di: cardiology

It is my sole intention of my personal life this weekend to 1) run a 5K and 2) write an actual blog about life and not all these series posts for y’all. Hell, maybe I’ll even finally blog about running….

Or lets not get ahead of ourselves.

Anyway, I want to MAKE SURE I am keeping up with my internship posts every week for both y’all and for me.

So last week I did my Cardiology rotation. And it was awesome.

Truthfully, I see cardiology and a dietitian’s role in cardiology as more a preventative role and/or outpatient role. Inpatient cardiology is not primarily diet related. (or at least that’s my interpretation from the last week.) Therefore, I thought this rotation was super awesome because of all the medical things I learned, and not so much the nutrition interventions I performed. I understand heart disease and heart problems SO MUCH BETTER after going through this rotation than I ever could have understood just reading about it in a text book.

So before I get ahead of myself – I did several other things in this rotation, but I’ll mention those later in the post. As for the true inpatient, acute cardiology patients – most that I saw were post-surgical and/or had complications related to their heart disease. I saw some random thoracic diseased patients too, but I can’t mention those because they are more rare (and thus I have to protect patient privacy).

I spent a lot of time in the ICU – so that’s why I was seeing those post surgical patients. Of the patients I saw just on the general cardiac floor, most had Congestive Heart Failure and I did a lot of diet educations for that disease over the week.

In the ICU, here’s a flavor of what I saw. A lot of Post-Coronary Artery Bypass (called CABG) patients. You know when you hear someone had triple bypass surgery? This is the surgery they mean. I also saw several aortic aneurysm patients, both thoracic aorta and abdominal aorta. I saw both surgical and medical management of these aneurysms. Then I saw several patients with complications of coronary artery disease – for some it manifested in their mouth, others in their lungs, etc. I wish I could go into more detail, but I can’t.

For most of these patients in the ICU, we had them on tube feedings. We had a few patients over the week on TPN, so I got some good practice with that. But I did a LOT of tube feedings, which I love. A lot of these patients were ventilated and sedated, so not a lot of patient interviewing or speaking with them. I will say I got a LOT more comfortable over the week being in the ICU, which I really hadn’t been comfortable until this week.

As for the floor patients, I did mostly Congestive Heart Failure educations. The principles of this education is a 2gram (2,000 mg) sodium diet and fluid restriction, if the doctor had them ordered on it. I really enjoyed these CHF educations, though they were really really simple. Most of the patients are already eating low sodium, so I don’t feel like I helped them much – but maybe I did?

I didn’t do too many other educations, because I attended a discharge diet education class done by our Diet Tech for the post CABG patients and their families (I’m sure other heart surgery patients were there too.) This class was more the classic cardiac diet education – low fat, low cholesterol, low salt, etc. The Diet Techs at Baylor do these educations, so that isn’t something the RDs typically do day to day.

That’s mainly what I did for just the pure cardiology part of the rotation. I was seeing ICU patients on my own by the end of the week, which was great! This week was week 4 in clinical and I could really really tell how far I’ve come in 4 weeks with reading charts, understanding the medical information and separating the medical info from the nutritional info.

So as for these other things I did, I spent half a day in a Cardiac Catheter Lab, which was AMAZING. I swear y’all, if I had to pick one other part of medicine to work in – it’d be in this lab.  I had the best time and I want to hang out in there every day.

I don’t want to go into too much detail on cardiac catheters (but if you have questions, please let me know). I have NO nutritional affection on these catheter patients, it was more of a multidisciplinary activity to see what happens when someone is sent to the Cath lab and what happens when they have a stent or angioplasty done. FASCINATING.

After the cath lab, I spent the rest of the day at a heart and vascular hospital. This hospital specializes in both invasive and non-invasive cardiac interventions. This is a really small hospital with fast turnover, so there is only one RD there and she runs both the clinical side and the foodservice side. The RD there is a former Baylor intern from last year’s class, so it was great to be with her for the day. (and I’ll be back to do a foodservice rotation here in a few weeks).

We saw clinical patients, but we also spent time in the kitchen – making a gluten free menu for a patient and participating in the foodservice team huddles for the day. I attended meetings with her, which definitely wasn’t my interest. Reminded me a bit too much of my last job. I’m all for less sitting, more walking around seeing patients, thank you

Anyway, overall it was an amazing week. I learned SO MUCH. I can’t say I would want to work in this area of dietetics on the inpatient side, but I could definitely see myself working with cardiac patients in an outpatient setting. The heart is simply amazing.

What cardiac questions can I answer for you?