Rough.

I'm ready for this week to be over. I'm just exhausted. 

This week has been full of running all over, going to meetings, leaving one meeting to go to another, finishing up case studies for the current week, starting readings and case studies for the next week, preparing for my literature review presentation on Monday, getting evaluations done...yatta yatta. 

I know I'm sure I say this every week, but I am really enjoying the rotation I'm in currently. It's a mixture of inpatient counseling for newly diagnosed diabetics, outpatient counseling for liver transplants, and also inpatient eating disorders. There's always something to do or a patient to check on, but it's never overwhelming. Every patient is seen and task gets completed by the end of the day, but there's no need to rush.


As for my oral case study subject that I'm keeping a close eye on, I'm just trying to get him to eat anything! Today I took him a tray of multiple supplements, hoping that at least one of them will spark some interest so he doesn't have to go home on a tube feeding. I took him Carnation Instant Breakfast, Mighty Shake, Boost Kids Essential 1.5, whole milk, 2% milk, soy milk, and vanilla pudding. There's got to be something in there that he likes! He's the complete opposite of many of the kids in the hospital, or even adults for that matter. We need him to eat! ANYTHING! I'm encouraging his mom to add butter and oil to foods for additional calories, to purchase high fat, high protein foods to get some meat on his little bones. But overall, this little boy is the cutest little kid ever and is so animated. Did I forget to mention I'm incredibly excited to be back in pediatrics?


But tomorrow should be a lot slower paced. Fortunately/unfortunately, my little buddy is hopefully going home tomorrow, but I'll miss him. Hopefully he just continues to eat so he continues to gain weight. I'm very excited that it's almost the weekend. I feel like this week has taken a chunk of my life out of me. Next week is going to be equally crazy. I'll be in pediatric cardiology, in which I have to be there at 6:30am! It's going to be a long week full of an incredible amount of TPN practice. Which may be challenging, but I'm going to have to learn the trick of the trade. So, bring it on! 


So. Tired.

Liver Transplant Clinic

...is where I spent the majority of my day today. The liver transplant clinic is for patients who wish to be on the transplant list, who are already on the transplant list, or who have undergone a liver transplant. And of course, they're all cute little kids! 

It's interesting how many of these kids have the same diagnosis (mainly biliary atresia, treated with Kasai procedure or liver transplant), but their cases are so completely different. Not only in terms of nutrition, but different cases when it comes to social work, psychology, diet, medications, overall lifestyle, etc. For example, one of our patients was very compliant, taking medications and had a great support system. His liver transplant will most likely give him no complications in the future and he'll lead an overall healthy life.

Then, there are patients who are extremely non-compliant, despite the fact they've had a liver transplant, or even had TWO liver transplants! Poor diet, lack of exercise, extreme weight gain, super-obese ranked BMI and non-compliance with medications. It's amazing, but...you can't help someone who doesn't want to change. That's one thing that I've realized since being in the internship. I have the extreme desire to want to help people change their lifestyle, but if they don't want to change...it doesn't really matter. What I say will most likely enter one ear and exit the other.


But, on a better note - the patient who I chose to do my oral case study on is doing well. He's SO incredibly and utterly adorable. He's eating more and trying more protein-rich foods. He likes to wave and blow kisses, and "roar" like a tiger. 


Did I mention I love this internship? 136 days...

Love...

Yep, it's good 'ol Valentine's Day. And I must say...mine was wonderful. 

Starting every new rotation as a dietetic intern is an interesting experience. Most of the time, I'm meeting my preceptor for the first time. Their note-writing format is unfamiliar, their patient base is unfamiliar, and the need to make a good first impression is key. Needless to say, my preceptor this week is amazing. She's very laid back but incredibly intelligent. Forgot to mention - I'm back in pediatrics, which makes this week even better. But, my preceptor is mainly in charge of patients who are newly diagnosed diabetics, liver transplants, and eating disorders. Today we only had 2 patients to go and see. One who was leaving today, and another, who I ended up choosing as my oral case study subject. 

The oral case study is a huge presentation that every intern has to complete solo. It's a 35-45 minute presentation covering a specific patient that we personally deal with and follow, covering bases of disease state, history, treatment, outcome, prognosis, etc. The patient I chose is under 5 years old, just received a liver transplant because of a rare genetic disease known as argininosuccinic aciduria. It's a disorder that leaves out an important component in one of the metabolic processes, causing an increase of ammonia in the blood. The high levels of ammonia in the blood causes developmental delays, sometimes even death if it's not caught early.

But besides my great first day of this rotation, I received beautiful flowers from my love. No better way to arrive back after a long day at the hospital.

The only thing that could ruin this day? My car. The fact that this car is 2,948 years old and it's been a crazy winter aren't helping the fact that my car needs to make it through 5 more months, at least. GRR. Anyone have a nice, smooth-running car they wanna donate to my cause? That would be wonderrrrfullllll...

PSYCH!

...is exactly where I worked a lot today. It's weird to think sometimes, while working at the hospital and being around all these foreign and crazy disease states, it makes me feel incredibly blessed to be "normal." Some of the states I've seen this week are:

Depression

Schizophrenia

Bipolar disorder

Eating disorders

Suicidal ideations

Panic disorders

PTSD

Phobias (today I saw aquaphobia - fear of water!)

Obsessive compulsive disorders

...and many, many more!

Now, most of the patients in this area are screens, but it's important to see if they have any intake issues while they're at the hospital. Again, it's just a whole different patient population.

Tomorrow is finally Friday.

Cardiac medicine = tons of education opportunities.

Which, is nice. Some patients are more receptive than others. I met with a really nice old man who took my education to heart and I could tell he had every intention to be proactive with his diet. But then again, I met with a woman in her 30's, with heart failure, who seemed to not care less.

This rotation has exposed me more to the ICU than any other rotation. Which is very rewarding if a patient improves and is able to move to more moderate care and then eventually go home, but it breaks my heart when during rounds the doctor basically told a family that their brother/son/father was brain dead. It really makes me appreciate everyone in my life and especially my health. It really makes me want to spread the word even more about the importance of a healthy diet and lifestyle.

As well, while all of dietetics is science based, cardiology seems to be more of a mystery in which you have to take clues and find rhymes and reasons for them. Take for example one of our patients, who had no previous medical history, but came in after a heart attack. She virtually eats nothing all day, but consumes 2 liters of regular pop and ice chips all day. She complains of hunger but doesn't like to eat much. She has a history of goiter and hypertension.

What types of things does this make me think of?
Pica - the urge to eat abnormal things such as dirt, clay, ice chips, etc. Usually due to an iron deficiency.
Diabetes - extreme thirst causes diabetes to help excrete excess glucose in the blood.
Goiter - iodine deficiency, lack of sodium in the diet (99% of table salt has iodine in it to prevent goiter).
Hypertension - basically too much fluid retention, which can be caused by high sodium intake, so we can't just supplement sodium to decrease changes of goiter.

SO...lots to look at. But these days, my days are super long and it seems like my brain is working 3,502,895x overtime. During the middle of one week, I have to start preparing for next week. Especially when this week's cardiology rotation came with a whopping SIX case studies and 4 pages worth of vocabulary/medical terms to look up/study/research.

I'm ready for the weekend.

142 days...

So I know I haven't written much since the "huge" snowstorm last week, but since many of the dietitians couldn't come to work, we had a lot of catching up to do on Thursday and Friday. But, I can't say there was much to note that I hadn't already. I did some bariatric diet educations and wrote notes, but I did come across a few interesting disease states. Search "Mullerian agenesis." Crazy.

But surprisingly, I really enjoyed GI surgery. I could definitely see myself working in this area. It just seems as though there is such amazing variety of patients and disease states. Not to mention, for those who undergo bariatric surgery and I have to do a follow-up diet education, those patients want to be there. They are so optimistic and excited to be receiving education. 

Anywho, this week is my last week with adults. I am in the area of adult cardiology. Today I had a great variety of patients, nothing too crazy or out-of-the-ordinary. I wrote two notes by myself, one on a patient who was in the ICU and on a ventilator. If a patient is on a ventilator, it completely changes what caloric predictive equation is used and there are many things that have to be taken into consideration, such as infection, fluid status, and medications. That's a big thing with this cardiac population is fluid levels. It seems as though, if I do educations, a lot of it will be on cardiac diets and low-sodium diets.

We did meet with a very cute elderly man who was very interested in our low sodium diet education. He had such good intentions to transform his lifestyle and while we were there he was making lists. This is the part I'm going to miss about being in adults, is talking to the patient directly and doing the educations with them versus the patients. But don't get me wrong, I'm super excited to get back to pediatrics. After this week, it will be kids here on out! YAY!

JK!

Just kidding! We definitely didn't get the massive amount of snow that they had predicted. Of course, we got lots of snow, but not the 13-24 inches they seemed to take a guess at. But it wouldn't have mattered either way, because as an intern (at least at U of M) there are no snow days. And instead of a regular day, all 12 interns were called in to be "emergency staff" in the food service area. Because of this, I stayed in Ann Arbor for the night at another intern's apartment.

What does this all mean? I was walking a mile to the hospital at 4:30am. Yep. In a blizzard.

But, it was nice to be back in the kitchen and to see all the staff again. I didn't end up doing much, just helping things get set up and waiting for regular staff to come in. I only ended up working in food service until about 7am, then I went back upstairs and resumed my regular clinical rotation.

Except for the fact that my preceptor wasn't able to get to work because of the crazy snow! So, I was kind of in the professional staff experience all over again where I had to get everything set up, decided who needed to be seen, for what, if it was urgent, etc. I got to see all but one patient, and that's because it was getting late and their assessment technically isn't due until tomorrow.

Sadly, I didn't have too many crazy patients today. I had a few diet educations on low fat diets and Dumping Syndrome. This syndrome is characterized by bad diarrhea almost immediately after eating a meal. Patients get this because of surgery they have on their stomach, which decreases the ability for a sphincter in your stomach to open and close properly. The patient I saw had a Whipple procedure, which is where the head of the pancreas is removed because of cancer.

Anywho, I'm extremely tired tonight. All I know is I am super tired. 145 days...