Can't believe it's already my third week at Texas Children's! By the end of this week, I'll be more than halfway done with my rotation here, and then I'll be done with all of my clinical. Time really is flying.
Monday:
Today I was with Libby in the Cystic Fibrosis clinic. She is super nice! I really liked working with her. Cystic fibrosis is a genetic disorder that causes the production of really thick mucus. This mucus affects a lot of important organs and glands (lungs, intestines, pancreas, etc.) This disorder especially affects the lungs. These kids get this thick mucus in their lungs, which increases their susceptibility to infection. Nutritionally, a lot of these kids are underweight. The mucus coats their intestines or affects the enzymes that help digest their food. As a dietitian, your job is to pack as many calories as you can and help keep these kiddos healthy! It was sad to see the families with multiple children affected by this disorder in the clinic. One of the patients we saw was the recipient of a Make a Wish trip to Disneyland! Her prognosis wasn't good, but it was so cute to hear how much fun she had on that trip.
Tuesday:
Today was a NICU day with Nidia. I was able to update my flowsheets on my case study baby. I chose the baby that was more of a "classic preterm" infant. The other baby started developing some other medical issues that would've taken away from my prematurity research. I attended rounds with Nidia. Rounds are interesting in the NICU. Some days we just round with one attending physician. Other days we round with the attending, residents, and nurse practitioners. The NICU is also huge and there are multiple different teams rounding all at once. It's all kind of a blur! Today we went to intestinal rounds. All of the dietitians rounded with the team that sees all babies with intestinal disorders/problems. Today I was able to spend some time researching for my case study presentation. Nidia has lots of great resources from her nutrition fellowship with Baylor.
Wednesday:
Today I switched gears completely and spent a day with one of the eating disorder dietitians. Texas Children's has outpatient dietitians that meet with eating disorder patients, but today I was with one of the inpatient dietitians. All of her eating disorder patients are admitted to the hospital. Pam is really good at her job and is really an impressive dietitian. This was her last week of working at Texas Children's before she left for another position, so I'm really glad I could spend a day with her before she left. We helped some of her patients fill out their menus for the next few meals. We also helped some of the patients plan meal ideas for when they discharged from the hospital. We attended an interdisciplinary meeting with the physicians, psychologists, etc. that work with the eating disorder patients. That is a whole different world. I think it's really interesting, but I don't think I could work with eating disorders long term. It'd be really hard! I don't think I have the right personality for it.
Today was our weekly (more like every other week) intern meeting. Instead of having a meeting, we all went to a really good pizza place with Claudia (our program director). It's fun to see everybody outside of meetings and internship business. The pizza was really good too. You can't beat when your program director pays either :)
Thursday:
Today was another day in the NICU! I spent the day with Amy. It's been really fun to work with so many different dietitians. I love meeting people and talking to strangers (weirdo, I know) so I've really enjoyed getting switched around! My case study baby is on one of Amy's team. Interesting development with my case study baby. He started developing meningitis! So sad! His list of complications keeps getting longer and longer. The other baby that I almost chose ended up being totally fine and is just a "normal" preterm infant. Funny how it turned out opposite of what I thought. Should've expected that, right? It just gives me more to research and learn I suppose. Today was also journal club. I think the dietitians do journal club about once a month? I may have made that up. From what I understand, journal club is when one or two of the dietitians give a presentation on a certain topic. It's informative and helps the dietitians earn continuing education credit. Today's journal club was on all of the different types of milks there are! Cow's, almond, soy, hemp, coconut, etc. There are so many different milks! It was interesting to have them all compared and learn more about them.
Friday:
Today I was with Monica. She works with the cardiac patients. A different specialty means another competency. I'm getting quite the collection of good information. Nothing too crazy this day. I really liked working with Monica! Can't beat a good Friday to end the week! Officially more than halfway done with my rotation!
Tuesday, November 24, 2015
Week 8
To be honest, I was a bit disappointed with my first week at Texas Children's. I think I had built it up in my mind too much and it ended up being a really different week than I expected. I also was surprised by how much I liked being at Ben Taub, and I was a lot more sad to leave than I expected. Luckily my second week at TCH was much better than my first and I'm starting to really enjoy it.
Monday:
I got the day off for Labor Day! So much for the "interns don't get holidays or breaks"...I actually wish that I could've come in to get more hours, but since I don't really know what I'm doing at this hospital it didn't make sense to come in with the "skeleton crew." Not the best learning opportunity when the staff is so few in numbers. So, instead I slept in and enjoyed my day off!
Tuesday:
Today I was back with the ketogenic diet dietitian. I was supposed to be with a different dietitian who also covers these patients, but she was sick today. She taught me some more about the ketogenic diet as well as the low glycemic index diet and their uses with her patients. We saw the patients she had scheduled for the day and I finished up a chart note from the MDA clinic on Friday. Apparently outpatient dietitians have up to 5 days to finish charting on their assessments. I don't know how you're supposed to remember stuff from 5 days before, but it's nice to have some extra time if your work load is really heavy.
Wednesday:
I switched things up today! I was with Kari who is the dietitian that works with all of the bariatric patients. She sees patients pre and post bariatric/weight loss surgeries. It takes a lot for pediatric patients to qualify for bariatric surgery. We're talking severly morbidly obese kids who often also have significant cobmorbidities of being overweight. It's so sad so see such young kids already in danger of high cholesterol and blood pressure. A lot of insurance companies require these kids to go through about 6 months of a supervised weight loss program in order to qualify for the surgery. Kari helps with the nutrition counseling portion of this. She also helps kids post surgery adjust to their new lifestyle. Obviously if you had your stomach surgically shrunken, your portions are going to have to significantly decrease. Kari makes sure these kids are receiving all of the vitamins/minerals/etc. that their bodies need after having their GI tract altered by surgery.
I also attended a presentation in the NICU. The physician's presentation was titled, "Neonatology Physiology Lecture Series-Cardiac Surgery." I like attending these conferences. There's always a ton of information! The NICU is so foreign to me. It's nice to be able to gain more medical background on these patients. Plus, you can't beat a free lunch! It's the little things when you're an unpaid intern.
We also had our weekly intern meeting on campus at UH. We finished up the last few pathophysiology presentations. I've enjoyed these, especially since I've been doing my clinical rotations. I have definitely seen quite a few of the diseases in my patients.
Thursday:
Today I was with Brittany, the dietitian that covers the bone marrow transplant patients. She was really nice and so fun to work with. Brittany and I reviewed the competency and were able to see some of her patients. Her floor is really neat. It has special air filtration and is more strict on its visitor policies. Most of the kids aren't allowed to leave the floor after they receive their transplant. Their immune systems are so suppressed that any kind of infection could be really harmful. A lot of the kids on her floor have ALL (acute lymphoblastic leukemia). I learned a lot about pediatric cancers while with Brittany. It was kind of sad, but the kids are so cute! I also received more information on 2 different babies in the NICU. I'm deciding which one to follow for my case study. Both are very premature and have their fair share of medical complications.
Friday:
Today was another day with Brittany. In addition to seeing her patients, I also attended a lunch conference in the NICU on Midgut Volvulus. Basically this means that the infant's intestines have become rotated because of a malrotation during formation. It was really interesting. I'm always learning about things I've never even heard of before in the NICU. Brittany and I also practiced calculating TPN for her kiddos. You can ever have enough practice with TPN, that's for sure.
After my rotation, I went a football game at my high school alma mater with some good family friends that I've known since kindergarten. It was so fun (and weird) to be back at my high school. It was a fun way to mix up the week! Can't beat those Friday Night Lights!
Monday:
I got the day off for Labor Day! So much for the "interns don't get holidays or breaks"...I actually wish that I could've come in to get more hours, but since I don't really know what I'm doing at this hospital it didn't make sense to come in with the "skeleton crew." Not the best learning opportunity when the staff is so few in numbers. So, instead I slept in and enjoyed my day off!
Tuesday:
Today I was back with the ketogenic diet dietitian. I was supposed to be with a different dietitian who also covers these patients, but she was sick today. She taught me some more about the ketogenic diet as well as the low glycemic index diet and their uses with her patients. We saw the patients she had scheduled for the day and I finished up a chart note from the MDA clinic on Friday. Apparently outpatient dietitians have up to 5 days to finish charting on their assessments. I don't know how you're supposed to remember stuff from 5 days before, but it's nice to have some extra time if your work load is really heavy.
Wednesday:
I switched things up today! I was with Kari who is the dietitian that works with all of the bariatric patients. She sees patients pre and post bariatric/weight loss surgeries. It takes a lot for pediatric patients to qualify for bariatric surgery. We're talking severly morbidly obese kids who often also have significant cobmorbidities of being overweight. It's so sad so see such young kids already in danger of high cholesterol and blood pressure. A lot of insurance companies require these kids to go through about 6 months of a supervised weight loss program in order to qualify for the surgery. Kari helps with the nutrition counseling portion of this. She also helps kids post surgery adjust to their new lifestyle. Obviously if you had your stomach surgically shrunken, your portions are going to have to significantly decrease. Kari makes sure these kids are receiving all of the vitamins/minerals/etc. that their bodies need after having their GI tract altered by surgery.
I also attended a presentation in the NICU. The physician's presentation was titled, "Neonatology Physiology Lecture Series-Cardiac Surgery." I like attending these conferences. There's always a ton of information! The NICU is so foreign to me. It's nice to be able to gain more medical background on these patients. Plus, you can't beat a free lunch! It's the little things when you're an unpaid intern.
We also had our weekly intern meeting on campus at UH. We finished up the last few pathophysiology presentations. I've enjoyed these, especially since I've been doing my clinical rotations. I have definitely seen quite a few of the diseases in my patients.
Thursday:
Today I was with Brittany, the dietitian that covers the bone marrow transplant patients. She was really nice and so fun to work with. Brittany and I reviewed the competency and were able to see some of her patients. Her floor is really neat. It has special air filtration and is more strict on its visitor policies. Most of the kids aren't allowed to leave the floor after they receive their transplant. Their immune systems are so suppressed that any kind of infection could be really harmful. A lot of the kids on her floor have ALL (acute lymphoblastic leukemia). I learned a lot about pediatric cancers while with Brittany. It was kind of sad, but the kids are so cute! I also received more information on 2 different babies in the NICU. I'm deciding which one to follow for my case study. Both are very premature and have their fair share of medical complications.
Friday:
Today was another day with Brittany. In addition to seeing her patients, I also attended a lunch conference in the NICU on Midgut Volvulus. Basically this means that the infant's intestines have become rotated because of a malrotation during formation. It was really interesting. I'm always learning about things I've never even heard of before in the NICU. Brittany and I also practiced calculating TPN for her kiddos. You can ever have enough practice with TPN, that's for sure.
After my rotation, I went a football game at my high school alma mater with some good family friends that I've known since kindergarten. It was so fun (and weird) to be back at my high school. It was a fun way to mix up the week! Can't beat those Friday Night Lights!
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