The Various Roles of an RD: Clincial Dietitian

As many of you know, I am currently in the middle of my Dietetic Internship (DI) which is the last step before I'll be certified to take the exam to become a Registered Dietitian (RD). Every DI across the country, whether based out of a college like the one that I got matched to or based out of hospital, has three elements to the rotations: clinical, community, and food service. Some DIs focus more on one particular element, but each program must incorporate each of those elements at some point. It's a great way not only to learn from many different preceptors and prepare us for the big exam that comes at the end, but also to see the varied roles that are out there for an RD once we pass the big exam! So I've decided that as I go through my internship and work with RDs in different settings I'll highlight that career path here. Hopefully this will give you a better picture of what an RD does and the various options available to someone in this field. Keep in mind that these descriptions are based on my experiences with people in these roles but the responsibilities are certainly different in different places.

Clinical Dietitian
A Clinical Dietitian works in a hospital with patients who are admitted as "in-patient" - this is different from someone who might work in a hospital with patients who schedule appointments to see him or her (that would be "out-patient").

At my clinical rotation a typical day for a clinical dietitian would look something like this:

First thing in the morning, print the sheets that tell us everyone who is currently admitted to the hospital including what date they were admitted and what their admitting diagnosis is. Based on their diagnosis, we then figure out when we need to see them. Basically if they are admitted for something nutrition related, we see them sooner. This prioritization is necessary because there isn't enough time to see everyone while they're in the hospital and it would not make sense for us to go see someone who has had hip surgery but has a normal appetite when someone who has stopped eating gets discharged before we have a chance to see them!

Based on their diagnosis, or if a nurse or doctor has requested that we see a patient, we now know who we need to see that day (each day's notes get carried over to the next day so that we can keep track of how many days a person has been here and when we need to see them based on the prioritization). Once you know who you'll be seeing that day you can start to do some research into their past: what is their medical history, have they had weight change recently, have the nurses been recording their appetite, etc. After the background has been researched we head to the floors where the patients' rooms are. We hope that the ones that we need to see are in their rooms and available though often they're off the floor for a test or busy with another medical professional. Once we do get in to see the patient we do our interview to gather information from the patient. Depending on their admitting diagnosis we ask questions such as: What is your normal weight? How is your appetite currently? Have you noticed your pants are feeling looser? Do you typically follow a diabetic/low salt/fat free diet at home? Would you be open to trying a supplement such as Ensure?

Once the interview is over we go off to type our note into their medical file. The note includes information from the interview as well as our nutrition diagnosis. The nutrition diagnosis is written as a PES statement: Problem, Etiology, Signs and Symptoms. Here is an example of a PES statement: Inadequate oral intake related to nausea and vomiting as evidenced by patient report of not eating for 5 days prior to admission. We then address what we're going to do about the nutrition diagnosis such as suggest supplements, educate them on the diabetic diet, etc and how we will monitor their progress (track lab values, weights, how much they're eating).

In addition to repeating that process for all of the patients on the list for that day there are also meetings such as interdisciplinary rounds to attend and patients on nutrition support to follow-up with (tube feeds or total parenteral nutrition).

There is even more that a clinical dietitian does in their day-to-day role in a hospital but hopefully this sheds some light on one very important role that an RD can play!

The Campaign Against Sugar Sweetened Beverages

When you're studying to become a dietitian, you end up talking a fair amount about sugar sweetened beverages. That's the official name for soda, juice, sweet tea - pretty much any drink that's full of calories but doesn't fill you up. SSBs, as we refer to them, creep their way into many different conversations. Should kids in schools have access to them? Should people be able to use food stamps to buy them? Is giving your kid a soda every day akin to child abuse? And now the conversation has entered the public arena with the recent ban on certain sizes of soda in New York City. Whether or not that law will go into effect remains to be seen, especially since the beverage industry has begun to fight back. But regardless, it's gotten the general public, and not just people in the nutrition industry, to talk about SSBs.

My internship director recently passed along this video about The Real Bears put out by the Center for Science in the Public Interest. I debated whether or not to share it here; while I agree with the message that soda consumption needs to be greatly reduced in many people's diets, I'm not sure if this video is an effective way of getting that message across. Take a look and then let me know your thoughts!

Get Active! Get Dirty...

So you've been a runner, you've tried the whole cycling thing, maybe even started swimming so that you could do all three and call yourself a triathlete. But where's the fun in pounding clean pavement, coasting down pristine roads, swimming in (hopefully) crystal clear waters? If you're ready to take your workouts to the next level and get good and dirty, then it might be time to try something new.

Soiled Runners

Tough Mudder Vermont 2012

When you're ready to combine running with getting good and dirty, plenty of options await you. Perhaps you want to get dirty but not covered in dirt - then you could find a local Color Run where you where white and get pelted with colored corn starch during the race so that you end up looking like a rainbow. Or if you need obstacles mixed with dirt, try a Warrior Dash, a 5K that has boot-camp style elements. Want to mix in some blood with that dirt? Take it one step further and do Tough Mudder race, where not only do you have obstacles which will likely involve you falling into cold water, running through fire, and on your hands and knees in the mud, but you get shocked by electrical wires at the very end, after jumping (and smacking yourself up against) a half pipe which is, of course, covered in water and mud.

Riding Rugged
I always assumed that if you were a cyclist and you wanted to get dirty, you picked up mountain biking. Mountain bikers, in my experience, enjoyed the dirt, liked the fly recklessly down bumpy mountainsides with their fat knobby tires, and did very little uphill riding. Well, turns out that if you want to get your skinny tires dirty, there is a sport for you too! I recently attended the Gran Prix of Gloucester, a championship cyclocross race. In cyclocross, participants ride several laps of a course featuring any number of obstacles such as sand, stairs, wooden risers, hairpin turns, muddy pits, etc - all on a road bike (or a special cyclocross bike which looks a whole lot like a road bike). Sometimes they have to dismount and un-clip their pedals, or if they're really skilled they can bunny hop up and over (jumping while still on your bike). The riding goes on for approximately 45 minutes and whoever finishes the course first wins! For local races in your area, check out the race calendar.

Gran Prix of Gloucester 2012

Gran Prix of Gloucester 2012

Love that Dirty Water
I like to at least pretend that all of the water that I swim in is clean - or at least a very safe level of unclean - so I won't focus on races you can do if you're a swimmer who wants to get dirty. However, because of the nickname, here is information on the Charles River Swim, a 1-mile race that takes place each June, assuming that the water has been deemed safe and free of toxic algae by the government...

Good, Nutritious, and Cheap: Can it Be Done?

Before starting my dietetic internship in a couple of weeks, I have to complete an assignment where I eat for three days with the budget suggested by the USDA Thrifty Meal Plan. Based on my age and the fact that I only cook for myself, that will give me about $19 to stretch for three days. Oh, and I have to attempt to get in all of the suggested amounts of macro and micro nutrients with that money. I'm actually really looking forward to the challenge and have been contemplating various meal combinations over the past few days.

Today I ran across a link to this site, the Environmental Working Group's Good Food on a Tight Budget. While eating for cheap and still getting nutritious food is going to be hard enough on its own, it's interesting to think of the added challenge of also picking foods that have the fewest pesticides or the least amount of added chemicals. Take a look at their lists of good food on a tight budget and see if it inspires you to make a change in the way that you grocery shop. And if you have any suggestions for my three days of eating with a budget, let me know!

Eggs Still Excellent

www.freedigitalphotos.net

Perhaps you've seen the recent headline about how eating eggs is just as "dangerous" as smoking cigarettes. I know it caught my eye on more than one occasion, especially as multiple news outlets picked it up and ran with it. The gist of the recent study is that egg yolks can clog your arteries just as much as smoking tobacco can clog your arteries. If I had more time on my hands I'd read the study to figure out just what kind of correlation they were basing this headline on. Luckily, the editor over at Livestrong did that already, so here's the link to his article: Do Eggs Cause Heart Disease?

What it (hard) boils down to is that eggs are a great source of protein and the yolks are full of important vitamins and minerals. Yes, they also contain cholesterol, so as you would with any food that has some good parts and some less-amazing aspects, enjoy in moderation!

Talking Nutrition with Triathletes

Healthy food for hungry triathletes!

Last night I gave my first of (hopefully) many talks about nutrition to athletes. It helped that the athletes in question were members of my triathlon team and helped even more that I had the support of Nicole Cormier, RD of Delicious Living Nutrition in case there were any questions that I couldn't answer! Back in my former life as an editor, I hired Nicole to work on several nutrition books, which she's still doing. It's great to be working with her in a different capacity now.

The talk was at the bike shop that sponsors my team, Wheelworks in Belmont and about 17 teammates came out for the "Everyday Nutrition for Triathletes" talk. I brought lots of fresh fruit and veggies along with hummus, greek yogurt mixed with dill, and two healthy dishes, recipes below. We talked through daily calorie needs based on the Harris Benedict Equation, daily protein and carbohydrate needs, and talked a bit about pre- and post-race nutrition and hydration. I think it went really well and people were really receptive. It's always great to get little reminders of why you've made life changes like this - I love talking to people (especially athletes) about healthy eating, and look forward to continuing to do it for a long time!

Southwestern Protein Fiesta

1 bag Trader Joe’s frozen Fire-Roasted Corn, defrosted

1 bag frozen edamame, defrosted

1 can black beans (no-salt added), rinsed

1 bunch cilantro, rinsed and chopped

1 container fresh salsa

 

Mix all ingredients together and bring cold to a potluck or BBQ, serve warm over rice or quinoa for dinner, roll it in a whole-wheat tortilla for lunch, throw it over salad, or put in your morning eggs!

Whole-Grain Mediterranean Toss

½ cucumber, diced

½ container cherry tomatoes, halved

1 can garbanzo beans (no-salt added), rinsed

1 package low-fat feta cheese

3-4 cups cooked whole grain (quinoa, brown rice, whole-wheat orzo, or barley)

¼ cup fresh basil, chopped

Balsamic vinegar, pepper to taste

Mix all ingredients together and serve hot inside steamed halved peppers, cold at a picnic, or as a side with grilled chicken!

Go Nuts!

I'm a huge fan on snacking on raw almonds. They've got protein, calcium, monounsaturated fat (the good kind), potassium, vitamin E... the list goes on. So this morning I was excited to read in the Tufts Health Letter that new research by the USDA Agricultural Research Service shows that almonds actually have 24% fewer calories than originally thought! The American Journal of Clinical Nutrition published the article, which shows that for some foods like nuts, the original way of figuring out how many calories a food contains could be inaccurate. They got real nitty gritty to measure this, by analyzing "output" shall we say, from people participating in the study. Here's an article that summarizes the study. Keep in mind that this new information only applies to whole, raw almonds, not chopped or roasted or those covered in wasabi, honey, or chocolate!