BusyBusyBusy

I'm going to go ahead and state the obvious...my blog has been on the back burner. Between finishing projects for rotations, putting together my capstone portfolio, cleaning up my resume, and applying for jobs on the other side of the United States, I haven't really even thought about blogging. Graduation is right around the corner and I could not be more ready. Now the hard part...finding a job. Wish me luck! 

Over the past few weeks I have been all over the place. I completed two weeks in school foodservice, 1 week at the Northern Kentucky Health Department, and I am now at Meals on Wheels. Yes, at the beginning of the year I was there for a few weeks creating their cycle menu but now I get the opportunity to see the menu being implemented. Today was a little rough since I had to be there by 4am. Kudos to those who do that everyday, I'm not so sure I could do it. I worked the tray line putting together 1,300 meals and was first put on spaghetti duty but was then quickly demoted to scoping sauce. Let's just say I wasn't the fastest and I looked like Lucy and Ethel on the chocolate factory episode. Thankfully, the rest of the week does not require me to work the tray line. Only a few more rotations left so I'll do my best to keep everyone updated. 

Enjoy the chilly but beautifully sunny day!

Weight Management

The first week of the last quarter on my journey to be an RD has ended. I was at an amazing facility that dealt with surgical and nonsurgical weight loss. On Wednesday I was able to observe two weight loss surgeries, a bypass and lap band. Quick overview: bypass makes the stomach smaller and causes the food to bypass part of the intestine. Lap band does not require any cutting or stapeling of the stomach. An adjustable band is put around the top of stomach causing a restriction on the amount of food you are able to eat. Both of these surgeries also help you feel fuller faster and stay fuller longer.  


Everyone has their own opinions about weight loss surgeries and I'm not here to spark a debate but, it's truly remarkable the hundred's of ways there are to lose weight. I have now had the opportunity to see weight management in children and adults, both surgical and nonsurgical, and I have to say I love weight management for either population. I should have seen the signs earlier since 99% of my blog is about weight management. Unfortunately, that was my only week with them and next month I move on to schools, health departments, and meals on wheels. 


Tomorrow is the last day of National Nutrition Month. I hope everyone had the opportunity to get involved or get into eating healthy and exercising. Now...we begin the countdown for next year!

Portion Distortion

This post is inspired by an experience I had yesterday morning that I am still racking my brain about. It all started when Nolan and I were headed out to get our day started. We were hungry and decided to stop on our way out to get a breakfast sandwich and some coffee (I'll keep the name underwraps). We get there and I order a breakfast sandwich and a small iced coffee. I was then informed that if I order a medium (a size BIGGER than I wanted) it would be cheaper. I quickly said no thank you, I only want a small and then thought to myself...what the heck?! how on earth does that make sense? They just offered me something more for less money...I don't get it, and I still don't get it. My second thought was no wonder everyone in America is gaining weight. The concept of portion sizes is all wrong. I understand everyone is pinching pennies left and right, myself included but, when it comes to food/my health I don't settle. Here's an example: The small coffe I got was 120 calories the medium they offered me is 200 calories. doesn't seem like a huge difference is calories but heres where my thought process is going...


I am not a big coffee drinker but I imagine people out there that would choose the cheaper medium coffee over the small the 5 days a week they work. If this is the case that is an extra 1,000 calories a week, 4,000 calories a month, meaning you would gain a little over 1 pound a month because of this coffee (or about 12 pounds a year). You then spend money dieting etc. all because you  didn't want to spend the extra 20 cents (or whatever it was) just to buy the smaller size. It's a vicious cycle, I know. So next time someone offers you a bigger size for less, I know it may be tempting but think of the overall picture. The amount of food you eat and drink plays an important role in energy balance and choosing smaller portions can help you lose weight and keep it off.

Here are some ways to control portion sizes:


1. Downsize your dishes. I've said it once and I'll say it again. Use smaller plates and bowls. We tend to fill up the plates we use and then eat it all. When you use a smaller plate your brain will think you are getting more when the same amount of food is put on a smaller plate
2. Use visual cues. A tennis ball is about the size of a piece of medium fruit, a deck of cards is one serving of meat etc.
3. Split an entree with a friend. Most restaurants serve more than the amount of food one person needs to eat in a day. Share with a friend (and it will be less expensive!) or, ask for a doggie bag to save it for lunch the next day.
4. Don't mindless eat. If you eat in front of the TV, put the amount of food you want on a plate instead of eating out of the package. It's easy to overeat when your focused on something else.
5. Figure out how big your portions really are. Measure the amount your plates, bowls, glasses actually hold.
6. Measure out a fixed amount. Measure out a serving size (check the label!) to see what it looks like in your dishes. Also, make your own 100 calorie packs of your favorite snacks (again, check the label for calories per serving). 






check out www.choosemyplate.gov for more information on decreasing portion sizes and a daily food plan to help manage your daily intake. 

The End is Near(er)

This week was a big week. I ended my 7 week rotation at Children's (so sad to go!). This week was my obesity rotation and I have to say, I really loved it. As we all know, obesity is on the rise and is considered an epidemic in this country. According to the CDC, about 17% (12.5 million) children, ages 2-19, are obese and the prevalence rate since 1980 has tripled. More than 1/3 (35.7%) of U.S. adults are obese resulting in countless medical problems. 


I worked with a group they have called HealthWorks! that teaches overweight kids and teens how to eat healthy and exercise. I was also in the bariatric center for those who are either in the decision making process or in the treatment phases of bariatric surgery. On top of those, I spent a day in the lipid and hypertension clinic. During this rotation I did feel bad for some of these kids but, I was also so grateful that they were getting the help they need. The largest patient there this week was a CHILD with a BMI of 70 (morbidly obese). I got to sit in with each person on the team so I really got a good sense of who the patient was and what was going on in their life. This week I learned such a great lesson...you never know what someone is going through. The perspective I had of some of these patients during the nutrition interview was so different than when I went in with the social worker. Even though someone may put up a good front, they may really be struggling inside. But, thats what my job entails...helping people get healthy and love who they are.

Today I presented my big project for the year. My partner and I's topic was eating disorders and for our seminar we gave a presentation for the first hour and had a dietitian that works in eating disorders come and speak for the second hour. Man o man am I so happy to have that over with!! So, let's go through the check list for the year....Lunch and learn-check, case study during acute care-check, intern forum-check, case study during peds rotation-check, intern seminar-check. From here on out it's smooth sailing (I hope)! 


It's hard to believe that there are only 2 1/2 months until I complete my dietetic internship AND graduate. Two huge chapters are quickly coming to an end. For now, time to enjoy what's left and finally get some R&R during spring break in one week. 

Get Your Plate In Shape

The first day of March has arrived which can only mean one thing...It's national nutrition month! For those of you who don't know, national nutrition month (NNM) is a nutrition education and information campaign that was created by the Academy of Nutrition and Dietetics (AND). It  "focuses attention on the importance of making informed food choices and developing sound eating and physical activity habits." 


A drum roll please....the theme for this year is....get your plate in shape.

This is a great theme for this years NNM since the pyramid guidelines are no longer and it is now MyPlate. The new MyPlate guidelines and NNM encourage everyone to take a look at what your putting on your plate and focus on getting the recommend amount of portion sizes, fruits, vegetable, grains, protein, and dairy each day. A press release about NNM from AND stated "each year, National Nutrition Month provides us the opportunity to remind consumers of the basics of healthy eating. By focusing this year's theme on the new MyPlate, we can help people make the simple changes to their daily eating plans that will benefit them for a lifetime."


Take a look at whats really going on your plate and check out some suggestions below from the food and nutrition experts from AND on how to get your plate in shape. 

• Make half of your plate fruits and vegetables: Eat a variety of vegetables, especially dark-green, red and orange varieties. Add fresh, dried, frozen or canned fruits to meals and snacks.
• Make at least half your grains whole: Choose 100 percent whole-grain breads, cereals, crackers, pasta and brown rice. Check the ingredients list on food packages to find whole-grain foods.
• Switch to fat-free or low-fat milk: Fat-free and low-fat milk have the same amount of calcium and other essential nutrients as whole milk, but less fat and calories. For those who are lactose intolerant, try lactose-free milk or a calcium-fortified soy beverage.
• Vary your protein choices: Eat a variety of foods from the protein food group each week, such as seafood, nuts and beans, as well as lean meat, poultry and eggs. Keep meat and poultry portions small and lean. And be sure to choose seafood as the protein at least twice a week.
• Cut back on sodium and empty calories from solid fats and added sugars: Compare sodium in foods and choose those with lower numbers, and season your foods with herbs and spices instead of salt. Switch from solid fats to healthy oils like olive and canola oil. Replace sugary drinks with water and choose fruit for dessert.
• Enjoy your foods but eat less: Avoid oversized portions. Use a smaller plate, bowl and glass. Cook more often at home where you are in control of what’s in your food. When eating out, choose lower calorie menu options.
• Be physically active your way: Adults need at least 2 hours and 30 minutes of physical activity every week. Choose activities that you enjoy, and start by doing as much as you can.

There are tons of activities that happen during NNM so check out your local community to see what's going on. If your in the Cincinnati area, this weekend is the Nutrition Council Food on the Run 5k and 10k fitness run/walk downtown (I'll be starting off NNM by running in the 5k!) and for the first 4 friday's in March from 10am-12:30pm there are children's activities and display booths at the Museum Center. This Friday I'll be helping out and we will have the kids "complete their plate" and lead a movement activity.  



For more information, games, reading list, eduction resources etc. check out http://www.eatright.org/nnm

Cookies for Breakfast

I am a big advocate of eating breakfast, just ask anyone near and dear to me. Whether they want it or not, I'm always preaching how important it is to not skip meals and eat breakfast. The biggest complaint I hear is "I don't have enough time" which I can fully relate to. My day starts early and ends late (if I haven't fallen asleep by 10pm) and when my alarm goes off the next morning, I'd rather squeeze in any extra minutes I can than eat breakfast. This is where a new food product comes into play. This new product is Belvita, a breakfast biscuit or as they like to call it "a new kind of breakfast". They are like cookies, very convenient and portable as they come prepackaged. There are 4 biscuits in a package and they are packed with whole grains, B vitamins, and fiber. All 4 biscuits contains only 230 calories, 8 grams of fat, 35 grams of carbohydrates (18-20 of these are whole grain carbohydrates), and 4 grams of protein. Another added bonus: they contain NO high fructose corn syrup, no partially hydrogenated oils, and no artificial sweeteners. I have only tasted the golden oat (they also have blueberry and apple cinnamon), in fact I had them for breakfast this morning. The taste is comparable to graham crackers but sweeter and crunchier. I paired it with a glass of milk to give myself a little more protein because I knew I would be having a late lunch today. I was surprised to find I stayed full until about 1pm but I'm usually starving by 11am.  Other breakfast pairings with Belvita could be fresh fruit with greek yogurt, an apple, or a banana with the one (or two) cups of coffee we need in the morning. So, along with the new breakfast biscuits and other breakfast tips and tricks there are literally no more excuses. 

What's Your Poo Telling You?

Today marked the end of my 3rd week in peds and the end of my GI rotation. I spent all week talking about none other than poop, or to put it lightly 'output'. Most of the patients I saw had Crohn's disease or short gut syndrome. 


Here's a little bit about each of those: 
Crohn's- A form of inflammatory bowl disease that usually affects the intestines. People with Crohn's disease have chronic inflammation anywhere along the GI tract. With chronic inflammation you can imagine that it wouldn't be too fun to eat. So, we work with them on 'safe' foods, what their eating patterns should be, or if they are on enteral feeds we adjust their feeds to best fit their needs 
Short Gut- This name has a literal meaning...these kids have a short gut. This is because their intestines are not working correctly, usually exhibiting significant malabsorption and they have had some type of bowel resection to correct this problem. To get nutrition, these kids are usually on enteral nutrition and sometimes TPN. We work with their feeds to make sure they get the proper nutrition they need. 


To know if the kids are tolerating their feeds and their intestines are working correctly we had to focus on their output. How much, what did it look like, etc. that way we can make adjustments if needed. Sounds like fun, right? It's amazing how much your poop can tell you. Here are a couple of fun facts:


1. Poop should sink- Floating stools can indicate a high fat content, which can be the sign of malabsorption (your not absorbing enough fat and other nutrients from the food your eating). 
2. Shape matters- The perfect stool is an S shape. This shows that your getting enough fiber in your diet (fiber helps bulk up your stools and keep them together).
3.75% of your poop is water
4. The average human poops 2 pounds a day. 


So, the next time you hit the john check out what your poo is telling you. 

Pediatrics

I've been waiting for this day ever since I found out they accepted me into the pediatric rotation and the day came faster than I could anticipate. I am currently in my second week at one of the nationally ranked children's hospital where they house at least 50 dietitians and, I am more than thrilled to be given the opportunity to spend 7 weeks with them. However, coming from the adult world to the child world has been quite the leap. It's a whole new way of thinking and basically nothing I have been trying to perfect since August applies, but I am absolutely willing to redirect my thinking since I ultimately want to work with children. I have nothing crazy or interesting to report yet since I'm still trying to get my bearings down but I will keep posting as time goes on. 





This weeks rotation at Children's: transitional care unit, spinal cord clinic, and vent patients in the pulmonary clinic














Update on training for the 10k: I have to admit I've been slacking the past week or so. My motivation for the first 2 1/2 weeks was sky high and I couldn't believe that I lost 6 pounds that fast. My goal in this was not to lose weight but hey, it's an added bonus. Lately my knees have been starting to really ache and it's been deterring me from running. I'm thinking maybe I'll take some advil before I run to help this problem? If anyone has any advice on keeping my joints from aching please let me know! 

Fuel Up to Play 60

This weeks rotation involved Cincinnati Public Schools and a nation wide program called Fuel Up to Play 60. FUTP60 is an in-school nutrition and physical activity program to combat childhood obesity launched by the National Dairy Council and the NFL. FUTP60 helps to improve the opportunities for kids to consume nutrient-rich foods and get at least 60 minutes of physical activity every day. The ultimate goal is to ensure changes made at school are sustainable and complement an academics-focused environment.


The program is already widely successful by empowering kids to make healthy choices and giving rewards for their successes. They can track their progress, become a student ambassador, and have the opportunity to be part of a team. FUTP60 has 18 different supporters including the First Lady Michelle Obama's program Let's Move! which is helping to solve the epidemic of obesity within a generation. 


Each month the schools complete a challenge that is posted on schooltube which is like youtube but for schools. Last month the challenge was eating healthy and this month is a physical activity challenge. We went into different schools that are participating, filmed the kids doing their challenge and them talking about why they think it's important to fuel up with chocolate milk. They all gave impressive answers and it was really great to see the kids getting excited about physical activity and nutrition. 

You Can't Trust a Skinny Chef

The old saying goes you can't trust a skinny chef but, in my eyes they are the one's you want to trust. They know how to eat properly and stay healthy, something a lot of American's struggle with. Part of my job as an RD-to-be is keeping up with the latest health news. The top headline this week: Paula Deen confirms type 2 diabetes diagnosis. As a health professional I am saddened to hear another person is diagnosed with diabetes as this epidemic is booming. I would never wish diabetes on anyone but I think we could have all seen this one coming. Reading many articles and watching the clip of her on the ABC television show "The Chew" I quickly became quite angry over this situation. 


I have never been a huge fan of Paula Deen partially because each recipe she makes calls for a minimum of two sticks of butter and one cup of sugar. I felt bad for Paula Deen for about .2 seconds until this fact came to surface: she was diagnosed with diabetes THREE years ago. I can understand if she didn't want to share the news with the world three years ago but continuing to cook and encourage people to eat their way to getting diabetes really pushed my buttons. It's as if marketing herself and money was more important than the health and well being of people around the world. Last year Anthony Bourdain famously blasted Paula Deen calling her "most dangerous person to America". Sadly, I have to agree with his point of view. Now that she has confirmed her diabetes the comments continue on his twitter with "Thinking of getting into the leg-breaking business, so I can profitably sell crutches later" and "most dangerous person to America" who's "proud of the fact that her food is f------ bad for you." Yet again, I understand where he is coming from. 


On "The Chew" Paula Deen stated "this is not a death sentence" but unfortunately more often than not it is. Last quarter during my clinicals it was far too common to see diabetes on someones medical record as they sat in the hospital because of kidney failure or other complications caused by diabetes. Diabetes is not something to take lightly, nearly 26 million Americans have type 2 diabetes and approximately 79 million adults have prediabetes. If those numbers don't scare you, I don't know what will. Eating the food the Paula Deen proudly cooks can only contribute to this number and the numerous complications. Just to put it in perspective here is a small list of complications that can arise form uncontrolled diabetes: kidney disease, stroke, hypertension, foot complications, and eye complications. 


Deen also stated "she didn't expect people to eat her food 365 days a year". This may be true but when people find something they love they stick to it. She is already loved by so many and my hope for her coming forward is that she can now be an advocate for type 2 diabetes. She can show American's how modify recipes, keep their diabetes under control and turn their health around. 

It's All in the Shoe

As a new runner I didn't understand the importance of a good running shoe until yesterday. For the past two weeks I have been running about 15 miles a week starting out on the treadmill and then jumping to the track. Once I hit the ground my shins instantly began to sting and running those laps was a lot harder than I imagined. I chalked it up to being a newbie and pushed through the pain. I was already feeling defeated in my journey to run this 10K until I remembered something:

Here in town we have an amazing running store, Bob Ronker's Running Spot. I decided to head over there and see what they had to say. The verdict: My flat, flexible Nike Free Run's were the complete wrong shoe for my type of foot. Inherited by my mother are my small but cute, very high arched feet. Turns out that wearing flat shoes are not good for me and all the pressure goes onto my heels and arch. Apparently that is the reason my shins were hurting, all the pressure was shooting upward. I was fitted for shoes, took a short jog outside in each one and finally settled on a pair of Saucony's.




Today I was anxious to try them and boy oh boy did I instantly notice a difference. My shins never hurt and my feet felt like I was running on a cloud. I was able to run 4 miles with no problem whereas before I was struggling with 2 miles. So, for all those out there who want to start running I highly recommend finding a local running store and getting fitted for shoes. It truly does make a world of difference. I am no longer feeling defeated and can see my goal in sight.

Family History

This week I worked no 9-5 job. If there is one thing known about food service it is the early morning (or late night) hours. As my alarm went off at 5am, a nice change from 3:30am I breathed a sign of relief that it was my last day. As I said in my last post this was the dreaded rotation. Not because I do not enjoy cooking but, because of the excruciating early mornings and the painful pins and needles feeling in my feet from standing for 8 1/2 hours. I haven't done that in a while a realized I don't want to do it again. To all my fellow high school classmates, I thought you might get a kick out of this: After talked to one of the sisters for a while I told her where I went to high school she looked at me and said "well, I won't hold that against you". I began to talk to another sister she said the same thing. I asked her why and she knew a few of them (one happened to be from MND) and informed me that the Sisters of Notre Dame had a reputation of being very strict and mean, which is why she decided to become part of the Sisters of Charity.







































Today I worked the salad prep station and couldn't help but think of my family history in food service. Although I am the first one to take a 'traditional' path in nutrition, as I thought back I realized many before had the same idea. This runs in both my Mother and Father's sides of the family and, for the sake of turning this post into a novel due to my large extended family, I will only mention my grandparents, aunts and uncles. 


Let's start with my Mother's side. Her father was a restaurant manager for 7 years and then went on to own his own restaurant for 10 years. 5 out of the 10 children (including my mother) have been in the restaurant business, mainly in manager positions. On to my father's side. His grandmother (my great grandmother) worked and owned many bars in the Steubenville, OH area and was a cook for priests. My grandmother followed in her shoes for 35-40 years. She was a cook for two bishops in the Steubenville area and, for her service the bishops presented her an award from the Pope and she then went on to cook for the Priests of the Immaculate Heart of Mary. 



I had always thought I just ran into majoring in nutrition but the more I look back I realized it runs in my blood and maybe it was somehow a divine intervention. 

Dish Duty

Although most people think that the only role a dietitian has it to tell people what to eat, we wear many hats. A dietitian can work in foodservice usually in a management position. This could be in a school, hospital, prison, restaurant, business, or a motherhouse. They come up with new menus, coordinate programs, train and supervise, and so much more. 

Today marked the first day of the dreaded food service rotation. I am at the Sister's of Charity Motherhouse which is a gorgeous campus inside and out. I guess it's about time to give back to all those nun's that taught me throughout the years. I have had some experience in food service as a hostess, busser, and waitress. I absolutely loved waitressing (could have a little something to do with the instant cash) so I didn't think it would be all that bad. My duties today were to work the dish room and tray line. The dish room is exactly what you think, I washed dishes but, for the tray line I took a certain position (cold food items) and put those foods on the trays to be delivered to the nun's who can not walk to the dining area. As the day went on I was quickly reminded of all the things I did not enjoy about serving...my feet hurt, my back hurt from lifting heavy dishes, and by 1:30 I was exhausted. As the day went on I questioned what the point of this was? I didn't put in so much work for the past 4 years to be an RD and work in a dish room. At the end of the day we spoke to the RD who is the food service director and she said something that put things into perspective: The things you do this week will come back to better you in one way or another. Basically, you have to understand the fundamentals before you can do anything else. 

New Year's Resolutions

Personally, I'm not one for new year's resolutions. It always seems as if resolutions are made and a week or so later we all fall out of touch with them. For me, every minute is a new time to do something for yourself. This year I decided to change it up, set a new year's resolution, and keep it. The month of March is National Nutrition Month and every year a 5/10k run/walk is held the first Saturday. I have always walked the 5k but this year I will be running the 10k (6.2 miles). This may sound like a small goal for some but, I am not a runner. Let me repeat, I am not a runner. Not to mention it's the dead of winter so running conditions are not the best. Yoga, swimming, biking, dancing, etc. are no problem but when it comes to running you can count me out. 


I have always admired runners for the dedication and willpower it takes and desperately wished I could pop on my running shoes and run a marathon. Well, my new year's resolution is the first step to that. 8 weeks and counting until I cross that finish line. 












Here are some of my favorite tips to help keep your new year's resolution:

• Make measurable goals.  Instead of making your goal 'drink less pop', make it 'have 2 pops a day instead of 3'
• Write it down. Look at your goal every day for a reminder 
• Take baby steps. You didn't develop these habits over night so, don't expect them to go away over night. 
• Track your progress. Keep track of small successes, they will help keep you motivated in reaching the big picture. 
• Reward yourself. Treat yourself to something you love that doesn't contradict your resolution.