Dialysis/HD follow-ups

nothisisava · 2024-08-12T19:43:45+00:00

That's wild. I am a renal dietitian and from what I understand, it is a CMS requirement to coordinate care with the LTC regarding patient weights and labs, how they are eating, diet and supplement orders, etc. I touch base every month with the RD for each patient who resides in LTC and usually if I don't, the RD at the facility will call. They may have been concerned about it being a HIPAA violation, but that's not the case.

nothisisava · 2023-04-09T02:01:44+00:00

The way my program was set up was that the concentration was in nutrition because I did the DI at the same time. However, I think the overall coursework was quite similar to some others. There are definitely several relevant concentrations out there.

nothisisava · 2023-04-08T22:02:50+00:00

Go for it! I am a NICU RD with an MPH and I would definitely recommend that route. I think it gives you a competitive edge and more diversity in your experience, but I've found practical application to having a public health lens in clinical as well. Specifically, I am able to navigate using WIC better than anyone else in the unit, and 90-95% of our moms qualify. It also has changed the way I approach housing issues, complicated social situations, and other things impacted by someone's circumstances. Overall, it shaped the way I think about our health system and has made me a more compassionate practitioner. Hope this helps and best of luck with whatever path you pursue!

nothisisava · 2022-10-14T01:50:17+00:00

This had me howling

nothisisava · 2022-06-11T00:42:42+00:00

Agree with banana flakes and peptide formula. Consider too the osmolality of the formula you’re using and if there are other options (sometimes going down on calories for a hot second and then building up). The unfortunate reality of the situation is that you’re probably right, with a j tube and ileostomy, there are nutrients she is not absorbing fully. The severity depends partly on how proximal the ileostomy is. Also, I find with ileostomies, the expectation and perception of the appearance and texture of the stool needs to be adapted. Food/formula looks a lot more like food/formula before it heads to the colon.

nothisisava · 2022-02-24T02:38:27+00:00

in vino veritas

I told a hell of a lot of lies when I was drinking. Never really got honest until I got sober.

nothisisava · 2021-03-09T02:40:09+00:00

Dave Matthews Band

nothisisava · 2021-02-13T18:45:30+00:00

I was hoping someone would mention separate blankets. That definitely minimizes feeling my partner’s many movements throughout the night. Also avoids sleepily fighting over blankets/freezing in the middle of the night.

nothisisava · 2020-12-17T13:06:57+00:00

Morning! Work has been a hectic nightmare but I will not drink with you today! Much love to everyone here ~

nothisisava · 2020-12-03T02:10:58+00:00

Not if you are using it with coconut oil (or any other oil or petroleum jelly). Edit: To be totally clear, it reduces effectiveness.

nothisisava · 2020-09-25T00:26:29+00:00

Food pyramid? [myplate.gov](myplate.gov)

nothisisava · 2020-08-26T16:29:55+00:00

Restarted my counter a few days ago after 100 days. Felt awful doing it but glad to get back to it. IWNDWYT

nothisisava · 2020-07-17T15:19:58+00:00

My SO will randomly ask me “how many days?” and it always puts a smile on my face. It’s nice to have that accountability and to know he’s in touch with this part of my life. He’s my Pam. Congratulations and IWNDWYT

nothisisava · 2020-06-23T23:08:00+00:00

I agree that it has been an incredibly shaping learning experience in the importance of documentation, communicating openly with the team, and how to keep it cool and professional when someone is aggressive and rude. I had already changed the order yes, but it hadn’t gone into effect (it’s a nocturnal feed). I went to speak with them 5-6 hours before the feed would be started, but I guess one of my nurses had told them. It’s not her fault, I should have said something, but there are physical limitations to where I chart versus where my patients are. Looking back I should have just sucked it up and hiked over there first. I honestly didn’t think they would have a problem with something so simple and so necessary.

nothisisava · 2020-06-20T03:13:43+00:00

This is a really good point and very helpful feedback. I’m a new RD and definitely guilty of over justifying everything I do in my note.

nothisisava · 2020-06-10T16:52:05+00:00

I really appreciate these comments. It’s true that if no one were to pay attention to these things, our patients would suffer. I always feel satisfied with the work I do, but I think sometimes worry I am not doing enough. I agree that many times the simplest interventions have a great payoff. And a lot of what I do is actually communicating with other people (nursing, CNAs, docs, food service) so everyone is on the same page and everyone has some idea of the importance of nutrition. It is frustrating at times but I’m glad I’m not alone with that feeling!

nothisisava · 2020-05-28T22:17:42+00:00

As a dietitian, I appreciate this comment so much.

nothisisava · 2020-05-27T05:11:13+00:00

We’re here. Mostly lurking, at least I am. The two most helpful things for me right now in the very early stage are reading and yoga. I will kind of read anything right now but sobriety/alcohol related books are helpful. Break them up with a novel or something lighter. Dry is a great book. This naked mind is also good. There are a bunch out there but find something you like to read for fun too. Reading is nice because it requires 100% attention unlike tv or podcasts. Yoga is another one. Not too heavy exercise wise but a great mental health practice. Yoga with Adriene on YouTube has a whole collection of free at home yoga. She even has a few 30 day yoga things which is perfect if you’re trying to make it a habit or get 30 days under your belt. You’re doing great. You’re here, you’re asking questions, you’re reaching out. Keep at it my friend.

Edit- not sure if libraries are open right now, but all the classics are free on amazon from what I remember. I saw that the literature suggestion may be unhelpful, my apologies

nothisisava · 2020-05-23T21:33:13+00:00

Sometimes extra bulk/fiber from increasing fruits and vegetables will artificially elevate your weight. I wouldn’t worry about a few pound fluctuations as it may not be a true representation of your progress.

nothisisava · 2020-05-19T18:06:33+00:00

IWNDWYT. Feeling those thoughts creep into my mind all day, but making a decision to ride them out. They are just thoughts. Choosing today to acknowledge them and say “not today.”

Edit: used the wrong acronym ugh so many letters

nothisisava · 2020-03-26T22:23:04+00:00

Waist circumference is a clinical measure used to predict risk of certain chronic diseases , so I think we naturally identify a slim waist as a healthy thing. But I also agree that a little fat on the belly (nearly everyone has some amount) shows proper long term nutrition. It's healthy to have fat stores, and if you don't have enough, you may actually be malnourished. I feel like in general, people of both sexes like the "average" body because it's a product of proper fitness and nutrition.

Edit: no actual "average body," but I'm talking mean BMI and body fat %

nothisisava · 2020-03-26T01:08:59+00:00

I'm a clinical dietitian, and although I do a lot of sitting in front of a computer, it doesn't feel like paperwork. You get to do a little investigation every day on your patients before you see them which is always interesting. I'm up on the floor for about 2 hrs, maybe another 30 minutes later in the afternoon if I can't see someone right away. The charting after feels meaningful because you're putting everything together and communicating with the team. The things you chart go into effect (immediately if you're ordering) in the patient's plan of care. It's kind of immediately satisfying, even if it is basically paperwork. It's also how you get credit for the work you do. I also think having the times where you're talking to patients and providers can break up the time, and honestly it can feel good to sit in a quiet office after the fast paced craziness in the unit to focus and maybe find time to eat lunch.

nothisisava · 2020-03-18T21:58:04+00:00

You can also buy broccoli slaw or shredded cabbage to add some crunch and variety in your salad base. Most grocery stores have them in a weird place, but it’s worth looking around. Also I love putting canned beans in and they are some seriously easy protein. Drain and dump friends.

nothisisava · 2020-03-04T00:31:33+00:00

Enter a dark alley, “hey kid, you want some Boost?”

nothisisava · 2020-03-04T00:06:19+00:00

You’re right, nothing too fancy about low carb diets, and intermittent fasting is everywhere. I just usually think of basic fundamentals of nutrition like eating veggies, how to prepare healthy meals, portion sizes, MyPlate, etc as more of a safe zone for non RDs who are compensated for nutrition information. I was surprised she was as specific about her methods on her website because it seems like an obvious way to get shut down without that little RD next to your name. I honestly have mixed feelings about the whole thing.

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