Cath Lab Digest

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Registered dietitians from across the US offer their best practices, tips, tricks, and techniques for dealing with unintended weight loss and wounds, so we can improve the level of care we offer when faced with these challenging problems.

  As a dietitian new to consulting in healthcare but with a culinary background, I can see clearly how many people eat with their eyes. I would like to see more creativity used in foods served in the long-term care setting—from the sparkle of the glasses to the colors on the plate. I look for ways to create garnishes that are not only a delight for the eyes, but also a boost for the body. For example, I never put a piece of parsley on a plate, but instead I take the time to mince it and sprinkle it over eggs, a salad, or potatoes. Finely minced chives are a color popper on the plate. A diced tomato tossed with a basic vinaigrette is a colorful edible garnish that adds pizzazz to the plate. A simple strawberry fan or some cherries soaked in preserved peach syrup add a creative twist to nourishments. The way we present foods shows a level of respect for the resident. — Cynthia Ann Chandler, MS, RD, LD, CDM, Louisville, KY

  Unfortunately, weight loss is no stranger in the long-term care setting. I have found that many times a nonconventional method of bulking up calories is sometimes the best way to get residents to accept more nutrients and increase their appetite. Getting to know residents’ likes and dislikes is paramount in stopping weight loss in its tracks. For example, Mr. X had significant weight loss, had a depressed appetite, and refused supplementation. As an activity, our facility had a celebration with Cold Stone Creamery® ice cream. Despite his poor appetite, Mr. X discovered he loved the Coffee Lovers Only® ice cream. We now offer Mr. X Coffee Lover’s Only ice cream nightly, and his weight loss has reversed. Another resident loved Oreo (Kraft Foods, Inc) milk shakes—an Oreo milk shake every evening before bed was written into his plan of care. Think outside of the traditional supplement. Get to know what residents like and dislike. This is the best way to increase food acceptance and stop weight loss. — Angela Brekken, RD, LD, CLEC, Clearbrook, MN

  I tell my patients to think about high school chemistry. Carbohydrates (breads, cereals, pasta, and rice) are made up of carbon, hydrogen, and oxygen, linked with single bonds. These molecules are easy to break down and move from the stomach to the blood. This process raises blood sugar. Foods that have protein (lean meats, fish, cheese, and nuts), fat (oils, butter, avocado, and nuts), and fiber (whole grains, vegetables, and beans) are more complicated—with double bonds and nitrogen—and take more work to get from the stomach to the blood. Eating carbohydrates with a little fiber, protein, or fat helps stabilize blood sugar. Eating small, frequent meals that have carbohydrates with protein, fat, or fiber every 3 to 5 hours is the best way to keep blood sugar stable. When it comes to managing blood sugar, an apple with cheese is a better choice than an apple alone. — Stacia Helfand, MEd, RD, CDN, Long Island City, NY

  I have repeatedly observed unintentional weight gain or loss in persons with chronic illness. In many cases, this is an artifact of the person changing his/her habits and not necessarily the diet itself. People who maintain a steady weight over time generally have steady eating habits. When they become sick, they may become more sedentary and their appetite may change. Add a new diet to the picture, and these patients may need to work consciously, often with a professional, on reestablishing that equilibrium.