Weight Loss Center

During the beginning of November I went to a weight loss center for one of my rotations. This was a very interesting rotation because when I think of weight loss centers I think of helping people make modifications to their diet and exercise regimen. This center definitely did this, plus more. This center offers Bariatric Surgeries to those that need it. These patients can be referred to them for multiple reasons. Many of the patients have tried dieting to no avail. This can be a result from numerous reasons; genetics, hormones, medications, and other morbidities as a result from obesity. To qualify for one of these surgeries you must have a BMI of 40 or greater, or a BMI of 35 with at least 3 other co morbidities. Some examples of co morbidities are hypertension, sleep apnea, uncontrolled diabetes mellitus, and obesity related physical and functional impairment that interfere with activities of daily living (ADL’s).

To be a candidate for the surgery the patient must get pulmonary clearance as well as cardiac clearance to make sure they are safe for surgery. The patient must also get psychological clearance to make sure that they are ready emotionally. This is a huge lifestyle change and patients must be prepared as possible.

There are three types of bariatric surgeries that work in different ways. There is a restrictive procedure, malabsorptive procedure, and combination procedure. The weight loss center I interned at does not do any malabsorptive procedured (ex. bilopancreatic diversion BPD). There are a variety of bariatric surgeries but this center specializes in three. There is the lap band, the roux-en- y gastric bypass, and the gastric sleeve. The sleeve and the Roux-en-Y are a combination of being restrictive and malabsorptive procedures and the Lap band is just restrictive.

http://www.nationalbariatriclink.org/articles-news-weight-loss-bariatric-surgery.html

With the Sleeve Gastrectomy approximately 60-80% of the stomach is removed. It leaves the stomach in more of a banana shape which is not as big as an average stomach. There is also a decline in the production of a hormone known as grehlin, which causes a person to feel hungry. With the decrease in size and grehlin, there is a decrease in food intake.

The lap band creates a small pouch that causes the individual to feel full quickly and will eat less. The band can be tightened or loosened by adding or taking saline solution out of the band through the port on the inside of the skin on the abdomen. The tighter the band is, the longer the food remains in the pouch increasing the duration of satiety. Because such a small amount of food may be consumed, nutrient deficiencies are possible.

The Roux-en-y is the most common bariatric surgery which also creates a small pouch. It not only does that, but also bypasses the entire duodenum and a short section of the jejunum. Because of this, deficiencies may also occur if supplementation and a healthy diet are not consumed. An advantage of the gastric sleeve surgery over the Rouxen-Y is that there seems to be less malabsorption, and dumping syndrome doesn’t occur as easily.
Before any type of bariatric surgery, most patients are required to see a Dietitian at least once if not multiple times. Pre- surgery goals are determined in these sessions, which will ultimately improve nutritional status of patient if goals are met. The patients must also try to adapt to not drinking soda or smoking pre-surgery.

The Dietitian plays a critical role in helping ensure the patients can be successful. Just because this is a weight loss surgery, does not mean that the patient doesn’t have to make life style changes. If anything, it is more critical that they do make these changes to ensure better health and better results.

Drop 10 in 10!

In late October I got a wonderful opportunity to attend a wellness class for hospital employees. The name of this class was called drop 10 in 10 and the programs mission is to help participants take small steps in changing there lifestyle potentially resulting in dropping 10 pounds in 10 months. The education material had some really catchy tips and they were usually offered in sets of 10. The class was ran by 2 Registered Dietitians so it changed the pace a little bit. In the middle of the class we all got up and used stretchy bands to do some weight resistant exercises.

Below are 10 tips for the week I was able to attend.
1- Commit to 10 minutes (this could be exercise and could be spread out and do it 3 times a day)
2- Strive to drink 10 cups of water a day
3- Delay 10 minutes when a craving hits (it may pass!)
4- Wait 10 minutes before going back and getting a second helping of food
5- Try not eating out for 10days ( or try not doing another habit)
6- Count to 10 when your upset instead of turning to food
7- Take a 10 minute power nap when your tired
8- Take 10 slow deep breaths when your tired
9- Take 10 minutes atleast a day for ME time
10- When you are bored try to get busy for 10 minutes

“Be informed, what you don’t know really can hurt you!”- RD teaching the class

iCook Sessions 1-4

So if you have been following my blog, you have heard about the program iCook! This program has been a very big part of my life over the past year and a half. When we did the pilot I was not able to participate in the classes because of distance. With the “real” study we were able to have some of these classes in Morgantown which really made me ecstatic. I got to teach four different lessons to a group of wonderful children.

Lesson 1: This lesson really taught the children how to use knives. We went through different tools you will come across in the kitchen and taught them how to hold your knives and hold the food properly to keep all your fingers out of the way. For this lesson we prepared a fruit salsa and tortilla chips.

Lesson 2: This lesson we really focused on food safety. We did a couple experiments. The first experiment we used cinnamon and oil and focused on hand washing. The next experiment was a demonstration using sponges, red paint, cucumbers, cutting board and a knife. I demonstrated the importance of not cross contaminating which was a very good visual. We then separated the parents and the children and the children made smoothies with me. I really tried to make it hands on so the children used teamwork in figuring out how much of which ingredient was needed. We made a green smoothie that had spinach in it which really threw the kids for a loop! We also made a pink fruit smoothie as well. The final verdict for the green smoothie was that they were surprised they couldn’t taste the spinach in it!

Lesson 3: For lesson three we did an awful lot of cutting foods. This was probably the most challenging lesson for the children because it required them to cut and peel a sweet potato, parsnip, chop carrots, mince garlic, and the grand finale…………….cut up an onion!!! These children were all crying, heck we were all crying! Most of children and parents had never tried a parsnip and they don’t eat these vegetables like this very often so it was good to take them all out of their element a little bit.

Lesson 4: This lesson was probably the busiest lesson. We spent most of the time focusing on cleaning and opening cans safely. We also focused on what things were canned in. Each child looked at the cans and tried to determine what it was canned in and what the best option is. The lesson also looked at more processed foods and why they might not always be the best option, especially for health. The recipes that were made were a canned fruit salad, a spinach fruit salad, and a baked cinnamon stuffed apple.
From all of these lessons I am going to share the most surprising and delicious recipe that we made so you could try it at home. Drum rolls please, the spinach fruit salad! I do not have an exact copy of the recipe in front of me, but that is the great thing about making salads, you don’t have to use exact measurements.

Spinach Fruit SaladIngredients:
1bag of spinach
1 pear chopped (if available)
1 can of mandarin oranges in juice (and save it)
¼ cup feta cheese
¼ cup pecans
¼ cup dried cranberries
Mandarin Orange Juice (amt. based on personal preference)

Directions

Mix all of the ingredients in a large bowl and toss till mixed and coated with juice. You might also want to add a little pepper on top to give it more of a punch!

Octoberfest!!

For the month of October, the kitchen at where I am rotating decided to have Octoberfest day. This meant that they wanted to offer a themed German meal for the employees to purchase. This is a big deal seeing how this facility is on a 2 week rotating cycle. This means the menu is set for two weeks and once the second week is over, it starts back again. When a different option is available, the staff really appreciates it. I got the wonderful opportunity to work in the kitchen and help with this German themed meal. We decided to have bratwurst and peppers, and sauerkraut with kielbasa. I volunteered to try and prepare the spatzal which is dough noodles with butter over it or a sauce. This was probably one of the hardest things I have made! For dessert we made apple dumplings and black forest cake and they were both absolutely delicious!

These are the pans of bratwursts with peppers and onions and the kiebalsa and sauerkraut.

Here I am making the spatzal!

The yummy apple dumplings.

The staff thoroughly enjoyed the meal, and I enjoyed the opportunity to learn how to prepare large quantities of food in a professional kitchen with those who prepare food as a profession.
Since Halloween is in October, there was also a pumpkin decorating contest. Dietary had requested that us interns decorate the pumpkins and we will pick one to enter into the contest. Below is a picture of our pumpkins and mine is the minion! His name is Gary.

My pumpkin is on the left.

Dialysis

The medical dictionary says dialysis treatment replaces the function of the kidneys, which normally serve as the body’s natural filtration system. Through the use of a blood filter and a chemical solution known as dialysate, the treatment removes waste products and excess fluids from the bloodstream, while maintaining the proper chemical balance of the blood. There are two types of dialysis treatment: hemodialysis and peritoneal dialysis.  Dialysis is for people that are suffering from End Stage Renal Disease, known as ESRD. This is when the kidneys are not able to filter the blood the way they were made to do

 Hemodialysis is where blood is taken out of the body through a complex set of tubes, run through a filter called dialyzer, cleaned of various impurities, and returned back to the patient. During its passage through the filter, the blood comes in contact with dialysate, which mirrors the body fluid except for the presence of impurities. This is conventionally performed in dialysis centers across various medical and commercial facilities and typically involves patients receiving dialysis three times a week with four hour session each time.

 Dialysis has not been that much of an issue so far while rotating in the rehabilitation center, but is still a specialization option when I become a Registered Dietitian so I thought I would dive into the two different types as a refresher for a review from my Medical Nutrition Therapy class. I got the opportunity to sit in on a patient receiving dialysis and really got a feel for how much the nurse needs to know and be quick on her feet.  For example, if a vein was not providing enough blood, the nurse would need to resolve the problem as quick as possible so the blood in the machine won’t have time to clot and clog the hoses up.  They also need to be quick because if a hose or tube would come undone, the machine circulates blood so fast the patient could lose all their blood and would essentially die.  

 Peritoneal Dialysis is the other form of dialysis where a synthetic tube is placed in the abdominal cavity which then allows dialysis by exchange of dialysis fluid at regular intervals. It can be tailored to individual needs so that the patient can perform this at night while asleep with the help of a small machine called “Cycler” or during daytime by performing around four manual exchanges, each lasting around 15-30 minutes. The picture directly below shows peritoneal dialysis.

This picture is showing peritoneal diaylisis.

 Taken from:  http://nephrology.medicine.ufl.edu/patient-care/renal-replacement-therpay/home-dialysis

Pressure Ulcers/ Pressure Wounds

Pessure wounds or pressure ulcers are another important topic when dealing with sedentary patients that aren’t able to move as often.  Being in a rehabilitation hospital many of the patients are in a wheel chair and are only able to take a few steps a day during therapy.  Most of them are trying to be able to walk enough to help their caregiver with transportations so they won’t have to worry as much about heavy lifting.  With all the sitting and laying that comes with an injury or an illness, the chance for a pressure wound to occur increases greatly. 

Below is a list of risk factors for getting a pressure ulcer.

1. Functional Dependance

2. Bed or chair bound

3. Difficulty swallowing or chewing

4.  Poor nutritional status

Indicators are:

• Triceps skinfold in depleted range

• Serum albumin ≤ 3.5 g/dL

• Dietary intake < 75% of daily needs

• Weight loss of ≥ 5% in 30 days or ≥ 10% in 6 months

5. Dehydration

6. Poor circulation

7. Stool and/or urinary incontinence

8. Poor skin condition

9. History of pressure ulcers

10.  Advanced chronological age

Taken from: wounds411.com

 

There are also different stages of pressure ulcers.

webmd.com

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In general, dietitians recommend an overall healthy diet when a person has a pressure ulcer. However, you should make sure you eat the following key nutrients to help a pressure ulcer heal:

• Protein     
• Vitamin      C
• Zinc

Traumatic Brain Injury (TBI)

So I have been rotating at a rehabilitation hospital this month of September and thoroughly love it.  One of the aspects I like the most is that the goal of the facility is to get the patient to a place where they will be able to go home and perform the activities of daily living (known as ADL’s).  This is a very fast paced environment where the patients go through intensive therapy of at least 3 hours but ideally 4 hours a day.  I have seen everything from just muscle weakness to amputees to stroke patients.  I am just going to pick one of the topics I am learning about and find very interesting.  This topic is Spinal Cord Injuries also known as SCI.  This is a very common injury in the rehab center and can occur to anyone at any age.  There are multiple types of injuries to the spinal cord that can occur and it can also depend on the location of the injury on the spinal cord. 

Taken from: serious-injury.com

  Depending on the severity of the injury will depend on the nutrition diagnosis to follow.  Since the patients activity level will be decreased due to their injury, watching the calorie and fat intake is very important to prevent weight gain.  On the same note, you also want to make sure the patient is receiving enough protein to help preserve muscle mass.  We also want the patient to receive enough fiber and fluids to help decrease the risk for constipation.  The bottom line is that we want to help the patient learn to eat nutrient dense foods to help the body have increased chance for a better/quicker recovery. 

 

Information adapted from Sci-health.org

iCook Recruitment

Outside of one of the schools.

Goofing off!

Waiting to talk to the kids.

As many of you know, iCook has been a huge part of my life for a little over a year now.  I was the campus coordinator for the pilot and it is also what my thesis is based around.  Since the beginning of the year the iCook research team has been planning the best way to try and recruit the 8,9, and 10 year olds needed for this study.  In May of this year we went to all the elementary schools to try and let the children know about this wonderful opportunity.  We got a few children from these efforts, but not what was expected.  Since the recruitment plans hadn’t panned out the way to be expected, the research team had to hit it hard again once school began.  That means that for the past three weeks we have been going in and out of the elementary schools in Mon County trying to get more children excited and interested in iCook. 

To try and make it more fun, Wendy and I decided to wear green mustaches to show to the kids that we are all about having fun!  I also decided that it might be a good idea to try and write a song/cheer to help get the children excited about iCook.  Since my dad was in the military I asked him and my other family members to help me out.  On a lazy Sunday we all were sitting around the living room trying to write a cheer.  This is what we came up with:

Food and fitness, family fun

Eating healthy on the run

I can do it, you can too

iCook Study just for you!

(This is the basic military repeat after me tune.)

Spread Positivity

Found this on pinterest!

As many people know graduate school is a very challenging time in ones life.  For my current rotation we are supposed to try and focus on becoming a better person weather that is becoming healthier, focusing on God more or just trying to have more “me time”.  Being in grad school I have quickly realized that it is impossible to keep everyone happy.  I have always been a people pleaser and try my hardest to do this even if it makes myself miserable.  I think this is one of the many lessons people mention about graduate school. It is even more important to learn while becoming an adult.  The key is to not let others get you down.  When you allow someone else to bother you it not only hurts you emotionlly but also hurts you with your work productivity. 

I was recently told to just focus on spreading positivity and I think that is wonderful.  No one likes to walk around unhappy and make others mad at them.  Whenever you get caught in those negative thoughts, weather your mind just wanders there or someone puts you there, it is important to try not to get sucked in.  My personal goal is to try and stay positive no matter what life throws at me.  I know I won’t be perfect at this, but I will do the best that I can!  Everyone reading this, try to spread positivity!

 2 Timothy 2:23-24

Don’t have anything to do with foolish and stupid arguments, because you know they produce quarrels. And the Lord’s servant must not quarrel; instead, he must be kind to everyone, able to teach, not resentful.