Rating the Rotations: Reviewing my Dietetic Internship-Part 1

My internship is halfway done. Which areas of dietetics did I like the best?

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For those who know me, or have been following my blog, you know that I have been on my nine-month long internship through Idaho State University. So far, I am about halfway done with the internship, so the end is in sight, and getting that RD/RDN title after my name is sounding delicious. That said, I am going to review the rotations I was on for the first half of the internship, give some of my thoughts, and some of the lessons I learned that might differ from person to person. The order will be chronological, rather than based on my personal rating.

Food Service
Overall, I actually liked this rotation. I got to meet plenty of interesting people, and serve many patients their meals in the hospital. In many ways, it helped to slowly introduce me to interacting with patients, rather than outright forcing me to examine them for health outcomes, and figure out the best course of action.

The reason this one is rated so low, even though I enjoyed it, was I don’t see myself working in this kind of position, and if I do, not for very long. I got to oversee how things were run in an area that dietitians have some impact on, without doing a whole lot of dietetics work. I mostly did administrative tasks, like figuring out how to reduce food waste, or justifying to staff why certain equipment was a good choice to buy.

Ranking: 3rd/4

Long-Term Care
Oh boy, this rotation. This is one that definitely highlighted just how bad I am at writing notes within the Electronic Medical Record. I am improving, but for the two weeks I was here it was definitely a learning process. I also learned that I need to ask for help more than I was. I thought I was doing well, and was willing to figure things out on my own, but the preceptor said she wished I would have asked for more help so I could be quicker with everything.

I don’t like working with the main population we saw. I worked with the super advanced elderly that were unable to care for themselves. I felt like my role as a dietitian was just to ensure they were eating and drinking. This is not something I really want to do. I prefer working with a crowd that is willing and able to make changes to better their health.

Ranking: 4th/4

WIC
I want to start by saying WIC is a great program for improving the health of Americans. It gives citizens within certain income brackets some assistance with food if they are pregnant, nursing an infant (be it breast or bottle feeding), or have a toddler up to five years of age. Food packages include several foods that are high in protein, vitamins, and minerals.

I actually really liked this rotation. I thought it would be weird, me being some single guy with no children, but everyone was welcoming, even clients. I found writing notes got easier, and the feedback I got was more helpful here than the other rotations. I was able to do other activities within this rotation, like tour restaurants with Environmental Health, talk about the impacts of smoking and vaping on health through the ages, and write for an employee newsletter.

Overall Ranking: 1st/4

Wellness
This was an interesting rotation. I was able to work with a small group on health promotions, both within the hospital I am interning at, and outside of it. Followers might remember that I worked for another program called Food Hero back when I was in my undergrad. This was a similar program.

While here, I got to learn about another health program called the Complete Health Improvement Program, or CHIP. This is a program centered around improving ALL aspects of health, rather than just diet or exercise. It has been found to work really well.

I am rating this lower than WIC just because I already did something similar to it, so I didn’t necessarily learn a whole lot.

Overall Rating: 2nd/4

This is only about half of my rotations, so there will be another post come around May or June that will cover the other half. From there, I might even write a post covering the whole internship, what I thought about it, and recommendations I would have to any incoming Dietetic Interns.

Have any of you worked in a setting like the ones listed above? How was it for you? Are there any Dietetic Interns that would like to share how their rotations are going? If so, feel free to leave a comment (remember to not violate HIPPA! I don’t want any of you getting punished for my blog)!

The Nutrition Before Christmas

This is a basic thing I wrote, based on The Night Before Christmas, but based on my blog!

Twas the night before Christmas, when all through the house
Not a cook was cooking, not even in the bakehouse;
The cookies were placed on the mantle with care,
In hopes that St. Nicholas soon would be there;

The children were nestled, all snug in their beds,
While visions of soda pop danced in their heads;
And mamma in her PJ’s, and I in my bed,
Had just settled down, blankets up to my head,

When out on the lawn there arose such a clatter,
I sprang from the bed to see what was the matter.
Away to the window I flew like a flash,
Afraid the world outside was burning to ash.

The moon on the breast of the new-fallen snow
Gave the lustre of midday to objects below,
When, what to my wondering eyes should appear,
But a rock band playing, and fans drinking cheap beer,

With a little old DJ, so lively and quick,
I knew in a moment he must be a prick.
With words of encouragement, piercing the night,
This wack job was encouraging people to engage in a fight!

“Now, DASH’EM! now, MOSH’EM! now, PUNISH and SMASH!
Oh, COME ON! You’re STUPID! Go ROCK’EM and BLITZ’EM!
Let’s smash some heads together!  Let’s have a big brawl!
Now dash away! Clash away! Go kill ’em all!”

As dry leaves that before the wild hurricane fly,
The fans charged toward each other, willing to die,
Moshed in the middle, bellies full of cheap brew,
I closed up my window, unsure what to do.

And then,with some swearing, I heard on the roof
The stomping and pounding of a big goof.
As I drew in my hand, and was turning around,
Down the chimney some smart-ass punk came with a bound.

He was dressed all in black, from his head to his foot,
Like his clothes were all covered with ashes and soot;
A bundle of food he had flung on his back,
And he looked like a weirdo with a rather large snack.

His eyes — how they twinkled! his jaw line how hairy!
His manners were poor, his was quite scary!
His big fuckin’ mouth was drawn up like a bow,
Why his face had a grimace, I do not know;

Staring at the mantle, he gritted his teeth,
And pulled out a plate of greens, like a wreath;
He had a thin face and a love of rock,
He was straight and narrow, like a celery stalk.

He plugged in some tunes, and turned it all the way up
And poured some Oregon beer in his favorite cup
Blasting some Rammstein, he began to bob his head
I had no idea what this angry German man said;

He spoke not a word, but went straight to his work,
And filled the fridge with produce, he is not a jerk!
Just when we thought the fridge couldn’t fit any more,
He flipped me off, and walked out the front door.

He sprang to his car, and cranked up the radio
The engine sprung to life, and I didn’t know where he’d go,
But I heard him exclaim, as he drove like a winner,
HEALTHY CHRISTMAS TO ALL, AND TO ALL A GOOD DINNER!

Happy Thanksgiving: Ideas for a Healthier Holiday

We are less than a week away from Thanksgiving in America. What are some ways you can stay safe and healthy?

We are less than a week away from Thanksgiving in America.  This is the day that typically is celebrated by engorging yourself on a variety of food.  This can have a negative effect on your health.  It’s found that all the food eaten at once can spike your blood sugar, increase the amount of inflammation in your body, and can spike your blood pressure, increasing your risk of having a heart attack.  How can you celebrate the holidays without feeling like you’re missing out?

To start with, exercise can help.  Exercise changes the way your body processes the food you take in, and a variety of exercises (i.e. lifting, running, even just walking) can shift your metabolism from storing excess materials as fat, and instead storing them as energy for muscles.

Another bit of advice is slow down.  Not everything needs to be eaten in one sitting, or even day.  Spreading out what you eat over multiple meals can help manage blood sugar.  It gives your body a chance to process what you’ve already eaten, rather than having a whole days worth of calories dumped on it at once.

Another suggestion is to eat more fruits and vegetables. These are low-carb, high-fiber, high-nutrient items that can help fill you up and keep you from feeling like you are missing out on any food.  These can also be made into many fall staples, like acorn squash, sweet potato/yams, carrots, and even green beans.  Many common dishes can also be modified to be less energy dense.  Green bean casseroles can be made with less cream, and more green beans.

One thing, whether you are into healthy eating or not, is to prepare all food safely.  This can mean a variety of things.  Turkey should be cooked to an internal temperature of 165 degrees F to make sure any pathogen is dead.  However, in the rush to get everything done in time, you might have accidents with knives and other cooking equipment.  I’d rather my readers keep their fingers attached to their bodies, but that might just be me.  Another accident that can occur is when people deep-fry turkeys.  The dangers of using hot oil is it can catch fire, or burn you.  If you do decide to deep-fry your turkey, rather than roast it in the oven, be careful and follow the directions on how to do so safely.

One important thing to remember is to have fun, and be thankful for the day.  It’s not everyday that many people can have a good time like this.  As someone who is very much into cooking and food, this is one of my favorite holidays.  

What is your favorite dish to eat during Thanksgiving?  Feel free to leave your comments!

The Big 8 Food Allergens

Today I talk about food allergies, and the ones that most people have.

Continuing with my theme of food safety as I wrap up my first rotation as an intern, today I am talking about food allergens, and where to find them.

Food allergens are ingredients in food that trigger allergies.  Allergies (at least in terms of food) themselves are an over-reaction to something, usually a protein, in the food.  Symptoms can vary from person to person.  Less severe ones include hives and an odd taste in the mouth.  More severe symptoms include choking, changes in pulse, and a difficulty in breathing or swallowing.

So how can you determine if you have an allergy?  Usually, a doctor will do a skin prick test, or blood test to see if you have a reaction.  Other times, you are less fortunate, and eating the food is what tells you that you have an allergy.

You can treat minor allergies with topical skin cream and allergy medications.  Other times, avoidance is the best way to deal with allergies (especially if you are allergic to gluten, like in Celiac disease).  Other times, an epinephrine shot or hospital stay is the best treatment.

That said, I would like to go over what the Big 8 Allergies are, and where they’re found.  The Big 8 are responsible for 90% of allergies in the United States, and is required to be put on food labels, so they are a pretty big deal.

Wheat:  Wheat is that thing you can find pretty much every where.  It’s in bread, pasta, cereal, and most other grain products you can find.  The way you can avoid this is to read food labels if you are not sure if a product is wheat free.  It will also tell you if the food was made in places that handle wheat.

Soy:  Soy is found in a lot of meat substitutes, bean sprouts, and other types of products.  Again, reading the label is beneficial.  If you are planning on becoming vegetarian or vegan and have a soy allergy, I would suggest finding alternatives that do not use soy, such as seitan.  However, do not eat seitan if you have Celiac, since it is made from gluten, the same protein responsible for wheat allergies.

Fish:  This is that animal that swims in the water.  This is found usually in a whole or portioned out form.  Common ones include tuna, salmon, cod, and anything with fins and swims.  This one is somewhat easy to avoid:  just don’t eat fish.  Often, if you are unaware of the presence of an allergen, its because wherever you went had issues with cross contamination.

Shellfish:  Similar to fish, this one is also somewhat easy to avoid.  Just don’t eat things like shrimp, crab, or lobster.  Shellfish are sea creatures that have hard shells, called exoskeletons.  Again, often if this is in something you weren’t aware of in the food, it was due to cross contamination.  Be warned though, because there are chitin supplements available, and those might use shellfish shells.  Read labels to make sure its right for you.

Milk:  This is a sneaky one.  Milk can be avoided in whole foods, like fresh milk, cheese, or yogurt.  However, milk can be added to a variety of baked goods.  Again, reading labels can save you here because you can see if milk is added to something.  Also:  milk allergies are different from an intolerance.   An allergy is a response to the protein casein, which has symptoms like hives, swelling, and trouble breathing, and happens within moments of exposure.  An intolerance is a response to lactose, which is a sugar that might not be broken down in some people.  This is usually evident in about half an hour after consumption, and has symptoms like gas and diarrhea.

Eggs:  Again, this is another sneaky ingredient.  While eating a whole egg can trigger an allergy, this is also present in a variety of baked goods as well.  Eggs are also present in some vaccines, such as the flu shot.  The good news is that there are shots available for those older than 18, so you can get all the benefit from the vaccine without triggering an allergy.

Peanut:  This is a mix between sneaky and evident.  It’s in foods like peanut butter, snacks, and other products like that.  However, it can also be sneaky.  If you read the labels for the allergens (which you should do if you or someone you care about has an allergy), sometimes it will say something about being processed in a facility with peanuts.  This means that because of some equipment or environmental contamination, there might be some particles in the food.

Tree nuts:  This is similar to peanuts.  However, this is a broad set of nuts, which includes almonds, walnuts, cashews, and hazelnut/filberts.  These are in a variety of foods as well, including trail mix, candy, and sandwich spreads. This will often appear on a label as well, often it will say that the facility processed other allergens.

When you have an allergy, food can be scary.  Thanks to improved label design, knowledge about ingredients is more transparent between food service, manufacturing, and the consumers.  The take away message I want with this blog post is to empower consumers, and encourage you all to read the labels.

What is your experience with food allergies?  Any comments, questions, or discussion on this topic is welcome!

Sick of You: Norovirus

It’s almost the peak season of norovirus. Wondering how you can keep yourself and others safe?

Food service is not all fun and games, and dietetics is not all about telling people to eat  more fruits and vegetables.  A large part of dietetics is actually managing food service.  This takes place in hospitals, restaurants, and anywhere else food is served to people.  My first rotation for my dietetic internship is food service management in a hospital kitchen. I had to do a presentation on sanitation, which lead me down the rabbit hole of research showing food service professionals don’t know enough about food borne illness.  That said, I am going to (hopefully) start a series where I talk about different illnesses, and how to prevent them in your own kitchen.

If you couldn’t read the title, today I am discussing norovirus.  Chances are you have gotten norovirus.  It’s that bug that makes you puke your guts out, or shit your guts out, or both.  You probably call it something like “stomach flu,” or “gastroenteritis” or “fuckmepleaseendmysuffering.”  Fortunately, it only lasts a couple days before you are better.  The biggest concern is dehydration, which can definitely impact children under five, or the elderly.  Symptoms of this include faintness, rapid pulse, and exhaustion.

Norovirus can be spread easily, which is why it seems like when one person gets sick, everyone else follows suit.  It can be spread by having contact with poo particles and puke particles.  It can even become airborne if these particles float up in the air.

To prevent it from spreading, make sure to clean and sanitize food surfaces.  This means clearing the mess, and using some sort of chemical (like bleach) to kill the germs.  Cleaning the surface of the mess does not mean it’s free from germs.  Using sanitizer on an area without cleaning it means some germs can be trapped under the mess.

If you are sick, stay home from work.  Do this until two days have passed since you stopped having symptoms. Since norovirus is easy to spread, any fecal or vomit particles you might have on you will get into the air, potentially making others sick.  Hell, you might even reinfect yourself, and I highly doubt you want that.

Norovirus, being a virus, cannot be killed with an antibiotic.  Trying to use an antibiotic to stop it is problematic for a multitude of reasons.  One, you should take your whole prescription and not leaving pills behind because it ensures you won’t leave behind any of the bacteria you were infected with.  Reason two is that prescriptions like that get less potent, meaning they get less effective.  Reason three is that you kill the good bacteria in your gut, which can allow other germs to grow, or promote the growth of antibiotic resistant bacteria.  Which is bad.  You cannot get vaccinated against norovirus, because it mutates frequently, and there are multiple versions of it.  Think of norovirus like a cold in your intestines, as disgusting as that sounds.

My role right now in the hospital is to make sure that food safety protocols are followed, and directing the actions of some staff.  Norovirus outbreaks are bad in restaurants, and even worse in hospitals.  Restaurants can get shut down for outbreaks, just look at Chipotle when e coli got several people sick.  Hospitals also have to content with the fact that critically ill people are there, which can include young children and the elderly.  Exposure to other germs can get them very sick.

Norovirus is a shitty illness to get–literally.  Chances are though, it won’t kill you.  If you do get sick, take some time off, and drink plenty of fluids to prevent dehydration.

What did you all think about this post?  Is food borne illness something you want to learn more about in the future?  Any feedback will help me!

 

Weird Science: Can Lab-Grown Meat Be Considered Vegetarian/Vegan?

This is my first blog post while on my internship in Idaho! I am going to examine in vitro meat, and discuss with consumers if it’s something they are interested in, and if it can be considered vegan or vegetarian.

Hello from Pocatello, Idaho!  I am finally on my internship, meaning my route to becoming a Registered Dietitian is super close!

Anyway, in food, there are a lot of oddities that arise when science gets thrown in.  For example, the botanists told the food people that strawberries are NOT a berry, but bananas are (it has to do with where the seeds of each plant are located, and skin thickness).  One such example of something new is in vitro meat, or more commonly referred to as lab grown meat, or cultured meat.

Cultured meat is essentially meat cells are added to a solution, and that allows them to grow free of the animal.  This can reduce concerns about ethical treatment of animals, can reduce the carbon foot print of meat production, and can make meat much more affordable.  However, the invention of in vitro meat brings about other questions, such as can cultured meat be considered vegetarian/vegan, and how will consumers perceive it?

Lab-grown meat is made when muscle stem cells are added to a collagen “goo,” and allowed to grow with other regenerative solutions.  This essentially allows meat to be made without killing an animal.  However, it has not been perfected yet, and still lacks some components of what makes meat desirable, such as marbling.

My stance is that cultured meat is not going to be considered vegetarian or vegan for the large population.  While an animal is not directly involved in the process of making the meat, it is still made from animal cells.  For me, vegetarian is not eating meat, aside from animal products (such as eggs, cheese, and milk), whereas vegan is NO animal products whatsoever.  Lab-grown meat does not fit in with either of these definitions, as it is still made from animal muscle, even if it’s grown in a pitri dish.

As a fun thing I asked a few people I knew what their opinion on the topic was.  Sara Kerr, a fellow nutrition student, had this to say: “I would think by definition it may be able to be considered vegan, but I wouldn’t think all vegans would be interested in eating it since people choose to be vegan for a spectrum of reasons, be it moral, health, social, cultural, or economic. I could see there being some variation on vegetarianism that this would fall under, similar to lacto-ovo vegetarian. Maybe synth-meat vegetarians or a trendier moniker that rolls off the tongue a little nicer.”

Another person said “Yuck. I won’t eat it. I support sustainable and humane animal raising. How are we to know is this “meat” is animal, vegetable or even human. No Petri dish sirloin for me! Soylent green next?”  To answer the question, it has to do with where the stem cells come from, so for example, while plants can move, they do not have muscle.  There are standards for food in place that would prevent humans from being eaten… for now.  Someone else was in agreement with the previous statement saying ” I don’t think I could handle it. Gross!”

However, not all people are opposed to the idea.  One person said “ Lab grown meat sounds amazing,”  with another saying ” If they can make it work and make it affordable I’d be down. My only wonder is whether or not this meat would be all lean or if they could also grow marbled meats.”  Right now, it sounds like it’s only lean meats are being grown, but I would think marbling would be possible.

So what do you all think?  How does lab-grown meat sound to you?  Do you think it could be considered vegan or vegetarian?  Comment your opinions below!

I’d like to give special thanks to Sara Kerr.  You can find her website here, and her Instagram here.  Go ahead and check out her work, she has some fantastic photos and artwork.

Drink with the Living: How to Transform Your Water

Fast Facts and Opinions on different ways to drink water during the heat of summer.

Right now, Oregon is having a brief cool period before the heat comes back.  When it’s hot outside, people should be drinking more fluids.  To clarify, I mean things like water, and not beer.  While drinking a cold beer on a warm day is nice, it will not hydrate you as much as a glass of water.  Alcohol is a diuretic, which means you can lose more water (via pee) than you consume.  Not to mention there are several other negative health effects that alcohol has, but that’s not the main focus of today’s post.

What I am going to be talking about is ways to drink more water during the summer.  Now, my suggestions assume that you have access to safe and clean water, ingredients to add to the water, and any other things you might need, so this is not a one-size-fits-all kind of deal.

Plain water:  This is the classic version.  This kind of water has the benefit of being calorie free, sugar free, caffeine free, and mostly anything else that could possibly negatively impact your health.  However, this version is also highly subject to other conditions such as water additives, pipe conditions, if it’s stored in the fridge (any other fragrant foods, such as garlic, can impact the taste), or anything else that can make the water taste off.  You can try to use a water filter, but this can be costly, and can take up valuable refrigerator space when compared to drinking straight from the tap.

Bottled water is available, but can also take up space, depending on how many you buy at a time.  I personally just use tap water, let it run until it’s cold, then add ice.

Flavored water:  I count this as something different than infused water (which I will talk about below) or sodas.  These are waters that usually have flavoring agents added, be they natural or artificial.  I haven’t seen anything really for or against using flavored water in place of plain water.  Check the label of these water flavoring agents, as they might have salt (aka sodium), artificial sweeteners (there’s not been much conclusive evidence for or against these from my research), or any other additive that you as the consumer might be against.

Infused water:  This is a category of water that uses fresh or frozen fruits, vegetables, and/or herbs to flavor the water.  What’s nice about infused water is that it is very customize-able, and there are plenty of recipes out there, especially on Pinterest.  The issues are that this takes space and time in the refrigerator to allow the ingredients to infuse into the water.  Another possible setback is the quality of the product if you are unsure of how to prepare it, or are unsure of the proportions.  There is also food waste if you chose not to eat what you put into the water.

Coffee/Tea:  Wait, doesn’t caffeine dehydrate you?  Well, yes and no.  Yes, caffeine can cause several issues, such as anxiety and cardiovascular issues, and can be a diuretic.  However, when consumed normally, your body compensates for this, and it is not as affected.  My preference is to coffee black, and tea without cream and sugar.  This reduces the Calories down significantly, but can have an off-putting taste for some.

How do you beat the heat during the summer?  Do you drink anything special to help cool down?  Feel free to comment below.