In my eight years as a dietitian at the Milwaukee VAMC I have witnessed the integration of countless directives, programs and polices into our health care system. None have filled me with such immense pride, nor been so inspiring as primary care’s newest movement, the Patient Aligned Care Team. Based on the Patient Centered Medical Home Model, PACT is sweeping the nation with innovative practice redesign, increased access to care, improvements in care management and superior care coordination for in all Veteran’s Affairs Medical Centers. 
Veterans are at the center of PACT along with their families and caregivers.  By being the heart of each PACT, Veterans are active participants in their health care management. This ensures that the wants, needs and preference of each individual are respected.  Each Veteran will be assigned to a core team of health care professionals called a teamlet. The teamlets are comprised of a primary care provider, a nurse who serves as the care manager, a clinical associate, and an administrative clerk. Veterans will get to know their team members as individuals by working together with the same health care team. This bonding can result in improved communication and cooperation toward meetings the Veteran’s health/wellness goals.

Along with the teamlet, every Veteran may also receive assistance with meeting their goals and needs from integrated team members. Dietitians, social workers, pharmacists, mental health practitioners, specialists, and non-VA health care professionals work together with each Veteran to coordinate a variety of health care resources.

Dietitians are a great fit for every PACT team because nutrition counseling naturally involves the Veteran in his/her own care. The PACT dietitian can improve Veterans’ health and quality of life by empowering them to prevent and better manage their chronic diseases and conditions; creating nutrition strategies tailored to individual progress and nutrition needs; and building an access system designed to provide the Veteran nutritional intervention at desired time of service. If you are a Veteran with nutrition questions, ask your PACT Dietitian and he/she will be there to help. If you are a PACT team member and you are not familiar with your PACT dietitian or you are unfamiliar with nutrition interventions available to your Veterans, we are also here for you.

Amy Thompto has been a dietitian at the Milwaukee VA hospital for eight years. She completed her masters degree in 2009 and has since served on many National committees including ALS Task Force and Traveling team of the Nutrition and Food Service PACT Committee.

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Published on Sep. 30, 2011

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  1. Krista Arneson, RD October 19, 2011 at 6:05 pm

    As a VA dietitian, I love working with Veterans. I look forward to the PACT teams in Portland being staffed with more dietitians so we can make a bigger impact for our patients!

  2. Craig October 15, 2011 at 5:56 pm

    Maybe I can receive additional help considering my unique health situation. I am a disabled service connected cancer survivor who has had his stomach removed now just five years ago this month. I can’t gain any weight as I am 6’4” and weigh on average between 143-151lbs with clothes if I am lucky. I am grossly malnourished and cachectic. I have been seen by a dietician at my local FHC and I must say I appeared to be a jaw dropping patient to the dietician. One of my many eating issues is that every meal, every day for more than five years now (I originally had the majority of my stomach removed ten years ago) I have dumping syndrome and as such I also have bouts of hypoglycemia with its symptoms. Upon my last surgery I had a “J” tube or feeding tube implanted which was removed several months after the procedure. However as my weight is so precarious that upon consulting with surgeons to have to have the feeding tube re-implanted I was advised that this and any other additional surgical procedure should be only performed to save my life as I have so much scar tissue internally that the surgeon felt that I could not survive the procedure to at best add perhaps ten pounds of additional body weight. I have tried “Ensure” and all these additional supplements but I can’t seem to hold them down and tolerate them. I have found that my diet consists of soups daily. If I could gain twenty to thirty pounds this could mean literally the difference between life and death in my case. I have pain and vomiting or regurgitation with each and every meal and so as with any malnourished person have also developed additional or secondary health issues stemming from just not being able to eat. Any suggestions?

    • Krista Arneson, RD October 19, 2011 at 6:07 pm

      I hope you are still working with your VA dietitian. It sounds like you do need to be followed closely to help get your weight back up. Good luck!

      • Craig October 21, 2011 at 11:58 am

        That is the point I guess that I am trying to make, I need dearly nee help as my life and health is in a precarious state. My primary care doctor has every good intention however, I feel that I am just another patient amongst hundreds and so all he has said every year is to try and eat more. But as I have no fat reserves, a case of influenza could cost me my life or that if I were to need to have an emergency surgery as I have had an obstructed bowel in the past due to the previous stomach surgeries or an infection. I have as I said a tremendous amount of scar tissue internally so I live in constant fear about my weight along with the exhaustion that malnourishment presents to a person. My civilian gastroenterologist said given my height and build and body type that if I were to reach 140lbs that I should be hospitalized, I have hovered just above this weight for the past five years. In the past when I have been treated at the hospital for various things, the doctors have ordered banana bags and IV’s to help with dehydration and malnutrition. My wife asked what about the VA prescribing banana bags as a routine to assist me, is this even possible? Also my wife has read about with patients that suffer from eating disorders such as bulimia and so forth, that these patients have had a port implanted to help assist these patients to receive gravely needed nutritional supplements, will the VA do this in a case such as mine? I just can’t physically eat enough to gain any weight and it takes everything that I have to keep my current weight at what it is now, it has been five years as I have said. I have been examined and tested by a gastroenterologist to eliminate any scar tissue or obstructions of blockages or anything physical and there is none, the reason is that the stomach that was made by the surgeon was the size of my thumb, that’s it. Several doctors have said that this is as good as it is going to get. The VA C&P doctor said that this surgery that I had was to sustain life, that the quality of life is an afterthought. Most people are just the opposite and need to lose weight to save their lives and I need to gain weight to help keep mine. Any suggestions Krista or anyone else?

  3. Charles T. Cauthen October 12, 2011 at 3:27 pm

    Why does the VA employ so many fat people?

  4. Ann McCartney RD October 5, 2011 at 5:47 pm

    Nutrition and Food Service professionals have developed the Healthy Teaching Kitchen initiative, to encourage Veterans to enhance their self-efficacy via mastery in the kitchen.
    These programs offer the Veteran an opportunity to learn the true mechanics behind a healthy diet and become an effective participant in their own health care. Your PACT
    Nutrition professional can advise you on program availability at your VA medical center!

  5. Tabitha Nicholas October 5, 2011 at 11:18 am

    Great summarization of RDs role in PACT. I am proud to be a RD that is able to help those who have served our country!

  6. Barbara Knippel RN BSN October 3, 2011 at 2:05 pm

    PACT coordination of care is working at the Milwaukee VA. When the RN, MD/PCP and RD all speak to our vets about the same things and include their goals and decisions we develop plans that work!! My vets love our dietician Amy Thompto because she accepts people as they are and helps them work with a diet on their terms. My vets see me after their diabetes appointments with Amy and are excited about carb counting!! Yes, that’s right, excited! They feel a real sense of accomplishment in managing their disease and we help and encourage that as an integral part of our roles in PACT. Our A1C’s are dropping for many of our patients who are involved in Diabetes classes, RN visits and dietician 1:1 visits. We will be starting group visits in our clinic as several vets have expressed an interest.

  7. Chap. Mikel Ryuho Monnett September 30, 2011 at 10:41 pm

    My doctor enrolled me in MOVE. After a few weeks, I asked the dietician why she never mentioned the work of Dr. Neal Bernard (who has successfully treated diabetes through diet) or Dr. Dean Ornish (likewise with heart disease). She replied “Oh, those require too much discipline for these guys.” Veterans. Unable to accept discipline.

    I walked out and never went back.

    • Dana Strohmaier, RD October 3, 2011 at 10:47 am

      Chap. Mikel Ryuho Monnett, I am sorry that you felt unheard of all your options regarding diet and physical activity. As a registered dietitian who has worked in the VA for 7 years, I can tell you that RDs at the VA care deeply about your health and want to assist you with lifestyle changes.

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