Joselin Anandam, M.D.

Throughout her practice at UT Southwestern, Associate Professor Joselin Anandam, M.D., noticed a pattern of dehydration and malnourishment in her inflammatory bowel disease (IBD) and ostomy patients. The pattern did not seem to be caused by a lack of care, but rather by a lack of information on the part of the patient. In response, Dr. Anandam created two separate clinics to help educate IBD and ostomy patients—the Surgery C Ostomy Nurse Clinic and the Surgery C Nutrition Clinic.

The Surgery C Ostomy Nurse Clinic provides care to patients struggling with their ostomies. Any provider can refer a patient to the clinic. If a patient might need an ostomy or will have one as a result of a surgery, the clinic is set up to educate the patient and his or her family. The ostomy nurses mark a good place for the ostomy on the patient’s abdomen, taking into account skin folds, bony landmarks, where the patient wears a belt, and where the patient can see it to take care of it, personal preference, etc. They also follow up with the patients after surgery in case they have questions regarding the care of the ostomy, and to make sure the correct supplies are ordered. Currently, the ostomy clinic serves eight to 10 patients per week.

“I felt that better education would help ostomy patients,” Dr. Anandam explains, “and the clinic could decompress the patients coming to the ER. It has been a great success. Our readmission rate for dehydration from ileostomies has greatly dropped. I also wanted our patients to get proper ostomy education prior to surgery. Prior to my starting the clinic, we would call the inpatient ostomy nurse and then the patient would have to wait one to two hours for them to come over to the clinic. Other ostomy problems would often be addressed in the ER.”

The Surgery C Nutrition Clinic is for cancer and IBD patients who are malnourished and need surgery. The goal is to improve the patient’s nutritional status before surgery to reduce complications after surgery. If patients meet criteria, they begin taking an immunonutrition drink five days before the surgery and are given enough for five days after the surgery. There is good evidence that immunonutrition supplements before and after surgery decrease complications. The nutrition clinic is also for ileostomy patients before and after surgery to educate them on changes they need to make in their diet for normal output. The clinic also refers patients with severe malnutrition and patients with near obstructing colorectal cancers who need education on special diets. Currently, the nutrition clinic sees five to seven patients per week.

“I mainly started the nutrition clinic because I saw that many of our ileostomy patients were coming back to the ER dehydrated,” says Dr. Anandam, “often because they did not understand what foods to eat or how to manage diarrhea. I also saw many malnourished patients who needed surgery and had read that immunonutrition could improve outcomes in colorectal surgery. Nutrition is a key component in healing and colorectal surgery has a high complication rate, so I thought I could reduce our complication rate by pre-operatively addressing patients’ nutritional status.”

Patient satisfaction has increased; and readmissions, ER visits, and complications have decreased. Many facilities do not have ostomy clinics. In fact, Dr. Anandam doubts there are any others in the DFW area. Her ultimate goal for the clinics is education. Despite the fact that one million people in the U.S. have an ostomy, there is still a stigma associated with it. The clinic currently distributes a magazine and DVD produced by the United Ostomy Associations of America to its patients, but Dr. Anandam would like to add additional educational materials. She also has plans for expansion.

“I would love to expand the nutrition clinic to all patients undergoing colorectal surgery. There is a great lack of understanding regarding nutrition amongst our patient population. We have many obese patients, and I think it would be valuable for many of them to see a dietician. We see so many young patients with problems with their colon due to improper diet and exercise."