A balanced diet is a key component to feeling healthy and looking great even when on dialysis. Only, you need to know what will create a balanced diet when on dialysis! Also the definition of balanced diet when on dialysis will be based on the imbalances in your body. It will revolve around foods related to correcting imbalances with phosphorus, calcium, potassium, sodium, fluid, and protein most of the time. Many other nutrient imbalances are corrected through your medications and dialysis. Getting your blood tests monthly as recommended and reviewing them with your dietitian and doctor, can help you know regarding your imbalances. Changing your food pattern after talking to your dietitian will help you get your blood test reports better next month.

A good way to keep the balance of the nutrients is possible when you learn to cook healthy at home. Nutritional control of nutrients such as potassium, phosphorus, fluids, protein can be individualized to the needs. Eating out often will have poor nutritional control as you cannot choose the ingredients and the way they cook food. Cooking healthy meals at home doesn’t have to be challenging or time-consuming. Check our recipe section for cooking foods at home.

People on dialysis are at higher risk for heart diseases. Hence cooking healthy is very essential step to good health.

Tips to cook healthy:

1. Watch on the way you prepare your food

• Use the methods of cooking which need very less oil such as steaming, sauteing, baking, boiling, roasting.
• Use non stick pan.

2. Enhance the taste with spices and herbs

• Do not add salt while cooking food. Ask your dietitian, the ways, foods can retain natural flavor and taste good even without salt. She will individualize based on your needs.

3. Watch the fat intake

• When cooking poultry, take out the skin and trim the extra fat.
• Use mix of oils such as sunflower, safflower, rice bran, olive oil sparingly and avoid coconut and palm oil.

• Indian sweets cooked in reheated oil and pure ghee are high in saturated fat. Reheated oil can be carcinogenic.
• When deep frying occasionally, use good quality oil and maintain proper frying temperature to minimize absorption of excess oil.  Foods to be fried should be at room temperature. After frying, place the fried foods on the plate lined with paper towels to remove excess oil.

4.  Keep a check on the ingredients you use

• Use mix of low potassium and medium potassium vegetables as suggested by your dietitian.
• Use dairy only as suggested for cooking to keep your phosphorus under control. Know your phosphorus needs from your dietitian.
• Use water for cooking as recommended.

Try these simple tips to help with managing your fluid intake:

- Squeeze the juice of one lemon (‘nimbu’) in half a glass of water and pour this water into an ice tray. Once frozen, whenever you feel thirsty, you can suck on a cube of ice for relief for a long time. Plus the cold feeling on your tongue really helps you feel good on a hot summer afternoon. Remember to include the quantity of water in your daily fluid limit.

- Gargle with a mouthwash. This gives your mouth a fresh feeling and helps reduce craving for water.

- Try certain astringent foods like ‘kala jamun’ or ‘imli goli’. This creates a puckered sensation in your mouth and helps prevent thirst.

- Always have very cold or very hot water. This also prevents you from gulping water thus reducing the amount of liquid consumed.

- Try the Pink Watermelon cooler recipe in the Recipes section. It is a fantastic way to have a treat in these hot summer months!

World Kidney Day is on 14th March 2013!

On this occasion, let us all take a pledge to take small, simple steps to protect our kidneys. It really isn’t that difficult. The trouble is it is really important. Here are some simple things you can do to protect your kidneys:

- Keep your blood sugar and blood pressure under control: Diabetes and Hypertension are the leading causes of kidney disease. It is very important to keep these under control.

- Stay fit – do some exercise regularly. We tend to get so caught up in our work that we keep postponing this. Remember, all you need is 30 minutes. Can’t we even pull out 30 minutes from our work for exercise? Especially if it going to give us many healthy years?

- Drink only moderately if you must. Never binge. Never overdo it.

- Don’t smoke. No concessions here. There are absolutely no benefits. Only very disastrous consequences.

- Drink plenty of water – the elixir of life! Drink at least 8 glasses of water every day. Make a plan to reach this goal. Don’t leave it open ended. Measure out the quantity in a bottle and make sure you finish it.

- Don’t self-medicate – Painkillers and antibiotics must be taken with extreme caution. This year’s World Kidney Day focus is Acute Kidney Injury, one of the causes of which is this. They might give you relief but the long term consequences are dangerous.

- Get a medical check-up regularly – especially if you are at risk. Once a year, a complete medical check up can’t be that big a problem, right?

Simple things like these can give you complete peace of mind when it comes to your kidneys. Your kidneys are at work 24 hours a day, seven days a week, doing things for you that you aren’t even aware of. You owe them a little effort!

Happy World Kidney Day!

To be happy is what is longed by everyone, whether on dialysis or not on dialysis. Once I read from a book that for any one, their thoughts form their world! “What you focus in your life grows and what you think about expands and what you dwell on, determines your destiny.” Remember these principles and guide your steps to happiness. When your thoughts wander around word “ESRD”, just be aware what you are thinking first.  Remind yourself that you need to move away from negative thoughts. Stop thinking about your end! To stop negative thinking, feed the brain with positive. You do not need to stop doing things which you were doing unless your doctor asked you to stop. Think of those things which you want to do and make a list. Plan the ways you would like to accomplish those things if you do not find much time. May be you can do just one thing a month. Doing something which you wanted to do will give you tremendous satisfaction and in turn will improve your quality of life!

Just to name few, you can go meet your grand daughter and take her out for a treat or buy her something you never gave her.

Cook for family once a month

Read a book for kids at home once a week

Keep in touch with your friends who make you feel good. Do not multiply your dialysis issues by talking most of the time with them. You may share a little and spend good time. Share more with those who understand and can help you.

Indulge in a sport, hobby or teach a skill you know to your helper

Have some agenda!

Problems are always there and will be there, but do not neglect your own happiness. Without happiness of self, you cannot give any one anything.

What you have, you can give it to others. If you are unhappy, you will spread unhappiness around.  If you are happy, happiness will prevail for everyone around.

This is sad. Dialysis is a therapy that can genuinely make the patient feel better. If the dialysis is of a good quality and is delivered in an optimal dose.

Let us take an example. Let’s say you have a headache. You visit a doctor and the doctor says it is not very serious. ‘Please take one tablet of Crocin and you should feel better.’ Now you go home and open your medicine box and find the strip of Crocin but decide to take only half a tablet. What would happen? You would definitely not benefit. The headache would not go completely! Would you really blame the Crocin for not curing you of your headache? Would you say that Crocin does not give relief in headaches? No! You must realize that any therapy has its desired effect only if it is taken at the optimal dose.

Exactly the same applies for dialysis as well.

Every individual has a different requirement for dialysis. There are many parameters involved in dialysis. It is extremely important that these parameters be customized to suit the individual receiving dialysis. Dialysis is definitely not a ‘one-size-fits-all’ therapy!

Make sure your center is measuring your dialysis dose by a scientific method and acting on the results. If it is estimated that you are not getting even adequate dialysis, you will definitely not feel well.

Remember, dialysis can make you feel very close to normal. If you are not feeling that way, you are not getting optimal dialysis. A lot of things can be done to correct this, fortunately! Talk to your nephrologist and clinical team to discuss this.

It would be ideal if we could get dialysis for as much time as the amount of time healthy kidneys function. Unfortunately, that would not be practical. We would only be doing dialysis and nothing else! However, we must try to reach as close to this ideal as possible.

Many people dialyze for 7-8 hours every night, 6-7 nights a week! This gives very good dialysis. Some people dialyze daily for 2-3 hours. This also gives reasonably good dialysis. Most of us however, get thrice weekly, four hours every time. This is the bare minimum.

With this modality, there is one big disadvantage, however. There is always one gap between sessions that is 2 days long. This gap is very unhealthy and dangerous for the heart. This is because the build-up of toxins and fluids in the body becomes too much for the heart to handle. Studies have shown that most deaths among dialysis patients occur during this 2 day gap. It for this reason that this 2 day period (always co-inciding with the weekend) has been called ‘the killer weekend’ in countries like the US and Australia!

There is fortunately, an easy solution: never give a 2 day gap!

With a little change from your current dialysis schedule, you could easily avoid the 2 day gap. Dialyze every other day. For example, let’s say you start dialyzing on a Monday in a particular week. You would dialyze on Wednesday and Friday. Normally you would dialyze next week also on the same days. However, what you would do under this schedule is to dialyze on Sunday and then next week on Tuesday, Thursday and Saturday! The following week you would again dialyze on Monday, Wednesday, Friday. You would continue this 2 week cycle of 7 sessions each.

This gives you an extra session every two weeks which would make sure your body does not have to suffer the harmful effects of a high level of fluid and toxin overload! This would reduce your chances of getting heart related complications greatly as well.

Of course, one problem with this is that many dialysis centers are closed on Sundays. All NephroPlus centers remain open on Sundays allowing our dear guests to take advantage of this beautiful regimen and make sure you never, ever have to suffer a 2 day gap again!

Having a plan on the fluid helps a lot. Rather than drinking at any time, having a plan on when to drink what and how much helps manage this much better. One thing which is commonly recommended is to measure out your allowed quantity of water in a bottle and drink only from that. When you drink something other than water, discard an equal amount from the bottle. Plan your day so that the bottle lasts you till you go to sleep.

Another good way is to write out your fluid plan for each day. Think about what’s important for you. Let’s say, it is important for you to have 3 small cups of tea – one early in the morning, one at around 11:30 and another cup in the evening, write these three things down. This could probably come to about 300 ml. Put in about 100 ml of water after every meal. The total comes to 600 ml. You still have 400 ml to play with for different things. The key is to fix up the time, the quantity and what exactly you would like to have and write this down and follow it as much as possible.

By doing this, you have no surprises. In case you feel like having a gulp of cola at dinner, you can skip one round of tea. I believe very few things are entirely out of bounds for people who get thrice weekly dialysis. You can have everything in limited quantities provided you plan it well.

If there is something you really relish which is high in potassium, ask your doctor if you can have a small quantity during the first half an hour of dialysis. If you are otherwise compliant and dialyze regularly without skipping the prescribed sessions, you can afford to take some liberties during the first half an hour of dialysis since the dialysis will remove the excess potassium during the treatment. Of course, every individual is different. So, please check with your nephrologist or dietician before doing anything out of the ordinary!

Aashayein is a great event for dialysis patients. There have been two events organized in Hyderabad so far and patients have loved it. There are educational talks by nephrologists, transplant surgeons, vascular surgeons, dieticians and patients. There’s usually some great entertainment as well.

One of the highlights of the event is the elaborate lunch prepared as per the dialysis patient diet. Usually, patients have very limited eating options when they go for any such event. Most of the food is too dangerous for them to eat. This can be very frustrating. They see all the fancy food and people gorging away and they can only look! At Aashayein, the tables are turned. Patients get the fancy food while people with normal kidneys are served a modest meal!

Patients are also given a whole bunch of goodies.

Registration is mandatory and will close when the capacity is filled. For more details about the event and to register, please visit the Aashayein website.

Ingredients:

1. Raw rice 200 gm

2. Potato 2 small pieces

3. Mustard ½  tea spoon

4. Chana dal Broken 1 tea spoon

5. Green Chilli 1 piece

6. Garam Masala 1 table spoon

7. Paneer grated 1 cup

8. Cooking oil 1 table spoon Salt – a pinch

Method:

For Stuffing:

Leach the potatoes, mash them and mix with grated paneer along with garam masala.

For the base:

- Wash the raw rice and leave it soaked for 1 hour.

- Decant the water and spread the rice on a piece of cloth.

- Allow it to drain all the water and grind it in the mixer to a fine powder.

- Sieve it to remove the unground granules.

- Keep the ground rice powder aside.

- Take 2 tspn cooking oil and fry (thadka) mustard and chana dal.

- Add the thadka along with the chopped green chilli and salt to the dry rice powder.

- Mix the entire powder thoroughly.

- Boil about 200 ml of water in a vessel and add the mixed powder slowly and keep stirring so that it becomes viscous.

- Knead hard enough to make small balls. Add water if it becomes too hard while cooking.

- Flatten the ball and stuff it with the paneer-potato.

- Seam the ball.

- Steam the balls in an idli holder in a pressure cooker without the weight whistle for 10 minutes. (Spread a little oil on the idli plates to avoid sticking.)

- Serve hot!

Dialysis patients must never go by this logic. Remember, dialysis barely achieves 5-10% of what kidneys do. No amount of dialysis can remove all the toxins and fluid in a perfect manner. There is no question of dialysis removing all the water and leaving nothing for the kidneys to do.

Kidneys function 24X7X365. Without a break! Dialysis is done mostly thrice a week for four hours each time. So, even assuming that the dialysis that happens during the session is 100% of kidney function (which it isn’t, its not even close!) the number of hours for which this is happening is only 12 per week compared to 168 for the normal kidneys!

So, dialysis patients must never skip a session. As it is, we are getting much less than what we need. If we reduce even this, the effects can only be deleterious. In the short term, toxins and fluid would start building leading to discomfort, breathlessness and nausea. In the long term, it could lead to other, more severe problems.

So, dialysis patients must realize this and try not to miss sessions. It would benefit us greatly.

Follow Nephroplus on Twitter and Like Nephroplus on Facebook !