Week 7

I'm finally starting my second rotation! This is the second part of my clinical rotations, and I will be completing it at Texas Children's Hospital, which is also part of the Texas Medical Center. Unfortunately I couldn't trick security into giving me a discounted on site parking pass. Instead I will park at a $1 lot by the Rice football stadium and walk a mile to the hospital everyday. Here's to hoping it doesn't rain too much...

Monday:

First day at a new place is always exciting! Texas Children's is a really nice hospital. There are fun colors everywhere and lots of fun displays (trains, artwork, etc.). Definitely a change from Ben Taub. It helps distract from the depressing part of working in a children's hospital for sure. I spent my first day with Nidia who will be my main preceptor while I'm here for the next 5 weeks. My schedule is full of a wide variety of specialties, but Nidia will be my main contact and the dietitian I will spend the most time with. She is one of the dietitians in the NICU (neonatal intensive care unit). Nidia's background is really impressive. She did a special nutrition residency in the NICU through the Baylor College of Medicine. She knows a lot about NICU nutrition. She gave me a tour of the NICU. It's divided up into different levels and pods based on the severity of the baby's condition. She even let me chart on my first day, and we reviewed the NICU competency and infant formula calculations. Overall, a good first day!

Tuesday:

My second day was with the outpatient GI dietitians. I spent my morning by myself reading through the competency for gastrointestinal patients. Each specialty at TCH (Texas Children's Hospital) has its own "competency." This is a packet of information compiled by the dietitian with a case study/quiz at the end. It's great for learning, but boring when all you do is work on these for 3-4 hours...Later in the morning we attended the Houston Pediatric Nutrition Group meeting. The physician's presentation was titled "Nutritional and Microbial Therapeutic Interventions for Inflammatory Bowel Disease." It was a very interesting presentation. Inflammatory bowel disease include things like Crohn's disease and ulcerative colitis. The doctor covered the manifestations and origins of disease as well as nutritional therapies. We also got free lunch, so I can't complain about that! We saw a couple patients in the afternoon, all of which were related to childhood obesity. We went over a lot of healthy food options and eating strategies for portion control. These type of pediatric assessments definitely require a lot of family involvement.

Wednesday:

I was with the same GI dietitian again today. I spent my morning alone with my competencies and readings again. Super exciting...Today was the obesity clinic day. When patients come into the clinic, they're seen by the nurse, doctor, dietitian, etc. Everyone just takes turns going in the patient's room. I also saw a patient with one of the other GI dietitians. It's been good for me to see different dietitians' counseling styles. It's nice to pick and choose the things I like as I develop my own style for assessments.

Thursday:

Changed things up today and worked with the ketogenic diet dietitian. The ketogenic diet is intended to help control seizures in patients with epilepsy. The diet is high in fat, provides appropriate protein, and is very low in carbohydrates. It intentionally places patients in a state of ketosis. It was really interesting to learn about. The patients on this diet are very closely monitored. They come in for frequent doctor appointments and blood/urine tests. Want more information? Look up The Charlie Foundation.

Today Nidia also gave me information on two babies in the NICU. I will choose one of them to complete a case study presentation on. One has more complications than the other, and I'm aiming for more of a "classic preterm infant." I'll decide soon-ish :)

Friday:

Friday I was with the ketogenic diet again, but today we were covering the muscular dystrophy clinic. Muscular dystrophy basically causes progressive muscle loss and weakness. From a nutritional standpoint, this is concerning when it comes to digestion, swallowing, etc. We want to make sure the kids with feeding difficulties are receiving adequate nutrition.

My first week was okay. A little slower pace than I'm used to after being so independent at Ben Taub. I'm gathering a lot of good information from the competencies and readings, but I'm hoping my interactions with patients will increase. I guess the disadvantage to seeing such a wide variety of specialties is that I won't be able to go into as much depth. TCH will be a good learning experience and has a lot more resources than Ben Taub. I'm glad that I have the opportunity to complete my clinical rotations at two different hospitals. I think my internship should be all about gaining exposure and learning as much as I can, and I think my schedule will provide that!