Georgetown Week 9

Today was my last day in Oncology. The RD gave me one of her floors, so I was pretty much on my own today.

I had one consult for a woman with peritoneal CA, who requested to speak with a dietitian because she has lost about 24 lbs since she was first diagnosed. She basically wanted to know what to eat to start gaining some wt. It was a bit challenging because she says she has a milk allergy, it's not just lactose intolerance. We talked about nutrient-dense foods, and sneaking in calories with honey, peanut butter, nuts, oils, gravy, etc. We also discussed making shakes with soy milk and supplements, especially because she gets full very quickly. I provided some handouts from NutritionCareManual.org.

I saw two pts that are bascially going downhill. One was started on TPN because she has a partial SBO, and he's only on clears right now. He is not a candidate for surgery and it is likely that they won't start chemo either. So basically, there was no other option.
The other pt has stomach cancer. He is on a mechanical soft diet, but he also gets full very quickly because of a stomach resection. He just had an abd CT which also showed a bleed (I was confused about why he's allowed to be on a diet), so GI says he's not a candidate for a J-tube at this time. He also has liver mets, so pallative care is hesitant for TPN. We had rounds today and most people, including the medical team, think this case will probably end up with hospice since we're running out of options. But, the pt doesn't want to give up!

On a different note, I saw a f/u Psych pt today, on my own. We see pts on this unit by consult only. She is a vegetarian and initally wanted to talk to us because she feels that our kitchen is "not equipped" to provide appropriate vegetarian meals. She says the vegetarian meals do not consistenly have enough protein. The kitchen says they are sending her what shes ordering - grilled cheese, salads with cheese, and beans, but she says she doesn't get what she orders. So, I don't know. I asked the kitchen to give me a copy of the vegetarian menu. Last time we recommended soy milk, yogurt, and peanut butter with all meals. She's been getting these things but is sick of eating the same things over and over again. Understandable. I requested a PAB check.