Finally Nidan

I had a milestone this week. I just had my nidan (second-degree black belt) demo. I felt I have been preparing for my nidan test for about eight months. However, because of my transplant, I was not able to take my formal test last February (see my original post). Last Saturday, I finally had a chance to perform my demo and receive my certificate.

Right after my transplant, I was not even sure if I could train in aikido again. I was in so much pain that it took so much effort to just move around. Also, I have had to avoid trauma on my kidney “surgery spot,” so I was not sure how I could manage my training.

Slowly but surely, I was able to start training again. First, I just started with weapons class where we do not normally have close contact or take (too many) falls. After I was getting more confidence, I attended general practice once a week, then twice. After all, I had an exam to train for. Although twice a week practice wore me out a bit, I hoped (and still hoping) that I would eventually get used to it.

I did not have a formal test, because my Sensei felt it was not necessary. He said that I was basically ready for my test in February and was already training at a Nidan-level back then. The demo was just a formality.

During the celebration, Sensei gave me a card with Yosa Buson’s Autumn Haiku (see photo in this post). It reads:

Ichigyo no

Kari ya hayama ni

Tsuki wo insu

On the mountain crests

A line of wild geese

And the moon’s seal

To me it represents, a new season, a new beginning, and the continuing journey that I will have in aikido.

Onegai shimasu.

Working 9 to 5

We’re in crunch time mode at work the last few weeks, and I have been working really long hours. Although I have been working from home three days a week, my projects have been taking up most of my time. I barely have time to cook or exercise. Fortunately, my husband still takes care of the household: he even cooks and encourages me time to take my walks or go to the gym. I definitely had no time to tweet, re-tweet, and blog.

I am somewhat surprised that the workday wears me out. Before my surgery, I remember working longer hours and did not feel as tired as I do now. This is with dialysis for three hours, three times a week and regular (but shorter) exercise sessions.

I do remind myself that it has been only a little over eight months since my surgery – not even a year. My body is probably still healing and adjusting. My scar still occasionally hurts, but not unbearable. Sitting eight or more hours per day also now hurts my back. Because of my surgery, I have only been doing minimal exercises to strengthen that area: mostly rotational exercises and light knee-to-chest stretches (at least working my way through it).     

I do think that as long as I continue to keep a few things in mind, I can adjust to my workload without sacrificing my health, and for that matter, my sanity.

Pace yourself: I was Ms. Multitasker before. Now, I am finding that doing two or three things at once is more distracting. I have to focus on one thing at a time and do the best job that I can. I prioritize the items on my list and do them according to priority (or what I can fit in at the time remaining). With this, I find that I am able to accomplish more important things. I also stop when I am getting to the point of diminishing returns, i.e. my brain is too full that I can barely function.

Continue eating healthy: It is very tempting to start eating junk food when working late. I still bring my lunch and snacks to work (Thanks to my husband): lunch is usually a combination of grains, veggies, and healthy proteins like chicken or vegetarian options. Snacks have been granola bars lately (with low glycemic index), but I really should go back to eating a variety fruits in the afternoon.

Take breaks: When I have been sitting for a long time or feeling mentally tired, I find that taking short breaks help me out. I take a short walk, some stretch breaks, and if I am working from home, maybe even take a meditation or hula dance break. After 5 or 10 minutes, I find that I have more energy to tackle the task-at-hand and am more mentally alert,

Continue being active: After a long workday, I find that exercising is helpful in releasing any stress from work or any mental pressure. It helps me take my mind off work and helps me relax in the evening. In fact, each time I go to my aikido or hula class, I sleep really well that evening (Again, I am thankful that my Hubby encourages me to have the time to exercise).

Rest! Although being continually engaged is tempting, R&R is very important. My husband also reminds me that I not only have I been working too hard, but also playing too hard: Aikido weekend three weeks ago then a hula workshop a week ago Although I am one of those geeky people who relax by blogging or looking at Pinterest, sometimes unplugging is really beneficial. Cooking, browsing through a magazine, reading a book, or just napping usually works for me. 

This advice probably applies to every one, but especially those who are coming back from medical leave. I am hoping that crunch time ends soon (hopefully next week) and I can have a semi-normal work life soon.

Enough blogging now… Back to work... On a Sunday!

Take Me Out To The Ballgame!

My husband and I had recently enjoyed a couple of San Francisco Giants games at AT&T Park. The first one was courtesy of the Leukemia and Lymphoma Society (it was the kick-off event for the Light the Night Walk) and the other, the most recent one was our own choice – the Polynesian Heritage Night. During my recovery period, we bought tickets so we could have something to look forward to after my internment.

Although we were looking forward to the game, I knew one of the challenges would be finding transplant-friendly ballpark food. Both games were night games, so I would want to have a decent dinner. Fortunately, AT&T Park has been known for great food, so I thought it would not be too much of an issue.

Tempting! Cholesterol-wrapped Phosphates!

However, the nutritionist at UC Davis said that probably the best foods for me at the ballpark would be cotton candy or peanuts. However, I wanted something close to real food, so the dilemma continued.

I googled the dinner possibilities at AT&T park and found some options. However, during our first visit, we were in the bleacher seats, and although there were a number of very tempting options, it was quite limited for a transplant patient. Present were the usual pre-made hotdogs and burgers, kielbasas, even bacon-wrapped dogs, but nothing hot or prepared only for me. Given my choices, I opted to get a veggie burger without lettuce and tomato. I figured that would have the least concern of bacterial growth. I also had a Ghiraldelli ice cream sundae for dessert. Yum!

On our second visit, we decided that the safest bet was to have dinner before the game. We opted for something familiar: Momo’s right across the street from the park. My hubby and I shared lamb meatballs to start. He had the lettuce wedge as always, and I had the gumbo, which was nice and warm and quite yummy. Not only did we get hot and delicious food in an enjoyable outdoor café setting, we also saved some money since ball park food can be a bit overpriced. We were so full after that mean that we did not need to eat at the ballpark, except for the obligatory red vines and cracker jacks.

Did you know that the toy in cracker jacks is now a mini comic book. Really?

At the main entrance at Willy Mays Plaza, we found that there are a couple of other convenient sit-down options: Public House and Mijita. Hubby and I made a mental note to check these out next time we’re at The Yard.

One not-so-secret note: According to a post in another blog, if none of these options appeal to you, AT&T Park allows folks to bring in outside food – no questions asked. If you feel like it, you can fill your bag with goodies - either kidney-friendly or transplant-friendly - for the game. That may be the safest, most convenient bet of all.

Play Ball!!

"No" to the Proposed Medicare Cuts on Dialysis

My blog post this week is about the proposal by the Centers for Medicare and Medicaid Services (CMS) that would cut Medicare reimbursement for dialysis. I am very concerned about these proposed cuts, and how it would impact my friends at the dialysis center. According to one of the articles that I’ve read, these cuts would reduce the reimbursement rate by 10% to almost $20 per dialysis session. Medicare reimbursement already does not cover the cost of dialysis. At three days a week at about four to five weeks per month, that would be at least an additional expense $240 per month.

If I were still undergoing dialysis treatments, these cuts would probably not make significant difference for me. Thanks to my employer, I have excellent health insurance. Since I had been on dialysis for some four years, I did rely on Medicare to pay for 80% of my dialysis treatments. Since the rest was paid for my insurance, I have had minimal costs per treatment and for that, I feel fortunate. However, I am probably in the minority.

I am thinking of the other patients in the center who completely rely on Medicare to pay for their treatments. For someone with a fixed income or are unemployed, an additional $240 per month would be a significant strain on their budget. People on a fixed income already have a difficult time ‘making ends meet.’

I am thinking specifically of the lady who usually sat across from me. I believe her name is Lupe. She is an older lady, and usually has a hard time when she was having treatments.  She did not speak English; so we rarely had a conversation (I am not that conversant in Spanish either).

Lupe had to stop working because her dialysis treatments were making her very exhausted. For extra money (probably really to make ends meet), she made and sold tamales. Making tamales probably also kept her mind off dialysis and her kidney disease. She would sell tamales in the center, and the technicians loved it. They would order 10 at a time and different flavors (she sells them for $1.50 each). I actually had two of them, and they were absolutely delicious.

I cannot imagine what might happen to Lupe if these cuts are implemented. An additional $240 per month would be hard on someone who is unemployed. This may mean that she has to cut on food or worse, on prescription drugs and even on some dialysis treatments.

And it is just not Lupe, it is also Jerry, who has to continue dialysis because he is considered too old and too ill; the Chinese lady who did not seem to have any family who would take care of her, and my husband’s buddy and fellow Pittsburg Steelers fan, who has to keep on working because he has a family to help take care of. Multiply this number with the number of dialysis centers all over the country and there would be thousands of very good people affected.

Dialysis patients are suffering enough - we need to support them as much as possible. As the petition states, “We urge the Administration and Congress to ensure that Medicare reimbursement for dialysis is sufficient to cover the cost of care.” Please contact your local representative through the National Kidney Foundation's Take Action Network.

It is the humane and compassionate thing to do!

Flashbacks

Last week, one of my friends at work asked me a question about dialysis. Her husband, unfortunately, has to start dialysis soon, and they were hoping that they could postpone starting dialysis for another month. Their reason for postponing was not frivolous (and personal that is why I am not sharing it in this post), so I understood why they are thinking of delaying the inevitable. 

We had a brief, but good chat about dialysis, and I was glad to share my experience. It looks like I answered her question and gave her some good tips. At the end, she said her husband is trying his best to maintain the little kidney function that he has.

I mentioned to her that I was in a similar position when I was diagnosed and had to watch my diet closely. Although I did not share this with her, I remembered that my husband and I tried to keep my kidney function up, primarily through diet. I did have to watch my diet like a hawk to keep it from falling completely. I ate very little protein per day: only four ounces, if I remember correctly. I had to give up my favorite soy chai lattes and had to be very creative with meals. Most days, I was having no protein for breakfast, two ounces for lunch and two ounces for dinner, or some combination of thereof.  My meals were mostly carbs and vegetables. It was not the good, high fiber carbs either; it was white bread, white rice, white flour – ugh! No more brown rice, Wheaties, or multigrain muffins. I was lucky to be Asian and having white rice as a staple in our diet. My favorite meal was usually breakfast when I can have muffins! I figured since I am watching everything, I can have some sugar twice a week. Occasionally, I can have an egg for breakfast since that was considered one ounce.

I was fortunate back then; I was still peeing so I did not have any fluid restrictions. I think that was one of my treats. Since I was suffering from gout, I was drinking black cherry juice. I would have that with some of my meals, but dilute it with water and ice (black cherry juice was a bit too sweet for me).  I even considered making a faux-sangria with it by adding apples and oranges (did not attempt to do so though – not the same without wine). Speaking of sangria, I had to limit my alcohol intake. I probably just limited it to one glass of wine (or sangria) per week, if any. Yes, I became an inexpensive date (not cheap, though).

My diet back then was very restrictive. I kept (and am still keeping) a food diary so I can keep track of my intake and things that trigger my gout attacks. I can imagine that this would be trying to anyone especially if you have a “meat and potatoes diet”. I was able to stay out of dialysis for a year. During this period, my husband and I were very thankful for every .01 increase in my GFR (Glomerular filtration rate - a measure of how well the kidneys are working).

I hope all goes well with my friend and her husband. They have a lovely family and their young kids would need Dad around for a long time. I wished them well and offered my advice anytime she needs it. Been there and doing my best to give back… and not to be there again.

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!!!

Walk On

“To grow, to discover, we need involvement which is something I experience everyday, sometimes good, sometimes frustrating.”

- Bruce Lee

Feeling down this week.  There is a situation in my hula group with one of the newer students, and I think her behavior will force me to quit the group. I am deeply saddened and extremely angry with this. I love dancing hula, and I have been in this group for more than five years. To leave because someone is uncivil and disrespectful is disappointing.

This situation has caused a lot of stress and agony.  My blood pressure has been elevated and have not been sleeping very well. I have been very sad, angry, and moody as a result of this.This week, only after two days of crying, anger, meditation, and introspection, I have finally returned to my happy normal self.

In my introspection, moving on may be the best move for me. If one is in a negative situation, the best defense is almost always to walk away.  Some may think that it is running away, but I interpret this as taking the high road, avoiding a truly destructive situation, and not stooping down to their level. As someone who is only had a kidney transplant less than six months ago, having a positive attitude is important.  I feel that given my priorities, it is not worth it to attempt to continue going to a place where I regularly experience stress, especially if it is an extra-curricular activity. As much as I love my teacher and most of my hula sisters, I have a new kidney to protect, and weekly stress and frustration will not be beneficial to it and my overall health. 

I still have other activities to enjoy, and will continue dancing hula, whether it is on my own or with a new group. As Bruce Lee had said, “Walk on”.