Meet Abby: Healing Through Nutrition
During National Nutrition Month, we sit down with Abby Usen Berner, Oncology Dietitian, to learn more about her role on the cancer center team, the importance nutrition plays in successful treatment and how she spends a lot of time clarifying ‘Dr. Google.’
While a junior in high school, Abby Usen Berner unexpectedly picked up a waterborne illness on a 10-week outdoor experiential education trip in Arizona and New Mexico. This life-changing event led to severe gastrointestinal issues, numerous medical tests, a strict elimination diet and subsequent unplanned weight loss.
Over about six to nine months, Berner slowly learned how to reintroduce foods into her system by gradual reintroduction, literally one bite at a time, by adding one new item per meal.
“It was through nutrition that I was able to heal,” says Berner, adding this experience fueled her interest in medical nutrition therapy. “Since I experienced what it was like not being able to eat, I have a level of empathy with patients. This is when I started to become interested in the idea that food is medicine, and it’s my major passion.”
As the Oncology Dietician at Cape Cod Hospital, Berner, MS, RD, LDN, provides patients with an individualized nutrition care plan and offers advice on ways to deal with weight loss, fatigue and nausea, and other nutritional side effects brought on by illness or side effects of treatment, or ideally how to minimize nutritional side effects from the start of treatment. She serves as a liaison between the radiation and medical teams to help build nutrition goals for the best possible treatment outcomes.
Berner sees patients based on diagnosis, nurse or physician referrals, or if someone specifically asks to see an oncology dietitian. Most of Berner’s patients, acute cancer patients, are dealing with side effects from treatment such as swallowing difficulty or unplanned weight loss. Berner and her team have also started a collaboration with the Outpatient Speech Pathologist and see patients with head and neck cancers in a combined clinic twice a month.
“If they are getting radiation and receiving chemo at the same time, it can be a painful and challenging process as it relates to eating and there are a lot of functional issues,” says Berner.
“I help them with their eating and how to meet their nutrient needs in a modified texture.”
Common concerns and clarifying ‘Dr. Google’
During a typical day, Berner will meet patients at her office on the second floor of the Davenport-Mugar Cancer Center. She will also schedule appointments in-person, virtually, over the phone or chair-side during chemo treatments. Berner will see patients as often as weekly until they are showing signs of improvement and meeting their goals. Common concerns and issues include lack of interest in food, decreased or no appetite, taste and texture changes and side effects of chemo.
So how does Berner encourage creative ways to improve their food intake?
“I found it’s really helpful to just listen and hear the patient’s situation, support systems and access to food and figure out how to help them,” says Berner, who started her career in pediatric nutrition, working with children with developmental disorders, and later in diabetes education. “My job is about building a rapport with people. “Food is personal. Food touches a lot of memories, and it touches a lot of emotions.”
Berner points out that a big part of her job is clarifying what Dr. Google says, and navigating misinformation provided by the Internet, media and sometimes what friends and family are telling them. “I’m trying to provide evidence-based information for patients.”
Digging into the plate method
Berner encourages small, frequent meals and emphasizes the plate method—with a variety of healthy foods including whole grains, healthy fats, lean meats and fish, and vegetables and fruit. “Protein is definitely a big push.”
Every case is different, explains Berner, and it’s like putting together a puzzle and figuring out what the barriers are to eating. Berner will ask patients: “Are you able to grocery shop?” “Are you able to prepare your own food?”
If someone is tired and doesn’t want to cook, for instance, she suggests utilizing the resources offered by Meals on Wheels or Cape Wellness Collaborative, who provide nutritious meals to patients with cancer, as well as fresh fruits and vegetables.
Nutrition program grows more than 50 percent
The Oncology Nutrition Program at the cancer center has grown more than 50 percent this year by adding a day a week to our capacity and improving our identification and referral of patients at risk for malnutrition, says Katie Michaud, Executive Director of Oncology.
“When I first started more than two years ago,” says Berner, “I was seeing four patients a day. Now I see, on average, about eight to nine patients a day.”
Berner’s diverse background in nutrition, such as her work in gastroenterology, solid organ transplant, diabetes education, and years collaborating on a pediatric feeding team helps her see the patient’s nutritional needs beyond their cancer diagnosis, says Michaud. “She is a jump-starter and a convener who sees patient and system-level barriers clearly and frames them as opportunities to enhance care. Patients love her, and we are very lucky to have her as a resource to advance our cancer program.”
The most rewarding parts of the job, says Berner, are seeing people have more enjoyment of food, reaching that survivorship stage and feeling better. “It’s gratifying to see people pop their head in my office and thank me for my suggestions and guidance. It’s not just me. It’s the whole team — I’m just a tiny component to all of this.”
