Month: September 2013

Why I Put Down the Wheat Thins

Alright, bloggees. I’m about to get real….

Today’s been a SHITTY day. I’m not even going to get into it. But I have a feeling it has a little something to do with this. Anyway… it’s been rough. And after getting home from my internship, I saw where my night was headed: a half-eaten box of Chili Cheese Wheat Thins and a tub of Greek-style hummus was calling my name. I was going to sit in front of my TV, watch The League (until I decided I wanted to watch something I could cry over), and consume that ENTIRE damn half-box/tub duo. I was in pretty deep. But I stopped. With about 10 crackers left in the bag (and a lot in my belly), I heard a voice: “You deserve better than this. ESPECIALLY on a day like today–when things just don’t feel quite right.” This voice was filled with love. She directed my attention out my big bedroom windows, and reminded me I had a few hours of daylight left (the best few hours, in fact, right before the sunset).

With much hesitation, I put the remainder of my “snack” down (YES, there were only 10 left, but it was time to STOP!), peeling my body off the chair, feeling double my actual weight (because of the depression–not so much the Wheat Thins ;-)). I changed into some comfy walking clothes, and headed out the door with my iPod in hand. I turned on one of my very favorite podcasts–The Mental Illness Happy Hour–and listened to the truthful, honest, and darkly comedic words of Stefanie Wilder-Taylor as Paul Gilmartin interviewed her about her struggles–from depression to an eating disorder to overcoming a drinking problem, all the way through the truth about motherhood and what true love is.

In the spirit of being honest–I do love this podcast, but I haven’t listened to it in quite some time. I think deep inside, even though I KNOW hearing others talk about their struggles always helps me get through my own, I’ve worried what listening will do to me. When I’m capable of it, I like to keep my negative thoughts folded neatly in a corner of my brain, where they can be left alone, and forgotten. But shouldn’t we all know by now–that never works.

To my surprise (not really), I felt comforted and warm while listening. I laughed and I cried, sending myself on a true roller coaster of emotions throughout this particularly long two-hour show (NOT complaining). There were parts of it that made me hurt, and parts that made me realize I was ok enough to be loved. But the thing that helped me most was realizing what Paul has been trying to show his listeners all along–I am NOT alone.

I am NOT alone.

We are NEVER alone.

No matter what you’re thinking, no matter what you feel, no matter what awful, terrible, embarrassing, disgusting or weird urge, desire, or thought you’re too ashamed to talk about–SOMEONE has thought it before, and more people than you ever believed possible WILL relate.

As a result of the combination I allowed for myself–a little exercise, some fresh air, and tuning into a podcast I worried would send me on a downward spiral–I changed the course of my entire night. I did not go back to those tasty little conniving, addicting Wheat Thins. I did not mope myself to tears. Actually, I came home with a smile on my face, my cheeks still pink and flushed from the cold ocean air that was rolling in after sunset. I cleaned my room and put away laundry which had been overwhelming me for weeks (if you don’t get it, ask someone with depression and/or anxiety–I’m 95% sure they can explain it to you). I even cleaned my kitchen, did the dishes, and cooked myself a wholesome dinner out of REAL food.


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I feel great. And I know tomorrow might be rough. And I know I HATE my depression, and still have a voice that loves to remind me that IT’S NOT FAIR. But the difference between me now and me 3 hours ago is that I now feel prepared to deal with it FOR NOW. I can tackle tonight. Tomorrow morning I’ll see what I can handle. I’ll get out of bed, and carry on to the best of my ability. And I’ll do the same thing the next day, and the day after that.

Commit to your own recovery–whatever that is for you. If you try, and you bring yourself toward the right path, there’s no way for you to fail. There’s no way you won’t come out 1 step further than you were when you started.

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Also, if you haven’t–check out the Mental Illness Happy Hour! Download it off iTunes or wherever you get your podcasts, or go to mentalpod.com. I am not lying when I say it has literally changed my life.

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Goodnight! Love yourself.

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Week 2/3: Outpatient Begins in an Endocrine Setting

Well, what a few weeks it’s been. I have learned a lot already–about outpatient counseling, carb counting, insulin, and even a bit about myself. Let’s start with my first week of rotations:

Monday: Orienting. Chaotic. Most of the day involved explanations, introductions to supervisors and systems, and a fair amount of confusion on everyone’s part. The day concluded with a brief meeting with the RN who supervises the Diabetes Center–where I would be completing my Endocrine/Diabetes rotation, and 1 week of outpatient.

Tuesday: 9 hour day. Got to meet my RD preceptor who I knew I’d get along with famously (I rarely meet an RD I don’t like…). I got to sit in on her 1:1 appointments, and observed a “Diabetes 101” 4 part class taught by the RD and another clinical team member. This class was the fourth of a four part series, and it was great to see the participants graduate at the end of the evening with confidence in their ability to own and manage their disease!

But finally sitting at home around 10pm, I found myself seriously questioning whether I have what it takes to get through this, and hoping for a better tomorrow.

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Hashtag Overwhelmed.

The day was challenging for a number of reasons, but a major hurdle I’m running into is the lack of understanding it seems people in other disciplines have as it relates to dietitians, dietetic interns, and our level of competency. Although I have an assignment which involves me teaching a nutrition education class (for which tonight would have been a PERFECT opportunity), the RN supervisor overseeing me stated she did not feel comfortable allowing me to teach, and that she felt I was there more for observation than participation/practice. I can’t blame her–she’s just not been told what a dietetic intern does, and that we are here to get hours in SUPERVISED PRACTICE. It has become frustrating on a number of levels, but I imagine it’s a taste of what some Registered Dietitians face on a daily basis. I do hope our reputation in the medical field is improving–we’ve worked hard to get here!

Wednesday: What an improvement! This day I got to have some actual patient interaction, and felt that I did relatively well. I worked with the Physician’s Assistant/Certified Diabetes Educator who does more of the medical side of diabetes education. I got to act as a true “RD-in-training” whenever her patients had a nutrition-related question. I felt needed, competent, and believed-in. My mood only started to decline once I realized how much work there was to do, and how in deep I really am.

Thursday: Similar to Tuesday, I got to mainly shadow the RD. I wasn’t able to jump in and do any 1:1 counseling on my own due to the supervisor’s wishes. But we found ways for the RD to assess my abilities, and I am meeting my competencies for the rotation.

Friday: For the final day of the week, I took a break from the Diabetes Center and reported to the main hospital across the street: Alta Bates Summit Medical Center – Ashby Campus in Berkeley. I met briefly first thing in the morning with the Food Service Director who greeted me with a bubbly sense of pride that I couldn’t have needed any more at that point. We discussed some basic logistics–what I needed to know to survive the day. She then sent me off to the diet office where I met the nutrition assistants. Throughout the day, I shadowed, asked questions, and saw the world of Alta Bates Med Center through their eyes. I got to meet the team of clinical dietitians at this campus, as well, who will be leading me through much of my clinical rotation.

The last part of my day went from 2pm-4pm, and gave me chills… LITERALLY! I observed and assisted in tray line, which lasts about 2 full hours, and actually takes place in a REFRIGERATOR. Temps in this room are very close to 40 degrees Fahrenheit. My hospital works on a cook-chill system: the food is prepared then frozen at a main kitchen, plated in tray line, and then sent off to wherever it will be served (if trays are going to a campus away from the main kitchen), and reheated immediately before serving. It’s a system I’ve learned about many times, but have never seen in live action.

Here is a flow chart that outlines the steps of the cook-chill system in comparison to a more common cook-serve system (Original link to diagram found here).

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Production flow charts for school lunch boxes

^ Cook-Serve [Green]

So the tray line takes place in a cold environment so that there is no chance for food temps to reach the danger zone: 40-140 degrees–the window in which bacteria thrives. This tray line ends up providing meals for patients at the campus I’m primarily working at, in addition to the campus nearby which houses our psychiatric and residential eating disorder treatment programs–they produce HUNDREDS of trays! It was really something to witness… These hours served as a highly valuable learning experience. I’ve always found that when employees thoroughly understand the inter-workings of an entire SYSTEM, and not necessarily just the requirements of THEIR jobs, it allows all employees to perform their jobs at a higher level–even if all of the positions do not seem to cross paths directly.

After that week, I was beyond ready for a nice long weekend. Saturday I got to spend connecting to my Jewish heritage, as I participated in a Yom Kippur fast. Once we hit sundown, it was bagels and lox until our bellies stretched to capacity  (and beyond), and some of us even may have had to undo a top button…

Sunday was a bit more fun–got to attend a concert we had been looking forward to for months (The Slackers, for any ska fans out there), and spent the day in beautiful Santa Cruz.

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The instant serenity-inducing beaches of Santa Cruz — No filters needed here.

image (1) We rode that pirate ship ride that goes back and forth at the Boardwalk… It remains terrifying, in case you weren’t sure.

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The Slackers put on a seriously entertaining show, per usual.

The week began again far too quickly, but I jumped in with all the enthusiasm and vigor I could muster. My second week in Endocrine allowed me to hone some of the skills I was merely introduced to the week prior. Week 2 felt more hands on, as I felt more comfortable providing input during patient sessions, and knew which questions to ask both patients and practitioners. I also got to write my first very own chart note! I had the opportunity to attend another Tuesday night diabetes education class–this week was part 1 of 4, so it had a different feel to it. These participants were likely newly diagnosed, or just newly motivated. A lot of emotions filled the room that night–from excitement and enthusiasm, to denial, to fear, to confusion and unknowing. It was refreshing to realize I wasn’t alone in having those feelings ;-). By the end of the class, it was great to say goodbye while hearing the joy in the voices of some as they said “I’ll see you next week.”

Friday involved another diet office training. I got to meet a few more team members, and learned more about the management side as I shadowed the Patient Services Manager for the day.

The week wrapped up nicely, and I embarked upon the social weekend I had planned for myself! Met some great new people, and attended the last Movie in Dolores Park of the year before the weather turns cold (because it’s been just a blazingly hot summer here in San Francisco–oh wait, no it hasn’t).

I am now beginning week 4 of my internship: Patient Services and Clinical Nutrition Management. Check back at the end of this week to see how it shapes up!

In the meantime, be kind to yourself–I know I’ll be trying :).

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*Note: Most of my pictures within posts at this time are not necessarily going to be dietetics-related, as I am waiting on permission to use pictures I take at my rotation sites on my blog. So enjoy my personals! And check back–hopefully I can utilize the professional ones!

Build a Better Burger: National Cheeseburger Day!

WHAT? Today is NATIONAL CHEESEBURGER DAY?! Sweet. Well, I think in honor of this grand event, I’ll talk a little bit about how to eat a SMARTER BURGER. Below, a few tips.

1.Enjoy yourself!

I am here, as a soon-to-be dietitian, advocating that it is not only OK to eat a burger from time to time—I’m in fact letting you know that there are actually BENEFITS to red meat. It is true that you can get the iron, vitamin B12, and protein for which red meat is so famed from other sources. So if you do not prefer red meat, you CAN save yourself from deficiency. Keep an eye on my Nutrient Spotlight page for updates on that. However, if you are a fan of beef, it is an extremely bioavailable source of iron—meaning your body absorbs it more easily than it does from other sources (e.g. leafy greens). And iron-deficiency anemia happens to be the most common and widespread nutrient deficiency worldwide, according to the World Health Organization. So don’t pour on the guilt—congratulate yourself for making a good choice that will provide your body with a ton of nutrients

2. Go Grass-Fed and Local

There is a fair amount of controversy surrounding the meat industry, and it’s often difficult to decipher what to avoid, and what is mainly hype. A safe bet is to choose local meats as much as possible, and look for organic grass-fed beef. This will ensure that the cows destined to be your burger were fed a diet that their gut could understand and break down properly, and that the animals weren’t treated with hormones or anything not naturally occurring in the animal already.

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Happy cows come from….

3. Dress It Up Right

Many foods become demonized, thwarting high levels of not-so-good-for-us nutrients, and are forced to wear the diet-version of a “Scarlet Letter.” However, sometimes it’s not the food itself that has so many adverse effects as much as what goes with the food. Moderate amounts of ketchup and mustard (think: 1 Tablespoon) are great additions to a burger. But to get more nutrient bang for you calorie buck, try taking out high saturated fat condiments like mayonnaise to be replaced with avocado. It will introduce an interesting new texture to your burger, as well as some serious creamy goodness! And avocados provide healthy fats that are required for every day bodily functions, and can help prevent heart disease and inflammation, in addition to cancer-fighting antioxidants. Avos can also have a fab effect on hair, skin, and nails. It should be mentioned, however, that due to this super food’s high fat content (although it’s the GOOD KIND), avocados are high in calories, and should still be consumed in moderation.

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Those are some delicious looking antioxidants.

ALSO—pile on as many veggies as you can! No reason to stop at the standard lettuce-onion-tomato. Through some peppers on your grill, and stack them on your burger. The hot ones have major metabolic benefits. Any non-starchy veg would probably go great on a burger—experiment! And let me know what works and what doesn’t!

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One more note (as it is nat’l CHEESEburger day)… Cheese is a great source of calcium, and provides protein as well. I will admit to being an absolute cheese lover. But it’s a food to moderate, as it typically contains high amounts of saturated fat and sodium. Some cheeses are available in part-skim versions–go for those whenever possible. Or just enjoy a smaller amount of a full fat version. Either way–ENJOYMENT is very important!

4. Choose Your Bun Wisely

Not only can you pack an extra serving of veggies into your burger, but you can even utilize this meal as a chance to squeeze in an extra serving of whole grains. When at the store, all the choices we’re given in which to wrap our patties can certainly overwhelm a person. The simplest rule for choosing whole grains is this: the VERY FIRST INGREDIENT should read: WHOLE WHEAT FLOUR. If it doesn’t, it’s not a true whole grain.

Examples:

images-3^Whole Grain

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^Not a whole grain (the first ingredient is ENRICHED FLOUR)*

*I know this is a confusing topic. Please feel free to email me (samfink14@gmail.com) or comment with any questions.

If you’re not a bread lover, you can even wrap your burger in a lettuce wrap. I’d recommend choosing darker romaine leaves over iceberg—the darker your veggie leaves, the more nutrients they contain. But don’t be afraid of a few carbs—they can provide much-needed fiber, as most of us don’t get what we need from our diets.

If you’re trying to avoid red meat, or prefer a more plant-based diet, you can always go for a veggie burger! Just make sure you’re not replacing a beef burger with something that’s highly processed, because health-wise you are doing yourself no favors with that choice. Your best bet may be to make one at home using whole ingredients. Here’s a recipe for one that uses LENTILS (a great plant source of protein)! You may also see beans used, and any other starchy protein. I actually was recently at a restaurant that served a veggie burger made of quinoa and beets! If you prefer to purchase a packaged version, check the ingredients list, and choose one with a short list of ingredients, and words you can pronounce. Watch the sodium level on these items as well.

And remember–as with all things–moderation is key. A burger every once in a while can provide you with major benefits. But one every day may result in lethargy, fluid retention, high cholesterol, and weight gain. So have a happy National Cheeseburger Day! And enjoy yourself!!

Week 1: Orientation

Week 1 of my dietetic internship has officially been completed. This past week has been filled with too much information, not enough sleep, and some seriously tasty Southern BBQ (note: if ever in Atlanta, go to Bone Lick!). I also had the opportunity to meet and get to know my incredible fellow Morrison Chartwells interns. While there is some sadness about having to leave, and not getting to spend more time with new friends, I have no doubt that we will remain a strong support system for one another.

Here, an abridged recap of the week:

Day 0: My flight arrived into Atlanta from San Francisco at 9:00pm Monday night. Completely out of chronological whack, I remained awake late enough to meet my roommate for the upcoming week as she arrived around 1am (which felt like only 10pm). After some extended introductions, we turned in, both eager and terrified for what the week had to bring.

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Ready to go…

Day 1: The morning went leisurely, as we did not begin orientation until noon. Little did we know how much we would long for the liberty of having those morning hours back throughout the week. Our first day was… let’s face it… basic and boring. All logistics–things we all know, but need to hear again. Adjourning at 5pm, my roommate (who I already miss!) and I joined some of her local friends for a Braves game (they won! … don’t shun me, Dodger fam), and the BEST BBQ and jalapeño-bacon mac & cheese I have EVER had. My introduction to the Southern United States did not disappoint.

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Outfitted in Business Cas for Day #1

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Still surreal…

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Everything in moderation–including beer!!

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OH! And did I mention they put us up on the JUMBOTRON??? All we had to do was agree to air guitar when relief pitcher Kimbrel walked onto the field, as Welcome to the Jungle was played. Check out the video here! Embarrassing? Yes. Worth it? Totally.

Day 2: Wednesday captivated our interest just a bit more–and also managed to spike our cortisol levels significantly. Today we learned more about our School Nutrition Management rotation, of which I will personally not have the pleasure until mid-February. Chartwells is the sector of our overarching company (Compass Group) that oversees K-12 school accounts. Throughout the day we heard lectures from a number of accomplished (and YOUNG!) people in the field of dietetics who happen to be a major component of the Morrison Chartwells program. We were introduced to the inter-workings of the company, and taught who does what from Directors to Regional RDs to Resident Dietitians. We had the pleasure of being introduced to the Morrison CEO, followed by an introduction to the Cornell Plate Waste Study through the university’s B.E.N. (Behavioral Economics in Child Nutrition Programs) Center in which we will be participating. Cue 35 Type-A stress-induced heart attacks. As we learned about what would be involved in this study, and what our responsibilities would include, many of us began to panic at the sheer magnitude of information we would need to be collecting. The study basically focuses on how much food is being thrown out in schools across the country. After a solid hour-and-a-half or so of rapid-fire questions, and confusion-inducing answers, we were reassured that, as important as our contributions were, we were but a “data point” on the B.E.N. Center’s graphs, and an error did NOT in fact indicate epic failure. After learning as much more as we possibly could about our School Nutrition Management rotation, we headed back to the hotel to freshen up for a group dinner at Sage. We looked forward to some fun after such a rough day!

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Our yummy desserts… And the “Sage” in the olive oil above is written in Balsamic!

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Me, with the best roommate ever!

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Day 3: Thursday was the day I both looked forward to and had been dreading. It was the much anticipated CLINICAL NUTRITION DAY! Bright and early at 7:30am, we all met at the office, and began guzzling down mediocre coffee (sorry, Compass group–it is what it is). Each of us had worked LONG hours completing to the best of our abilities four clinical modules: General Medicine, Cardiovascular, Endocrine, and Renal. Although a thorough review was expected, we were greeted with a game of clinical nutrtion Jeopardy instead! Fortunately I am a total Jeopardy (and nutrition) NERD, and didn’t mind this at all. We concluded the day with FOUR HOURS of information from Abbott Labs, the company who provides many of the enteral nutrition (tube feeds) and supplements that are often used in clinical as well as non-clinical settings. Some of the products we learned about and/or had the opportunity to taste included Ensure (we tried Clear and Complete), Glucerna, Vital, and Pediasure.

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Above squiggly line: end of day. Below: new day. The difference between tired and awake.

We adjourned slightly early around 4:30pm, at which point most of us headed out to the vans that had been transporting us throughout the week. I stayed after for what I thought would be a few minutes to chat with the internship director, Karen. Unfortunately, a situation arose that could have been easily avoided with the implementation of the BUDDY SYSTEM, and I was left behind!

Karen politely offered to take me back to the hotel, and it turned out to be a great opportunity to get to know my director a bit more in the short time we had together.

That evening, four other interns and I decided to experience Atlanta the best we could during our limited stay; we hit the town with some friends of one of the interns, learning some more about the city’s delicious food and nightlife!

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A beautiful Southern evening.

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On our way!

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5 of us at a great taqueria–amazing fried pickles and jalapeños!

Knowing how much we might regret our decisions to be out late the night before our travels home, we gladly owned our choices, and arrived back to the hotel just in time for a solid 4 or so hours of sleep.

Day 4: Our FINAL DAY commenced around 6:30am, as we needed to pack our bags, check out, and make it to the office in casual Friday wear for some last-minute information by 8:00. After scarfing down my last complimentary breakfast (courtesy of Staybridge Suites), we crammed those of us remaining at the hotel into a van along with each of our sets of luggage, and enjoyed one last ride together.

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Still unclear on the reasoning for limes at the breakfast buffet, always next to the coffee… Insight, anyone?

We learned about our Long Term Care rotation, and had a nice long lecture on wellness coaching and motivational interviewing. We were able to close things up early around 1:30pm or so, at which point we all said our goodbyes and migrated to MARTA (Metropolitan Atlanta Rapid Transit Authority) to head toward the airport.

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On the way we got a solid last peak into the ways of the urban south, as we were graced with a man shouting the gospel at us on the train (rather inaccurately, per my friend who knows the Word pretty solidly). Fortunately, we were all rescued by this guy:

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We made it to the airport, and said last goodbyes as we boarded our respective flights, and I prepared for the long hours I would spend sitting in a seat in the sky.

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I like to make fun, but seriously SO GLAD I bought this…

After a long half day of travel, I finally made it back, safe and sound, to my very favorite place: home to San Francisco. I have wrestled with some regret over applying to a distance program, and feeling as if I may be missing out on the “real” dietetic intern experience. But after this week, learning what an incredible program I am lucky to be a part of, I could not be more excited to get to remain in the first place I have truly loved living, and have felt as if I fit. I love this city, and all of the diverse experiences it offers. Sorry, San Francisco–you’re stuck with me!

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And made it home just in time for the uncharacteristically beautiful weather! And also for a date night with my favorite guy on the planet :).

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Sandals? What??

Now, time to get myself re-situated, and ready to begin my clinical rotation at Alta Bates Summit Medical Center in Oakland TOMORROW!

Stay tuned for updates on what I am sure is to be an eventfully crazy week.

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Great group! Morrison Chartwells 2013-2014

P.S. My Instagram is @realfoodisthebest. Follow for more like this blog!

Made it to Atlanta!

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Where I started my day today: Daly City BART Station

After months of waiting, and weeks of non-stop preparation, the day is finally here! I have now arrived in Atlanta, Georgia for a week of orientation before beginning my dietetic internship. And now after a long day of traveling, this little dietetic intern is off to bed.Stay tuned for updates as the week progresses!IMG_0002

Excited (and tired) face.