University Health Service: Outpatient

Although I only had this rotation for two weeks, it was definitely one of the best. I got to counsel people from all different areas on a huge variety of topics. We had some international students who were having trouble navigating the American food system ("Where can I find something that isn't so sweet?") and we had people with digestive issues trying out the FODMAP diet, or people who had disordered eating patterns looking to rebuild their relationship with food. Some clients wanted to gain weight, others wanted to lose. 

I really admired my preceptor and her way with clients. She was kind and welcoming, but also knew when to push patients a little further to help them overcome obstacles or to help them see where they might be making excuses. This isn't to say that this is easy, it's definitely not! If it was, I would be out of a job ;)

In this rotation, I would see people like you, my readers, who have some sort of health struggle they want help with. Sometimes it can be nice to just talk with someone who understands, someone who gets that "eat less, move more" just doesn't cut it in most scenarios. 

I was fortunate to be able to sit on many of the appointments and participate in the counseling process, so I could help people with that very problem. I have had a lot of experience at this point, so I felt comfortable jumping in and coordinating care with my preceptor. I also made some educational material. Sometimes clients came in feeling hopeless, so we tried to help with that. We also referred out when necessary, sometimes having an entire team on your side makes all the difference! We aren't there to wag our finger and say "eat your broccoli." We provide support, we strategize with you, and we develop a plan of action that fits your life (have class for six hours in a row? we can work with that. want to eat with your cat every day? we can probably work with that too).

One client who came in had previously been hospitalized for hyperglycemia. She actually had diabulimia. It's a rare form of an eating disorder where a Type 1 diabetic (where you don't make insulin, so you need to give it to yourself) withholds their insulin so that they don't absorb glucose into their body (thus helping them maintain their weight/lose weight). There is a myriad of health consequences to this, the most dangerous being DEATH. Yes, you could literally die without insulin because of the way extreme hyperglycemia affects your body. Your body likes to run on glucose, it's the preferred fuel, so if your body doesn't have it, it will break down fat and muscle tissue. When those stores get depleted, it starts to shut down. Our patient experienced mild blindness which is what brought her to the ER to begin with. After our appointment? We recommended inpatient, and that she go to the ER when she left. She hadn't given herself an insulin dose in 8 days, and hadn't checked her glucose levels either. It was a dangerous situation for sure. That's the barrier with college populations though, they are over 18 so we have very limited power as to who we can contact and what we can do without the patient's permission.

Something we focused on a lot was a hunger/satiety scale. We wanted to help patients begin to deceipher what they were feeling before and after meals to prevent over and under eating. Mindfulness comes into play a lot these days, and as a yoga instructor, I'm in full support of it. We are so busy going and doing and seeing that we forget to slow down and enjoy our food. We want to make it a time of relaxation, rather than a stressful experience (like trying to chomp through a granola bar as quickly as possible on the way to a yoga class... who would do something like that?!)

Check out this beaut...

made with copyright-free photos by yours truly <3

made with copyright-free photos by yours truly <3

Do any of these topics really catch your eye? Tell me in the comments and I'll write out a whole post about them!

live long and eat good food,

-NN

How food became our biggest reward

How food became our biggest reward

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