Roanna Martin

"make [food] simple and let things taste of what they are." {Curnonsky}


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Family Mealtime

“It’s dinnertime!”

What does that mean for you? Is it grabbing some food and eating in front of a TV, is it picking up take-out on the way home from Junior’s late basketball practice, or is it dinner around the table with your family- perhaps chicken with mac & cheese and broccoli and a glass of milk?

Increased frequency of family meals has been associated with increased intake of fruits, vegetables, grains, and calcium-rich foods, and decreased soft drink consumption (1). In addition, having more meals together as a family may reduce chance for disordered eating behaviors (2), and curtail other high-risk behaviors among adolescents (3).

The kitchen table is a wonderful place to build relationships, nourish the body, and rewind after a long day.

As part of my graduate program, I am working with a West Virginia early childhood obesity prevention project called Choose to Change

A few weeks ago, we hosted a “Family Fun Night”, where families simply came to a community center for a free meal, and engaged separate activities for kids and adults, promoting the importance of family meal time. 

The tables were set and waiting for families to arrive. 

The benefits of family meal time aren’t about a beautiful table setting or fancy courses. It’s simply having people together, talking and sharing life with one another.

However, we did put a bit of extra effort into creating some masterpiece centerpieces- turkeys crafted out of melons, grape skewers, and pepper slices.

Fruit and Vegetable Turkey

After the meal, I hung out with the little preschoolers. We had fun activities like a relay race to set the table, and bean bag games where some colors were “healthy foods” and others were just “sometimes” foods.

Choosy, the mascot for the program, showed up. This was a huge hit with the kids. I managed to get a picture with him too!

Celebrity Shot

Family meals were always a priority in my home growing up, and I’m incredibly thankful that my parents chose to make these evening rendezvous an essential part of our day. I learned a lot around the kitchen table.

As a college student, family-style meals can’t always happen, so I’m even more thankful when they do occur.

These past 6 weeks I have been completing a clinical rotation about 2 1/2 hours from where my apartment is. I’ve been blessed by living with a great couple here, who have graciously opened their home to Emily and I.  Here we are, enjoying a family-style meal together. A bit of Thanksgiving dinner and sparkling cider at the dining room table- this didn’t happen every night, but we did enjoy eating dinners together when able.

Late Thanksgiving Dinner

It’s hard to believe that this clinical rotation has come to a close already. Good-bye, Charleston!

The Gold Dome of the West Virginia Capitol Building

 


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Preventive Maintenance

So, this past week brought a bit of extra (unwanted) excited in regards to my mode of transportation.

I drive a 1999 Ford Escort- a basic, run-of-the-mill, get-me-from-point-A-to-point-B type of deal. I try to take good care of it, and regularly check the oil before long trips, get my oil changed every 3000 miles or so, keep plenty of windshield washing fluid inside, wash the outside whenever I’m at my parent’s house and have easy access to a hose, and vacuum it out with moderate frequency.

When I went to get my oil changed this past week, the mechanic called me in to the shop to look at my tires. Much to my chagrin, the inner part of my front tires was worn completely bare. I was aghast, and he informed me that I should probably have my alignment checked. Alignment?! I didn’t know that was part of car maintenance. But alas, apparently it is. So I promptly purchased new tires, and had my tires aligned. The front tires were so badly aligned that it was off the charts. If  the alignment had been checked earlier, I could have saved myself the expense of buying new tires. As an added note, I’m going to make certain to take a quick look at my tires from time to time. Because even I can easily do that, and it would have clued me in to the issue before I went for an oil change.

I felt so, well, STUPID, because I didn’t know that alignment should be checked (every 6,000 miles according to one dealership site, 20-30,000 miles according to another site) with moderate frequency. Obviously, I don’t know much about the world of mechanics and automobiles, so I’m thankful when others can teach me things that I do not know.

I was thinking about how there are likely many people who don’t know about preventive health maintenance. Things that seem obvious to me may not be so obvious to others. As I proceed in the field of dietetics, I need to remember that what seems common sense for health may not be for other people.

This analogy was taken even further in a hospital room at my internship on Friday, when there was a newly diagnosed diabetic who already had several diabetic ulcers on his leg. Ironically, this patient was an auto mechanic.

If he had spoken with a health care professional earlier, regarding his symptoms of increased thirst, increased urination, and blurry vision that accompany hyperglycemia, he may have been diagnosed earlier. At that point, he could have begun to control his blood sugars through diet, exercise, and perhaps medication if necessary. With this preventive care, much like my tire alignment, he could have saved himself the complication of the diabetic ulcers in the same way that I could have saved myself a pair of tires!

Maintaining good health is the best kind of preventive maintenance.

Here are 5 lifestyle habits for health maintenance:

  • Adequate physical activity
  • Good nutrition
  • Decreased tobacco use and exposure
  • Decreased alcohol use
  • Positive thinking

Source


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Maintenance of Weight Loss

A brief article published on Eatright.org- the website of the Academy of Nutrition and Dietetics, the world’s largest organization of food and nutrition professionals- caught my eye recently.

Entitled “Four Ways to Shed the Weight for Good”, the article puts forth a few strategies employed by people who lost 10% of their body weight and successfully kept it off, as compared to those who lost similar amounts and regained the weight.

  • Weigh yourself regularly: it’s best to weigh in at the same time of day and on the same scales to monitor progress.
  • Keep it going: continue to employ the habits that helped you to lose weight. Keep food and activity logs, and continue to practice portion control.
  • Plan ahead: Use problem-solving skills to prepare for upcoming potentially difficult situations, as well as catch yourself mid-stride.
  • Engage in positive self-talk: using positive reinforcement mentally, verbally, or even journaling can be a great place to do this.

Speaking of journaling, I’m a huge fan. I haven’t implemented this practice as much for weight loss/maintenance in my life as much as I have used it for mental and spiritual health. The blank white pages present a clean white slate to scribble, scratch, design, paste, sketch, and scrawl.

I began journaling when I was about 6 years old, and I’ve filled nearly 26 journals since then. Journaling and introspection are a big part of who I am, and as I am in the midst of taking steps towards becoming an RD, I find it important to have habits in my life that are grounding and provide balance. My journal is a place where I can process emotions and have a creative outlet, without fear of judgment or rules.

But back to the practice of journaling for weight loss and maintenance, I found a great list of journal prompts. When modified to exclude the term “diet” in it’s mainstream definition as “a restrictive food pattern” because I think that overall food habits should be the most emphasized, these are some great questions.

Here are a few of my favorites:

Having a healthy weight is important to my health because… 

When I lose a few pounds it will be fun to…

One year from now the foods that I consume will be… 

I feel wonderful in my body when I eat… 

The thoughts that help me most with weight loss are… 

Eating sweets makes me feel emotionally… 

 


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Medical Ethics

Through my clinical dietetics rotation today, I had the opportunity to attend two medical ethics meetings- a meeting of the Ethics Committee this morning before work, and an “Ethics in the Round” lunch and learn event.

“Medical Ethics” is a term used to refer to the values and guidelines that govern decisions in medical practice. All health care professionals need to be cognizant of the ethical issues that they make each and every day, and dietitians are no exception.

One of the areas that most relates to the work of a clinical dietitian is the use of enteral or parenteral nutrition. Enteral nutrition refers to feeding through the gastrointestinal (GI) tract using a tube, catheter, or stoma that delivers nutrients from a location further down the tract than the mouth (1). Parenteral nutrition refers to administering nutrition directly into the circulatory system (1). Most of the time, being able to use these methods to deliver nutrition to an individual is a wonderful thing that can sustain them while they are recovering from trauma or illness.

However, there are cases in which artificial nutrition will prolong life, but not necessarily promote a high quality of life.

Many of you have likely heard of the Terri Schiavo case. In this case, there was dispute between family members (which lasted from 1998 to 2005) over whether or not to continue feeding through her PEG (percutaneous endoscopic gastrostomy) tube, although doctors declared her to be in a “persistent vegetative state”. Eventually, after the case escalated to a point of federal involvement, the feeding tube was removed for the final time.

An excellent article from Today’s Dietitian addresses the issues related to PEG tube feeding at end of life. Associated risks and indications for placement should be considered prior to using a PEG tube. Although the dietitian is typically not involved in the decision of whether or not to place the PEG, they should be aware of the rationale behind the placement.

Risks include:

  • Potential complications of the surgery to place the PEG
  • Possible infection around the PEG placement site
  • Tube malfunctions (such as a blocked or leaking tube)
  • Intolerance of feeding
  • Possible fluid overload and electrolyte imbalance

 

The most evidence-based and clinically useful indications for placing a PEG tube include:

  • head and neck cancer
  • acute stroke with dysphagia
  • neuromuscular dystrophy syndromes
  • gastric decompression

 

While some practitioners may believe that tube feedings are a level of basic humane care, the wishes of the patient and family must be considered.

One of the best things that can be done is to have advance directives or living wills that clearly spell out your desire to have or not have artificial nutrition placed in case of a medical event.

Other topics discussed today were the use of “bloodless surgery centers”, in order to eliminate the need for blood transfusions during surgery for some religious groups.

As I am diving more in depth into patient cases and medical histories, I am learning so much about the world of health care. I am realizing that I still have a LOT to learn, and I am so thankful for the many things that I am being exposed to over the course of this internship.

(1) Nelms, Sucher, and Long. Nutrition Therapy and Pathophysiology, 2007.


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Delicata Squash: A Template

Who wants to know what I ate for dinner tonight? Well, I didn’t really think anyone would… but Emily encouraged me to blog about this, so here goes:

For $2 at the Morgantown Farmers’ Market on Sunday, I picked up a wee little gem: a Delicata Squash.

Photo Courtesy of Serious Eats

They are typically about 5 or 6 inches long, and 2 or 3 inches in diameter, and make a perfect meal for two people.

I first discovered the beauty of cooking with these fall vegetables last year, at which point I called them: “My New Favorite Convenience Food” on my previous blog. 

Chop the squash in half lengthwise, and scoop out the seeds.

Place both halves cut side down in a container with a little bit of water. Then either microwave the squash for about 4 or five minutes, or bake for about 15 minutes.

Then, turn the squash over so you have little “canoes”. Fill with items such as cooked beans, tomato chunks, cooked rice, cooked ground beef, sauteed onions, and whatever spices you please. This is a great way to use leftover chili, or pieces of chicken, or anything that’s in your fridge, really! Top with a sprinkle of reduced fat cheese.

Return to the microwave for five minutes or until contents are thoroughly heated and cheese is melted.

For those of you who like measurements and ingredients, here is what went into mine tonight.

Combine in bowl:

1 cup cooked kidney beans

1/2 c shredded low-fat mozzarella cheese (reserving a small amount to sprinkle on top)

1 tsp chili powder

1/2 teaspoon cumin

1/2 tsp garlic powder

1/2 tsp red pepper flakes

1/4 teaspoon black pepper

Place mixture in partially cooked squash, and return to oven or microwave to finish cooking.

When you pull it out, top each half with 1/4 cup salsa.

 

 

When prepared this way, each squash half contains:

252 calories

6.4 g fat

34.8 g carbohydrates

10.2 g fiber

14.9 g protein

66.4% RDA of Vitamin A

(Nutrient Analysis: Recipes.Sparkpeople.com)

Winter squash is a more-than-excellent source of vitamin A, which is known to help promote and maintain healthy skin, teeth, connective tissues, and vision. So, rather than pay money to pop a pill, why not try some real food that’s super high in vitamins and minerals?


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The Role of the Clinical Dietitian

Many of you may wonder exactly what a dietitian in a hospital does. If you are admitted to the hospital, you may or may not see a dietitian, depending on your diagnosis and what happens to you over the course of your stay.

Here’s a meme which I think does a pretty good job of explaining the role of a dietitian.

 

(Image courtesy of fellow blogger HappyDietitian)

My friends may think I’m all about a perfectly balanced and healthy lifestyle, society may view me as someone who works in the media, patients view dietitians as policemen (the most common joke I hear when I walk into the room and ask if a patient is following any sort of diet at home: “Yeah- I’m on the ‘see-food’ diet. I see food and I eat it!”).

Doctors have a tendency to think of dietitians as food service workers. Although we do work alongside food service to provide nutritionally adequate meals to patients, we are not working in food service. I have a lot of respect for food service workers, to be sure! “Catering assistants” (also called “dietary aides” or other names depending on the facility) are sometimes the friendliest faces of the hospital to many patients, as they come to the room to take menus and bring trays.

And then of course, I like to think of myself as having hours to sit down and counsel patients, helping them to think through how to have optimal health and make changes to improve their dietary patterns.

In all reality, the past week and a half I have spent most of my time reading medical charts and running a calculator to assess the nutrient needs of patients. This week I am working in the ICU, so many of my patients are on tube feedings.

I read through the chart to find out what brought the patient to the hospital. Then I assess the calorie needs for the patient, based on their height, weight, and current condition. For example, patients that have traumatic brain injury have higher energy needs, and those with skin breakdown have elevated protein needs. I had learned the various needs for different conditions through classes, but it is extremely different when you have a real live person for whom you are calculating their nutrition!

Medical nutrition therapy is an integral part of the healing process, and it’s pretty neat to be a part of it.

Contrary to my opinion when I began my dietetic internship, I’m finding some aspects of clinical dietetics to be quite enjoyable. I suppose that is the purpose of this internship- to force myself to be exposed to various opportunities within the dietetics field where I might be able to work.

ps. The power is back on at my house! While I thoroughly enjoyed the “camping” experience, it’s nice to have modern amenities restored 🙂