Roanna Martin

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


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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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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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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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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 🙂


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Overly Inspired.

FNCE finished up on Tuesday, and oodles of ideas are dancing around my brain. I filled a reusable grocery bag with the handouts and information from the conference. Neatly categorized? Not so much, but available, for when I decide to revisit some of the topics that were discussed.

The conference center was overrun with dietitians- an overwhelmingly estrogen-rich population- wearing purple name badges and discussing and brainstorming and networking like it was their job.

Oh wait: it is their job.

I think one of the most beautiful roles of a dietitian is to connect people and communities with the information and resources that they need to make conscientious and healthful decisions about the food that they consume in order to maximize health.

That is a pretty broad statement, and there are a lot of avenues that this job can play out.

By the way, the opening session of FNCE featured Dean Karnazes, UltraMarathon Man. Incredibly inspiring. I had seen him featured in Runner’s World (a Rodale publication, interestingly enough) a few years ago, but it was awesome to hear him in person.

This is what Day 1 of the conference looked like for me:

“Community Influences to Enhance Childhood Overweight Interventions: Putting Research into Practice”.

• Social determinants of health lead to certain behaviors which in turn lead to health outcomes.

• We are strongly influenced by the environment in which we live.

• Additional information from the White House Child Obesity Task Force report can be found here.

 

“Tomorrow’s Culture Shock: What it Means for Health and Wellness”

• In 2012, there are 314 million people in the US with an average life expectancy of 78 years.

• In 2050, there are projected to be 439 million people with an 83 year life expectancy.

• The changing demographics in the future have a multitude of implications on healthcare and nutrition.

 

“Calling All Food Bloggers: Stay in the Game”

• It was great to learn from 2 dietitians who blog for the Food Network “Healthy Eats” blog.

• There were all sorts of tips for writing great blog posts- some of which I will try to implement in this intern blog, and others of which are probably more appropriate for a different style of a blog that I may write in the future.

 

“To Inflame or Not to Inflame: An Evidence-Based look at Omega-6 Polyunsaturated Fatty Acids”

• There has been speculation that a high Omega-6 to Omega-3 ratio in foods is linked to inflammation, but this theory has been discredited according to the latest research.

• According to human studies, there is no data to suggest that omega-6 causes inflammation.

• Basically what it comes down to is that inflammation is very complex, and pinpointing the condition on one small nutrient is useless (In my mind this is a “duh” observation- although great progresses have been made in nutrition science, there are so many things yet to be discovered. Chemical and hormonal pathways in the body are incredibly interwoven, and we can’t possibly break nutrients and foods into stark black and white.)

So, that was an overview of my Day 1. I’ll save more about the conference for future posts!


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FNCE: Food and Nutrition Conference and Exposition

I am currently in Philadelphia, PA for one of the very largest gatherings of nutrition professionals in the country.

This event is put on by the Academy of Nutrition and Dietetics, and is an awesome networking event for dietitians and other food professionals.

This is my first FNCE to attend- and I’m very excited to be here.

The event officially kicked off this evening, but today I got to attend a pre-conference workshop that was right up my alley: a Rodale Farm Tour.

I’m a member of a dietetic practice group HEN (Hunger and Environmental Nutrition), which focuses on empowering members to be leaders in sustainable and accessible food and water systems. This practice emphasis lends itself well to partnership with organizations such as Rodale Institute.

Rodale Institute has been pioneering in the field of organic agriculture since 1947, and I’ve read a lot of their publications, so I was excited to visit the farm today.

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Here, an organic dairy farmer from Vermont spoke to HEN members about herd management and health. The farmer who actually owns the herd was at a family reunion today, but it was great to get a perspective from a New Englander who is also a member of the Organic Valley Family of Farms Cooperative.

 

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Here are the hard-working gals themselves. As a farm girl from Lancaster County, I was in my element in the rolling hills of southeast Pennsylvania. It was enjoyable to be there with a group of dietetics professionals from all over the country- Boston to LA.Image

 

The milking equipment is pictured below. Research on milk quality and profitability is underway as this farm has recently transitioned to an organic model. It sounds like there are some pretty exciting results that will come out of these studies- I’m hoping to see some news headlines by the end of the year, but I don’t want to give out a spoiler!

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Zuma. Isn’t she beautiful?Image

 

The tour ended with a fabulous lunch with Maria Rodale- and she even gave us a copy of her book “Organic Manifesto”. Image

Dairy farming is hard work. It’s a struggle to make ends meet financially- and selling organic dairy products provides an option for a more livable income for family farmers.