What about pureed cheese and crackers...?

SOOO, I don't really have any cool photos or anything to show off today. Mainly, I just had a really cool dietitian-y day and I want to brag about it.

First of all, I'm managing about 5 patients for now. This is pretty good, considering the outlines for clinical one say at the end of week 3 only require me to be managing 3ish. I was at 4 until this morning, when I walked into my preceptor's office at 8:05 and she gave me a slightly evil grin.

'Boy, do I have a patient for you.'

Okay, so it wasn't really evil. She's a lovely lady. Maybe just a bit devious, sort of like this baby:

She didn't stick her tongue out, though.

Disclaimer: I am making this as vague as possible while getting the story across. Boyfriend suggested to do it in a way that no one who knows this pt (except maybe another health care provider) would know who I'm taking about.

So anyway, my new patient has some injuries. This pt also decided they didn't appreciate tube feeds, and so, naturally, removed it. This tube feed happened to be nasogastric - you can imagine pulling a tube out from up your nose that may or may not still have had tube feed formula coming out. (This sweet elixir of life is almost always brown, a bit like weak coffee with lots of milk.)

Nommers!

I go talk to this pt and they pretty well start off at the basics.

'This food tastes like paste made of sawdust.'

Valid point, my friend. Pt was on a pureed diet, which as anyone will tell you, is not exactly what you'd like to have for lunch. I've tasted pureed mac and cheese, and was absolutely astonished to find it actually tasted like mac and cheese. How weird is that? Just because it was pureed, I expected it to taste totally different. I can totally understand that it's completely unappetizing. Pt seemed to be over the swallowing issues and had a full set of teeth (and had family bringing in tasties anyway), so I upgraded them. This is not something I haven't heard before, at any rate.

GET IN MAH BELLY.

I ended up negotiating a calorie count, since pt is also losing a bit of weight. Pt is going to write down everything they eat for the next 3 days and then we'll sort something out. Although, even if they are eating peanuts and peanuts alone, tube feeding isn't an option anyway. Anyway, the point of this is that I dealt with this fairly complex patient all by my onesy.

Patient #2: There are some potential issues with this pt. They know they need a different learning style, but can't get so far as to tell you what it is. They also couldn't figure out what exactly they were going for, and were getting very frustrated that we couldn't figure it out for them. So, we're going on and not really getting anywhere, and my preceptor has another appointment. I had told her in past I do fairly well with this sort of thing, and she decided to let me take them on myself.

For the most part, we suggest/encourage/support patients to make their owns decisions and gain information. Other pts apparently feel this means we were making them do all the work. Therefore, I spent half an hour shamelessly bossing around this person, using plastic food to come up with meals, and making grocery lists out of it. I sometimes forget some people don't know how to grocery shop (and this coming from a girl who had a roommate who thought whoever had a car took care of groceries). Yet again, it comes up that I need to remember not everyone is as obsessed with food and diets and the like as I am. Anyway, the end result was that my preceptor told me I seem to have an innate sense of what works for pts when their style is a bit out of the ordinary. I want to work in mental health, so I'm thinking this could be a good thing.

We looked back at all my other pts, and it turns out all of my interventions worked! One pt's gazillion supplements were cut down (pharmacists are wonderful), one was finally getting enough to eat and enough insulin to deal with it, and the last was finally getting food they liked. For various reasons, this pt has a hard time feeding themselves, and they also have a hard time with memory. Finally, I found something they were excited about (and they were excited about every bite, since they couldn't remember what they were eating!): cheese and crackers. I find this is a pretty big hit overall, actually, if you offer someone cheese and crackers they'll rarely say no.

Moral of the story: Most people like finger food and purees look bad enough that a lot of people don't care how they taste. True story.