Monday, May 31, 2010


had another great week last week, nothing too new with what i've been doing, but still great! trying to get two little babies to grow who are waiting for heart transplants...their weight keeps dropping and one little one is almost back to her birth weight (she is two months old). so that had been a challenge. but they are doing ok as of now. i am sort of on my own tomorrow checking on our transplant patients because the dietitian i've been with is that's kind of cool, minus not getting paid.

i start a new rotation this week in hematology/oncology, so i'm preparing myself to once again see some pretty sad stuff, but i'm looking forward to it. the dietitian i will be with also works with failure to thrive kids, or kids/babies who just are not growing properly. their height/weights are typically way below where they should be on growth charts. there can be a huge variety of causes of failure to thrive- chromosomal defects, heart/lung problems, kidney issues, GI problems, metabolic issues, etc. or it just may be a environmental factor such as not enough food available, emotional issues, etc. huge variety. it's important obviously to reverse this growth stunting so that they can reach appropriate milestones for their age. anyways, i'm super excited to start this and to continue to get to work with kids.

keep praying (BIG prayers!) for my application at cinci children' a no for one application, but my other was sent to a hiring manager, so i'm praying for a phone call this week and maybe an interview. we'll see, i'm focusing on being hopeful this week.

Wednesday, May 19, 2010

eating disorders.

so i got the chance to sit on a counseling session for a patient with anorexia last week and it was super interesting. when i got to work this morning, the RD i'm working with said another anorexia patient came in over the night so she was ours to follow. i was pretty excited to see how they handle things inpatient because of how strict the protocol for anorexia really is. this patient is very young, and weighs all but 80 pounds. so sad. but seems very open to trying things and doesn't seem to have too many food aversions (things they simply will not eat), which is good. a lot of patients are obsessive about what they will and will not eat and that makes things very difficult.

these patients come in and are kind of thrown into the therapy they do inpatient without having any idea what exactly it is and it's very shocking, especially for the young ones and to the parents. every privilege these patients have revolve around them eating, the therapy they use is called the Maudsley approach. they are weighed every morning (are not told their weight) at the same time in a gown and after they have gone to the bathroom. they are allowed three aversion foods, or three foods they REFUSE to eat. other than that, the RD's pick everything they eat while in the hospital. we start at a very low calorie level, (800-1200 cal) depending on what they have been used to eating at home. we increase calories by 200 each day, working usually up to 2600 cal/day which is what most of them need to steadily gain weight back. if they don't eat all their food (which is eaten in a nurse's office with someone), they must take the equivalent in calories of what they didn't eat in Ensure (a supplement drink). they have 30 min to eat everything and have to stay in this office for 30 min after eating to ensure it stays in their stomachs. if they do well and eat everything, they get phone privileges & a hour of visitation. if not, they get these taken away.

there's a lot more to this protocol, this is just a snapshot of what happens initially. there is no messing around with this, it's so serious and a lot parents think it will just go away and get better. this is a lifelong struggle for these girls, its heartbreaking. i really enjoy working with this population though. frustrating, but very interesting. i love food to much to not be able to eat it haha keep praying for a sweet little baby waiting for a heart, she needs it badly!

Thursday, May 13, 2010

love my job!

still LOVING what i am doing!!! i'm beginning to be able to function/think on my own without having to ask questions every other second. was able to see a couple heart patients yesterday on my own-check their ICU flow sheets, see how they were tolerating feeds, see any weight gain, etc. it's cool with little babies because they have a certain growth velocity they should be gaining every day (example-20-30 grams a day) and so you can really chart whether their formula they are on is working for them or not. and i wrote and signed my own notes! i feel like a little kid getting excited over that...but it's exciting for me haha.

i completed my own consult today too for an EIGHT day old baby-eek! so so tiny! he was in the hospital because he had been feeding really poorly and losing weight-he isn't below his birth weight yet, so hopefully he starts gaining instead of losing. i called the medical team taking care of this little guy and explained why we needed to up his formula rate to give him more calories and protein...annnd get this, they asked ME if i wanted them to change the order! what is that?! typically doctors completely write me off with any suggestions. it was great to see the order change within 10 minutes of talking to them! i was a nervous wreck before they called, but i survived :)

anyways, that was my day today...i love it! i applied to a job at cincinnati children's yesterday, so please say a prayer. i'm not counting on getting a peds job right out of this fellowship (even though that would be ideal), so we'll see what happens.

Monday, May 10, 2010

quick update.

four days into everything and still loving it!!! like i said before the dietitian i am with is a saint and is ammmmazing at being patient with me and she is super smart. i'm doing my cardiology rotation right now and working mainly with cardiac transplants. i LOVE it! i don't know how long it's been since i've had four straight days of work that i love...a long time, that's for sure. haven't done TOO much, still just shadowing, but i have my computer access, so i should be able to do a little more! a patient waiting for a heart was listed on the transplant list thursday and got a heart saturday!!! so that is WAY exciting- hearts don't come around that quickly usually. pray this little guy stays healthy and recovers quickly.

i am currently applying to a job at Cincinnati Children's, so please say a prayer if you remember. i am trying to be hopeful about it and think positively...i've been stuck in a hopeless rut lately and don't want that to be hanging over my head when i start reapplying again. more soon once i have INTERNET on wednesday, ptl.

Wednesday, May 5, 2010

day one!

day one started out terribly and ended wonderfully!! i had my physical this morning and then had to get bloodwork drawn for my titers (hep A, rubella, chicken pox, etc) so if i don't have antibodies to them, i can get a free vaccination. kind of nice, but i don't like getting blood drawn. however, i am not scared of getting it drawn...i've had it taken so many times over the years that i'm OK with it. i sat down and told the nurse "i'm not so good with needles, but i've never passed out". so what do i do?? I PASS OUT! i was soo embarrassed! she had to stick me twice and made me squeeze a ball so i think i got freaked out thinking about how i was pumping blood out of my body. and i fainted. and woke up to four nurses holding my head up, holding ice packs on me and fanning me. haha horrible.

but i worked with a fabulous dietitian and she gave me a tour of the hospital, showing me where everyone covers, what unit clerks to avoid and what she does. i'm SO excited to really start getting into it and learning how to function on my own there. she was telling me how much more dietitians are valued over there and how they are more involved in the patient's care. i am going to enjoy working here so much, i can already tell. i was a tad overwhelmed just because not only do i need to get back into writing assessments, but i need to learn how to assess pediatric patients. MUCH different than adults.

i have a feeling i am going to appreciate my health and the health of those kids in my life that are healthy. the dietitian i was with was telling my how a couple of patients have already died on her and how upset she was. these poor kiddos were dealt a rotten hand for the beginning of their lives and i have a feeling i'm going to be doing a lot of praying as i come into contact with these kids. say a little pray for a sweet two month old baby girl i met this morning, she is waiting for a new heart. i'm so excited though to be doing this. i finally felt the Lord's blessing on this opportunity today.