A New Week, A New Rotation

This was such an exhausting last 2 weeks, sorry it's been so long since I've updated!  I had to do a 10-pg paper and a 20-min presentation last week.  My presentation was called "Hard to Swallow: A Case of Altered Mental Status, Dysphagia-Related Nutrition Support, and Guardianship."  Sounds exciting, yes?  The presentation went well overall.  I'm so glad to be done with it, a huge weight has been lifted.  I was getting 4 hours of sleep...it wasn't good. But its over with. And it is considered one of the most difficult presentations of the semester, so I'm glad to mark that off my list.  Did I mention that my presentation was video taped and I have to watch it and evaluate myself?  NOT EXCITED.

Now I am in my surgery rotation. I'm with the same preceptor, just a different floor. I've only gotten to talk to 1 patient so far, as I only started my rotation today.  The patient was a man that just had part of his pancreas removed and some re-routing of his intestinal tract. After patients have surgery that involves their intestine, it is recommended that they consume a post-surgical soft diet. This is a diet that consists of easy to digest foods such as simple carbs and protein.  High fiber and high fat foods require more effort for your body to digest, so these types of food are avoided initially after surgery (usually ~10-12 days).  We went to talk to the patient to see if he had any questions about this diet restriction, since he was going to be discharged soon and still had a couple of days to go on his post-surgical diet.  He and his wife were so lovely!  He told us to talk to his wife, since she is "the boss."  She only had a few questions, but then we realized her daughter-in-law is an RD, so we ended up talking about that more than her husband's diet!  They were just really great people and being around them really made me miss my family. I wish all patients were so easy going and easy to talk to!

Me and some of the interns decided to go to Oktoberfest here in Boston for a study break 2 weekends ago.  That was pretty exciting, but ridiculously crowded!  It was in Harvard Square.  Here is a picture from that:

Also, I took a couple of pictures while I was at the hospital.  Here are the patches that we where on our left lab coat sleeve, which we are in charge of sewing on by the way.  This is so everyone in the hospital knows we are students, I guess. Note: I didn't realize that the symbol above "Dietitian" said MGH until about 5 days ago.  Oops.

Here is a picture of me in my lab coat!  Justin takes me very seriously when I wear my lab coat, so I'm glad I really do have more authority when I wear it! This picture was taken in our intern "office."  It's very small and is crowded when we are all trying to access our lockers.

Well, that is it for now.  I don't have anything else that is new and exciting going on right now. I have another project due next Tuesday about Pancreatic Insufficiency that I'm actually really pumped about, so I'm going to be starting that soon.

Oh!  I forgot to tell you.  I found out something the other day.  So when you get a Bachelors in Dietetics, to become an RD, you know how you have to do an internship, right?  Well, 10 years ago about 75% of students got into internships that applied. Well, they just released the data and only 50% of the students that applied to internships were matched with an internship. It's so competitive and it's only getting more so.  I am so thankful that I got matched!

I think I'm going Vegetarian.

Two posts in one day! I couldn't ignore this article that I read just now. You should check this out, if you are interested in what is really in those "Chicken" McNuggets at McDonalds.  Brace yourself...

Pre-McNugget "Meat"

Should I become a vegetarian or should I swear off McDonald's?  I'm not sure, but I will keep you updated. This picture says so much about the current fast food industry.

Are you a "4th Mealer" and completely unaware of it?!!?

Time is flying and I can't believe that at the end of this week, I will be halfway done with my Medicine/Surgery rotation.  So what has happened recently?  Well, I started talking to patients on my floor without my preceptor standing over me.  The first did not go so well, but amazingly I am building up my confidence and starting to talk to patients better and better!  This is so exciting!

Also, I had a really great moment on Friday that I absolutely must share!  A patient of ours was barely eating, probably eating <50% of her breakfast, lunch, and dinner.  But somehow, this went unnoticed by the nurses (scary, I know!)  But at the last minute, before the patient was discharged, a doctor came up to me (yes, yours truly!) to tell me that he wasn't going to discharge the patient until I assessed the patient.  Of course I started panicking.  I immediately dropped what I was doing and started flipping through the chart of this patient.  To our surprise, she was hardly eating anything. I went and talked to her (on my own!) and asked her what was going on with her eating. To make a long story short, she is depressed and has no appetite.  She has tried supplements, such as Ensure, but she just can't stomach them any longer.  When I left the room, I immediately told the doctor that we can't discharge her yet.  She was going to be released to an assisted living home where there isn't really a lot of supervision with meals.  We set it up so we could record everything that she was eating (calorie counts) and I put in my own tube feed recommendation, if she continues to not eat.  Tube feeds are one of the things that interns fear most, but they really aren't that scary!  The doctor agreed with my recommendations and she was still at the hospital today! I felt amazing.  You have to realize how great MGH is for students.  In some hospitals, Dr's don't even consider what the RD says.

So, that was my amazing moment last Friday.  I have a huge presentation next week that I am trying to find time to prepare for.  We have 4 presentations during the entire course of this 1-year long internship.  And I'm about to do 2 of them this month.  Kind of freaked out, but at least, by some miracle, we get Columbus Day off, so I can have extra time to work on it (and sleep in!)

Also, I thought it would be nice to add some pictures on here.  This is a picture of the subway station where I get off to go the the hospital.   MGH is on the "Red Line." My commute takes about 45 minutes and involves 1 transfer (each way!):

Also, here is a picture of MGH...did I mention that MGH is not 1 building, rather a small city?  All of these buildings are part of the campus.  Crazy, I know.

Other more exciting things, we had a party for one of the interns birthday this weekend.  It was so great to see everyone out of the hospital.  Also, Justin, me, and my roommate went apple picking this weekend. Can I just say that the only way that I'm staying sane during this internship is by maintaining a normal life on the weekends?! It's so good to get out of Boston every now and again!

One more thing, I recently read a study that came out of NC Chapel Hill about snacking.  In the past 30 years, the average calories from snacks have increased from 345 cal/d to 547 cal/d.  Can you say 4th meal?? Do you know how much you are snacking!!?!

Week One and Week Two

Sorry I haven't posted since I've begun the internship (a mere week ago today, eeekk!!). But honestly, you didn't really miss out, considering the first week was all about orientation.  Here is a brief synopsis of my first week: met all of the interns (everyone is awesome!), learned my rotation schedule, did a scavenger hunt in the hospital (awkward, but helpful), had talks from preceptors about what to expect in each rotation, went on a Boston Harbor Cruise with the interns from last year (got the dirt on everything), and finally, the week ended with everyone presenting a brief autobiography about themselves (nerve-wracking...who likes to talk about themselves in front of a huge group of people?)

My first rotation that I have been assigned to is Medicine and Surgery (AKA Med Surge).  This is often the most dreaded of all the rotations. It's during this rotation where I will be learning how to talk to assess patients -- looking at their charts, assessing their needs, talking with patients, making notes in charts, etc.  I will be at this rotation for the next 6 weeks. Today was my first day with my preceptor in Med Surge.  Her name is Ellen.  She is in her late 40s and just completed  her dietetic internship 2 years ago.  She is very motherly and very understanding that I don't know a lot. This is a very good thing!

I saw my first patient today and was overwhelmed with sadness.  She is 80 years old, and is the cutest, tiniest Asain woman I've ever seen. Unfortunately she has squamous cell carcinoma.  The cancer is malignant and for some reason, the woman is sure that her cancer has been cured. Her chart said that she is dealing with her cancer by being in a state of denial.  She has been living alone and hasn't been able to take care of herself for about 8 months, so you can only imagine how nutritionally deprived she is. We asked her if she drank her Ensure (a supplemental drink) this morning and she said she couldn't remember, even though the empty can sat right on her tray in front of her.  Also, when asking her about foods she tries to avoid, she said she avoids eggs because she wants to keep her cholesterol down.  Now please realize, a person who has lost a significant amount of weight due to muscle wasting and catabolic activity in the body shouldn't be too concerned about cholesterol intake, relatively speaking.  But she is so set in her ways and said that she didn't want to start developing high cholesterol now, so no eggs for her.

So what do we do for this type of patient?  We want to provide her with as much nourishment as possible. If she will drink supplements, we will give her those.  If she wants pickles (which she did, in fact, request) we will request that she gets some during her next meal.  It's all about providing her with nourishment to give her strength during the remainder of her life. 

I really don't want to leave this entry on such a somber note.  Everything else has been nothing but positive at MGH.  I really feel comfortable at the internship and I couldn't be happier that I am in Boston.  I have lots of projects and assignments that are waiting for me, so I better get back to it.  Thanks for reading!

Pre-Internship Assignments and Money

My summer is officially over!  Okay, so maybe I shouldn't be that dramatic, but I recently received my "pre-internship assignment."  I just printed off this 20-page assignment that stands between me and my internship.  Lots of it includes case studies where I'm supposed to come up with a diet for a person who has a specific condition (diabetes, renal failure, etc).  Some of it is a list of medications that I must provide the nutrient interactions for.  Some of it is a list of the 20-odd different diets that they serve at MGH.  Looking over it now makes me realize how absolutely terrible my memory is.  I graduated a mere 6 months ago, but some of this stuff looks Greek to me.  Oh well! I wouldn't have been accepted to this program if they didn't think I would come out successful...right???

Another issue I've been dealing with is money.  I'm about to take out my very first loan for this internship.  I'm pretty overwhelmed and can't say that I'm excited about it.  But, I like to think that this is an investment.  I've been looking for a part time job, but I honestly can't say that it would be a good idea for me to sign up for a job before I know exactly how demanding of my time this internship will be.  Most of the internship involves 8-hour days, typically 9-5, Monday through Friday.

I just realized that I didn't explain what I actually do during the internship...oops, this might be pretty useful if you will be reading this blog!  The internship is broken down into rotations.  There are 12 interns, including myself, and we each do our rotations seperately, i.e. each intern will be working alone with a preceptor (an actual RD at MGH).  Here is the break down:

11 weeks: Inpatient Clinical & Acute Care Nutrition (working with RDs that look after patients in general medicine/surgery, pediatrics, etc)

7 weeks: Ambulatory Care & Community Nurtrition (counseling patients and learning about WIC)

12 weeks: Food Service System Management (ordering, running, and working in the hospital cafeteria)

1 week: School Foodservice (working with RDs in charge of developing menus for schools)

1 week: Research (learning how to use DEXA scanners, calorimeters, and different types of software)

3 weeks: Business Plan (proposing a business plan to be implemented at MGH)

6 weeks: Concentration Rotation (another 6 weeks in intern's choice of "Clinical" or "Managment")

6 weeks: Staff Relief (take over for an RD)

This is the general outline of the program.  I will randomly be assigned the order of rotations, so I could be doing Foodservice and then Clinical or vice versa.  We also have "Class Days" where we get to meet with other Boston-area interns and discuss all things nutrition.  Lastly, we do get a few holidays off, but very little compared to a regular school year, i.e. no "Winter Break."  Guess this is my first taste of the real world!

I will try my best to mention 1 tip/fact/topic that is interesting to me that you might find interesting too.  That way, hopefully you will get something out of reading this blog, if nothing exciting ever happens!  Did you know that you can determine your body frame size by the size of your wrist? I'm sure you've heard people say that they are "big-boned."  Well, measuring one's wrist can tell you whether you are small, medium, or large!  Here is the information (from NIH):

Body frame size is determined by a person's wrist circumference in relation to his height. For example, a man whose height is over 5' 5" and wrist is 6" would fall into the small-boned category.

Determining frame size: To determine the body frame size, measure the wrist with a tape measure and use the following chart to determine whether the person is small, medium, or large boned.

Women

• Height Under 5'2"
• Small = wrist size less than 5.5"
• Medium = wrist size 5.5" to 5.75"
• Large = wrist size over 5.75"
• Height 5'2" to 5' 5"
• Small = wrist size less than 6"
• Medium = wrist size 6" to 6.25"
• Large = wrist size over 6.25"
• Height over 5' 5"
• Small = wrist size less than 6.25"
• Medium = wrist size 6.25" to 6.5"
• Large = wrist size over 6.5"

Men

• Height over 5' 5"
• Small = wrist size 5.5" to 6.5"
• Medium = wrist size 6.5" to 7.5"
• Large = wrist size over 7.5"

Internship Approaching

So I initially started this blog to just write down my thoughts during college.  I didn't really keep up with that.  Then I decided that I would keep a blog during my summer study abroad to Mexico.  I wasn't really successful with blogging about that either.  I'm thinking/hoping that the 3rd time is the charm.

I am about to start an internship at one of best hospitals in the United States, and do I dare say, in the world.  Boston's Massachusetts General Hospital (MGH) is an overwhelmingly huge and prestigious hospital.  No, I'm not going to be a doctor.  At least, not this go around.  I will be studying there for the next 12 months (starting Sep 13th) to become a Registered Dietitian.  When I tell people this, I usually get the same series of questions that I will answer once more for you. Right here, right now:

1. What is the difference between a nutritionist and a Registered Dietitian (RD)?

This is one of the most frustrating questions.  Thanks to the media, many people consider nutritionists to be equivalent to RD's.  THIS IS NOT TRUE!  I will quote Wikipedia here: "In many countries only people who have specified educational credentials can call themselves "dietitians" — the title is legally protected. The term "nutritionist" is also widely used; however, the term nutritionist is not regulated as dietitian is and is not an accurate term to give to a dietitian. People may call themselves nutritionists without the educational and professional requirements of registered dietitians. A nutritionist is not a dietitian, as a dietitian is registered to a national board and accredited and a nutritionist is neither."  Thanks Wiki, I could not have said it better myself.  RD's deserve more credit, especially considering they are completing a certified Bachelor's program in Dietetics, followed by an unpaid internship that typically costs ~$5000.  Yes, I am paying to work for free.


2. Do you think I need to lose weight?


No. Yes. Maybe.  I cannot tell you because I'm not an RD.  Yet.  But even if I was, would you really want someone to answer that question? Obviously you are already feeling skeptical.


3. Do you eat healthy all the time?


No. I like milkshakes and cheeseburgers like everyone else.


4. How many calories are in ____?


I don't know.  I haven't memorized the caloric content of foods.  At least not yet.  I can give you a ballpark estimate.


These questions and answers may come off as negative/bitter/absurd, but don't get me wrong, I love all things nutrition.  I love how multi-faceted the career is... ranging from community health, clinical rotations, public policy, media, etc.  I love how I could teach my own father to lose weight by teaching him what I learned in school.  I love how everyone could use nutrition advice, no matter what their size, shape, or story.


I do not, however, love how expensive this internship costs!  I should be filling out loan applications rather than ranting and raving about my love for nutrition.  Do me a favor and eat a piece of fruit today.  Or tomorrow.  Make an effort.  The typical American diet is significantly lacking in fruit consumption. OJ with HFCS shouldn't be your only source of fruit!!