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THE BEAN:
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 Meet Jane Doe. Jane is a 55 year old teacher living in Jacksonville, Florida. When she isn’t busy planning lessons and activities for her students, Jane is catching up with friends, chasing her dogs around, or relaxing with a good book. Her health is one of her top priorities, so she is mindful of keeping up with her annual doctor appointments. This year, her primary care physician diagnosed her with hypertension after seeing the log of blood pressure readings Jane has kept. Let's review Jane Doe’s case.
Jane Doe has been taking her blood pressure regularly for 3 years at the instruction of her primary care provider when she noticed it rising.
Her doctor decided to refer her to nephrology since the original medications did not seem to be working. Ms. Doe met with Dr. Munjal who made a small, simple change in her medications. Dr. Munjal decreased her blood pressure medication and now her readings are in the 150s and the uncomfortable symptoms of “low” blood pressure have been minimized. Once these symptoms went away, her regiment was changed again to further lower the readings. The uncomfortable symptoms came back briefly, but soon went away as her body acclimated to having lower blood pressure again. Her new goal is 130-140 for her systolic readings. Dr. Munjal explained: “When someone has hypertension, the body can acclimate over time and not experience symptoms of hypertension. This means that when we try to bring the blood pressure back down to a lower range, you may not feel as great as the readings may look. It is important to keep this in mind when working to reach blood pressure goals. When we set a goal, we know that this may take a while to reach since changing blood pressure has to be done in steps. You may feel worse before you feel better.” Working with blood pressure readings is not a sprint, it is a marathon. We must pace ourselves as we work through the steps needed to safely get the blood pressure down to a manageable range. If you have questions or concerns about your blood pressure, call to schedule an appointment with Dr. Munjal!  Did you know that sleep can be directly related with a risk of developing hypertension? Sleeping problems like trouble falling asleep, staying asleep, and too little sleep are all associated with increased risk of high blood pressure. It’s no mystery that a good night’s sleep and good sleeping habits can make a world of difference in overall health.
Effects of Sleep Deprivation Sleep deprivation does not always mean chronic sleep issues. Sleep deprivation symptoms can start after just one night. Some of the symptoms may include:
So, how do you fix it? Here are some recommendations for getting a good night’s sleep:
Some results may be immediate, like feeling more well rested, while others may take getting into a routine to see effects. Keep in mind that this is only one of the many factors that can affect blood pressure. For blood pressure concerns, please call our office to schedule an appointment with Dr. Munjal. As always, stay safe and healthy! Resources: Mayo Clinic: High Blood Pressure and Sleep. The Sleep Foundation: Sleep Hygiene  Did you know that, according to the World Health Organization, it is estimated that 1.28 billion people (aged 30-79) in the world have hypertension? Surely, not all 1+ billion people with hypertension have the same cause, right? Listed below are 11 factors that can contribute to changes in blood pressure.
Each person is different and can have multiple other factors working both with or against them when it comes to managing their blood pressure. If you have hypertension, consider the factors that are within your control and what you can do to improve your health. Make an appointment with Dr. Munjal for a consultation and additional guidance on your blood pressure management. As always, stay safe and healthy! Resources: https://www.who.int/news-room/fact-sheets/detail/hypertension  Do you know how to read your blood pressure readings? Oftentimes, Dr. Munjal does not need to know the exact details of each reading you take. We want to know what the average reading is, or what the numbers look like more than 50% of the time. This answer can sound something like this: “Most of my readings are in the 130s/80s. I have had a few high readings, but they are few and far between.” Let’s learn how we can get our average and read our readings more accurately.
The Reading: Systolic:This is the number on the top of the reading. It is the pressure inside your arteries when the heart is pumping/contracting, at the time of the heartbeat. Diastolic: This is the number on the bottom of the reading. It is the pressure inside your arteries when the heart is filling, between the heartbeats. For most people, the diastolic is normally ½ to ⅔ of the systolic. Generally, when we talk about your blood pressure, we look at the systolic number, or top number of the reading. That’s not to say that the bottom number is not important. However, when you can work with and control the top number, the bottom number will tend to follow. For example, if a reading or goal is referenced as “130s,” we mean the systolic reading. When to Take Your Reading: To get your “normal” reading and the most accurate results, it needs to be taken in “normal” circumstances. You should take your blood pressure when:
Finding an Average: There are occasions when you may be asked for an average of your readings. This can be done by adding a minimum of 2 readings together and dividing by the number of readings used. Here’s an example: Reading 1: 125/72 Reading 2: 137/80 Reading 3: 117/70 Added together (379/222) and divide each number by 3, the number of readings we are averaging. Average: 126/74 Trend line: Another way to view your blood pressure readings is on a graph. Some tracking programs, like Remote Patient Monitoring, can provide the graph for you. Once your blood pressure readings are drawn out, you can draw a line to find the trend of your blood pressure. This line should essentially go through the middle of your readings. A trend line is a great visualization of what your blood pressure looks like over time. While those high or low readings are important, knowing how to read your readings and find a trend is important in the big picture of things. For more information on blood pressure, you can click here to be directed to our hypertension page. As always, stay safe and healthy!  To round out our FAQ posts, we want to answer some questions about the home modality we offer, peritoneal dialysis (PD).
Q: Will I be tired on treatment days? A: While on PD, you should feel well consistently since the machine will be filtering/cleaning your blood on a daily basis, just as your kidneys would. It is important to listen to your body and rest as needed after dialysis. It is also important to note that you keep up with all other aspects of your healthcare too as they play a role in your overall health. Q: How do deliveries work? A: Deliveries are scheduled by the supply company, not the patient or the clinic. The clinic will place the order based on what the patient already has on hand. Someone must be there to accept the delivery. The number of boxes will vary from delivery to delivery based on the supplies needed. Q: Do I need someone to be with me during treatment? A: PD can be done independently and does not require a care partner. However, it is recommended that one be trained in the instance that the patient is unable to dialyze themselves or has a medical emergency while dialyzing. Q: Will someone be available to help me while I dialyze or if I have equipment issues? A: Your dialysis nurse will be available during business hours and there is a number for the manufacturer on the machine that can be used outside of business hours. The machine should walk you through each step of the process, so, if done carefully and correctly, there should be no issues. If a medical emergency occurs, please call 9-1-1 immediately. Q: What storage is necessary for the supplies and equipment? A: It is recommended that there be enough storage for at least one month’s supply. A spare bedroom is a great place to store supplies so they are out of the way of your living space. Do not store your PD supplies in the garage or outdoor sheds. Q: What are signs of distress or that something is wrong? A: For PD patients, during your training, you will learn the signs of peritonitis, the swelling or redness occurring in the peritoneum, the lining of your belly. Common symptoms are cloudy or discolored dialysis fluid, abdominal pain, and difficulty getting fluid in or out. If you experience shortness of breath or chest pain, call 9-1-1 immediately. Q: How often will I be monitored by my care team? A: You will have monthly appointments with your nephrologist and care team. Depending on your labs and treatments, you may have additional appointments with your dialysis nurse as needed throughout each month. Q: If there is a storm and I lose power, what are the protocols and procedures? A: All protocols and procedures will be outlined in the Patient Handbook given at the beginning of your time at DialySuites. Your team will also review these protocols with you annually. Additionally, your team will keep you informed as any imminent storm approaches as to how to proceed. For home dialysis patients, it is generally recommended that you have a month’s worth of supplies on hand in the event of an emergency. Q: How is my diet going to change? A: Because dialysis is done daily, the diet for peritoneal dialysis is not as strict as the diet for in-center hemodialysis. Q: What lifestyle restrictions will I have now? A: Peritoneal dialysis allows patients to live their lives with as few restrictions as possible since most exchanges are done at night while the patient sleeps. However, there are a few restrictions that must be adhered to strictly. PD patients are not permitted to go into public pools, hot tubs, or saltwater pools. The ocean and private, well-maintained, chlorinated pools are generally okay, but still not recommended. It is best practice to avoid submerging your catheter altogether. If you are to go into the ocean or a chlorinated pool, follow the below listed steps to reduce risk of infection:
Q: How does bathing/showering work? A: Due to the catheter that is in your belly, baths can no longer be taken. However, showers are permitted. It is recommended that you clean the shower head weekly with bleach to reduce the risk of infection. Q: Do I need to dialyze at the same time every day? A: Treatments will need to be done on a daily basis. So long as they are done within the 24 hour period and before midnight, there should be no issues. If you have questions about timing, please contact your care team to discuss. If you have any questions or concerns regarding dialysis and your treatment path, please feel free to contact our office or DialySuites Bartram for more information. As always, stay safe and healthy!  Did you know that sodium has multiple secret identities and they’re hidden right under your nose? Sodium can be hidden in food in the form of preservatives. While a food may be labeled as “No/Low Salt, “Salt Free,” or “Low Sodium,” it does not mean that it is sodium free. Let’s uncover sodium’s secret identities.
Sodium as Preservatives When looking at an ingredient list, you may not always see just “salt” or “sodium” listed on the ingredients. This is because it is usually hidden in the form of a preservative or sodium compound. Listed below are common sodium identities:
Sodium Replacements Some products are labeled as “Salt/Sodium Free,” but still taste salty. Why is that? Great question! Companies can replace sodium chloride with potassium chloride which generally has a salty taste as well. This, however, may be equally as dangerous for those with kidney diseases. Just as sodium does, potassium helps your body to maintain mineral and fluid balances. Eating too much potassium can affect fluid balance, muscle function, and other cause other side effects or symptoms. It is important to be mindful of what your sodium may have been replaced with. When in doubt, opt for using only herbs and spices when cooking and be sure to check your food labels. Misleading Advertising When a food product is labeled as “No Salt/Sodium Added” it does not necessarily mean that the food is free of sodium. Many food products are made by one producer, relabeled, and sold by another. This means that by the time it gets to the second company, if nothing is done to it, they can claim that there was no salt or sodium added BY THEM. This can be incredibly misleading. This is why it is important to read the nutrition label closely and understand what your sodium limit is. When grocery shopping, always be sure to check your food labels and ingredients lists. You never know what may be hiding within them! As always, stay safe and healthy! Resources: https://www.capecrystalbrands.com/blogs/cape-crystal-brands/sodium-food-additives-a-complete-guide https://www.ncbi.nlm.nih.gov/books/NBK50952/ This website is for informational and educational purposes ONLY. While we strive for accurate, general medical information, this does not replace professional medical advice. Do not rely solely on this information. Please consult with your physician for more information regarding your specific needs. If you are experiencing a medical emergency, please call 911. 
 Managing your blood pressure can take multiple things working together as a well oiled machine. This can be a combination of medications, food choices, hydration, and exercise. Did you also know that relaxation techniques can play a vital role in blood pressure management as well? Let’s dive into how relaxation can help manage hypertension and how you can apply simple practices to see results.
How does relaxing make my blood pressure go down? Great question! Stress can contribute to and exacerbate a number of health conditions, with hypertension being near the top of that list. When we experience stress, whether on the forefront of our minds or not, our bodies can release hormones that will raise blood pressure temporarily. Stress and elevated blood pressure over time can lead to other conditions, like heart and kidney diseases, that will also negatively affect your blood pressure. So, what can I do? I’m so glad you asked. While you may not always be able to remove the stress from your life, there are a number of things that you can do to help alleviate the side effects of stress. These include:
Unfortunately, stress tends to be an ever-present part of life. Remember, managing your stress can help to improve your blood pressure. Improved blood pressure can help to protect the kidneys from damage. We hope to help empower you with ways to reduce the side effects and live a healthier, happier life. As always, stay safe and healthy! Resources: Mayo Clinic- Blood Pressure Control Mayo Clinic: Meditation  More often than not, Dr. Munjal asks his patients to monitor their blood pressure and/or weight readings at home between appointments. You may find yourself asking “why am I still being seen in the office if I am tracking this at home?” Great question! There are aspects of your care that require different levels of attention from Dr. Munjal and our care team. Let’s discuss what those are and why each is equally important.
Home Monitoring Dr. Munjal asks most of our patients to monitor their blood pressure readings at home. He does this so we can get a better idea of what your readings look like normally, in everyday circumstances. A singular reading may not accurately represent your average blood pressure. When blood pressure is taken consistently, trends over time are able to be identified. This helps Dr. Munjal to make better informed decisions. A blood pressure tracker is available on our website here to help you track at home. To assist with making tracking your vitals easier, we have a Remote Patient Monitoring (RPM) program. Monitoring programs, like ours, typically only focus on one aspect of your care. Stabilizing and ‘fine tuning’ your blood pressure readings and regiment appropriately can help with your overall kidney health. Adjustments are made, as needed, between regularly scheduled appointments. To learn more about the RPM program, head over to our website by clicking here. Appointments Regular appointments, whether virtual or in office, are still necessary as there are a number of other factors and events that can contribute to changes in your health over time. At appointments, Dr. Munjal provides a more comprehensive check-in to explain lab results, any pertinent changes in diagnosis and health status, and if there are other conditions or concerns to discuss. He will also order tests to continue to monitor your health or refill prescriptions as needed. Appointments are also where those home readings come into play. Dr. Munjal will review the readings you’ve taken at home to assess your blood pressure and/or weight management. Please bring your blood pressure tracker back so he can review it with you. In short, home monitoring 'fine-tunes’ and assists with creating the big picture of your health for regular appointments. If you have questions or concerns, please feel free to reach out to your care team. As always, stay safe and healthy!  Previously, we have discussed general FAQs for patients new to dialysis. This week, we want to go more in-depth based on modality, or the type of dialysis you are receiving.
Q: What can I do while I have treatment? A: Each suite has an individual TV for the patient's entertainment while they dialyze. Additionally, you can:
Q: What is the typical routine on treatment days? A: Each patient will find a routine that works for them. A typical routine on treatment days can look something like this:
Q: Who will I encounter at the facility? A: At DialySuites Bartram, your passionate, dedicated team will be with you from the time you walk in, to the time you head home. You will encounter the facility coordinator, patient care technicians, dialysis nurses, and your nephrologist. You can read more about the team here. Q: Can I drive after treatment? A: Many patients are able to drive themselves home from treatment. However, some patients can experience fatigue and other symptoms after treatment, so having a back-up ride or a care partner there to pick you up is a safe option. There are also transportation services available through some insurances. It is recommended that you have transportation scheduled for your first week of treatments to assess how you feel before driving yourself to and from treatments. Q: Will I be tired on treatment days? A: After receiving dialysis, you should begin to feel better. Some patients report experiencing fatigue after treatments. Listen to your body and rest as needed after dialysis. Q: Can I eat while receiving my dialysis treatment? A: Unfortunately, no. Eating while on dialysis can risk choking, nausea, vomiting, and/or hypotension. Additionally, it is a sanitation hazard while in the clinic. For in-center hemodialysis, based on your preferences, you can eat before or after your treatment. No food or drinks (even water) are allowed on the dialysis treatment floor. Head over to our Facebook page and comment other questions you might have about in-center hemodialysis. As always, stay safe and healthy! |
