Georgetown Week 2

During my second week, I continued my GenMed/Endo rotation. I think I met my favorite patient last Monday, Mrs. G! She is a 98 yo renal patient, who doesn't eat. She is so cute, she was wearing purple satin pj's, and reading a gossip magazine with a magnifying glass! And, she speaks with an accent.

So, the renal team requested calorie counts, which we completed at the end of week 1, because they were strongly encouraging (actually threatening) to put in a PEG if she doesn't increase her intake. However, the pt doesn't want TFs. The nurse said she doesn't have much of an appetite, but when I spoke with her (on my own!) she said that she doesn't eat because she doesn't like the food, so we recommended to D/C the megace. She's been in the hospital for about a month, and Georgetown is only on a 1 week menu cycle, so I can understand that Mrs. G is "just sick of it!"

Previously, the dietitians recommended that she try Glucerna to increase energy intake, but she doesn't like it and it gives her diarrhea. So, my preceptor and I recommended Resource Breeze, which is the clear liquid juice-like supplement in berry flavor.

Mrs. G has been on a Medium Consistent Carb (MCC) diet because she also has DM. We decided not to give her a low-sodium diet because she doesn't want it, and she barely eats as it is; so we would rather get her to have a little bit of the MCC diet, rather than none of the LS diet.

Since I was familiar with this simple case, I did the follow-up with Mrs. G, who said that Breeze is also giving her diarrhea. I even went through a lot of the menu options with her, but she doesn't like anything; she orders out once in a while. Hoping that we could find something to please the pt, so that she doesn't have to get a PEG and tube feedings, I put in a request to have the clinical nutrition manager speak to her about her food preferences. I hope we can find something she will eat!