A Crazy Week

So, I started the dreaded Patient Food Services. I'll admit, it's not as bad as I thought it would be. But it's definitely not my absolute favorite rotation.  My project is to potentially move one of the staff members shifts up by two hours. She currently works 1p-9:30p, but the office needs more help from 11a-1p, so they are thinking about moving this lady's shift up by 2 hours. That being said, I have to observe the office from 11a-1p and also from 7:30p-9:30p, make a decision about this, and present it to my preceptors. It's not that difficult, but it is a bit frustrating, since this means that I have to work the 1p-9:30p shift on some days, including today.  Other than that, the rotation is not that bad. Honestly it's going by pretty fast, which is great in my book!

In other news, Justin and I will be moving to North Carolina at the end of the internship (August). He is going to the University of North Carolina Greensboro this fall to complete his DMA.  It was an extremely tough decision to make, but we are both happy with our decision!

20 Weeks To Go!

Wow. So, I continue to be terrible at updating... oh well. That's how things go when you are overworked!  Let's see what has happened since I last updated..

I had my panini presentation! It went okay.  It was a grand total of two and half weeks into another rotation, but oh well!  Things always seemed to get pushed back further and further these days.  Update, all of my paninis are selling very well.  A lot of them have even been selling out .

We had our business plan presentations!  I don't want to go back and think about it, but the whole department was there.  We did well and we all could not be happier that we are done with this.

I completed six weeks in research!  Plus another presentation! I had a great time spending six weeks back in research. I had already spent one week here, but I went back for 6 more weeks, because we are able to choose six weeks in a "concentration." I did a wide range of things during this time. I worked with patients, performing waist measurements and skinfolds, I assisted with bone scans, I developed a metabolic diet snack (i.e. a snack that had very specific requirements, think 250 kcal, 8 g protein, 9 g fat, 50 mg potassium, etc.)  I worked with autistic children, women with eating disorders, men with schizophrenia, college students, etc. It was a great six weeks that ended with, you guessed it, another presentation and a paper.

So, I'm guessing you see a theme here.  I do a lot of presentations.  Well, I've done six and I have two left!  I cannot wait to be done.  Presentations = nervous wreck.

In other news, Justin is trying to decide where he wants to go to school for his Doctorate in Music. I've started working part-time at my old job to get a couple more dollars coming in.

Also, I went to two Celtics games. Unfortunately, we lost both. But it was a great time nonetheless.

 
Also, we gave Noel a bath. As promised to my sister, I will post a few pictures...  She looks very unhappy here, but she's really loving life right now!! Promise.

That's all for now. Starting a new rotation tomorrow. It is Patient Food Services. Once I know what my project I will be assigned, I will discuss what it is and what this rotation is all about!

The Anti-Stress: Yoga

We had to defend our business plan on Friday in front of a committee. It went pretty well!  Fortunately, we were given a list of a few of the questions that we were going to be asked, so we were able to answer most of the questions fairly well.  Now that we have the hard part out of the way, we still have to do a presentation to the staff.  That won't happen for another two weeks though...

As for my panini presentation, it got postponed due to scheduling problems!  I'm pretty disappointed because this means I will have to do this presentation in a week and a half, in addition to the business plan presentation, which is when I am supposed to be focusing on my research concentration. Oh well!

Due to all this preparation for presentations, you can imagine that I'm a bit stressed.  But during my concentration, when I have a set schedule (finally!) from 7-3:30 every day for six weeks, I'm hoping to do something that I've neglected to do since I've started this internship. I'm going to make an effort to take better care of myself.  Me and one of my fellow interns, Kate, have been going to an amazing (life-changing!) yoga class. Let me first say that before this, I was completely new to yoga. But only a few classes in, and I'm in love!  I can't explain how one week's worth of stress can leave my body in only an hour and a half. But it does. And it's great.  I know that I'm only a beginner and that I can't really do any of the positions correctly the first time, but I love the fact that I found something else that I'm interested in.  I have no money to go to the gym, so these $5 drop-in yoga classes will have to suffice. And if the weather warms up soon, I hope to start running 2-3 times a week.  Also, I'm trying my best to start eating healthier.  Of all things, this is what I should be practicing more often than not, but I don't!  I hate to use it as an excuse but I have so little money that I do find it hard to eat better.  I know, I know.  You can still eat healthy on a small budget, but seriously, when I have to buy groceries for two people on my insanely limited budget, it doesn't work too well.  But now that Justin and I are in a bit of a better financial situation, I'm hoping to eat a lot better.  I got groceries this weekend and was sure to start buying some healthier options.  I'm starting to realize that I really don't want to look back on this internship and think about how I was so stressed and uptight the whole time. Life is too short for that, and I should know that seeing the terrible things that I do on a daily basis should be a constant reminder of this.

The End of Sleeping In and Panini Taste Testing

I've been working on the business plan with my amazing group members for three weeks straight.  I'm exhausted, but at the same time, I'm so proud of all of our work!  I can honestly say that I've never enjoyed group work as much as I did while working with the group that I was in.  Our project was to design an online nutrition counseling service that would allow clients to receive nutrition advice via email, phone, webcam, etc.  Technology is all about convenience and this is what our project was about.  The name of our program was mySPOON (My Supportive, Personalized Online Outpatient Nutrition.) I won't bore you with all of the details, but this week we will be presenting our business plan to "investors."  I'm expecting to be drilled on a lot of things. But I'm just trying to remember the best advice that I ever got during my thesis defense and that is, "there is no reason to not be confident, you and you alone know your project better than anyone else in the room."

Meanwhile, I'm back in retail, getting ready to present my all of panini research and creations at the end of the week.  These are the 12 new paninis that I came up with:

1. Roast beef, Swiss cheese, Peppers and Onions on French bread
2. Ham & Provolone Cheese, Pineapple w/ brown sugar on French bread
3. Peanut butter, Banana, Honey, Cinnamon on White or Wheat Bread
4. Ham & Cream Cheese on Raisin Bread
5. Ham and Swiss cheese on Rye Bread
6. Corned Beef, Pastrami, Swiss cheese on Rye Bread
7. Chicken, Bacon, Ranch on French bread
8. Turkey, Bacon, Swiss Cheese, Chipotle Mayo on Wheat Bread
9. Mega Melt: American, Swiss, Provolone, and Cheddar Cheese on White or Wheat Bread
10. BLT and Cheese on White or Wheat Bread
11. Sesame Chicken Wrap
12. Grilled Chicken, Roasted Red Pepper, Shredded Mozzarella, Spinach in Low-Carb Tortilla

I got my "finalized" schedule for the internship and I was overcome with a feeling of achievement. I really don't have that many rotations left and I'm so amazed at how much that I've already done so far. All that I have left is:

• Research (6 weeks)
• Patient Food Services (4 weeks)
• School Food Service (1 week)
• Health Centers (3 weeks)
• Pediatrics (2 weeks)
• Production (4 weeks)
• Staff Relief (6 weeks)

That means 3 more presentations and I'm ding dong done!

I don't have much more news, other than 1 month from today I will officially be headed home for my Spring Break!  Very excited!

Happy Valentine's Day!

Weight Loss Counseling, Lots of Macaroni and Cheese, and Endless Panini Recipes

Where does the time go?  It's been over a month since I've last updated this thing. Oops!  No worries, I will fill you in on what I've been up to!

Before Christmas:
I miraculously completed my outpatient rotation!  I counseled 6 patients on weight loss and it went surprisingly well! I was nervous, don't get me wrong, but all of the RDs told me I was doing very well and I didn't seem even the least bit nervous.  One of them even told me I was "a natural." I'm not sure how I managed to keep a poker face during those sessions. I mean, on the inside, my stomach was in knots, I felt overwhelmingly nauseous, and I was sweating like a snow cone in Phoenix (sorry, couldn't resist the Mrs. Doubtfire reference.)  But this rotation confirmed, yet again, what I've heard at the end of every rotation that I've done so far, which is.... I'm way too hard on myself.  I wish I could be more confident going into these rotations, but that's just not how my thought process works, you know?  Anyways, I feel really good about my future as an RD, I felt like I really helped some people out by suggesting small, but important changes to improve people's eating habits and hopefully trim off some pounds. One thing that I learned by the way, is that eating a regular (American) sized bagel is equivalent to eating 5 slices of bread!  Isn't that mind-boggling? Outpatient nutrition counseling is all about these portion distortion issues.  When you ask someone if they would like to eat 5 slices of bread in the morning, they would most likely say no, right? Yet, so many people eat bagels for breakfast!  What's so fascinating is helping people realize the portions that they are eating. When a patient of ours realized how much bread bagels really consist of, you could tell that they were thinking "Maybe I don't really realize how much I'm actually putting into my body."  And please, don't think that I'm saying bagels are bad for you!  I'm definitely not, I had one today for lunch as a matter of fact  But for someone who is trying to lose weight and is eating 2-3 bagels a week, this is an obvious change that they could make.

Here are some (staged) pictures from my rotation!  I look so professional, right? :)

Christmas and New Years:
For Christmas, Justin and I took a 5-day trip back South.  We spent half of our break in Raleigh and half of our break in Atlanta. It was a hectic break, but it was soo good to see everyone and eat delicious food. (Nothing says home sweet home like Mom's Mac and Cheese and a round of Farkle!!)  Justin and I only got to spend 5 days away from Boston, so it was really difficult to leave everyone so soon, but we had to be back for work and what not.  Luckily, my awesome friends (and future bridesmaids!), Jessica and Erika, came from GA to visit me for New Years!  It was so good to see them and we had a great time!! Here are a few photos from Jessica's album from their trip:

Justin was thrilled having 3 girls in the apartment with him! Haha.  He managed to survive.  Probably because Justin found this to be a perfect opportunity to spoil Noel with attention. He loves when I add pictures of him on here ;)

After Christmas/New Year's:
Since I've been back to the hospital I've been working at one of the hospital's cafes in my "Retail" rotation.  My project? To change up the panini menu. The cafe that I'm working at doesn't have a full kitchen, meaning not a lot of big equipment can be there, therefore the menu is limited. What they do serve for lunch, as a main entrée, are panini sandwiches. My job is to come up with some new panini options. So far I've come up with four:
1. Mega Melt (a friend's idea -- Swiss, cheddar, American, and provolone grilled cheese sandwich)
2. BLT with cheese
3. Sesame Chicken Wrap (Sesame dressing, chicken, spinach, onions, and carrots in a low-carb tortilla)
4. Chicken, Bacon, Ranch (a completely stolen idea from Subway, I must admit)

I've got to come up with a few more, especially healthier options, in order to finish the project.  It's difficult to have healthy options when every sandwich usually contains cheese, but we'll figure it out.  They already have soo many panini options on the menu (5 standard: cheese, ham and cheese, turkey and cheese, hummus/spinach/tomato/cheese, and eggplant parmesan AND 2-3 specials: can be anything from a reuben to a chicken quesadilla).  Coming up with tasty, healthy, cheap, and easy-to-make sandwiches is no walk in the park!  Any creative suggestions/ideas are welcome!

I've been doing a lot of recipe testing at home too.  One delicious recipe I got came from the infamous Paula Deen, it is a Fried Peanut Butter and Banana Panini (recipe here: http://www.foodnetwork.com/recipes/paula-deen/paulas-fried-peanut-butter-and-banana-sandwich-recipe/index.html). It was delicious but even me and Justin, the peanut butter lovers that we are, thought that this was too extreme for the general public!  Here is a picture of this tasty treat:

I will be working in this cafe for another week and then I'll be matched up to a group of 4 interns and we will work on a Business Plan. This Business Plan is something (a product, teaching tool, service, whatever) that we come up with and do a HUGE 3-week project on in order to develop the item/idea on paper and into a presentation.  For example, one group last year came up with the idea of a Wii game that was basically a game where you would go grocery shopping with a dietitian and she would give you advice on what to buy. Of course, the game wasn't actually produced, but they had to do all the work-up for it as if it was going to be put on shelves ready to sell tomorrow.  Crazy, right?  I will let you know what idea we decide on.  As of now, I can't think of anything creative, but hopefully we will think of something epic!

Two New Rotations, Plus Lots and Lots of Turkey

A lot has happened since I've last updated.  Let's see what I can remember...

The Week of Thanksgiving:

I spent one day with the RD that counsels patients with Continuous Ambulatory Peritoneal Dialysis (CAPD). People who have failing kidneys need alternate methods to filter their kidneys in order to stay healthy.  There are 3 ways to filter the kidneys (generally speaking). One way is hemodialysis.  This is what you might be most familiar with, where people go to centers and hook up to a machine for 3-4 hours, 3 times a week.  The second method is sort of a continuous hemodialysis, where a patient is hospitalized and hooked up to the machine 24/7. This is for the most severe cases.  Lastly, there is CAPD, where patients hook up a tube to a port that is created in their abdominal wall, put in a "clean" solution into their abdominal cavity,  waste is filtered into solution from the surrounding abdominal organs, and then they hook up a tube to excrete the "waste" solution.  This is crazy to think about, considering there is basically always solution sitting in these patient's abdominal cavity when they are living their daily lives.  So, I spent a day with the RD that talks about the nutrition issues with these patients.

For the next two days, I shadowed the transplant dietitian.  She sees patients before and after transplant procedures, talking about what they can and cannot eat.  It was a good experience, but my "week in transplant" was cut short due to the holiday.

Thanksgiving:

On the day before Thanksgiving, we had a Thanksgiving dinner at our apartment. A few of me and my friends didn't get the chance to go home for Thanksgiving, so we thought to try to have our own "family" dinner.  It turned out pretty well!  I made Cauliflower Gratin that was a hit!  Props to my sister for giving me the recipe.  Here it is if you want it: http://stickygooeycreamychewy.com/2009/12/12/cauliflower-gratin/

On Thanksgiving day, Justin and I spent our day with some members of the Boston Symphony Orchestra. It was a little awkward, especially the part where we had to go around the table and say what we were thankful for, but it was good all in all. The food was AMAZING. All I remember is these figs stuffed with feta cheese, wrapped in prosciutto, covered in some indescribable sauce.  Yum!

Since Thanksgiving:

Since Thanksgiving, I've been in the Outpatient rotation. This is where patients go for nutrition advice when they are not hospitalized. Most of the patients that I've seen so far are in for weight management, mostly overweight and obese patients.  I have seen some interesting patients such as a lady with a protein allergy, someone with Celiac's disease, a young girl trying to gain weight, and finally, a crazy mom trying to get her pre-teen to lose weight.  Yes, I will explain that last one in more detail!  So, this mom comes in and says in front of her daughter, "My daughter is too comfortable wearing her bathing suit around other people, she just doesn't care that she's fat."  Mind you, this girl is 12 years old. Still growing, still a sponge soaking up everything around her. STILL CAPABLE OF DEVELOPING AN EATING DISORDER.  Anyways, to make a long story short, let's hope the best for this young girl.

I've seen diabetics, patients with Cystic Fibrosis, and tomorrow I'm going to see some kids with stomach problems, basically picky eaters and allergies. I counseled my first patient on Tuesday.  It was kind of nerve-wracking, but the woman I counseled was the sweetest lady and said that I would do really well in my field!  She was too cute and I really think I gave her some great advice!

I will be in outpatient for the next 2 weeks. I have to counsel 5 more patients on my own......and then, Christmastime!! Speaking of Christmastime, Justin and I usually make a Gingerbread House every year. This year, my sister bought us something different.  A Rice Krispies paint-your-own house set.  See the pictures for our adventure. Note: Do not judge the house that I painted. It is HIDEOUS, I'm aware.  Things weren't working, so I intentionally made it tacky, I swear!

Two weeks from today and Justin and I are heading home for the holidays. We are both really excited!

Oh!  I forgot to mention. I met with the director of our program. She asked me how I thought I was doing in the program and I said "I'm doing okay.  But I'm doing the best that I can.  Sometimes I can be a little to hard on myself."  And she replied, "Well, I think you're doing better than okay. I think you are doing very well."  But she also said, "You are way too hard on yourself and you need to be much more confident with the amount of knowledge that you carry."  Wow!  This was such a major win in my book. I know I have the confidence issues going on, but I didn't realize I was doing so well!  I'm glad that all this work is paying off.  It's really hard to push yourself when you work yourself really hard and don't get to hear feedback like that very often. But it is much appreciated and definitely a push to keep working hard.

Last thing, I haven't posted about new nutrition stuff in awhile, but I wanted to discuss Greek yogurt for a minute. I've just started eating it and I can't say that I'm in love with it yet (I think it's going to be an acquired taste/texture for me.) But it's definitely turning me off of the low fat non-Greek yogurt that I usually buy. Greek yogurt has twice the amount of protein as other yogurts!  I think that the honey flavor is the best that I've tried.  I must admit, one of the biggest things we see that can be adjusted in a lot of people's diets is adding some protein to breakfast.  Getting protein will help you feel fuller longer. Think: not overeating later.  I'm reading a new book about mindful eating that I hope to mention about in the next post.

Happy Holidays!

The End of a Great Week!

So, my week in research was 100% fantastic!  I loved every minute of it. I did a lot of different things while in the rotation. I practiced measuring skinfolds, which is an extremely difficult skill, if I must say so. Also, I took hip and waist measurements on some patients, which is undoubtedly an extremely awkward task, but I guess you eventually get used to it.  I also took some basic heights and weights. Here is a picture of me getting the height on one of the other RDs in the office, for practice. And yes, I have finally met a male dietitian, a rare occurrence in this field!

Also, during this rotation I had to develop a diet in the metabolic kitchen. In a lot of the studies done at this research facility, they use "weighed diets". This is basically a really precise diet, where the food is weighed out to the gram so each participant receives exactly the same amount of calories, protein, fat, and carbohydrates. It takes months to develop some of these menus because there are usually a ton of restrictions. As you can imagine, it is very difficult to try to estimate everything in grams, since we Americans don't think about our food in the terms of grams, rather cups or tablespoons.  My project was to develop a one day menu. It was very difficult, taking me about 3 hours to tweak it on the computer so it was just right. For my dinner entree, I chose spaghetti noodles with sauce and shredded mozzarella cheese.  I then had to request food from the hospital kitchen to reproduce my meal. I ended up with exactly what I ordered, spaghetti noodles and sauce. But the kitchen didn't have mozzarella cheese, rather they only had grated parmesan cheese. When I had to substiute 28 g of shredded mozzarella cheese with 28 g of powdered parmesan cheese, I ended up with almost 3/4 cup of parmesan cheese. This is a ridiculous amount of cheese and if you know me, I don't even like parmesan cheese, so this was an interesting predicament.  Our assignment then required us to eat the food and weigh the tray after we ate to determine exactly how much we ate (I told you it was precise!!).  Needless to say, I had a lot of parmesan cheese left!!

The next thing I learned was how to try to use Dual-Energy X-Ray Absorptiometer (DEXA).  This machine measures the density of your bones. It can examine your entire body or just certain parts, such as your hip, your spine, or your forearm.  The machine spits out some numbers that you can use to determine whether or not you have osteoporosis, osteopenia (at risk for developing osteoporosis), or healthy bones.  I was able to get a full body scan while in this rotation, and I'm proud to say that I have no signs of osteoporosis or osteopenia!  You have to be certified to use this machine and to examine the x-rays.  But the RDs let me try it out.

Finally, the last thing that I was able to do is talk to study participants!  Some people come in with food diaries and the RDs have to go over what the patients have eaten over the past couple of days.  This is always interesting to me because I love to hear what people eat everyday.  Also, in the Research office, they have a ton of awesome food models that you get to use to discuss portion sizes. These are expensive but really helpful for the patients.

All in all, I had such a great week!  During our internship we get to choose a rotation that we really enjoyed and get to spend an extra 6 weeks there. Of course there is a project involved, but it is a really good chance to really get a feel for that career path.  I've already talked to the director about choosing Research for my concentration! I'm really hoping it will work out.

Tomorrow, I will be starting in Renal and Transplant.  I'm supposed to get a full week of this rotation, but because of Thanksgiving, I will only be getting 3 days.  I hope it goes well!  Apparently one of the dietitians in this rotation grills you with questions.  So, I'm pretty nervous. But I'll keep you updated!!