Every week I learn more and more. Entering my cardiology rotation, I’ll admit, I was not super prepared. I was wonder how this was going to be different than the weight management clinic? In the grand scheme of things it was, but I learned a little bit more about how we metabolize nutrients and got to help families make small changes without upsetting their whole routine.
One of the hardest parts about nutrition for me is applying the physiology we learn in class to how nutrients and food are actually metabolized in the body. That was probably my biggest take away from this week in the outpatient clinics I was in. I’ll just give a quick recap. When we are talking about heart health and nutrition, it pretty much comes down to a few things, cholesterol, triglycerides, and sodium. In these clinics we mainly focused on cholesterol and triglycerides. Here is what I learned, saturated fats increase low-density lipoprotein (LDL or bad cholesterol). DUH! We all know that!! But I also learned that sugars, like sweets, and low fiber, non nutrient dense carbohydrates increase triglycerides. Crazy right? The sugar we consume affects the fat in our blood stream not just our glucose levels. The last thing that really just helped sum things up for me, is that high-density lipoprotein (HDL or good cholesterol) are increased with exercise.
In addition to out patient clinics I spent one day in inpatient cardiology. Which was really interesting because a lot of my patients that day were babies. The tricky thing with this population is that you often can’t provide them optimal calories without overdoing their fluid restrictions. This is so important because most of these babies do not have their chests fully closed up yet do to fluid retention. This experience just goes to highlight that there are very rarely situations where nutrition is as black and white as we are taught in school.
Following this the Cardiology rotation, I spent a week in the Pediatric Intensive Care Unit (PICU). It was intense to say the least. To avoid any HIPPA violations I’m going to refrain from going in to too much detail this week, because all of the patients have such unique and severe cases that it would be easier for them to be identified.
In the PICU the dietitian I was with rounded with two different teams, which makes it a little hard to keep up, especially since they round at the same time. Often in the PICU it’s about getting the patients as much nutrition as possible because with their conditions they often do not want to eat. However, there are also several patients who require feeding tubes either enterally (using their digestive tract) or parenterally (infusing nutrients directing into the blood stream for use). This requires calculations and adjustments on the dietitians end to ensure that patients are getting the best nutrition possible for their disease state.
This week definitely topped the list for favorite rotations. I loved being involved in so many complex cases that were so different. I will say that it did make me a little less sensitive to other peoples problems, because these patients had such serious illnesses. But over all I think I could be here everyday. I also got to really fine tune my TPN (total parenteral nutrition) calculations, which is not something that all interns get to learn. Like I’ve said before, your internship is what you make it, take advantage of the opportunities given to you.