Talk about allergies...

This week I've continued my staffing of the oncology/medical floor, which I've thoroughly enjoyed. I've had a lot of good patient and family member interaction, and I feel like I've made a good impact on several people. One little wife of a little old man told me that she really liked having students help her husband. Some nursing students had been there before me, and she told me they were as caring as they could be. She was really grateful for my consideration of her husband's wishes. So cute.

However, I happened upon my most interesting patient of the week today. I thought it was just a normal diabetic education for a middle aged man who couldn't learn how to control his glucose very well. I looked at the chart where the MD wrote the orders for a RD consult, and it said "Nutrition consult--allergies." Nothing about diabetes... I go in the room, and the patient is asleep. However, there is another man in the room (I think the patient's brother...), who was happy to see me. It was he who had asked the doctor to ask for a RD consult. Apparently the patient had stomach stapling performed during the 1970's, which caused some complications, and he had to have it reversed. In the process of these complications, the patient developed "allergies" (supposedly...) to: all meats, poultry, seafood, green vegetables, and strawberries, along with some medications. The patient also has CKD, diabetes, CHF, CAD, HTN, etc. His brother told me he follows a diet of primarily grain-based carbs (chips, biscuits, cereal, tortillas), vegetables (which only included corn, pre-soaked potatoes, and KETCHUP--yes, he said that), eggs, bacon, and the occasional piece of fruit. He had a semi-working knowledge about foods with potassium and phosphorus. He said that his brother is usually in the hospital about once a month. They just moved from Washington, and the RD at their old hospital took care of them all the time. So I was trying to figure out what kind of diet to put him on... vegetarian + renal + diabetic + cardiac + no allergies? Awful. I ended up printing out a menu for the next 3 days and having him fill out what he wanted. The brother filled it out for him and basically wrote in that he wanted cereal for every meal, with a piece of fruit, and 2% milk (milk three times a day = phosphorus, anyone?). I gave him some handouts about K, Phos, and carbs, but who knows if that education will do any good. Who knows. A bit hopeless.