Slowing Down

During my Nidan demo a few weeks back, my sempai mentioned that I needed to slow down – feel the blend, feel the connection before applying the technique. After my test, I did feel that I rushed through my demo. In fact, even my training partner said that I was throwing her so fast, that she was exhausted after my demo.

For some weird, perhaps cosmic, way, I am finding that the “slow down” theme resonated through the month. With my working long hours, it helped me cope with all my work, extra-curricular activities and in keeping my health in check. 

The obvious example is applying it to aikido. I have been quite exhausted at work and going to class tired. However, when I made an effort to warm up (a bit), meditate before class, and take a deep breath before each technique, the experience becomes more profound and more meaningful. It became a completely different experience.

I am taking the same approach at work. We are slammed because of an upcoming software release. Tasks and more issues are coming left and right. However, if I focus on each task at hand and avoid multitasking, I find that I feel more productive… and probably finish my work faster, at a higher quality.

The same applies to maintaining my health. When I take my meds, I try my best to be mindful and just focus on that. When I do that, I find that I make better note of what I took and take them on time.

I also try to be more focused when preparing my food. I find that it is more relaxing if I take my time when I am preparing food or cooking. It’s like a moving meditation. Even chopping seems to have a deeper meaning: I learned to appreciate the colors and texture of what I am chopping and not rushing through preparing a meal.

As I slow down, everyday things seem to have more meaning and substance. I am able to see subtle things that I normally would miss if I were rushing. It made me experience things in a different dimension.

I am still learning and finding more ways to slow down. I am still hurting a bit, and it is important to listen to the signals my body is sending my brain. I must admit it is difficult a lot of times, particularly if you have very limited time and there are a lot of demands on you. It does take time… to slow down and smell the roses.

Six months later...

It has been six months since my transplant. Overall, I think I am doing great. In my appointment with my transplant nephrologist last week, he said that my lab numbers look great. If these numbers continue, I may just need to go to the labs once a month. My doctor even said that these are ideal for a kidney transplant recipient. My last creatinine was 0.95! My husband and I couldn’t be any happier.

I am elated with these results and am very determined to maintain these numbers. For me to able to maintain these great numbers, I need to remember to do these key items.

Take your medications regularly. Taking your immunosuppresants, anti-infection, and other maintenance medications are very important for any transplant recipient. This ensures that the immunosuppressant levels, which are critical in preventing the body to reject the new kidney, are at optimum levels. I should read my post on taking your meds as a reminder.

Keep moving.  This means exercise, exercise, and more exercise. I find that when I walk, my body (and mind) is able to function more efficiently. I make it a point to exercise at least 20-30 minutes a day whether if it is walking, practicing aikido, or dancing hula. Sometimes I do overdo it, like last Saturday, when I went to a 2-hour hula workshop and walked almost 40 minutes (one way) to go to a baseball game. While it is important to move, do it in moderation and consult your doctor before you start a new exercise routine. I have to keep reminding myself that my surgery was not too long ago. Rest and recovery are still equally important.

Maintain a balanced diet. Must. Eat. Healthy. Since I now have a healthy kidney, I can pretty much eat whatever I want. I do not have any more restrictions on phosphorus (and therefore no need for binders) so I can add whole wheat and other grains in my diet. I loved experimenting on different grains. When I was in dialysis, I was pretty much limited to white rice and white bread. Now, I can have quinoa, barley, corn meal, and oats (my favorite). I still need to be careful though; immunosuppressants may increase potassium in one's system so you may need to watch high-potassium foods like bananas, mangoes. and coconut. More on this later…. I feel a post coming.

Maintain food safety. Just as important as keeping a healthy diet is maintaining excellent food safety.  Bad bacteria in foods can make you sick, and since my immune system is lowered, I am more susceptible to illness. Also, my nutritionist said that certain salmonella can considerably damage my kidney. Maintaining good food preparation habits and selecting reputable restaurants with a clean kitchen are very important. Check the National Kidney Foundation's article on Food Safety or my previous post on this.

Keep hydrated. My new kidney needs to be constantly hydrated, so I need to drink plenty of water. In fact, my excellent creatinine results were partly due to the summer heat. I was drinking so much water since I was always thirsty with this summer heat. To my surprise, my creatinine considerably improved. I do need to go to the bathroom more… deal with it!

Manage your stress levels. Stress has been known to adversely affect one's health: whether it is stress from your medical condition, work, or relationships. I try to keep my stress-levels low by having a positive attitude and surrounding myself with positive people. I also try to have some quiet time either through meditation, walking, or even blogging. These allow me to center myself and hear my thoughts better.

Have a good support system. Having an understanding husband and good close friendships were very key during my recovery. My husband provided most, if not all, of the physical help needed in that period: cooking meals, cleaning, driving me to doctor’s appointments. He was a rock, and I am very grateful he is here to support me. My friends also provided encouragement and support even though some of them are hundreds, if not, thousands of miles away. They kept my spirits up and kept me going. I need to remind myself to maintain my relationships and never take them for granted.

I still have a long way to go, and getting through these last six months is just a step in the process. I want to have a healthy kidney for a long time, maybe for the rest of my life. To accomplish that I need to continue to always keep these tips in mind.

I’d love to hear from you if you have any more advice for me. Wish me luck!!!

Take your meds!

I recently saw a (web) presentation on medication adherence. According the presenter, about 50% of patients living in developed countries do not follow treatment recommendations. I was very surprised to hear this statistic (So surprised, that I even confirmed it via wikipedia). Fifty percent is a huge number, and I think that taking your meds the way your doctor has prescribed them is critical to improving your health, especially during one’s recovery from surgery.

Bracelet to remind me of my binders

As an example, when I was getting dialysis treatments, the dietician and the charge nurse always reminded me to take my binders to keep my phosphorus levels low. I hated those pills – they were horse pills (See my previous post – Got pills?). I could not count how many times I almost choked on those things. Regardless, I took them with every meal and snack. I was determined to keep my phosphorus low, even if there were times when my phosphorus levels were going the opposite way and I did not think the binders were working.

After my transplant, taking my medication is even more important, specifically the anti-rejection or immunosuppressants. To ensure that I have adequate levels in my blood stream, I need to take my medication every 12 hours, like clockwork. It is very important. I have an alarm in the morning and in the evening as a reminder and a prescription diary to keep track of what I take daily.  The transplant pharmacist once told me that a transplant recipient lost the kidney because that patient kept forgetting to take his/her medication on time. Since I am determined to keep this kidney for a long time, it is very important to me to take my meds at the specified time. 

I have an alarm for meds!

Don’t get me wrong. I do forget my medication sometimes. I can think of more than a handful of times when I forgot to take my blood pressure pills or even my phosphate binders. The key is to make it the exception, not the rule. For blood pressure pills, take them as soon as you remember. Also, make a note on what occasions make you forget to take them (mine is usually when I am in a hurry or distracted) and try to correct it.

In that presentation, I learned that many people never order their prescriptions. Some order them, but never pick up their filled prescriptions from the pharmacy. Other people pick up their medication, but don’t follow their physician’s instructions.  Although I have had a history of researching every medication that has been prescribed to me and sometimes questioning why I take them, I usually work with my physician to get a win-win situation. As an example, I have not been a big fan of taking statins for cholesterol. I’ve read of the side effects, have seen those side effects first-hand, and would prefer an alternative drug. However, I worked with my then primary care physician to lower my cholesterol (specifically triglycerides) without taking statins. We found an alternate drug. Ironically, I am taking statins now for maintenance (I may have a conversation with my transplant nephrologist after a few months).

That presentation inspired me to be more mindful of taking my medication regularly, and I am hoping this post will inspire you to do the same. Do whatever it takes to take them on time and at the correct dosage, whether you need to set an alarm or keep a diary. “Not taking your medicine as directed can also lead to other health problems, especially if you already have asthma, diabetes, or high blood pressure” (From ScriptYourFuture.com). And remember, diabetes and hypertension can lead to kidney disease.

On My Latest Doctor’s Visit: Five Tips for a Productive Monthly Check-up

I had my latest doctor’s visit last Tuesday. Overall, it was pretty good. My routine lab numbers are great, particularly my creatinine and BUN (Blood Urea Nitrogen) – both are very important measures of kidney health. My blood pressure has stabilized, although it is still a bit on the high side. And, I am back to my extra-curricular activities, even though it is not as often. Overall, I am in good shape.

I am writing this post not just to update you on my current health status, but also to offer some tips on a successful doctor’s visit. Since I’ve been back to work for two months now, I have regular meetings with my manager, associates, and some of our clients. On my last doctor’s visit, I treated it like a meeting with my boss.  Here are some tips based on my observations:

1. Be prepared to say what’s new and how are you feeling. I was actually unprepared for this, but was able to share the state of my health, from my own perspective, of course. Think of it as a status of what you’re working on. Focus on both the good and the bad. 
2.  Prepare questions ahead of time and prioritize them in the event that you do not have time to ask them all. Some of these may not be related to your current status, but rather about something down the road - still important. One of my questions was whether I can now travel. This is important because I may need to travel for my new projects at work. I wanted to know if there were any concerns or precautions that I should take.
3. Do your homework before your doctor’s visit. If something is troubling you, do not hesitate look it up on the internet or other resources you have. I believe that the more informed you are about your condition, the more productive your visit will be. Fortunately, unlike your manager, you do not always need to be pro-active and have solutions ready for your physician; although, often times, it can help. As an example, for this visit, we called ahead to request for another ultrasound because of my high blood pressure and some weight gain again. Physicians see hundreds of patients weekly, so they do not necessarily memorize each patient’s history until the actual visit.
4. Review your notes before the meeting. This is important so you know by heart what your main concerns and questions are. Also, if your physician does not have enough time, you may need to ask them as fast as possible. As an example, this time, the medical clinic was running about 30 minutes late. If I did not have my notes and, for that matter, knew them, I would not have been able to cover all of my questions. I think I covered one question per minute!
5. Lastly, your caretaker should be as familiar with your questions and your concerns, at the very least, the most important ones. If you are too sick to share your questions and/or concerns, your caretaker should be able to represent you. Fortunately for me, my husband can and would do a very good job for me.

In my last visit, I think I did well on most of the items, but need to work on 1. As is with all things, practice makes perfect! 

First Quarter Later: Pros and Cons

It has been three months since my kidney transplant – One quarter!!! In Jimmy Fallon-style, here are the pros and cons of the first quarter.

Pros	Cons
I can eat a lot of things that I couldn’t enjoy before. This includes ice cream, corn bread, pancakes, and waffles.	I am gaining weight again. I do think that some of it is unusual and may be fluid retention, since I am not eating enough to gain a pound in one day. I am still concerned that another angioplasty may be coming.
I’ve completed my first month working; two weeks of which was full-time work.	Uh-oh, here come the projects. No more time for blogging and watching “Scrubs”!
I registered for the Kidney Walk, and in just 10 days of fundraising, I am 75% of goal.	Oh, my legs… sore from the daily training!
I’ve rejoined my hula class. It has been awhile since I have danced with my hula group. The last time that I attended class regularly was almost two years ago. I stopped going regularly because I had to go three days a week to dialysis.	Now, my knees are sore too! And I am so tired after class that I find myself falling to sleep early that evening, thereby missing late night TV.
I’ve enjoyed my first aikido (weapons) class just yesterday (Saturday). It felt really great to be back in class – the friends, the exercise, and all that energy.	Four words: Afternoon naps are back! Oh, and the “knees-thing” apply too.

For those not familiar with Jimmy Fallon’s Pros and Cons, here’s an example (of course, his skit is funnier). Warning: some of it can be a bit crude, but that is the nature of late night TV.

Overall, I feel pretty good: my blood pressure is stable, my lab values look great, and my skin is not as dry. Also, no more dandruff (probably from phosphate build-up) and thick hair growing all over my body (side-effect of the medication). I feel I am getting more energy, day by day. More importantly, I am slowly getting back into my old healthy, productive routine, and not going into dialysis three times a week. Given that, I still have some concerns, which is somewhat normal. Hopefully, we’ll get this resolved during our next doctor’s appointment in a couple of weeks.

Back to Work - Full time!

As of last week, I went back to work full-time. I had mixed feelings going back to full-time, since I had become used to and somewhat enjoyed my medical break routine: I walked in the morning, prepared and ate lunch, napped, and then walked again. I would even have the television on in the background to listen to Chopped, Kitchen Nightmares or CNN’s Wolf Blitzer. As I mentioned in one of my tweets this week, I have memorized most of the commercials – at least, those on CNN, BBC, and The Food Network (just ask my husband!).

I had planned to work from home all week, but my project required me to spend some time in the office. It was a welcome change to being home, but I was concerned about the drive and the ability to stay awake (no more naps!). My plan was to enjoy a phosphorus-caffeine-boost (translation: a soy coffee latte) midday to keep me up and about. An added bonus was being able to get new nail polish and a new CD this week – from an actual store!

Actually, things went quite well this week. I went into the office twice and got to interact, catch-up, and laugh with my friends at work. I was also able to both start and complete my project. The only casualties were a cancelled meeting (so I could complete my assignment), my jeans, and now a sore back. My tummy was still a bit bloated, so my jeans were really tight while I sat down.  Bummer, but it gives me a chance to wear (cute) dresses more and shop for accessories. The sore back may be due to sitting and not moving around very much. I guess my body is rebelling from sitting 8 hours a day in the same chair.

Next week is another full workweek. I am again hoping that I can work from home most of the days. However, as has been said before, the best laid plans often go astray. I probably should rest up!

Adjustments and Anxiety

I am somewhat on pins and needles today. With the rise of my blood pressure this week, an accidental hit on my new kidney spot, and to top it off, starting our tax preparation, it was a pretty stressful day.

I am hoping that this anxiety is normal. After all, one does not experience a kidney transplant everyday. I find myself very protective of it, much like a mom protecting her new baby. I embrace a pillow every time Meow is around to prevent her from jumping on me, wear a mask and gloves when I go to my check-ups and my weekly trips to the labs, watch my potassium, and the list seems to go on. Any little change is stressful: I always ask myself if the new kidney is still working or did I do something wrong? Sometimes, today included, I feel that it was better when I was on dialysis.

Hubby always reminds me that the stress and anxiety is somewhat counterproductive, maybe more harmful to the new kidneys. While I agree in concept, I am finding it difficult to remain calm and centered. He also points out that we were both used to the routine and diet with dialysis; major surgery and a big change like this will surely require adjustment.

Hopefully, tomorrow will be better. My meditation project starts tomorrow, and even if I meditate for five minutes each day, it may help calm me down.

Also, in hindsight, maybe we should have our taxes done by H&R Block this year.

One Foot in Front of the Other – Part II

As part of my recovery, I’ve been asked to walk daily. For those following me at my tweets at twitter, you know that at first, I thought I was supposed to walk for only 10 minutes a day. Looking at my discharge orders, I was shocked to see that I was not walking as much; it is supposed to be 10 minutes for three times a day. Whoops!

A portion of my Daily Walk

I guess that this is consistent with the “Let’s Move Program” which recommends physical activity for 30 minutes for adults. Got to get in the program. It is actually about the same amount of exercise I used to get during my dialysis days (I exercised more on the days that I did not go to dialysis).

I have been walking around our condo complex. I used to walk only about 75% of the perimeter, but now I have to increase the distance. Just in case something happens, Hubby does not want me to go outside of the complex yet. Also, even though I am in the complex, I carry my cell phone, just in case. I walk about three to four laps, twice a day. It’s 0.8 of a mile, and it takes me about 18-20 minutes.

My first goal is to walk without pain. The incision still hurts a bit but not enough to stop me from walking, and I still have some lingering pains outside of the incision related to the surgery. Once the pain disappears, I am hoping that I can get back to my old pace; 55 minutes for about 3 miles.

Then I will begin training for the Kidney Walk.  Wish me luck.

BTW, check out my original post on walking.

Vindication - Hopefully

Hurray! My potassium is now 5.0 – thanks to a reduced dose of Tacrolimus and a low potassium diet. It did increase slightly from Monday’s lab results by 0.1, but my nephrologist said that the difference is not significant enough to be of concern.

I am hoping that with the reduced Tacrolimus, my potassium will continue to lower. For now, I have been advised to maintain a low potassium diet – that means forgoing my beloved tomatoes, avocados, and bananas. My cereal now has low potassium almond milk with 1 teaspoon of sliced almonds. At least, I can have Honey Bunches of Oats - until I have a chance to check the potassium content. Today, I had a half a bagel with only cream cheese – I miss having tomatoes and avocado on it. That is one of my guilty pleasures.

Balanced diet? Some phosphorus, Some potassium

My frustration is that dairy, which is high in phosphorus, is also high in potassium.  Ice cream is the ultimate guilty pleasure for me. I couldn’t have ice cream when I was on dialysis; I had to settle for a sorbet when I wanted something cold for dessert, and I missed ice cream’s creaminess and sweetness. When the dietician recommended that I have a huge ice cream sundae, we went ahead and indulged in some ice cream bars and Haagen Daz. The dietician still recommends that I continue with my ice cream habit, until my phosphorus rises; unfortunately, it’s decreasing again!

At least, my potassium is now within normal range, but still on the high side. Hopefully, with a semi-balanced diet, I can tackle both Hyperkalemia, Hypophosphatemia, and any more Latin that they throw at me. Or is that Greek?

Hubby thinks that the answer lies within peanut butter. I don't think he meant Peanut Butter Ice Cream.

Until my next lab results!

Missing Aikido

One of my disappointments with having a kidney transplant was not being able to train in Aikido while in recovery. I was very close to my Nidan test (second degree black belt) and felt good about the material. In my last class, Sensei asked me to demonstrate how to do counter-attacks from two different attacks. I was able to do them successfully. My friends said that I looked ready. Little did I know that that was my last class before surgery.

Now, I am on sabbatical.

I am not even sure if I can train again.

Some people have said that I may need to quit my martial arts training after I get a kidney. Others (nurses, teachers) say that being back on the mat is possible. Aikido is unique in this instance because it is generally not a full contact martial art. Sure, we occasionally punch or strike, but if one does the techniques correctly, the strike is avoided.

I miss being on the mat, and I hope to be back on it as soon as I am ready. I will use my sabbatical to really get to know and organize the material for my test. By the time I am back, I will be mentally ready. Physically? I hope so.

Me on my Shodan (1st degree black belt test). Nidan next?

If that does not happen, I think I need to be ready for the next chapter of my life. Aikido has taught me to be present, be in the moment. In the last seminar that I attended in our dojo, our Division Leader, Pat Hendricks Sensei had brought her calligraphy as a present to our sensei. One of it is “Founder,” and she was hoping that it would inspire us to find our own niche in Aikido. Maybe that will be my path.

Onegai shimasu.

Sleep

Meow: She sleeps 16 hours per day.

Just like my cat, I have been sleeping and napping a lot these days, maybe because I feel tired most of the time. Last Monday, I needed to go to the labs to get a number of tests done. The labs were just an easy 15 minutes from our house, but this time around, it seemed like a long way. After that trip, I felt that I used up all my energy. Everything else was a big effort: getting water, taking my meds, showering. What a big difference from the Type A person that I have always been. It’s rather scary how fragile we humans really are.

The following Wednesday, I had a chance to take a short deep nap after lunch. After I woke up, I felt rejuvenated. I felt that I could tackle the world again, although I was not sure how long.

I used to think that sleep was a necessary evil.  With a good chunk of my week spent in dialysis, I hated wasting time, and I would get furious if some unforeseen issue threw me off my schedule. As a result, sleep was something I never got enough of. I used to get six hours a night Mondays through Saturdays and maybe seven to eight hours on Sundays.

Now, I know that I was mistaken. Hopefully, since I will not be in dialysis three nights per week, I can get home at a more reasonable time, and get more sleep.

For more benefits of sleep, here’s an article on Health.com. 

Sweet dreams.

Hypophosphatemia

Not too long ago, I was diagnosed with Hyperphosphatemia or High-levels of Phosphorus. I was very perplexed because my diet almost had no phosphorus in it – no dairy, no high fiber foods, no cheese (except for cream cheese), almost no nuts, and limited protein. The nurse and the nutritionist at dialysis kept nagging me about my increasing phosphorus levels. At the end, I found my diet was not the culprit, but we still increased my binders.

This week, we had our first transplant follow-up visit and the pharmacist declared that my phosphorus was too low. TOO LOW! I think this is called Hypophosphatemia. Hubby and I found that extremely funny because not long ago, we were having the opposite argument. She said that low levels of phosphorus may cause tiredness, which is what I am experiencing. She also said that if it does not increase, she might prescribe phosphorus supplements to me. What a difference a new kidney makes!!!

Our version of Phosphorus Supplements: Yummy!

So, I am making an effort to have a bit more phosphorus in my life, but not too much since we know what the opposite means. After that visit, Hubby bought us two ice cream bars! I have not had one of those in a very, very long time, and neither has he! We both enjoyed each bite, and he promised to get a pint of Haagen-Daz during his next trip for groceries (Note: he’s never bought ice cream before).

This week, I also enjoyed a generous amount of peanut butter with my Pain Perdu (ok – it’s just French toast, watched way too much Food Network yesterday). I did have to make it with rice milk because one of my anti-rejection medications require that I do not have dairy two hours before and after taking it (more on this later). Guess what, no naps that day! I was able to make my own lunch with little help! I think it is working. I am even going back to my phosphorus-laced Aveeno moisturizer with soy.

My new motto: An apple and ice cream a day takes the doctor away!