Poll: Who should deliver your advice?

[orlamk]

Hi I am a student and I am interested in who patients prefer to deliver their salt management advice. Who usually delivers this advice in your treatment and does impact on how you think about meals and adding salt? I would be very grateful if you could take part in the poll. Also please discuss below if you have any thoughts on this poll. 

[Rerun]

New patients don't realize how important salt restriction is because most of them still have some urine output.  But, once their kidneys totally shut down it hits home to them because the salt makes them thirsty and then the fluid has no where to go but in the tissue.  Then it is hard to get off and they cramp etc.  We only listen when there are consequences and cramping will make anyone a better listener. 

I've always said we should forget waterboarding our prisoners... just hook them up to a dialysis machine until they cramp and they will tell us anything!

I use Mrs. Dash as a substitute.  What do you suggest to your patients?  I know some salt substitutes have potassium so we have to steer clear of those.   

[Riki]

The dietician is who is SUPPOSED to give that kind of advice.  If they are not, then they are not doing their job

[Joe]

I count on my dietician for this kind of advice.

[sullidog]

I find most dietitions, not my current one, but one I had in the past, all she wanted to do is complain about what you weren't doing, and not  help you do what you are suppose to be doing, for example, my k was very low, she said she's not going to change my diet because of it, and my palpuations were stress related, but I knew in my  mind what the real issue was and I was right.

[malaka]

Geez, I thought all advice these days came from the Internet. 

At my center, the dietician hands out a monthly "report card" with lab test results on it and written suggestions like "avoid high potassium foods" which by itself isn't much help, but it does remind me to look what foods are forbidden and which are not.  (My wife doesn't quite understand that summer squash is o.k. but winter squash is not, for example). 

[sullidog]

What I meant to say she said my palputations were stress related when in fact they were k related which she would not let me eat more k even though it was low. I couldn't have fistula surgery because of her and spent 2 days in the hospital. I should of just took my own advice and did what I knew was right.

[jeannea]

I've seen a lot of people here complain about their nutritionist. How many of you actually listen to their nutritionist? I hardly ever did. My disease is odd and most of her standard advice didn't apply. (For ex., my potassium was always low. Always. I even had to take potassium supplements. But all her handouts said no potatos, etc.) Where do they learn to act like kindergarten teachers and give us smiley faces or gold stars? It keeps us from taking them seriously. I would go to PD clinic and many of them would refuse to see our nutritionist. There has to be a better way. Maybe some honesty would help, admitting that keeping to the diet is very hard and people struggle and cheat.

[stringbandbeth]

I am not a patient but I do my husbands Home- Hemo. He is unable to do most of it himself. He has been on D for almost 14 yrs.  I think folks are more inclined to be compliant with the diet if there is a team approach. Docs , nurses, and dieticians  need to coordinate if there is a issue. If the patient is complaining of swollen feet and shortness of breath it may take someone with more authority , like the Doctor , to really drill in the need for better sodium control. 
   The nurses in our Home D. unit also do a LOT of diet education with the patients. They are the ones who look at the labs first and address any issues that can't wait for the monthly clinic visit. They are also the ones who look at the daily flow sheets and see the weight gain and blood pressures every day.
   I'm sorry to say that Bear hardly ever listened to the dietitian.  The stupid printout of the blood work with the stickers and smiley faces ends up in the shredder every month. We receive a copy of the actual lab results for our records. Really the only advice we ever found really useful from the dietitian was all the lists of foods and their nutritional values.
   

[cdwbrooklyn]

It is very hard to obtain the renal diet and telling a grown person not to eat something that he/she has been eating all his/her life.  It goes thorough one ear and out of the other.  My dietarian does not tell me not to eat something because she knows I will not listen to her and eat it anyway.  However, she tells me how much I should eat and how many times to eat it in one week.  It helps because I’m not being told not to eat this and not to eat that.   I admire her for it as she understands that being on any diet is not that easy.   

[drgirlfriend]

My understanding, also, was that the dietician was in charge of such things. At first I was completely annoyed with her because all we got were lists of things not to eat. It seemed like nothing was left TO eat! Once the boyfriend (the one on dialysis) and I figured out that it was a balancing act, it was much easier. If he keeps track of what he eats, he can compensate for a high sodium lunch here or low protein dinner there. Nothing is completely off limits, you just have to be cautious.

I think a lot of the seemingly weird attitudes dieticians & nurses take with patients stems from a lot of the patients being elderly, not understanding what they're supposed to do, and some of them flat refuse to change. I believe that dealing with non-compliant patients will turn you into a kindergarten teacher eventually. The boyfriend is 27 and has had to tell nurses to back off with the nagging and over-explaining. I think they forget how to deal with regular adults.

[orlamk]

Thanks for all your comments

Seems like everyone has very different experiences with their dietitian. I understand that it can be a very difficult diet to stick to. I hope all your comments will help me to become a better dietitian and help me to empower patients to make them feel that they are in control of the changes they need to make and not feel that being told what to do.

[WishIKnew]

From whom

dietitian for me