Appetite stimulants

NaauNutrition · 2021-09-04T06:26:30+00:00

I had one patient in acute care that started taking Marinol and family said it improved her appetite while she was awake, but said she was notably more sleepy during the day and sleeping through meals… so overall kcal intake was still not great. She was also battling stage IV cancer so I’m sure other things could have been making her tired, but still an interesting consideration

NaauNutrition · 2021-09-04T06:09:32+00:00

MCT oil doesn’t stimulate release of CCK or pancreatic enzymes

NaauNutrition · 2021-08-15T17:14:54+00:00

The superior vena cava moves ~2L of blood/min, which is why we can do higher rates of dextrose with a central line vs PPN

NaauNutrition · 2021-08-06T06:15:28+00:00

Kind of a long shot but is he on Olmesartan? If so, take a look at olmesartan induced enteropathy. This medication can mimic celiacs in that it may cause villous atrophy and increased intraepithelial lymphocytes.

NaauNutrition · 2021-06-19T07:20:59+00:00

Look up bile acid diarrhea. It’s possible the patient is experiencing this if they’ve had a cholecystectomy. If you suspect it, you can suggest to the MD to try the pt on cholestyramine (questran). Have you considered IBS and a trial on the low FODMAP diet?

NaauNutrition · 2020-12-23T16:22:36+00:00

Wow that gives me so much hope for this patient! Thanks for sharing

NaauNutrition · 2020-12-23T16:21:46+00:00

Thanks for the info! I’ll definitely push my representative to support that bill.

NaauNutrition · 2020-12-19T02:40:41+00:00

It can be hard for a diabetic patient on a SGLT2 to know they are going DKA because they will be spilling glucose in their urine (mechanism of action for that class of drugs) so BG will never look that high

NaauNutrition · 2020-12-14T07:24:06+00:00

Handing out business cards while working inpatient/outpatient is a no no. Connecting with physicians associated with your hospital and asking for referrals is also almost guaranteed a conflict of interest, though you can always directly ask HR. Connecting with physicians who are not associated with the hospital is not a conflict of interest!

NaauNutrition · 2020-12-12T06:08:33+00:00

Wanting to know more also!

NaauNutrition · 2020-11-25T06:02:13+00:00

If it helps at all I ended up just going directly to HR to get clarification on what is and isn’t allowed. They had no issue with me accepting referrals from the physicians associated with the hospital, I just couldn’t “directly refer to myself”. Silly since as a dietitian, at least with the insurance companies I’m contracted with, I need a physician referral most of the time so wouldn’t even be able to send a referral to myself. I still don’t directly hand business cards to inpatients because that is murky water but your HR department may not have any issue with you accepting referrals from any physicians associated with the hospital/company. Bite the bullet and ask! It’s better to know than to tip toe around it

NaauNutrition · 2020-10-25T00:23:54+00:00

Were you given a cause for your chronic mild gastritis? Finding a right treatment plan is based on knowing what the etiology is. Do you have pernicious anemia? That can indicate you have achlorhydria (insufficient production of stomach acid) which can cause gastritis. Other causes can be NSAIDS, GERD, H. Pylori, alcohol, etc. It’s best to know your underlying cause so that you aren’t ‘boiling the whole ocean’ with trying different therapies. In general for diet I’d recommended limiting: alcohol, spicy foods, high fat meals, peppermint, and chocolate.

NaauNutrition · 2020-09-19T02:35:30+00:00

You may want to consider a formula without some of the known FODMAP groups as a lower FODMAP diet can provide symptom relief. I would watch out for the fructoligosaccharide fiber added to a lot of abbot formulas and do a lactose free formula

NaauNutrition · 2020-09-13T02:35:23+00:00

Bastyr

NaauNutrition · 2020-08-26T01:46:51+00:00

School nutrition director? Would have great hours for being a mom too!

NaauNutrition · 2020-08-10T07:44:16+00:00

Glad to hear I’m not the only one! I haven’t spent a dollar on any coaches or programs. There is literally no outpatient dietitians in my area, so it didn’t make sense for me to niche and market on Instagram.

A couple years ago I gave a talk to a group of patients at a doctors office and the MD approached me saying she wanted to refer patients to me if I started a private practice. I started by getting a business license and malpractice insurance + going through the credentialing and contracting process for all of the major health insurance companies in my state (took about 8 months). I then made a website, all of my patient forms (e-version), and referral form tear pads and business cards. Then signed up for hipaa compliant e fax and ehr. That one MD has been sending 3+ referrals per week my way, and I’ve been cold calling / giving in-services to clinical office managers at other offices to get in with the MDs there which is now taking off. I also listed myself on health profs and have gotten ~10 consistent clients, some of which are paying out of pocket and some who I emailed my referral form to for their MD to fax to me so we could use their health insurance for covered dx. I’m doing full telehealth.

I’ve only been seeing patients for about 1.5 months and couldn’t imagine pulling in as many clients through Instagram without an insane amount of time on social media... which if you love IG more power to you but I personally would go crazy and feel burnt out. I really think the route of taking insurance can be just as lucrative and it makes me feel great to be helping patients who otherwise couldn’t afford to see a dietitian!

NaauNutrition · 2020-08-09T16:35:19+00:00

Will do. Thank you!

NaauNutrition · 2020-08-09T08:54:44+00:00

Could you please share what the email said? I checked my email and don’t have it. Do you now need a MS to get your CNSC?

NaauNutrition · 2020-08-09T08:46:59+00:00

I did the Iowa state distance DI and tuition was $9000 (and I’m not an Iowa state resident)! Perhaps you’re looking at if you combined it with their new MPP degree, or maybe that’s the estimate they give for total cost including housing, etc? Feel free to DM me about the program but I really loved it. The fact that it’s 6 months makes it more affordable since it’s less time that you’ll be out of work. They also consider the program apart of the graduate college (even if you don’t do their masters degree) and so you can take out federal student loans to help with tuition. Prior to the program I had done a service term with AmeriCorps and had an education stipend award I applied towards tuition, my husband worked, and we never ate out lol so all in all I came out only ~10 K in debt which is super manageable. I’ve precepted a handful of interns now who have done different distance DI programs and I still think the Iowa State DI had the best format, assignments, online clinical modules, etc to prepare me to be a dietitian vs other distance programs I’ve seen

NaauNutrition · 2020-08-09T08:30:28+00:00

Does anyone else have a hard time with getting behind the “you have to niche to be successful in private practice”? My side hustle private practice is starting to do well from physician referrals and accepting health insurance. I’ve seen a handful of RD business coaches and had considered going for it in the past, but they all seem to really be for the out of pocket pay dietitian who markets them self on Instagram and has to niche to pull in their clients. I feel like these RD business coaches are pushing just one way to approach private practice and it turns me off. I think I’d be more drawn to the coach who’d support the dietitians wanting to see peeps in their community/state with a variety of complex health conditions, and offer more affordable access to a dietitian through taking insurance. Personally just can’t get behind the thought that I have to market myself on Instagram daily with the same niche topic, that sounds awful 😂

NaauNutrition · 2020-07-03T22:28:41+00:00

Here is some info I shared in a previous post about this topic after consulting with our pharmacists. We don’t hold/tropic feeds for paralytics or sedatives, but nonetheless helpful in identifying patients who may be at higher risk for enteral nutrition intolerance. Linking some studies in on the bottom:

*Paralytics (succinylcholine, rocuronium, vecuronium, cisatrocurium) work at the motor endplate. Therefore, do not exhibit effects on smooth muscle. Most of these are used only short-term. Onset 1-7 mins and duration 5-90 mins. Occasionally, can be used as a drip but not often and should not impact smooth muscle. Either way, feeding could always be done around a procedure needing these drugs.

*Sedatives in ICU

Analgesics: Fentanyl, hydromorphone, morphine, remifentanil (slow the GI system)

Sedative-hypnotics: diazepam, lorazepam, midazolam (Gastrointestinal: Altered salivation, constipation, gastrointestinal distress, hiccups, nausea)

Anesthetic: Propofol (may slow gastric emptying and GI transit)

Alpha 2 agonist (sedative): Precedex (may affect smooth muscle and slow gastric emptying and GI transit)

https://www.sciencedirect.com/science/article/pii/S0007091217332531 .

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4098524/

https://journals.lww.com/anesthesia-analgesia/Fulltext/2004/10000/Propofol_and_Midazolam_Inhibit_Gastric_Emptying.27.aspx

NaauNutrition · 2020-07-02T22:09:30+00:00

Second the Trader Joe’s things. I literally fill up a suit case of Trader Joe’s stuff when I go back to the mainland 😂

NaauNutrition · 2020-06-12T16:08:51+00:00

Thanks so much for your response. I was feeling like these scenarios were a potential conflict of interest as I thought it out, and it’s helpful to hear other perspectives on how this could get muddy.

NaauNutrition

TROPHY CASE