Friday, March 19, 2010

Clinical Dietitian Kris Mogensen


Does the thought of doing nutrition support for the critically ill excite you? What about dealing with daily surprises and interesting cases routinely in a teaching hospital? Today I have the pleasure of sharing my conversation with my Medical Nutrition Therapy Professor Kris Mogensen with you. Even though she has a very full schedule she set aside time to answer my questions thoroughly both via email and before our lovely MNT class in the evening:
  • Briefly, could you tell me a little bit about yourself and what you do? I'm the clinical manager of the Metabolic Support Service at Brigham and Women's Hospital. Our service is comprised of four surgeons, three physician assistants, a medical assistant, a part-time dietitian, two administrative assistants, and me! Our surgeons and physicians focus much of their time on parenteral (venous) access and enteral access procedures; three of our four surgeons also act as inpatient nutrition support attending physicians who round with the inpatient dietitians. Two of those surgeons work with me and our part-time dietitian to manage home parenteral nutrition patients. My job is to organize our service, keep things running smoothly, do all of our quality improvement activities, do some research, provide patient care, and teach the trainees who come through our service.
  • What drew you to the field of nutrition? I initially thought I wanted to go to medical school, but I realized that I wanted to get out into the workforce fairly quickly! I always loved food and cooking, so I thought I might be a chef. It seems that my many food allergies would be a barrier to being a good chef, so I had to come up with another option. My initial major when I started in undergrad was "Chemistry, Foods, and Nutrition" but I soon realized that being a registered dietitian would be an excellent career path so I changed my major to Nutritional Sciences and the rest is history, as the old saying goes.
  • How did you discover that clinical nutrition was your calling? I was pretty surprised that clinical nutrition turned out to be my passion. Given my initial interest in being a chef, I really thought that I'd end up doing hospital food service management. My internship at Massachusetts General Hospital was excellent preparation in that area! However, once I started clinical rotations, I realized that I liked that aspect best (I guess going back to my initial interest in medical school). Once I did my intensive care unit rotation with all of those tube feeding and TPN calculations, I absolutely loved it and I knew I wanted to specialize in nutrition support.
  • What is your favorite part about being a dietitian? I think the best part for me is seeing patients respond well to a nutrition plan--it's really rewarding to hear from a patient "wow, I can walk up the stairs to my bedroom without taking a break." Or, " since I started the TPN, I have more energy to do the things I like to do."
  • How rewarding do you find your job? I find nutrition support incredibly rewarding--it requires a team approach to manage such complex patients
  • What's the most frustrating part of your job? Trying to get home nutrition support therapy covered by insurance companies; it can be quite a challenge at times to get coverage for a much-needed therapy.
  • I personally think you are an excellent professor. Is teaching something you anticipated doing in your career, and how do you like that aspect of nutrition?>> Wow, I'm glad you like my class!! I love teaching, and I always enjoyed working with dietetic interns. I had the opportunity to work with medical students at Tufts and Harvard, so I knew I liked the classroom experience and decided that if the opportunity presented itself, I would like to teach nutrition students. I feel very fortunate that Dr. Durschlag gave me the opportunity to teach at BU!
  • Have you had some favorite jobs? I would say that my most favorite job was as the surgical intensive care unit dietitian at New England Medical Center (now Tufts Medical Center). I was really part of the patient-care team and had many excellent mentors there. I wouldn't be where I am today without that experience. Communicate with confidence! Know literature well and be confident that you are the nutrition expert.
  • What is one thing you wish you could get every American to do to make our country healthier? Exercise! Not just cardio, but strength training as well. Dr. Miriam Nelson's research is very compelling in this area.
Thank you Kris for taking the time to answer my questions. Listening to her talk about preneteral and enteral nutrition has greatly increased my respect for clinical dietitians, and I am much more interested in trying it out during my internship. The things she sees in her hospital are amazing-and she has shared some very interesting case studies with us! The effects of her work can be seen immediately, and literally mean life or death for many patients. It is empowering to see the things she does on a daily basis, with a well-respected medical team. Dietitians do not just belong in the kitchen!

3 comments:

robert taylor said...

“Unnecessary risks are being taken by patients seeking the liberation treatment.” says Dr. Avneesh Gupte of the CCSVI Clinic. “It has been our contention since we started doing minimally invasive venous angioplasties nearly 6 years ago that discharging patients who have had neck vein surgery on an outpatient basis is contra-indicated. We have been keeping patients hospitalized for a week to 10 days as a matter of safety and monitoring them for symptoms. Nobody who has the liberation therapy gets discharged earlier than that. During that time we do daily Doppler Ultrasounds, blood work and blood pressure monitoring among other testing. This has been the safe practice standard that we have adopted and this post-procedure monitoring over 10 days is the subject of our recent study as it relates to CCSVI for MS patients.”

Although the venous angioplasty therapy on neck veins has been done for MS patients at CCSVI Clinic only for the last 18 months it has been performed on narrow or occluded neck veins for other reasons for many years. “Where we encounter blocked neck veins resulting in a reflux of blood to the brain, we treat it as a disease,” says Gupte. “It’s not normal pathology and we have seen improved health outcomes for patients where we have relieved the condition with minimal occurrences of re-stenosis long-term. We believe that our record of safety and success is due to our post-procedure protocol because we have had to take patients back to the OR to re-treat them in that 10-day period. Otherwise some people could have run into trouble, no question.”

Calgary MS patient Maralyn Clarke died recently after being treated for CCSVI at Synergy Health Concepts of Newport Beach, California on an outpatient basis. Synergy Health Concepts discharges patients as a rule without in-clinic provisions for follow up and aftercare. Post-procedure, Mrs. Clarke was discharged, checked into a hotel, and suffered a massive bleed in the brain only hours after the procedure. Dr. Joseph Hewett of Synergy Health recently made a cross-Canada tour promoting his clinic for safe, effective treatment of CCSVI for MS patients at public forums in major Canadian cities including Calgary.

“That just couldn’t happen here, but the sooner we develop written standards and best practices for the liberation procedure and observe them in practice, the safer the MS community will be”, says Dr. Gupte. “The way it is now is just madness. Everyone seems to be taking shortcuts. We know that it is expensive to keep patients in a clinical setting over a single night much less 10 days, but it’s quite absurd to release them the same day they have the procedure. We have always believed it to be unsafe and now it has proven to be unsafe. The thing is, are Synergy Health Concepts and other clinics doing the Liberation Treatment going to be changing their aftercare methods even though they know it is unsafe to release a patient on the same day? The answer is no, even after Mrs. Clarke’s unfortunate and unnecessary death. Therefore, they are not focused on patient safety…it’s become about money only and lives are being put at risk as a result.”

Joanne Warkentin of Morden Manitoba, an MS patient who recently had both the liberation therapy and stem cell therapy at CCSVI Clinic agrees with Dr. Gupte. “Discharging patients on the same day as the procedure is ridiculous. I was in the hospital being monitored for 12 days before we flew back. People looking for a place to have the therapy must do their homework to find better options. We found CCSVI Clinic and there’s no place on earth that’s better to go for Liberation Therapy at the moment. I have given my complete medical file from CCSVI Clinic over to my Canadian physician for review.” For more information Log on to http://ccsviclinic.ca/?p=866 OR Call on Toll Free: 888-419-6855.

Leo Voisey said...

Chronic cerebrospinal venous insufficiency (CCSVI), or the pathological restriction of venous vessel discharge from the CNS has been proposed by Zamboni, et al, as having a correlative relationship to Multiple Sclerosis. From a clinical perspective, it has been demonstrated that the narrowed jugular veins in an MS patient, once widened, do affect the presenting symptoms of MS and the overall health of the patient. It has also been noted that these same veins once treated, restenose after a time in the majority of cases. Why the veins restenose is speculative. One insight, developed through practical observation, suggests that there are gaps in the therapy protocol as it is currently practiced. In general, CCSVI therapy has focused on directly treating the venous system and the stenosed veins. Several other factors that would naturally affect vein recovery have received much less consideration. As to treatment for CCSVI, it should be noted that no meaningful aftercare protocol based on evidence has been considered by the main proponents of the ‘liberation’ therapy (neck venoplasty). In fact, in all of the clinics or hospitals examined for this study, patients weren’t required to stay in the clinical setting any longer than a few hours post-procedure in most cases. Even though it has been observed to be therapeutically useful by some of the main early practitioners of the ‘liberation’ therapy, follow-up, supportive care for recovering patients post-operatively has not seriously been considered to be part of the treatment protocol. To date, follow-up care has primarily centered on when vein re-imaging should be done post-venoplasty. The fact is, by that time, most patients have restenosed (or partially restenosed) and the follow-up Doppler testing is simply detecting restenosis and retrograde flow in veins that are very much deteriorated due to scarring left by the initial procedure. This article discusses a variable approach as to a combination of safe and effective interventional therapies that have been observed to result in enduring venous drainage of the CNS to offset the destructive effects of inflammation and neurodegeneration, and to regenerate disease damaged tissue.
As stated, it has been observed that a number of presenting symptoms of MS almost completely vanish as soon as the jugulars are widened and the flows equalize in most MS patients. Where a small number of MS patients have received no immediate benefit from the ‘liberation’ procedure, flows in subject samples have been shown not to have equalized post-procedure in these patients and therefore even a very small retrograde blood flow back to the CNS can offset the therapeutic benefits. Furthermore once the obstructed veins are further examined for hemodynamic obstruction and widened at the point of occlusion in those patients to allow full drainage, the presenting symptoms of MS retreat. This noted observation along with the large number of MS patients who have CCSVI establish a clear association of vein disease with MS, although it is clearly not the disease ‘trigger’.For more information please visit http://www.ccsviclinic.ca/?p=978

Cara Menghilangkan Flek Hitam said...

Thanks about this information