Outpatient nutrition: cystic fibrosis, cardiac rehab, and diabetes

I have not updated you on the internship in quite a while except to say that I’m ready for it to be over.

In reality, it has been really good lately.  After my long inpatient hospital rotation, I went to three different outpatient clinics: cystic fibrosis (CF), cardiac rehab, and diabetes.

CF is a disease where sodium channels in membranes of organs are messed up, which results in a sticky thick mucus in the lungs that leads to chronic infection and coughing; thick secretions from the pancreas (which normally squirts out bile to help you digest your food) that make it difficult for digestion and absorption; and sometimes CF-related diabetes because of issues with insulin secretion as a result of this thick sticky crap.  For some reason, there is a huge CF population in the Southeastern Louisiana, and there is a dietitian hired full time to work specifically with these patients – in other places CF patients are simply one of a long list of patients the RD sees in a day.  The role of the dietitian in managing CF care is determining how many pancreatic enzyme pills the patient needs based on body size and meal size, encouraging a high-fat high-sodium diet to help with weight gain (with malabsorption issues, CF patients are often small and weak), and monitoring the patient’s weight and eating habits.

Cardiac Rehab is a clinic where people can come after a cardiac event – stroke, stent, valve replacement, or heart attack.  The clinic has three employees: a nurse, a dietitian, and an exercise physiologist.  Patients come for two hours a day, 3 days a week, and have an hour of exercise in the GYM (!!), followed by an hour of education (more or less) about topics related to cardiac health.  The RD does initial nutrition assessments on the patients, counsels them individually, follows up regularly, teaches classes, and does an exit interview.  One important thing to note about cardiac rehab is that the three-month phase 2 program is covered by insurance.  How awesome is that?!  The healthcare system kind of cares about nutrition!

Diabetes was a component of an endocrinology office across the lake in Slidell.  The RD was very well respected by referring physicians (which you don’t always see), and covered all sorts of topics with patients.  Some had been seeing her regularly for years and just following up with new labwork or adjustments to meds or insulin, while some were brand new and needed a lot of education about how to eat with diabetes, how to use a pump, or how to inject insulin.

Overall, I love love LOVE outpatient! 

In all three of the settings, people were there because they wanted to be there.  In the hospital, people are there because they have to be.  When you think about stages of change, these people are in action phase whereas hospital patients often really don’t care about what you have to say.  That makes outpatient much more pleasant – people are receptive to education.

Additionally, you have a lot of time with the patient, which means you get to know the person behind the nutritional issue.  Once, Andrea told me that I would make friends with a wall.  It’s true.  I love getting to know people.  I love figuring out the things that make people tick, what their motivation is, and how to make a healthy diet and lifestyle fit with all of that. Being a dietitian is way more than being a scientist that understands the ins and outs of glycolysis and the structural differences between amylose and amylopectin.  It’s about relating to the human component, understanding the local food environment, and coming up with solutions that work for the person you are dealing with – they are not their disease, and there is a lot more than just the disease to consider.

In outpatient, you become FRIENDS with your patients! Replace those milkshakes with green juice and that could be my future. Not that I’m a fan of green juice. Maybe replace them with water and a fruit platter. Actually…everything in moderation

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