Episode 132 – Interesting Experiences with Clients

Key Topics Covered

Dietitian in a consult.

We wanted to share these stories, keeping in mind the following criteria;

  1. We really value working with our clients and our goal is to genuinely help as much as possible.
  2. When I posted these stories on Instagram, 99% of feedback was positive. But one comment touched on the thing I wanted to avoid. Basically, the commenter said “These people are humans who have come to you when they are vulnerable. They are people, not curiosities.”
  3. I feel like I had actually navigated that problem well on Instagram. My perspective is that we CAN try to help people as much as possible, respect that they have come to us for help AND be fascinated by their case too. And we can share that case in a de-identified way, without it being done disrespectfully. So while I think I navigated that well on Instagram and I honestly assume the commenter just didn’t read my post fully, I also hope we can do that today.

Leah – Story 1

Wheelchair in aged care facility.
  • A 90 year old client with dementia had been sent to me for management of diabetes & weight loss.
  • But her dementia was fairly progressed, she didn’t have any idea who I was, where she was or what she was doing sitting in my clinic.
  • I went to the facility to talk to the nurses and care advisors regarding this client but no one wanted to talk to me the couple of times I visited.
  • I sent letters, emails and wrote to the doctor and this poor lady kept being brought into see me.
  • So I would just let her talk for 20 minutes sometimes, she would discuss this one other lady in the nursing home (Rose) who she had beef with.
  • She was honestly quite fun but I wasn’t really able to help her.

This Sparked Two Questions

  1. How would I help someone like this?
  2. What do I do if the nursing home isn’t willing to work with me to accommodate for this client? What can I possibly do as a dietitian?

Luckily for me, it is not something that I have come across again but I still wonder about how I would and if I would be able to help someone in this situation.

Leah – Story 2

  • The client was diagnosed with CSID & was also an ultra-endurance cyclist.
    • CSID – doesn’t have the enzymes to process certain carbohydrates (sucrose and starch).
  • Conundrum on how to actually fuel this as most sports products contain sucrose or starch, which resulted in pretty immediate diarrhea and nausea.
  • During training, we used a homemade sports drink that was 2:1 (dextrose powder and fructose powder with added electrolytes and then used sugar-free cordial to flavour).
  • Carb loading was a whole other issue as well, not something that we could do that effectively.
  • To add another layer, this client also wanted to be vegan but we did end up straying away from the idea just because of how hard it was to manage the CSID already.

Why This One Stands Out to Me

  1. I feel like this client really prompted my interest in CSID.
  2. It brought a lot of satisfaction being able to solve some pretty hard problems.

Aidan – Story 1

  • This was Government-funded situation, where I was doing home visits in a nursing home.
  • There were many clients who I was visiting who didn’t remember me, due to dementia.
  • This was a difficult situation obviously..
  • I had got advice from another dietitian to write their meal plans on the wall as well as many other strategies.

Why This One Stands Out to Me

  • This drove me to go all in on my own business.

Aidan – Story 2

Boy with autism and food aversion.

  • The client was a 14-year-old boy with autism and food aversion.
  • He was primarily non-verbal so the mother was a part of the consults.
  • He had gained 10-20kg quite quickly prior to seeing me and was at around 90kg.
  • The common food aversion was the typical “only eats white foods” type situation – so we were looking to address gaps in his diet/
  • He had a huge intake of sugar, and loved baking and soft drinks.
  • His mother had him exercising on a treadmill most days. 100% she was trying so hard to help. Every decision came from a place of love.
  • The killer was that baking was his biggest joy, by a lot.

Why This One Stands Out to Me

  • The combination of autism + food aversion, and love for baking left me in a very challenging position. But it was an interesting case overall.
  • We managed to find some strategies to help.

Aidan – Story 3

  • This was one of my first ever client, probably within my first 3 months of working (not at Ideal Nutrtion).
  • I had about 20 sessions with this one individual.
  • He previously had T2DM for quite some time and then had a recent diagnosis of stage 4 CKD.
  • By the time you have stage 4 CKD it is INCREDIBLY rare for it to improve back to normal function.
  • Logistical challenges of having to monitor protein intake and electrolyte intake (e.g. limiting protein and veg – which for me were my key moves at that time)
  • Lost 10kg in the first 6-10 weeks. He monitored all of his intake, created his own spreadsheet. One of my most motivated clients ever.

Why This One Stands Out to Me

  • This was an early client for me. And in a truly non-judgemental way – it was interesting seeing that the stage 4 CKD diagnosis was a moment of huge motivation. 
  • Was also quite a complex client, which I enjoyed.