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From The Director's Chair
Social Work at Your Service: Sailing Your Own Ship
One Year of EASIER
WDI News
You Did It!
Kidney Friendly Eating for the Holidays
Access to Dialysis: What is the Transonic?
Life…a challenge, an adventure
From The Director's Chair
Obesity - Why it is even more of a risk for you as a patient on dialysis.
Paul S. Kellerman, MD
As you all know from news on television, in magazines and newspapers, there is an epidemic of obesity in the United States. We define whether we are overweight using a term called the Body Mass Index, or BMI, which looks at your weight proportional to your height. A person is considered to be overweight if the BMI is between 25 and 30, and obese if the BMI is over 30.
In 1960, it was estimated that 13 percent of adults were obese. Now the figure is 22 percent, with 60 percent considered overweight. This is acknowledged as the most important public health threat in the U.S. today. Our eating habits have changed over the last 40 years in terms of both what we eat and how much we eat (notice the term “Supersize” has only been around the last 10-15 years).
Recognizing this health threat, for adults, restaurants are routinely providing healthy meal alternatives. In addition, there are now measures being taken in the school systems across the nation to provide healthy alternatives to high fat foods, because in 1960, only 5 percent of children were overweight, whereas now, 11 percent are overweight.
Specific to kidney patients, we nephrologists feel that the epidemic of end-stage kidney disease requiring dialysis is due to large numbers of people developing diabetes and high blood pressure, which in turn is primarily due to increasing numbers of people who are overweight. But now that you’re on dialysis, does it matter if you’re overweight?
It really does matter for you, even more than someone who does not have kidney failure, for the following reasons.
First, as described in a previous newsletter, vascular disease (heart attacks, strokes, and circulation problems) is much more common in dialysis patients, due to high blood pressure, high blood lipids, calcium and phosphorus abnormalities, diabetes if present and the kidney failure itself. We know that obesity contributes significantly to lipid abnormalities, high blood pressure, and diabetes.
Second, obesity limits your chances for transplantation. People who are significantly overweight have increased problems with rejection of a kidney transplant, as well as surgical complications such as infection of the wound.
Weight loss is very difficult, a fact to which I can personally attest. The good news is that your prescribed diet on dialysis will help you lose weight, since it is high in protein and thus lower in fat. But weight loss does not occur by dieting alone. It also requires exercise to burn calories.
If you are overweight, losing weight will result in improved control of your diabetes if you are diabetic, improvement in your blood lipids, and possibly improvement in your blood pressure as well, all which will significantly reduce your chances of developing or worsening vascular disease. If you are overweight and considering a transplant, losing weight will result in less chance of rejection of the kidney transplant, and less surgical complications.
Our dietitians, Ann and Fran, are your key resources to weight loss. They not only can counsel you on a healthy weight loss diet while on dialysis, but have been instrumental in developing the exercise and activity program for Wisconsin Dialysis patients. Please ask them how you can lose weight if you are overweight.
Social Work at Your Service: Sailing Your Own Ship
Anastasia Korbitz, LCSW
I once worked with a nephrologist, who told his patients in a most affectionate way, “When it comes to your body, you are the captain of your own ship.” This means that each person has the right and responsibility, when capable, to make his or her own decisions about their body.
Being the captain of one’s own ship requires a lot of responsibility however. You will be required to chart your coarse, sail over choppy or calm waters and anchor when needed. Since you are likely to know what it is best for you and your ship, it’s a good idea to let other’s know your thoughts and give them the ability to help if your ship ever capsized.
There are three questions you need to answer when captaining your ship. First, how will medical professionals know what is wrong with my ship and how to make repairs? Second, how will I, as chief and captain of my ship, keep track of repairs? Finally, how will I let others know how I want my ship sailed if I can’t be the captain?
Letting the pros know
There are many ways that emergency personnel can determine what is wrong with you. You may have signs and symptoms, medical tests can be performed, or an assessment can be conducted. However, there is one thing you can do to help emergency personnel and that is to wear medic-alert jewelry.
Medic-alert jewelry is quite helpful as it contains important medical information specific to you. You can include such information as allergies, your dialysis access, and current medical conditions. A medic- alert bracelet or necklace can be ordered through most pharmacies, and although, would cost you some green, will be worth its weight in gold to anyone trying to help you.
If you are a dialysis patient, you can have one ordered free of charge through the National Kidney Foundation. Talk with your social worker. Finally, there are several web site options for ordering medic-alert jewelry such as www.laurenshope.com.
Keeping Track of Repairs
As captain, you will want to keep track of how your ship sails. You can do this by keeping a Captain’s Log or a medical journal, as the case may be. This log will help you keep track of the surgeries and procedures you have had done, along with the results, and your current medications and immunizations. It’s a handy tool for travel, when visiting your physician, and to help you keep it all straight. Look at the table below for some suggestions on how to set up and what to include in your Captain’s Log.
The End of Your Journey
No one likes to think about it, but our ship will see its final sunset at some point on the horizon. We don’t know when, but when it is finally time to retire your ship, it would be helpful to have some control as to who will steer your ship if you can’t.
A Power of Attorney for Health Care (POA) is one way you can assign agents, or co-captains. With a POA, your agent, would be in the position to help make decisions regarding your health care if the time ever comes that you cannot. These decisions would be anything from placement in care facilities to end of life decisions.
Most importantly, your agents would be carrying out your wishes. Also, give some thought about organ donation. As you know there is a shortage of organs available for those who need them. Would you like to donate the ships engine if you no longer need it? If you are interested in learning more details about completing a Power of Attorney for Health make a point of visiting with your dialysis social worker.
I hope you found this information helpful, and as said in the old naval blessing “May you always have fair winds and following seas.”
Captain’s Log
Name: Mr. I. M. Captain
Address: 1234 Ocean Cove, The Atlantic
Conditions: CKD, hemodialysis
Medication: Tums
Allergies: Eggs, Pennicillin
Emergency Contact: Ms. Polly Wana Crackr
Physician: Manover Board, MD
Date Event
6/01/04 Confirms CKD diagnosis
6/10/04 Placement of access
7/15/05 Started Dialysis
*I have a power of attorney for health care
One Year of EASIER
By Jan Schuh, RN BSN CNN
Our kidney support group, EASIER (Education and Support: Information EnRiches) has now been active for a year! We have dealt with a variety of topics and issues and the patients that have attended report that these meetings have been helpful and meaningful. Please refer to the listing below for a quick glance of all EASIER has accomplished over the past year.
I am fortunate to have several staff at WDI helping me with the meetings and selecting speakers, Helen Rugowski, Ann Mader, Penny Andrews (they have also been speakers too) and Fran Kittel. I would like to take opportunity to thank our physicians who have been speakers, Dr. Chris Hall, Dr. Millie Samaniego, and Dr. Shalin Sanghvi.
There is a faithful group of patients who always attend, but I would like to see the program help even more of you! Now, I would like to hear from all of the patients and families. What other topics would you like to talk about? What would make it EASIER for you to attend? We hope to keep EASIER going in the future, so please join us and find out ways that you can make your life a bit EASIER too!
Making Life EASIER through support
And Learning with others
October 2004: 3 Faces of Well-Being
November 2004: Jazz Up the Holidays
December 2004: Communication
January 2005: Communication II
February 2005: Diabetes
March 2005: Live Long & Live Well
April 2005: Let’s Talk Transplant
May 2005: Gear Up For Exercise
June 2005: 4 Directions for Longevity
July 2005: 4 Directions for Longevity II
August 2005: Keep Your Heart Healthy
September 2005: Taking Shape
October 2005: Quiz the Nurse & Doctor
WDI News
It's Coming! Medicare Part D
Helen Rugowski, MSSW
We make a living by what we get.
We make a life by what we give.
-Winston Churchill
“To live with a chronic illness is not a limitation but a special invitation to those who are willing to accept the challenge.”
-Shad Ireland
- Contact the Salvation Army “Christmas Assistance Line”. If you are interested in getting gifts for your children or food for your family on the holidays call 250-2245. Registration for gifts and food begins on Monday October 24th at 9 am. Register Early as quantities may be limited.
- WDI recently celebrated Nephrology Technician Week. WDI would like to recognize the contributions of Jan GV, Jill, Mark, Sherri, Deb, Pam, Marcia, Kelly, Emily, Heather, Molly, Eric, Martha, Karen, Cheyenne and our newest tech Elizabeth. Your hard work and dedication is much appreciated by staff, patients and families.
- Legislative News: What are they up to on the Hill? Have you ever wondered what goes in the Legislature as it relates to your dialysis? Well, a new bill was introduced in Congress by Rep. Jim McDermott (D-WA). The name of the bill is Kidney Patient More Frequent Dialysis Quality Act of 2005. This bill hopes to provide more reimbursement for people who require dialysis more frequently. If approved the bill would allow Medicare to pay for up to 5 hemodialysis treatments for qualifying patients. Currently, Medicare only pays for 3 hemodialysis treatments per week. The nephrologists would determine which patients would need and benefit from more than the standard 3 treatments per week. Many patients who have more frequent dialysis experience an increase in overall health.
You Did It!
Ann Mader, Dietitian
Thirty of you completed the annual exercise program, Congratulations! You all did a great job! In recognition of those who accomplished their exercise and activity goals a special celebration was held.
The banquet was held at the Park Ponderosa in McFarland on September 8, 2005. Fifteen of the 30 participants attended the event and almost everyone brought a guest. The evening started with trips to the buffet. John Hensey, WDI Administrator, kicked off the event with a warm welcome, Chaplain Penny Andrews presented an inspirational blessing and Maureen Wakeen, NP introduced our special speaker, Dr Tom Pintar.
Dr Pintar, a former nephrology fellow from UW who now practices in Fort Wayne, Indiana, presented his achievements as an Iron Man competitor and his connection with the Shad Ireland Foundation. Dr Pintar has worked with and raised money on behalf the Shad Ireland Foundation because the money raised is put toward fitness grants for dialysis patients who want to excel in becoming more active.
Finally, Fran Kittell and Ann Mader presented participants with their certificates of accomplishments and gift cards (proceeds provided by Amgen). It was a wonderful, inspirational evening and we are planning to continue the program annually.
Look for information in the spring of 2006 for our third annual summer Exercise and Activity Program. This program is a great way to begin working exercise and activity into your daily life through the use of individualized activity plans and logging of personal progress. The program runs from June to September.
Kidney Friendly Eating for the Holidays
Kristi Wenzel, Dietetic Intern
with Fran Kittell, RD, MS
Worried about the upcoming holidays? As the holidays approach, do you begin to panic about all of the food that will be presented to you? Get that out of control feeling? Nuts, dried fruit, chocolate, Ugh! Well, you are not alone. Many holiday parties seem to revolve around food, but enjoying the holidays while maintaining control over your diet can be done by following some simple strategies that will appear later in this article.
It can be difficult to feel satisfied when you need to watch what you are eating. At this point, it can appear as if all of your friends and family are eating everything placed on the table. There is no need for you to feel deprived in this situation. Eat more of the allowed kidney friendly foods. Enjoy smaller portions of foods that may be higher in salt, potassium, or phosphorus. This way you will still get to taste everything.
Cravings are defined as having an intense desire for something. Many people experience cravings related to food, especially foods that they like but know they should avoid. It is important to satisfy your craving or you will desire it more. Don’t deny yourself a food when you are craving it. Satisfy your craving by eating a smaller portion of that food. This can help prevent overindulging later.
Don’t panic if you fall off of the holiday eating wagon. Everyone slips once in awhile and overindulges. If you do overeat at one meal, conserve your intake for the rest of the day. Go for a walk or exercise to work off some of those extra calories. There is always tomorrow. Begin with a clean slate the next day.
Strategies to Help You Stick to Your Diet
- Call the host of the party to see what they will be serving ahead of time. This will allow time for you to plan the foods you will be able to eat when you arrive.
- Make a dish that you know you can eat and take it with you as a dish to pass.
- Save up some of your fluid allowance so you can enjoy a beverage at the party.
- If you know you will eat a lot at the party, eat less for the rest of the day.
- Munch on healthy appetizers such as veggies instead of chocolate, dried fruits, salty chips, and nuts.
Some Tips for the Big Meal
- Avoid salty foods.
- Choose fresh, unprocessed meats (turkey, chicken, beef, or pork).
- Avoid ham and self-basting turkey as they are high in sodium.
- Substitute rice or stuffing for potatoes.
- Fruit pies are lower in potassium than pumpkin, pecan, and chocolate.
Don’t forget to ask your dietitian for kidney friendly foods that are safe for your needs.
Kidney Safe Recipes: Clip and Keep
Homemade Gravy
Roast turkey drippings
1 1/2 tablespoons of cornstarch
1/2 cup cold water
Mix the 1/2 cup cold water with the cornstarch until all lumps are gone. Add enough water to the meat drippings to equal 1 1/2 cups. Place meat drippings in a saucepan and gradually stir in the cornstarch mixture. Cook over low heat until mixture comes to a boil and is thickened. Season with onion, celery, pepper, and sage.
Sour Cream Pound Cake
1 cup butter
2 3/4 cups sugar
5 eggs
3 cups flour
1/4 teaspoon baking soda
1 cup sour cream
1 teaspoon vanilla
1 teaspoon grated lemon or orange rind
Preheat oven to 350 degrees Fahrenheit. Spray a bundt or tube pan with cooking spray. Cream the butter and sugar. Add the eggs, sour cream, and vanilla. Combine the flour and baking soda and gradually add to the mixture. When all ingredients are combined, stir in the grated lemon or orange rind. Pour into greased pan and bake for 1 hour and 20 minutes.
Access to Dialysis: What is the Transonic?
Martha Buettner, PCT
Perhaps you’ve wondered what I am doing dragging around a lap top on wheels throughout the dialysis clinic. It is actually a Transonic Testing system that screens your vascular access (your fistula or graft) during your dialysis treatment.
With the test we get an instant “snapshot” of the amount of blood flow going through your access. We can now spot problems before the access is clotted or lost, giving you time to be examined, investigate the access and decide on a treatment plan. This also gives you time to be able to make an appointment – instead of having to go directly to the ER for an emergent declotting.
If Transonic tests detect a decrease in vascular access flow over time, it signifies that a stenosis (narrowing) may be forming. This can then be corrected to extend the life of your vascular access. The tests screen your vascular access so problems can be caught early. The test is simple and painless! They take about 10 to 15 minutes and produce immediate results.
First I clip a pair of sensors onto the dialysis lines. A small amount of saline is then released. This tests if any blood from the dialyzer recirculates through the arterial line to be dialyzed again. We’re looking for 0 percent recirculation.
Next I switch the dialysis lines and release another small amount of saline. This time the monitor tells how much blood is flowing through your graft or fistula. Your nephrologist uses this information to keep track of the health of your access and keep surgery to an absolute minimum.
We monitor the access flow rates (AFR) once a month. If the AFR is below 600 ml/min. or if the AFR decreases by more than 25 percent over four months – we will refer you for evaluation. OK – this part may not be totally painless, but we’re talking about your access here…your lifeline!
Information is power. The more information we give to you, our dialysis patients, the more empowered you can be to take care of yourselves and, particularly, to take care of your access. You are the owner of your access, and if you are armed with the correct information, you can be proactive in the care of your access.
Maya Angelou was asked what she has learned from growing older and this is what she said...
“I’ve learned that no matter what happens, or how it seems today, life does go on, and it will be better tomorrow.”
“I’ve learned that you can tell a lot about a person by the way he or she handles these three things” a rainy day, lost luggage and tangled Christmas tree lights.”
“I’ve learned that regardless of your relationship with your parents you’ll miss them when they are gone from your life.”
“I’ve learned that life sometimes gives you a second chance.”
“I’ve learned that you shouldn’t go through life with a catcher’s mitt on both hands; you need to be able to throw some things back.”
“I’ve learned that whenever I decide something with an open heart, I usually make the right decision.”
“I’ve learned that even when I have pains, I don’t have to be one.”
“I’ve learned that everyday you should reach out and touch someone. People love a warm hug, or just a friendly pat on the back.”
“I’ve learned that I still have a lot to learn.”
I’ve learned that people will forget what you said, people will forget what you did, but people will never forget how you made them feel.”
Life…a challenge, an adventure
Chaplain Penny Andrews
Helen Keller said, “Life is a daring adventure or nothing at all.”
Having an illness like kidney disease is a major challenge. It also offers us a journey to self-discovery: teaching us humbling aspects like limitations and vulnerabilities, but also those aspects that are our deepest strengths and places of resilience. In my world we talk about the fact that often people become strongest where they have been most vulnerable.
Martin Luther King, Jr. has said, take the first step in faith…you don’t need to see the whole staircase, but you need to take the first step. When we start any venture towards greater well-being, we take that first step.
And taking that first step is about creating a new kind of relationship with yourself–One that acknowledges the challenges, but at the same time builds on the faith that something good can come of that step.
Let us give thanks for this life that gives us the spirit to be resilient.
Let us give thanks for the will power to make healthy choices.
Let us give thanks for the medical world that makes lives better.
Let us find ways to celebrate the triumph of the body mind and spirit by our willingness to bring forward new steps towards well-being in our lives.
May our lives take up Helen Keller’s challenge, for she understood quite well the nature of challenge. Let our lives be reflections of adventure and faith in our steps ahead.
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