4/8/11

Even closer

I was eager to finish my last day, of my second week, on the cancer unit and hoped for a great day. The first 3 days went rather smoothly and I expected another great day. Well, the day was great but it started off really busy. I prioritized my list of patients and noticed I had two assessments that needed to get done before my follow-ups. I spent a good chunk of the morning working on a pt with celiac disease/diverticulitis and another pt who had roux-en-y revision, after having gastric bypass surgery. While I am familiar with both conditions, the status of both patients left me overwhelmingly confused. First I couldn't read the handwriting of the Gastroenterologists so I was kinda stuck on the current status of my patients. Once I finally deciphered the handwriting, I then had to google the procedure done on each patient because I wanted to know what my patient had experienced and the reason behind the current status. Whereas much of my patients have similar procedures and tests, these two patients were rather complicated, not to mention each of them had very specific dietary needs.
After about 7 hours, I finished my task list for the day and went the extra mile by working ahead on some patients for the unit RD, so that she wasn't so overwhelmed by her normal busy Friday. It takes about an hour to go over my task list (the RD has to sign-off and write orders for tube feedings, supplements, labs, etc. or anything else that I request for my patient) so I feel like I accomplished a lot for a really complicated day of patients.

I am really struggling with the motivation/discipline lately to study for my quiz and MNT Final (both this weekend) but I am sure I will find a way to pull it together and get some strength to study. The sun is shining and it is warm outside (just like I like it here in Florida!!) and I am really looking forward to some triathlete tan-lines this weekend. My bike is calling my name as are the open roads and fresh air.

Just 2 more quizzes and 2 finals on my to-do list, and 8 more days of interning. Official LAST DAY = April 22nd. This is a dream 3 years in the making and my third "degree" in 11 years. Thanks for hanging in there with me!


"Every great dream begins with a dreamer. Always remember, you have within you the strength, the patience, and the passion to reach for the stars to change the world."
Harriet Tubman


BTW - if you believe you would be a great Oakley ambassador because you perform beautifully you should apply for this contest...
http://apps.facebook.com/performbeautifully/contests/99398?ogn=facebook&order=recency


If you feel I would make a great ambassador, you can vote for me here:
(search for my name either on new entries or all entries). Thanks!!
http://apps.facebook.com/performbeautifully/contests/99398/voteable_entries/19525813?ogn=facebook&order=recency

4/7/11

Love You and Thank You

Have you said "I love you lately" or even "thank you" to the many important people in your life that have supported you, cared for you, encouraged you and have given you guidance in this thing called life?

I am about to finish my 2nd week of my staff relief rotation, with only 2 more weeks to go. I am feeling very comfortable and confident with where I am right now and my intense 9 month internship (thus far) has prepared me very well for this last part of my rotation.
Having said that, this is my last day on the Cancer unit, which I have been covering all by myself. Every patient is unique and special and I feel privileged that I have been able to assess and follow so many courageous and strong men and women. Not all of my patients have cancer but 99% of the patients that I have seen this week have been high risk, partly for the chief complaint of why he/she entered the hospital (ex. GI bleed, intense abdominal pain, hyperemesis/nausea, etc.).

I have learned so much this week and unlike other floors at the hospital, the patients with cancer have different needs and requirements than on other floors. There is a bit of compassion that needs to be placed on a patient with cancer and not every person can be assessed "by the book".

While assessing a new patient yesterday who was receiving day 1 chemo (while I was in the room), I quickly thought back to the other day when one of my patients was recently diagnosed with cancer, and then I thought about another patient who had had several bouts of different cancers. While the body can be cruel at times, it is also an amazing piece of art. While not everyone respects his/her body, takes care of it and fuels it properly, it is important that we take a little time to think about life and how short it can be.
Be sure to take a little time everyday to thank and love the people that are in your life that make your life amazing. Also, take a little time to thank your body for allowing you to cross finish lines, play with your children, spend time with friends/family/significant others and most of all, for letting you be you.

My most favorite Blog Post..
http://trimarni.blogspot.com/2010/09/dear-body.html


A few quotes to make you smile:
"Develop an attitude of gratitude, and give thanks for everything that happens to you, knowing that every step forward is a step toward achieving something bigger and better than your current situation." Brian Tracy

"Count your blessings. Once you realize how valuable you are and how much you have going for you, the smiles will return, the sun will break out, the music will play, and you will finally be able to move forward the life that God intended for you with grace, strength, courage, and confidence." Og Mandino

4/4/11

Protein and Exercise

One of the most beneficial aspects of my many years of higher education is learning how to differentiate fact from fiction. As a 4x Ironman athlete, I have learned to take research with a grain of salt when it comes to fueling for endurance events. With several years of experimentation, all while trying to keep up with current research, I have learned that my training needs may differ from the athletes around me and my environment is not controlled like it is in a scientific test.
Because not every athlete is alike, I don't believe that there is one perfect diet out there that can be applied to every athlete. Sure, there are general guidelines that will encourage performance gains and weight loss/maintenance, but we all have different needs based on our training routine, body composition goals and lifestyle requirements. Because of that, we need to recognize our individual strengths and weakness when it comes to the diet and how we view the fuel that we put in our body.

In my latest issue of SCAN Pulse (Sports Cardiovascular, and Wellness Nutrition) from the ADA (Spring 2011, vol 30, no 2), the cover article featured Protein and exercise. As I have been mentioning in previous posts, there is an abundance of research dedicated to protein in the diet of athletes and that research is ongoing and somewhat inconclusive. Just like all research, there will always be new guidelines and new suggestions as researchers try to prove/disprove previous theories and hypotheses.

There was so much valuable information in this article that I just can't sum it up in one blog. I wanted to post a section that is of "hot-topic" with athletes, especially when it comes to discussions of how much protein to consume following exercise.

The appropriate amount of protein to consume following exercise is another important factor. Many espouse the old approach, "if a little is good for you, then a lot must be much better." Practitioners often recommend large doses of protein to stimulate the greatest muscle hypertrophy, but recent findings suggest there is a limit to the amount of protein that will effectively increase the anabolic response. Canadian researchers recently demonstrated that the response of MPS (Muscle Protein Synthesis) to increasing doses of protein following resistance exercise plateaus (Moore, Am J Clin Nutri, 2008). The response increased incrementally up to 20g, but no difference occurred in the response between 20g to 40g. Moreover, amino acid oxidation increased at the higher doses, suggesting that the excess protein was merely broken down and oxidized for energy. Thus based on this study, there is no reason to recommend ingestion of very large amount of protein (ex. >50g) following exercise.

Another situation in which nutrition may play a key role for athletes is with overreaching and overtraining. Many athletes find themselves in a situation where they have trained too hard and/or too long and their ability to train and perform declines. Studies suggest that increased carb intake may help ameliorate the symptoms of overtraining, but until recently no one had investigated the impact of a high protein intake (Witard, Med Sci Sports Exerc, 2010). Well-trained male cyclists dramatically increased their volume and intensity 1 week on two separate occasions (A protocol that typically results in a 10% decline in time trial performance). In one trial the cyclists consumed their habitual protein level (1.5g protein/kg body mass/d): in the other trial, the amount of protein consumed was doubled. Carbohydrate intake was clamped at 6g carb/kg body mass/d in both trials and the trials were isoenergetic. Decrements in performance, mood state and functional capacity of the immune system resulted in both trials. However, these declines were ameliorated during the high protein trial compared with the control. These data offer support for the concept that a higher protein intake may help attenuate the negative consequences of overreaching and overtraining.

4/3/11

The end is near

"To will is to select a goal, determine a course of action that will bring one to that goal, and then hold to that action till the goal is reached. The key is action."


It was a great decision but a tough one. It was only a year and a half since graduating with my Masters in Exercise Physiology and 3 years since graduating with my bachelors in Exercise Science (and a minor in psychology). I found myself with a new passion and stuck in my career path. Understanding that Florida requires registration and a license when prescribing nutrition information, I decided to do the right thing and go back to school (at the age of 25) to pursue my third degree.

Sometime near the end of 2007 I decided to go back to school to become a dietitian. Without fully understanding the necessary steps to receive those two letters behind my name, I started my journey on Jan 7th, 2008. This was my first official day of class a future RD.
http://trimarni.blogspot.com/2008/01/back-to-school.html

Fourteen months later I was ready for step 2 in becoming a RD and had my life shattered when I wasn't accepted into my only two internship choices.
http://trimarni.blogspot.com/2010/04/life-goes-on.html

Only July 13, 2010, I started my first day of interning, which was my community nutrition rotation (8 weeks). Never did I realize that becoming a RD would require so much time and dedication.
http://trimarni.blogspot.com/2010/07/day-1-fda-conference.html

On Sept 20, 2010, just 8 days after crossing my 4th IM finish line
http://trimarni.blogspot.com/2010/09/ironman-wisconsin.html, I started my next rotation, food service for 11 weeks.
http://trimarni.blogspot.com/2010/09/food-service-rotation.html

On Dec 7th, 2010 I started my last rotation. Although a long one, my clinical rotation started with 5 weeks Long Term Care, followed by 9 exciting weeks of acute clinical nutrition.
http://trimarni.blogspot.com/2010/12/last-first-day.html
http://trimarni.blogspot.com/2011/01/1-week-down-12-to-go.html

It's hard to believe that this journey is nearing the end. As a start my 2nd week of Staff relief, it is hard to believe that I have been pursuing my RD credential for the past 1181 days. With only 3 more weeks and 12 more days of interning, words can't describe what I am feeling right now. I am overcome with emotions and I find myself smiling and tearful. It was my decision to go back to school but with the support of so many people, I was able to stay focused in reaching my dream.
Wanting the elusive "RD" behind my name started when I had the idea that I wanted to write a book a few years ago. Not wanting to publish nutrition information without the right credentials gave me reason to head down the dietetic track. It is unimaginable to describe what I have learned throughout the past 3 years and how determined I am to help change the lives of others.

"The prizes of life are at the end of each journey, not near the beginning; and it is not given to you to know how many steps are necessary in order to reach your goal. Failure you may still encounter at the thousandth step, yet success hides behind the next bend in the road. Never will you know how close it lies unless you turn the corner."