Friday, 27 January 2012

Renal Diet: Day 5

It's my last day on the renal diet....I MADE IT!! (barely!)  It was not an easy week...and I have to admit that I cheated today and had whole wheat bread.  My colon was begging me for some fibre!   

I also went out for dinner last night for a friend's birthday, and the birthday girl decided on Chinese food.  Since I have been depriving myself of fluid and feel quite dehydrated, I had an extremely difficult time controlling my thirst after our salt-laden Asian meal.  Actually, I went home must have drank a litre of water!  I'm positive that if I were a dialysis patient, I would be fluid overloaded right now!

This week has been an eye-opener.  My colleagues and I realized just how difficult it is to change life-long habits, and we only changed one small aspect of our lives.  Our patients on dialysis have so many more changes they have to face - being on a machine 4 times a week, taking an abundance of medications at different times of the day, limiting their favourite foods, not travelling as they please, not being able to work....the list could go on and on. 

I'm really proud of all of our colleagues that completed this challenge with us and blogged regularly on their experiences.  I'm even more proud of my dialysis patients, who do this each and every day and still manage to keep it together and keep a smile on their face.  When I drink my wine and eat my chocolate tonight, I will be toasting to their discipline as individuals.  More importantly, I really feel I'll remember this experience, and be a more empathetic health professional when I counsel my patients from this day forward.    - Arti 
Thank goodness, it is Friday! Two more renal meals to go then I can go back to my “usual diet”.  This is something that our renal patients are not able to say or do.  For me, the most difficult part of this whole experience was not carrying out the diet since I am well aware of the ins and outs of the renal diet.  I had a hard time trying to balance cooking meal for the family and cooking for myself.  If felt like I am in the kitchen all the time! 

This whole experience has made me even more empathetic towards patients who have family to take care of and at the same time finding the time to take care of their needs. It definitely is not an easy task let alone it is a life long task! 


Fruit Explosion blew up on me!

Ok, this morning I was STARVING. The calories and carbs and lack of satiating fibre etc. must be having it's impact on me. I gave in to my craving and went to Tim Horton's in the hospital lobby (after all, I see my patients there all the time). I chose a fruit explosion muffin. Seemed reasonable, no fibre, I saw blueberries in it, must be low K and at least sort-of low phosphate. I was actually a bit embarrassed walking through the lobby with my paper bag. Everyone surely must know there was a muffin in there...something I would normally not indulge in - all that fat and sugar! Sitting in my office afterwards, I am informed by my Arti that the muffins at Tim's have phosphate additives in them. In fact, pretty much everything at Tim's has phosphate additives - even the cream for the coffee!  There is only one food at Tim Horton's that Arti says I could have had - a plain bagel with cream cheese. My coffee was ok because I used just a bit of milk in it - no additives in that.
Good grief! This is one of the easiest, most accessible places for our patients to grab a snack or meal pre or post dialysis.
I have learned so much this week about how much I value my freedom to choose my food based on my likes and wants - and not based on what I am being told is a must-do because I have an illness that requires it. If nothing else, I am more empathetic. And more concerned for the patients - and more aware of how their dietary restrictions must burden them on top of the burden of coming to dialysis 3 times a week. Will it change my bedside practices? Maybe. Maybe I will be more accepting and understanding of the values that I see on routine blood reviews that are done in the unit. Given the fact that there is no solid evidence as to what phosphate value we should be targeting in our hemodialysis patients, we really don't know if 1.5 is better than 1.7. Maybe quality of life - achieved through a slightly more liberal dietary intake - is more important to patients. And that is something that I learned to appreciate this week. Arti, thanks for jumping on my weak suggestion that we should do this and actually ensuring that we did. Ann, Carol, Roshina, Julie Ann, and Jeff, thanks for joining in the fun.
I for one am really looking forward to my weekend of liberation!


Thursday, 26 January 2012

Renal Diet: Day 4

On a positive the midst of trying to find kidney-friendly snacks (which we know is quite the challenge)...I've re-kindled my love with popcorn!  I found this ?"organic" brand which is lower in sodium and absolutely delicious.  I've shared a bag with my work colleague for the last two days....and can't wait to pop another one this afternoon! : )   I imagine my love affair with popcorn, will get old pretty fast, but I am thoroughly enjoying it at the moment!

Tonight, I am planning to go out with dinner with some friends.  I am already dreading how I will manage this, while still enjoying my dinner.   I've referred to a great website for people with chronic kidney disease, to try to get some helpful hints on dining out. (The link is below).  Will keep you posted on how it goes....     - Arti

Day 3 on Tums

We all know by now that I like taking my Tums...but I intentionally skipped my dinner dose on day 3.  Why? Because I was annoyed with having to carry a bottle of Tums in my purse, to and from work.  I left the bottle in my office.  Maybe I'll use a plastic baggie to carry around a small mobile supply.  

I approached a patient today to discuss his high phosphate and lack of compliance with binders.  He seemed embarrassed and admitted that he often forgets his Tums.  I tried to suggest ways of remembering to take binders but could tell that he felt I was lecturing him.  I tried a new approach - told him about my Tums challenge and suddenly he seemed to be paying more attention to what I was saying.  He seemed to take my advice more seriously when he realized I was speaking from experience and was also struggling to take my Tums regularly.  This phenomenon can be observed in the waiting rooms, where patients often exchange medical advice, often contradictory to what our team of experts has recommended.  As far as they're concerned, you're not an expert until you've lived through it.



I avoided my usual half sandwich for breakfast for the past 2 days because I didn't want to face the mint of TUMS XS in the a.m. A hot drink sufficed.  Made me wonder how many of our patients do the same. I pulled myself up by the bootstraps this morning, and now again while having lunch, to embrace the cool mint sensation of the TUMS long after it dissolved. May I say that I've also noticed a change in my GI motility. Therefore, I've ramped up my dietary fibre.

Do what you have to do to stay as healthy as possible...

Wednesday, 25 January 2012

Double Whammy

This renal diet is pretty tough - but what if I were also diabetic? What if my cause of End Stage Renal Failure was.....Type 2 Diabetes? All too real a possibility, especially in North America - about 40% of our patients on dialysis are there because of complications of diabetes - mainly Type 2. That would make this even more difficult. Many of my acceptable options for low phosphorus/low potassium snacks are high calorie - cookies, jelly beans, fruit loops.I feel like I would not even know where to start!
Maybe some of what we are struggling with this week is the transition from our routines to a new way of thinking and planning meals. And this is why we have dietitians on our teams - to assist in teaching and coaching patients through these learning curves. I am appreciating our dietitian colleagues more and more this week.

Arti showed me a great app that would be useful for patients to use when planning meals on a renal diet if they had a mobile device.