you be able to get one? This question can only be answered by first answering a number of other questions: What is the present status of organ transplantation? Advances in medical science now make it possible to replace a variety of malfunctioning human organs. For instance, since 1954 thousands of kidney transplants have taken place. Techniques for transplanting kidneys are cur-rently the most advanced, but progress is also being made in overcoming transplantation problems connected with the liver, pancreas, heart, bone and other tissue. How are organs for transplantation obtained? They are donated by individuals like yourself-with the donation going into effect at the time of death. Is there a need for organ donors? Yes. Thousands of lives every year are lost because there aren't enough donors of kidneys and other organs. A donated organ, successfully trans-planted, is literally the gift of life-your gift of life. How can I become a donor? Write to: National Kidney Foundation P. O. Box 353 New York, New York 10016 Is there an age requirement for donors? Yes. Anyone eighteen years of age or over and of sound mind may become a donor by signing the card. An individual under eighteen years of age may become a donor if either parent or legal guardian gives consent. Do I have to register with some agency? No. Your signed and witnessed donor card is all that is needed. Do I have to mention the organ donation in my will? No. Your donor card is a kind of "pocket will" and is all you need. Men-tion it in your will if you wish. But obviously it's important to carry the card and also inform your family and physician to ensure their co-operation. Can I change my mind later? Yes. Simply tear up the card. Nothing else is necessary. Can I be sure my gift will be used? Yes, if circumstances permit and the organ donation can be used to benefit the health and life of another person. When will my gift be used? For purposes of transplantation, organs must ordinarily be removed within an hour after death. According to the Uniform Anatomical Gift Act (the "model law" that governs such matters in the states), the physician in attend-ance has the responsibility for determing that life has ceased and that the donor's wishes may now be carried out. The Act specifies, however, that the physician attending the dying person should not participate either in the re-moval process or in transplantation. That's the job of the hospital and the transplant team. Will organ donation affect funeral and burial arrangements? No. Removal of organs or tissue authorized by the donor will not interfere with customary funeral or burial arrangements. If a person wills his body to a medical center for anatomical study (line "c" on the donor card), arrange-ments must be made in advance with the particular medical center. Will my estate be paid or have to pay for organ donation? No. What are the ethics of organ donation and transplantation? Moral leaders the world over favor such donations as expressions of the highest humanitarian ideals. The gift of an organ essential to the life of an-other human being is consistent with virtually all religious and ethical groups. If you have any question in this regard, consult your religious leader. What does the future hold? As the problem of organ rejection comes under better control and as tech-niques for tissue-typing and organ preservation are improved, kidney and other transplants will become increasingly feasible. Thus, thousands of peo-ple who might otherwise die will live. What else can I do to advance this life-preserving program? Acquaint others with the donor card program. The more donors available, the more this new and important medical advance can be used for the benefit of mankind. Learn more about organ donation. Your Kidney Foundation will be happy to give you more information and to provide donor cards. credit: National Kidney Foundation, 116 East 27th Street, New York, New York. Kissing HITTING A FUNNY NOTE