Archive for the ‘Guest Post’ Category

Hi, my name is Uma Vullaganti and I have been a renal socialworker since September 1997. I fell into this field because I needed a local placement for my internship. I had no idea what dialysis was, prior to this placement. And now I can say it is my true calling. I cannot imagine doing anything else. I have 2 bachelors degrees, Psychology and Socialwork, and a masters in Socialwork from University of Alabama. A renal socialworker’s job is very unique in that we deal with chronic situation. Our patients do not come and go. They are with us for the rest of their lives, dialyzing in our clinics 3 days a week, until transplanted. This creates a unique situation for a certain level of bonding. This is true for all disciplines. It is going to be difficult to pinpoint a renal socialworker’s job description, because we are seen as “problem solvers” “travel agents” “insurance agents” “listeners” and a “catch all”. One of things I focus on is the “New patient”. So for this blog, here is a peek into their world…The New Patient

Advocating for the New Patient

When we have a new patient start with us, one of the first things we tell them is that they are not alone, that their care will be followed by a “team”. This considerably reduces their anxiety when they know that they will be cared for by the MD(doctor) CRNP(nurse practitioner), RN ( registered nurse), Tech (patient care technician), RD (registered dietitian and SW ( social worker).

For the new patients, the first 90 days and sometimes beyond, of initiating dialysis can be a period of intense anxiety and vulnerability. Many of our patients have minimal knowledge of End Stage Renal Disease (ESRD) and are confused about the treatment regimen and expectations. Time is spent to build trust and gain their confidence. We are sensitive to the new patient’s needs, communicating with them as we focus on reassuring their fears.  We do this by tending to their needs, however simple. Many face a dramatic change in their lifestyle as they prepare themselves for the dialysis routine. There are several issues they may have to face, such as the possibility of leaving their jobs, thereby losing their livelihood, applying for retirement benefits or disability benefits, dealing with insurance coverage, prescription coverage, trying to meet expenses of daily living with limited income, reduced ability to care for self, unable to perform activities of daily living, etc. The renal social worker addresses all of those.

It is not an easy transition from life before dialysis to life after dialysis. More later…..


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A Dietitian’s World

Well this is not Jennifer or Jason blogging today.  This is Jennifer’s sister, Stephanie Gossett writing for the blog today.  I am a renal dietitian and have worked in dialysis for the past 12 years.  I received my undergraduate degree in Dietetics from Jacksonville State University and my Masters in Human Nutrition from the University of Alabama.  While completing my graduate program, Jennifer had to begin dialysis for a second time.  After graduating, I felt a strong pull to work in dialysis to help these patients. There are many aspects to dialysis that the general population has no comprehension of.  Besides the doctor, there are nurse practitioners, nurses, patient technicians, water treatment technicians, social workers, and dietitians who work together to make life “as normal as possible” for the patients. Most people ask me, “Why in the world does a dialysis patient need a dietitian?”  Well, I am about to tell you.

Each month, I review the lab work for the 120 patients in my clinics. When the kidneys stop working, labs “get out of whack”, not a medical term but easily understood.  There are several lab values that are tied to what the patient does or does not eat.  The Dietary Labs that have the most impact on dialysis patients are: Albumin or protein, Phosphorus, and Potassium.  During this blog session, I will concentrate on ALBUMIN.

Albumin is a major protein made in the liver and found in the blood. It’s function is to help with 1)growth and maintenance of body tissue, 2)prevention of anemia, 3)prevention of  loss of muscle mass, 4)helping to  fight off infection, 5)helps with healing of wounds, 6)providing a source of energy, 7)helping keep body fluids in balance.  When a dialysis patient does not eat enough calories or protein, the liver does not have enough protein to make new albumin which causes lower albumin levels in the blood.  Research has shown that patients with a low albumin levels over time have a higher risk of death.

The best source of food to for the liver to use to make albumin is PROTEIN.  Protein from animals is the best source of protein.  If a patient does not eat enough protein, the body will start destroying muscles to get protein it needs. Therefore, the patient is even weaker than the dialysis treatments make them.  Although eating enough “meat” seems to be an EASY for most of us, it is difficult for dialysis patients.  Their sense of taste is altered due to toxins in the body, they are tired from treatments, they may not be able to afford meat, or they have gastrointestinal problems in addition to kidney failure.

It is a challenge for both the patient and dietitian to find ways to increase protein intake to help improve the patient’s overall nutritional status and health.  I try to encourage my patients to eat 8-10 oz of meat per day (3 ounces is about the size of a woman’s palm).  Most of the time, this would require eating meat at all 3 meals.  I also usually do not restrict any type of meat they want to eat.  They may choose a higher sodium meat such as a hotdog or process sandwich meat.  Although this may not be the optimal choice, it may be all they can afford.   In addition to meat consumption to help the “albumin level”, there are nutritional protein supplements available.  Boost, Ensure, Nepro-for dialysis patients are liquid supplements patients can purchase but these are usually expensive ($45.00 for case of 24).  The most economical choice of protein supplement is whey protein powder.  A container will last approximately 3 months and is about $14.  One scoop of this powder has the amount of protein as 3 oz of meat.  It can be sprinkled on food or mixed with juice or other foods, and can be found in the supplement sections of drugstores or large chain retailers.  My patients have found it is an easy way to add protein to their daily protein intake if they don’t feel like eating meat at each meal.

I could go on and on about the need for dialysis patients to eat plenty of meat. Many times, I have been called the “Albumin Queen”, because that is all I talk about to the patients.  They see me coming and say, “I know, Eat More Meat”.  There have also been several occasions when they tell me, “You know, I ate more protein like you said, and you know what? I feel better!”  Those are the days and times that I know what I am doing matters, and this is the job God has called me to do.

So, until my next guest blogging (where I will talk about Potassium), when you meet a dialysis patient, ask them, “Did you eat enough meat today?” I bet they will know why you are asking!



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