Mysterious weight loss

On Friday, I did an initial assessment of a patient who came in with a diagnosis of primary ciliary dyskinesia (Kartagener’s Syndrome). This is a rare genetic disorder where the cilia lining the respiratory and male reproductive tract are abnormal and therefore, unable to move properly. People with PCD have chronic respiratory infections and bronchiectasis and men are usually infertile. It sounds a lot like cystic fibrosis. Nutrition was consulted because this patient had weight loss of about 8% in the past 4-6 weeks. The patient’s description of his BMs made us suspect that the weight loss is due to malabsorption, and in fact, the patient is being worked up for cystic fibrosis. I am really excited to see results from his fat-soluble vitamin labs and fecal fat study tomorrow. If it is CF, it will be interesting to educate him about CF, figure out his enzymes, etc. If it isn’t CF, it will be even more interesting to try to address his weight loss, because nothing I’ve read about PCD suggests an association with malabsorption.

I had a couple of other helpful experiences this week. On Thursday I saw a patient’s ostomy bag. In rounds, the team had mentioned the patient’s discomfort with the ostomy bags the hospital provided, saying that they fell off too easily and expressing a strong preference for the bags he uses at home. He said the same thing to us when we stopped by to do a brief ostomy diet refresher. It was kind of yucky to see the ostomy output. I can definitely imagine how self-conscious I would always be about having an ostomy bag and how important it would be to me to use supplies that I knew worked so that I would avoid any mishaps.

Additionally, we were consulted for nutrition education for a man newly diagnosed with diabetes who required insulin. He was a rehab patient who may or may not have really understood everything that was going on, but Diane did a lovely education and helped his wife understand the basics of a consistent carb diet. As we were finishing up, the nurse came in to give the patient his insulin, so we stuck around and watched. The wife is still new to doing a fingerstick and using the glucose meter, so the nurse and my RD talked her through it, showing her how to “milk the finger” to get a good drop of blood out and then to place the meter at a 90-degree angle to the finger to get the blood into the strip. The reading was 153, which was just above the sliding scale “normal” range. My RD discussed with the patient’s wife what she could do next: either administer 2 units of insulin or go for a walk/PT to help bring the glucose levels into a normal range. It was super helpful to me to be watching someone learn about managing diabetes and to actually see a blood glucose reading done.

Onto the burn unit next week!