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February
February
Inside this Issue
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A Quick Guide for
Diabetic Foot Checks
Fluid Management
A Quick Guide for
Diabetic Foot
Checks
Foot checks are performed monthly
for each diabetic patient. It is
important to participate in these
monthly foot checks to identify
potential problems that may lead to
discomfort and infection. The
following tips are things you can do
to help keep your feet healthy.
TIPS FOR EVALUATING
APPROPRIATE FOOTWEAR:
Cover Your Cough
Stopping the Spread of
Viruses
1. Check for foreign objects,
torn lining and proper
cushioning
Keep Your Potassium in
Control
Advance Directives
What
are Directives
they?
Advance
2. Avoid pointed and opentoed shoes, high heels,
thongs and sandals
Continued
Phosphorus Game
Making Lower
Phosphorus Food and
Drink
Choices
Be Kind
to Your Heart
Dealing with Depression
Dealing with Depression
Continued
3. Shoes should be made of
breathable expandable
material such as canvas,
leather, suede
4. Footwear should be
adjustable with laces,
Velcro, or buckles
5. Properly fitted athletic or
walking shoes are fine for
daily wear if there is room to
accommodate any
deformities
6. high risk patients may
require depth-inlay shoes or
custom molded inserts
!
DO’S AND DON’TS OF
FOOTCARE AT HOME
DO:
✓
Wash feet daily with warm
soapy water
✓
Dry feet well, especially
between the toes
✓
Inspect feet daily: tops,
bottoms, and between toes
✓
Apply moisturizing lotion
daily to tops, bottoms, and
heels of the foot
✓
Trim nails straight across
✓
Wear shoes that fit and
protect your feet
✓
Check inside shoes for
hidden objects before
putting them on
✓
Break in new shoes
gradually
✓
Tell your doctor or dialysis
staff if you have any foot
problems
(Continued next page…)
DON’TS:
➢ DON’T Soak feet, it causes
dryness
➢ DON’T Check water
temperature with feet or
hands, use elbow or ask a
friend
your kidneys are not working
properly, dialysis can remove some
of the fluid, but you will also need to
drink or eat less fluid. Having “too
much” fluid can cause problems,
some of which are serious. It is very
important for you to follow the fluid
restrictions your health care team
prescribes for you.
➢ DON’T Use lotion that
contains alcohol or perfume,
it can cause further dryness
What happens if I have too much
fluid?
➢ DON’T Put lotion between
the toes, it may cause
buildup of moisture
Some problems you may experience
from gaining too much fluid are:
➢ DON’T Trim toenails
yourself if you have poor
vision, ask for a podiatry
referral
•
Swelling in your ankles and
feet called edema
•
Weakened heart muscle,
and eventually heart failure
caused from too much fluid
stretching the heart muscle
(enlarging the heart)
➢ DON’T Use razor blades or
over the counter corn callus
removers, consult a foot
doctor
➢ DON’T Wear sandals or go
barefoot
➢ DON’T Wear stockings with
tight tips or seams which
rub
➢ DON’T Expose feet to
space heaters, car heaters,
hot water bottles, or heating
pads ♥
Fluid
Management
Adapted from DCi, Empowering
Patients
For a person on dialysis, fluid is
usually restricted or limited. One job
of healthy kidneys is to remove
excess fluid from the body. When
•
Shortness of breath caused
from too much fluid around
the lungs
•
High blood pressure
•
Sudden drop in blood
pressure causing you to feel
faint or dizzy
•
Chest pain
•
Cramping during dialysis
•
Headaches, nausea and
overall “bad” feeling during
and after your treatment
How do I know if I have too
much fluid?
Any of the symptoms can
indicate you have gained too
much fluid. For a person on
dialysis, fluid is measured by
weight gain between dialysis
treatments. The members of
your health care team will
monitor your weight gains each
time you come for a treatment.
Your “dry weight” is your weight
without extra fluid. This is used
as your target weight after fluid
has been removed. In dialysis,
weight is often measured in
kilograms. Each kilogram
equals 2.2 pounds.
Limit your fluid intake to 4
cups per day. It is important
not to gain more than 2 kg (4.4
lbs.) between each treatment.
For every 4 cups (32 oz) of
fluid you drink/eat, you will
gain about 1 kg.
How can I control my fluid intake?
1. Avoid salt and salty foods.
Salt makes you thirsty and
can cause your body to
retain fluid.
2. Measure all fluid with a
standard measuring cup.
3. Chew sugar free gum.
4. Take medications with
applesauce instead of liquid.
5. Suck on sugar free hard
candy, especially sour
candy.
6. Prepare a spray bottle with
water and lemon juice or
cherry juice and use to
lightly spray your mouth.
(Continued next page)
7. If you have diabetes, control
your blood sugar. High
blood sugar will make you
thirsty.
8. Rinse your mouth with cold
mouthwash. Do NOT
swallow.
same amount that you just
drank into the bottle. When
that bottle is full, you have
used your fluid allowance
for the day.♥
9. Use a smaller glass with
meals.
10. Brush your teeth often
some tips to help stop the spread of
germs.
•
Cover your mouth and nose
with a tissue when you
cough or sneeze.
•
You may be asked to put on
a surgical mask to protect
others.
•
Wash with soap and water
or clean with alcohol based
hand cleaner.♥
11. A frozen lemon slice or a
couple of frozen grapes can
take the edge off your thirst.
12. Keep a daily fluid intake
diary.
13. Start each day with an
empty liter sized bottle (~32
oz bottle or quart jar). Each
time you drink, pour the
Whether we like to believe it or
not, we live in a world filled with
germs, bacteria, viruses, and other
creepy crawly things. It is hard to
remember to protect you and others
against germs you can not see, but
we all know they exist. Here are
Keep Your Potassium in Control
Potassium helps your muscles work and your heart is a muscle. Too much potassium can be
dangerous for patients on dialysis. If your potassium is too high it can cause your heart to stop!
For safety and feeling good, keep your potassium levels at 3.5-5.5.
We get potassium from the foods we eat. People who are not on dialysis do not have to worry
about their potassium levels because their kidneys will get rid of any excess potassium the body
does not need. People who are on dialysis must control the amount of potassium they consume
each day so that excess does not cause life threatening problems. A low potassium diet is
considered to be around 2500 mg potassium each day. This may sound like a lot, but consider
that 1 medium banana has over 450 mg potassium and 1 medium potato has over 700 mg
potassium!!!
Cover Your
Cough
Many fruits and vegetables have a lot of potassium. Choose from the following list of
lower potassium fruits and vegetables to ensure your potassium does not get too high.
Remember, limit each serving to ½ cup serving sizes. Discuss with your dietitian
about how many servings of fruits and vegetables you can have in one day.
Lower Potassium Foods: apples, grapes, strawberries, tangerine, plum, canned
peaches, canned pears, pineapple, apple juice, cranberry juice, carrots, green
beans, peppers, corn, cucumbers, zucchini, and radishes.
Advance
Directives
An Advance Directive is a document
that allows you to have control over
healthcare decisions when you are
no longer able to make decisions or
communicate your wishes regarding
your healthcare. Simply put, it
allows you to “direct” your care in
“advance” of the need.
There are 3 types of advance
directives:
1. A Living Will states that if your
doctors know you cannot
recover, you want only comfort
care provided. A Living Will
cannot take effect until you can
no longer make or communicate
decisions for yourself. Some
states do not recognize the
living will. Check with your
social worker to be sure your
state recognizes a living will;
otherwise your wishes will not
be able to be carried out.
2. A Durable Power of
Attorney for Healthcare, or in
some states it is called a
Surrogate or Proxy Directive, is
a document that allows you to
choose someone to make
decisions on your behalf when
you are no longer able to make
those decisions.
3. A Combine Directive lets
you name a healthcare
representative and tells that
person your treatment wishes.
It is important to ask your social
worker about the types of advance
directives available, since legal
documents may vary from state to
state.
may be necessary for a
court to appoint someone as
your legal guardian. Or,
your family may have to go
to court to stop a treatment
that they think you wouldn’t
have wanted. An advance
directive assures that your
family knows what your
wishes are. It helps take
any burden away from your
family members if they were
to have to make decisions
about your healthcare.
What if I change my mind?
You can change an advance
directive or cancel it any
time. If you change it, you
need to give new copies to
anyone who may have had
a copy of your old advance
directive.
What treatments can I
include in my advance
directive?
You can choose to receive
pain medicines for comfort
even if you refuse other
treatments. You can accept
or refuse other treatments
such as: CPR
(cardiopulmonary
resuscitation), tube
feedings, mechanical or
artificial respiration
(ventilator or respirator),
antibiotics to fight infection,
dialysis, surgery, and blood
transfusions.
Do I need a lawyer to
make up an advance
directive for me?
Can’t
my
family
just decide my healthcare for me
without an advance directive?
It is important to talk with
family and communicate
your wishes regarding your
healthcare. However, if you
do not have an advance
directive and your doctor
and family does not agree
on your care decisions, it
No. Your dialysis social
worker has advance
directive forms.
Depending on the type of
advance directive, it may
need to be witnessed or
notarized.
What is cardiopulmonary
resuscitation (CPR)?
CPR is a common
emergency procedure that is
done to attempt to restore
someone’s heartbeat. It is
done by giving mouth-to-
mouth breathing and
pressing at intervals on the
chest. “Shocks” to the chest
are also done, if needed.
Do I need an advance
directive if I do NOT want
CPR?
The dialysis staff will
respond to any dangerous
lowering of your blood
pressure by taking usual,
ordinary measures for
treatment of low blood
pressure. This would be
treatment such as giving
you intravenous fluids and
placing you in a physical
position to improve blood
flow to your upper body.
If this treatment does not
work and your breathing
stops or your heart stops
beating, CPR and electric
shock treatment can be
done, after which you will be
taken to the hospital.
To plan ahead in case this
happens to you, a staff
member will ask you to
decide if you would want
CPR or electric shock. You
will also sign a paper that
indicates the choice you
make. This paper will be
part of your medical record,
and the staff will be informed
of your wishes. It is
important to know that if you
refuse these life-saving
treatments, it can result
in death. Before you
make this decision, you
will have a chance to ask
questions and discuss
this with anyone you
may choose. ♥
Choose Foods & Beverages Lower in Phosphorus
INSTEAD OF
CHOOSE
Mental Floss
Tips, Tactics, and Humor
By: Janice R. Lee, MSW, LCSW
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select it and overwrite it with yo
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Your By-line
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template with your company's art.
Select the picture you want to replace,
point to Picture in the Insert menu, and
click From File. Choose a new picture
and then click Insert. Select the Link to
File box if you don’t want to embed the
art in the newsletter. This is a good idea
Are you flossing? I’m not talking
about teeth. I’m talking about
MENTAL Floss and your mind!
Picture in your mind a piece of
string going in one ear and out the
other; the string moving back and
forth in a flossing motion. This is
mental floss! You have just cleared
some cobwebs making way for new
thoughts, ideas and actions!
I think there is a reason the first
two letters in Mental are ME. I am
challenging each one of you to live
your life to YOUR fullest. The
T stands for Team. We, at your
facility, are here to support you in
blowing out those cobwebs of
thoughts that are keeping you trapped
in thoughts that are keeping you from
reaching your goals or being happy.
We are also here to give you facts.
This knowledge is to help you make
good decisions. We would also like
the opportunity to address any myths
so your health decisions are not
affected by untruths.
The rest of 2013 will be an
enlightening year of hearing your
stories. We want to promote open
conversations with our patients. We
want you to know we are opening
our ears to your struggles and
successes.
Since February is Valentine's
month, let’s focus on bringing up
different feelings whether they are
Happiness, Resistance, Anger, Love,
Grief, Loneliness, Hopelessness, or
Shame.
TIP: DON'T IGNORE talk it out
TACTIC: A Valentine gesture can be a
random act of kindness
HUMOR: ASSIGNMENT – Watch a
funny movie and tell us about it so we
can post in our Mental Floss
Column next month. If it makes you
smile, it will likely make someone else
smile too!
Be Kind to Your
Heart
2. Discomfort in other areas of
the upper body, for instance,
pain in the arm, back, neck,
jaw, or stomach.
3. Shortness of breath
Did you know that kidney disease
can cause heart problems? Here’s
how:
Congestive Heart Failure can
happen when there is too much fluid
in the blood. The heart fails to pump
well enough to circulate all that fluid.
The result is that it becomes hard to
breathe, you tire quickly, and you
have swelling (especially in your feet
and legs).
Increase Heart Muscle Size
(Hypertrophy): This is when the
heart muscle is overworked and
thickens. The extra workload is
caused by too much fluid and
anemia. In anemia, there are not
enough red blood cells to carry
oxygen, so the heart pumps faster
and harder to try to circulate more
oxygen.
What can you do?
♥ Control your fluids.
4. Others: sweating, nausea,
dizziness
Depression is not just a rare day of
sadness. Feeling hopeless and
helpless for a few weeks is a clue
that you might be depressed.
Sleeping or eating more or less than
usual or missing dialysis treatments
can also be clues.
Reduce other risk factors for
heart disease.
✓
Stop Smoking
✓
Control Blood Pressure
✓
Exercise
✓
Control Your Blood Sugar
. . . . . . . .
. . . . . . . .
. . . . . . . .
♥ Don’t skip treatments. When you
skip treatments you miss important
doses of EPO and iron needed to
keep you from being anemic.
♥ Know the warning signs of a heart
attack. Get help, if you have these
signs:
1. chest pain or discomfort that
lasts more than a few
minutes, or that goes away
and comes back
The good news is that depression
can sometimes be prevented, and
can always be treated.
Why is depression important to
me?
Depression can take the joy out of
life. It can steal your energy and
make you feel like there is no hope,
or no reason to go on living. If you
are depressed, getting dressed and
out of the house can feel like
climbing a mountain. Being
depressed can also make your
health worse.
If you are depressed, it can be hard
to believe that life can get better
again but it can. Getting help for
depression can give you your life
back.
♥ Take blood pressure medicines
as prescribed by your doctor.
♥ Exercise
you happy work any more. It is
sometimes called “the blues” or
being “down in the dumps”.
Depression is very common after
some of life’s most cruel events,
such as death, divorce, or learning
you have kidney failure. Experts
say one of every three dialysis
patients experience depression.
Dealing with
Depression
What is Depression?
Depression is a state of mind where
none of the things that used to make
What can I do if I feel sad or
afraid?
When you learn that your kidneys no
longer work, it is normal to feel
angry, fearful, and sad. Your doctor
or nurse can answer medical
questions, and a social worker at
your unit can help you during this
hard time.
As a dialysis patient, you have so
much to learn and many changes to
fit into your life. (Continued next pg)
Write down your questions, so you
can get them answered and reduce
your worrying. You will have ups
and downs as you adjust to kidney
failure. This is normal.
Problem
How can
I prevent
it?
What
should I
ask?
I just want
to pull the
covers
over my
head and
sleep all
day.
•
•
Ma
ke
pla
ns
for
a
day
that
you
will
loo
k
for
war
d
to.
After you get used to your new life
and get answers to your questions,
you should start to feel better. Even
though your dialysis schedule and
new eating plan may be hard to get
used to, they should start to feel like
a normal part of who you are and
what you do each day.
Is
ther
ea
sup
port
gro
up
me
etin
gI
cou
ld
go
to?
•
Are
ther
e
clas
ses
nea
rby
that
I
cou
ld
tak
e?
Try
to
kee
p
bus
y
•
•
Wh
ere
cou
ld I
vol
unt
eer
to
hel
p
so
me
one
els
e?
•
Sta
rt
exe
rcisi
ng,
eve
na
little
.
Is
ther
ea
beg
inni
ng
exe
rcis
e
gro
up I
can
join
?
•
Mo
ve
aro
und
to
upb
eat
mu
sic
that
you
real
ly
like.
•
•
Sur
rou
nd
you
rsel
f
with
sig
hts,
sou
nds
,
and
sm
ells
that
giv
e
you
hap
pin
ess
I have no
energy.
I’m
restless,
and have
the blahs.
•
Spe
nd
at
lea
st
10
min
ute
s
eve
ry
day
out
sid
e in
the
fres
h
air.
Wal
k if
you
can
or
sit.
•
Is
ther
e
any
one
I
can
wal
k
out
sid
e
with
?
I feel like I
got a bad
deal in
life.
•
•
List
wh
at
you
are
grat
eful
for.
Loo
k at
you
r
list
eac
h
day
and
add
to
it.
Wh
o
are
the
peo
ple
wh
o
hav
e
bee
n
goo
d to
me
?
•
Wh
o
are
the
peo
ple
I
hav
e
bee
n
goo
d
to?
•
Try
to
see
the
bea
uty
and
goo
dne
ss
in
the
wor
ld
aro
und
you
.
Writ
e it
do
wn.
•
Hav
e
an
attit
ude
of
grat
itud
e.
•
Re
ach
out
pas
t
you
•
I can’t go
on like
this.
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Ca
n
you
rec
om
me
nd
a
ther
api
st
for
me
to
talk
to?
•
Talk
to
you
r
soci
al
wor
ker
or
reli
gio
us
cou
nse
lor.
•
•
•
•
•
•
Are
ther
e
me
mor
ies
I
trea
sur
e?
•
Re
ach
out
to
you
r
fam
ily
and
frie
nds
for
sup
port
.
•
Ca
n
you
pre
scri
be
an
anti
dep
res
san
t
that
will
be
saf
e
for
me
to
tak
e?
See
k
prof
essi
ona
l
hel
p,
Ask
for
What can I do if I am
a depressed?
refe
Try the following tipsrral
everyday for a
to a helped many
few weeks. They have
people feel better. Ifcou
they do not
nse
help you at all, or if you feel like you
lor.
want to die, tell your
• doctor and or
social worker. There
are many
Ask
types of medicationyou
that can help
r
you feel better.
doc
tor
abo
ut
dep
res
sio