I started my dialysis treatment on September 2003 and has been through it for almost seven years now. I have experienced so many things all that time, have seen fellow patients come and go , but still I’m at it up until now. A friend once asked me if I ever get tired of dialysis? Of course I do. But for someone who’s been through a lot and fought all the way, succumbing to weariness is never an option.

If you’re wondering if I ever experienced depression, well the answer is yes, I did. I was diagnosed with Chronic Kidney Failure at 26 and for someone who’s merely starting to make something of his life, the reality of my predicament is just too much to handle. I guess anybody, under the same circumstances, would feel the impact and would think about what tomorrow might bring. In fact, almost any patient (not just with kidney failure) would go through some form of depression or another. Maybe it’s simply human nature to ask the “Why’s” whenever we’re faced with life-changing events.

I did go through a state of depression while I was still at the early stages of my treatment. I still go through it now from time to time. The only difference I made is that I never let it show, not if I can help it. Depression, for me, is a mind set. The more you think about it, the more you would feel it’s effect on your life. I’m not saying that I’m numbing myself from all the pain and the weariness. All I’m implying is that when depression sets in, it’s still your choice whether to fight that feeling or simply succumb to it and allow it to conquer you instead.

I’m still here, fighting as best I can and looking forward to win an uphill battle someday. Need I say more that I chose the former? That I never allowed depression to take the most out of life, eve through the most wearying times of my treatment? They say that I’m an optimist and I tend to look on the brighter side of life. That I am. Why wouldn’t I? I’m already living on the side of life where darkness just looms beyond the horizon. Believe me, I wouldn’t deprive myself the pleasure of looking on the bright side.

I hope you would too.

- images courtesy of RLHyde and ktylerconk

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I had my monthly laboratory test for the month of June taken last week and only just now did I find the time to post it here. The past week had been quite busy for me, redesigning Dialysis Postings and my other blogs - Private Corner and Itlog de Arina, and my grandfather being rushed to the hospital due to uncontrolled Diabetes. But that’s all behind now and I’m here once again updating DP, posting my recent lab results, and trying to spew bits and pieces of information that I hope would be quite useful to my dear readers.

Enough with the chatter. My hemoglobin is down to 8.2 gm/dL. Anemia is on the rampage again and there are numerous factors that might be causing it. It might be that I’m not having sufficient doses of EPO injections, or my body’s not responding well to my current EPO therapy. Either way, I should resolve the issue immediately or risk the possibility of my hemoglobin’s further decline and the need for blood transfusion.

My creatinine level’s a bit high at 14 mg/dL. I might be the culprit on this one because I’ve been consuming more protein than I’m allowed recently, especially red meats. The solution – stricter protein intake, less or no red meat, and back to eating fish more often. The others – Phosphorus, Calcium, Potassium, Sodium, etc. – are fairly under acceptable levels.

I also had my Hepatitis Profile taken together with my monthly laboratory. Both the test for the virus – HBsAg and HCV – turned non-reactive, meaning I don’t have Hepatitis. The only sad outcome is that the test for my antibody against the virus – Anti-HBs – also turned out non-reactive, meaning my body’s still not producing enough antibody to have me protected.

To sum it up, I’m still doing fairly well with my lab results and treatment. Although there are certain adjustments I have to make and try to implement them as soon as I am able. But it’s all good and I’m still in business with the my battle against kidney failure.

image credit – positivenation.co.uk

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Based on randomized, controlled data, omega-3 fatty acids in fish oil are now routinely used to prevent the progression of IgA nephropathy, the world’s most common glomerulopathy

Image courtesy of Club Marine

I was surfing the net and happen to pass by this article about Omega 3 fatty acids. Being a kidney patient, I am always careful on what I eat, and try to follow my prescribed diet as best as I can. Having fish in them is a good choice, if not a must. It doesn’t only gives you the protein your body needs, but fortifies your heart and brain health as well. Another advantage for dialysis patients of substituting fish for beef or pork is that you could get a much bigger portion without as much by-product or waste.

It’s true that red meat offers a higher quality of protein than fish do. But for people who have malfunctioning kidneys, acquiring protein from a source that generates less waste after being broken down by the body could mean a lot. It doesn’t just helps you keep your Creatinine level checked, but it also lowers your Triglyceride level and reduces your risk from Heart Disease.

I, for one likes fish. Since time immemorial, fish courses was already a staple in our family table. The only difference, now that I’m suffering kidney failure and under dialysis treatment, is the way I prepare or eat them. Before that, fish in any form of preparation would do. May it be fried, dried, soured, sautéed or raw like sushi, I’ll eat it no matter what. But now is a different matter because of the factors to consider. My advice for my fellow patients is that it’s best that you’ll be the one to prepare the dish. That way, you could stick with your diet restrictions without sacrificing the taste of your food.But if you can’t cook, try to explain how would you want your fish done to the person who would do the cooking.

Among the fishes that are rich in Omega 3 fatty acids are Mackerel, lake Trout, Herring, Blue fin Tuna, Salmon, Albacore Tuna, and Sardines, to mention a few.

A word of advice for my fellow dialysis patients – always try to consult with your renal dietitian or nephrologist regarding your diet for the simple reason that every patient has unique dietary and nutritional needs. What’s good for others might be bad for you.

But all in all, fish is good for you. Let’s make fish a part of our diet and pave a way for a healthier life.

Fish be with you all!

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In a few hours I’ll be off to my dialysis treatment. I’m already planning in advance how I would conduct my travel from our house in Manila, to the clinic in Quezon City. It’s only about 30 minutes away from our home, that’s if you have your own car, which I don’t. I take public transports (Jeepneys) and it takes 3 transfers before getting to the clinic. It’s tedious for patients like me, but there’s no getting around it, and besides, it’s a lot cheaper than taking a cab.

~ Image courtesy of www.a2gov.org

But it’s not the travel that bothers me. It’s the heat. You can’t hide from it whenever your outside, and even when you’re in the shade, you still can palpably feel the heat. It’s summer here in the Philippines, and to make matters worse, we’re currently under the El Niño Phenomenon. I have posted before on this blog the effects of summer and heat on dialysis patients. Today I reiterate it once again that excessive heat and humidity has a significant impact on dialysis patients.

We find it hard to tolerate the heat simply because we have a higher body temperature than normal people.

Mean oral temperature in hemodialysis patients was higher than in healthy individuals [98.7 degrees F (37 degrees C) vs. 98.4 degrees F (36.8 degrees C); p < 0.001], as was the mean average axillary temperature [97.7 degrees F (36.5 degrees C) vs. 97.5 degrees F (36.3 degrees C); p = 0.02] and mean left axillary temperature [97.9 degrees F (36.6 degrees C) vs. 97.6 degrees F (36.4 degrees C); p < 0.001].

~ Pub Med

And, if bad comes to worse, when our tolerance for heat comes to an end, the first thing that comes to mind is to beat the heat – that is, to drink water to quench our thirst and alleviate the heat we’re experiencing. It’s all good and well, drinking lots of water to rehydrate oneself and avoid the dangers and perils of dehydration or heat stroke. But for us with malfunctioning kidneys, drinking too much water tells a different story and would be quite dangerous at some point.

But don’t despair my fellow patients. There are lots of ways we could tolerate excessive heat and avoid the dangers that comes with it. Here are some that helps me survive the day, and I hope would be helpful to you too.

• Stay in the shade and stay away from direct sunlight, especially from 10 am – 3 pm, where it’s the hottest part of the day. If you’re not working and don’t have anything important to do outdoors, it would be best to just stay in the house.
• If you really have to go outside on the hottest part of the day, bring adequate protection from the sun, like an umbrella or sun shade. Also, don’t forget your towels or an extra piece of clothing, as you might need it.
• If you’re quite thirsty and finding it hard to regulate your fluid intake, go ahead – drink some water. But remember, sip and don’t gulp. But if your fluid intake is really ‘that’ restricted, try sucking on an ice cube, or some sour fruit like lime or calamansi, or brush your teeth to freshen up your mouth. It somewhat relieves your thirst.

These are some tips that worked for me and I hope would be helpful to you too, although every person is unique and has different needs. Summer time is somewhat of a punishment for us patients, but there’s no getting around it. So what can we do?

If you can’t beat ‘em… try to enjoy ‘em! A wonderful summer to you all!

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Hypertension or High Blood Pressure, as it is more commonly known, is one of the silent killers that plagues the general population. It owes its lethal efficiency to the fact that it goes on undetected for months, and even for years, up until a point where significant damage has already been done. Such as it was in my case, where I neglected and took it for granted, in spite of being aware of its past devastation on our family’s medical history. But that’s all in the past, and as I have always told myself, regret is one of the most futile and unproductive of all human emotions. So there’s really nosense in trying to undo what’s already been done.

What about you? Are you also suffering from Hypertension? You know you might be, and worse, you’re not even aware of it. This is a common enough scenario, especially for the population’s poorer class who’s financial capability to seek medical attention is virtually non-existent. Nobody could really blame these people the tendency to take for granted the sensibility of early detection through screening. But if you’ll ask me, however, this should not be an excuse.

Why is high blood pressure dangerous?

The higher the blood pressure, the harder the heart has to work to keep on pumping against increasing resistance. If, in the course of time, the heart muscles tires, it could eventually lead to heart failure. Because of the enormous burden it puts on the arteries, high blood pressure adds to their wear and tear, especially in the target organs, the brain, coronary and kidney vessels. Stroke and Myocardial Infarction (heart attack) are frequent and dangerous consequences of untreated hypertension.

Recognizing high blood pressure

High blood pressure is a Silent Killer simply because it doesn’t show typical symptoms that might serve as early warning signals. In fact, in certain cases, many people feel well and energetic despite their high blood pressure. There is only one way of finding out whether or not you have hypertension and that is to have your blood pressure checked. Measurements must be repeated at least once a year. If an elevated pressure is detected in time, early treatment can help prevent the possible fatal consequences.

Prevention of complications from high blood pressure

Bringing the pressure down relieves the strain on the heart and arteries; this lessen and often eliminates the dangerous consequences of elevated pressure. With proper treatment, high blood pressure can be normalized, or at least brought down to a tolerable level. The treatment does not call for any heroic measures; regular checking of the blood pressure, a few generally painless changes in one’s eating and living habits, and taking the prescribed medication everyday. If detected and treated in time, hypertension should not stop you in leading a normal and productive life. All that is required is determination and close doctor-patient cooperation.

Protect yourself against high blood pressure

A genetic predisposition is a frequent cause of hypertension. It “runs in the family”. Caution is advised if you have a family history of high blood pressure. Your way of living could have an important bearing on whether or when you will develop hypertension. If you are overweight, has a high sodium intake on your diet, under psychological stress, agitated and hyperactive, you’re more likely a candidate, or can exacerbate an existing tendency. Losing weight, cutting down on salt in the diet, and avoiding stress are useful precaution to help you keep your pressure down.

Protect your health why you still can and when you still can. As always, being well-informed is being well-prepared.

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Did you recently encountered the question “Why do you blog?”. I do, and I always find the time to read through posts just to know why bloggers do what they do. You might be amazed at what you’d discover. From the bland, to the usual, to the eccentrically mundane reasons, bloggers have various opinions for setting up their blog. As for me, after more than 2 months of writing in this blog, I finally decided to write a post about why I blog and why I chose dialysis and kidney failure as my topic.

Why do I blog?

I blog simply because I like doing so. I am not much of a talker, and I can easily express myself through writing. I tend to grab every opportunity to write about something, and blogging, as most people could attest to, is one excellent way of doing so. Thus, here I am, blogging my heart out.

Why blog about Dialysis and Kidney Failure?

If you have been to this blog before, you’ll know that the reason behind this is fairly obvious — I am suffering from Kidney Failure and had been under Dialysis treatment for six years now. On my earlier days of writing on Dialysis Postings, my primary aim was to simply have an online journal. A kind of personal diary where I could write about my experiences with life in kidney failure and dialysis. But seeing how powerful a blog could become, I was encouraged to rearrange my purpose.

I am still blogging about my experiences in living with dialysis. But I also blog with the hope of creating awareness on the issue of kidney failure. This is a significant issue that most people wouldn’t even notice. I really can’t blame them, for I myself was completely ignorant about it before. Until I got diagnosed with the disease. It is true that it’s quite hard to detect kidney failure early enough to avoid it’s devastating effects, because it doesn’t show any symptoms on its early stages. But I do believe that having adequate information about it would forewarn people on its gravity, and would encourage them to have the initiative to take action before it’s too late.

If you are at risk of getting kidney failure, it ‘s wise to have yourself screened for kidney disease. Let my past attitude of nonchalance be a lesson to you so that you won’t find yourself in regret of not having to take any action before.

Remember, forewarned is forearmed.

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Dialysis patients are required to take monthly laboratory tests. This is to ensure proper monitoring of our body’s blood and chemistry levels. These tests are also used by doctors as reference on how patient’s respond to dialysis, if they are eating right, their responsiveness to EPO shots via their hemoglobin levels, and so on. I have been through this routine tests all my dialysis years and still going through with it. My lab test schedule for the month of May would be performed on my next dialysis session, this coming Thursday to be specific. My past blood test, since I started my treatment, were fairly okay. There are certain blood levels that dialysis patients and doctors use as reference and it’s quite different from the ones normal people use.

Let me state this as an example:

• A normal person’s hemoglobin range: 12 – 14 grams per deciliter (g/dL)
• A dialysis patient’s hemoglobin range: 10 – 12 grams per deciliter (g/dL)

To elaborate this further, I have prepared a list of the common laboratory tests that I take along with their acceptable ranges. The blood levels below are provided for your reference and are to be used as guidelines. Levels may vary upon individual differences or depending on the dialysis unit;s laboratory procedures. It is always advisable to talk to your doctor, nurse, and dietitian about your blood levels.

• Blood Urea Nitrogen (BUN) : 60 – 110 mg/dL
• Creatinine : 8.0 – 20.0 mg/dL
• Potassium (K) : 3.5 – 5.0 mEq/L
• Calcium (Ca) : 8.5 – 10.5 mg/dL
• Blood Sugar (fasting) : 60 – 100 mg/dL
• Blood Sugar : less than 140 mg/dL
• Alkaline Phosphatase : 25 – 100 units/L
• Phosphorus (P) : 2.3 – 4.7 mg/dL
• Sodium (Na) : 135 – 145 mEq/L
• Albumin : 3.8 – 5.5 gm/dL
• Total Protein : 6.0 – 8.0 gm/dL
• Hematocrit (HCT) : 33% – 36%
• Hemoglobin (Hgb) : 10 – 12 gm/dL

Basically, through this monthly lab exams, a dialysis patient, doctor, nurse, and dialysis unit’s medical staff can monitor the patient’s progress while undergoing treatment. For me that has been going through with it for quite a long time now, and for other’s as well, it may sound routinely boring. But I hope this article may serve as reminder on how vital this monthly blood tests are to a dialysis patient.

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Most of us already know that our kidneys filter the waste from the food we eat. But few are aware that waste filtration is only one of the numerous jobs our kidneys perform in our body. It also produces hormones that regulates blood pressure, among other things. But do you know that the kidneys are also responsible for our body’s production of Red Blood Cells? Yes, they are, and is described further in this piece of article:

Anemia is common in people with kidney disease. Healthy kidneys produce a hormone called erythropoietin, or EPO, which stimulates the bone marrow to produce the proper number of red blood cells needed to carry oxygen to vital organs. Diseased kidneys, however, often don’t make enough EPO. As a result, the bone marrow makes fewer red blood cells. Other common causes of anemia include blood loss from hemodialysis and low levels of iron and folic acid. These nutrients from food help young red blood cells make hemoglobin, their main oxygen-carrying protein.

– Source:  NIDDK/NKUDIC

Before I was even diagnosed with kidney failure, I already noticed a slight pallor in my complexion. But ignorant and unaware as I was before, I merely put it down as lacking of exposure to sunlight. I thought that a bit of time under the sun or outdoors would soon resolve this and restore my complexion into a much healthier pallor. I should have known better. Today, six years into my treatment, I am happy to say that I am much well-informed.

Anemia in kidney failure and dialysis patients has two treatment options (It has two, in our clinic, at any rate. First, the more recommended, is by injecting a genetically engineered form of Erythtropoetin or EPO. It is usually administered via injection under the skin and this procedure is much more recommended because the hormone is better absorbed by the body when given through the subcutaneous region. Other patients who can’t tolerate needles has the alternative to take it via intravenous (IV) line, while hooked on a dialysis machine. The intravenous method, however, requires a larger, more expensive dose and may not be as effective.

The second treatment option that my fellow patients in our clinic follow to treat anemia is blood transfusion. Although this is not fully recommended, on the simple fact that there are certain dangers and uncertainties that comes with blood transfusion, it is a lot more cheaper than taking injection twice or thrice weekly. I really can’t blame them, in any case. I guess the little money that a patient could save through this option outweighs the dangers.

In my case I am taking EPO shots twice a week. I was taking 5000 units of Recormon (Erythropoetin or Epoetin Beta) during my earlier days of treatment. Last year I was shifted to Renogen (Epoetin Alfa). Both drugs treat kidney failure-related anemia. The shift was due to economical reasons, since Renogen is a lot more cheaper than Recormon and my body seems to respond much better to the former that the latter.

Though I must advice my fellow patients that they consult with their physicians first before taking EPO injections. This explains why:

The U.S. Food and Drug Administration (FDA) recommends that patients treated with EPO therapy should achieve a target hemoglobin between 10 and 12 grams per deciliter (g/dL). Recent studies have shown that raising the hemoglobin above 12 g/dL in people who have kidney disease increases the risk of heart attack, heart failure, and stroke. People who take EPO shots should have regular tests to monitor their hemoglobin. If it climbs above 12 g/dL, their doctor should prescribe a lower dose of EPO. The FDA recommends that patients whose hemoglobin does not rise to the target level with normal doses of EPO ask their doctor to check for other causes of anemia.

– Source: NIDDK/NKUDIC

So it is imperative that you work closely with your doctor or the medical staff in your dialysis clinic while treating anemia so that they could monitor your progress and perform necessary adjustments whenever the need for it arises.

I know it might be harrowing to think about the complications that comes along with kidney failure and dialysis. But being a dialysis patient myself, I am aware that I don’t have much choice on the matter. I have learned through experience that it’s much better to accept, learn about your illness, and find out ways to relieve yourself of the already difficult life of a dialysis patient. Besides, it always pays to have an optimistic frame of mind.

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Hypertension or high blood pressure runs in our family. Several of my relatives either died of a heart attack or stroke caused by hypertension that’s been left untreated. I had hypertension as early as my high school days, although I am completely unaware of it. It was just brought up to my attention six years ago, when I was first diagnosed with chronic kidney failure. It was both shocking and unbelievable for me at that time. Being a 26 year-old, it’s quite hard to accept at first that I am already suffering from chronic ailments and would probably face medication and treatment for the rest of my life. But there it was, already out in the open.

The kidneys play a key role in keeping a person’s blood pressure in a healthy range, and blood pressure, in turn, can affect the health of the kidneys. High blood pressure, also called hypertension, can damage the kidneys and lead to chronic kidney disease (CKD).

– Source NIDDK/NKUDIC

This might seem both alarming and outrageous, but it’s true, and it’s a fact. And I just don’t say it from research or reading journals about it, but I’m saying it from experience. Had I known myself to be inflicted with hypertension, I would have done steps to prevent it from helping destroy my kidneys. My doctor said that besides CGN or Chronic Glomerulonephritis, hypertension became one of the contributing factors that lead to kidney failure. But I was young then, and thought myself impervious to such diseases and conditions. Well, I was wrong, and paid dearly for it.

I am still suffering from hypertension up to this day simply because it’s closely associated with kidney failure. Although I am a lot wiser now than before and medications help me maintain my blood pressure at acceptable levels, I still make it a point to implement ways to keep my hypertension at bay.

• I avoid salty and sodium-rich foods as often as I can. Salt makes you more thirsty and if you drink too much water, you might experience fluid overload that will increase your blood pressure.

• I try to stay cool and avoid staying under the sun too much for the same reason that this would make you want to drink more.

• Avoid fatty and deep fried foods, as well as those that are high in cholesterol. Not only will it trigger your blood pressure to rise significantly but will also put you at risk with stroke and heart attack.

• Consult with your doctor on a regular basis and always take your medications for hypertension. Skipping them would desensitize your body to the drug and would cause dangerous spikes in your blood pressure.

It’s hard enough coping with kidney failure and dialysis alone, and even harder to manage different complications that comes along with it. But with sensible management, eager determination, and abundant amount of faith, things could go as normal as it can be for patients like me.

Be wise. Well-informed is well-prepared.

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I recently wrote an article on why dialysis patients must be sensible on their eating habits, and the equal importance of consulting with your Nephrologist and Renal Dietitian before starting a diet plan. This time, I’m writing about the basic minerals found in food that concerns a dialysis patient, like Protein, Potassium, Phosphorus, Sodium, etc. You can work closely with your renal dietitian to decide on the meal plan that includes some of your favorite foods and is best for you.

Your individual meal plan will be based on your age, your weight, foods you like, your dialysis treatment and other medical conditions such as diabetes, heart disease, and high blood pressure. It will be tailored to your needs but may not meet the specific needs of other patients. Most people with kidney disease must modify their intake of certain nutrients such as protein, potassium, sodium, phosphorus, and fluid. Following the meal pattern suggested by your renal dietitian will help you feel your best.

The following are some things a dialysis patient needs to know about:

• Protein is used to build and repair tissue. Several of the foods you eat contains protein. The best sources are meat, poultry (chicken, turkey, etc.), seafood, dairy products, and eggs. The best source, also called High Quality Protein, comes from red meat like beef, though it produces more excess waste in the body than other sources. Your renal dietitian might limit you from taking these.

• Potassium regulates nerve and muscle function. Since your heart is made mostly of muscle, this mineral plays a vital role in the regulation of heartbeat. Excess potassium in the body is removed by the kidneys. For people with malfunctioning kidneys, dialysis performs this job. But if you accumulate too much potassium in between treatments, it might cause heartbeat irregularities. Worse, your heart might suddenly stop if potassium is left uncontrolled. Almost all foods contain some potassium. Some foods that are very high include bananas, avocados, oranges, tomatoes, winter squash, dried fruits, milk and nuts. How often these foods can be eaten, and/or their portion size may need to be limited.

• Calcium and Phosphorus work together in the body. They are balanced to keep your bones strong and healthy. There’s an imbalance of these minerals in kidney failure but it can be restored with medications and a moderate level of phosphorus in your diet. Since calcium and phosphorus are found in many of the same foods, it is difficult to get enough calcium without getting too much phosphorus. Almost all foods have some phosphorus, but the highest levels are found in dairy products (milk, yogurt, cheese), eggs, meats, dried beans and nuts. You may be asked to take a calcium supplement and a phosphorus “binder”. It is advisable to ask your doctor about it.

• Sodium helps regulate the fluid balance in your body. High-sodium foods may upset this balance in kidney disease. Some foods that have the highest amounts of sodium are cured, processed, and smoked meats and cheeses (ham, bacon, sausage, cold cuts, cheese and snack foods like potato chips, pretzels, corn chips, salted nuts and pickles). Some foods that do not taste salty have a lot of sodium. Examples are soups, ketchup, mustard, relishes, some seasonings, steak sauces, meat tenderizers, canned or packaged foods and restaurant foods, When you prepare foods from scratch, you can control the amount of sodium used, like salt, for instance. Also, avoid using salt substitutes because they’re most likely to be high in potassium, and it’s more harmful to you than sodium.

These are meant to serve as a guide and a patient is still advised to consult with his/her doctor and renal dietitian for individual meal plans. Eating wisely and sensible food choices are vital for a kidney failre patient to stay healthy while undergoing dialysis treatment.

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