I typically start my day at 7:30am, but on my later days I start at 9:30am. I’m fortunate enough to work only 4 days per week, which makes for long days, but they go by fast – especially since I used to routinely work 10-12 hour days in long term care. I will check any messages from patients on my phone and email, then make sure I have paperwork ready for the day.
I usually schedule 5 patients a day, depending on what else I have going on. For example, once per week I see patients in the hospital the day after they have had surgery. And twice per month I teach a beginning bariatric nutrition class where my patients learn how to eat healthy and gear up for eating the bariatric way.
Patients come to see me prior to getting weight loss surgery as part of their clearance process. It is still strange to me that the surgeon relies so much on my evaluation of our patients, but I really appreciate that he does that. I think that it makes our patients more successful in the long run because they are more prepared for what to expect after surgery. How long they see me depends on each patient and their insurance – the average patient will see me for their intro to nutrition class, an initial one-on-one visit, and a follow up visit, but some need a little more time or their insurance may require that they see me for up to 6 months or even a year. Some patients get frustrated with the longer diet documentation requirements, but I think they are very helpful. Many of my patients who see me for those 6 months will lose up to 60 or even 80lbs before they even have surgery!
So what do we talk about in our pre-op meetings? First, I figure out where my patients are. I start where they are and with what they can do, and then we progress from there. Some patients come in with very lofty goals, and others want to start small. I individualize the process as much as I possibly can while still making sure that they get everything they need for after surgery. They learn about weight management before surgery, about what the diet will be like to get ready for surgery, and about how they will change their diet after surgery.
I also see our patients after surgery. In fact, I see them right in the hospital the day after they have their surgery done. A lot of times they are pretty groggy and might not even remember seeing me, but I give them helpful tips for surviving the first week or so after surgery, and then I see them again a week after surgery. That first week is tough for a lot of my patients, and I think it really helps them to see a familiar face helping them along the way.
My favorite appointment is the three month post-op appointment. At this point you can really see our patients’ weight loss. What I tell them is that they look to me now how they have always looked in my mind. It is truly amazing when some of them will bring in an old picture to their appointment and I don’t even remember how they looked before. At this point most of our patients are feeling much better and are eating almost normally. They still have the surgery propelling their weight loss forward, and this is the key time for them to stick to their diet! We call it the “honeymoon” phase – they could eat almost anything and still lose weight, but that phase will eventually end, and they need to know how to eat in order to maintain their weight loss after the honeymoon is over.
In addition to my appointments and classes, I also attend our group support meetings once per month. This has become one of my favorite parts of my job. We have different topics each month, from staying active to meal planning to being a good supporter. I love seeing the patients come back and absolutely glowing with pride as they continue to lose weight. I also love helping patients back up who feel like they have fallen or failed. Our group is absolutely phenomenal at supporting each other.
I work with an absolutely amazing team. My boss, the clinical nutrition manager of the hospital, supports me and fills in for me in my absence. The bariatric center manager, who is not just a co-worker but one of my best friends, is my biggest supporter. We work so well together to support our patients and she keeps me sane! What I don’t think of, she does, and vice versa. Our amazing surgeon – not only is he ridiculously smart and talented, but he is so kind and has a wonderful bedside manner. Never have I had a patient complain that he didn’t take enough time or hear what they had to say. The nurses that work on the floors and in our surgeons office, who take the worried phone calls of our patients and care for them as they are recovering. There are too many people to continue to name – our team is great, we work very well together, and it is because we know what is truly important… that each and every patient feels like they are our only patient and our only priority.
So really, this post was supposed to be “a day in the life of” but it turned out to be why my job is so freaking amazing. Seriously. It is the best feeling to love what you do, day in and day out. I love my job!
RD on the Run 