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...