nutritious

Weeks 29 – 36: The FINAL 8 in School Nutrition Management

Well, it’s been a long road, but I can finally say with pride rivaled only by exhaustion that I have COMPLETED my dietetic internship!

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School nutrition management was my final rotation, and it was an experience unlike most of the others. Something I enjoyed was getting to work with a team of managers who worked in non-nutrition disciplines. For most of my 8 weeks, I spent time with our Food Service Director, a Manager in Training, our Associate Director, and worked closely with our head chef and catering manager as well. My rotation took place at San Francisco State University.  As I may have explained in previous posts, my internship was completed (love putting that in the PAST TENSE!) through Morrison Chartwells, a subset of Compass Group. Compass Group has a multitude of sectors, which provide food and nutrition services to establishments from hospitals, to schools, to business and industry settings. Morrison is the sector of Compass that serves healthcare establishments, which is where I did my clinical rotations. Chartwells is the sector that serves schools (and Chartwells Higher Ed, to further categorize, serves college campuses). My experience was unique in that I was working with Chartwells Higher Education, which works on college campuses – most other interns in my program were rotating in K-12 Chartwells accounts.

 

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Now that that’s out of the way….

 

My school nutrition rotation taught me a lot about management, and working with a team in which you are often the sole nutrition representative. I did have the opportunity to work with the Regional RD, Laura, who oversees Chartwells Higher Ed accounts. However, this was a long distance relationship, and  Laura did not have a scheduled trip out to SFSU during my time there. She was always available by phone and email, and was a large part of my learning experience in this rotation. Not having an RD present at the site on a daily basis taught me many times over to be proactive and independent.

Chartwells at SFSU incorporates a concept called Balanced Kitchen, which I was so excited to be a part of. Balanced Kitchen focuses on wellness on college campuses. At one point, I conducted an audit to ensure the dining center was meeting the wellness criteria for this concept – and our SF State champs did very well! I remember being a freshman in college, and staying well with healthy foods was such a challenge. It is great to see higher education moving in a direction that promotes the importance of a healthy lifestyle.

 

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Some of the criteria for Balanced Kitchen (aka Balanced U), and what the dining center strives to promote.

 

This was a project-centered rotation. In these 8 weeks, I think I completed upwards of 10 projects – and all of them took some serious time commitment! Some highlights:

 National Nutrition Month Activities:

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Me, beaming in the presence of my food models. Typical.

 

Nutrition Educations:

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Weird shadow on my face… But here I am giving a lesson on eating local and seasonally. My favorite educational tool right now is my local foods wheel. Ask me where you can find one!

 

Participation in Sustainability and Real Food Events:

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IMG_7790 A real local food-focused event!

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Put on a Farmer’s Market

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Enjoyed soo much delicious local produce.

 

Stress Reduction Fair:

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Focused on how to use good nutrition to keep stress in check! So much fun talking to students – and I met someone I’ve communicated with in the blog world! Amazing.

 

and Staff Trainings, and Food Service & Sanitation Audits (not pictured, because not that exciting – bein’ honest, folks).

 

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By the end of my rotation, I had made some strong connections with Compass employees at SF State, and I feel this rotation was the best opportunity to get to know some of the higher-ups who work for corporate! Getting to know some of the big wigs who manage entire regions was not only inspiring, but also allowed me to make an impression, shake some hands, and learn more about Compass as a whole.

 

As this blog is about honesty, I don’t want to leave out how much I struggled to get through this last rotation. With 8 weeks standing between me and RD eligibility, the to do list seemed forever impending. It’s not that the rotation was extremely challenging – I have been SO grateful to be done with clinical, and the stress level was NOT THE SAME here. But I did feel often paralyzed when I looked down at the list of projects to complete, and it even took me a few weeks to get started on some. But as of posting this, my assignments are COMPLETE, and I am awaiting the OK to sign up for my RD board exam (eeek!). This is a good reminder for me that it will all get done if I work toward it, but I have to remember to stay calm, get focused and organized, and just keep moving forward.

 

Well, folks, that wraps it up! Thank you to everyone who continued reading through my experience! I hope I was able to shed some light on the experience of dietetic internships for those of you embarking on this path. If you have questions, or just want to let me know how I’m doing (or how YOU are doing), please drop me a line below, or shoot an email over to thenourishedsoulblog@gmail.com.

 

This may be the end of my 1240+ supervised practice hours, but don’t you worry – there is still plenty of living, studying, and trying not to have panic attacks that I’ll be continuing to write about. Stay tuned, beautiful people! The best is yet to come over here.<3

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Vitamin D: The Sunshine Vitamin

As we say goodbye to the winter months, we welcome the spring time with open and bare arms. We get to say goodbye to sweaters, scarves, and 4pm sunsets, and hello to sun dresses and sun-kissed cheeks. So for this Nutrient Spotlight, I thought I might talk about a vitamin we get from the wonderful, amazing, nutritious rays of the SUN! Vitamin D is a fat soluble vitamin responsible for an array of crucial bodily functions — maintaining bone density may be the most talked about. The primary role vitamin D plays in bone density involves allowing absorption of Calcium.

So, where do we get Vitamin D?

Did you know that most of the Vitamin D that our bodies make comes from sunlight? Now, it doesn’t take a day of sunbathing on the beach to reap the benefits of the sun’s nutrient-saturated rays. All you need is about 5-10 minutes of direct, UNPROTECTED sunshine (that means no sunscreen, with some skin showing) per day to get enough exposure. So, if you can make that happen, you’re covered! After your allotted Vitamin D time, definitely throw on that sunscreen to protect yourself from irreparable skin damage, which can lead to visible changes and skin cancer.

Here’s the process, from sun through skin:body-vitaminD

If 5 minutes of sunshine per day is not possible for you, as is often the case in the summer months here in San Francisco, do not fear. There are other ways to meet your D-quota for the day!

What are good dietary sources of Vitamin D? How can we make sure to get enough when the sun doesn’t want to come out to play?

The good news for those of us who won’t be getting to soak up the sun during summer months, or for those dreading the winter’s gloomy return, is that there are alternative sources of Vitamin D. Food sources are limited, but do exist. They include fatty fish, mushrooms, and fortified milk; egg yolks provide a small amount as well. A number of other foods may also be fortified with Vitamin D, including cereals and milk substitutes like soy. Just be sure to read the labels on these items, and try to avoid adding highly processed foods into your diet in the pursuit of added nutrients — my opinion is that it’s not worth the trade off.

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 Keep it natural!

There has been some controversy over the use of UV (ultraviolet) lamps to increase vitamin D production. On one hand, the rays have been shown to increase the nutrient concentration in mushrooms, which produce Vitamin D the same way we do. Also, users of these devices have reported noticeable improvement in mood, and fewer symptoms of Seasonal Affective Disorder (SAD) during winter months. However, these lamps also come with risk of skin damage and cancer. It may be best to discuss the risks and benefits with your doc to determine if a UV lamp is right for you.

If you are still having trouble getting enough quality sun time, and feel your diet may be lacking, speak with your physician about getting a simple blood test to check for Vitamin D deficiency. Your MD may then recommend a Vitamin D supplement if you are deficient. I highly recommend checking your levels before starting a supplement, and always check with your physician before starting any kind of regimen to avoid dangerous interactions or toxicity (too much Vitamin D). Remember, supplementation will typically only provide benefit to those who are deficient in a nutrient. Otherwise, you might as well be swallowing capsulized cash.

 

What do you think?

What are some ways you clock some outdoor hours to make sure you get enough sun time? Do you take supplements, or use a UV light? Want to share your favorite recipe using Vitamin D rich foods?

10 Minute Dinner: Loaded Sweet Potato

I’m all for treating yourself to a long drawn out home made dish. But sometimes ya need some quick nutrition, while still feeding yourself solid, wholesome ingredients. Below is one of my very favorite recipes. I’ve listed the yield here for 2, but I make this dish for 1 all the time (all the single ladies, yeaah!). Enjoy!

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Ingredients:

2 sweet potatoes

1 can black beans (drained, rinsed)

1 cup Kale, or green of your choosing

1/2 cup of cheese (cheddar, monterey  jack, or any other type)

1/2 Tablespoon olive oil

Salsa

Preparation:

1. Using a fork, poke holes all over sweet potatoes, and microwave for about 5-6 minutes each.

2. Meanwhile, place skillet over medium-high heat, and add olive oil—once hot, add beans and kale. Cook until kale wilts. Once sweet potatoes are done cooking, cut in half length-wise, and top each with half of bean mixture.

3. Top with 1/4 cup cheese each, and salsa as desired.

I wanted to keep the ingredients list around 5-6 for this post, but remember that you can always beef it up (so to speak) with extra veggies! Get creative, or use whatever you have on hand this week. Below is an example. Run with it!

colorful vegetables in skillet

Kale, mushrooms, and orange bell peppers

Did you enjoy this post, and try out the recipe for yourself? Would love to hear your feedback! What would you change or improve? How about pictures of your final product?

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 :).

Nice Melons!

…Thanks, they’re local.

 

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Just picked up a mini watermelon from my local produce market. Upon arriving home, I found this sticker on it:

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Melon Up! allows you to enter your fruit’s assigned serial number, and see where exactly your snack was grown, thereby being able to gauge how far it traveled to get to you.

And according to this map taken directly from the website, these services are available in a number of locations across the United States, Mexico, and Central America! Hooray!

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Thank you, Melon Up! for making eating local even more feasible.

Enjoy your weekend!

Weight Loss Weapon: The Big Mac

Browsing Yahoo! News a few weeks ago, I came across the following article:

http://news.yahoo.com/mcdonalds-ceo-lost-weight-being-160332002.html

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Brief synopsis: CEO of McDonald’s states that he was able to lose 20 lbs through increasing physical activity. The shocker here is that Mr. Don Thompson claims he’s not changed his habit of supporting his golden arches by eating there… EVER. SINGLE. DAY.

Upon reading this, I found myself enraged, wanting to rant to the world my thoughts on why this was a huge problem. Then I remembered…. that’s why I created THIS BLOG! So, here’s my take:

ONE: HE’S NOT LYIN’

 I don’t doubt Thompson’s claim. If you are a sedentary person, if you begin exercising,  your body will require more calories. If you make NO changes to your diet, but are increasing your energy expenditure, you creat an energy deficit. In other words, you are taking in fewer calories than you are getting rid of, which happens to be the exact recipe for weight loss.

TWO: LOW-CAL DOES NOT EQUAL HEALTHY

While McDonald’s does provide meals that clock in at astronomical percentages of one’s daily needs (1 large French Fry order alone will provide you with 500 calories, 44% of which comes from fat–mostly NOT the good kind), there are some lower-cal options. However, my primary concern in putting this “food” (if that’s what you want to call it) into my body, and the bodies of those I love, goes beyond the sheer number of calories it provides. If you’re a regular reader here at The Nourished Soul, you know I am seriously partial to REAL FOOD. I believe that a healthy diet may certainly include indulgences, but that these treats are best consumed in the form of real ingredients–not chemicals, additives, and perservatives. McDonald’s–and other fast food joints–take processed food to the extreme. Not only are the offerings of this international chain NOT something I would consider near the realm of real food, as it is all highly processed, but additionally, the additives and non-food ingredients (i.e. chemicals — some of which even *I* cannot pronounce) are substances that our bodies do not recognize, and cannot break down, digest, and use as fuel, or for any other purpose, other than poisoning our insides. I mean, does “dimethylpolysiloxane” sound like something your body can translate?

“Could I get a medium fry, hold the sodium acid pyrophosphate, please?”

 

These are my personal and professional opinions on the idea of losing weight through maintaining calorie deficit alone–meaning to completely ignore what type of calories we are putting into our bodies. Yes, we all CAN lose weight by simply counting calories. But I believe in head to toe wellness, and if you’re reading this, my hunch is you do too. And I strongly feel that to be our best and feel our best, we must treat ourselves LIKE THE BEST.

What do you think? Is Thompson’s method healthy, because it does lead to weight loss?

What are some healthy tips that have worked for you in the past?

YogaGlo — NO MORE EXCUSES!

I know, it’s easy to find excuses not to exercise. Especially when the type of exercise you’re working toward is an activity you don’t particularly care for. That’s why I firmly believe in picking an activity that you LOVE. I heard some great advice once. Paraphrased, it was: choose a work out that you love so much, you would do it EVEN if it wasn’t GOOD FOR YOU! And for me, that work out is YOGA. I can honestly say it is in my top 5 list of ABSOLUTE FAVORITE THINGS (including non-exercise activities) TO DO, and I choose it as my mode of exercise as frequently as possible.

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See? 😉

But, being a busy person on a strict budget, I often run into 2 significant hurdles — insufficient funds to maintain membership at a yoga studio and, even if my income permitted, I have a schedule that doesn’t often allow me to get to the classes that are offered. I’m sure many of you run into similar problems.

 

Well, fear not fellow… busy poor people! There’s an app for that! Well, a website. Yogaglo.com brings the studio to your personal computer screen. They have a seriously vast selection, and are breaking it down for you by teacher, yoga style, level of difficulty, and duration of the class. And when I say vast, I am NOT messin’ around (and neither are the wonderful people at YogaGLO). The site offers nearly 2000 videos at this time, and styles range from Ashtanga to Kundalini to Vinyasa (and then some). They even have Meditation classes available ranging from 5 to 60 minutes. 

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There are a number of really useful tools on the site, as well, that will help you commit to your yoga practice, even if you can’t commit to a studio. You are able to set goals for number of classes per week, and it will track how many you’ve completed (I just signed up, and am already 2/3 of the way to my goal for the week!). You can also add items to your “queue” to take the classes later, and have the option to note which time of day you’d like to use that particular video.

 

I know there is more, and I’m still discovering! The site is also incredibly user-friendly, and offers some great tutorials on how to use different tools. It should be noted that IF YOU ARE NEW TO YOGA, you should take extra caution in your practice. Take it slow, and if something doesn’t feel right to you, don’t push it (this is true at any level of yoga practice). Taking classes in-person with a certified instructor is always great, but if that’s not an option, YogaGlo supports the idea that it’s no excuse to discontinue your practice. And if you are new to yoga, check out the site’s Beginner Center under the Yoga for You tab–lots of great videos to get you started!

OH, BEST OF ALL: Membership cost for YogaGlo is only $18 per month–some studios charge nearly this much for a drop-in class! They currently have a 15 day free trial that you can sign up for. DO IT!

I will miss the personalized adjustments from certified yogis that so often make ALL the difference — but there’s no harm in popping into a studio every so often for a tune up :).

 

Enjoy this beautiful evening, and check out YogaGlo! And most importantly, do something that nourishes you tonight :). Feed your soul!

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