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Code Red Shake Up!

Oh Mother Nature, you really stuck it to me yesterday.

When I woke up yesterday morning, it looked as though it were still night.  The sun peeked out and then hid as quickly as it had come out.  I noticed it getting darker and darker.  A little before 8am, I decided I need to make a run for it to work before the down pour hits.  I left my apartment and by the time that I got to the lobby, I found sheets of rain. 

I walked into my office with my pants soaked up to the top of my thighs.  I had a patient in 25 minutes.  I grabbed paper towels and tried to soak up water from the bottom of my pants.  It helped some.  Walking around helped to air them out, too.  They were dry within 90 minutes. 

I had a fabulous lunch with our diabetes nurses (they’re in their late 50′s/early 60′s and are so cool!).  We all headed back to our desks to begin charting from our morning patients.  I suddenly realized I felt dizzy and it felt like I was slightly swaying from side to side.  I glanced down at the computer chair as though to find  tiny person moving it.  Clearly I didn’t see anything.  I figured I just got one of my dizzy spells after lunch but was still a little suspicious.

Within a minute one of the nurses said, “Hey guys….”  I quickly turned around to her point my finger at her and said, “YES!  I felt it, too!”  We both had been sitting and working on our computer, the other coworkers who were more distracted and standing didn’t notice a thing.  I was convinced that the nurse and I weren’t crazy.  We both were trying to find out something via internet or radio to see if anyone else was admitting to some rumbling.

The overhead speaker came on in 10 minutes and announced a code red.  I’ve never even practiced a code red.  The ladies told me to grab my purse and head outside.  We had recess for about 20 minutes (lucky for us the rain was over!).  Our next patient actually found us in the parking lot among the rest of the building’s workers.

Thanks Virginia for the work break!

Once I got home I made sure to clear my schedule for 30 minutes for:

I finally bought this about a week ago at Target.  Yes, those are 2 pound weights.  If you know me or have seen my arms, you’d understand that 2 pound weights are like giant boulders to me.  I find Ms Jillian to be slightly annoying (random laughing, telling her sidekicks that they are trying to cheat when she’s not looking but she’ll get them!…sometimes silence is golden, Jillian), but her workout definitely gets my heart rate up and leaving me with a subtle burn.  It does the job while I take care of the ole bum knee.

After turning of the Jill Master, I headed over to the boy’s house for dinner.  It turned into a bit of a headache: I forgot to bring over olive oil since he had just ran out, randomly ants had attacked the bag of walnuts and they were only discovered by boy once he had used them to make pesto, etc, etc, etc.  I was so hungry by the time that dinner was ready that I had no patience to take a darn picture of it. 

We Boy cooked the pasta and a small part of the bread for garlic bread from his Friday night goodie bag:

And then I made a quick salad to kick off the meal.  It didn’t take much to stuff me.  I had a bowl of salad, serving of pasta, and a 3″ piece of garlic bread and said, “No more!”

Dear Wednesday: please bring gentle earth events that bring another afternoon recess.

Happy RD-Day To Me!

I remember exactly what I was doing 365 days ago.

My main event of the day was to take (and pass!) my RD exam that I had worked my butt off for the past 5 years (and countless dollars). 

I can remember hooking up the boy’s GPS in my car that morning so I wouldn’t have to think about directions and could keep my thoughts collected on nutrition.  I picked up a Starbucks non-fat vanilla latte and put gas in my car at the near-by Mobile on the way out of town.  I talked to myself the entire drive up to Madison.  I remembered telling the corn fields that they are lacking tryptophan.  Upon arrival to the community college where I’d take my test, there were “no parking” signs everywhere!  Finally I said screw it and parked somewhere.  It was summer, those signs don’t count then, right?

If there was one test where I thought I’d vomit before, during and after, it was this one.  I can remember the testing lady coming out into the hallway to let me know that I could take my test 40 minutes earlier than expected.  What?!!  Don’t spring this on me!  Give me 20 minutes.  I reviewed the political system for the community section (which was a waste since no questions were asked about it).  I went in and had my picture taken, rules explained, marker board and marker given, wearing a jacket rules were explained, my driver’s license was copied….the list goes on and on.  They weren’t messing around!

I sat down in a small room where 3 other people were taking their GED.  I caught a glimpse of a few of their geometry questions as I was walking in to sit down.  The test began and my brain was on high.

I was plowing along and suddenly the screen went blank!  I was now asked to take a survey about the testing site.  Are you crazy?  You want me to think about my feelings towards the testing site when you have the answer to if I passed the RD exam?! 

Click.

Click.

Click.

Click.

Click.

Click.

I have no idea what ratings that I gave the testing site.  I kept clicking until I got to the page that told me “Congratulations!”  I passed the RD exam.

I passed the RD exam??

Tears.  The tears came.  I walked out of the room with my marker board and marker and handed it over to the testing lady.  She saw my tears and was a little nervous to say anything, so instantly handed me a Kleenex.  She softly asked me, “Did you pass?”  I nodded my head.  She let out a sigh of relief and began retrieving my test results in the computer.

And now a year later I’m working as a dietitian and have CDE as my next goal.  It never ends.  We always need something to keep us going. 

Last night’s dinner was chocked full of nutrition.

Stuffed pepper and broccoli and pepper tops on the side. 

I figured that I might as well save the cut-off pepper tops and to mix them in with the broccoli.  The broccoli looked prettier, I got more money’s worth from the pepper, and had an extra boost of nutrition. 

This may look like a hefty amount of vegetables for only two people (especially when we’re already having a stuffed pepper in itself), but I actually had to tell boy to stop eating all the vegetables because I wanted some for my lunch the next day.  I’ll take having the problem that my boyfriend wants to eat all the vegetables though.

How Does Your Doctor Know That You Have Type 1 Diabetes vs Type 2 Diabetes?

People with type 1 diabetes go through the same tests as people who are diagnosed with type 2 diabetes.  Once blood sugar levels and/or A1c percentage confirms a diabetes diagnosis, the doctor must determine if the patient has type 1 or type 2 diabetes. 
 
Now like with any professional, you have a hunch. Most medical professionals can figure out quickly that you are type 2/type 1 quickly based on labs, signs, and symptoms.  I will say that I’ve had a recent experience of a patient being diagnosed with type 2 diabetes (all this occurred in another state) and was continually being hospitalized. Upon an inpatient visit with him he told me that we (as in my hospital) figured out to check to see if he has type 1 diabetes instead.  Mystery solved.  
 
To verify that a patient has or does not have type 1 diabetes a few things can be checked:
 
1. Auto antibodies that are commonly associated with type 1 diabetes can be checked for.  Type 1 diabetes is an autoimmune disease that results with all beta cells dying-which are what produces the insulin.
 
2. Urine is checked for both ketones and glucose.  High blood sugar with Type 1 diabetes (and uncontrolled type 2) results in the sugar you eat essentially being peed out.  This then is what can cause weight loss.  When the sugar is hanging out in the blood and spilling into the urine, fat stores are being used as energy which is another factor in weight loss.  When fat is broken down, ketones are produced and are excreted through the urine.
 
3.  C-peptide levels may be checked.  C-peptides are linked to insulin when produced by the body.  If C-peptide levels are low, then it is assumed that little to no insulin is being produced, showing type 1 diabetes diagnosis.  People with type 2 diabetes will have normal or high C-peptide levels.
 
Reasons that a doctor may have a hunch that you have type 1 diabetes:

1. Your breath smells fruity (and not because that you use had a stick of Juicy Fruit gum).  Ketones give off a fruity smell.  Remember what I just said about ketones up there?
 
2. Significant weight loss.  You’re peeing out your sugar and using fat stores for energy since there is no insulin available to let sugar into your cells to be used as energy.
 
3. You’re young and at a normal weight.  Most people diagnosed with type 1 diabetes are under the age of 40, but closer to the age of 14 years old.  Juvenile diabetes is a term no longer used in the medical field due to the obesity epidemic causing so many children to be diagnosed with type 2 diabetes.
 
4. You’re lying in a hospital bed for diabetic ketoacidosis (DKA).  If you have been diagnosed with type 2 and come in with DKA, your hospital most likely will be checking you for type 1 diabetes. 
 
Of all the people in the world who have diabetes, only 10% have type 1.  And remember, just because you’re on insulin doesn’t mean you have type 1 diabetes.

Mediterranean Lunch Hour

Why do I keep thinking that it’s November 22?  I guess I’m ready for cold weather and all things pumpkin.  Something is so soothing to me about fall.  Maybe that’s what I’m needing.

I had complete seeing capabilities yesterday so I actually was able to get out!  I was low on milk so decided it was a perfect morning to grab a Starbuck’s breakfast of an iced non-fat vanilla latte and “perfect” oatmeal.  About an hour later, I headed to the Boy’s where I discovered he needed to eat lunch soon.  We went to a local bistro-type of restaurant.  I carefully decided on where to eat based on outdoor seating.  Am I the only one that does that?

It had only been about 2 hours since I’d eaten breakfast, but um I was ready to eat!  Something odd has been up with my appetite lately.  It’s increased to where I’m never satisfied.  Onset of prader willis syndrome? 

I ordered the Mediterranean melt.  Such a good decision!

A hummus and roasted vegetables (bell peppers, onion, and zucchini) stuffed pita and fresh fruit on the side.  I guess it’s “CHIP” approved, which is some previous Rockford program for “Coronary Health Improvement Project.  Meh, it’s some Rockford thing that was pretty big in the past.  Patients bring it up to me and I really don’t know that much about it-again, not ADA approved, so it’s not never been a priority to dig up research.

After lunch we went to a movie (which is super rare).  We The boy chose to see “30 minutes or less.”  Just the title of the name turned me off, but I agreed to see it when he brought it up.  Should have gone with my instincts.  I recommend to wait to see the movie once it hits cable and all other channels are broadcasting the same government speech. 

Sadly the rest of my Sunday was spent meal planning, grocery shopping, and baking.  I just keep telling myself I’ll be happy that I did it on Sunday rather than being forced to on a Monday night after work.  Another thing that I’m happy I did: buy a Brita water filter.  I peeked into my filter last night and found this

Is our city’s water trying to add extra iron to our diet?  Time to clean this out.

RD exam tip:

Read each question word for word.  Before looking at the answer choices, see if you can answer it on your own.  Sometimes answer choices can sway your reason of thinking.  Determine what the question is truly asking for you to answer.

Example: What mineral aids in blood clotting? 

The first thing that most dietetic students think of is vitamin k when you see “blood clotting.”  If there were 4 answer choices and one was “vitamin k,” you may have the urge to click that mouse before you give yourself and extra second to think about it.  Taking an extra second allows you to realize that it asked for a mineral, not a vitamin!  The mineral that aids in blood clotting of course is calcium.

Fridge Cleanout

Painless vision is muchly taken for granted.  Today I have a painless left eye.  I had to flush my eye with water throughout the day and go contact-less and glasses-less yesterday for about 8 hours.  Must check into lasik!!

My day was pretty uneventful due to eye issues, soreness, and a long work week leaving me tired.  Nothing exciting to report on, but I did manage to burn roasted garlic though.

Since roasted garlic is so heavenly, I took a second attempt.  I had plans for delicious roasted garlic hummus and it’s just not doable without the obvious roasted garlic!

Round 2:

Much better!  I made hummus with the opened chickpeas that have been waiting patiently in the fridge to be used up.  I also had leftover tortillas, shredded mozzarella, and corn from previous dinners this week. 

Fresh, raw corn is the only way to go with corn!

Mama P’s vegan (vegetarian) crack wrap, please!

This is what cleaning out the fridge looks like!  And it tasted delicious, which was great since I had a second one.  My hunger lately has been unstoppable.  Must replenish the fridge soon!

Dietitian Play-by-Play

I have not been productive today.  My left eye has been throbbing in pain all day!  Something is in there besides my contact.  I’ve been asking for it to nicely leave, but it hasn’t yet! 

With a painful eye, I’ve been relaxing.  I mean, there’s not much to do when you are left being near-sighted without your contacts in.  Luckily being near-sighted allows me to be able to see my computer screen sans contacts!  You’re probably thinking I should just put my glasses on.  My glasses have been MIA for months now. 

Yesterday (when I had 2 fully functioning eyes) I was all over the hospital campus.  I thought I’d give a run down on my day to clue in on what a dietitian does all day. 

7:45am: Arrive at work.  Print out the day’s outpatient schedule.  It was slim pickings today.  I only had an 8am and was marked down for cardiac rehab from 9-12. 

7:50am: Consult with co-dietitian on what floor(s) to take since there were 2 dietitians off.  I was given my floor’s screens to determine what patients needed to be seen today.

7:55am: My 8am patient arrived.  Brought patient back, weighed patient, received patients food/lifestyle history, counseled and collaborated with patient, and set up a follow-up appointment for patient.

9am: Walked very quickly 2 blocks over to cardiac rehab.

9:10am: Arrived at cardiac rehab.  Saw 3 patients to discuss their various needs that are pertinent to them right now.  Charted on all 3, printed out the notes and stuck them all within the appropriate charts and filed charts away.

12:05 pm: Arrived back at office.  Entered billing information for my 8am patient (before I’d forget!). 

12:10pm: Ate lunch with a few dietitians. 

12:30pm: Started screening in patients for my floor I was taking over for the day.  Searched throughout their electronic charts to make sure to catch anything to determine if they are at any sort of nutritional risk.  I check for: albumin level, po intake, BMI/IBW%, nausea/vomiting/abdominal pain, recent unintentional weight loss, diet order/status, and admitting diagnosis.  I realized only 1 patient needed to have an initial assessment today and that all follow-up patients were seen yesterday. 

1pm: Checked with co-dietitian to see if she needed to give my any patients since I only had 1 initial patient assessment and 1 diabetes education.  She passed over 2 oncology patients for initial assessments and a tube feeding order that had been started but doctor needed a goal rate to be determined.

1:10pm: Screened the 2 oncology patients. 

1:15pm: Began tube feeding calculations.  Resulted in a goal rate of 65 mL/hr of Jevity 1.5.  Entered the goal rate into computer ordering program.

1:35pm: Headed over to the hospital to talk with patients to see how their symptoms (GI) are currently doing, wt changes, appetite changes and if I could send them any supplements as well as the diabetes education. 

2:20pm: Returned to office to begin charting on patients.  Charted on patients and assigned a level of nutrition risk to each which determines a follow-up date (should they still be admitted by the time the date rolls around). 

3:40pm: Finished charting on all patients.  Checked the progress of the remaining dietitians.  They were all in good standing. 

3:45pm: Organized my desk, checked Monday’s outpatient schedule.  Grabbed my lunch things, wished all the dietitians and 1 nurse a good weekend, and headed out the door. 

I really only ended up leaving about 20 minutes short of an 8 hour work day.  I was hoping it’d be sooner since I’d had longer days earlier in the week, but I was more satisfied with doing good work and helping out the other dietitian.

After work I tried a cherry berry basil smoothie for the first time.  I wanted either a decaf iced coffee or the smoothie.  I figured there’s better nutrition in the smoothie and it’d be cheaper on my wallet.

The basil brightened and freshened up the smoothie, kind of like mint.  I adapted from this recipe.

Later on in the night the boy called and asked me to come up the pizza he had planned to take home.  It ended up being a lot more than just pizza.

Talk about a carb jackpot!  This all was a benefit from the side work that he does!  He had contributed his garden’s sage to the owners of a pizza/pasta business and they gave him a bag of the lemon sage pasta they made from it.  I was thinking that it was a perfect time to flee the state with all of these delicious carbs so I wouldn’t have to share!  I stayed though and ate only 2 of the 3 pizza slices that were left (boy made sure to eat 1 before he handed it all over to me!).  Basil pesto, onion and tomato on a pizza??  So good! 

Now what to do with the rest of the carbs?  Bread pudding?  I haven’t dared to make bread pudding since junior year of college when I was the designated bread pudding baker in our food service production class.  Should I make a savory mushroom bread pudding-then I could call that dinner!

Time to flush this eye out with water, otherwise I need to think of near-sighted activities to do for the day.

Encore

I’ve said it before and I’ll say it again.  The show must go on!  What happens when the audience patients need more?  We stay for an encore of work.  I went into work a little before 8am and left quarter till 6pm.  I’ll look at the extra 1.5 hours as free experience towards my career. 

Boy sent an email asking me when I’d be getting off work.  I told him that that was a great question and I wish I knew.  At 5pm (half hour after I planned to leave work), I had completed my inpatients, outpatients, attending our department’s inservice, caught up on all pertinent charting, all while in good company with the other dietitians that were still cranking out their charting.  I asked if a tube feeding order had been completed yet.  It hadn’t.  I grabbed the consult sheet since everyone else still had a chunk of work to do. 

I investigated what was going on with my patient.  Once I knew what the case was, my fingers scurried across my calculator’s number pad, writing down nutritional needs.  Double checked my math.  Wrote up an initial patient assessment including my tube feeding recs.  Clicked save.  Was asked to see a patient for an inpatient education.  Grabbed my lunch bag and purse and stepped out into the  sunlight. 

Boy came over to my apartment so we could attempt tomato basil cream pasta for dinner.  He asked immediately, “This doesn’t involve any cream though, does it?”  He’s catching on to me!  I met him as he was walking in with an abundance of basil in one hand and Full Circle kolsch beer in his other hand.  What a sight! 

First things first:

It’s truly summer in a bottle.

Boy and I had dinner on the table within the hour.  I had had a salad in my lunch for 2 days that had gone uneaten (too busy at work), so I tossed it in a bowl and shared it.

The pasta turned out ok.  I think I’d process the sauce differently next time to get it creamy rather than gritty.  Boy and I knew it needed something more.  I plan to add onion, red pepper flakes and parmesan cheese for the next attempt-which we know would no longer make it vegan.  That’s ok since I’m neither vegan or vegetarian.

Next up: plopping down on the couch to watch the next episodes of Grey’s Anatomy.  Don’t ask me why the clinical dietitian comes home from work to cook and watch shows that take place in a hospital.  I passed out quickly in the middle of an episode, woke at midnight, stumbled around in the kitchen to make breakfast, scraped my dry contacts off my eyes, and fell into bed.  I’m awake and get to repeat it all again.  Thank heavens that it’s Friday!

Dietitian lesson of the day:

If you don’t have dedication towards your job/patients, you may want rethink your career field.

Mama Knows Best

Cold showers are making it hard to wake up in the morning.  Where has my hot water gone?  It’s August, aren’t all things hot right now?

I at least went to bed with a happy stomach.  Cue a Mama Pea recipe.  I’m not letting her cookbook out of sight!  She is making meat seem so blah-ze.  I wanted to tackle her summer succotash quesadillas since I had a city market fresh zucchini waiting to be used.  I drafted the boy to help with dinner since I had to make salsa for the Nacho Mmm saucse which then I made the Nacho Mmm sauce and roast asparagus.  Boy worked on the succotash part and I finished off the quesadilla portion. 

My first few quesadillas got a little too toasty, if you know what I mean.  Too much too fast. 

I was ready to dive into the quesadillas but the fork snagged the asparagus.  And then I picked up the quesadilla and I never looked back!  I can’t really tell you my exact thought upon first bite because it’s not PG-13.  I won’t lie, this meal took a bit of time and effort to make since it had a few components, but after first bite I realized I’d do it all again in a heart beat! 

After I stuffed my face with quesadillas, I cleaned up my messy kitchen and started on laundry (and watching Grey’s while in between laundry switches).  As I was folding all of my clean clothes I realized my number one priority to be washed never saw the washer-my lab coat.  I swear I have the memory of a goldfish.

No health lessons today.  Must get to work a bit earlier today.  Have a great day!  And if you need some study tips to become a dietitian, see this post!

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