As I make my way back to AW from documenting my other patients while we wrap up Change of shift. AW seemed to have had an interesting conversation with Elisia Marchena. …” Well AW, How did it go learning about CMS Regulations?”…. AW replies ,” Man the information was heavy, Mon, but it was very interesting. It amazes me what is all involved in this Dialysis stuff.”……. “Question for you Dwelyn!….” Can we eat here? “ I’m starving!!! ……” Well it’s funny that you ask that. ……and just as I started to turn my body to head to the offices in the back, one of the lovely Dietitians was making her way to the Jamaica Pod. We call her Vibrant Beth…. We call her that because she is so full of life and always smiling with such a glow about her. She’s definitely one of a kind. As she walks towards AW and me………she replies “ Dwelyn how are you doing? I replied….” Hey Beth, I’m doing grrr……….and before I could finish, Beth replied…….” Ahhhhhh I see a new Faaaaaaaccccceeee!
RDB: Good morning Mrs AW. I’m Beth, and I’ll be your Dietitian here at dialysis. How are you doing and have you worked with a Dietitian before?
AW: I just feel overwhelmed and want to do everything right. I’ve only been eating foods that I saw on the menu at the hospital because I didn’t know what to eat. Some family members have been telling me to cut out this or add this, and I saw a Dietitian in the hospital, but I just couldn’t keep my mind on anything except that I was going to have to do this dialysis. Can you just write me a menu, and I’ll follow that?
RDB: I promise that my job is not to take away every food you love, it’s really to find a way to fit your diet and lifestyle into meeting goals for your lab values and feeling your best and healthiest… Let me answer any pressing questions you have about the diet before I jump in to telling you what I know.
AW: You aren’t going to take away my chips and soda?
RDB: Nope, I may steer you toward chips that aren’t going to give you as much salt or potassium, and a soda that won’t raise your phosphorus, but there is room in your diet to still have things that you love. There is really only one food that you cannot have on dialysis…starfruit.
AW: What is that… I don’t even know that food. Why can’t I have it?
RDB: Starfruit is a tropical fruit that looks like a star when you slice it. You see it a lot on fancy fruit trays, but most people don’t eat it every day. It has a chemical in it that doesn’t come out with dialysis, so it could cause brain damage or death.
AW: Well, I won’t miss it since I’ve never had it.
RDB: Now about that menu. I know that sounds fast and safe if I just tell you what to eat, but you will have lots of time with me for teaching and learning. What I really want to do is have you know what to do or choose or eat in any situation. If I tell you to eat: oatmeal, a tuna fish sandwich and spaghetti. You might do that for a few days, but after that you will get exhausted of that and maybe those were not things you liked to eat, and then you won’t know what things you can change.
RDB: Today we will talk about a few things, and I’ll ask you some questions to get to know you better, so I can do a better job teaching you what are good alternatives if something doesn’t fit into your diet. I have this 3 ring binder of information…but I don’t want you to sit down and read it…it’s a lot to take in. What I have in here is just the basics. If you want to read the chapter on Getting Started” it will tell you an overview of what to do. Then each time I come to see you I will bring another chapter, so we can go over each part of the diet “in bite sized pieces”…. Dietitian humor… I know…corny…get it…corny.
RDB: Ok first let’s talk about how you are feeling? Are you having a big or small appetite? Are you having any nausea or vomiting?
AW: I was sick all the time, but it has gotten better once I started dialysis, and now I feel like I can eat again.
RDB: How about any problems with constipation or diarrhea?
AW: Nope, thank goodness for that.
RDB: Do you have any issues with chewing or swallowing? Are your teeth painful or do you find it hard to chew?
AW: Nope I’ve got good teeth and can eat just fine.
RDB: How about weight loss?
AW: Yes, in the hospital they started to treat me, and they just kept making me skinnier and skinnier. (see episode 1)
RDB: That happens sometimes. As the kidneys stop filtering well, you can build up poisons in your body that make you feel tired and forgetful and food doesn’t taste right anymore.
AW: Yes, all those things happened to me!
RDB: When that happens you might lose weight, but at the same time you may be retaining fluid. A lot of times you may not realize how much weight you’ve lost because of that fluid. Then, when they remove the fluid in the hospital, you are left with weight loss that you didn’t know you had. My goal is to have you feeling better and eating well so that the weight loss stops.
RDB: I sometimes say that the kidneys are like the muffler on the car. You put gas in the car and the car uses the gas as fuel. The parts of gas that the car can’t use, is what the muffler filters out as exhaust. Your kidneys do a similar thing. You put food in your body as fuel. The parts of food that your body can’t use, the kidneys filter out and send out as exhaust in your urine. If the muffler (your kidneys) doesn’t work well, then you back up exhaust. Dialysis is like a temporary muffler until you are able to get a transplant. Is that something you are thinking about?
AW: Yes!!! I really want to get better and get a transplant.
RDB: Wonderful!! Let’s start talking about what you like to eat, so we can get you closer to that goal. Can you tell me about you and your family and what your diet looks like? If I was to come over to your house in the morning…are you eating breakfast and if so what do you eat?
AW: I’m not great in the morning…mostly I just start with coffee…can I still drink coffee?
RDB: You bet. Here are the things we want to think about for coffee…you want to keep the size of the coffee to a lower volume (don’t have a great big 24oz (0.91 kg) coffee), just a cup is perfectly fine. And do you take anything in your coffee?
AW: Nope, I just drink it plain, no cream and no sugar.
RDB: That is fine…if you added cream, we would talk about options for this and how it impacts phosphorus…but we’ll get to that later. What is the next time you eat?
AW: I like to have a kind of brunch at 11am and then dinner. Most days I eat eggs with onions, peppers, and tomatoes with a type of bread that I grew up eating.
RDB: That is perfect!
AW: But at the hospital they told me I can’t have tomatoes.
RDB: First, I’m thrilled that you are cooking at home. That is the best way to know you are not having too much salt. You are right that tomatoes are higher in potassium, but if you are just adding a few into your eggs, this is still OK. If you were to eat a heavy tomato-based sauce, that would be a bigger concern for me.
AW: You mean like spaghetti? I thought you said earlier that spaghetti would be something safe to eat.
RDB: Aha…good catch, let me explain further…if you are going to make spaghetti from a jar or from scratch… I want you to add everything but the kitchen sink to it. Add in zucchini, mushrooms, garlic, basil, onions, and ground meat…all things that will thin out the tomato part of the dish.
AW: Oh I see…the tomato sauce might be high, but if I add to it then I can stretch my meal, but also each serving will have less potassium in it. That’s smart!!!
AW: What about fish and seafood? I eat a lot of that at home. I like to make brown stew fish and peppered shrimp. My grandkids love it when I cook foods that I grew up eating.
RDB: I’m delighted by your food choices…we all tend to gravitate to comfort foods that we grew up eating when we aren’t feeling good. Both of these foods are great. Again, it’s so good that you are feeling strong enough to be cooking, and that you are cooking at home which reduces salt intake. Seafood and fish are both healthy protein foods and getting enough protein on dialysis is one of the most important things. Protein foods (meat, fish, seafood, eggs, tofu, beans) are what help your body heal, they build muscle, and they help boost your immune system. I’m thrilled with how you are eating. See we aren’t taking away foods you love…just looking at ways to make them fit into the diet.
AW: I’m getting a little tired (and hungry) thinking about all this cooking and good food. Can we continue at another time?
RDB: You bet. I’m here at the dialysis unit much of the time, and you don’t have to learn it all at once. I’ll keep checking in on you and seeing when you are ready to talk about all the things with the diet. In that “Getting Started” chapter in the binder I gave you it will give you the very basics of: protein, potassium, phosphorus, salt and fluid. We will go over each of these in time. But it sounds like you are already eating and cooking well. My phone number is on the front of that binder, so please, please call me if you have any questions that come up.
AW: Thank you so much Beth… I really thought I was going to have to change everything that I eat. I feel so much better that I’m still going to be able to eat foods that are important to me.