Officially official

So I'm very happy to be officially a full-time employed RD! Just wanted to send out some wishes to all of the newly started dietetic interns in all the programs around the United States. It will be a fun-filled, grueling year, but I've said it before and I've said it again...I can't imagine going into any position without having the experience.


Since my last post, I've been given the title of an "employee" at U of M Mott Children's Hospital. I've spent a lot of time covering the PCTU area (Pediatric Cardio Thoracic Unit) while the usual RD in that area works on some research. It's one of the most difficult and challenging areas but I know it's the area where I most welcome the experience, because it will only help me extend my knowledge. 


I've also spent a lot of time in an area that I didn't spend any time in during the internship - pediatric surgery. A lot of the kids in this area are from MVA's (motor vehicle accidents) and are in the hospital long-term. Another big population in this area are bowel surgeries for Hirschsprung's disease, diverticulitis, pancreatitis, etc. I really like this area, as I feel it somewhat relates to the PICU area and that it requires a lot of nutrition support. The dietitian in this area also helps with the pediatric surgery outpatient clinic.


For my position, if no one is gone, I am general help with the team, especially when the hospital census is so high. What's going to be cool in this position as well is that I may have the opportunity to be a preceptor! For example, if the person I'm supposed to cover that day is also scheduled with an intern - I'd be the one to take over. I find that so weird. I suppose I should get used to it though...


Anywho, in the meantime, I'm officially a resident of Ann Arbor and it's wonderful. I finally have my own space and I must say that it will never be taken for granted after spending a year living in other people's houses and basements. I can decorate if I want, leave my bed messy if I want, turn the music up as loud as I want, and go to bed when I want (with it being quiet). 


For any of those starting internships and weighing the option of commuting or moving to the area, they both have their pros and cons. While I did save a lot of money by commuting and living with family rent-free, I do feel as though I missed out on a lot of opportunities to become closer to other interns and experiencing the local atmosphere (especially that of Ann Arbor). But I underestimate the expenses of the extra time, money, car trouble, and not to mention gas. Remember in one of my first posts how I mentioned I'd spend ~$1500 for gas? HA. That definitely didn't happen. I'd say I spent twice that. But in the end, as far as my bank account, I came out ahead (just a lil, though). 


Making pros and cons lists have become my new favorite thing. Ha.

Change of life plans!

So...you know how the last post said that I'd be a traveling dietitian? Well, I lied (kinda)! 


Turns out that fate took it's course and I ended up being offered a permanent pediatric clinical dietitian position at Mott Children's Hospital! So this girl is setting up a few roots in Ann Arbor. I'm more than excited/stoked/relieved. After much thinking about which position I'd rather have, I had to put it into perspective. 


- I've been traveling from room to room, house to house ever since I left home after high school.
- Both positions are float positions (basically), but at Mott, it'll be purely pediatrics!
- I'll be able to get involved with projects and committees at Mott, make a name for myself.
- I'll be able to establish myself an address, a group of friends, and a room of my own.
- I'll be closer to home, and be able to make future plans, as I know I'll always have weekends off.


So, it took some thinking, but in the end, someone gave me a great piece of advice, she said: "I know neither position is your dream job, but which one will get you there faster?"


No. Brainer.




Oh, and not to mention, I passed my RD exam yesterday! So happy that it's over. Surprisingly a lot more difficult than I anticipated, but I passed and I'm all done, nonetheless. So now, with my free time, I'm doing a lot of reading, relaxing, and soaking in feeling of accomplishment...because I simply have no other place to be, and nothing else better to do.


Well, until I go back to work on Monday, anyway. 

Rewind and review.

Ok, ok, ok. I know, I know, I know. I haven't written on here for over a month and it's completely my fault!

But, the good news is that I successfully completed my internship, $4,500 in tuition and 1,560++ hours of free labor later. Our graduation ceremony was very nice and relaxing, my family really enjoyed it and it came and went so quickly, it seemed.

Following the graduation ceremony, I left for a family July 4th weekend party in which I went golfing and enjoyed the sunshine and lack of responsibilities, assignments, and places to be. Then, the following day was my birthday in which I turned 23! Jeez I'm getting old...hehe.

Then, the day after that, I started my new job as a temporary clinical dietitian at Mott Children's Hospital. Basically, in all reality, I'm doing exactly what I was doing during the internship, but now just getting paid. I'm covering RD's who go on vacation, take a day off, or who are on maternity leave. It's a nice variety and I've covered multiple positions including PICU, transplant, cystic fibrosis, among many others.

Needless to say that I'm still living in my extended family's basement. But, that will all soon change because...

I got a (permanent) big girl job!

This "Will Work For Free" blog must now be renamed. I got a position as a clinical resource dietitian for Sodexo. Basically, I'll be traveling all over the East/Midwest in Michigan, Ohio, Pennsylvania, West Virginia, New York, and many other states covering for RD's who go on long vacations, maternity leaves, or if someone suddenly leaves and they need someone to fill in before they hire a new person.

BUT - the cool part is, is that I can travel for as long as I'd like. The position is permanent and full-time within Sodexo, but when I'm ready and there's an opening in an area I like, I can apply, interview, and (hopefully!) secure a position in one particular hospital. Then, I no longer travel. It works out perfectly as I'm young, not too much holding me down, and I have wanted to travel for a while. Even better - I'll be getting paid to travel.

That adventure starts in late August. But for now, I'm still putting in my last two weeks at Mott Children's and studying for my RD exam. A few girls from the internship have taken it already and successfully passed, which makes me feel a little better. Of course, no matter what, I'll be freaking out the day of the exam.

So, hopefully all of those who were accepted to an internship are gearing up (or have already started?) for their internships. It was a really long, strenuous, stressful, but extremely rewarding year, and I can't imagine going straight into an entry-level position without doing an internship first. Good luck!

But, seeing as how I'll have a little extra time on my hands while I'm on the road, I've decided to keep blogging from my new position as I travel. Although the title of my blog will need to be changed...

Endless consults and what's next!

Today was a busy busy day. Every year, about this (exact) time, the medical school interns graduate. This means we get a new batch...and they are all so excited and anxious and ready to change the world of medicine. But, this means that I'm getting consults for some rather interesting things. Such as a patient vomited after a feeding, when in reality, after speaking with parents, it was normal spit-up. Or that a patient had decreased intake a day before being admitted to the hospital, when in fact they had meningitis.


After looking back at the internship, if I could offer any advice to future interns and/or students...is to not lose sight of the basics of nutrition. Like serious basics. I'll take it back to the beginning. We have a new dietetic technician (DT) at the hospital who is new, younger, and has a good nutrition background. The DT's at the hospital are the ones responsible for inputting the calorie count information, computing the total calories and protein consumed, then relaying that information to the proper RD.


I got a page regarding one my 5 year old patient who is admitted for a bone marrow transplant, saying that she ate 320 calories and 90g of protein. Before you think that it's weird for a 5 year old girl to consume 90g of protein (which is a) true, b) more protein than I consume), what's the first thing that's wrong with this picture. It's so easy that it's difficult to see...


4 calories per 1 g protein. The most nutrition math out there. 90g protein = 360 calories. Not to mention the patient had only consumed 4 rolls with butter, 3 Andes mints, a handful of Goldfish crackers, and a candy necklace. I know, I know. I might just be ranting here. But it's the basic knowledge, but when it becomes a deciding factor if a patient needs to be put on TPN (which brings a wide variety of risks and possible complications), it makes a big difference. 


Whew! Off my soapbox.




So what's next in store for me? Well, since I ranted a bit above, I suppose I'll just make an easy list:

• Graduate on Friday!
• Celebrate my birthday with family and friends on July 4 (yes, that's really my birthday!)
• Start my new job on Monday, where I am now, filling in for RD's who go on vacation
• Summer bucket list
• Skydive
• Run/train this summer for the Chicago Half-Marathon
• Buy a new wardrobe (I still wear clothes from middle school!)
• ...more to come later J

Well, here it comes...1 full day left! Yayyyy! 

Wait...2 days to go...what?

Finally...down to the final couple of days. I started this countdown on September 8, 2010, and it was a whopping 296 day countdown. I'd love to say that it flew by, but it really didn't. I felt each day, each rotation, each evaluation, each project. I'm incredibly ready to be done.


But, looking back, there's no way that I can imagine going straight into an entry-level position without the internship. The things that added on to what I learned in undergraduate work are astounding. Even though the last post was discouraging to me, I haven't cried since then (luckily...knock on wood). The fact that I had one of the most difficulty staff relief positions was initially daunting, but now that it's completed I can say that I was shoved into the pool, and I learned how to swim (well, tread water well, anyway). 


As far as my staff relief, I'm down to the last two days and hopefully my BMT patient load will go from 2 patients to 1. I'm really hoping that one of our patients will be able to go home while I'm still here. She's been in the hospital for over a month now, battling gastrointestinal graft versus host disease (GVHD). She has a horrible history of chronic diarrhea (over 3 liters a day), cramping, and not being able to eat anything. We have her back on a pretty bland diet of crackers, rice, plain chicken, plain cereal, lactose-free milk, etc. Hopefully she can keep up the good work and get home! Plus, she invited me to her graduation/celebration-of-being-out-of-the-hospital party...I felt honored.


The general service is booming as usual, but nothing insanely outlandish that would be worth putting in the blog. Mostly just kids with fevers, urinary tract infections, rash, monitoring, etc. The kids on that service just blaze in and out faster than I can keep track. There may be a few consults here and there for nutrition-related things, but more along the lines of kids being picky eaters and/or having food allergies. 


So what's next for me after Friday? You'll have to wait for the next post to find out - as for now, time for bed! 

First time tears

Well, I made it 98% way through my internship without crying at work, but yesterday was a rough day and I just broke down. Staff relief is the most beneficial, yet grueling and challenging rotations. Especially when I have such huge shoes to fill and I don’t have the extensive experience under my belt. As I’ve said, I’m doing my staff relief in the pediatric bone marrow transplant position. The lady who normally covers this position went on vacation, so she’s not even in house for questions, as the case usually is during staff relief. So I’m truly doing this by myself.

The usual BMT RD is an amazing woman who knows pretty much everything about BMT and TPN: the medications, interactions, new therapies, what to do when this or that happens, when to start something, when to stop, how to teach, where to be, who to contact, etc., etc. She’s been doing the position for 10-20 years. I’ve been doing this position for two weeks. The second I got to work yesterday the phone rang, and it was another BMT team member.

We’re trying to cycle a patient’s TPN down so she can go on day passes, and hopefully eventually go home. The problem was, was that she was going to get an ECP treatment yesterday, that caused a 4-hour break in the middle of her TPN. From what I was told from the woman covering me, is that on days of ECP treatment, just run it as a 24-hour cycle and then resume normal TPN cycles the next day. So there was some debate about what to do, as we can’t just “make up” lost time by running a TPN faster. If you do this, it makes the dextrose enter the bloodstream too quickly, which can cause high blood sugars, or even collapsed veins.

It wasn’t really an issue, as I stated that I’d work on the issue and find a way that we could make everything work. What made me upset is that the staff member then asked the person who is signing my notes, and eventually called the lady I’m covering, who’s on vacation in California. I just felt as though 1) I wasn’t being taken seriously, 2) I was making huge mistakes, 3) that now my preceptors/other RD’s think I have no idea what’s going on, and 4) that my recommendations weren’t being trusted.

And for the first time in my internship, 9 ¾ months through…I cried at work.

But…I got through the day, I found a TPN schedule that would work and wouldn’t be a setback. My preceptor backed up my recommendations, and I got a morale boost from the MD. They reassured me that I’m doing fine. Today went better, as luckily the patient has no upcoming ECP treatments.

And…that I only have 7 days left. YES.

BMT, head pus, and modified goeckermans, OH MY!

Ugh. I'm getting SO close to being done! Today went much better than last Monday, and even had more to do than last week. I had 3 clinic patients, 2 BMT patients, and a handful of general pediatric patients. 

That's what I like about this position. I have a few patients who I see on a regular, daily basis. But then, I have a handful of patients that are on the general service and are in for a multitude of reasons such as dehydration, feeding problems, moderate injuries, or monitoring. There was a couple crazy admits this weekend, though. 

Such as...one of the patients was jumping on a trampoline with a friend when his friends teeth went through the back of his head. He went to an outside hospital to get staples in his head to patch it up. Well, the wound got infected and he was sitting at a race track over the weekend and the wound burst open and started pussing and bleeding everywhere. SICK! Needless to say he's here getting a strong antibiotic course and making sure that his head heals correctly.

Then, another patient was admitted for an intense skin treatment called a "modified goeckerman therapy" for severe eczema. It's for people who have chronic eczema or psoriasis. It's a week-long hospital treatment that involves the little boy being put in a spacesuit looking contraption. It pumps the suit full of moisture and chemicals that relax and soothe the skin. It will hopefully be a long-term solution for the skin. But this little boy has it worse - he has multiple food allergies including milk, soy, peanuts, and beef. But, he also doesn't like fruits, vegetables, orange-colored foods, or odd-shaped foods. Unfortunately for him, there's not much that I can do, especially since he's not being admitted for anything nutrition-related. But, I'm trying to help the parents find a multivitamin that's red colored (because that's the only color multivitamin he'll eat), and especially one that doesn't contain any of his allergens.

Did I mention that it's only Monday?

10 days!

Staff Relief Update

So, now the second post about staff relief! Turns out that yesterday and today went much more smoothly than Monday. I wasn't getting constant pages and I'm getting the hang of what I need to do and when I need to do it. Now with the small amount of extra time I have at the end of the day, I look toward the next day and figure out what will need to be done, who I'm going to see in clinic (what I might do pending how they're doing), and maybe even start my reassessment notes. 


My two BMT patients are doing well. One of the patients has a rather stubborn mother when it comes to tracking intake and providing supplementation and those sorts, and yesterday I had my first experience with standing my ground. She wanted to decrease the cycle time of TPN, in which would cost her daughter much needed calories and protein. I stood firm on that she'd go home on what I wanted her to, and put up a good fight. I still lost, but I didn't back down to what she wanted to do. She still wouldn't give in to ordering supplements, though I suppose I should just take it one triumph at a time.


In this position, I also cover one of the general pediatric services. There's not too many crazy conditions in this position, just more of kids who may be coming from the PICU, in for simple infections, or monitoring after surgery. Tomorrow I'll write more about some of the side conditions these kids have, which are very interesting...


I can't believe my first of three weeks is already halfway done, and I've survived! Tomorrow all the interns are having our pictures taken so there is a picture of us on our graduation program, as well as our director hangs the picture in her office. On Friday I have my end-of-the-year evaluation with the internship director, along with returning all of the books she provided us. After that, it's time to start studying for the RD exam, which I hope to pass in August.


What is really nice at this point is not having 5,204,183 projects and papers to work on when I get home. It's nice to just relax and do something for myself at the end of the day. 


15 days!

Staff Relief

I'm so overly excited that this is my final stretch. 3 weeks of staff relief. I was placed in one of the most challenging positions - pediatric bone marrow transplant (BMT). 


Let's just say that today was incredibly overwhelming. Definitely do-able, but overwhelming. It's like being at a new job and you know what needs to be done, but it all seems to come flooding in on the first day. Rounds got started late, 2 big patients came into clinic, 4 inpatients (2 incredibly needy ones), plus the pager never seemed to stop. 


What is nice is that I have no more big projects or papers to write. Thank goodness!! That is one thing that I'm glad to have a break from. 


So my day is as such...get to work at 7:15-7:30am, chart and catch up on patient labs and medications until 9am, when rounds are (supposed) to start. Then, rounds last until around noon-ish. After that I have to order the TPN for the patients for the next day, altering them as needed. Then, I complete any new assessments or reassessments for patients on the general service (which my position also covers). If there are any patients coming into clinic, I have to escape rounds/visiting patients/charting to visit them. All the while altering TPN prescriptions, tube feeding orders, and encouraging everyone to eat. Not to mention the 9,387,104 pages that I get and attend to. I usually work right up until 4pm, when it's time to go home. 


The nice thing is, is that I get to come home and do whatever I want. So today I went for a nice walk, painted my nails, and read my book. Things definitely even themselves out. I'm sure I'll have more to write later when I get the hang of things and settle into a routine.


But until then...


17 days left! 

Project Healthy Schools

Yesterday I spent pretty much the entire day driving around Ypsilanti Public Schools. It was SO incredibly hot, but very worthwhile.


Project Healthy Schools (PHS) is a health and wellness initiative for local Ann Arbor and Ypsilanti schools, aiming to improve their overall outlook on healthy diet and exercise. Yesterday started off by visiting Ypsilanti Middle School, where we promoted asparagus. They had asparagus they had on the hot lunch line was baked with some salt and (lots) of pepper. It was pretty good! We also put the informational fliers that I made on the tables, as well as went around with samples for all students to try. It was really fun encouraging kids to try new foods. Some really liked it, some said it was ok, some hated it, and some wouldn't even look me in the eye. It was awesome being around kids and having them be interested in a new food, or at least being more aware of what it is.


After that, we went to a local high school to do a screening of a student. With PHS, there have been a handful of published studies on the program, and whether or not it makes a long term effect. This student had been exposed to PHS when he was in middle school and now MHealthy staff members are following him, every year completing a survey. The survey includes data such as height, weight, blood pressure, cholesterol, blood glucose, and a lifestyle questionnaire. They take his and thousands of other student's information and compare it to students who weren't involved in PHS, to see if it makes any difference.


After the high school, we stopped at an Ann Arbor elementary school to drop off informational booklets to a teacher who is getting more involved with the administrative side of PHS.


So, needless to say it was a very long day on that aspect. Not to mention it felt like 100 degrees outside.
So after PHS later in the evening, I attended a MHealthy Weight Management class for adults. The class I attended was all about rearranging self-talk from negative into positive, and how it can change the overall outcome. 


Today's weather is supposed to be even worse. But luckily I'm not doing much traveling and will be spending the morning with one-on-one MHealthy counseling. More on that later...


22 days until graduation.
25 days until my birthday.
26 days until I start my new job! 

MHealthy

MHealthy is a health and wellness promotional program for U of M staff members. This program also encompasses Project Healthy Schools, a health initiative for local schools to improve physical activity and diet choices.


My day started off by going to a staff meeting where they discussed a big health fair they're going to be doing in September and October of this year. They're going to be doing cooking demos, having lots of health stations, and raffles and prizes. After the meeting, I met with one of the coordinators for Project Healthy Schools (PHS) in which she told me about what's going to happen tomorrow. I'm going to be going to a local area school to talk with them, promote, and give samples of asparagus! I also created a handout for tomorrow which gave fun facts and recipes for asparagus, and even a word search.


For the second half of the day, I went to a PHS site to figure out logistics of a field day that MHealthy is helping to put on. It was interesting to go to the schools and see the locations that MHealthy is working at and trying to help kids build healthy diet and lifestyle habits. 


Overall, I'm just ready to head back to the hospital. 


24 days.

Not so much.

I'm ready for this week to be over.


Yesterday I worked with another RD who does general nutrition counseling as well as works in the ALS clinic. This was definitely an interesting population with varying degrees of illness. We had some patients who you'd never know they had a degenerative disease that is eventually fatal, while others were no longer verbal, on ventilators, and completely dependent on others. The RD's role in this population is to make sure they don't lose weight, especially when their intake starts to decrease. This would happen because they lose motor neurons in their throat and lose the ability to coordinate a swallow. The patients, while they may be slightly overweight, are encouraged to have high calorie and protein intake. In doing so, it will preserve their muscle and prevent excessive weight loss.


Otherwise, today I was with the ketogenic diet RD. Again, we had no patients. It's definitely frustrating as I've just (literally) sat at the computer for 8 hours today and played around on a ketogenic diet calculator. Definitely frustrating. It doesn't help that I got my written case study back today and the RD who graded it was rather harsh. Guh. 


But, tomorrow I'm with the general nutrition counseling RD and it seems as though we have a wide variety of patients to see. One is an extremely obese pregnant woman and another is a man who has had bullet fragments in his abdomen for the past 10 years and is having some GI issues, which may or may not be related?


28 days. Please hurry up. 

Oh hey, heat.

Goodness gracious it's super hot outside.


And, it doesn't help that I don't have air conditioning in my car. 


But, it does help that I'm back at the hospital this week and they have air conditioning there. This week I'm in the Nutrition Counseling Center working with two different RD's in two different areas. One of them works mainly with initiating and following-up with kids who are on the ketogenic diet. The other RD works mainly with patients who have ALS, or amyotrophic lateral sclerosis. 


Today I worked with the RD who works with kids on the ketogenic diet. Unfortunately she pretty much has no patients this week which makes me kind of frustrated. So I'm just working with some of their nutrition programs and reading up on the ketogenic diet. If you don't remember, I also worked with a ketogenic patient my first week ever of the clinical rotation. So, luckily I've at least had some background experience with what goes on and what the diet is like. But...I'm afraid no patient interaction this week. Boo.


Tomorrow I'm working with the woman who has ALS patients. I've never worked with this patient population so I'm very excited. I'm hoping to at least have some experience with working with the patients this week, or be able to sit in on a counseling session.


Otherwise, it was SO NICE to have a three day weekend. It reminded me of the summers I used to have when I was in school. No more of those now, though! It's into the working world for me.


Speaking of working world, remember the job interview that I went on? Well, they contacted me for a second interview, but I actually turned it down. The job would be for a federal health program and making house calls to people who are using the program. While it would be a job, it's not what I want to do. I really enjoy the clinical realm and I believe that there is another job out there that will lead me to my professional goals. And anywho, I have my temporary position at U of M for the summer...yipee! It's crazy where the last 9 months have put me, I'm excited to see where the next month goes and then after that, the next 3.


30 days left...yayy!! 

Flooded.

Nope, not with homework tonight. With water. Our basement flooded. I'm taking a 2 minute break from pumping out the water.


More later.


GUH. 

What happens when you work in a hospital, you're super stressed, you don't get enough sleep, and probably 4,290 other factors? Ya get sick.


Yep, that's right folks, I have bronchitis. I seriously can't remember the last time I had a cough this nasty. Luckily (if there is such a thing), I'm in the outpatient realm right now and I'm able to keep my distance from patients. And, most patients that are coming in aren't at high risk. So, because I don't want to have to do any extra projects or come in for make up days...I'll deal. And, wear a mask if I have to.


I'm still at the Brighton Health Center and the High-Risk OB clinics this week. Today was just a lot of diet counseling for weight loss and such, but we did have an interesting patient...


A two year-old girl who was allergic to what seemed like everything. Wheat, dairy, soy, peanuts, and eggs. It doesn't help that she's two years-old and is already a picky eater. She only ever wanted to eat Craisins and bacon. Luckily her parents are very supportive and enjoy cooking and experimenting with food. Surprisingly the little girl was of adequate weight and height for age, despite her numerous major allergies. She was tons of fun and because my preceptor was mainly covering this patient, the little girl and I played the entire time. We colored, played with her toy camera, and she was bouncing all over the room. Not to mention I somehow got spit on and colored on. But...it's amazing to see kids in good health after working in the inpatient side for so long.


But otherwise, just working on the numerous community projects and papers, as well as the projects and papers that are due for each individual rotation. I seriously can't wait to be done, finally getting paid for what I love to do. Giving me the opportunity to finally move out of a basement and be on my own. 


38 days left. 

HROB and CCC

Yesterday, I was in the high-risk OB clinic or HROB. The first half of the day, from 8am to noon was spent in the gestational diabetes class. Which was actually pretty familiar from my two weeks spent in the diabetes education rotation. It was a much smaller class, of only three expectant mothers who were recently diagnosed with gestational diabetes. The class was extremely quiet, which made the first half of the class go by quickly. Because it got done quickly, there was about 30-45 minutes that there was nothing to do until the RD showed up (the RN taught the first half of the class). So it was suggested that I start going over a lot of the nutrition stuff...and I did! 


I started with teaching some general tips for gestational diabetes, ie: not skipping breakfast, incorporating fiber, keeping carbohydrates consistent, etc. After that, I moved on to reviewing the nutrition label (looking at serving size, carbohydrates, fiber), then reviewing a cheat sheet of carbohydrate content of common foods. It was my first experience of teaching a class completely alone. It was awesome how much more comfortable I was when someone wasn't watching me and...I guess even judging me. 


Then, today I spent the day in the Comprehensive Cancer Center, or CCC. Today was the symptom management clinic and we saw 6 patients. The idea behind the symptom management clinic is to help control symptoms of cancer treatment. These symptoms could be dry mouth, mouth sores, weight loss, muscle loss, taste changes, vomiting, nausea, diarrhea, constipation, among so many others. The role of the dietitian in this area is to help the patient find ways to manage the symptoms. The patients always have questions, especially from a lot of the "fad" things they hear about cancer treatment and nutrition, such as the idea that sugar feeds cancer...


Sugar DOES feed cancer. But sugar feeds ALL CELLS. Including cells that help fight the cancer. The body runs on sugar, it is the primary energy source. Even if someone ate a diet composed completely of protein and fat, the body would break down some of the protein and fat to make sugar, or glucose. 


A lot of patients already come in restricting themselves completely of sugar - from refined sugars, breads, fruits, and sometimes even milk. This is exactly what a dietitian doesn't want, only because a cancer patients diet is completely wide open - high calorie high protein. When a patient says that strawberries are the only thing that applies to them - we suggest that they cover it in heavy whipping cream, chocolate sauce, and ice cream, and blend it together. The higher calorie, the better. Times of cancer treatment are not times for weight loss.


But tomorrow and Friday will be spent in the Brighton Health Center! More to come about that later...


43 days...

Day off...wait...what?

A day off? Is this possible? Is this real life? Am I dreaming? NOPE! I got a call as soon as I was out the door to my new rotation - the Brighton Health Center and High-Risk OB clinic - and it was to tell me that my preceptor had cancelled all of her appointments for the day. Unfortunately she had a family emergency and wasn't going to be able to make it.


So...a day off for me! I decided to initiate my job search, which presents more challenges than I thought. First of all it takes a while to apply to just one position, I'd say about an hour. And that's just for an "insert resume here" type application. All of the online applications (which is 99.9% of them) require me to register with the website, then I have to alter/upload my resume and cover letter, then answer a variety of questions. It's seriously like the interview is taking place in just submitting a resume.


So needless to say at about 7am I was applying for positions. I got a call from an unknown number around 10am. It was one of the places I applied to, wanting an interview!! Talk about quick turnaround. I'm really not into missing hours of the internship for an interview, so I was unsure of when I'd be able to go. Well...convenient that I had the day off!? So, I went TODAY! I drove about an hour there and an hour back for the interview. I think it went well, but my lack of experience is working against me. It's an employers market as far as hiring, so that stinks. But I think the interview went well and I won't hear back for a few weeks. I'll fill everyone in as to what the position was/for when I find out either way.


BUT! Regardless, I have a temporary summer position at Mott Children's Hospital! Management decided to take a handful of interns to help cover the dietitians who are going on maternity leave and vacation over the summer. So, I'll at least have a position until Labor Day. 


But time to keep the productivity going and do some laundry! Happy job hunting, everyone.


45 days.

MDA and AHAHW

I don't think I have enough acronyms in my life (insert sarcasm). This week was actually a huge blur and went by so quickly. On Monday, Tuesday, and Wednesday, I had the usual diabetes education rotation, which nothing new really happened than the previous week. This is why I'm unsure if I'd truly like community work, because a lot of things are constant. The same patient population, with the same problems, needing the same advice, with small variations. Whereas in the hospital setting, there are so many different disease states in patients who's status could change so quickly. Yes, it is a little more stressful, but it's what I like and I like exercising my knowledge of science, math, and biochemistry on a daily basis. 

But then again, that was only one community rotation. Don't get me wrong, if I found a job in the community, specifically with kids, I'd totally go for it. I'm just not sure it's going to be in diabetes. For the next two weeks, I'll be working at the Brighton Health Center and in the High-Risk OB clinic. I'm sure this'll spice it up a bit! 

So on Thursday and Friday, all the interns and I, and many other dietitians from around the state attended the Michigan Dietetic Association Conference in (convenient) Ann Arbor! It was a nice little "vacation" from the usual routine and I learned a lot from many different speakers. There were speakers on nutrition support, Fuel Up to Play 60 UDIM program, licensing issues, dietary guideline controversies, etc. But on an odd note...I don't think I've ever eaten so much in my entire life. There was always food being served. We'd get there in the morning and there's bagels, eggs, turkey bacon, Chobani yogurt, white/chocolate milk, fruit, juice, (extremely strong) coffee. Then during (what seemed like) every speaker there were more yogurt snacks, sushi, or a parfait bar. Then, there was an exhibitor time when all the different food companies and medical supply companies came together and gave away free knick-knacks, food, and pamphlets. It was like being at the food show all over again!

But now it's finally the weekend. And you may ask why I'm up so early...because it's the American Heart Association Heart Walk in Ann Arbor! I'm team captain of the Food Fighters! There's four of us interns and 3 of my family members walking today, and we've raised over $500...we kicked butt. Now, if only the weather would cooperate...

47 days left!

Diabetes Education (again!)

That's right, folks. I'm in diabetes education for the second week in a row! I am with the same preceptor at the same place, but definitely not with the same patients. 


Today was a very interesting and informative day, nonetheless. I spent the first half of my day in the diabetes education class. Remember how I attended a diabetes education class last Monday? Well, the class is broken down into four, 2.5 hour classes. The first class is taught by an RD and revolves around what diabetes is, carbohydrate counting, how insulin affects blood sugars, etc. The second class, which I attended today, is about medications that are given to those who are pre-diabetic and diabetic, as well as symptoms and what to do about hyperglycemia and hypoglycemia. It was interesting and the dynamic of the patients/students is always fun!


Then I ate a (super) quick lunch and it was onto the next patient of the day, a woman who was starting her insulin pump. This is a HUGE day for a diabetic patient, as they will no longer have to inject themselves 1-4,203,957 times a day with insulin needles. It was an extremely informative session and the patient was so happy to now have an insulin pump. 


An insulin pump is a device that is worn by the patient 24 hours a day. It has a soft plastic needle that attaches to the persons abdomen (or any fatty tissue, really), and has a long tube that is attached to a device which clips onto their belt. The device is similar to the size of a small cell phone, even smaller than a deck of cards. This device holds the liquid insulin and when prompted, it injects insulin through the tube, through the needle, and into the patient! 


The afternoon ended with a general type 2 diabetes education to a patient who was only borderline type 2. More of just healthy diet and lifestyle changes that could help avoid a definite diagnosis. 


Overall, the day went so quickly! Hopefully tomorrow goes just as fast. Tomorrow is another day where I don't have to be there until noon, but I stay late to attend the type 1 diabetes class. Through the process of being there on Tuesdays, I've come to the conclusion that I'm definitely a morning person. Even though I don't have to be in until noon, I find myself waking up at 5:00am and having a workout in and being ready for work by 8:00am. And that's with taking my sweet time. Luckily it's the last time I'll have to do that! 


On an even better note, I'm an official published author! The research I worked on in undergrad has been published in the Journal of Drugs and Aging. I'm SOOOO excited! The link is below if anyone wants to check it out :)


Polypharmacy and Nutritional Status in Older Adults: A Cross-Sectional Study


52 days and counting...

Diabetes Education

...is exactly what I've been up to all week! I've spent all this week at Domino's Farms in Ann Arbor, where the diabetes education RD's have their own office...which even has an administrative assistant, crazy! 


But every day, there are about 3-5 patients who come in for outpatient counseling for control of their diabetes. A lot of the patients are interested in weight loss as well and they kind of go hand-in-hand. It's crazy about the wide variety of patients who come through on a daily basis. Some are completely compliant, get good exercise, have an adequate diet, and control of their diabetes. Then, on the other hand, there are patients who are completely non-compliant, don't count their carbohydrates or even attempt to regulate their diet, and they wonder why they haven't been able to lose weight or have blood glucose values all over the place.


I'm definitely learning a lot, though. Especially for this being my real first look and chance to get experience with counseling. Today I was in the "hot seat" and took the lead on a patient, but my preceptor was in with me as well. There were a few times where I came to a stand-still and didn't know what to say next, but my preceptor picked up on this and filled in right away. Although I felt like I failed completely, she said that I did well for my first time counseling and that it just takes a lot of practice. She reassured me that she had to work at it for a while and became more comfortable over time. Because she's been counseling diabetic patients for a while now, it seems as though she has a certain flow of questions that just seem to come naturally for this population. 


Practice, practice, practice. I'm gettin' there.


On another note, I'm exhausted. I can't believe that everyone is in their finals week and graduation is coming up, and I still have 2 months to go...


56 days to go. 

Into the community I go!

Needless to say I only had 1 post last week because it was spring break, and while incredibly relaxing, I didn't do anything too wild. Unless you want to consider going to the doctor, dentist, eye doctor, cleaning out my car, taking the dog for a walk, and sleeping in, a wild and crazy week.

But, it was good to rest up and have a fresh start in the community today. Today through next Wednesday I will be working in the Metabolism, Endocrinology, and Diabetes clinic observing and counseling outpatients who have type I, type II, and cystic fibrosis related diabetes. This morning I observed a type I diabetes education class. The class takes place in 4 sections, in which the RD is active in the first and last class. The first class covered what diabetes actually is, what foods affect blood sugars, and how to read food labels. The last class covers exercise and overall healthy lifestyle. 

After the morning class, which lasted from 9:30am-noon, we ate a quick lunch and then spent the afternoon with outpatient clients. There were 4 clients who each had one hour sessions, which covered reviewing the diet history and glucose levels, setting goals, and other information and education.

I think the community work is going to challenge me the most. Since I'm really into the science, number crunching, and biochemistry of nutrition, it's the total opposite of what I'm used to in counseling. I'm really looking forward to these next 6 weeks to work on my nutrition counseling skills. My preceptor for the first 1.5 weeks is really outgoing and open towards helping me learn, which I am going to take full advantage of. 

But I told my preceptor this today - about how working in outpatient community work has a whole different feel to it. Patients (for the most part) want to be there and are interested in how to lower their blood glucose levels and possibly lose some weight. They're interested, engaged in the conversation, and are proactive about what they want to do. Versus the inpatient side of things where diet education is lower on the list of priorities when it comes to intensive care unit survival. 

Anywho, I'm sure I'll have more to report later. But this girl doesn't have to be at work until noon tomorrow because I am going to be going to the type I diabetes night class. Yay! Still getting up early though so I can stay on my schedule. We'll see how that goes...

59 days...

Spring Break. YES!

So incredibly needed. A break. 7 days to do absolutely nothing and enjoy every second of it. Unlike undergrad, where you'd have to return from spring break ready to turn in a bunch of projects, papers, or exams the returning week...not in this internship. Friday marked the last day of my clinical rotation so now I have a nice, relaxing week to prepare for my community rotation, which will last 6 weeks. I'll  be spending time with diabetes education, MHealthy health promotion, general health care centers, high-risk OB clinics, the comprehensive cancer center, outpatient nutrition care counseling at the hospital, HomeMed, and the pediatric cardiology clinic.

So I remember that I said I'd update everyone on my elective PICU rotation patients. The burn patient was definitely one of my best learning experiences patients during the week. Just the dynamics of nutrition approach to burn patients was incredible. The patient was put on ECMO and was still on it on Friday, but they were going to be trialling her off of it. I'm not sure how it went and I won't be able to find out until I return next week. On a better note, my preceptor was out of the office on Friday so I covered the position all by myself! It was crazy. I actually wrote the TPN's myself (and had a quick last check from another RD, of course), but had no changes to them, which made me feel very confident in what I've learned this year! It's crazy how clinicals came and went so quickly! And especially how comfortable I am becoming with everything (writing TPNs, NCP notes, working with physicians, residents, and other medical students), but still learning so much every day. I'm really getting the hang of it and I feel like I could take an entry-level position at this point. Now, if I could only find one...

But anywho, I feel like I've accomplished a lot so far in my spring break as well! So far on break I've spent lots of time with friends and family, gotten my yearly doctors checkup, went to the dentist, ran on the track at my old high school (that was a weird feeling), scrapbooked, made dinner, gave myself a mani and pedi, and started a new book! Hopefully the rest of the week is just as productive and relaxing. Perfect.


66 days...

Whew.

I'd love to write more about what's been going on this week in my elective PICU rotation, but I'm simply too exhausted.

But, since I have a week off...I'll definitely fill everyone in next week. 

Whew. I'm pooped.

Elective Week!

This week is the last week of my clinical rotationnnn!! 

How crazy/awesome/scary is that!?

So, for my last week in clinical, I saved the best for last - my elective in the PICU. Now that I have successfully completed all of my rotations, I can easily say that this was/is my FAVORITE rotation. The diverse patient population in both disease-state and age of patients. 

Monday started off with a bang with a burn patient, which I haven't had experience with. Burn patients are such an interesting population in that their energy and protein requirements are one-of-a-kind, in that their SO high! It doesn't help that the burn patient that was admitted to the PICU is now also on ECMO, which is playing more with her nutritional requirements. Tomorrow she'll have an indirect calorimetry reading which will give us an exact look at how much energy she is burning. It also doesn't help that she might be put on CRRT, which will double her already sky-high protein requirements. This is the first patient that I may see exceed 4-5 grams of protein per kilogram! An average adult needs 0.8-1.0 grams per kilogram. 

Another interesting patient that we have right now is a little girl who has a mystery metabolic/genetic disorder that's directly related to nutrition somehow. We aren't sure if it's a glycogen disease, fat metabolism disorder, or something else crazy. This makes it really interesting for providing nutrition care because we aren't sure what type, if any, of formula we should provide and if we provide her needs from TPN, if we should include fat! I'll definitely keep you updated on that.

But what's better than being in the PICU!? Not a lot comes close, but I must say that my spring break next week gives the PICU some good competition. Unfortunately I won't be going on a trip anymore for various reasons, but I have lots of fun stuff planned which includes mounds of relaxation.

How many days until spring break? 3 full days.
How many days until this internship is done? 73

Ehh not my favorite.

As it says, this week hasn't been my favorite. Don't get me wrong, I want to be a manager one day and make my way up the professional ladder, but that's not where I want to be this point in my life. I miss the patient interaction. I miss the challenge of writing TPNs. I miss the NCP notes. I miss the little tykes in general. 

But nonetheless, it's been a great experience and I've learned a lot about project creation, especially that of policies and procedures. It's been refreshing to be in a group with other interns again, too. We created five great policies and procedures for the new Milk Room in the new children's hospital. They range from consent forms, eligibility requirements, labeling, medication/supplement documentation, and discharge of unused breast milk. I don't think I've ever typed "breast milk" so much in my life.

Turns out this upcoming week is going to make me earn my spring break. It will be another round of the PICU (my elective!) and trying to finish up my written case study. I feel like an expert on necrotizing enterocolitis now. 

78 days left...

Clinical Nutrition Management

Otherwise known as CNM. In this rotation, I am acting as a "manager" and practicing the act of hiring, looking at resumes, and creating policies and procedures.

For this rotation, I'm working with two other interns, which is nice to finally be around other interns my age. Don't get me wrong, I like all the preceptors and everything, but it's nice to be around other people who can relate to what I'm going through. We're all getting worn down, restless, poor, and eager for what's going to happen to us after the internship. 

For our CNM project, we'll be creating five policies and procedures for the Milk Room that will be in the new C&W Mott Children's Hospital that's opening in November. A Milk Room is a room that is controlled by dietary staff, ensuring that a mother's expressed breastmilk is properly handled, stored, and fortified (if needed). So, as interns, our project is to create a handful of the policies and procedures related to drop-off, delivery, storage, handling, and discharging the breastmilk. 

This week we also have a handful of other small assignments including a resume review, NCP chart audits, among other things. I can't believe that next week is my last week in the entire clinical rotation. Then it's about a month of community work and then about a month of clinical professional staff experience. Then I'll be done, OMG!

What I'm most excited for at this point is that our spring break starts next Friday, FINALLY. Much needed. I'll be hanging out at home, sleeping in, and visiting friends, family, and my love ♥. 

81 days.

Losing ideas for blog titles.

So, after almost a year of writing in a blog (who knew?!), I'm running out of ideas. I usually try to make it something related to food, or my rotation, or the internship, or how tired I am, but alas, my mind is running dry.

Either that, or my brain is just in overdrive because of my written case study that I'm preparing on necrotizing enterocolitis. This paper is basically like the oral case study but on paper and much more in-depth. But I know I'll live. I'm actually learning boat-loads about the subject and happy to report that the actual patient the paper is based on is doing well and hopefully going home soon.

Like I mentioned before, I'm in my BMT rotation. I mentioned yesterday that I really like the interaction with patients, which is still very true today. I find that I really like this patient population but for some reason today I found myself becoming very emotional when I was rounding on one of our BMT patients. She's a high school-aged girl who has leukemia, which she's had a bone marrow transplant, chemotherapy, lost all her hair, feeling horrible, mouth sores, etc. I'm not sure why I became emotional...it's weird and has never happened to me before. I'm not sure if it's because she's (somewhat) closer to my age and we have a lot of similar interests. She has amazing support as well through family and her significant other, so I'm not sure if it's just the overwhelming sense of love and support in the room that gets me out of sorts. I mean, it's not like I start tearing up or anything, but it's nothing I've experienced. .Weird Maybe it's because I can somewhat relate because when I was in high school, an acquaintance of mine had cancer and I was never sure how to react. Then again at the time I wasn't sure what the cancer treatment was really like.

But all personal things aside, I'm learning a lot (as usual). I am getting more practice with TPN, as well as discharge information and ordering forms and HomeEd consultations. HomeEd is the company that comes in and helps a family learn how to administer home tube feedings. The new attending that is on rounds with the BMT team is very thorough so rounds take about 1.5 times as long as they did before. But he's brilliant and has tons more experience than I do, and he's very open to educating medical students, residents, and interns like myself so I'm not about to complain.

87 days left. Gettin' there...slowly but surely.   

Pediatric Bone Marrow Transplants!

So, my last "formal" clinical rotation (this week - yikes!), I'll be working with kids who've had bone marrow transplants. These kids have all sorts of cancer, and I'll even be seeing adults up to 35 years old. This is because there is an overflow from the main hospital.

Many of the patients I'll be seeing will be on TPN, so I'll get a lot of practice again this week. It will still be a challenge, especially since these kids weigh a lot more than the little preemie babies I was with for the past two weeks. So far I've worked with little preemie babies who are as small as 400g to elderly adults, and now it's going to be time to work with those inbetween. I feel like I'm really going to like it. 

One thing that I know I'm going to love about this patient population is the ability to interact with the kids. Now that I got some of that again today, I realize how much I've missed it over the past week. As "depressing" as it may seem to work with children who have cancer, it never seems that way. These kids have such high spirits and amazing attitudes! So I'll get patient interaction, more practice with TPN, formula feedings, diet education, and also, this rotation is only a week long...

But, I'm still restless. While I do love being in an internship and doing what I love, it's somewhat draining to be doing everything for free and having the stress of working 60+ hours a week at the hospital and endless homework, with no pay - and no ability to hold a side job. BUT like I've said many times, I'm forever grateful for the opportunity to even be in an internship...and even better...only have 3 more months to go!!

Which reminds me - congratulations to everyone who got placed yesterday! 

88 days!!

Almost there?

I hope so. Yesterday marked the three-months-left-to-go mark. The second half of my NICU rotation went well, as I was able to continue to follow my patients and watch them grow. I find that I really like that area, and it's a toss-up between the NICU and the PICU that are my favorite. All I know is that I love the intensive care units. The patient care, nutrition support, watching them grow, the math and science aspect, it's perfect! Definitely my niche. 

For the NICU rotation, there weren't as many various medical diagnoses. I'd say about 50% of the patients in the NICU are just patients who were born prematurely, and they need to stay there to mimic intrauterine growth with heat and enteral/parenteral feeding. There were a few genetic disorders, such as cerebral palsy and congenital heart defects. There was also good exposure to necrotizing enterocolitis, otherwise known as NEC. It's commonly seen in neonates and results from decreased blood flow to the intestines, basically causing death of intestinal tissue. These patients are on total parenteral nutrition. I actually followed two patients of these all by myself, so I had amazing practice with writing TPN. 

Next week will consist of a bone marrow transplant (BMT) rotation. I will be working with pediatric patients who have/had cancer and therefore bone marrow transplants. A lot of these patients are also on TPN, mainly because they are unable to consume the amount of calories they need. Their needs, both caloric and protein, are so high and a lot of times their gut is so worn and injured from radiation that they are unable to tolerate eating food or consuming formulas. I'm sure it'll be an interesting week!

After this upcoming week, I will only have my clinical nutrition management (CNM) week and my elective week. The CNM week will be working with the administrative part of the clinical nutrition aspect. I'll get practice with formula purchases, scheduling, and other administrative issues. I'm not really sure what to expect?

Anywho, I'm not sure how to respond to comments left on my blog, but just a couple notes about the U of M internship as far as schematics:

• I haven't had to work any weekends for the internship, but I might have to work 1 or 2 during my community rotation. But, if I work weekends, I'll get time off on a few weekdays.
• It's extremely tough (or so I've heard) to hold a side job during the internship. One of my fellow interns had a night job as a hostess and it became too much and she ended up leaving to dedicate full attention to the internship.
• Commuting is much more expensive than anticipated. But, still much cheaper than monthly rent payments.
• I've made about $100 from donating a small amount of time (and blood) as a "healthy participant" for U of M clinical studies.

But, that's it for now! If you have any questions about the internship, feel free to post a comment and I'll answer them in my next post :)