RE: State Surveyor Question - one last comment

[Guest guest]

I would strongly suspect the resident told the surveyor 'I avoid tomatoes

and strawberries' specifically that is why they questioned the RN on these

two products due to dated diverticuli diet education- the old seeds and nuts

mantra.

Busted diverticuli s/p diverticulitis are a key reason for ascending

colostomy after a temporary transverse. IBD- (not IBS) is the main reason

for Ileostomy (next is gun shot wounds). I still receive the united ostomy

associations newsletter having spent the 80's as a rep with ConvaTec: pee,

poop and pus or the PC version: ostomy, incontinence and wound care division

of Squibb. Yes, the Pope and President Regan both wore Sure-fit Ostomy

bags after they were shot. Sinatra too for a temporary, one of the

Bush boys has IBD and an ostomy but I think may have had a Koch pouch done?

a little trivia for this gloomy Jersey Friday.

R

_____

From: rd-usa [mailto:rd-usa ] On Behalf Of

Pat Bollinger

Sent: Thursday, June 04, 2009 11:13 AM

To: rd-usa

Subject: Re: State Surveyor Question

Adding to to Ronni's comments about the surveyor and remembering anatomy

and physiology of the colon.

*If* history of IBS-D is documented food intolerance could be possibly

involved. Her symptoms do not suggest IgE reactions or food allergy.

They could suggest a type 3 or type 4 delayed type hypersensitivity to a

food or chemical leading to the release, most likely of cytokines that

are causing the symptoms. Because these reactions can happen over 4 to

72 hours after consuming the trigger food(s) food records and history

make finding the the culprit(s) a guessing game though they may be some

help. After R/O anatomical reasons for the diarrhea Mediator Release

Testing from Signet Diagnostics anend-point test for many types of

triggers, *not food allergy testing* would be the logical next step to

find the cause (s) of the problem.

Pat Bollinger, MS RD

Helena, MT

ronni alicea wrote:

>

>

> There are documented 160 food items that have elicited allergic responses-

> the question is if the resident said she was allergic/intolerant to these

> before her colostomy during their interview. Review her food history and

> document that. I agree that the surveyor is out of line and forgot their

> anatomy of colon water absorption. I would be concerned with Vit K, B12

> and other things that lower bowel bacteria manufactures.

>

> Ronni

>

> _____

>

> From: rd-usayahoogroups (DOT) com <mailto:rd-usa%40yahoogroups.com>

> [mailto:rd-usayahoogroups (DOT) com <mailto:rd-usa%40yahoogroups.com>] On

> Behalf Of

> Mavis

> Sent: Wednesday, June 03, 2009 7:14 PM

> To: rd-usayahoogroups (DOT) com <mailto:rd-usa%40yahoogroups.com>

> Subject: State Surveyor Question

>

> I consult at a LTC facility currently in survey. The following occurred

> today and left me basically speechless.

> This was a new one on me. The RD surveyor didn't ask me directly but asked

> the DON and unit manager the question. There is a resident with a very

> high

> colostomy, they were looking at her for non-dietary reasons. Her stool is

> very watery which we attributed to how high the colostomy is placed. Shane

> asked the two RN's if the dietitian had ever considered allergy

> testing for

> things like strawberries or tomatoes to see if that was the cause of the

> loose stools. When this was relayed to me later in the day I said I'd

> never

> heard of that. Are any of you aware of something new in this area?

> Wouldn't

> recommending allergy testing be outside my scope of practice? Any

> suggestions or information would be greatly appreciated.

>

> Mavis , RDLD

> mimco@... <mailto:mimco%40cfl.rr> <mailto:mimco%40cfl.rr>.

<mailto:mimco% 40cfl.rr. com> com

>

>