Outpatient Nutrition Counseling

People require dietary counseling for a variety of medical conditions including diabetes, obesity, high cholesterol, high blood pressure, gastrointestinal problems, and many more random reasons. Counseling is a talent, it takes practice. I strictly observed the dietitian this week, paying close attention to her techniques. Motivational interviewing is used to get the client to find answers and solutions to their own problems by asking them the right questions. Some clients come in to the counseling session expecting the dietitian to come up with solutions to all of their problems. They want the RD to tell them exactly what to eat or what not to eat. Some people have unrealistic weight loss goals and simply don't know that the high fat, high sugar foods they are currently eating are standing in the way of their weight loss success. I assisted the RD with educating a newly diagnosed gestational diabetic. I got to teach her how to follow a consistent carbohydrate diet for the duration of her pregnancy. Being an outpatient RD is interesting and tiring. An initial visit is usually at least an hour or over two hours of hearing about the client's story, motivating, and teaching. When the sessions were done I charted on them using the nutrition care process and then the RD checked it over and faxed it to the doctor's office.
Over the weekend I enjoyed the sunny skies with temperatures in the 70s and went for a really long run around White Rock Lake.

Presbyterian Hospital of Plano--Clinical

This week I got thrown out to the wolves! By Friday I felt like a dietitian! I gained a lot of confidence with this clinical stuff because I got to work independently and at my own pace. Each day I would get a list of 4-6 patients with a variety of problems. Some were assessments, some were follow-ups, and some I had to give nutrition education to. I had some patients that had difficult nutrition problems...for example I did my mini-case study on a man that was admitted with hepatotoxicity (liver damage related to alcohol overdose) and hypokalemia (low potassium in the blood). Here is the story: 46 year old male who has had alcohol abuse for 30 years, lives at home with his wife and 6 kids. He owns a landscaping company and used to fight in warehouses for money. He lives on his couch and drinks 1.75 liters of whiskey ever other day to prevent withdrawal symptoms. He hasn't left the couch or his house since October. He hasn't eaten solid food for three months, but does drink smoothies with raw eggs daily. He frequently falls and has mini seizures. He was admitted due to a fall that gashed his forehead. Interesting huh? It was great experience. I also got to attend my first 'rounds'. That is when the doctor, social worker, case manager, dietitian, nurses, insurance person, and a few others walk around patient's room to talk about how the patient is progressing. Since these were ICU rounds there were several patients on tube feedings which a dietitian plays a huge role in.
Friday I went to Humperdinks with intern, Megan to have dinner and some beers and to chat about our rotations and life. On Saturday I went with her to go boot shopping in Denton. Then we went for a walk in the woods on some paths and had some deeeelishous delicious Thai food for lunch. Saturday evening I had a blast babysitting for my internship director's twins! Sunday I went to intern, Kristin's house to watch the BIG game! GO PACKERS! YAY! The Packers are coming to visit me in Dallas for the SUPER BOWL!!! ......If anyone would like to find me a ticket, I would gladly go and represent Wisconsin.

Diabetes, Psychiatry, Rehabilitation, Pulmonology

I felt right at home this week when there was SNOW and freezing rain in Dallas with temperatures in the 20s and 30s. My car doors were actually froze shut one morning. I didn't sign up for this cold stuff!

This week was full of learning. I got to do nutrition assessments on a wide variety of patients. Some with COPD and Diabetes, a suicidal patient, and a patient with hyperglycemic hyperosmolar nonketotic syndrome. Diabetes is quite the complex disease. I'm learning about medications and their interactions with nutrients and other medications. Psychiatry was interesting. My preceptor and I went walking around on the 5th floor (the crazy floor) and a lady started talking to us, who happened to live in Wisconsin for some part of her life. She told us her life story which included being involved in some cult in Necedah, WI. She knew where Stevens Point was along with all the hospitals in that area....that lady made my day. I got to follow a Respiratory Therapist for about an hour to see what they do. They deal with patients on ventilators (life support) and other forms of receiving oxygen.

Saturday night I went to intern, Kristin's house to watch The Packers!!! What an awesome game! We were screaming at the TV and having a blast. Hopefully I will see the team right here in Dallas in a couple weeks for the SUPER BOWL!!

Administrative Project Week: Isensix

The week of 1/3/11-1/7/11 was spent trying to complete my food service administrative project with my partner, Anna. We will present our project to the food service director, my internship director, and department managers on January 31st. We had a very productive week. We developed training materials to in-service staff about how to use Isensix (a remote temperature monitoring system), made a PowerPoint, wrote a paper, and spent a lot of time working out the kinks of the system. Our project will be implemented on 1/12/11, meaning that when temperatures on refrigerators and freezers are out of range an alarm will go off that needs to be deactivated by an employee. That employee then needs to log their actions taken to solve the problem on the computer. This system saves time and paper. Instead of logging temperatures of hundreds of units everyday with paper and pencil, a manager can simply log onto the Isensix website and check all of the units on the computer and click 'checkpoint' to log the temperatures of every unit in the nutrition department.

On Thursday we had our intern class in the hyperbaric unit of the hospital. Hyperbaric oxygen therapy is done in a large chamber and is used to heal diabetic and ulcer wounds, treat deep sea divers who may have suffered from air embolism following a dive, prepares athletes for higher endurance (Lance Armstrong, mountain climbers). While in a hyperbaric chamber, pressure is increased while completely pure oxygen is supplied to the patient. Increased pressure drives oxygen into damaged cells so they heal properly.

Friday night I went with an intern, Megan, to pick up her wedding dress. Afterwords, we both got huge, greasy 1/2 pound burgers.

Christmas Break!!

Short and sweet version...with pictures! This 2 week break from 12/18/10 - 1/2/11 was much needed after 3 long weeks of internship craziness. When I checked in at DFW airport on the 18th at 6:30 am it said the current temperature in Wausau, WI was zero degrees! Yay! I am so happy I got to see family and friends that I haven't seen in about 5 months. I finally got to meet my cousin Ty, who is now 2 months old. I stayed busy by visiting with family and friends, going to Christmas parties, having family pictures taken, playing wii, sledding with my cousin Kody, drinking beer, wine, and white Russians, and eating A LOT of delicious food and cookies.

On December 30th Sara and her boyfriend, Tyler, flew back to Dallas with me. We spent New Year's Eve day making appetizers (meat balls, bruschetta, and Bassindale cheese dip). Dan arrived in Dallas at about 9 pm, just in time for the festivities to begin! On New Year's Day we joined a bunch of Horned Frog's Fans at a bar to watch the Wisconsin Badgers get beat in the Rose Bowl. We were entertained by a weird fan getting a little too in to the game. I'm pretty sure we were the only Badger fans in the bar. Sunday we played Monopoly while the Packers beat the Bears. Thanks to Sara, Tyler, and Dan for keeping me company on New Years =)

...And now for the last stretch of this dietetic internship thing...I don't have a break until Memorial day. I hope everybody had a very Merry Christmas and has a great NEW YEAR!

Rotation 14: Cardiology

Sorry for delay. The past month has been crazy. I did my cardiology rotation from 12/13/10-12/17/10. The week was very interesting but difficult for me to deal with. Many of the patients I saw were in their early to mid 90's with irreversible heart conditions nearing the end of their life. Cardiology deals with conditions of the heart like heart failure, coronary artery disease and much more. Patients at risk for these conditions or who have these conditions are informed about adapting to healthy lifestyles and eating a heart healthy diet that is low in sodium and fat. During the week I observed a cardiac stress test and a cardiac catheterization on two different patients. I am enjoy seeing these procedures because it helps me understand what the patients I am talking to are going through.

My favorite part of the week was the Dietitian/Dietetic Intern Christmas cookie exchange! 18 of us participated in the exchange, all with a different kind of cookie. We got to have at least two of each kind. I brought Chocolaty Caramel Thumbprints. They were a very "putsy" or time-consuming cookie. I highly recommend making them, especially if you are in the mood to procrastinate. I took one bite of every cookie during the exchange.

During the last part of this week I had my friend, Kristin, and her cat, Kitty, stay with me because in was en route back to Wisconsin for her. Kristin helped me transport my fishy, Lloyd, to one of the intern's houses so he wouldn't croak on me during my two week break. Surprisingly, there was still water in the bowl after an extremely bumpy, winding ride.