Touring the upper GI tract

There was no way my super cheerful RD was going to let us cry this week! We got to observe a bedside PEG placement yesterday and it was awesome to watch the scope go through the esophagus, into the stomach, and then into the duodenum, just to check things out. I felt like I was on Ms. Frizzle’s Magic School Bus. The people placing the PEG were doing so for the first time, so the head physician explained each step of the process, which was helpful to my understanding of the procedure. The most memorable part was seeing one end of the thread coming out of the abdomen and the other end coming out of the patient’s mouth, almost like they were flossing her GI tract. They hooked the mouth end of the thread around the tube, pulled it gently into the stomach, and then yanked it through the abdominal opening (the lady had 5.5 inches of subcutaneous abdominal fat, so it took some force to get it through).

I saw the nicest gentleman this week, who unfortunately has a very poor prognosis. He has kidney failure and had had head and neck cancer and radiation treatment left him with a trach and barely able to talk. He is being fed through a J tube and came to the hospital from a skilled nursing facility because the tube became infected. Because of the infected J tube, the patient received no fluids and was severely dehydrated (Na was 177 when he was admitted and his other electrolytes were out of wack). Two days ago, my RD had developed a combination TF regimen for him of a 1:1 ratio of RenalCal and Standard Isotonic formulas to meet his challenging protein and electrolyte needs. Today, I assessed the changes in his labs after he started the formula and it was really exciting to see them trending towards normal! It is the first patient where I’ve been able to really observe the benefits of a nutrition intervention, and it was very rewarding.