Retail

Well, it's a few more weeks down and that much closer to having a real job! These past few weeks have been spent in Retail Management. This rotation was a very eye-opening experience. Though my past experience in retail has been minimal, I learned a lot about how to manage people in a different way than I have ever been taught before. It's all about developing rapport and creating a sense of mutual respect within the work environment. I know what you're thinking... DUH. But I think we have all had a manager who...perhaps did not learn that. So let me tell you all about how these dietitians mastered the concept.

Each day, the dietitians (Beth and Levi) go to "do rounds" in each area they are in charge of, which includes four dining areas. They manage more than 50 employees, including students, part-timers, and full-time employees. They know everyone by name and seem to keep tabs on how they are all doing; not only at work, but in their social lives as well. Each morning during rounds, they make sure to check in with supervisors of each area to see how things are going.

From an outsider's perspective, it was cool to see how relaxed the employees were when Beth and Levi came around. I know of many places where I was employed that when "the boss" came around, everyone suddenly became all-star employees with perfect posture and big smiles. Their work areas are magically in ship-shape and all customers are treated like celebrities. Even to an outsider, it can seem staged and insincere. However, when Beth and Levi come around, everyone continues to go about their business and do the jobs they are supposed to do because--get this--they're already doing a good job. I think that's the difference between earning respect and demanding it. Levi and Beth are approachable, fun, and fair, which I think the employees really appreciate.

In addition to learning a new approach to management, I also learned about creating new menu items, marketing, procurement, and recipe standardization. The hospital just signed on to Lady Obama's Partnership for Healthier America (PHA), which will radically change the types of foods that can be served at the hospital. By 2015, 60% of the meals served/sold at the hospital must comply to a certain set of standards. This required an in-depth view of what is already being served in each of the dining areas, trying to figure out what we already had to work with, and how we could fix the rest. It was my favorite project to work on! We got a spreadsheet of the nutrition information for each entree and side that is served at the hospital. The important criteria include percent saturated fat, total calories, and mg of sodium. For over 300 items, Dagny (my partner in crime for the week) and I had to write "yes" or "no", indicating if each food item fit into these standards. The next step was to take a few items that were close to meeting the requirements, but not quite, and see what we could do to modify those recipes. For example, one of the pizzas we looked at had 666 mg sodium, when the requirement was that it had to fall below 600 mg. The percent from saturated fat and the total calories were fine. So, what could we do to decrease the sodium? By looking at the ingredients containing sodium (cheese, sauce, and crust) and using half the amount of each, we were able to bring the sodium down to 593 mg instead. Plus, even though the other criteria were OK, we ended up decreasing both calories and saturated fat as well! And guess what? IT WAS STILL YUMMY! Victory!

Isn't nutrition fun? 

Cruisin' Christmas

Instead of gifts this year, my "other" family took us all on a cruise for Christmas. I can't remember a time when I have actually felt warm on Christmas Day, let alone in a swimsuit on a beach!

It. Was. Awesome.

We boarded the Carnival Destiny on Christmas Eve and took a five-day cruise to Nassau (Bahamas) and Grand Turk. We were also supposed to stop in Half Moon Cay, an island open only to Carnival cruiseliners, but the water was too rough for us to get to shore. Total bummer.

That is probably the worst thing that happened though; if you could even call it a bad thing, considering we got to spend the day outside--reading and bronzing our skin. Not many people can say that for a day-after-Christmas event!

The rest of the time we spent stuffing our faces with the best food ever. We're talkin' all you can eat frozen yogurt, lobster, strawberry bisque, shrimp, sushi, pizza, fruit, a chocolate buffet--I'm shocked I didn't need to be rolled off the ship!

Between meals, we got to stop at beaches, take little Allie to the kiddie pool...

(which as you can see, she LOVED.)

...get all fancy for dinners...

Stare at the amazing views...

...and spend quality family time together!

Can you say yearly tradition?!  

A big thank you to John and Luanne Schmidt for making it happen! 

Finals Week

Please excuse my absence in the last...mmmm...month or so. Clearly, I could never be a blogger for a living! I just finished up my rotation through Neuroscience, which was a great experience. It helped build my confidence, again, to see different patients with a number of problems that could be helped with nutrition! Yay!

I am so stinkin busy studying for finals next week (grad school + internship = need for more wine ;) ) but I will update you with more information. Basically I wanted to stop by and let you all know that I'm still alive! My new rotation is through Family Practice/Internal Medicine. Most of these patients have some kind of liver/kidney issues, so I know I will learn SO much. I promise to fill you in!

Until then, enjoy these pictures from the Jingle Bell Run in Iowa City. A few of the interns got together to run 3.1 miles to fundraise for Arthritis awareness and research. Notice the festive attire!

Seriously? Who has one of these? Answer: Ryne. He actually has two. hahah

Back to Basic Math

I've been having so much fun in my rotation through the Nutrition Clinic that I haven't updated this baby in a few weeks now. I know I mentioned that I was in outpatient, which means we should be getting a variety of patients, but for the most part it has been diabetes. There have been a few with Celiac, IBS, fructose-intolerance, and bariatric surgeries, but overall they have been patients with diabetes. It's been amazing to see the changes that the patients are able to make simply by counting carbohydrates and swapping out some high-calorie options for lower ones. 

One patient that came in recently initially presented with a Hb A1c of 15-something, and in three months lowered it to 6.8. (HgA1C is a percentage that represents the average blood glucose level over a three month period. For diabetics, it is considered "controlled" when the Hb A1c is less than 7.0. For people without diabetes, the normal range for the hemoglobin A1c test is between 4% and 5.6%. Hemoglobin A1c levels between 5.7% and 6.4% indicate increased risk of diabetes.)  He said that he started exercising more, stopped drinking soda and coffee entirely, and started eating more fruits and vegetables. His fiancee came with him and said that Natalia has been the only one who took time to explain how to count carbohydrates in a way that was understandable to him. She thanked her repeatedly and complimented her style of teaching. 

With each patient that has come in after that (and believe me, they are not all success stories), I have been more tuned-in to how Natalia interacts with her patients. What I like most about Natalia's style of teaching is that she is able to adapt and change the way she explains things depending on how the patient reacts to her suggestions. No two counseling sessions have been the same, and as a result, I am learning how to interact with all types of patients. 

For example, we tell patients that for one carbohydrate exchange, it is 15 grams of carbohydrates. Then we design meal plans around how many exchanges or how many grams they will be allowed to have in a day. Some patients easily understand that and are able to use labels to know how many grams of carbohydrate are in the packaged foods they eat every day. Like on the box of the granola bar I just ate, it said there were 24 g of carbohydrate. Because that is closer to 30 g (2 exchanges) than 15 g (1 exchange), I would count it as 2. So if I was a patient told I could have 5 exchanges at breakfast, I would know that I should eat 3 more.

Other patients have a hard time grasping the connection between grams of carbohydrate and exchanges, so we just tell them, "At lunch, you can have 5 exchanges." Every patient is given a booklet that states the portion size of common foods, and each one counts as one exchange. For example:

1 exchange of carbohydrates = 17 grapes = 1/2 c oatmeal = 1 slice of toast

...and so on. Based on my weight, diet history, and physical activity level, I would likely be given 200 g carbohydrates in a day. Based on that number, let's say the dietitian told me I could eat 3 exchanges for breakfast. Therefore, I could eat 17 grapes (1 exchange), 1/2 c oatmeal (1 exchange), and 1 slice of toast (1 exchange). Or I could eat 17 grapes (1 exchange) and 2 slices of toast (2 exchanges) and not eat any oatmeal. In other words, I can divide up the exchanges however I want to, as long as for every breakfast I always have 3 exchanges...not 1 or 5. 

Clear as mud? Good! Consistency is key here. The more consistent the patient is when eating carbohydrates, the more likely they are to maintain control over their blood glucose...which is the main goal in the end! The biggest thing I can take away from this rotation is the importance of quick adaptations. All patients need things explained differently, so the worst thing I could do would be to go into the counseling session with the same attitude, the same "script", the same demonstrations, and hope that everyone understands things the same. 

Can you tell I L-O-V-E this rotation? I really, really hope I can find a job in outpatient. If anyone hears of any job openings, you know who to call :)

I'm in Love and I Don't Care Who Knows It!

What an amazing photo shoot we had with Hannah White (<--- click this link to see her pictures...amazing!!!) We got to frolic through fields, pose with huge rocks, hike through trails...everything I ever hoped for in an engagement picture session.

But first, can we talk about this sunset?! Couldn't have asked for a more beautiful evening to take pictures :)

How lucky am I to spend the rest of my life with this guy!?

Outpatient Nutrition Clinic

My rotation in the burn unit is complete, and I'm moving on to the outpatient world. Specifically, my rotation is through the Nutrition Clinic. I am working with a super friendly and fun dietitian named Natalia. Yesterday was only day one for me, so I don't have a ton of updates. So far I like outpatient WAY more than inpatient, though! It seems much more laid back and there are many more opportunities to use my motivational interviewing skills.

For those of you who are unfamiliar with motivational interviewing, it's a way to counsel people in a way that is conducive to behavior change. It helps people come up with their own solutions to problems they may be facing by setting their own goals which they believe they can accomplish. The counselor must ask questions that will enable the client to see that they need to change and, in addition, use reflective statements to confirm what the client has already stated. For example, I might ask something like, "What have you heard about diabetes?" This would show me what the client may already know, but at the same time may reveal some misconceptions they may have about the topic. If the client were to say, "Well, I know that when you have diabetes, you can't eat carbs, because they turn right into sugar and that's bad," I might respond with something like, "You're afraid that if you eat carbs, it might have some sort of negative effect on the treatment of your condition." The client might go on, or I could say, "This might sound different than what you have heard, but carbohydrates are an essential part of the diet, even for people with diabetes..." and so on. The whole process may take longer than me simply saying to the client "You need to balance your carbs into your diet by doing this, this, and this," but would that make the client feel good? Probably not.

If I've learned anything in my internship so far, it's that people just want to be heard and treated like...well...people. No matter how sick they are, they deserve to be treated the same as anyone else. That's why motivational interviewing is held in such high regard. It allows the client/patient to feel confident in what they already know, feel like they are being heard or understood, and also to motivate them to change without  overwhelming them with research, facts, figures, etc.

From the sounds of it, this week I will just be observing while Natalia does the counseling. She said we would also do some role playing so I could practice my counseling skills before I have to actually counsel her patients. Then the last two weeks, I get to be the main counselor, while she helps me out if I miss things. I'm pretty excited because nutrition counseling has always been an interest of mine. She said most of our patients have diabetes (type 1, type 2, or gestational), IBS, or Celiac disease. I have been doing a lot of reading on these topics, especially regarding the nutritional impact, and I have to say, I have learned a lot! I know I learn best by doing things, so I have confidence that I will continue to grow in this rotation.

Burn/Trauma Unit

While I'm making the transition into the clinical world of dietetics, I am learning so much about so many things. Wow. Vague. Let me explain.

I've officially completed two full days in the Burn/Trauma unit. This unit has been particularly difficult for me, emotionally, to rotate through. I know, it's only been two days, but it's been tough! First of all, the patients at UIHC, in general, are the sickest of the sick. Going into this rotation, I thought I might see somebody who burned their hand really badly on the stove. In my head, this person might be a busy mom, who forgot what she was doing and ouch! Better go get it looked at in the hospital. But I was very wrong. Right now there are patients there as young as 3 months old and as old as their upper 70s, with wounds caused by grease fires, scalding water, meth explosions, and bed sores. Their wounds are as small as 5.5% of their bodies all the way to 55%. I cannot imagine the amount of pain these people are in, and I always catch myself thinking that this could happen to anyone. 

But then I see this light among the darkness. The dietitian I am working with is the nicest, light-hearted person you'll meet. She is educated and has years of experience in the field. I feel lucky to study under her, especially because she actually knows the answers to all my million questions. When she talks to her patients, she is non-judgmental and caring, and speaks with words they can understand. I hope to gain traits like these when I am a dietitian as well. 

Like I mentioned, as an intern, I have a million questions. I also have this...fault...you might say, in that I expect to understand everything and retain it the first time I hear it. We were talking about a patient's protein needs at one point, and she mentioned that this person needed 1.2-2 g protein/kg. You see, in classes, they say things like, "You give them 1.2-2 g/kg and adjust when you need to." Which leads me to think, "What happens if you give them too much? What happens if you give them too little? Can they die if they get too much or too little? What classifies moderate stress vs. mild stress? How do you know how much to adjust it by? How can you tell if you're giving them too much?"...etc. So anyway, 1.2-2 g/kg is a HUGE range if you calculate that, so she ultimately decided to give this particular patient 1.5-1.7 g/kg. I asked her why she chose that, and she kind of laughed and said, "Because when you do this for as long as I have, you just sort of..know." 

So, rant for one second. I remember a specific time in college when I asked a similar question in class, and the professor responded, "Because I just know." And I wanted to ask, "Well how can I learn that?!" I was so mad, because how rude! I was doing my best to learn everything I could and she was so snobby about it! Like when you're a kid and you ask your mom if you can do something and she says "no". When you ask why, she says, "Because I said so." Hello! No lesson learned whatsoever. 

Ok, back to the story. Because of my previous experiences, my initial reaction was to blow her off. "Here we go again. I'll never learn this." But then, it hit me! By practicing more and more, I will eventually understand it. She "just knows it" because she has done the same thing every day for the past 10 years. I'm sure she's made mistakes and had to correct them so many times, so now, she knows what to do. 

I know, my epiphany is not one for books, but I feel some sense of security in the fact that I don't have to know everything yet. That's why I'm in an internship. If I knew everything, I would be makin' the big bucks, and be a world-renowned dietitian. But I don't yet. And that's ok. Especially since I have an awesome preceptor who will teach me :)

I promise I will try to keep y'all updated more often. (When I sat down to write this, I didn't think I would have anything to say. Ha!) Stay tuned for more about this unit! I'll be there for 5 more days!