Taking Healthcare by Storm: Industry Insights with Jillian Pate

In this captivating episode of Taking Healthcare by Storm, delve into the world of expert insights as Quality Insights Medical Director Dr. Jean Storm engages in a thought-provoking and informative discussion with Jillian Pate, MS, RD, CSR, LD, a Renal Dietitian Nutritionist.

Connect with Jillian:

• https://jillian-pate.clientsecure.me/ 

National Kidney Foundation: Dining Out with Confidence

If you have any topics or guests you'd like to see on future episodes, reach out to us on our website: https://www.qualityinsights.org/qin/taking-healthcare-by-storm

This material was prepared by Quality Insights, a Quality Innovation Network-Quality Improvement Organization under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services (HHS). Views expressed in this material do not necessarily reflect the official views or policy of CMS or HHS, and any reference to a specific product or entity herein does not constitute endorsement of that product or entity by CMS or HHS. Publication number 12SOW-QI-PCH-082523-GK-A

Transcript

Welcome to Taking Healthcare by Storm, Industry Insights, the podcast that delves into the captivating intersection of innovation, science, compassion, and care.
 
 In each episode, Quality Insights Medical Director, Dr.
 
 Jean Storm, will have the privilege of engaging with leading experts across diverse fields including dieticians, pharmacists, and brave patients navigating their own healthcare journeys.
 
 Our mission is to bring you the best healthcare insights, drawing from the expertise of professionals across West Virginia, Pennsylvania, and the nation.
 
 Subscribe now, and together we can take healthcare by storm.
 
 All right, welcome everyone to Taking Healthcare by Storm Industry Insights.
 
 We are talking to Jillian Pate today.
 
 Welcome, Jillian.
 
 So, why don't you tell us your background and why you decided to become a dietitian?
 
 So, I am a West Virginia native, and so I stayed close to home and went to Marshall University, and I decided to become a dietitian my senior year of high school.
 
 I knew how important it was to help others, and I was trying to find a field that I could go in where I could help others.
 
 I knew that nutrition would always be something that would be prevalent in everyone's life, so I felt like that was a good avenue to go to really help, you know, just kind of meet people where they're at.
 
 It was very superficial at the time, but through the years, it has become so much more rewarding.
 
 Sure, and I'm guessing that there's a big need for you in West Virginia, a huge need.
 
 Yes, yes.
 
 So, I stayed here in the West Virginia area.
 
 I have family here, so that always helps.
 
 But, yes, the need for just helping to prevent chronic, you know, disease states, helping to just really bring preventative nutrition to this area.
 
 Unfortunately, West Virginia has gotten a lot of stigmas that aren't always on the positive side of things, and a lot of it falls into really how nutrition plays a role in their every day, you know, day to day of what they're doing.
 
 Right, right.
 
 So I thought we would start with just a few questions.
 
 I know there is a lot of information on social media that is put out by nutritionists and dieticians, and I thought if you could just clear it up, what is the difference between a nutritionist and a dietician?
 
 Yeah, so I appreciate you actually asking that question.
 
 I have a lot of respect, of course, for all my fellow dieticians.
 
 There's a lot of dieticians out there providing a lot of great information online.
 
 However, a lot of their work gets kind of miscued because there are a lot of other nutritionists in that same space.
 
 So as far as a nutritionist goes, a lot of times someone can go through kind of like a six to eight week program and just get kind of the basics of nutrition.
 
 I respect those that are trying to learn more about nutrition, but at the end of the day, a dietitian has spent four years receiving their undergraduate and dietetics and then moving on now, you have to have your master's in dietetics to be a registered dietitian.
 
 And then we have to sit for a board.
 
 So we become board certified.
 
 So that way it's across, you know, across the US.
 
 We are making sure that we have the right foundation for what us as dietitians can bring to the health care industry.
 
 So really, by becoming a dietitian, you're getting more of that research base and knowing that the person you're working with has the qualified information.
 
 And they kind of just know a little bit more in depth of what they're working with.
 
 Yeah, really important with that certification, most definitely.
 
 So tell us how you specialized in CKDN renal issues and why you pursued that avenue.
 
 Yeah, so I actually started working at a dialysis facility about seven years ago.
 
 I just really took interest in it because that's the beauty of being a dietitian.
 
 There's a lot of different avenues as a dietitian you can work in.
 
 So I decided to work in the dialysis setting.
 
 And through that, they did a great job really giving me more of a foundation of what to really educate these patients with.
 
 But I really kind of noticed quickly on that it was so much more than that.
 
 I had a lot of patients coming in that never really even got control over their diabetes or their hypertension prior to starting dialysis.
 
 So I looked a little bit further.
 
 And thankfully, the CDR, which is the Dietetic Association here in the US., they had the opportunity for you to become a renal dietitian.
 
 So with that, I put the hours in and I sat for another board.
 
 And through that, I got to learn so much more in depth as far as medication, supplementation, really just looking at the disease state more as a whole and how, you know, as far as my background as a dietitian goes, how much more I could build on that to give them, you know, more clarity and what they're looking at.
 
 Yeah, it's really interesting how things can specialize depending on the disease state as far as nutrition goes.
 
 And, I mean, it's just it's pretty amazing.
 
 Yeah, I'm grateful for the opportunity because you got to think as far as, you know, a physician goes, you get the opportunity to specialize in different areas.
 
 And so I was grateful for the opportunity as a dietitian to specialize in something that is so prevalent.
 
 And and really going through even my masters, you just kind of don't get as much education during that time in a specific field.
 
 So by becoming renal certified, I got to expand on so much more of what what I could do with nutrition.
 
 Yeah, that's that's great.
 
 So let's walk through how a patient would come to see you, how they would make an appointment to see you.
 
 So here in West Virginia, I've had the opportunity to work with about 10 or 12 nephrologists here and and in my area that I'm in.
 
 So right now, I have doctors that are able to just refer to me.
 
 So their patients will be able to have my services provided to them at their at their appointment with their nephrologist.
 
 And then from there, the nephrologist would refer them to me.
 
 However, I've started to try to put myself out more in the social media platform just because I know that a lot of times that's what you know family members are doing for maybe their family that might not even be on social media.
 
 And actually, that's where I have received probably the last hub of my patients have been coming from family members just Googling my services.
 
 And and I have more information for that that I can add on to that at the end of this.
 
 Great.
 
 Yeah, because I think a lot of people, a lot of individuals will be really looking into how they can get access to you.
 
 I think a lot of individuals are really taking control of their chronic diseases, really doing some of the self-management and nutrition plays a huge role.
 
 And I think it's really becoming more so recently.
 
 So what insurances will cover an appointment with you?
 
 So that's a great question.
 
 So that was something when I set out to be a renal dietitian, something that I realized is that not only is this something that's prevalent and that medical nutrition therapy needs to be a big part of their plan, but I know that in this area here, the barrier for finances is huge.
 
 So I made sure very quickly on to get credentialed with Medicare.
 
 Some credential with Medicare, Blue Cross Blue Shield, UnitedHealthcare, and Humana.
 
 Oh, and Aetna as well.
 
 Yeah, you would think insurances would be very much into what diet can prevent progression of chronic kidney disease.
 
 So I would think that they would get on board with your services.
 
 Makes sense.
 
 Yeah, and that's what's so nice is just really at this point, streamlining the process of getting those referrals in and making it, it's honestly seamless as possible for those that are really, you know, looking at getting nutrition education.
 
 Yeah, most definitely.
 
 So this service, I know you are practicing in West Virginia.
 
 So is this type of service only available in West Virginia or is it available across the country?
 
 So I actually, so I am licensed in West Virginia and Ohio, so I can take, you know, both of those residents that come from those states.
 
 But, you know, I do know that there are a lot of kidney dieticians that are across the country.
 
 Where is such a prevalent disease state?
 
 It is really refreshing to see more and more renal dieticians coming out and really providing the same services I have.
 
 But I will say this, as far as being like a West Virginia native, I really, I know the difference between talking with someone here in my own state versus someone and maybe across in the West Coast.
 
 You know, our, you know, what we're recommending isn't going to change, but the way we deliver it and we know, you know, we know our community.
 
 So we know what they're going to be better well to receive as far as the education goes.
 
 So that's something I like to do provide is, you know, to meet really the people here in West Virginia where they're at.
 
 But I do love that, you know, I have several renal dieticians in, for example, California, and they know exactly how to reach their clients there.
 
 So it's definitely a rewarding place to be when you get the right person you're working with.
 
 I completely understand and agree as a physician that's practiced in West Virginia.
 
 And I've practiced now in Pennsylvania in the long term care space.
 
 It is very different.
 
 West Virginians just have a special place in my heart.
 
 And I agree, I mean, to tailor your approach regionally really makes it more effective.
 
 I agree.
 
 Yeah.
 
 So we're talking about, you said you are licensed in Ohio.
 
 Do you practice telehealth?
 
 I do.
 
 I do.
 
 So actually, so when I launched my business, it kind of followed suit with COVID.
 
 So telehealth became a lot more really the only option, you know, we had at that time.
 
 So actually, what I do is I provide 100% of my services via telehealth.
 
 And the reason I do that is so that way I can get these patients scheduled quickly.
 
 It's a lot more time efficient.
 
 It also helps reduce the barrier for them if they have to, you know, be transported somewhere.
 
 I have a lot of patients that are bed bound or, you know, they want their family to be involved.
 
 And that's another thing I like about telehealth is they have that opportunity to have their friends or family, their support team there with us.
 
 And so that way we can kind of come together.
 
 And not only am I providing the support for them, but then they get a walk away from that session and know that their family was on the same page with them.
 
 Yeah, that's really great.
 
 You can like get them in quickly and then see them exactly where they are.
 
 Telehealth is really gaining momentum, definitely probably because of the pandemic.
 
 But, you know, the good thing that came out of the pandemic, I think.
 
 Exactly.
 
 So during the first visit, what types of things do you discuss with a patient?
 
 So during the first visit, what's nice is where I have a good system so far.
 
 I get a referral from their doctor.
 
 So at that point, you know, I'm able to already see the medications are on the supplementation they're taking.
 
 But I get that time, I kind of get that space for the patient to really tell me, you know, what their past medical history is.
 
 I can read it on a paper, but it sounds so much different when I hear it from them, what they've experienced.
 
 It helps me to build rapport with them to really understand what they've gone through.
 
 And then with that, by building that rapport, we're going to have an opportunity to build a relationship where they're going to understand my intentions for how I'm helping them.
 
 So I think that's important right off the gate to set a good foundation.
 
 When I go into a first session, I look at it as, hey, we're going to be working together for a little bit.
 
 You know, kidney disease, it's one of those things that, you know, you can read a lot of information on it.
 
 But at the end of the day, you need some of that support.
 
 So I look at it as a way for us to start building on, you know, building on what they may already know or just really starting out fresh and letting them kind of establish goals initially for what we want to start seeing as we work together.
 
 That's great.
 
 Are there any?
 
 So we're talking about chronic kidney disease here.
 
 And obviously, we're talking about diet and nutrition.
 
 So we all know that chronic kidney disease kind of goes in stages as oppressive that we say CKD stage one, CKD stage two.
 
 So are there any different diets a patient should follow depending on what stage they're in of chronic kidney disease?
 
 Yes.
 
 So that's a great question.
 
 So a lot of times when you know you find out that you have chronic kidney disease, you ultimately kind of go straight to Google.
 
 You go straight to, you know, what you can find as far as that goes.
 
 And a lot of it's going to start being conflicting because you're absolutely right.
 
 The different stages you're in, it's going to look a little different.
 
 Something else is that it's a lot of it is based on their individual labs.
 
 So I go off of lab work a lot.
 
 Being in the kidney world for the last seven years, I know exactly what lab parameters we're looking at, what ranges they need to be in.
 
 And I've also known how nutrition plays a role in getting those labs within normal limits.
 
 So that's kind of something we look at.
 
 You know, honestly, someone with kidney disease stage two versus kidney disease stage four, a lot of them might have some similar things to them.
 
 But if their labs are off, we have to focus on what we're looking at at that time.
 
 And that's why it's important to not only go off of what you see.
 
 A lot of the patients I work with, if they get diagnosed with kidney disease, they quickly start eliminating everything from their diet.
 
 And so by the time I get with them, they are at the point where they're eating peppers and carrots and apples because they really limited their diet when all that they needed to do was make some minor changes for the disease state that they were at.
 
 Yeah, that's why I think it is so important for patients to come see you instead of going on Google and just deciding like they're going to go keto or whatever.
 
 You know, they're going to listen to some random person on Instagram, you know, and then kind of, you know, really make huge changes to their diet, which they don't need to.
 
 Right, exactly.
 
 So what about salt?
 
 I know everyone is talking about salt these days.
 
 Some people are saying we need more salt.
 
 Some people are saying we need less salt.
 
 You know, with chronic kidney disease, I think it's probably, you know, very challenging in that arena.
 
 And then once you address salt, I want to talk about salt substitutes because they seem to be like the big rage maybe several years ago, but I'm guessing that some people are still thinking that these salt substitutes are safe.
 
 So what about salt in chronic kidney disease?
 
 Yeah, so a lot of times the biggest thing that we kind of work on and kind of going back to the initial, you know, session, like what do we look at?
 
 Salt is always my very first topic that we discuss, mainly because, like you mentioned, it's already out there.
 
 So by the time I get to them, they probably have read something about eliminating salt from their diet.
 
 So I want to make sure to address that early on.
 
 So with that, you know, the biggest thing is, of course, get out of the behavior of using salt at the table.
 
 Just because a lot of the foods that we're eating nowadays, they already have salt added to them while we're cooking.
 
 So by just already eliminating that behavior of having the salt, that's one step in the right direction.
 
 Now, then I find individuals who have already done that, and they think, I'm good.
 
 I've already eliminated that.
 
 Well, we're thankfully in the right direction.
 
 But nowadays, our food, especially being so processed or relying on eating out alive, we're running into our sodium intake sometimes being included in just one meal of that day.
 
 So early on, I addressed the importance of sodium, how higher sodium intake, the effects that it has on their kidneys and making it work harder.
 
 We also talk about fluid retention because a lot of my patients at this point typically have hypertension or some sort of cardiovascular disease.
 
 So we definitely get kind of into the weeds at times because we want to make sure that we're not missing any opportunities to let them know, like, you are doing a great job, but we still have some work to do as far as the sodium goes.
 
 Yes, sodium is like a huge...
 
 So what about salt substitutes?
 
 How do you feel about salt substitutes?
 
 Do you recommend them to people with chronic kidney disease?
 
 I think they're normally with potassium instead of sodium.
 
 Yep, yep, you got it.
 
 So that's the thing is a lot of salt substitutes, honestly, all of the substitutes are going to have potassium in it.
 
 Not everybody that has kidney disease has an issue with potassium, but it is something that we're going to look out, you know, from the very beginning as far as monitoring that potassium lab.
 
 So if there's something that we can do to not make that an issue, we're going to go ahead and address that.
 
 You can get potassium through so many different foods, and I would much rather them be nourished and eating foods they still enjoy and finding different ways for them to season their food so they don't have to worry about that added potassium coming from that salt substitute.
 
 Now, as far as salt goes though, you know, by enhancing the flavor with different citrus fruits, doing fresh herbs, really even doing garlic, Mrs.
 
 Dash, there's a lot of great options.
 
 I agree.
 
 I think people forget about all of those other things that we can add to food.
 
 People are just automatically going by habit to the salt shaker.
 
 But there are so many other things.
 
 Talking about some tips, do you have any just some basic tips of how people can limit the salt in their foods?
 
 Yeah.
 
 So something I always encourage is, you know, especially, I really feel like the best way you can capture it is when you're in the grocery store.
 
 A lot of times we're grabbing the items that we've had, you know, that we've probably been purchasing for like the last five or ten years.
 
 It's something we enjoy.
 
 We like the way it tastes.
 
 We just throw it in our grocery cart, right?
 
 But if they can just take an extra moment just to flip over and read the nutrition facts, the item that they might be enjoying, it could have almost a thousand milligrams in just one serving.
 
 And right beside of it, it could be a completely same product with more than, you know, more than less than half of what you would be getting from the other product you normally use.
 
 So sometimes it's just taking the time to kind of slow down.
 
 No one really wants to be in the grocery store longer than they need to be.
 
 And so that's why a lot of times I do recommend different brands and I really try to help out my clients so that way they feel more comfortable, but also educating them because at the end of the day, as much as I love working with each, you know, each client I get, I want them to walk away feeling more confident and knowing exactly what they need to look at to make better choices.
 
 And by slowing down, reading the nutrition label for just a moment, looking at what they can do to just swap out some things, that's going to make a big difference in eliminating some of that sodium from their normal day to day.
 
 Yeah, and that's a small little thing that people can do to kind of make a big difference.
 
 So what about sugar and patients who have CKD?
 
 Do they worry about excess sugar in the diet?
 
 So a lot of my chronic kidney disease patients are diabetic.
 
 So we oftentimes will address their glucose labs, we'll address their A1Cs.
 
 We're going to look at that as well as we're working together.
 
 So of course, as far as my diabetics go, I am going to of course encourage them to really eliminate, but also just limit the amount of sugar they're putting in their diet.
 
 I still like to be flexible with them because I want to make sure that what we're doing is something they're going to stick with through the duration.
 
 If we start restricting so many things, I don't know about you, but it makes it really hard to stick with it in the long run.
 
 So I try to definitely meet them with where they're at.
 
 If they're not diabetic but they do have a family history of diabetes, I still bring that to light and just the importance of us making sure that we're not always relying on sugar for our whole meal, but how we can kind of modify it as far as portion goes just to make it something that's going to be a sustainable choice for them.
 
 Yeah, sustainable, I think, is the key word here, most definitely.
 
 So, there's a lot of talk about protein these days and getting enough protein.
 
 Do patients with chronic kidney disease worry about getting enough protein or eating too much protein?
 
 Yeah, so protein is a big topic, and one of the things I want to address kind of early on is that a lot of the fad diets especially are going to really push a lot of protein intake.
 
 And if you don't have kidney disease, and your body and your kidneys, your liver, everything's functioning more at where it needs to be, that's an option.
 
 But once you find out that you do have kidney disease, we have to look at protein in a different perspective.
 
 Protein is still just as important for their muscle mass, so we have to make sure that they're getting enough protein in.
 
 But we also have to recognize that a lot of the waste that comes from protein, the way our body digests it, breaks it down, absorbs it, you know, we have to remember that our kidneys are what help also break down and get rid of that extra waste that comes from those protein foods.
 
 So, you know, a lot of times looking at protein, not only do we look at how much protein they need to have, we actually also look at the source of protein.
 
 We look at animal-based versus plant-based protein, because those do make a difference.
 
 And here in the West Virginia area, you know, I don't work with a lot of vegetarians because we're more, that's not really our culture here.
 
 But thankfully, I do have a way of, you know, really calculating their protein needs based on their activity level, based on their kidney disease state.
 
 You know, I look at a lot of different things while I'm calculating their needs.
 
 And then when we do that, I know hands down, my clients are able to walk away feeling more comfortable knowing that this is the amount of protein I need to get every day, knowing how important it is to actually spread that protein out throughout the day, because your body can actually use so much protein at a time.
 
 So if we're putting all of our protein in one meal, we're already setting our kidneys up to work even harder just in that one meal.
 
 So that's really a good reason why patients with chronic kidney disease should see you, because we want to make sure that they continue to maintain their muscle mass, as we know it's very difficult to maintain muscle mass as you get older.
 
 So I'm sure you have strategies then to avoid muscle mass loss as patients get older.
 
 Exactly, because not only are we doing a diet just for their kidney disease state, we're also doing it to keep them nourished, to keep them to be able to move forward and not let this kidney disease define their whole life.
 
 Yeah, that's really huge.
 
 So doing a little bit more on the front end with their diet can really prevent it from the kidney disease from kind of taking over their whole life.
 
 Yeah, absolutely.
 
 So what about fluid intake, liquids?
 
 Should patients with chronic kidney disease limit their liquids that they're drinking?
 
 So kind of going back to the different stage that you might be in, a lot of times, if you're more at the earlier stages, fluid is definitely going to be promoted.
 
 Hydration is key.
 
 We want to make sure that your kidneys are staying hydrated because you're helping them to be able to still function the way they were designed to function.
 
 However, when you kind of get later in the stage four, stage five, you might honestly start being symptomatic.
 
 You might be retaining some more fluid.
 
 A lot of times, I'm going to see this with a patient that has more cardiovascular issues.
 
 So that's something we have to kind of balance at that time.
 
 But as far as earlier stages, we definitely want to keep them hydrated because it's going to ultimately just help prevent further decline with their kidneys.
 
 So we're talking about liquids.
 
 What about alcohol?
 
 I'm sure people are asking you, if you want me to keep drinking my liquids, can I drink beer?
 
 Absolutely.
 
 Absolutely.
 
 So that is a very common question because once again, you know, we're trying to meet them where they're at.
 
 We're trying not to eliminate all the different things that they do enjoy.
 
 Food is always something that they enjoy.
 
 So by us taking things from it, there are a lot of times skeptical, but then you bring alcohol into the equation and it's a different level.
 
 This is where people use it as a social opportunity.
 
 You know, it's something that they're normally doing with, you know, family or different, you know, work environments, you know, things like that.
 
 They're trying to still feel like their kidney disease is affecting their day to day.
 
 As far as alcohol goes, though, it can sometimes leave your body a little bit dehydrated.
 
 So just kind of going into the liquid, you know, the fluid, you know, we want to keep you hydrated.
 
 And so if we're bringing alcohol in, it can sometimes dehydrate and make it harder for your kidneys to work.
 
 However, it is still, you know, perfectly fine to have one or two beverages a day.
 
 The biggest thing is that you just don't want to be consistent with it because over time, you know, there can be more effects with the liver.
 
 And a lot of times when the liver starts to decline, declining the kidneys will also kind of step in and try to help out as well.
 
 And if your kidneys aren't in their prime state to really be able to help, it starts becoming harder on your kidneys and your liver.
 
 Really good tips.
 
 How about, so if chronic kidney disease progresses and then we have an individual who's on dialysis, we have a lot of individuals in West Virginia and across the country who are on dialysis, should they start to limit things like phosphorus in their diet?
 
 Right.
 
 So once they become on dialysis, you know, dialysis kind of steps over and takes the role of what their kidneys should have been doing, right?
 
 So it's going to start eliminating a lot of toxins out of their body.
 
 Phosphorus, though, is a little bit harder to remove during the dialysis process.
 
 Once again, though, they will get monthly lab work, sometimes weekly, depending on what their labs come back.
 
 I have several individuals I've worked with, their phosphorus has remained within goal since they started dialysis, and they've never needed to really be restrictive with their phosphorus intake.
 
 I've unfortunately have had some, and I really do believe it just depends on the kidney function that's left.
 
 And at that point, their phosphorus level tends to be elevated, and at that point, we do have to scale back on higher phosphorus foods and drinks.
 
 So what are some higher phosphorus foods and drinks?
 
 So right out the gate, this is one that I really honestly encourage, even if you don't have end-stage renal disease, is dark colas.
 
 So dark colas like Coca-Cola, Pepsi, Dr.
 
 Pepper, they're going to have a lot of the additive phosphates in it.
 
 Those phosphates that are added to those dark colas, our bodies actually absorb them so quickly.
 
 So it makes it really hard to manage their phosphorus level because of that additive they add with it.
 
 Dairy products.
 
 Does it mean you can never have dairy products?
 
 It just means that we have to scale back on how much milk and cheese we're taking in on a daily basis.
 
 And a lot of processed foods.
 
 So a lot of times when I educate people about phosphorus and we go over dark colas, processed foods, dairy food groups, I can leave them feeling like they don't have any options, okay?
 
 Because those are a lot of things that are heavily relied on.
 
 But the most important thing is just to look at what they are having and just scale it back on how much they're having of that.
 
 Yeah, dark colas, that's a really good...
 
 You can just switch to non-dark colas, like a clear colas.
 
 And there's actually root beer, there's different root beer brands.
 
 That's the only dark colas that doesn't include phosphates.
 
 There's a couple of different root beer brands.
 
 Oh, great.
 
 So can patients with chronic kidney disease safely lose weight?
 
 Yes, yes, they can.
 
 And a lot of times, that's something else.
 
 So kind of going back to that initial session, when we're talking about goals, we're talking about things we want to work on together, I've had multiple clients say, I want to lose weight.
 
 And a lot of times that's where they kind of associate a dietician in our work anyways, is losing weight.
 
 But in this setting, I'm for it, because I know that if they're not within a normal weight, any weight loss that we can promote is going to ease the work of their kidneys as well.
 
 It's going to help lighten the load.
 
 So kind of getting them closer to more of their ideal body weight is what we work towards.
 
 And the way we do it is we just make sure to, once again, identify how much protein they need.
 
 We spread it out throughout the day.
 
 We talk about physical activity.
 
 We talk about different barriers that maybe they've had in the past to lose weight.
 
 But absolutely, they can lose weight.
 
 We just make sure that we do it in a more safe and optimal way than really relying on like a fad diet that might, you might see those quick, you know, weight loss results.
 
 But in the turn, you honestly can be damaging your kidney a lot quicker.
 
 Yeah, fairly important for patients with CKD, chronic kidney disease.
 
 They want to lose weight to visit you to do it effectively and safely.
 
 Exactly.
 
 So do you advise patients who have kidney transplants?
 
 I do.
 
 So a lot of times, you know, they'll actually bring it to me as a question.
 
 Oftentimes, it's presented to them from their nephrologist who's brought it up to them about, you know, becoming on the transplant team, you know, or, you know, transplant candidate.
 
 So I've actually had the opportunity to work with a patient prior to transplant and then post-transplant.
 
 And that was really rewarding to work with because I got to be on the front of it, where we really did modify a lot of things in their diet.
 
 Post-transplant, it looks differently, you know, and that's how we want it to look.
 
 But the most important thing to remember is that if you get the opportunity to be transplanted, you want to make sure that everything that you learned prior, you're going to take it with you to continue to live a healthier life.
 
 Yeah, to make sure that that kidney stays healthy, that new kidney.
 
 Yes, because honestly, if you nurture it and you're taking everything with it before, it's not going to have to be nearly as restrictive with a lot of things.
 
 But a lot of the basics of learning, you know, as far as like we just talked about, keeping that weight controlled, you know, still be mindful of sodium, you know, minor things like that will still go a long way with their new kidney.
 
 So if a patient with CKD comes to see you and they say that they just love going to restaurants, that's what they do a good amount of the time, that's how they have their social time.
 
 Do you advise them that they should stop eating out at restaurants or are they still able to go ahead and eat out at restaurants?
 
 Absolutely.
 
 So the National Kidney Foundation, they actually put out a great resource called Dining Out with Confidence.
 
 And I love it because it breaks it down from the different cuisines that we can eat out.
 
 And it's a very simplified, choose this, try to avoid that.
 
 And I utilize that a lot because I think it's just a very simple form, it's a simple thing for them to read over.
 
 But that's something else which is nice is when I work with these clients, a lot of times they'll tell me their favorite restaurants.
 
 Here in West Virginia, sometimes it's a lot of mom and pop restaurants, which makes it hard to look up really what's in the food items.
 
 So I just kind of direct them in the best case scenario for if you're dining out.
 
 This is what it can look like.
 
 And it can honestly be as simple as just saying, hey, you know, we don't know what they're putting in their sauce.
 
 It can come out with a lot of sodium in it, maybe even ask for light sauce or sauce on the side or ask for, you know, the lunch portion and take some of it home.
 
 You know, just finding different ways to to help them feel confident when they're going out and not feeling overwhelmed, because a lot of times they're either going to go out to eat and still choose what they're eating and it's not good for their kidneys or they're going to go out to eat and they're going to feel so overwhelmed and not even know what to order.
 
 So once again, it's just kind of letting them feel more confident in their choices by educating them prior.
 
 Yes, education gives them freedom.
 
 Absolutely.
 
 So how can patients get in touch with you, Jillian?
 
 So they can find me on social media as far as renalRDWV.
 
 I also have a Google form that I'm going to attach to this podcast.
 
 And all they'll have to do is click on it and it goes straight to this kind of this very simplified questionnaire.
 
 It gives me a little information about them and their disease state they're in and a way for me to contact them.
 
 And then I'll contact them and we get something set up to talk more about what they're looking for as far as a renal dietician goes.
 
 Wonderful.
 
 I hope that everyone, anyone who has CKD will just reach out to you and get the help they need.
 
 Thank you.
 
 I appreciate it.
 
 All right.
 
 Thank you.
 
 Thank you.
 
 Thank you for tuning in to Taking Healthcare by Storm, Industry Insights with Quality Insights Medical Director, Dr.
 
 Jean Storm.
 
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