By Lisa Drossos, MSSW, LCSW & Heather Fisher, RD, MS, LD/N Many factors can influence our health, such as family history, living environment, choices we make and our coping skills. These factors, to varying degrees, are within our control. Our individual health practices can have a positive impact on overall health and well-being through all stages of kidney disease. Attached is a quick quiz for you to determine whether you are making healthy choices. Which of the following choices is NOT a healthy way to manage stress? a. Set aside some time for laughter.
b. Learn to use relaxation techniques, such as yoga or meditation.
c. Openly discuss your problems with friends, relatives or counselors.
d. Try to be perfect and expect perfection from others. d. People make mistakes. Be aware of your shortcomings and more accepting of others, despite their imperfections. It takes a lot less energy to let things go. What steps can help you get a better night’s sleep? a. Keep regular sleep hours.
b. Before bed, take a hot shower or bath.
c. Light reading
d. All of the above d. Too many sleepless nights can push you over the edge. If you notice a pattern, ask your doctor. Who is the most important member of your treatment team? a. Your nurse
b. Your physician
c. You
d. Your dietitian c. If you are actively involved in your treatment, you will have more control over your illness. Which statement is true about taking your medicines? a. Take your pills exactly as prescribed by your doctor.
b. If you have trouble remembering when to take your medications, use an aid such as a chart, pill box or wristwatch alarm.
c. Before you decide to stop taking a medicine because of side affects, speak with your doctor.
d. All of the above d. Never substitute or quit taking medicines unless your doctor says to do so. Which of the following statements is true regarding hemodialysis access? a. Planning for hemodialysis access should begin within a year before the need for hemodialysis.
b. For most patients, a fistula is the first choice for an access.
c. A graft may be used for people whose blood vessels are not strong enough for a fistula.
d. All of the above d. To allow plenty of time for you to receive the best access choice for your needs, planning for access should begin early. Which organization is NOT a source of education/support for those affected by chronic kidney disease (CKD)? a. American Association of Kidney Patients (AAKP)
b. Humane Society
c. Forum of ESRD Networks
d. National Kidney Foundation (NKF) b. The Humane Society is not a source of support for those affected by CKD. AAKP, NKF and the Forum of ESRD Networks are excellent sources of information. Which of the following are common feelings experienced for those diagnosed with CKD? a. Sadness
b. Anger
c. Fear
d. All of the above d. These feelings are normal in adjusting to CKD. If they persist or interfere with your ability to function, seek help from supportive people in your life, your doctor or a counselor. Those diagnosed with CKD should consider doing which of the following: a. Work
b. Play
c. Travel
d. All of the above d. Continuing an active lifestyle is best. Your self-esteem will increase, and your moods will brighten. At what stage of kidney failure is it important to restrict protein intake? a. When your kidneys no longer function, and you require dialysis.
b. In the early stages of kidney disease, when you do not yet require dialysis.
c. When you receive a kidney transplant.
d. All of the above b. It is important to eat enough, but not too much, protein in the early stages of kidney failure. This is because kidneys filter and excrete by-products of protein, and eating too much can cause the kidneys to overwork. Protein-rich foods include beef, poultry, pork, dried beans, peas, nuts, eggs, tofu, milk and milk products. The general recommendation intake of 6-8 ounces of meat per day is likely safe. However, ask your doctor or dietitian for recommendations specific for you. At least how much exercise is recommended for adults? a. One hour per week
b. 30 minutes per day, most days per week
c. One hour per day
d. Both b and c are correct. b. Exercise is great for improving circulation, blood pressure, blood glucose levels, muscle tone, energy and emotional and mental well-being. Exercise helps you lose weight if you are overweight or obese, and helps you maintain a normal weight. Check with your doctor before beginning an exercise program. What are some things that you can do to control your blood pressure? a. Take blood pressure pills as prescribed.
b. Limit your intake of added salt and foods with sodium.
c. Limit your fluid intake.
d. All of the above d. The kidneys have an important role in keeping blood pressure at healthy levels by removing waste and extra fluid from the blood. When kidneys are damaged, they may stop doing their job. Extra fluid in the body increases fluid volume in your blood and makes your blood pressure higher. Also, eating a diet high in salt will further increase blood pressure because salt attracts water. It is important to check your blood pressure regularly and maintain it around 120/80. Take blood pressure medicines as prescribed and limit your intake of salt by restricting added salt, processed or canned goods and “fast food.” True or False. Because of my kidney failure, I will need to cook separate meals for my family and myself. False – The entire family can benefit from eating healthy. All foods fit into a healthy eating plan when portion sizes are taken into account. Excess intake of high calorie, high fat foods can lead to weight gain. Weight gain can lead to chronic health problems, which should concern everyone. Below is a list of foods rich in nutrition, along with appropriate portion sizes: Milk products • 8 oz glass of 1 percent or skim milk
• 6-8 oz container of yogurt
• 1-1/2 oz slice of cheese
• Milk and milk products are high in phosphorus and potassium. You will, at some stage in your kidney disease, have to limit these. Discuss this with your doctor or dietitian. Grains • 1 slice whole wheat bread
• 1/2 of a hamburger bun
• 1/2 of a bagel
• 1/2 cup cooked cereal
• 3/4 cup (1 oz) cereal
• 1/3 cup rice
• 1/2 cup pasta (whole grains offer more fiber and vitamin B) Meat • 3 oz meat (about the size of a deck of cards) Fruit • 1 small to medium piece of fruit is about the size of a tennis ball
• 1/2 cup canned fruit
• 1/2 of a grapefruit
• 4-6 oz juice Vegetables • 1 cup raw vegetables
• 1/2 cup cooked vegetables
• 6 oz vegetable juice
• Fruits and vegetables are good food choices for all stages of kidney disease. Just remember, if your kidneys have failed, you should restrict potassium. Many fruits and vegetables such as tomatoes, potatoes, dark greens, orange juice, bananas and melons are high in potassium. Ask your dietitian for a more detailed list. In conclusion, remember to continue to set goals and try to do your best. Ask for help when you need it. Taking the first step to living well and living long requires knowledge about good health practices. DISCLAIMER “The analyses upon which this publication is based were performed under Contract Number 500-03-NW07 entitled End Stage Renal Disease Networks Organization for the State of Florida, sponsored by the Centers for Medicare and Medicaid Services, Depart-ment of Health and Human Services. The content of this publication does not necessarily reflect the views or policies of the Department of Health and Human Services, nor does mention of trade names, commercial products, or organizations imply endorsement by the U.S. Government. The author assumes full responsibility for the accuracy and completeness of the ideas presented. This article is a direct result of the Health Care Quality Improve-ment Program initiated by the Centers for Medicare & Medicaid Services, which has encouraged identification of quality improvement projects derived from analysis of patterns of care, and therefore required no special funding on the part of this contractor. Ideas and contributions to the author concerning experience in engaging with issues presented are welcomed.” Lisa Drossos, MSSW, LCSW is the Community Services Coordinator for FMQAI: The Florida ESRD Network (Network 7). Lisa also serves as Chair of the Florida Gulf Coast Council of Nephrology Social Workers and is on the Board of the National Kidney Foundation of Florida. Heather Fisher, RD, MS, LD/N is a dietitian in Tallahassee, Fla. She has worked as a renal dietitian with both hemodialysis and peritoneal dialysis patients. Currently, Heather is Coordina-tor of Clinical Programs at Florida State University’s Thagard Student Health Center. She is also President of the Tallahassee Dietetic Association. This article originally appeared in the December 2004 issue of Kidney Beginnings: The Magazine, Vol. 3, No. 4.
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