Veterans Affairs North Texas Health Care System - RENAL

5/16/11-5/20/11

I spent one week with the renal dietitian at the VA. I interviewed patients while they were receiving hemodialysis treatments and assessed a few inpatients. Hemodialysis is a treatment for end stage renal disease (kidney failure), in which blood is removed from the body, filtered through an artificial kidney, and then the clean blood is returned to the body. Treatment needs to be done three days a week and takes four hours each time. The kidney has many functions like getting rid of the body's excess waste products and fluids, regulating fluids, chemicals, blood pressure, and stimulating the production of red blood cells.

The dietitian plays an important role because patients have to be on restricted diets. Kidney failure patients have increased protein needs and its necessary to restrict their potassium, phosphorus, and sodium. These values show up on their lab results. The diet gets complicated for the patient when they also have diabetes. There are about 60 patients that come to the VA hemodialysis unit every day. The dietitian is required to see every patient once a month.

Once again, I had a great time talking with patients and hearing their stories. I even like talking to the grumpy ones, they were frustrating and challenging because they eat whatever they want and just don't care.

Thursday afternoon we had class on Biomedical Ethics--dealing with feeding and hydration at the end of life. It was very interesting. I found out my case study presentation date...June 9th...guess what I'm doing this weekend!

5/20/11--Orange Stormy Sky

Veterans Affairs North Texas Health Care System-Inpatient Wards

5/2/11-5/13/11

For two weeks I was at the VA Hospital in Dallas working with a dietitian in inpatient wards. I was mentally drained and exhausted after each day. Many of the patients I saw had numerous health problems including: diabetes, hypertension, liver disease, heart failure, kidney failure, post traumatic stress disorder, amputations, gout, alcoholism, obesity, cancer, HIV/AIDS, drug addictions, etc...It was challenging and fun to test all that I have learned this far. I gained a new appreciation for clinical dietetics during this rotation because I got to experience the difference I can make in a patient's stay at the hospital or in their life. It was very rewarding hearing the veterans stories. I know I chose the right career path.

I worked at Suze on a Tuesday night during a big wine tasting party. I had a great time tasting $150/bottle wine. The wine maker himself was also there from Scotland, he used to be a lumberjack, nice guy. I also got to meet Dallas local celebrity, Dirk Nowitzki. Well, he's actually a national celebrity since he plays for the Dallas Mavericks (NBA), currently in the Playoffs. I recognized him from the news since I don't pay attention to that sport. He had to duck to get in the door at the restaurant. The chef sent me on an emergency run to the fish market to get some Sea Bass, special for Dirk's table. I got to deliver their fried potatoes and special dipping sauce.

Addendum:
I forgot to talk about Lloyd's near death/fight for life episode. I got home from Suze around 10:30 on a Friday night and Lloyd was NOT looking good. He had freakishly huge pop-eyes and was just floating without any movement. I performed an emergency water change and tried not to panic, but I did. Memories of him swimming happily were going through my mind. I wondered who would keep me company at home for the remainder of this internship. After the water change, he had a wobbly swim and did not eat. I kept a very close eye on him all weekend. He is better now and looks normal. I am pretty sure this all could have been prevented if a water change had been done after half a bottle of Andre Champagne sprayed all over my kitchen/dining room...also known as Lloyd's home. So maybe Lloyd was drunk.

Texas WIC (Women, Infants, & Children)

4/25/11-4/29/11
WIC provides services for pregnant, breastfeeding, and postpartum women, infants, and children up to 5 years of age. Services provided include nutrition education/counseling, food packages, breastfeeding promotion/education, and access to prenatal, maternal, and pediatric health-care services. It is funded by the USDA, Food and Nutrition Services. The 21 WIC clinics in Dallas County serve more than 111,000 participants per month. Nationally, WIC serves 8.7 million each month. Back in the 1960's national nutrition surveys showed that children from low income families had high rates of iron-deficiency anemia and poor growth patterns and pregnant women from low income families had poor pregnancy outcomes. I observed the registered dietitian and counseled high risk clients: weight gain above or below recommended range during pregnancy, weight loss during pregnancy, and children less than the 5th percentile or greater than the 95th percentile in weight for height. I counseled a Spanish speaking client by communicating through a language line. It was difficult to hold eye contact with the client while trying to shout into the phone and it took twice as long because everything the client or I said needed to be translated. Counseling is very challenging for me and a skill that I definitely need practice with - I get nervous. Some things I need to work on include: establishing comfortable rapport with clients, asking open-ended questions, and making SMART goals for the client (specific, measurable, attainable, realistic, and timely). I spent part of one day with a peer breastfeeding counselor, she promoted breastfeeding by sharing it's many benefits with new moms. I taught a class to WIC participants called "Nothing but the Tooth," it talked about proper tooth care during pregnancy and infancy (limiting sweet/sticky foods, baby bottle tooth decay). I'm thankful I had a class with people who participated. It was fun seeing so many cute babies and kids, but not so fun when they were being naughty or screaming.

On Wednesday, I turned 24. I got to share my birthday with my internship director, Kristi =) I'm so excited I got to celebrate by having dinner at Rafa's Cafe Mexicano with some of the interns. We had a great time catching up! For class on Thursday, Alyssa made Kristi and I a Chocolate Chip Cookie Cake with chocolate frosting! YUM!

Birthday dinner at Rafa's Cafe Mexicano with interns

Amberlee drawing on the table

Alyssa with her masterpiece =)

After WIC on Friday I met some interns at Yogurtland, a yummy frozen yogurt place where the ice cream is weighed by the ounce and you can add any and all kinds of toppings you can imagine. I made a chocolaty-coffee creation with all the chocolate toppings I saw. Megan and I went for a walk that led to having a few beers and then doing a work-out dance video at 10:30 at night. Fun times!

Saturday I volunteered with some other interns at the Get Kidz Fit Fest at Market Hall in Dallas. There were all kinds of sports and fitness activities to try, cooking demonstrations, and booths educating the 5000+ kids and parents about nutrition and wellness. I was at the portion distortion booth explaining proper serving sizes. After, Megan and I went to a very unique and fun work-out class, then destroyed our hard work by eating Raising Cane's chicken fingers and french fries.