A difficult patient... Help please

[Guest guest]

Hi all,

I have a very non compliant patient who had a sleeve gastrectomy in April 2007 and keeps readmitting with GIT symptoms such as nausea and vomiting.

She has a Psych history (depression) however pre op assx by psychologist was positive to go ahead with surgery. However post op she has proven to be very difficult and is not going back to see the psychologist despite our strong recommendations.

Her reported intake is < 500 Kcal /d and < 20 grams pf protein - she is not consistently compliant with any protein supplements, meal replacements or multivitamins.

Her LFTs and EUCs and all Folate B12 are normal. The only deficiency is Fe and we are waiting on Thiamine results..

Which does not reflect her reported symptoms of vomiting and poor intake..

Its so hard to assess her actual intake - she has never kept a proper food chart for us and despite frequent follow ups and educations she remains very passive with her treatment.

Through investigations recently there was a pouch formed next to the sleeve (diverticula) and this was resected. Post op she developed bladder dysfunction and had a to be catheterised. Catheter is out but she reports very poor urine out put .. (well it could also reflect her poor fluid intake ~ 500 mls/d max)

However the surgeon I work with was wondering if her bladder dysfunction is nutrition related ..?

Any thoughts would be much appreciated..

Thanks so much and happy new year to all

Nazy

Nazy Zarshenas

Senior Dietitian - GIT Surgery

The St Hospital

Nutrition and dietetics department

Level 2 Pritchard Wing

NSW 2217 Kogarah

Email: Nazy.Zarshenas@...

PH: (02) 9113 2752

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