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THE BEAN:
Kidney Empowerment

The Case of Jane Doe

9/19/2024

 
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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. 
  • In year one, her blood pressure was in the 130s. 
  • In year two, her blood pressure was in the 150s.
  • In year three, her blood pressure was in the 180s. 
Ms. Doe has never had symptoms of hypertension. Her doctor put her on blood pressure medication and Jane felt terrible, but her readings were now back in the 130s. If her blood pressure is better now, why does Ms. Doe feel so bad?

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! 

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You (Don't) Snooze, You Lose

9/12/2024

 
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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:
  • Low energy
  • Mood changes
  • Lack of focus
  • Poor memory
  • Inhibited or risky decision-making
Chronic sleep deprivation can also lead to increased risk of a variety of illnesses and conditions. These include, but are not limited to: cardiovascular disease, diabetes, obesity, mental disorders, and hormone imbalances. According to the Mayo Clinic, these hormone and metabolic disruptions lead to an increased risk in developing hypertension.

So, how do you fix it?
Here are some recommendations for getting a good night’s sleep:
  • Create a sleep-friendly environment in your room: 
    • Reduce light: light exposure can throw off the circadian rhythm which helps the body produce melatonin, the sleep hormone. 
    • Turn the thermostat down: The body’s temperature naturally drops while we sleep, so a cooler environment is more conducive to good sleep. Rooms that are too warm can negatively affect the sleep cycle and create more fatigue. 
    • Eliminate excess noise: Use a white noise machine, ear plugs, headphones, or soft music to drown out external sounds. 
  • Limit naps: naps can alter the circadian rhythm. It is generally recommended that naps be taken in the early afternoon and kept to 20 minutes. 
  • Reduce caffeine and alcohol intake: Caffeine can remain in the body for hours after consumption. While it may make some drowsy, alcohol can reduce sleep quality. Both should be avoided in the hours before bed.
  • No blue light or over-stimulations before bed: TV, computers, and cell phones stimulate the brain and can make winding down incredibly difficult. Additionally, the blue light emitted from electronic devices can affect the circadian rhythm as well, making it harder to fall asleep. 

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

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Factors that Affect Blood Pressure

9/9/2024

 
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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. 

  1. Exercise: Lack of exercise over time can lead to weight gain and cause higher blood pressure. Exercise can also temporarily raise the blood pressure, which should resolve on its own. Getting into a regular exercise routine can improve cardiovascular health and help lower blood pressure naturally. 
  2. Age: As we age, our blood vessels stiffen and harden, increasing the risk of high blood pressure.
  3. Nutrition: Diets high in sodium and/or low in potassium can lead to high blood pressure as these electrolytes balance one another out in the body. 
  4. Hormones: Hormones like aldosterone, cortisol, and catecholamines can affect the blood pressure due to their influence on fluid and electrolyte balance. 
  5. Stress: Changes in blood pressure due to stress are generally temporary due to changes in lifestyle and eating habits to assist with coping to high stress levels.
  6. Certain Chronic Conditions: Kidney disease and diabetes are two of the most common contributing factors to hypertension.
  7. Smoking/Vaping: The nicotine and chemicals in cigarettes and vapes can cause the blood vessels to narrow, causing the heart to beat faster, subsequently raising blood pressure. 
  8. Alcohol Consumption: Alcohol can increase blood pressure temporarily, but over time, it can lead to long term increases. Additionally, alcohol can lead to weight gain that will potentially lead to an increase in blood pressure as well. 
  9. Prescription and Non-Prescription Drugs: heart medication, steroids, diuretics, and drugs for pain management can all influence blood pressure.
  10. Pain: Pain can cause an increase in the heart rate and thus increase the blood pressure.
  11. Sleep Apnea: Obstructive Sleep Apnea (OSA) can cause high blood pressure due to a drop in blood oxygen levels. This can also have an effect on the cardiovascular system and kidney function, both of which may also contribute to hypertension.

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

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Reading Your Readings

8/29/2024

 
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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:
  • It has been 1-2 hours AFTER any blood pressure medication has been taken. This will help us evaluate how effective your medication regimen is.
  • You are in a seated position with your legs uncrossed and feet flat on the ground.
  • You are most relaxed. If you were just up and moving, driving, in a stressful situation, eating, or exercising, do some deep breathing and wait a minimum of 10 minutes before taking a reading. 

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!

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Kidney Korner: Dialysis FAQ Part 3, Peritoneal Dialysis (PD)

8/22/2024

 
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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:
  • Cover your catheter well with a dressing and tape
  • When done in the water, immediately remove the soiled dressing, wash with soap and water, and cover with a clean dressing.  

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!

Sodium's Secret Identities: Finding Hidden Sodium in Your Food

8/15/2024

 
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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:
  • Monosodium Glutamate (MSG)
  • Sodium Benzoate
  • Sodium Nitrite/Nitrate
  • Sodium Carbonate
  • Sodium Phosphate
  • Disodium ethylenediaminetetraacetic acid (EDTA)
A more complete list of sodium preservatives can be found using the links in the resource section below. 

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.

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Learn the Label: How to Read a Nutrition Label

8/8/2024

 
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Learning to read a nutrition label is one of the most important things you can do to better yourself on your journey to better health. Below, we will learn the label, what is included, and important factors to note for patients with Hypertension and/or kidney diseases. 

Serving Size and Servings Per Container
Be sure to check the serving size of the food item. Usually, the nutrition facts are based on a single serving size. In some cases, like on cans of soup, you may see 2 side-by-side sections on a label. This is due to calculating nutrition facts based on serving size and the entire container. If you eat more than the amount noted, be sure to adjust the nutrient calculations. It is equally important to note that a majority of these calculations are based on general nutrition advice and a diet of 2,000 calories per day.

Micro- vs. Macronutrients
The nutrition label is separated into micro- and macronutrients. 
Macronutrients are nutrients that we need in larger quantities to maintain bodily functions:
  • Protein
  • Fats
  • Carbohydrates

Micronutrients are nutrients that are equally important, but consumed in much smaller quantities:
  • Vitamins
  • Minerals
Micronutrients include sodium- one of the most important factors to take into consideration for patients with Hypertension and Congestive Heart Failure (CHF). Excess sodium intake can lead to fluid retention, hypertension, and more.

Let’s do Some Math:
To the side, you will see a sample nutrition label. Let’s do some math based on this label. If you eat this whole container in one sitting (all 6 servings), you would be eating:
  • 1500 calories- 75% of your daily value
  • 2,640mg of Sodium- 114% of your daily value
  • 306g of Carbohydrates- 114% of your daily value

Important note: This information is based on the general recommendation of a diet of 2,000 calories per day.​ For patients with Hypertension or Chronic Kidney Disease, the daily sodium intake is recommended to stay below 2,000mg.

Come back next week as we learn more about   ingredients lists with hidden sodium. As always, stay safe and healthy. 


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.

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Relaxation for Blood Pressure Management

8/1/2024

 
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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:
  • Deep breathing exercises and meditation: Deep breathing and meditation can help bring a sense of calm, peace, and relaxation that can direct thoughts away from stressors and negativity. These activities can reduce your heart rate and blood pressure and increase your oxygen intake. While this won’t cure anything, it can help to manage the symptoms. There are a number of different types of breathing and meditation exercises to try. Don’t give up if one doesn’t work out. 
  • Walking and exercise: Mayo Clinic states that 30 minutes of moderate physical activity on a regular basis can help reduce blood pressure. Walking can also help improve oxygen levels, cardiac health, muscle tone, and flexibility.
  • Yoga: Yoga is a great combination of gentle exercise and focused breathing. Both of these can help to relieve stress symptoms and side effects, as mentioned above.
  • Talk therapy and journaling: Therapy and journaling are great tools to help us organize and identify our thoughts and emotions. These can also help us identify and allocate resources needed to help with stress or emotions we are experiencing. As few as five minutes of journaling per day can help guide our thoughts toward gratitude and positivity and away from stress and negative thoughts.
  • Hobbies: Hobbies can help to pull your mind away from your stress and focus on another task. These can be activities like: reading, crocheting/knitting, painting, writing, poetry, and listening to music.

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

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Home Monitoring vs. Office Appointments: What's the Difference?

7/25/2024

 
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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!

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Kidney Korner: Dialysis FAQ Part 2, In-Center Hemodialysis

7/18/2024

 
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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:
  1. Learn something new: take an online course, listen to a podcast, or read a book about a topic you’re interested in
  2. Travel from your chair: go on a virtual tour of museums
  3. Socialize: Call and catch up with friends or family, scroll through social media
  4. Rest and relax: try to catch up on rest by taking a nap and enjoy the time away from work or other responsibilities
  5. Get creative: If you have a catheter or mature access, you can crochet, knit, write, color, draw, or do other activities.
​
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:
  1. Arrive 15 minutes prior to your chair appointment time and check in at the front desk. The team does their best to maintain chair time schedules, but depending on the patients before you, there may be a small delay.
  2. A Patient Care Technician (PCT) will come get you when your suite is ready.
  3. You will weigh and have your vitals taken. Remember to use the restroom before you weigh!
  4. Your PCT will connect you for your treatment.
  5. Sit back, relax, and enjoy any of the above listed activities. Your vitals will be monitored regularly throughout treatment.
  6. When your treatment is done, a PCT will disconnect you from the dialysis machine. Your vitals will be monitored until you are stable, you will be weighed, and then released to go home. 

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!


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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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Jacksonville, FL  32258
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