Texas Scottish Rite Hospital for Children--Clinical

4/18/11-4/22/11

Texas Scottish Rite Hospital for Children provides care for children with conditions related to their muscles and bones. This week was a very unique and rare experience. I worked with pediatric dietitians who help children with conditions like scoliosis, clubfoot, neurological problems, spina bifida, cerebral palsy, and much more. Some nutrition problems that need to be addressed are chewing/swallowing problems, constipation, tube feeding, failure to thrive, steroid therapy, underweight, and obesity. I helped the dietitian with nutrition screenings and assessments of children by plotting their heights and weights on growth charts and calculating their energy, protein, fiber, and fluid needs. It is truly amazing what this hospital can do for children who need the help. During the week I got to be involved in the care of a child with Juvenile Dermatomyositis. It is an autoimmune disease marked by muscle weakness and skin rash; it is treated with steroid pulsing therapy. I educated the patient and his family about the importance of good nutrition while receiving steroid therapy. There is an emphasis on getting enough calcium, vitamin D, and potassium because the use of steroids increases the risk of bone loss and fractures, limiting salty and sugary foods and drinks, and choosing healthy, low-fat foods.

I was able to observe a feeding evaluation with an occupational therapist and a video swallow study with a speech-language pathologist on a child with cerebral palsy. He was currently on a ground diet, but his mother knew he could eat solid foods. These studies are done to ensure that it is safe for the child to eat. In the feeding eval I observed his actions during meal time, how he moved the food around in his mouth, how he chewed, and how he swallowed. For the swallow study, a video X-ray shows the mouth, throat, and esophagus as you swallow a variety of liquids and foods mixed with a metallic liquid called barium. This study shows exactly what happens to the food once it is in your mouth. Very cool! This rotation was all very new to me, but it was very interesting being exposed to conditions that I've never seen or heard of before.

On Thursday we had class on medical nutrition therapy for the HIV/AIDS patient and medical nutrition therapy for the burn patient. It was very informative and kind of gross because we saw a lot of pictures of some nasty looking burns.

I was blessed with more company again over the weekend. This time my brother, Kyle, came for a visit over Good Friday/Easter weekend! He showed up late Thursday night (11:30); after talking for a bit he passed out on the air mattress while I stayed up for another two hours doing homework. His snoring made it hard to concentrate. He kept himself busy while I was working by getting his truck detailed and enjoying a small $9.50 Bloody Mary...welcome to Dallas, Kyle! When I got home he was laying by the pool with a cooler of Shiner Ruby Redbird (grapefruit beer...yum). After relaxing for a while, we decided to go to Billy Bob's in Fort Worth. One thing I hadn't tried yet was some Texas Barbecue. I got out my D-Magazine and checked out the dining guide. We picked Angelo's Bar-B-Que in Fort Worth. It was beyond delicious! We got the rib plate-it came with beans, slaw, potato salad, a pickle, bread and a cup-full of BBQ sauce. We also got a huge frosted shooner of Budweiser. Next, we traveled to the Stockyards for a night out. We went to the Basement Bar, where there happened to be a burlesque show...very entertaining! Then to Billy Bob's for Luke Brian where we made up our own dance...the Texas-two-step...Vlietstra style! Saturday Kyle bought some cowboy boots then we went to Six Flags Over Texas for some roller-coaster fun. We were there for six hours and went on a total of 3.5 rides. The 0.5 is because while we were in line for an hour for the Texas Giant-- it started lightening and they shut the ride down. So we had a total of two minutes of riding roller-coasters. Easter Sunday we had lunch at the hospital, layed by the pool, and went to Top Golf. It was a fun game where you get points if you hit the golf ball in the rings. I kicked Kyle's butt =) We had Outback Steakhouse for dinner, then watched a movie. He was off to work, back in Iowa, early Monday morning. What an eventful visit, so nice to see him!



Fall-off-the-bone hickory smoked ribs



Kyle enjoying the ribs

At the Basement Bar, Fort Worth

World's Largest Honky Tonk, Fort Worth

Top Golf, Dallas

Surprises =)

Megan chopping veggies and checking on the soup

Friday after work Megan and I decided to make potato soup and drink wine for the night. In the middle of making the BEST potato soup ever, we heard a knock at the door. I walked to the door in my cow apron with my glass of wine to look out the peep hole, I didn't recognize the face, but I opened the door anyways. It was DAN!!! With a suitcase, just standing there, I was shocked and speechless. His family was suppose to be visiting him in South Carolina and he wasn't suppose to come visit Texas for another week. My first thought was that he was going to ruin my plans with intern, Anna, who I thought I was going to the Kenny Chesney concert with on Saturday, but then Dan said I was going with him, and I was like, but what about Anna? It was all a trick! Tricky, tricky! He pulled off an unforgettable surprise =)


Dinner at Royal Thai

Since the soup had a lot of cooking left, Megan took it home with her to finish it. Dan and I went to dinner at Royal Thai because we were both starving and it was 9:30.

Before Kenny Chesney with the tickets

The Goin' Coastal Tour had an awesome line-up. Uncle Kracker, Billy Currington, Zac Brown Band, and of course--Kenny Chesney.


At Cowboy's Stadium



The Biggest TV in the World
Cowboy's Stadium



I cried when he came on =)

At the end of the concert all the performers came on stage. It was very cool. I was in disbelief during the whole concert. 

Long Term Acute Care at Kindred White Rock and Kindred Dallas

4/11/11-4/15/11
I was at Kindred White Rock and Kindred Dallas Hospitals two weeks ago, only this time instead of focusing on nutrition support, I did follow-ups and assessments on all types of patients. I monitored patients' lab values, blood sugar, and diet tolerance. Many of the patients are there for wound care. I saw some pretty scary looking wounds. A dietitian plays an important part in the healing of wounds by making sure the patient gets proper nutrition.
Thursday afternoon us interns had a class to learn about our strengths, writing cover letters, and writing resumes. My resume needs some work. I brought some Maple Coffee Cake and Alyssa brought some Black Bean Brownies for treats. After class, Megan and I went to White Rock Lake to go for a walk, but we decided to go kayaking instead. It was a very windy day! We paddled down the river for a while then turned around and attempted to go against the waves. It ended up being a very wet ride.

Cardiovascular Center

4/4/11-4/8/11

I spent the week working with exercise physiologists, physical therapists, and a registered dietitian in the cardiac rehabilitation program at the Texas Health Dallas Finley Ewing Cardiovascular & Fitness Center. I was the first dietetic intern to ever go through it so I got to help plan out the schedule for the next lucky interns.

Cardiac rehab is a progressive program with a goal of helping patients restore and maintain optimal health while helping to reduce the risk of future heart problems. Sessions take place on Mon, Wed, and Fri and each patient gets a personalized exercise prescription, education, and lifestyle-modification programs. To qualify for the program patients have to have certain heart conditions or have gone through specific procedures like coronary artery bypass graft, heart transplant, angioplasty, among others. On Wednesday I was with the cardiac rehab dietitian. We did a few assessments on some rehab participants. I also sat in on her two classes about label reading and healthy cooking.

On Thursday the interns got a tour of the US Foodservice warehouse in Garland, TX. It is where Presby gets billions of dollars worth of food from every year. I couldn't believe all the food that was there. There were fork lifts driving around up and down the aisles. We got to walk into the giant freezer, but thankfully we didn't stay long. Afterwards me and some of the interns stopped to take pictures in the Bluebonnets.

On Friday I did follow-ups on the cardiac patients. I checked up on them to see if they accomplished the goals that they established with the dietitian. If they did I gave them some other goals to work on. Friday night, intern Megan and I were thirsty after a long week of work so we went for a walk and stopped at a few bars along the way. We took the scenic route on the way back and Megan wanted to check out this small lake from the dock. The dock was not attached to land however and Megan was knee deep in smelly muck.

Saturday, all the interns spent the day at the Fort Worth Zoo together. We had a great time together and took lots of fun pictures. After the zoo, Megan and I stayed in Fort Worth to visit her friend and spend the night out on the town. Sunday, we got breakfast and I participated in trying on bridesmade dresses with them.



In the Bluebonnets

  

Presby interns on the Crocodile at Fort Worth Zoo



At Mi Cocina in Fort Worth



Jumping around in the Bluebonnets



Nutrition Support at Kindred Dallas and Kindred White Rock

This was my third week of nutrition support. I did the same as I did at Texas Health Dallas except I went between two facilities. It was a huge challenge however, because I had to learn a different computer system and all the medications I was learning were kind of the same, but they were generic names. Another foreign language. Kindred hospital is a Long-term acute care facility. Patients who can no longer be in the hospital due to insurance reasons but are not ready to go home come to a long-term care facility. I assessed and did follow-ups on patients for tube feeding orders. It was a crazy-busy week. On Thursday, the dietetic interns of Dallas attended an annual professional seminar at Baylor hospital where we learned about the RD Exam, our first interview, compensation and benefits, and we got to hear from previous interns about getting their first jobs. Friday I had the day off so I got my oil changed, used my massage gift certificate from Dan, and got a haircut.

Pictures from Rock n' Roll Dallas 1/2 marathon

Click on the link below to see the pictures from the race. I was a happy runner. Action Sports International - Rock 'n' Roll Dallas Half Marathon benefiting Susan G. Komen Marathon for the Cure Custom Header and Footer: "Copyright 2011 ASI Photo"

Rock n' Roll DALLAS 1/2 Marathon and Katy's Visit to Dallas

Dan's sister, Katy, flew from Brookfield, WI to Dallas on Thursday 3/24 to run the half marathon with me. Thursday night we had an amazing dinner at Suze. For dessert we had a strawberry rhubarb shortcake with a biscuit. Then we watched part of the WI basketball game.

Friday, Katy took naps and hung out by the pool while I was at work. When I got done we went to the Health and Fitness Expo to get our race number, timing tag, T-shirt, and bag. We also got a few freebies and ate a bunch of samples of energy bars, gels, and drinks. We went to the Iron Cactus Mexican Grill and Margarita Bar for margaritas, appetizers, beer, and dinner. The Ahi Tuna Ceviche was deeeelish! Then we watched a movie and Katy pretty much slept through the whole thing.

Saturday we went for a short (2.5 mile) run. It was hot and we were kind of dying and both wondering how in the world we were going to run 13.1 miles the next day. I took Katy to Central Market, the coolest grocery store ever, where we got ingredients for our amazing dinner for later. I also made her taste-test the dreamsicle weight-gain drink. It was really tasty, but we both decided that we didn't need the extra calories. In the afternoon we went to the Dallas Arboretum to see the Dallas Blooms. Lots of pretty tulips and other flowers! So purty. For dinner we had homemade spaghetti with chicken-feta meatballs and a blend of vegetables with jalapeno-cheddar cornbread rolls. YUM. We had to fuel up for the race!

Sunday was the BIG day. I was scared we were going to miss the start of the race because of traffic, but we made it! As we crossed the start line we saw the Dallas Cowboy's Cheerleaders cheer us on. There were over 15,000 runners! I was so nervous. It was perfect running weather-50 degrees and cloudy, a big difference from the day before which was 85. The 13.1 mile course was neat, it started in downtown Dallas and we ran right over the spot where JFK was shot, then through Highland Park (big mansion houses), and ended in Fair Park. There was a band at almost every mile marker to keep us motivated. Katy's cousins were there to cheer us on, they had a sign and we got some high fives :) I felt really good during the whole race, I have the weather and Katy to thank for that. My goal was to finish and I did! My time was 2:37:25--I'll take it for my first half marathon! Once we were done it was freezing cold. It was so cold we both turned down beer and didn't stay to watch the Bret Michaels concert. It took a good hour to leave Fair Park and we were both VERY sore. We went home to freshen up then went to P.F. Chang's for lunch because we got a discount for being in the race. We took it easy the rest of the day. Katy had a 6:00 am flight on Monday.

Thanks for running with me Katy!!

Nutrition Support at Texas Health Dallas

3/14/11-3/25/11

I spent two weeks working with the nutrition support dietitians at Texas Health Dallas. Nutrition support is tube feeding (TPN-total parenteral nutrition-nutrition through the veins) or (EN-enteral nutrition-nutrition through a tube that goes from the mouth or nose to the small intestine or from a PEG which is a hole in the gut to the outside of the body on the abdomen). It was pretty intense and I learned a lot! I wore a white lab coat and looked like a smart doctor walking around the hospital. A nutrition support dietitian works with many health care professionals during the care of a nutrition support patient such as physicians, physician assistants, pharmacists, nurses, and other dietitians.

My first day I was given two new patients in need of nutrition support. I had to figure out what was going on with them, what their calorie needs were, which formula to use, and how much formula to give them. I didn't know where to start. I'll just keep this short and say that after my first day, I felt like I learned nothing in my four years of college and thus far in my internship. When it was time to go over the patients' notes with the dietitian, I thought I had it all figured out. Nope. The dietitian was asking me all sorts of questions like why is it bad to have high blood potassium and why is it bad to have low blood phosphorus and what is ALS, among other abbreviations. I didn't know and she didn't give me the answer, my assignment was to look it up and let her know the next day. It was frustrating. The worst part was really getting to know all the medications. Some patients are on 20-30 different meds. I had to keep looking up meds over and over again, I feel like I'm learning a foreign language. Its important for the dietitian to know drug-nutrient interactions and side effects that meds can cause because they can affect eating habits or digestion such as nausea, vomiting, diarrhea, indigestion, constipation, or abdominal pain. I got to take part in ICU rounds because I had a few patients in there on the vent. I had to laugh when I saw a younger doctor dozing off behind his computer during rounds. At least he woke up in time to talk about his patients. After the first few days, I felt more comfortable and was pretty independent. Each day I would get one or two new patients and follow-up on the ones from a couple days ago. It was nice to get to know my patients and keep up with what was going on with them. I knew I was becoming a dietitian when I blurted out in the office, "He pooped!" I was so happy that one of my patients pooped! I was getting worried because he hadn't in over a week.

Some challenges I had were figuring out calorie needs and a nutrition plan for obese patients and dealing with patients that I knew were not going to live much longer. Several of them were on the ventilator because they went into respiratory failure and some just underwent major surgeries like the Whipple and triple bypass surgery.

I got to watch a nurse on the nutrition support team place a Dobhoff tube (feeding tube from the nose to the ligament of treitz--in the small intestine). That was kind of gross. I can't imagine having a tube thread through me. I also saw the nurse place a PICC line. A PICC is a peripherally inserted central catheter. It is used to deliver IV fluids, long term antibiotics, or TPN. A line is inserted through a vein in the arm and threaded through the heart and into the vena cava.

Overall, I really enjoyed this rotation because I learned so much and it made sense. However, I'm not so sure I would like it as a career, at least until I become more familiar with all medical conditions, medications, and terminology.