Digestive Health Clinical Nutrition Program
Comprehensive Nutrition Care
The physicians, dietitians, nurses, clinical pharmacists, social workers and wound care experts of the Clinical Nutrition Program work as a team to support patients with nutrition disorders or malnutrition through all stages of the care process. Loyola has staff dietitians in several of the outpatient multidisciplinary clinics, and patients wishing to consult with a dietitian can be seen at various Loyola locations. Additionally, patients with complex problems such as abnormal weight loss, malnutrition/malabsorption, short bowel syndrome, celiac disease, long term IV nutrition (“parenteral nutrition”), feeding tubes and other nutrition-related disorders are managed by physicians and dietitians working together to treat the entire patient.
Why Choose Loyola for Nutrition Care
Loyola’s commitment to “also treat the human spirit” shines in our Clinical Nutrition Program. Loyola is fortunate to have a unique outpatient Nutrition Assessment Clinic where patients with nutritional difficulties are seen at the same time by a dietitian and a physician. Our program is fully integrated into all of Loyola’s clinics and hospitals so that nutrition support is a key component of the total care of the patient. Our registered dietitians are top-notch clinicians, most with specialty experience managing particular diseases. Our nutrition support pharmacists have decades of expertise managing complex intravenous feeding and supplementation. Our physicians all have advanced training or board certification in nutrition support and are nationally recognized for their expertise. Loyola’s clinical nutrition specialists ensure that nutrition care is a central part of your healthcare experience and path to wellness.
What Conditions are Treated by the Clinical Nutrition Program?
The clinical nutrition specialists at Loyola Medicine are experts at diagnosing and managing patients with the following conditions:
- Abnormal weight loss
- Celiac disease and gluten sensitivity
- Chylous (“fatty”) ascites (excess fluid in the abdomen)
- Food allergies or intolerances
- Gastrointestinal fistulas
- Intestinal malabsorption
- Iron deficiency anemia or any other vitamin deficiency
- Irritable bowel syndrome sufferers who want to discuss dietary options
- Malnutrition, malabsorption, and severe diarrhea
- Pancreatic insufficiency
- Patients with feeding tubes (gastrostomy, “PEG”) or who need feeding tubes inserted for nutrition
- Protein losing enteropathy
- Short bowel syndrome
- Small intestinal bacterial overgrowth
- Wasting from cancer, heart disease, cirrhosis, cystic fibrosis, HIV, or other chronic diseases
Diagnostic Services Offered in the Clinical Nutrition Program
The Clinical Nutrition Program uses a variety of testing to help diagnose and manage nutrition-related diseases. As part of the evaluation of nutrition conditions, patients undergo one or several of the following tests:
- Indirect Calorimetry: Patients who are losing weight for unknown reasons may have a problem with metabolism and may need more calories than expected. Loyola has the ability to measure the body’s daily calorie needs and metabolism through specialized breath testing to help your doctor determine how much food you need to eat to maintain, gain or lose weight.
- Hydrogen breath testing for lactose and fructose intolerance: Breath testing for food intolerances involves administering a small dose of oral lactose and fructose and then blowing into a balloon collection container every 15 to 20 minutes for several hours to determine if your body can digest lactose and fructose.
- Small intestine bacterial overgrowth testing by hydrogen breath test and/or small intestine fluid sampling: Patients with gas, bloating, diarrhea or weight loss may have too many bacteria in their small intestine, causing malabsorption. In a similar process to lactose and fructose intolerance testing, we give a small dose of a liquid medication and have patients blow into a balloon collection container every 15 to 20 minutes for several hours to determine whether excess bacteria exists. We also perform direct cultures of small intestine fluid by performing an endoscopy to obtain the fluid and then growing bacteria in the lab.
- Gastrointestinal motility testing: Some people have poor nutrition due to a malfunctioning GI system. Loyola offers the full range of intestine functioning tests, including tests to determine the stomach’s ability to empty (gastric emptying scans), tests of the function of the esophagus, stomach and upper small intestine (esophageal and antroduodenal manometry) and tests that can determine the function of the entire GI tract (SmartPill).
- Other tests for malabsorption: Loyola’s clinical nutrition specialists perform a wide array of tests to determine the cause and amount of intestinal malabsorption. This includes stool tests, blood tests for vitamin and mineral deficiencies, gastrointestinal endoscopy and biopsies, “pill camera” endoscopy where patients swallow a small capsule that takes pictures of the entire small intestine, and small bowel enteroscopy where doctors can use specialized endoscopy cameras to go deep into the small intestine.
Clinical Nutrition Treatments at Loyola
Loyola’s clinical nutrition specialists have advanced training in all levels of nutrition support and offer comprehensive management of nutrition-related diseases using a multidisciplinary approach. At Loyola, all members of the Clinical Nutrition Program are available to help patients and their families return to a healthy diet that supports healing.
Loyola’s clinical nutrition specialists are experts in:
- Comprehensive nutrition evaluation and assessment: People with nutrition-related disorders have consultations with our experienced registered dietitians and physicians to assess their current diets, degree of malnutrition, and to provide a patient-centered feeding plan to support health and healing.
- Placement and management of intestinal feeding tubes: Many people have diseases that prevent them from eating normally, and often those people need to have devices inserted into their nose, stomach or intestines to provide feedings. Most of these devices are called “feeding tubes” and are usually made of medical-grade plastics or silicone. Loyola’s clinical nutrition specialists are experts at placing these devices and managing problems that can occur when using them. We also have a device to allow us to place feeding tubes through the nose into the stomach or small intestine without the need to put people to sleep or perform an endoscopy.
- Endoscopic closure of fistulas: Sometimes people who have had feeding tubes removed have wounds that do not heal. The Interventional Endoscopy and Minimally Invasive Surgery programs that work with the Clinical Nutrition Program have expertise at closing non-healing wounds through minimally invasive techniques, including endoscopy, a non-surgical procedure where open wounds can be closed in ways that traditionally were done by a large complex surgery. This allows faster healing with less risk than a surgical repair.
- Management of parenteral nutrition: Patients who have non-functioning intestines or who have had large portions of their intestines removed often need intravenous feeding through a catheter inserted into a large vein in the arm or chest. Our nutrition support pharmacists and clinical nutrition specialists have extensive experience managing patients on parenteral nutrition and are well trained to minimize the discomfort and complications associated with intravenous feeding.
- Dietary counseling for patients on special diets: Loyola’s registered dietitians have advanced training in medical nutrition therapy, including educating people with certain medical diseases like Celiac disease, pancreatic insufficiency, food allergies and irritable bowel syndrome about the types of diets that can help them improve the symptoms of their disease.
- Intestinal rehabilitation: Patients with intestinal failure and short gut syndrome need intensive medical therapy and dietary counseling to manage their nutrition and symptoms through a detailed and often difficult-to-follow diet. Loyola’s clinical nutrition specialists have helped many patients manage this difficult disease and bring some control back to their life.
- Medical therapy of poor appetite due to chronic illness: Many people who suffer from chronic illnesses lack an appetite or desire to eat. Loyola’s clinical nutrition specialists are familiar with techniques and medications that can help improve nutrition for patients who are struggling.
- Treatment of vitamin deficiencies: While many vitamin deficiencies can be treated with pills or oral supplements, some require intravenous infusions, and all require monitoring to avoid side effects and complications. Loyola has several forms of intravenous iron and other vitamins, and our clinical nutrition specialists routinely monitor for vitamin deficiencies.
- Nutrition support during transplantation and cancer therapy: Organ transplantation and cancer therapies cause severe strain on our systems, and good nutrition is vital to improving outcomes from therapy. Loyola’s registered dietitians have advanced training in transplantation and cancer nutrition support, working with patients throughout the care process to ensure the best path to wellness.
Overview of the Nuclear Medicine Residency Program
The nuclear medicine residency at Loyola is a fully accredited program of the American Medical Association and leads to eligibility for the American Board of Nuclear Medicine examination. The Loyola University Medical Center and Edward Hines Veterans Administration Hospital jointly sponsor the program. The maximum number of residency positions is five.
Graduates of the three-year nuclear medicine residency program are eligible for certification by the American Board of Nuclear Medicine (ABNM).
Prior Qualifications: In conformance with rules of the Accreditation Council of Graduate Medical Education (www.ACGME.org) and the American Board of Nuclear Medicine (www.abnm.org) the applicant must have completed one preliminary year of residency (PGY-1) in an accredited program in the United States or Canada.
Step III: Unless completed already, Step III should be taken by May of their first year. You may not promote to PGY3 if you do not pass Step III by June.
Faculty: Four Board Certified nuclear medicine physicians and two basic scientists are assigned to the teaching program.
Case Load: The combined Hines/Loyola procedure volumes are approximately 28,000 per year. Residents participate in all clinical cases through an "Officer-of-the Day" program.
Didactic Sessions: There are 3-5 scheduled didactic sessions per week and one journal club per month. One-on-one discussions with faculty are encouraged.
Research: There are ongoing research opportunities in nuclear medicine. Residents may join as co-investigators or submit projects of their own design for review.
Call: Residents take first call beginning approximately two months after entering the program. Attending physician backup for residents is always available through a second-call schedule.
Rotations: Residents rotate through Nuclear Medicine at the Edward Hines VA Hospital and rotate through CT, MRI, Radiation Oncology, Medical Oncology, Neuroradiology & Nuclear Medicine at Loyola University Medical Center.
Second-year residents (PGY3) attend a radiation emergency medicine course (REAC/ts) in Oak Ridge, TN.
Applications: The nuclear medicine program does participate in the national residency-matching program (NMRP). Applications are excepted through the Electronic Residency Application Service (ERAS) in August, and the program receives access in September. Interested applicants should apply to Nuclear Medicine at the beginning of their preliminary year. The application should include the electronic application form, personal statement, three current letters of recommendation, current program director's letter of recommendation, medical school transcripts, Dean's letter, USMLE scores and a photograph. Application material should be complete by December. Selected applicants will be invited for an interview. Interviews begin in November.
The current LUMC policy allows for non-traditional trainees (someone who is transferring from a residency program or a lapse from clinical training for 1 year) to apply. However, these applicants would need to be reviewed and approved by our GME Department.
Loyola adheres to all non-discrimination rules with regard to residency acceptance.