Blessed Assurance: Success Despite the Odds

by Jacquie Lewis-Kemp, Author & Health Coach for Living life with diabetes and organ transplants, rather than limiting life because of them.

Browsing Posts in Healthy Living

 

Donald JonesAn article recently published in Annals of Internal Medicine has many people wondering what role fats, including saturated fat, should play in their daily diet. In a nutshell, researchers did not find any relationship between total saturated fat intake and heart disease risk. This seems to contradict everything we have read for the last 40 years! So is it time to break out the pizza and ice cream?! To get to the bottom of this, let’s take a look at the different types of fats and dietary sources:

  1. Monounsaturated fats (MUFAs) can be beneficial to your health, when eaten in moderation. They can help reduce bad cholesterol levels in your blood and lower your risk of heart disease and stroke. Examples include olive oil, canola oil, peanut oil, sunflower oil and sesame oil. Other sources are avocados, peanut butter and many nuts and seeds.

  2. Polyunsaturated fats (PUFAs) can help improve cholesterol levels and lower your risk of heart disease. Omega-6 and omega-3 (types of PUFAs) are essential fats your body needs but can’t produce, so they must be consumed through foods you eat. Sources of PUFAs include soybean oil, corn oil and safflower oil, some nuts and seeds, as well as fatty fish like salmon, mackerel, herring and trout.

  3. Saturated fats are generally thought to increase your cholesterol and Low Density Lipoprotein (LDL) levels and this can increase your risk of cardiac disease. Saturated fats are found mostly in animal products like fatty meats and full fat dairy. According to the Harvard School of Public Health “pizza and cheese are the biggest food sources of saturated fat in the U.S. diet.”

  4. Trans fats sometimes occur naturally in foods, but are mostly made from oils through a process called partial hydrogenation. Trans fats can increase your LDL (“bad”) cholesterol levels and lower your HDL (“healthy”) levels, thus increasing your risk for cardiac disease. Trans fats are often found in commercially baked goods such as cakes and cookies. Other sources are fried foods, shortenings and margarine. You can determine the amount of trans fats in packaged food by looking at the nutrition label.

We’ve read about the heart, but what about diabetes? According to Mayo Clinic consuming MUFAs may “benefit insulin levels and blood sugar control.” They also state PUFAs may “also help decrease the risk of type 2 diabetes.”

The bottom line is fat is an important and necessary part of your diet but should be limited. At 9 calories per gram, it provides nearly double the amount of calories per gram of protein or carbohydrates. In general, consuming an excessive number of calories from any dietary source will result in weight gain, and excessive weight increases risk for heart disease and diabetes. Heart disease is a risk factor for kidney disease and kidney disease is a risk factor for heart disease because the heart and kidneys are interconnected.

Before you pick up the phone to order pizza for dinner, talk to your health care provider to find out what kind of diet, including what type of fats, will work best for you!

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Do you know someone who has diabetes?

Or do you want to learn about diabetes?

Find out more by attending the:

 

8th Annual U-M Diabetes Health Fair
Saturday, November 8, 2014
9:00 a.m. to 1:00 p.m.
Sheraton Ann Arbor Hotel
3200 Boardwalk (I-94 State Street exit 177)
Ann Arbor, MI 48108

  • FREE AND OPEN TO THE PUBLIC!

  • Free health screenings (while time and supplies permit)

  • Dozens of diabetes and health exhibits

  • NEW! Crafts Corner for kids

  • Three free presentations (first-come, first-served seating)

  • Cooking demo by Food Network Chef Curtis Aikens

  • With emcee Brandon Roux, WDIV-TV meteorologist

  • No pre-registration necessary

FREE HEALTH SCREENINGS (as time and supplies permit):

  • blood sugar and A1c
  • blood pressure
  • cholesterol (HDL, triglycerides, and total, non-fasting)
  • body-mass calculations and waist-to-hip ratios

For people with diabetes only:

  • foot screenings
  • eye exams

For relatives of people with type 1 diabetes:

  • Blood tests to check for antibodies (the TrialNet Study) will be available.

Medication review:

  • The College of Pharmacy will check for drug interactions (bring your medication containters or a list).

 

FREE PRESENTATIONS (first-come, first-served seating):

9:30 am: “Diabetes Updates from the Pediatric Clinic and Research Lab” by Brigid Gregg, MD, Physician and Clinical Lecturer, Pediatric Endocrinology Division, U-M Mott Children’s Hospital

10:30 am: “Popular Diets: Finding the Right Balance for Diabetes and Heart Health”- Joyce Patterson, MPH, RD, Clinical Dietitian, U-M Health System, Cardiovascular Medicine

12:00 pm: “Cooking Demo with Food Network Chef Curtis Aikens” sponsored by the Novo Nordisk Diabetes Academy

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What to eat when dinning out?

…from the U-M Comprehensive Diabetes Center

Tips for dining out

Adapted from a forthcoming publication by the U-M Adult Outpatient Diabetes Education Program.

Dining out can be one of life’s pleasures. You can enjoy yourself and still take care of your diabetes. It takes some planning and asking for what you need to achieve this goal. Also, the more you measure food portions at home, the better you can estimate portion sizes when dining out.

Here are some tips to get you started!

  • Choose a restaurant that offers      heart healthy options. Some helpful websites to help you find one are the      Healthy Dining Finder from the American Heart Association (HealthyDiningfinder.com)      or calorieking.com.

  • Some restaurants have their own      websites with menus that you can review in advance, or ask for a nutrition      guide at the restaurant.

  • Ask how a food is prepared and      steer away from gravies and cream sauces.

  • Read the menu creatively. Order      fresh fruit from the breakfast menu, or choose an appetizer and a salad as      a dinner entrée.

  • Choose a smaller portion from      the lunch menu, or split a meal with someone.

  • To control portions, ask for a      “to-go container” to be served with your meal. When your meal      arrives, portion out what you would like to eat, then put the rest in the      container.

  • Ask for substitutions. If your      meal comes with French fries, ask if you can substitute vegetables.

  • Choose no-calorie beverages      such as water, club soda or diet pop.

  • Be choosy at salad bars. Choose      greens, vegetables and beans. Limit the higher calorie foods such as      prepared salads (for example, potato or macaroni salad).

  • Plan ahead for desserts and eat      slowly; share your dessert with someone.

  • Avoid the      “value-sized” options (supersized, jumbo, giant, deluxe) and      order a regular or junior-sized sandwich instead.

  • Skip the French fries, choose      fruit or a salad with low-calorie dressing or flavored vinegar instead.

  • Choose grilled chicken instead      of breaded, fried chicken.

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DATING WITH DIABETES

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The scenario: The waiter arrives. He places the entrees in front of you and your date. You look at the food. You glance towards the bathrooms. What do you do? Do you check your blood glucose at the table or do you politely excuse yourself and hope he or she doesn’t think something is wrong?

Dating can be hard enough. Dating with diabetes puts another twist to things. In addition to the “Where are you from?” and “What do you do?” conversations, should you initiate the “I have diabetes” conversation? If so, when do you bring it up? Before the appetizers? After the third date? On your wedding night?

Let Life Happen

On top of the “I have diabetes” conversation, there is the rest of the Diabetes 101 syllabus that you could offer your date (maybe wait until the plates are cleared). Bolusing. Carb counting. Hypoglycemia. The list could go on and on.

One approach to dating and diabetes is to let life happen and explain as needed. “I find that the majority of people are quite uneducated about diabetes and that when they see how nonchalant I am about everything, it piques their curiosity. They want to ask more questions,” shared Karen, a fifty-something from Wisconsin. “The way I look at it, I should manage my life, including my relationships, versus letting diabetes manage them. If they can’t handle that, they’re not the kind of person I want to be with anyway, so it wasn’t meant to be.”


 

From the Other Side: Tips on Dating a Person with Diabetes

Written by Howie, a thirty-something from Washington, DC, the significant other of a person with diabetes

  1. Learn as much as you can. The more you know, the better you can understand the physical and emotional experiences of your partner. It helps to share that common bond and provides comfort to your partner in discussing his/her feelings if they are going through extreme shifts in their blood sugar levels for example.
  2. Offer to become involved. Gauging how involved you should become in your partner’s blood glucose and meal planning can be difficult. Some partners might not want that much involvement, and others do. However, offering that support shows you care and can provide your partner an emotional lift. Sometimes I inquire about what my girlfriend’s glucose reading is after a test. If it is low, then I will offer to help her find something to eat or drink. If it is too high, then I know not to suggest having a meal right away.
  3. Be flexible surrounding meals. I generally eat on a structured schedule – breakfast before going to work, lunch around 11:30 and dinner when I get home from work. However, one with diabetes might not always be able to eat on such a structured schedule; it may depend on his/her blood glucose level at the particular time. In my relationship I have learned to be more flexible in my meal/snack schedule, but we have also communicated that to each other that if one person is hungry and the other isn’t (or can’t eat at that particular time), then it is acceptable to go our separate ways.

 

“When I watched Karen so casually measure out her dosage and poke her arm right through her clothing, I thought she’s one tough cookie!” Karen’s new fiancé Rob commented. “I had always hated shots. The idea of piercing the skin with a needle would make me cringe. But I found her more attractive as a result of the experience.”

Twenty-something Dayle from Washington, D.C., brought her boyfriend along for the ride of day-to-day living with diabetes. “When I first went on the pump in college, my boyfriend accompanied me to the training sessions. My diabetes educator found a loaner pump for my boyfriend so we spent the first few days pumping saline solution together. I think it helped him to develop understanding and empathy for my diabetes lifestyle.”

“Diabetes is not something that should be kept secret,” advised twenty-something Dana from Alabama, “unless you would rather say you’re just part of a not-so-secret international club that subscribes to rigorous blood glucose testing, reverence of A1C numbers, and a lifelong addiction to insulin!” jokes Dana.

By being open about your diabetes, you can help to make the other person feel more comfortable. Jim, a former boyfriend of a person with diabetes weighed in, “If the fact that she had diabetes made me feel uncomfortable, educating me on the various aspects simply resolved that problem.”

No big deal?

Let’s face it — diabetes is serious. But if you look healthy and act healthy, then it can be easy for your partner to forget it takes a lot of effort to maintain this level of good management.

“There is a downside to my openness and matter-of-fact attitude. My boyfriends have often assumed that because I’m always testing and bolusing — and because they’ve never seen me have a bad reaction, get sick, or lose consciousness — that diabetes is ‘no big deal,'” shared Miriam, a forty-something from Maryland.

“The guy I’m currently dating said that to me recently, adding that he thought I was ‘doing really well’ with my diabetes. I was surprised, because I often complain to him about my frequent high blood sugars and try to explain the destructive long-term consequences of less-than-optimally controlled diabetes.”

On the other hand, diabetes is not an automatic death sentence — for you or your love life. “When I was diagnosed with diabetes 3 years ago, I thought my love life was over,” commented Keith, from Indiana. “Who would knowingly date a ‘diabetic,’ right? But on a blind date, I made a short comment about my diabetes while I was reading the menu. I found out that my date had been diagnosed with diabetes when she was 15! We ended up talking for hours… and we even put a friendly wager on which one of us had the better A1C result at our next doctor’s appointment! I can only say that having diabetes actually helped me get that part of my life back.”

Love and Understanding

Finding someone who is compassionate can make a big difference when dealing with difficult situations. Having a sense of humor also helps!

“My guy’s ‘no big deal’ attitude did come in handy when I went on the pump last December,” Miriam said. “I was really worried that he would be turned off by the whole ‘medical-ness’ of it, but it doesn’t bother him at all. I, on the other hand, am still struggling with the logistics when it comes to sex and the pump!”

Recently, twenty-something Allison from Virginia was preparing for her wedding and contemplating the switch to a continuous glucose monitoring (CGM) system at the same time. “With the thought of having a family in the next five to ten years, my fiancé Ross became my biggest cheerleader and advocate when we decided I should try a CGM. Unfortunately, it wasn’t in the pre-wedding budget!”

But Ross had different plans. Two days before the wedding, he presented Allison with a CGM starter kit as an early wedding gift. “I joked with Allison that I wanted to have an additional life insurance policy for the person I loved the most,” quipped Ross.

Needless to say, the wedding gift was a hit. “As Ross was taking off my garter at the reception, he checked the CGM that was stuck in my thigh holster to make sure everything was going smoothly,” said Allison. “Naturally, that made our guests cheer all the more!”

For more information or assistance, contact the American Diabetes Association National Call Center at 1-800-DIABETES.

 REPRINTED FROM THE AMERICAN DIABETES ASSOCIATION WEBSITE
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THE NEW INTRODUCTION TO EXERCISE VIDEO FEATURING JAMIE BROOKS IS NOW AVAILABLE FOR PURCHASE!

 

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Diabetes and Christmas

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Try these tips for festive gatherings this holiday season, brought to you from across the pond.

 Christmas brings seasonal joy and the comfort of the family. With a wealth of food available though, it can also be a trying time.

 

Keeping discipline to control sugar levels and portions can be particularly difficult.

 So for those of us for who willpower doesn’t come too easily, here are our tips for enjoying sensible eating at Christmas.

Commit yourself to a food plan

It’s very easy to get carried away by what’s on the table. To reduce the chance of this happening plan how much you intend to eat and make a point of sticking to it. If you’re not cooking, find out what will be served in advance.

 For sensible drinking see Diabetes and alcohol

 It’s best to make this plan at a time when you’re not hungry as hunger can distort your judgement. Don’t forget to factor in that alcohol contains high calorie content and also causes sugar levels to fluctuate.

Plan how much or whether you will drink and stick to this too.

 

It’s a good idea to let you your family know in advance of the Christmas meal too so they won’t offer you anything you’ve planned not to have.

Avoid feeling hungry for too long

It’s a well drilled family that gets the Christmas meal to the table on time. If the meal is taking longer to prepare, it can lead to an unusually long period of hunger and anticipation. 

Say you actually wanted to overeat, the best way would be to make yourself very hungry before eating.

One way to avoid being so ravenous is to break the delay.

 Protein and/or non-starchy vegetable based pre-meal snacks are a good choice as they are filling and slowly broken down.

Have a glass of water before eating

Having a glass of water before you start your meal is an easy and effective way of reducing your food intake; it makes you feel full earlier on, thus reducing your appetite.

Base your meal on non-starchy vegetables

Vegetables are the staple of sensible eating. Make sure that vegetables account for a good percentage of your plate.

Eat gradually

Eating with the family is a nice occasion but if you’re a fast eater, it can make things more difficult. If others are still eating, you may be tempted to have another helping. 

Eating slowly will help with this and will also allow you to savor and better enjoy the food you’re eating.

Don’t feel guilty about turning offers down

Any food you eat is going to end up in your blood stream and on your body so don’t feel shy about turning food down

Feeling stuffed can be quite unpleasant by itself and it’s also worth bearing in mind that the body’s natural reaction to having to digest a particularly large meal is to release extra sugar into the bloodstream.

Go easy on the puddings

One can be forgiven for indulging every once in a while. If you’re a pudding person Christmas can be something of a trial of restraint though. If you cannot resist pudding make sure you stick to at most one and keep the serving sensible, remembering that sweet dishes are very fast absorbed. Once again apply the rule about eating gradually.

After and between meals put foods away or under cover

Remember the classic Christmas cracker joke about a ‘sea food’ diet – “I see food and I eat it”? Food left out and exposed grabs the eye, therefore grabbing the attention of the mind and this can all too easily lead to ‘small’ indulgences. 

A couple of mince pies will typically have over 500 calories, a quarter of a woman’s daily energy, and a fifth of a man’s; not forgetting the 70 plus grams of fast acting carbohydrates. Apply the rule ‘out of sight, out of mind’ and this can help to avoid between meal snacking.

Walk away from the craving

If temptation is proving a taxing task and hard to avoid, it can help to literally walk away from the craving. A 20 minute walk in the crisp air should be enough to increase endorphins and serotonin which can help to overcome cravings.

Test your blood where possible

If you self test, commit yourself to testing your blood sugar more regularly, over the Christmas period, to catch those blood sugar fluctuations early.

 

Reprinted from http://www.diabetes.co.uk/food/diabetes-and-christmas.html

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The final leg of our 3 Legged stool of glucose control is diet. Our diet or the food we consume is the source of the glucose our bodies use to fuel our cells. Therefore the more we focus on the ultimate purpose for the food we eat, the more efficiently our bodies can use the fuel and function best.

According to the National Institutes of Health, “It [The diabetic diet] should take into account your weight, medicines, lifestyle, and other health problems you have.

Healthy diabetic eating includes

  • Limiting foods that are high in sugar

  • Eating smaller portions, spread out over the day

  • Being careful about when and how many carbohydrates you eat

  • Eating a variety of whole-grain foods, fruits and vegetables every day

  • Eating less fat

  • Limiting your use of alcohol

  • Using less salt

With these parameters, The American Diabetes Association recommends a “meal plan” which it describes as “a guide that tells you how much and what kinds of food you can choose to eat at meals and snack times. A good meal plan should fit in with your schedule and eating habits. Some meal planning tools include the plate method, carb counting, and glycemic index. The right meal plan will help you improve your blood glucose, blood pressure, and cholesterol numbers and also help keep your weight on track. Whether you need to lose weight or stay where you are, your meal plan can help”.

The Exchange Method

Medicinenet.com gives a detailed account of the food pyramid and how to incorporate each of the food groups into a daily meal plan. It also details the serving sizes in order to comply to the appropriate calorie limits prescribed by your doctor.

http://www.medicinenet.com/diabetic_diet/page4.htm#tocf

Carb Counting

TheJoslinDiabetesCentersuggests the following steps for Carbohydrate Counting.

1.     The first step in carb counting is to have a meal plan.  A meal plan is a guide that helps you figure out how much carb, protein and fat to eat at meals and snacks each day.  If you don’t have a meal plan, meet with a registered dietitian.

2.      Step two involves learning which foods contain carbohydrate. Most people know that starchy foods, such as bread, pasta and cereal contain carbs.  But other food   groups, such as fruit, milk and desserts and sweets, have carbs, too.
There are three main ways to learn about carbs in foods:

o       Ask for a food choice list from your dietitian.

o       Learn how to read the Nutrition Facts Label

o       Purchase a food counts book that provides the number of grams of carb in various foods.

3.      Measuring tools.  In order to accurately count carbs, you’ll need to be accurate with the portion sizes of foods that you eat.  Invest in a food scale to weigh foods such as fruit and bread.  Use measuring cups to measure cereal, pasta and rice, and use liquid measuring cups for carb-containing beverages such as milk, juice and energy drinks.

The Glycemic Index

Web MD defines,  “The glycemic index is a ranking that attempts to measure the influence that each particular food has on blood sugar levels. It takes into account the type of carbohydrates in a meal and its effect on blood sugar.

Foods that are low on the glycemic index appear to have less of an impact on blood sugar levels after meals. People who eat a lot of low glycemic index foods tend to have lower total body fat levels. High glycemic index foods generally make blood sugar levels higher. People who eat a lot of high glycemic index foods often have higher levels of body fat, as measured by the body mass index (BMI).

Talk to your doctor, a registered dietitian, or a diabetes educator and ask if the glycemic index might work to help gain better control of your blood sugar levels”.

The Plating Method

Here’s a quick video from the American Diabetes Association on how the Plating Method works.

Ask your doctor to prescribe or refer you to a dietician to prescribe a meal plan or daily calorie count, and also ask which diet method is best for you.

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In my health coaching practice I use a Three Leged Stool approach to diabetes management. Simply put, there are three major areas to consider to balance blood glucose levels and manage diabetes: Exercise, Diet and Medication.

This week’s emphasis is on exercise. While food raises blood sugar, and medications ultimately lower blood sugar, exercise too burns blood sugar therby removing it from the blood stram. This is the specific benefit to diabetics, however there are several benefits of exercise for everyone including the heart, lungs, brain, bones, muscles and more.

My friend Jamie Brooks, a personal trainer, and I are working on an exercise video that will offer some exercises everyone can do at home as well as teach the correct way to use equipment at the gym.

Enjoy a sneak peak . . .

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 Am traveling with my son and husband. We are in Las Vegas for the National FuneralDirectors & Morticians Association convention. I am fortunate selling books at the Bass-Mollett Publishing booth as another reason to visit the booth.

I am reminded about some traveling tips for people with chronic illness:

1. Carefully pack all medication and necessary supplies in your carry on bag. If bags are lost, you want to make sure your medication is with you.

2. Pack extra medication in case you are delayed returning from your trip.

3. Don’t forget supplements and other medications to treat medication side effects.

As with anything we do, it is done as well as people without chronic illness as long as we do  a little extra planning and preparation.

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Managing a chronic illness like diabetes is more an issue of behavioral change than it is a medical treatment. Sure for insulin dependent diabetics, management requires not only learning to administer the injection, but how to manipulate the doses. But the majority of diabetes management involves understanding how various foods and exercise affects blood sugar levels, and learning to orchestrate a routine that keeps a relative flat line of glucose levels within the normal range

The same is true of living on dialysis or transplant living. Other than being compliant with the doctor’s orders, most of the activity while on dialysis or maintaining a healthy transplant, involves a behavioral change.

Many times, dietary restrictions like low sodium, low fat, low glycemic, means that people need to learn to eat and cook differently. Often times this means a change not only for the person afflicted with the chronic condition, but the entire family. For instance, my husband has a condition unrelated to diabetes or transplant that requires him to eat a low sodium diet. Since I prepare about 99.99% of the meals in our house, that means that after a life of no sugar and low carbohydrate diets, I now add to our meals, low sodium! But it doesn’t work if I prepare his meals separately. In a world of processed foods with lots of added salt, eating low sodium is healthy for everyone.

Since a lot of chronic conditions are aided and best managed by lifestyle changes and establishing a routine, I’ve started a health coaching practice which works is concert with your doctor’s care plan. Once your doctor has prescribed the necessary activities, I work with the patient to develop a regimen that makes those changes fall in concert with your current life.

Perhaps the busiest and most difficult to manage time in my life was when I was a dialysis patient. I was CEO of a manufacturing company, married with a son in elementary school. My job was an hour away from my son’s school. He played soccer and went Kumon twice a week after school. Peritoneal dialysis required that I did one midday exchange and connected to a Cycler at night to perform the dialysis as I slept. My diabetes required glucose monitoring four times a day and insulin injections twice a day. Because dialysis can cause the blood pressure to fluctuate to dangerous levels, I also needed to monitor my weight daily and blood pressure several times a day.  At that time I was sodium restricted as well as on a diabetic diet, and so the best way to control sodium and sugar was to prepare meals myself. As a busy wife, mother and CEO, that was more than a notion, but necessary and therefore not impossible.

All of those requirements—medical, occupational and familial could be summarized like this:

  • Eating out had to be a rare treat

  • I needed diabetic and dialysis medication and testing supplies handy at home and at work

  • In order to cook healthy meals and eat at reasonable times, I had to have them prepped to the point of spending an hour to finalize them for dinner.

  • In order to attend my son’s sporting events and participate in the snack schedule or take him to Kumon even when I would normally work late, meant I had to have business resources at home (computer, fax, printer, binding equipment, presentation folders, etc.).

When I finally got my Ultimate Multitasking Routine in swing, this is how it ran…typically.

  • My workday began at 5:30 am in order to disconnect from my cycler, do all of my testing (weight, glucose, blood pressure), take my insulin plan and prep dinner, prepare lunches for everyone to take to school or work, prepare a light breakfast, and if necessary complete any last minute items for work.

  • Our routine was that my husband usually took my son to school and I usually picked him up from school. As they left, I dressed and left for work. My commute was about 45 minutes which allowed me time to clear voicemail and not walk into any surprises.

  • I kept a three drawer plastic storage cabinet under my desk to store a glucometer, testing supplies, dialysis fluid, blood pressure cuff and supplies, an extra pair of pantyhose and nail polish remover—for other emergencies. The key to being compliant with doctor’s orders is to make the process easy to do and have all of the necessary items available. So at midday, I was ready to test and do my midday dialysis exchange. I kept my stock of dialysis fluid replenished by loading up the car on Sunday night and bringing it into the office each Monday morning.

  • If my son had an after school activity, I would also load up the car the night before with the team snack or whatever was necessary so that I could leave work, pick him up from school and be ready with whatever supplies.

  • Because dinner had been prepped that morning, it was usually within an hour of being done, if not crock pot ready. While completing dinner, I supervised my son while doing homework and was available for questions.

  • In the evening, I completed bedtime testing, took medications, and finished any job related work and prepared for the next day.

 

While of course, things didn’t always work out this smoothly, it was my home base, and when things like illness or other family functions got in the way of this routine, I knew where to return.

I would like to help others with chronic conditions to develop the routine that works best for them to be compliant to their doctors orders and live healthy lives without making overwhelming changes to their current lifestyle.

FOR MORE INFORMATION ON HEALTH COACHING, click on the Health Coaching Tab above.

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