soooo where do I get this amazing DTR study guide?

I am a complete failure at consistently posting on this blog.  I'm sorry friends!  By some stroke of luck, those of you that Google a phrase similar to "DTR study guide" may find yourself directed to a post of mine from December 2013 (yikes) when I wrote about how I passed my DTR test.  I get lots of lovely emails from lovely people asking for this lovely resource.  At least half of these correspondents sound a tad frantic and stressed.  If you find yourself in any of these boats, fear not!  Here is the famed study guide!  I would like to make it clear that I did not make this because the author deserves all of the credit for selflessly making this fantastic FREE resource.

In addition to asking for the study guide, correspondents frequently ask how much time they should dedicate to studying.  Unfortunately there is no magic number.  My advice is to schedule your test as soon as you can.  This immediately creates a date you can mark in your calendar and should scare you into studying sooner than if you lolly gagged on such scheduling.  I am not assuming there are any lolly gaggers out there, I am mostly thinking of myself at the time!  Note*, you can always change the date of your test up until 48 hours of your scheduled date so you might as well just schedule and pay for it!

Ballpark, I would recommend 1-3 months time to study.  Time frame would be different depending on how much time you can dedicate to studying.  I worked a frantic, awful, sporadic, sometimes miserable hospital schedule while I studied.  Being too burnt out on 8+ hours of work based nutrition, I tended to study on my days off.  The closer the test got, the more serious and meaningful my studying became.  I did push my date about 4 weeks because I didn't feel 100% confidence.  Looking back, I probably would have passed if I took the test earlier.  However, pushing the test gave me peace of mind.  After I pushed it though, I had to take it by a certain date since my work scheduled me as a DTR on a specific, looming date.

Please feel free to ask any questions you may have!  Fingers my blogging will become more frequent!  There have definitely been some professional updates recently :)

Glorious Study Guide Found HERE!

*Totally sound like Jean Inman right now.  Those of you who don't get the reference, just wait until it's time to study for the RD exam.  Trust me, you'll chuckle then!

Nutrition Grads of 2014: Be Patient, Be Positive, Be Proud

Two years ago I graduated with a BS in Nutrition.  Although graduation weekend was a celebratory time, I couldn't help feeling extremely panicked about my future.  While my family showered me with praise and presents, I didn't feel deserving of it at all.  I wanted to become a Registered Dietitian. However, I did not have the experience to get into a internship in the state I lived in and didn't have the funds to move out of state to attend one immediately after graduating. I couldn't help but feel extremely jealous of my classmates who already had jobs lined up in other fields. Here I was moving back home with no idea what to do with my new degree. So I stayed in my college town (soaking up my denial of entering the "real world") quite literally up until the minute the lease ran out on the apartment I shared.

Upon moving home, I worked as a nanny.  I had plans to take the DTR test and look for jobs that required a nutrition degree without an RD credential.  Looking for jobs online turned up ZERO interviews.  I felt hopeless, worthless, and even more panicked about my future.  I worried about everything, lost sleep, and was anything but happy or confident in my abilities.  Looking back I wish I could tell myself to hold off on the pity party.  It is ok (not ideal but still ok) to be unsure of the future. It is ok because as long as you're actively doing something about it, it will eventually work itself out.  Here's proof:

After giving up on online search engines, I cold called every hospital in the Orange County and Long Beach area looking for diet technician, diet aide, and diet clerk jobs.   I got two interviews at the two hospitals closest to my house. Then got job offers from both. Nearly two years later I work as clinical dietitian at the very hospital I accepted a job at as a lost college graduate.

I know it's been awhile since I diligently blogged, but I have gotten several emails over the last year from young graduates  about finding their place in the gap between degree and RD.  I plan on sharing more about tips and stories about this gap-studying for the DTR test, what kind of jobs to look for and where to look, applying to internships, etc.  For now I want to share this: if you can relate at all to how I felt after graduation, stop immediately.  Be patient.  Be positive.  Believe in your abilities and your dreams.  You just finished at least four years of school so be proud.  

Everyone's journey to RD is different; some are longer than others. Don't focus on the time it takes to get there.  Focus on how you get there.  It may take longer, but that also means more time on the journey to gain experience and build relationships with others in the field.  I know for a fact I would not be where I am today without the journey I took from degree to RD.

Eggs, the Incredible Edible or the Terrible Unrepairable?

I had an aversion to over easy eggs...thought they looked gross until tried Eggs Benedict for the first time and realized what I had been missing all these years!

It's  hard to come by a person that doesn't like eggs.  I've been known to eat them breakfast, lunch, or dinner. (Note, I did not say breakfast, lunch, and dinner) (Oh dear I just said "Note"...for all you people studying or who have studied the Inman review, I apologize) Eggs are an inexpensive form of protein, quick to whip up, versatile, and delicious.   So why the bad rap?  Egg yolks contain cholesterol, as do all animal sources.  Our body makes most of the cholesterol we need, and the remaining small portion comes from food we eat1.  Heard of HDL and LDL cholesterol? They both have to do with our total cholesterol, but one is good (HDL) and one is bad (LDL).  I remember this by thinking that we want HDL to be high and LDL to be low.  Eating foods high in cholesterol, such as egg yolks, can increase your LDL (remember, we want this number to be low)1.  Refer to this American Heart Association article here for more info on HDL & LDL.  One egg yolk contains 215 mg cholesterol2, the most current USDA guidelines recommend less than 300 mg of cholesterol per day3.  Considering cholesterol can be found in anything that comes from an animal, starting your day with multiple yolks doesn't leave much room (or any at all) for other foods with cholesterol.

Ugh, did that just break your heart?  Remember, the yolk contains the cholesterol, not the white.  So have one whole egg, and two whites. (Two egg whites=one whole egg)  I do that for scrambles because I like the yolk color.  Or you could do egg substitutes.  I find these incredible easy to use (1/4 c=1 egg). I would also like to note the redeeming qualities of the egg, such as choline and selenium which can be found here.  Eggs are not the enemy.  However, if someone has history of heart disease or existing high cholesterol, talk to your doctor for specific recommendations.

I recently found a study comparing the effects of eating egg yolks and smoking cigarettes to heart disease4.  It caught my attention, but with studies it is so important to look at details.  In this case, it's important to remember that the subjects were over 40 years old and referred to a vascular prevention clinic, most after having a stroke or TIA (Transient Ischemic Attack, it's like a mini stroke).  This is not a good representation of the general public.  Therefore, this study can't relate to the general public even though it will grab the general public's attention easily.  

So is there a magic number? Recommendations vary.  When I interned at a diabetes outpatient center, no more than 3 yolks per week were recommended.  This recommendation is shared by some of my sources as well2,5.

As an ending thought, I really liked what a Harvard School of Public Health article had to say about egg consumption, supporting the idea that health is with moderation, "To your cardiovascular system, scrambled eggs, salsa, and a whole wheat English muffin are a far different meal than scrambled eggs with cheese, sausages, home fries, and white toast"5.  For me, this means I can have an egg over easy, just one, but I pair it with whole grain toast, spinach and tomatoes.  If I want to have bacon and eggs, I do whites. Moderation, moderation, moderation!


1 About cholesterol.  American Heart Association. 15 July 2013. http://www.heart.org/HEARTORG/Conditions/Cholesterol/AboutCholesterol/About-Cholesterol_UCM_001220_Article.jsp Accessed 11 March 2014
2 Eggs, are they good or bad for you? Nutrition411.  February 2011. http://www.nutrition411.com/component/k2/item/1650-eggs-are-they-good-for-you-or-bad-for-you. Accessed 11 March 2014
3 Dietary guidelines for Americans 2010.  United States Department of Agriculture and United States Department of Health and Human Sources.  December 2010.  http://www.health.gov/dietaryguidelines/dga2010/DietaryGuidelines2010.pdf.  Accessed 11 March 2014
4 Egg yolk consumption and carotid plaque J. David Spence, David J.A. Jenkins, Jean Davignon Atherosclerosis 1 October 2012 (volume 224 issue 2 Pages 469-473 DOI: 10.1016/j.atherosclerosis.2012.07.032) Accessed 11 March 2014
5 Eggs and heart disease.  Harvard School of Public Health.  http://www.hsph.harvard.edu/nutritionsource/eggs/Accessed 14 March 2014

Vitamin ABC's

Inspired by my job alphabet and my RD exam studying, this blog is dedicated to vitamins! Unlike the alphabet, not every letter has a vitamin (never heard of vitamin L or T) and some letters have lots of different vitamins (Vitamin B).  It is essential to eat a variety of foods so the body can receive as many vitamins and minerals as possible.  I know green smoothies are popular now, but vitamins come in a variety of colors so make sure you eat a variety of colors (eat the RAINBOW!) Multivitamins are an easy way to get most vitamins at once, however it's best to try and eat your vitamins through your daily diet.  Some vitamins have toxic levels that should not be exceeded, some medications are sensitive to vitamins, and some health states require more of certain vitamins...it's best to consult your doctor before you begin taking any supplement because they are so concentrated.  So whether you're a student studying vitamins like me or trying to get more vitamins in your diet, read away!

Vitamin A: found in yellow and orange fruits and veggies, dark leafy greens, fish, liver, fortified milk.  Works to protect skin and vision.  Wondering about the connection between carotene found in carrots and Vitamin A? Carotene is a precursor that turns into Vitamin A, a form the body can use.

Vitamin B1: aka thiamin, found in oats, wheat germ, sunflower seeds, beans, pork, liver.  Metabolizes carbohydrates.

Vitamin B2: aka riboflavin, found in liver, milk, meat, soybeans, mushrooms.  Metabolizes protein.

Vitamin B3: aka niacin, found in peanuts, cereals, and rice. Aids in metabolism of macronutrients. 

Vitamin B5: aka pantothenic acid, found in animal products.  Functions to synthesize coenzyme-A, which is essential for energy release.

Vitamin B6: aka pyridoxine, found in meats, cereals, and corn.  Important for metabolism of protein/amino acids.

Vitamin B7 or H: aka biotin, found in egg yolk, corn, and organ meat. Functions in both glucose and fatty acid metabolism.

Vitamin B9: aka folate, found in cereals, beans, and some fruits and veggies.  Really important for women who are pregnant or planning on becoming pregnant since it can prevent neural tube defects (brain, spine, spinal chord dysfunction) in infants.  It is important that women planning on becoming pregnant make sure they are getting enough of this vitamin because the neural tube develops within the first month of gestation, a time when pregnancies can be undetected.

Vitamin B12: aka cyanocobalamin, found in animal products.  Important for protein metabolism and preventing pernicious anemia.  Vegans and the elderly are at risk for deficiencies. 
-Vegans because they don't eat animal products...can get B12 injections, supplements, or find fortified soy products, milks, cereals
-Elderly because they can develop atrophic gastritis which is when the stomach lining becomes thin and the amount of intrinsic factor decreases.  Intrinsic factor helps the small intestines absorb B12.  Without it, B12 is not absorbed and pernicious anemia may develop.

Vitamin C: aka ascorbic acid, found in citrus, bell peppers, guavas, strawberries, kiwis, tomatoes, peas, and papayas.  Helps with iron absorption, wound healing, and producing collagen.

Vitamin D: found in egg yolks and fortified milk.  Vitamin D is popular in current research and has shown to have multiple benefits.  Notably, Vitamin D plays an important role in Calcium metabolism and bone health.

Vitamin E: found in vegetable oils, whole grains, green vegetables, and almonds.  Functions as an antioxidants (prevents oxidation, a process that gives electrons or hydrogen to something that wants to oxidize, which results in the production of free radicals.  These rascal radicals stimulate chain reactions and can damage cells.  Antioxidants stop these chain reactions by getting rid of free radicals by sacrificing themselves to be oxidized). 

Vitamin K: found in dark leafy greens and helps with blood clotting.

Here is a little quiz I found online! It covers more than I did and is a great tool to see how much more you know about vitamins. 

Registered Dietitian Jobs, A-Z

Don't mind the lint...

It's a Monday morning and I'm on my second cup of coffee after sharing and spilling my first cup with the LA Times reading the Oscars' reviews. In normal fashion, I was wearing my stretchy

Gravity defying messy masterpiece

pants and messy bun crossing my toes looking for job opportunities when I realized how vast the field of dietetics has become.  Within five RD job postings of each other was a job with Disney and a correctional facility. This blows my mind. Long-gone are the stigmas of straight laced dietitians endorsing strict diets of steamed veggies and baked fish.  Our field has become so prevalent, promising, and essential to humanity that dietitians are found beyond the hospital and weight loss clinic and now in grocery stores, schools, and corporate America. So I bring you, Dietitians A-Z:

A-Agriculture: Agriculture includes nutritional science and food science.  Farms and companies require dietitians to be food experts for their companies analyzing nutritional value of foods. I happened to be in the College of Agriculture as a Nutrition student during my undergrad at Cal Poly San Luis Obispo and even went to another Agricultural school, Utah State University, for my dietetic internship

B-Baker: Being an RD-Baker would seriously be my dream come true. Sound like an oxymoron to you? I think not.  An RD-baker could come up with substitutions for baked goods and develop healthier recipes.  

C-Corporate America: Corporations can reach out and hire dietitians to encourage health and wellness to their employees.

D-Disney: who knew you could work for the happiest place on Earth? Yup. Saw a posting today for Manager of Healthy Living. Go Mickey!

E-Education: Dietitians that can educate the public are in high demand for schools, diabetes and renal outpatient centers, and public health just to name a few.

F-Fast Food: Restaurants need dietitians to modify and develop menu items to meet health needs.

G-Grocery Stores: Many grocery stores are starting to hire dietitians to answer customer questions, highlight nutritious food choices in stores, present grocery store tours, and create educational handouts for customers.

H-Home Health:  RD's are needed to assess and follow-up with patients requiring home health that may be on tube feeds or have poor appetites. 

I-Inpatient: RD's will always be an essential part of the health care team in hospitals.

J-Jails: also known as correctional facilities, dietitians can work here to ensure people are meeting their needs.  I can imagine it may be a grim atmosphere, but that might inhibit appetites, thus making RD's essential.

K-Kitchen Manager: Working as a kitchen manager would give excellent managerial and food service experience for someone who wanted to be a Food service Director/RD someday.

L-Long Term Care Facilities: This is a huge and growing field as the baby boomers age.

M-Magazines: All kinds of magazines (cooking, health, family, women, men, kids) need dietitians to write everything from how-to's to Q & A's to informative consumer articles about trends such as coconut oil

N-Navy: Armed forces need dietitians too! If the Navy isn't for you, NICU (Neonatal Intensive Care Units) are another "N" option for an RD wanting to specialize in neonatal pediatric nutrition. 

O-Outpatient: Many dietitians work as counselors and educators in clinics that focus on diabetes, dialysis, weight loss, and more.

P-Pharmacies: Some pharmacies may team up with dietitians to work as a team helping clients.

Q-Quality Assurance: RD that evaluates performance and services of dietetic services.  Could also pertain to food manufacturing. (HA bet you didn't think I could come up with a Q!)

R-Representative of Sales: RD's are needed as sales reps for medical supply companies such as Abbot and Nestle to promote nutritional supplements.

S-Schools: Most school districts need a dietitian to analyze school menus to meet the USDA's school lunch and breakfast guidelines.  RD's can also modify meals for children with allergies and specific needs, educate students, and even work as Food Service Directors.

T-Teachers: RD's are needed to teach health classes as General Ed and nutrition classes for diet tech students at a community college level. You could get a Masters or PhD and teach as a professor at a college level.

U-Urban Gardener: Why not? It doesn't take an RD to plant an urban garden, but for a profession that promotes fruits and veggies, seems like a perfect marriage to me!

V-Vice President: An RD could be the VP of a food manufacturer or corporate company!

W-Wellness Programs: Wellness programs for companies or through insurance require dietitians to encourage nutritious preventive care and counseling as a health coach or educator. 

X-Xtra Hard Worker: Ok, sorry I couldn't come up with anything for X, but I know that no matter where an RD ends up, they always work Xtra hard! (It was either that or something to do with X-Men)

Y-Yourself: No matter what an RD does, it is always important to be YOURSELF! If working in a clinical field doesn't work out for you, look at how many other options there are!

Z-Zoologist: Zoology refers to evolution and habits of all animals. Why not become a zoologist RD and investigate the eating and wellness habits of the human animal?

Internship, Check

Well, my dietetic internship diploma came in the mail this week.  Yup, I'm done with my internship.  I thought this would bring me relief and a sense of accomplishment.  Unfortunately, those feelings have been smothered by anxiety and a personal sense of urgency to find a job and pass the RD exam almost simultaneously.  Therefore, I have resorted to a schedule that mostly consists of waking up, job hunting, job applying, and studying the enthralling Inman's review in my uniform of stretchy pants and a messy bun.  (I decided to compromise with "messy" because in my head I envision a Pinterest-worthy ballet bun while the mirror shows a cross between Miss Frizzle and an Asian warrior.)

I think what it comes down to is now that my internship and assignments are done, the last leg of the journey to RD is up to me.

In an effort to stay away from whining (and wining* for that matter), I've come up with some methods to bring some balance and gratitude to this time.  

• Gratitude- instead of focusing on studying and job hunting as stressful, I am going to be grateful.  I think back to myself when I started this blog and dreamt for a dietetic internship.  That girl would have given both her arms and legs to be where I am.  I think back to the hard work I put in during my internship, and the hard work and energy spent on me by teachers and preceptors.  So when I want to put my head down, the notecards away, and the Netflix** on, I take a second to remind myself not to take this time for granted.
• Marathon, not a sprint- I get so overwhelmed on studying, passing the exam, finding a job, applying to jobs and I want to do it all at once.  This is not effective. I remind myself that this journey is a marathon, not a sprint.  I may be on the last leg of this journey, but there is no need to rush.  I cannot expect myself to complete a month or week's amount of work in a morning or a day.
• Breathe, enjoy-as long as I feel my list is, I need to remember to breathe and enjoy this time.  As bad as I want to find a job, I can see my future employed self missing these stretchy pant/messy bun times that offer flexibility to attend 10 AM classes at the gym or take a day trip or wear yoga pants 7 days a week.

So here I am.  This time also allows me to blog topics I will be studying for the RD exam, as well as any job/interview tips and experiences.  Can't wait to see where it takes me!

* I recently saw a neurologist for a bizarre migraine I had and learned wine can cause migraines.  As well as nuts, cheese, chocolate, and MSG.  I obviously stay away from MSG for obvious reasons but wine, cheese, nuts, chocolate?? If I could make my own version of MyPlate or the food pyramid based on foods I love, those would be it! Anyways, I have to go easy on these things.  For now, wine is only for special occasions. The neuro was pretty funny, told me people with migraines tend to eat a lot of cheddar cheese.  I fall into that group plus I never fail to have a baggie of almonds with me at all times. Sigh.

** Mad Men and House of Cards...that's all I have to say.

Images from http://femmepiricalevidence.blogspot.com/2013/04/take-chances-make-mistakes-get-messy.html

http://www.fanpop.com/clubs/mulan/picks/results/245553/what-style-like-mulans-hair

http://designed-for-life.tumblr.com/post/72959129953

Rotations

Running off to inpatient!

A dietetic internship is usually composed of three major rotations: clinical nutrition, public health and community nutrition, and food service.  Here I briefly describe the rotation, what to expect, and some of my experiences.

1.    1. Public Health/Community Nutrition Rotation: the aim of public health is to provide access to healthcare typically to people who may not be able to afford or would have difficulty affording it.  Public health also focuses on prevention and overall wellness, and nutrition is a great tool for both of these. Some dietetic internships may even focus their program on public health or community nutrition.  I’m sure rotations vary, but I have found that most interns do theirs at WIC or Head Start.

-What to expect: Interning at WIC, you will learn a lot about counseling, education,  maternal and child nutrition including weight gain during pregnancy, prenatal nutrition, coping with side effects of pregnancy, preventing pre-term birth, breast feeding, child nutrition and eating habits, proper growth for children using growth charts, promoting activity and exercise with children, promoting decreased screen time for children.  I learned SO MUCH about nutrition and pregnancy, child nutrition, and the WIC program itself.  I was pretty hands on doing height and weight measurements, counseling with my preceptor observing, and running group classes.  I did struggle with the slow pace of work since my facility had primarily Spanish speaking clients. I’m not too familiar with what would be done at Head Start but I think it would be more education and child based.  If you’d like to learn more about the WIC organization, refer to a previous post I wrote: WIC post

2.   2. Clinical rotation: a clinical rotation can be broken into several categories and although programs vary, most will want you to spend time in a mix of them.  People probably think of an inpatient (hospital) rotation as clinical nutrition, however there are also rotations in the outpatient, pediatric, and long term care worlds. Most programs will also require you spend time as full time staff relief meaning you work as a dietitian would, you are still considered an intern, but it would be expected that you are able to see as many patients as an RD-don’t stress, this is usually at the end when you are much more experienced!  So let’s break it down!

• Inpatient: this is done at a hospital and in my experience, I was able to work in all units (surgical, medical, telemetry, ICU, CCU, postpartum, even a gero-psych ward).   Definitely didn’t start in ICU or CCU, I built up to that!  I could do another post about what to expect from different units in terms of medical nutrition therapy.  You do a lot of screening, seeing patients, educating patients, writing notes, calculating tube feeds, calculating PPN/TPN (at my hospital the pharmacy was in charge of parenteral feeding; we would recalculate their formula to give energy, fat, protein, fluid, etc. to make sure it met the patients’ needs), ordering supplements; basically making sure patients are meeting their nutritional needs.  In my experience, I had a lot of independence and saw patients basically as an RD would and had my preceptor sign my notes at the end of the day.  If you’ve never worked in a hospital before, prepare for a fast paced and sometime smelly environment J  However, you get to wear a white coat which makes you feel super legit!

• Outpatient: this could be done at a diabetes center, renal/dialysis center, or some sort of eating disorder clinic.  In my experience at a diabetes center, it is primarily counseling and group classes.  Slower paced that inpatient, but great because RD’s can build relationships with patients since they come back for multiple appointments.

• Long-term care: this could be done at a skilled nursing facility, hospice facility, and possibly home health.  I haven’t done this one yet-will have to report back! I am doing mine at a skilled nursing facility.

• Pediatric: usually done at a children’s hospital or a general hospital that has a pediatric unit. Unfortunately I was not able to find a peds rotation L

       3. Food Service rotation: I have not started this one yet, but will report back when I do! It can be done at a hospital, school, or maybe a long term care facility.  I am doing mine at a school which incorporates child nutrition and school lunch/breakfast programs

My rotations themselves varied from 2 weeks to 13 weeks.  Here’s what mine looked like:

Public Health/Community: 4 weeks

Clinical: 6 weeks inpatient, 2 weeks full time staff relief (done at inpatient), 3 weeks outpatient, 2 weeks long term care (13 weeks total)

Food Service: 13 weeks

So you can see, my internship is 30 weeks long plus 1 week of orientation.  Note that your required hours do not take into consideration driving or doing assignments for your program.  Although I had time to work on assignments in community and outpatient,  there was zero time in inpatient-it is that fast paced!