TED Talks, round-up 7

1. Sandra Aamodt: Why dieting doesn’t usually work

So many people fixate on dieting and are convinced that by simply restricting calories (or eliminating one type of food, or adding one special “super” food every day, etc) they’ll be able to lose weight and keep it off.  For them, the belief is that food is the only factor that needs to change when it comes to weight.  Most people forget that the brain plays a role in weight management, too.  Aamodt’s talk barely skims the surface of the brain’s role in weight management, but it’s such a complex topic and her talk is good for a quick intro.  Plus, she touches on mindfulness and food, which is becoming a huge topic.

 

2. Mick Cornett: How an obese town lost a million pounds

Oklahoma City once was on the list of most obese cities in the United States.  When the list came out, Mayor Cornett at first had a bout of denial.  But he eventually relaized that he and his city needed to lose weight.  Mayor Cornett led the charge for Oklahoma City residents to lose a million pounds by changing infrastructure.  Like Aamodt’s talk, this talk is a good reminder that there is more to weight loss than just watching what you eat – the infrastructure of where we live matters, too.

 

3. Bill Davenhall: Your health depends on where you live

My internship’s focus was on Health Disparities and one of the topics we discussed was how where you live can affect your health.  Davenhall’s talk does a great job of explaining how geolocating can be tied to our health records to determine what health issues we’re at increased risk for.

Advertisements

Guest Post! Being a Meredith College Dietetic Intern

New feature!  Starting today, I’ll occasionally have guest posts from people who completed their internships in different programs.  First up, a post from Tessa Nguyen, who just completed her dietetic internship at Meredith College in Raleigh, NC.  If you would like to get in contact with Tessa, you can reach her on Twitter at @TNutritionista or check out her blog.  

 

Hi everyone! I’m Tessa Nguyen and I just completed my Dietetic Internship through Meredith College in Raleigh, North Carolina. I was excited when Christine asked me to write a guest post about my time during my internship, as I love hearing how Dietetic Interns’ experiences vary from program to program.

When I started my search to see which Dietetic Internship Programs I wanted to apply to, I was drawn to Meredith College’s not only for their focus on developing leadership, but also because their internship comprised of rotations in multiple areas of nutrition. I had a strong idea I wanted to end up in sports nutrition, but I still wanted to work and gain insight into what other areas of nutrition had to offer.

Meredith’s internship consists of rotations of varying lengths in different areas of nutrition including food service management, clinical, wellness, community, long term care and enrichment. Our enrichment rotation was the chance for us to work with a Registered Dietitian in any field of nutrition and in any state or country of our choosing. This was great for me, as I was able to spend more time in two of my favorite areas of nutrition: sports performance and wellness.

Here are just a few highlights from a couple of my favorite rotations.

 

Food Service Management Rotation at Rex Healthcare Hospital

Black Hat Chefs

Black Hat Chefs’ New School Hospital Food Blog

 

My first rotation was with the food service management team at Rex Healthcare. I was ecstatic to learn I had landed this rotation, as I had heard many great things about the food service team and the Black Hat Chefs. I went to culinary school before graduating with my Bachelors in Culinary Nutrition, so I am very passionate about making healthy food taste good. The first day I stepped into Rex’s kitchen, my eyes were wide with surprise. I had never worked in a hospital where the chefs were actually using knives to cut up ingredients, rather than whipping out the can openers and scooping out food onto patient trays.

Rex’s Director of Culinary and Nutrition Services, Jim McGrody, is the namesake behind the Black Hat Chefs concept of providing training and education to the cooks within the hospital to learn the skills and techniques of proper cooking. One of his right-hand-men in leading the evolution of hospital food includes Rex’s Executive Chef, Ryan Conklin. Both Jim and Ryan were great mentors during this rotation for me, as they were both open to letting me fly free in the kitchen to gain as much insight and experience as I wanted.

One of Meredith’s food service management projects includes putting on a “theme day.” This was the opportunity to create a meal and serve it to the patrons and staff of the hospital. As many people have grown to know how strong of an influence my Vietnamese background plays into my cooking, I wanted to make pho for my theme day. Pho is a traditional Vietnamese beef noodle soup made from a hearty, rich beef broth with rice noodles and various aromatic herbs. I grew even more eager to share this meal with those at Rex when I saw how excited Ryan and Jim got when I mentioned how I was thinking of making this meal for my theme day. I know I wouldn’t have received the same encouragement had I not been in a healthcare facility that valued and practiced from-scratch cooking by using proper cooking techniques. This truly was an awesome experience and I always look forward to the updates from Chefs Jim and Ryan on how they are advancing and changing the world of hospital food.

 

Enrichment Rotation at EXOS (formerly Athletes’ Performance) at Raleigh Orthopaedics

EXOS link

 

I ended the year with my enrichment rotation in performance nutrition at EXOS at Raleigh Orthopaedics. I was looking forward to this rotation the most, as I got to hand pick both who my preceptor would be and which area of nutrition I would be working in. I had the great fortune to work with Gabe Staub, MS, RD, CSSD, CSCS. He showed me the ropes of everything he does from when the client first arrives at the facility to the nutrition follow ups when they leave for the season. Gabe has a strength and conditioning training background, which made it very cool to see how he was able to incorporate nutrition tips into his training sessions and vice versa. As someone who also has a dual-background, this made me realize how much clients value a professional who wears multiple hats. These athletes are always looking for the “edge” in their performance, so they actively seek out Registered Dietitians that are also knowledgeable and educated in another area that can help them reach that next level of performance.

I also appreciated this rotation because I was exposed to a new nutrition concept or supplement each day. These clients are bombarded with different products from their coaches, management and/or teammates. They would then turn to us with questions regarding which type of diet they should be on or if they should be taking a certain supplement. It’s our job to sort through the products and research to see if they were safe for them to be taking while competing. This kept me on my toes and gave myself even more assurance as to why I want to continue working in sports nutrition. This particular field of nutrition is constantly evolving and changing and I look forward to learning more about it every day.

As you can see, these highlights are from only two of the six rotations offered through Meredith College’s Dietetic Internship Program. As I was writing this post, it’s amazing to see how a few paragraphs can sum up a year of your life! My internship experience was truly great, as I had the chance to gain knowledge and experience from so many Registered Dietitians, Chefs and other healthcare professionals over the course of the year. Although having our completion ceremony last week was bittersweet, I look forward to starting my career as a Registered Dietitian and seeing where it takes me next!

Final rotation: Staff Relief

Sorry about the silence these last couple of week folks, but I had a really good reason!  I spent the last couple of weeks studying for the exam, which I passed Friday!  Yay!  I’ll post about prepping and taking the exam later, but for now… my last rotation.

The very last rotation of the internship was Staff Relief which took place for the entire month of May.  About a week before we started the rotation, we were told what rotations were available for coverage.  Our director then asked us to write our top three choices down and to make a note if we had been applying for any particular type of job (clinical, LTC, etc).  As a group, the interns had already sort of discussed how we were all going to rank our choices, but there was always the possibility that our the director could change things up.  Our director took our lists and, while we were getting a class talk from one of the RDs, our director met with the head of clinical nutrition and the two of them took our choices and decided where they wanted each of us.

Well, I was thrilled to end up providing coverage for the Medicine/General Surgery ward.  I think my director was a little surprised and amused when one of the other interns and I high-fived each other upon finding out where we were headed.  The other intern was to provide coverage for Nutrition Support, which meant the two of us would be in the same location.  Since we had already talked about how we were going to rank our choices, we had already decided that if we ended up with those rotations, since we both wanted both rotations, we would share any interesting cases and help each other out.  Of our group of six interns, three went to the in-patient clinical wards, one to LTC, and two to outpatient.  The preceptors told us that we were the first class in a while they can remember doing that – apparently, it usually ends up the whole group wants to do clinical or the whole group wants to do outpatient.

So, the first couple of days of staff relief we got some help and some information from the dietitians we were “replacing.”  See, in addition to assessing patients like we did during our rotations, we were supposed to cover the meetings the dietitians go to, track all patients in our wards for follow-ups and assessments (ALL, as opposed to how during rotations, we saw the patients the preceptors assigned to us)… Basically, we were being THE dietitian for the month.

And that is a lot more intense than just being the intern.

The first week was nonstop action of being busy and trying to get everything done before the end of the day. I know a few of the interns, myself included, spent quite a few days staying later than planned.  By the end of the first week, though, we found our groove, even if we were constantly busy.  On the really busy days, we split up the workload and helped each other out.  Plus, we all still had one or two projects we were wrapping up. I think my ward was completely full the entire time and it sounded like the two other interns at the same location were in the same situation.  Some of my patients tranferred out of my ward into the the long term care unit, which was being covered by another intern.  It was nice to get little messages from her that my notes were great and, the few times I had one of her patients transfer to me, I told her the same about her notes.  (Well-written notes from previous encounters are a godsend.)   We quickly gained confidence with everything and by the middle of the second week, we were all feeling a lot more comfortable acting as the RD for whatever ward we were assigned to.  Plus, we weren’t completely alone since we all still had preceptors, because we were all still interns so we couldn’t sign notes without a registered dietitian co-signing it.

One of the things I had wondered a lot about the SRE (Staff Relief Experience) rotation was where the dietitians would be and what would they be doing.  Some of the dietitians took their vacations during our staff relief month, since with six interns doing a lot of the work, there was plenty of coverage.  But for the most part, the dietitians were all still there and were answering any questions we might’ve had, but they let us do the bulk of the work.  The dietitians who had interns were given special projects to work on while we were there, so they were kept busy, too!

By the end of our staff relief rotation, even though we enjoyed it, we were all excited because the end of staff relief meant the end of our internship!

Rotation: Health Promotion Disease Prevention

The VA has a program called Health Promotion Disease Prevention (HPDP) and we dietetic interns each spent three weeks with the program.

HPDP is very different than the clinical rotations.  With clinical rotations, the focus is fixing the immediate health problem the patient is facing.  With HPDP, the focus is to prevent the health problem in the first place.  This is a concept I think a lot of health professionals can get behind.  Heck, not just health professionals – everyone!  It’s no secret that health promotion and disease prevention will save money and lives in the long run.

But I digress!  With HPDP, I got to participate in a variety of wellness projects, not just nutrition projects.  I wrote newsletter articles on safe driving that will be used in the winter newsletters. I helped out with a Cooking Matters class that was just for Veterans and had a lot of fun working with the Veterans in the class.  A lot of them had never cooked before being in the class, so it was nice to coach them along so that they did all the real cooking work.  During the class, one Veteran asked me if I thought that foods with chemicals in them were bad and he went on to tell me about an email he had gotten that told him lard and butter were better for him than the “so-called heart healthy stuff” or supplements.  Apparently the email told him that anything with a chemical sounding ingredient was automatically bad for his health.  I pointed out that it all packaging can be misleading unless you’re really paying attention to the label, pointing out that one food might have a lot of sugar in it but the sugar could be listed in three different forms so it doesn’t get listed as the first ingredient.  He pressed the issue, so I finally asked him if he’d drink a glass of dihydrogen monoxide.  His immediate answer was “Of course not!”  He was kind of taken aback when I told him it was another name for water.  The RD I was working with was amused by that conversation.  (If you ever want to chuckle, check out http://www.dhmo.org/ – I find it quite hilarious.)

I also observed and led nutrition portions of MOVE! classes.  MOVE! is a great weight loss program run by the VA.  I’ve helped out with MOVE! classes now in two different VA systems and it’s always amazing to help out with the classes.  The in-person weight loss classes are taught by a three-person team – a dietitian, a physical therapist, and a psychologist.  The dietitian goes over the nutrition topic for the day, the physical therapist teaches exercises and ways to modify the exercises so everyone can do them, and the psychologist goes over behavior change strategies to help make the weight loss a lasting change.  MOVE! is truly a lifestyle change class and it’s amazing to see the progress of the Veterans who participate.

While I had fun with everything I’ve mentioned so far, my favorite part of HPDP ended up being something I wasn’t originally scheduled to do.  On my last day, I went with one of the HPDP dietitians to Camp Hope, a non-profit lodge specifically for the use of combat Veterans, to help teach a cooking class.  The Veterans were there for a multi-day retreat just for Veterans who had suffered TBI and they were working with social workers, physical therapists, psychologists, and a whole host of other health professionals.  We were there to help them learn healthy cooking habits by having them make their own lunch for the day.  I think a lot of the Veterans were a little nervous when the RD told them, “This is your lunch, so you guys better follow the recipes because you guys are going to have to eat it.  There is no backup meal.”  They all ended up doing great and a few of them who claimed they never cooked seemed proud of themselves for cooking, and deservedly so.  We were also there to encourage them to break out of the “meat and potatoes” mindset and a few were surprised to learn that vegan chocolate cake tastes just as good as regular chocolate cake.  Camp Hope is a truly wonderful place and I highly encourage anyone who can volunteer or help out with it to do so.

HPDP definitely ranks up there as one of the highlights of the internship.  The Veterans I worked with were all great, as was everyone who was an HPDP employee.  I can easily envision myself working in a health promotion field now.

Community Rotation: St. Luke’s Hospital

After Cardiology, I had a month of community rotations – HPDP and St. Luke’s.

At St. Luke’s, our preceptor was an RD who is part of the community outreach team at St. Luke’s.  She teaches or hosts most of the nutrition-related classes that St. Luke’s holds for the community, goes out into the community to teach classes at organizations, works at health fairs in the community, and works at St. Luke’s health events for its own employees.  Her schedule was always changing.  This meant that for the St. Luke’s rotation, every intern had a different experience because it all depended on what events had been scheduled the week each intern was there.

In my case, I got a taste of corporate and community wellness.  My week with St. Luke’s was packed and I hit the ground running.  Right after I got a quick tour and introduction to everyone I’d be working with, I was told I would be helping with the “Bone Builders” class that night.  That was a really interesting topic and I learned a few things.  The class was taught by the dietitian I was helping, a physical therapist, and a pharmacist.  From the physical therapist, I learned a couple of methods to help keep my posture aligned properly.  From the pharmacist, I learned about what to look for when buying calcium supplements.  The dietitian and I covered sources of dietary calcium.

I spent the next day with a IBCLC.  This was a very different experience than working with the IBCLCs at WIC where I met with moms who had been moms for months or years.  With the St. Luke’s IBCLC, I spent the day meeting moms who had just had babies – as in, some of the babies weren’t even 24 hours old.  The day I was there, all of the moms recovering were not first-time mothers, but they all still had questions.  One mom was having difficulty with breastfeeding, so I got to see the IBCLC and the nurses “in action,” so to speak.    I also was able to answer some questions about nutrition and breastfeeding, weight loss, child nutrition, and general nutrition.

The next day, I worked with the RD and a group of nurses who were all trained health coaches at an employee wellness event for St. Luke’s employees.  This let me get a taste of wellness screenings and health coaching, as well as corporate wellness since the employees get incentives for improving or maintaining their health. After that, it was time for the big event of the day – a “Lunch and Learn” for the City of Manchester.  We wanted to have food samples available for the presentation, so a lot of my late morning was spent prepping the food samples.  I had already worked on the presentation the night before and the RD had approved it.  Because we ended up pressed for time, she gave the presentation while I finished up the food preparation.  Just as I made sure every one had samples, she finished up the presentation and it was time for me to lead a “Blubber Burger” exercise.  (That’s always a hit with participants, no matter the age.)  We stayed afterwards to answer questions.

For my last official day at St. Luke’s, I worked with the RD at a health fair at one of the nearby colleges.  This was a fun event as there were lots of health related companies present, as well as free massages, music, and puppies to play with.  We had a small “spin the wheel” game for people to play and we shared information about St. Luke’s events/classes, the Spirit of Women program, and recipes.  While there, I finally got around to signing up for the Bone Marrow Registry.   I highly encourage anyone who can to join the registry, especially if you’re of mixed ethnic ancestry.  If you’ve thought about joining in the past, but didn’t meet the medical guidelines, please check again as I used to be disqualifed.

I loved working with St. Luke’s so much that I ended up coming in to volunteer on the Saturday after my rotation.  I had previously volunteered with St. Luke’s for a presentation on how cancer and diet are linked, but this time I got to staff a booth at a community health fair where we did diabetes screenings.  I got pretty good at conducting the screenings, but I was nowhere near as good as the RD who basically could do the screenings with one hand.

If you’re in the St. Louis area, definitely check out the classes and events hosted by St. Luke’s – a lot of them are free and totally amazing.  And if you’re a female living in the St. Louis metro area, give some consideration to joining the Spirit of Women program- you can get some pretty cool discounts with it.

Clinical Rotation: Cardiology

My internship officially ended Friday, so expect a lot of catch-up posts today and tomorrow!  

 

After HBPC, my next rotation was Cardiology, my last clinical rotation before Staff Relief.  For Cardiology, I worked with the dietitian who covered the in-patient Telemetry ward and the out-patient HemOnc clinic.  This allowed me to get a little oncology nutrition experience, too.

It’s probably not a surprise to anyone who’s ever worked with cardiac patients, but I spent a lot of time encouraging patients to adopt a low-sodium diet.  I spent a lot of time explaining that sea salt is just as bad as regular salt in terms of sodium content and reducing hypertension.  For my patients who were cooks, I often went over different ways to prepare foods while cutting back the sodium content (using herbs instead of salt, looking for hidden salt in their seasonings, etc).  For patients who didn’t cook and typically microwaved their food, I went over label reading, provided sodium guidelines for foods they purchased, and suggested ways they could reduce sodium in general.  (A tip that everyone seemed to love and feel like they could manage was rinsing canned beans.)

I also promoted the DASH diet a lot, spoke about reducing dietary cholesterol, reducing saturated fat, and fluid restrictions.  Talking about reducing dietary cholesterol and saturated fat was primarily done with patients with hypercholesterolemia, since lately the link between saturated fat and heart health has been questioned.  While diet recalls are always an important thing to gather during assessments, it felt like they were really important in Cardiology because I felt like more often than not the patient’s dietary and lifestyle habits had contributed to the CHF or CAD diagnosis.

In addition to nutrition education from me, patients also got nutrition and lifestyle education from a cardiac nurse.  There were three who met with every patient who came in with a new diagnosis of CHF, CAD, or AMI.  The lead cardiac nurse also managed the heart healthy lifestyle classes, where patients came for a once a week class on different topics to help improve heart health (exercise, nutrition, smoking cessation, medication management, etc).  My preceptor and I taught the nutrition class which focused on a low-sodium diet.  Initially, I was just supposed to observe, since the class was on my second day in the rotation and the other interns didn’t have the class until a week into the rotation, but I showed initiative (key thing to do in the internship, btw) and jumped right in.  My preceptor told me she got good feedback on how well we played off each other and how good a team we made, which made me extremely happy to hear.

One of the best experiences in the Cardiology rotation was being able to watch a patient get a stent placed.  This meant I ended up hanging out with the Cath Lab (video’s not of the lab I worked in but gives you an idea of what a cath lab is like) and the really cool team that works there.  The day I was there, there were a couple of nursing students so I didn’t get to be in the actual room during stent placements (the surgery room was too small for that many people) and I ended up watching from the observation room.  Still pretty cool since I could see and hear everything, plus a sales rep was there and he was able to explain everything that was happening.  Because we had to wait for test results, I had some time before the procedure to ask questions, and afterwards, I spoke with the doctor who had done the procedure.  I ended up spending most of the morning with the Cath Lab who were all very friendly and willing to explain everything to me.  In the afternoon, I ended up providing nutrition counseling to the patient.

As for the bit of oncology nutrition experience, there was a lot of focus on just getting oncology patients to eat.  Often, when going through treatment, patients lose their appetite, their taste changes, or they experience frequent nausea and vomiting.  So you really have to focus on getting the patient to just eat so they have the energy to get better.  Check out this guide from the American Cancer Society for more information about the challenges of food and nutrition during cancer treatment.  We didn’t really talk about diet for cancer prevention – that’s something that after treatment was completed and the cancer in remission was covered by the outpatient dietitians.

For more information about nutrition as it relates to cardiac health, check out the American Heart Association’s Nutrition Center.  For information about cancer prevention, check out the National Cancer Institute’s Division of Cancer Prevention website.

 

Clinical Rotation: Home Based Primary Care

Next up in rotations was Home Based Primary Care (HBPC).

This was an awesome rotation and I absolutely loved it!

I’m not sure about other internships, but I’m fairly certain HBPC is fairly unique to VA.  HBPC is pretty much what it sounds like – getting medical care in the home.  HBPC teams are composed of an MD, a nurse or PA, a social worker, a PT/OT, and an RD.  When a Veteran is homebound, the Veteran is considered for HBPC and the MD or a nurse visits the Veteran at their home.  If the Veteran meets certain qualifications, then he or she is admitted to the HBPC program.  Each member of the HBPC team then goes to see the Veteran in his or her home, does an assessment and decides how often they need to follow up with the Veteran.

Doing a nutritional assessment in the home is different than doing one in the hospital.  In the hospital, if the patient is telling you they eat healthfully, you can’t tell if they’re just saying what you want to hear or if they are being truthful.  (Although, labs can sometimes give you an idea.)  In the home, if a patient tells you that they eat well, you can always pointedly look at half-eaten bags of cookies and chips and ask, “How often are you eating these?”  With home nutritional assessments, I felt like I got a better sense of how the patients were doing nutritionally.  You could tell if their kitchen equipment was being used.  You could get a better idea of if they could only microwave food or they could cook.  You could look around and look for signs of pests.  If you saw something that worried you that wasn’t nutrition related (for example, uneven carpet that could be tripped over), you could immediately let the OT or SW know.  In HBPC, you might only see 1-4 patients in a day while you might see double or triple that in the hospital.  This is partly due to the travel you have to do between homes and partly because the HBPC visits take longer due to the complex issues of the patients.

HBPC requires skills that you develop in all of your rotations – counseling, geriatrics, nutrition focused physical exams, tube feeding – plus some extra skills like being familiar with all sorts of medical equipment.  I got to see what kind of medical equipment one can purchase for the home – things to make it easier for the patient and for the caregiver.  We brought some of our own equipment, too.  We ended up using this portable wireless wheelchair scale which reminded me of something out of science fiction.

As part of my rotation, I also assisted with a nursing home inspection.  I think I was the only intern to participate in a nursing home inspection during HBPC – everyone else did that during Geriatrics.  It really just depends on the inspection schedule and what rotation you’re in.  The nursing home inspection was interesting.  Since the VA doesn’t have the resources to build nursing homes everywhere to care for the Veterans who need skilled care, the VA contracts out with established facilities.  However, the facilities have to meet VA standards so a team comprised of people from engineering, nursing, social work, long term care, and nutrition go out and inspect the facility on a regular basis.  My preceptor and I inspected the kitchen, the serving areas, training records for the kitchen staff, temp logs, food storage areas, expiration dates…everything associated with a regular food service safety and quality inspection.  Plus, we also inspected the contract the facility has with their RD and her records associated with the Veterans at the facility.  I’m not sure what the social work or nursing teams look for (I can make some guesses, though), but we rode with the guy from engineering and he was looking at building safety – fire alarms, electrical outlets, sprinkler systems, etc.  It was a cool experience.

I know if I don’t end up doing HBPC with the VA, there are companies that provide home health nutrition.  However, I really loved the fact that I worked with a team and I loved the team I worked with.  While you work with a team in all rotations, this felt different- more relaxed, more congenial.  We shared an open office (meaning, everyone was in one big room with workstations) which made it so easy to immediately let another healthcare provider know something we might have seen that we thought they needed to know about right away.

While I loved HBPC, it’s not for everyone.  Some people are uncomfortable going into other people’s homes.  You might feel that some of the neighborhoods or homes are unsafe to enter.  I never felt that way, but I know some of the other interns mentioned those things.  Some interns had horror stories of disgusting homes crawling with bugs, but I never did, and I suspect that everyone’s definition of “disgusting” is different, as is everyone’s tolerance of bugs.  (I’m not going to be bothered by twenty spiders, but someone else might freak out at one.) As an intern, you never go alone, and part of the initial assessment done before the patient is even accepted into HBPC is to gauge how safe the situation is for the healthcare providers.  HBPC kind of reminded me of Meals on Wheels because depending on my route for MoW, I sometimes went into people’s homes to deliver their meals.

If you like the idea of providing personalized healthcare to homebound individuals and helping to keep them out of the hospital, you might like HBPC.  Or, as in my case, you might really love it.