Change to Good Habits, One Step at a Time 

Exercise and Dialysis? Ideas from Chair 13

When Exercising as a Person on Dialysis, Does My Diet Change?

Prescription for Health: Medications to Treat Pain

Minding the Spirit of the Body

Announcements

Recipe: Sugar Cookies from My Grandma Lorena Rawles

Change to Good Habits, One Step at a Time
By Anastasia Korbit, Editor

Why does it seem to be so easy to develop bad habits and keep them then it is to start good habits and keep them? It could be that the bad habits seem more enjoyable. For some, sitting on a cozy couch watching a favorite show seems far more enjoyable than sweating during a workout! For some, eating a McBurger could certainly be more enjoyable than a bowl of fruit. Others find smoking far more enjoyable than a nicotine patch!

More than enjoyment, we get something even better from a bad habit, an immediate reward! This type of reward feels great at the time, but it’s often short-lived. For example, you may feel stress about an issue and the first thing you want to do is eat a big McBurger. So now you’ve packed on a gazillion calories, fat grams and your body is now full of all kinds of things you probably don’t need AND your problem is still staring you in the face! Whereas, if you had stress about an issue and went out for a walk to clear your head and come up with a plan to deal with your problem, it would have a longer term benefit for you than just eating a McBurger.

Don’t blame yourself. There are times we all engage in bad habits that are not in our best interest. We look for ways to get away from discomfort and move toward comfort, even if the reward is short-lived.

So why is it so difficult to develop good habits? Well, because change is hard and sometimes we get frustrated because we may have to try and try again before a good habit sticks. Also, there are times we want immediate comfort instead of discomfort and we look for quick fixes or we’re just not motivated to change. And sometimes when we want to form a good habit we get upset with ourselves when we don’t see immediate results or can’t find the magic bullet.

Change is never easy and bad habit breaking and good habit building is a process. Mark Twain said “Habit is habit, and not to be flung out of the window by any man, but coaxed downstairs a step at a time.” This quote suggests that habits need to be eliminated or developed one step at a time and the process will take time, so be patient.

In the end, change and developing good habits is an individual choice that others cannot do for us. Rats! See what I mean…no magic bullets. We can certainly look to others for support, such as a weight loss support group, but ultimately, we must do what we need for ourselves on our own.

Everyday, we have an opportunity to many chances to make a good choice for our health or a poor choice for our health (form a good or bad habit). What will you do? Will you always take the immediate reward, the McBurger route, or will you seek good habits as a process that takes time with rewards along the way? Ultimately, at WDI, we can provide you with the best information we have about that forming and maintaining good habits as a dialysis patient, but in the end, it really is up to you.

The goal of this edition of Pathways is to focus on the value of physical activity, ya know, one of those “good” habits many of us try to incorporate into our lives. Remember, one doesn’t build a good habit, by running a marathon, but by taking one step at a time.

Exercise and Dialysis? Ideas from Chair 13
By Randell Weinbrenner

After my last article related to the speaker I listened to on transplantation, everyone should know how important exercise is at every stage of life. Most of us think exercise means just physical, but as we get older and we face more and more challenges, exercise means considering all aspects of well-being which includes physical, mental and spiritual activity.

Starting with physical exercise, as we age some of us get the attitude that we cannot do a lot of thing and our bodies may not allow us to be as active as we would like, so we have to be creative.

When I was a kid, I grew up on a farm and work was our number one form of exercise and you know there never was a day we could say “I can’t find something to do.” Now days we’ve been spoiled by TV: Watching professional sports, entertainment and we forget we can still exercise, maybe not like the professionals, but we can do something!

The main exercise I do is walk. I walk as much as possible and at a fast pace. I like to ride a stationary bike in the winter months. What do you like to do?

Mental exercises are important to keep you sharp and it’s helpful to pass the time while you are on dialysis. A lot of people like to do crossword puzzles, word games and play cards. I grew up doing this and really enjoy a good euchre card game. Reading may not seem like exercise, but if you do it for pleasure and find things you enjoy reading, it can be very motivating and good for the mind. I like reading about history, especially World War I and II. Do you do any of these activities while on dialysis? If not, consider trying something new.

I mentioned spiritual exercise and this may be most important, no matter what you believe in. For me faith, if the belief there is a higher power or purpose.

This higher power can help me through a tough time. It gives me a good attitude. When I was younger I went to church every Sunday. I enjoyed it very much. This spiritual upbringing I feel was very important. Although I don’t attend church as often, I still read the Bible, pray and carry on what I think God would want me to do. What do you do to exercise your spiritual side?

So in summary, now that you’ve read my article I hope you enjoyed it and you get the idea of the importance of exercise. We’ve headed into late summer and fall; both are beautiful seasons to enjoy and to come up with a plan to exercise! Set up a program, talk with your doctor, dietitian or social worker and get started today.  Also, set a goal for yourself. My goal is to play baseball in the 65 and older league in Florida when I’m 65. What’s your goal?

When Exercising as a Person on Dialysis, Does My Diet Change?

The benefits of exercise are numerous. Some benefits include:

• assists in maintaining OR decreasing your weight
• helps muscles become stronger
• improves your levels of fats in your blood
• helps you feel more energetic

More specifically for you on dialysis, Vanderbilt conducted a study in 2007 showing exercise as a potential treatment for wasting syndrome directing more nutrients towards the muscles. In Greece, researchers have found exercise reduces restless leg syndrome symptoms improving quality of life. Furthermore in South Australia researchers have found exercise helps decrease serum phosphorus while also increasing the removal/clearance of a specific waste product urea. Lastly researchers have found for people with end stage renal failure who exercise, their red blood count significantly increased, providing more energy for daily activities.

With all these benefits, how can you afford NOT to exercise?  Nobody’s advocating a marathon here. In fact, the more specific findings associated with those on dialysis, were generally resistance type exercising three times weekly and under supervision. Start with simply becoming active. Start small, such as performing a household task, or exercising your arms and legs while seated for fifteen minutes, or parking your car further away from the front door of the store. Something is better than nothing! Begin with something that’s easy. It all starts with just ONE step or just ONE rotation of the arms. Keep at it. It’s easy to get bored and quit. Work in some variety to keep it interesting. Work towards a goal of something EVERY DAY for ten minutes working towards 45 minutes.

For you with diabetes, your diet may indeed change. Exercise increases your need for sugar for energy. A drop in blood sugar can occur up to 6-10 hours after an exercise activity. Check your blood sugar before and after exercising. After exercising if your blood sugar is below 100, eat a balanced meal. If it is between meal-time, eat a piece of fruit, graham crackers or one-half a sandwich. Eat a balanced meal later (refer to the box below).

Another tip for those of you with diabetes would be to check your blood sugar before bed time. If your blood sugar is less than 100, eat a bedtime snack such as a ½ bagel with cream cheese, cereal and milk, an apple, or a 1/2cup of cottage cheese to prevent low blood sugar during the night.

Other general diet tips include:

• select a wide variety of food from each group
• eat the suggested serving size
• choose high fiber foods, such as no salt pretzels, to create a feeling of fullness
• eat three meals daily; do not skip a meal
• attempt to eat all your recommended fruit and vegetables every day
• choose lean cuts of meat, poultry and fish, such as top sirloin, tenderloin, round, and ground round. Trim visible fat; remove skin from poultry
• limit foods high in fat, such as butter, mayonnaise, oils, even olive oil), desserts/pastries, and fried foods
• limit foods concentrated in simple sugars, such as regular soda pop, candy, and cakes.
• Hang in there! Remember to go slow and take baby steps.

Exercising may require more thought in planning of your dietary intake and checking blood sugars if diabetic, but the additional thought and planning required will be well worth it considering all the rewards and benefits exercise provides.

Prescription for Health: Medications to Treat Pain
By Kim Holdener

Do you ever wonder which pain medications are safe to take when you are on dialysis? This is a common question for people with kidney disease. Some medications are safer than others and depending on what type of pain you are experiencing (chronic pain or short term pain due to an injury) the answer can be different.

Acetaminophen (Tylenol) is the analgesic (pain medication) of choice in dialysis patients for short term pain such as pain due to an injury, headache, or muscle ache. Acetaminophen is available over-the-counter without a prescription. It does not harm the kidneys when used alone and at recommended doses. It is cleared by from the body by the liver, and therefore, should not be used by people with liver disease unless recommended by a physician. The maximum safe dose of acetaminophen is 4000 mg in a 24-hour period.

Other pain medications that can be bought over-the-counter are non-steroidal anti-inflammatory drugs (NSAIDs). Commonly used NSAIDs include ibuprofen (Motrin, Advil) and naproxen (Aleve). These medications can help reduce inflammation as well as relieve pain. They should not be used by people with kidney disease who have not yet started dialysis. People who are on dialysis may use NSAIDs with caution. NSAID medications can increase the risk of bleeding in people with kidney disease, may increase edema (swelling in the legs) and may increase blood pressure. Kidney disease patients who still make urine, especially those on peritoneal dialysis, should avoid NSAIDs because they may reduce the amount of urine that is made. NSAIDs should only be used for a limited time, for example 3 to 7 days.

For severe pain that can not be controlled with over-the-counter medications, narcotic pain medications would be the next option. Narcotic pain medications include oxycodone, codeine, hydrocodone, hydromorphone and morphine. Narcotic pain medications can be used in combination with acetaminophen or NSAIDs. Common examples of these combinations are acetaminophen with hydrocodone (Norco, Vicodin), acetaminophen with oxycodone (Percocet). Narcotic pain medications have more side effects than non-prescription pain medications. Side effects that can occur with narcotics are drowsiness, confusion, stomach upset, and constipation. Some narcotics are removed from the body by the kidneys and are not as safe for use in dialysis patients. All narcotics have the potential for dependence (addiction). Narcotic pain medications should always be used under the supervision of a physician.

People who have problems with long-term pain and need chronic pain medications should be under the care of a physician for their pain medications. Long-term use of pain medications, even non-prescription ones, can be associated with complications and should be monitored by a health care professional.

If you are having trouble with pain symptoms, whether they are short- or long-term pain, talk to your physician. There are many medications choices beyond what is discussed in this article. There are also non-medication methods of dealing with pain that may be appropriate for you, such as meditation or physical therapy. Everyone has the right to proper pain management.

Minding the Spirit of the Body
By Chaplain Penny Andrews

A colleague recently said that feelings are like the weather, there’s always something going on. That’s a pretty intriguing thought. After testing it out for a couple of days, it appears to ring true. In other words, whether you’re doing a crossword puzzle, having a conversation with a friend, or gardening, if you stopped yourself in the middle of any activity  and asked ‘what am l feeling right now?’ something would  come to mind. You might say, ‘calm, anxious, happy, sad’ or some other feeling, but something would come forward.

Our bodies seem to work like that, also. Our bodies are often communicating with us, only it is often below our ‘radar’ if you will.

Are we high energy, low energy, no energy? Are we peaceful, ready to dance or fidgety?  Most of the time we ignore these cues, but what probably would be a health benefit is to listen to our body’s wisdom and pay attention by following the lead.

The cues may be subtle at first. It takes a lot for most folks to stabilize, after being on the dialysis machine. But there comes a time, maybe after a rest, where there’s a little energy to work with. Body wisdom tells us to make the most of it.

For instance, if you like to watch TV in the evening to unwind, how about having a couple of 1 lb. dumbbells (or a can of Campbell soup)  near by to do some muscle flexes—especially if you can sense you have more energy than sitting in front of the TV requires.

Our body wants to move and sometimes we can engage our spirit to help us. Get going—not to the point of exhaustion, but to a point where our energy shifts. The amazing results in study after study, is that our body rewards us with a greater sense of well being when we utilize it to the extent we are capable.

Whatever stage of health and capability we find ourselves, we can do something. You will be strengthened when you use your spirit to strengthen your body.

Announcements

GOOD NEWS: A physical therapist, Laurie Barger, will be meeting with any patients who are interested in learning more about exercise during dialysis. She will help create a program just for you. Please let your social worker or dietitian know if you want to participate. More information to follow on the patient bulletin board!!

Nephrology Technician Week: WDI would like to recognize and thank the following Technicians: Jan, Jill, Mark, Sherri, Deb, Marcia, Kelly, Martha, Karen, Ashley, Dametra, Danielle, Cassandra, Paula, Lindsey, Gloria, Aleacia, Samantha, David and Cheryl.

Believe it or not: It’s time to think about the holiday season. If you or your family need a little assistance over the holidays, please call United Way at 211, yes only dial 211. A volunteer will get you the information you need.

VOTE: Don’t forget to exercise your right to vote on Tuesday November 4th. The patient bulletin board will feature information about voting, but if you have any questions ask your social worker.

Recipe: Sugar Cookies from My Grandma Lorena Rawles

Ingredients:

• 2/3 c. shortening
• 1/2 c. sugar
• ½ t. orange peel (optional)
• ½-1 t. vanilla
• 1 egg (beaten well)
• 4 t. milk
• 2 cups all purpose flour (sifted)
• 1 ½ t. baking powder
• ¼ t salt (optional)

Directions: Preheat oven to 375 degrees. Cream together shortening, sugar, orange peel and vanilla. Add egg and mix thoroughly. Sift together flour, baking powder and salt. Combine flour mixture with liquids. Chill one hour. Knead on a flour board. Roll to 1/8-inch thickness. Cut into desired shapes. Bake on a prepared cookie sheet for 6-8 minutes.