Happy Registered Dietitian Day! By this day next year I’m planning on being part of the club. But for now, here’s a post about what it’s like as a clinical dietetic intern. Enjoy!
7:30AM Arrive at the hospital. Today I am scheduled to observe a gastric bypass surgery! Gastric bypass, or Roux-en-y surgery, is a a type of weight loss surgery. In this type of surgery, a small part of the stomach is used to create a new stomach pouch, about the size of an egg. This new, smaller stomach is then connected to the small intestine (or jejunum), “bypassing” the rest of the stomach and the top of the small intestine (or duodenum). Those that undergo this surgery have to follow a strict liquid diet afterward because the stomach is now so small it cannot handle large amounts of solid food. Eventually the diet can progress to regular food and the patient will only be able to consume small amounts at a time, resulting in weight loss. It was my first time ever inside an operating room! The surgery was done laparoscopically and a portion of it was also done with a surgical robot. It was fascinating!
12:15pm: After observing the surgery I headed back to the nutrition office to eat my lunch quickly before heading over to the Cancer Center.
12:30pm: Drive to the Cancer Center. This week I’m working with our oncology dietitian.
12:45pm-3:00pm Visit patients in the infusion center. We talk with patients while they receive treatment. We discuss how they’ve been eating, if they have an appetite, etc. This is a good time to talk to them because they are already here receiving treatment and are usually here for a few hours. They don’t have to worry about scheduling a nutrition appointment, we go right to them. Side effects of cancer treatment include loss of appetite, dry mouth or bad taste in their mouth, mouth sores, and nausea/vomiting all of which can result in weight loss and put the person at risk for malnutrition. Some patients are prescribed medical marijuana to increase their appetite and relieve symptoms. I spent some time going through recipes to give to them. Never in my life did I think I would be doing this as part of my internship!
3:00pm-4:00pm. One-on-one initial nutrition counseling session. Patients can also schedule appointments with the dietitian one-on-one. Like I stated above, the biggest side effect of cancer or cancer treatment is decreased appetite and weight loss. The primary goal for patients with these issues is weight maintenance. We discuss ways to increase calories and protein during the day. Eating more small, frequent meals will give them more energy, while more protein will prevent loss of lean muscle mass. Both are very important during cancer treatment.
Boost is a supplement frequently recommended to patients who don’t have much of an appetite. They also may be fatigued and too tired to prepare meals. It’s a quick and easy way for them to get adequate nutrition. Although consuming real foods is always preferred, sometimes drinking their meals are all that the patient can manage.
4:00-4:30: Write a tube feed! Today the RD showed me the demo that she uses when showing patients how to tube feed.
Some patients require a tube feeding (also called enteral nutrition) because they have trouble swallowing (called dysphagia) or eating food by mouth. The tube can either be placed through the nose to the stomach or intestine, go directly into the stomach to the intestine, or directly into the small intestine to be absorbed. Today I finally got to write a tube feed for an actual patient! This patient needs a new enteral nutrition formula to prevent weight loss. I suggested that we find a more concentrated formula for him so that he gets more calories per carton, providing him more nutrition. The RD checked over my tube feed calculations and approved it! We can now write it on a prescription pad to get signed by the MD. So cool! I have to say writing tube feeds is one of my a favorite parts of being a dietetic intern.
4:30pm Drive home. I have to say I am loving my clinical rotation. This was the rotation I was most nervous about, by far! But I am having a great experience at this hospital. Every week I’m with a different RD who has a particular specialty, so I get to see all aspects of nutrition in a clinical setting. They have been amazing mentors.
Seven years ago I sat down at an information session for a nutrition program. Little did I know it would be seven years of hard work. Back then, the internship seemed like it would be eons away. Now, I have three months left of the internship and then I can take the RD exam. It’s all going to pay off! If you are a dietetic student reading this, just know that it will all be worth it in the end!