GI and TPN

We rotated with the GI surgery RD last week, which was a good way to set us up for the TPN rotation we started today. Last week was pretty slow, actually, but I liked the GI surgery patients I did get to see. I am pretty amazed by how adaptable the GI tract is and how relatively quickly people can get back to (mostly regular) po intake after their surgery.

Like other people have mentioned, the post-bariatric surgery educations made me a little nervous for the patients because they seemed so unprepared. The 2 I spoke with both had to have 6 visits with an RD prior to the surgery, but those visits were a year before the surgery. They couldn't tell me anything about the diet they needed to be following after their surgery. One lady, who appeared to have no family/friends helping her, didn't have any of the nutritional supplements (sugar-free Carnation Instant Breakfast, etc) that they are supposed to drink for extra protein. I'm not sure how soon she will be feeling up to going shopping for food, and it make me a little worried that she hadn't stocked up on these foods before she went in for surgery.

The new medical interns started last week, and it has been fun to educate them about what we do and need. I explained why we ask for metabolic cart studies to one intern today. Diane helped another intern who didn't know which were the fat soluble vitamins.

TPN is not common among UNC patients. There are about 25 adult patients on TPN at any time in the hospital, and there is a special adult TPN team made up of a pharmacist, RN, 2 MDs and 2 RDs. Each member of the team follows patients, and they swap if a patient has needs that are someone else's area of expertise. During rounds today, I was pretty surprised to hear the stories behind the patients - including people who can eat but want to stay on TPN instead. If I have a patient like that, I have already decided that my intervention will be baking cookies and bread outside their room until they caved. :)