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! 

Carol

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!

Alison

Thursday 26 January 2012

Renal Diet: Day 4

On a positive note....in 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


http://www.davita.com/kidney-disease/diet-and-nutrition/lifestyle/dining-out-on-the-dialysis-diet/e/5336

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.

Roshina

Confession

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.

www.kidneydiet.com/index.htm

Alison

Renal Diet: Day 3

I'm halfway through my 3rd day of the renal diet. I have to say, I've gotten much better at planning out my meals in advance. Some of the highlights include a homemade zucchini bread with tea in the morning, and homemade chicken noodle soup for dinner and lunch today.   I've got a good menu for a week....but beyond that, I think this would get extremely repetitive.  


I feel that this challenge is definitely do-able for the week (not even - 5 days!)...but to think of being on this diet indefinitely is a bit unimaginable.  It would be so hard to give up my favourite foods indefinitely, and yet I hear so many of my patients say they haven't had a banana in years or they have cut out chocolate or cheese completely!  I am impressed with those patients, but not at all envious.  Occasional cheat days and 'treats' are important for ones sanity...I will be much more accepting of this with my patients from now on.      - Arti 

It's right in front of me, why do I overlook it??

Here I am on day 3... My container of TUMS is in front of me and 3/4 way through lunch I remembered that I didn't take it. I'm not going to beat myself up about it but appreciate that taking new medications requires a change in mindset, and an understanding of its importance...but I do understand why I should take it and why it's important. But oohh, that mindset, what a hurdle!!

If I were relatively new to dialysis faced with an avalanche of new information, it would probably take me a while (months) to get my bearings and sort things out. Also, the last thing I'd want to hear is a treatise on why I shouldn't miss my binder. Perhaps I'm still feeling a bit defensive about not taking the binder right away. Irrespective...ask me about how I'm managing/coping with being on dialysis, what supports/resources do I need in place, how's the family coping, talk about moving forward. Ann

Day 2 on Tums

I forgot my breakfast Tums again.  But did remember with lunch and dinner.  I must say, I almost LIKE taking the Tums...it has a refreshing taste and makes my mouth feel minty and clean.  Feels like I'm having a mint except I get the benefits of no heartburn and a bit of calcium supplementation, as well as phosphate binding (since I'm pretending to be on dialysis).  Bring on Day 3!

Roshina

Tuesday 24 January 2012

What I Miss the Most

Day 2 - (only day 2) ....and I find myself thinking alot about two things that are no-nos on a renal diet. One is chocolate (I like a square of 85% in the evening) and the other is nuts. And I am doing this diet challenge as an option. This is my choice. I wanted to know what the patients I care for are experiencing. Lucky me, I don't have to eat this way long term! I realize now that if you had to eat this renal diet because you suddenly found yourself on dialysis, that would really be pretty crappy. It's a whole big learning curve for one thing - and one that would also impact on your family unless you wanted to cook separate meals. I found myself discussing serum phosphorus levels today with a patient with a different perspective than last week. This week I realize it is just not that simple to make these dietary changes - even if it is "good for you" as a dialysis patient.
Aha moment of the day? I think if I ever needed dialysis, I would want to consider the daily nocturnal form - maximum clearance, minimum dietary restrictions.
Alison

Day 2 on binders

Today at lunch I switched to regular TUMS to see if it would make a difference... I took a couple from Ro. Although it was on the table in front of me, I was half way through the meal before realizing that I had not taken it. A near miss.

No probs with residual taste...the coolness of the mint in my throat is not bothersome...yet. I'm glad no dietary modifications, seems like a lot of planning. I'll see how dinner goes. Ann

Binder at dinner

I discovered with chewing the TUMS, I have a residual taste of  it in my mouth. TUMS gets trapped in my molars, hence the residual taste.(Is this t.m.i.?)
Ann

Day 1 on Tums

I have agreed to take Tums with meals - should be a piece of cake.  Forgot my breakfast dose, but was given a friendly reminder at lunch by our dietitian.  So I chewed my mint flavoured Tums at the beginning of lunch and expected to have the taste linger throughout the meal.  I found that the taste was gone after my first bite of food.  So far so good - I'm thinking this won't be much of a challenge. Except that I can't remember to take my Tums.  I missed my dinner dose...then indulged in a Tums-free bedtime snack.  Felt guilty before bed and packed a bottle of Tums in my purse so that I can stay on track tomorrow.

Roshina

Monday 23 January 2012

Reflections on Day 1

This was a tough day - I mean, I have tried changing my diet before, but this goes against so many things that I have always believed to be healthy. That has been a huge mind shift for me. For example, my usual snack mid morning is a handful (1 serving) of almonds. On a renal diet, my snack options (as provided to me today by my dietitian colleague in an ever-so-convenient handout...illustrations and all) might include:
- bread sticks
- unsalted pretzels (but the salt is the best part)
- sugar cookies (yikes- so much for satiety)
- pound cake (ditto)
-dry cereals - e.g. fruit loops, lucky charms, or cornflakes (aren't those for kids??)
Ok ,  I could also have a low potassium fruit (apple, berries, grapes)
or low potassium veggies (bell peppers, carrot sticks - but only 8!)

Lesson for today - this renal-friendly diet takes discipline and planning. And it's only day 1!

Alison

Day 1: On the renal diet

I've survived day one on a renal diet....barely!  It's a Monday, and I didn't do a great job of planning for the week....so I had to rely on a lot of purchased food.   I think I came pretty close to exceeding my sodium limit for the day.  Nonetheless...the food was pretty tasty!   Here's the breakdown:

Cinnamon raisin bagel with cream cheese for breakfast (566 mg of sodium)

A romaine salad with low potassium vegetables and asian sesame dressing for lunch (a little over 700 mg sodium...yikes!) 

A few crackers and ginger snap cookies for a snack

Shrimp scampi with linguine, mushrooms, and little bit of spinach (This was homemade with lots of herbs just a pinch of salt).   And yes...the spinach is technically high in potassium...but I only added a 1/2 cup of raw spinach per serving, which is acceptable : ) 

I got a bit of time tonight, so I will be planning for tomorrow.  Stay tuned...

Arti

Day 1: Lunch

My challenge is to take binders for the week with meals. I missed the binder with breakfast this a.m. Decided to start with lunch. Took 1 TUMS XS after 1 forkful of food as I would advise patients to do. No problem!! Half way through lunch, I still had the sweet taste of the TUMS at the back of my throat when I swallowed. Maybe it was my imagination. Let's see what happens at dinner.Ann

Day 1: Breakfast

Breakfast is already a challenge. I am wondering what to do without my whole wheat bread and peanut butter!! Instead I had a plain bagel with cream cheese. I also allowed myself a serving of yogurt as I am not a milk drinker.
I am wondering how I will stay satiated without my mid-morning serving of almonds....

Alison

Sunday 22 January 2012

Some background info about our "Walk the Talk" Challenge

Welcome to our blog! We are a group of health professionals working in the dialysis unit at St. Michael's Hospital in Toronto.  We work with patients who are on dialysis as a result of their kidney failure.  These patients visit the hospital three times a week to have their blood filtered via a machine for a duration of 4 hours. They are on a strict diet that is low in potassium, low in phosphorus, low in salt, high in protein and they are restricted to 1 litre of fluid per day. In addition, they take medications during every meal that that bind to the phosphate in their foods.


Now as health care professionals, we know the benefits of being compliant with phosphate binding medications and following diet restrictions. Therefore, we are constantly reminding them, educating them, and hope that they follow our instructions.  Although, we all seem to understand that these restrictions are not easy for our patients, it's safe to say that we don't really know what they're going through. 


About 2 weeks ago, our nurse practitioner, Alison, read a blog post (www.weightymatters.ca) about "walking the talk".  Meaning, if we as health care professionals are going to give advice about making lifestyle changes, it would probably be beneficial to get a better understanding of what we are asking our patients to do.  

Our group which consists of nephrologists, nurse practitioners, pharmacists, dietitians, and students have agreed to take this challenge for the upcoming week.  Some will follow the diet restrictions and others with take phosphate binding medications with all of their meals.  We will write about our experiences (and our adherence) on this blog.


We hope at the very least, that we can gain some perspective and empathy the next time we recommend something to our patients.