More instruction at Rex

I'm still doing my combined DM/cardio rotation, and that involves a lot of instructs, as I'm sure most of you know.

On Monday, I observed "Cardiac Class" for pts who have had CABGs. It's necessary to do a class since there are so many CABG pts at Rex (my preceptor would spend all of her time doing instructs otherwise), but it's hard to tailor the class to everyone's co-morbidities, lifestyle, learning abilities, etc. It was small on Monday with 3 pts, but I can see it getting really hard with 10+, which is more usual. I'm hoping there won't be too many when I teach it Friday.

I've been getting lots of practice doing diabetes instructs on my own. One was with a woman who has had T2DM for ~10 yrs, but she still has the idea in her head that all carbs are bad and that she can't eat any. She seemed shocked that she got a whole wheat English muffin at breakfast. I spent quite a while with her, reiterating that carbs are good, she just needs to pay attention to how much she has and when. I had another interesting one with a pt's adult son who will be taking care of her, along w/ home health aides. I wish I had thought more ahead of time about the logistics of planning someone else's meal pattern.

I've also done several instructs for post-bariatric surgery pts. (I'm not sure why this RD gets them along with cardiac pts...) With all of the interest in bariatric surgery (and weight loss in general), there are new products coming out, so I feel like I always get asked about something I've never heard of before. Pts have all been understanding, though, and appreciative when I say I'll get back to them on whether a particular item is ok. I never thought I'd be using Google for info as an RD, but sometimes it's the only way to find out what's in a given brand of protein powder.

An interesting situation: we have a post-op bariatric pt who is gluten intolerant. She's had some complications, so unlike most pts, she wasn't discharged before starting full liquids. Rex doesn't have much in the way of gluten-free full liquids, so a diet tech actually went to Whole Foods to get her stuff.