DIET
Eating properly is important when you are on dialysis. To feel well, you need to eat
the right food. Your dietitian will help you plan a diet for your special needs.
WHY DO I NEED TO BE ON A SPECIAL DIET?
Because your kidneys are not able to get rid of enough waste products and fluids,
your blood and your body now have special needs. You will need to limit fluids and
change your intake of certain foods in your diet. How well you feel will depend on:
1. Eating the right kind and amounts of food from your diet
2. Having the hemodialysis treatments your doctor orders for you
3. Taking the medications your doctor orders for you.
Your diet is very important to your care. It is important that you have the right
amount of nutrients, fluids, vitamins, and minerals each day. Some of the nutrients
you may have to modify are potassium, phosphorus, calcium, protein and sodium.
Your dietitian will help you plan your meals to make sure you get the proper
balance.
FLUID
On dialysis, you may require a fluid restriction. The goal of fluid restriction is to
help you feel comfortable before, during, and after your dialysis sessions. Even
though your dialysis gets rid of excess fluid and waste in the body, it is not as
effective as healthy kidneys. Going over your recommended fluid allowance can
lead to too much fluid building up in your body between treatments. This build up
causes swelling and increases your blood pressure, which makes your heart work
harder. Too much fluid can build up in the lungs, making it difficult for you to
breathe. Some people experience muscle cramping during dialysis when they gain
too much fluid weight. Taking off too much fluid can also cause a drop in blood
pressure, which can leave you feeling nauseated, dizzy, and weak after your
treatment.
If you require a fluid restriction, here are a few hints:
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You can travel if dialysis is available at that location. If you plan to travel, speak to
the Social Worker as early as possible. Arrangements are made well in advance.
HEPATITIS B
Hepatitis B is a virus that infects the liver. The Hepatitis B vaccine is given in 3
shots. When your body gets the vaccine, it makes antibodies. These antibodies
attack the Hepatitis B virus if it gets in your body. Some people already have the
antibodies and do not need the vaccine. Sometimes, the vaccine does not work. If
this happens to you, we test your blood once a year to make sure you do not have
Hepatitis B.
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You may get low blood pressure near the end of your treatment. This
makes you feel dizzy, tired and cold or as if people are talking to you
through a tunnel. If you have these funny feelings tell your nurse. Your
nurse may:
May give you saline
Stop or slow down fluid removal
Tilt your head back so that more blood gets to your head
Give you a drink or something salty to eat
CHANGE IN APPETITE
When you first start dialysis, you may not feel like eating very much. As the
dialysis removes the toxins from your body, your appetite should return.
Please let the nurses know if you are having difficulty eating.
CHANGES IN YOUR ENERGY LEVEL
When you first start dialysis, your energy level is low. Having less
hemoglobin in your blood or high toxin levels in your body makes you feel
this way. As the dialysis removes the toxins, your energy returns. Many
people feel tired right after dialysis but feel better about 2 hours later. Many
people return to their former activities after they start dialysis.
ANSWERS TO COMMON QUESTIONS
HOW CAN I GAIN SO MUCH WEIGHT IF I DONT DRINK ANYTHING?
Without knowing it, you may eat too much salt. This makes your body
retain fluid. Also, you may eat foods that have hidden water. Such foods
include: jello, soup, gravy and frozen foods that are liquid at room
temperature, like ice cream or sherbet.
WHY IS IT SO HARD TO REMOVE 4-5KG IN ONE DIALYSIS
TREATMENT?
Central venous catheters are made with a double-lumen design with one
port designated as arterial flow (red) and the other as venous flow (blue).
Keep catheter dressing dry
Do not allow anyone other than the hemodialysis nurse and/or
nephrologists to access your catheter
Signs and symptoms of infection and how and to whom it should
be reported:
Increased temperature
Shaking, chills
Discharge noted at exit site
Redness at exit site
Pain at exit site
Report these signs and symptoms to the nurse or to the nephrologists
What to do in case of accidental removal or cutting of catheter:
Clamp the remaining tail of the catheter
Direct pressure at insertion site with occlusive dressing
Seek medical attention
Call the dialysis clinic for further instructions
HOW DO I TAKE CARE OF MY FISTULA/GRAFT?
IMPORTANT!!!! Your fistula/graft feels as if it is buzzing. It also makes a
swishing sound called a bruit. These are normal. If they stop, call the
renal unit immediately. It may mean that your fistula/graft is clotted. We
must act quickly to save your fistula/graft.
Do not let anyone use your fistula/graft except the dialysis nurses and
doctors.
Do not let anyone:
Take blood from your fistula/graft arm
Start an intravenous (IV) in your fistula/graft arm
If you think your fistula/graft is infected, tell your nurse at your next dialysis.
Your fistula/graft may be infected if:
Looks red
Feels tender
Swells
Hurts
Has fluid running from it
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These are different kinds of blood pressure pills. Do not take blood
pressure pills before your treatment unless your doctor tells you to take
them. Side effects of blood pressure pills include: dizziness, swelling,
coughing, and slow heart beat. Tell your nurse if you have any of these
symptoms.
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Your Nephrologist may order any of the following drugs for you.
ERYTHROPOIETIN/ARANESP
Aranesp helps your bones make red blood cells that increase your
hemoglobin. Your nurse gives you Aranesp through your dialysis line at the
end of each treatment. It takes 4 to 6 weeks to feel the effects of Aranesp.
PHOSPHATE BINDERS
These include calcium carbonate, and drugs, such as Tums, Renagel or
Oscal. These drugs bind with the phosphate in your food to lower the
amount of phosphate in your body, and must be taken with food to work
properly. Keeping your phosphate levels under control helps your bones
stay strong and healthy. Take your phosphate binders with your meals or
snack. Talk to your dietitian about controlling you phosphorus levels.
IRON
Iron is needed to make red blood cells. Iron pills may upset your stomach
and turn your stools black. Take iron when your stomach is empty before
you go to bed. You also may get iron through the dialysis line during your
treatments. Do not take iron at the same time that you take your phosphate
binder. The phosphate binder binds with iron and makes the iron inactive.
MULTIPLE VITAMINS
These replace the vitamins that you are unable to get from your diet. They
also replace vitamins that you lose during dialysis. Take vitamins after your
treatments. Talk to your pharmacist or dietitian about taking the right
vitamin.
BLOOD PRESSURE PILLS
ACCESS CHOICE
You can be attached to the machine in several different ways. The most
commonly used methods are:
Internal fistula
Internal graft
Central venous catheter
FISTULA
The fistula is the best method for providing access to the bloodstream. To
make a fistula, an artery and a vein in your arm are surgically connected
together. Fistulas can be used about 12 weeks after surgery. You will be
encouraged to do some special exercise to help the fistula develop or
mature. One exercise you can do after your stitches are out is squeeze a
tennis ball or sponge many times daily.
ADVANTAGES
Reduced incidence of clotting
Reduced incidence of infection
Requires less daily care from patient
Avoids potential for allergic responses to synthetic materials
Has a great longevity (70% over 3 years)
A fistula is considered to be the ideal choice of nephrologists and
vascular surgeons.
GRAFT
better long-term health, and an overall ability to have an active and healthier
lifestyle. You will feel better and be more able to do the activities you like. The
dietitian is based in Barrie and is available in the unit on Wednesday and Thursday.
Feel free to call the unit with any questions or concerns.
ADVANTAGES
Can be used sooner than a fistula
Provides large surface for cannulation
Blood flow not dependent on vein maturation
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SOCIAL WORKER
PAIN DRUGS
You or your family may have problems getting used to your dialysis. It may help to
talk to the social worker. For example, you may want help with financial issues,
drug costs, work, or getting to the renal unit. The social worker may be able to
arrange community resources to help you. Tell your nurse if you wish to talk to the
social worker.
If you need something for pain, use acetaminophen. A trade name for this drug is
Tylenol. Do not take Aspirin (ASA) unless your doctor tells you to take it.
PHARMACIST
The pharmacist helps you understand the medication you are on. They make a list
of when you should take your medications. Example: Iron pills should not be taken
with Calcium pills. They will inform you of the side effects of these medications and
when and how to take your medications.
DIETITIAN
The dietitian will explain the importance of controlling your eating habits and food
choices and will work with you to develop an individualized eating plan that meets
your special needs. The renal dietitians main goal is to help people make wise
food choices and learn how to include their favourite foods in their eating plan
when possible. To construct this plan, the dietitian will ask you questions about
your eating habits and food choices. Then other information is considered, like
blood test results, medical history, and current health concerns. Although your
eating plan may be easy to understand, its not always easy to follow. It is
important that you understand why your dietitian might encourage certain food and
drink limits. Healthy kidneys work 24 hours a day to remove waste products from
the blood that build up mainly from the foods we eat. Since your blood is not being
constantly cleaned, it is important that you limit the amount and certain types of
foods and fluids you consume each day. Your dietitian can recommend healthful
food choices that reduce the amount of waste and fluids that build up in your body.
By making better food choices, you will have more comfortable dialysis treatments,
ANTIBIOTICS
You need to take antibiotics before and after you have dental work. Dental work
includes having your teeth cleaned. The antibiotic prevents infection in your blood.
Tell your nurse or doctor when you are going to the dentist.
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CLIENT SERVICES
TREATMENT OPTIONS
SELF-CARE
PURPOSE:
To strengthen health links with the community and with RVH by:
Sharing information
Identifying health needs of consumers
Addressing opportunities for improvement on both an inpatient and
outpatient basis
Promote public awareness of prevention of kidney disease in
partnership with other community agencies
Promoting awareness at RVH of our clinic and fostering better
relationships with appropriate departments
MEMBERSHIP
Each council will have members representing:
Hospital services
Community providers Kidney Foundation, ANAF
Consumers patient
Spouse of patient
Previous patient (transplanted)
Current clinic volunteers
Regional Centre (OSMH) Nurse Educator
Self-care clients learn to set-up their dialysis machines. Some patients put
their needles in, but this is not a requirement. With self-care, you have
more control over your treatments. If you want to learn more about selfcare, speak to your nurse or nephrologists.
YOUR CAREGIVERS
DOCTORS
A Nephrologist is a doctor with special education in kidney diseases. The
doctor plans your medical treatment. If you need to speak to your doctor, or
have an urgent issue or need a prescription, please tell your nurse.
There are 2 nephrologists available at the unit:
Dr. Derek Benjamin
Dr. Murali Krishnan
based in Barrie
based in Barrie
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NOTES:
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Dialysis clients can park on the west side of the white building. There are 4
designated wheelchair parking located in the front of the unit. The clinic is
wheelchair accessible.
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Gary Foisie
Manager, Renal Services
(705) 728-9090 Ext. 24550
Derek Benjamin
Nephrologist
(705) 728-9843
Danielle Pento
Administrative Assistant
(705) 728-9090 ext 24509
Nephrologist
(705) 728-1962
Cathy Goodfellow
Resource Nurse
(705) 728-9090 ext 24505
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CONTENTS
About the RVH Dialysis Clinic....2
Hours.....2
Parking .....2
About yourDialysis...3
Treatment Options...4
Self Care...4
Your caregivers...4
Social Worker...5
Pharmacist.5
Dietitian..5
Access Choice..6
Fistula6
Graft...6
Central Venous Catheter.7
How Do I Take Care of my Fistula/Graft..8
What Tests Can I Expect..10
Living with Dialysis.11
Diet ..12
Fluid .12
Should I Wear A Medical Alert Bracelet.13
Is it O.K. to Travel 13
Hepatitis B..13
How To Deal With Common Problems..14
Low Blood Pressure..15
Common Questions..15
Medications..16/17/18
Dialysis Advisory Council..19
Terms of Reference...20
Patient Representative
728-9090 ext. 44510