My haven.

Few minutes to chat

2010-08-02T19:09:00.000-07:00

I can't tell if Haven is in bed for the night (as of 5:30!) or if this is a late nap that is going to screw my night and therefore my day tomorrow. I didn't even change her diaper after getting her at the babysitter. Or her clothes for that matter. But she passed out after eating and I transferred her to her crib and now we're past her usual going to bed time so let's all hope...

I'm trying to get a professional photo session set up for us in the next few weeks while Dan's home. Already got shot down by one gal who is booked through October. Oops. I have another backup plan but if that's booked too I'm in trouble. I'm hoping to do something a little artistic and outside. Exciting if I can get it together.

I'm going to have help (flown in) this week which I cannot wait for! Not only do I have help, but I have an old friend to laugh with, talk for hours on end with (she's a talker let me tell you), shop with, eat with, enjoy Haven with.

I got pulled over this morning. Freaking me. I was speeding. I knew I was speeding. Truthfully, I speed every single day- TO and FROM work. Because quite frankly, well, I'm from Chicagoland and in Chicago you drive as fast as your car can go when you have an open highway. And I am always trying to get to where I need to be as fast as I can so I can get on with what I need to get on with and that's kind of how my day rolls. As does everyone else's in this country who drives 70 when the speed limit is 60. Ok 75-78 according to the cop. And apparently I changed lanes in a manner that was unacceptable to him as well so I got a second fine for that. The funny thing is, I saw a car in my rearview mirror directly behind me and I thought, "that could be an undercover cop car." Two seconds later my ADD mind was somewhere else and ten seconds after that, I got the flashing lights.

So Haven now has 6 teeth through. Holy Haven. She has apparently chosen to sleep through teething. Except for during the day and several times at night. On the subject of getting "bitten", as in while breastfeeding: it happened to me EVERY TIME I FED HER. And it sucked. And I was to the point that I was super tense about latching her on and ready to strike (not literally) at any second. Then I told my babysitter to stop letting her chew on the bottle and somehow, we are not biting mommy anymore :)

I feel like I should probably lay down and get some rest instead of doing things like blog while Haven is asleep. Or maybe eat dinner seeing as how last night's dinner was chips and salsa and chips and bean dip and tonight's dinner has been rice crackers and hummus and a root beer (I know, bad dietitian). Otherwise I really have no room to complain about being tired or not well nourished. Really, I wish I could be outside on these evenings to stroll in the sunset and enjoy long summer nights...
There aren't many left.

It's time for a renewal around here

2010-07-29T09:14:00.000-07:00

It's been almost a month since I've been here. I sort of decided I was going to be done with blogging for good since I just plain old don't have the time or, let's be honest, creative energy that I did a year or two ago. But the truth is I like to blog, or really for me-- journal. That's what blogging is for me. Journaling my thoughts. Tracking the little day to day things in life. And this is important because I can reflect, remember there were good and bad times before, see I got through, see I enjoyed, and see that there will be good and bad times again. And that nothing in the past seems to compare to the present.

So in order to launch my renewal I have to make a few decisions:

1. Does anyone care? Does anyone come here anymore?
Answer: Turns out even if it's just me that cares, that comes here, that's enough. And what is up with all the creepo messages/ads for Viagra people are leaving on my comments? I'm confused. Why is this happening on my blog and not on other peoples? Is it some form of spam? It's wierd and rude. And if you're doing it, you're weird and rude. Goodbye.

2. What do I want to write about?
Answer: I don't want to be boxed in to one category (i.e. nutrition), so I think I'm going to make this... as I said in an earlier post... a 2-dimensional blog that reflects my 2-dimensional life: work and Haven. Although that leaves out Dan, but since he's not here, maybe he will just make cameos.

3. How often can I really do this?
Answer: Doesn't matter. When I have time and inspiration, I'll journal. Haven does take naps, and chores and errands can wait once in awhile.

So let's just cut to what has been going on the past month:
1. Haven has 5 TEETH. This is crazy because she just turned 5 months old. This makes me excited to start solids which my plan is to start going back to the farmer's market once a week and use seasonal produce to make her "solids". This is a great theory. But with a lot of things in my life lately, I have to let go of ideals and work with what works so that I don't have a breakdown on a daily basis just to hang on to ideals. Welcome to the story of every mom in America.

2. Haven is cuter than ever, happier than ever, sweeter than ever, more fun than ever.

3. Work is going better than ever but leaving me exhausted. I find myself putting more energy into my kiddos because I just keep thinking, if that were Haven..... And there is no limit to the perfection you would want to achieve if your infant/child were in the hospital. I love the women I work with and have found a support system in them. Which makes leaving Haven for 10-11 hours a day tolerable.

4. The GI clinic role I now have at least once or twice a week is waaaay better than it was a month ago. I am much more comfortable there and that makes a huge difference. I really enjoy it now and it has just made me a more well-rounded clinician. It's like I've closed the gap of what happens after the kiddos discharge from the hospital, go off into the atmosphere, never to know what becomes of them. I have seen so many success stories... one little peanut who came to us at 5 weeks old, terribly failure to thrive. She was like a floppy little noodle with bones. Turned out she had profound protein allergy and was simply malnourished from intolerance to her feeds. We got her on the right formula and now just a few weeks later, this baby is AWESOME! I could not believe it when I saw her-- her eyes were so alert and her skin tone and muscle tone were so improved. Almost shocking.

5. I am taking on another new role as a metabolic/genetic disorders dietitian in a new clinic starting at my hospital. It's a huge responsibility and a whole new level of research and learning to do but I think it's a good opportunity I don't want to pass up. I'll be flying to Denver for a conference to learn about all of this which will be fun and exhausting with the little one in tow.

6. I have lost all my baby weight I just realized the other day :)

7. I have recently and suddenly had the profound realization that I have a daughter and she may be my only daughter. She is almost half way to one year old and I have not indulged in buying her tons of girly baby clothes or toys or really taken the time I should to just stare at her and take it all in. And take the time to do nothing but play and help her learn and show her new things and new experiences and to be really happy with her. I feel like I've just been surviving through the days. So I started wondering, am I really doing everything I can to make every day for her count? Again, welcome to the story of every mom in America. But that doesn't make it less important just because we all feel like this. I want to make sure I take a picture or video of everything and make a big deal out of new things and oh my gosh, I should sign up for one of those baby/mommy swim classes and work on her tummy time.....

But for now she's asleep and I need to sweep. Welcome to the new blog!

Time keeps passing

2010-07-03T20:38:00.000-07:00

I can't believe how much time has passed since I last blogged... weeks has it been?

That's the story of my life these days. If I sound like the world's biggest complainer, frankly, I don't really care. I deserve to complain. You would too if you were me. I've learned to say "I don't really care" a lot these past few months. Because sometimes you can only put your energy into the really important things and everything else just has to not matter. Which is hard.

Not that it's all bad. I'm just really really tired. And a bit lonely. And my life is 2-dimensional: work and Haven.

Lucky for me those are two things I like. The trouble is they both require an immense amount of energy-- physical, emotional, mental. So I'm running on fumes to say the least. My cats hate me. And my house needs a serious deep clean. And I have the hardest time not being irritable, sour, and a complainer every time I talk to my husband. Which is once a day for 10 minutes if I'm lucky.

I've had some positive strides on the work front-- I am officially a FTE employee which means I get benefits and I'm in the union. I'm working 32 hrs/wk at minimum but my boss will schedule me more if I would like. I am (sort of) cross-trained to work in the outpatient GI clinic which is quite intimidating let me tell you. That place feels like a nonstop enormous freight train barreling through the world and you just have to hang on for dear life and hope at the end of the day you didn't make a mistake. Yikes it is fast paced and busy busy busy. Which is why I'll be there once a week or so-- too much work for the current staffing model over there. They all have to chart at home because there's no spare time for charting which means weekly overtime. Not good for me as I am caring for an infant BY MYSELF. So that should be interesting.

Haven had her 4 month well-child checkup... 19 lbs 15 ounces and 27.5 inches, although who knows what her length really is-- they have the worst method of measuring there. Nothing too exciting going on with her health status although she now has 2 teeth on the bottom! Crazy little kid. She is so well behaved and "easy" though I swear (this is the only reason why I am not totally off my rocker yet).

Now I need to take advantage of having a day off tomorrow and get myself to bed for a good night's sleep instead of trying to catch up on life or do anything enjoyable... you know like blog here :0 Happy 4th of July ... It's one of my favs!

Haven's friend comes for dinner

2010-06-16T21:14:00.000-07:00

Can you stand it? Haven was touching her and trying to "hold" her hand. Finnley is 7 wks, about 1/2 Haven's age and such a cutie!

She's going home!!!

2010-06-15T20:11:00.000-07:00

No not me. Well actually now that I think of it, yes I will be going home next week... but that's not what this story is about.

This story is about the little sweet cutie patootie girl who has been in the hospital for almost as long as I've been working there and SHE WENT HOME TODAY!!!

I worked on this little complicated darling from Fontan to ECMO with trickle NG feeds and TPN. To months of Portagen. To a nonfat PO diet + Portagen. To dysphagia for thin liquids and therefore honey thick PO liquids + Gtube with Portagen. Then while I was on maternity leave she left and came back and was back to TPN. Then slowly back to Portagen via Gtube. Then Portagen via Gtube + nonfat PO diet + restricted PO honey thick liquids. To finally Monogen via Gtube + nonfat PO diet with 500 ml/day PO honey thick fluid restriction. And one Boost Breeze PO per day. And AquaDEKs. Did I leave anything out? Oh yeah, a few translations in Espanol.

The not so exciting news is she will be back. Her Fontan is failing. But she gets to go home for a bit which we think will do wonders for her spirit and overall health.

The other not so exciting news is I'm not working in my beloved inpatient role this week (except for Friday). I'm training (I write with the heaviest sentiment of "uck") in outpatient. Training just brings me back to feeling like an intern. Like an inadequate new employee floundering and flailing and constantly feeling awkward and inadequate and desparately trying to make sense of what the heck I'm supposed to be doing so I don't look like a total idiot. It's just not comfortable. And I really need anything possible in my life to be comfortable right now. Like my bed... which is calling my name.....

These tooths were made for eatin'

2010-06-13T14:41:00.000-07:00

Haven is getting a tooth! She's not even 4 months old! The whole thing is just hilarious as to me it just solidifies the fact that the girl was born to EAT! We have been wondering if she was showing signs of teething since she's been drooling and putting everything in sight in her mouth these past few weeks. Last night I was at a barbecue and she put my finger in her mouth and there it was-- sharp and coming through! She'll have to wait to use those chompers for 2 1/2 more months though. Omg she is going to look so hysterically cute with a little tooth in that smile!

Coping

2010-06-07T17:32:00.001-07:00

Or finding a new way to live I guess. Half dozen of one, 6 of another. Is that the saying? Anyways. A few "silver linings" I've discovered:

1. Time goes by really fast when you do the jobs of two people running one household with two cats and one 3 month old. Which come to think of it may not be all that good when the lifespan of your firstborn infant goes by in a blink...

2. Good food stays around the house longer when there isn't a man with the appetite of a teenage boy around.

3. The grocery bill was less and I felt justified to buy more of what I like than what he likes.

4. Haven naps really well after being in a strange place with a talkative, attention-grabbing 2 year old all day. So I can do quiet mommy activities like blog , dinner, laundry and Facebook :)

5. Dropping the last 5 lbs of baby weight should be a snap since I'm on the too-busy-to-think-about-feeding-myself diet plan.

*****

A few "pains in the asses" I've discovered:

1. Getting up, ready and out the door by 6 AM is nearly impossible with one parent operating on not enough sleep on a Monday.

2. Carrying the items needed for a first day at the new babysitter's is definitely impossible with one parent and a 20 lb 3 month old (not sure if she's 20 lbs yet but I'd bet the farm she's close).

3. Focusing on work is fairly difficult with Haven at the new babysitter's house an hour away.

4. Bartell's does not have grocery carts. See: 20 lb 3 month old.

5. Carrying and breastfeeding the 20 lb 3 month old all day makes for a very sore back with what feels like a protruding vertebra in the middle of my spine. See: world's worst health insurance.

*****

But despite all the crappy pains in the asses above, my worst day doesn't hold a candle to even 5 minutes in the day in the life of the parents of my patients. Holy cow.

I had an 11 month old today getting chemo.

A previously healthy, normal 9-week old with irreversible brain damage caused by an infection that turned into septic meningitis.

A 2 month old with a terrible heart and brain malformation that was not detected on the 20 week fetal ultrasound; so parents expected a healthy baby and instead have a baby who cannot even coordinate feeding by mouth and whose limbs are constantly rigid from seizure-like issues.

A 5 year old who has been in the hospital for months on end. With a bad heart. Who had reconstructive heart surgery. That is now failing. Who has gone back to surgery and will go back again. Who essentially can't eat and has to drink thickened fluids and gets fed through a tube permanently surgically placed in her stomach and is oh I could go on and on with her and her sweet family.

A 12 year old who is dying from a chronic condition that has had her in and out of the hospital at least 4 times in the past month. And she wants to just die at home.

*****

And that was maybe half my day today. The moral of the story: Love your life, love your babies, love your silver linings!

Friend-ly meals

2010-06-01T09:46:00.000-07:00

Last week (now this has been like two weeks ago-- I started this post and didn't get back to it for days...) we had to say goodbye to yet another couple of good friends we've made here in Seattle. So many of our friends move from here. Seattle seems like a bit of a transplant city. Many friends we make here aren't from here, and many friends we make here move away from here. The latest to come and go are Eldon and Julie. I can't say enough how great these two are. Eldon is one of the funniest people I've ever met and when him and Dan are together-- I rarely see Dan that way. They are constantly laughing about who even knows what. They even gab on the phone, almost on a daily basis, AFTER being together all day at school. Julie and I called them boyfriends because it was seriously some sort of love affair. (Dan would hate me for saying that on public internet so don't repeat :)

And Julie. Oh sweet Julie. She was fill-in mama for my baby girl absolutely any time we needed her. She was there at the drop of a hat, no questions asked, and wanted little in return. She stuck it through the first few rough weeks and helped Haven learn how to take a bottle and how to function without mommy and daddy. She even took Haven when I was sick as a dog AND during Dan's graduation while Haven screamed her head off (and Julie essentially missed graduation!). She is one of the most genuine people I've ever met and I trusted her so easily with Haven which is not an easy thing to do. This alone speaks volumes about her.

We had so much fun with Eldon and Julie these past few months and I am so sad they aren't in our immediate lives anymore. We sent them off with a Louisiana-inspired dinner: jambalya... Which was kind of hilarious because 1. I didn't even realize I was making a "theme" dinner (they're moving to Louisiana)-- I just picked that meal because it's delicious and I can practically make it in my sleep... and 2. Eldon nor Julie had NEVER had Jambalaya before! Anyways they totally loved it and we are so sad to see them go and who knows-- maybe we'll reunite sometime in Louisiana or Alaska or Seattle or Chicago or who knows where we will all land.

So last weekend we had dinner with a group of people I work with -- 3 of us having babies pretty much one right after the other. Haven is 3 months younger than the other two boys but weighs more than both of them and is almost the same length! Hilarious. We had cedar plank salmon, peanut thai noodles, grilled potatoes and a green salad. Good fun.

So then two nights ago Dan and I had our last night out to eat before he takes off for the Gulf. We went to Chinoise here in Queen Anne for sushi (and left Haven with her new babysitter for a trial run). Sushi was awesome but the experience was not quite the same as we ate with heavy hearts knowing what was to come. Put it this way-- I CRIED at the table. Ha! It's kind of funny when you think about it... The waitress kept coming over to get the check and then she would see me and stop dead in her tracks, do an about face and leave.

We got through that dinner and now here we are. No Danimal. Should be interesting.

Calling all babysitters...

2010-05-25T12:09:00.001-07:00

Can you babysit my kid for the first 3 weeks of June? She's really cute, really easy, and sleeps some during the day so you can accomplish other things (like blogging). I can pay you a little. I can also pay for a plane ticket to fly you here.

Let me know by yesterday.

Thanks,
Stephanie

Just to try to entice you.............

Can I keep going?

2010-05-19T11:10:00.000-07:00

Or is this annoying? Whatever, sending this out to the universe may bring me some untold good fortune somehow. Or at least a few encouraging notes from good friends :)

I'm pretty sure I have pink eye now. Double dose. On top of whatever this raging sinus infection or world's worst cold is. Home today with Haven and trying to not get to close to a 3 month old who needs a lot of care is pretty difficult. But if my kid gets this I'll be scrooged. In more ways than one. Heading to the Bastyr Clinic later today where I get a 50% discount for being an alumni! Sweet!

Finally figured out our insurance. It sucks. That's the bottom line. We should have known how (bad it sucks) limited this "limited" plan really is a long time ago but when you read the information that pregnancy, delivery, doctors visits, well child checkups, immunizations, etc are all covered you think that means you're responsible for your 30% and they pay their 70%. No, no, no. There are tiny limits to all these things, after which we are responsible for 100%. Thus we are drowing in bills. But we have a few plans in the works to attack these things and the bottom line is, my kid is worth $16-$20K. Going forward I am exploring every option possible to get better insurance stat. And in the end, this will all be ok.

Great some jerky just pounded on my door and woke up Haven. Wrong address buddy. More later.... maybe even some good news?

The World's Worst Day. Ever.

2010-05-18T12:38:00.001-07:00

5/5? My last post was on 5/5? Maybe the chaos that has been our lives explains why my last post was on 5/5. Yesterday was the. worst. day. ever. I had a mild mental breakdown that hasn't really ended but just gone to a place in the back of my brain so I can get on with life. But it keeps trying to creep up on me. Ok, here's yesterday:

1. I got sicker than a dog. Left work after 2 hrs, after driving an hour to get there and another hour to get home; therefore wasting gas, my time, my babysitters time. Still sicker than a dog but back at work because we need the money. Which leads me to my next item.

2. We continue to have claims denied from our insurance, resulting in what is now going on $15+K in medical bills. I think? Ballpark? I've lost track. Yes, we should know our policy in and out before embarking on any medical suares, but some things fall by the wayside when you have a newborn and work almost full time. And don't really understand the first thing about insurance. I'm learning, to put it nicely.

3. Found out my husband is likely going to be working a job that schedules 1-2 months at sea at a time. So I'll essentially be a single mom. Which let me tell you is REAL exciting after you read number 4 and 5.

4. Haven full-volume vomited what looked like an entire Nalgene bottle of breastmilk right before we were trying to put her to bed. So we had to clean everything in the 5 foot radius in which the vomit projectiled to. Then gave her a bath, started puke laundry, and had to start over with the feeding her/putting her to bed process. And all I wanted was to go to sleep with the worst sinus infection/cold in history.

5. Got a phone call that Haven has genetic markers that put her at high risk for developing type I diabetes. Great. Granted, type I diabetes is no death sentence (although it can be if mismanaged), but it is not a walk in the park to manage. Especially in the teenage years when kids decide they don't care to count carbs and test blood glucose and give shots of insulin anymore. I see these guys at work all the time . I give diabetes educations to families on a weekly basis at my job and always think how bad it would suck to have to deal with all the tedious measuring and counting and testing and pricking and dosing and administering shots. Let's hope "high risk" really is just a way of saying she has a 3% chance of developing it.

Is that enough to consititute the worst day ever? Now that I re-read it, maybe not.

An evening at BASTYR with DR. OZ

2010-05-05T13:40:00.000-07:00

!!!

This little prize showed up in my mailbox yesterday and I think it is just too cool for words. Dr. Oz! The one guy on TV who talks about nutrition to which I say-- Yes, that's totally true! Yes, I totally agree! Well him and Jamie Oliver. Dr. Oz and his wife Lisa are coming to Bastyr June 2 to receive honorary doctoral degrees and participate in a "conversation" with attendees. Which I could be one of those lucky attendees..... (!) except that I can't afford the fee of $150 to attend. Or the $500 fee for the VIP reception. SO if anyone in the area or out of the area wants my invitation, let me know. I'll take your best offer... tee hee.

I only feel slightly guilty about the fact that I just posted about Sloppy Joe's before this... Hey, I pride myself on being that dietitian at the party that doesn't make other people feel uncomfortable about what they are eating in front of me. I am realistic and from the Midwest people! I know food is about more than nutrients-- it's about quality, nourishment, socializing, and connecting. And by saying "I'm from the Midwest" I mean that I can get down with down-home cooking; you know-- the meat and potatoes thing that really isn't all that bad for you if you're talking about good, well-raised meat and potatoes.

Ok let me know about Dr. Oz!

Homemade Sloppy Joe's

2010-05-04T09:24:00.001-07:00

Looks pretty, no? Ok so it's not the fanciest meal in the world, but it's good, easy, and uses simple ingredients laying around the kitchen. This is what we're cooking these days. Sigh.

1 lb organic ground beef
1 small chopped onion
2 cloves minced garlic
1/2 cup or so cocktail sauce
Few squirts of yellow mustard
Few pinches brown sugar
Ground black pepper to taste

Saute onions and garlic with ground beef until beef is browned. Add the rest of the ingredients and stir well. Cover pan and simmer for about 15 or 20 minutes. Serve on whole wheat buns.

Thank you Baskin Robbins

2010-04-28T18:49:00.001-07:00

... marketing department for making this first day back to work end awesome-ly by having your 31 cent scoop day today! Just for me! How sweet of you! I love ice cream! Dan is currently out getting me 3 scoops: 1 Pralines and Cream, 1 Chocolate Peanut Butter, and 1 Strawberry. Mmmmm.

SO. Work today. Oh boy. I am out of practice and realized how on "autopilot" I was with so much of my day before maternity leave, and now all the things I could do with barely having to think about them- I had to think really hard and really long about today. Thus, I saw three patients all day. Oops. In my defense, they were three REALLY complicated kiddos. Like three of the most complicated cases I've ever seen. Well two of them were, one was just mediocre-ly complicated. Luckily I had my AWESOME coworkers by my side who I could bounce ideas off of and ask questions and get that vote of confidence I needed before doing anything. I realized today how lucky I am to have a job. A really, really good job. It requires A LOT of focus and dedication and thoroughness and frankly, guts. But I do really, really like it. It just fulfills me and gives me a purpose that not even just being a mom gives me.

Ha! Dan just texted me he's "standing in line and it will be awhile." I texted him, "Aw u don't have to if it's totally ridiculous." We all know he will stand in line. That's just the Danimal.

SO. Haven today. Me without Haven today. Haven with my friend Julie today. Well, Julie survived, that trooper. I literally did not call her once all day today because I knew how Haven would be and I knew that I would not be able to focus at work after hearing her upset. So this morning before I left for work went well: I got up at 4:45. Haven got up a few minutes later. I fed her. I showered, put on make-up, got halfway dressed, and fed her some more in an effort to get her to go to sleep before Julie got here. She did not go to sleep. I hurried and tried to get all-the-way-ready for work by 6:00 when I wanted to leave. And Haven was still awake, so I decided to give her one more shot on the boob. And it worked. She conked by 6:15 and I put her in her bassinet and after that I have no idea what happened. Except that she went five hours refusing the bottle but crying for hunger, for me, for sleep. Somewhere toward the end of the five hours Julie called Dan and he gave her some tips and said he would call her back in an hour. She texted him before that hour with "she just took 5 oz." Julie said she had about two hours of happy time sometime after that, then went back to crying for two hours. Somehow throughout the course of the day while I was gone she ate almost 18 ounces. Keep in mind she probably ate 4 ounces before I left and then another 6-8 since I've been home. Is it any wonder my kid is 17 lbs at 9 weeks old?! Anyways, she was so precious when Dan and I got home (around the same time). Just big eyes staring into our eyes and smiling and talking. Precious. She then had a nursing-fest with mama and is now totally passed out on the couch.

Good first day back to real life. Cannot wait for that ice cream. Did everybody know I worked for Baskin Robbins when I was a senior in high school? My boss was a creep but we got one free ice cream treat per day worked and it was an easy/fun job that gave me spending money for a few months. Ooh, Dan just walked in. What? Limit to only two scoops per person? Lame-o. Well, beggars can't be choosers I guess. Bye-- time for ice cream and Haven.

Off the charts

2010-04-24T14:43:00.000-07:00

My kids is, that is, literally. Doctor's appointment yesterday. Here are the stats:

Weight: 16 lbs, 10 oz

Length: 24.5 inches (using a sketchy method of measuring length-- the old lay-her-on-the-table-and-draw-a-pencil-mark-at-her-head-and-feet technique... highly inaccurate but oh well I guess).

Head: 41 cm

All three growth indices are off the charts-- ha! I love it and have a feeling this has something to do with why she sleeps through the night so well-- that girl doesn't need any extra at night as she obviously gets what she needs all day! Just so you can get a perspective of her cheeks:

First day back to work coming this Wednesday. I'm really excited in a way actually- to have a reason to get dressed and things to accomplish during the day other than housechores. I just hope Haven takes the bottle well with the babysitter and doesn't get too stressed out without seeing me all day. Luckily I will only be working two days this week. I seriously feel like I forgot everything as I've been out of work for about 12 weeks now. Yikes. I am SO happy though that my first day back I'm working with my fav coworker who had a baby last November and totally understands what it will be like to get back in the swing of things. It will be different seeing the sick little babies now compared to before I had Haven. I have a feeling it might be hard to separate my emotional response with the babies, but overall I think I'll be a better dietitian and will be even more invested in helping the little patients. Should be interesting-- I'll keep you posted.

Flavored pasta

2010-04-21T17:36:00.000-07:00

What an easy way to make something simple, special. When Dan's mom was here a few weeks ago, she graciously prepared and fed us dinner every night. One yummy dish she made was another semi-homemade-type dinner using lemon-pepper pasta and shrimp. It was so good and just a little off the beaten path, so I got the pasta again from Trader Joe's and made it yesterday. I did a butter-garlic sauce which tied all the flavors together. I forgot that Pike's market has a stand chock-full of all different kinds of flavored pastas, including chocolate, thai, chipotle pepper, and citrus flavored pastas. Imagine how easily you could make something simple, special. My lunch yesterday with my favorite coffee:

Meanwhile, here's a new pic of my (big!) happy baby Haven doing what she loves to do-- stare at me and smile and "talk".

Haven takes a trip to Pike's Market

2010-04-14T13:47:00.000-07:00

My grandparents, Haven's great-grandparents, made a trip to the Northwest to see their first great-granddaughter after a string of 5 great-grandsons. Keep in mind, they are in their late 80s and still travelling the world! These two are amazing, so full of life, stories, and energy. All they really wanted to do here in Seattle was visit with us, but I knew they would love a day at Pike's market... and so did Haven.

We ate lunch at Lowell's in Pike's market, which we eat there pretty much every time we go to the market (which seems like is only when we have company in town). They have the best fish and chips according to Dan. I love their salmon quesadillas. And yes, Haven was a perfect sleeping angel all through the market AND lunch. I was surprised when we got rejected to sit in the "view" side of the restaurant because apparently it's considered a bar and apparently Haven is considered a minor who is not allowed in a bar. So wierd if you ask me. Anyways, I love taking Haven these places-- she is becoming more and more a little Seattle girl.

Jamie Oliver's Food Revolution

2010-04-12T11:10:00.000-07:00

Ok I have a brief slot of time before Haven wakes up so here we go with Jamie Oliver's Food Revolution.

Here's what I have to say: Watch this show! The scoop on the show is Jamie Oliver (chef from England who has worked to make changes in their food systems) is in a town in West Virginia that is statistically the "unhealthiest" city in America. He is using this town and its people as an example of what is really going on in every city and town in this country-- to show the reality of our food systems, our food culture and the outcomes. He spends time in the trenches of school lunch, one-on-one with an obese family, and teaching hundreds of people how to cook a simple, healthy, whole foods meal. Shockingly (to me anyway), not everyone is on board with Jamie's efforts to help this town and our whole country really. I can share the frustration he had in the school lunch system as I had literally the EXACT same experience. Cooks who don't actually like to or know how to really cook; government parameters that make it virtually impossible make a healthy, palatable, kid-approved meal that meets macro and micronutrient guidelines within a budget of about $1.30 per meal; and kids who cannot identify a carrot when presented as a whole carrot with the stem on top (they only recognize "carrot" as small oblong round orange things that come in a bag).

You have to watch the show to see what is really going on in our food systems and how they are impacting our nation's health. I felt so frustrated and disgusted after my experience with the school lunch program last year. I watched as overweight child after dejected, lifeless-looking child went through the lunch line, choosing pizza and chocolate milk for breakfast, and then pizza and chocolate milk for lunch, and knew that's what these kids ate every single day, twice a day, all year long. And I can only imagine what home food is like. The most difficult and disappointing realization is that so many kids are dependent on these meals as they are on a "free or reduced priced" meal program in which the government provides meals for kids who come from low-income families. So this is what we are giving the kids whose parents can't afford to feed them. Great. I felt responsible in a way-- knowing this information and knowing what eating like this every day will do to these kids, and now seeing kids in the PICU with type 2 diabetic ketoacidosis, pancreatitis, NASH (non-alcoholic steatohepatitis), and obesity.

So definitely try to catch this show-- Friday evenings on ABC, Jamie Oliver's Food Revolution. Can't miss it.

What the Swells has been going on?

2010-04-09T19:23:00.000-07:00

On the career front:
I am officially going back to work in 2 1/2 weeks. I am working 2 days my first week back and then increasing to 3-4 days per week. In terms of having a newborn, this schedule is pretty great. In terms of returning to my job, this is actually not so great. I passed up the opportunity to work 5 days/week with full benefits in the position I was in previously. Turns out someone else with seniority over me is taking the position anyways, but still. It is so hard and wierd that I will not be going back to the role I was in before having the baby. I will be "filling in" more so as needed in both inpatient and outpatient. Which means I will be working in someone else's workspace, I won't be familiar with the patients, I won't have a consistent rapport with the medical team, AND I have to learn a whole new ball of wax on the outpatient side... which is sort of intimidating and a bit overwhelming to be honest. Why? Because the outpatient world is different than where I was before-- the computer system is slightly different, the charting is different, the doctors and medcial teams are different, the assessments and overall patient goals are different, etc. So I will have another learning curve, more time of feeling like I'm the new person, etc. The positive things are that 1) I have a job! Let's not forget to be grateful for that! 2) I will gain more diverse experience that can only help me in the future. 3) I will have a good balance between my home life as a mom and my work life as a career woman fulfilling my passion and helping really sick kids. Yay! I hope :)

On the Haven front:
My kid has sleeping 7+ hrs straight nightly for the past 3 weeks. Cue flying daggars in my direction from all parents of newborns. Yes, somehow I am the luckiest parent of a 6 week old in the world. How is this possible? We are probably just very very lucky, but I also have set up a little routine that has worked for the past 3 weeks now. In the morning, around 7:30 or 8:00 AM Haven wakes up for the day. I dress her in real clothes and have the lights on and blinds up all day. We speak at full volume, have the tv on, play with musical toys, etc. We get out at least once per day, whether it's to run an errand or take a walk-- usually both. I feed her on demand throughout the day (whenever she wants which is pretty frequently, about every 2 hours or so). Around 6:30 or 7:00 PM, we get Haven's pajamas on. Anytime after 7:00 PM that she falls asleep, we put her in her bassinet and shut the door to her room (note, bassinet is not in our room anymore). She usually falls asleep for the night between 9:30 and 10:30 PM. I put her in her bassinet and she will stay asleep till usually around 4:30 and 5:30 AM when she wakes up to eat, stays up for 1-2 hours, then goes back to sleep for about an hour and a half. This has changed our lives in the past 3 weeks and I can say I am a much happier mother!

Haven is HUGE. In a good way! She is starting to out-grow 3 month clothes. Keep in mind she is 6 WEEKS OLD. Ha! Dan and I had to go shopping today as so much of her current wardrobe is unusable. Can't wait to see how much she weighs in two weeks at her check up.

On the "me" front:
I am basically fully recovered from the whole delivery ordeal. I have been cleared to resume all previous activities (i.e. exercise!!!) although I am not sure how I will fit working out into my daily routine but we'll make it work. I am still extremely stressed over Dan and I's life situation... meaning will Dan find a job right away after finishing dive school in 6 weeks? Where will the job be? Will we have to move or will he have to leave for periods of time? How long and how will I manage that? How are we going to pay the millions of hospital and medical bills that keep flowing in? Will I desperately want to be home with Haven when I need to be working to pay these millions of bills? Should I be working more to pay the bills or is it important to have more time with Haven? When will Dan and I have some semblance of a relationship again after having a newborn? How will I have energy to devote to work and Haven? When will we ever be out of debt? When will we ever have a home? Who is going to watch Haven long-term while I'm working? How will she do with someone else taking care of her all day? Do my friends still want to have anything to do with me considering I have been holed up and basically incommunicado for the past 6 weeks? All I can do is live in the present moment and basically survive. Isn't that the way it is with every new mom? Or are there really new moms out there who have it all-- a husband who makes tons of money and allows the mom to stay at home, a big nice house filled with nice new furniture and matching dish sets, a perfectly healthy, and a cute baby who sleeps through the night? Well hey, 1 out of 3 ain't bad and I'll take the sleeping baby any day!

So I need to get back to the tv as Jamie Oliver's Food Revolution is on! Love this endeavor of his and shared so much of this experience in my internship rotation with school food service. More to post on this next time!

A little video for a little girl

2010-03-31T13:55:00.000-07:00

Dan and I both agree, this is Haven's song. Every time we hear it I feel like I'm going to cry and it's not even a sad song-- it's happy really. I think we heard it a lot toward the end of my pregnancy, then right around the time she was born, then over the past 5 weeks of her little life. To my little soul sister:

And by request, I tried posting a few short videos of Haven doing what babies do at 3, 4, 5 weeks old... which is not all that much. But it's not working so I'll keep trying when I find the time!

In other news, I'm dying to chat about Jamie Oliver's Food Revolution-- amazing, couldn't agree more, shared that experience, want to do what he's doing.... watch it-- ABC on Fridays (I think?).

Semi-homemade Swells Nutrition

2010-03-22T12:14:00.000-07:00

Now that I have this little-miss-attached-at-my-hip (literally, she is sleeping on my legs as we speak, er type)... I have had to alter my level of cooking a bit. Not that I was any sort of chef to begin with, but things are a bit more semi-homemade these days. I'm actually surprised and stoked that I'm able to prepare meals at all at this point! So semi-homemade works for me. I'm sure anyone with a newborn is in this boat so maybe we can share some semi-homemade ideas for those of us who want to still have real-ish food but have a baby who wants us at all waking and sleeping hours of the day?

I found this package of soba noodles at Trader Joe's that comes with it's own spices/sauce. Soba noodles are made from buckwheat so it's a nice change of pace from wheat, wheat, wheat. I made a semi-homemade meal by stir frying tofu, carrots and celery and adding it to the noodles. The tofu and veggies add protein and fiber and vitamins and minerals and make it a whole meal in one bowl. And yes, it passed the Danimal test. Even better: leftovers for me for at least 2 more lunches. So we had this for St. Patrick's Day dinner. Hmm, Japanese on the Irish holiday?

Another easy semi-homemade side dish: jazzed up pasta salad. Pasta salad is super quick and an easy way to pack in nutrition. I like to use whatever leftover scrap veggies I have from making previous dishes. Adding some assorted fancy olives, marinated mushrooms and feta from the deli section of the grocery store spruces things up and makes it more interesting than your standard pasta salad (got this idea from when my mom was out here and she put that together). I had this last night with lentil soup for protein.

Tonight we're having a dinner fit for a true Southerner: sauteed kale and spicy sausage with cornbread muffins. I used a box mix for the cornbread and then added chopped green onion, cayenne pepper and cheddar cheese to the batter. Then I topped them with a little more cheddar. The cornbread muffins are really sweet and the sausage and kale is really salty and spicy so it all goes together well.

Another quick and really simple semi-homemade lunch: roasted red pepper and tomato soup and quinoa. I get the soup at TJ's and add quinoa to give it some oomph. With quinoa being a complete protein, this can be a meal in itself. I had mine with my "morning" coffee (at about noon). Tee hee.

My new life.

2010-03-14T13:19:00.000-07:00

As you may have noticed, I'm not able to blog as often as usual now that Haven is in our lives. I'm hoping there will be some stage to come after this newborn stage where she will either A) sleep more, B) not cry as much when she's awake, C) take a pacifier, D) hang out in her swing while I do things-- like blog and housework and cook and eat. We spend most of our time together breastfeeding. Holy Lord, yesterday she ate ALL. DAY. LONG. I think she has a "3 wk old growth spurt" coming which the pediatrician warned us about. Not kidding, she barely even slept-- she just went from one boob to the next-- It was actually physically exhausting by the end of the day and all I did was sit on the couch and watch TV. I will say she gave me a good 6 or 7 hours of sleep last night (not consecutively but hey, I'll take it) so I was grateful. What happened to newborns sleeping 18-20 hrs per day? I feel like my kid sleeps like half that.

We have been very productive though as she weighed 10 lbs 2 oz at her checkup last Tuesday. Which means she gained 2 lbs in less than 2 weeks since discharging from the hospital. And she looks huge. Seriously she looks like a 2 month old, and is wearing 3 month old clothes at 2 wks old!

Dan and I have both been sick which intensifies the exhaustion factor and decreases the patience factor significantly. Dan is currently knocked out on the couch under the Thera-flu spell. Haven is being nice to me and sleeping on him. I'm actually feeling much better and so far Haven seems to have dodged the bullet.

On the food/nutrition front, I've basically been eating like a king-- or queen I guess-- thanks to my mom and mother-in-law who kept me full and fed these past few weeks. Somehow I have dropped about 30 lbs since delivering Haven about 2 wks ago. And I'm pretty sure after subtracting Haven and the placenta, I have sweat out the rest as extra fluids at night. Seriously I'm going through about 3 sets of pajamas nightly. It is ridiculous and gross. Since Haven is being so nice right now, I actually fixed myself a little something for lunch:
Sauteed onions, green peppers, and black beans over avocado slices with a little salsa and spices. And a banana :) Hope this doesn't give her gas later! A baby screaming in pain is no fun.

Before I get back to my motherly duties, I want to mention how amazed I am at the generosity of people since having a baby. I can't believe how giving people have been-- even people who barely know me or don't know me at all. I've had coworkers who I don't actually work with give me gifts; another coworker I rarely work with brought a full meal for us and she lives an hour away; some of my mom's students many states away have given little outfits for her; the nurses in the hospital who stayed by my side all through labor and then came at the drop of the hat all night long in the middle of the night; and of course my friends and family have given infinite amounts of time, gifts, support, and service which we would have never made it through without. All for little Haven :)

Haven.

2010-03-02T20:35:00.001-08:00

Believe it or not, our little baby girl finally came to us. Last Thursday at 1 AM I woke up with my water breaking and strong contractions right out of the gate. I spent a few more hours at home waiting for the right time to head to the birth center, and left somewhere around 6:30 or 7:00 AM I think. I was in a lot of pain right from the start and this only got more intense during my time at the birth center. I hopped in the tub as soon as I got there because I just needed some sort of relief. I spent about 30 minutes in there and then my midwife wanted me up and walking around. So I started walking up stairs and doing lunges up the stairs and just walking around. I felt like I had absolutely zero energy in my body for any of this and all I wanted to do was lay down and sleep. Pretty soon I was violently barfing my brains out. On the stairs. Outside of an apartment complex. Meanwhile yelling and moaning at the top of my lungs and saying Lord knows what as random passerbys came into my line of vision now and then. I felt so weird acting like this in front of total strangers but as they say, modesty and manners go out the window when you're in labor. I could have been naked for all I cared at that point. I was just trying to survive.

Quickly I felt so horrible I could not go on any longer. I was completely out of my mind in pain, was convulsing head to toe, and alternated between shivering violently and sweating like a maniac in about 30 second intervals. I was screaming and begging God and anyone within a 1 mile ear shot to please help me. At this point I was face to face with Dan (sitting on the toilet because I constantly felt like I was going to have the biggest bowel movement or pee of my life), and I saw Dan starting to get choked up. It broke my heart because I know he couldn't take it any longer either.

We transferred to the closest hospital around 11:15 or so. I screamed the whole way there, in the lobby, down the hall, into my room, and sitting on my bed as I had contraction after contraction while the anesthesiologist placed the epidural catheter in my back. I had no idea how I could stop my convulsing long enough to prevent the needle from hitting the wrong spot in my spine and wreaking havoc, but somehow I did it.

By 12:00 noon, I was a completely normal human being. The epidural had worked. I was dilated to a 6, and continued to remain a completely normal human being until about 8:00 PM, when I was dilated to 9 cm. At this point, somehow the additional pain med they gave me wore off and the epidural was not able to touch the type of contractions/pelvic pressure I was having. So into transitional labor with no drugs I went in the snap of a finger, and I was right back to where I started-- screaming at the top of my lungs, completely out of my mind, convulsing head to toe, in an alternate universe. During this state, the doctor came in and said we needed to do a c-section as the baby positioned in a way that would not allow her to come down through the pelvis, my membranes had been ruptured for a long period of time, and I was running a fever. I remember saying, "Can you just give me something for the pain so I can think clearly for a second and make a decision?" But they couldn't do that since it would throw off the anasthesia I would need for the c-section. All I cared about was surviving at this point, so I said yes-- just give me something NOW!!!

Off to the OR we went and within minutes I got spinal anasthesia and was a completely normal human being again. I was smiling and chatting it up with the anasthesiologist and Danimal-- he was already tearing up at the fact that we were about to see our baby girl. I was just barely back on planet Earth and seeing him and hearing him say this made me realize-- Whoa, I'm about to have this baby! I asked whoever was around and listening if I could have a minute or two to collect myself before the monumental moment-- they said yes but probably just carried on with their agenda-- who asks the surgeons to please wait a minute? Ha!

I barely even knew that they had started surgery and she was born to the world. They didn't really do the whole lift the baby up over the curtain for mom to see thing-- at least I don't think they did. They pretty much whisked her over to be cleaned and weighed and measured and suctioned. She cried a little bit but what I loved was seeing her cough as she was trying to breathe and get the junk out. It was so cute that little cough. Haven Alyse Wells was born at 9:14 PM on February 25; 8 lbs 13 oz, 22.5 inches. Not quite the 10 1/2 lbs they predicted. But as I sit here and look at her next to me in her swing, I have no idea how that baby fit in my body a few days ago.My recovery after the c-section has been about as good as possible I think. I'm not in tons of pain, not having tons of bleeding, and not totally exhausted. I have had so much help from my mom and Dan though-- literally waiting on me hand and foot. Cooking and feeding me, bringing me water, holding, rocking, changing, you name it.

Haven is probably the best breastfeeder I've ever seen. My milk came in after about 3 days and she had already gained 3 oz as of Monday from her hospital discharge weight Saturday night. When she latches it is so funny because I try to get her to do it my way (the "right" way), and she will either fight it and do it her own way or take it my way, then come off and use her hands to do it her way. She definitely knows what she wants! She also has a certain cry-- actually she kind of screams or squeals softly when she's hungry. She's done it from day one and it is the cutest thing in the world. Dan and I melt every time she does it. As of right now, she likes to feed about every hour over night and every 2-4 hours during the day.

Everything about her is perfect. She has the sweetest little personality. She is so easy to take care of and love. She is absolutely adorable. She has long skinny legs, a little bit of strawberry-blondish brownish hair, and big "doe eyes" as Dan says. When she cries she says, "Llllaaaaa! LLlllaaaa!!!" like she's singing. Oh it kills me! She has this little seahorse gloworm toy that plays soft music that just puts her in a trance so we use it every time we change her clothes or diaper. And she is so cuddly and snuggly and loves to be held and rocked. Well she's getting ready to want some attention here so that's it on Haven's birth story for now. I'll be back soon!

Sorry for the hiatus...

2010-02-22T10:42:00.001-08:00

Did you think I hadn't blogged in a bit because the baby was born?

Well, she's not here yet. I can't even believe this. I have had a hard week this past week for reasons I don't want to get into on a blog (sorry) and have basically been holed up in my little world since last Monday. I haven't been returning many phone calls, emails, or texts but am starting to reopen to the world again. Hopefully I'll have great news any day (minute!) now and we can have a huge awesome blog dedicated to my labor and delivery and the new little girl!!!

Update to previous post: Operation GET BABY BORN.

2010-02-12T11:34:00.000-08:00

Ultrasound was good. I feel relieved, although I don't know why.... considering they estimate her weight to be 9 lbs 1 oz currently. I guess it's because I've expected her to be 9 or 10 lbs all along because that's what my husband and I weighed at birth. The radiologist said he thought that's why she hasn't dropped yet, because she's big. But I don't understand that. I know it's a bit of a myth that a baby can be too big to fit into the pelvis-- it's rare for that to truly be the case in developed countries. I'm hoping my midwife has some insight. Meanwhile, bring on the hula-hoop hip action, walks, cat's pose, Mother's Cordial herbal tincture, and anything else anyone may suggest!

BTW, Dan's home sick today which is good and bad. Good because I won't be bored out of my mind again today. Bad because there's a pretty good chance I'll be getting sick soon-- not good timing!

YAY OLYMPICS!!! Oh, and I want to add that I will be rooting for Apolo Ohno (hometown hero :), and any other American in the games for that matter. But I'll root for Canada too. Weather here is still way to warm for good skiing and good snow. Hope they pull this off!

It's 5 AM. Been up since 2. Went to bed at 12.

2010-02-12T05:22:00.000-08:00

That adds up to 2 hrs of sleep for me. Awesome. I didn't mean to go to bed at 12. But I was beyond disappointed after having an appt with my midwife last night (at 39 wks and 5 days). Disappointed to find out I'm not dilated or showing any signs of progress. The baby is nowhere near dropped. They even were "confused" by her position which is total news to me as every week for the past two months they have felt her as head down. So I'll be getting an ultrasound to "confirm position", walking incessantly like a crazy woman, hula hooping my hips, practicing cat's pose from yoga, and will continue to wait.

The other night I was super energized and super hungry so Dan and I decided to go out to eat for what we expected would be our last night out as just us.. in a sense.. you know what I mean. Here's me making an effort to not wear sweatpants and one of Dan's t-shirts for a few hours.
In other news... I am SO EXCITED for the Winter Olympics!!! I absolutely LOVE the city of Vancouver and Whistler and am so stoked for the world to see what an amazing place British Columbia is. The people are so healthy and active; the city is modern, conscious, and embraces the best of both worlds in terms of urban culture and an appreciation, nay, an obsession with the outdoors. I may even root for Canada :)

Dietetic intern placement rates

2010-02-10T15:32:00.001-08:00

Did you know that only 50% of all applicants for dietetic internships got placed to an internship last year? Scary! Especially considering the time, money, dedication and hard work that goes into the preceding degree! There was an article in this month's issue of ADA Times about the "shortage" of internships. I say that in quotes because some feel that there isn't so much of a shortage as there exists more of a "weeding out" process so that only the "best of the best" get matched.

In any case, this is the current reality that dietetic students are facing. And this is daunting, not to mention extremely stressful. The key is to know that this is reality, and then do something about it to make your future what you want it to be. You have to look ahead. In other words, I would recommend talking to internship directors at the beginning of your program and find out what you can do during your schooling to be a stronger candidate for the internship. Talk to interns who are currently or were previously in that internship to find out how they got in. If you are serious about becoming a dietitian, you will have to work hard to stand out to even be considered for an internship. As of right now, that's just the way it is.

Some of my tips:
-Strong GPA
-Volunteer experience in each of the major domains: clinical, community, food service.
-Work experience, especially dietetics-related, but other jobs as well, as many skills you may have developed in previous jobs can translate to being a dietitian.
-Strong letters of recommendation, which means strong relationships with professors, previous employers, RDs you may have worked or volunteered with, etc.
-A strong, professional internship application when that time comes. Make it clean and flawless in terms of grammar, organization, including all necessary pieces, making deadlines, etc.
-Leadership experience. This can range from being active in organizations at school, starting clubs or mentoring younger students, or contributing to your community in some way.

Sound like a lot (on top of school)? It is, but if you really want it, you will do what it takes to get there.

So what exactly do you DO as a dietitian?

2010-02-07T16:27:00.000-08:00

I get this question a lot when I tell people I'm a dietitian. I wondered this often myself when I was in school, working so hard toward a career I really couldn't have understood until I stepped into it. I have a hard time putting it into simplified terms that make up a sentence or two so as not to totally bore the person asking me. But to say, "Oh I basically manage the nutrition needs of really sick kids in the hospital" doesn't exactly say much. I think it's important for anyone who is wanting to be a dietitian to understand what the job really entails-- because it is not an easy road to actually get your RD, and if you end up not wanting to do the job, you could regret spending so much time, energy, and money on the education. So if you really want to know...

I start my day at 7 AM. Part of my job is managing the "feeds" for our babies and kids. I only see the most critical patients or the patients who are at highest nutrition risk, so the majority of my patients are not actually eating food by mouth like a healthy person. In the mornings, I pick up a stack of papers from the kitchen office -- these papers are orders that came in overnight from MDs for various formulas or tube feedings for patients. I have to calculate "recipes" for these feeds depending on how many calories/oz the kid is supposed to be getting, and then figure out how much daily volume the patient will need. Sometimes the formulas are really complex, with modular additives like protein or thickening agents (if the patient has swallowing issues). I use a spreadsheet with all the different formulas and modulars on it to calculate how much formula, how much water, how much of the modular needs to go into the recipe for 24 hrs worth of feeds. This whole process is about 10-30 minutes of my morning.

After that, I gauge the workload for the day, meaning how many patients have to be seen, how they should be prioritized, and my goals for getting all this accomplished, taking into consideration any meetings I may have (which I have a lot). My first priority is the PICU. I print the unit census, which has all the patients' names, diagnoses, length of stay, nutrition order, etc. I spend about 30 minutes researching the new admits-- reading over their H&P (history and physical), which is a thorough synopsis of why they admitted, what their status is, and what the tentative game plan may be. I gather information quickly about the patients weight, growth pattern/growth chart percentiles, medical history, labs, etc. I basically need to be prepared for questions that I may be asked during rounds-- like what type of feeds the patients should be started on, what type of feeds they were on before, what their disease state or condition is, if they should be fed into the gut at all, if they may need TPN (IV feeds), if they have had previous intolerances or GI issues that may impact whether or not they should be fed, at what rate, how quickly the rate should be advanced, if they are on high levels of sedation, if they are on the vent, what type of vent, ECMO, if they should have a specialized formula, etc. I also briefly review the existing patients that need to be followed-up on to see if there have been status changes that may impact my nutrition intervention for them. All of the above happens between 7:30-ish and 8 AM.

At 8 AM, I go to PICU rounds. Here gathers the team of physicians, nurses, respiratory therapists, social work, child-life specialists, cardiologists, surgeons, pharmacists, nurse practitioners, and me :) We go from patient room to patient room and listen to the night MD give report to the day shift MD. The other MDs/staff will give input about the plan, alternative treatments/plans, ask questions that may not have yet been asked, provide additional information, etc. When you have infants and kids as sick and complex as those that require intensive care, it is crucial to have many eyes looking from many angles at all the factors of the patient's overall picture. In this way, each person at rounds has an area of expertise they are responsible for.

During and after rounds, I spend a few minutes visually assessing each patient-- looking to see if they have edema, what their perfusion looks like, what their breathing sounds like (if they're not on the vent), what rate their feeds and various drips are running at, how their wounds are healing... basically noticing anything out of the ordinary that may not match up with information in the chart. Sometimes I talk to parents or nurses at this time if I need to get additional information.

From there (usually about 8:30 or 9:00), I go to my office and get my game plan set for the day. I mark on the census which kids need an initial assessment, which kids need follow-ups, which parents/patients need educations. In some cases during rounds, the doctors will specifically ask me to see a particular kid or will ask for specific recommendations. In some cases, a certain kid's status has changed that may bump them to the top of the priority list. After rounds, I prioirtize the patients I need to see that day and start plugging away at assessments and charting. My goal is to try to get all the PICU kids seen by about 12:00 so I can help with the workload for the rest of the hospital. Sometimes this happens and sometimes it takes me all day, just depending. If I'm working alone, I have to figure out how I'm going to see the whole hospital in that day (which means prioritizing patients big time). My assessments involve gathering info, analyzing the issues, coming up with a plan, and charting all of these things. Then I have to communicate my recommendations to the doctor. Sometimes he/she agrees, sometimes he/she does not. If they do agree, I have to put that plan in motion and communicate it to all players involved (the nurse, the caregivers, the kitchen staff, etc). The majority of my day is spent seeing patients, creating plans, and executing these plans.

The "assessment" involves looking at past medical history, current diagnosis, growth, labs, medications, swallowing function, GI function, fluid status, and estimating calorie, protein, fluid, and in some cases micronutrient and education needs. I would say about 25% of my job involves doing math calculations, 25% is clinical assessment/information gathering/decision making/problem solving, 50% is communication-- whether it's with parents, patients, providers, other staff, or charting. Yeah by the way, if you're not into math, clinical inpatient dietetics may not be for you. And if you're at all squeamish or overly sensitive, find a way to deal with that. I think most people get desensitized quickly though. An intitial assessment takes about 30 minutes, sometimes up to an hour or more, depending on how complex the kid is and how complex their intervention may be. A follow up assessment takes about 20 minutes but can also be up to an hour or so.

The "plan" includes what type of nutrition support (tube feeding or TPN) or diet the kid should be on, what rate and schedule the kid should receive nutrition support, if any labs need to be ordered, if any micronutrients need to be supplemented, if the kid needs to be evaluated for oral feeds by speech, if the caregivers need education around how to make specialized formulas, breastfeeding/pumping, what the daily goal intake is (if the kid is taking feeds by mouth), what the goal for growth/weight gain is, or any other diet education needs. Another big aspect of the plan is making referrals to other providers when needed. There is only so much that can be done in a small window of time a patient may be in the hospital, and it is sometimes hard to track change to see how the plan is working. So basically all of our patients who are on any kind of nutrition support (tube feeds, modified feeds, TPN) or kids with certain disease states (diabetes, renal, GI disorders, failure to thrive, cardiac defects, feeding difficulties, swallowing issues, developmental delays, seizure disorders, the list goes on)-- all need to be followed by outpatient dietitians after they leave the hospital. We have a superb team of RDs on the outpatients side who pick up where we left off -- or vice versa -- often times we are passing back and forth if a kid is really chronically sick or takes a turn for the worse. We also refer to speech, GI docs, put together paperwork for WIC, coordinate with home infusion companies (who manage the technicalities of the equipment and formula needed for nutrition support after the patient discharges), etc.

Throughout the day, I am constantly getting called, paged, and emailed by doctors, nurses, diet techs, nutrition assistants, the kitchen staff, etc. I spend a decent amount of time putting out fires, troubleshooting, problem solving, etc. Some common issues are missing or running out of formulas, kids with multiple food allegies who are having trouble finding appropriate foods to eat while in the hospital, consults for education (i.e. diabetes, food allergies, wt loss, wt gain, failure to thrive, renal disease, GI disorders) or consults for new very high risk patients that need to be seen right away.

Usually around lunchtime, the diet tech brings me the hospital census, which they print out daily and screen the newly admitted patients. I review the screens, which are labeled as low, moderate, or high. The lows are automatically followed by the diet techs and the highs are automatically followed by the RDs. I review the moderate patients and determine if I need to see them or if they can be followed by the diet tech. This takes about 10-20 minutes. All the highs are kids we need to see, so the goal is to get them worked into the current day's workload. That way we are always staying ahead of the game instead of a day behind. That way we are able to drive the nutrition interventions instead of coming in after the MD has started something and then sort of evaluating whether this is appropriate, what else needs to be done, etc. That way we can save the MD time and get the patient started on the right track from the get-go. This is the goal, but as you can imagine if we are slammed, we sometimes aren't able to get to these kids that day so they go into the next day's workload.

My patient population includes everything from neonates from the NICU to 18 year olds. We take NICU babies postoperativley (i.e. cardiac repair), or if they have been discharged from NICU and then have to readmit because they got really sick and require intensive care. Disease states I see are all the ones I've mentioned already, in addition to traumas (car accidents, non-accidental trauma aka abuse, etc), toxic ingestions.... you name it, we see it.

This has all been a super steep learning curve and I'm finally feeling confident and comfortable with all aspects of my job.. it's taken about 6 months (and now I'm on freaking maternity leave!!!). In the future, I will probably transition into having more responsibility over various department projects, training other staff, and will spend more time doing research, attending conferences, doing in-services, etc.

I absolutely love my job. It is extremely challenging on multiple levels and so rewarding. I love working with parents and supporting them when they are basically in shambles. I love seeing so many different types of kids, babies, families. I love having success in the plan I implemented and knowing a kid will be set on the right track. Ok, congratulations if you're still reading this-- it was a long one! Any questions-- just ask!

Februrary 3rd, 1998

2010-02-03T18:25:00.000-08:00

I decided today I want to make a yearly tribute to Andrea on this day as a way to keep her spirit alive... That sounds so cliche, but stay with me...

It's been 12 years since she was taken away from us. I have been thinking about and anticipating this day for weeks, as I always do, because I never know how I'm going to be when this day comes. Some years I revert back to how it was at that time and will have nightmares and anxiety. Some years I just get really really sad. Some years I somehow go through the day without it weighing heavy on my mind. I read my post from last year and wow-- that was not a good year, and I really don't know why. This year, I started writing, then I stopped. I always feel weird about splaying this kind of thing out there-- but then I always think that she should never not be remembered; that her life should never not be shared; that if it were me, I would want people to remember me and talk about me the way people have been talking about her today (I loved seeing all the comments on Facebook). I will never forget the conversation we had, when we were in probably 7th grade or so, about dying. We were having a sleepover at her house, which we did almost every weekend it seemed like, and we were laying there talking in the middle of the night like always.. I can remember the goldfish she had in this goldfish bowl with blue pebbles-- that thing lived forever it seems like. She won it at a fair I think. Anyways, somehow we started talking about what it would be like if we were gone-- like if we died... I know that sounds really weird, but didn't you have those conversations with your best friend at that age? Like after you saw the movie My Girl or Ghost for the first time? Anyways, I just remember her saying that she hated the thought of being gone and that life would just continue on without her. The world would just keep going and she would miss it. And she didn't want the world to just go on without her. I have never forgotten that as it hit me like a ton of bricks when she said it. And I thought about it after I gathered the shambled pieces of my mind 12 years ago. And I've thought about it often since. So this is me not letting the world just go on without her. In a way.

Part of me was sort of hoping this girl would be born today-- that somehow having a new life, a new girl in the Meyer family today, would change the inevitable heaviness of February 3rd. But instead I think I'm relieved she didn't come today. It would be hard to go through her birthday each year and have that horrible day in the back of my mind. Now I'm hoping she'll come on her birthday-- that would be cool and it would mean I'd only be pregnant for a few more days. If she's anything like me, she'll need a whole day all to herself. I mean, come on. But it would still be kind of cool. We'll see.

Jambalya from scratch!

2010-02-01T14:02:00.000-08:00

***I just realized this recipe is not adapted from Betty Crocker, it's a Better Homes and Gardens cookbook, Celebrating the Promise (breast cancer awareness) edition. Oops! Just sub for Better Homes and Gardens for Betty Crocker below.

...with the help of good old Betty Crocker, with love from my mother-in-law for Christmas this year. I felt like Julie yesterday from Julie and Julia (or is it Julia and Julie?) cooking from this time-honored traditional cookbook.

How many words can you think of that are more fun than Jambalaya? And this dish is FUN... it looks like a party bowl of confetti with all the colors. And tastes even better. It's packed with fiber, vitamins and minerals and is a complete meal in itself-- meaning it has protein, veggies, and whole grain. I did my own twist on the recipe and it is a hit let me tell you... very easy too.

Jambalaya from scratch (adapted from Betty Crocker :)

Olive oil
1 white or yellow onion
2-3 cloves garlic
2 celery stalks
1 green pepper
1 14.5 oz can diced tomatoes
1 cup uncooked quinoa
1 1/2 cups chicken or vegetable broth
4 andoullie sausages
1 tspn dried thyme
1 bay leaf
3/4 lb or so baby shrimp
Cayenne and ground black pepper to taste

Chop the onion, garlic, and celery while oil is heating in a large skillet. Saute these until soft. Chop up green pepper and set aside. Add sausage, cut into bite size pieces, as well as quinoa (rinsed), broth, tomatoes (undrained) thyme, and bay leaf. Bring to a boil, cover and simmer 15 minutes. Add green pepper and shrimp and simmer another 5 minutes. Add cayenne and ground black pepper to taste-- depending on how spicy you want to make it! This takes less than 30 minutes altogether to make and will leave you with leftovers you will be happy to have the next day (unless of course you have a big family). So filling. So packed with nutrition. And it's a whole foods, well-rounded meal. Isn't it pretty?

*****

In other news, I am currently dying of pregnancy. I am a heap of terrible. I'm crabby. I'm swollen everywhere. I'm tired, impatient, depressed. Work is next to impossible because I'm exhausted and just mobilizing my body from point A to point B is like running 12 miles each time. But being at home sucks because I can't DO anything except lay on the couch and do the occasional house chore. I tried to run errands today and made it to the third stop of about 7 when I had to just head home because I was hot flashing, having trouble concentrating and ready to pass out. I don't know if this is normal or if I am just a huge wus but I cannot take this much longer! Must. Give. Birth. Now. Please! Look at me!

And yes, I wore this outfit in public today-- to the Bastyr Clinic, to the mall-- including the nice jewelry store to get my rings cleaned/inspected-- WHICH don't fit my fingers anymore. Yes, those are navy blue sweatpants. And yes, they do say "Pom Pons". And yes, they are from high school. And yes, they do have a big hole in the crotch. And yes, they are just about the only pants that fit at this point. Sigh.

Michael Pollan on Oprah today!

2010-01-27T17:02:00.000-08:00

Hope you had a chance to catch the episode.. if not I think Oprah is on at night some time too. Michael Pollan has an amazing way of communicating the simple message of eating whole foods as a way to revolutionize our food system and the future of our nation's health. Particularly interesting points he makes and that I have also discussed in talks I've given on food choices and health include:

-The percent of income we spend now on food vs healthcare compared to 50 years ago (9% dollars go to food and 17% dollars go to healthcare today compared to the complete reverse 50 years ago),
-The types of chronic diseases plaguing our nation now vs 100 years ago (today we are plagued with obesity, cardiovascular disease, diabetes, and cancer, and these health issues were rare if not obsolete 100 years ago),
-The need for a revolution in the food production system in our country (less processed foods, more whole foods, animals raised in a healthy manner instead of mass produced which may mean consuming less meat as a whole in this country-- and more fruits, veggies, whole grains, and legumes!).

If you miss the Oprah episode (which really the first 30 minutes are worth watching), I would highly recommend checking out Michael Pollan's newest book, Food Rules, which gives simple and practical-- oh-that-is-so-easy-and-makes-so-much-sense information around making food and health choices. And I swear he must have snuck into my classrooms on a daily basis at Bastyr because these are all the messages we learned and shared there! For example:

Don't eat anything your great-grandmother wouldn't recognize as food. Or
Don't eat foods that contain ingredients a 3rd grader cannot pronounce. And
Eat animals that have eaten well for themselves (i.e. no antiobiotics, hormones, or foods that are not part of their species' natural diets).

Or if you'd rather watch a movie than read a book, watch Food Inc. Form your own opinions; but just get informed.

Upcoming Pediatric Nutrition Conferences

2010-01-25T18:26:00.000-08:00

... that I am going to miss. I'm so pissed because I can't think of anything more educational, helpful, productive, and important to my career than going to one of these conferences. The clinical peds world is basically not a part of dietetics education. Everything we learn is as it pertains to adults. Peds is a "specialty" that you can only hope to experience during your internship if you're interested, and then from there it's really all self-taught. Thus pediatric nutrition conferences in my opinion would be KEY to being successful as a peds dietitian. I've been telling my boss how much I want to go to a conference and get my hands on the latest research, find out what other people are doing around the country at other hospitals, get tapped in to more resources, network with people, etc. So how excited was I when I got the flyer in the mail for this one?

Neonatal Nutrition Conference at the Sheraton Suites in Houston Feb 28-March 3.
Cosponsored by Baylor College of Medicine and Texas Children's Hospital (who authored THE reference manual I use for practically everything in my assessments and decision making). Some topics:
---Systematic Reviews and Their Application to Evaluating Neonatal Nutrition Outcomes
---GI Development
---Calcium, Phosphorous and Vitamin D Needs of Premature Infants
---Fluids, Electrolytes and Glucose: Too Much/Too Little
---Prebiotics/Probiotics
---Delivering Optimal Nutrition to the Neonate with Congential Heart Disease (lots of my kiddos!)
---Cholestasis
---Short Gut Syndrome

VERY EXCITED! Until I realized I will probably have a 2 week old at that time and I probably shouldn't travel to Texas with a 2 week old. Not to mention the whole breastfeeding every 1.5-2 hrs thing. Sigh.

We also have Children's Memorial Hospital, Chicago- "Establishing Competencies in Pediatric Nutrition" Wednesday, February 25, 2010 at Bigler Auditorium. Topics include Vitamin D, food allergies, anthropometrics and more. Not quite as interesting and critical as the Texas conference, but still-- considering I have family/friends there, this would have been ideal to go to.

Then there's the always important Clinical Nutrition Week put on by ASPEN, February 8-12 at the Las Vegas Hilton. There are too many topics to even list here, but it's ASPEN-- THE source of knowledge, research, and guidelines for a variety of disciplines when it comes to nutrition support. Crikeys.

Let me know if you go. Get me some materials please :) I'll be home and jealous. I guess there's always next year.... or maybe these guys will do something later this year?

Randoms of the day

2010-01-21T17:56:00.000-08:00

-The kind of patients I always thought I would spend a lot of time with are actually the ones I don't even see at all. The nature of healthcare is one that leaves the healthcare worker with more work than is possible to actually do in a shift. So what you have to do is prioritize who is most important. It sounds kind of bad to put it like that, but it's the way it is. There's a system we use to do this which involves Diet Techs screening all the patients in the hospital and referring the most critical ones who have the highest "nutrition risks" to us. From there, we further have to prioritize who we can fit into the day, who we might have to put off until the next day, and basically how we can cut the most corners to get as many kiddos seen as possible in the day. (Today I saw 12-- booyah an all time high! Of course I did NOT see about 7 kids in the PICU I really wanted/needed to see today....)

I have known people who have been hospitalized for various reasons who were never seen by a dietitian and before I actually worked at my job, I was shocked by that. My friend and her mom did a liver transplant and neither of them were seen by a RD. A liver transplant!

But things like newborns with pyloric stenosis, we usually don't even see them. They have their surgery, they stay a few days until they prove their guts are working, and then they go home. Full on kids with cancer-- often times we don't even see them unless they have radiation to the neck, chest, etc that fries their little mucous membranes making it impossibly painful to eat by mouth. For example, I have a 3 month old with hepatoblastoma, stage III, who is just not feeding after having chemo who has bad mucositis that we will likely have to start TPN on. But then today I had a little girl (in for what? I didn't even have time to look!) who has multiple food allergies and bad eczema head to toe. And I won't even be following her as my patient. I popped in to ask the mom and dad a few questions, provided a VERY brief education, relayed the info to the nutrition staff below me, passed her care to them and that's the end of my intervention. She'll be loosely followed by the Diet Techs and then sent home. Did I really help that kid and her parents? Not nearly as much as I could if I had time to. It was the bare minimum and I just wish I had time to do more.

-------moving on---------

-Homeless guys love pregnant people. Ha! I swear I get more genuinely friendly comments from homeless dudes about "Good luck with that little one." (followed by, "Hey are those donuts good?" --It was outside of the grocery store :) And, "Don't worry-- won't be much longer." And this morning the homeless fellow outside of the hospital said, "That bun looks like it's ready to come out of the oven!" I love it. Except one crazy one started yelling at me for "dying my hair brunette" (I haven't dyed my hair in years).

-------------------------

-Had a four week old today with apneas/bradys/poor feeding/lethargy/hyponatremia who came to the ER then transferred to the PICU as they found her urine to be positive for benzos. Google benzos. If you're wondering why a four week old would have a positive drug screen, we're wondering the same thing ourselves. Hopefully between CPS, social work, and the MDs we'll find the answer....

--------------------------

Can't wait to see what tomorrow has in store for me.

Tea Party!

2010-01-17T06:46:00.000-08:00

My awesome friends threw me the sweetest baby shower yesterday. I can't believe how much everyone did/gave to me. I feel so weird about showers-- like I didn't really do anything to deserve all these gifts... but someone put it another way and said, "It's ok with a baby shower because it's not really for you, it's for the baby." So that's true.. but I was feeling the love yesterday :)

What a cute idea-- a tea party! These are the hostesses-- they brought everything to my house, including decorations, set it all up, and I did nothing!The party favors: chocolate truffles from UW farmer's market... yum!

The decor :)

I had seen this outfit and wanted it but didn't buy it and Autumn somehow picked it out for me without knowing I wanted it.Some of my girls from Bastyr.

Something else I got that I'm stoked about-- Megan gave me the website/contact info for a photographer who does unique and personal photo shoots of families and newborns. She said she could give me a discount -- her website looks really cool: http://www.jocelynkbrownphotography.com/

Thanks again for everything ladies!!!

I am the epitomy

2010-01-15T17:51:00.000-08:00

of laziness.

I hate it. I hate every second of it. Mostly because I feel like crap. And to me there's nothing worse when I feel like crap than laying on the couch. It makes me feel crappier. But at 36 wks pg'd, there is nothing I can do when I get home from work besides lay on the couch and feel like crap.

People say to me, "Stephanie, you're pregnant; it's ok to be tired and lazy." That may be true, but it doesn't mean I like it.

I ate CHIPS for dinner two nights ago. Because I was lazy I think.
I wanted to balance the checkbook and pay bills a few nights ago and was TOO LAZY to do that even. How hard is it to hold a pen and a calculator?
I have blogged 4 times this month and we're halfway through January.
I have not done a single housechore in weeks.
I shave once a week- ha!
I take my prenatals maybe once a day (instead of three).
-I am sounding like a horrible dietitian! Well at least I'm honest.

But don't worry anyone out there who may fear your child's nutrition care is in my hands... I am dynamite for 8-10 hrs at work. Attributed mostly to the fact that I'm back on the sauce (cringe), -- coffee. I know- BAD pg person/dietitian, but I just don't know how I would do it otherwise. Sorry unborn :)

What does all of this mean? Well it means 100% of my energy and effort goes into work, 0% goes into me, Dan or anything else in my life, and Dan does 100% of his school, 100% of his work, 100% of taking care of me, including feeding me, and 100% of everything at home.... the bills, the cleaning, the grocery shopping, the laundry, the putting away of the laundry, the installing of the carseat, the hanging of the decor in the kid's room, the running to the store for toothpaste... you get the picture. If I were him, I would be having a breakdown right about now and resenting everything about the situation. But Dan just seems to enjoy it all. That's the Danimal for ya. He actually told me yesterday I was a good pregnant person. Well that's pretty hard to believe. I can't wait to be me again.

Questions of the week:

2010-01-07T19:40:00.001-08:00

Why would anyone leave a 1 year old and a 2 year old alone in a bathtub?

How/why does a 21 month old get stage IV neuroblastoma?

A walk through 2009, in food.

2010-01-03T10:23:00.000-08:00

I'm not sure why I'm so reflective about 2009.. Maybe because it's my last year of freedom. Maybe because it's my last year of my 20s (connect with me if you are interested in a "I turned 30 this year and want to go on a vaca/getaway with Dan and Stephanie"). Maybe it's some odd form of nesting? Well, I wanted to look at where I started and ended over the past 12 months. 2009 was a big year. I started as an intern and ended as a professional. I started as one and ended as two. I started in a studio in the city and ended in a two bedroom in a neighborhood. I started as a student depending on my husband's income and ended with my husband as a student depending on my income. I started... with January

Wwwweeeeellll, I must have erased all my pics from January cause no food pics from Jan 09. Um, let's move on.

February: Baked squash sauteed with a brown rice medley and green onions. Nothing says winter in a dish like winter squash.

March: Shrimp bruschetta over whole wheat pasta. The lightness in this picture reminds me of how spring feels in Seattle. It is an awakening experience like nowhere else.

In April, I had a birthday and someone made me a birthday cake he was really proud of.

By May it was high time to get by the water and get picnic-ing. This was Indian-spiced lentils with potatoes, carrots and maybe cauliflower, enjoyed on the grassy lawn of the Ballard Locks.

In June I celebrated finishing my journey to becoming an official registered dietitian with a lovely dinner at my internship director's house. I remember feeling really, really nauseated that evening for one of the first times after just finding out I was pg'd. I tried desperately all night to deny it and convince myself otherwise so I could enjoy this feast.

Oh July. Oh Ray's Boathouse with Kohl and Katy. Oh king crab legs. Oh garlic mashed potaotes. Oh asparagus. Oh. My. Gosh.

August: Again, no food pics saved in this month's files, but this picture represents the last dinner we had with the last of our o.g. core group of Bastyr girls left in Seattle before Jen moved to Cali. We had good Bastyrian food... and lots of hummus :)
I remember this September day when the rain felt like it officially had rolled in to Seattle for the duration. I had a spa day alone with the rain and made this fresh and healthy pasta salad.

October: Beer bread made with pumpkin ale after a day at the pumpkin patch.
A little November pre-Thanksgiving-inspired meal: Chicken with sauteed purple cabbage and onions in cranberry chutney with cornbread stuffing.

December: Our Christmas/wedding anniversary getaway to Portland... enjoying Northwest cuisine 30 stories over the city.

And now it's time to get showered, get food to make some January 2010 meals, get some motherly supplies, and get some fuel in me to make this all happen (aka egg nog latte.. please do not be out of the coffee shops yet).

Foodwise Nutrition, take two.

2010-01-03T10:16:00.001-08:00

Autumn's site is now up and running, as are her services. The website looks great and her office space is is even better! Autumn Hoverter is a registered dietitian (and good friend of mine!) in Seattle seeing clients in a private practice setting. Go to Foodwise Nutrition to learn more about her areas of expertise.

www.foodwisenutrition.com

Reflecting on a decade. My New Year's Resolution.

2010-01-01T17:21:00.001-08:00

Can this year really be over? Nay, can this decade really be over? Did I really just go through my entire 20s? Am I a grown up now that I'm almost 30?

Wow, how things change. One of my best friends emailed me reminding me of where we were 10 years ago-- at some random New Year's Eve party in some kid's basement the night after we got hit by a drunk driver (we were completely fine). But it was more than that-- we were 19.. we were in college.. we were carefree and broke and not serious about really much of anything except having fun.

The other day I was remembering how fun I used to be. In high school I did really well in school, but let's face it, my priority was my social life.. my girls.. what we were going to do that weekend. I couldn't stand being in the house-- I always wanted to be out doing something, having fun.

In college I did ok in school, but by far my priority was my social life. I had no money. Not much direction. But I had my friends and I had my fun. We spent hours getting ready-- taking turns showering, blasting music, trying on outfits from each other's closets, gabbing while we did our makeup, plotting what parties we would go to and in what order. We danced and laughed and I have never had so much fun.

When Dan and I moved out to Seattle our mission was to explore this whole new world that was so different from where we came from. We hiked mountains (in multiple mountain ranges), camped in remote forests, waded in streams and rivers and the ocean, stood in awe of beauty in nature I never dreamed existed, always looked for somewhere new to explore. If we had a free weekend, we were going somewhere new. And we traveled outside of the Northwest. I remember a few years there where I lived life from one vacation to the next. We worked so we could go places. We didn't have important jobs or many friends here, but we had each other, we had a common urge to live life's adventure to the fullest, and we had fun.

I am craving that fun in my life again. I am craving that part of me that I haven't been able to indulge to the fullest in over 4 years. I committed to finding passion in my work-life when I set out on this new career path. Dan committed to finding passion in his work-life last summer. Now we have a new person coming into our lives, and I want to remind myself of our goals that we had all those years ago when we started on the journey together across the country to the unknown. So my New Year's resolution for 2010, and this new decade, is to remember to always seek out the adventure and to make having fun a priority again.

Christmas Wells 2009

2009-12-29T18:41:00.000-08:00

Photo: Me, wearing many Christmas gifts before going on a walk in the 50 degrees and SUNSHINE in Seattle. 12/25/09.

As with most things these days, Christmas was pretty low key this year. It was a one day event as Dan and I both worked day before and day after. Since we actually had a day off together (the 2nd one since he started school, not counting Portland), we decided to finish the nursery (for the most part) and just stay home and (do what else.....?) EAT all day.

Started the day with good old cinnamon rolls and bacon. What a winning combo that was (for both a pregnant person and a man with the appetite of a teenage boy).

Filled up on some good old fashioned cheesey hash brown casserole with cornflakes on top for lunch. Any dish with the words "cheese", "casserole", and "cornflakes" in it came from someone's kitchen in the Midwest. It may not be good for you, but it is good.

Ended the day with Italian beef sammies and an old family favorite: Rich and Charlie's Salad. I've probably already posted the recipe but I'm too lazy now to go back and check... so here it is (a bit modified from the original)-- an old standby in my family, derived from a favorite St. Louis restaurant called, yes, Rich and Charlie's:

Rich and Charlie's Salad
1 head Romaine Lettuce, chopped
1 jar artichoke hearts
1 small jar pimentos
1 red onion, thinly sliced
1/2 cup grated parmesan
1/3 cup red wine vinegar (whisk with olive oil before drizzling over salad)
1/3 cup olive oil
salt and pepper to taste

It is sooo good. I have always loved it. Even my vegetable-opposed brothers love it. I think it's the artichokes that make it.
Mmmmm ... Italian beefs... gettin' me some iron!

And here's the almost finished product:
Wouldn't YOU love to sleep there?!

Stress in pregnancy = crazy kid?

2009-12-22T17:55:00.000-08:00

So I've been concerned over the last month or two about my stress level and being pregnant. I am in a constant state of adrenaline-rush for 10 hours or so per day, and being into human biology and physiology, I often wonder how this stream of stress hormones pumping through my blood vessels is affecting my kid's physiology. I asked my midwife what she thought about it (she had previously talked to me about "sending messages" to the kid and every time I'm in to see her she talks to the kid via my stomach and I can practically feel her sending love vibes through her fingertips as she palpates my belly, so I figured she'd understand what I was getting at). She said something along the lines of, "Well it depends on how that stress becomes a part of you. If it is draining your spirit and making you miserable, then yeah, the baby is probably feeling that too. But if it drives you and gives you energy and enriches your spirit then I think it's ok."

I thought about what she said and tried to sort out how my stressful work environment really affects me. After today, here's what I think:

When I get treated like s@*!, make mistakes, or feel responsible for a patient not having the best care/best health outcomes-- that's the stress that makes me wake up in the middle of the night in a sweat and fills my mind constantly until I find some way to fix whatever happened (or the next attending is on for the week).

When I have a busy day, rushing from kid to kid, from parent to parent, nurse to doctor to case manager to speech therapist to outpatient dietitian, charting charting charting, putting out fires, pager going off every 10 minutes, consult after consult after parent education after assessment assessment assessment, math calculations and formulas and numbers swirling until I can't see straight-- that's the stress that drives my energy and gives me purpose and fulfills my passion.

Luckily the first kind of stress is not an everyday thing (although for a few weeks there it was.. yicky). The second kind of stress is more the norm, and I think it's ok. It hasn't driven me to early labor yet. And it makes me like my job. We'll see if my kid turns out all crazy and hyper and anxious...

Ate our way through PORTLAND

2009-12-17T17:54:00.001-08:00

This city is COOL. Very small city, but tons of character down there. I really felt like I was somewhere else being there-- you know what I mean? I mean, Portland and Seattle are similar in a lot of ways (weather, people, culture), but Portland has a vibe of its own. Dan and I were wondering though, is Portland one of those cities like St. Louis where no one really lives or spends time IN the CITY? It felt a little empty-ish downtown. Maybe it was the predicted-but-never-showed-up- "arctic blast" that kept Portlandians cooped up in their abodes last weekend. Damn shame if the people of Portland don't spend time IN their city. Dan and I loved it.

We stayed at The Benson, which we sized up in about 2 seconds after walking in the lobby that we were far too poor to actually be staying there. I mean Hotwire hooked us up, but I felt a little like a sore thumb among the grandiose chandeliers and men sipping whiskey in suits and ties and women dressed to the nines in holiday cocktail dresses and heels at the classy bar in the lobby. Whoa. The only shoes I brought were Target's version of Uggs, tennis shoes, and blue faux fur trimmed Crocs. Ha!
We ate at the Portland City Grill the first night. Probably a bit cliche to the locals-- but what a way to see the city at night-- from the 30th floor! The food was DELISHISHNESS. I had crab cakes (shocker) and Dan had seafood risotto. Oh and they decorated the table for us with rose petals and confetti and a card for our anniversary.

The next morning I had one of the best breakfasts of my life (thank God for pregnancy at times like these-- the ability to devour obscene amount of food after obscene amount of food). Mother's. If you go to Portland. GO TO MOTHER'S. You will not regret it I promise. I had Challah French Toast with a side of sausage and Dan had biscuits and gravy with a side of bacon. We shared. We loved. And no, that is not Adam Lambert.Breakfast was so big, our snacks at the movie were enough to tide us over till dinner Saturday night. At Old Towne Pizza. Where people used to get shang hai'd back in the day. No, literally men would come in, get drunk, and get dropped through a trap door at the bar and held prisoner until they were sold into slavery on pirate ships or something. I think that's the story I saw on the food network. Supposedly the now pizza place is haunted (by Nina :). Good pizza though and cool ambiance.

The next morning we could not leave Portland without a trip to VOODOO DONUTS! Oh yes. I'll let the pictures do the talking. Do not bring your conservative mothers to Voodoo donuts.
What else did we do? .... Uh, well, that was about it. I was sick with a sore throat/headache/cold and tired cause I'm pregnant so eating alot was about my best effort all things considered.

Green Christmas Tip

2009-12-10T10:50:00.000-08:00

Ever get home with gifts and realize you forgot to ask for a freaking gift box? I do it every time. Then I thought of this:
Cereal boxes make perfect shirt boxes! There are so many other food packaging items that can be reused for gift wrapping purposes-- boxes from granola bars, canisters of oatmeal, glass jars of jelly-- all those things we put in recycling can be put to good use.

Weekly stats

2009-12-03T17:39:00.000-08:00

As of Thursday, Dec 3rd, 2009:

4 days worked: 1 overdose/suicide attempt, 1 DKA/pancreatitis, 1 distal tubular renal acidosis, 1 rapid response, 1 family care conference, 1 Pierre Robyn Syndrome, 1 spinal fusion surgery, 1 FTT with new Gtube, lots and lots and lots of screaming from a pt in a room across from my office.....
Zero deaths *yay*
1 midwife appt
-$1000 on the books for November
1 reminder that I was to blame for a life threatening event
1 awkward conversation where I was "put in my place" in front of a room full of colleagues (who mostly probably don't really consider me a 'colleague' now that I think about it)
30 wks pg'd
+25 lbs
1 major traffic jam= 2 hrs to get home
25-30 patients assessed
1 really cool dream that made my day/my week
2 days without coffee

What WILL Friday have in store for me?

Banana Almond Oatmeal Muffins

2009-11-29T10:22:00.000-08:00

... in a jif! These are so easy and I whipped them up early this morning before Dan was even up. I tell ya, since being pg'd I am a fury of productiveness from about 6 AM to 1 PM. Then my energy slowly dwindles to complete laziness until I am ready to hit the hay at about 7:30. Friday night I went to bed around 7:30 or so, woke up at 1:30 AM and had a million things on my mind stressing me out. After not falling back asleep for an hour or so I got up because I was also STARVING. So I had a snack at 3 AM... Ha! At least Say Yes to the Dress was on so I was semi-entertained.

Ok here's the recipe:

Banana-Almond-Oatmeal Muffins

4 (over-ripe) bananas, 5 if they're really small
1 egg
1/2 cup sugar
5 T butter, softened
1/3 cup or so sliced almonds
1 1/2 cup whole wheat flour
3/4 cup or so uncooked oats
1 tspn baking soda
1 tspn baking powder
1/2 tspn salt

Put bananas, egg, sugar, butter and almonds in a mixing bowl and mix up with beaters. Combine dry ingredients and add to banana mixture and continue beating until mixed well. Bake for 20-25 minutes at 350 in muffin tin. My recipe made 11 muffins. They smell awesome and taste even better. -- Healthy-ish too :)
And YES my Christmas decor is up! (And it's barely 10:00 AM!).. I also knocked out the majority of my Christmas shopping in one fell swoop yesterday. AND we got a car seat yesterday and ordered a changing table/dresser combo this morning. Will this full steam ahead attitude carry me through this week at work? I hope so!

Thanksgiving with the Wells's

2009-11-28T09:15:00.000-08:00

LOOK at this spread... we had enough food to feed the entire city of Seattle. Maybe not quite.

Wish I would have taken more pictures of actual PEOPLE. Hate when I do that-- I was busy being hostess I guess :) Everything turned out really good-- esp my vegan stuffing-- YUM! I was pretty proud of myself on that one. Our friends brought awesome assortments of fancy cheeses, homemade dips, homemade crackers, homemade mini pies, homemade regular pie, homemade sprouted cranberry salad, and probably more. We kicked back mimosa's and red wine and seasonal ales. We gabbed and gabbed and gabbed. We stuffed ourselves silly. We gabbed some more. Anyone who wants a great vegan stuffing recipe for Christmas (or Thanksgiving 2010)... Hit it!

Vegan Stuffing

1 stick Earth Balance
Swirl of canola oil
1 bunch chopped celery
2 small white or yellow onions, chopped
3 cloves garlic, minced
A dozen or so leaves of fresh sage
1 stick of fresh rosemary
1 T or so of fresh thyme
Approx 1-1.5 big loaves of bread-- I used 1/2 sourdough and 1/2 multigrain (read the label to make sure it's vegan)
1.5-2 cups vegetable broth (low sodium so your stuffing isn't too salty-- you can always add salt)
Salt and pepper

(I set the sourdough bread out early in the morning next to a cracked open window to let it get a bit stale.) Melt the Earth Balance in a pan with a swirl of canola oil. Add chopped celery, onions, and garlic. While these are cooking together, chop of the herbs as tiny as possible. Add those to the mixture. Add a pinch or so of salt and ground black pepper. Let this cook until the onions and celery are soft. Meanwhile, toast up the whole grain bread slices and start cutting or ripping all the bread into bite size pieces and toss into a huge bowl. After the celery/onion/herb mixture is soft and smells delicious, let it sit for a minute or two to cool a bit. Then pour this over the bread and stir. Add the vegetable broth-- I used enough so that the bread was a bit moist but not anywhere near soaked. Toss this all together really well, then pat into two bread loaf pans greased with canola oil. I baked mine for about an hour or so covered with foil on 325. Then I took the foil off and let it bake another 10 or 15 minutes. That's it!

Adapted from a recipe on vegweb.com 2009

Now I am going to attempt to do some Christmas shopping..... I think. Maybe a cup of coffee first.

Dear World,

2009-11-22T09:57:00.000-08:00

Can you please be nice to me?

Pregnancy is one of the three periods in a woman's life when there seems to be a lowering of the ability to cope with the emotional experiences of life. The other two times are at puberty and menopause (A. Christine Harris, PhD).

Thanks,
Stephanie

Maybe this is why I started crying while recounting to Dan my exchange with the doctors at work today. Let's just say you had a better day than me if you were not blamed for a 1 year old having a "life-threatening event" today. As a woman I worked with a long time ago once said to me, "This must be why God made the days with nights so that one ends and a new one begins."

The End of Food

2009-11-22T09:40:00.000-08:00

By Paul Roberts.

This was the book we read for this most recent book club-- got together last night to "discuss it"... Teehee... Does any woman's book club actually in-depth discuss the book? We talk about it for about 10 minutes and gab about everything else under the sun for the other 3 hours. Anyways, this book explores the history of the human diet- going back to caveman days; the evolution of the food system from a global perspective over the past century, and the future of food in terms of feeding a population that is exceeding its resources (i.e. water, land, energy to produce food, etc). It was very interesting and echoed a lot of things I learned at Bastyr, but a little hard for me to stay engrossed in-- aka it was a bit dry. It also kind of gives you that creepy, overall depressing feeling that the world is just going to hell in a handbasket. But hey, at least we're educated about it.... And can do something about it (?).

Paul Roberts also wrote the book, The End of Oil, which may not seem like it, but is probably tied to a lot of the concepts in The End of Food. --In the sense of the global, economical, political implications of something that essentially sustains life as we know it and what the reamifications of that are and what the outcomes of that may be.

Next book club we are going to read something a bit lighter and fun, which I'm looking forward to! Anyone who wants to join us is more than welcome-- just let me know.

What's with today, today?

2009-11-18T19:49:00.000-08:00

And if you can name that movie, we are definitely friends.

Seriously, this day has shaken me from start to finish and I just can't turn my brain off, so instead, I'll turn to the computer and vent it on the keyboard.

Started with seeing a fatality car accident at 6 am on my way to work. This involved a major traffic jam and me being (only) 15 minutes late to work. Then I got to work, had my plan of patients that needed to be seen for the day, and only ever got to ONE patient on that plan. AND I WORKED A 10 HOUR DAY. Not that I was supposed to be there 10 hours, but that's the kind of day it was. Consult after consult kept coming in from the doctors, which take first priority over other assessments. One involved a lengthy assessment of a really complex little 6 month old, ex 30-week preemie with failure to thrive, short bowel syndrome, 20% of her ileum removed and 80% of her colon removed, and stridor. Then I had to do an education for a 10 yr old with seizures, possible encephalitis, obesity, hypercholesterolemia, hypertension, and ADHD. Then some time got eaten up having to sort through a big list of new pts referred to us by the diet tech who referred some that we didn't really need to follow, but I still had to review them and put a blurb in the chart and then communicate with the diet tech the plan. Then I had another consult for a kid with a new Gtube placed and really not much more info. Then I had a meeting in the PICU that lasted longer than what I had time for. Then I did a follow up on a kid who has been through the ringer for the past 2 months with H1N1 and sharply declined the past 2 days. (This was the ONE thing on my original to do list for the day). Then I had to do 2 calorie counts (which I think the diet techs should be able to do but that's just my opinion), for 2 kids on TPN- - one recovering from a rocky H1N1 hospital course involving being in the PICU, on the vent, chest tubes placed, and he's already BMI <5th%ile-- the other a pt with severe Crohn's and severe malnutrition/cachexia, depression.

So toward the end of the day my boss calls and says, "I'm sorry but I need you to be on call tomorrow. Unless Steph has her baby we'll be over budget for staff hours." I'm like NNOOOOO!!!! But instead I said, "Oh, shoot. Ok. Thanks." On a normal day this wouldn't be a big deal-- the other RDs are way (more) capable (than me) to handle things. But I felt HORRIBLE because I was leaving them my pile of patients that I wasn't able to get to who I've been following and know well and could do quickly (if I had the chance!). Plus my poor coworker is 41 weeks pregnant at this point, that poor thing, and there's nothing worse than a chaotic stressful day for a 41 week pregnant person! She belongs on the couch! Or in the delivery room :)

The other reason I'm bummed about not being there today is because all week the PICU staff has been planning a care conference for a very critical pt (another kiddo with H1N1) who is a former 27-week preemie, chronic lung disease, on long term home vent, Gtube dependent for feeds, who is growing really really suboptimally. To put it lightly. As you can imagine her daily health care needs are really complex and require a lot of diligent care. So in preparing her for home, we need to spend time educating the caregivers and all other players involved about the new home regimen as there have been some significant changes since this admit. AND I WON'T BE THERE. Yes, my coworker is MORE than capable of doing this in my place, but it's the principle of the fact that I know the kid intimately, I know the ins and outs of the caregivers and how they communicate, what their level of understanding is, what their expectations are, and what goals I want for this kid to achieve in the near future. So frustrating to not be there.

I need to go for a run and blow off some steam. A walk would do although it's just not the same. Cross your fingers, 9-10 more weeks until I'm not pregnant anymore :)

Foodwise Nutrition!

2009-11-15T16:42:00.000-08:00

Today I had the great PLEASURE of getting to see one of my friend's/former classmates/former intern-mates in all her glory at her open house for her new PRIVATE PRACTICE! Wow, I am so proud of her and impressed at what she has done and is setting out to do. The office space is amazing-- it's in a large building in the heart of lower Queen Anne. The office itself has an intimate, comfortable feel with such inviting decor. I just loved the feel of it and I could not believe how well put together and professional it all was. The open house was for all of the practitioners who are part of this new location of Seattle Therapy Alliance. Most of the practitioners there are therapists of some sort, and Autumn is the only dietitian. Seattle Therapy Alliance is an organization that provides therapy for women, regardless of income, on a sliding-scale basis. Autumn is not exactly part of that group, but is practicing independently along side of them. I wish the best for her and hope that I can someday have a space that amazing to be proud of too!

And I just realized I forgot to bring home one of her brochures so I don't have her business contact info at the moment (shoot!).... but I will soon in case anyone is needing a great dietitian in the Seattle area.

Edit to this post: Autumn's website for Foodwise Nutrition is now up and running. Check it out at www.foodwisenutrition.com

Warm Beet Salad (and Friday night.. what has my life become?)

2009-11-14T10:21:00.000-08:00

This is what I did last night...

Yeah looks good, but sort of depressing way to spend a Friday night.

Sharing this delicious recipe for a warm beet salad. It is so yummy and a good blend of sweet, spicy, and tangy. These are Italian beets apparently, which aren't quite as sweet as your typical beets... courtesy of Full Circle Farm.

Warm Beet Salad

3 large beets, scrubbed and ends trimmed
1 large clove garlic, chopped
1/3 cup or so goat cheese
2 T olive or canola oil
Ground black pepper

Boil beets, covered, for about 45 minutes or until soft all the way through. Drain water (save it for some nutritious beet juice-- a good detoxer!), and cut beets into bite sized pieces. Drizzle olive or canola oil over beets and toss with goat cheese and garlic. Grind some black pepper over the top and serve with a hearty fall meal. Love it!

More fall cooking

2009-11-08T13:21:00.000-08:00

What can I say, I am really into eating these days :) I thought I'd share some of the deliciousness I've whipped up over the past few weeks... I love fall food, esp in the Northwest, and esp being in second (now third I think) trimester of pregnancy and having the biggest appetite I've had since I was 14. And if you scroll down, you can see what these dishes are feeding (heehee):

The old standby Butternut Squash Soup. I added tofu for extra protein and garnished with my FAVORITE yogurt brand ever-- Nancy's.

Steak sauteed with Kale in Green Curry Sauce over a Brown Rice Medley. Steak from PCC-- which by the way you can get a screaming deal on organic steak there, esp the "stew meat" and "stir fry" cuts. So cheap!

This little invention consists of Tofu, Black Beans, Bok Choy and Onions simmered in Masala Sauce.

Tarragon Chicken with Cabbage, Garlic and Onions simmered in Cranberry Chutney with Stuffing! Ok, the stuffing is not homemade (TJ's), but boy it was GOOD!

Leftovers of the dish above Stuffed in Baked Delicata Squash. To DIE! Do you love my little pilgrims? :)

There she is in all her glory at 26 weeks or so. Like my clown outfit? No that is not a Halloween costume, that was my Saturday-on-the-couch attire. My options are seriously limited these days, ask my coworkers.

So that's why I feel like I'm going to explode!

2009-11-03T20:12:00.000-08:00

I've gained 14 pounds in the last 6 weeks! Holy crap! No wonder why I feel like I'm busting out of every square inch of my skin. Good-Ness! And I just really want some ice cream tonight. Think Dan will make a run this late?

Dig these Mussels!

2009-10-31T08:51:00.000-07:00

A week or so ago I watched a show on the food network with Jeff Corwin- who I think normally does travel network shows or animal planet shows-- I don't know. Anyways, the show was something along the lines of extreme food, and the premise is he goes to some crazy location in the deep crevasses of the world and he dabbles in the crazy seemingly unedible fanfare and we all go eeeewwww, wwwiiieeerrddd. I think. I've never actually seen an episode before this but this is what I gather.

So. The reason I watched THIS episode was because he came to the crazy deep crevasse of ....... the NORTHWEST. Ooooooh. Ahhhhhh. No the Northwest may not seem particularly exotic, but we do have sort of an "extreme" terrain, climate, and geography that gives life to some pretty exotic animal and plant species-- particularly on the coast and in the deep cold waters. I watched him dig for geoduck (pronounced gooey-duck), a very strange looking, huge saltwater clam that lives feet below the surface in the sand and has this huge long "neck" or siphon that extends to the top of the sand. He also ate sea cucumber he dove for himself, and shared a huge traditional clam bake with a large group of Native Americans on an island they canoed to for 2 hours.

Last weekend I passed Taylor Shellfish at the farmers market, and couldn't help but remember that clam bake from the show. I have tried their clams once before, so I knew I was in for a treat with the Mediterranean Mussels. I surprised Dan made this feast the other night:
Look at the size of those things! Have you ever had mussels in a restaurant that big? I don't think I have. And these were so fresh and flavorful. I sauteed onion and garlic in butter, then added white wine (Pinot Grigio), brought it to a boil and threw those babies in (after I washed them). Put a lid on it, turned the heat down a bit, let them steam up for about 5 minutes, and finito! Paired with a de-li-cious Fall Wheat Berry Medley including apples, dried cranberries, fresh rosemary, and some salt and pepper. It tastes just like fall. Try this one, it is so easy, quick, and cheap. I got a 1 lb bag of wheat berries (the grain of the dish) for $2.00. And it made a HUGE amount that we have been eating in yogurt and other "fall medleys" all week. Dan LOVES it too. Here's what they look like dry:

To cook these you rinse them, then soak them overnight (or for about 7-8 hrs). Drain the soaking water and then refill the pot with water. Bring to a boil, cover, simmer for about 1 hour. Drain any excess liquid. That's it!

Conversations

2009-10-27T10:37:00.000-07:00

At this point, we are back in equilibrium in the Wells world. Insurance is worked out, I think, although I'll believe it when I see it at this point. Different carrier, same midwife, one postponed appt, hardly a scratch in the end.

I've been thinking lately though about a conversation I had a few weeks ago. Someone who has read my blog said to me something along the lines of, "I like the way you make food and eating sound good and interesting. It seems like most of the time you hear about food as kind of the enemy and it's all about how bad this is and that is for you." This kind of stunned me for a minute. And gave me a reality check.

Is this really how we feel about food and eating? Has it become the enemy? Is there so much out there about the state of health in our country related to diet that we have come to view eating as something bad?

If this is the case, I will start the crusade (or maybe I already have a little?) to change this point of view. After all, aren't we supposed to praise our kids more for what they do right than criticize them for what they do wrong to shape behavior? Aren't we supposed to sing and dance around our puppies when they go potty outside instead of shoving their face in it and yelling at them when they go inside? Aren't our mentors and supervisors supposed to commend our good work and lead by example instead of degrading us for our mistakes and not supporting us when we need leadership?

Food is great. Eating is wonderful. Cooking is fun. Creating is life. When I educate people about diet changes, I try really hard to phrase things in a positive way-- like, "Focus on getting a lot of fiber, fruits, vegetables. Load up half your plate with these. Try cooking at home once a week. Let your child pick out one meal that you make each week, and let them pick the vegetable at the farmer's market." Instead of, "Stop eating out every day. Don't eat chips and cookies anymore. Don't drink soda. You're not feeding your kid enough fruits and vegetables."

And the other thing is, what does healthy really mean? It doesn't mean a number on a food label, or a category of foods, or a certain diet, or a certain lab value, or a certain diagnosis. I think it is a feeling, a lifestyle, a part of life, a relationship with yourself and other people, choices that make you happy and enrich your life. If vanilla ice cream makes you happy and sharing that with your grandson on his birthday creates a memory you or him will always remember, that is healthy. If never having food you like that tastes good to you makes you miserable, that is not healthy, no matter what the label, scale, or blood test says. Right?

When I think about this, for some reason Paula Deen comes to mind-- you know that sweet, jolly, adorable lady on the food network that is just like everyone's grandma (or the grandma you always wanted and the grandma you want to be)? Paula Deen cooks what she cooks, in her style, and she is happy when she does it and she is happy because of it. You can see it and feel it from her. Now she doesn't look like Giada or Ellie Krieger or Bethenny Frankel or any of these other visions of health we all seem to have to strive for. But is she any less happy? Therefore, is she any less healthy?

There are a lot of cases where health issues are directly impacting our quality of life, and even our quantity of life. Sometimes changes have to be made to change health outcomes, which changes life outcomes. But remember, in the end, you are in charge of your life and your life choices. The people who love and care about you can want you to change, but you have to want to change too.

At some point quality of life, the life we have today, needs to factor in to the big picture of health over a lifetime. Ask yourself what really makes you feel good -- what really makes you at peace with your life -- what enriches your spirit. Let that be your guide.

I knew there was a reason.

2009-10-22T13:11:00.000-07:00

For that sweet email that started what ended up being a tumultuous day of rage and stress, nicely. HOWEVER, stay with me, because this day had a happy ending. All things considered.

So I go to my dentist appt yesterday, and the receptionist promptly tells me that my insurance is not currently valid. I'm like, that's weird, esp when I had specifically confirmed with Dan the previous day that everything was all good with our insurance since he changed positions at work to be part-time when he started school the beginning of this month. So I'm instantly panicking a bit and super embarassed and ask if I can just reschedule until I figure out what's going on. The dentist was standing there and said, "Tell you what, you're here now; let's just do the cleaning/checkup and I'll just charge you the 20% as usual, as a gift." I'm like ok, thanks. And humiliated.

I come home later. Dan comes home later, panicked, and tells me we have no insurance whatsoever. Not just dental, but no HEALTH INSURANCE PERIOD (did you know I'm 6 mos pregnant?). I proceed to have a breakdown, launch off on him, and go to bed crying. At about 3:30 in the afternoon.

I get up about 10 minutes later and proceed with my day, which included speaking in front of a group of about 10 dental hygenists about nutrition. And you know what? That talk changed my whole day, my whole attitude, everything. I felt so good when I left there because I ENJOYED so much speaking with these women and I could tell that they were really interested and appreciative about what I had to say. And it fulfilled me. And it didn't matter so much anymore what was going to happen 3-4 mos from now.

So I came home, gave Dan some brownies the ladies had given me, and made peace. Still not sure what's going on with the insurance, it looks like we may be with another provider-- who knows if they will cover the midwife I've now gone through half my pregnancy with, or any midwife for that matter, or the birth center I want to deliver at. If not, I'll deliver this kid by myself on my floor :). And invite my midwife to come over for dinner coincidentally while I do so. Just kidding. Sort of.

Who's thinking of you (on the other side of the world)?

2009-10-21T10:57:00.000-07:00

If you're lucky, you're journey in life has led you to meet so many amazing, good people along the way. Mine has. Some of these people stay with us, even if not in the physical sense, and we think of them often. They come to us in dreams, when a familiar old song comes on, or when we're alone and wish they were there. Some of these people, we only think of from time to time, for no reason really, but they bring a smile and a handful of good memories.

Today I got a message from an old friend I knew in high school. We were in poms together- an experience I will always be so grateful for. We didn't keep in touch after high school, and the only time I've reconnected with her really was summer '08 at my high school reunion. We had so much fun catching up-- she's in New York acting and singing and living the amazing life of a young, single girl in New York City. Fast forward from that night over a year ago, and she's now in Australia, doing what, I'm not sure, but I'm sure it's something fabulous. And she wrote ME to tell me she "was riding on this bus in Coral Bay, Western Australia yesterday, looking out the window at this glorious coastline, and you popped into my head. I can't say why, girl, but nevertheless, it made me smile."

Something about the way she said that and the image it brought to my mind and the thought that someone on the other side of the world, from another time in my life, for no particular reason, thought of me... it made my day. Especially when she went on to say she saw on Facebook that my family had done a walk for my cousin who passed away my senior year of high school, and she wanted to do something or give something to the cause.

Sometimes the good in people amazes me. And what comes to your mind, even when you're in another fabulous country doing amazing things. Do you wonder who might be anywhere in the world thinking of you?

Fall means...

2009-10-18T13:30:00.000-07:00

Queen Anne Farmers Market out, Ballard Farmers Market IN! Ballard goes all year round and it's one of the best in the area. I met a few friends there today and came home with a haul: Let me highlight the best purchase of the day (other than those Liberty apples-- they are killer-- as my friend said, they taste like apple cider. Is there any better apple than one that tastes like apple cider?)... No, the purchase of the day is by far that bacon flavored hummus. Emphasize the "flavored" part-- this is 100% vegan! And the best part-- my friend Martha is the cute gal selling the delicious stuff. Go see her-- get a free sample-- and get some to bring home. She works for Sound Bites, a "fiercely local" company that uses a more sustainable, local oil (as opposed to imported olive oil) to flavor their products: grape seed oil from Yakima Valley. She explained to me the bacon flavor of the vegan bacon-esque hummus comes from smoking the Chardonnay oil used in it. Can't wait to try it out on Dan, then spring the vegan part on him. Love getting him to love stuff he would usually instinctively shy away from (i.e. anything that does not involve meat in some way).

Start the day off right!

2009-10-17T10:32:00.000-07:00

Do most of your mornings feel rushed? If I have to work mine usually do. I used to never really be much of a morning person. It's not that I had a particularly hard time getting up or that I really loved sleeping in. I just didn't have the most energy in the morning. But, like most people I guess, the older I get, the more of a morning person I've become. I go to bed and get up early without trying-- even on my days off. I enjoy a morning run. And lately I am most productive in the mornings. At work, after about noon or 1:00 I feel like I move slower and my brain is just not firing at full speed any more. And forget about being productive at all when I get home.

These past two days I've had off, I started the day off right. Listen to this. You are going to be so jealous. Are you ready??? Yesterday, I went and got an hour long MASSAGE at 9 AM. OMG it was the best thing ever. And actually for the rest of the day I was so relaxed and tired I could barely stay awake. But what a way to start the day.

This morning I spent some early QT with the Danimal (talking, laying in bed till 8 AM). Then I dashed to the grocery store and got stuff to make this:
Cooking by music, no tv, only the rain pouring. Yes, the pancakes are from scratch :) I'm still full. The rest of this day is packed since yesterday, every time I got the urge to DO SOMETHING, I made a conscious choice to just not. And to relax. I needed that day. So TODAY:

-shower (still need to do that :)
-thank you cards
-post office
-grocery store #2 and 3 for the day (I like different things from different places!)
-library for my new book club book-- excited!
-yoga
-walk/make some phone calls to catch up with friends
-prepare for a talk I'm giving Wednesday

but only if I feel like doing these things.... there's still always tomorrow. When I will start my day by going to church, which is always relaxing to me for some reason. And maybe another pumpkin spice latte (did I mention I snatched that little treat while at the grocery store this morning?). Try setting the tone for your day with a little something special or relaxing or a belly full of home cooked, nourishing food. It can really make a difference.

Meanwhile, in a land far far away called Chicago suburbia, my family started the day off right with a walk to support domestic violence victims in honor of my cousin who passed away 11 1/2 years ago. Wish I could have been there.

Interestings from the week

2009-10-15T19:00:00.000-07:00

So I did the Best and Worst of this week. But let's explore my interestings of this week. I get a lot of interesting patients-- it's probably the thing I love about my job the most. Privacy is a huge issue in healthcare, so I will be have to be a bit vague and non-specific in terms of patient identifiers while sharing these experiences:

1. Abdominal trauma on a kiddo that lacerated the pancreas into two pieces. So they had to take part of the pancreas out. This becomes challenging since your pancreas makes a lot of the hormones and enzymes you need to digest food and then dumps them into your gut as food is going through. Unfortunately, this kid had to be on TPN (total IV nutrition), which means the gut had no activity/nutrition for a few weeks. With the gut, if you don't use it, you lose it-- meaning the gut atrophies and trying to use it again can be an uphill battle of vomiting, cramping, constipation, dumping, "intolerance". Plus since 70% of the immune system lines the gut, a lack of perfusion/activity can mean a lack of stimulation to this oh so important body function in the hospital. So to eventually refeed this kid by mouth, we not only have to worry about his gut atrophy, but about how the pancreas will react to needing to work again. We can tell this by looking at specific labs (amylase and lipase), which are enzymes normally found in the gut that will be seen in high levels in the blood as the pancreas is inflammed and basically leaking its contents into the bloodstream. Good news is, this kid will be just fine. Eventually.

2. A precious little sweetheart who has had a hard, hard little life. This cutie came in for heart surgery, "coded" shortly after surgery, ended up on ECLS (extracorporeal life support) as a result (a setup where the patient's chest is left open and the heart vessels are basically connected to a machine that does the job of the heart/lungs outside the body. It is used for patients who demonstrate at least an 80% predicted mortality due to inadequate oxygenation and ventilation despite using every other resort possible. So the blood is being pumped by a machine instead of the heart. The kiddo was paralyzed with meds during all this). Fast forward a week or so and the kid's off ECLS, off the vent, and starts tube feeds. Unfortunately, the kid developed chylothorax, something I've been seeing a lot of lately it seems.

Chylothorax: After you eat fat, triglycerides are transported out of the gut by a "chylus" system that uses the lymph to transport the TGs to the liver. Sometimes as a result of open heart surgery, parts of the chylus system has some knicks/trauma to it. The lymphatic system is associated with the lungs in the body, so with chylothorax, the triglycerides and lymphatic fluid, etc essentially leak into the space surrounding the lungs (pleural cavity). THIS IS REALLY BAD for lung function. The pleural cavity fills with a milky, fatty, tube feeding formula-y substance that you can see clearly in chest tube drains. Feeds have to be stopped immediately and the kid needs to be on TPN until the "leak" closes up. You can tell when the leak is probably closed by checking chest xrays of the lungs daily as well as the chest tube drain output.

SO, this little kiddo was on TPN for weeks, then just started tube feeds again with a special formula called Portagen that has primarily medium chain fats (that don't use the chylus system for transport, bonus). As you can imagine, this little sweetie was dying to eat after not having any food in oh at least a month or so. So we tried to go with completely fat free food options like applesauce, green beans, peaches, jello, etc to start with to be on the safe side. I was in the room next door when I heard the poor little pity just PUKING their little guts out. Oh! I felt so bad. I mean just barfing their brains out. Sometimes it takes the stomach a while to get back in the swing of things. So that's where we were as of yesterday with that.

3. Another little precious newborn with renal dysplasia and failure to thrive. Part of the renal issue is urine freely flowing back up into the kidneys. The fluid and protein intake for this kid has to be carefully monitored. Momma will have to pump all breastmilk into bottles so that we know exactly how much volume the baby's getting to make sure the baby's getting the necessary amount-- higher than for most little ones that age, but this kid is thirsty and hungry and is taking down the volumes well at this point. The kid will have to be monitored closely going forward for infection, serum electrolytes, renal function, and catching up on some weight gain. The interesting thing about this case? Using a computerized translator! Yeah, try understanding renal issues from someone else who does not speak your language. Not easy and there were tears, but the caregiver left feeling more confident and comfortable than when they came. That's what matters.

Lots of others, but aren't you tired of reading?

Showered

2009-10-15T16:14:00.000-07:00

Went home last weekend for a friend's wedding.... p.s. if you EVER get the chance to go to a GREEK wedding, GO! It was amazing. The ceremony was really cool, but the reception was even better. The groom's family is Greek-- like his 97-year-old grandma was there, from Greece, and doesn't speak a lick of English. They worked the Greek culture into the reception really well-- including the circular dancing we all did and throwing tons and tons of money on the bride and groom (and some other people too-- still don't understand that whole thing. I should look it up).

Anyhoo, being home this weekend my awesome family threw me an awesome baby shower. We had so much fun-- good food, good punch, good laughs, and basically me, opening gifts, for about 3 hours. Maybe longer.
Thank you awesome family!

Best and Worst

2009-10-14T18:58:00.001-07:00

Of this week. Oh Lord, I'm about to make a best and worst list and it's only Wednesday. The bright side is there IS a best list. So here we go, best and worst of the week of October 11 in the life of Stephanie:

Worst:
1. Retaining water out of my mind and feel like I'm going to explode.
2. Didn't finish my work on 2 consecutive days and had to stay over an hour late at work both days.
3. Lost a patient today in the PICU. Drowning accident. Infant. Sad.
4. Swollen ankles due to number1.
5. Plus 10 lbs on the scale from last time I checked (oh maybe a week or so ago?). Hopefully due to number 1. I'm not kidding.

Best:
1. Got a pregnancy massage gift card from Danimal. Booked that for Friday. Booyah.
2. Got my work done and left only 15 minutes late today.
3. Belly full of Oreos. Maybe that has something to do with my worst list too..
4. Got a body pillow from Danimal.
5. Felt like I really helped at least 3 kids in the past 3 days.

Ravenous insatiable human garbage disposal.

2009-10-07T19:00:00.000-07:00

A.k.a. Me :)

This is borderline ridiculous. I mean, I seriously am struggling to find the time and space in my gut to eat the amount of food my body is demanding this week. I eat and eat and eat and then I wake up at 1 AM with hunger pains and again at 5 AM at which point I eat breakfast and then I'm starved by the time I get to work at 7 AM and I'm hungry again after rounds around 9 AM and I'm famished by lunch then I have GOT to eat something in the car on the way home around 4 PM and then by the time I get home I am more than ready for dinner and then I hit the hay and the cycle continues.

Goodness. Not that I'm complaining... it's fun really. But kind of exhausting.

Pumpkin Patched.

2009-10-04T16:49:00.000-07:00

For the second year in a row, the Northwest gave us an amazing fall day to go pumpkin patching. Dan found this farm that the minute we pulled up to I yelled, "It's just like Roloff Farms!" And who isn't dying to go to Roloff Farms this time of year? So this place had it all and I am telling you, it was so freaking cute. Swan Farms it was called-- had it all. We're talking hayrides, farm animals, duck races, HUGE corn maze that is mapped out like the state of Washington complete with over 600 historical facts and "landmarks" for people to learn about as they go through, pumpkins as far as the eye can see, gift shop, an indoor hay maze, snacks including polish dogs, kettle corn, HUGE caramel apples, apple cider donuts, pulled pork sandwiches, corn on the cob, YUMMM!

On the hayride.

See Mount Baker in the background?Meal.

Post meal.
City meets country.
Found it!

To top the pumpkin patch day, we made beer bread with a pumpkin ale. MMmmmm...With hot peppercini beef. Pumpkin patching works up quite the appetite ...

On a more serious note... Thinking about my little cousin (who's really actually 21 now-- not so little but that's how I always think of him) who had a head injury and is in ICU. Knowing that scene all to well, I'm optimistic for him but can imagine how my aunt/uncle/other cousins are feeling. Say a prayer for Brennan to heal and recover. After enduring a brain tumor once in his short life already, he deserves this second-- well actually third-- chance.

Water aerobics! (Who knew? Oh wait, my Grandma Meyer does.)

2009-09-29T10:54:00.000-07:00

So yesterday I was watching Monday Night Football with the Danimal and as I watched D'Angelo someone or other from the Carolina Panthers run the ball (that man is amazing by the way-- he is SUPER fast-- like an explosion of speed when he gets the ball), I heard myself say out loud, "I wish I could do that." That longing to run or do something more physical than walking or yoga combined with this huge rush of energy I had after dinner (imagine me dancing and bouncing around, annoying Dan as he's trying to watch the game, heehee)...

I remembered the little booklet I picked up from the local indoor pool about classes and open swims. I decided to see when the next class was and maybe this could be something that could fill that void in my life. At 10 till 7, I saw the next water aerobics class was at 7. I made the snap decision, bolted into my room, threw my bikini on, grabbed a beach towel, threw my hair up and contacts in, grabbed $5 from a vest pocket, and I was out the door to water aerobics. (Yes, it's only $5 a class and you can drop in anytime!)

O.M.G. It was SO fun! I really got a workout (I have more and more respect for you Grandma Meyer-- 86 and still doing water aerobics 3 days a week!)-- and although I couldn't do all the moves and at times I felt like a brick was going to fall out of my crotch with all the bobbing and boucing (sorry for the vulgar visual), I left there with that feeling I have after a good run on a cool day. Invigorated, cleansed, open, free, clear... it's hard to put into words but man it is a feeling I love. And miss. And Dan is stoked that our kid is getting in the water early-- he's dying for a little water baby as he still loves the water like a little kid. Which is why he is making a career of being underwater :)

Steak and green tomato sandwich, featuring Grateful Bread

2009-09-26T17:40:00.000-07:00

Sooo tired. No good reason to be tired. I had a really short work week. I slept for about 11 hours last night. Yyyaaawwwnnn.

Had an eventful week. Found out we're having a GIRL. Worked like a madwoman on picking stuff for our registry(ies- plural) as I'm having a baby shower in two weeks. Still have work to do on picking more stuff. Yyyyyaaawwwwnnn.

On another note, I made the most delicious lunch today. I'm still focused focused focused on getting iron in my diet so I can stave off having to take an iron supplement (i.e. constipator). Believe it or not, I found these organic steaks at PCC (Puget Consumer Co-op, aka best grocery store ever) for CHEAP CHEAP CHEAP. 1/2 lb steaks that last me two meals at least for like $2.00 each. So I broiled one up, put it on fresh baked organic bread from Grateful Bread (who cameo-d at the Queen Anne Farmer's Market last week), with dijon mustard and green tomatoes from Full Circle Farm. So good I might have it for dinner too. Enjoying it with grape Kombucha on my patio in the beautiful fall sun:

Yyyyyaaawwwwnnn.

Girls Lunch!

2009-09-21T08:29:00.000-07:00

I canNOT beLIEVE I didn't take any pictures of my girls lunch! So pissed! Well it was really fun and so good to just be surrounded by girlfriends-- laughing and eating and just chilling out for an afternoon. Here's what I served:

Yellow split pea soup with sausage
Purple cabbage and cucumber salad with goat cheese
Pear/mango/concord grape fruit salad with European style yogurt and gluten free granola
Gluten free bread from Flying Apron (really good stuff by the way) with butter and hummus
Vegan mini donuts from Mighty O's
Mimosas, tea, and coffee (although none of my well-behaved friends went for the mimosas :)

Plus the girls brought muffins from Macrina Bakery, sparkling grapefruit juice and sparkling blueberry something (?) I didn't have, farmers market plums, homemade oatmeal chocolate chip cookies, and a garden grown cucumber. We had a FEAST! It felt so good to finally be able to entertain people in my home after a two year hiatus living in our studio. Thanks girlfriends!

A day at the office

2009-09-15T17:56:00.000-07:00

Today at work was a bit intense. As the flu/asthma season ramps up, so does our patient load. We almost lost a 4 year-old in a code (kind of like on TV when the person "flatlines" and a huge team of people rush in and attempt to resuscitate/save the person). I had to give a talk to about 10 pharmacists that I literally had looked over once and then presented on the fly. Many complicated cases going on and after 3 days off, I felt out of the loop, to say the least.

But this morning, one doctor really made my day. He wasn't really talking to me, and it wasn't really about something I did specifically. And although my role is small, it is still a role- and to me it is huge. We were rounding on a patient we've had for a couple weeks now. The patient came in so sick with (presumed) H1N1 that the doctor stated today the patient had a 60-70% risk for mortality, and that was being very generous. The patient's care was extremely tedious and sort of outside of the box. We had many obstacles and road blocks with this one over the past few weeks, and the prognosis was very much unknown. This was one I thought about when I came home at night and wondered what I would find on Monday morning. Miraculously, this person has really improved over the last few days now and is looking to be out of the woods so to speak. The doctor commended the team for all of their hard work and dedication for this patient and that we were the reason why the outcome is where it is. In that moment, I knew what I had done for this person. I knew that I pushed for what I felt this person needed to have the best chance for recovering. I felt good about what I did at the office today.

Going from this to that

2009-09-14T12:43:00.000-07:00

Because of this:
I need to get rid of that:
And that:

Going through all of these boxes was like a tactile-visual representation of the blood, sweat, tears, exhaustion, and accomplishment of the last four years. Looking through some of my notes, I realized how much I've already forgotten; how much I stuffed in my brain that is only sort of there now; how hard I worked; how dedicated I was. It is hard to throw away but really, do I have a use for it?

The nice/frustrating thing about becoming a dietitian is what you use in your specific job is a relatively focused skill set and knowledge base. You will acquire the resources you need to look up the things you don't know, and you will have a network of people to go to if you need advice or a second opinion. It's nice that you don't have to remember every little biochemical pathway of the liver or the estimated nutrient needs for a burn victim with wounds covering 75% of their body. Unless of course you work in a burn unit. (Keep these things in mind when you have a breakdown in the middle of class or almost pass out during a rotation.) Anyways. My point is, just because these things don't exactly pertain to my day-to-day assessments of infants and children, doesn't mean I'm ready to let go of all that wealth (and by wealth I mean between $50 K and $100 K in school loans-- ballpark) of knowledge I worked so hard for. But where will I put the plethora of things I need for another person coming to this house? Something's gotta go, and it doesn't look like this is going anywhere anytime soon.

How to enjoy a rainy day in Seattle, 101

2009-09-13T17:43:00.000-07:00

People often ask me, "How can you stand all the rain in Seattle?" And I usually say, "It really doesn't bother me that much. And the rain isn't as bad as people say." Maybe that's subjective, because no, the weather here is not for everyone. I think there is something in my heritage that makes me handle and even appreciate the weather here. Dan and I both always say how in some strange way, we actually look forward to that time in the fall when the clouds move in and don't really leave. Usually, this happens in October I would say, although we still have nice days here and there up until November.

So we had a taste of that good ole Seattle rain last weekend. Of course this weekend it's been 85 and gorgeous. But here's how I enjoyed a rainy day (home alone) in Seattle:

These guys did this all day:

I transformed my place into my own private spa...

Yoga by candlelight:

An extra-warm shower by candlelight:

Lunch made fresh accompanied by the sound of rainfall:

And lots of reading this:

I love this book-- (my first book for my first book club I recently joined!)-- but you have to like food, history, and culture to like it. Ok, probably everyone would say they like food, history, and culture, but somehow I can see some people maybe getting bored with this. It's a non-fiction, and the author basically follows the trail that a group of writers took across the nation during the Great Depression. These otherwise out-of-work writers were part of the Works Progress Administration, put together by the government to stimulate job opportunities. Their purpose was to write about the culture, traditions, recipes, and general observations of the way America eats: from the deep South to the Northwest and everywhere in between. Their work never got published, but Pat Willard, the author of America Eats! mimics their journey city by city and writes about what she finds, while including historical excerpts and photos from the WPA group. It really is a cool book and the comparison of the old days and modern times is fascinating to me. Mainly how so much really hasn't changed when you get to the heart of this country. Which I think is a good thing. Anyways, good rainy day book!

A little PSA on the flu

2009-09-11T19:39:00.000-07:00

Hi everyone. I probably am about to sound like one of those paranoid, over-reacting health officials that talks on tv about epidemics and pandemics and outbreaks (who I usually ignore and shrug off and know I won't get it). But I just want to put something out there because for some weird reason, I'm not seeing this message out there like I would expect.

Flu season is here and the Swine Flu is here in a bigger way than ever. Everywhere I turn (facebook, other blogs, friends, MY JOB) there is one person after another coming down with something. With school starting, we have our perfect petri dish.

No, I'm not a doctor. BUT I am a huge health advocate. And with flu symptoms, it is EXTRA important to STAY HOME. Please -- have permission -- from me :) -- to take a day (a week to 10 days if your doctor tells you it's the flu- meaning influenza A, B or Swine Flu) off. Stay away especially from kids, elderly, pregnant women and the public in general. I have seen one case of the swine flu so far this year in my PICU and it was, well, scary. Like life and death scary. And this was an otherwise completely healthy individual with no remarkable past medical history. It wasn't even a young kid, baby, or elderly person. This flu takes a hold and can take a person down. Fast. I don't want to get sick. I don't want to get you or your kid sick. I don't want to see your sick baby or kid in my hospital. And you don't either. Trust me. The screams of agony I heard from a little boy today were haunting. Just stay home, go to the doctor, and stay home some more. Feel better!

Interested in the Bastyr MS in Nutrition or Bastyr Internship?

2009-09-08T18:17:00.000-07:00

I got a facebook inquiry about my experience at Bastyr-- both in the Master's of Science in Nutrition program and the Dietetic Internship. Anyone else out there interested? Here's my reply:

My experience at Bastyr was absolutely amazing. I did my MS there and learned so much that changed my life. The MS program goes far beyond what other schools/curriculum out there cover. We take more credit hours, more classes (in addition to ADA requirements), and are required to do 300 volunteer hours in clinical, food service, and community nutrition. In addition, we have a teaching clinic where we did two quarters of real patient counseling with real patient charting. All of these experiences were invaluable in setting me apart and ahead in this field. There are so many interesting and inspiring people doing unbelievable things at Bastyr. I seriously cannot say enough good things about it.

The internship was a great experience as well. The rotations are all in conventional settings however, so the "Bastyr", whole foods, Complimentary and Alternative Medicine experience is not as strong as throughout the MS degree. We worked the Bastyr philosophy into projects done in addition to the rotations, and we also each spent a week at the Bastyr Center for Natural Health (the teaching clinic).

Hope this has been helpful and let me know if you have any other questions!
Stephanie

Also-- check out Bastyr's website to find out more details about their programs, the internship, and what Bastyr is all about. I'm always happy to talk more about Bastyr!

Midwest Meat(loaf) and (mashed) Potatoes

2009-09-06T08:20:00.001-07:00

I'm from the Midwest. In general, I grew up on meat and potatoes. As did most kids my age in the Midwest. As did our parents. As did their parents. Calling back to my meat and potatoes roots, I made this lovely dinner a few nights ago:

Midwest Meat(loaf) and (mashed) Potatoes
2 lbs organic ground beef
2 eggs
3/4 c chopped celery
1 chopped onion
4 cloves chopped garlic
1/3 cup chopped parsley
1/2-1 cup milk
1/2 cup dry oatmeal
1 tsp salt
1 tsp curry powder

Top:
2-3 T ketchup
2 T mustard
1 T brown sugar
pinch nutmeg

As usual, the above measurements are guestimates. Anyways, mix all of the top list in a large bowl with your hands... then wash your hands really well. Pat into a bread loaf pan and top with the remainder of ingredients. Bake at 350 for 1 hour. Serve with whipped mashed potatoes, loaded in butter and milk :) Do you think I shouldn't say things like that because I'm a dietitian? The American Dietetic Association and the government in general would like me to say 'choose foods lower in fat, like skim milk and low fat butter-like spreads'. But I believe in real food like whole milk and real butter. If you are healthy and consume these things in appropriate portions, there is absolutely nothing wrong with these foods.

Dan went crazy over it. Of course. I just cannot eat a lot of meat at once. Especially meatloaf. It was good, but I could go another year without eating meatloaf again. So to keep my red meat intake up (needing all the iron I can get these days), I made beef stew the next day. It was a stew-in-the-crockpot kind of day. Have a good Sunday!

The new place

2009-09-02T19:38:00.000-07:00

We moved this week. Monday I think it was. Is today Wednesday? Good that means tomorrow is Thursday, then Friday I'm off till next Wednesday. So I can work on getting this together:
It's going to be fun! I already found (I think anyways) a rug I want for the "family room" area- on sale for $40-- can't beat that with a stick! Still stuff to go through, things to put away, things to be hung, decor to be placed, etc. Then I'm going to host a girl's lunch as soon as I'm done. Finally I can have people over again. Welcome (to my) home.

Stephanie Wells, MS, RD: Featured Speaker?

2009-08-30T09:17:00.001-07:00

I did a nutrition talk yesterday for a low income church group in an area of Seattle I've never really spent time in. My talk was over general healthy eating/chronic disease prevention and eating healthy when money is tight. It was such an awesome experience. Oh my gosh-- I was introduced as the "featured speaker" for the event. Whoa! I felt so inadequate for that introduction- standing up there (in a spotlight), younger than most people in the room, far less life experience than most people in the room, and far more opportunities afforded to me than most people in the room. But despite that, somehow I connected with the audience (I think so anyways). The people there were so gracious and so interested in what I had to say. Several of them came to me after and said what a good job I did.. some asked me for my business card and email.. one little girl said, "Stephanie, you did really good." Aw!

I'm so glad I got that experience yesterday. It was quite a change from the daily going-ons of the hospital. Much more intimate, and in a different way, really important. The point of yesterday was to connect this part of the community with all the opportunities for healthy food and healthy living the rest of us have (and may take for granted). And I loved how thankful and appreciative they were to have that shared with them. It was so cool-- there was a gal from the Seattle Bike Coalition talking about getting more physical activity. She brought a "bike blender": a stationary bike with a blender on the back that you can make smoothies with by pedaling! There was a whole informational board-area on Seattle's P-Patch program (plots of gardens for members of the community to use to grow their own stuff). There was a huge spread of healthy foods and recipes to share. It was really cool and I was honored to be there.

*******

Moving on to today. My last day in my little studio! WHOOO!!!! I do love parts of this little place. I love our view. I love the big open windows in the front. I love that it let me finish grad school without going bankrupt. I love the hardwoods. I love the location.

I do not love the teeny tiny mini Mickey Mouse House kitchen. Smaller than Mickey Mouse House (whatever that is). I do not love the teeny tiny bathroom that just never feels sparkling clean no matter how hard I try. I do not love that we have no table to eat at. I do not love having no space for guests (although Kohl and Katy gave it a good stab).

I am relieved and so stoked to get into our new place. Especially since I can't "do much" to actually move us in. Tee hee. So tomorrow I will get up, leave one home, go to work, and come home to a new place. Yay!

Sanity and Tempeh

2009-08-25T18:31:00.000-07:00

Ha! I was just looking at my blog for a minute and I noticed that right next to, like right next to, my little tyrant on how I "believe in whole foods" blah blah blah in the right hand margin, was "Can you say OREO MILKSHAKE?"

HA! So funny I am. Ok, well in addition to whole foods, I also believe in a little something called NOURISHING THE SOUL. And sometimes that means an Oreo milkshake. And let's face it, health is partly about sanity and well, pregnancy does a weird thing to your sanity. Like takes it and throws it out the window.

My coworker (29 weeks p.g.) told us this hilarious story about how she had a huge meltdown last night, crying in her closet in a heap, over not being able to wear anything in her old wardrobe and not being able to fit into any "sexy" bras cause her boobs are too too too big now for anything other than those sizes that don't come in "sexy". She said for the first time in her life she could identify with that whole body image issue so many women/girls have. From my perspective the whole thing was just really cute and kind of sweet... but for her there was no perspective, no rationale, no consoling-- no sanity! See now how the Oreo milkshake supercedes the whole foods mantra?

You do. You get it. If you don't, we can't be friends. Just kidding. No I'm not.

*****************************

On another note, have we talked about tempeh yet? I think we have. It's a cool little fermented soy conglomeration sort of like tofu but with more texture and flavor. The beans are closer to whole form than tofu (if that makes sense). Maybe I'll just show you a picture:
Sorry- it's in tupperware. I sort of ate it and packed it up and this post was an afterthought. Ok, so I had done bbq tempeh before where I basically just baked it in bbq sauce. And it was alright but I didn't love the bbq sauce so that kind of messed things up. So this time, I decided to just pan fry the sheezy out of it in butter. (Yes I consume real butter.) All I added was a little salt, then ate it with baked beans. This was a winner! Missing a vegetable, sure, but groceries are slim pickins here (even though we JUST went to the store). PLUS this meal is loaded with iron (which I'm needing these days). But I'm telling you, pan fried salted tempeh is really good. And there's probably lots of other awesome pairings I could have come up with.... like quinoa and cucumber salad, or couscous and tomato with mozzarella, etc. You try!

This is why I wish life as I know it weren't over:

2009-08-24T18:58:00.000-07:00

Dramatic? A bit. Sorry to anyone I may offend (including you, unborn). But seriously...BALI?!

Well here ya go all you fellow RDs looking for jobs. A dream come true. Served on a silver platter. From Jenny Westerkamp, dietetic intern extraordinaire and co-founder of All-Access Internships.com:

Anyone interested in working in Bali?? A friend passed along a job opp for anyone interested in moving to Bali for this 2 year contract position starting in Dec 2009. (((COMO Shambhala Estate (www.como.bz), Ubud, Bali, Indonesia - 5-star wellness resort is looking for a Resident Nutritionist.))) Email amyjo.johnson@cse.comoshambhala.bz if interested!!

UGH. A holistic retreat center IN BALI?! Why me? Not that I'm not grateful to have a job. But this is a TRUE DREAM JOB!

Ok, now drool: Shambhala Estate, Bali

Have I mentioned my appetite is back?

2009-08-21T19:07:00.000-07:00

Can you say OREO MILKSHAKE? I know I can.

Is that not the most heavenly invention ever? Whoever whipped that concoction up needs to win the Nobel Peace Prize or something. And you know that if a bunch of angry people over in warring nations all had their fill of Oreo milkshakes, there would be peace in this world.

Seriously. That. Good.

Moving on. With my appetite back, my cooking is coming back. Ugh- for awhile there I did not want to so much be around food for any length of time before eating it. So cooking was down, appetite was down, morale was down, nutrition was down, weight was down, life as I knew it was down.

But I'm back up! Here's a few tasty tasties I've put together lately:STEAK! And don't worry- it's organic my friends. And no, the red wine was not mine. Steak, spinach salad, and butter/garlic gnocchi. Gnocchi is basically little dumplings made from potatoes. One word to the wise, do not get Trader Joe's pre-made gnocchi; it's yucchi. :)

This fiber-packed lunch special (that my kitties were oh-so-interested in apparently) is comprised of broccoli slaw, black lentils cooked with ham, and a dollop of dressing. I had this one day at work, and it kept me full through an afternoon of working on the floor ("working on the floor" = running around the PICU/hospital), which is NOT an easy feat for any meal for a pregnant person.

See the meal patterns there? Protein, veggies, starchies, yay! A little fruit (or an OREO MILKSHAKE) for dessert and you got yourself a well-rounded, nutritious meal.

Working woman

2009-08-19T18:42:00.000-07:00

So today is day 3 of really truly working my job, job. Except that I'm training with someone so it's kind of like really truly working my job. So far I love it. The other RDs I'm working with are so nice; the doctors, pharmacists, and nurses seem really nice. The PICU is just enough challenge for me I think, which is good.

I feel fairly comfortable/confident in what I know and what I'm doing. It's just going to be a matter of doing the job day after day for a long time before I encounter a huge variety of situations and know what to do, etc. And probably just a few weeks to get a good pattern down. I'm all about the patterns. Makes learning new things so much easier.

I see a few things I may want to change/expand about how the job is done now, which is cool that I feel like there is room to grow and advance what's currently happening. I'm so excited to get this career going! Really, really bad timing to be having a kid I have to say.... There are a plethora of women in my department who are pregnant right now so it's good in a way that we all are sort of on the same wavelength in terms of HUNGER, THIRST, HAVING TO GO TO THE BATHROOM, ENERGY, etc. Pretty hilarious group we are!

Off to Vegas!

2009-08-13T08:33:00.000-07:00

Short hiatus folks-- I'll be in the sun and fun on the strip this weekend! I can't wait. Vegas will actually be a relaxing vacation for me I think. That's what happens when you're pregnant in Vegas. Ha!

Did you SEE my post below? I know, doesn't seem like the most earth-shattering cause... BUT if you or your child experiences food allergies you know how huge of an impact it has on your life. A friend of mine just found out her 5 year old has a peanut (and tree nut) allergy. It's devastating for the whole family because they have to scrupulously keep any and all remotely peanut (and tree nut) containing items out of the house. This is really tough with two other kids who live and breathe by p-b-and-js. My friend now must carry an epi-pen (a loaded syringe with epinephrine in it that arrests the anaphylactic reaction-- anaphylaxis is deadly) and educate her child's teachers, friends' moms, and other family how to give her son a shot should he be exposed to peanut butter.

Anyhoos, I want to have something to give for the walk next weekend. If nothing else, it should be fun!

AND I'm super excited-- I am giving a talk on August 29th for a large group on healthy eating and eating on a budget. AND IT'S PAID! WOO! My first official speaking engagement as a professional RD! (Don't tell the audience-- to them I'll be an old pro!). I'm so stoked and have tons of good ideas.

Ok see you in Vegas baby!

WALK for Food Allergy & Anaphlaxis

2009-08-09T18:22:00.000-07:00

Dear Family and Friends,

I will be participating in the Food Allergy & Anaphylaxis Network’s (FAAN’s) Walk for Food Allergy: Moving Toward A Cure. The event will be held on August 22, 2009, in Seattle, WA. The FAAN Walk for Food Allergy is designed to raise funds to find a cure for food allergy and to educate others about its impact.

Please support my fundraising efforts with a donation. Your tax-deductible donation will make a difference in the lives of many! It is faster and easier than ever to support this great cause - you can make your online donation by clicking on the link at the bottom of this message. If you prefer, you can send your tax-deductible contribution to me (make check payable to FAAN), and I will send it in.

Any amount, large or small, helps FAAN continue Moving Toward A Cure! I greatly appreciate your support and will keep you posted on my progress.

Sincerely,

Stephanie Wells

To make a donation online, visit my personal fundraising Web page.

To send a donation, make all checks payable to FAAN and mail to:

The Food Allergy & Anaphlaxis Network (FAAN)
Walk for Food Allergy
11781 Lee Jackson Hwy, Suite 160
Fairfax, VA 22033-3309

If mailing in a donation, please include a note indicating the walker and location (Seattle) to which the money should be credited.

Pretty Photos 8/7/09

2009-08-07T19:31:00.000-07:00

purple carrots

a home garden in Queen Anne

trees of Greenlake

Rafiki smelling heirloom tomatoes

What has this RD been eating since getting knocked up?

2009-08-06T09:52:00.000-07:00

So most people who know me know that I tell it like it is and I don't try to hide the way I feel or be fake about things. I feel like being ourselves is the best way to connect with other people who are really feeling the way we do-- so we can relate, understand, feel better, etc. Which brings me to today's topic:

What has this RD been eating since getting knocked up?

Oh Lord, some of it is not pretty. I am here to bare all. Judge if you will... like I said... open book. I tell you that these choices are really not in my hands-- it's like there's another force in my life drawing me like a magnet to certain foods and repelling me from others. It's never the same day to day and I usually don't really want it again after I have it (with a few exceptions). Which makes grocery shopping kinda hard. Ok, in no particular order, here is the (dirty) laundry list:

1. Trix cereal, dry. I made Dan go get this at 9:30 at night.
2. Hard boiled eggs
3. A Tombstone frozen pizza (no other brand could be accepted at that moment)
4. Grape suckers
5. That Fritos bean dip that comes in a can, with tortilla chips
6. Nectarines, and keep 'em coming
7. Bacon
8. Trader Joe's organic version of Pop-tarts. I haven't had a Pop-tart since I was 8 probably!
9. Subway
10. Dr. Pepper AND Mountain Dew (not together)--no diet
11. Jalapeno poppers
12. Mashed potatoes/baked potatoes
13. Cafe Flora in general (this amazing vegetarian restaurant here-- thanks Angie!)
14. Barbecue sauce-- with which I made Barbecue Tempeh
15. "Chili's" nachos (although I still haven't gotten to eat them-- we have no Chili's around here)
16. Shrimp Portofino a la Macaroni Grill
17. Chocolate chip cookies
18. Charleston Chew-- one of my FAV candies from when I was a kid-- still haven't had this either.
19. Pho, and I drove to Magnolia for it.
20. Rice Krispie treats, and keep 'em coming. Preferably with plain iced tea. Can be found in any Starbucks or Tullys.

Ha! Is this hilarious or what? I find it hilarious. And somehow I still haven't gained weight.

Berries, Berries, Berries

2009-08-05T19:34:00.001-07:00

We are lucky in the Northwest to have a plethora of berries that grow here. Blueberries, blackberries, strawberries, raspberries, huckleberries, marionberries, boysenberries, cranberries-- you name it, we got it. The best place to get these guys is right from the farm or farmers market. Sooooo tasty (look at my breakfast down there!). There are several farms outside of Seattle that let you visit and pick... and there are several blackberry bushes IN Seattle ready for the picking (Discovery Park hint hint).

So what to do with all these berries?

Here's my take on 'em, but read on for a really fun creative opportunity...
Sorry this is a bit last minute, but a gal I graduated with from Bastyr is teaching this class called Berries, Berries, Berries tomorrow night (Thursday) at South Seattle Community College. She is amazing and here are the details:

Class Description:

Take those scrumptious berries this summer season brings and turn them into tempting meals! Using fresh, local ingredients, learn to spice up traditional recipes and create new dishes that will tantalize your taste buds. Class is taught by a West Seattle dietitian skilled in developing tasty meals with hidden healthy ingredients.

Thursday, 6:00 PM - 8:30 PM; 1 session on August 6, 2009
Cost: $49.00 Materials Cost: $15.00
Instructor: Christine Weiss
Location: SSCC, Culinary Arts Building (CAB), CAB Main Kitch

Go Chrissy! I wish I could be there but until I actually get a paycheck from this job, no fun extras like this (sigh).

Danimal turns 29

2009-08-01T18:15:00.000-07:00

Dan's not so excited about being 29. He said it makes him feel "weird". Well, we had a pretty good day yesterday anyways. The original big birthday event I wanted to do with him couldn't happen because he only had Friday off and my plan required Friday-Saturday off. I found this out earlier this week so needless to say, I was short on big birthday surprises for him. Oops!

So I told him we could do ANYTHING he wanted all day. This is not only sort of a foreign idea to Dan (I can be a little demanding :), but he still continued to ask me all day what I wanted to do. I just laughed and kept saying, "Dan it is whatever YOU want to do, it's YOUR birthday." So funny he is.

So here's what we did, start to finish:

1. Got donuts. Three pudding-filled, chocolate covered and one glazed for Dan and one sugar-covered for me.
2. Got coffee (Stumptown!).
3. Opened (my sort of lame) gifts. One homemade/sentimental, one store-bought. Here's homemade/sentimental:Yeah, we're having a kid in case I didn't spill the beans yet. I didn't did I. Dan's pretty stoked; I'm very very slowly warming up to the idea and then not so much some days. The letter on the frame is one I found that Dan's grandpa had written to him before he passed away in 1999. I thought the words were so fitting.
4. Did some house chores.
5. Went to open-air, Sound-side Cactus on Alki for lunch. Dan LOVED his birthday flan they brought him, in case you couldn't tell.6. Went to Greenlake to swim and lounge around on the water.
7. Dan went to hit golfballs for a long time while I cooked a mean birthday dinner: Sausage-pepper-onion sandwiches. Courtesy of Giada de Laurentis. Find the recipe here. Prepare, eat, die, go to heaven.
8. Rented Gran Torino.
9. Called it a night.

I hope this lukewarm birthday isn't why Dan feels "weird" about turning 29. I hope I can still fulfill my original plan before summer's over. It's an outdoor, overnight thing (hint hint). All we need is a few days off together... I like making his birthday huge!

Stumptown

2009-07-31T18:28:00.001-07:00

In case you haven't heard the word yet-- If you live in Seattle, this is possibly Seattle's best coffee. (Not to be confused with "Seattle's Best Coffee.") Seriously good stuff. I only started drinking coffee during grad school, and even through those years it was pretty sporadic. Like if I had a death march of a day or series of days I would do the coffee thing. But then when my internship started, I officially drank coffee every morning. And sometimes half way through the day.

I used to pride myself on the fact that I wasn't a coffee drinker-- especially amongst all the fanatics out here in Seattle. Seriously, you won't believe it until you see it. Coffee is an obsession here. With the demands of having to be "on" every day in the internship, coffee was the skip to my step.

Since the internship ended, I haven't been drinking coffee at all. But this morning I popped into Eat Local to grab some sausage for this awesome BIRTHDAY DINNER I'm making Danimal (happy birthday post to come soon-- with picture), and outside written on their A-board: "Stumptown Coffee. $1 Lattes and Americanos." I had heard rave reviews from various people about Stumptown so I figured I'd get Dan and I each an Americano. How can you say no to $1 high quality Americanos?

We were not disappointed at all! Even Dan was impressed, which kind of takes alot. So go to Eat Local, try this amazing stuff out for a buck. Or go seek out Stumptown in your neck of the woods. You will love it. Although Caffe Ladro is a very very close second. And they're organic/fair trade for the same price as Starbucks, etc. Plus they're on my way to the highway...

*** I just googled Stumptown and it looks like they're actually based in Oregon and ship their coffee elsewhere.

Kim Chi- a unique food source of probiotics

2009-07-29T12:20:00.000-07:00

I try to emphasize getting good food sources of probiotics in my weekly diet. Probiotics are the beneficial bacteria that line our gut and protect the gut-associated lymphoid tissue (immune system). These bacteria have many functions, most of which we don't fully understand quite yet. (Researching microbes that number in the billions and differ from human to human is a tricky task). We do know they serve as a barrier to potential pathogens coming through the gut, aid in digestion, produce vitamins in the body like vitamin K and biotin, and mediate inflammation. The colonies of beneficial bacteria in our gut can be destroyed or disrupted by things like antibiotics, stress, poor diet, etc.

Most of us have heard about yogurt as being a good food source of probiotics. This is because yogurt is a fermented food. Live cultures of bacteria are introduced to milk during the yogurt-making process. They ferment components of the milk and create that tangy flavor yogurt has. When we eat yogurt, we are eating the bacteria in it too. That is if they're still alive-- this issue is debatable but in my opinion, yogurt should be shipped and stored at proper temperatures to ensure viability of the bacteria.

Another food source of probiotics is Kim Chi. This food has been a part of Korean culture for thousands of years. That says something, don't you think? Similar to yogurt, kim chi is composed of fermented cabbage, onions, other vegetables, and spices. I think of if as Korean cole slaw. It has a strong taste, but I love it. I will caution-- the flavor is not for everyone. Dan hates the smell of it; it is pretty pungent. But it adds such a unique flavor to your every day meals. Bonus- it's full of other great vitamins and minerals too. You can buy it in Asian markets. I even found this jar at the local grocery store. You can make your own too-- which might turn out more to your liking than the store bought stuff. I'll save that lesson for another day :)Time to BEAT THE HEAT. It's going on 101 degrees today and I have no AC! My poor kitties.

How do you store your tomatoes?

2009-07-27T18:05:00.001-07:00

Did you know that you're supposed to store tomatoes at room temperature? Yes, many people (including me sorry to say) store them in the fridge. But storing them out at room temp preserves their flavor. And man is it true! The pint of cherry tomatoes I got at the farmers market are de-freaking-licious. Room temp and all. Guess I did learn something from all that cramming for the RD exam :)

My call

2009-07-26T12:49:00.001-07:00

This morning I was at church and found myself praying for strength to do well in my new job. As soon as I started asking for this, I realized, wait-- why am I praying for myself in this scenario? I should be praying for the sick kids that I'll be working with. So that's what I did. They need it more than me.

It's interesting because I remember before I started my clinical rotation, I was really scared. And really nervous. I would be exposed to and working with illnesses and death that I've never been around before. I remember praying in church for strength to do well in clinical. To stay focused on what I needed to learn and do to succeed. To have the energy and stamina to run the floors of a hospital all day long. To just not pass out!

My perspective is so different now. Now that I feel accustomed to the environment I'll be working in (somewhat anyway), it was really calming to have that message come to me today. I don't need to pray for help for me. This is not about me. My job is not about me. My job is about these kids. They need the prayers.

To be honest, I don't often get too much out of readings I hear in church. Sometimes I have a hard time paying attention for whatever reason. And sometimes I just don't really get it. But today, I loved the second reading. It reminded me that I have a calling, and that I am not doing this alone.

Eph 4:1-6

Brothers and sisters:
I, a prisoner for the Lord,
urge you to live in a manner worthy of the call you have received,
with all humility and gentleness, with patience,
bearing with one another through love,
striving to preserve the unity of the spirit through the bond of peace:
one body and one Spirit,
as you were also called to the one hope of your call;
one Lord, one faith, one baptism;
one God and Father of all,
who is over all and through all and in all.

I love it!

Queen Anne Farmers Market!

2009-07-24T15:40:00.000-07:00

As if this neighborhood couldn't get any cuter...

I want to credit the artist who designed this beautiful poster that hangs around Q.A. as well as on vertical banners on light posts. Her name is Elizabeth Mullaly and I think she did just a great job.

So even though I've lived here for going on two years, I have never been to the Q.A. Farmers Market. Partially because it is seasonal-- it runs June through end of September. Partially because I always was working or busy from 3-7 on Thursdays, and partially because I was a regular at the Ballard Farmers Market. So yesterday, Dan and I meandered through and it was awesome! As Dan put it, they pretty much have the best of everything. Lots of variety in fruits, vegetables, cheeses, breads, honey, flowers, local vendors, etc. Urban Skillet was even there! I begged Dan to get something from them because he's never had their stuff, but he said, "Next week."

With $20, I got a HUGE cucumber ($0.50!), a bunch of radishes, a bag of salad greens, 3 ears of corn (yum- my first of the year!), 4 nectarines (to die for), and a pint of a variety of cherry tomatoes. I was pleased... and here's what I made for lunch with some of my goodies:

A salad with kidney beans, sesame sticks, radishes, and a little mozzarella. And I sliced that huge cucumber to make an open-faced sandwich with rye bread, white bean hummus, and a little dill on top. Paired with a pickle-- quite the summery-farm-fresh lunch!

Quite the rig-a-ma-roll, this RD credentialing thing.

2009-07-23T09:21:00.000-07:00

Whew. So who knew how many steps there were to getting all the credentials and requirements together to be a dietitian? (Officially). To prepare anyone out there for what to expect, here's what I've encountered so far:

1. Complete internship. Check.
2. Pass exit exam for internship. Check.
3. Pass RD exam. Check. Yay!
4. Receive email from Commission on Dietetic Registration that I owe them money. 50 bucks. Check. In the mail tomorrow.
5. Need to obtain Certified Dietitian credentials. This varies state to state-- some states are licensed, some are certified-- you'll know if you need a CD or an LD. Go online and download large packet to be filled out with demographic info, "personal data", professional training and experience, previous credentials, AIDS training attestation, etc. And of course, a fee (35 bucks). Not yet completed.
6. Need to do AIDS training, a 7-hour DVD lecture with test. Need to pass AIDS test (I hear it's not too difficult). Not yet completed.
7. Update CPR/First Aid certification. Check. (Last night).

I'm not sure at this point if there will be anything else thrown my way, but this is enough to keep me busy for now!

Hoping to make it to the farmer's market today. It's been awhile and I'm craving me some delicious farm-fresh fruits and veggies!

Success!

2009-07-22T09:10:00.000-07:00

I have to apologize for being away for so long and being sort of sporadic with posts lately. I am back, will be more regular, and am looking forward to the release/enjoyment I get from sharing and processing life and health through this blog.

BUT on to what has been going on..... I got a job! My dream job really. I got hired as a pediatric clinical dietitian. It's a "temporary" position covering ~ 6 months of maternity leaves but I'm hopeful it will become a permanent position (i.e. one of the dietitians may not come back or may not come back full time). I will be covering the med/surg unit and the PICU. PICU! And we all know how I loved adult ICU! So I'm definitely happy and relieved to have a job, but feeling nervous about the responsibility I'll have as a new dietitian. But if anyone can do it, I can.

ALSO, I passed my RD exam... that was quite a strange experience. Definitely the wierdest test I've ever taken. I felt unsure of my answers for a LOT of the questions which is not a great feeling to have going through a major test like that. But apparently I did just fine because I passed with flying colors!

My job is starting beginning of August-- lots of orientation and training which is great. Between now and then I'm going to try to rest, get my life in order, relax, and get prepared in any way I can for this challenge. Off to be productive and sneak a tennis game in with the Danimal. See you soon!

Our special dinner, by Kohl and Katy

2009-07-14T20:12:00.000-07:00

Mostly Katy. So before I get into an update on my stress level since the last post... I have GOT to post about this ridiculously amazing dinner Kohl and Katy put together for Dan and I. They came to visit, we did a million and one things there are to do in Seattle and Washington while they were here, and the week culminated in this:Katy prearranged this whole dinner at Ray's Boathouse, such an awesome restaurant. The views are breathtaking. The weather was perfect. Our food was to die for. And the company was even better :) Katy pre-ordered appetizers that were at our table right after we were seated:
The appetizers were all cold seafood like dungeness crab, scallops, king crab, and mussels. It sounds kind of weird to have cold seafood, but it was all really delicious. They were all marinated and had unique flavors-- very different from any of these things warm. But so good. At our place settings were custom menus that had our names on them and everything. After apps we got to choose either Corn Chowder Soup with Crab (yum!) or from a list of salads. We also had an array of entrees to choose from-- I got crab legs, duh.
And then after the main course we were brought the top three most popular desserts-- also pre-ordered by Katy. We had a delicious chocolate cake with REAL mint ice cream, a lavender cheesecake, and a cherry crisp. We were so stuffed but loved every bite. Thanks guys for spoiling us-- what a treat!

Stress is coming over me in waves, really close together

2009-07-10T10:34:00.001-07:00

I am feeling so stressed out this morning. This past week-- since Sunday night-- I have been SO SICK. For two days I barely even got out of bed (one day I didn't get out of bed at all). Sore throat, cold, fever, bad bad bad. The part I hate most about being sick is when I start feeling better and everything that I could have/should have done over the past however many days just crashes on me at once.

I need a job. I applied for a job about 2 weeks ago. My dream job really. A job at a place I did a rotation where they loved me and talked to me about this job and how they wanted me for this job. So I put my heart and soul into that application, cover letter, and resume. And so far, NOTHING! I haven't heard a thing back! I'm panicking at this point because I have GOT to get this job for reasons I will explain later. I feel like I at least have GOT to get an interview. But so far, nothing. The process is sort of annoying-- a random "recruiter" goes through the slew of applications and he/she picks out which ones are worth looking into more. Then several rounds of interviews with several layers of people are conducted. But what does the recruiter know about me??? Yes, all the RDs there know me and like me and know what I'm capable of... So, I emailed the RD manager today to see if she had any insight into this whole thing and now I'm just bracing myself for-- "Oh, you didn't get a call yet? Yeah, they started interviews. Your application must have been passed up." AHHHH!!!!

Second-- I have this enormous RD exam looming over me that I NEED to pass asap for two reasons: 1. It costs $200 per attempt. 2. You have to wait 45 days if you don't pass it the first time. I don't have 45 days to pass it again! I need a job now!!! Again, with the being sick for the past week I haven't gotten any quality studying in... Which makes me debate whether I should cram and take it next week before a trip home from my bro's wedding or after the wedding... Studying for a life-altering exam that encompasses everything I've learned over the past 4 years is enough to drive someone crazy. AHHHH!!!!

SODIUM alert!

2009-07-07T15:22:00.000-07:00

So over the past week or so, I ate a fair amount of processed food. I had my 23 year old brother (Kohl) in town and his 22 year old girlfriend (Katy). As per his usual visits, I had the house stocked with "junk", much like we all desire to eat when we're on vacation. I guess it's been awhile since I ate boxed and packaged foods because WHOA did I get slapped with the salt! Our tastebuds get desensitized when we eat lots of salt so that things that have a ton of sodium in them (processed foods like chips, crackers, processed cheese, frozen foods, etc) end up not registering as really salty. It's an easy way for the food industry to flavor food-- especially processed foods marketed as low fat or healthy.

A few foods I was surprised my salt-sensitive tastebuds went through the roof with?

Triscuits! These guys have a good amount of fiber but whoa-- so salty they didn't even taste good. I wanted the hearty wheat taste I thought I remembered but instead it was just too much salt.
Goldfish crackers. Again-- for some reason I don't remember these being super salty but after not having them for a few years-- yikes.
Processed Kraft cheese ("Deli Deluxe"). Dan and I normally get organic blocks of real cheese as opposed to processed cheese, but we were doing a beach barbecue and out of convenience we got this stuff. Have you ever eaten a slice of that plain? It is SO salty! Very strange as again, I don't remember it being like that.
Frozen pizza. Oh Lord. This was off the charts. I couldn't even enjoy it really. We usually make our own pizza and somehow they turn out much less salty and much more tasty!

So part of me does wonder if more sodium has creeped into these products than before or if I just have more sensitized taste buds as I prepare/salt most of my own foods. It's kind of a shame though really, because so much salt covers up any flavor that might be there. Plus it can be problematic for people with sodium issues like kidney disease, congestive heart failure, and hypertension (it can also lead to these issues along with other factors). Bummer if you're not into cooking. The beauty of cooking with whole foods is you can control the amount of salt and other flavors you add to things. You can appreciate food and flavor for what they are.

Happy 4th of July!!!

2009-07-04T11:18:00.001-07:00

I L.O.V.E. this holiday.... Middle of summer.... good food.... good weather.... good friends.... good fun! So much to catch up on. Lots going on despite being unemployed. Back soon-- lots of pics, food, and life to come!!!

Intern grad party

2009-06-25T15:46:00.000-07:00

Debra, my amazing superwoman internship director threw us a "graduation" party on Saturday night. OMG it was awesome. As per Debra's usual, she went all out and no detail went unnoticed. Everything from the decor to the fancy beverages and appetizers to the elaborate meal-- Get this, she had to create a meal to fit a group of 9 interns with no gluten, dairy, lemon, or onion, and a vegan diet. Wow. We told her it was her final exam to create a menu for that group after all the challenges she gave us. She ended up with a spread that had something for everyone, including salmon for the none-veg's.Right before dinner, she presented us with our final Verification Statements and gave a little speech about each of us. She gave each intern a "blessing"- which was a word she chose that represented us and would carry us through our careers (i.e. grace, wonder, groundedness, etc). What was my word? SUNSHINE. Ha! If you know me you know this is hilarious because I have a tendency to have a "mean resting face" and can give off a cold-ish vibe. I really don't mean to, but sometimes when I'm working hard or concentrating intensely (i.e. all of the internship) I can get really serious and forget to smile and be light and fun. So the fact that she gave me SUNSHINE either means I have come a long way or it was her way of reminding me to bring that out for people. Either way, I like it!

GELATO is my friend

2009-06-24T16:38:00.000-07:00

Nothing quite hits the spot like gelato after a good run in the sun. Ok, you may be thinking, "Doesn't that defeat the purpose of the run?" Say what you will; this is some good freaking gelato. I was driving home from Greenlake and literally pulled a U-turn in the middle of Queen Anne Ave when I drove past Cafe Bonjour and remembered their creamy treat: in raspberry-honey nonetheless. Oh heaven. Can you say YUM?!

So far, unemployment is not fun

2009-06-23T10:30:00.000-07:00

I need a job people! It is day 2 of week 1 of no internship, no school, no job. It is not fun. Cleaning, errands, running/walking, and cooking just are not doing it for me.

I applied for a job at the Pro Club in Bellevue-- an amazing top notch health club chain in the Seattle area. I got the call this morning that..... they are going with another candidate. Bummer.

I have a feeling this is what is going to happen until I am actually a RD. This process is very long and getting longer by the day. Yes I finished school, and yes I finished the required 1200 hours of internship. But I still have to sit for my RD exam which the soonest I can take it is around the 3rd week of July. Then, assuming I pass, I have to wait another stretch of time (months?) for my credentials to actually be sent to me. These days, a lot of places won't hire you until you have those credentials in your hands.

Not good for me! I need to do something productive in the meantime. I'm not quite sure where to go for a "summer job" at this stage of my life. Any ideas? And please don't say the movie theater or the mall. I just don't think I could do it :O

A labor of love

2009-06-13T09:16:00.000-07:00

Wrapped up my rotations yesterday. It feels so good to know I will not be an INTERN ever again. Or a STUDENT for that matter. Not that it was all that bad.

The past few years have been the most difficult and amazing ever. I sacrificed everything to explore my passion and have a better life. I worked harder than I ever have for anything every minute of this journey. I challenged myself to do things I never dreamed in a million years I could do.

And although I feel like my life has been on hold for the past 4 YEARS... I have found a way to still live life.

I started taking prerequisites in Fall 2005 to even be able to apply to the Master's in Nutrition program at Bastyr while still working 40 hours a week. I would get up really early, go to a 7 AM Anatomy and Physiology or Organic Chemistry class, get to work by 9:30, work until 6, and then turn around and go back to school in the evening for another Chemistry class. This went on for a year and I was scared to death that after all this work, I still might not get into grad school.
Spring 2006, I got in.
Summer 2006, I got proposed to on a roadtrip down the West Coast, through Oregon and Northern California to Yosemite and back.
Fall 2006, I started grad school, while working 3 jobs plus volunteering for 2 different organizations. And I was planning for a wedding.
Winter 2006, I got married and went to Hawaii.
After that came 2007, and I made it through the school year, streamlined down to just 2 jobs, a clinic shift, and no volunteering by summer 2007.
Fall 2007, I went to Europe.
I continued working -- Fall 2007 I started at Children's-- so just one job, another clinic shift and another year of school.
Winter 2008, I applied for the Bastyr Internship and hoped and prayed I would get it.
Spring 2008, I got the internship. Soon after, I graduated.
Then I went to Mexico to celebrate.
Summer 2008, I worked and saved for a year of working without getting paid. And paying a lot to be in the internship.
Fall 2008, the internship started and so did the whirlwind that has been my life for the past 9 months.
And training for a marathon for the past 3 1/2 months.
Which brings me to today. The day I am done.
Until next week, when I have my "exit exam". And then several weeks later when I have my RD Exam.
And that is where my journey will end and begin at the same time.

As of right now, I have a few little job leads hanging in the balance. I'm hoping and praying that I get these. When I hear more, I'll share. In the meantime, I'm enjoying the feeling of accomplishment. Or trying to at least. Live in the moment.