Butternut Squash Soup

If you’re into fall cooking and love squash varieties, then this soup is for you! There is just something about a cozy and flavorful bowl of creamy soup in the cooler months, isn’t there? It feels and tastes like a hug in a bowl to me. ๐Ÿ˜‚ Too much? Okay, let’s get straight to the recipe for y’all rolling your eyes at me.

Prep time: 15 minutes Cooking time: 1 hour Total time: 1 hr 15 minutes

Serves: 3-4

Ingredients

  • 3 Tbsp olive oil (use per tbsp separately- instructions given when)
  • 1 medium-large butternut squash
  • 1 medium yellow onion
  • 1 medium red pepper
  • 1 Tbsp garlic
  • 2 cups vegetable broth
  • 1 can cannellini beans
  • 1/2 cup nutritional yeast
  • 1/3 cup coconut cream
  • 1 tsp sea saltย 
  • 1/4-1/2 tsp pepper (add to taste preference)
  • 1 tsp smoked paprika
  • 1/8 tsp nutmeg
  • 1/2-1 tsp cinnamon (add to taste preference)
  • 1 tsp herbs de provence, or add dried oregano, basil, thyme, etc.
  • Optional: fried sage to top, sriracha to top or blend in, parmesan to top, or better yet- parmesan crisps!

Directions

  1. Preheat oven to 425F. Line a large baking sheet with parchment paper.
  2. Take your butternut squash and cut off the top and bottom. Then cut in half lengthwise. (See below.) Scoop out the seeds and discard (or clean, dry and roast later to avoid food waste).
  3. Take your yellow onion and cut into 8ths. (See below). Place both the butternut squash, skin-side down, and the onion on the parchment paper. Use 1 Tbsp of olive oil and brush to coat both. Sprinkle the butternut squash with sea salt and cinnamon. Place in oven and set timer for 50 minutes.

4. In the meantime, you may air-fry the red pepper for 15-20 minutes at 400F or add this to your baking sheet with 20 minutes left in the oven. Don’t forget to coat in olive oil! ๐Ÿ˜‰

5. Once roasted, take a fork to pierce and ensure the squash is thoroughly cooked. Once cooked and cooled a bit, scoop out the butternut squash from its skin and add to a large blender or food processor. Add onion and red pepper then puree. Add the next 4 ingredients (garlic, veg broth, beans and nutritional yeast) and puree again until a smooth consistency is formed (about 3-5 minutes, depending on the tool you’re using).

6. If you have enough room in your blender or food processor, add the coconut cream. If not, transfer the puree to a large pot with 1 Tbsp olive oil over low-medium heat. Warm, add coconut cream and spices, then mix.

7. Once warm- hot, serve in bowls with toppings of choice. Enjoy!

Did you enjoy this bowl of warming, fall joy? If so, then please leave a review below and/or treat me to a matcha! ๐Ÿต You can donate one here.

Thank you in advance for your following and support! For more delicious, healthy recipes, follow me @feed.me.happy and join my email list here!

All my love, ๐Ÿ’– Danielle

Does eating dietary fat make you fat?

Fat.

What do you think of when you hear this word?

The word fat tends to have a negative connotation attached to it. After years of being exposed to diet culture, I’ll be honest and tell you that my mind used to instantly go to body fat. Now that I have reframed how I perceive dietary fat, I no longer fear it and actually embrace this macronutrient. Now, I tend to think of dietary fat as nutrient-dense energy that fuels and nourishes my body. I also start day dreaming of my favorite foods that contain fat- avocado, nuts and nut butters, and seeds. Yum!

Try reframing in this moment by saying, “Fat is a nutrient that makes food taste good, nourishes my body, and keeps me alive and well!”. Go ahead. Say it out loud. There ya go! ๐Ÿ™Œ ย Because that’s what it does. Just like carbs, fat should NOT be demonized. It is called a macronutrient for a reason. Macro, meaning large, and nutrient meaning nourishing our bodies. We just need to educate ourselves on how much our bodies need and from what sources. Let’s get started!

Starting with the basics, I’m going to break down two types of fat for you: saturated vs. unsaturated fat. Saturated fats are typically solid at room temperature (think butter, coconut oil, or animal fat). They contain single bonds that make the substance stable, which means it doesn’t oxidize easily. Therefore, this fat also takes longer to decompose. Saturated fat builds up in the blood vessels and arteries over time, especially when consumed in excess, leading to atherosclerosis and heart disease.ย The Dietary Guidelines for Americans recommends that a healthy individual eat <10% saturated fat of their total daily intake, while one at risk for heart disease consumes <7%.

Unsaturated fats are less stable and prone to oxidation and rancidity. So why are unsaturated fats favorable? Unsaturated fats do not clog your arteries like saturated fat does. It breaks down easier, and many monounsaturated and polyunsaturated fats actually have heart health protective qualities (in addition to other health benefits). You heard that right!

In short, as long as you stay within the macronutrient range of 20-35% total daily intake of a healthy mix of fats, with <10% of saturated fat (<7% for those at risk for heart disease), your body should utilize that fat for essential bodily processes. So no, consuming fat does not make you fat, as long as you eat a variety of fats in a balanced manner. Note: some athletes or individuals with medical conditions may need MORE fat in their diet. When I was marathon training, my average daily fat intake was up to 40% because I was burning through so much energy.

I think the fear of dietary fat came from misinformation, but also the myth that dietary fat converts directly into stored fat on our body as adipose tissue. This is FALSE!

Other functions of fat include:

  • temperature regulation (insulation)
  • energy storage
  • makes up the lipid membrane of the cell and other bodily structures
  • aids in fat-soluble vitamin absorption
  • neuroprotective
  • cushions and protects our vital organs
  • are precursor to hormone production & secretion
  • omega-3s are anti-inflammatory

The list goes on!

As you can glean from the above, dietary fat is crucial to maintain life and a truly healthy body. There are even minimum amounts of body fat men and women should possess for health, especially women and maintaining their menses monthly (now recognized as the fifth pillar of health). This number varies with gender, age and other factors.

Fat-free diets that were followed by our parents are not the answer or way to go! Sure, some people with medical conditions may need to monitor their fat intake a little more closely than others, but once again, aim to stay within the macro range of 20-35%, and you’re good. Furthermore, the quality of fats you’re consuming DO matter.

Some great dietary fat choices include:

  • avocados
  • nuts
  • seeds
  • tahini (ground sesame that is used in hummus and now many dressings)
  • olive oil
  • olives
  • ghee (not for those limiting saturated fat though)
  • avocado oil
  • fatty fish (salmon, tuna, sardines, anchovies)
  • full-fat, organic Greek yogurt or kefir (the reason I recommend organic for full-fat animal products is because toxins can be stored in animal fat)
  • cheese
  • eggs
  • coconut- coconut oil is fine but be mindful of serving size

In fact, you will want to be mindful with most dietary fat servings. It’s easy to overdo it, but that doesn’t mean you have to count the nuts and seeds you consume. That’s an easy road to forming disordered eating patterns. Just be aware and educate yourself (or seek education from me!) on what average portions look like.

I do suggest incorporating fat at most meals and sometimes snacks, for satiation purposes, among other reasons mentioned above. It just depends on what your particular diet and lifestyle look like. Once again, I am happy to help in any way I can, so if you have questions, feel free to reach out or schedule a nutrition consultation with me HERE.

How much protein should I consume?

Another common question in nutrition is: How much protein do I need? Before I break this down for you, let’s start with what protein is.

Protein is one of the three macronutrients, alongside carbohydrates and fat. It is composed of amino acids, it’s building blocks. There are 20 amino acids that we focus on: 9 essential amino acids and 11 nonessential. Essential meaning that we need to get these amino acids from our diet since our body cannot synthesize them like the nonessential ones. Some nonessential amino acids become conditional in times of high stress, illness, or injury.

The nine essential amino acids include:

  1. histidine
  2. isoleucine
  3. leucine
  4. lysine
  5. phenylalanine
  6. valine
  7. tryptophan
  8. threonine
  9. methionine

Complete vs. Complementary Proteins

A protein source is considered complete if it contains all nine essential amino acids. All animal proteins are complete, but plant-based eaters may need to be more mindful of pairing complementary proteins to get their full dose in. A common example of this is rice and beans, since the limiting amino acid in beans is methionine and rice contains methionine.

What does protein do for us besides build muscle?

The main function everyone thinks of for protein is MPS (muscle protein synthesis), but protein contributes much more to our health! Protein also regulates the following physiological processes:

How much protein is currently being consumed?

The Dietary Guidelines for Americans of 2020-2025 suggest that 3/4 of the U.S. population consumes over the recommended amount of protein. However, nearly 90% do not eat enough fish (the recommendation is 2-3 times a week of 4 oz servings), and more than 50% do not consume enough nuts, seeds, and soy products. It is good to differentiate your diet in general, proteins included, since you receive various nutrients from each source and feed certain gut bacteria ๐Ÿฆ  with each food.

How much protein do I need?

The Average Macronutrient Distribution Range (AMDR) for protein is 10-35%. That’s a wide range. We can also reference the Recommended Dietary Allowance of 0.8-1.0g/kg. This is the lowest recommendation, for those are sedentary or lightly active. If you are moderately to highly active, you may want to aim for a bit higher, say 1.2-1.5g/kg. Serious or elite athletes are looking at anywhere between 1.5-2.0g/kg. A study was conducted in 2016 to determine the safety and efficacy of the 2.0g/kg dosage. It results in determining that this was safe & healthy for those who engage in intense exercise.

Those who are ill, injured, pregnant, breastfeeding, require increased intake of protein due to increased energy demands.

You can calculate your protein needs yourself or consult with me to determine if you are over- or underestimating. If you are underrating and are not getting enough protein, you may experience:

  • frequent hunger
  • fatigue
  • longer recovery time
  • increased anxiety
  • poor sleep
  • exacerbated depression
  • weakness
  • hair, skin and nail issues
  • compromised gut health

So, where can you get protein from?

Here are some quality food sources:

  • organic, grass-fed beef
  • wild-caught fish
  • shellfish
  • turkey or lean chicken
  • duck
  • lamb
  • pork
  • pasture-raised eggs
  • milk, yogurt, cheese
  • nuts & seeds
  • beans & legumes
  • soy foods, such as tofu, tempeh, soy milk and edamame
  • seitan
  • protein powders
  • protein bars

In conclusion, every individual is different in terms of needs, activity level, current medical status, etc. that influence their protein needs. You can simply calculate your needs with the guidelines above, but know that they may not be 100% accurate. Feel free to schedule a consultation HERE to determine your macronutrient needs.

Should I go low-carb?

Going low-carb has remained popular over the years and has been around since the late 1800s. I will try my best to lay out the pros and cons of a low-carb diet and who could benefit from this protocol without being TOO biased. ๐Ÿ˜‰

The low-carb diet has cleverly masqueraded as the Atkins diet, Paleo, Dukan Diet, and now the infamous ketogenic diet. All of them primarily condone eating animal protein, healthy fats, and very limited (if any) grains, starchy vegetables, fruits, and anything containing sugar (carbs). While this may appear to be a grand idea at first, especially because society associates sugar with being “bad”, we need to look at the full picture here.

Typically, the Average Macronutrient Distribution Range (AMDR) for carbohydrates is from 45-65%. For a 2,000 calorie diet, that amounts to 225-325g. Many studies define a low-carb diet as anything <130g, and a very low-carb diet as anything <20-50g. Below is a chart depicting what the Atkins diet, Paleo Diet, and Ketogenic recommend/require from macronutrient distributions compared to that of the recommended ranges.

So, why do people choose the diets above? Good question. The main motivator is weight loss. When people cut carbs that retain water, minimize their overconsumption of carbs that convert into fat, and focus on their intake of whole food proteins and fat, weight loss is bound to occur in those who have some to lose. However, this weight loss is typically short-term and regained after a period of time because reintroducing carbs has an adverse effect from restricting it for so long…you start to retain that water again, you might even over consume by excess portions, and just feel like you’re losing control again. The list goes on and on.

In addition, if your body is not in a true and constant state of ketosis (using ketones as energy), low-carb diets under the recommended 130g for DIABETICS will ultimately make you crave…you guessed it…carbs! This could partly be why you are craving sweets- because you are not consuming enough carbohydrates or not the right sources of them with protein and fat.

 In a study published in the European Heart Journal in September 2019, researchers concluded that people who ate the least amount of carbs had the highest risk of death from cardiovascular disease, stroke, and cancer.

So who can benefit from a low-carb diet?

THOSE WITH THE FOLLOWING MEDICAL DIAGNOSES!!

  • Diabetes
  • Polycystic Ovary Syndrome (PCOS)- not all need to go low-carb!! Moderate carb intake should work when given the proper nutrition education
  • Epilepsy
  • Metabolic Syndrome
  • Glycogen Storage Disease
  • Obesity
  • GLUT1 Deficiency Syndrome
  • Nonalcoholic Fatty Liver Disease

Other medical conditions that have showed promise with a low-carb diet but need further research on humans (not rats) for application:

  • Multiple Sclerosis
  • Parkinson’s Disease
  • Autism
  • Alzheimer’s
  • certain autoimmune diseases

To conclude, unless you have the medical conditions listed above and consult with a doctor and dietitian of consuming less than 130g of carbs/day, then there is no need to subscribe to a low-carb diet. Carbohydrates break down into sugar in our bodies (fruit and veggies included!). That sugar is also called glucose that our brain uses as its primary choice for fuel. Fun fact: Our brain needs about 120g on average a day. OUR BRAIN ALONE AND NOT INCLUDING THE REST OF OUR ORGANS! Feed and love on that pretty brain and body of yours. Don’t fret about carbs.

Need further guidance? I got you, boo.

Email me at daniellencahalan@gmail.com or schedule your nutrition consultation HERE.

Where to Start With Nutrition?

I’ve been racking my brain on where to begin with covering my nutrition bases for all of you. There are endless choices to choose from in the nutrition library, but I think that’s the problem, right? It’s easy to get overwhelmed, distracted, confused, and worst of all- misinformed.

We want to be healthier (whatever that means and looks like for you). We want to maintain a sustainable and life-supporting weight, and we want to feel energized, our absolute best, and THRIVE on the day to day. Do you agree?

The issue is that we don’t know where to begin, and instead of allowing medical professionals to be at the forefront of guiding us throughout our health journey, we have been subjected and duped to believe that diet culture is the fast track to health and weight loss success. NEWSFLASH- THIS IS FALSE! Don’t be fooled by diet culture. Furthermore, many randos on TikTok and Instagram are making up their own shit when it comes to nutrition and not following science-based evidence that dietitians and other licensed practitioners do.

Nutrition is SO very individualized. Your allergies, dietary preferences, sensitivities, aversions, medical history, and much more need to be taken into consideration to determine a plan and protocol that is best for YOU. Surely an Instagram post can’t be speaking to the general population at all times….

Instead, dietitians provide you with the nutrition education, exercises, and tools to have full autonomy over your own decisions, health trajectory and WHAT YOU EAT! Imagine that!

So, let’s get back to the original question: Where to begin with nutrition?

The answer is to STOP Googling nutrition “facts” and diets. STOP listening to TikTok videos and non-credentialed influencers, and instead, consult with a dietitian to pursue a healthy approach and relationship to food that is right for you.

Sure, you can start with tracking macros on your own, but do you know why you’re tracking them, the true recommended ratios for you, and what is going to help you reach your health and weight goals?

What about micronutrients? Have you gotten bloodwork done to determine your current nutrition status?

Do you know how to support your vagus nerve, adrenals, and gut microbiome? Ya…the list goes on and on. My point is that there is not a one-size-fits all approach and everyone begins at a different spot in their nutrition journey. If you need help figuring out where to begin, please email me at daniellencahalan.com to schedule a nutrition consultation or book it yourself HERE.

Talk soon. I look forward to helping you along your health journey.

โค๏ธ Danielle

Lemon Blueberry Loaf

Hello all! I have been absent on this blog for a bit because I’ve been workin up a storm at my 3 jobs- 1 of which is nutrition counseling at my own private practice that I founded- eeek! ๐Ÿ˜† It’s been very exciting to launch Danielle Cahalan Nutrition, LLC, but it has also been time consuming with behind-the-scenes tasks. I am also working as a per diem (as needed) clinical dietitian at a hospital, and I just put my two weeks notice in for my social media marketing director position of 2 years at All Access Dietetics. That job was wonderful as a student and intern and I am so grateful for the experience and what I learned along the way, but I no longer have the time and attention to dedicate to it.

With all of that said, I will have more time to focus on my private practice, and that includes more recipe development again- yahoo! If you’ve been following me for awhile, then you know an e-cookbook is one of the long-term goals. I was unrealistic with my timeline to launch this this past spring, so the new goal is to launch a compilation of delicious and healthy recipes by next summer. ๐Ÿคž๐Ÿผ

I’m jumping back into the recipe making’ game with this summer winner- a sweet & light Lemon Blueberry Loaf. I highly recommend pairing it with vanilla ice cream or yogurt with a drizzle of honey on top. Please enjoy and let me know what you think in the comments! I would love to get your feedback. โค๏ธ

Lemon Blueberry Loaf

Ingredients

Dry Ingredients

  • 2 1/2 cups blanched, almond flour (3 cups of all almond flour should work just fine too instead of the coconut flour addition)
  • 1/2 cup coconut flour
  • 1 cup rolled oats
  • 1/2 tsp sea salt
  • 1 1/2 tsp baking soda

Wet Ingredients

  • 1 1/2 tsp lemon extract
  • 1 lemon squeezed (about 2-3 tsp lemon juice)
  • 1/2 cup nonfat Greek yogurt
  • 1 full egg, 1 egg white
  • 1/2 cup honey

Other

  • Fresh blueberries (I’m sure you can use frozen too, but I haven’t tested this!)

Directions

  1. Preheat oven to 350F. Line loaf pan with parchment paper.
  2. Mix dry ingredients in a large bowl.
  3. Mix wet ingredients in a small-medium size bowl.
  4. Add wet ingredients to dry ingredients and mix well, until no visible dry clumps are present. Let sit for 5-10 minutes to soak up wet ingredients.
  5. Fold in 1 cup blueberries. Add the batter to the lined loaf pan. Lightly press blueberries on top to make a design or dot the top.
  6. Bake at 350F for 30 minutes, or until light golden brown on top.
  7. Remove from oven and let cool for 10-15 minutes before cutting. Add lemon zest if you’d like. ๐Ÿ‹
  8. Top with whatever you’d like, such as ice cream, yogurt or honey, and enjoy!

How I Started My Nutrition Private Practice

Hi there! I’m assuming that if you’re reading this, you are interested in starting your own nutrition private practice. The thought alone is exciting, but the extensive research and preparation that goes into starting your own business (and properly) is no joke, costly, and downright overwhelming. I am not here to sugar coat things, nor will I deter you from taking this route. I am simply providing you with the steps and resources I used to get started in the hopes of helping a fellow peer out. You can take it from here, and you best bet you’ll have my support and encouragement along the way too. ๐Ÿ˜‰ Please keep in mind that I am not a business pro, so all of the information below are things I came across on the interweb.

1.Decide on your business structure: a sole proprietorship vs LLC.

A sole proprietorship is any business where the owner is fully liable for their business. The business does not have to be registered by the state, and you are responsible for all facets (including absorbing business taxes along with personal ones). An LLC stands for Limited Liability Company, which partially protects the owner and their personal assets should bankruptcy occur. In addition, you are officially recognized as a business by your state, and taxes are filed separately from your personal ones. You can learn more about these frameworks here.

2. Reserve a business name or file for your sole proprietorship or LLC.

You can simply reserve a business name through your Secretary of State’s Office or file for a sole proprietorship or LLC here. To be honest, coming up with a business name was the most challenging part for me! Whichever you decide, I recommend doing more research to do determine which business framework is best for you, your business, your goals, and your situation. I personally filed for an LLC because I wanted to be officially recognized as a business from the get go, but this is a bit pricey up front. Filing took 2 1/2 weeks, but it can take up upwards of 4-6 weeks. This waiting period is good to be aware of since you want to wait for filing to be approved before taking on paying clients (for payment tracking and tax purposes).

3. Protect yourself with health professional insurance.

This component is also pricey, especially upfront, but you can also pay monthly with interest. Getting insured was an important and crucial step for me to protect myself as a health professional. After 4 years of working towards my credential, I refuse to put myself in any situation that someone can take it away from me. I’m sure you wouldn’t want to jeopardize your license either. You never know, so be smart and get insurance! I was set up via phone with HPSO.

4. Decide on a HIPPA-compliant platform if you plan on virtually counseling.

After weighing the pro’s and con’s of a few online platforms, I landed on Practice Better as a user friendly portal to communicate with my clients on and store their personal health information (PHI). Video chat is an option on here, so I didn’t have to pay extra for Zoom’s Healthcare Plan.

5. Set up a checking business account to properly track your earnings, expenses, and overall income.

I set my business account up through Bank of America, and then I linked that account to Stripe so I had a payment processor on Practice Better for clients to pay through.

6. Gather legal client forms and contracts (usually provided when you register your business) to have future clients sign before working together.

GovDoc provided these for me, but I also created a contract for clients to sign stating they would be obligated to pay the entire fee they signed up for, and prior to sessions. In addition, I created a 10-page comprehensive new client form on jotform.com.

7. Determine how you will track your finances.

I will be using Quickbooks to properly organize my income and have records for tax purposes. My brother-in-law (who is both an accountant and lawyer) and other business owners I’ve spoken with say this is the go-to service for this- as user-friendly as it gets.

8. Figure out how you are going to gain clients and market yourself.

I was already on Instagram and under the name Feed.Me.Happy on my WordPress blog here. While I was never consistent with posting due to school, my internship, and life in general, I still had a presence and reach to promote to. Figure out how you want to market yourself, and aim at being consistent! Streamlining your messaging and areas of specialties can also help attract your ideal clientele.

Okay, friends. That’s all I have for now. I hope this brief overview on how I started my very new business helped a bit. If you have further questions, I recommend doing your own research or consulting with a business coach or professional, even a lawyer for some parts.

Thank you for your understanding in me providing information this way. My time and energy is precious to me, especially with 3 jobs now, so it was easier to streamline this info here. Take care, and good luck if you choose to pursue this entrepreneurial route! And speaking of, join the Nutrition Entrepreneurs (NE) DPG group through the Academy for more valuable content and resources too!

My First Job as an RD

I am happy to share that I officially took my first job as a Registered Dietitian! And get this- it’s at the hospital I interned at. WHAT?! Ya, I never in a million years thought I would start in clinical, as it’s not what I want to do long-term. However, the position I took is per diem, meaning that I can accept or decline shifts as they are offered. That flexibility alone sold me because I want to start my own business (which will take time), travel, and continue to live my life as I want, not in the conventional M-F 9-5 way. I also plan on staying at my part-time gig at All Access Dietetics for the time being, especially since it only requires 15 hours/week.

More than likely, your first job isn’t going to be your dream job, and that’s okay! You have to start somewhere, and my somewhere is with a fabulous group of clinical dietitians that I adore and can learn A LOT from. If I just started a business isolated at home, I wouldn’t have the consistent expose and influence to learn and push myself. I also snagged a once a week outpatient counseling job within the same hospital that will give me the counseling experience I so desire.

This is a win/win/win situation, and I’m looking forward to what’s to come.

I’m writing this not only to share the good news, but to also inform you as a future dietitian or other professional that it is OKAY if your employment opportunities don’t look exactly like you imagined they would. You have to start somewhere, and you never know where those experiences and connections will lead you.

โœŒ๏ธ

Clinicals: Week 6

Happy holidays and New Year, friends! ๐ŸŽ† I hope you had a lovely couple of weeks and some down time to reset. Since I am interning at the hospital, I chose to stay home with my husband and two dogs to keep my family safe. Although we had COVID back in March, it has not been confirmed that COVID antibodies last long-term (or for what duration), and being on COVID floors makes me uneasy (not for me, but passing it on to others). My 92 year old at-risk grandma lives below my parents, so it’s not worth chancing to me. While I am open to approaching 2021 with hope (my chosen word of the year), I am cautiously optimistic and holding reservations with COVID still in swing. I’m planning 2-3 months out and taking life one day at a time, which is sometimes all we can do. Okay, that was a little intro- onto my clinical recap! ๐Ÿ‘‡๐Ÿผ

Week 6 of my clinical rotation was just what I needed, an over-the-hill turning point! On Monday I completed my first patient notes with NO CORRECTIONS!!!! AHHHHH!!! ๐Ÿ‘๐Ÿผ This was such a big deal and win for me since I’m such a type-A perfectionist (not always a good thing), and every correction and edit I received felt like a punch to the gut lol. However, as I mentioned in my previous post, this is part of the learning process and time of growth for us future dietitians. It just also felt good to bask in the glory of my error-free note haha.

Then on Tuesday, I wrote my first tube feed order with no corrections needed! Man, I was on a roll and floating on cloud 9 (at least in the office). Like I said, COVID is still in full swing, and I’m reading too many H&P (History & Physical) notes detailing depression, suicidal ideations, and other mental illnesses exacerbated by COVID and isolation. It’s sad, and I’m so impressed with the medical personnel who see this on a daily basis. I can’t imagine, since I’m just reading about it. The other difficult component is speaking with family members pleading to help their loved one when you’re calling to retrieve wt, ht, and nutrition Hx info. This part challenges your communication skills and evokes empathy and compassion (other crucial components of patient care).

Aside from those two wins of writing correct patient notes and a tube feed Rx, I learned that thiamine is used as MNT intervention for alcoholism, refeeding syndrome, and sepsis in the critically ill. I now order this for any patient who presents with any of those since thiamine is depleted, and subsequently impairs glucose metabolism, which can cause elevated POC glucose levels.

I have come across many patients with trouble swallowing too, so I’ve had practice and open communication with contacting the SLP (speech language pathologist) on staff. My preceptor told me a story of when she was an intern. Her patient reported mild trouble swallowing. The doctor said it was fine, but she ordered the speech consult anyways. The SLP found said patient had cancer in their voice box. Had she not had the bravery to listen to her clinical judgement, the patient might not have been diagnosed as early as they were with cancer. That story spoke to me, so I thought I’d share. The moral of the story is that you should focus on providing your patients with the best care possible. If you suspect something within your scope of practice, follow up, refer out, or place an order. It can’t hurt, only help.

I’m not sure if I mentioned this, but I’ve been shadowing the RD who covers the GI floors and COVID wing. We don’t go on the primary COVID floors, but they’ve overflowed to other floors. On the GI floors, I’ve seen many patients with SBOs (small bowel obstructions), ileuses (lack of movement in the intestines), ischemia (tissue and cell death), etc. Very interesting! If these patient’s issues do not resolve and their bowel isn’t working fully, TPN is initiated 5-7 later. I will be learning more about parenteral nutrition on the IMCU over the next two weeks.

I was surprised that I only had to work half days on Thursday and Friday for NYE and NYD- so exciting and nice! I really have loved and appreciate my experience at Swedish Hospital, made possible by the incredible dietitian team there.

4 weeks left- 2 on the IMCU and 2 as staff relief on floors assigned to me- OMG, so so close! ๐Ÿ˜†

Terms I learned

  • Ogilvie Syndrome: dilation of the colon, which causes a pseudo-obstruction

Abbreviations I learned

  • ESBL: “Extended Spectrum Beta-Lactamases” are chemicals or enzymes secreted by harmful bacteria that make them more resistant to antibiotics
  • MRDO: “Multi-Drug Resistant Organisms” are bacteria themselves resistant to antiobiotics
  • KUB: a kidney, ureter, and bladder (KUB) X-ray
  • MAP: mean arterial pressure
  • HCV: Hepatitis C
  • PCT: procalcitonin (marker for sepsis, and COVID)

Happy to discuss this post further and hear you thoughts. 4 weeks and counting! Happy New Year again, and best wishes in 2021.

Clinicals: Week 1

I started my clinical rotation at Swedish Hospital for my dietetic internship last week. It’s my last of 4 rotations, and it was the one I was looking forward to the LEAST. Why? Well, healthcare workers are normally under a lot of pressure, but they are stressed more than ever due to the COVID pandemic and in the midst of a second surge. I was so nervous to enter a medical facility, especially a hospital, and I was unsure of what to expect and what my preceptors (mentors) expected from me as an intern. I asked myself… “Was I ready? Am I competent? Would I be safe from exposure to COVID?”. My mind was reeling the week leading up to my first day. Then, my first day arrived, and a wave a calm and excitement washed over me. Somehow I knew I was ready.

Me on my first day of clinicals.

On my first day, my preceptor met me in the waiting room. I was brought to the dietitian’s office and soon after, I got a tour of the hospital. As we were walking through the units and floors, I realized these bright red signs on the doors with photos of masks and other PPE wear. I was told that these were for droplet pts (patients who are high risk) and/or COVID patients. “Wait, WHAT?!” I thought to myself. “I’m on a floor with COVID patients?”. I was stunned because my impression was that COVID patients were quarantined to their own wing within the hospital. I was then told that they are staying on floors that correlate with the level of care they need and require (i.e. CCU vs ICU). Makes sense, but it was still a surprise because I wasn’t aware that I’d be working in close proximity to the virus. This immediately made me reevaluate seeing my family and friends for the next 10 weeks, the duration of my rotation. I had a discussion with both close friends and family members of whom I regularly see. I told them that I didn’t feel comfortable seeing them for their own protection and safety and that we’ll have to stay in touch virtually for now. They understood, thankfully.

Put COVID aside, I started learning Swedish Hospital’s EMR (Electronic Medical Record) system, Meditech. Yaaaa….so I was VERY overwhelmed navigating this portal to say the least. The medical jargon, abbreviations, and correct entries were a bit much. Plus, there are about 15+ areas I need to know to pull information from. It’s a tedious system to get to know intimately, but it’ll just take time, practice and patience (my new mantra). I really wish my DPD courses integrated medical terminology, nutrition-related medications, and prepared me more for charting. I understand that learning hands on and in the field is best, but there is something to be said about feeling prepared with an introduction to this knowledge. Luckily, my preceptor is amazing and patient. She had me observe her screen patients several times before I attempted to do so. She created a scavenger hunt to help me navigate Meditech, and she even had me conduct a mock NFPE on her to see what I felt like prior to performing one on an actual patient.

My first NFPE was the highlight of my week. It was on a woman with Down’s syndrome. We struggled to gather information during her assessment due to minimal verbal communication, but we successfully carried out the NFPE. During it, she extended her hand to me. I instinctually clasped mine in hers. We held hands for a bit before I moved down to her legs. My heart cannot tell you how sweet and memorable that moment was for me. It embodied the need and desire for human contact for our patients, especially in a time of distress.

I did another NFPE later in the week on an elderly man. He kept urging my preceptor and I to take care of ourselves so we wouldn’t end up like him. He said he wished he knew how to take care of himself earlier in life so he wouldn’t be like this man. That was tough to hear and respond to while then trying to ask about his frickin bowel movements…These are things we don’t talk about in our classes. Someone is in pain, whether mentally, emotionally, and/or physically, and we must relay our empathy while still carrying out our job in a concise time frame. This comes with good mentorship and practice. Luckily, I have both right now.

Besides screening, assessing, conducting NFPEs and writing notes, I listened in on two inservice webinars. One was on COVID Nutrition Interventions re critically-ill patients. This was super interesting! I’m going to do follow-up research then write another post on this to extend my COVID nutrition tips/sources. The other was on a food insecurity initiative Swedish Hospital is rolling out. Many of you reading this are probably aware that I started a food pantry at Dominican’s campus last year, so you know I’m super passionate about minimizing hunger. I was asked to create a flyer insert of tips on how to utilize foods being distributed to patients who discharge. That was fun!

All in all, my first week was overwhelming and a learning curve, but I am looking forward to staying open-minded and positive over these next 9 weeks. I know that I’m going to learn so much from the incredible and experienced dietitian team, so I plan on absorbing as much information as I possibly can.

For my future dietitian friends, I thought I’d share some medical terminology and abbreviations I wasn’t familiar with that may help you for your clinical rotation and practice. I also suggest researching nutrition-related medications to be familiar with these names. The hospital you intern at should also have a food drug booklet to reference should you need it (which you will).

Terminology

  • Dyspnea- shortness of breath
  • Vasopressors- medication used to raise blood volume and pressure when BP is low
  • Laminectomy- removal of the lamina (part of the vertebrae)
  • Oophorectomy- removal of the ovaries
  • Cachexia- muscle wasting that can include fat loss

Abbreviations

  • PMH: Past Medical History
  • PTA: Prior to Admission
  • A&O: Alert & Oriented
  • N/V: Nausea/Vomiting
  • C/S: Chewing/Swallowing
  • C/D: Constipation/Diarrhea
  • RVR: Rapid Ventricular Response
  • HL: Hyperlipidemia
  • AMS: Altered Mental State
  • CKD: Chronic Kidney Disease
  • ARF: Acute Renal Failure
  • Times to administer a supplement/day:
  • QD: 1/day
  • BID: 2/day
  • TID: 3/day
  • QID: 4/day
  • IC: Indirect Calorimetry
  • PI: Pressure Injury
  • DKA: Diabetic Ketoacidosis
  • CABG: Coronary Artery Bypass Surgery

There are more terms and abbreviations, but I’ll have to do a better job of remembering and jotting them all down. Did this help? If so, let me know if the comments below or shoot me a DM on Instagram! I plan on writing a reflection and summary of each week during my clinical rotation. I think it’ll simultaneously help me process and review while hopefully relaying ym experience and pertinent information that can help you along your journey.

Have a great weekend!