whoooops.

so i haven't posted in a long time on either of my blogs. i finished up my GI rotation and it was a blast. and went by SO fast! i'm on to neurology, which i have to admit, is the one i've been looking forward to the most. i love working with the ketogenic diet since it's so personal to me and i know a lot about already. i met a patient's mom yesterday who's baby went from having around 50 seizures a day, down to 1 or 2 through being on the ketogenic diet and is on no meds. how amazing is that? the neurology dietitian is amazing. i'm convinced she knows just about everything and is so great to work with. she is excellent at throwing me in and letting me do however much i can and then she jumps right back in without making me feel stupid, and takes over from where i get stuck.

i was at a muscular dystrophy clinic today which was super interesting and i saw most of the patients on my own, yay! there are many forms of muscular dystrophy, but a loose definition is its a group of disorders characterized by muscle weakness and a loss of muscle tissue that gets worse over time. there is no cure for muscular dystrophy and the severity of the disorder depends on the type of MD it is and how fast symptoms progress.

i did see one patient with SMA. Spinal muscular atrophy type 1 or SMA type 1, is a very severe muscular disease and is detected shortly after birth. the mortality rate is around 90-95% by 18 months of age. they lose their ability to suck and swallow, so parents must decide whether to put a feeding tube in or not, depending on the severity of their disease. the saddest part of a lot of these neuromuscular diseases is that the brain is not really affected. so most of these kids are of average intelligence and are not mentally handicapped, however, their bodies just aren't working properly. i really really enjoying working with this population though. so much to learn about and so many ways to help these kids.

i did get a no to the neuromuscular position i applied to, so i was pretty bummed. still waiting on a couple other positions and am looking into nannying too until i find something else. thankfully i have a lot of fabulous people in my life reminding me that the Lord IS good and He is still in this, even when i can't feel Him and feel hopeless. He is good and He is walking through this with me.

new rotation

quick update before bed! i started my gastrointestinal rotation with a faaaabulous dietitian on monday. she is super fun and talkative and makes the work day go by fast. and she is super smart, i've been learning a lot. a tad overwhelmed, but its been great! i would really like to work in a GI setting. i've seen a lot of kids with various issues with their GI tract, so wherever food passes through...constipation, irritable bowel syndrome, crohn's disease, eosionphilic esophagitis, food allergies, intolerances, etc. all very interesting and very nutrition related issues! the gastroenterologists (who study the GI tract and related diseases) really utilize dietitians which is great (most of the time!). i've met most of them and they are super nice. the only drawback is its a lot of phone calls and i hate the phone! so that's taken some adjusting.

still waiting on hearing about those jobs, keep praying! my time at children's is quickly nearing its end...i'm done august 13th, so it's crazy i'm over half-way through. sad :( off to carrollton for the weekend with the newlywed lavelles and seeing jordan! and HOPEFULLY my bestest friends/roomies ever as well :)

rotation #2 done.

i finished up my second rotation with an amazing dietitian in hem/onc and a lot of failure to thrive kids. i learned sooo so much working with this population and really liked it! so sad at times, but i still love what i'm doing. i like having a job in which i feel valued (most of the time!), except when people put a consult in because a 17 year old kid won't eat vegetables. that didn't happen to me, but it did to the last dietitian i was working with. really?! that's not what we do! haha. although working with kids can be very sad and there are so many sad situations, there are lots of funny stories that come of it! one lady said that her child wasn't throwing up on the outside, so the doctors were looking to see if she was throwing up on the inside. hahaha. i cracked up with that one.

moving onto working with a RD who does mainly outpatient GI (gastrointestinal) clinics. i'm anxious to start this rotation, i think it's going to be so interesting and something i would like to do. and the RD who i'm with is super fun and spunky which always makes the work day better :) please keep praying for the jobs i applied for. i know it will work out perfectly, but i'm still struggling with finding peace in that. working with kids is what i'm so passionate about and i know i love....so i hope that i get the chance to do this for real.

new rotation.

i'm onto a new rotation this week, hematology (study of the physiology of the blood & blood disorders) and oncology (cancer). i think i mentioned this in my last post, i can't remember, but the dietitian i'm with also works with a lot of failure to thrive kids. very sad stuff, but i like the challenge of working with families and kids and trying to find what works to get them to grow whether that be through a tube feeding or regular food.

saw a patient with ALL (acute lymphocytic leukemia) today. ALL is the most common leukemia seen in kids and is also the most treatable. there is also a type called AML (acute myelogenous leukemia) which is treated much more aggressively and is harder to get into remission. i also will be seeing another patient tomorrow with hodkin's lymphoma (type of cancer originating in the white blood cells, that spreads from one lymph node to another). the survival rate is very high when detected early on. this patient i am seeing is having a bone marrow transplant soon for the treatment of her disease. props to oncologists...although these diseases are super interesting, it has got to be such a difficult job to lose so many patients. i can't even imagine being a pediatric oncologist. it just seems so unfair to these kids, they are perfectly normal/healthy and then boom, their worlds are turned upside down. they are amazing really (the kids that is). i suppose the doctors are too...

i think i'm doing my neurology rotation next which i am SO excited about. i loved working in neurology last year during my internship and really hope i hear back about the neurology position i applied to.

update.

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 off...so 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's...got 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.

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!

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.