An Interview with a Nutritionist

A: I focus on dialysis nutrition-those patients who have problems with their kidneys but are not able to receive a transplant yet. Dialysis helps wash out the toxic products in their bodies up to at least three times a week. However, in addition to washing out the toxins, dialysis washes out important proteins and minerals. My job is to help these patients boost their diet, by particularly regulating their intake of specific foods.

Q: Please describe a typical workday.

A: The first thing I must do upon meeting a patient is to give him/her a full assessment. I ask them what his/her food preferences and food frequencies (how often they eat food) are. Then, I ask him/her for a 24-hour recall. This is when he/she tells me what he ate the day before for breakfast, lunch, snack, and dinner. He must tell me how much he ate and what he specifically ate. It is a very detailed and specific procedure.

Next, I must ask him how much weight he has either gained or lost. Then, he must tell me about his appetite and details about specifics, such as how his chewing and swallowing are. I also question them about their habits, such as where do they shop for food, do they enjoy going out to eat, and if so, what kind of restaurants. I ask them: Do you smoke or drink? Do you have any allergies, nausea, or gastrointestinal problems (GI)? I also see information about medications he is currently taking from his medical charts.

Q: What kind of diet do you usually give to these patients?

A: I give them what is called a renal diet. This diet is very high in protein foods, and very low in phosphorus, sodium, and potassium. The diet also includes six cups of fluid ounces a day. Foods that are high in protein include meat, such as chicken, turkey, fish, beef, and eggs. Patients need at least 10 ounces of meat a day. Low blood protein could result in a high mortality rate. Phosphorus containing products include, dairy products, such as cheese, chocolate, beans, and peanut butter, and should be taken in low quantities. A medication, called BINDER, binds the phosphorus in the stomach and gets rid of it in the form of a stone, so that the system cannot absorb it. A low potassium diet would include 1 serving of a fruit or vegetable a day. Foods are separated into categories of high, medium, and low potassium. They can choose two to three servings from a low to medium potassium food, such as broccoli, cabbage, carrots, and green beans. Or they can choose one serving of a food from a high potassium food, such as spinach, tomatoes, mushroom, potatoes, bananas, and oranges. To limit salt, I always tell my patients not to add table salt to their foods. Food already contains a decent amount of salt. Instead, I tell them to use natural spices, like lemon or pepper. I always tell them to avoid high salted foods, like TV dinners, canned foods, and soup. In addition to all these instructions, I like to give them a handout that will explain everything I said even more clearly.

Q: Patients have to eat quite a lot of protein. What happens if they don't?

A: I know how difficult it is to eat a lot of protein throughout the day. Can you imagine eating three eggs for breakfast? I now recommend my patients to take supplements, such as Nepro, which is specific for dialysis patients. I also encourage them to eat protein bars.

Q: How did you decide to go into this field?

A: Well, I've always enjoyed cooking. I thought that nutrition would be related to cooking, so I chose this path. However, nutrition isn't really that much about cooking at all. However, I love it all the same.

Q: How long have you been a nutritionist?

A: I have been a nutritionist for over fourteen years now!

Q: Why did you decide to focus on the kidney?

A: The kidney and diabetes are the most dangerous cases that need nutritionists. The heartbeat relates to the balance of potassium. Any unbalances can cause sudden death. When I first went into residency, I was assigned into renal care, and I found that this is one of the most challenging jobs a nutritionist can do. Also, this area of focus means that I can really help the patients and see them improve. I feel like I play a very active and important role with my patients.

Q: What are the perks/rewards to this job?

A: I love making sure that the patients feel good and happy. Seeing their labs after working with them helps reinforce my willingness to help them. When I see that they appreciate my help and I see that they are doing well, I feel a great sense of accomplishment.

Q: What are the drawbacks?

A: I get very frustrated when my patients do not comply with the diets that I have prepared for them. Also, there's a special CQI number that I have to reach as part of my job, and when I don't achieve this number, I feel badly, even though I know that I have tried my best. In addition, for nursing home patients, the nursing home controls all the food that is given to patients. I can call the nursing home to tell them what to vie the patients, but mostly, they do not feel my patients what they are supposed to eat.

Q: What's the most interesting case you have ever taken on?

A: There was this one patient who thought she knew everything. Whenever someone talked to her, she would state that her doctor had already told her what she needed to know, so she didn't need to listen to a nutritionist. Once, I told her that she had a very high potassium level, and she was furious at me. Well, knowing that she was a former ice-skating coach, I knew how important it was for her to keep healthy. I told her that I would buy her some green tea, which I did. In addition, I approached her in a different way. Instead of telling her that her potassium levels were extremely high, I told her that they were high, but not too bad. The levels were stable and not increasing. Then, I gave her a hug to show that she had done well. Since then, she has never refused my treatment, and also says that I am the best nutritionist there.

Reflection:

I had a really fun and interesting time talking with Ming Zhao. I did not realize that nutrition could have such an intriguing and intense benefit on patients, especially those with a particular disease. I knew that there were nutritionists for diabetics, but I did not know that there were nutritionists for dialysis patients, too. I think the most enthralling aspect I learned is about the renal diet. I did not realize how strict each diet had to be. I think it's very difficult that dialysis patients have to eat so much meat, so it was nice to hear that there were other supplements, such as protein bars. I also found the BINDERS medication to be fascinating. After this interview, I really appreciate the value of nutritionists and how hard they work to improve the quality and condition of patients. Nutritionists really can help patients and improve their lives in a positive way.