You're Pasteurizing What Now?

This week my rotation was at the Mother's Milk Bank of Iowa. The Milk Bank just celebrated its 10th birthday at the beginning of this month, and everyone who works there is super excited about it. It's an amazing experience, and not something that is "typical" in a dietetic internship, since there are only 12 milk banks in the U.S. I consider myself to be pretty lucky to be helping out there for even a few days.

Let me tell you guys a little bit about how the Milk Bank works. Milk is donated from mothers all across the state who are producing an excess of milk after their own babies are born. For some women, this means just producing a ton of milk, and sadly for others, it means that their baby died at birth, but they are still producing milk. We learned that one of the donors produces over 40 ounces per day! She feeds her own baby, and still donates GALLONS at pick up time. Bless her heart!!

Those who want to be donors must go through a screening process. There are three steps to the screen: verbal, written, and a blood test. The verbal and written screens are very similar to a screen you would take before donating blood. The potential donor can't take any medication, except for the occasional tylenol. Basically, these screens are to prevent any diseases from spreading from the milk to the baby. After she passes, she can drop off her donations at a location convenient for her. Pick ups occur at "depots" all around the state--from Sioux City all the way to the brand new one in Oscaloosa. There are 14 depots in total, and are spread out throughout the state. The only area that doesn't have a depot is the southwest part of the state, but it's in the works!

After the milk is donated, it is distributed to babies who need it most. These include preemies, kids in the NICU, babies that aren't tolerating formula, etc. Some insurance plans cover this treatment, since it really is like medicine for the little guys.

I will be the first to admit that I was (and still am) super duper excited about this rotation. I got to go with another intern (usually we have to go by ourselves) and it just so happens that this other intern is my workout buddy, my Packer game partner...we're pretty much inseparable during the week. The only we reason we separate is when she has to leave for the weekend to visit her boyfriend. So...having her here with me made it that much more awesome.

PLUS, we got really geeky about what we were doing, meaning that we took a zillion pictures of the process. I'll call these series of photographs, "Amy's Day at the Milk Bank".

Here's how the pasteurization process works:

First, you grab a bunch of donor milk from the freezer. It's best if you grab a variety of donors (at least 10 different ones!) so the milk has the antibodies, vitamins, minerals, etc. from different people. That's when the best nutrition happens!

All the milk is pooled into these Erlenmeyer flasks. Each flask should contain at least three different donors' milk. The pooling process ensures that each flask is combined into the others.

Milk is then poured into these little bottles. They are filled to exactly 100 ml because Human Milk Fortifier is added, and the "recipe" calls for 100 ml breast milk. The fortifier adds protein, carbohydrates, fat, vitamins, and minerals that might be missing from the breast milk for one reason or another.

Here is a picture of Amy pouring milk into the bottles...a process that can be difficult when the milk is still frozen!

Each bottle must be sealed once it is capped. This is achieved by radio frequency (with that cool little wand). I should mention that you do have to use your hands...Amy just wanted to show off her gloves.

After all the bottles are capped, they are put into a water bath for 30 minutes at 62.5 degrees C. They are cooled rapidly in ice for 20 minutes, and then placed back in the freezer. And viola! That's it! Isn't it neat!?

Time to Play Catch Up

Good morning, blog world. What a crazy few weeks it's been. I have been horrible at posting things, I know...I had really good intentions with updating this weekly. Anywho, we can play catch-up now!

Since I last wrote, I have been working in Patient Services.. I was there for four weeks total, and I honestly felt like it was a real job. I loved the preceptors I worked with, and even got to know a few of the staff. I did observations of many of the staff to see what their jobs were like: tray delivery, call center, menu passers, dishroom workers, and formula makers. Like I mentioned in the last post, UIHC operates its meals kind of like hotel room service. Patients call down, and their food is brought up to them. That's why the call center employees, tray delivery staff, and menu passers need to work well together.

It's an interesting perspective, being a dietetic intern. Since I didn't know the ins and outs and the "who's who" of the area, my preceptors thought it would be good for me to do reports on my observations, so they could get a feel for what is actually happening among the staff. The job of those working in Patient Services is extremely important, because they might be the only positive people the patients see all day. Think about it: everyone else that goes in the patient's room makes them do stuff they probably don't want to do if they're already sick. They get poked for blood draws, have to go through sometimes painful physical or emotional therapy, etc. Food is the best thing ever, compared to that! Therefore, Patient Services employees are trained to take their job seriously--to be positive, happy, and friendly.

Patient Services was an interesting way to learn about customer service. Because I've had the privilege of working at the Gap at the same time, I have learned a lot about how to treat people (outside of common courtesy, of course). At the Gap, we have cranky customers all the time. Many of my fellow workers, and myself included, get frustrated with people when they come in and brush us off and don't want to talk at all. It's always a gossip sesh after they leave, like, "Oh my gosh! Did you see that lady! What the heck?! She was so rude!"

But you know, what if that lady just found out that her daughter was diagnosed with cancer? Or that her husband has end stage renal disease? (I don't know why you would choose to go to the mall at that point, but you know what I mean.) Working in Patient Services gave me a whole different perspective. When delivering trays, the staff usually knows what floor they are going to, which often gives insight into what kind of patient might be there. Staff might see that they are delivering trays to the 8th floor, which is the Burn Unit. Tray delivery to the Mother/Baby floor often brings about a different attitude and environment than going to the burn unit, if you see what I mean. So you might understand why these patients may not be exactly thrilled to sit and chat about what's going on in their lives, more so than you might in another setting.

I thought that was a good lesson that should be taught at all levels of customer service. There's no telling what a person might be going through on a day to day basis. Just because they are at the mall, or getting their oil changed, or grocery shopping, it doesn't mean that everything is perfect in their lives. I'm not saying some people aren't just plain rude, but there is a great deal of people going through really tough stuff on a day to day basis. Life still happens, even though their world might feel like it should be on hold. Groceries still have to be purchased and day to day chores still have to occur, so they still have to get things done. Maybe that's something to think about the next time a "cranky" lady comes into your place of work!

Ok, I should probably go get ready for the day now...but I hope you guys enjoy your Tuesday! More updates to come!

P.S. Speaking of customer service, everyone who ever wants to work in a hospital should read this book:


It was an awesome way to learn more about hospital customer service and how important it is. I have a whole report about it if you want to learn more.

Engagement Party Bliss

These past few weeks have been crazy (and I promise an update on my internship is coming!), so I'm attempting to catch up here in the next few posts. Josh and I celebrated our engagement with our families this weekend. Because most of both our families live in the Milwaukee area, we decided to have it at Josh's dad's house. (Isn't it funny how things like that work out? All my life, I have been going to my aunt and uncle's house for Thanksgiving, and Josh's dad lives five minutes away. The stars decided to align only two years ago!)

We spent the day catching up with family we haven't seen in a while. We had about 40 people come over for the family portion, and then had friends over for a bonfire after. I finally got to hang out with Josh's best friends from high school. It's crazy to be at the point that you're practically married to someone and not even know their best friends yet! A bunch of my friends who live in the area were also able to come, and it was wonderful to be able for everyone to meet each other.

Here are some pre-engagement pictures for you to look at while we procrastinate booking our photographer :)

Schmidt Kids

My family (except my Dad, who is missing for some reason..)

Grandpa Schmidt (aka Schmidty, as he introduced himself to my mom) and Allie even posed for a picture! This grandpa cracks me up. The first time I met him, he asked me what my name was.

Me: Alex.
Grandpa: Alice?
Me: No, Alex.
Grandpa: Allie?
Me: No, A-lex. Like the boy name.
Grandpa: Alec, oohhh, okay.

At the time, I didn't have the heart to continue correcting him, so I figured it would work itself out. I thought wrong. When he got to the party, he handed Josh's mom a card addressed to "Josh and Alec". Luanne laughed and told him she would cross the "c" and make it into an "x" for him. He then walked over to me and said,

"I got somethin' to tell ya!"
Me: What? Did you forget my name again?
Grandpa: Nope, but I didn't know your name was Alex! All this time I thought it was Alec!

Oh good times, good times. Anyway, hope you enjoy the pictures. Like I said--internship updates are coming soon! I promise!

Two Hearts, One Love...Lisa and Keaton's Wedding

You guys, my best friend is MARRIED! I am so excited to share a few of the awesome photos from the evening, including our photo booth pictures, which are HIIIII-larious.

The bunny ears, the toy horse, the fro...so many wonderful props.

Single ladies? Not us!

Cheering for the new couple!

There are no words for this one...

Bridal party silly-ness (note, we were asked to do a "smiling one" for this picture...leave it to Mel and Ash to make it awesome...)

Doesn't get much better than that! I had so much fun...everything was beautiful and I'm pretty sure there wasn't a dry eye in the room when she walked down the aisle with her daddy. (If you haven't heard the song "Make Us One", you can listen to it here. Even listening to it now makes me tear up!)

Cheers to the bride and groom!

Patient Services: Week One

Week one of rotations is officially crossed off the list! I've learned so much this week: in classes, my rotations, and through others I've met along the way.

Monday and Wednesday are class days. Our first day was a total breeze. Our professor for two of our classes wasn't there, so we were handed our syllabi and scooted out the door. Easy enough! We also took a test on all the topics we've covered so far: enteral/parenteral nutrition, diabetes, the nutrition care process, and nutrition assessment. (It was really nice to have "pre-classes" before we got into the clinical rotations so that all the interns are on the same page as far as expectations from the hospital are.) Wednesday we had our first real day of classes. I'm taking two Nutrition Research classes, but from looking at the syllabus, I am pretty sure it's going to be very similar to Nutrition Counseling. And, I loved that class, so bring it on!

On Tuesday I was able to meet my preceptor, Ray. He is a native Spanish speaker, so when he gets really excited about something, you REALLY have to pay attention! (Our internship director always yells at him, apparently, "Ray! Spanglish! You're speaking Spanglish!")  Because he is the director of the A La Carte Patients Services area, he is a busy man. This rotation focuses mainly on the management aspect of dietetics, so my first projects were attending meetings, evaluating cycle menus, and reviewing food safety with supervisors.

Patient Services is somewhat unique in that the way patients receive trays is by means of a call center. Patients receive a menu and are then instructed to call down to order their trays. My favorite project is evaluating patient trays. I get to be a "secret shopper" and call down to the call center, order whatever I want off the menu, and fill out an evaluation of my experience. I rate the friendliness of the employee, food texture, temperature, quality, and if everything I ordered was on the tray. I have experienced both ends of the spectrum when I get the tray I ordered. The first day I did it, I was sent a ground chicken sandwich instead of a grilled chicken sandwich. Ground chicken is usually saved for people who have swallowing problems (i.e. dysphagia diet!). Needless to say, it wasn't the tastiest thing I've ever eaten. The next day though, I ordered a bean and cheese enchilada with fruit and cottage cheese---much better!

Another project I have been working on with another intern is recipe standardization. We chose a recipe (from Iowa Girl Eats, of course) and are turning it into a recipe that can be made in larger batches. Basically, what we do is make the recipe one time exactly how it says to on the recipe provided. As we go, we weigh out all ingredients on a food scale, and record them. The reason for this is to make the recipe CBORD-compatible. CBORD is a computer program that holds all the recipes at the hospital in a standardized format. From this program, it is really easy to switch to a recipe that serves 80, rather than 5. It also provides nutrition information for the recipes. Because hospitals are held to standards for the amount of fat, carbohydrate, sodium, etc., it is important that the recipe we make provides proper amounts of everything. If it doesn't we will have to make the recipe again and make it fit into the standards. After all this is taken into account, we make changes to the recipe according to how it tasted the first time. For example, the first time we made our recipe, there was an overabundance of cumin, and very few vegetables. The second time we made it, then, we tripled the amount of vegetables and cut the cumin amount by two thirds. This time, the food tasted SOOO much better! We still have more to work on (like putting the recipe and weights into CBORD), so we will continue with that tomorrow.

I was also really lucky to attend a number of meetings with my preceptor's boss, Doug. He invited me to go along with him to a meeting for "higher up" management (the CFO and COO of the hospital were there!). I sat between him and Laurie, my internship director, and they introduced me to a number of other people they collaborate with on a daily/weekly basis. The meeting was two hours long (so long, in fact, that part way through, Laurie turned to me and said, "This taking foreverrr...so...what's your new last name going to be when you get married?") and covered topics like patient satisfaction, employee awards, the release of the new menu for patient services, construction of the new Children's Hospital, the grand opening of Iowa River Landing (the new outpatient clinic), and where to park on Hawkeye game days (since the stadium is right across from the hospital). Interesting stuff. A lot of it went over my head, but it was still nice to be included and introduced to some hospital big wigs!

So far, working at UIHC has taught me to expect the unexpected. In school, a lot of topics were skimmed over because "you won't see patients with (insert complicated condition here) hardly ever". They forgot to add "...unless you are working at the largest teaching hospital in the state of Iowa"! That just means that I'm learning a TON. Slowly, but surely. I am absolutely loving my internship, and I would be happy to give any undergrads a tour ;)

Real or not real: One week closer to being an RD!

These past few weeks have been a whirlwind of exciting things happening. First and foremost, Josh and I got engaged!! Words cannot describe how happy and blessed I feel to spend the rest of my life with this guy...

Also, I started my dietetic internship at the University of Iowa Hospitals and Clinics. The other interns (I would say girls, but we are super lucky and have a BOY in our program!) are all so awesome and we're having a great time getting to know each other. Plus, it's nice to get nerdy about nutrition with people who are equally as nerdy about it! 

We spent the first week talking about nutrition support (tube feedings), diabetes, the nutrition care process, diet histories, and writing chart notes. Most was a review, but I finally learned how to calculate tube feeding regimens! I spent the entire last semester stressed and angry (and not doing well on tests) because I could not get the hang of it, and in one day it's totally clear. So my advice to other dietetics students in the same position as me last year is--don't worry! You will have someone teach you in your internship! :)

This week begins real classes, tests, and rotations. I begin my rotations in the hospital in Patient Services. This is a management rotation, and I am actually pretty excited about it. I'll admit, I once dreaded all management rotations because I haven't really liked food service in my field experience. As long as I remember that I will be playing the role of dietitian, rather than a dishwasher or head cook, I will definitely be able to handle it! I will keep you updated on any interesting things I learn about.

Here is a video, totally unrelated to dietetics or being engaged. I just love the song. I heard it in church yesterday, and I forgot how powerful it is. One of those you-can't-help-but-raise-your-hands-'cause-God-is-so-awesome kind of songs :)

The Pros of Menu Planning (+Black Bean Burgers!)

As many of you know, I have a total OBSESSION with the blog Iowa Girl Eats. I use it often, especially when I'm planning a dinner menu for the week.

Menu planning is the best thing I have done for organization at our house since we moved in. I know it sounds tedious, but taking 30 minutes to make a menu for the week certainly beats out the ol' "What should we have for dinner?" question every single night. All I do is list all the days of the week and choose a recipe for each day. I do this at the same time I'm making my grocery list, so I am sure to remember everything I need. For example, tonight I'm making black bean burgers. I take out the recipe for them and see that I don't have panko bread crumbs, so that goes right on the list.

Easy, right?

It also helps to have the final list on the fridge. That way, I always know what to pull out of the freezer in the morning (or night before, if needed) before heading to work. Honestly, if you haven't tried it yet, you should really start menu planning!

Now on to the yummy stuff: black bean burgers!

I altered the original recipe a little, by omitting the chipotle pepper in abodo sauce, because we didn't have any and I thought it might be expensive to buy. The good news is, the burgers turned out just as delicious without it!

Ingredients (serves 4-6)

• 1-15oz can black beans, drained & rinsed
• 1/4 small white onion, roughly chopped
• 1/2 teaspoon cumin
• 3/4 cup corn kernels (canned, fresh, or thawed)
• 1/4 cup bottled chunky salsa, plus more for topping the burgers
• 3/4 cup panko bread crumbs
• 1 egg white (or 3 tbsp Egg Beaters All Whites)
• 1 avocado
• garlic powder
• salt & pepper
• 2-3 whole wheat tortillas, cut in half
• 4-6 slices provolone cheese

Instructions

• Combine half the black beans in a food processor with the white onion, garlic powder, cumin and salt. Pulse until nearly smooth, scraping the sides if needed. (Alternatively you could mash the black beans with a potato masher and mince the onion, combining with the other ingredients.) Remove mixture to a bowl then add remaining black beans, corn, salsa, panko bread crumbs, and egg white, then mix well with a spatula. Mixture will be wet.

• Heat a large flat-top skillet over medium heat then generously spray the skillet with non-stick spray. Shape the bean mixture into four patties then cook the patties for 5-6 minutes a side, or until firm and golden brown.

• Meanwhile, mash the avocado with garlic powder, salt & pepper in a small bowl. Place the cooked burgers on tortillas, then top with the mashed avocado, cheese, and extra salsa, if desired.

P.S. I have to show you guys what helped me do the cooking tonight. My Aunt Vicki sent Josh and me a housewarming gift--totally adorable, right!?