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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 :).

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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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Ommm

NAMI Walk in Ventura, Ca

NAMI Walk in Ventura, Ca

An incredible event, raising awareness and funds for mental illness, which plagues so many without access to help, is happening in Ventura, Ca TOMORROW, May 4, 2013. I wish I could be a part of it. If you are in the area, sign up (FOLLOW THE LINK ABOVE :D)! Otherwise, head to the Ventura Beach Promenade to offer your moral support, and to learn more.

Have a wonderful, relaxing, self-respectin’ filled weekend, bloggers. Do something for YOU over the next two days ;). 

Tuesday’s Quick Tip

Tuesday's Quick Tip

Social networking websites like Tumblr, Pinterest, and various blog-o-spheres are filled with pictures and words to use as motivation. Instead of using pictures of others’ bodies as a catalyst for our own change, why not use other goals? For example: I would love to one day hold a hand stand away from the wall for more than 30 seconds. This allows us to focus more on the power of what our bodies can DO, rather than on how they LOOK. After all, that’s truly the objective for improving your health, isn’t it? 🙂

Monday’s Quick Tip

Today’s Quick Tip: TAKE THE STAIRS! It’s a great way to squeeze activity into your busy day, and will give you the boost you need to kick those Monday moody blues in the bee-hind.

Going up sound daunting? Try skipping the elevator on the way down. You’ll still work your muscles (especially if you go slowly), and at least you’re moving.

Enjoy this beautiful sunny day! (Sorry, cold-locale readers)

Did YOU do something active today?

Spam-A-Lot

…And I mean a LOT. As I log onto wordpress to find 15 new comments, I am elated… Only to find they are about 95% spam (sad face). I am so very interested in what my readers think. Please, if you have a thought or question on a post, or would like me to write about something specific, leave a comment! I could use the inspiration ;-D.

Intermittent Fasting and The Secret to Weight Loss

Thank you to all of you who voted in the Intermittent Fasting poll. To see the results, or vote yourself, you can find the poll here.

After reviewing the results, I have a clearer picture of my audience’s stance on this topic, and I really appreciate it.

 

 

While the idea of caloric restriction has been around for some time, I most recently heard about this idea of intermittent fasting when listening to the Dude, Where’s My Health?! podcast. Clark’s guest for this episode was Brad Pilon, deemed an expert on intermittent fasting. After some digging on my end, I fear I’ve come up short on the scientific side of things. I was able to find a few small studies boasting fasting’s success for weight loss in obese subjects, but nothing overwhelming. To be fair, I was able to find NO scientific evidence concluding that intermittent fasting is definitely correlated with negative effects. Through my limited research, I feel I can conclude that more research must be done in the area to draw a true and valid conclusion with which those in the nutrition sciences can be confident. So, I would like to put the science aside for a moment, and discuss some other aspects of fasting.

 

I think we’ve all heard it before, and it’s hard to disagree: “America needs to put down the fork.” This is a fair statement, seeing as how, per the most recent CDC data, more than one-third of Americans are obese. That number is pretty astounding. Because weight loss and maintenance truly is essentially about calories in vs. calories out, it stands to reason that Americans need to eat less. But, there are ways of decreasing caloric intake without feeling like your body is heading into starvation.
While the idea that intermittent fasting asserts may sound like a solid idea to some (eat normal dinner, followed by no breakfast or lunch, followed by a normal dinner, over a 24 hour period 1 time per week [there are variations on this]), there is a bubble I just cannot refrain from bursting (sorry). For most of us, if we go all day without eating, it is highly unlikely that we will have the will power, or the level blood glucose, to sit down at the dinner table and make a nutritious, or “normal” choice, as with such high levels of hunger, our bodies’ ultimate preoccupation is receiving calories in any form available.

The relationship that most Americans (and many others) currently have with food, the wonderful sustenance that is meant to carry us through our days, is so tormented. This is in large part due to the two extremes of dieting we are receiving at all times: one minute we are told to over-consume until moving is compromised, while the next, we are told that if we don’t cut out whatever food group is being demonized at that particular moment we should be ashamed. Everyone is looking for the hot tip, the magic pill, behavior, superfood, or devil ingredient to avoid, that will grant them the weight loss or health goal they have been wishing for, when the answer really is much simpler than it is presented to be (in theory).

 

The truth is, we have each been born with a major untapped resource–the incredible entity that is the human body! Our bodies have come equipped with a number of organs designed to detoxify us and regulate hunger, along with many other ridiculously awesome functions. All we need to do to allow our bodies to do their thing is eat a moderate and balanced diet, incorporating variety wherever possible. For a healthy individual, there’s no need to cut out entire food groups, no need to initiate a juice cleanse, and certainly no need to go without food for large windows of time (from what I have read, this can be anywhere from 16 to 24 hours).

 

Here is the bottom line… When you choose a dietary lifestyle, ask yourself this question: Can I do this for the REST of my life? Be honest. If the answer is truly a resounding “YES,” more power to ya. But if your approach is to do this for now, and go back to “normal eating” after a certain point, or if you foresee yourself dreading every fast day as it quickly approaches, I urge you to reconsider.

 

Life is short. Don’t waste it being unhappy. Just eat less, and move more (although I know this is more challenging than it sounds, I also KNOW that YOU absolutely can do it). Listen to your body, give it what it’s asking for (what it’s TRULY asking for–different than just a craving, story for another time) as often as possible. Grant it that, and it will return the favor by functioning optimally, allowing you to reach your health goals.

Balance. Variety. Moderation. THAT IS THE SECRET. Now go tell your friends. And enjoy today.