As I entered the 7th week of my internship I wasn’t really sure what to expect. The Gastrointestinal (GI) field is so broad, but I went into it with an open mind and it was an interesting to say the least.
I’m glad I walked into week 7 not knowing what to expect because I couldn’t have predicted how this week would go. First off, my preceptor for the first two days was covering for another dietitian who is usually on the GI service, and she was also covering for the Liver team, I am so glad this was the case. This particular RD is really involved in the feeding team and has extensive experience working with pediatric oncology, so although she does not necessarily do inpatient GI she has a ton of experience with the GI disorders and how the GI system is affected by other medical issues a patient is experiencing.
Becasue we were covering the inpatient GI service for just a few days, in nutrition interventions were minimal. We still gave nutrition recommendations for all our patients, however, when you are covering another RD’s service, you don’t want to shake things up too much with the team or with families because when the other RD returns you don’t want to have set them up to contradict you, and you don’t want to contradict them while you are providing care. Overall, this is better for patient care because patients and their families are hearing one message, and it’s also a professional courtesy to avoid complicating your fellow RD’s day.
Since we weren’t interacting with too many patients for the above reasons. I took some opportunities that my preceptor gave me. First, my preceptor asked me what I wanted to learn. I was a little unprepared for this, because I want to learn all of it! But what I was dying to learn was Total Parenteral Nutrition (TPN). This is a venous infusion of nutrition for those who do not have a functioning GI tract. In order to provide TPN there are a series of calculations that need to be preformed in order to determine what the patient can tolerate. In order to give TPN recommendations in many hospitals you need a special certification, because if TPN is not administered correctly it can be life threatening.
Although we learned how to do TPN calculations in undergrad, it was something that seemed very complicated to me and just did not stick. However, the hospital I was at does their TPN calculations differently than most other hospitals, so eventually I’ll have to relearn it, but it was nice to get a better understanding of the components of TPN. I also learned a lot about the many different GI diseases but there is just so much that can be hard to wrap your head around in just two days.
The next two days, I worked with in the outpatient GI clinic. However, we were on call for part of the time, meaning we waited until a provider (either a physician or a nurse practitioner) determined a patient needed a nutrition consult. And the other part of the time, we had scheduled patients but we ended up having quite a few no shows. Even though I didn’t see many patients this week, I had another extremely knowledgeable RD who gave me a lot to read and research. This may sound boring, but the topics were interesting and many of the resources were patient friendly.
The two major topics I looked at were the low FODMAP diet and the specific carbohydrate diet (SCD). I had heard about the low FODMAP diet but the SCD was new to me, however, it did have some similar components to the low FODMAP diet. For now I’m going to leave out the specifics, a great opportunity to do some of your own research, but the bottom line is they are both elimination diets that can benefit digestion and gut function.
I also looked into short-bowel syndrome (SBS), which was fairly new to me, but very interesting. With SBS, part of the gut has been respected which has a huge effect on digestion, nutrient absorption, and overall health. SBS is a complex disease in which the nutrition recommendations very person to person, depending on which sections of the gut are not functional.
The bottom line is, even though I didn’t have a ton of patient interaction, I still learned a lot. Like I have said in previous posts, your internship is a lot of what you make it and what knowledge you seek to learn. Additionally, the research I got to do was right up my ally, I love the idea of tailored diets for optimal health. Plus, it was nice to be able to do some research during the day, instead of at night when I normally do my homework.