Low Sodium School Lunch Ideas

Here are my first 5 school lunch ideas for under 400mg sodium (check the labels please and make sure of your brands sodium count). Not all are healthy per say but definitely kid friendly. People with kidney disease are on all different types of restriction so please make sure this fits with your doctor's orders.

Grilled REAL cheddar cheese sandwich (not processed stuff but 1oz slices REAL cheddar) grilled in unsalted butter, grapes, chocolate soy milk

1/2 large bagel with low fat cream cheese and 1 slice chopped cooked bacon (turkey or low sodium), orange slices, chocolate soy milk

English muffin pizza (made with no salt tomato sauce & pizza seasoning) topped with 1oz shredded mozzarella cheese, served with spinach and green leaf salad including chopped hard boiled egg, and water (my kids won't eat cooked spinach but they love the spinach leaves). My son loves an olive oil/vinegar blend dressing (we send it in a small container on the side so he can pour on at lunch time)

Black bean & brown rice burrito (cook up a batch of dry black beans, save some for other dishes.) Cody likes black beans, add the brown rice and cumin, garlic powder and 2 Tbsp salsa - heat on stove. We add a little water to "hold" the ingredients together. Serve with carrot sticks and homemade hummus

PB & J sandwich, applesauce, 2 chocolate chip cookies (check the labels and make sure you get the smaller, lower sodium ones)


When school starts, I will be sure to post pictures of what I send with him that week along with measurements. Send lots of fresh fruits and veggies as fillers - this prednisone makes him HUNGRY!!!!

Have a good day everyone! :)

What Cody ate Today

Breakfast: Banana/Flax/Walnut/Peanut Butter Oatmeal
Well - just visit this link for the recipe and you'll
get the idea! I just found the site KERF (Kath Eats
Real Food) recently and love it! Will be going back
for more whole food type recipes.

http://www.katheats.com/?page_id=2032

Total sodium = about 100mg

Cody's thoughts - he loved it but wanted a little more brown sugar (most of what you see in the pic is ground flax seed - he only started with a Tbsp of brown sugar and we went up to 2 Tbsps)





Lunch: One of Cody's faves - we just did it one day and it stuck. We call it No Sodium Spaghetti - that's just how he differentiates between that and regular. It's basically noodles (which he chops up with scissors for some reason which is why it looks like rice kinda) with olive oil, italian seasoning, garlic powder, and red pepper flakes. With it he had a spinach salad and 2 tsp light ranch dressing.

Total Sodium = about 131 calories for the 2 tsp of light ranch
He loves this dish because on Prednisone the appetite seems to increase ( a lot!!!) and he can eat as much of this as he wants (without dressing). We keeped cooked noodles in the fridge for him to warm up in the microwave.





Dinner: Pork Chop (4oz center cut = 290mg sodium)
Homemade mashed potatoes with unsalted butter
and pepper (0mg sodium)
Extra Fine Frozen Green Beans (3mg sodium)

We used Mrs. Dash original seasoning blend on the
pork chops and Cody loved it!

Total Sodium = about 293mg sodium.

For snacks today Cody ate an apple and 1oz of real cheddar cheese (179mg sodium)



Today's total sodium = 524mg.

Yes he is allowed to eat 1200mg per day but we are just trying to eat healthier, whole foods. Today's low day may mean he gets to eat something higher tomorrow (normally it's mexican or italian for him).



Right now I am working on school friendly lunches to pack so he doesn't feel so different from the other kids but last year when I was packing lunches for my boys and we were focusing on healthier - not low sodium - he never wanted to trade because his friends wanted some of HIS lunch

Thanks for coming!!

Stacy & Cody

.

Low Sodium Diet

Sorry it's been so long since our last post. Later tonight we will be posting what Cody ate today for an example of a low sodium diet that is under 1200mg sodium. We will be including pictures and Cody's thoughts on the dishes.

Thanks for everyone's support and to those who keep coming back for updates.

Stacy

Morning Routine

Every morning here is what happens:

*Cody wakes up, pees in his urinal, we use Albustix to check for protein

*He checks his weight

*We take his blood pressure

*Record all of the information in his notebook for our next doctor's appointment.

If your child only has IgAN, he/she will not be doing these things most likely. If they have IgAN with Nephrotic Syndrome, problems with retaining fluid, high protein spillage, or high blood pressure then they most likely will be doing some of this.

For new parents out there, this is not a long term thing. Cody will be doing this until 1)his protein is trace or negative for at least 3 days in a row or 2)he is off the prednisone.

We were only checking his protein levels until he started swelling in the abdomen, back, and in the genital area (which he had never done before) and we were told that the prednisone can cause you to retain salt and fluid (enter 1200mg low sodium diet here along with 4 cups of fluid per day - unless he's doing sports and sweats a lot then the nurse told us to go ahead and give him more) and losing high amounts of protein in urine causes oedema. Once that happened, the nephrologist told us to monitor weight and blood pressure also.

About My Biopsy

When I got in the room they laid me on the bed. They put a clip on my finger that told them how fast my heart was beating. They put cartoons on so that I felt relaxed. Then they turned me on my stomach they squirted a gell on me and rubbed it on my back. It tickled me!!!!!! Then they put a medicine in my IV so that I would go to sleep and not feel anything. It didn't hurt it felt like cold water going up my arm. My mom and dad were with me the whole time. I fell asleep. I didn't feel anything. When they were done they put a bandage on my back. When I woke up my mom and dad were right by me holding my hand. Then I had to lay flat for six hours in my room. On my first picture that was when I got in the room and they laid me down. In the second picture later that night the person that did my biopsy came to check on me and see how I was doing.

Taking My Medicine

When I took my first pill I was a little scared. The second time it was easier. The Fish Oil I poke a hole in it and squirt it in my drink. I think that is easier. I only have to take them in the morning. I am used to it now. The first time I took my medicine my doctor said to put it on the back of my tongue. I think it is cool to take pills that help my kidneys!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!Tomorrow I will tell you about my biopsy.

Cody

Helping Your Child Take Medication

Cody and I were talking about what we should blog about next.....it seemed natural to discuss medication since that was the next step for us after getting diagnosed. Cody will post his own thoughts on this later this evening for all the kids out there to read. When you come on here with your child, if you scroll down, on the right side, there will be a section titled "find posts by category" then underneath you will see one of the links titles "A Kid's Perspective" - this will include ALL of Cody's posts so when your child is reading on here (and hopefully sometime commenting to Cody) they will see ONLY Cody's posts.

Anyways, back to medication. Here is an article on ways to help your child take their medication (if they've been prescribed any yet - not all are).

Pill Swallowing: Helping Your Child

Some children have difficulty swallowing pills and capsules.

*The easiest approach is to convert the medicine to a liquid form. Empty out the capsules or crush the pills. You can do this with any pills except slow-release or enteric-coated pills. (Check with your pharmacist or physician if you are uncertain what you can do.)

*Slow-release capsules can be emptied as long as the contents are swallowed without chewing. Since capsules usually contain medicines with a bitter taste, the contents need to be mixed with a sweet food.

*Pills are usually made as a convenient alternative to the liquid form, and they may not taste bad. Pills can be crushed between two spoons. Crushing is made easier by first moistening the pill with a few drops of water and letting it soften for 15 minutes.

*Place the pill or capsule far back on the tongue and have your child quickly drink water or Kool-Aid through a straw. If your child concentrates on swallowing (even gulping) the liquid, the pill will follow downstream without a hitch.

Model for your child the steps in swallowing a pill:

*Place a pill on the back of your tongue.
*Keep the tongue flat.
*Take liquid in the mouth.
*Tilt the head backward slightly.
*Swallow.

Here is a link to that article
http://www.aboutkidshealth.ca/HealthAZ/Pill-Swallowing-Helping-Your-Child.aspx?articleID=8784&categoryID=

Please check with your nephrologist first before doing any of them. We got permission to poke a hole in Cody's fish oil capsule and drain it into soda or juice. Two of the others are quite small and the prednisone he will sometimes swallow whole and sometimes break in half depending on his mood LOL.

Getting Diagnosed

In early April of 2008, Cody had a case of strep throat. He was treated with a 10 day course of antibiotics and all was well until one morning we noticed swelling around his eyes and mouth.

At first we thought it was allergies and it went away within a few hours so we didn't worry about it. The next couple days it came back and was only in the morning and always went away within a few hours. I was sure there was something in his room or on his bedding that was causing an allergic reaction, however, it was Friday and I decided to make an appt with his pediatrician to see if he needed allergy medicine. We went to the appt and the doctor didn't seem satisfied with an allergy diagnosis and asked us if Cody had been sick recently and I told him he had had strep a few weeks back and I am telling you, his face totally changed and he asked how his urine was....well, seeing as he's 8 I don't really look at his urine but Cody had mentioned a few days earlier that his pee was kinda brown at school but I just figured he was getting dehydrated and that it wasn't really brown - well, now that the doc brought it up, I remembered and told him Cody said it was brown at school a few days ago but had been yellow since. He instantly did a urine test for blood and protein and told me that his protein was +4 and his red blood cells were TNTC (too numerous to count) he then had us go to the lab and get blood drawn and microscopic urinalysis then sent us to get a chest xray to check for fluid. We then went out for lunch where my mom met me (after taking off work when receiving a phone call from me and finding out what was going on) and we were told to come back after an hour or so when the most of the lab work would be back. He called the main nephrologist at St Louis Children's Hospital and spoke with him. He said they are going to treat as post streptoccocal glomerulonephritis for now since the labs that came back were normal along with the xray. We were then told to come back in one week and we would do more tests to make sure the blood and protein were decreasing and check for swelling, etc.

We went back the next week and there was never anymore swelling at that point and his urine was a light yellow (almost clear) so we were expecting good results. Needless to say, we didn't get the results we wanted. The rest of his labs from the week before came in just that morning and while his protein was +3, and his red blood cells in urine had decreased (at least to an amount they could count finally) the results from the blood test that would have shown antibodies confirming post streptoccocal came back negative. The doctor said it was a type of glomerulonephritis that wasn't going to go away on its own in a few weeks and had us wait while he called the Nephrologist in St Louis again. Cody's pediatrician came back in and we were told we had an appt in St Louis on the 29th (5 days away - he was coming in early to see Cody) with the leading Nephrologist there, that he wanted more blood work done, and another microscopic urine test so that he would have those results by the time we got there. The pediatrician said he would most likely want to do a biopsy so be prepared to stay there maybe that day or a night.

We were still quite ignorant at that time despite googling everything I remember hearing, mainly due to overload on internet info and since most of the prognosis' scared the crap out of me, I had to shut the computer down and wait for a diagnosis before letting my mind wander down any dark roads. I thought, ehh, we might stay at a hotel that night (insert ignorance here) so Cody and I made our lists, packed bags and I tried to be as positive and proactive as I could with him since by the second visit to the pediatrician, Cody started plugging his ears (in this case, ignorance via not hearing what was said, was bliss)

We arrived at the hospital for our visit (very sobering places to be, Children's Hospitals) and went to our appointment. The Nephrologist came in, went over results and stated he thought it was IgA Nephropathy. He checked us in the hospital and set up a biopsy to be done the next day. Cody cried and was very nervous, okay if I am to be completely honest, his dad and I held our brave faces - his eyes welling up and mine let some tears slip but we did the best we could for Cody. I started my best case scenario/worst case scenario questions. In case you don't already know about me, I do not normally fall apart but instead opt to go into vigilant mode which normally involves a 3 ring binder, copies of medical records/tests, TONS of information on diagnosis, etc

We went to the lab for additional testing and to radiology for an ultrasound of his kidneys and another chest xray. These pics were a couple hours after we knew we were staying and Cody REALLY loved the hospital - they spoiled him rotten giving him books, handfuls of baseball cards, tokens for $5 at the gift shop, etc - I cannot say enough how much the staff at St Louis Children's Hospital put us at ease. Those are special souls who look after kids and go above and beyond the call of duty to make them comfortable and put a smile on their face.

God bless every single one of them and the volunteers who visit them everyday, volunteers who spend their own time and money setting up large wonderful fish tanks and care for them, the food service people who go out of their way to make sure even us parents are fed, and the janitors and housekeeping who made sure the hospital stayed as spic and span as it was and kept it as germ free as possible. Sorry for going off topic there but I just can't say enough about the staff and volunteers there.

So we got checked into our room (we were there for 3 nights and never had to share a room) went up to the rooftop garden and walked around there for awhile, looked out of the thingies - I wanna say telescope but don't think that's correct, went back to our room and he got his IV put in then we settled in for the night and what would be a long day tomorrow.

I'll try to shorten this up a bit.......the next day he went in for the biopsy and they had a tv with cartoons on for him. We both stayed with him up until he was fully sedated - seriously - the doctors and nurses were all in there complete with ultrasound machine to help them guide the biopsy needle and were ready and waiting then Cody "fell asleep" and we left. They gave us a round pager thing that supposedly big cities use in restaurants that would light up and vibrate as soon as they were done. We went down the hall to the radiology waiting room (st louis cardinal theme complete with stadium seats - soooo kid friendly it's crazy) and it was the longest 30 minutes of our life up until that point. We went back to our room and he had to lay flat for at least 6 hours and they tested his hemoglobin that night and the next morning. After 6 hours, he still wasn't allowed to really do anything but could at least elevate the head of his bed to kick our butt at Uno Spin and Clue. This pic is of the doctor who performed the biopsy - taken when he came to check on Cody that evening. The next pic is the following day playing our I-lost-count-game of Clue (checked it out of the play room) We got to take him downstairs to the cafeteria area - it was gorgeous!!! I forgot to take a pic of the actual tables complete with umbrellas and street lamps but had a very cafe feel to it. They had everything from Pizza Hut, Dairy Queen, Weight Watcher meals, Healthy Wraps, Salads, fresh fruits and veggies, etc Here's a pic of what I saw looking up from the street cafe style cafeteria.

That evening the Nephrologist came in to go over the biopsy results with us. At least part 1 of the results and the other 2 would be ready by our next appt. Cody put in his mp3 player while we talked out in the hall. He said it definitely fit the classic characteristics of IgAN. My stomach dropped and part of it felt like a dream - I had my list of questions and a pen ready because I knew I wouldn't remember all of what was said. What it basically boiled down to was he has IgAN and Nephrotic Syndrome (caused by his high protein spill). He set up a 4 prong treatment for Cody and we were to stay another night to monitor his hemoglobin. Poor Cody was already dressed and ready to go but at least they took his IV out that night. They also started him on his meds: 60 mg prednisone, 10 mg simvastatin because his cholesterol levels were slightly elevated, 5 mg lisinopril (ACEI also thought to help the kidney resist disease) and 1000 mg of fish oil - we tried for 30 minutes to get that boy to try to swallow that honkin' big pill but alas, we got permission to just pop it and squirt the fish oil in juice and he could take it that way. They said normally kids don't want it that way cuz of the taste but Cody could care less - maybe it's a boy thing but they get quite pleased with themselves when they conquer disgusting challenges. These were the only instructions up to this point besides seeing his pediatrician to check for swelling in the feet and abdomen 2 weeks after leaving hospital and back to see Nephrologist 4 weeks after leaving hospital.

After having hopes of going home dashed, we decided to go on an outing and explore the rooftop garden once again, head off to the school room and the play room for some entertainment. The first pic is in the school room where kids who are in the hospital for long bouts of time can get help in keeping up with their school work. Cody just played learning games on the internet :) The second pic is in the play room where they can play the playstation 3, play with toys, sign out games, movies, etc

This is Cody back in the room for the night.

We went back to the pediatrician office two weeks later and everything looked good. He didn't draw more blood since the neph didn't ask for it to be done - just checked him for swelling in feet and abdomen, did urine test, and listened to his lungs for fluid.

2 weeks after THAT, we went back to the Children's Hospital to see the neph again, they drew about 5 tubes of blood and we brought our first morning urine (on ice) then they took more urine for microscopic. We also signed up with the research center to take extra blood, urine, and his kidney tissue once the hospital was done with it so they could use it for research on kids with kidney disease. Cody was glad to give them that one tsp of extra blood and urine when he thought it may help another kid. The neph said they definitely saw IgA deposits in his kidneys so it was 100% now. He also said as of now, Cody's kidneys have no scarring, no damage, and full function. The neph is doing his best to protect his kidneys via medicine and controlling protein spillage although the pred isn't working totally yet but has managed to get it from +4 to mostly +2 with a few +3 thrown in there on "brown pee" days. Cody also developed another bout of

Nephrotic Syndrome and his genitals started to swell along with eyes and face again so he is now on a 1200 mg per day sodium restriction and 4c of fluid restriction per day until he is either trace or negative on protein levels for 3 days in a row or once he's off prednisone. This is because he never had that problem before and since losing protein causes swelling, and prednisone causes water retention, these two combined caused a slight problem. If he has very active days and has sports on certain days, we allow him more water and the neph nurse approved. In only 3 days of doing this restriction, Cody lost almost 5.5 lbs of water weight.

Well, finally, that's it for now. I hope this has helped some of you who are finding yourselves in the same unfortunate position of having a kid diagnosed with kidney disease even if it's not IgAN. We go back July 25th for another follow up but until then, I am working on kid friendly low sodium lunches he can pack for school this fall and not feel deprived. I'll post some of those soon.

Thanks for reading this long - hope to connect with others soon.

Stacy

About the Doctor Visit

When I got there my mom was talking to Dr. Sean. He said I had to do the blood test.I got a little scared. When I got done she said,"I think I messed up." I got dizzy and everything was purple. The docter laid me on a bed. I got two suckers. They did some last Friday, three tubes of blood. On Thursday they only took one tube of blood. This Tuesday mom dad and I are going to Saint,Louis for a docters visit.Today I am feeling better.

Cody