Spring semester is nearly over–just a couple more days of my dialysis rotation are standing between me and spring break. Then I’ll have one final 6-week long summer session with my food service and long-term care rotations before I’m done with my dietetic internship. This week I attended Advocacy Day with the Illinois Academy of Nutrition and Dietetics and began my dialysis rotation.
Here’s what my week looked like:
Monday:
No supervised practice yet today, but I did still have my weekly night class. This week we learned about different gastrointestinal disorders. We were split into groups again to give a presentation on one of the different GI disorders. My group presented on Crohn’s Disease and Ulcerative Colitis. This is the last class where we’ll have an actual lecture–next week we’re just giving our final presentations for the semester.
Tuesday:
Today was advocacy day at the Illinois State Capitol building in Springfield, Illinois. I woke up bright and early to get to a fellow intern’s house by 6am so that we could carpool for the additional 3 hour drive. We learned about the role of lobbyists and advocates in the legislative process and were coached on how to talk to legislators. Then they split us into groups and had us go talk to our legislators about bills that pertain to nutrition and dietetics. I don’t actually vote in Illinois (I vote in Minnesota), so I pretty much just tagged along with my group to talk to the people who would be my legislators if I voted in Illinois. None of them were available to actually talk, however, so we just dropped off information about the bills we’re supporting. Then we all piled back into the car for our long drive home. It was really cool to actually see the capitol building though even if it was a hike to get there.
Wednesday:
First day of my dialysis rotation! This is also the first rotation I’ve had where my commute is less than 45 minutes one way which is extremely exciting (even if it’s only for 5 days). My preceptor gave me a tour of the dialysis clinic which is pretty small overall. It’s split into essentially three parts: the lobby, the dialysis room, and the staff area where there’s offices and the break room. When patients come in for their dialysis session they wait in the lobby until a dialysis technician is available to connect them to a dialysis machine. They sit in an armchair that has a TV on one side and a dialysis machine on the other. There’s just over a dozen of these setups around the perimeter of the dialysis room. Patients generally have to come to dialysis three days a week and each session is typically 3-4 hours long. This may seem like a lot, but when you think about the fact that healthy kidneys clean your blood 24/7 it’s kind of impressive to me that dialysis can do this in about 12 hours a week.
After showing me around, my preceptor and I did rounds with the patients. Basically, we go around and check on patient’s lab values and ask about how they’ve been eating. When patients are on dialysis they have to follow a renal diet which requires them to pay quite a bit of attention to what they’re eating/drinking and how much. Most of the patients we saw today have been on dialysis for years, so they didn’t have a lot of questions or concerns about the renal diet.
Thursday:
We had a kidney disease class to teach today. About once a month, the dialysis clinic I’m at offers a free kidney disease class for the general public. The purpose of this class is to teach people with lower stages of kidney disease how to slow the progression of their disease and delay the need for dialysis. There are five stages of kidney disease with one being the least severe and five being the most severe. Once a patient is at stage five their kidneys barely work, if at all, and they require dialysis and/or a kidney transplant to survive. In this class, we covered the basics of kidney disease. We also talked about how it progresses and how to slow progression through diet and lifestyle changes. At the end, we covered treatment options once kidney disease has progressed.
After the class, we met with a couple more patients to discuss how well they’re following the renal diet. Besides daily rounds, the dietitian meets with patients monthly. They talk in detail about the patient’s lab results and how these reflect how well they’re managing their kidney disease. Rounds generally happen three times during the dietitian’s workday. This is because there’s three different dialysis “shifts” that patients are assigned to.
Then, I changed the bulletin board in the lobby. The clinic has bulletin boards that discuss a different component of kidney health. I designed a bulletin board around building a kidney friendly kitchen and grocery shopping tips. Diet is a huge part of the successful management of kidney disease.
Friday:
I met with a patient to talk about diet strategies to lose weight while still following the renal diet. In order to be on the kidney transplant list patients can’t be too overweight as this increases surgery risk. My patient has to lose about 25 pounds in order to be eligible for a kidney transplant. Rather than eating too much, her problem is actually that she isn’t eating enough. Kidney disease and dialysis often make patients lose their appetite to some degree which causes them to eat less. If you don’t eat enough to sustain your body’s basic needs, your body lowers your metabolism which makes it extremely difficult to lose weight. Essentially, you need to eat enough, but not too much in order to lose weight. I spent the rest of the day reading different materials my preceptor provided about kidney disease.
My (not sure how many I’ve written for them at this point) post for the Chicago Academy of Nutrition and Dietetics was posted today as well. I wrote about how underrated lima beans are for Lima Bean Respect Day. You can find the post here.
Weekend:
I have a presentation due on Monday, and a paper due the following week so I spent most of the weekend working. With the end of the semester just around the corner I have a lot to do!
Next week I’ll be finishing my dialysis rotation, giving my final presentation in my night class, and finishing spring semester. Until then!