Veterans Affairs North Texas Health Care System - Outpatient Nutrition Clinic

6/6/11-6/10/11
This was the last rotation that I left of the dietetic internship! It was also my last of four weeks of being at the VA. Most of the rotations at the VA were fun, but I am just thrilled that I don't have to drive through the south Dallas ghetto anymore and see dead stray dogs on the side of the road and pack my own lunch. I'm so done with Dallas traffic. And the VA has a weird smell and some people are creepy. This week I practiced my outpatient counseling skills, which is not my best skill. I did lots of educations: weight loss, weight gain, diabetes, Warfarin (drug-nutrient), and high cholesterol. There were quite a few very interesting/challenging patients. I feel so helpless when money is an issue and patients can't afford to buy food or when the patient is in denial that he has diabetes even though he has been diagnosed for several years and has done nothing but gain weight. I just have to realize that not everyone can or wants to be helped. I gained a lot of confidence this week by talking to veterans and educating them. I had a lot of good laughs with some of the veterans, some with them in the office and some once they left. I still need practice with motivational interviewing which would also help me with keeping a flow of conversation during counseling sessions. I know I'm smart, it just doesn't come out like I want it to. Monday-Wednesday  I was at the library until 12:30 am. Not much sleep this week.
On Thursday, June, 9th I presented my case study on Polycystic Kidney Disease to the interns and dietitians at Presby. I'm not sure what the time was once I was done, but it was suppose to be ~40 minutes long, including questions afterwards. It felt like I was talking forever up there. I was pretty nervous. I am very happy to have that behind me, now I have to finish up the 20 page paper. Lots to do yet.
TWO WEEKS LEFT!!

Pre-presentation Pep-talk from Alyssa

Clinical Staffing - Week 1 - Oncology/Neurology

5/31/11-6/3/11
This week was only four days because of the holiday. I spent my first week of clinical staffing feeling comfortable with the Presby computer programs again. It had been a while since I had a rotation there. The idea of clinical staffing is to literally do the job of the dietitian by performing all of their job duties. I attended rounds and meetings and saw all but one or two patients each day. I'm sure in my last two weeks of staffing I will be seeing 100% of the patients. I noticed how much I improved since the first time I was with the same dietitian back in November. It used to take me all day to do one or two patients, now I can do six or seven. It was a great experience! I stayed at the hospital most nights to work on my case study presentation. On Thursday the first two girls presented their case studies.
On Friday afternoon there was a going away party for Kristi with some really good chocolaty cake. When I got home Friday my apartment was all decorated for Megan's bachelorette party. I hosted a party for Megan with all the interns and her friends. The menu was amazing! Jalapeno-cheddar slider burgers, veggies, Velveeta cheese dip, noodle salad, red-velvet cupcakes, Wisconsin cheese, and Flirtinis. We ate, opened some gifts, then went out in Uptown Dallas to the Penguin Dueling Piano Bar and then to a dance club.

Engagement Ring Red-Velvet cupcakes with Cream Cheese Frosting

Anna, Megan, and I

On Saturday we woke up late and ate leftovers and wine spritzers then went to the Village Country Club pool party for the afternoon. That night, Kristi hosted a fun "Clean Out the Freezer" party. She made burgers, ribs, and sausage and then the interns brought appetizers. After eating, all of us played Catch Phrase, which is something else I have improved at, no one wanted me on their team. I was very happy to be on the winning team =) Sunday I worked on my case study for most of the day.



Clean Out the Freezer Party at Kristi's



Meals on Wheels

5/23/11-5/27/11



Ready to Deliver Some Meals

 This week I was not feeling good. I was literally sick and tired. Not fun. The Meals on Wheels (MOWs) rotation was only three days long, Tuesday - Thursday, and I got to do it with another intern. I spent Monday at the hospital library all day long working on my case study. On Tuesday Rachel and I delivered 13 hot lunch meals to an apartment complex in DeSoto, TX. It was very rewarding to hand deliver the meals to people because it was obvious that they were in need. MOWs provides a nutritious, hot, home-delivered meal to home-bound residents who are unable to provide or prepare their own meals due to illness, advanced age, or disability. I loved walking through the apartment complex because outside the residents' doors were huge displays of plants and door decorations, it seemed like each person was trying to out-decorate their neighbor. Delivering all those meals made Rachel and I very hungry so we stopped for lunch at Cracker Barrel. That night I worked my last night at Suze, it was bittersweet, but I had to be done there so I could focus on my case study and get assignments done. I gained a great customer service experience by dealing with snobby, rich people. I will really miss the delicious food.
On Wednesday Rachel and I worked on MOWs assignments from the library. We re-did educational nutrition handouts for Vitamin A, Potassium, and Lactose Intolerance to be given out to the people who receive meals. We each also made a PowerPoints, my topic was protein and dairy. Case Study for the rest of the day.
On Thursday we met with our preceptor at MOWs and made a bunch of phone calls to MOWs participants to do nutrition screenings which determines their eligibility. For our intern class we went over all the competencies and objectives that we met during the entire internship. Case Study until 9:30, no dinner, got home and packed for a 7am flight to Wisconsin.
I put my brain to rest for four days over Memorial Day weekend, which was not easy to do, knowing how much needed to be done. There was a lot going on in Green Bay. Friday was Dan's nephew's baptism, Saturday was hanging out and a wedding rehearsal, Sunday was the beautiful wedding of Mr. Jay and Perry Kelly, and Monday was playing at the Tundra Lodge water park and flight back to Dallas. I did not catch up on sleep. It was so nice to see some familiar faces and Dan's family. Over two months and I will get to visit my family.

All dressed up for the baptism

Baby Emmet =)

Dan and I

Jay and Perry's wedding

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.

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.

OB/GYN and NICU

3/7/11-3/11/11

* *Each week in the United States, 9,246 babies are born premature.

I spent the week in the Neonatal Intensive Care Unit (NICU) figuring out calorie needs, enteral, and parenteral nutrition support (tube feedings) for teeny, tiny babies. They are so tiny they are weighed in grams. One of my babies weighed only 980 grams (2.14 pounds). Babies born prematurely, before 37 weeks, are at increased nutritional risk due to poor nutrient stores, physiological immaturity, and/or illness which increases nutrient needs. They usually have under-developed lungs, requiring them to have breathing support as well as an under-developed gut. If they are born before week 34 of gestation, infants demonstrate uncoordinated suck/swallow which requires tube feedings. Parenteral nutrition (food through veins) is often started right after birth. It consists of separate solutions of protein, carbohydrate, and intravenous lipids (fats) as well as electrolytes (sodium, potassium) and minerals (calcium, phosphorus). Enteral feedings (food fed through tube that goes into stomach or small intestine) consists of special or premature formulas or breast milk. Some of the special formulas need to be mixed. This is done in the formula room by the diet technicians. I got to help out one day. In the picture above I am weighing out the correct amount of formula to be blended with a specific amount of distilled water...my favorite is the hairnet :) Basically, the week consisted of lots of calculations. While doing some calculations for homework, I was reminded of the days of algebra back in high school when I was crying at the kitchen counter because I didn't know how to do it. It was quite frustrating at times.

The other part of the week was the OB/GYN part. This consisted of learning about the nutrition requirements during pregnancy and breast feeding. I got to observe a breast feeding class. I thought this was just remarkable and very interesting!

On Saturday I ran the Saint Paddy's Day Dash Down Greenville 5K run with Megan, Anna, and her husband. There was lots of green. People were handing out Jell-O shots to the racers during the race. Afterwards, I hydrated myself with beer and spent the day walking down Greenville in a sea of green people. I've never seen such a huge party. I spent the entire day Sunday doing nutrition support homework. It was rough.

Texas Health Allen & Radiation Oncology

Monday I had the day off, meaning I didn't have to go anywhere, but there was work to be done. I used the day to catch up on folders and evaluations and to get my car's air conditioning fixed again.
Tuesday I went to Texas Health Presbyterian Hospital Allen. It is a small 80-bed hospital about 20 miles north of Dallas. My preceptor at Allen is the one and only dietitian on staff there. She sees all the outpatients and inpatients as well as gets involved in the community. I did a few assessments and a diabetes education on patients.
Wednesday and Thursday I was with an outpatient radiation oncology dietitian at Dallas. She is only there two days a week and catches patients as they are arriving or leaving from radiation. I was surprised to learn that many radiation clinics don't offer the services of a dietitian. A dietitian plays a huge role in the success of cancer treatment by helping with symptom and side effect management. Some side effects of radiation and chemotherapy include: loss of appetite, changes in sense of taste and smell, constipation, diarrhea, dry mouth, nausea, sore mouth, sore throat, difficulty swallowing, vomiting, and weight loss. During this time a patient can eat whatever they want as long as the can tolerate it. If they can't get enough calories by eating, tube feeding may be required. One of my assignments is to taste-test and evaluate two nutritional supplements. One is a vanilla flavored powder for weight gain. It says to mix with milk. I'm going to try mixing it with orange juice and hope that it tastes like a dreamsicle. All together it will equal 520 calories and 20 grams of fat, but only 8 grams of protein.
Friday was another day with the Allen dietitian. We spent the day in McKinney, TX at Collin College for their health fair. We had information on healthy eating, cholesterol, how to lower sodium in your diet, and tips for healthy grocery shopping. I was amazed by all the crazy questions that people had for me.
I spent the weekend resting up, baking, doing homework, and going for some longer runs...that 1/2 marathon is right around the corner!

Outpatient Diabetes

Monday, Tuesday, and Wednesday morning I sat in on a three hour diabetes class. A nurse and a dietitian taught the class and covered various topics about what diabetes is, medications, blood sugar monitoring, insulin, weight loss, carbohydrate counting, and making healthy diet choices. It was a nice refresher class for me. In the afternoons I sat in on outpatient diabetes counseling assessments and follow-ups. For lunch on Thursday, a representative from Omni-Pod came in to teach the dietitian and two nurses how to use it. The Omni-Pod is a tubing-free insulin pump that is wireless and waterproof. It can be used by Type 1 diabetics instead of giving themselves several insulin shots a day. I turned down the offer to wear one for the day, but I still got a better idea of what diabetics go through for their insulin therapy. Thursday was also the day I followed a consistent carbohydrate diet, one like a diabetic would follow to help control their blood sugar. First I had to figure out how many calories I needed to consume in one day. I got 2100 calories. Then I calculated the amount of carbohydrate, protein, and fat I could have. I got 195 grams of carbohydrate, 77 grams of protein, and 30 grams of fat. Next I had to plan a menu for the day, one that includes a variety of foods from every food group. My consistent carbohydrate diet is as follows.

Breakfast: 60 grams
AM snack: 15 grams

Lunch: 45 grams

PM snack: 15 grams

Dinner: 45 grams

Bedtime snack: 15 grams

I would have followed my menu perfectly if I wouldn't have had the lunch that the Omni-Pod guy brought in from Panera Bread. I accidentally had 75 grams of carbohydrate. Oooops. This exercise helped me understand how difficult it can be for a diabetic to plan meals and feel uncomfortable at restaurants. Now I find myself counting carbs at every meal I eat. On Friday morning I got to check my own blood sugar--I was scared. My fasting blood sugar was 93 mg/dl, which is normal. I went with my preceptor to the Federal Reserve Bank of Dallas for an employee health fair. The security was crazy, like an airport. We talked to people about diabetes. I participated in some of the fun things that the health fair was offering. I wore a stress dot for the day...it was black all day, which meant I was very stressed. Go figure. I also had my blood pressure checked...that was not so good either, but I think I was just anxious for Dan's arrival. At least my Bone Density scores are good. Our gift for participating in the health fair was $80 in destroyed money in a little baggy. Federal Reserve Banks are responsible for the destruction of unfit currency and destroy several million dollars each business day.

Dan's Visit

Dan flew in from South Carolina Friday night. Saturday we had an amazing dinner at Suze with intern Megan and her fiance Ryan. We enjoyed lots of delicious food and wine! After dinner we went boot scootin' at Billy Bob's Texas in Fort Worth. Buddy Guy was the main event. We learned how to two-step and country swing dance. I need lots of practice. The country swing dance made me dizzy. There's lots of spins! I had one fall, but I blamed it on my boots because they are slippery. My goal is to master these dances!

Food Service Director Shadow

Monday was a free day for me, but I decided to go to the hospital to help with the start up of the last building for the hospitality program. I also caught up on some homework while I was there. My Valentine had roses delivered to me in Nutrition Services, which is two stories under ground. Apparently he had some help from Kristi, my internship director. Sneaky sneaky =) I worked at Suze on that crazy Valentine's Day night. The whole time I was taking reservations for that night, I was thankful that I wouldn't be the one working. The night went pretty smooth until about 7:30 or 8:00 when six different parties came in and there were no open tables. To avoid complaining I just offered them a glass of wine or champagne.

Tuesday and Wednesday I went to Texas Scottish Rite Hospital for Children to shadow the food service director. It is a small hospital that does Patient Room Service as well as some larger catering/conference events. We talked a lot about budget and inventory, both something I won't fully understand until I actually have to do it myself. It was very interesting getting advice and learning from someone who has been in that position for about 20 years.

Thursday and Friday I was back at Texas Health Dallas shadowing the food service director there. She has a crazy job, always running around to different meetings or calling people to schedule another or deal with situations in the kitchen. I tagged along with her to the meetings and while she did employee rounding. One of my assignments was to write an apology letter for when patients are unhappy with the service they received from nutrition services. Thursday Anna and I presented our administrative project. It is nice to check that off the list. Friday was extra crazy because a case study patient was found for me. The patient has Polycystic Kidney Disease. I don't know anything about it yet, but by the end of this project I will be an expert. Lots of research hours in my near future.

Friday night Megan and I went for a walk and then went to The Village Country Club for dinner and drinks. Everyone at the bar was extremely nice. We had many good conversations with people we had never met before. There was also a karaoke contest that night. A Mexican lady kicked off the night by singing The Star Spangled Banner. That was hilarious! We sang All I Wanna Do by Sugarland with a girl we met. We did not win. That was a hard song to sing, I can't even sing Happy Birthday in tune. Saturday I went to yoga then Megan and I went for a jog/walk around White Rock Lake (9 miles). After that we were moving slow so we got a Gatorade and went to Humperdinks for some food and a margarita. We got some fried pickles served with jalapeno-ranch sauce. YUM! Today I am sore.

The Green Bay Packers Super Bowl XLV Victory in Dallas!

I didn't get tickets to get into the Super Bowl--they were a little out of my price range. I did get to tailgate with Kristin (intern) and her fiance in the Panda Express parking lot with The Big G. http://www.thebigg.info/ We got to the tailgate area at about 11am. Such an awesome experience!! It was a huge rush to be around a bunch of craaaazy Packer fans at Cowboy's Stadium. News stations came by the RVs to interview fans and check out the inside of the RVs. I think I might have made it on TV in London. I tried on some guy's championship belt. I ate DEEElishious Miesfeld's Brats from Sheboygen, WI. I walked around the perimeter of Cowboy's Stadium through massive crowds of Packers and Steelers fans and street preachers. I had a memorable bathroom experience. Weirdest thing, everywhere I went the line for the men's bathroom was out the door. I walked right up, did my business, and then walked out with a huge grin-the boys were so mad. Seriously, when have you ever seen a line for a men's bathroom? Oh yeah, I also met Randy Jackson and got a signed picture of him. I watched my first episode of American Idol five days prior to meeting him. He's a cool guy. I watched the Super Bowl on a TV between two RVs with Cowboy's Stadium in the background. I got teary eyed when the Packers scored the first touch down. It was cold. Then it started to rain. No more TV outside. TV got moved inside the RV along with 20 craaazy Packer fans, including me. I screamed a lot. Then the Packers won and I screamed some more. Holy cow. That was neat! We all celebrated in the rain until about 11pm then sat in traffic for the next two hours to get home. I didn't feel tired the next day because I was so excited, but my throat hurt probably due to all my screaming and cheering.