San Francisco

Sitting with Uncertainty (and other things I’ve felt while living unemployed…)

Hello beauties!

A happy mid-June to you all. I hope the weather is beautiful where you are. If not, get a load of this:

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I’m as shocked as you are. This is San Francisco, for Pete’s sake.

Well, last I checked in, I had just completed the final rotation in my dietetic internship. Uncertainties abound, but the newness of being free from supervised practice hours for the rest of my career was enough to keep at bay the flaming ball of anxiety that often inhabits my gut.

Prior to completing my internship, I firmly proclaimed that I required some down time, during which I could focus on studying for my RD board exam, and with money I had saved, I could get myself through a few more months unemployed. After passing the exam, I would carry on with my job hunt, warp speed – factor 10.

Well, to my utter shock, as soon as I had about 3 weeks left of my internship, I awoke from a haze to find I had been frantically perusing nutrition job websites, and noticed fingers that looked like mine typing away at cover letters and requests for references. What. Is. Happening?!

I wish I could say I caught myself in this old behavior, realized I wasn’t giving myself the unstructured time I so wanted and deserved, closed my laptop, and refocused my energy on passing my exam while enjoying life around me. Alas, this was not the case.

A number of weeks into practicing my daily routine of wake up, coffee, procrastinate, job hunt, “organizing” (shuffling things around until piles look manageable), listening to 1/4 of an Inman RD exam review track, and back to “organizing”, I had a nice little epiphany at which I so peacefully arrived by having it slapped upon my face.

Through networking and good fortune, I was put into contact with several people who were offering jobs that looked promising. After phone conversations and/or email correspondence, these opportunities looked like potential hires. They were jobs that I would be completely happy exploring, and I thought it would take away the anxiety I have felt relating to the dreaded day I run out of money. Well, time and time again, after informal interviews went as perfectly as they could have, I was told I would be a great candidate for the position, but right now they were looking for someone who had already passed their exam.

Alright – what’s the big idea, Universe? I was told early on in my plight into dietetics that many companies are ok with hiring prior to passing your exam, with the expectation that you pass within a certain amount of time from hire date. But that was proving wrong over and over again.

And then I remembered… Isn’t this exactly what I asked for? Didn’t I say I wanted and needed time to focus on this exam, and getting my life together post-internship? And didn’t I predict how I would struggle to just sit back and ALLOW this to happen?

Hm… Seems like the Universe just might have my best interest in mind here.

So currently where I sit is here:
Going against the voice in my head that tells me I’m not good enough because I get to live life on my own schedule these days, I have put the job hunt on hold. I am mostly focused on studying for this exam, and on appreciating what else I have going on, from a blossoming social life in a fantastic, still relatively new city, to community involvement and being of service to others. I have ACTUALLY done some legitimate organization which looks like this — a calendar where I can view things both weekly and monthly, noting sections of my exam review to go over each day to keep me on track to be as prepared as possible come test day. My exam is scheduled for July 23, which gives me over a month from right now to prep. I’m sure this time will fly by, so I’m avoiding the mind set that I have plenty of time and can get it done when I feel like it, which has often plagued me in the past; however there is enough time between now and the test for me to not be so susceptible to full-fledged conniption-style panic attacks if I only get through 5 pages instead of my intended 6 on any given Tuesday (if you don’t believe this to be a possibility, you were fortunate enough not to know me circa 2012).

For those fellow RDs to be who are curious about how I am studying and what materials I am using, I am going through Inman’s Review of Dietetics, and listening to the CDs where she reviews each domain and notes specific important details. That’s all I’ll say for now, and hopefully I can return in about a month to tell you that what I did actually WORKED, and share more at that time.

Until then, I will be sitting in some discomfort, and remembering to refrain from complaining about receiving the things I’ve always asked for.

Keep smilin, lovelies. Our futures are lookin damn bright.

<3,
Samantha

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).

 

 ***

 

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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Weeks 23-28: Long Term Care and Community Nutrition

 

 

Every time I realize my clinical rotation is completely behind me, I feel completely shocked. Clinical rotations were something I had been anticipating since I came to understand what exactly happens in a dietetic internship. I am so excited to be moving down this path so quickly, and can’t believe the speed at which it’s flying by.

 

Immediately after my clinical rotations, I began the next two weeks in long term care, at a place called St. Paul’s Towers in Oakland, California.

 

Long Term Care: St. Paul’s Tower’s, Oakland, CA

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Older picture, but it’s still this HUGE!

 

St. Paul’s Towers is what is referred to as a Continuing Care Retirement Community, or a CCRC. By definition, CCRCs offer living facilities across all levels of care, which include independent living, assisted living, and skilled nursing (aka SNF). Here is a link to a basic description of each level of care: Long Term Levels of Care.

One of the jobs I worked before starting my dietetic internship was as the Dietary Director of a skilled nursing facility. With this under my belt, I felt I had already gained a fair amount of exposure to the job of a dietitian in a long term care facility. As it turns out, I was correct, but of course had volumes more to learn.

Fortunately for me, St. Paul’s happened to be going into mock survey during my first week there. Mock survey is something that, to those with a bit of knowledge of regulations in skilled nursing, sounds very scary, but is actually a positive thing. To start, I will explain the dreaded SURVEY. Every skilled facility has a survey “window” – for example, the SNF that I worked at had a survey window from April through July, if I recall correctly. What this window means is that any time during these months, surveyors who are usually sent from the state or federal level can show up at a facility and will audit everything from nursing to medical records to dietary and nutrition, looking for any errors  — anything at all you’ve done incorrectly or inadequately over the last year. So, survey itself is definitely SCARY. But MOCK survey is a company’s way of preparing for the true surveyors. During mock survey, the overarching company that runs the facility will send their own representative to audit all of these areas, and act exactly as a surveyor would. It is still terrifying, as each department (very much including nutrition) is looked at on such a microscopic level, that you can basically expect that any mistake you made over the last year will be found, addressed, and acted upon to correct. But, while this induces every self-critical voice in a young dietitian’s mind, mock survey is a good thing, as it is not put in place to get everyone in trouble, but to catch mistakes and assign them a plan of correction before the actual survey happens. Because the thing about a true survey is that if they catch too many mistakes, or just a small number of mistakes that show to cause harm to a large number of residents, the facility can have major penalties, and even be shut down completely.

 

So, it was great to have exposure to this process. When I was at my SNF about a year ago, I never had the… pleasure… of undergoing survey – but we were all constantly on edge, prepping for them to walk through the doors at any moment, so I was familiar with how to prepare for a survey. But getting this additional opportunity to hear everything from the preparation phase through the exit conference where the mock surveyor shares all of her findings with us was very beneficial.

 

A large portion of the week was spent shadowing and observing, but I also got a ton of hands on experience doing kitchen audits, dining room observations, and clinical assessments. My favorite part of my 2 weeks here was how creative my preceptor liked to get to bring a little extra joy to her residents. Mondays she took a little time to make hot chocolate and deliver a cup to any resident who was interested. One day per week she also would deliver fresh baked cookies to each resident. All of these practices that the RD implemented were a great way to add a little excitement to each week, boosted morale for employees (who got sweeties too!) and also acted as a great method for sneaking in some extra calories for those residents experiencing difficulty with weight maintenance!

 

Overall, my Long Term Care rotation was a great experience, and allowed for some unexpected new exposure. Next up was Community Nutrition at WIC!

 

Community Nutrition: WIC (Women, Infants, and Children)

The day after LTC was completed, I jumped in my lil’ Kia Sportage, and enjoyed a solo roadtrip down the California coast to spend the next 3 weeks at Normandie WIC near downtown Los Angeles. WIC is a supplemental nutrition program that serves low income families, assisting with food and providing nutrition education and counseling. The program serves pregnant mommies-to-be, and continues to assist as long as the family remains eligible until the child is 5 years old. Additionally, if the mother miscarries, services are still available up to 6 months after end of pregnancy. Different food packages are provided to these families, a picture of which is below (my WIC rotation was done in California – this is a picture of Florida WIC’s food packages, but they are similar):

 

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Supplemental Food Breakdown

 WIC will provide supplemental nutrition for the mother while she is pregnant, and will continue to do so after her pregnancy if she is breastfeeding. As the image above indicates, food packages vary based on whether the mother reports she is completely breastfeeding, mostly breastfeeding, or only providing some breast milk, or none at all.

 

WIC provides special WIC checks which can be used at participating stores for to obtain these foods. Participants can tell if a store will accept their WIC checks by looking for this image:

 

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During this rotation I learned so much more about the challenges that come with breastfeeding your child – although at the same time, I was reminded of all the incredible benefits both mother and baby receive when breastfeeding is made a part of the child’s first year. I was so happy to be reminded of the preventative benefits of breastfeeding, like decreasing disease risk and risk of obesity and cancer for both mother and the baby. Additionally, the emotional bonding that occurs between mom and child from skin-to-skin contact is truly amazing. And, of course, the nerdy nutrition girl that I am, I would be remiss not to mention the nutritional benefits of breastfeeding right away. WARNING: If you do NOT wish to get nerdy with me, please skip ahead to the next paragraph. Hello? Anyone left? Awesome, I knew I could count on you… So, later on in pregnancy, the mother’s body does begin to produce breast milk. However, the milk at this stage is what is referred to as colostrum – it is a substance that is a bit more yellow in color, and is made up of mostly protein. When you feed your baby right away with this early breast milk, they tend to see an array of benefits. Also, it just so happens that the nutritional makeup of colostrum is just EXACTLY what the infant needs at that early stage of life – now it’s pretty hard to dispute nature in all her perfection, am I right?

 

Now, if you’re just joining us, let me assure you of what a fun time we had in science land…

 

During this rotation, I was required to be very proactive in making sure I got the experience I needed/wanted. It was difficult to gain hands-on experience with counseling and educations due to a few limitations. Firstly, I did not have access to the computer charting system, since I was only at this site for 3 weeks. The computer was pretty imperative in conducting a counseling session, so most of what I did was observation, while providing input when it came time to conducting educations. The second and very significant challenge and limiting factor here was the language barrier. With only 3 years of high school Spanish under my belt, I knew I would not be able to have intellectual conversations about nutrition, nor convey all the information and passion I normally feel capable of communicating. I had been warned that when working at WIC, it is HIGHLY beneficial to be bilingual (at the very least), but I must have underestimated just how beneficial. It took me a few DAYS to be able to even observe anything because everything was being conducted in Spanish, Armenian, Russian, or Korean (and then some…). It was only later in my rotation that I mustered the confidence to decide that I could at least observe in Spanish, at which point I learned that I had a basic enough understanding of the language to at least follow along (although I was correct in feeling I could not communicate on my own…).

 

Given these significant limitations, a lot of the benefits that came from this rotation came in the form of projects that I asked my preceptor to be a part of. I requested to be given assignments, like creating handouts, which I could work on during the day as I was waiting for a counseling or education class in a language I could understand. During the course of my 3 weeks, one handout I created deals with what is safe to eat during pregnancy.

I also got to work on a presentation that I gave to the staff on my last day on a topic of their choosing. The staff requested dietary carbohydrates, weight loss, and calories in food – so I chose to address carbohydrates, and encompass the other two within.

A link to both of the projects is availabe on my online portfolio (click it, click it!!!).

My WIC rotation was a nice break from the hustle that was my clinical rotations. And I so enjoyed my time in Los Angeles, where I got to experience being a nutrition professional in my hometown, and got to spend three whole weeks with family and old friends.

 

Reminder from Mom...

Reminder from Mom…

Surviving 3 weeks of LA traffic, and remembering to BREATHE

Surviving 3 weeks of LA traffic, and remembering to BREATHE

Spending time with some of my oldest friends...

Spending time with some of my oldest friends…

...and the best family.

…and the best family.

And takin' in all the beauty.

And takin’ in all the beauty.

After WIC, it’s hard to believe, but I’m on to my next and FINAL rotation: School Nutrition Management. With about three weeks left at this point, you can expect the summary of that rotation shortly.

 

And a QUICK NOTE to those of you who went through the dreaded DICAS match these past few months: if you matched, CONGRATULATIONS! It’s an incredible accomplishment, and you have many challenges and some incredible learning experiences ahead of you.

 

If you didn’t match, just remember how AMAZING you are. As a reminder, I did not match my first time applying either. And as it turns out, not matching put me exactly where I need to be in my life in so many ways. If you’re lookin’ for a pick me up, check out this post I wrote the night before my first, unsuccesful match, and reposted a year later. And if you just need to remember that the world is good, please view this Buzzfeed post on baby elephants learning to use their trunks — I promise it will at least make you smile.

 

Thanks for tuning in, everyone. And stay tuned for my next and FINAL post as a dietetic intern!

 

Love Yo’self.

2014: Year of the Trailblazer

2013 –

I can’t say you and I didn’t have our moments. You certainly didn’t make things easy on me. Over the last year, there have been some major peaks, coupled with significant valleys, each accompanied by imperatively important lessons to be learned.

This year I’ve seen what makes me tick, what makes me smile, what makes me giggle until I cry, and what makes me cry until there’s nothing left to do but laugh.

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I’ve learned that most of the time I’m bubbly, but it doesn’t mean I don’t also feel anger. And I’ve learned that I love Star Trek, and I’m totally ok with it.

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I’ve found that I love myself more when I’m sober than I thought I ever could. And I’ve learned that one should be ridiculously, laughably, wildly in love with his or her own life — and even more important, I’ve seen how within my control that is, and have had to remind myself multiple times that this control ironically often comes from accepting the things over which we have no control.

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2013 in summary – I moved to the city of my childhood dreams; landed jobs I never thought I was qualified for (and did just fine); matched to a dietetic internship, solidifying my plans to become a registered dietitian, and met clinical cases I thought I wasn’t capable of solving (sometimes excelled, sometimes looked utterly foolish, but after all I turned out ok); I cried a lot, laughed a little bit more, moved on from a wonderful relationship that had run its course, letting go of someone I loved deeply, learned to handle my emotions without alcohol to numb them, and determined who some of my real friends were whether I was ready for it or not.

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Oh, and finally got to try poutine (Canadian french fry dish with cheese curds and gravy goodness that has been on my bucket list for some time).

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(It was delicious, of course)

All in all, 2013, it’s been REAL. No other phrase seems quite as fitting. And to your successor, 2014, I say BRING. IT. ON. I’m ready, and can’t wait to dive in, blazing my own pathway from here to Happinesstown. I am open and ready to receive the bliss I deserve. Let’s do this!

Week 7-12: Renal, GI Surgery, Oncology

This post may be a little extra long, as I’ve neglected to update in over 5 weeks. So get ready, as I tell you all about my experiences in renal and antepartum, GI surgery, and oncology.

First up… RENAL/ANTEPARTUM

This rotation was marked for me by a significant amount of personal difficulties. During the two weeks I spent on the hospital’s Renal and Antepartum floors, I decided to embark upon a journey into sobriety due to circumstances unrelated. Days after I made this life-altering decision, my boyfriend of three years and I decided it was time to end our relationship. I may talk more about each of these struggles in future blog posts on my main homepage, but am trying to keep this portion of the site dietetics-focused. I just want to mention it to remind us that life goes on while we’re going through this internship–that was something I think I had forgotten until something happened that seemed to cause the ground beneath me to shake, and I was looking at a life I didn’t recognize anymore.

Despite this change in lifestyle and relationship status, with puffy eyes, and way too many feelings to filter through all at once, I did the best I could to keep my head in the game, and my eye on the prize. I allowed myself a few days of tears (ok, maybe a little more than a few days), but really tried to remember why it is that I am here–to fulfill the dream I’ve been working toward for nearly 7 years now. I had to keep reminding myself–I’M ALMOST A REGISTERED DIETITIAN!

During these weeks of my rotation, I was under the preceptorship of the clinical dietitian who covers the renal/dialysis floor, as well as the antepartum floor. One of the things I’ve noted as a challenge has been the fact that I may be in a rotation entitled “renal,” but given that we are in a real-world setting, it doesn’t necessarily mean I will see a single renal patient that week. It all depends on who gets sick when, and what overall census looks like. So in this rotation, I learned to go with the flow a little more than usual, and had to remember that I may not meet every single competency outlined for me exactly on schedule.

Some of you readers may be well-versed in renal health. But in case you are in the (I’m assuming large) pool of people who are not, let me define dialysis briefly for you. Let’s start by discussing the function of a couple of our primary detoxifying organs: the kidneys. When the kidneys are functioning normally, they filter the blood for excess fluids, vitamins, minerals, and toxins. In people with Chronic Kidney Disease (CKD), the rate at which their kidneys filter out these items is much lower. In the clinical world, we look at a lab value called Glomerular Filtration Rate (GFR), which is basically a big scary word that indicates the rate at which the kidneys are filtering–and indicator of kidney function. In people with compromised kidney function, GFR is usually low. At Stage 5 CKD, the most advanced stage, GFR is typically lower than 15, which indicates probable kidney failure, and a likely need for dialysis. Dialysis is a process by which this filtration of fluids and waste from the blood can be done in those with compromised kidney function. Dialysis patients are hooked up to a machine for a few hours, usually multiple days per week (most patients I saw were 3 days per week), and the machine does the work of which the kidneys are not capable. Dialysis is not only used in Stage 5 CKD patients–it can be utilized earlier on in CKD, and is sometimes used in episodes of acute renal failure or acute kidney injury as well. Patients on dialysis may often get away with a slightly more liberalized diet–if you think about it, it’s because they have external kidneys helping them out! However, this doesn’t mean these individuals should go out and enjoy all the sodium, potassium, and phosphorus they can stomach. If they were to do this, dialysis can end up being a much more painful process than it needs to be, as this can lead to some serious discomfort.

I did manage to see a fair amount of patients with kidney injury and CKD during my second week in this rotation. It was a great way to become more familiarized with the restrictions of a renal diet, which can often be complex. So many nutrients are filtered by the kidneys, so when they are not functioning properly, it can mean some heavy restrictions are in place. Sodium, potassium, and phosphorus are in so many food items. And given that many patients with renal disease tend to have co-morbidities (to which the kidney disease is often secondary), diets for these individuals can become highly restrictive, and it can be difficult to meet needs. It’s moments like this that supplements like Nepro with Carb Steady come in handy!

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Our other unit, antepartum, housed expectant mothers who were hospitalized, often due to complications of pregnancy (i.e. these women were NOT in labor). The role of the dietitian on this floor is primarily to work with patients who have Gestational Diabetes (often referred to as GDM), and were a part of the Sweet Success program. Sweet Success is a program that is part of the California Department of Public Health‘s diabetes and pregnancy program. It provides resources to expectant mothers with GDM, as well as healthcare professionals to increase the likelihood of healthy pregnancy outcomes.  GDM is a tricky type of diabetes that occurs during pregnancy. The mother does not remain diabetic after delivery, but it places her at higher risk for developing Type 2 Diabetes later in life. *If you want to know a little more about diabetes, check out my post from my Endocrine rotation, or my Diabetes month video*

The GDM diet is highly specialized as well. Although the mechanism is not entirely understood, it is well-supported that certain foods and food combinations cause particularly high blood sugar levels in these patients. The primary restrictions are: no fruit OR dairy in the morning, and no fruit and dairy TOGETHER at any meal. As you might imagine, in a hospital setting, the GDM menu can become tiresome, especially at breakfast. Unfortunately, many of the items we have become accustomed to at breakfast time are carbohydrate-dense. And dairy and fruit tend to be thought of as sensible breakfast choices! I often saw frustration coming both from the patients, and my preceptor, in trying to work out appropriate menu choices, and began to feel the frustration myself. If I had this rotation to do over again (perhaps with a little more time), I think a great project would be to figure out some GDM-friendly breakfast options that would not add too much to the workload of kitchen staff—maybe something to think about for you FUTURE DIETETIC INTERNS??

This rotation did come with a side project, though! I spent one day down in the kitchen observing one more tray line (back to the refrigerated room!). I observed as the Sweet Success trays were plated to ensure servings of carbohydrates and starches were done accurately. Very riveting stuff here, folks.

And the results…..? PASS! Maybe it was just because I was watching, but I will express how impressed I am with this sweetly successful audit. Go Alta Bates kitchen staff!

Moving right along to my next rotation… GI SURGERY!

During these next two weeks, I learned far more about the gastrointestinal (GI) tract and its various potential complications than I thought possible. And I must say, I found the information interesting. I may not want to study colostomies over dinner, but the intricacies of the GI tract are, to quote my favorite Vulcan, FASCINATING. Although I was a bit sad when I learned I would not be observing an actual GI surgery, I did have the opportunity to spend part of a day with the hospital’s wound care and ostomy nurse. I observed as she did an education with a patient who recently had a part of his colon removed, and would be spending the next 6 or so months with an ostomy bag. I will explain what an ostomy bag is briefly here so you don’t have to Google it (please, do NOT Google it).

FAIR WARNING: The following may not be for the weak-stomached… If poop makes you squeamish, skip ahead 1 paragraph.

An ostomy bag is used when a person has undergone a GI surgery that interrupts that pathway of digestion. Essentially, feces is not able to takes its usual route, so a stoma (or hole, basically) is created in the abdomen. A bag is attached to the stoma, and collects the waste. A procedure like this is often done in patients with different types of cancers of the lower GI, but has other uses as well. I met with one patient who had this procedure done to facilitate the healing of a wound near his coccyx, rerouting his digestive process to avoid putting extra stress on the area that required healing. Again… FASCINATING.

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Just maybe not through the same route…

IF YOU DECIDED TO SKIP THAT, you may rejoin us here :).

After two weeks in GI, I had the privilege of moving on to ONCOLOGY.

Although this rotation had some emotional ties for me (probably for most… cancer is sad), I think I enjoyed it the most out of all rotations so far. Three days a week in this rotation, I was working on the hospital’s inpatient oncology unit. Many people on this floor were undergoing chemotherapy. Some were newly diagnosed with poor prognosis, and were not receiving treatment, but being “made comfortable”. Others were being prepared for a surgery that may or may not be curative. The other two days out of the week I was at the outpatient Radiation Oncology department, working with individuals who would visit the center for outpatient radiation.

Oncology and nutrition seem to go hand in hand. There is the prevention side, which I one day might really love to be a part of, in which an overall healthy diet and lifestyle is beyond important. And then there is the treatment side. When a person is undergoing cancer therapy (or multiple therapies, in  many cases), so much is beyond their control. But nutrition is something that, while challenging to maintain in the face of nausea, dry mouth, and taste alterations, is an area in which we can try endless different combinations to see what works, and what doesn’t. As a nutrition professional, in the oncology department, I actually felt empowered to make a difference. I found my response to this interesting, because I really didn’t expect it! Who would have guessed that in the face of this wretched disease, where so much is beyond the patient’s and clinician’s control, that this is where a dietitian might feel in control, and able to make a difference?

The world of radiation was also an incredible experience, and I’m so grateful to have had it. Firstly, there is something about the energy in an outpatient facility that I think I like a bit more than inpatient. Of course, there is the lovely factor of NO WEEKEND SHIFTS. But there is a different kind of calm that seems to permeate outpatient facilities that I have visited so far.

During my Oncology rotation, I also presented my CASE STUDY! What a project… My case study patient was one with pancreatitis. I will be posting my slides and a recording of my presentation to my online portfolio if you are interested!

After Oncology, it was home for what I feel was a well-deserved Thanksgiving break. I decided to take a solo scenic route road trip from San Francisco to Los Angeles, and brought my camera along for the ride:

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Most AMAZING Acai Bowl from Cafe Brazil in Santa Cruz. Seriously. Go there.

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Rocky Canyon Bridge, just before Bixby.

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Made it home, just in time for a shameless selfie.

The solitude and quality time with my good ol’ trusty Canon is exactly what I needed. Oh, not to mention the family time that followed:

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True love.

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Probably the first time we’ve ALL (dog included) successfully gotten together for a family portrait. Go Finkelsteins!

As of Friday I have finished my Cardiology rotation as well! But so as not to lengthen this post too much, I will save it for my next update. Tomorrow begins my Critical Care rotation in the ICU!

I hope that you all had a wonderful Thanksgiving, and were able to share it with loved ones.

Remember to nourish yourself this week! ❤ TNS

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!

Changes, Changes–Someone once told me they’re positive.

 

 

With all of my recent posts, I’ve been so EXCITED about sharing random new information with the blogosphere, that I did not realize… I neglected to explain WHAT THE HECK IS GOING ON, and why my clientele has suddenly made a shift from the elderly to the not-so-much. Well, allow me to explain…

 

Now, while this is a TRUE statement:Image

 

…I also LOVE preventative nutrition, and LOVE teaching others how to develop a POSITIVE relationship with FOOD. In some ridiculously fortunate curveball the Universe threw at me, it turned out that an eating disorder treatment program to whom I had sent my resume back in July/August decided to contact me (some time around Novemeber/December), looking to fill a part time position at their San Francisco location. I informed them that while I was so honored to hear from them, I had already accepted a full time position in Santa Rosa, Ca (about an hour north of SF). “It’s so interesting that you say that…” stated my soon-to-be supervisor… I am on the edge of my friend’s car seat at this point…. “We are opening a location in Santa Rosa in the next few months, and are looking for staff.” WHAT? YES. So, long story short (too late)… I began my second job in Santa Rosa (Saturdays and some evenings), doing EXACTLY what I had in mind when entering the field of nutrition.

 

Now… for about 3-4 weeks, having this job on the side of going to the Skilled Nursing Facility (SNF) M-F (and some weekends) invigorated me. I felt capable of dealing with every challenging aspect of my primary bread-winning job, even though it was not where my fervor for nutrition lie, and even though I felt rather limited in my ability to actually help my patients.

 

However, one day, out of SHEER frustration, after an extremely rough day at the SNF, I arrived home–likely in tears–powered up my dinosaur of a laptop, and logged on to a nutrition jobs website. There I saw the dream opening for most clinical-RD-hopefuls: “UCSF Nutrition Assistant/Diet Tech.” While I realized this was a LONG SHOT, I filled out an application. With the click of the “Submit” button, I felt a large amount of tension physically LEAVE my body. I figured that would be it, and maybe if I just sent out a few far-fetched applications every few weeks, I would be able to cope until eventually matching to a dietetic internship, and moving on.

 

Well, much to my surprise…. Not only was I contacted for an interview, but I actually got the job.

 

To conclude… I am now in my “week off” between the SNF and starting at UCSF (which has really been anything but… yet I am GRATEFUL for it). I begin with an orientation in SF on Monday, and am on the floor training on Tuesday. I am looking so forward to what these upcoming months have in store for me.

 

So, expect my posts to shift a bit, and if anyone out there needs a comrade in how to manage change, a COMMUTE, and still being sure to take good care of yourself, I’m your girl ;-).

 

I look forward to sharing the journey with you!