Sunday, November 29, 2009

Who Knew Diabetes Was So Interesting?

I noticed this morning that the last of the golden leaves are falling from the trees. I didn’t think they would last as long as they did and I’m sorry to see them go, especially because they made my commute for the last two weeks that much more beautiful. I’ve been working with Jennifer Okemah, an RD who has specialized in diabetes and has created a diabetes counseling and education program at Valley General Hospital in Monroe. I know Jennifer from previous volunteer experiences, and from the ADA diabetes camp rotation this past summer.

This rotation was a lot of fun and challenging for me because while I’m a fairly low-key, slow-moving and thinking person, Jennifer is a fireball. She’s always doing three things at once, and probably thinking about twenty. My brain was challenged just by trying to keep track of her movements around the room. Nevertheless, she always had time to answer my questions in detail and to give me guidance when I needed it for an assignment or project.

My hours during the week were shorter to work with Jennifer’s schedule so I was also there on Saturdays to make up the difference. The six-day-week (including Monday seminar) was tough for me but it was certainly nice to get home early every day.

The goal of the diabetes program is to provide people with diabetes with education and counseling to help them manage their diabetes. Jennifer’s partner in the program is an RN/CDE, so they're able to address the patient’s needs from both the medical and the nutrition standpoints – and there is some crossover in each one’s expertise so they complement each other well.

In general, patients have two or three individual appointments with Jennifer and/or her partner and attend a series of four group classes designed to provide more general information about diabetes management. When I first arrived, there was a fairly full calendar of patients to look forward to but every day that I was slated to observe appointments there were several cancellations or no-shows. That was really the only disappointment for me in this rotation, and after the third day of this pattern, I started to feel like I was cursed.

There was a silver lining to this curse. I had more time to ask Jennifer questions, and to work on some of my assignments. During some of this down time, Jennifer let me in on some of the difficult political and bureaucratic issues that an RD faces, both generally and in the position of program coordinator, including the general lack of knowledge that exists around the expertise and scope of practice of an RD. She asked me to sit in on her presentation to the hospital foundation that funds her program (in part) so that I could observe her advocating for herself and the program.

Despite all the no-shows, I did manage to observe several appointments and was astounded (really, I shouldn’t have been surprised) by the level of knowledge and experience that is necessary to truly inform patients about how to manage their diabetes. I was continually reminded of the complexity of the disease, not just medically but in psychosocial terms, especially for the newly-diagnosed. I’m attracted to the idea of specializing in diabetes because I think I would be a better specialist than a generalist, and diabetes is complex enough to be continually engaging for a practitioner.

In the second week, I led a meal plan appointment. I calculated the patient’s energy needs and carb allowance, and explained how to distribute carbs throughout the day. We did some carb education (which foods have carbs in them?) and talked about how diet helps with blood sugar management. That was fun -- not the calculations but the talking to the patient -- though I know I could have done better.

I had lots of opportunities to practice overcoming my greatest fear: PUBLIC SPEAKING (dum da da dummmm). I led parts of two different group classes with lots of backup from my supervisors, taught 6th graders how to look at fat, carbs and sodium on nutrition labels, and did two back-to-back hour-long cooking demos at the YMCA for National Diabetes Month. In the middle of that, I co-taught a cooking demo for people with diabetes through a different outpatient diabetes program with two of the other interns.

I feel like this stage fright should just about be burned out of me by now, but it doesn’t seem to have diminished a lot. What has changed is my ability to deal with the stress of public speaking. I know I have to be prepared (duh). I know I have to have certain parts, especially the intro, scripted out for myself because those parts require some verbal finesse that isn’t always present when I’m nervous. I know now that I don’t have to be perky and perpetually smiling to hold the attention of the audience, even 6th graders, as long as what I’m saying is engaging and makes sense.

Something else I learned was the difference between the CDE (certified diabetes educator) and BC-ADM (board-certified advanced diabetes management) credentials. Jennifer has both credentials and both are useful, though there’s a distinct difference between the two. In short, the main differences are that the BC-ADM requires an advanced degree, the test is harder, and the scope of practice for the BC-ADM is more advanced than a CDE, including “advanced clinical assessment, prioritization of complex data, problem solving, counseling, and clinical intervention and monitoring”. Most diabetes educators are CDEs, some are BC-ADMs and a very small percentage are both.

So that was my outpatient diabetes rotation. I’m sure I’m forgetting something but this will have to do for now –- dinner’s being served. I have another diabetes rotation early next year and I’ve heard that the philosophies and practices are quite different there from what I’ve observed here with Jennifer, so that will be interesting. My next rotation, however, is with WIC. Looking forward to learning more about that program!

Sunday, November 8, 2009

Now We're Getting Somewhere

I have two different rotations to tell you about this week.

The first one was not officially a “rotation” but was still a lot of fun and I learned a good deal. For two days I shadowed Michelle Babb, a private practice dietitian who also happens to be an instructor at Bastyr so we knew each other ahead of time (always nice to see a familiar face during a transitional time like this internship). It was fairly leisurely, as she had a couple of no-shows, so we talked a lot about the challenges of private practice, about my plans for the future, and about nutritional approaches to different types of problems and different kinds of people.

For the patients that we did see, I was interested in observing a professionally-run nutrition appointment from start to finish. All the appointments were follow-ups so I missed out a bit on the original intake, but was able instead to witness the positive impact Michelle’s counseling had on these people’s lives. Michelle was very generous in asking for my input during appointments and letting me work with her on charting. It was a great introduction to my rotation the following week at the Bastyr Center for Natural Health, which is where I had done my nutrition counseling shifts in the last year of my program.

I had six four-hour shifts, four with NDs (naturopathic doctors), one with homeopathy and one with acupuncture. All the shifts were fascinating and showed me a bigger picture of complementary medicine than I got on my nutrition shifts at BCNH. The homeopathy shift was the most foreign to me, and I did not have a chance to participate in the patient’s care because of the nature of it. Maybe I’ll write more on this later…

Each shift supervisor had their specialty but the structure was generally the same for each shift: get the bigger health picture for the patient, prioritize the most important issues and treat them, with a follow-up plan to address the other issues later. Treatments ranged from individually-formulated botanical tinctures and teas, to pharmaceutical-grade supplements, to antibiotics for a protracted case of UTI, and referrals for imaging or blood tests. In this context, nutrition issues were often supplanted (and rightly so) by more acute medical problems like head colds, shoulder pain, etc.

However, I did my best to chime in when I thought there were ways to address the priority issues with nutrition, or when I felt that a referral to the nutrition department was called for. Most of my patient contact was very short (1-5 minutes) though I did have a 20-minute conversation with a patient with severe involuntary weight loss during which I intuited a more emotional component to the weight loss, and I shared this with the students, though I will not get to find out what the cause actually was (and therefore find out if my intuition was correct). During the midpoint, I got to do some of my handy-dandy nutrition calculations and reassure the students that the patient was still above ideal body weight, and in the end was able to give the patient some input into how to prevent further weight loss. Very satisfying. And for the last appointment of the last shift, and the highlight of my week, I gave a 30-second lesson in how to make calcium-rich bone broth for a child on a dairy-free diet.

I’d say my biggest surprise in this rotation was that I was able to convey important nutrition messages quickly that fit in with the overall plan for the patient. My other surprise was how grateful patients were for my input.

Over the next two weeks, the gears really start turning. I’m working with an outpatient diabetes program and will be teaching two or three classes, including a couple of cooking demos for National Diabetes Month. I’ll have a lot more to say about that rotation in a couple of weeks.

Wednesday, October 28, 2009

There's a Revolution Going On

My first rotation was with an organization called Readers to Eaters (also called R2E), a relatively new company that aims to promote food literacy by selling books about food, publishing books about food (starting in 2010), and developing educational programs about food. The owners of R2E are Philip and June Jo Lee – he has a background in radio and publishing, and she is a research consultant to the food industry. To Philip and June Jo, being food literate means having an awareness of what one eats and where food comes from.

My internship director set this rotation up for me because of my background in writing and my special interest in nutrition education in the public school system. I had thought it would be a gentle introduction to the internship, encompassing some writing, some observation of Philip in his daily work, and a little research… as usual, my expectations were quite off the mark (yes, this is an ongoing problem for me).

Instead, my task was to conduct a needs assessment for a food literacy program in the community. Philip’s goal was to create a unique curriculum that fills the gaps left by existing programs. I worked from home, using the Internet to find non-profits, for-profits, school districts and individual schools, and government agencies that are promoting food literacy at some level. Over a two-week period (which was really eight days because we have seminar on Monday), I collected notes on a number of local programs, querying some by email or phone to find out what their staff thought were the unmet needs for food literacy in the community, compiling a resource list for Philip, and writing up my recommendations for a nutrition education curriculum that would answer these unmet needs.

I found some fantastic organizations: Food $ense, Operation Frontline, 826 Seattle, School’s Out Washington, Solid Ground’s Apple Corps (LOVE the name), and Sustainable Table. There were many others; in fact, there are literally hundreds of individuals and programs out there trying to teach kids about food through cooking, gardening, and nutrition education. Everyone I spoke to was passionate about food, interested in the R2E mission, and eager to share information.

I am even more excited now about my long-term goal to get involved in nutrition education in the public schools, though I think it will be more interesting and useful to talk about how to grow, cook and eat real food than to teach the principles of nutrition. These are exciting times, folks, when kids are getting turned on to healthy food by pulling a carrot out of the ground, or by tasting roasted kohlrabi from their own school’s organic garden. Unfortunately, the UK seems to be beating us to the school lunch revolution (thanks in part to Jamie Oliver). Is anyone else out there foreseeing interesting changes in school lunches thanks to the Obamas?

Saturday, October 10, 2009

Orientation: Week Two

Week two of orientation is over. We are now so thoroughly oriented that we all point due north. By Friday mid-morning I was utterly wiped out and emptied of most of my questions, except for the big one, “How do I fit all of these rotations, projects and assignments into nine months… AND do a good job?” Ahhh, life... it’s one long series of questions.

Back to my week. Three of us gave a lesson in doing a cooking demo for the interns who hadn’t taken Cynthia Lair’s class last year. We started by describing the elements of a demo, then we showed them what to do by demo’ing Cynthia’s French lentils with sage butter, then showed them what NOT to do (actually Misha showed them what not to do in her inimitable way) in a cooking demo/food safety nightmare skit. Then the other six each did a quick cooking demo for us – they were all so good that you would never know they hadn’t taken the cooking demo class.

We also had a lesson in maternal/child nutrition from an ND, who was such a font of knowledge that she got us excited about our WIC rotations. Later that same day an RD talked to us about WIC and the new food package, which now includes fruits and veggies, whole grains and non-dairy protein options! Hooray! The RD reminded us that the population seen by WIC staff often have higher priorities than nutrition counseling and that we could end up just helping someone figure out how to use their WIC checks, or how to pay their rent that month. No matter, we were still excited about our WIC rotations.

Note to self: Since the WIC population is considered a vulnerable population, working with WIC right out of my internship would qualify me for the loan forgiveness (here's a rather dry description of the program). In other words, if I went to work for WIC, a portion of my student loans would be written off. Hmmm, it's tempting, though the maximum they’ll forgive is $10,000 over five years. (More information on loan forgiveness programs here.)

Wednesday and Thursday were spent working on our group projects in smaller teams. My team finished up our plan for the cooking class we’ll be teaching on white-colored foods. On Friday we basically checked in, talked briefly about our group projects, went over the continued learning portfolio required by the ADA (for RDs, not interns) and then went on our merry ways (my merry way took me home for a nap).

Saturday, October 3, 2009

What a Week!

It was the first week of a two-week orientation for the Bastyr dietetic internship. We met every day except one with our director in a small classroom on the south side of the building (Bastyr University is essentially one large U-shaped building), far removed from the usual student traffic and looking out onto a walled-in grassy area. Clouds and rain threatened for most of the week, but occasionally the sun would come out to warm and invigorate us.

Without giving away the whole curriculum, we had a number of activities and discussions structured to help us get to know each other and to build our “team.” And of course we discussed the requirements of the internship, went over our rotations, and got a feel for what our year would be like. There were also a couple of field trips, including a "retreat" day at our director’s home with a vegetarian potluck (including some gluten-free and dairy-free options), and a trip to a dialysis center to learn what it’s like to be a renal dietitian. Four of the interns have a special renal rotation, but the rest of us do not so it gave us a nice glimpse into the practice of renal dietetics and dialysis.

In addition to the usual rotations, we have a number of intern projects to complete. We’ll each lead one project, with the other eight interns as resources, and we spent a fair amount of time on the last day planning for the first two projects: a series of cooking/nutrition classes for Bastyr employees, and a research project culminating in the production of a publishable paper, potentially resulting in a published paper with all of our names on it!

As for the nine interns, we are a widely varied group in age, experience, and interests. Personalities run the gamut from irrepressibly exuberant to low-key (that’s me) with many shades of “color” in between. I think everyone liked everyone else, and that we’re going to be a good team for the next 9 months.

Monday starts with a lesson in doing a cooking demonstration. Normally this is taught by the amazing Cynthia Lair, but since three of the interns, including myself, took her course in this very subject in the last quarter of our program, Cynthia turned the class over to us. So three of us will demonstrate how to do a cooking demonstration to the others, then they will have a chance to do a short cooking demo and be evaluated by their peers.

At the end of this first week, I am simultaneously excited and frightened out of my wits about the coming experience. During this week we all expressed some level of trepidation, either about doing or saying something wrong during a rotation, not being able to remember information when it’s called for, and/or public speaking. I’m also fearful of letting down my director or my fellow interns in some way, which would also be letting myself down, but after hearing everyone express these fears I felt somehow better.

Part of being human is to be fearful – fear keeps us vigilant and charged up to meet a challenge. I remember driving to school in the first quarter of my first year of the nutrition program, on my way to doing my first presentation in class. My fear of public speaking is fairly intense, and was even more so then. My heart was racing, my hands were shaking, and my legs were weak. There was absolutely not a happy thought in my heart at that moment and I felt an almost uncontrollable urge to turn the car around and go home.

In that condition, my only recourse is usually to talk myself down from the ledge by finding a new and less scary perspective of the situation. That day, I got past my fear by reminding myself of the purpose of fear. The “fight or flight” response is a programmed reaction to imminent danger. Public speaking is (arguably) not dangerous. That simple logical progression was enough to calm me down and allow me to get to school and do my presentation.

Frankly, I expect to have to “talk myself down” pretty regularly throughout the next year. After two years of practice, it’s a well-developed skill that will help me meet all the challenges of the internship. Now I know that I also have the support of eight others who will be facing the same challenges and who may call on me for support when they feel like they’re out on a ledge.

Wednesday, August 26, 2009

Last Days of Summer

You know, even though I promised another post about the ADA camp, I just don’t have it in me. Maybe it’s that summer is winding down and I’m getting nervous about the official beginning of the internship. I have a lot of catch-up studying to do, and I’ve been doing a lot of other things over the summer that have kept me from getting all that relaxation time I was looking forward to! So, nothing more for now. The internship starts on September 28th, so stay tuned.

Monday, August 17, 2009

Diabetes Camp: Blood Sugar Control

Kiki trying (not too hard) to get some sleep.


I helped out on midnight checks two nights out of the four I was at ADA camp. Midnight checks were one of the highlights of my experience. It was the one chance I had to directly assess and treat blood sugar levels – under the supervision of the providers, of course. An RD’s scope of practice with diabetes is fairly limited, but in reality that all depends on the provider the RD is working under. One RD told me that we are never allowed to puncture the skin, but I know another RD who is a CDE (certified diabetes educator) and is working on her BC-ADM (board-certified advanced diabetes management) who gives insulin injections, manages insulin pumps and is allowed to adjust insulin doses, so it all depends. One of the ARNP’s admitted to letting high school kids do finger sticks in other venues.

Midnight checks entailed stealth maneuvers through the woods past raccoons and cabins full of sleeping campers, identifying our ADA kids in the dark and wrangling their arms out of their sleeping bags, performing finger sticks on them without making them cry, and administering snacks if their BG was low (<150). Most of these kids were incredible – they’d stick out a hand and fall back asleep while we did our thing. However, if a child had a low BG, it was much more challenging to get him/her to sit up and eat a snack. One of my girls hated the fruit roll-up I gave her so much that she started gagging and crying right there in the top bunk in the dark at midnight with her eyeshade pulled down around her chin. I tried to keep her calm and get her to swallow. Telling her, “the faster you eat it, the sooner you’ll be done,” was NOT the right thing to say and in the end, she had to wash down the half-chewed fruit with some Boost. Within seconds her tears had dried and she had settled back down into her sleeping bag – that's what I love about kids, that ability to move on. Next day we had a little laugh about it together. If faced with that situation again, I think I’d go for the Boost first time around. It’s not a whole food but it’s easy for a groggy child to drink down quickly. The second time I did midnight checks, all three of the kids I checked on had BG’s within normal range so I didn’t have to do anything special but this experience was satisfying in its own way – it meant that we (the ADA staff and the kid) were doing a good job! It also meant that I didn’t have to stay up for 2am checks.
Annie and Stefanie, biding their time 'til midnight.


I ended up staying up anyway because Aaron, the provider “on call” that night, was in a teachin’ mood. We (me, Aaron, Stefanie, an RD, and Annie, a dietetics student) took our headlamps and some snacks (dark chocolate and Weinhard’s root beer) and went outside to the picnic area so that our talking wouldn’t wake up the people sleeping in the ADA cabin. We passed a raccoon and her little one rummaging through the garbage just outside – they snacked on camper trash while we sat and talked.

Aaron gave us a lot of insight into the mechanisms behind diabetes, the different kinds of insulin and their best uses, and showed us how he calculates an insulin dose based on the child’s BG, their carb count, their insulin-carb ratio and the insulin correction factor. These last two are calculated from the kid’s total daily dose (TDD) of insulin, which is established by the child’s care team outside of camp based on the child’s weight and insulin sensitivity.

Aaron, diabetes provider AND provider of
delicious snacks and evening entertainment


Dosing the kids at camp was a little different from dosing them at home, because kids tend to be a lot more active at camp. Activity naturally brings down blood sugar, so the insulin doses were adjusted down to account for the increased activity. If a child was on a pump, their basal rate was adjusted when they arrived at camp and as needed throughout camp, and bolus doses to cover meals and high blood sugars were also lower than usual to keep them from going too low between meals and overnight. Children who injected their insulin got a lower dose of Lantus, a long-acting insulin. It was a real balancing act!

I’m sure my explanations are insufficient to describe the whole process that goes on in a provider’s head when deciding an insulin dose. The provider’s judgment is based on the child’s history and TDD, but after a few days at camp and getting to know the kids a little better, I’m guessing that there were countless other small details that influenced the dosing.

So that was what I learned in a nutshell about blood sugar control at ADA camp. It was really a great opportunity to witness the daily challenges of maintaining blood sugar levels for both the kids and the providers.

I still have a few miscellaneous experiences that I’m anxious to write about, so stay tuned for one more post about ADA camp!

Wednesday, August 12, 2009

Diabetes Camp: Day One


I recently spent five days on an optional rotation at a summer camp with the American Diabetes Association. Here's what day one was like:

Early departure at 6:30 am. I carpooled with Maria, who just finished the Bastyr internship in June and is about to take the RD exam (good luck, Maria!). Besides having Bastyr in common, Maria and I have a connection through a very good friend of mine. Maria's husband is a childhood friend of my friend's husband. Five degrees of separation.

I actually brought my Krause with me because I hadn’t had a chance to read up on MNT for diabetes. When I told Maria I’d brought it she just laughed. She said that the diabetes experience at ADA (American Diabetes Association) camp was barely touching the tip of diabetes, and she should know because besides having done camp before, she’s a Russian-trained endocrinologist with extensive experience with diabetes.

Maria and me at the shoreline


The drive and ferry ride were uneventful, except in how charming and rustic Vashon Island was. We arrived at Camp Sealth just in time for breakfast. And what do you imagine was being served to the Type I diabetics in the dining hall? Belgian waffles with syrupy strawberries and whipped cream (oh, but the syrup was sugar-free!), an assortment of refined cereals like rice crispies and corn flakes, and fresh fruit. The protein was bacon. The fresh fruit was nice, but I had expected there would be a greater attempt at providing more blood sugar-friendly food for our beleaguered little ones.

I should clarify a couple of things before I go on. This was not a camp for diabetics. This was a regular summer camp session with special provisions (i.e., the presence of the ADA staff) for kids with diabetes. We were told at orientation that about 70 kids out of 300 would be Type I diabetics. Secondly, the primary goal of the ADA in this setting was to keep the ADA kids safe while they had a "normal" summer camp experience. Apparently, this included eating the same non-food as the "normal" kids. The only special provision for the kids made by the kitchen was to provide sugar-free syrup for the waffles, and sugar-free canned strawberries for the strawberry shortcake. I hope I don't have to point out the irony of this to you...

Interestingly, special care was taken to provide options for the four vegans/vegetarians at camp, and for the one child in camp with a severe peanut allergy.

The rest of the day was a blur of meeting the ADA staff (most of whom would be replaced the next day by a new crew), getting the lowdown on the life of a camp intern from Misha, another Bastyr intern, and learning to carb count… oh joy! My preceptor would not arrive until late that evening, so Misha’s preceptor, Susie, helped to orient me.

Inside the ADA cabin: tables for checking BS and getting dosed


By mid-afternoon I had a fair idea of what my days at camp would look like:

There would be two ADA staff locations at camp, called “pods.” ADA kids would come to one of the pods before each meal to look at a sample plate of food for that meal, tell us what and how much they were going to eat, and we would count up their carbs. The kids would then do a finger stick and get their insulin dose based on the carbs they planned to eat and their blood glucose level. The insulin dose was decided by the providers, most of whom were nurse practitioners, and administered by nurses or by the kids themselves.

Other than mealtimes, ADA kids would come in if they weren’t feeling well (and go through the same drill except for the carb counting), and at bedtime so that they could get a snack or an insulin dose to take them through the night.

These were my main duties: 1) Prior to every meal, get the menu and do a carb count based on product labels or carb counting books; 2) Plate up reference portions of food for the kids to look at; 3) Write the menu and carb counts on a board; 4) Go through the menu with the kids before each meal, tallying the amount of carbs they planned to eat. Other than that, I would have a chance to supervise the kids doing their finger sticks, participate in midnight blood sugar checks, and wear an insulin pump loaded with saline for a day or two.

Sleeping arrangements: I slept in one of four beds in an area behind a partition at the back of the main room of the ADA cabin. Since this was open to the front of the cabin, I knew there would be no rest for me until midnight checks were done and all the lights were off. I’m a very light sleeper so I always come prepared with ear plugs and eyeshades, but the effects of these were dulled by my racing mind, an awareness of stealthy activity in the next room where staff members were passing the time until midnight checks (more on this later), and SNORING! I counted three different snorers that night, one of them so loud that the noise penetrated my ear plugs (rated for 30 decibels) from a room down the hallway and through a closed door.

Everyone quieted down within a couple of hours and I did eventually fall asleep, but I had a long time to mull over my day and ponder how a snoring person could sleep with such a thunderous sound vibrating through their own skull. ZZZZzzzzzzzZZZzzZ.

Saturday, July 25, 2009

First Rotation Done!

I finished my first rotation for my internship yesterday. I actually have two summer rotations, the second of which comes around in another week, and which you will hear all about when it’s over. This first rotation came as a surprise from my director about a week after graduation. She emailed us about the possibility of helping out with two summer food programs in the Auburn School District.

The cool and unusual thing about this rotation is that the internship director’s husband is the Food Service Director for the Auburn School District and I know his reputation for being passionate about whole foods, good nutrition and supporting local farmers. I also know that he started an organic garden and fruit orchard at one of his schools with the hope of bringing fresh food into the cafeteria and teaching the kids about gardening. This rotation would involve working with two different programs in the Auburn school district – the Summer Food Service program and the Summer Food Academy – so I immediately signed up.

The Summer Food Service program is a continuation of the National School Lunch Program, making free lunches available throughout the summer to those families who qualify for free or reduced lunches during the school year. Most school districts, at least in Washington, set up one or two meal sites throughout the district and require the families to bring their kids to the sites every day to get their lunches.

The Auburn School District, on the other hand, literally goes the extra mile by bringing the meals to the communities that need it most. Besides the free meals provided at schools where summer school is in session, there are about 33 other sites where free lunch is served throughout the summer. There are teams of two or three people who prepare the food, pack it into a bus or station wagon, drive out to a neighborhood and literally set up a tray line on the side of the road or in front of an apartment complex so that the kids in the neighborhood can get their free meal. Any child in the neighborhood can come have lunch. Each team goes out to 4-6 sites every day.

As an intern, I participated as part of one of these teams and observed trends in food selection by the kids. They did a pretty good job for themselves! Most of them took both fruit and vegetables, though not many of them knew that the little pinkish-yellow fruit I was offering them was an apricot. They thought it was a peach or a plum, and one kid even said, “I’ll have the mango.” Actually, I think it was the parent who called it a mango.

The Summer Food Academy (days 2 thru 4 of the rotation) is more like a day camp for kids. They enroll in the program ahead of time and pay a fee of $36.00 for a 3-day experience. They help cook breakfast and lunch for the group, and in between meals there are lessons in the organic garden about bugs and plants (and nutrition, now that there are Bastyr interns!) taught by an educator from the FoodSense program.

Part of my responsibility at the Summer Food Academy was to incorporate nutrition “messages” into the curriculum, so I taught a little lesson on “What is a Whole Food?” based on Cynthia Lair’s lesson from the Whole Foods Production course at Bastyr. The kids got really into trying to decide whether or not chicken pot pie was a whole food, and they were absolutely positive that Cheeto’s were NOT a whole food. Guess I did my job there.

The second day I talked to the kids about fiber: what kind of foods have it, what it does for the body… They liked hearing about the 100,000,000,000,000 bacteria (10x the number of cells in the human body) living in their intestines, and how eating fiber feeds the bacteria and keeps them healthy. We also talked about pooping and constipation, not the best topic for breakfast but they took it in stride.

I also did a lesson on “Chip” the compromised corn cob (from Jenn Dazey’s book Naturopathic Gardening -- Jenn teaches organic gardening at Bastyr). Jenn taught us that a plant that successfully fends off bugs and disease or survives a drought has strong genes and a powerful innate immune system that should be preserved by being replanted. The Mayans, famously reliant on corn for food, always kept the seeds from plants that bore Chip-like ears of corn and mixed them in with other corn seeds in a 50:50 ratio, thereby ensuring genetic diversity and a strong crop for the following year.

I learned in a different class altogether that plants that are allowed to defend themselves against adversity (meaning that they aren’t sprayed with pesticides or otherwise artificially protected) actually contain more phytonutrients, the compounds in plants that function as an immune system. This is good to know for those of us who are put off by the imperfect produce at the farmer’s market, or who are used to the uniform and unblemished produce in the grocery store.

I combined these two lessons and taught the kids that the imperfect or blemished fruits and vegetables they see in the store may actually be more nutritious than the perfect F&V. Carey, the garden educator, added a great illustration of this concept by explaining how having chicken pox gives our bodies the tools to fight the virus off and strengthens our immunity.

This was a fantastic experience for me. I found that I instinctively know how to talk to kids despite not having kids of my own, though I need to practice using a louder voice. I tend to start big and loud and end with a whimper. I think I could also practice making a point in two or three different ways, so that the kids who don’t understand a concept the first time around might understand the second time.

I also had some practice in asserting myself (something that is challenging for me), because the people I worked with weren’t sure what I was supposed to be doing and I needed to make sure I fit my assignments into their schedule. I think I did a good job of communicating my needs and also at being flexible about my lesson plans and when and how to offer them. On my last day, Janet, the kitchen manager, told me that I hadn’t been a pain in her butt – this was meant as a compliment. I guess she expected to have to do some hand-holding but I was independent and helpful and didn’t get in the way. Mission accomplished!

Sunday, June 28, 2009

After the Pomp and Circumstance


Before all the details slip my mind, I need to write about my graduation from Bastyr University this past Monday. It was a true celebration, far more grandiose and joyful than I expected. Just trying on my gown the night before felt momentous, even if it did make me look like a linebacker.

The time spent rehearsing, eating a quick lunch provided by Bastyr, and getting lined up for the procession was our last chance to bond before going our separate ways. After all, we had spent the last two years in the same classes every quarter – these faces have become a part of my life. I felt buoyed by the collective excitement, proud of our accomplishments, and ready to move on.


My mother had flown in from California, and my brother and his family came from Arizona to witness the ceremony. As I filed into Benaroya Hall with the rest of the graduating students I had no hope of finding them in the audience because nearly every seat was full, and the noise from the cheering and clapping was so tremendous that it would surely drown out any sound they made. Nonetheless, I was not five steps down the aisle when I heard someone yell my name and, looking to my right, saw my family shouting and waving at me, my husband holding the camera up high above his head in an attempt to videotape the procession.


I felt like a star. In retrospect, that sounds a little ridiculous, but at the time it felt great. And of course I wasn’t the only star that afternoon – we were a constellation of stars! (I can’t help being maudlin…) This was nothing like my first college graduation, twenty years ago now. I can barely remember that graduation. This one I will likely never forget. This one I really worked hard for, and this one felt like the end of a journey, not just a transition.

Later, my husband stood at the edge of the stage to capture the moment that my name was called and I crossed the stage to accept my diploma. My sister-in-law whooped loudly enough to scandalize her two boys, and Dr. Kestin, who was presenting me with my master’s hood, said, “Sounds like you’ve got a fan!” I don’t if that’s how I would put it, but I was definitely feeling the love!

When all the Master’s grads had made it onto the stage, Dr. Church officially conferred us with our degrees and reminded us to “master” ourselves, rather than others.


Five days later, I’m still feeling a little choked up and am suddenly aware of the friends who have already moved away for their dietetic internships in far-flung states. Luckily, several friends remain here in the Seattle area, some who will be interns at Bastyr with me. This next year is the proving ground for us in our chosen field of dietetics, and I’m very excited and a little fearful, but mostly looking forward to this next challenge.

And now begins the rest of our lives. Congratulations everyone!

Friday, June 19, 2009

Getting An Early Start

It’s only June, and I haven’t even graduated yet, but I’m already beginning my internship!

The Bastyr interns have been offered the opportunity to complete 32 hours of a diabetes rotation by working at a summer camp on Vashon Island for 4 days. This camp will be slightly unusual as these summer camps go because it will be a mix of “normal” kids (what kid is normal, anyway?), kids with T1DM and kids with celiac disease. Out of about 300 children, only 70 will be diabetic. This will also be the first year that the camp integrates gluten-intolerant kids (they’re expecting about 30). Since 5-10% of T1DM kids have celiac disease, there will be some overlap between the two groups.

Today I attended an orientation of sorts. The orientation took place at the GIG conference in Seattle and our small meeting was led by Cynthia Kupper, RD and executive director of GIG, the Gluten Intolerance Group of North America, and Jennifer Okemah, the lead RD and diabetes expert for the camp. Cynthia is a dynamic personality (so is Jennifer) and has been instrumental in new legislation and policy-making related to gluten-intolerance. She is the person to watch in all things gluten-free, especially in terms of gluten-free certification for food producers.

We talked briefly about the structure of the camp and how the GIG contingent and the diabetes contingent will interface. The main goal will be to monitor the children with celiac and diabetes while keeping out of their way as much as possible as they do kid-at-summer-camp things. I’ll get to practice doing finger sticks and reading blood sugar levels and, of course, counting carbs.

I’m really looking forward to this! I'll post more about the camp as it happens.

Wednesday, June 3, 2009

In a Mediterranean Mood

Tonight my soon-to-be-graduating class of Masters of Nutrition Science students put on a shindig for, get this, the preceptors for this year’s outgoing dietetic interns. It was a thank you dinner for the preceptors, put on by the interns, but the meal was planned and executed start-to-finish by my class as a project for Food Service Management.

It was gorgeous. I wish I had pictures of the venue and the food – I’ll try to get a hold of some from our FSM instructor. The theme was “Savoring the Mediterranean,” and in order to avoid having to make special meals for those with food intolerances we planned a gluten-free, dairy-free menu.

Let me just recount it for you here so that you can salivate over it:

Apps: Roasted red pepper and walnut pesto, hummus with preserved lemon, and olive tapenade, served with homemade sourdough bread and chickpea-rosemary GF crackers
Salad: Mixed greens with fig-shallot vinaigrette and edible flowers
Dinner: Quinoa cakes with basil and sun-dried tomatoes, served over braised greens and cannellini beans, all topped with sautéed oyster mushrooms
Dessert: Almond cream tartlet topped with fresh strawberries

If I’ve left anything off the list, I’ll certainly hear about it from my classmates.

We had a pretty great leadership team. They were bossy and got the job done! Theresa, who completed culinary school before she came to Bastyr and is a masterful vegetarian cook, was running the kitchen and the cooking crew, and Laine was in the “front of the house,” making the most of her natural leadership ability and vast experience working in restaurants.

Exuberant Wendy was in charge of us all, acting as mother hen and cheerleader. She also kept in touch with the interns and the internship director to make sure everything went smoothly. And Cheryl and her donations team raised $2000 in cash and in-kind donations to put the cherries on top of this dining experience.

And finally, let me put in a few good words for the grunts: the prep cooks, line cooks, fry cooks, pastry chefs, waitstaff, bartenders, and the decoration team. Oh, and the dishwashers! We did a great job!

The glitches were few, like when we ran out of beans-and-greens and had to whip up another batch, or when some of our tartlets collapsed into puddles of almondy deliciousness. No matter… the dinner guests knew nothing of our setbacks and had a fantastic time.

So congratulations to everyone for a job well done. If our exit exam was based on our performance tonight we would all graduate with honors!

Monday, May 11, 2009

The Road to Here


So, a little about myself. I have a BA in literature and writing that led me into 18 years of doing things like: writing copy and directing photo shoots for a mail-order catalog; editing, publishing and writing for a monthly arts and culture paper; designing and programming websites; then, very incongruently, providing clerical support and doing billing for a home health agency.

Somewhere in there I began to notice my food. I noticed that what I ate affected the way I felt and looked. I noticed how so many modern diseases were connected with poor diet. I also noticed that there were bigger issues with food than what to have for dinner. Thanks to several people who happened to be right where I needed them with a timely bit of advice or information, my interest in food and health was nurtured, and I ended up here at Bastyr University, getting my Masters degree in nutrition.

In case you haven’t heard of it, Bastyr is a university of health sciences that offers a “multidisciplinary curriculum in science-based natural medicine.” The university trains naturopathic physicians, and also has programs in nutrition, exercise science, acupuncture and Oriental medicine.

Bastyr has a fantastic nutrition program with faculty who are very dedicated to training their students in “whole foods-based” nutrition, while still giving them the down-and-dirty biochemistry of nutrition and preparing them for work in acute clinical settings. Bastyr also has a dietetic internship with a focus on… you guessed it, natural medicine!

I was very fortunate to have been selected for the 2009-10 internship at Bastyr, and now here I am, between my Masters degree and my RD license, just itching to get started.

Saturday, May 9, 2009

Welcome to DIY!

This is a highly specialized blog, possibly only of interest to students who are in the midst of a didactic program in dietetics and looking forward to the internship application process next year, or who, like me, will be beginning a dietetic internship in 2009-10. It might also be interesting to those of you who have already completed your internships and are now officially RDs (congratulations!), about to start your careers in this challenging field.

I'm going to document my DIY -- dietetic internship year -- to provide a little insight into the process for those who are anticipating it themselves, to act as a companion for those who are going through it along with me, and to elicit advice and nostalgic commentary from those of you who have finished your internships.

It'll be a slow start, since I'm still in the last quarter of my masters program. Check in now and then over the summer as I write about getting ready for the internship, and by late September I'll be going full-force as my internship begins.

Be well!