Let’s talk about kidneys takes a deep dive into the chronic kidney disease patient journey. We’re here to inspire meaningful conversations and to help people living with CKD gain a full understanding of their disease. Today, we’re talking with Dallas Nephrology, associates, clinical dietitians, Carolyn Cochran, and Nadia Connie about medical nutrition therapy. They will be explaining what it is, why it’s so important for a CKD patient and its role in comprehensive patient care, Nadia and Carolyn. I’m so glad that we are getting to sit down today because the topic that we’re talking about today truly is something that I’m interested in learning more about myself. So, you know, I’ve heard of dietitians and I’ve also heard of a nutritionist. Your credentials happen to include both. So I’d love for you to kick us off Nadia by telling us the core differences between nutritionists and dietitians.
Carolyn / Nadia (00:55):
Bri. This is such a great question and it’s a true nutritionist. So very interesting. Right? And when it is used by itself, the nutritionist, then it may not always hold a value to it. Meaning somebody could have read a book on nutrition, taken a weekend course, and called himself a nutritionist. In fact, even someone that may have done a PhD course could be a nutritionist. However, all nutritionists are not the dietitians, but all dietitians are nutritionists.
Oh, okay. Well, and so Nadia, do dietitians also have specialties like other healthcare providers?
Carolyn / Nadia (01:33):
Absolutely. And specifically clinical dietitians can specialize in oncology, pediatric dietitians. They are sports dietitians. There just any field you can think of that is for a healthcare provider, dietitians are involved in it because the diet really makes a difference in most medical issues. And people who are specifically interested in an area can move on to become certified. We’re both renal dietitians, but Nadia has become credentialed as a renal nutrition specialist. I’m also renal, but because of my strong interest in diabetes, I became certified as a diabetes care and education specialist.
Well, and so what we’re talking about today is medical nutrition therapy. So Carolyn I’d love for you to, to, to share what exactly is that? What does that mean? Well,
Carolyn / Nadia (02:28):
First of all, medical nutrition therapy is a phrase that was coined by Medicare and it is provided by a, a registered dietitian and it is based on, well, it is evidence based an evidence based practice that is based in the scientific literature and expert consensus. So it involves a process. The process is assessment of the patient, where they are medically and personally it involves nutrition, diagnostics that help guide the areas that you’re gonna address during a session. It, involves interventions that have to be determined that are going to be the most effective for patient management. Where patient is part of the solution, not just part of the problem. And finally it include evaluation and follow-up.
Well, is there anything to add from your experience in the profession as well?
Carolyn / Nadia (03:25):
Yes. So as far as M T goes, very evidence based. And in addition, it is very specific to the patient is tailored to their needs and what their medical problems may be in addition to, in our case kidney problems. And we have a team of dietitians that are, they come to us with, of course, you know, very strong clinical background from hospital settings, from dialysis centers. And then they get additional advanced training to be working with us, to provide M and T for patients with chronic kidney disease.
Yeah. Well, and it sounds like a lot of this is very focused patient centered. This is very a patient centered aspect of their care. So what is a medical nutrition therapy session like Carolyn?
Carolyn / Nadia (04:12):
Well, you’ve gotta kick it off with a patient’s medical record. So we walk into a session prepared having already reviewed the physician’s progress note, what the medical problems are, their list of medications and laboratory results.
I can imagine there’s yeah. What else goes into it? So it
Carolyn / Nadia (04:30):
Starts with that preparation part. And then the next thing, really, the session starts with finding out what the patient schools are. And we’re taking an account, several things, including their GI issues, their personal preferences, their food choices in general, from cultural backgrounds or religion, you know, related reasons. So all of it is taken in account, their allergies, the list really goes on for it. So to do a comprehensive session where it’s just telling someone what to eat, but it’s stuff that they will like, and they’ll be able to do, keep it realistic and be able to adapt and sustain long term.
I can imagine that the patients, how often do they have questions? You know, we we’ve talked a lot about, you don’t know what you don’t know, and you being the resident experts in that situation, you know, what kind of questions come up for them in their sessions?
Carolyn / Nadia (05:24):
Well, I suppose the first question they have invariably, the first question they have, number one, when we say what do you hope to get from this session? And they say, well, I really hope to find out what I can eat. Mm. You know, just straightforward.
So I must admit out of curiosity, you know, I hopped on the internet and to see that I might find out more about a diet for chronic kidney disease, the information available though. Definitely overwhelming. Right. And there’s, it’s often confusing as well. So have your patients found that to be true as well, Nadia?
Carolyn / Nadia (05:59):
Oh my goodness. That is so very true. Internet can be a really good resource a best friend. However, it can also be the worst enemy. Our patients come with so many questions and it is overwhelming. It’s sometimes conflicted. A lot of times this information that doesn’t even apply to their specific condition.
Yeah. I’d love for you to add what experience you’ve had when patients are coming in and have used, you know, the internet quite a bit before they’ve met with you. I can imagine they’re equipped with a lot of either questions or potential misinformation.
Carolyn / Nadia (06:35):
Well, it’s true. So I’ve think the first thing is to really sift through what they feel like they’ve already learned, and then try to focus on their individual problems related to their own blood work results. Many times patients interpret what’s on the internet and come away with something that’s much too strict for, for where they are. Oh,
Much too strict. Stricter than you actually expect.
Carolyn / Nadia (07:00):
Absolutely. Yes. In fact, a lot of stuff on the internet is about what they cannot have and they come to us. Oh my goodness. I can’t eat anything. You know, I looked up stuff, I have kidney issues. I’m supposed to help my kidneys out. And what do I do? I can’t eat anything. And what we’re doing in our role is to help the patient identify things that they can have instead of what they cannot have. Yeah. And again, you know, a lot of information may just not be applicable for them. Right. So they’ve looked up stuff, but we have to really tell them that, Hey, this does not apply for you just yet. Or at all, you know there’s just too much information
You inject the medical part of medical nutrition therapy, or we’re looking at your records, we’re looking at your labs.
Carolyn / Nadia (07:46):
And being able to leverage that in the process. I’d love for you to add more.
Carolyn / Nadia (07:52):
Well, I was gonna say to be personalized and individualized, I think one of the most useful tools that a patient can walk out of a session with is a very basic shopping list that has things that they truly
Carolyn / Nadia (08:06):
Yeah. Truly enjoy, and that are appropriate for them. And they can use it immediately when they walk out the door.
Well, and all of that’s so wonderful in terms of what you can actually eat. Right. You should still enjoy food. Right, right. It’s but how does someone get to see a dietitian, you know, especially with someone at DNA?
Carolyn / Nadia (08:24):
Well, of course, it’s got to start with a physician’s referral. The physician can determine during a session that he would introduce he, or she would introduce this idea to the patient and say, they’re going to be referred to a dietitian for medical Nutri therapy. Or if the patient has actually done some research on their own, we’ve had cases where the patient has asked the physician for referral for M and T. And the, the support staff can also help facilitate that process. And once the doctor enters in the order for the M and T, then the next step is the nurse sends it in for our billing department to verify patients benefits. And what’s great about Dallas nephrology associates is that we have a lot of these internal services. So we have a billing department that can verify benefits very fast. And once the benefits are verified about insurance coverages we have this amazing seamless process called centralized scheduling specifically for medical nutrition therapy scheduling with the dietitians. So the benefits are verified and then the tasks so to speak is sent to this, our scheduler. And she’s finds the right times for the patient. We have a team of dietitians and they cover a variety of locations. So the patients scheduled soon after the benefits are verified.
Carolyn / Nadia (09:49):
It’s also good to know that our staff are all Medicare providers and we are credentialed with the majority of major insurance carriers to provide services.
And so what about a patient who is happens to not be covered by Medicare or another insurance? Well,
Carolyn / Nadia (10:07):
Bri, they can always choose to, to pay on their own. It’s, it’s always an option.
Well, and so do you have a dietitian at every clinic? Or how do you, do you offer telehealth at this point? Nadia?
Carolyn / Nadia (10:19):
So we have been expanding and with the American kidney health initiative, which was put in place by the executive order, the interest in nutrition and the coverage of nutrition has grown, which has helped us expand our services and have more dietitians join our team. And we have a dietitian that is available to see patients at every one of our large offices currently. However, we have so many patients that live in the outskirts and even when you know, in general, just the drive so long. So the one great thing that’s happened is the option of doing telehealth. Yeah. Telehealth is, is a process where a patient can be comfortable in their own home. They can have their primary care provider with them, or perhaps multiple family members. It’s wonderful because if they bring up certain food items, they can carry us to the kitchen. And say, oh, look at this, look at this. And I’ll say, well, you know, a read the label or vitamin and mineral products, you know, maybe that they have not even mentioned to their physician when they’re in the clinic yeah. That they can show at that time. So I think it has really been an interesting benefit that evolved from the pandemic where everyone is wanting to stay at home.
Yeah. And it offers that option.
Carolyn / Nadia (11:39):
Yes, exactly. It is a safe option. And we also of course see patients in clinic, but the telemed option that we have a lot of patients, you know, initially really fearful for it about, oh, I don’t know how to work the technology, but the ease and the access of the platforms that we use, it’s simply sending a text message to our patients. And they click on the link, that’s it, there is no nothing to download. There is nothing to fill out, you know, so it is a really easy system. So for patients that have transportation issues, or just in general may not be as physically able having that telemed option has been a fantastic addition for dietitians to offer
Well. And so I’d love for you to share anything else, you know, especially when we look at the outlook and what the future, you know, looks like for medical nutrition therapy, what else do you have to add?
Carolyn / Nadia (12:30):
Well, I certainly hope that the health option is adopted for the future. You know, in the past it was only for remote and rural residents, but it seems like that the American public has become accustomed to this method of receiving healthcare.
For better, for worse.
Carolyn / Nadia (12:51):
And so I think it should, I’m really hopeful that it remains an option to them.
Yeah, absolutely. What about you,
Carolyn / Nadia (12:57):
You know, Bri, if I were to summarize what we all do at do nephrology associates, one mission in one sentence, it would be to help our patients do whatever we can to help slow down the progression of their kidney disease, whether it’s in direct patient care or, or someone that may be in other departments, including HR, it, accounting, marketing, billing, scheduling everyone’s role is to then support that ultimate goal of slowing down the progression of disease. And with medical nutrition therapy being in evidence based practice, it is taken patient an account in so many different facets. It’s patient-centric and it’s of course, I think M and T’s great, but it is research based that in fact, it shows that even one session with a dietitian can help slow down to progression of disease processes. And our patients mostly don’t come with one problem. They have so many other medical issue is to address an in combination of it, what, you know, combination of kidney problems with having diabetes with high blood pressure, with weight control, all these things that can help slow down to progress control of these problems to slow down to progression of the disease.
Carolyn / Nadia (14:09):
And if Mt can do that, how nice and how nice to empower our patients to involve them in their own care, in something they do every day eat. Right. Absolutely. So we love being part of that, and we really hope that we continue to see more people recognize and make this part of their therapy.
And you said it exactly, you know, one, one mission, one team. And I think one of the things that I I’ve learned is Dallas nephrology associates really has a, a team based approach to a patient’s care. So there are multiple people involved. So kind of in closing, I’d love to hear Carolyn, you know, from, from your experience in years with, with the organization, what it’s like being part of the solution, right. You’re a part, like you mentioned, you’re working with a primary care physician. You’re working with the other care providers as a part of the team.
Carolyn / Nadia (15:01):
Well, we certainly enjoy working with our nephrologist and in terms of the practice, I have certainly seen it evolve over the last four decades. It is remarkable how the advent of medical nutrition therapy about 20 years ago has become a more formalized method of providing care to patients. And I just wanna say thank you to Dallas nephrology associates. For allowing us to share our, a perspective today and how proud we are to be part of the healthcare team.
Fantastic. I’m so glad we got to sit down today. Thank you so much for your time.
Carolyn / Nadia (15:40):
Thanks for tuning in today. Learn more about Dallas nephrology associates at www.dneph.com that’s D N E P h.com. And if you found the information valuable, be sure to share with those also impacted by chronic kidney disease.