Good question. I’ve been up to a lot lately, including spiking a 101-degree fever while stuck in a secure parking lot and projectile vomiting into a trash can (tmi?), running back to my car soaking wet from the pool with earrings poking my heel because I forgot they were in my shoe in my hurry to get home to retrieve the bra and underwear I so idiotically forgot to pack with the rest of my post-6AM swim clothes and almost making it to work on time anyway except that I was the first person in line for the railroad crossing just about .05 miles from the hospital I was working at, and crisping up my shoulders because my little bit of biking followed by swimming followed by shower and change for Freret Street Festival turned into a “bike forever because it is so nice out, bike straight to Freret because friends are there, realize your shoulder skin is on fire 5 hours later”, then hurrying home to change and shower in time to counsel a client then realizing that my door (which doesn’t lock) is somehow locked (broken doorknob) and I am on the outside without clothes. OOPS.
Lots of potentially frustrating situations lately that I have found to be hilarious (except for the puking, but I got over that in ~14 hours and everything was great again) which means that I am definitely livin’ well. The ability to make not-so-great situations into little jokes with yourself is a skill that I try to hone whenever possible, and the past week gave me plenty of opportunities. Sure, I might be a poor unpaid intern with an insane schedule and a pain in the ass injury that has messed with some plans that were important to me, but really, life is pretty darn great.
I don’t feel like I am going to die anymore!!! I still suck (obviously) but the learning curve is so steep at the beginning that I feel like a champ. One of my friends said it well “Running is easy, you take a step and you go forward. With swimming, you take a stroke and you might go forward, backwards, or down. Sometimes it just doesn’t work out the way you want it to, but just stick with it!” I know I’m getting better, and seeing as I really couldn’t care less about being fast, life is good. I can feel my body changing with the new exercise and I like it a lot – feeling much stronger in the arms and core (not teaching HIIT classes three times a week, I’m not getting as much core work as I used to) and leaner all around. Pretty awesome!
Folks, I am happy to say that MY LEG FEELS AWESOME!!! Now, I have yet to run on it but I can jump, skip, and dance without pain, and this was not the case a few weeks ago. I am giving it another week and then starting up slowly with a couch-to-5k type run/walk progression that will build my mileage a tiny bit at a time over a lot longer than I took to get back into it from the last injury. I have promised myself not to sign up for any races until I’m running at least 30 MPW solidly without pain, and I want to try to keep swimming in the routine more often to get in the cardio without all the pounding. And vitamin D, I started taking my supplements again…why I always let that fall by the wayside even though I am an up and coming dietitian I will never know.
I have had two charting-heavy rotations as of late.
Long Term Care is just another way to say nursing home. My LTC rotation was a little bit different – instead of going to one place for the week I went to four different facilities and was able to see the way people do things at a few places. The main difference between LTC and inpatient clinical nutrition is that in LTC facilities, this is the day-to-day life of these people, so quality of life is a main concern. There is a push to liberalize diets (so take the cardiac patients off 2g sodium restrictions, etc) and control chronic diet-related diseases and conditions with drugs. When people are at the point that they need to be in one of these facilities, therapeutic diets are often more trouble than they’re worth. It’s a little bit disheartening, but totally understandable. We need to figure out a better way to reach people before they get to these places. So what does the dietitian do, if not to tell people not to eat the good stuff (joking, of course)? Every resident’s chart and labs are reviewed, mainly keeping an eye on weight, anemia, and bone health labs. Supplements and snacks are often recommended and a note is written and signed. The RD may also be in charge of writing the menus and ensuring that they comply with certain nutrient standards.
Inpatient Pediatrics and NICU up until this past week I had only done clinical nutrition with adults, but at Oschner, I worked with the peds dietitian for a week, who happened to be also covering the NICU. I’m glad she was, because there was far more work to be done in the NICU than in general pediatrics. Nutrition-wise, kids are totally different than adults, and infants are totally different than older kids. Because they are growing, their nutrient needs per kilogram are far greater than adults, and a deficiency in almost any vitamin or mineral can have much more significant effects. My favorite kid that I saw in peds was a 6 year old who was newly diagnosed with Crohn’s disease, so I went in and spoke with his mother about how to deal with the disease (he was chowin down on some watermelon and didn’t have much to say). It feels awesome when the information that you have to tell someone is so vitally important to the well-being of their child, they are eager to listen and learn more, and so thankful for everything you teach them. I really loved that. In the NICU, things are a little different. Most of these babies weigh less than 2kg (4.4 pounds), and are really sick. Almost all are on tube feedings and TPN (nutrients given intravenously) to help them gain weight. These kids need to be seen almost every day, their average weight change calculated, nutrient needs calculated, the exact amount of calories, grams of protein, and mL fluids that they are getting calculated, and the rates of their tube feedings or TPN adjusted accordingly. Nutrition is so essential in getting these kids better that the demand for the NICU dietitian is extremely high. It was a lot of math and charting, and though I know my role was extremely important in helping these kids, I don’t really like the NICU. I want patients who talk to me!!
I have decided to neither run the race nor go to Massachusetts. It’s just not in the cards right now, but I’m not too upset. I will be back, and it will be glorious.
Y’all, I have been having a blast. I think that the combination of the weather (laying outside on this 75 degree partially cloudy as I type this post) and the impending end of the internship, which may mean moving away, has got me appreciating this city and my friends a lot more than I had before. Here are some photo snippets of my life as of late: