1/28/11

1 week down, 12 to go!!



I can't tell you overjoyed I am to be a clinical dietetic intern at St. Vincent's Hospital. I imagined that I would enjoy my acute care clinical rotation but this is beyond my dreams. Considering that I have never been admitted into a hospital for an illness, broken bone or condition, this is all a really exciting (and new) experience for me as a future RD.

Aside from interning, this was a planned recovery week from training. I had to change around a few workouts from my normal routine (due to time constraints of being a clinical intern) but other than that, I was able to get in at least an hour to 75 min of exercise every morning this week. The intensity in my training will increase during the next two week of build, but due to my internship, I will be cautious not to increase in training volume during the week. I only have so much time in the morning to train and I can not sacrifice sleep in the morning hours. Weekends will have an increase in both volume and intensity.
Despite waking up at 4:20am every morning this week (aside from recover day Monday), I have a lot of energy and feel very rested. My day is super long but I never feel depleted or drained. Interning and training could be exhausting but I am making it a priority to be asleep by 9:30pm every night (that means that I am in bed at 9pm) to give me a full 7 hours of sleep. I have not been waking up during the night so I have been waking up feeling super refreshed. Additionally, my diet is key to making sure I have enough energy during the day, as well as recovering as quickly as possible from workouts. I spend 30-60 min a day (from 6pm - 7pm) preparing dinner, as well as my breakfast and lunch for the next day. I typically make my next day lunch, from dinner and while I am preparing the dinner I will also get together several snacks/sides for the next day. I am not able to have a planned snack while interning so I make sure that my meals are as balanced as possible. I also make small snacks (that I keep in the dietary offices) for when we finish reading charts and seeing patients on the floor (ex. carrots, apples, cheese, walnuts). My meals are packed with fruits and veggies so that when it comes to dinner, I do not feel as if I have missed any food groups. Also, I always have a snack for the drive home (30 min), so that when I finish interning I am not feeling starved when I get home. This allows me to take Campy for a run before I start preparing dinner and so that I will want to take the time to make a healthy dinner after a long day of training and interning. Most importantly, by planning ahead and sticking to a schedule that is down to the minute, I feel as if this is routine that I can keep up for the next 13 weeks. I don't live my life on what I "once did" or what I'd "like to" do but rather what "I can do". This allows me to plan for the now and prepare for tomorrow.
A few days this week I sipped on protein powder and water between meals in my water bottle just because I was feeling a little hungry as I was adjusting to my new schedule. Thankfully, my blood sugar doesn't drop very quickly after my yogurt, cereal and fruit breakfast w/ wasa cracker and PB (oatmeal wasn't working for me so I had to change) but I make sure that I do not go longer than 4 hours without eating.

Monday was my first day at St. Vincent's and I was able to meet the kitchen staff and several of the dietary office managers. I also met a few of the dietitians but they were super busy (as always) so I wasn't able to talk long with anyone. I got my parking pass and INTERN badge so I guess I am official in the hospital. With my white lab coat, I fit in very nicely with all of the professional people in the hospital. The dietary manager took me on a tour and she took me to the maternity unit for our first stop. The hospital is super big and I have no idea how I am going to find my way around after my 9 weeks of interning. Since I finish with 4 weeks staff relief, I will be playing "Clinical RD" and will have the same responsibilities as the other dietitians but I just can't sign-off my name in the charts.

Tuesday was an orientation day....just what I needed. One of the RD's (I think there are 7-9 RD's that work at St. Vincent's) spent a few hours with me and 2 other interns (from UNF) discussing the forms and charts, as well as electronic charting, that are used at St. Vincent's. She also went over tube feeding calculations (enteral and parenteral) which was really helpful. After I left on Tues, I felt much more prepared for this part of the rotation.

Wed was a great day but an early one. I was at the hospital at 7am (not 8am, like a normal interning day) to spend the day with the dietary technician. We completed LOS (Length of Stay) forms which involved going to the rooms of patients who had been in hospital for 5 days. We needed to see if they triggered on the nutrition database for being at nutritional risk so we looked through the clipboards (outside each room) to find key information that we could checked off our sheets. We then imputed the information in the charts on the computer (St. Vincent's is 90% electronic charting, aside from physicians notes and orders). I seemed to pick up rather quickly with the information that was presented to me today but still wasn't able to find my way around the hospital all by myself. The dietary tech is super nice so overall, it was a really enjoyable day that went by really quickly. We covered almost every floor, from open heart surgery, infectious disease, ICU, cancer and a few others.

Thurs was my first real clinical day with a RD. The RD that I spent the day with was amazing! I am so excited cause I will be spending a few more days with her next week. I could tell that she had interns in the past because she was able to explain everything to me in a way that I could pick up things, very quickly. I still have a lot of learning to do but with two really challenging cases presented to us (a pt. with hyperemesis at x-weeks pregnancy w/ PPN feeding and another pt with severe abdominal bleeding, N/V, 0% po intake and possible x-cancer) I guess you could say I had a really exciting first day as a clinical dietitian.

Everyone at the hospital is super nice and professional. It is a great environment and I love coming HERE every day (Mon - Thurs)




As for the rest of my life...I DON'T HAVE ONE!!!
When I am not training, interning or preparing meals, I am studying. My life is studying but it is paying off in my weekly Fri/Sun quizzes. I try to stay ahead of my readings and studying so that means a little studying every evening. Karel is starting his racing season this weekend and I am bummed that I won't be with him at his first race. I will also miss the next race but plan to go to his race near my parents in Dade City/San Antonio (Karel loves this race weekend).


I can't believe this is the last part of my dietetic internship and I will be eligible to sit for the National Registered Dietitian exam on May 2nd. I don't plan on taking the exam until late June (so that I can study for at least 4-6 weeks).

I am looking forward to keeping you all updated with this exciting part of my dietetic internship!! Thanks for reading!

1/26/11

Protein-packed vegetarian meal

Just because you are a vegetarian, this doesn't mean you can't have a protein-packed meal! I find that many vegetarians (not to mention, vegetarian athletes) feel hungry all day due to the high concentration of carbohydrates in the diet. Compared to protein and fat, vegetarians often find themselves eating and grazing on carbs. More so, even when protein sources are included, there may be very little fat to promote satisfaction.
Sure, fruits and veggies seem to be the obvious vegetarian choices but grains, breads, crackers, cereals, sweets etc. may seem to comprise a large portion of your diet. With a high concentration of carbs (fruits and veggies included), comes an increase chance of fluctuating blood sugar levels, thus causing sweet cravings and a constant feeling of hunger. I can't tell you how many residents I saw in the nursing home (for a short stay, likely due to a fall), with a healthy BMI (18-24) and lab work showing blood sugar values of over 200!! Normal values are likely between 70 and 130 depending on how the blood sugar is taken and when. When I asked them about their current diet, instead of hearing "ice cream and sweets" I heard fruits, fruits and more fruits!! Can you imagine being diagnosed with pre-diabetes or diabetes at the age of 70 or 80 yrs because you eat too much fruit?? With a little education, telling the residents to combine protein with carbs was the easiest way to help control the blood sugars.
I believe that the only difference between me and Karel is that he eats meat and fish and I don't. Therefore, when it comes to a protein-packed vegetarian meal, balance is key. When planning vegetarian meals, I find it helpful to decide on the protein choice, prior to planning the rest of the meal. Once you figure out your protein choice (ex. eggs, tofu, vegetarian meat, cottage cheese, beans) you can then complement that plant-based protein with other macronutrients. Typically, it will be really easy to fill your plate with a variety of carbohydrates (ex. fruit, veggies, grains, etc.) so don't forget about your heart-healthy fats to slow down digestion and help with absorption of fat-soluble vitamins (A,D,E and K).

I hope you enjoy my latest creation!

Protein-packed Asparagus and lentil dish

Lentils
Asparagus
Mushrooms
Tofu
Onions
Garlic
Eggs

1. Prepare lentils according to bag (should take around 20 min).
2. While lentils are cooking, steam asparagus. When asparagus is almost ready (7-8 minutes), add mushrooms. Drain water and season with a little pepper and add 1/2 tbsp olive oil.
3. Cook tofu, onions and garlic in a non-stick pan w/ a little olive oil. Season with paprika to help with browning. Top with chili flakes for a little spice.
4. While tofu is cooking, cook eggs (with a little milk) in a large bowl (sprayed with a little non-stick spray) in the microwave for 60 sec. Give a little scramble with a fork and cook for 30-40 more seconds. Optional - add a little cheese.





Don't forget to make extra's for a super-delicious meal for work the next day!!!
I enjoyed this on my lunch break while interning at St. Vincent's Hospital.

1/24/11

Burgers and Fries

Confession, Karel and I got out for burgers and fries all the time.

JUST KIDDING!!!

Why eat out when you can enjoy a meal at home???
A heart-healthy YUMMY Marni Creation!!

Enjoy!!

Vegetarian Burger and Steak Fries:
1 veggie burger
Toppings: Romaine lettuce, steak tomato
Cheese: Jalapeno
Bread: fresh sesame loaf

1 potato cut long-ways, tossed in olive oil and topped with paprika, pepper and a pinch of sea salt. (I like to use long small potatoes and cut semi-thin to cook quickly).
Purple onions, thick cut.

1. Preheat oven to 475 degrees.
2. Place fries on baking sheet, lined with tinfoil. Toss in olive in and season.
3. Place bread in oven for 2-3 minutes or until slightly toasted.
4. Cook veggie burger in oven (on tinfoil in a baking pan) until cooked.
5. Add onions to french fries (toss in oil) and cook with fries. Fries should take around 15 min to cook, they will start to get crispy and a little brown.
6. Assemble your burger and enjoy!
(Not pictured, honeydew that is on Karel's plate)



Chicken burger w/ steak fries

Chicken
Lettuce
Tomato
Onion
Bread
Cheese
Condiment - store-bought artichoke hummus

Potato - same as above

1. Prepare chick to your liking - I used lemon pepper and olive oil for Karel's chicken and cooked it with the fries (in a separate pan)
2. Prepare burger (with toasted bread) to your liking.
3. Serve with fruit or fresh veggie (Honedew was $2.50 at wal-mart on Sunday and super sweet and delicious. The selection of fruit was sad so in addition to apples and bananas I had to pick up something sweet since the cherries I got the last two times, went up in price)


1/23/11

Productive training

Early this week I was super tired, my back and legs were speaking to me and I did what any athlete would do...well, what a non-stubborn athlete would do. I RESTED!!! Years ago, I suppose I tried to "get through" workouts for whatever reason. You know, I really don't know why athletes (myself included) feel the need to push through pain, tiredness or extreme fatigue. Seriously, is that 1 hour run, 30 min swim on an active recovery day or 90 min interval bike really worth it? Trying to get through one workout because it is on the schedule or because it gives you an excuse to eat x-food or perhaps it defines your fitness (or toughness factor) will likely increase more days off from training, with no performance gains what so ever.

Looking back, I really regret trying to "get through" so many workouts as if my pain, soreness or tiredness would magically disappear. I learned the hard way, as so many of us do, and injuries and illness come because we don't listen to our body when it speaks to us.

Likely, 24 hours is all you have to wait to overcome the funk that is keeping you from feeling productive but more often or not, athletes don't like to rest.....especially if the schedule doesn't tell you do so.

I have had several close calls with my leg acting up (previous injury which took about 3 years to overcome and hasn't affected me for last 9 months..yay!) and feeling a bit under the weather. I rested, listened to my body and I am still going strong with my training. I suppose that it is easier said than done but I am feeling productive with my training (with a lot of performance gains) despite resting my body when needed. Take it from me and from a physiological point of view, if you can't give your 100% for the prescribed workout (due to fatigue, injury or tiredness) ask yourself is "it" worth it? I know it will be hard but taking care of yourself for a few days will only allow yourself to reap the benefits of listening to your body. In my opinion, it's all about quality training..not quantity.

Because I skipped my workout on Tues (interval bike), I moved the workout to Thurs. I am not a fan of making up missed workouts the next day (ex. adding an interval bike to my already packed training for Wed) but in the case of having a bike on Tues and Thurs, I knew what the rest of my week would bring and I felt confident in moving my interval bike workout to Thurs. Whenever my athletes need to move around workouts, I always ask them to email me first so that I can make sure that they are not doing too many intense workouts in a row. Training is all about getting the most physiological adaptations with the least amount of training stress.

Thursday's bike workout was a killer and there was no way that my body would have accepted the workout on Tues.
Thank you Karel for the crazy hard pyramid set:
1 min on, 1 min off
2 min on, 2 min off
3 min on, 3 min off
4 min on, 4 min off
5 min on, 5 min off
6 min on, 6 min off
4 min on, 4 min off
2 min on, 2 min off
1 min on, 1 min off

For the "on" I tried to hold around 160 watts which is above tempo effort for me (105+ rpm cadence) and for the "off" it was spin easy. This pyramid set has been a work in progress for the last month. This was the longest pyramid that I have done thus far and I was happy with how it turned out. I do my tues/thurs bike rides on the trainer (at 5am) which is much easier than outside to control my power.
After the 1 hour and 45 min trainer ride (which went by super fast), I did 2 fabulous Campy miles and got ready for my last day of interning.

Fri was another fabulous swim. The main set included 2 sets of 4 x 150's with some pull and IM sets in between. I dared myself to swim in the "fast" lane again and with a 2 minute cycle for the 150's, I was doubting my ability to swim with the fasties. I can't recall swimming on that cycle since college but I didn't want to doubt myself before we got started.
Amazingly...I made it!! Granted it was touch and go with about 4-5 sec rest but I made all of the intervals on a 2 minute cycle. I am not sure how I managed to swim 150 yards in 1 minute and 52-55 seconds, but I did it! YIPEE!!

This weekend I felt the good kind of soreness. No lingering injury pain but rather soreness from my last week of build before a well-needed recovery week.

This weekend kept me inside. With 2 full days of studying on my schedule, I needed to get my workouts started and completed before the day got away from me. Sat I was on the trainer for 2 hours and 45 minutes and I didn't mind it one bit. I did my Thurs tempo workout which had a main set of:
3 min VO2max (170+ watts) w/ 3 min easy spin
32 min tempo (138 watts averaged, 95 rpm- which is now slow for me but I was hurting and just couldn't get my legs to spin any faster)
10 min recovery
15 min tempo (142 watts averaged)
5 min recovery
5 x 30 sec on/30 sec off (on are all out just spin as hard as you can go. Typically I can get over 200 watts but today I was just fine with 180..a painful 180).

This tempo workout has also been a work in progress where I started with 15 min and built up to 22 min and now 32 min. I never thought I would hold an interval on the trainer for 32 min but with Karel's excellent coaching I am really seeing progress with my cycling. After the bike I was super tired but my adorable furry friend was begging me for a run. Not realizing that he wanted a "long" run off the bike, Campy and I did an enjoyable 3 mile run in perfect running weather. Thanks Campy for the great run!

Today was a long run on the treadmill. It was cold and I needed to get the workout finished to prep for my RD-prep quiz on vitamins, minerals, deficiencies and acid/base balance. I had lots of entertainment on the treadmill TV to keep me from feeling bored but my main set kept me even more entertained and my workout was over and done with before I even knew it.
30 min warm-up
8 x 40 sec "fast" (9mph) w/ 20 sec straddle treadmill recovery (get the HR up)
Main set 5x's /.5% incline)
.5 miles @ 7:19 min/mile, 10 sec rest, .3 miles @ 6:57 min/mile). 1 min rest (straddle treadmill) and repeat set.
5 min easy jog
2nd main set 3x's:
.25 @ 9mph (1% incline) w/ 1 min rest.

Total: 1 hour and 35 minutes, 12.5 miles (7.9 mph average)


Well, I am officially finished with my "base" training and looking forward to several changes with my training (not to mention my first day at St. Vincent's hospital for my acute care rotation..which starts on MON!!).
I will be adding structured bricks into my workouts (in addition to Campy miles).
I will be doing a 2 week build, 1 week recovery (instead of the typical 3 week build, 1 week recovery).
I will continue working on endurance and speed.
I will continue taking off on Monday.


Time for a little reading to get ready for the upcoming week of interning!