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THE BEAN:
Kidney Empowerment

The Season for the Sniffles: Flu Season 2023

9/7/2023

 
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‘Tis the season for the sniffles. As the summer season comes to an end and fall starts, flu season kicks into high gear. Patients with Chronic Kidney Disease (CKD) and End Stage Renal Disease (ESRD) are at a higher risk for developing more serious symptoms and complications from the flu. It is imperative that CKD and ESRD patients receive the vaccine and protect themselves from the flu. Let’s talk about all things flu- from how to stay safe, vaccines, and symptoms to look out for to keep you safe this season.

Flu season is generally October to May with the peak between December and February. During this time it is increasingly important to follow health guidelines. The following are recommended health and safety practices for the flu season:
  • Practice good hand and personal hygiene
  • Avoid touching your eyes, mouth, and nose with unwashed hands
  • Wash hands regularly with soap and water for at least 20 seconds
  • Stay home when you are sick
  • Cover your nose and mouth when coughing or sneezing
  • Stay on top of best practices and procedures for work and school environments

Beyond good hygiene practices, getting the flu vaccine is a good way to protect yourself from the flu or severe flu symptoms. Essentially, the injectable flu vaccine is a dead flu virus that works to help your body identify and fight the active/live flu virus. Oftentimes, patients may feel flu-like symptoms after receiving the vaccine, which is normal. What you are experiencing is your immune system's reaction to the introduction of the dead virus. Listed below are locations you can get a flu vaccine:
  • Minute Clinic in CVS
  • Walgreens
  • Publix Pharmacy
  • Primary Care practices (that you are established with)
  • Dialysis Patients ONLY: in-center at your dialysis clinic- inquire with your care team
  • Flu Vaccine Locator

So you know how to keep yourself safe, but what if it doesn’t work and you get sick? Monitor for the following symptoms below:
  • Fever and chills
  • Sore throat
  • Stuffy or runny nose
  • Muscle and body aches
  • Headache
  • Fatigue

The CDC has a great resource for information and FAQs regarding the 2022-2023 flu season. You can find more information from the CDC here.

If you have any questions or concerns regarding the flu season, contact your primary care provider or your local pharmacy. If you are experiencing flu-like symptoms and have an appointment with us, please give us a call at your earliest convenience so we can discuss appointment options. As always, stay safe and healthy!



Resources:
https://www.cdc.gov/flu/prevent/actions-prevent-flu.htm

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Eating with the Seasons

8/31/2023

 
By: Kayla Holmes
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In the past, we have shared renal-friendly recipes on our Facebook bi-weekly in a segment called Tasty Tuesday. We are shifting this to our blog to focus on seasonal foods, gardening, and recipes on a monthly basis. We want to include what to start in your garden, foods that are in season (and may be on sale), and recipes to use these abundant whole foods. In this introduction post, we will share resources for recipes, local nurseries, and informational sites to visit to find more information on how to begin eating with the season.

Seasonal foods are generally more nutrient dense and tastier due to optimal growing conditions and being harvested at their true peak. Very few additives and chemicals are needed to change the environmental conditions to enhance or alter the growing process. Additionally, seasonal foods are also a great way to change up the fruits and vegetables we eat regularly as well cut back on food spending. These foods provide us opportunities to expand our palettes and explore new recipes that we may not have considered otherwise. 

Renal Recipe Sites:
These sites provide a wide variety of kidney-friendly recipes. Some of these sites have search features that allow you to narrow your search to the desired ingredients or dietary restrictions. You can also use the seasonal food guides as a reference point for looking for recipes.
National Kidney Foundation
Mayo Clinic
Northwest Kidney Center
American Association of Kidney Patients
Renal Support Network

Gardening:
UF/IFAS Gardening Guide
Farmer's Almanac

Seasonal Food Information:
Seasonal Food Guide
USDA Seasonal Produce Guide

Savings Guides:
Weekly Sales Flyers
Nerd Wallet: Grocery Savings Tips


Eating healthy and with the season does not have to be difficult. Join us in this series as we eat with the seasons!

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Kidney Korner: What is Dialysis?

8/24/2023

 
By: Kayla Holmes
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This segment of the Kidney Korner is all about dialysis. Who needs it, what it is, the different modalities, our dialysis clinic, and more. We want to empower our patients by helping them understand that there is life on dialysis and we are here to help you live it to the fullest. This post will go over the most basic points of dialysis so we can expand upon them in the coming posts. 

What is dialysis and who needs it?
Dialysis is a type of renal replacement therapy for patients with End Stage Renal Disease (ESRD). In some cases, patients with more severe acute kidney injuries will require dialysis until their kidney function returns to their normal levels. Dialysis is not a cure for ESRD; it is required for the rest of the patient’s life or until they receive a transplant. Essentially, the process of dialysis acts as an artificial kidney, filtering out the waste and toxins and transferring the clean blood back into the body. It works to do the job of a kidney by balancing the fluid and minerals in the body as well as work to maintain blood pressure. Read more about how kidneys work in previous Kidney Korner segments here and here. 

What are the different types of dialysis?
There are a variety of types, or modalities, of dialysis to consider. It is important to explore all options to suit your goals and lifestyle. There is life on dialysis and we want you to be able to keep living it as you wish. The 3 types of dialysis are:
  • Hemodialysis
  • Home Hemodialysis
  • Peritoneal dialysis 
Beyond dialysis, a transplant is another type of renal replacement therapy. Be on the look-out for another Kidney Korner segment on transplantation in the near future.

Where can I receive dialysis treatment?
Depending on the dialysis modality and situation, there are a few locations where patients can receive treatment:
  • In-Center, at their designated facility (like DialySuites)
  • At home
  • In the hospital

What do I need to change to be successful?
Success on dialysis depends on your attention to your health as well as open, honest communication with your care team. Your team wants the best for you and is there to support and guide you through these changes. These can look like:
  • Changes in work schedule
  • Changes in diet
  • Changes in exercise habits

We will touch more on the different modalities, treatment centers, and lifestyle changes needed to be successful on dialysis in the following Kidney Korner segments. If you have any questions or concerns, please reach out to your care team. As always, stay safe and healthy!

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Technology at Jacksonville Nephrology

8/17/2023

 
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At Jacksonville Nephrology, we work to utilize technology as much as possible. We believe that it provides secure, efficient care with a large number of benefits to patients and providers alike. 

Ease of Access: The increase of technological developments and usage has also greatly increased the accessibility of pertinent information, leading to more efficient and effective care.  
  • Downloadable and fillable paperwork 
  • Information-dense website for all things kidneys
  • Patient Portal 
    • Lab results and reports
    • Medication lists
    • Communications with the office
    • Health Trackers
    • Visit Summaries
  • Email, text, and call reminders for appointments
  • Electronic access to multiple laboratories and hospitals
  • Healow Insights: using the Health Information Exchange to grant and gain access to patient records to/from authorized providers within the network
  • Electronic prescriptions: by requesting an electronic prescription through the pharmacy, we are more accurately and efficiently able to respond to prescription refills and authorizations. 

Security: Our top priority is keeping your information safe. To do this, we have a number of security measures in place to ensure that your data is secure and utilized appropriately. Here are a few ways that we keep your information secure:
  • Verifying providers and secure fax numbers before transmission
  • No credit card information kept on file
  • Only sharing information with verified patient contact information
    • Including HIPAA compliant contacts, required to be updated annually
  • Third-party software providers are up-to-date with security enhancements and abide by HIPAA rules and regulations

Technology can be one of our greatest tools in our toolbox. We can utilize it in a myriad of ways to benefit our patients and provide next-level care. As always, stay safe and healthy!

Appointments at Jacksonville Nephrology: What to Expect

8/10/2023

 
By: Kayla Holmes
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We strive for excellence and efficiency at Jacksonville Nephrology. We work to serve all patients with a smile, going above and beyond in your care from the moment you walk in the door. New patients can expect to spend 45 minutes to an hour in our office during their first appointment. This includes paperwork, meeting with the medical assistant and doctor, and scheduling a follow-up. Follow-up appointments can expect to take approximately 30 minutes from check-in to check-out. Some additional, annual paperwork may be due, so please arrive early when possible. 

Let’s walk through what an in-office appointment with Jacksonville Nephrology looks like. 

  1. Check in: After arriving at Suite 1001, you will be greeted by our fabulous front desk. Here, we will verify any pertinent information needed and provide you with annual or new patient paperwork as necessary. We will also ask for any copay or account balance due and copies of insurance information, so please have the applicable cards ready upon arrival.
  2. Vitals and Medications: Our marvelous Medical Assistant will take you back to an exam room. She will take and record your vitals, note medications and any changes, and verify your medical history if you are a new patient. 
  3. Meet with Dr. Munjal: Dr. Munjal will meet with you and discuss all things kidneys. This includes, but is not limited to: lab results, pertinent imaging studies, dietary and lifestyle recommendations, and education on your specific condition(s).
    1. RPM training: If you are eligible for the RPM program, our Patient Educator will meet with you to discuss the program details and train you on your new devices.
  4. Check out: Our front desk team will have your lab orders and any other information from Dr. Munjal printed and ready at the time of check out. They will schedule your next appointment and go over the paperwork with you.

We also offer virtual visits. Here’s how the process works:
  1. Check in: Our front desk will call approximately 10 minutes before your scheduled appointment time to assist with getting you logged in and collect any copay or account balance that applies. 
  2. Vitals and Medications: You will connect with our Medical Assistant who will go over medications and ask what your vitals have been recently.
  3. Meet with Dr. Munjal: Dr. Munjal will connect with you and discuss all things kidneys, just as he normally would. 
  4. Check out: Our front desk aims to call patients back to proceed with check out and scheduling follow up appointments within 30 minutes of ending your call with the doctor. Paperwork from your appointment will be posted to your patient portal. 

If you're a new patient with us, take a moment to go read "How to See Dr. Munjal: The Referral Process" to get a better idea of what is needed for a new patient appointment and how to establish at our practice. 

​*Please note that virtual visits require up-to-date paperwork to be completed and on file with us within the past year. These appointments are subject to insurance coverage and are set to be discontinued by December 2024 by Medicare. Many commercial insurance carriers have already incorporated virtual coverage into their plans. Please contact your insurance carrier should you have questions regarding your virtual visit coverage.*

We work to see patients in a timely manner, with all details accounted for to create the most efficient and effective appointments possible. If you are interested in scheduling, please contact our office at (904) 260-9898. We look forward to being a part of your care team! 

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Frequently Asked Questions

8/3/2023

 
By: Kayla Holmes
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We know that addressing changes in your health can be a scary, difficult time. You may find yourself asking a million and one questions, leading to feeling overwhelmed and anxious. Our team at Jacksonville Nephrology is here to help. Find our most frequently asked questions and Dr. Munjal approved answers below!

What is Chronic Kidney Disease?
Chronic Kidney Disease (CKD) is the gradual decline in kidney function over time. It is expected that everyone’s kidney function will naturally decline with age due to normal “wear and tear.” It is determining if it is a normal decline or excessive and determining the root cause. 

I have protein in my urine. What does it mean? Are my kidneys failing?
Think of your kidneys as a coffee filter. It has two jobs: let the coffee through and keep the grounds in. Similarly, kidneys want to get rid of waste, but keep the good things in. We check protein levels in the urine. Protein particles are large and should not be getting through the filter. High protein levels in the urine are indicative of kidney damage.

I had a high blood pressure reading. Do I have hypertension now?
When we look at your blood pressure, we are looking for a trend over time. One reading may be an outlier or an anomaly. We want to see what your home readings look like on a daily basis, rather than just once in the doctor’s office. Many patients experience “White Coat Syndrome” or higher blood pressure and/or pulse due to being at the doctor’s office or in a medical setting. However, if this high reading is accompanied by symptoms like headache, irregular/fast heart rate, or nosebleeds, please seek medical attention.

My kidney function came back abnormal in my recent lab results. Do I need to go on dialysis now?
You most likely do not need to go on dialysis. It’s important to review just how abnormal a lab result is. People can live with a full life with decreased kidney function for years. For example, someone who gives a kidney will have 50% of the normal kidney function, but still be able to live a full, prosperous life. Dr. Munjal will look at your lab results and your medical history to work to determine the root cause of what caused the change in kidney function. 

I only have high blood pressure. What do my kidneys have to do with that?
The kidneys play an integral role in the balance of sodium and fluids in the body. If the kidneys begin to not work properly and these levels become unbalanced, then we can see changes in the blood pressure. They also manage and balance the other electrolytes and some hormones that can contribute to blood pressure. 

Everyone is unique and requires individual attention to details. Dr. Munjal works to look at the facts and treats the root cause. Every situation and treatment course is all dependent on the unique patient. If you have questions or concerns about your kidney function, please do not hesitate to contact us and set up an appointment!

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How to See Dr. Munjal: The Referral Process

7/27/2023

 
By: Kayla Holmes
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Beginning the process of seeing a specialist and establishing care can be daunting. We are here to help and make the process as smooth as possible. 

I’m concerned about my kidney function. How soon can I be seen?
Our goal is to see New Patients within 1-2 weeks of receiving an appointment request. However, this is not always possible. We keep an up-to-date callback list in order to move appointments within our goal time frame. 

Do I need a referral?
Formal referrals are not required for some insurances and policies. We use the term to encompass the process of establishing communication with another provider or office and the documentation that is most helpful to facilitate a productive appointment. Formal referrals with referral authorizations are only required in certain circumstances based on the individual
 Insurance policy. If you are unsure if a referral is required, please contact your insurance carrier for more information.

What documents are needed for my first appointment?
The information needed to facilitate the most productive appointment includes, but is not limited to:
  • Most recent labs (basic/comprehensive metabolic panel, renal function panel, urine studies, etc.)
  • Insurance information (including referral authorization if required)
  • Demographic information (name, address, phone number, date of birth, email address, etc.)
  • Most recent progress notes from primary care or referring specialty provider

How do I get the necessary documents to your office?
Obtaining lab results and other information pertinent to the appointment is preferred to make your appointment run smoothly and efficiently. There are a few ways to go about sending information over:
  • Call the facility or provider that suggested an appointment with an nephrologist and request that the most recent progress notes and lab results be faxed to us at (904) 260-9891. 
  • Sign an authorization to release medical records and we can fix the request for you
  • Bring a physical copy of records with you to your appointment and we can scan them into your chart

We will work with you every step of the way to ensure that you are prepared for your appointment and can be seen in a timely manner. If you have any questions or concerns regarding the referral process or how to see Dr. Munjal, please feel free to reach out to our office.

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Kidney Korner: Fluid Intake- Dehydration

7/20/2023

 
By: Kayla Holmes
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We’ve touched on what fluids are, how much too much can be, so it’s only right that we touch on dehydration to round out this segment of the Kidney Korner. Dehydration is simply when the body doesn’t have enough fluids to complete normal functions or when fluid intake is less than fluids lost. With summer in full swing, it is important to know the signs and symptoms of dehydration and how to treat it. Let’s discuss what causes dehydration, what symptoms to watch out for, and what to do if you become dehydrated. 

What does dehydration have to do with my kidneys?
Your kidneys control the fluid balance in your body. When you become dehydrated, your kidneys will have to work harder to try to maintain a fluid balance as well as perform their other functions. Dehydration can lead to increased blood pressure, a potential Acute Kidney Injury (AKI), or the worsening of Chronic Kidney Disease (CKD).

What causes dehydration?
  • Nausea and vomiting
  • Diarrhea
  • Sweating (heat, exercise, illness, etc.)
  • Infections
  • Medications- some medications can increase the risk of dehydration by increasing urination or reducing appetite

How do I know if I’m dehydrated?
  • Excess or complete absence of sweating or tears when crying
  • Nausea
  • Fatigue
  • Confusion
  • Lack of urination
  • Dark urine
  • Extreme thirst

What do I do if I’m dehydrated?
  • Increase fluid intake* (avoid consuming too much too quickly)
  • Rest in a cool, shaded area, preferably indoors
  • Eat a salty snack to help replenish salts and reduce upset stomach
  • If severely dehydrated, seek medical attention immediately

Munjal’s Musings:
Dehydration occurs when the amount of fluids taken in is less than the fluids lost. Let's say you drink a gallon of fluids a day. Keeping that in mind, look at the two following scenarios:
  1. You spend the day inside reading, watching a movie, and doing light chores. You are well hydrated and not losing as much as you’re taking in.
  2. You spend the day outside, in the sun, doing yard work and swimming in the pool. You become dehydrated due to sweating and losing more fluid than you’re taking in.

Dehydration can be very dangerous if left untreated.  This summer, remain mindful of the causes and symptoms of dehydration and learn to treat them immediately. Remember, hydration is a very delicate balancing act, so be sure to consult with a physician regarding your specific needs. What works for some, will not work for others. Tailor your needs accordingly and, as always, stay safe and healthy! 

*If you are on a fluid restricted diet, consult with your doctor and discuss these scenarios.

To read our previous Kidney Korner posts on fluids, see the links below!
Kidney Korner: Fluid Intake- Part 1
Kidney Korner: Fluid Intake- Part 2

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The Importance of Setting Goals and Creating Healthy Habits

7/13/2023

 
By: Kayla Holmes
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Habits and goals work together to become a dynamic duo when working towards accomplishing a task. Set a goal, then create habits to help facilitate the desired outcome. Let’s discuss the benefits of setting goals and creating habits. 

  • Goals give us something to work towards. By setting goals, we are acknowledging that we are committing to working towards something meaningful to us. Whether that goal is walking for 30 minutes a day, taking more consistent blood pressure and weight readings, or making healthier food choices, we are committed to achieving success in that area of our lives. Goals can give us a sense of purpose. There are different ways to set goals as well. Here are a few:
    • Setting goals with others can help us create a network of support and accountability as well as foster a sense of belonging
    • Setting smaller goals before the end-goal can help us feel more accomplished and motivated. Larger goals can seem daunting and we may lose sight of the light at the end of the tunnel. Milestones help to increase motivation and passion towards the end goal.
    • Create a vision board or place a visual of your goal(s) somewhere you look daily. By visualizing and being reminded of the goals daily, you are more likely to succeed in accomplishing them.
 
  • Habits assist in helping us achieve the goals we set. There are a lot of ways to begin building habits. These can include:
    • Habit stacking: This is when someone does two habits at the same time. This uses an old habit to build a new one. An example of this could be something as simple as “After I take my medications, I’ll take my blood pressure,” or “I’ll take my weight and then brush my teeth.”
    • Habit Trackers: Habit trackers are a visual way to see progress on building a new habit. Habit trackers come in a variety of different formats, so it may take some trial and error to find one that works for you. I have found that a color-coded coloring habit tracker is the most effective for me. 
    • 21/90: They say it takes 21 days to create a new habit and 90 days for it to become a part of a lifestyle. Give yourself some time and grace when trying to get something to stick. Mark these on your calendar or habit tracker to help visualize that timeline.

Goals and habits can be particularly helpful for those with chronic illnesses that may need more in-depth and consistent healthcare. By creating healthy habits, like taking weight and blood pressure readings regularly, patients are able to better assist their healthcare teams in identifying trends and intervening more effectively and efficiently. This can help to increase time between required or recommended appointments as well as reduce emergency interventions, like hospitalizations. 

We have created a habit tracker for tracking weight and blood pressure that can be found on our website here. There are also a number of books and resources that delve deeper into the importance of habits and goals.

If you are setting goals that may alter your lifestyle or health significantly, please consult with your physician(s) before continuing to ensure it is safe. As always, stay healthy!

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2023 Q2 Employee of the Quarter

7/6/2023

 
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We believe in recognizing and acknowledging the growth and hard work our team has shown. To do this, we began a program within the office we call KUDOS+. Our team is able to give praise and acknowledge exemplary work by their teammates throughout the quarter. At the end, the teammate with the most KUDOS+ given by their team is appointed the teammate of the quarter. Christopher, one of our fabulous Front Desk Coordinators,  is our second quarter Teammate of the Quarter for 2023. We had the opportunity to sit down and learn more about what makes him an outstanding employee.

What is your schooling, background, and experience?
I graduated from UNF this year with a bachelor degree in healthcare administration, and am BLS & CPR certified. I come from a long line of healthcare professionals in my family, and I can’t seem to break the curse! This is my first job in the healthcare field, and I want to demonstrate how much I care for my community through this wonderful opportunity.

​What are your hobbies and interests outside of work?
 
I enjoy going to concerts, and indulging in my vast music collection. Going on walks and practicing my photography skills with my partner on some nearby nature trails has been a truly therapeutic pastime for me recently!

​What got you interested in healthcare?
My father was certainly the biggest influence on my interest in healthcare; his profound love of caring for his own patients provided me a unique perspective where I could both philosophize on the importance of human life with him, as well as study his textbooks on the awesome complexities of our anatomy in my free time as a kid. He seemed to have the answer to every question I had. I have him to thank for pushing me in this direction.

What are your passions? What drives and motivates you?
All I ever wanted was to love and care for as many people as possible. Through my tribulations, I’ve garnered a sincere appreciation for what we’re all capable of, and I want to do my part in contributing to our time together on Earth. My motivation stems from the kindness and generosity of my partner Darren, who never gives up on me – to him, I owe so much.

Do you have any special certifications or achievements? If so, what are they?
Before I started college, I would frequently train students of all ages the martial art of Brazilian Jiu-Jitsu, which I studied for about half a decade. I became a NAGA champion twice, and have carried on these skills and taught others basic self-defense ever since. I can also finally tie a tie by myself after 23 years.

Do you have any other fun facts about yourself you’d like your team and our patients to know? 
I sometimes make music online with my friend in South America! He’s a one-man band that invites me to perform vocals over his instrumentals. If you want to talk about music, I’m all ears!

What do you enjoy most about being part of the team?
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I absolutely adore the level of respect we have for each other. We work incredibly well as a unit, and we all share the same passion for our patients and community. I was welcomed so quickly and seamlessly – it feels like this is somewhere I belong! Personally, my team is part of my family. I love knowing that I can rely on each of them for any and everything, and vice versa.

​Way to grow, Chris! Thank you for your hard work, passion, and hunger for knowledge.
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    About The Bean 

    The Bean is a blog on a mission to share valuable information in the world of Nephrology.  We believe in empowering through education and The Bean is a great place to find resources and information on topics related to high blood pressure, kidney disease, dialysis, and topics that enhance the kidney minded lifestyle.    Enjoy and be sure to subscribe!

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13241 Bartram Park Blvd., Suite 1001
Jacksonville, FL  32258
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