Protinex

I thought that getting care from a dietitian was required for all patients in the ICU and IMCU.  Today, I saw Gayathiri check two patients’ charts, close them, and move on without doing any diet orders or counseling.  She later informed me that the doctor who sees those patients refuses any other person’s care.  He does not accept dietitian or physiotherapist opinions.  He says that the patient is his and that he will give all of the care.  The dietitian approached him about this once, and she was shot down.  It seems ridiculous to me to turn down the care of other professionals.  In the United States, it would be illegal for this doctor to be giving orders that he received no education, degree, or certification to quality him to give.  This is an example of why the speaker yesterday at the Abbot Nutrition Meeting told the dietitians that they must be firm with their profession.  When speaking to patients, though, they are sometimes too firm! One patient’s caretaker informed her that he had given the patient vada, coconut chutney, samosa, etc.  These foods are all either deep fried or high in saturated fat.  The patient had diabetes, though, and these fried foods are not good for her.  The dietitian told them “this person has diabetes, how could you possibly give her these foods?”  This statement feels very judgmental, and this is something we are told not to be when educating patients. 

Today, some patients worsened, others stayed the same, and some improved.  One patient has been receiving crackers at each meal along with all of the food through the Ryles tube.  She is being given these biscuits solely to test her ability to handle solid foods.  She continues to reflux, though, so she cannot progress to a regular diet.  Another patient has gone four days without pooping.  He has been bloating and has abdominal disturbance.  His tube feeding was reduced from 100 mL/hour to 75 mL/hour and he was put back onto an IV.  The dietitian said this stoppage could be from medicine or some other deeper issue.  Hopefully, he resumes his movements soon.  There was one woman who improved drastically today.  A few days ago, she had a CVA, cerebrovascular accident, but she is only 32 years old! Apparently, she is from northern India, where ghee is very popular.  Here in South India, Brahmins consume a lot of ghee, but most other people cook with oils.  In northern India, many people cook all of their food with ghee.  Some families consume 15 kg each month.  This is a lot of saturated fat!  This goes to show you how diet can seriously mess with your health even as a young person.  This woman now has hemiplegia, which is partial paralysis, all because she was cooking with one type of fat over another.  Considerations like these over the long haul can affect you severely. 

Later in the evening, I went to another nutrition meeting!  This meeting was hosted by protinex, a meal and protein replacement company.  The first half was in English, but the speaker gradually switched to Tamil half way through.  One thing that I do want to mention that he said is that, at least in diabetes management, the work dietitians do to change a patient’s diet and exercise habits will contribute 60% to the recovery of the patient.  He said doctors are secondary and that medicines like insulin or metformin can only contribute 40%.  He told the dietitians to make this known to the doctors and to push for diet counseling for all patients.  This seemed pertinent today considering Gayathiri told me that some doctors refuse dietitian considerations.  This view is also opposite of Dr. Siva when he told me, two weeks ago, that diabetes was caused 80% by genetics and treatment was mainly by medicines.  It is nice to see that researchers and companies are pushing for more recognition of the importance of this aspect of care.  Gayathiri also spoke about low glycemic index diets and diabetes management.  One cool thing she mentioned was how diabetic people can eat their favorite, sweet foods.  If they combine these high glycemic index foods with certain things like healthy fats, which slow stomach emptying and digestion, or foods with soluble fibers, which make sugars less available for absorption, their blood sugar will not spike so severely.  After the meeting, we had dinner at this hotel.  I told the BHC driver to arrive one hour and 15 minutes after the scheduled end-time, and this ended up being just enough time. 

Also, I will post pics of this last weekend soon; the internet is kind of wonky sometimes and wouldn't support uploads.