Thursday, May 27, 2010

Pep Talk

So in about 14 hours, I will be in the middle of my GIANT end of clinical placement presentation on Non-Diabetic Hypoglycemia. The problem is that I don't actually really know anything about this topic. Well I know some, but not nearly enough to talk for 20 minutes about it! AH! And of course the less prepared I feel, the less I want to practice and the more I want to just give up and sleep through it. I think just what I really need is an awesome pep talk. So I am going to be inspired by this little girl, and give my self an intense pep talk in front of my mirror tomorrow before the presentation to get pumped up!

Wednesday, May 26, 2010

Strawberry Overload

Until now, I did not believe it was possible to overdose on strawberries. But apparently eating two pounds of strawberries in one sitting is a bad choice. I can't move. My belly hurts. I think my heart may be failing. I'm sitting in the kitchen working on my non-diabetic hypoglycemia presentation for Friday and the berries were just sitting beside me on the counter. Without even thinking I finished em off, and then when they were gone, realized how much pain I was in. I feel like Violet Beauregarde, and may need an oompa loompa or four to roll me away and deflate me. If only I knew some....

Of course, since I'm working on my hypoglycemia presentation, all that's running through my mind is the pathophysiology of eating that much strawberry. I'm sure my glucose has spiked sky high causing a HUGE insulin response to prevent hyperglycemia. I'm sure my liver is busy converting all the excess glucose into glycogen to be stored there until I get hungry and need the blood sugar boost. I am also sure I am an absolute dork and really really need to learn how not to think about food. If I could go even ten minutes without some kind of edible thought I would dance around this kitchen with joy. It's quite pathetic actually.

Tomorrow is my last day of internship in Canada this summer, and quite possibly my last day of internship on PEI ever. I had my evaluation with my preceptors today and it went well, which was a relief! I wish I had remembered to wear a shirt that doesn't show sweat though because I had hard core nervous sweats going on before the meeting with them. I didn't anticipate any bad reviews, but you never know! I basically spent the afternoon awkwardly trying to do things normally without raising my arms. It involved quite a bit of flailing, I'm not going to lie. If you've ever tried to keep from your elbows up glued to the side of your body while still going about life as usual, you know what I mean. It was basically the opposite of those deodorant commercials where all the girls are secretly sniffing their arm pits to make sure they don't smell. I like to think that no one noticed, but at the same time I'm really glad that my evaluations were completed before I spent the afternoon looking like a complete crazy person. On the bright side I did learn an important lesson today. Always wear white or black on days you will be hot, nervous, or if you are just, in general a sweaty person. I am now going for a bike ride with Jess to attempt to deflate sans oompa loompa. I'm not very optimistic though...I also really wish I had weighed myself before the berries and again after...just to make sure I really got my moneys worth and got the whole 2 pounds!

Monday, May 24, 2010

Summer Lovin'

I got my first taste of island summer this weekend and I have to admit, it was just as glorious as everyone keeps telling me.

(Sambo and I at Canoe Cove today)

The only thing missing was a BBQ, which I don't own unfortunately. My intentions for the weekend were to be super productive and get lots of work done. I wanted to go into my last week of internship with everything done and ready for my presentation on Friday. Needless to say, that didn't happen. It was sunny and hot all weekend, so I spent as much time outside as possible, went for a few walks along the boardwalk, lunch with friends on patios, had some drinks on my deck, soaked in the sun and jumped some rope in the backyard. There are few crucial PEI summer happenings that I have yet to experience. The first is a field party; which I am told is a high school thing only, but I still might crash one before I leave in 2 weeks. The second is a bonfire; I almost went to one this weekend but plans fell through unfortunately. I want to roast marshmallows, make s'mores and roast hot dogs and cut them so they turn into octopus when roasted on the fire. I realize this may make me sound like I am about 5 years old and that's ok. I like to think I'm young at heart.
I found out today that I will be home for the MCC home regatta! This is basically the best news I have heard in a very long time! I love home regatta! I'm going to try to sneak into a war canoe if I can, even though I haven't paddled since Nationals. I'll have about a week to train up between the time I get home and the regatta so I might be able to survive the 180 meter race. Mostly I'm excited because it means everyone will be in one place for a whole day. The problem with only being home for one week this year (between Christmas Holidays and Christmas Holidays) is that you have all these intentions of seeing everyone and hanging out with everyone but there just isn't enough time to fit everything in! So I am apologizing in advance to anyone I said I would go see and don't get to. Luckily almost everyone I want to see will be at home regatta which is extremely convenient. While I'm home, I also really want to go to the Harry Potter Exhibition at the Ontario Science Center. I love that guy.
The problem with getting a 3 day taste of summer is that it makes internship look a lot less appealing. Obviously I'm not complaining because I have loved interning at the hospital and will be sad my placement is over. But at the moment, all the school work associated with internship is a huge pain, and my presentation on Friday is looming above my head like an annoying fly buzzing in my ear that won't go away no matter how many times I swat and swear at it. But, this time next week it will all be over...until I get to Kenya. Wouldn't it be nice if all summer I could be free of responsibilities, and just roam around the city in flip flops, pony tails and sunglasses? Taking trips to the beach on a whim, reading books in my deck with a cold beer in hand and watching Earl explore the grassy backyard, munching on ants? Sign me up!

Friday, May 21, 2010

Billy Bridges

The Friday before a long weekend is always fabulous, especially when you get a call at 11 letting you know you have the afternoon off! Yahoo! It also helps that its sunny and warm out!

This morning at the hospital was excellent! It was a pretty slow morning, and we even had some downtime in which I searched for peer reviewed journal articles about hypoglycemia. I mentioned a patient a few days ago who had had a colostomy and as result had an external colostomy pouch. We were referred to see her again today to increase her calorie consumption. When we arrived to see her, her colostomy bag had just burst, so the nurse was in helping her clean everything up. We waited in the hall until she was decent and then went in to see her. The doctor had prescribed 3 cans of Peptimen 1.5 daily with flavour crystals for taste, but for some reason she wasn't getting them. Peptimen is a supplemental beverage that is basically pre-broken down and ready for absorption by the body. This patient was having a lot of issues because everything she ate was going right through her without being absorbed. She was wearing the largest, most heavy duty pouch they have but still have to empty it about 3 times per meal! The poor women! She broke down and started crying while we were there out of frustration. You can't help but feel for her! She has kidney disease on top of the whole colostomy disaster, and doesn't even have any family ever coming in to see her. Unfortunately, if the peptimen isn't tolerated, there isn't much more we can do for her, so needless to say our fingers are crossed that it helps at least a little bit!

This week is The Canadian Paraplegic Association week at the hospital, so we were fortunate enough to have Olympic gold medalist in Sledge Hockey, Billy Bridges, give a talk at the hospital. He talked about how he got involved in sport, how he struggled with his disability growing up and how sport changed his perspective about his disability. Obviously I can't exactly relate as I have been fortunate enough to be healthy my whole life, but one of my favorite things about sport is that all athletes can relate on some level. No matter what the sport, it all takes hard work, dedication and involves the same frustrations and triumphs. He passed around his Olympic gold medal at the end and was around to answer any questions anyone had. It was a great way to end the morning! The most interesting part of the talk for me was his disability. He was born with spina bifida, also known as a neural tube defect. He was lucky enough to have a milder case of it. The interesting thing about spina bifida is that it's completely avoidable. It's caused by a maternal folate deficiency in the first 4 weeks of pregnancy. Unless the pregnancy is planned, it is not uncommon to not even know you are pregnant until 4 weeks in. How scary is that? Without even knowing you are pregers, you are permanently damaging your baby. It is for this very reason that it is recommended that all women of child bearing age take supplemental folate. It's also one of the reasons that the majority of commercial grain products, such as pastas, cereals and breads, are now fortified with folate. I must admit, I am of child bearing age and am not taking a folate supplement, so I can't exactly sit here and preach to everyone to run out and get some, but it definitely wouldn't be a bad idea if we all did!

I got my packing list, emergency evacuation plan, itinerary etc for Kenya today, which is super exciting. I also only have THREE days of internship left! As sad as it is because I love my placement, it's a little bit of a relief at the same time! I'm excited to have a break from homework and assignments and 2 hours of driving everyday. I am also super super excited to go home! Just a little over 2 weeks!

Thursday, May 20, 2010

100 Things To do With a Banana

I spent the day at a Food Security Network Workshop which was super interesting and I learned a lot! I was hoping to write about food security issues tonight but I also have a huge assignment due tomorrow that has turned my brain to mush. I am therefore, sharing this link outlining 100 things to do with a Banana.

PS Get your heads out of the gutter! It's not that kind of site.

Wednesday, May 19, 2010

Damn You HCM!

As much as it sucked that I had to retire from paddling in September, I know I had it pretty easy compared to some other real athletes who are forced to retire from Olympic / national teams, or professional teams where they are playing for a living. Take for example Zac Herold, a member of the Toronto FC who, at the age of 17, has been diagnosed with HCM and has been forced to retire even before his first match. I can only imagine how he's feeling right now! Talk about bad luck! On the bright side, since he's been diagnosed and has thus far been asymptomatic, I guess he's really lucky. He could have potentially dropped dead on the field, which wouldn't be that uncommon for someone with HCM. I realize most of you saw this article a few days ago in the Toronto Star but as usual I'm a few days behind! Below is the article that was posted on Yahoo!

17-year-old Zac Herold forced to retire before first pro match

Football is sometimes described as a game of immortals. Whether it be on the club or international stage, it's a sport in which men some might consider well past their prime can be the spark of a team or magical title run. This, however, will not be the case for 17-year-old Toronto FC rookie Zachary Herold. The club announced Monday that due to a serious heart condition, their 2010 MLS SuperDraft second-round pick will be forced to retire before playing his first professional match.

Says TFC's official website:

Herold suffers from the condition Hypertrophic cardiomyopathy (HCM) – which causes abnormal thickening of a part of the heart muscle. With this condition, under strenuous exercise, there is a risk of developing a potentially fatal irregular heart rhythm, or arrhythmia. Unfortunately the only way to reduce this risk is to put significant life-long restrictions on exercise.

On Saturday, May 22 the team will honor the 2010 MLS SuperDraft pick in a ceremonial coin toss before the 1 p.m. ET kick-off against the New England Revolution at BMO Field.

A sad story about a promising young talent who has had his dreams dashed due to a health condition he has no control over, but at least now he's aware of his life-threatening condition.

Herold, who passed on interest from the Bundesliga's FC Cologne to join MLS, is coping with the situation as well as one can hope:

“Announcing my retirement from soccer at this age is something I never, ever thought would happen to me,” said Zac Herold. “I am grateful to Dr. Smith, and all the specialists I’ve seen over the last few months – this news was very hard to take but I know it’s the best decision for me and my health. My parents have been with me every step of the way, and it means so much to me that I’m able to `retire' as a Toronto FC player. The whole team has been wonderful to me and my family and although it’ll be a tough day, I’m looking forward to seeing everyone on the 22nd."

Aside from the troubling reality of such an early retirement, questions will now surely be asked of Toronto FC director of soccer Mo Johnston, who spent a valuable second-round pick on the former Under-17 U.S. men's national team member:

“Early in pre-season we did medicals on all our players, and obviously our doctor, Ira Smith, was concerned with some of Zac’s results,” said director of soccer Mo Johnston. “From there he then began a series of tests with a variety of doctors, in both Canada and the U.S. Zac’s health was first and foremost in this process. Our hearts go out to Zac and his family; it’s a very difficult situation. We felt it was the right thing to do by honoring him in front of our fans, and give them a chance to show their support.”

Toronto FC supporters will find it extremely troubling that Mo or anyone else at the club didn't know about such a serious condition before the pick was made, only to discover Zac’s problem through the team tests after he was drafted and his Generation Adidas contract was signed. Even still, it's better that they found out when they did instead of having something horrible happen on the pitch.

Tuesday, May 18, 2010

Just throwing this out is FINALLY spring in PEI! I wouldn't go quite as far as saying summer, but it's an improvement! A shorts and t-shirt run at 8pm is welcome any day. It was actually perfect running weather, hot enough not to need to bundle up but cold enough not to melt. Today was the first day nice enough to leave me starring longingly out the window from inside the hospital as we marched around visiting patients in various wings this afternoon.

It was a windows down, sunglasses on, barefoot, music blasting drive home. AKA Marvalous! And good news...after getting a new wheel bearing a few weeks ago, getting my muffler reattached and my oil changed, the Mary Kay is running nice and smoothly. I was informed, however, that a brake light was out and I need new tires. Nothing urgent though luckily. I'll fix the brake light this weekend (I'm becoming so car savy!) and wait til September for the tires since I'll be gone in less than 3 weeks. So if anyone is wondering what they can get my for my birthday....I would love a tire or two (or four).

Apply, Apply, Apply

So much for posting every day this month! Oh well....

We see a lot of patients in clinical with lower gastrointestinal disorders and diseases. I saw a women today who had had her colon removed, and as a result had a bag attached the to the outside of her body to house her poop. Most people who are unfortunate enough to need an external colon, keep it hidden under their clothes. Not this lady. It was just hanging out there, for the entire world to see. Not only was it clearly visible (and full!) she decided it would be a good idea to show it to us, in fine detail. Not only that, but she has a jug that she empties it into throughout the day, which was also full, and which she also felt the need to show us. Since her colon is gone, the poop doesn't actually solidify, so she handed us a jug of chunky brown liquid to look at. One would think that a normal person doesn't just leave a jug of fecal matter on their bedside table, but I guess she wanted to really drive home the fact that her food was going right through her, leaving her hungry all the time. Needless to say, we kept the meeting short and high tailed it out of there as soon as we could assure her that we would have the kitchen send her extra snacks several times throughout the day.

This little exchange made me really appreciate nurses. The longer I spend in the hospital the more I realize how much crap nurses deal with (literally!). We see gross stuff like that occasionally but nurses deal with it regularly. In fact, I'm sure that we make the nurses deal with even MORE poop and vomit as were prescribe patients various supplemental beverages that are frequently not tolerated by patients. It's not uncommon for the supplemental beverage to rush back out of a patient, from one or both ends. Although last week was nurses appreciation week, I am offering my belated appreciation to all you nurses out there now.

My first official meeting for Kenya is tomorrow, but I've met with the internship coordinator and the professor who is going with us already to sort out some details. I am no longer doing my June food service internship rotation because I'd actually only be available for less than half of it because of meetings and leaving for Kenya etc. Since I'm doing 5 weeks of placement in Kenya, I'll actually still end up being one week ahead of the other interns by the end of the summer. The great news??! I am now flying home to Mississauga on June 7th and will get to be home for a full week followed by 3 days in Ottawa, followed by another few days at home before I go. This will allow me to see all the people back home that I was sad I'd be missing all summer. I'll be home in less than 3 weeks and am unbelievably pumped! I'll probably even get to go for a spin or two in my boat...assuming I can still balance it after not being in it for so long! I am crossing my fingers that I can catch a war canoe practice at some point but I'm sure it's doubtful since I'm home for such a short time.

This past year has been very stressful and a lot of hard work but somehow I've managed to get everything I've wanted! I feel so spoiled! I've been trying to figure out what I have changed in order for everything to fall into place so nicely for me. Sure the whole having to retire from paddling thing wasn't exactly ideal and really really sucked, but then I ended up getting into the internship program which would have forced me to retire regardless. I've received scholarships for the first time in my life, I became an Academic All Canadian for the first time and I've been granted the opportunity to work with Farmers Helping Farmers doing exactly what I've dreamed about doing since high school in my all time favorite place ever. I can't think of a single thing I could want right now. Looking back, the only difference I can find that I've made is that I've just applied for more things. In high school, I just assumed I wouldn't have a chance at winning awards or making teams etc, so I didn't bother applying. But I have learned to just apply for everything, regardless of how outside your chance is of getting whatever it is you are applying for. So my advice of the day: apply. Even if you have a less than 1% chance of being accepted or winning, at least you just got extra practice writing an application letter, which will make your next one better, and increase your chances of getting the next thing you apply for.

Thursday, May 13, 2010

This is just a quick note because I've managed to post every day this month except one and now feel pressured to keep up the good work.

I experienced my very first two difficult / crazy / extremely rude patients today, met with my internship coordinator and decided to cancel my food service placement for next month, decided to do 5 weeks of 10 instead of 10 of 10 weeks of my community internship placement in Kenya so that I could gain Canadian experience as well in the field of community dietetics, filled out my Visa application form and set up a meeting to figure out how I can get a course credit while in Kenya since I'm a course behind. I also made the most bad ass packing list ever created. The trick will be getting everything on my list into my backpack. I will share crazy pt stories tomorrow when I have more time, plus I'm in In Patients all day tomorrow so there are sure to be some additional crazy people stories.

Now to bed for the next 4 hours until I wake up again to do it all over! Gotta love Casual Fridays though...jeans are extremely fabulous.

Wednesday, May 12, 2010


I spent the entire day in Out Patients today which was fairly uneventful. I got to take the lead on counseling another patient today who was supposed to be in for weight loss but revealed as she sat down that she was actually in for diverticulitis. Good thing I am a diverticulitis pro now and so it didn't phase me. This disease just keeps popping up!

We also saw a man who has had 18.5 FEET of his intestines removed (leaving only 1.5 feet remaining) due to severe Crohn's disease and Crohn's related surgery complications. He basically didn't have enough bowels left to digest or absorb anything he was eating so it went right through him, resulting in 6-8 bowel movements daily. He was on a tube feed to get adequate nutrients but still had issues keeping weight on. Not surprising! As interesting as patients like this are to see, it really makes you appreciate your health. I am with people all day who are ill, injured, diseased and dying. And they are all generally in good spirits and are just happy to have someone to talk to. I have learned that when people come in to see the RD, they just want to talk to someone about their problems. People love to talk about themselves, and the appointment is about them figuring out their own nutritional issues with a little bit of help as opposed to me jabbering away about everything I have ever learned about their disease. We provide guidance, answer any questions the client might have and teach them what they need to know but at the end of the day, unless they want to make a change, and believe that the change is feasible, they will not be successful. This is why I try to let the client's decide for themselves what they want to change and how they are going to do it.

I got a whole slew of emails about Kenya today with about a million dates for mandatory training sessions that I must attend. Unfortunately, all of these take place during internship hours, so I have no idea how my food service placement is going to work out next month, or if it is at all. I might have to make that placement up next summer. I have a meeting to figure it all out tomorrow though. I am also getting an all expenses paid trip to Ottawa for three days in June to attend cultural sensitivity training. I'm more excited for Dirienzo's and Kettleman's than the training though. Unfortunately Geoff will probably not even be there when I am, but I love Ottawa and am excited for the free trip with the whole Kenya gang none the less.

Tuesday, May 11, 2010

KP Versus Machine

If my day was a movie, the robots and machines would have come to life and taken over the world. I was with the Out Patient RD this morning, and in celebration of Nurses Appreciation Week, we were giving coffee break nutrition sessions about healthy eating and shift work. My first task of the day was to get about a million different resources photocopied. No big deal. Except, she wanted them to be double sided. I was pretty proud of myself for figuring out how to make normal, one sided copies for one of the resources. This is one of those GIANT photocopier, printer, fax machine type things like they have in important places like offices and such. While making copies may not seem like much of a feat, there are A LOT of buttons on that sucker. It does so many crazy things that it seemed like a miracle that I got it to do exactly what I wanted and only what I wanted. There were a lot of nurses all around me too so the pressure was on not to screw up. Not to mention the fact that my preceptor was waiting for these handouts. Now came the tricky part...creating a double sided handout out of two single sided handouts. First try was an epic failure. Not only did I not end up with a double sided handout, nothing printed at all. Finally, after doing the exact same thing 3 times in the hopes that it would eventually work, (I know, BAD idea! Clearly resending the job wasn't working and I had now sent 90 copies to be printed) and starring at the machine pressing random buttons trying to make it look like I knew what I was doing, I realized that it ran out of paper. Sweet! I could easily just add some more in! So I put in another package of paper and immediately everything started spewing out of the machine at once! Several print jobs from various offices, 90 copies of my handout that we NOT double sided like they were supposed to be and I don't even know what else. It was basically like witnessing photocopier clearly had no control over what was coming out. Eventually I had the sense to cancel the copy jobs and stopped the printing at about 40 copies and saved myself the 50 copies left to be printed. At the time I thought that no one had noticed my photocopy FAIL but I must have been kidding myself. After that fiasco I just sucked it up and asked the nurse at the desk beside me who thought she knew how but didn't. Luckily I was smart enough to only make 1 copy until I could confirm it worked. Anyways, she proceeded to ask another nurse who asked someone else who then asked a janitor who then asked a patient's brother who was there visiting. Eventually someone figured it out, but by that time there were about 6 of us standing around the stupid photocopier scratching out heads and wasting paper. And these are the people keeping you alive in the hospital! Of course when my preceptor finally came to figure out where I was, I was just finishing up, and just kinda said "man it's a busy place! between paper jams and everyone trying to print everything all at once it takes forever to get copies done!" Luckily she agreed and said that it always works that way. I feel like a terrible person for lying but somehow I don't think they let you be a RD without being smart enough to at least make copies properly.

I had a ton of homework tonight and I learned last night that being at home makes me really unproductive because there are so many distractions and I get lazy and sleepy when I'm in my room because the only place to sit is on my bed. I have a desk but no desk chair. I need a couple war canoe blocks to kneel in! I headed to Starbucks to set up shop for a few hours and pound out some school work before coming home to watch Glee with Sam. I got about half way home from Starbucks and all of a sudden there was a horrific screeching coming from my car as if I was dragging my bumper across the ground behind the car. I pull over right away and got out and took a look thinking ' you have got to be kidding me! I just got this stupid car fixed!' Anyways, obviously it wasn't my bumper, but my muffler was just hanging out, no longer attached the the underneath of the car. Well shit. I had to get it home and didn't really want to drive the last 700m with the muffler dragging along the road behind me! I didn't really have much choice though, so I embarrassingly drove home with my muffler squealing along behind me. I called my Dad asap since I am pretty much the least car savvy person alive and he told me that if I could reattach the muffler to the bottom of my car with a wire coat hanger, and just needed to crawl under it and find places to hook the hanger onto. Picture me with a headlamp squirming my way under a car with a bent coat hanger in hand, clearly with no idea what I was doing. I somehow managed to get my muffler hooked back up high enough so that it doesn't appear as though it will drag anymore until I can take it to the garage to be fixed. I emerged from under the car covered in black, leaves in my hair, covered in dirt but so proud of myself that I showed off my blackened hands to everyone in the house. In the mean time I'm lucky to be able to carpool to Summerside. I am also extremely lucky to have the most fabulous roommate ever who is willing to drive me to meet my carpool at 645am!

I had my interview for the internship in Kenya after work this afternoon and by the time I got home from Summerside (about an hour later) I had an e-mail waiting in my inbox to congratulate me in my acceptance! Yahoo!! So in 40 days time I will be on a plane to Kenya with another Nutrition student, 4 nursing students and a couple professors. I am absolutely beyond pumped! I think I might even get a chance to go home for a weekend before I go to see everyone. I'll be able to grab my Swahili dictionary, Tilley Hat and some clothes I want to take with me, and maybe plan a big giant group dinner so I can see everyone before I go. There are no details yet to share since they just picked people today, but I'll keep everyone posted. Unfortunately this means no half marathon running this summer since I won't be here for it. Maybe if I ask nicelI'll pick up some running tips while I'm there! I'll be in the Mt Kenya region, and am going to see if there is any possible way I can climb Kilimanjaro while I'm there. I have no idea what my work schedule will be or if I get enough time off at any point to be able to venture down to Tanzania and up the mountain. I think I'm just dreaming now! Probably not very likely but time will tell!

Monday, May 10, 2010

Bowels Need Buddys Too

Today was a pretty fabulous day. It went by super fast and at the time it didn't seem very exciting but now that it's over, it makes me happy and excited to tell people all about it.

This morning I was working in In Patients. We only actually saw one patient all morning which isn't a lot but I got to work on a tube feed order for the first time. There was a patient transferred to PEI last night and is now at the hospital where I am. We don't carry the type of product that she was being fed and they sent over a couple bottles of the product she was being tube fed but she wasn't being released anytime soon and there was only enough food sent over for a day or two max. I spent most of the morning finding a comparable product carried by the company that supplies my hospital and then doing all the calculations to make sure that the new product was providing enough calories and protein for her injury needs. Protein needs increase quite a bit when we're sick or injured, and she has several open wounds which made her protein requirements particularly high. Unfortunately, none of our products fit both the calorie and protein needs, so I also had to figure out how much additional protein she would need via protein powder. Once the calories and protein are figured out, we needed to make sure her fluid requirements were also being met by this tube feed, and then adjust the rate of administration accordingly. So we figured it all out so that she's getting enough calories, protein, fluids and at what rate in mL / hr it would be given to her. So fun!! I can't wait to get another tube feeding patient!

The actual patient we saw today wasn't all that exciting. We had a patient with diverticulitis, which I actually knew everything about already because I already saw an Out Patient with it, but when we went to her room to talk to her she was being wheeled away for x-rays. We normally visit about 3 people a day who are either sleeping or not in their rooms or being attended to by other hospital staff so we have to leave and come back. Sometimes we'll visit someone as many as 4 times in one day without ever actually getting to talk to them. We got lucky with our patient today though as she was in her room and ready for us to talk with her. She was being counseled on weight loss...not my favorite. But the fact that she was a mental health patient spiced things up a bit atleast!

This afternoon I went to the Diabetes Education Center for the first time and met a new preceptor. Another classmate is already placed there so we were both doing stuff together all afternoon which was nice. We saw two clients but it was kind of boring. Diabetes isn't really my most favorite topic. Specially type 2 which is essentially a weight loss consult anyways. Although I do really like how many lab values are associated with diabetes. Blood sugars, Glucose A1C etc. I like looking at lab values and being able to interpret them.

The highlight of the afternoon was the Bowel Buddy! The diabetes center often gets products sent to them to be handed out free to clients. I guess the theory is that if the client gets it for free and likes it, they might go out and buy it themselves when their free supply runs out. Makes sense. The dietitian refuses to give any one anything that she would not eat herself, regardless of how diabetic friendly the product is. Today we tried Bowel Buddy Pomegranate Bran Wafers. Sound yummy don't they? Well at first bite, they taste exactly like they sawdust. But by the end of the cookie...for those who manage to stick it out to the end..they start tasting ok. Still not fabulous but edible and somewhat pleasant. My preceptor hated them. Couldn't even finish half a cookie and was going to throw them out unless I wanted them. Free cookies? Yes please! I realize that this is a little bit pathetic. Why on earth would I want diabetic fiber cookies even if they are free? I just really hate seeing food get thrown out, and I love cookies...even the gross kind. On the bright side they have 5 grams of fiber per cookie, and only 3 grams of sugar! The recommended consumption of fiber per day for a women my age is 25 grams. So naturally I ate three of them on the drive home. The third one took a bit of good old H2O to get down though, but none the less I am very content with the giant bag of them sitting in my pantry. Bowels need buddys too.

Sunday, May 9, 2010

Mother's Day

One of the best parts about getting older is being able to get to know your parents as more than merely the people who impose your bedtime and make you clean up after yourself. You finally realize that your parents are real normal people, with dreams and goals and weaknesses and lives that don't always revolve around you. Personally, I love this, and think it's one of the best parts about growing up. As I get older and have more responsibility and get closer and closer to being a grown up, I keep realizing how much hard work it is, and can't even imagine trying to throw three kids into the daily routine consisting of working full time, errands, household chores, physical activity, social life, appointments and the endless to do lists that always seem to be growing. Although I clearly have no idea how stressful it really all is, I'd like to give a shout out to all those parents out there, especially moms, and let you all know that eventually your hard work will be appreciated.

Since today is Mothers Day, I am dedicating this post to my own mother. She is actually the hero of my life, and I can think of no better compliment than "you are just like your mother." Me and my mom are very alike (at least I like to think so); we have the same sense of humor (or lack there of haha), we have the same birthday, and we both stress a little bit too much and we're both total dorks. No offense mom...but exhibit A below:
My mother is strong, smart, fun, caring, independent, understanding, beautiful, passionate, genuine, selfless, and too many more fabulous things to name, all bundled up into an amazing woman. She puts up with my hysterical stressed out e-mails, my constant request for advice and supports me without hesitation. She's my running buddy, my voice of reason and my inspiration. Happy mother's day mom!

Saturday, May 8, 2010

Congrats to the Grads of 2010!

Today is graduation day here at UPEI and as exciting as it is for all my graduating buddies, it's a little bit sad knowing that I will no longer be seeing them on campus and around town. They will be officially grown-ups by this afternoon when they receive their well deserved and hard earned diplomas. This time next year it'll be me crossing the stage to get mine (hopefully!), and I'm sure the year will fly by and be here before I know it.

Everyone at UPEI who has achieved the required grades will be crossing the stage today, but this isn't so for those students at Lincoln University. The university has implemented a rule that those graduating students with a BMI of over 30 must complete a required physical activity course that meets 3 hours a week. The class consists of water aerobics, dance classes, tae bo and other aerobic classes. If students are assigned to this course and do not complete it, they cannot graduate. BMI stands for Body Mass Index, and can be calculated by dividing your weight in kilograms by your height in centimeters squared. As a (future) dietitian, we use this calculation to determine disease risk and health status. BMIs are categorized as follows:
<18 = underweight
18-24.5 = normal weight
25-29.8 = overweight
30-34.5 = obese
35-39.9 = obese class 2
>40 = morbidly obese (obese class 3)
The problem with BMI is that there are a lot of factors that can affect body weight other than fat. For example athletes, or those with a higher percentage of lean body mass (muscles etc) may have an overweight BMI but not actually be overweight. In this case, waist circumference is also used to determine risk of developing chronic disease. Waist circumference and BMI are usually combined to determine a more accurate disease risk. The article does mention that for those who appear to have an overweight BMI simply due to increased muscle mass, they also record a waist circumference to weed these people out.

The Chairman of the school's department of health stated: "We, as educators, must tell students when we believe, in our heart of hearts, when certain factors, certain behaviors, attitudes, whatever, are going to hinder that student from achieving and maximizing their life goals."

Clearly there is a ton of uproar about this regulation, and as a result has been dropped by the administration and is no longer a requirement. The students affected by this rule are university students. The average age of a graduating University student is between 21 and 24 years old. These people are adults, and although many of them still depend on mom and dad for financial support, they are adults none the less. Do I support this rule? Not exactly, but I'm not in an uproar either. I like to think that by the time a person is 21-24 years old, they are old enough to understand the consequences and risks associated with being overweight / obese (obesity increases a person's risk of heart disease, type 2 diabetes, stroke, some cancers and other ailments). By this age, these people ( most of them) have made a conscious choice not to live healthier lives, not to exercise and not to take an active role in managing their body weight. A this point, I don't think that forcing them to exercise 3 hours a week is going to make much difference. They'll take the course because they have to, and then the majority will revert back to old habits and their old lifestyle.

What I would LOVE to see, however, is drastic measures like this being implemented on elementary, middle and high school children. The rate of childhood obesity is sky rocketing and type 2 diabetes is becoming more common in children now then ever before. I'm not saying we should lay the smack down and force all these kids to exercise relentlessly until they all have normal body weights, but I think that we should be making much more of an effort to expose these kids to a wider variety of physical activities than we currently do.

Obviously I am slightly biased as a former athlete and lover of exercise, and I understand that some people really do just hate to exercise, but I also went through public school, and have participated in my fair share of gym classes. I am the first to admit that I hated gym class in high school. I'm horrible at everything associated with gym class; basketball, floor hockey, volleyball, scooter boards, softball, field hockey, soccer...pretty much any ball sport or team sport. I have no hand-eye coordination and and a total spaz. It's not fun going to gym class knowing you suck at everything and feeling like the entire hour or so is going to be spent letting your teammates down. With experiences like this, you can't blame kids and teens for never wanting to exercise ever again. Luckily I have been exposed to different types of physical activity outside of gym class, and I believe that there is some sort of physical activity out there for everyone. The key is to teach kids this, and give them greater freedom to pick for themselves how they want to exercise. For some it will be a walk, others badminton, other yoga. By providing kids with exposure to a wider variety of activities, my theory is that a greater percentage of them will find something they like, encouraging them to remain active after school and throughout their lives.

I know this probably sounds a little bit rant-ish and I don't really mean for it to. I would just really like to see everyone happy and healthy! Especially children who don't have as much control over what foods they consume (fed by schools and parents mostly) or may not have the opportunities to try new activities outside of school.

Friday, May 7, 2010

If we work for a living, then why do we kill ourselves working?

I was invited to go out for lunch with my afternoon preceptor and some other dietitians and hospital staff this morning after I had already arrived with my packed lunch in tow. I was really torn because on one hand, I don't exactly currently have the finances to keep going out for social lunches with dietitians, but on the other hand it would have been a great opportunity to network and meet people in the field. One of the best parts about this internship is the opportunities it presents to meet and work with dietitians across several provinces and kind of get your foot in the door. So I felt bad turning it down, but since I am in fact paying someone to work full time, hopefully they understand and don't think I'm antisocial and lame.
My solo (ish) counseling session today ended up being more ish than solo. My client got overwhelmed with her current living situation (she's under a lot of stress: job, 2 kids under 3 etc) and actually started crying mid-interview. I also have not quite mastered the whole writing and talking about something unrelated at the same time thing yet, which is where my preceptor filled in the silences. I'm making it sounds like it was a total disaster, but I think it went ok. I guess I'm just expecting myself to be completely competent already after only a week. After this entire month, I'm only expected to be a novice or advanced beginner, which would mean I am incompetent of completing interviews on my own. I am discussing my performance today with my preceptor on Wednesday of next week to see how I did, where I went wrong, etc. Until then, my weekend is going to be filled with chart notes, research and presentations. On the bright side, it doesn't even seem like homework because it's actually relevant.

My interview for the Kenya trip is on Tuesday, so I should know more then. It's going to be a quick interview-decision-arrangements-leave process. Only a little over a month from departure.

It's now about 10 pm on a Friday night and I am pooped. I am not used to this whole working 8 hr days and commuting an hour each way thing. Mad props to all you working peeps out there.

Question of the day: if we work for a living, then why do we kill ourselves working?
Also, I came across a cake celebrating cupcakes. A cupcake cake. Or if you prefer, a cup(cake)^2 (read cupcake squared). I can't think of any better way to celebrate cake than with more cake!
Check out more fabulous cakes by clicking here.

Thursday, May 6, 2010


If there is one thing I have learned from working in the hospital, it's that 90% of all conversations are either directly related to, or somehow manage to incorporate poop. If not poop, then bowel movements which in my mind is the same thing. Even if no mention of poop or bowel movements was made, people tend to say do do a lot. Not on purpose, but in a normal everyday sentence without even knowing it. The trick is not letting them see how hard you are trying not to laugh. Apparently not everyone thinks it's as funny as I do. For those of you who are unsure as to how someone could say do do with out realizing it, here is an example: "It doesn't matter what you do do, as long as you don't do that." I'll admit it, I just snickered while reading that sentence in my head.

As a dietitian, poop seems to cause a lot of people's issues, and is often the reason for a referral. Too much poop, not enough poop, runny poop, hard poop...we hear all about all of it. I learned this week that often patients, specifically elderly patients and those in palliative care, will become really irritable and grouchy and difficult for the nurses to handle. This is understandable, I would also be grumpy if I was stuck in a hospital for a prolonged period of time while sick. The one thing that makes these people less grumpy, and in fact quite pleasant, is nice satisfying bowel movement. So basically our patients are of two types; those who's bowel movements are causing the problems, and those who just want more of them. After seeing so many people with bowel movement issues, you definitely learn to appreciate the small things in life...such as regular bowel movements.

Since I am working in a hospital, obviously there are a lot of wheel chair accessible bathrooms. Normally in large public washrooms, depending on where you are, you can be fairly certain that if you decide to use the extra large wheel chair accessible stall, there will not be someone angrily waiting in their wheel chair when you come out, trying to kill you with their eyes for taking advantage of their misfortune. But in a hospital you can't be so sure. The hospital where I am placed is really small, so each washroom is just a single person room. There are two washrooms right beside each other in the cafeteria, one is wheelchair accessible, and the other is not. Well after lunch the other day, the none wheel chair washroom was occupied but the wheelchair one wasn't. I stood there for a couple minutes trying to figure out what to do. On one hand I had to pee, and probably wouldn't have thought twice about using the wheelchair washroom except for there was a nurse using the ATM right beside me. This made me wonder: what is proper wheel chair bathroom etiquette? I looked down the hall, both ways, didn't see anyone in a wheelchair coming in my direction and I just went for it, hoping that the nurse was too busy getting cash for lunch to notice me, or at least too busy to notice me enough to recognize me at a later date as I walked past the nursing station. I still have no idea what proper etiquette in that situation is. Obviously had there been someone in a wheel chair either waiting or approaching, I would have waited and given then the washroom, but there wasn't. I'm hoping this doesn't make me a terrible person.

I wasn't actually in the hospital today, we had a Clinical Dietitian's meeting with about 12 clinical RDs from across the province. We discussed interesting case studies people had encountered, new and innovative resources that were being used to educate clients and patients, and had a rep from Abbott Laboratories come in to do a presentation on elderly patients. The presentation was all about the syndromes that are associated with the severe weight loss and anorexia that often develops in older individuals and how to improve the care we provide in hospital to these clients. She also brought a new product called Promod (or something like that?) for us to taste. One of my performance objectives that I must accomplish to "pass" this internship placement is an evaluation of the commercial nutritional products that we prescribe and recommend to patients. Examples are Boost shakes, Ensure, Glucerna etc. Last night I brought about 5 different products home to taste test and since I didn't want to do it alone, and wanted more opinions for my report, I invited my roommates to join in on the fun. The first product was Boost Vanilla Pudding. I had high hopes for this one...I like pudding, it can't be THAT bad right? WRONG! I almost threw up my intestines after tasting it. It was horrible! Only 2 of the five products, in my opinion were edible. Chocolate Boost and Chocolate Graham Glucerna Bars. I could never ever make a patient consume these products knowing how horrible they are. The only time I think I could prescribe them is for an enteral feeding (tube feeding) because that way the patient doesn't even have to taste it. I for one, do not want to spend the last few days of my life being force fed gross chalky nutritional supplement drinks. When I get to that point, I want nothing but ice cream, milkshakes, real pudding or rice pudding, whip cream and yummy delicious things. I am assuming that by this point I'll be on a mechanical soft diet due to lack of teeth, saliva and ability to chew anything or really swallow much, hence the exclusive inclusion of all soft foods.

Tomorrow I am doing an assessment and counseling session for a self referred client in out patients all by myself! My preceptor will be there, but sitting quietly in the corner unless I screw up. The client is coming in for a weight loss consult, so I'm reading up and gathering resources for the client.

Wish Me Luck!

Tuesday, May 4, 2010

New Disease of the Day: Diverticulitis

Another fun filled day of clinical placement down which is a little bit sad because it means I only have 17 days left! I started out the morning with the out patient dietitian. I hadn't met her yesterday but she's awesome. I just sat in on her assessments and appointments to see how she rolls and what she does, but hopefully I will have more hands on stuff to do tomorrow such as help assess and counsel clients. Eek! I got to learn about a couple of new diseases today such as diverticulitis. I had never even heard of it before but I feel fairly confident in my ability to counsel someone with the disease after just one day! My preceptor was really great at answering all my questions about the disease and giving me a whole bunch of handouts about it that the clients also receive. I just kind of sat in the corner and listened today which was a little boring, specially since the room is nice and cozy and warm which made it more difficult then I would have liked to stay awake. The out patient dietitian also does clinics for the community and has invited me to attend and help teach a hypertension clinic next week. A lot of her patients are referred for weight loss counseling in association with one of the many co-morbidities of being overweight such as type 2 diabetes mellitus, hypertension, hyperlipidemia etc. I don't think I will like out patient as much as impatient because I feel like you see a lot of the same thing, and a lot of weight loss which isn't exactly something I want to deal with every day.

This afternoon I was back in In Patient. We started the afternoon doing rounds. We met with all of the Nurses, Physiotherapy, Occupational Therapy, and manor liaisons from each wing and went over each and every patient in that wing to discuss their release and prognosis and if they need a particular service that they have not received yet (such as meeting with the dietitian). After two hours of these meetings with several different wings, I learned about so many cool and interesting people that were admitted into the hospital. There are soo many interesting and random and crazy cases in the hospital! It was really interesting and cool to hear about how they are being treated and it was nice to see how closely all the different health care teams work together within the hospital to provide the best care possible. After two hours of meetings, we finally got to go out onto the floor to see patients. We only had time to visit one person because he was complicated and had about a million food allergies. Although we can't exactly cater to everyone's individual wants and needs, we do legit try our best to keep everyone fed and happy. This particular person could not consume gluten, any bi-products of beef (meat, gelatin, dairy), soy, or legumes or fruit or anything really so we asked tons of questions and talked to the kitchen to see what we could do for them. I am very impressed with the service we provide so far, which makes it a lot easier to love working in the hospital.

After work, I headed to Starbucks and spent the evening reading through my nutrition text book to learn about reactive hypoglycemia for my clinical presentation at the end of the month. I also made sure I learned all about diverticulitis and freshened up on the medical nutrition therapy for nutrition management so that I could be more useful in my out patient placement tomorrow afternoon. I think I just need to be more vocal and outgoing tomorrow, so that's my goal. until then I'm going to watch Glee, make my lunch for tomorrow, and get everything ready for tomorrow. The extra sleep is key, specially if I don't want to be drifting off in the out patient dietitians office tomorrow afternoon!

New Disease of the Day: Diverticulitis
Diverticulitis occurs as a result of diverticulosis, which is when small pouches (called diverticula) form on the outside of the large intestine or the colon. When this pouches become clogged and inflamed, it's called diverticulitis. This can be painful and requires an altered diet to control and reduce inflammation. When the pouches are not inflamed, we recommend a high fiber diet, lots of fluids and avoidance of nuts and seeds and often those suffering will also avoid corn and peas and things that can get lodged in the pouches. The high fiber helps keep the contents of the intestine moving which helps prevent inflammation from occurring. When the pouches are inflamed however, we recommend a diet low in fiber until the inflammation subsides to rest to colon and give it time to heal and then patients should gradually re-introduce a high fiber diet. This is a just a super brief rundown so if you are suffering from diverticulosis or diverticulitis, you should see your dietitian before following any of the following advice as each individual case will have slightly different needs!

Monday, May 3, 2010

Clinical Day 1!

Although my first day at the hospital was fairly uneventful, I think I am going to love my placement! I spent the majority of the morning taking a tour of the hospital, which was fairly useless because I still have absolutely no idea where any thing is, but I got to see 2 patients after the tour. I loved seeing patients! They were both very friendly and easy to work with. One had an allergy to chlorine and couldn't drink tap water or eat anything that was cooked in tap water, and the other had post polio syndrome. Both interesting cases that I had never seen before. My preceptor just graduated from the UPEI program this past November so she knows exactly what it's like to be an intern and is super chill about making sure I complete all my learning objectives. I spent the afternoon at a manor with a different dietitian since my preceptor only works part time in the mornings. The afternoon was spent analyzing the nutrition composition of recipes that the manor makes in order to determine if the diet recipes are in fact appropriate for diabetic patients and patients with special diet orders. We were looking at the calorie, protein, carbohydrate, sugar, fiber, fat, sodium and potassium values for each recipe. I ended up meeting up with a few of the other interns throughout the day in various places and talked to another two after I got home. I can't help but wonder how this isn't a reality tv show yet! I guess the whole patient confidentiality thing messes that up, but some of the stories from today are a little crazy already and its only been one day!

The days are going to fly by! I'm usually with the In-patient dietitian in the morning and the Out-patient dietitian in the afternoons, with a 1 hour lunch in between. Although the day went by fast, I am pooped! I had to get up super early because I was so unprepared last night for this morning. So right now I am packing my lunch and my books and my clipboard and my name tag and making sure everything is ready so that I can just wake up, eat breakfast and hit the road. I'm hoping this will give me at least an extra half an hour of sleep. I drove out to Summerside by myself this morning but have found someone to carpool with from now on which is awesome because it'll save both of us on gas money. My carpool starts half an hour before me but I'm planning on bringing my book with me and grabbing a coffee while I wait, or going over my notes from the day before or working on my presentation on non-diabetic hypoglycemia.

I am sooo pumped for tomorrow! I'll be meeting a new dietitian in the morning to do Out-Patient and then I'll be back with my preceptor from this morning to do In-patient in the afternoon. I feel like tomorrow is really my first day because today was just orientation and stuff. I'm off to get ready and get to bed early so I'll be ready for a big day tomorrow. It;s also POURING rain right now and is supposed to start thunder storming soon too. Our house is super old so I can hear the rain on the roof in bedroom. Perfect for cozying up nice and early with a book. 9 pm bedtime it is!

Sunday, May 2, 2010

Beardcapped Zombies

T minus 11 hours until my alarm will be buzzing and I'll be dragging my butt out of my bed to get ready for my first day of internship. I am currently making copious amount of chili and soup to put in my freezer so I'll have things to pack in my lunch, printing off directions so I don't get lost and making a sweet mix tape to rock out to on the drive. I am extremely excited to get this internship business started. First there was a 3 year build up to the application process, and since there has been a build up to actually starting placements. This time tomorrow I should have a lot more to blog about though!

This weekend was pretty low key. I got my car fixed on Friday afternoon. It is no longer making a horrible noise and is running nice and smoothly and is seemingly good as new. I worked Friday through Sunday but still managed to squeeze in some shopping, and a dinner with the girls on Saturday night.

My application for the internship in Kenya is officially submitted and I should have an interview sometime next week. This time next week I should know if I'm a winner or not, and from there we'll just be waiting to see if we get the funding or not. While stumbling online, I came across a list of the most useless travel gear, which was randomly appropriate, and I came across this fabulous bearded cap. Perhaps it's true that it's a little bit useless to bring traveling (unless of course you're traveling to the arctic) but I think it would be perfect for those long against-the-wind walks to campus in the winter. And if 'the gentleman' style isn't really doing it for ya, you can always invest in 'the farmer' style instead. But beware, apparently there are fake beardcaps out there. The fake version even comes with optional add on Mario, Walrus or Fu Manchu staches. I think I know what'll be on my birthday wish list next September!

Tonight I'm going to a screening of a movie called Dead Run by Peter Murphy. He's a friend of a friend and was featured in this month's Buzz. It's a zombie movie and should be a good time! It's loosely inspired by Run Lola Run which I'm a huge fan of so I'm pumped! My friend Jess has been doing some acting in his current project so I'm stoked to see that movie too! I'll have a full film review tomorrow hopefully!

Saturday, May 1, 2010

Beekeepers Beware

How crazy is this? Colony collapse disorder and the drastic decrease in the honey bee population keeps getting more and more serious, and in Japan is leading to honey bee theft. Check out this short article I stumbled upon:

Thieves rustle honeybees in Japan

The Japan Beekeeper and Honeybee Association has warned its members about a spate of hive thefts caused by a government ban on honeybee imports.

Police suspect a gang of specialist thieves is stealing honeybees, after the price of the insects doubled to more than $400 due to the ban.

Eight hives of 60,000 bees were stolen together from five farms in the central Shizuoka prefecture, where farmers keep honeybees to propagate strawberries.

The number of honeybees has dramatically decreased since November 2007, when queen bee imports from Australia were halted after they were found to be infected by the nosema parasite.

Over two million honeybees were stolen in 2009 and thefts are becoming more frequent, the BBC reported.