My name is Heather Sadler and I’ve been a Renal Dietitian at the Trust since 1995. I work as part of a fantastic team of doctors, specialist nurses, healthcare assistants and other therapists, and I lead a team of Dietitians within our department.
We have less than two full-time Dietitians to provide a service for over 970 chronic kidney disease (CKD) patients, 200 dialysis patients, an inpatient ward and around 60 patients who have a kidney transplant each year. So, I am kept very busy!
Why do we need Renal Dietitians?
If you have CKD, eating the right way can slow the progression of the disease, improve symptoms, and reduce the risk of complications. Even small changes to your diet and lifestyle can make a huge impact on your health and quality of life – that’s where I come in.
Contrary to popular belief there is no such thing as a ‘renal diet’. Every patient is different – the diet they need depends on their level of kidney function, their blood biochemistry levels, fluid balance, medications, symptoms and how well-nourished they are.
Patients with CKD often have other conditions such as diabetes, vascular disease, cancer or gastrointestinal problems which need to be considered. Understanding their social situation, their values and beliefs around food and health, and their level of motivation is also important.
Many patients have to manage a special diet on top of an arduous dialysis regimen and multiple medications, so they need a lot of support. More of our patients are elderly which brings its challenges. We monitor patients closely and adjust their diet according to their blood biochemistry. But it’s just as much about what they CAN eat, as what they can’t eat. We want patients to enjoy their food – it is such an important part of life! Eating well is a priority because many of our patients are malnourished, and unnecessary restrictions can contribute to this.
Everybody has experience of, and opinions about, food. There is such easy access to nutrition information (and misinformation!) online these days and this can be very confusing for patients. We need to keep a step ahead so we can help them pick out the truths from the myths, and translate the evidence into practical advice relevant to them and their CKD.
Food is quite a personal and sensitive issue for some people – nobody wants to be told what to eat and what not to eat. As an enthusiastic young student Dietitian, I soon found out that giving advice is not enough to bring about behaviour change. Yes, Dietitians provide information, but in a way which builds motivation and facilitates change in a non-judgemental way. I strongly believe that engaging with patients at an early stage of the disease helps with this. We are much better these days at working in a patient-centred way. After all, if you work together with a patient to come up with a diet plan they are much more likely to put it into practice then if you just tell them what to do.
Over the years I’ve been a Dietitian I have learnt that the most important skill is listening. Patients are more likely to listen to you if you listen to them, try to see things from their perspective and work with them, not against them – easier said than done! And a large dose of common sense and a sense of humour go a long way.
So what do I actually do?
Here are some of the things I might do in a typical week:
- Give a talk to a group of CKD patients about healthy diet and lifestyle to help protect their kidney function
- Talk to a patient on haemodialysis who is struggling to stick to a 1L fluid allowance, about ways to help manage thirst
- Explore barriers to change with a patient who needs to lose weight in order to be accepted onto the kidney transplant waiting list
- Encourage a haemodialysis patient with unwanted weight loss to relax her low potassium diet and eat more high energy foods.
- Write to a GP to request nutritional supplements for a peritoneal dialysis patient who is struggling with eating due to an infection
- Discuss a low potassium diet with a haemodialysis patient with a high blood potassium level
- Liaise with the catering manager about a patient requiring a complex special diet while in hospital
- Review monthly blood results for all my dialysis patients to identify patients with biochemistry levels outside target ranges
- Discuss the dietary needs of a patient with dementia with the manager of their care home
- Liaise with a consultant at an MDT meeting about adjusting medications for a patient with high blood phosphate levels
- Arrange home delivery meals for a patient who is recently bereaved and struggling to cope alone
- Phone an elderly dialysis patient in Bude to check how they are coping with their new diet plan
- Liaise with the renal pharmacist about suitability of a new ‘supplement’ a patient has bought online
- Assess the nutritional requirements of an acutely ill renal in–patient and design an enteral feeding regimen which fits with their dialysis and fluid restriction
- Work with a young patient to adjust the menu plan given by their personal trainer to bring it in line with his renal diet requirements
- Provide an immuno-compromised kidney transplant patient with information on food safety in order to reduce their risk of food poisoning
- Review the evidence base for a new patient information leaflet
- Deliver a teaching session on nutrition to a group of junior doctors
Why do I enjoy my job?
I became a Renal Dietitian because I love working with people; I enjoy the healthcare environment, I’m interested in biochemistry and I love food!
Working with patients with a chronic disease has its challenges but it is hugely rewarding to build a relationship with patients and their families over a long period of time and see them through their CKD journey from diagnosis through to transplantation and beyond.
I have had the privilege of getting to know patients over many years and help them through the ups and down. I am always amazed by the resilience of people who have to live with the burden of chronic disease and I am proud that what I do can make people feel better, reduce their anxiety, keep them out of hospital, and help them to live longer with a better quality of life.
I am proud to be a valued member of a team which works to a shared goal of helping people live the best life they can within the limits of their disease.
Heather is writing as part of the #WeCare2 campaign that will be running across our Trust communications. Look out for more from Dietetics, and their AHP and HCS colleagues, on our social media pages, Trust screensavers, Daily Email, Vital Signs and much more.