The holiday season is filled with activity — family gatherings, travel, cooking, shopping, and celebrations. It’s a joyful time, but also one when routines and healthy habits can easily slip away. That’s why staying connected with your Remote Patient Monitoring (RPM) care coordinator is especially important during this busy season.
Even though time feels short, your health is vital to keeping up with the chaos and enjoying the moments that matter most.
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Why Your Monthly Check-In Matters
Your monthly call with your care coordinator is more than just a program requirement — it’s a chance to make sure your care stays on track. That single conversation can help you:

• Review recent blood pressure and weight trends and make adjustments if needed.
• Discuss any medication changes to ensure your records and care plan stay accurate.
• Talk through lifestyle changes — from new foods to altered sleep schedules or exercise routines — that might affect your readings.
• Share any concerns or symptoms you’ve noticed so that small issues can be addressed before they become bigger problems.

Even if your schedule is tight, your coordinator is here to help. If setting a specific day or time makes it easier, just let them know — they’ll work with you to make it happen.

A Little Connection Goes a Long Way
Your care coordinator isn’t just checking boxes; they’re your partner in wellness. They understand the challenges that come with busy seasons and are here to provide support, encouragement, and insight. By staying connected, you’re helping ensure your blood pressure and weight stay in check — and that you can move through the holidays feeling your best.

Make Your Health a Priority — You Deserve It
Between the gatherings, the travel, and the to-do lists, remember to pause for your health. That one monthly call can bring peace of mind, keep your care plan on track, and remind you that you’re not managing it all alone.
Your health doesn’t take a holiday — and with your RPM care coordinator by your side, neither does your support system.

The holidays are a time for celebration, connection, and a little well-deserved indulgence. But amid the hustle and bustle — travel plans, rich foods, changing routines, and maybe even a bit of stress — it’s easy to let self-care slip to the side. One habit that often gets overlooked during this season is keeping an eye on your blood pressure.

Why It Matters More During the Holidays.
​While the holidays bring joy, they also bring changes that can affect blood pressure:

• Heavier meals and salty foods: Holiday dishes are delicious but can lead to fluid retention and higher blood pressure.
• Stress and lack of rest: Busy schedules, family commitments, and travel can elevate stress hormones, which impact your health.
• Less routine and movement: Disrupted sleep and fewer opportunities for exercise can make it harder to maintain healthy numbers.
• Extra caffeine and alcohol: Seasonal treats and celebrations can add up, sometimes without realizing how much they influence your body.

Checking your blood pressure regularly — even once a week at home — helps you stay aware and in control. Small changes are easier to make when you have the information to guide them.

Self-Care That Helps You Thrive
Monitoring your blood pressure isn’t just about numbers — it’s about taking ownership of your well-being. Here are a few ways to support yourself this season:

• Keep your routine: Try to check your blood pressure around the same time each day or week.
• Balance indulgence with intention: Enjoy your favorite foods, but pair them with water, fruits, and vegetables.
• Move a little more: Take a short walk after meals or plan active family traditions.
• Rest and recharge: Prioritize sleep and quiet moments to manage stress.
• Stay connected with your care team: Share your readings during appointments or remote monitoring calls — it helps guide your care plan.

Give Yourself the Gift of Awareness
Your health doesn’t take a holiday — and neither should your self-care. By keeping track of your blood pressure, you’re giving yourself the gift of awareness, prevention, and peace of mind.

So this season, celebrate, enjoy, and remember: a few mindful habits can help your kidneys stay as joyful as your holidays.

Coffee is one of life’s simple pleasures — the warmth in the morning, the comfort on a busy day. But for those living with kidney concerns, especially hypertension or chronic kidney disease (CKD stage 3 and above), it’s natural to wonder: Is coffee safe for me?

The Benefits of Coffee
Research shows that coffee, in moderation, can provide health benefits:

• Boosts energy and focus
• May contain antioxidants that support overall health
• Can be part of a healthy lifestyle when balanced with good nutrition and exercise

​What to Watch For
However, there are a few important things to keep in mind:

1.  Blood Pressure:

• Coffee contains caffeine, which may temporarily raise blood pressure.
• If you have hypertension, monitor how your body responds. A spike in blood pressure after coffee may mean you need to adjust your intake.

2.  Kidney Function (CKD Stage 3 and Above):

• As kidney function declines, your body may have difficulty processing excess potassium or phosphorus.
• Some creamers and flavored coffees may contain these hidden minerals, which can add up quickly.

How to Enjoy Coffee Safely

• Stick to 1–2 cups per day (unless your care team advises otherwise).
• Choose black coffee or low-phosphorus creamers.
• Avoid adding high-potassium or high-phosphorus ingredients.
• Pay attention to your blood pressure before and after drinking.

The Bottom Line
Coffee can often remain a part of your life, even with kidney disease or hypertension — but like all things, moderation and mindfulness are key. Always check with your dietitian or nephrologist for guidance that fits your unique needs.
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☕✨ Enjoy the ritual, savor the taste, and let your health team help you find the balance that works for you.

Fall isn’t just about pumpkins and cozy sweaters — it’s also a season that invites us to slow down and take care of ourselves. Stress is one of the hidden factors that can raise blood pressure, and learning how to relax is just as important as taking medication or eating well.

The stress–blood pressure connection
​When you’re stressed, your body releases hormones that tighten your blood vessels and make your heart work harder. Over time, this can push your blood pressure higher. Fall offers a natural opportunity to reset by embracing peaceful, calming habits.
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Simple ways to relax this fall:

• Practice “autumn breathing.” Try 5 minutes of slow, deep breathing while sitting by a window or outside in the crisp air.
• Unplug in the evenings. Shorter days are a reminder to wind down earlier. Try reading or journaling instead of scrolling on your phone before bed.
• Bring fall indoors. Light a cinnamon or apple-scented candle, listen to calming music, and let your space feel cozy and restful.

Don’t forget the basics:

• Monitor your blood pressure. Keep track at home and share your numbers with your care team.
• Take medications as prescribed. They’re an important piece of keeping your blood pressure in check.
• Stay connected. Share your journey with family, friends, or a support group — encouragement keeps you on track.

Fall reminds us that change is beautiful — and so is taking care of yourself. By embracing this season of slowing down, you give your body (and your blood pressure) the gift of balance.

As the air slightly cools and we admire the northern leaves gracefully change, fall reminds us that every season offers a fresh start. Just as nature slows down and prepares for renewal, this season can be the perfect time to pause, reset, and refocus on your health — especially your blood pressure.

Why focus on blood pressure?  High blood pressure (also called hypertension) often has no symptoms, but it’s one of the most important things to manage for your heart and kidney health. Think of it as the “silent stress” inside your body — when left unchecked, it can lead to serious problems like heart disease, stroke, or kidney damage.

The good news? Small, steady changes make a big difference. Fall gives us natural cues to slow down, breathe deeper, and create healthy routines.

A few fall-friendly resets for your blood pressure:

• Take mindful walks. The cooler weather makes it easier to enjoy short walks outside. Just 20–30 minutes a day can help lower your blood pressure.
• Enjoy seasonal foods. Apples, butternut squash, and cranberries are in season — packed with fiber and nutrients that support kidney health.  Try them roasted with a little drizzle of olive oil.
  • Fall squashes are higher in potassium and therefore should be eaten in moderation if watching potassium intake.
• Reset your routine. As the days get shorter, try setting regular sleep and meal times to keep your body in rhythm.

​This fall, let the changing leaves remind you: your health can change too — one small step at a time. 

Rebound hypertension occurs when the blood pressure rises after stopping or lowering a blood pressure medication, including the use of emergency blood pressure medications. Let’s meet John and Jerry, two patients who are experiencing rebound hypertension.  

John’s Story
     John Smith is finishing out his career as a police officer and is looking forward to retiring with his wife, Jenny. He is passionate about being a police officer and works diligently to maintain his health. John loves to watch football, hike with Jenny, or golf with his buddies when he is not working.
     Despite his efforts to stay healthy, John’s blood pressure continually increased and he was diagnosed with hypertension seven years ago. He was put on medications to lower it and he has since been stable. However, in the past year, he has experienced spikes in the 180s, well outside of his normal range of 120s-130s. With these spikes, he was experiencing headaches and his heart would race. His nephrologist prescribed him an emergency relief drug, Clonidine, a short-acting drug that reduces blood pressure quickly. 
     The Clonidine seemed to work for John when he experienced his blood pressure spikes. His blood pressure would return to its normal range, as intended. Not long after that, John would begin feeling another headache. He would take his blood pressure again and his reading was back into the 170s. “That’s odd,” John thought to himself. “I just took my medication and it was back to normal.” This happened two more times in the coming weeks. He called his nephrologist and explained what he was experiencing.

Jerry’s Story
     Jerry Williams is a retired accountant. She spends her days watching her 3 grandchildren, reading, and baking. She is diligent about looking after her health and overall wellbeing. Jerry was diagnosed with hypertension three years ago and was put on medication to control it. Along with her medications, she also implemented daily walks and swimming, when the weather allowed and worked to reduce her sodium intake. 
     Jerry’s blood pressure did well on the medication regimen and she saw significant improvements when she added the recommended lifestyle changes. Her blood pressure has begun dropping into the 100s and she experienced dizziness and lightheadedness. At her next appointment, her nephrologist took her off of her blood pressure medication to help bring her blood pressure back up and stop her new symptoms. 
     After her medication reduction, Jerry noticed her blood pressure was elevated, with readings consistently in the 160s.  “We only adjusted one of my medications,” Jerry thought. “Why is my blood pressure acting like this?” She notified her nephrologist and went to be seen for another appointment. 
 
     At their respective appointments, Jerry and John heard this from Dr. Munjal: “It looks like you are experiencing rebound hypertension. Rebound hypertension occurs when the blood pressure rises after stopping or lowering a blood pressure medication. The good news is that this tells me exactly what I need to know.” For Jerry, the current dose is too much and zero is too little. She was put back on her medication and started the weening process. John had one of his other regular medications adjusted to reduce the potential for the spikes and saw a reduction in his emergency medication use. 
     What we can learn from both John and Jerry is that blood pressure is not one size fits all. We expect changes to happen over time which is why rebound hypertension tells us just as much as the initial diagnosis. It helps us make adjustments to keep blood pressure stable as the situation changes. Not everyone needs the same types of changes, so it can take a few tries to get the medication dialed back in to meet each patient's specific needs and circumstances. If you are experiencing rebound hypertension, please contact your doctor to discuss or go to the ER if you experience a hypertensive crisis. As always, stay safe and healthy!

Resources:
https://medlineplus.gov/ency/article/000155.htm#:~:text=Rebound%20hypertension%20occurs%20when%20blood,like%20beta%20blockers%20and%20clonidine.
https://www.mayoclinic.org/diseases-conditions/high-blood-pressure/diagnosis-treatment/drc-20373417

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According to the CDC, approximately 129 million people in the United States have at least one chronic disease like cancer, hypertension, diabetes, or heart disease. That is almost half of the entire population. Many chronic illnesses are accompanied by a number of comorbidities as well. These illnesses require constant attention, both mentally and physically, to maintain balance in the patient's life. Let’s explore some of what reality may look like for some people. 

Habits
Having a chronic illness often means that patients have to develop healthy habits and routines to ensure they are staying on top of their healthcare between appointments. This can look like:

• Taking and recording different readings daily (blood pressure, weight, blood sugar, oxygen levels, etc.)
• Taking multiple sets of medication
• Regular exercise or physical therapy
• Tracking fluid and food intake based on dietary needs (low carb, high protein, fluid restrictions, etc.)

Appointments and Labs
Chronic illnesses often mean additional appointments with primary care, a variety of specialists, treatments or infusions, and labs or imaging. We often hear that many of our patients have an appointment a day every week for themselves and their spouses. Can you imagine how limiting that can be on someone’s personal schedule?

Remission and Relapse
As we age, our bodies naturally change over time, whether we want them to or not. Blood pressure, especially, is an ongoing, ever-changing thing. It is only a matter of time. Seeing a decline in lab results or changes in blood pressure can be disheartening, especially when a patient has been “doing all the right things” to keep themselves on track.

Importance of Monitoring
Regular monitoring by patients and doctors together is vital to ensuring that we are able to catch trends and intervene sooner rather than later. Programs like Remote Patient Monitoring help us track changes more closely and identify trends early. Monitoring does not replace regular appointments, but is an incredible tool in assisting your care team in seeing the bigger picture of your health. However, a formal program isn’t always necessary. Tracking daily weight and blood pressure readings at home also help in the decision making process. We want to know what readings look like on average in a normal, day-to-day setting. In an office, there can be multiple other factors contributing to different weight and blood pressure readings, like additional shoes/clothing, eating/drinking, traffic, White Coat Syndrome, etc. This is not to say that these readings are inaccurate, but seeing the home-setting trends are equally important to avoid over- or under-medicating.


Considering all these patients have to go through, manage, and keep track of, they deserve an award for handling their lives and continuing to push forward. Share a smile or warm hug and offer assistance to others when you can: you never know who may need it most. 

Resources:
https://www.cdc.gov/pcd/issues/2024/23_0267.htm

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To understand uric acid, we must first understand where it comes from. Uric acid is a waste product from the body processing purine. Purine is a naturally occurring compound found mainly in meat products like beef, fish, and poultry. If you have a diet that consists of a large quantity of foods that are purine-rich, you are more likely to have high uric acid levels in your blood. With healthy kidneys, this generally is not a problem. However, high uric acid can lead to some painful problems down the line, like gout and kidney stones. 
Common Foods High in Purine:

• Anchovies
• Bacon
• Bouillon
• Broth
• Codfish
• Consomme
• Haddock
• Herring
• Mackerel
• Meat extracts
• Mussels
• Organ Meats
• Sardines
• Scallops
• Shrimp
• Venison
• Yeast
• Yeast Extract

Gout
Gout is a complex form of arthritis caused by the development of uric acid crystals due to high levels of uric acid in the blood. These crystals settle in the joints, commonly the big toe. The settlements can cause gout attacks, or flare-ups, of discomfort, pain, swelling/inflammation, and discoloration of the joint. Gout attacks can last 1-2 weeks, but may last longer depending on treatment and severity.
Kidney Stones
Uric acid kidney stones form when there is too much uric acid present in the urine and/or when the urine is too acidic on a regular basis. Once these kidney stones form, some may pass on their own, but others may require intervention from urology. Symptoms can include: Severe pain in the sides/lowerback, flank or stomach pain, fever, nausea/vomiting, urine that smells or looks cloudy, or blood in the urine. 
Prevention and Treatment
Preventing uric acid build-up can be as simple as being mindful of your consumption of the purine-rich foods listed above. Prevention can also include weight management to reduce the risk of kidney stones. If dietary changes are not sufficient, there are medications that can be prescribed that can help lower the uric acid as well. If you have kidney diseases, please consult a nephrologist for treatment options. 

​As always, life is about balance and enjoying everything in moderation. If you have concerns about your uric acid levels, contact our office today to schedule an appointment with Dr. Munjal. Stay safe and healthy!

References: 
https://www.kidney.org/uric-acid-stones#:~:text=A%20uric%20acid%20stone%20is,smells%20bad%20or%20looks%20cloudy

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Did you know that there are more than 30 unique benefits to walking daily? Sounds too good to be true for this seemingly simple exercise, right? As a team, we embark on a challenge to be healthier through the holidays and we want to challenge you too! We know we will be indulging in sweets, rich meals, traveling, and off of our normal schedules in the coming months, so we are trying to get ahead of the curve. Incorporating more steps into our daily routine is one of the easiest ways to create balance with all the treats this season. Throughout our challenges, our team has seen a number of benefits like weight loss, decreased resting heart rates, improved oxygen levels, increased stamina, and noticeable muscle tone. 
The first few weeks of building a habit are always the hardest, especially with the stress of the holidays upon us. “How can I possibly work something else into my already busy schedule?” I’m glad you asked! Below are 8 ways you can make choices that can increase your step count for the day!

• Take a brisk walk outside first thing in the morning. Walking can help with insomnia and getting sunshine first thing in the morning can help your sleep and circadian rhythm.
• Take a short, 10 minute walk after each meal. Walking helps aid in digestion, too! 
• If you have a pet or children, take them on walks and lengthen it a little more each time.
• Dance to your favorite song.
• Challenge a friend or family member to a step challenge! Accountability buddies can be incredibly supportive and beneficial.
• Do laundry in smaller batches or on the other side of the house/room from your wardrobe. 
• Shop in-person at stores rather than ordering online. Laps in an air-conditioned store or mall can make it more pleasant.
• Walk the golf course instead of renting a cart.

Still not convinced? Check out these facts about walking for some extra motivation to lace up those sneakers!

• Less than 5,000 steps a day is considered a sedentary lifestyle.
• Walking lowers blood sugars and reduces the overall risk of type 2 diabetes.
• Walking reduces arthritis-related pain. Walking 5-6 miles per week can even prevent arthritis!
• Walking reduces the risk of heart diseases and strengthens the heart.
• Walking regularly can help reduce blood pressure.
• Walking can stop the loss of bone mass for those with osteoporosis.
• Walking can reduce the risk of varicose veins.
• Walking helps to improve the memory, build more neurological connections, and help to prevent dementia later in life.

Moving your body and staying active during this season is so important for your physical and mental health. Once you get up and in the habit of moving, you will find yourself craving the benefits daily. After all, a body at rest stays at rest, while a body in motion, stays in motion. How will you get to stepping this holiday season?

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