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Re: I feel dejected because of my one nephrologist WaterSapphire

Posted by Racer on August 31, 2008, at 14:40:28

In reply to Re: I feel dejected because of my one nephrologist, posted by WaterSapphire on August 31, 2008, at 12:21:44

> I was wasting salt ... and automatically assumed it was only because of an intake of the sodium. He did not bother to see what the cause of the abnormal cravings that I get here and there were from.

This is very hard for me to write, because I'm afraid it sounds as though I'm invalidating your experience, when I'm actually trying to help you reframe it from a more positive perspective. That's the disclaimer.

The doctor isn't all wrong on that.

Now, he was significantly ineffective in communicating a lot of what I'm about to say to you, and he probably was writing you off to a large degree. (No use trying to pretend otherwise, when that's been my own experience, too, so many times.)

First of all, MANY people can't give an accurate account of their actual sodium intake. (Or, for that matter, their intake of any dietary element.) The sugar free soda I drank today has 35 mg of sodium. The three varieties of diet soda my husband drinks regularly have 35, 70, and 130 mg. There are many sources of sodium we wouldn't think of when we try to estimate. I have an aversion to the taste of salt on most foods, so I don't cook with added salt, and I don't salt my food at the table. I'd estimate my sodium intake to be within normal limits, and probably on the low side of average -- but despite my avoidance of table salt, I won't try to tell a doctor that my sodium intake is below recommendations, because it probably isn't.

Why am I saying all that? Because the next thing I'm going to suggest won't make nearly as much sense if I don't explain that.

In your situation, one thing I'd include in your little self-chart package is a detailed and complete food journal, with sodium content of all those foods estimated as accurately as possible. Give a daily total in mg, and a daily average over about two weeks. You might find that there's some validity to his theory. He might see that he jumped to a conclusion. Kinda depends on what the food journal shows.

Also -- although this guy doesn't seem to have treated you with anything resembling an effective bedside manner, sending you home with the advice to limit your sodium intake, which I assume he did, is actually pretty reasonable standard of care. Despite my thing above about hoofbeats, when you hear hoofbeats, it's mostly gonna be horses. So, he's clarifying the picture -- if you limit your sodium intake, and you document that adequately, and you go back to see him again, he's ruled out one common cause and will have to move on to a less common cause. Ruling out causes is often important.

There's another thing I don't know that I said, though -- I was a little concerned at first that you were putting so much faith in this guy. Research or not, published or not, he's unlikely to fulfill expectations set quite that high. Examining both what expectations of him are reasonable and why you'd invest so much in your expectations of him might both be interesting and productive exercises for you.

Good luck




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