Greetings! My name is Christine Yip and I am a Sodexo dietetic intern in the Philadelphia/New Jersey campus. I relocated from New York City to Pennsylvania to complete my dietetic internship. I completed both my undergraduate and graduate degree in nutrition in New York and relocating to another city was a new and exciting experience! My main campus rotation is at Aria-Jefferson Health. Aside from seeing patients with various diseases, I’ve also had the opportunity to shadow a wound care nurse and see patients with ostomies or staged wounds. Also, I was able to get a full tour of the operation room and scrub in on a laparoscopic cholecystectomy surgery of my own patient! I even got to hold the patient’s gallbladder (with my gloved hand, of course!) after it was removed. My internship experience so far has taught me to feel more comfortable speaking to different people and to be more open-minded. You never know where a conversation could take you! This mentality allowed me to gain unexpected opportunities and experiences. Aside from learning from every encounter and person I speak to, this internship brought me five new friends (my internship classmates) and they have become a huge part of my support system!
Hi everyone! My name is Kathryn. I was matched to Sodexo's Dietetic Internship in fall 2017 with a concentration in Medical Nutrition Therapy. I have experienced and learned so much in such a short time. During my rotations I was given the opportunity to spend time at MANNA in Philadelphia, Pa. The organization is a not for profit that was established in the early 90's as a way to give nutritional meals to members of the HIV/AIDS community in the city. It began in a small basement church near Rittenhouse Square Park, servicing local people in need. Community members could come in for counseling and have meals delivered to their homes, so that they would be fed when they were at their sickest points. Oh, I forgot to mention almost all of the people working were (and still are) volunteers. They receive funding from a multitude of people, places, and other organizations. Local companies and schools come in groups to help cook, package, or deliver food. In the recent years, they have expanded their services to include counties outside of Philadelphia. The organization now provides aid through modified menus and nutritional counseling for other diseases that can cause increased nutritional risk such as diabetes and CKD.
Throughout the years, workers at MANNA were able to collect data and provide research that shows how their nutrition service aids in decreasing length of hospital stays, lowers hospital readmission, reduces health insurance cost, and increases overall quality of life in the community they served. They took this research to local health insurance companies and began partnerships that allowed for reimbursement of services. Health insurance companies now refer patients there! I couldn't help thinking about amazing that was.
MANNA's ever increasing serviced population eventually outgrew its four walls. Their new location was just opened and through the Sodexo dietetic internship, I was privileged enough to be given a full tour of the new facility. The new location has been designed to invite. The entire space has been made so that walls can be wheeled aside and rolled up to reveal a venue perfect for hosting fundraisers and community events. Available are designated areas for volunteers to gather and relax, coffee stations to keep you moving, and a kitchen complete with huge mixers, steam tables, and assembly line style packaging/storing. Private rooms are offered for dietitians to provide nutritional counseling to their members. They even have enough space for interns, like me, to get a great experience. Workers and volunteers alike are there for one reason, to increase the health of a community in need. With their new location they are now able to double meals delivered from approximately 1 million meals to 2 million meals per year.
MANNA has shown that with a little bit of hope and a lotta bit of love, food can help heal and I was thankful to have the opportunity to see it all in action….
As a dietetic intern we are taking the first step out into the real world of dietetics and away from the classroom. Our workload however, still remains rather consistent; but unlike undergrad, we have the opportunity to apply our new, exciting knowledge into actual everyday practice.
One of our requirements for the internship is to prepare, plan and present on a professional research topic of our choice. When I presented this to my preceptor she was intrigued by the new area of diagnosing malnutrition. The dietitians at Holy Family Hospital had just learned how to conduct a Nutrition-Focused Physical Assessment, a growing new practice of today’s dietitian. Malnutrition can present its self in many different ways such as reduced food intake, unintentional weight loss and physical signs and symptoms of a patient’s appearance. My preceptor was really interested in how to recognize if a patient has a vitamin or mineral deficiency. I was going to get the opportunity to not only learn about physical signs of vitamin and mineral deficiencies, but to actually get to practice my new skills on new patients that might be at risk.
Patients that are diagnosed early with malnutrition are more likely to have a positive outcome. It can help us identify the big picture of what is happening. Small changes to a person’s general appearance can give clues to hidden deficiencies. Through my research, I found an assessment of vitamin and mineral stores involve observing distinct areas where deficiencies may present themselves: the skin, hair, eyes, nails and mouth. Vitamin and mineral deficiencies may be more present in certain disease states when there is inadequate intake, malabsorption disorders or if the patient has a higher energy demand that increases the loss of important vitamin and minerals.
By observing changes of these focus areas we can decipher which vitamin or mineral that may be missing. Subtle changes to the color of the skin or texture of the nails can indicate a specific deficiency. For example, signs of iron deficiency may be a lack of color in the skin and eyelids or a “scooping” of the nail plate. Other deficiencies may contribute to changes in the tongue or lesions on the skin. When visiting my patients I can now use these skills to identify clues of possible deficiencies that manifest themselves through a patient’s appearance. I will be presenting my research on vitamin and mineral deficiencies to our dietetic staff at Holy Family Hospital in the beginning of August.
Needless to say, this is an exciting time to be a dietitian. We now have the opportunity to act as though we are detectives. We get to piece together clues to figure out the nutritional status of our patients. This gives dietitians an advantage to improving and expanding their skill set to make them a greater asset to the medical team. Now I can have a more hands on role in the diagnosis and treatment of vitamin and mineral deficiencies.
Hello! My name is Molly Selvidio and I am a Sodexo Distance intern working on my third month in my clinical rotation at Saint Josephs Hospital in Nashua, NH. I graduated from my undergrad 2 years ago and was nervous about starting this journey so starting my clinical rotations was exciting but also very overwhelming! I learned so many things within days of starting at the hospital, some refreshers on what I learned in school and some very new topics! Very quickly in my rotation I realized how many patients were suffering from COPD in the acute care setting. My CNM had also realized this pattern and spoke with the doctors about consulting the dietitians when a COPD patient is experiencing exacerbation. I found this topic particularly interesting because when you think of COPD you think of difficulty breathing; after doing more research on this disease you I found it is actually connected to increase energy expenditure and weight loss.
At Saint Josephs hospital we initiate nutritional supplements to patients who are experiencing COPD exacerbation to aid in oral intake for those who are unable to consume their estimated needs due to shortness of breath. This is found to increase their overall outcome and reduce their risk for extended stay! It is suggested 1.2 -1.3 x REE to provide additional energy intake and avoid weight loss. I do agree with this information, although I feel there should be more research and information on patients who are experiencing COPD exacerbation but are overweight and eating appropriate meals. My question would be do you give a patient who has adequate oral intake an additional supplement? The guidelines are unclear and could benefit from a stronger outline.
If you haven’t already I would strongly suggest checking out the Today’s Dietitian magazine. It is an awesome magazine that provides research articles on current new nutrition topics and trends that you may find patients are asking you about! Take a look at the following article on COPD exacerbation and weight loss; I am sure you will find this interesting as well!
Hi my healthy friends! My name is Sarah, and I am a Sodexo dietetic intern at the Philadelphia campus. I am half way through my internship and completed my clinical rotations at Capital Health in Trenton, NJ. My opportunities have ranged from spending a few days in the Neonatal Infant Intensive Care Unit at Children’s Hospital of Philadelphia, to helping a school dietitian make dysphagia meals for students with special needs. My concentration, leadership, is the best of both worlds. I am learning how to become a more effective leader in the field of dietetics, while also expanding my interest in school food nutrition and policy. This concentration allows you to choose an elective you’re interested in while still learning how to apply leadership skills. Throughout these past couple weeks, I have been working on a survey that will help Sodexo’s efforts in schools, by interviewing state agencies about their regulations related to the Healthy Hunger Free Kids Act. This alone has given me a boost in confidence and leadership skills.
A special experience that I was a part of during this rotation was an important conference call with the National Dairy Council. The efforts of increasing the consumption of milk in schools is a difficult one with many other sugary juice drinks and sodas on the market. But as a future dietitian, I am very concerned about the importance of milk consumption in children, for calcium and vitamin D. Children are also still lacking the knowledge of where food and milk comes from, so the focus of our meeting was to come up with ways to educate children on dairy farms and the benefits of milk. Sitting in that meeting was very fulfilling, especially when I gave input on things I’ve done as a dietetics student to implement farm to fork.
One idea we came up with was printing barcodes on milk cartons so children can take a picture using an app with their smartphones to show exactly what farm their milk came from! Another was to create an easy-to-use, interactive website where children can click on a cow, all the way to the distillery machines to see how milk is transported to grocery stores. It was amazing to see who was all involved; from school directors, to milk distilleries and farmers, to Sodexo dietetic interns!
Thanks for reading! And good luck on your dietetic journey!
I recently completed my community presentation for seniors. As I was wrapping up my presentation, I had a lady raise her hand enthusiastically and ask if bananas were a “bad” food? I asked her why she thought that, and her response was “I saw an article online that a doctor had written about how bananas were bad for you.”
Or course I tried to debunk that myth by explaining that I don’t personally believe that foods should be labeled “good” or “bad” and that everything should be eaten in moderation. Haven’t we learned that fruits (and vegetables) are supposed to make up 50% of our plates for breakfast, lunch and dinner?
Fast-forward a week later while I am at my outpatient clinical setting for a week, I heard similar words while listening in on an education with a diabetic patient. “Bananas aren’t the best choice….they have a high glycemic index and can spike blood sugars easily. There are better fruit choices to make.”
I can understand the reasoning behind this, but what about the patient that doesn’t like other fruits? Perhaps a better alternative would be to suggest their usual banana with a protein option such as peanut butter or plain Greek yogurt so blood sugar levels don’t spike so quickly?
Bananas can provide many benefits from their B6 content, high potassium levels and the much needed fiber that most Americans lack in their diet.
What are your thoughts? Do you agree that bananas are “bad”?
Hello! My name is Kimberly Thoman and I am a dietetic intern with the Allentown program. I write this post with unique perspective, as I have just completed the last of my 1248 hours of supervised practice! As I reflect on the last 10 months, I am so grateful to have had such positive and enriching experiences in my clinical, community and food service management rotations. While I found each rotation to be both challenging and rewarding in different ways, I would have to say my concentration rotation is the one that truly inspired me, pushed me out of my comfort zone and enforced strong communication and critical thinking skills.
I chose the leadership option, with an emphasis in clinical pediatrics, and completed 232 hours at Nemours Alfred I. duPont Hospital for Children in Wilmington, Delaware. I’ve always had an interest in pediatric nutrition but was lacking hands-on clinical experience. My concentration rotation allowed me the freedom to explore this area of interest while further honing my leadership abilities. I was able to participate in the nutritional management of children with medical conditions in a variety of specialty areas including weight management, GI, liver, nephrology, epilepsy, eating disorders, cystic fibrosis, endocrinology, surgical services, rehab, hematology/oncology, and critical care (NICU, PICU, CICU). As you can imagine, there was a lot to learn in 232 hours, and each day was filled with enlightening, humbling and educational experiences.
One thing I learned was how to diagnose malnutrition in the pediatric population. Of course, the malnutrition guidelines are much different for children than they are for adults. You can diagnose malnutrition in two ways, depending on the anthropometric data available for a particular patient. The first way is to assess primary indicators when only a single data point is available such as weight-for-length z score, BMI-for-age z score and/or mid-upper arm circumference. Ideally, more than one data point will be available to assess growth and evaluate overall trends. The primary indicators when two or more data points are available are weight gain velocity (<2 years of age), weight loss (2-20 years of age) and/or deceleration in weight-for-length or BMI-for-age z scores. In addition to growth trends, it’s important to assess nutrient intake to determine whether or not a child is meeting his or her estimated energy and protein needs, as this can offer valuable information and further support a malnutrition diagnosis.
The following chart depicts the criteria for categorizing malnutrition as mild, moderate or severe. It’s also important to establish whether the malnutrition is acute (<3 months) or chronic (>3 months). One of the most challenging aspects of assessing malnutrition is choosing the most appropriate data points on the growth curve to determine the severity of malnutrition. It’s important to use clinical judgment, rule out potential outliers, which may be a result of inaccurate measurements, and keep in mind the context and timeline of the acute or chronic condition and other social or environmental circumstances that may have contributed to a malnutrition diagnosis.
Meet the Purple Pepper
I thought I was well versed in most local fruits and vegetables until I came across the purple pepper at my local farm stand. Measuring about 4 ½ inches high and 3 ½ inches wide with a rich, dark purple hue, it completely caught me off guard as I perused around the veggie area. The smell is much stronger than its mild crisp and slightly sweet taste.
These purple beauties are packed with fiber, vitamin A, C, K, B6, potassium, and manganese and are also a good source of thiamine, niacin, folate, magnesium and copper.
I prepared them by cutting them in half, stuffing them with avocado, corn, tomato, goat cheese, basil, and cilantro with a squeeze of lime and a sprinkle of olive oil and Parmesan. I then baked them on 425F for 20 minutes. I also kept the seeds so I’ll be growing purple peppers next year.
Practice sustainability and get to your local farmer’s market to try them while they last!
Hello my fellow interns! I write this post with great excitement (and sadness) as I wrap-up my Leadership concentration with the Rhode Island Department of Health (RIDOH) and Governor’s Office.
How did I get there, you ask? When first accepted to the Sodexo Southcoast DI, I immediately chose Leadership as my concentration for two reasons: (1) leadership experience and exposure is critical as dietitians in education, research, advocacy, and public policy are newly emerging and essential career avenues in the dietetics field; and (2) the Leadership concentration allows interns to design a 200-hour rotation centered on their personal career interests and goals. Sounds amazing, right?! The possibilities are endless, but I was determined to design a leadership rotation with a focus on state-wide food policy in Rhode Island.
On a whim, I contacted Sue Anderbois, Rhode Island’s first Director of Food Strategy. For those who live far from this tiny state, we’re doing amazing things with our food policies! In an effort to grow Rhode Island’s economy and support healthy families and communities, Governor Gina M. Raimondo announced the hiring of the State’s (and nation’s) first Director of Food Strategy to lead the development of Rhode Island’s first comprehensive Food Strategy (attached). Designed to be a five-year action plan, the Strategy takes a holistic view of the state’s food system and is organized around three core themes: Health & Access, Economic Development, and Environmental Sustainability & Resiliency. Wanting desperately to be a part of this work, I met with Sue to discuss her initiatives within our state and pitch the idea of having a dietetic intern on her team.
Here’s a tip for all you interns and early professions: If you like what someone is doing in any field - even if it’s slightly related to dietetics - reach out to them! Chat through email, meet for coffee, join a conference call – whatever it is, collaborate as best you can and offer your services as a dietitian! As a dietetic intern, I worked closely with Sue’s partners from the RIDOH to establish the beginnings of a state-wide healthy retail initiative and hunger-free task force. I’ve compiled spreadsheets that detail what other states are doing to address food insecurity and hunger, and brainstorm ways in which Rhode Island can begin to develop a hunger-free task force (e.g., who is part of this conversation, who are our key stakeholders, do we need annual or biannual meetings). I also compiled spreadsheets and contributed to drafts that will help local concession stands and corner stores promote, place, and price healthy products to their consumers. Most importantly, I had the opportunity to sit-in on meetings with key Rhode Island stakeholders (RI Department of Education, RI Department of Human Services, Food Access committee members, SNAP outreach and education, RI Community Food Bank) to brainstorm ways in which we can shape the food environments in our local communities.
Our food environments are changing and dietitians should be at the table of discussion!
Beans, Beans, and…. chocolate chip cookies??
With the popularity of diets such as Paleo and Keto, sugar and carbs are on the top of many peoples avoid list right now. In many ways, carbs have become the new fat, in reference to the low-fat diet craze of the 1990s. Excess sugar in your diet can be pro-inflammatory and leave you short on energy and nutrients throughout the day. On the other hand, more complex carbohydrates, like legumes, are a fundamental source of energy, fiber, and some important minerals. Legumes, like lentils or beans, are prime examples of complex carbs that have been taking over the snack aisles of your grocery store as healthier alternatives for crunchy savory goodness.
If you have a big sweet tooth like I do, there are days when you really intend to have a healthy snack but nothing quite fills the bill. Cookie dough hummus made with garbanzo beans and nut butter is an excellent, easy-to-prepare option if you want something sweet like cookie dough, but with a healthier twist for movie night or a study sesh. The cookie dough hummus is full of flavor with extracts of vanilla, cinnamon, almond nuttiness, and dark chocolate chips. This cuts down on the need for excess sugars that are devoid of nutrients.
Garbanzo beans, with 6 grams of both fiber and protein in just a half cup, make them ideal for a snack that is filling for both you and your healthy gut bacteria. The nut butter adds an energy rich source of healthy unsaturated fats to the mix. Beans and almond butter are also important sources of magnesium, together providing 20% of the recommended daily allowance in a half cup serving of hummus. Magnesium is an important mineral for energy production and metabolism of sugars and carbs.
You’ll want to keep your food processor handy more often for this nutrient dense faux cookie dough that you can enjoy by the spoonful. Because it is packed with energy, it is still important to take caution of your portion size. I recommend scooping out a half cup portion of the dough in a separate bowl so that you aren’t tempted to overdo it! Although it has less sugar than the same volume of regular chocolate chip cookie dough, it still has 12g of sugar per serving. However, a half cup portion is nutrient dense and contains just over 200 calories, which is ideal for a snack.
Recipe for Cookie Dough Hummus