Roanna Martin

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


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Deviled Chicks…

It’s the end of spring break here at WVU, and well, I’m getting ready for something New. Fitting, isn’t it, with Easter being tomorrow?

I didn’t make any big plans because I knew it was going to be crunch time for me on thesis and end-of-semester things. And I’m sure glad I didn’t! However, I was able to visit a friend in Maryland, where she had a SNOW day- she’s an elementary teacher- and we got to spend all day just hanging out. Well, mostly just hanging out… I was working on my thesis for most of it, but regardless, it was still good to be with her.

The remainder of the week has been a bit quiet at my house without my roommates here, but it’s been great to focus and really work on the tasks at hand. (And I’ve been doing things to mix it up too- going running with friends, playing a game of Settlers of Catan with a few others, working at a coffeeshop, sitting on the porch to study, etc…) 

I’m completely done with my 1200 hours of rotations for my Dietetic Internship- it’s hard to believe that after rotating since last June, I’m FINALLY DONE! I don’t think it’s really sunk in yet.

But there are things that remain between me and graduation…

First priority has been my thesis defense presentation, which is scheduled for next Friday. At this point I’m really looking forward to giving it- I’ve been studying home food gardening and kids’ fruit and vegetable intake for the past two years, written a thesis on it, and I’m ready to talk about what I’ve learned. I’ll share more about that with you in a future post.

I also have a few paperwork odds and ends to finish up for my internship.

And, oh yeah, the something “New”:

 

I’m  working on curriculum development for my new JOB. Which is so exciting. I’m going to be teaching cooking classes to little 2-5 year olds and their parents until the end of September. How cool is that? I have the freedom to put together my own curriculum, so I’ve been researching other programs, and pulling from my past 6 years (!?!) of study in Nutrition and Dietetics to create a fun, interactive program. 

I plan to share more with you about that experience as it unfolds, but for now I’m just going to share one of my recipes for the class. I gave it a test run tonight, and I’m taking it to an Easter potluck at my church tomorrow.

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I got the idea (through Pinterest) from this website. 

I hard-boiled eggs using the method described in the America’s Test Kitchen cookbook that my roommate has. It’s super simple: put eggs in a large pot. Cover with cold water, place uncovered on high heat until the water comes to a boil. Remove from heat, put the lid on the pot, and set your timer for 10 minutes. Then place eggs in cold water (iced works best), and commence shelling.

To make these super cute little chicks, lay each egg on it’s side, and cut about 1/3 off the end. I highly recommend cutting on the broader (not pointed) end of the egg, as this is most likely where the yolk will have settled. 

Then pop out the yolk, and put in a small plastic bag, with a bit of yogurt, a squirt of mustard (I used dijon), and a dash of salt and pepper. 

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Seal the bag, mash with your hands, cut off a corner, and squeeze to fill the crater remaining in the white. 

 

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Ok, so it looks a bit gross. But trust me, it’s scrumptious. 

After you’ve filled the egg, cap with the remaining 1/3 of the white, and insert a little carrot triangle for a beak, and something little and black for eyes. I used coriander seeds, because that’s what I had in my kitchen. You could also use whole black peppercorns, or a small piece of black olive- whatever you have that works!

Recipe for a pair of chicks:

2 hard boiled eggs (see method above)

1 tablespoon yogurt (the recipe called for greek- I used regular and they were a bit runny. I would definitely use greek next time)

1 teaspoon mustard

salt and pepper to taste

bit of carrot

coriander seeds (or other small black edible objects)

Cut 1/3 off the end of egg. Pop out yolk and place in resealable bag with remaining ingredients. Squeeze out air, and mash ingredients until smooth. Cut a small hole in the corner of the bag and pipe filling into larger piece of the white. Top with remaining white, and give the little chick a nose and eyes.

Yogurt is seriously one of my favorite foods. It’s so ridiculously versatile (sweet, savory, and everything in between!), has a great texture, and is really great for your digestive system. I make my own, and go through at least a quart a week. In this recipe, using yogurt instead of mayonnaise for the deviled eggs cuts way down on the fat, and you hardly even miss it.

I hope you enjoy!

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WIC in Words

         I just wanted to share with you loyal readers a bit more about my experience at WIC (Women, Infants, and Children). 

            After learning about WIC in classes, it was extremely beneficial to be present in a clinic where I could see policy in practice. Throughout the 80+ hours of my rotation, I was able to learn about the “big-picture” policy, and shadow a large number of nutritionists in both the main Lancaster City clinic and in the smaller county clinics in Columbia and Ephrata.

            The busy clinic in the city was able to serve a large number of participants each day, and the demographics were notably different than in the county clinics. In both Columbia and Ephrata the nutritionists were responsible for more of the visit (i.e. lab work) than in the main clinic. I was also able to engage with other community agencies that provide services to low-income women and children such as Healthy Beginnings Plus and HeadStart.

            I learned a variety of practices and techniques specific to WIC, such as the contents of the supplement packages, and the VENA (Value Enhanced Nutrition Assessment) model. Although my rotation was too short to develop a firm grasp of the utilization of the QuickWIC (electronic documentation) system, I was able to become competent enough to perform nutrition evaluations and issue checks with the supervision of a nutritionist. I truly enjoyed sitting with each of the nutritionists (14 in total) and learning their style of nutrition counseling. Each one brings strengths to counseling that I was able to learn from.

            I developed a basic understanding of WIC policy, and refreshed my knowledge on maternal and child nutrition. In particular, the developmental stages of infants and the recommended timeline for introducing new foods and feeding practices was a good review. The opportunity to practice my Spanish language skills and enhance my vocabulary- particularly the colloquial “Spanglish” spoken in the region- was beneficial.

            I need to continue to develop my nutrition counseling skills, and I believe that this will come with more experience. In particular, I would like to continue to strengthen my ability in helping the client to share what motivates them to make change, and help them to identify ways that they could make a change.

           While it has it’s flaws, I see a lot of benefits of the WIC program for low-income, nutritionally at-risk mothers and infants.  


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Farmers’ Market Gleaning Project

As a member of the Academy of Nutrition and Dietetics, I get to choose a state affiliation. Since I’m living in West Virginia for grad school, I am currently a member of the West Virginia Academy of Nutrition and Dietetics (WVAND), and it’s been a fun way to get to know other dietitians in the state.

At the 2012 WVAND meeting, I committed to supporting local foods in my community, and I met that challenge by coordinating a gleaning project from the Morgantown Farmers’ Market.

I enjoyed coordinating this pickup and subsequent distribution to the local Salvation Army soup kitchen. 

My project description was just posted on the WVAND Website, and I thought I’d share it here as well!

“This past summer, after a suggestion from RoundRight Farm, and in collaboration with a graduate student in Ag Economics at the Davis College of WVU, I coordinated a market gleaning program from the Morgantown Farmers’ Market to the Morgantown Salvation Army Soup Kitchen.

Every Saturday as the market closed, myself or another volunteer walked around to each stand at the market to ask vendors if they had extra produce would like to donate. At the beginning of the summer, when there were just a few bags of greens, it was easy to walk the produce down the street to the soup kitchen. However, as the season progressed and beans, beets, tomatoes, and other hefty veggies were abundant, a car was necessary to transport the bounty.

The vendors were glad to see their produce being put to use, and the soup kitchen was creative in their use of the veggies. When I stopped by to see what they had made, they were serving green beans with sliced radishes!

We would love to see this project continue in the future, and are in the process of making plans to formalize, improve, and expand upon our current model. Perhaps this is even something that could be replicated around the state in other farmer’s markets.

If anyone is interested in providing future assistance in this program, either by helping with pickup, or potentially making a special dish out of the produce to serve at the kitchen, we would love to hear from you! 

Much thanks to Jessica Kozar, a WVU Human Nutrition and Food major, for her assistance with the pickup and delivery!”

Produce on its way!

Produce on its way!

And one of the creative dishes:

Green Beans and Radishes

Green Beans and Radishes


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Sprouts Harvest

 

So, after Day 5, came the day of harvest. I started a rotation at a rehab hospital yesterday, so that took priority over blogging yesterday and today- so sorry for those of you who were expecting the “sprout series” to wrap up earlier!

The tower was beginning to teeter, pushed askew by the  muscular mung bean sprouts at the bottom.

The Toppling Tower

The Toppling Tower

Here’s what each tray looked like immediately prior to harvest, which was exactly 6 days after the seeds were first place on their trays. There wasn’t a lot of broccoli left- I had snitched quite a bit to put in salads, wraps, and soups 🙂

Broccoli

Broccoli

At this point in time, the alfalfa is probably my favorite of these three varieties. It has a mild, slightly sweet flavor which is delightful to just eat plain. (Boring, I know, but I can’t always be gourmet!)

Alfalfa

Alfalfa

And these big guys. 

Mung Bean

Mung Beans

To save space in my refrigerator, I just put all of the sprouts in the same container. I think this is probably about 3 cups of sprouts. Including what I harvested earlier, I estimate that I got a little less than a quart of sprouts from 3 3/4 tablespoons (a wee bit less than a 1/4 cup) of seeds. That’s a pretty good yield for 6 days!

Mixed Sprouts

Mixed Sprouts

Tonight I wrapped a whole wheat tortilla with a generous spoonful of garlic hummus around a handful of sprouts, sauteed chicken strips, and some steamed kale. Delicious and simple dinner for 1!


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Case Study: Anorexia Nervosa

As a culminating experience of my recent clinical rotation, I compiled and presented a case study with the dietitians at the facility.

If you would like to learn more about this critically ill patient that I was able to work with over the course of the rotation, feel free to look through the presentation.

<div style=”margin-bottom:5px”> <strong> <a href=”http://www.slideshare.net/roannamartin/anorexia-nervosa-case-study&#8221; title=”Anorexia Nervosa Case Study” target=”_blank”>Anorexia Nervosa Case Study</a> </strong> from <strong><a href=”http://www.slideshare.net/roannamartin&#8221; target=”_blank”>Roanna Martin</a></strong> </div>


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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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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 🙂