Tell Me What You Eat

DIETETIC INTERNSHIP: Weeks 31, 32 & 35 (of 41)

Foodservice Systems:  Weeks 31 - 32
Culinary : Week 35

Where do Registered Dietitian’s work?  As of Oct 2013, there are approximately 89,000 RDs in the US and abroad, the vast majority of which (~70%) are employed in a clinical field (healthcare in hospitals, long-term care facilities, etc).  The other main RD fields are foodservice systems, and school foodservice.  Research and community dietetics round out the list.  Unquestionably, the preponderance of public opinion associates RDs commonly with “food” only despite its low occupancy.


     As soon as I utter the words “Dietitian,” most people:
             a) pat their belly or hips, grumbling out regrets regarding dietary intake;
             b) recall what was consumed at the last several meals; and/or
             c) silently, yet assuredly, bring food and weight to mind.
     It has not taken long to recognize this repeating response. :( 

Breastmilk, fiber, and fried rice

DIETETIC INTERNSHIP: Week 30 (of 41)

Women, Infants, and Children (WIC):  Week 30

WIC = Women,Infants, and Children.  Yep, that is all I saw this week during my week at WIC.  WIC serves the financially underprivileged through a nutrition commodity program.  Directly, no money changes hands, only vouchers and education.  Registered Dietitians play essential party to this transaction as the nutrition expert for the pregant and post-partum woman, and the growing infant or child.

In the weeks leading up to this week’s rotation, I was slightly apprehensive.  My assigned WIC clinic was at one of the least desirable shopping malls in South Memphis, known for its crime and tumbling desirability.  Yes, there was Macy’s, Sears, and close to Graceland, but the area has fallen from grace, and several armed security guards roam the corridors.  Two local friends warned me to not stay in the area after dark.  During my lunch breaks, I frequently exercise-walked the thoroughfares and browsed the shopping selections.  I unearthed several bargains, but constantly looked over my shoulder.  During one lunchtime saunter, my security was infinitely unmitigated as I spied one security guard plugged into the wall, focusing intently on his charging cell phone.

Going Back to School

DIETETIC INTERNSHIP: Week 29 (of 41)

School Food Service:  Week 29 - Memphis City Schools

Who remembers what it is like to be less than 10 years old?  What about in high school?  How did you respond in ‘social interactions’?  What did you like to eat?  When did you like to eat?  How much?

What an interesting change of pace to transition from medical maladies to school food service this week!  For one week my mind reverted to sophomoric ideologies and preferences; it was tougher than I remembered!  One day I worked as a Lunch Lady at an elementary school (what fun!), and one day at a high school (a bit nerve-wracking!).  Going back to elementary school was so much fun!  Not only were the cafeteria workers friendly and welcoming, the kids were hysterical.  I walked around talking to them about their favorite foods, favorite snacks, encouraging each to try different foods on their trays… generally forming a personal Inquisitorial Committee.  Before leaving the cafeteria, several kids insisted on sharing their love with me, passing me through lots of hugs, and “I hope you come back!” salutations.  The high schoolers, on the other hand, were not nearly as lovely.  It did not take long for me to read through the words and body language of the kids, recalling the constant turbulence of emotions.  I left that afternoon SO thankful of my age and perspective.  (That was a first; I usually lie about my age! J)

The Old and The Restless

DIETETIC INTERNSHIP: Weeks 26, 27, & 28 (of 41)

Vacation!:  Week 26

Geriatrics & Palliative care: Weeks 27 & 28

These next two weeks were filled with the old, the very old, the young old, and the very sick.  I spent two weeks alternating between Geriatrics (>65 years old, often inpatient 4-6 weeks for rehabilitation) and Palliative Care (less than 6 months to live).  I was full of emotions before this rotation began, knowing my past may interfere with my present.  Daily, valetudinarians dominated my workload, and I wobbled between emotions.

My past includes my father, a Veteran, who passed away at home 8.5 years ago.  He peacefully and painfully died at home, aided by personal administration of palliative sedation.  Any time some of these words are spoken within my earshot (particularly “palliative”), or in regards to a young individual, (my father was 54 years old), my nose begins to tingle and flare, my eyes open widely, instinctively searching my surroundings, reflective of my minds speeding thoughts and connections.  This rotation not only posed professional challenges of a new patient population and goals, but also of managing my own reactions.

Sight, Smell, Texture, & Feeling

DIETETIC INTERNSHIP: Weeks 24 - 25 (of 41)

Spinal Cord Injury: Weeks 24 & 25

The Spinal Cord Injury (SCI) population is a very unique group that ranges from tetraplegia (formerly known as quadriplegia) to paraplegia, with various stages of injury severity (complete v. incomplete) and mobility.  For example, an incomplete tetraplegic patient may walk with a cane or walker, but a complete paraplegia may not be able to turn him/herself in the bed, nor sit up.  Much of this has to do with injury severity.

I spent two weeks working with inpatient and outpatient SCI patients.  VA SCI individuals are frequently inpatient for extremely long durations; I visited with patients that had been inpatient for over 6 months or more!  Many SCI patients are quite healthy in mind, but uncooperative in body.  The injuries that resulted in SCI are far ranging, from a 32 year old enlisted officer that went butt over teakettle while mountain biking, to an older man that fell out of the top bunk of his prison bed.  One can only imagine that compliance to medication, which includes nutrition, is just as varied.  With some near complete immobility, nutrition is the #1 form of medicine… or the #1 form of disease.  

I had a blog post published nationally under the VA!  Read the original here, or below:

Every Body, Every Day: How to Get Fit

May 9, 2013 by Jessie Furman

How many times in one week do we hear about exercising? Eating right? Losing weight? Keeping our heart healthy? Many have heard and understand that exercising is beneficial for health; however, there are often many questions about exactly how much exercises is needed, the benefits to activity, what qualifies as exercise.

What does it all mean?

If your doctor told you that doing one thing for approximately 30 minutes per day, 5 days per week would significantly reduce your risk of:

Early death, coronary heart disease, stroke, high blood pressure, type 2 diabetes, breast and colon cancer, falls, depression.

Would you consider incorporating it into your life? It would cause no harm, only benefits, including health and financial gains. Would you do it? By now it is no surprise that this 30-minute per day “thing” is Physical Activity!

Watch this video, it is worth every minute:

How much?

Some physical activity is better than none.  For major health benefits the CDC , the American College of Sports Medicine, the U.S. Dept of Health & Human Services, and the American Heart Association recommend that adults:

The Administrative Side

DIETETIC INTERNSHIP: Weeks 20 - 23 (of 41)

Management: Weeks 20 & 21
Professional Development: Week 22
Research: Week 23

The Registered Dietitian’s exam includes various managerial topics, from theory (Maslow, Herzberg) to application (human v. technical v. practical skills).  In a pair with fellow intern Nick, we spent two weeks working with two different managers:  the Chief (of Nutrition & Food Services), and the Clinical Manager.  The tasks ranged from disciplinary proceedings meetings to face-time-only-required meetings to rudimentary analysis of current Clinical Dietitian medical chart documentation.  Meh.  While many people at my age are ready to progress beyond the day-to-day operations in their respective career and move into management, my feelings are slightly ill timed.  I suppose because the dietetics fields is a career change for me, I am entirely interested in solely patient care at this time.  Or perhaps I just want to stay away from financial analysis any time soon!?!  Regardless of sentiment, I like healthcare!