Speaker A [00:00:00]:
Hi, everyone. Today I have my friend and colleague. Rocky Roy is a registered dietitian. Now, she specializes in skin, so eczema and food allergies and things like that. But she used to work in an sci rehab. Welcome to the Paralysis Nutrition Podcast, where changing your eating habits is the key to losing weight, improving bowel health, and feeling your best. I’m your host, Fatima Fakhouri. I’m a registered dietitian who’s married to a quadriplegic and specializes in nutrition for paralysis.
Speaker A [00:00:33]:
Get ready to be inspired, educated, and motivated so you can take control of your health using the power of food. Let’s get started. This is the Paralysis Nutrition podcast. So, Rocky, welcome to the Paralysis Nutrition Podcast.
Speaker B [00:00:48]:
Thank you, Fatima, for having me.
Speaker A [00:00:50]:
I am so excited to have you because you worked on the other side. So I’m a dietitian that works with people with paralysis once they’re home. But you are a registered dietitian who used to work inpatient. Right? It was. It was at a rehab. So a lot of my clients have, I guess, gripes when it comes to the lack of nutrition information that they hear in rehab. And so I would love for you, Rocky, to just kind of talk us through. What was the typical day for you, working as a dietitian in an STI rehab.
Speaker B [00:01:30]:
Okay. So a lot of people will probably not get any nutrition education in a rehab center, mostly because most dietitians traditionally don’t even learn about nutrition for paralysis. So the rehab center that I worked at was a traumatic brain injury rehab center, and I worked for a company that was a consulting company, so that wasn’t even my main building. So what that means is if you’ve ever heard of agency nurses, where an agency deployed boys, nurses to other facilities to work and fill in gaps. That’s what I did as a registered dietitian. So in a month, I would go to, like, 10 different facilities ranging from the department of Health, ranging from psychiatric hospitals. And then one of the accounts that I had was the traumatic brain injury rehab. And we had a lot of patients there that had spinal cord injuries.
Speaker B [00:02:20]:
Right. Or they had paralysis. And unfortunately, the way it was set up did not allow me to really become nuanced in nutrition and my experience with my patients, because I was really only there once a month. You’re going to be like, that’s the shocking part. So I don’t know how other.
Speaker A [00:02:39]:
Rocky, There was no importance.
Speaker B [00:02:42]:
Yeah, there was no importance. No. So they put more. So they put. So again, maybe it’s different at every other Rehab.
Speaker A [00:02:49]:
Yeah, I think fair enough. This is her experience, this is Rocky’s experience at this one place. I know for a fact that a lot of the bigger rehab places, they do have dietitians.
Speaker B [00:03:00]:
Well, I can in house.
Speaker A [00:03:01]:
I’m going to interview her too. But in terms of what you were doing, you were covering nsci, tbi, rehab once a month.
Speaker B [00:03:11]:
Yep. So actually it also comes down to, I’m just going to say it like politics and money and what the, and what the president of that company is looking for. And their priority was to build a great experience for the patients and really cater to them. So they really wanted to just give them like five star meals. And it was more just like let’s give you like a restaurant quality experience and less on focus of the overall nutrition. So what I. So I had very limited things to work with. I did my best, but I think we had at one point about 40 to 50 admissions.
Speaker B [00:03:50]:
So we had some patients that lived there long term. They were still in recovery for over a year. So I did get to know those clients. But you know, if I was only there once a month, I wasn’t, you know, there were people coming in and out that were being admitted. I actually started once a week. When I first started at the rehab center, I was there once a week and then a new president rolled in and they said, you know what, diet is not important as much. We just want you here once a month. What they really placed importance on was I guess the physical therapy department, speech therapy for sure.
Speaker B [00:04:19]:
If anyone had like a tube feeding or dysphagia, I was really there to kind of help along the really critical cases, the ones that had injuries where they could not swallow. And I was there to kind of like more on the clinical side of things like what’s their tube feed formula and what’s their rate. And now my clients of course, who weren’t as critical, the ones who could feed themselves and they just had paralysis, for example, of course they did have issues with losing weight. Right. It was completely so much muscle. So in those instances what I would try to do is I would go and see those patients. But I only had like maybe five or 10 minutes because I had a long list of patients to see. No, nothing is done.
Speaker A [00:05:04]:
I know. I used to work in a hospital, girl, I know how it is. You get in trouble from your boss if you only see 10 or 12 patients for the day. You need to go see every single person. And not everyone’s in the mood, you.
Speaker B [00:05:19]:
Know, not everyone’s in the mood. Oh, yes. I will tell you about some of my patients, bless their heart. They were just like, oh, I don’t want to talk to the dietitian. Really, that’s my fault.
Speaker A [00:05:31]:
I don’t blame them. I will tell you this, Rocky. I do not blame them. If you just had a traumatic brain injury or you became paralyzed from any cause, whether it was an accident or if it was a stroke, do you really want somebody to tell you, hey, I know they have cheeseburgers on the menu, but I think that you should order a salad? No, that’s not it. And so when people, you know, either chat with me on social media or people in my programs tell me, they’re sort of exasperated, like, they don’t teach you this in rehab. I’m like, I know because I swear it’s not the right time.
Speaker B [00:06:08]:
It’s not the right time. And, you know, had I been there longer, I really would have loved to have done a nutrition committee. Like, I’ve tried to implement things at other places where, you know, we do once a month meetings where everybody comes to, like, the great hall or like the dining hall. And I would love, I really, really pitched the idea, like, let’s do a nutrition class. Because I had no man hours to literally go to 40 different, like, rooms and talk about nutrition with every single person. They had to, we had to triage the most critical admissions and I had to see those clients. And so there were some of, some of the patients that were there. I did get to build a little bit of a long term relationship while I was there for about eight months.
Speaker B [00:06:52]:
And one patient, I remember he was, I think he was, yeah, he was amputated from the knees down. And he was constantly talking about his bloating. And I know you talk about, yes, bloating about, like, you know, going to the bathroom and pooping. And I know very well, of course, like, we just needed to up his fiber in his diet, but unfortunately. So whenever you go to a rehab, you should have a dietitian and someone called a clinical nutrition manager or food service director who’s in the kitchen, who has some clinical knowledge. So the, when I was there, the clinical director, he had restaurant experience. So he was making like these, I don’t know, six ounce steaks. And I was like, yes, restaurant food.
Speaker B [00:07:39]:
And I was like, can we change this a little bit? Like, can we get more fiber on here? But the problem that we were finding is when I would ask for feedback, I was like, how did everyone like the new revised menu? He was like, nobody’s eating the salads or something, he would be like, nobody’s, like, wanting to eat the vegetables.
Speaker A [00:07:54]:
That’s true.
Speaker B [00:07:54]:
They’re all. Yeah. So it’s like they need the comfort.
Speaker A [00:07:59]:
Okay. They’ve had. You know, I think, luckily I have only ever been in the hospital when I delivered my babies. I did not order any salad. You know, it is a time for healing. And I think that is interesting. Right. Of what you were saying about what is your goal with the food at the place? And I know this from working in a hospital.
Speaker A [00:08:20]:
The hospital really wants patients to give a positive review of their experience. And the food at a. At a hospital is one of the biggest things that people are vocal about, which is so interesting. Right. And so they want the food to be something that people like so that they can say the food was good. Right. They’ll have something positive to say. If everything was, like, super healthy and, like, didn’t really, you know, hit the.
Speaker A [00:08:51]:
Hit the spot. They’re not going to get a good review. So I think. And you know, that ties into funding as well. You know, when you get good reviews, you get more funding. So I appreciate you bringing up that point because I think at rehab, they really have so many modalities of therapy to get through. They have respiratory therapy, they have speech, they have physical therapy, occupational therapy, and I don’t know if they have mental health. I’m sure that they do have social workers.
Speaker A [00:09:21]:
Yeah. And so when you think about it, and I’m a dietitian, I think nutrition is important. When I think about it in that way, like, it’s really not a pressing matter. Right. When you are in rehab. So the nutrition, I really think, should come before you leave. But then again, it’s like you’re getting ready to leave. Like, do you really have the patience and the want.
Speaker A [00:09:48]:
Like, people have to want to do this. Right. So when people join my program, they’re like, I can’t wait to get started. I don’t think anyone in rehab is like, I can’t wait to drink a.
Speaker B [00:10:01]:
Protein shake or whatever. I mean, I was probably seen maybe as the last person people wanted to talk to, which is sad.
Speaker A [00:10:11]:
Yeah.
Speaker B [00:10:12]:
But you know what? I get it. You are kind of. You’re coming out of, like, a traumatic experience. The last thing you want is someone to tell you what to eat. And also, I work with eating disorders, so I’m never here to be a food police with you.
Speaker A [00:10:25]:
I’m right.
Speaker B [00:10:26]:
Anything. I’m like, how do we add things to your. Your plate given what we have and the challenge that I always found was like, when we were trying to order things, it was always about food costs, what, what people want that’s not going to go to waste. Like, if it was up to me, I would tell, you know, my chef to be like, can we make chia puddings? Can we do something?
Speaker A [00:10:46]:
Yes.
Speaker B [00:10:46]:
But you know what?
Speaker A [00:10:47]:
That’s not constipated.
Speaker B [00:10:49]:
Exactly. You and I as a dietitian know, like, okay, smoothies, let’s do smoothies. Chia puddings. Like, let’s just do all the fruits. But guess what? The fruits that were available were things like banana, bananas. Constipating. Bananas are constipated oranges. I mean, eh, like, yeah, you got some fiber there.
Speaker B [00:11:09]:
But I mean, like we need more soluble fibers.
Speaker A [00:11:12]:
Yeah. To get some kiwis in here.
Speaker B [00:11:14]:
Exactly. Some pears and apples. Yeah. Some figs.
Speaker A [00:11:18]:
Yeah. So this is just not doable. Right.
Speaker B [00:11:20]:
And it’s not doable in the rehab centers.
Speaker A [00:11:22]:
No, it’s not. It’s not. And so that’s why I think it’s great after they get home that there’s some sort of, you know, my program is a resource. You know, my cookbook is a resource. But as a dietitian in the rehab, what do you think people were, I guess, looking for from the food other than it just tastes good?
Speaker B [00:11:45]:
Most of the clients really were just wanting. So they were saying they wanted to lose the weight, but they still wanted to have like a full plate of pasta or just starchy carbs. And it was like really reframing the brain to go like, okay, we need to like reeducate. So the problem also that I did come up with, it depends on like the level of care at the rehab center too. So I did have a patient there who I would educate her and I really would work, work with her about her soda consumption. For example, she would have a. I think she would have like 4 liters of soda a day.
Speaker A [00:12:18]:
Wow, that’s a lot.
Speaker B [00:12:20]:
But for her, because she had a traumatic brain injury, it’s kind of like short term memory in a sense for her, like where I couldn’t. Information overload her, for example.
Speaker A [00:12:29]:
I get you. Yeah.
Speaker B [00:12:30]:
We had to make baby steps with her, you know, And a lot of the times I was just like, well, what would you like to eat? We’ll try and get something ordered for you. And in that instance, the rehab center was really good in accommodating the patients. But after a couple of weeks, they saw what someone else in the dining hall was eating. They’re like, okay, I want that now.
Speaker A [00:12:49]:
I want that.
Speaker B [00:12:51]:
It was the environment, it was the community of kind of like, okay, I really do want to have the dessert and I don’t want to portion out my protein. And really, I didn’t blame them. You know, I didn’t blame them either.
Speaker A [00:13:03]:
At all. At all. And so what’s interesting is you’re saying you’re talking about weight gain. So this is a big thing that comes up when people have a spinal cord injury, right. I would say nine out of 10 people who I have spoken to with a spinal cord injury, they get admitted to the hospital, they lose a ton of weight. Right. Because their body is under such distress. Right.
Speaker A [00:13:25]:
And they’ve lost so much muscle mass. So what’s interesting to me is that I hear a lot of times, well, the dietitian just kept sending me ensure and kept sending me, like double protein and just told me to eat as much as I wanted. Which no one should ever be told that, really. Right. I mean, very.
Speaker B [00:13:44]:
I never told any of my patients, right?
Speaker A [00:13:47]:
No, no, no. But I’m saying when you have someone that loses a ton of weight, I think the. What I heard is that we want you to regain the weight. And the problem is no one ever tells you when to stop eating like that. So over time, people go home, they see their family members, of course the family members want to comfort them, you know, with food. It’s a love language, right? It’s a beautiful love language. But when you’re living with paralysis and you gain a lot of weight and then you end up having bowel issues as well, Kind of two separate things, but sort of not. Right.
Speaker A [00:14:22]:
It’s not a good quality of life. So when you were working in the rehab, did you feel like there was a lot of Ensure and like those types of. I call them medical drinks because they are meant for the hospital. But do you. What’s your experience with that?
Speaker B [00:14:39]:
Yeah, we had a lot of supplements and I try not to do the supplement route. If someone did needed extra protein, I would write an order for double protein to go on their tray.
Speaker A [00:14:51]:
But like real food, real food protein.
Speaker B [00:14:54]:
Exactly. And to be quite honest, like, I’m not a big fan of Ensure. Like, we need. We did have a little. Few better options. We did have like, Kate Farms was available. I know they use like a pea protein blend.
Speaker A [00:15:05]:
Nice. Okay.
Speaker B [00:15:07]:
And so if someone really wasn’t eating, that’s when I would order the supplement for them. Otherwise I would just say, okay, it doesn’t seem like you’re getting enough Adequate protein. We’ll do food first approach. But I always try to encourage consumption of vegetables as much as possible. I had no control, though, of course, of how the vegetables were getting cooked.
Speaker A [00:15:29]:
Of course, they’re like, steamed and. Right. Steamed.
Speaker B [00:15:32]:
Who wants steamed broccoli?
Speaker A [00:15:33]:
No, I don’t want that. Yeah, they’re roasting. That’s the roasted, sauteed. Delicious. It’s not good. But you know what’s surprising? Well, also not really surprising, Rocky. They could probably make the burgers taste okay, but they don’t take the time and effort to make the vegetables taste okay.
Speaker B [00:15:53]:
Exactly.
Speaker A [00:15:54]:
Totally could. You know, they just.
Speaker B [00:15:55]:
They really could. And, like, the chef, he was great. He was trying to go above and beyond with taste profiles and flavorings, but he was still, like, missing the mark with the vegetables. He was doing a great job on the starches and the protein, and maybe that comes from his chefing experience.
Speaker A [00:16:11]:
Yeah, because that’s a restaurant guy. That’s not a nutrition person, you know, and so. And I always tell people the easiest way to gain weight is to order takeout and not cook your meals at home, you know, so it’s like when you go to the hospital and they’re giving you food that tastes good, but it’s like restaurant food that’s not going to set you up for success.
Speaker B [00:16:32]:
And you know what? It’s funny that you say takeout food. Everybody at the rehab center would order takeout. They had, like a field. They had, like a field trip day or something. Something. And they would go out to the market, order their snacks or order their takeout food, and they would come back with that. And so for me, it was definitely challenging and difficult because I wasn’t even there that long. If I was there on a daily basis, I would love to have sat in the dining room with every single person and gone and talked to them while they were eating their meals.
Speaker B [00:17:06]:
But I wasn’t there every single time. So I would have to get report from nursing, and they would be like, oh, yeah, they went out to Denny’s or they went out here and it was happening more than once. You know, it’s great to order. It’s fine to order. Like, sometimes once a week in your program, you do that. But I was learning it was starting to happen on the daily. Like, every night that I would get the report that someone was ordering takeout. Every night, I was like, okay, what is.
Speaker B [00:17:32]:
What’s happening? Right? And so I would go to the room and I would say, like, how are you doing? How’s everything going with your nutrition, is there anything you would like to improve? And for me, it was always that challenge of, like. But I really just, like. Like to eat here, right? And I would, of course, give my advice and, like, okay, this is how you can make this meal healthier. When you go out to eat, like, these are the portions you. You can definitely try and stick to. But, you know, behavior change definitely takes time. If I’m only there once a month, I’m not able to.
Speaker A [00:18:05]:
It takes a very long time. And I will also say this, like, I just. It’s not the right time. It’s not the right time. Maybe for residential people, you know, it is more appropriate. But, like, Rocky, do you want to. When you are in the hospital, you know, recovering from something, do you want someone to sit next to you and be like, hey, I think that you should do this? But that is what they tell us we should do as dietitians, but we should do meals rounds. It’s like, nobody wants to see me, and you’re bringing me back to my clinical hospital days because it just felt awkward.
Speaker A [00:18:40]:
It just felt like, leave these people alone. Like, I remember I used to work the cardiac floor. These poor people have had heart attacks, okay? And I will say that if I caught them, like, the day they were leaving, there was a very specific type of patient that was, like, all ears. It was usually a person that was, like, very surprised that they had a heart attack or a cardiac event, and they were sort of scared straight. And so when the dietitian walks in and says, hey, this is what I think that you should do. I actually think that when it happened in that perfect kind of way, it was actually pretty helpful. But a lot of people are just, like, in there, scared. They don’t really know where they went wrong.
Speaker A [00:19:25]:
They might even be feeling, like, guilty and upset. This is the cardiac people, because they know that perhaps some of their habits got them to where they are. So it’s really just a difficult time. And that’s why I love working, you know, virtually. People only come to me when they want to do it. I’m not having to go up to them and say, hey, knock, knock. That you knock, knock on your door as you’re trying to, like, go to the bathroom. P.S.
Speaker A [00:19:55]:
you’re constipated now. Dietitian’s here. I mean, you’re lucky. I think we’re lucky if we don’t get cursed out, right?
Speaker B [00:20:02]:
Because it’s just I’ve gotten cursed out so many times.
Speaker A [00:20:04]:
Oh, God, you poor thing.
Speaker B [00:20:07]:
So here’s the thing also, I will probably say maybe a lot of your clients who are saying, like, they never got the education in the rehab centers from their dietitians, maybe there were dietitians who were just scared, literally, of that being cursed out because there is that traumatic experience from the Daijun’s perspective, going like, I am trying to help you, but I understand you’re also in this vulnerable place. I don’t want to push your buttons. So you kind of also pacify the situation, and maybe that’s what’s also happening. I think that’s probably what it is.
Speaker A [00:20:38]:
I’ll tell you honestly, sometimes I would just, like, wish or hope that the person, like, left before I got into their room because I’m like, oh, they’re.
Speaker B [00:20:47]:
Going to be mad at me.
Speaker A [00:20:48]:
Or like, oh, that guy looked grumpy before. Whatever it is, you know, like, let’s be honest, a lot of dietitians, most of us, are women, and it’s a lot of, I think young women, you know, your first job might be at some hospital, and they just kind of put you wherever they need help. Right. So we just kind of end up in these situations where it’s like, we don’t get training, unfortunately, on, like, how to approach patients who are vulnerable or how they’re upset. Like, we don’t get any training on that. They just tell us what we’re supposed to tell them in terms of the nutrition. So, yeah, I appreciate that perspective because it’s been a long time for me since I’ve had to go to somebody. Now I feel so more relaxed because they reach out to me, like, hey, I’d like to join your program.
Speaker A [00:21:34]:
It’s not like they’re being forced or anything like that. So I appreciate that perspective. What do you think about the constipation and the way that people are being taught about dealing with, you know, pooping? Because that’s like a huge, huge thing. And you can’t give them chia pudding and you can’t get them to eat vegetables. And what do you think?
Speaker B [00:22:00]:
Yeah, hands are tied in that situation because in rehab, like I said, I would try my best to see if we could get things ordered in the kitchen, put on the menu to, you know, get the ball rolling. I think we almost got a smoothie program there, started before I left. But, yeah, everyone. Everyone’s on Senna.
Speaker A [00:22:21]:
Everyone’s.
Speaker B [00:22:22]:
It’s so common. It’s so common.
Speaker A [00:22:24]:
Suppositories. Yeah.
Speaker B [00:22:26]:
Yeah.
Speaker A [00:22:27]:
So some people are going to always need a suppository. But I just. I Wish I could be like a fly on the wall, you know, at a rehab. Because I’ve never been through that experience. Right. Like, you know, I met my husband 10 years later after he was injured. So I never went through the experience of, okay, so we’re in rehab and now someone is coming to tell you that you need to be on blah, blah, blah. And I think.
Speaker A [00:22:51]:
Do you think these things get just like automatically ordered and they become part.
Speaker B [00:22:55]:
No, it’s an, it’s an automatic order. The moment someone walks through the door, there’s a list of medications and that is just like their bowel regimen program. That’s just like. And then of course, there’s other things there, like ibuprofen or like, those are like back ordered as well. Like if someone. Yeah, someone needs it, it’s like a PRN order. As needed.
Speaker A [00:23:15]:
As needed. So those are always fascinating to me. So it’s automatic order. So you would have to first of all ask, what are all these pills? And then you’d have to say, oh, I don’t think I want that one. You would have to, really? And why would you say that? Like, why would you question your doctor or nurse? Like, why would you do that? And so what I try to tell people is that I’m sorry that you were told that you cannot go without these things because that’s false. And you know, that’s scary for me. I don’t want to ever go against a doctor. You know, that’s not the hierarchy.
Speaker B [00:23:51]:
It wasn’t my place for them. For me, tell the doctor to take them off of this. Like, where I could interject with a recommendation was like, oh, if I think someone needed some kind of like micronutrient to be added, vitamin something or like if they had wounds. Juven, argonade, those sort of supplements, Pro stat for wound healing. Yeah, I could go in with that as my recommendation, but it was not, it was not something for me to be like, I would take this person off of Miralax. Right. It’s not.
Speaker A [00:24:26]:
We do not do that. We don’t order, we don’t diagnose, we don’t do any of that. And so it is super interesting to me that right off the bat these patients are being prescribed like bowel regimen meds. And it’s such a disempowering place to come from. You know, like bowel control is like a huge, huge part of people’s lives. Right. Especially I think, when they’re not eating well and it takes them forever and they’re on these pills. And I gotta tell you, I have clients who have been on Miralax for 20 years.
Speaker A [00:25:03]:
I have a guy who’s been on Miralax for 20 years. And the other day he quit at cold turkey and nothing changed. And I was. I mean, kind of happy because I’m like, okay, good. Nothing went wrong. But he was actually so mad because he’s like, I’ve been drinking this for 20 years and it didn’t do anything. This is somebody who poops one time a week. Okay.
Speaker A [00:25:23]:
And so to take that away and it did nothing was just. Can you imagine? Like, that’s so frustrating. Like, it didn’t do anything. Or people, when they learn that Senna. What is the number one side effect of Senna? Bloating and GI pain. You know, like, stomach pain. And so when people get off these things and start eating healthier, I think they feel more in control. Right.
Speaker A [00:25:45]:
More in control of their bowels, but also, like, of their life. Because what’s crazy is they’ve been taking these things for so long, I think they must be, like, developing a tolerance.
Speaker B [00:25:57]:
I think so. I really do. Your body also creates, like, a dependency on it. So it’s just like, that’s like, long term, not the goal. And no one’s really like, I even learned from you about neurogenic bowel.
Speaker A [00:26:11]:
Yeah. Because they don’t teach us that in school.
Speaker B [00:26:12]:
It was not something I did. Okay, you want to know something really funny? The first time I got a patient through the rehab door where he was just, like, super bloated, I was thinking, like, does he have ibs like this one?
Speaker A [00:26:27]:
Yeah. Like, we don’t know. They don’t teach us.
Speaker B [00:26:29]:
I thought it was ibs. And then later, of course, I was, like, finding out with the very little research, by the way, that’s out there, because I was trying to pull up, like, journal recommendations, and everything that was out there was for very acute severe care. Like in the icu, everything was about feeding.
Speaker A [00:26:46]:
Not for. Not for people who are out in the. Yeah. And out in the world.
Speaker B [00:26:51]:
No, no, no. So I could not find anything about neurogenic valves. So I was just under the impression, like, okay, maybe we just need to cut out some of these gas forming fibers to help with the bloating. Of course, later, it’s just like, well, you just have to eat the right types of fiber.
Speaker A [00:27:07]:
Yeah. And so I think that when it comes to people’s mindset, it starts at rehab. Like, they’re the ones who are telling you this is how your life Is So this is what you need to do. And I don’t think that it is an appropriate time. Right.
Speaker B [00:27:23]:
It’s not emphasized. It’s not. I got the feeling that the nutrition was not the priority when I was there. Like, my job was not as significant as maybe someone who was a PT for physical therapy, because that was happening on the daily. Right. Or occupational therapist. That was happening on the daily. Or even a speech therapist.
Speaker B [00:27:46]:
They were at least doing therapy twice a week. So I did the best that I could given the time constraints that I had to see everybody. And you know what was also unfortunate? When I left the company, they wanted to cut cost even more and they actually wanted a diet tech to take over. And I was like, no, this is not okay. So if nobody knows a diet tech, it has less hours of training than a dietitian. And usually the dietitian is the one who oversees what the dietetic is doing anyways. So unless someone was super critical care and they had a tube feeding in there, they would just call the dietetic to go in. And I was moved to another day.
Speaker B [00:28:25]:
That was the unfortunate part. So you can see where precedence took or importance was with nutrition.
Speaker A [00:28:32]:
Yeah, I hear you. And so do you think that when you’re looking at the whole picture of care at rehab, that nutrition is just not really part of it?
Speaker B [00:28:45]:
No, I really don’t. I think we have a healthcare system that just does not care about food. And then we have like a food service industry that doesn’t care about health.
Speaker A [00:28:57]:
And that’s preach, girl.
Speaker B [00:28:59]:
That’s why they don’t connect. So when you go to a restaurant, the portions are ginormous and you are taught to, you know, maybe clean your plate, eat all of that. And then when you go into the healthcare setting, the portions aren’t maybe as large as the restaurant, but they’re not also prioritizing. How can we make it as tasty as the restaurant?
Speaker A [00:29:21]:
Right, yeah.
Speaker B [00:29:22]:
So it’s like you’re getting two different, like, dichotomies here and they’re not meeting in the middle. That’s the biggest gap that I think I see in healthcare.
Speaker A [00:29:31]:
Yeah, I agree with you. It’s like when it comes to like, for example, the constipation, they’re not looking at teaching you how you can eat also and manage stress. Right. How you can do those things that will help you poop. They’re looking at what is the easiest, most cost effective thing for us to do for you. And so that would be giving you senna, giving you Miralax. Giving you Colace and then perhaps not even believing that you would eat healthy foods. Sometimes I think that doctors never talk to you about changing your eating habits or refer to a dietitian.
Speaker A [00:30:14]:
They rate you meds because I think they really do believe that you will not make those changes. Right? Like last year, I was diagnosed as pre diabetic, okay? And so when I heard that, every alarm in my mind went off and I was like, all right, girl, you got to eat enough protein. You can’t. You have to stop skipping breakfast. You need to get more active. Because I’m a dietitian. My doctor pretty much said nothing. Said, well, it’s genetic, you know, watch your habit.
Speaker A [00:30:43]:
No, no, no, wait. Cut out. Cut out desserts. I’m like, babe, I don’t eat desserts every day. I’m probably eating too much bread, and I’m probably not eating enough protein. But I don’t even think he knew I was a dietitian. It’s just funny, right? Like, being on the other side of that equation. And pretty much like his thing was, I think just, it’s not bad enough for me to put you on med, so go on your way, you know? And so our approach is more like, hey, let’s fix this before it becomes a medical problem.
Speaker A [00:31:12]:
And then you end up on meds. So I actually never knew that they automatically order. Order you those bowel. Those bowel medications. That’s, like, going to play in my head for the next several days.
Speaker B [00:31:24]:
And like, just. I mean, I could be. Maybe other rehab centers are not like that. Maybe they have a different kind of a medical director and they know better. But at the rehab center that I worked at, that was an automatic order. And I would get consults from the doctors, don’t get me wrong, like, you know, dietary, dietitian, consult. Like, I would have that on my paper. But again, I had maybe five to 10 minutes to speak to my patient, and the patient just got in.
Speaker B [00:31:50]:
They were getting situated. They had maybe 10 people coming into their room all at once. A nurse is coming to check on their temperature and their vitals. They have someone else coming in to, like, you know, give them a bath. Like, there was just a lot going on for them. And for me, I would just say, like, okay, I’m going to leave this hand up for you. If you have any questions, we can definitely talk about it. But then again, maybe they left and I did not see them again.
Speaker B [00:32:12]:
It was unfortunate that I could not always follow up with every single patient. There was just one patient. I Actually did customize a meal plan for him because he was diabetic. And I knew a lot of it for him was probably insulin resistance. And he was just frustrated because he’s like, I’m not even eating a lot of food. Food. Why am I not losing weight? You know, again, I re. Educate him.
Speaker B [00:32:33]:
I’m like, it’s not about eating less. It’s about eating the right foods to help bring down your blood sugar. That way you be less insulin resistance and you can lose weight. Because he was this guy who was like. He was on the bike in the PT gym, like, for four hours. He was determined to lose weight. I’m like, you’re putting in all this effort. And I wanted to really help him.
Speaker B [00:32:53]:
And so I kind of tried to customize a few things on the menu for him. But again, it was kind of that mindset of like, let’s try these new foods, too. And he was maybe not used to some of the recommendations. So we had. I had. I had my challenges cut out for me. I really did. I was like, this is what we got to work with on the menu.
Speaker A [00:33:10]:
This is what we have to work with on the menu. Yes, that is so true. And I think that people need to remember, you know, that the dietitian at rehab doesn’t have a lot of resources, nor do they have formal training on paralysis. I mean, I have my master’s degree in clinical nutrition. Not one day did they teach me anything about paralysis. Did they teach me anything about neurogenic bowel? Did they say anything much about. Honestly, anyone with a disability? Which is so now, I think is just so absurd, you know, that they don’t teach us nutrition for specific, you know, disabilities. They just don’t.
Speaker A [00:33:54]:
It’s not a class.
Speaker B [00:33:55]:
It doesn’t exist. It’s the focus mainly for dietitians, is diabetes, maybe kidney disease.
Speaker A [00:34:02]:
Heart disease.
Speaker B [00:34:03]:
Heart disease, the major ones there. But it’s not specific to a niche like paralysis, because that’s perfect, too.
Speaker A [00:34:12]:
Yeah. And I also think that when you are working at a place, you just follow the rules of the place. So if you’re in a rehab and it’s like you said, it’s an automatic order, everyone gets senna, Everyone gets this, everyone gets that. What are you supposed to do with that? Like, you’re going to, what, go in there and tell people, hey, don’t take this. You’ll lose your job.
Speaker B [00:34:33]:
See? And it comes. So there, I think, is where the system probably could change. And I do think maybe it’s going to take like a really ballsy, like dietitian, to come in and say, like, hey, like, I want to be on these meetings and this is the recommendations that I want to give you. And again, a lot of the evidence is like, a doctor will say, well, where’s the evidence? Show me the evidence that we don’t need to put people on all of these products. Right? That’s where you could have budding hides. I’ve had that happen to me, actually, one time.
Speaker A [00:35:09]:
And I have to say, like, let’s not pretend that they’re paying dieticians the best big bucks to get in there and ruffle feathers. Like, they’re not. It’s not really worth one’s time and energy when you’re not being const. You know, I was going to say constipated, compensated, you know, to be this advocate for the, for the patients. You know, it’s just not something that most dietitians are going to do. Like, we’re just going to sit there and be frustrated and be like, oh, I can’t believe they keep doing this, or like, the hospital food is so bad, or, oh, this, that we’re just going to do that. And then at 5 o’clock we’re going to leave. You know, and that’s a big reason why I love not working for a, you know, institution, because I can just sort of say, and you yourself, you’re in, you’re in virtual private practice too.
Speaker A [00:36:03]:
Like, you don’t have to go by anyone’s rules. You can say like, hey, this is what the evidence says. This is what my education and knowledge tells me. Let’s see how it works. You know, And I think when people are in a position where they want to work with you and they want to see changes, that’s so much more productive. Right?
Speaker B [00:36:25]:
It comes from the administration level too. Right. Because there have been moments where administrators were like, okay, trust your judgment. Like, yes, we can change this. This is fine, we can do this. But then there’s other times where the pushback has been like, well, we don’t have the budget for this, so we can’t bring this on this recommendation that you’re speaking of. Right? So it’s like we have to pick and choose our battles. And really I think the takeaway here is going to be maybe we might not be able to make an effective change the short time that you’re in rehab, but that there’s resources like you, Fatima, where now someone can go to after rehab and know that there’s options.
Speaker A [00:37:04]:
Right. And I appreciate that and I Think that, you know, through this conversation, I’m understanding more and more, like, it’s not the time, like in rehab, it’s really not the time. I do wish that they would educate people more on, like, forget the weight. What about just like the bowels? Like, just teaching people, like, hey, listen, we put you on these bowel things now because you’re just getting started, your diet’s not regular, but hey, moving forward, like, this is what you need to be doing and see how it goes. I just think that also having a quadriplegic husband, I understand there’s so many other things to worry about. There’s so many other things. I’ve had clients who are new to their injury who just came home a couple of months ago and they can’t even get in their front door without help because there’s so many things that need to be done. They.
Speaker A [00:37:55]:
They need to find the right chair to shower in, they need to find the right cushion. There’s just so many things to think about. And so I will say, I think the sweet spot for me with people coming to work with me, somewhere between like one and five years, somewhere in there, you know, before it’s like, there’s been just years and years of like bowel related trauma or before, there’s just been years and years of emotional eating and weight gain, you know. And of course, I get people who’ve been, you know, wheelchair users for 30 years, 20 years, and I love to work with them. But I think in a perfect world, somewhere between year one and five, you know, post injury, there should be, you know, a rethinking of like, nutrition, what are you eating, what are you doing? Because when it comes to your weight as a wheelchair user, it is about quality of life, right? People can say, like, hey, I don’t like this belly and I don’t like the way it looks. Okay, that’s fine and that’s valid. However, I’m more concerned with people who are gaining so much weight that they can’t transfer into their bed or they, you know, have trouble getting in the car. These are the things that I care about more.
Speaker A [00:39:09]:
Of course, it’s everyone’s right to say, hey, I want to lose weight because I want to, you know, you have.
Speaker B [00:39:15]:
The right to do that.
Speaker A [00:39:16]:
But when it comes to, like, quality of life, spending forever in the bathroom. So, yeah, so when it comes to, I think quality of life, at some point, I think there should be someone looking at your diet, you know, someone telling you, hey, you’re pre diabetic, you need to change your eating habits, you know, and it’s just like you said, a disconnect.
Speaker B [00:39:36]:
Yeah. And really it should be like the take home packet, like, okay, sorry about that, you guys.
Speaker A [00:39:42]:
Rocky lost her connection. But you’re no longer here, Rocky. But thank you so much for taking the time to be on the podcast. So Rocky’s experience, I think is very, very common. As a dietitian that works in a place. You work in a hospital, you work in a rehab, your hands are really tied. You cannot just order healthier food. They don’t have it, and you can’t just change the protocols.
Speaker A [00:40:07]:
So I never knew that. She just kind of enlightened me that as soon as a patient gets admitted, the doctor orders these, you know, bowel medications, these laxatives and things like that. So I think what’s important to, to recognize is that when you’re in rehab, this is a very, very kind of confusing, stressful time. Right. And nutrition is probably not your main concern. You need to do therapies. You need to, you know, maximize your experience. And listen, if you want to order the cheeseburger, that’s fine.
Speaker A [00:40:44]:
When you get home, if you want to live a long, healthy, happy life, you’re going to need to learn to eat right so that you can maintain your weight but also regulate your bowels. Nutrition is really the only way that you are going to manage your weight and manage your bowels. I’m sorry that we lost connection, Rocky, but thank you so much for your time. And until the next episode, that’s our episode for today. Thanks for listening. I hope you enjoyed it and that you learned something new. Remember, if you want to lose weight with paralysis, improve your bowel health and feel your best you can. It’s possible.
Speaker A [00:41:22]:
You just have to change your eating habits. If you need instruments for inspiration on how to get started, check out the paralysis Nutrition Cookbook. 101 recipes to help you lose weight and improve bowel health. The cookbook comes with a bonus 30 day meal plan and is the perfect way to start eating healthier. You can find it online@paralysisnutrition.com cookbook. I’ll talk to you again soon.
