finally, a GI patient…

today i saw my first gastrointestinal (GI) pediatric patient: a 15 yo boy who had just been diagnosed with ulcerative colitis.

ulcerative colitis (UC) is no fun. UC is a type of inflammatory bowel disease (IBD) characterized by a colon (large intestine) that is covered with ulcers. there are a number of etiologies: environmental, genetic, autoimmune, some think infectious (from a virus/bacteria/etc).

ulcers in one’s colon often leads to intense pain, diarrhea, bloody stools w/ mucus, and sometimes anorexia (loss of appetite) due to the eventual aversion to foods that trigger the symptoms.

the main medical nutrition therapy (MNT) for this type of patient in the acute hospital setting is first and foremost to stop the pain and inflammation (in this case with pain meds and steroids). once the symptoms are under control and the flare up has subsided, the second step is to get the patient on a low-residue (low fiber), low-fat diet with lots of fluids and fat-soluble vitamin supplements to allow the bowel to heal and replenish lost electrolytes and vitamins.

my job was to educate the 15 yo about his GI and his new condition. my main goals were to make a diet plan for him and his family to fall back on during the next flare-up, or teach him how to manage the condition through diet (e.g. lay off high-fiber, high-fat, high-caffeine foods during flare ups).

it was a major bonus that both mom and dad were in the room for the entire visit. they learned a lot as well.

we also talked about how the patient will slowly figure out his own individual “triggers,” or foods that bring on an acute flare-up. his triggers may be caffeine and stress, while his mom says she reacts to alfredo sauce (she also suffers from UC).

before i visited the patient, i really had to think about how i was going to educate a 15 yo boy about his bowels. not an easy sell. i had to figure out a way to make the patient care about his condition and take a bit of interest in the plan of care.

my idea: i would focus on his height. my thinking was that 15 yo boys (and girls) are really still thinking about linear growth, which at 15 is absolutely still happening and absolutely tied to nutrition. as a child becomes malnourished, the first thing to go by the wayside is weight, then height, then brain growth (in pediatrics, brain growth is measured by head circumference).

so, my plan with this kid was to start the conversation with my goals to continue to see nice, normal weight gain (only possible through good eating/bowel health), so we could protect his linear growth (height).

i think i got through.

more to come!