NKF Visit To Marina Barrage

National Kidney Foundation (Singapore) organised a trip to Marina Barrage for all its patients and their family members. This events was held on Sunday 28 March 2009. This trip was organised to strengthen the relationship between the patients, family members and the organisation staff. It was a lovely trip as it was shinny day and everyone was enjoying themselves.



The trip was given its fullest supports with the attendance of nearly 600 peoples including its patients, family members, the staffs and its volunteers.

The event was started with a 15 minutes of light exercises. and a small briefing.

Exactly at 9.30, the long walk around the barrage started. Its takes about half an hour to reach the end of the barrage.

Hmmm, I was unfortunate, was not even to start the walk, as I felt giddy. Straightaway, my wife informed the medical team of my condition. I was given a chair to sit on and my blood pressure and my sugar glucose level was taken. The reading was (b/p) 94/62 with pulse rate of 87 and my (bsl) was 18.4. This indicates I was having a low blood pressure. I was advisesd to rest and not to participate in the walk. I was given sweet drinks as its can rise up my blood pressure. Though sad not to participate, my kids still enjoys themselves.

My two kids enjoying theselves with playing waters with other childrens.




My son Md Nor Iziandy


My daughter Siti Nor Syakilla and her brother
Md Nor Iziandy


At 12 noon, everyone was given a packet of lunch and a bottle of 'New Water'. A lucky draw was also held at the end of the event with my Dialysis Centre (Woodlands 2) did not win anything.

The event end at 12.30 noon whereby everyone cheers loudly of happiness. Everybody was looking forward for the next event and trip.

Diet For Dialysis Patient

Nutrition and Dialysis

These are the guidelines that I must followed in order to stay healthy.

Diet plays a vital role in dialysis patients’ rehabilitative care. A well-balanced diet is necessary for them to stay fit as their kidneys are no longer functioning at its full capacity i.e. to get rid of the waste products and fluid from their blood.

To strive towards being healthy and happy dialysis patients, they would need to:

• Eat the right kind and amount of food on a daily basis
• Take their medication correctly as prescribed by the doctor
• Comply to the hemodialysis treatment, for instance, not “miss” any dialysis session.

Dialysis patients require a much higher intake of protein than the average person. Too little protein and calorie intake often leads to protein energy malnutrition. To achieve good dialysis outcome, dialysis patients need to closely and careful monitor their diet so as to help control the waste products and fluids accumulated between dialysis treatments. It is essential for dialysis patients to have the right amount of protein, calories, fluids, vitamins and minerals each day.

A Healthy Diet for a dialysis patient is:

• adequate in protein
• adequate in calories
• low to moderate in potassium
• low in sodium
• low in phosphorus
• controlled in fluids

Protein

Protein is essential for building and repairing of muscles in the body and daily growth. Protein can be divided into two categories: high and low quality. For dialysis diet, high-quality protein, for example, meat, poultry, fish and egg whites are more desirable. Most dairy products such as yogurt, milk and cheese also contain high-quality protein.

During dialysis, some amount of proteins are lost and therefore patients require a higher protein intake compared to people who are not on dialysis. Eating the right amount of protein will help dialysis patients stay fit as insufficient protein intake could result in weight loss, reducing the ability to fight infections and thus , leading to malnutrition.

REMEMBER, RIGHT KIND and CORRECT AMOUNT of protein is vital for dialysis patients to stay healthy. Protein food contains phosphate. Therefore it is very IMPORTANT that dialysis patients take their phosphate binders with ALL their meals.

Potassium

A mineral that is important for the nerves and muscles functions, potassium needs to be maintained at a safe amount in the blood. Excessive potassium level in the blood can cause muscle weakness, abnormal heart rates and in extreme cases, heart failure.

Since dialysis can only remove a fixed amount of potassium, it is crucial to control the amount accumulated through patients’ dietary intake. Potassium is found mainly in fruits and vegetables, with small quantities found in nuts, dry beans and dairy and meat products. It is important to avoid foods that are high in potassium and to take in moderation food that have low to moderate content.

LOW POTASSIUM (less than 150 mg of potassium per serving)

Fruits (½ cup or 1 small to medium size)	Vegetables (1 cup raw or ½ cup cooked)
Lemon, lime, grape, lychee, longan, apple pear	Lettuce, watercress, cabbage, kang kong, bean sprout

MODERATE POTASSIUM (150 to 250 mg of potassium per serving)

Fruits (½ cup or 1 small to medium size)	Vegetables (1 cup raw or ½ cup cooked)
Mango, peach, orange	Eggplant, capsicum, onion, cucumber

HIGH POTASSIUM (more than 250mg of potassium per serving)

Fruits (½ cup or 1 small to medium size)	Vegetables (1 cup raw or ½ cup cooked)
Banana, melon, persimmon, jackfruit, durian	Asparagus, carrot, cauliflower, broccoli, bitter gourd, tomato, potato, choy sam, corn, mushroom

Phosphate

In kidney failure, blood phosphate level rises and when it begins to build up in the blood, calcium is drawn from the bone. The calcium phosphate product forms hard deposits in patients’ tissues leading to skin itchiness, joint pain, eye irritation and hardens their blood 11vessels. Overtimes, patients’ bones become weak and brittle which may lead to fractures and constant pain.

Most food contain even a small amount of phosphate and patients must REMEMBER to take their phosphate binders with meals at all times. Phosphate binders, are an effective way in preventing phosphate from entering the bloodstream when taken together with meals. Generally, this tablet is prescribed in helping to prevent renal bone disease.

Food rich in phosphorus that patients need to avoid when they have high serum phosphate level include: (Not to be consume)

• All sorts of seafood and sardines, anchovies (ikan bilis), dried shrimp paste
• Dairy products e.g. milk, cheese, yogurt
• Bean products e.g. all forms of nuts, seeds, bean soup
• Malted drinks e.g. Milo, Horlick
• Oats, cereals
• Chocolate
• Organ meats e.g. liver, intestine
• Bone-based soups e.g. chicken feet and pork bone
• Colas

Sodium

Sodium is naturally found in all different types of foods, but the common source is table salt and different types of bottled sauces used during cooking. Sodium is like-hydrated sponge that absorbs fluid and makes you thirsty and wanting to drink more.

As a result, fluid weight gain arises and thus, an increase in blood pressure can be observed. Sodium restriction is critical for patients and thus helps to maintain their normal fluid balance.

To help restrict salt intake:

• Limit the salt added to your cooking
• AVOID using stock cubes and gravy browning e.g. Bovril, Marmite
• AVOID taking bottled chicken extracts
• Read labels on processed foods and AVOID items that has more than 250 mg of sodium per serving
• Minimise the usage of canned food. If you do choose to use them, do drain the brine.
• Try using fresh herbs and WHOLE spices in replace of salt in cooking
• Try to use fresh lime or lemon juice or vinegar to flavour food

Fluids

Dialysis patients can no longer excrete large quantities of fluid consumed. Excess fluid will be retained in the body resulting in overloading of the blood circulation. Symptoms such as shortness of breath, high blood pressure and swelling of the legs can occur. Thus, it is important that fluid intake be restricted.

REMINDER: Dialysis will only remove restricted amount of fluids and the remainder will accumulate in the body. It is important that dialysis patients follow the fluid regime designed by your nurse or doctor.

Daily allowance for fluid intake can vary from 500 to 1000 ml per day, depending on the patient’s urine output, if any. Limited urine output does not indicate dehydration in dialysis patients. However, it means that it is an indication of further deterioration of kidney functions.

Your daily fluid allowance includes plain water, tea, coffee, milk gravy, soup and porridge. Other fluids that are liquid at room temperature such as ice-cube, ice cream, jellies are considered as fluid too.

Resources :: National Kidney Foundation (Singapore)

Most Delicious Recipe For Diabetes

Hi guys, did you watched DID (Dont Ignore Diabetes) programme at Channel 5. It is informative and highly educational programme, Besides getting tips by doctors on every aspects about diabetes, a segment of diabetes recipes were also shown in these programme. Had you do so, I gathers all the recipes on the programmes and kindly like to shares with all of you.

The truth is I never miss these programmes. My wife have trird and cooked the recipes for me.
For truth, its quite delicious as its originality. I am hoping that you will also try these recipes.

Enjoys

VIETNAMESE CHICKEN CURRY

Ingredients

I chicken (about 1,5kg)2 thsp. og vegetable oil
1 red onion, chopped
1 thumb-sized knob of ginger, chopped
2 cloves of garlic, chopped
1 stalk of lemon grass, white stem only, bruised
1/2 cup of curry powder
500ml of unsweetened soya milk
2 potatoes and cut into large pieces
1 small yam, peeled and cut into chunks
1 small potato, peeled and cut into chunks
1 thsp of salt
And Pepper to taste

Method

1. Wash the chicken. Chop it into 6-8 pieces.
2. Heat oil in a pot.
3. Brown (saute) onions, garlic and ginger.
4. Add curry powder, made first into a paste with little water and lemon grass.
5. Brown the chicken pieces. Add water until it covers 1/2 half way of chicken pieces. Season.
6. Bring to the boil, then fire to simmer.
7. Add potatoes, yams, sweet potatoes (root tubers). Cook till chicken and root tubers are tender.
8. Add soya milk . Stir constantly till curry comes again to a gentle boil.
9. Adjust seasoning if necessary.

SEAFOOD LAKSA

Spice Paste

10 dried red chillies, softened in the water.
1thsp of belacan(shrimp paste).
1 cup peeled shallots,
5 peces of lengkuas (ginger root), peeled.
1 thsp of tumeric powder.
1 thsp of corriander powder.
White pepper to taste.

Ingredients

1 thsp dried prawns.
1 stalk lemon grass, white stem only, bruised.
8-12 medium sized prawns, peeled, leaving only the tails.
8-12 mussels.
4 fish cakes, sliced.
2 red capsicums, cut.
2 yellow capsicums, cut.
2 cups of unsweetened of soya milk.
1 thsp of salt.
1 thsp of sugar (best to omit).
1 stalk of laksa leaves.
1 thsp of peanut oil.

Method

1. Place ingredients for spice mixture into a food processor and chop finally.
2. Heat oil in the pot.
3. When hot, lightly saute spice mixture, together with lemon grass with dried prawns, till fragrant.
4. Add 3-4 cups of water and bring gravy to the boil.
5. Add prawns, mussels and fish cake slices.
6. Cover and simmer.
7. After a few minutes, check to see that all the mussels are opened. Discard all unopened shells..
8. Add the soya milk. Keep stirring till gravy comes to the boil, to prevent curdling.
9. Add salt and sugar (best to omit) or to taste.
10. Garnish with Laksa Leaves (polygonum).

DHAL LEMAK

Ingredients

1 thsp vegetable oil.
1 red onion, sliced.
3 cloves.
1 cinnamon sticks.
1 stalk curry leaves (helichrysum itacium).
1 tsp cumin seds.
1 cup of red or yellow dhal (lentils), soaked and drained.
2 potatoes, peeled and cut into pieces.
1 cup of unsweetened of soya milk.
1 tsp salt.
Pepper to taste.
2 eggs.
1 cup of water.

Garnish with 2 green chillies, snapped into pieces and fried shallots.

Method

1. Heat oil in the pot and fry the onion with all the spice and curry leaves.
2. Add the dhal and stir to coal it with the spices. Add the potato.
3. Pour in a cup of water and cook over low heat till soft.
4. When lentils are tender, add soya milk, salt and pepper to taste and bring it to the boil.
5. Break the 2 eggs into the pot,taking care not to break the yolks.
6. Serve garnished with green chillies and fried shallots.

PEPPER MUTTON

Ingredients

2 kg lean mutton, cut into large pieces.
2 thsp of low fat plain yoghurt.
2 thsp of canola oil.
Salt

Ingredients to flavour the oil
1 tsp of red/black mustard seeds.
2 springs curry leaves.
1/2 stick of cinnamon.
5 cloves.
1/2 tsp fennel seeds.
1 red onion, thinly shredded.
3 cloves garlic, thinly sliced.
4 cardamom pods (cracked).

Spice Paste (blend till smooth)

2 large red onions.
10 red small shallots.
5 cloves garlic.
A thumb sized piece of ginger.
1 stalk mint leaves.
2 dsp ground coriander.
2 dsp ground black pepper.
1 dsp chilli powder
1/2 tsp fennel powder.
1/2 tsp cumin powder.

Garnishes.

Fried garlic slice (keep to minimum or avoid).
Fried shallots (keep to minimum or avoid).
Fresh coriander leaves - chopped roughly.
Fresh mint-leaves.

Methods

1. The night before, place mutton pieces in a pot, cover with water and bring it to the boil. Switch off heat and when cool. chill covered in the refrigerator.
2. The next morning, remove the solidified layer of fat that has formed on the surface. Leave the stock aside.
3. Heat canola oil in a wok and fry the first batch of ingredients to flavour the oil.
4. After a minute or two, when oil turns aromatic, add the spice paste, stirring continually for about 30 minutes.
5. Add the cooked mutton and continue to fry at a lower heat, adding a little of the srock it it seems too dry.
   
6. Add salt to taste, cover and simmer till mutton is tender.Add the yoghurt, stir again, cook almost dry for about 15 minutes.
7. Add the yoghurt and stir again and cook till almost dry for about 15 minutes.
   
8. Garnish with fried garlic. shallots and fresh coriander and mint leaves. And Serve.

Note: Will post the others recipes in the future.

My Daily Medications

Everyday without fails, I will take my medications. Will it be in breakfast, lunch or dinner. There are 13 types of medications that I must take.

My List Of Medications

Insulin
Insulin is prescribed for diabetes mellitus when diet modifications and oral medications fail to correct the condition. Insulin is a hormone produced by the pancreas, a large gland that lies near the stomach. This hormone is necessary for tmy body's correct use of food, especially sugar. I will inject myself on my abdomen with a dosage of 46mg before breakfast and 26mg before dinner.


Omeprazole

Omeprazole decreases the amount of acid produced in the stomach. It is used to treat symptoms of gastroesophageal reflux disease (GERD) and other conditions caused by excess stomach acid. It is also used to promote healing of erosive esophagitis (damage to your esophagus caused by stomach acid). In simple English, omeprazole decreases gastro in the stomach on each time before meals. For this medications I only take 1 tablet every morning before breakfast.

Isosorbide

Isosorbide or isosorbide mononitrate is in a class of drugs called nitrates. It dilates (widens or relaxes) blood vessels (arteries and veins). When blood vessels are dilated, it is easier for the heart to pump. Also, more blood, which is rich in oxygen, can flow to the heart. Isosorbide is used to prevent angina attacks (chest pain). I take half tablet before breakfast.

Carvedilol

Carvedilol is in a group of drugs called beta-blockers. Beta-blockers affect the heart and circulation (blood flow through arteries and veins). It is used to treat heart failure and hypertension (high blood pressure). It is also used to treat or prevent heart attack. For these medication I take 1 (6.25mg) tablet in the morning and evening, each after meal.

Renal Vite

It is a formulated multivitamins for all the renal or kidney patients. I tablet for every morning after breakfast.

Enalapril

Enalapril is used to treat high blood pressure (hypertension), congestive heart failure, kidney problems caused by diabetes, and to improve survival after a heart attack. Normaslly, for these medication, will check my blood presuure before taking it. If my B.P is on the low side, I will not take these medication. On my doctor's advice, I will not take enalapril on my dialysis day as it will bring down my B.P. The dosage I am taking is 5mg twice a day

Simvastatin
It is a cholesterol-lowering medication that blocks the production of cholesterol (a type of fat) in the body. It also reduces low-density lipoprotein (LDL) cholesterol and total cholesterol in the blood. Lowering my cholesterol can help prevent me from heart disease.
1 tablet every night.

Amitriptyline

It is used for treating my numbness on my legs and hands,

Renal Calcium Carbonate

It is for binding all the phosphate in the meals I take. It is normally take by swallowing whole or chewing it before swallowing


Aspirin
Besides treating pains and aches, apirin intake is for thining my blood from clotting. Usually I take this medications by putting it under my tounge. 1 tablet every morning.



Medications that are given during my dialysis after blood test are taken.

Recormon
It is a hormone that stimulates the production of my red blood cells. It is also used for treating anaemia (a condition in which the amount of oxygen-carrying haemoglobin in the blood and the number of red blood cells are below normal). One Injection of 4000 IU in every 7 days.

Calcijex
Calcijex contains calcitriol as the active ingredient. Calcitriol is the active form of Vitamin D3. Calcijex is used for the treatment of hypocalcaemia (low levels of calcium in the blood) in patients undergoing dialysis for chronic (long-term) kidney failure. It can also reduce high levels of parathyroid hormone (PTH) in the blood which can cause bone problems. In healthy people, calcitriol is naturally produced by the kidneys. However, in kidney failure there is often a lack of naturally-produced calcitriol which can cause low levels of calcium and high levels of PTH in the blood. Calcijex is used to replace the body's natural calcitriol. Calcitriol raises blood calcium levels and lowers high PTH levels.

Vanofer
Venofer (iron sucrose injection, USP) is a brown, sterile, aqueous complex of polynuclear iron (III)-hydroxide in sucrose for intravenous use. It contains no preservatives or dextran polysaccharides. Venofer^® is indicated in the treatment of iron deficiency anemia in non-dialysis dependent - chronic kidney disease (NDD-CKD) patients receiving or not receiving an erythropoietin, and in hemodialysis and peritoneal dialysis dependent - chronic kidney disease (HDD-CKD) and (PDD-CKD) patients receiving an erythropoietin.