Thursday, November 12, 2009

My Favorite Organ

I have mentioned before that I have a great interest in Renal Disease. I had been hoping to work in the Clinical Setting of Dietetics and specialize in Renal Disease.

For a very brief overview: the Kidney is the organ that filters your blood and cleans out the waste, which then gets excreted as urine. It also place a large role in fluid balance in the body and can affect your hydration status, or whether or not you retain fluids.

Kidney failure and disease can occur as a part of other chronic or acute diseases such as Congestive Heart Failure, Diabetes, high blood pressure etc and so on…

Once someone enters Kidney Failure, they generally have to go on Dialysis, which is a process where one’s blood is filtered and cleaned out by an outside source (either a machine, or a series of “baths”) Also, ones diet is SIGNIFICANTLY affected, which is why I was so interested in it.

Basically someone with End Stage Renal Disease (ESRD) or Renal Failure has to very carefully monitor their fluid, phosphorus, sodium, calcium, and protein intake.
If they do not follow their diet, they will make their condition significantly worse, and can wind up with severe fluid overload, which in turn makes it much harder for the heart to pump, difficult to breathe, and overall a feeling of great discomfort.

I first developed an interest in Medical Nutrition Therapy (MNT) for this disease after taking MNT II (which was basically a course on treating pathological conditions through nutrition therapy.) We had a case study on renal disease, and had to plan a diet for our "patient. "

It seemed IMPOSSIBLE! There are soo many limitations to the diet. I feel as though I am pretty knowledgeable about food, and (according to my bachelor of science degree) nutrition. So the thought that I was struggling so much to design a diet for someone made me realize that this population REALLY needed professional help.

Also, as I mentioned, non-compliance with the diet can lead to severe consequences FAST, such as 40 pounds of edema (water retention) in a matter of days. So, in theory, the patient would be more compliant, whereas other diseases like cardiovascular disease, noncompliance has a significant effect but the patient can't persay sense it right away. Due to this, Renal Disease appealed to me as a specialty thinking that my patients would be more apt to listen to me.

At Mass General, I work in the General Clinical Research Center (GCRC) and I worked very intensively over the past 2 years on a weighed diet study of Renal Disease, which furture spiked my interest in the disease. Basically the study was trying to see if feeding individuals with renal disease, that is not severe enough to warrant dialysis, the renal diet, could improve their condition and stave off ESRD. The study is still going so I have no results for you yet, I'll try to keep you posted, but anyway, I got more insight on the disease and got to work very closely with the patient population.

Since the summer, I have also worked at St. Elizabeth's and have gained even MORE experience with the renal population. and what I have learned:

I DO NOT want to work with them... (or not as much, I'm still interested in it...) Despite the dyer consequences of them ignore their MNT advise, they completely ignore their diets and are in general very uncompliant.
There are of course exceptions, but over all, renal disease is just like type 2 diabetes, or hypertension, or cardiovascular disease. Very few people listen to the dietitian. It is depressing.

I am currently doing my Dietetic Internship at Caritas Carney Hospital, and my preceptor always says, to her own dismay, "it's the nature of the beast" the individuals who wind up with these diseases tend to not put a high priority on their health. They often lead sedentary lives, and eat unhealthy foods for their entire life. There are again, always exceptions, some people are just genetically predisposed to these conditions or they are subject to them as comorbidities and complications of other diseases they did not persay have control over- but for the most part- lifestyle plays a significant part in the development of Kidney Disease, and people are not generally that motivated to change.

It occured to me that the fact that I wanted to work with Renal Disease patients made NO sense in regards to the fact that I am mainly interested in prevention. Once some one has ESRD- they are at an END STAGE! there is no prevention here... which is why the process of elimination is detering me away from this field.

This post does have some relevance other than just a review of the Kidney... check back tomorrow.

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