Sunday, February 24, 2019

What Is It That I Do, Exactly?

Since lots of people have asked over the past couple years what exactly a dietitian does, here's my stab at providing an answer to that question:

I spent the past two years studying nutrition, which means I took several classes studying the ins and outs of metabolism (how your body breaks down and uses various nutrients and a little bit of where things can go wrong in that process). I also took classes looking at public health nutrition, epidemiology, biostatistics, how to teach nutrition (typically focused on group settings), nutrition counseling (lots of motivational interviewing and more focused on individuals), chronic disease and nutrition, and nutrition in acute care. We had one class that brought in various speakers from different fields and focused on how we feed a growing world population and how climate change will impact that. Another was essentially a book club, reading books about different aspects of food in our society. And so on.

All of that, plus my capstone project, earned me a master's degree. But I also had to go through a 1200-hour internship to be eligible to become a registered dietitian/registered dietitian nutritionist (RD or RDN - they mean the same thing, it's just personal preference as to which you use). The internship is to develop the skills you need to practice as an RD, complete several more assignments with each rotation, as well as introduce you to a variety of potential practice areas. Because there are a lot of places you can work when you're an RD:

  • Hospital, inpatient
  • Hospital, outpatient
  • Outpatient clinic not connected to a hospital
  • WIC (Women, Infants, Children)
  • Private practice (one-on-one counseling or maybe some group classes/sessions)
  • School dietitian
  • Long-term care/retirement community/assisted living
  • Veteran's Affairs
  • Military
  • Sports teams
  • Public Health agencies
  • Kidney centers
  • Food service - might be in a hospital or might be at other large food service operations
  • Industry - this could be anywhere from the dairy council to companies that produce tube feeding formulas
  • Home care company - these companies help people who need nutrition via tube or IV while living at home

There are probably others I'm forgetting, but the above a fairly extensive list. I didn't rotate through all of these work environments during my internship - usually I spent about 3 weeks at each site I went to. I did a community rotation at a camp for kids with type 1 diabetes and a WIC rotation. I spent 20 weeks doing inpatient and outpatient at hospitals (10 with adults, 10 pediatric - this was my chosen concentration). I also did management and food service rotations in a hospital, since I wanted to work in a hospital and our director was able to get me those rotations in that setting. Peers in my cohort spent time in dialysis (kidney) centers, eating disorder clinics, public health, schools, outpatient clinics, and private practice - you try to tailor some portions of the internship to your personal interests. After completing the degree and the internship, you have to take the RD exam (and get licensed by the state if that's something your state has) before you can practice.

What you end up doing depends a lot on the patient population you're working with. Food service management can include menu planning, waste assessments, purchasing, decisions around cafeteria layout, etc. WIC is primarily working with people who are pregnant and children under age 5. You assess growth and iron status, provide some nutrition education, and provide WIC checks for specific foods like milk, whole grains, fruits/vegetables, etc. Depending on your state and clinic location you might be able to provide referrals to a lactation consultant, social worker, or community health nurse (the WIC clinic I was at was able to provide all of these). In a hospital you could work in oncology, trauma, surgery, transplant, eating disorders, biochemical genetics (inborn errors of metabolism such as phenylketonuria or urea cycle disorder), etc. Sports dietitians work with athletes to optimize their intake for their particular athletic needs. And so on. Personally, I enjoy the hospital setting, especially working inpatient.

Finally, it's important to remember that, while dietitian is a protected term, nutritionist is not. In my opinion, if you want advice about your diet, nutrition, and especially how diet and any specific medical condition interact, you should definitely be looking for a dietitian. Once you find that, make sure they're a dietitian who specializes in your needs - because there are so many directions a dietitian can go with their career, not every dietitian will be the best fit for every person's needs.

Hopefully that helps answer some questions friends and family have had. If you have any others, feel free to ask in the comments!

Thursday, February 14, 2019

Snowmageddon

We had a very rare event the past couple weeks here (as you're probably already aware if you pay any attention to weather news at all): snow.

Typical Seattle snow is a flurry here or there for an hour or two and it doesn't stick. Or you might get a light dusting that's gone in a few hours once the weather changes to rain or warms up slightly. Or, like Christmas 2017, if the kids are really lucky, you might get 3-4 inches. Enough for a snowman and a small snowball fight. And then it's gone within 24-36 hours as we return to our regularly scheduled winter rain and 40 degrees. I love this about Seattle. It's a little annoying that streets don't get salted and no one shovels their sidewalks when we get those 3-4 inches, but I also understand that mentality since what's the point when it'll be gone in a day anyway?

The past couple weeks have not been that. We got hit with some snow a couple Sundays ago. Apparently I didn't even bother to take any pictures of it because I assumed it wasn't noteworthy at first. Then the snow stuck around and temperatures dropped and it turned into ice everywhere. School was cancelled Monday and Tuesday. Everyone was so over the snow by Tuesday - why is this white stuff sticking around, making it impossible to drive our (unsalted, now icy) neighborhood streets?! Parents were already desperate to send their offspring back to school. Temperatures were still below freezing Wednesday, but they had school with a delayed start (of course, that's also our early release day, so they were in school for all of 3 hours). Thursday was a full day but then the second wave was scheduled to hit Friday - with ice and snow still sticking around from wave one, so the schools called an early release. 5 days working from home for Ryan (he was feeling under the weather on Thursday).

I went to the store Thursday evening, realizing that we would need milk and a couple other items for meals over the weekend. The store was wiped out of produce, almost all milk, bread, tortillas, and meat. There were a couple packages of chicken livers left in the meat department. I got the last box of our favorite herbal tea and some of the last milk. It felt like people had arrived at the store, saw that what they needed wasn't available anymore, and just swept a bunch of stuff at random into their basket.

At work on Friday they encouraged everyone to leave as early as possible. But the snow took a while to start sticking, so a family from Alaska that I met at the bus stop was not amused that the city was already shut down. We waited a good 40 minutes for a bus (they usually come every 10) and by the time I got home the snow was starting to stick. A less than impressive amount (but a decent amount by Seattle's usual standards) fell Friday afternoon.


It started up again late Friday night and we woke up to a significant snowfall.


We all enjoyed it for a bit over the weekend and marveled at the postal workers still delivering mail. A mail truck got stuck on our street and in the end 5 passersby were trying to help move the truck.


They eventually got it out and backed it up, allowing it to change direction. I wasn't confident that it wouldn't just get stuck further down the street, but maybe they decided to stick to main roads after that. I did some shoveling of our stairs and front walk to try to prevent buildup, because at this point we knew we were supposed to get a third round. Main roads cleared up enough by Sunday that we were able to get out to the (restocked) store and purchase our groceries for the week. I made Ryan drive though, since our neighborhood streets were not in great shape.

Because more snow was called for on Monday, school was cancelled again. Sure enough, that afternoon it started up again and dumped several more inches. The evening commute was a little nerve-wracking as it was coming down hard and for the first time ever I was a little nervous every time the bus approached an incline. We made it though, and the boys decided to play outside that evening. There was so much snow on the bushes that they couldn't support it anymore. The snow on the deck was almost up to Mal's knees.



This round ensured school was cancelled for Tuesday as well. Things warmed up a bit after Monday and we started to get some rain, but roads around all the schools weren't clear yet, so no school on Wednesday. Not surprising, given our own street was pretty much impassable still, with high mounds of packed snow covered by slushy snow. In fact, the rain and warmer temperatures just increased the possibility of ice. Today the kids finally went back to school with a delayed start. Ryan got to go back to work today, after a week and a half stuck at home. Despite the roads being more clear, it ended up being the most treacherous walk to the bus stop yet - the melting snow/slush froze over during the night on one of the streets I have to cross, so I went crashing down. No horrible injuries, just a few scrapes/cuts on my hand and a little sore through my arm for a few hours from the impact. We are beyond ready to return to our usual rainy and 40 degrees with no snow in sight. Except for the kids, especially Mal, who loved getting to miss almost two weeks of school.

At this point, that initial snowstorm two weeks ago feels like a distant memory from months ago. Which might sound overly dramatic when you live somewhere that's flat and/or gets (and therefore is prepared for) more than an inch or two of snow each year. Apparently this is a once in 50 year type event for our region and I'm hoping it stays that way!

Tuesday, January 29, 2019

January

January's been a bit of a whirlwind and I keep finding myself shocked that it's almost over. M used his Christmas money from Grandma and Grandpa to buy a human body kit, and was super excited when it arrived.


The next several days were spent taking it apart and putting it back together over and over and over again.

A couple weekends ago I got a piece back from the framer, one I purchased at a community college art fair several years ago. My purchasing it seemed to make the artist's day - she said it was the first piece she'd ever sold. I was so happy when the framer and I found the mat to go with it (apparently they don't make mat in as many colors as they use to, so some pieces of art are getting difficult to find a good mat for, depending on what color paper the artist used).


I got the piece hung this last weekend, in a burst of "I'm going to be a responsible adult and accomplish things!" energy. (I even cleaned up that corner a bit after getting the picture hung.)


And, finally, I started a job last week! I'd interviewed for a per diem relief position just before Christmas and found out near the end of break that I got the job. Per diem means I'm not guaranteed a certain number of hours and relief means I'm filling in for RDs who are on vacation, sick, or otherwise out of the office; while I won't have guaranteed hours each week, from what I've observed many per diems are able to work several days a week and other RDs who've worked per diem previously have already told me to set boundaries, so I'm guessing getting sufficient hours won't be a problem. Relief can be a little scary because you have to know the basics of a lot of different services (i.e. cardiology, surgery, GI, NICU, etc.) and you aren't always on the service long enough to get to know your patients that well. But, as a new practitioner, I think it will have huge benefits in that over time I'll get to know and experience a variety of services that I didn't get to during my internship. It will help me build on what I learned in internship and create a nice, broad foundation before I narrow in on a specific service.

We are all still adjusting to our new schedule. Last Friday we had to ask a friend to pick up M from after-school care because I'd ended up needing to stay late and Ryan had to as well and Ryan's bus wasn't coming on time, so neither of us were going to make it home before the care center closed. I'm extremely grateful for the friends who help get G to and from school, since I'm definitely not around to help with that. About day 2 of me working we remembered that we had promised ourselves we'd be more consistent about kitchen cleanup each evening - when I came home to make dinner and realized dishes hadn't been cleaned up the night before and because of that I was definitely going to be late to orchestra rehearsal. We've been very consistent about it since. And the weekend had a mix of getting things like laundry and general house clean up done while also finding time to relax. Finding our new routine is going to be an adventure - frustrating at times, I'm sure, but worth it in the end. 

Thursday, January 10, 2019

Holiday Puzzle

We finished our holiday puzzle a few days before the kids had to go back to school:


This is Gareth's puzzle, but Ryan and I did most of the work on it. Gareth helped with the blue and purple tent a bit, but struggled with figuring out little clues as to which pieces might go together (slight differences in shading, etc). Ryan did most of the work on Harry. I did a lot of the rest. It was a fun puzzle to work on, with lots of interesting shapes to the pieces.

Friday, January 4, 2019

New Year Gingerbread House

We kept New Year's Eve simple, with basil chicken over rice for dinner. Mal didn't stay up at all (he's not old enough to realize this is a thing yet), but Gareth really, really wanted to stay up until midnight. So we broke out the cheese, crackers, and port or sparkling cider and plugged away at our puzzle while watching a couple episodes of Buffy and a bit of Infinity War. Ryan and I were ready to call it quits by 10, but again, Gareth insisted on staying up. Maybe in a couple years we'll just head to bed and let the kids stay up. We're still working on the puzzle, so no picture of it yet. As soon as it was midnight we immediately sent us all to bed.

I was busy with other things throughout New Years Eve, so didn't get to make gingerbread dough until New Year's Day. And then it took another couple days before we got a chance to decorate. Ryan joined in on the decorating this year. Malcolm wanted to make hearts out of all the things.





The kids have met up with friends here and there and I met up with friends today. It's been very nice to enjoy the holidays, but it'll be good to get back in the swing of things this next week.

Sunday, December 30, 2018

Christmas 2018

I decided not to buy another Lego advent this year, because they don't change all that much from year to year. So why not reuse it? Instead, I found a decent looking advent that we can put the Lego pieces in each year. I like that it has a variety of box sizes, some quite large, so we can put a variety of items in them if we ever decide to move away from the Lego scene. Of course, my kids' memories are way too good and at first they were kind of disappointed that everything was the same. But they got over it and still had a good time with it. Maybe we'll take a break from the Lego advent next year entirely and come back to it another time.


My mom always sends a countdown as well, which we've put up on the mantle the past few years. However, it felt like the mantle was getting a little overcrowded last year, so I needed to find a new place for the countdown presents. We decided to try out clumping them on either side of the fireplace, and I quite liked how that turned out.


I actually did a little baking this year! Not as much as I aspired to, but in the end, I did all that was needed. I made some cranberry orange pinwheels, which I had made years ago in our Indiana days, but forgot if we liked them or not. I also tried out some chocolate-raspberry thumbprints. I've been feeling drawn to thumbprint cookies recently. We made them many years when I was little, and then we all got tired of them or decided we didn't like them all that well or something and stopped making them. But I found this recipe and they looked lovely (the recipe calls for a chocolate drizzle, but I was too busy to do that) and tasted delicious. The chocolate dough isn't all that sweet, which is good when you've got a heap of jam or nutella or whatever you want in the middle. A couple of holiday parties made quick work of the cookies, but we all got a few before they were gone.



We received our traditional holiday grapefruit on the same day we went to get our tree. Tree selection was rather limited this year. I'm not sure if it's because we didn't get our tree until the 15th? But they had mostly blue spruce, which they wanted exorbitant prices for, and had very few noble firs and the prices on most of those were still well above what we remembered from past years. So we might have to re-think how we get our tree next year. But even with a little wonkiness here and there, it's been a lovely tree.



About a week before Christmas, Mal was being quite horrid. It really put a damper on things for me for a few days. We decided to set our expectations low for Christmas day and to return to having the kids select a present for one another, within a certain budget, to try to get him thinking about someone other than himself. So, the weekend before Christmas I took them out one at a time to the local toy store. I was pleasantly surprised that Mal did very well at remembering we were there to look for a present for Gareth and not for things for himself. And he even remembered things that Gareth had mentioned enjoying or wanting (they were out of his budget, but it was nice to see anyway). He also found a present for Ryan. We walked to the local coffee shop afterward for some hot chocolate and a gingerbread person and I told him many times how well he had done at staying focused on others.


Before we knew it, it was Christmas Eve. We went more traditional for dinner this year, opting for the ease of ham. Then we watched our traditional movie, with hot chocolate for the kids, and then sent them off to bed. I made a ginger pear punch to go with our dinner, which was quite tasty. Similar to the wassail my family made growing up, but much less sweet. And served cold, not warm (though you could do either). I did not garnish the drinks with dried pear. No way was I taking up my oven for 2 hours to dry pear slices. It looks pretty in their picture, but not worth it just for a garnish.

Ryan and I had to stay up until midnight before we could even hope the kids were maybe possibly sort of asleep so we could fill stockings and bring down gifts. But eventually we were all ready to go.


The boys didn't stir until 8am - they even stayed asleep when I went downstairs to prep some breakfast stuff! I thought for sure that would wake them up and they would be right on my heels heading back upstairs, but not a peep was heard. They excitedly waited for us all to be ready so we could head downstairs. Letting them watch something on my phone while Ryan and I showered helped with their patience.


Waiting at the top of the stairs. Ryan and I spent Christmas Eve night wondering how much longer Gareth will have this level of excitement for Christmas. We know it'll diminish at some point; it's a little sad to think he (and we) only have a few more years before that happens. What you enjoy simply changes a bit, but it is always a bit sad to lose that butterflies in the stomach kind of excitement.


Not only did Santa eat the cookie and toffee we left for him, but he also solved a puzzle of Gareth's and left it on the cookie plate.


Stockings were opened. Breakfast was eaten (after cleaning up a glass that was dropped on the floor during preparations; Mal dropped his grapefruit bowl with grapefruit in it on the floor twice during breakfast - it wasn't the smoothest of mornings). The boys wanted to help themselves to presents, so we let them each take a turn picking a gift before I took over as the manager of presents.




Mal was very pleased to receive the death costume he'd asked for. He spent the day alternating between being death and being the ghost of Christmas future from A Christmas Carol. It was very entertaining and he's worn the costume daily since.



He also got a ukulele, which we've all enjoyed taking a stab at.


Gareth was very excited for the family gift of a Nintendo Switch. He got a little confused, because we'd opened some presents from his grandparents that were labelled as being from Mom and Dad. So when this was also from Mom and Dad, he thought his grandparents had sent it (increasing his shock because he knew how much the system was and had deduced on his own that he could put it on his wish list all he wanted - no grandparents or aunts/uncles would be getting it). We clarified for him that it was from his mom and dad, not from his dad's mom and dad. And Malcolm momentarily thought that because Gareth had opened it that meant it was Gareth's ("not fair!"), which we also quickly clarified by having them re-read the tag on the present carefully.


Malcolm, while eating some jerky, declared it to be better than everything.


He also received a nether portal Lego set, which he immediately wanted to work on building. He makes great ghast noises.

Gareth received a dot-to-dot puzzle book that is definitely not for little kids. This is one of the puzzles. Another has just dots and provides a compass and compass directions which you have to follow.


Ryan's gift to me was some UW gear. My family are not much into the school spirit thing - I've never been into sports teams, and I never had any high school gear outside of my marching band shirts. I never bought any BYU stuff (it was expensive and, let's be honest, it was my safety school that I wasn't always thrilled about being at - as glad as I am now for the many friends (and a spouse) I met there and experiences I got to have and the lack of debt accrued). But I absolutely loved my time at UW and had actually been toying with getting myself something for a while. I ended up with a coat and a sweatshirt.

The coat. The purple is out of my comfort zone, but the coat is comfy and generally very simple (simplicity is a definite requirement to get me on board with school branded gear; it also needs to not have a "Rah! Rah! Sports Team!" feel). And it's good to push myself out of my standard black from time to time. Also, do note the boys in the picture. We were only at the store about an hour, but they talked as though we'd kept them there all day.


I look a little over-exuberantly happy over a sweatshirt here, but I was laughing at myself as I'm bad at taking selfies and wasn't expecting it to turn out very well. I think this is the only semi-decent selfie I've ever taken. How do people get them to turn out okay? It's a mystery to me.


Ryan's made the most progress of any of us on the ukulele, given he's practiced the most. Mal is actually doing quite well considering his age and lack of musical knowledge (which is where Ryan and I have an advantage; Gareth has the advantage of his fingers not hurting since he already has callouses from violin).

And that brings us up to date. We've been putting in some time on Mario Odyssey, which Mal isn't into. So now we've switched to more Super Smash Brothers, which he gets more enjoyment out of. This is pretty standard for him - he prefers games like Minecraft or Street Fighter on the computer and has not put much effort into Ori or games like that on the Xbox. We get another week of relaxation before everyone heads back to work/school.

Tuesday, November 27, 2018

Thanksgiving

I have to start by showing off the turkey drawing I did on our countdown board. The family was all duly impressed. I was quite pleased with how it turned out, given I've never had any artistic talent. Thanks goes to the online "how to draw a turkey" tutorial I found. I had to adapt it a bit to work with chalkboard markers, but that was easy enough. It's been rather fun experimenting with the markers.


I made the mistake of letting Mal watch GBBO a week or so before Thanksgiving (oh, btw, his new favorite show is Curious Creations of Christine McConnell, which combines baking and Halloween - the definition of Malcolm heaven). It was pie week on GBBO, and one of the pies had a lattice top, which he promptly requested we make. I've stuck primarily to pumpkin pies the past few years (since there are only 4 of us, we don't need tons of pies) and have never actually made a lattice top for a pie since our traditional apple pie in our family has a crumb topping. Also, due to watching GBBO and then doing some online querying, I decided to attempt blind baking my pumpkin pie crust. That didn't work out perfectly - I've started using a butter crust in the past couple years, which works well generally. But things got a bit rushed on pie-making day, and I really should have chilled the crust again before putting it in the oven. The butter definitely leaked out of the crust. Also, I was totally guessing as to how long to cook it and I'm pretty sure I didn't leave it in long enough. But the sides were shrinking in quite dramatically (I had a weight in the bottom, but I don't think it was enough to keep the sides in place), so I got nervous about leaving it in longer.


So that pumpkin pie basically boiled in butter while it was cooking. I didn't blind bake the other crust. I'm not sure they were drastically different. I'll have to work more on that skill, but the pies tasted good enough - no one in my family complained anyway!

I'm quite pleased with how the apple pie turned out. My BH&G cookbook had a good tip for how to easily weave the latticework. I ended up with extra apple filling and lots of extra crust, so the day after Thanksgiving I threw the leftover apples in a pie tin and covered it with crust, cinnamon, and sugar and baked it up. Apple pie without a bottom crust.


We had some lovely restful days together. Played some foosball (I joined in as well) and some video games all together. We also introduced the kids to "What's Up Doc?" and "Return of the Pink Panther"; Mal especially enjoyed the ridiculousness of Inspector Clouseau.