DALLAS: One Bite at a Time: 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!