I Hate Dialysis Message Board
Dialysis Discussion => Dialysis: General Discussion => Topic started by: MooseMom on August 07, 2011, 03:29:18 PM
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I remember my mother complaining about being told she shouldn't eat at dialysis in some clinics when she travelled. Different clinics seem to have random rules about this, and their reasons are varied, usually somewhere along the line of "you could choke if you crashed."
Well, our dear and inquisitive boswife asked about this over on Home Dialysis Central, and Dr. Agar responded with a very interesting and reasonable answer that I had never considered, so please read!
Posts:16 eating during dialysis
Hubby Bo likes to have treatments quite early in the morning, (4or 5am) and have his breakfast during treatment. We were just snacking, but have now gone to the full breakfast at times. We do try to do that towards the latter part of treatment. Having a smaller protien snack seems better to me but is this ok?
Hi also has another question. He gets tired of laying down and likes to sit up with feet down on the ground. Is this allowing the fluids to be sucked out easily or should he just do that for short periods?
Thank you so much for input. Reply With Quote .
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August 1, 2011 06:16 PM #2 John Agar
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Broadly, we do not encourage more than small snacks during dialysis … and there is a physiological ‘reason’ for this …
It all has to do with the ‘splanchnic circulation’. The splanchnic circulation (splanchnic comes from the ancient Greek word to describe the ‘visceral organs’) is that circulation that supplies the gut and the abdominal organs.
When (or after) we eat, blood is diverted into the splanchnic circulation to aid in the absorption of nutrients from our bowel as the food we have eaten is munched up and acid-dissolved by our stomachs, squirted with bile and enzymes from the gallbladder (bile) and pancreas (enzymes) to break down the fats and sugars released by the munching and dissolving of the stomach, and then is milked by a muscular squeezing process along the many feet of intestine where the nutrients are absorbed into the blood stream of the splanchnic circulation. Finally, water reabsorption and mucous secretion in the large bowel formulates our final stool (poo) for elimination at the rectum and anus.
Phew … there’s our bowel function in a single paragraph!
Eating triggers a diversion of a significant dollop of our total blood volume to this circulation … a circulation that almost runs as a parallel but ‘segregated’ circulation from our ‘systemic’ blood flow … the blood that wooshes down into our legs and arms and that supplies our kidneys (if they are there!), our brains, our lungs etc.
Eating ‘compartmentalizes’ a significant volume of our blood for absorption … and makes it relatively unavailable for the systemic circulation.
This means that the blood volume that has been redirected to the gut is less available for dialysis! Dialysis can access the systemic circulation … but not the splanchnic circulation!
You may begin to see now that this reduces the potential efficiency of the dialysis treatment as a means to ‘cleanse’ the total blood volume.
There are also blood pressure implications that can arise from splanchnic diversion, with hypotension a more likely complication of dialysis therapy delivered to a patient who has eaten on dialysis than if no eating had been permitted.
A snack? … let’s be fair … a snack is ok – but make it very light, and make it of easily digestible food. If the patient isn’t desperate to eat, then not eating is ideal. If eating is essential (some patients just can’t hang that long without something to eat) … then small amounts.
As for a full breakfast? I’d not be so thrilled, if I were your physician, to encourage that. Anyway, I reckon it’d be more enjoyable to have a full breaky after dialysis, in the sun, together, with the morning paper, and without a bunch of tubes hanging from the arm!
As for your question of whether he should have his legs down or up during dialysis … this is a question that is of enormous interest to me. We published on this – or a parallel issue – back in around 2004 (in ‘Nephrology’) and again in 2007 (in HDI) … looking at the effects on the serum albumin and on volume of recumbent versus erect (seated) dialysis. It’s a complex issue. So complex, indeed, that it is a little over-complex to deal with here … suffice to say, it is a fascinating academic ‘ride’ to delve into this murky subject.
From a practical stand-point, while there do appear to be some circualtory ‘advantages’ from recumbent dialysis, I’d not be at all worried if he wants to plonk his feet down!
In Australia, almost all conventional dialysis is semi-recumbent, at best … and many dialyse seated with their feet down. I suspect (no, I know) that this is also the case elsewhere around the world.
If he wants to sit up a while … go for it. But … as his blood volume has been changing through dialysis, he may be more easily prone to a postural change (a fall) in his blood pressure when he sits up … so do it slowly … don’t make a too-sudden change. It may help avert an unexpected ‘flat’. John Agar
http://www.nocturnaldialysis.org Reply With Quote .
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Here's the link for the whole thread:
http://forums.homedialysis.org/showthread.php/2955-eating-during-dialysis
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I have a small snack. I don't eat a huge meal. I don't think they'd let us eat a meal anyways. I used to buy a sandwhich at Tim Horton's every weekend on the Saturday evening dialysis run I was on that started about 6 pm in the evening. I sometimes brought a sandwhich in that I bought from there......they let me eat it......but anything more than a sandwhich I think that might have been a problem while dialyzing.
The hospitals where I'm from usually have a sandwhich/donut/muffin shop of some kind in them, so it was just so convenient to have supper from there once in awhile. I hated having to eat at like 4 pm in the afternoon before I left to be at the hospital before 6 pm. It took 45 mins just to get to the hospital.
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This is an interesting subect, as it has been one of great controversy at my center.
I'm diabetic - and have discovered that dialysis lowers my blood sugars dramatically, so much so that 2 hours into treatment I MUST have a snack or two! Without the snack, I'd crash in insuln shock or reaction and I know (for a fact) the center does NOT STORE fruit juices to avoid the crash. Further, I asked a nurse if I could store juices or fruit cups in their readily available refrigerator and she almost took my head off!
And so, I bring my fruit cups, crackers, etc and keep them in my tote bag, no matter what they say.
I AM IN CHARGE of my own health - and that includes diabetic low sugar issues. Been diabetic since 14 yrs. old (57 now) and no one's going to tell me to stop looking after myself independently, no matter how weird or strict the "rules" are. :)
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When I started dialysis 2 yrs ago, I asked about snacks etc. I told them I needed to have something in case my BS dropped. The nurse told me not to worry they would give me glucose if that happened. :banghead; it has not been a problem. My time starts at 6:30 am and I eat before I get there. I am starved when I am done and have to eat as soon as I leave. I carry my own monitor, apple juice, ritz bitz crackers and glucose tablets. I sit in he back in a corner and no one pays attention.
Pam
EDITED: Icon error corrected - Bajanne, Moderator
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My unit has a bowl of crackers and they offer water and coffee or tea. :)
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I quit eating on the machine do to it was making me nausous even just a small snack
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This is an interesting subect, as it has been one of great controversy at my center.
I'm diabetic - and have discovered that dialysis lowers my blood sugars dramatically, so much so that 2 hours into treatment I MUST have a snack or two! Without the snack, I'd crash in insuln shock or reaction and I know (for a fact) the center does NOT STORE fruit juices to avoid the crash. Further, I asked a nurse if I could store juices or fruit cups in their readily available refrigerator and she almost took my head off!
And so, I bring my fruit cups, crackers, etc and keep them in my tote bag, no matter what they say.
I AM IN CHARGE of my own health - and that includes diabetic low sugar issues. Been diabetic since 14 yrs. old (57 now) and no one's going to tell me to stop looking after myself independently, no matter how weird or strict the "rules" are. :)
If you click on the link and read the rest of the thread, Dr. Agar does in fact address the issue of snacks for diabetics. He does not suggest that you go into shock for lack of a small snack to keep your blood sugar level!
I suspect that if you dialyze at home, there may be a greater temptation to eat more than is prudent. I just wanted to provide some information about what is happening to the body if you are digesting and dialyzing at the same time, all in response to boswife's question. I have never heard the explanation given by Dr. Agar provided by clinic staff. Has anyone else had this issue addressed in this manner? Maybe this is common knowledge that I missed somewhere along the way!
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Just curious what this doctor meant when he said "an unexpected ‘flat’." Is he talking about a drop in the BP?
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I knew that full meals made it harder to get good results because of the shift in blood circulation to aid digestion. I guess I thought it was common knowledge, but maybe not.
The last time I went back up north where I lived pre-transplant, I dropped into my old center to say hi to the staff members I was friends with. I noticed they had covered a HUGE bulletin board with a full set of instructions about acceptable snacks, right down to having pinned ziplocs with appropriate amounts of certain snacks to the board as an example. I nodded at it and asked what was up with the lecture, since, as a diabetic, I had always had a full complement of snack foods available for my own use, and had never heard a peep from any one when I went there. It was a two word answer.
"Pizza deliveries."
Too funny!
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It SHOULD be common knowledge! Well, ya learn something every day. I had suspected that there was some blood-related reason that one shouldn't eat a big meal while dialyzing, but I had never really thought about it. Again, I guess the real danger is if you're dialyzing at home and your spouse is feeding you pizza while you dialyze. :rofl;
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This is very interesting and I can understand the reasoning behind it.
On the other hand, when Carl was dialyzing, he almost always had his regular dinner near the beginning of his treatment every night. That was about the only way we could schedule everything!
His labs and numbers were always great and his doctor was always pleased with how well he was doing. Perhaps those numbers might have been better had we waited until after dialyzing for dinner, but Carl would have passed out by then. LOL
Aleta
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I do in-center D 3 times a week in the late afternoon/early evening. I always bring in something to eat, usually a bowl of clam chowder from a local fish 'n' chips place. I need to eat, because by that time, lunch is usually gone. If I don't eat, I'll end up so hungry by the end of my 4 hours that I'll be shaking. I don't like that. My center has no problems with patients eating. I won't eat a full meal, but I do need to eat *something*.
KarenInWA
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My unit offers digestive cookies if you get hungry, and if your fluid goals aren't too high, they'll even offer you a drink. They have coffee, tea, juice or ginger ale. Some bring in their own snacks. I usually have hard candy, and another fellow brings a bag of peppermints in with him. They do prefer that you don't have anything more than a muffin or a few cookies while you're on, and the reason given was a simplified version of what's above... *G*
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It would certainly be stupid to allow yourself to pass out during dialysis because you haven't had time to eat anything. We all know that we have to take the information that's relevant and fit it into our own circumstances the best we can. It's just that I have a very distinct memory of someone on IHD talking about how great it was to do NxStage at home, in his own time, on his own schedule while having his wife serve him up his favorite dinner. I though, "Oh yeah, I can see how that would be very tidy, indeed.", but now I see it's not such a brilliant plan. :rofl;
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its a bit hit and miss with each idividual.
my story is as follows, in the beginning of dialysis,say 3 months in, i was on the graveyard shift 7pm-midnight.
about 10 pm, i started to feel a little ordinary, not one to complain, i stupidly put up with it, next thing i know is i'm sweating so much and it feels like someone is choking the life out of me, had enough energy to raise my hand,lucky the nurse spotted me,woke up with oxygen.
there were 2 of us on the graveyard shift,strictly forbidden to eat for minimum 3 hours before dialysis, only given a sandwich during treatment.
food and dialysis just don't mix for some people
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Thanks MM :cuddle; I loved haveing Dr Agar take the time to explain. The explanation i had gotton from both the 'center' and our nxstage nurse did not satisfy a very good WHY of not eating a full on meal or even a snack. (we had been told that it wasnt very sanitary, he could choke, and possible blood pressure drop) Neither refused anyones snack and the center actually encouraged it due to many were diabetic and all. But!!!!! Im one (as you are) who likes to know how things work, the nitty gritty, and wish they had informed me better so i would have had a real reason to not pack up the food for Bo and others at the center. :embarassed: It's nice to hear that others had better explanations from their techs or other :)
ps.... lol, you just posted and geesh, if it wasnt me who posted about "fixen dinner and serving him up his favorite", well, it could have been. Kinda glad i got this 'new' information. I was beginning to feel a bit of a hostess..hehe oh yea, now im just his foot massuse and 'snack' maker.. still, a bit easier than the full on meal deal though..
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Thanks for reposting John Agar's comments. It's nice to hear a real pyhsological reason that makes some sense rather than random excuses.
For the tecord there were never really any restrictions on us eating while on D in the unit. They provided (bad) sandwiches (which oddly enough I actually miss from time to time :rofl;) and a cup of tea/coffee and/or ice and maybe some fruit. We can bring in our own stuff. I guess the staff would have got a bit funny if someone brought in a pizza, or a roast chicken or something, but I never saw that. Mostly I had some peppermints in a jar, and more staff ate them than me! :)
In general I was fine with food before and during D - like Ang says everyone is different which doesn't help matters.
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When I was in NY, no one in the unit there said anything about food or drink.. now that I know more about it, because I didn't the last time I was there, we won't do what we normally do..
There was usually 4 of us, me, Mom, Kelly, and another friend. I'd go to dailsysis around 6pm and be there till around 10pm. Around 7:30 or so, Mom and the friend would go for a walk, and Kelly would stay with me. They always came back from their walk with food for all 4 of us. From what I understand, there's a Subway not too far away from the unit, so that's where they'd go. I think what we'll do next time, is eat before dialysis, hopefully somewhere where it's not hard to get a cab. Getting a cab in Manhattan around 6pm is NOT an easy task.. *L*
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i am a diabetic. i get transportation that picks me up at 4:10. usually we get on around 5 but it varies i was on at 455 on friday however it can be later than 6 if unit had troubles earlier in day which produced back log. the latest was 6:30 which means a 1030 start with 30 minutes to get home the 430 to 11 rt would gurantee low sugar maybe dangerously low however in england we are served food and drink for our shift a sandwich and tea and cookies too. you do not have to eat they take off an extra .5 if you do drink VERY SENSIBLE POLICY WHICH LEAVES INDIVIDUAL PATIENTS TO WHAT WORKS BEST FOR THEM
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i am a diabetic. i get transportation that picks me up at 4:10. usually we get on around 5 but it varies i was on at 455 on friday however it can be later than 6 if unit had troubles earlier in day which produced back log. the latest was 6:30 which means a 1030 start with 30 minutes to get home the 430 to 11 rt would gurantee low sugar maybe dangerously low however in england we are served food and drink for our shift a sandwich and tea and cookies too. you do not have to eat they take off an extra .5 if you do drink VERY SENSIBLE POLICY WHICH LEAVES INDIVIDUAL PATIENTS TO WHAT WORKS BEST FOR THEM
Hello, billmoria,
I have read several of your posts and you create a wonderful picture of how fantastic your Dialysis-centre is,
and also how wonderful the services you receive, like transportation etc., are.
You are no doubt aware how problematic Dialysis can be for so many people,
therefore they may wish to experience the same wonderful service you experience.
Perhaps you could let us know what Hospital or what Dialysis-centre you go to and where it is?
Thanks from Kristina.
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If Blokey didn't eat at haemoD he wouldn't eat till nearly midnight! Most people just eat the limp, soggy sandwiches provided, but it has been known for a couple of people to regularly pig-out on burgers, and chips, etc. despite the best intentions of the nurses and doctors.
Hello, billmoria,
I have read several of your posts and you create a wonderful picture of how fantastic your Dialysis-centre is,
and also how wonderful the services you receive, like transportation etc., are.
You are no doubt aware how problematic Dialysis can be for so many people,
therefore they may wish to experience the same wonderful service you experience.
Perhaps you could let us know what Hospital or what Dialysis-centre you go to and where it is?
Thanks from Kristina.
Kristina, billmoria's experience isn't that different from Blokey's. Blokey is offered sandwiches/toast (dependent on time of day) and biscuits, plus two drinks. Before you start the nurses ask if you're likely to have one or two (or no) drinks and adjust the fluid take-off according to your answer. Transport provided by the NHS is pretty standard for those who can't get to the hospital themselves (Blokey drives, but has had to use it in the past and I understand it can be a nightmare.)
Blokey has only had experience of two dialysis units but they've both been similar to billmoria's view. I'm not suggesting that it is a 'wonderful picture' of 'wonderful services', but it would appear to be standard within the NHS in the UK (although others may have differing experiences.)
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Thank you for your answer, Poppylicious.
I mainly asked because I am still pre-Dialysis
and I have only heard horror-stories
about hygiene, treatment etc. at Dialysis-centres.
I also talked with Dialysis-patients who appeared very suicidal to me;
they felt their dignity was being taken away from them in their Dialysis-centre,
and it was very very sad for me to come across that.
Adding to that, I don’t know if you have recently listened
to phone-ins & discussions on the radio:
it was mentioned that
every day three people on the kidney transplant list die in the UK
and I was wondering whether that was because of bad Dialysis-services,
but reading what you and billmoria say sounds rather encouraging.
Thanks from Kristina.
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Jenna brought in lunch or dinner nearly every time she went to dialysis. There were no restrictions at her clinic. In 3 years she never had a problem during dialysis (only trouble was afterward, when they'd remove too much fluid, even though she still urinated, we'd have to argue to keep her above her "dry weight." She'd feel wrung out and have a headache.)
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At my unit in the British Virgin Islands, there is no restriction, and I have seen other patients eating a full meal during dialysis. However, at the unit I go to in Barbados when I am visiting there, they prefer you not to eat during dialysis. The nurse there told me that same thing, that eating redirects blood that should be used in dialysing.
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My snack is without a doubt the highlight of the session! lol Sandwich, coffee (espresso) and water kindly offered by our center! :D Suprising considering its a public hospital in Italy! lol :D
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Well, we are all told that we are supposed to educate ourselves and find out as much as possible about our disease, our treatments and how to get the best results. So, this is just one more bit of information that we all can take or leave as we wish. If you want to have a full meal during dialysis and your clinic says that's just fine, then by all means do what you like, but at least now you will be armed with a bit more information to help you make good decisions, and that's what this forum is all about.
During the times that my I was visiting Texas to look after my mother, she would often ask me to bring her a Whataburger while she dialyzed, and I did. No one at the clinic said anything, so I am as guilty as anyone who thought I was doing my mom a favor by feeding her fries and Whataburgers, never knowing about the physiological consequences as outlined by Dr. Agar. It would have been nice if someone at the clinic had clued us in, but no one did, and that's a bit worrisome. But even if someone had, it is entirely possible that my mother would not have cared and would still have wanted that Whataburger, but at least she could have made a more informed decision.
We all bang on about fighting to get good dialysis, and it seems that dialysis is more "adequate" if there is more blood available to be cleaned instead of that blood being diverted toward digesting Whataburgers. I think we are all smart enough to know the difference between a small, easily digestible snack and a stonking great serving of bangers and mash, and I think we are all able to make good decisions for ourselves, but for those in particular who dialyze at home and think being out of a clinic environment enables them to have a main meal while dialyzing, then hopefully this information will be useful.
And boswife, no, it wasn't you I was remembering...it was definintely one of our male IHD members who dialyzes at home.
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MM, it may have been me that mentioned it! Hubby and me do eat alot of snacks while he dialysis's and, with time restraints, have had a full course meal! But most of the time, we eat big meal before, and then snack a little during!
It is nice to know the real effects of eating while D. Thank you for that cause I personally, never got a truthful answer on the subject! But that is the Beauty of doing it at home, you can if you want and if you dont want then you dont! But what Dr. Agar states does make better sense than anything I have heard!
Mentioned to my husband, and he said probably no more full meals, unless absolutely necessary! I never thought about the blood used to digest the food! Dah!!!!!!!! :Kit n Stik;
lmunchkin :kickstart;
P.S. Not going to stop the snacking though! Boredom tends to make us want to eat alot!!! lol
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Two opposing opinions:
Should patients eat during hemodialysis treatments? (2005) http://findarticles.com/p/articles/mi_m0ICF/is_5_32/ai_n17211656/
Why Not Meals During Dialysis? (2009)
http://www.renalandurologynews.com/why-not-meals-during-dialysis/article/154891/
And more from IHD members:
Eating In Dialysis http://ihatedialysis.com/forum/index.php?topic=222.0
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I also talked with Dialysis-patients who appeared very suicidal to me;
they felt their dignity was being taken away from them in their Dialysis-centre,
and it was very very sad for me to come across that.
Adding to that, I don’t know if you have recently listened
to phone-ins & discussions on the radio:
it was mentioned that
every day three people on the kidney transplant list die in the UK
and I was wondering whether that was because of bad Dialysis-services,
but reading what you and billmoria say sounds rather encouraging.
Thanks from Kristina.
You have to remember that that stat is much like the "average life expectancy while on dialysis" being at 5 years or something. These figures are skewed because your average age of a D patient is much older, and they probably have other conditions that could lead to mortality. Same with the tx list, even if most on the list would be younger in general (because patients over a certain age.. 70?? in general won't be accepted to be on the list)... even still there will probably be other conditions going on.
Don't get me wrong, if there were more organs available and more signed up to donate (live or otherwise) that figure would go down, but I don't think those figures can be used as a reasonable guide.
In my D unit I was, most of the time anyway, the youngest patient by a mesure of decades. I think just prior to my transplant, we had me-just turned 40, then a guy who was in his early 50's, then the rest being 60+. The oldest patient was I think 89, or 92, or something like that - he had done D for 20 years and unfortunately passed away due to some other complications he had.
I don't know about the patients you talked to, about their ages, if they were even eligible for tx etc, but we all know that this situation can lead to a lot of depression. To be honest with you if I didn't have the goal of tx to "look forward to" I am not sure MY attitude would have been so positive - at times it was the only thing keeping me going - that hope, that desire, for a better form of treatment.
You hear horror stories and good ones. Case in point about my very own unit, which everyone knows I loved for many reasons. It was far from perfect of course, but I was very happy. We had another patient there who was actually a qualified doctor(not renal) who was from the UK. He *HATED* it!!! I am sure he would report horror stories about the same unit that I loved - and we were on the same shift. It's all up to perception and your own experiences.
I don't doubt some units are poorly run and some folks have poor staff either numbers, or skills, or attitude, or whatever.... but for every poor one I think you'll find there are great ones.
I think you should try to not let these "reports" or what some patients tell you scare you. Think about all the folks here who cope well with D. If you can go in and have a positive attitude that can often be all the difference in my view.
of course that's just one view.
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Thanks Richard,
your reply is extremely well-balanced
and I think your analysis is probably right
and is very much appreciated.
Thanks very much for your time and thoughts,
kind regards from Kristina.
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IMHO, I think diabetic patients should take charge of their own needs, regardless of what the rules are at your center
Here's something interesting: while in the hospital, a nurse told me that patients are eatng HOAGIES during dialysis because the treatment gets rid of all the lunch meat junk at the same time! Say what!!!???? She's crazy. That patients are eating tomtoes, bananas, etc. - anything and everything on the no-eat list!!!
This would last in my center about 1 minute, I tell you!!! OMG
To be honest, I was told a LOT of things by nurses and assistants that are simply not true....... e.g. Centers ae SOCIAL CLUBS - no way! Our chairs are so far apart, you can't hold a conversation with anyone.
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well welll well okarol.... thank you so very much for the info. I tell ya, it's a tough road knowing what to do. Bo's albumin finally is rising and i was thinking mabie it's because of his 'meals' on D then i read about the blood thing and geesh!! Because he doesnt seem to have issues with dropping pressures, i wonder if then he's on the more OK side to eat.... except then less blood is available for process... oh brother...lol
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Just put hubby on D. and we ate:, chicken, green beans, squash w/onion, sliced tomatoes and cucumber w/onion in vinegar! His BP starting is 160/74. After we ate it was: 162/74, Just took again and it is 139/70.
Oh well, kinda throw all Logic up in the air! By the way, clinic called and said to hold EPO! He was on low dose for two weeks! Im really feeling blessed to have it peaceful for awhile!
It still makes sense that blood being use for digestive system when someone eats, but today was one of those "time restrainst" evenings!
lmunchkin :kickstart;
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When I transferred to my current center, a nurse went through all the rules with me. About food, he made it clear that "we discourage eating during dialysis" because of the blood flow issues mentioned here, and that choking could occur if your blood pressure changes suddenly while you're eating. That was the only "discouraging" they've ever done, though. Plenty of people eat snacks and meals while on dialysis, since my shift runs through lunch.
If I don't eat a large breakfast before dialysis or bring a substantial snack, I'm starving by the time I get off. Sometimes when I can afford it, I'll pick up an egg sandwich and coffee on my way to dialysis, and eat it there.
A year ago I was having problems with my blood pressure. It would routinely be up to 170/120 during dialysis (it turned out to be a problem with taking clonidine regularly), but sometimes it would be just fine, 120/80. Eventually I figured out that it went down to normal when I ate a meal as enough blood vessels in my digestive system opened up. For a while, I was eating full meals during dialysis just to keep my blood pressure down.
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when i was training for home hemo, the nurses didn't say anything about not being able to eat while dialyzing. In fact, before starting the training session, i was told to bring my own lunch.
My training session would start about 7:30 am, after I finished setting up the machine and everything, it would be between 8:45 - 9 am, and I'd set it for a 4 hour run. About 11:30 am, I would ask the nurses to get my lunch out of the fridge so I could eat it.
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Well well, once again it all seems a 'personal' or better yet, 'individualized' situation. How ya feel, and how you see your pressure etc #'s are going.. I would love to have a personal study done on Bo to see what HIS spacific needs are... ALL of them, eating, time on D, Speed of D etc.. Im on another listserv and we're discussing 'longer slower' dialysis situation and it's blowing me away as well. Mostly how it equals out weather you go fast or slow, and turbulance vs is it really turblance etc... lol Anyway, it's all very interisting to me but i do wish there was ONE answer to it all...
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I went back to that old IHD thread on this subject as Okarol suggested, and out of all of those posters, not one of them said anything about the physiological effects of eating a substantial meal while on dialysis. There was, to be sure, a member named Hawkeye who apparently worked for Fresenius, and s/he outlined some reasons why eating was not allowed, one being something about food adding "stuff" to the blood, making treatments less effective. Even that member didn't mention the idea of blood being diverted to digestion and made unavailable for cleaning. And I personally think that is an important piece of information to have when you are deciding how much to eat while you are dialyzing.
I just want to remind you all that Dr. Agar's advice was mostly applicable to eating full meals, not judicious snacking. If I let myself get too hungry, I feel awful, and I can't imagine feeling that bad AND dialyzing at the same time, so if it were me, I'd have something on hand to snack on if necessary, but I wouldn't be eating Whataburgers. Clinics may have their weird reasons for not wanting you to eat that suit THEM, but if you want some guidance to figure out what will suit YOU, maybe stay away from the Whataburgers. (I can't believe I let my mom talk me into doing that...) ::)
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This is excellent medical information and it is important for us to bolster ourselves with the best available info out there. I used to eat on the machine, not a huge meal but not a light snack either, and although it never made me feel ill or drop my pressure, if anything has the potential to make my hours on D less effective then I'd avoid it. They used to serve us full meals at the hospital and so at that time they too may have been unaware of the blood diversion issue.
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Thats just it Boswife, what may be good for my husband, may not be good for Bo! Wish that "One size" fits all could work with this junk, but unfortunately, it dont! I like running his Blood Flow Rate low because I want his access to last! I run it at 380 to 400. To some, that is not slow enough, and to others its too fast!! Go figure!! But if you run at a higher BFR like a 450 to 550 you are running alot more blood through the machine thus getting more blood cleaned! Less time too! But if you run it slower, it is less harmful to him and his blood is still getting cleaned but it takes longer!
I personally run him lower so as to not give him the washed out feeling or cramping!
He is very quick to let me know what he is feeling! But it is a fine balance. Just tweak here and there and you will find what works best for him! If I were to run it fast, then why not just put him back in center! That is what they are known for, is wiping you out, right? Yea, we have to do them more days a week, but at least they are not spending a day and a half getting over the day they dialysised.
As far as the eating while on D. Yea, it is a personal choice! I guess in the D world, we are like rebellious and just want to defy the rules! lol Just kidding, but we do just snack! The only time we eat a full course meal is when we a pressed for time. Even still, it is not huge portions, it just a moderate meal! Do you and Bo eat while he D? Meals or Snacks?
Well well, once again it all seems a 'personal' or better yet, 'individualized' situation. How ya feel, and how you see your pressure etc #'s are going.. I would love to have a personal study done on Bo to see what HIS spacific needs are... ALL of them, eating, time on D, Speed of D etc.. Im on another listserv and we're discussing 'longer slower' dialysis situation and it's blowing me away as well. Mostly how it equals out weather you go fast or slow, and turbulance vs is it really turblance etc... lol Anyway, it's all very interisting to me but i do wish there was ONE answer to it all...
Im so excited, thanks to House of Dialysis, I can now pull the Quotes!!! :bandance; :bandance; :bandance; :bandance; :flower;
lmunchkin :kickstart;
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Evidently, not every dialysis center agrees with this policy:
"The London Clinic dialysis unit is managed by a team of specialist renal nurses. It consists of four stations, using the latest haemodialysis machines from Gambro and Fresenius for both standard and high-flux bicarbonate haemodialysis....
"Patients have use of the electrically operated reclining chairs and flat screen LCD televisions with inbuilt Free view channels with headphones. A selection of sandwiches, tea, coffee and biscuits is also available for patients on request."
http://www.thelondonclinic.co.uk/specialties/dialysis__renal_medicine.aspx
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That's not a full meal. A drink and a sandwich isn't going to do much
When I first started dialysis, because I was in the hospital, as opposed to coming in, I was usually taken in first thing, around 7:30am, so when breakfast showed up at 8am, it was normally sent over to dialysis. I normally ate my breakfast in dialysis. I never had a hot breakfast, though. It was normally a bowl of cereal and a muffin, glass of juice and tea. No one ever told me that I needed to watch fluids, or anything like that. I think at that point, though, they were happy if I ate anything.
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If I saw that my husbands health would suffer in any way by eating, then absolutely, I would stop it immediately! But his labs are good, he is getting very good clearance (ktv) and if it aint broke, Im not gonna fix it! I mean, he is restricted in soooooooo many ways, why put that on him too! If it hurts him to do it, then yes I would stop it! Hopefully :thumbup; things continue to look great for his treatments & his health.
lmunchkin :kickstart;
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I've been to the London Clinic a couple times - that sandwich is served on proper china with the crust cut off, tea steeping in a proper tea pot, very civilized.
The first time I dialyzed at Tassin in '96 - the unit that boasted the best mortality outcomes in the world since the '70s - they served me a full meal: perfectly cooked steak, roasted potatoes, a cheese course and salad with lots of fresh tomatoes. It was delicious. When they told me I could have beer or wine I laughed and then realized that no you can have beer or wine. I hear the chef changed a few years back and since then people have dialyzed less and seen their outcomes return to norm.
I've always eaten. No eating policies are another instance of blanket rules made to accommodate the lowest common denominator.