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


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!