Month: February 2014

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Weeks 13-21: Cardiology, ICU, Eating Disorders, Staff Relief

It seems we’re developing a motif here, as this post will continue to cram 5+ weeks of rotations into one abridged post. But, hey, so goes the life of the dietetic intern.

Week 13: Cardiology

Cardiology was my only 1 week rotation – and man, it went by SO FAST! I do feel like the length of the rotation was appropriate, however, given the patient population. During this rotation, most of the patients I saw were status post heart attacks, CABG procedures (stands for Coronary Artery Bypass Graft, and is pronounced like the vegetable – “cabbage”), or admitted with Congestive Heart Failure (often referred to as CHF). Working in a hospital as a clinical dietetic intern for 13 weeks prior to this, I had already been exposed to most of these conditions, and I don’t feel that having a very long cardiology rotation would have enhanced my experience dramatically. I basically gained more practice giving heart healthy diet and CHF educations, which I welcome more of! My one complaint for this rotation is that it was my only week working on a unit at a different campus than my other weeks, and it was a bit challenging to get used to the different buildings, and a new set of operations in such a short amount of time.

Because the heart healthy diet is the primary need on cardiology units, I’ve created a separate post to provide an overview of the guidelines. You can view the post HERE! The rotation really inspired me to spread the word about heart healthy diets, and catching signs of heart failure, because death related to heart disease is typically so preventable.

If you are in dietetics, I welcome your feedback. And if you are just interested in learning about the diet for your own benefit or that of a loved one, please leave a comment and let me know if you found the information helpful. Questions and comments are ALWAYS WELCOME!

And after Cardiology, it was on to Critical Care!

Weeks 14-15: Critical Care

This rotation was INTENSE, mostly consisting of recommending nutrition support options. The majority of the patients I saw were NPO, so taking in no nutrition by mouth. I had the opportunity the learn about the current nutrition support guidelines according to ASPEN and the Academy of Nutrition and Dietetics, and gained a clearer understanding of what makes each formula unique and appropriate for various individual conditions.

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Lot of calculations and lab values in Critical Care…

Not only was my critical care rotation interesting, but I also felt like a very strong component of every patient’s care team. I attended daily rounds on the ICU floor in which each critical patient was discussed, and the opinion of the dietitian was typically obtained, and highly regarded – usually my recs would be implemented immediately without hesitation! In previous clinical rotations, I recall experiencing frustration when having to recommend the same diet changes multiple times, seeing no orders placed. In the ICU, I felt capable of making a difference in the care of patients, and felt truly empowered as a proponent of good nutrition, particularly as I got to watch the transformation some patients took once appropriate nutrition recommendations were implemented.

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You fellow interns and RDs feel me??

Week 16-17: BREAK!

After Critical Care, I was lucky enough to have a 2 week long break. I spent a nice chunk of that time catching up on clinical readings and assignments, but I certainly got to have some fun as well…

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Went camping…

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…in Morro Bay, California…

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…with my best friends in the entire world (my SISTERS and parents)…

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…who walked all over town with me when I just had to have some Cioppino (it was SO worth it)…

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…We even got to have a little camera fun…

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…and got so many beautiful sunsets…

Then I got to welcome 2014 with my sister and brother from other mothers in Seattle, WA and Vancouver, BC:

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…where I got to see Captain Kirk’s Chair at the EMP Museum

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…climb atop this Space Needle…

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…with THESE two…

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…clean ourselves up for a New Years Eve celebration…

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…and I even found my name in LIGHTS!

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And of course, once returning to San Francisco (<3), had plenty of time left over for tasty coffee, a farmer’s market…

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 …and a little at-home yoga :).

And it’s a seriously good thing I got so much me time over these two weeks. I was definitely going to need it entering my eating disorders rotation…

Week 18-19: Clinical Elective – Eating Disorders

In a happy twist of fate, on my very first day of interning, my CNM offered my fellow intern and me 2 options for our clinical elective: eating disorders, or NICU. I immediately jumped at the opportunity to claim EDs – although I wish I could have experienced both areas of specialty, I’m sure no one is surprised by my choice.

My elective week brought up a whirlwind of emotion, both positive and negative. But the greatest thing I took from these two weeks was that I felt right at home. It was incredible to be reassured that ED treatment and recovery is the field I am meant to be in, because of my passion, my skills, and my own personal struggle. I feel blessed to have found this so early on in my career, and am so glad to see I still feel the way I did at the start of this journey.

Most of the week involved a lot of shadowing. Given the high specialization and touchy nature of this field, at the start of my rotation it was unclear whether I would have the opportunity to counsel one on one. However, after a few days of sitting in on sessions and observation of groups, in addition to spending time note writing and reviewing the past medical histories of the patients, I was able to conduct supervised one on one sessions with a number of people. This experience was anxiety-inducing, incredibly exciting, and limitlessly humbling. I was reminded of the love I have for this field, and was also reminded that I am quite good at it naturally! But I also saw how much I do have left to learn, and look forward to the career ahead of me.

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^This is what note taking looks like in an eating disorders rotation…

Weeks 20-21: Staff Relief – FINAL WEEKS IN CLINICAL!

Staff relief… What to say about staff relief. Well, I’m sure I grew from it, and I can say that. There were also a lot of tears coupled with self-doubt and feelings of inadequacy. Not to get all negative Nan on ya, but this experience is what it is, and I’m here to share it with you.

I must say, now that staff relief is behind me, I could not be more appreciative of those two weeks. I think it is so important to have them under your belt before entering the field as a clinical dietitian. But it was TOUGH!

For those of you who are unfamiliar with the term, staff relief is the rotation that usually comes at the end of your clinical rotations. During staff relief weeks, the intern is to act as dietitian, covering a unit on his or her own. It’s really the first taste you get of working independently as a clinical dietitian.

After discussing my staff relief rotation with my internship director, I learned that my experience was atypical. This may be one of the challenges of being in a distance program – my director is unaware of how things are going unless I share the information with her. During staff relief, most interns will cover 1 unit – ICU, Oncology, Med/Surg, etc (per my director, interns typically cover Med/Surg floors). During this rotation for me, things were organized a bit differently. The dietitians from each floor would assign me about 2 patients, totaling up to about 6-8 patients per day. I found that the most challenging part of this was having to switch mental gears from oncology to critical care to cardiac to CVAs so many times per day. I feel this brought down my level of efficiency, and made it challenging for me to do a quality job while also seeing the appropriate patient load each day. This impacted my confidence significantly, and I really had moments when I doubted whether I have what it takes to be successful in the field of clinical dietetics.

The good news is, once I spoke with my director (2 weeks AFTER completing this rotation), she assured me that my experience was not typical, and that seeing so many different types of patients each day in fact WAS quite challenging. I was so relieved to hear this, and felt I could reassure myself that staff relief did not indicate that I had made a catastrophic decision in choosing to become an RD.

Let it be a lesson to me – to give myself a BREAK, and not jump to thoughts of failure so immediately at the first sign of struggle.

So, that’s a wrap for my clinical rotations! I cannot believe that one of the biggest challenges in my path toward my RD is behind me. My next post will talk about my experiences working in long term care and community nutrition. Please check back for updates soon!

And all you DI hopefuls applying through DICAS right now, you are in my thoughts as programs sift through your applications. Next will be interviews for many of you! Remember: smile, stay calm, and be yourself – you’ll do great :).

Stay happy :).

Protect Your Heart: Diet, Exercise, and Weight Loss

Congestive Heart Failure. Myocardial Infarction. Hypertension.

These are a bunch of scary words for conditions that can arise when our diets lack balance. But if you’re here, you’ve already taken the first step toward prevention – you’re looking for an answer to the question “What can I do to keep myself healthy?” … So congratulate yourself!

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It looks tough and strong, but it really needs your help!

There are a lot of bits of information out there, telling us how to improve our diets. However, current evidence points to a few factors that dietetics and science believe to be true about decreasing risk for certain heart health related conditions. If you have been told by a physician that you have high blood pressure or hypertension, or that you are at risk for developing heart failure (or CHF) or of having a heart attack, you may find this information helpful.

 

1. Weight Loss

One of the most basic things you can do for yourself to decrease your risk for heart disease is making sure you achieve and maintain a healthy body weight. Here is a link to a BMI calculator – you can input your height and weight, and the calculator will tell you your Body Mass Index, or BMI. This number is what clinicians sometimes use as a way of assessing whether your weight is in a healthy range for your height. The goal is to have a BMI greater than 18.5, and less than 24.9. If your BMI is 25 or greater, this is classified as overweight. If your BMI is 30 or greater, this is considered obese. The higher your BMI clocks in above 25, the greater your risk for developing heart disease.

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The topic of weight loss is all around us, and everyone wants to know the answer for how to shed pounds. Well, I have the answer RIGHT HERE. It’s not a pill. It’s not a powder you add to your weight loss shake. It’s not a superfood, or a magic berry, or anything some mad scientist crafted in his underground layer. It’s three words: BALANCE. VARIETY. MODERATION.

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I know, it’s not that exciting right away. But think of it this way: you get to eat WHATEVER YOU WANT! Just utilize portion control, and try to vary your choices. Now it sounds kind of great, right?

The other thing you can focus on that will help with weight loss, and has been proven to benefit those at risk for heart disease is increasing your intake of fruits and vegetables. Not only are these low-calorie, high-fiber options (a perfect recipe for healthy weight loss), but the minerals in most of the foods in these two food groups have been shown to help reduce blood pressure.

And, of course, get up and MOVE! I know the term “exercise” can sound truly unappealing to many. But remember – as long as you’re moving, your body can’t tell whether you’re at the gym on a treadmill, walking around the mall, or putting away laundry in different areas of the house. The point is, if you get moving, your body will thank you. Remember that ANY type of movement can count as physical activity!

Some of my favorite ways to get moving:

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Yoga

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Walks

Stretching

Dancing!

So, maybe you don’t need to lose weight, but your doctor has told you you’re still at risk. So what else can you do to protect yourself, and make sure you’re around for all the exciting things in the futures of you and your loved ones? Keep reading…

2. Reduce Sodium

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Sodium is a tricky bugger. You have probably heard it said before – it is in EVERYTHING. If you pick up any processed food product (basically anything in a package), the chances are high that on the nutrition label, next to “Sodium,” you will see a number of at least 150 mg, but often much more than that. Some prepared meals have over 1000 mg, which delivers almost 100% of what many of us need in a whole day in just one meal. The best way to cut back on sodium, and to promote not only weight loss but overall good health as well, is to stick to a diet made up of mostly whole foods. What I mean by whole foods is this: the next time you’re at the grocery store, walk around the perimeter first. See if you can stock up on only foods like fruits, veggies, lean meats, and whole grains. By avoiding the center aisles, you’ll avoid foods like chips, cookies, candy, frozen treats, and even the sneaky items like crackers and some cereals and bread products. Another scary carrier of major sodium is canned foods. Soups and canned vegetables can have a very large amount of sodium per serving. If canned soups are a big part of your current diet, try keeping it to 1 per day, and maybe choosing a reduced sodium version. In terms of vegetables, fresh or frozen is best, but if you must get canned, rinse them before eating or cooking – it will remove a significant amount of sodium!

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Aiming for a colorful diet is a great way to ensure nutritional variety!

Here is a map of a standard grocery store layout. See how all the fresh food is on the perimeter, with most of the processed items in the center aisles?

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Another thing you can try is not adding salt to food when cooking at home, and not adding salt to meals after they are prepared, either at home or when eating out. Additionally, eating at home almost always provides you with less sodium, and better overall nutrition than eating out does. If you’re feeling like your food is bland without salt, try some salt alternatives like Mrs. Dash, or experiment with different salt-free seasonings and herbs.

mrs-dashJust a few of your options…

But be careful of salt substitutes like NuSalt that are made up mostly of the nutrient Potassium. Our bodies need this nutrient, but too much of it can cause heart attacks. So check with your doctor before trying it!

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Some examples of potassium-containing salt subs – remember, ASK YOUR DOC!

3. Balance your diet to reduce high fat items

So we really are passed the low fat diet craze that bummed many people out through the 80s and 90s. But there is some merit in watching the fat you consume! The thing to remember is to keep it balanced. Enjoy whole foods, and try to enjoy healthy fat sources. These can include avocado, olive oil (and olives), wild fish, and nuts. Just remember – fat contributes a lot of calories per gram, so even when eating healthy fats, limit portions so as not to overshoot your calories for the day.

Sources of saturated fats—the ones you should eat in moderation (even more so than the healthy ones)—include butter, vegetable oils (particularly when used to deep fry), and high-fat meats (like rib eye steaks, bacon, etc). A good rule of thumb: if a fat is solid at room temperature, like butter, it’s likely a saturated fat, and in excess, may lead to heart disease.

4. Heart Failure Information

If your doctor has told you that you are at risk for congestive heart failure, or CHF, you may really benefit from observing the recommendations above. Another thing to remember is to monitor your weight, even if you are not trying to lose. This is important because, if you go into heart failure, your body begins to retain fluid. If you are at risk, try to weigh yourself daily. If your weight goes up 1-2 lbs in 1 day, or 5 lbs in 1 week, contact your doctor immediately, as this could indicate heart failure.

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The best thing you can do for your health is to try to implement one healthy habit today. So, what will you do? Eat an extra serving of fruit or veggies? Maybe go for a walk? Or decide on a lower sodium alternative to something high in salt you normally eat?

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Yumm, right?!

I would love to hear how you’re implementing these changes to improve your health and quality of life, and to keep you on this Earth a little (or a LOT) longer.

What will you change today?!