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!!

Reunited with My Love, Research

So, I just finished ICU. It was a hectic 2 weeks. I went to the conference that I mentioned in the previous post. It was pretty epic. The expo was awesome; I think I ended up with somewhere around 25 free protein bars (Luna, Odwalla, SlimFast, you name it!), lots of bags of pistachios, 6 single boxes of cereal, cranberries, nuts, and lots of other health foods of varying sorts. Every single food company you could ever dream of was there, Coke, Pepsi, Hershey, USDA Beef, Welch's, etc. And then there were new companies and foods. I tried some sweet potato chips, carrot cake frozen yogurt, vitamin drinks, a ton of new vegetarian products, etc. I went to some really good lectures and then some really boring lectures. But all in all, it was a pretty good experience.

Here is a picture of  my good friend, Kate, another intern in the internship, and I at the expo with the Laughing Cow. Tony the Tiger was there too!

During ICU, I was exposed to a lot of different things. Basically, I saw a ton of patients that were intubated, heavily sedated, and needed tube feed recommendations.   I saw patients who were severely burned, in near-fatal car crashes, overdosed on drugs, and in several other depressing situations. I've seen patients' families learn troubling news and seen patients discharged home.  It was a crazy two weeks that was ended with, what else, but ANOTHER PRESENTATION!  Yes, I had another presentation. I had to present 4 patients that I saw during ICU and present a recent research article on one. It was in the style of a roundtable. So, I had to sit at the head of the table and talk about my patients and answer a slew of questions. It went really well, considering this is considered one of the hardest rotations. I'm glad to be pretty much done with Clinicals!!

(Side note: While I was presenting, a couple of the other interns were giving tours to prospective interns. Apparently, the interns brought the students over to the window of the room that I was presenting in and told them "This is an example of one of the presentations that you will be doing if you get into our program."  One of the students replied, "It looks so scary!" I love this story.)

Today, I started the Research rotation. It was amazing! I'm so glad to be reunited with research!  (I'm a nerd, I know.) Today, I saw a couple of patients get bone scans and skinfold measurements. I also got my resting energy expenditure (REE) measured. According to the test, I burn ~ 1212 calories per day when I'm just "resting" or laying down.  For the test, I had to lay down and put a huge bubble over my head and lay down for 20 min and just breathe normal. Sorry, there are no pictures for that...

I love research so much!  I am really going to enjoy this week, I can already tell!!!  I will be getting my bone scan tomorrow, I shall report the results soon!

Intensive Care Unit is Pretty Intense... Well, Sort Of

Ok, so I've been awful at updating this thing!  Here is a recap of my last 2 weeks in my surgery rotation that I just completed last Friday!

10/18-10/22 Surgery Week One
*Oriented myself to the Phillips House surgical floor. This is my FAVORITE floor in the hospital. It's on the 22nd floor and it is exclusively private rooms. If you go to the solarium, you can see almost all of Boston.  I love this room. I will go here on my break and get lost in the view.  Sorry I don't have any pictures of it just yet, or I'd show you...
*Performed some educations on post-op surgical diets. Liquid diets for esophagus surgery patients. Low fiber, low fat diets for intestinal surgery patients. Proper nutrition for ostomy patients.
*Watched a swallow study!!  Dietitians work closely with speech pathologists.  These are the people that determine whether or not patients can adequately swallow by performing swallow evaluations. Basically, the study that I watched used a camera that was placed through the nose to the top of the back of the mouth.  The patient was then asked to eat/drink a variety of foods that were dyed with blue food coloring so we could see the substance being swallowed.  They record video of the patient swallowing the foods on the computer and then will review what the patient is allowed to eat-- only thin liquids (watery liquids), nectar-thick liquids (honey), etc.  Very exciting!

10/25-10/29 Surgery Week Two
*Basically acted as an RD and functioned as staff relief for my floor.  It was pretty exciting and stressful at the same time. I got to see a lot of interesting things such as: a gastric bypass surgery gone wrong, pancreatic cancer, heroin abuse, brain tumors, etc. Not all things had to do with surgery but they were interesting and rewarding, nonetheless.
*The rest of my week was basically consumed by my preparing for my presentation on pancreatic enzymes and pancreatitis. I did really well on the presentation and received really great feedback! Good story: I practiced my presentation in front of Justin the night before I performed it. The next night, after I had done my presentation earlier that day, I got to witness Justin explaining to a friend how pancreatic enzymes work. This might be one of the best moments of my life. No joke. He then attempted to explain the Whipple procedure, which was so awesome because he was so excited about it.  (Basically it is a procedure that is performed when a pancreatic mass has been detected. The surgeon removes the portion of the pancreas containing the mass and then cuts the bottom of the stomach to attach it to a point further down the intestine. By moving the opening of the end of the stomach further down the intestine, you get less complications of the now malfunctioning pancreas, but it often causes malabsorption of fat and weight loss. Very complicated, but very interesting.) Fun fact: Steve Jobs (Apple guy) had this done and it is why he is so skinny. Here is a picture of the outcome of this procedure:

I'm sad to be done with the Medicine and Surgery rotation. But don't get me wrong, it was one of the most exhausting things that I've done in a while.  My typical schedule was:

6:00a - Wake up, get ready, eat breakfast
7:00a - Catch train to work
8:00a - Work
6:00p - Catch train to go home
7:00p - Home/eat/take break
9:00p - Read, work on project
12:00a - Sleep

Yes, I typically work 10 hour days, only get a 30 minute lunch break and no pay.  Why am I doing this again?

Anyways, yesterday and the Monday prior, the interns and I attended a workshop at Children's Hospital in Boston.  It was all about pediatric nutrition.  It was a great 2 days and I'm really glad that I attended. I learned a lot about breastfeeding nutrition, baby formulas, pediatric intensive care nutrition, and special needs infants. It was awesome!

This week I started my Intensive Care Unit rotation.  This rotation lasts 2 weeks.  Today I was oriented to the Burn Unit.  Words cannot describe what I saw here.  Very intense, depressing, overwhelming.  I really enjoyed the atmosphere here though.  It was surprisingly calming.  Briefly, I saw a 24 year old patient today with 80% of his body covered in 3rd degree burns, he was flown in from another state after he lit himself on fire.  He was put on a feeding tube that is providing him with ~2700 kcal and basically enough protein for a wrestling team. He has such high caloric and protein needs due to the extensiveness of his body breaking down his muscle in attempt to reform the skin that is missing.  I think that is all I can really say about that for now.

Now for happier things...Last weekend I ran a 5k with my friend from Joslin and a fellow intern.  I finished in 28:00. Not my best, but not my worst either! We got cheesy medals and free beer after finishing the race.

This weekend, I will be going to ADA's FNCE (pronounced Fence-eee).  This is an acronym for the American Dietetic Association's Food and Nutrition Conference and Expo.  It is held every year and happens to be in Boston this year. Convenient, right? It starts this Saturday and lasts for 4 days.  It is a great time to network and meet with other interns from all over the US, meet RDs, and attend lectures. The guest lecturer this year is Anthony Bourdain!  Google him if you don't know who he is. Also, MGH is having a reunion for all the previous interns.  So, I will be going to that (did I mention that I am in the 101st class of dietetic interns at MGH?)  Hopefully I will meet some great people here (and establish connections for future job opportunities!!)

So, that is what is new. I have yet ANOTHER presentation next week.  It's funny, this internship only requires 8 presentations during the entire year-long program yet I have 3 within the first 2 months. Oh well!  After this next presentation, I am set until after Christmas, as far as presentations go...