OPD setting bermula

Alhamdulillah minggu pertama OPD di Poliklinik Beserah selesai, saya hanya mampu memberi kaunseling kepada 2 orang pesakit sahaja lantaran kurangnya pesakit yang datang membuat pemeriksaan.

Pesakit pertama saya dirujuk kerana HPT dan hypercholesterolemia. Agak berdebar juga saya untuk mengambil kes ni, tambahan patient agak kurang memberikan respon yang baik. dari segi lifestyle agak sukar untuk saya manage, eating out every meal due to living alone here in Kuantan. The family members are in Rompin. After taking the diet history, all the dietary intake leads to the problem..In addition, he shows low motivation to change even though he is obese, has hypertension and hypercholesterolemia... What I have to rite now?

I advise on the healthy eating out tips since the patient is eating out most of the time. What is it?

1. Choose healthy cooking method - steaming, grilling, baking, boiling instead of frying

2. Choose soup based dishes instead of fried food. Limit the intake of fried food to twice per week only. Aviod to drink the soup (because loooots of MSG there!)

3. Trim visible fat from poultry and meat, kalau yang ada kulit tu buang kulit dia ye.. Choose lean meat only.

4. Scoop out the oil in the soup / gravy

5. Increase the fiber intake from fruits and vegetables

6. Educate patient also on hidden salt - processed food (nugget, fishball, burger patty) and canned food (sardine, tomato puree, all canned items la..) because they use looooots of salt as preservative agent. Beware!!

All the recommendation is actually combination of low fat and low salt diet..

The next advise is on being active! Recommend the patient on doing physical activity, at least 30 minutes per session 3X per week. Besides, we also can perform the exercise at working area. Examples; using stairs instead of lift. Park the car far from the building so that we will walk to the office.

Maka selesailah sudah tugas saya untuk pesakit tersebut..

The next 2 days, I manage another patient. Of course man too! Diagnosed as DM, HPT, Hypercholesterolemia and Hyperurecemia (which will lead to gout soon. Aouch!!).. The management is almost same like previous patient, but I need more advise on controlling his blood sugar and also uric acid. I'm very happy to see this patient, very cooperative and gives respons. He also has high motivation to change. Saya bersemangat semula ^_^

Management of DM:

1. Educate patient on continuing regular meal time to avoid hypoglycemia

2. Emphasize on complex CHO (e.g. bread, rice, cereals) and avoid refined sugar (sweet foods and drinks).

3. Increase fiber intake (fruits & vegetables-twice per day, wholemeal cereals and bread)

4. Educate patient on fruits portion size (e.g: watermelon , honey dew, & papaya- 1 slice; apple, orange, banana- 1 no; dates- 2 pieces, etc)

5. Suggest patient to consume artificial sweetener, however it is better not to consume any sweet food and drink..

For uric acid management:

1.Educate patient on avoiding high purine food such as anchovies, seafood, yeast

2. Drink a lot of water.

* Since the patient also has HPT, I suggest to reduce the amount of cigarettes per day. Smoking also leads to constriction of blood vessels, lead to increaseng the blood pressure and affect the heart. Caffeinated drink also is limited to 2 cup per day only as it is vasoconstrictor and not good to our health ^_+

That's all for today, we will meet the 2nd week of posting. Iam waiting for Gestational Diabetes Mellitus (GDM) and Chronic Kidney Disease (CKD) patient..Hopefully ;)