Kristin, the CF dietitian, works with patients on their "anti-diet". She promotes adding butter, oil, cream to nearly everything to add calories. There is a direct correlation between BMI and lung function. For the most part, the higher the BMI, the better function you will have, Many of her female patients "forget" to take their enzymes in hopes of keeping a very slender frame. Kristin is constantly battling with them to take their enzymes to keep a BMI within healthy range (around 20-25).
We had a 20 something year old, male patient today who lost a few pounds from his already emaciated frame. His caloric requirements are... 7,000 calories a day. It almost seems unbelievable. He receives 4,000 calories overnight through a tube that feeds into his stomach to alleviate the almost impossible caloric goal during the day. He lost weight this week because he cannot afford his grocery list. He is supporting himself in college and as I am quite familiar with, funds are normally low. I suggested Costco to buy in bulk for a cheap price. My heart went out to him. His lung capacity is at 28% and he now wears an oxygen mask. I'm praying Costco can help him out, even throw a deal his way....
I enjoyed this rotation because the dietitian works closely with the patients. CF is a lifelong disease, so Kristin forms a bond with the kids, seeing them numerous times a year. The clinical team takes her expertise seriously and relies on her to keep these patients up in their weight. I like rotations in which the RD is valued. We don't go to school for nothing!
My girlfriend has CF and had a double-lung transplant two years ago. Even though her lung function is good (107% FEV1 on her last visit), her doctor still recommends a diet supplimented by butter and whole milk. We have a huge shelf of candy in our house. She doesn't go through it like she used to, but some days...she's gotta come close to that 7,000 calorie mark, I swear.
ReplyDeleteShe wieghs more than she would like, but I remind her that her BMI is more critical than her wieght.
I had a pt with CF when I was a diet tech, and I remember the first time I took down his dinner selection . . . it was so much food! But you are right, they do need a lot of kcals and it's so hard to keep weight on. I'm like you: I want to form long term relationships with patients, not just see them once or twice and then say goodbye and good luck.
ReplyDelete