what i ate

So as I’ve shared I’ve generally been pretty proud of my non-craziness in these rather trying time of unemployment.

BUT.

Healthy eating has fallen by the wayside fur realz. Yes, I realize that is ridiculous, given that this worsened basically once I officially got a masters in nutrition and officially became a registered dietitian.

But who doesn’t eat like rubbish when they have no structure to their life? When they can nosh whenever they want because they often don’t have better things to do? This is worsened by the fact that I’m too broke to justify joining a gym. Yes, one can exercise without a gym, but I think there’s something about the structure of incorporating gym visits into one’s life that makes one more prone to healthy eating as well.

So, last Monday I pledged a reset. I went to Trader Joe’s and didn’t get the peanut butter pretzels, the cocoa almonds, the smoked salmon and caper dip, and all the little tasty snackies that have made up FAR too large a portion of my recent diet. I was set up for success because my pal was out of town the previous weekend and ordered me to collect any eggs her chickens laid which turned out to number a whopping 28 (!!! I gave a dozen of them to my cousin and her hubs and the bebe; and another bunch to Malindi). And finally, I decided to be an old school food blogger, and blog everything I ate for awhile.

As a fairly voyeuristic person, I enjoyed the old-school style food blogs that were just like a daily diary. A peek into someone’s life, via what they ate. And this step was also intended to be good for me, since I am aiming to be more mindful about my food choices. So, please enjoy one week of eats.

Monday

BREAKFAST: None. Slept too late. I’ve kept terrible hours with this lack of structure!

LUNCH: 2/3 of an Amy’s frozen meal. A “Mexican”-ish burrito bowl with crumbled up corn tortillas and beans and things. I realized I was over it and stopped eating it after 2/3 (mindfulness!) and instead rounded out the meal with avocado toast (a slice of whole wheat bread, 1/2 a small avocado, and a generous sprinkling of Trader Joe’s all purpose seasoning)

AFTERNOON SNACKS: a kind bar, a 12 oz soy cafe au lait (coffee with a friend, hurray!), and 1/2 a bag of Trader Joe’s kale chips post-grocery shopping (so so crunchy and cheesy and good; but hard to justify the $ very often)

EXERCISE: a five-mile walk (I use mapmyfitness.com to track walk lengths!)

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The fiddleheads have now emerged and they are vair beautiful to see on my walks.

DINNER: Two eggs poached in tomato sauce and cheesy cauliflower rice

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Wanting to be a bit adventurous in my healthy eating, I bought some cauliflower rice at Trader Joe’s. So hot right now! I sauteed a clove of garlic in a teaspoon or so of olive oil and then threw in about two cups of the rice cauliflower. Cooked til golden (ish?) then added an ounce or so of shredded cheddar. Saved half the “rice” for the next day.

I served the “rice” with eggs in the style of shakshuka or eggs in purgatory or whichever culture you choose to attribute this brilliant idea to. Heated up a little more olive oil and added a generous sprinkling of crushed red pepper flakes. Then added some organic marinara sauce (just to coat the bottom of the pan). I gently broke in two of my friend’s chickens’ eggs and cooked them in the simmering marinara until the whites were just cooked through. The eggs were DELICIOUS! The cauliflower rice was a bit boring and I don’t totally get the fuss. I saw a food blogger who’d made cauliflower rice Thanksgiving stuffing and I wanted to hug them because I was so sad on their behalf.

PM SNACKS: A billion! Cashews (roasted but unsalted), other 1/2 bag Trader Joe’s kale chips, a pack of Trader Joe’s instant berry flax oatmeal, a spoonful of Peanut Butter and Company honey peanut butter (I got a coupon for a free jar- dietitian perks!)

Tuesday

BREAKFAST: Almond date scone and a low-fat latte at my beloved Guglhupf

I had a job interview (!) and rewarded myself for it going well (not a behavior I necessarily endorse but whatever, small victories) by hitting up Guglhupf.

Imagine my delight when a bloke then bought me a cookie! Like buying a girl a drink except way cooler and non-sketchy! We chatted for a bit, sitting outside. Very pleasant.

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LUNCH: leftover cauliflower rice, last 1/3 of that Amy’s frozen Mexican casserole meal from the previous day. Add, unpictured, 1/2 a bag of Trader Joe’s kale chips and an oatmeal pack

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EXERCISE: 4.3 miles of walking to various locales

DINNER: I had my sister over and made whole wheat pasta with artichoke walnut parsley lemon sauce, plus shrimp scampi.

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Here is the pasta recipe. It’s incredible. I made it once with the toasted breadcrumbs and it was (obviously) awesome but I can vouch that it is still really good without bothering with them (I already had a lotttt of pans going so I needed a break).

For the shrimp scampi I just sauteed a clove of garlic in some olive oil, threw in some thawed frozen shrimp to cook really quickly, and finished it with lemon juice and lots of chopped parsley.

PM SNACK: 1/3 of that large and delicious Linzer cookie from the dude (my sister ate the rest, at my request!), the other 1/2 bag of those Trader Joe’s kale chips, and a few spoonfuls of that honey peanut butter

Wednesday

BRUNCH: Two fried eggs from my friend’s chickens, avocado toast with Trader Joe’s all purpose seasoning

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Flowy egg yolk. It’s hard to even describe how incredible the eggs from my friend’s hens are. The yolk is like rich flavorful incredible cream. I just fill myself with vitality when I eat this.

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AFTERNOON SNACK: most of a bag of kettle corn (!) and a 12 oz soy cafe au lait

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I cannot endorse this Pop Secret Sweet ‘n Crunchy kettle corn because it’s much more in the fatty sugary dessert category than the wholesome whole grain snack category. But my damn sister turned me on to it and it is highly delicious. I had a much-needed wake up call when I actually looked at the nutrition information on it. I’d gotten into the habit of eating most of a whole bag, because I live alone and leftover popcorn is not a thing. I need to just not buy this any more, or only make it when I’m entertaining guests!

EXERCISE: 6.1 mile walk

Look at this freaking Japanese maple just looking gorgeous.

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DINNER: leftover pasta from the previous night (probably a cup or so of pasta, plus sauce), a Yoplait, and two wasa crackers with Chobani dip (<< I like this savory Chobani dip a lot but find it overpriced most of the time. But Food Lion was getting rid of it- probably low demand!- so it was on an excellent sale)

EVENING SNACK: three or four more Wasa crackers with that same Chobani dip, some raw walnuts, and a sugar free pudding (not something I think is the healthiest in the world but I was jonesing for something sweet)

Thursday

BREAKFAST: Odwalla protein shake

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This is SO packed full of sugar and I generally don’t go for soy protein isolate. Probably won’t get this again. But it’s sometimes just necessary to have a convenience option.

I was running out the door to arrive to my cousin’s house by 8am to watch this heavenly little creature.

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He is getting SO BIG! And having solids now- introducing him has been so fun! That being said, he had some issues that required giving him prunes, and the prunes were FRIGHTENINGLY effective, and the fallout from that was… devastating, honestly. Good grief, kid. Anyway, that’s his second outfit of the day. But he is ridiculously cute.

LUNCH: the last ~3/4 c leftover pasta with artichoke sauce, and ~3 oz leftover shrimp scampi (yes I know it’s gross to have leftover seafood but whatever). That was rounded out with avocado toast (you’ve seen it many times now!), and a bunch of walnuts.

AFTERNOON SNACK: more of that honey peanut butter, a sugar free pudding

EXERCISE: a 5.1 mile walk. Please admire this majestic tree.

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DINNER: 1/2 of this Trader Joe’s kale, butternut squash, and parmesan pizza (pictured below). Plus an unpictured salad from a Trader Joe’s mix which contained: spinach, craisins, bleu cheese, candied pecans, and raspberry dressing

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PM SNACK: a sugar free pudding, one of my roommate’s coconut chews (like a miniature hippie mounds bar), and a Kind bar

^^ These snacks were eaten while enjoying Amy Schumer’s new special on Netflix. Anyone under 35 will find it HILARIOUS. Mom, you would hate it and find it offensive.

Friday:

BRUNCH: a whole wheat English muffin with 1/2 a small avocado and a small pear

AFTERNOON SNACK: walnuts, and a chocolate walnut scone and iced coffee with soy milk when I met my girlfriend at Johnnys for some late afternoon gabbing

EXERCISE: An hour and a half of Zumba! I was so excited to spot this sign in town- I can justify $ on a drop in class if it’s just three dollars! We ended up having a small class because (obviously I was oblivious to this) UNC was playing a basketballs.

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After Zumba I felt kind of weird (my body is unaccustomed to exercise that late at night). I knew I was hungry, so I hit up the taco truck.

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DINNER: I ended up eating 3/4 of a large pupusa (left) with double curtido (a tangy cabbage slaw that’s delicious and I always want more); and a sope (right) which is a corn tortilla topped with rice, beans, lettuce, tomato, queso fresco

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It wasn’t exactly like I just sat down and ate those, though. It was more like I ate half the sope, then my sister and her boyf came to hang while I stared at the food and felt lightheaded and nauseated. Then I politely asked them to leave since I sort of felt like I was going to die. Then I lied in bed for several hours, but didn’t actually sleep. Then I realized I was starving and ate the rest (the other half of the sope and 3/4 of the pupusa)

Saturday

BREAKFAST: this incredible kefir

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I got this at the farmer’s market. GOSH it is incredible. I still felt vaguely hungover, despite not having had a drop of alcohol, and I really think the ginger and probiotics in this were good for me.

LUNCH: two packs of Special K pastry crisps (told you, my stomach was still unhappy). Again, not something I recommend, but it is true that sometimes simple carbohydrates are tolerated by a stomach that’s otherwise just not feeling it. Plus they were on sale.

AFTERNOON SNACK: the last 1/4 of the previous night’s pupusa with the remaining curtido, a small pear, and a slice of that kale pizza

EXERCISE: several walks, totaling 4.3 miles. Plus I babysat in the afternoon and played outside with the kiddos, which was a lot of fun!

DINNER: the last three pieces of the kale pizza, a smoothie with 1 banana, a few handfuls of spinach, ~1 cup almond milk, and 2/3 of a scoop of protein powder

PM SNACK: Tonight Dough ice cream. YEAH COME AT ME. It’s really good. I am capable of eating ice cream in moderation, unlike many other desserts (maybe because Ben and Jerrys is so expensive?) so it’s one of the few desserts I allow in my house from time to time. Plus out of sight out of mind, right?

Sunday

BREAKFAST: Nada. Slept late- was grateful to get a good night’s sleep after my post-Zumba poor Friday sleeping

LUNCH: Lobster tots (!) Tater tots, lobster chunks, pico, crema

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There was a food truck rodeo (magical phrase, right?!) by campus and the most popular truck by far was Cousins Maine Lobster which was apparently on Shark Tank or summat.

My friends are the woooooorst and told me they’d meet me there at noon. I arrived at ten til noon and snagged a good spot in the lobster line. My ridiculously late friends showed up in two sets at 12:45 and 12:53, respectively. I got the tots to share but since everyone was late I then spent quite awhile just roaming around looking forlorn holding lobster.

I didn’t eat that lobster roll- I got it for Kyle and Shaylen because I was sweet and kind enough to take their lobster truck order by text. Truthfully, it’s now a little awkward because it was hella expensive but they maybe kind of forgot to pay me back? Whatever.

The food truck rodeo was magical because for some reason there were a bunch of service dogs in training.

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(in no way, at any point, was “Do Not Pet” enforced)

EXERCISE: walking from home to the aforementioned food truck rodeo, then strolling around the arboretum with my franz, then walking back home. 5.3 miles or so.

Colton was in town and it was semi-nice to catch up. He wanted to take an engagement picture at the arboretum. This picture is so so classic us.

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AFTERNOON SNACK: We stopped at Yogurt Pump, a Chapel Hill institution, and I got a cone of cookie butter froyo (!!!!). Also got an iced coffee.

Then LATER AFTERNOON SNACK: my friend Steph and I had an awesome date night of drinks followed by Beauty and the Beast! We hit up B Side and I got a cocktail involving gin and lime and grapefruit that got me real stupid. We also split their Caprese special, which was fried green tomatoes (!!!!!) and fresh mozzarella

I enjoyed Beauty and the Beast a lot. I mean duh.

DINNER/EVENING SNACK: a serving of Trader Joe’s frozen sweet potato fries with some Chobani dip, two special K pastry crisps

Reflections on a week of eating:

  • I am a snack monster. But I already knew that. Trying to make healthier snack choices (pears, moderate servings of plain unsalted nuts) rather than unhealthier snack choices (like all the crap I’d been eating- peanut butter pretzels, imitation crab dip, fake fiber enriched things that jack up my stomach anyway, sugar-coated nuts that I just inhale, etc.)
  • I freaking love avocado. This is inherited from my mother.
  • I still eat out too much. It’s one of my favorite ways to socialize with friends, but I am too broke to justify it this much (though some of my friends were nice enough to treat me to some of the outings mentioned in this post, because my friends are really good human beings and some of them have real grown up jobs, unlike myself). Anyway, I genuinely enjoy preparing meals for friends at home and I need to get better about doing that.
  • You can’t fault my activity level. But it would probably behoove me to add some more strength training.
  • I definitely could not eat this much food and maintain my weight if I did NOT have that activity level. Whenever I get a full time job (dear God let it be soon) I’m going to have to watch the calories.
  • I would probably be less nosh-y if I ate more protein. I’m certainly not deficient in it, but I also probably get too many of my calories from carbs and (really) fat. That being said, the Mediterranean diet is highly validated for chronic disease prevention, and it’s fairly high in (healthy, monounsaturated) fat and carbs and low in meat.

we all need a tribe

I recently attended a talent show birthday party. It was EXCELLENT.

First of all, Shel Silverstein was there.

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Well fine, someone in a mascara beard reciting Sarah Cynthia Sylvia Stout and playing the guitar, but it was still amazing.

This was the second annual year of Impressa the Chessa- a talent show birthday party celebrating Chessa, a roommate’s-friend-turned-my-friend. Chessa is a musician and is friends with many other talented musicians, so there was a lot of that. Beautiful songs and instrumentals.

But, there was also a lot of total ridiculousness.

For example, a home movie of three-year-old Nicole doing a dance to the opening number from Gypsy.

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(Why yes, there is a beer prominently displayed in the foreground of that picture. Talent shows should always have supportive audiences, and my goodness, the audience really validated the performers thanks to all the alcohol consumed. I actually didn’t drink anything- was driving home- and still found the crowd to be the perfect mix of rowdy, easily amazed, and joyful)

There was also a sushi rolling competition (all the talents had a three-minute limit so these guys were under the gun, which was pretty hilarious)

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Also:

  • Two people who memorized the words to the Free Willy song (and one of them literally taught herself to play the keyboard just to play the chords to that song) and then displayed a lite brite Orca as their grand finale
  • A couple: he is an electronic producer and made a mix that sampled the sounds of crickets and cicadas from their backyard; she has trained as an Irish dancer and created this fascinating mixture of Irish dance, hip hop dance, and being a cricket
  • A science show, featuring liquid nitrogen!
  • A juggler who was good but not perfect (made a few perfectly understandable flubs) and then everyone was like WHOO BOY when he started juggling a machete in the rotation
  • A demonstration of a homemade geography game
  • A folk song performance with mandatory audience participation that involved me wearing a sign around my neck that said “Baby Fox #10”

My talent was this stellar red wine chocolate cake from Smitten Kitchen. I ended up pooling talents with a girl named Steph. Though she is an awesome musician and her new album came out, for some reason she elected to do fire starting (!) with a flint (!) for her talent, which was also awesome. So she lit the fire and then we used it to light the candle and placed it upon the cake. That cake is EXCELLENT, and handy if you are a lightweight like I am and tend to have half-empty bottles of wine floating around the house.

I also, when revealing the cake, quoted Julia Child, who said “A party without cake is just a meeting.”

The grand finale was… multidisciplinary performance art. There was a recording of these talented young women playing the recorder and singing a song about jellyfish. There was Enya, and Destiny’s Child. There was paper mache. It was EPIC.

jellies!

As you might have inferred by now, I had a LOT of fun.

And, earlier in the day, I was contemplating not going. I think sometimes we get so caught up in our own hype. Yes, some people get too caught up in their own positive hype (the Kanyes of the world). But some of us (maybe particularly women? Or particularly introverts?) tell a story to ourselves and the world, a story like, “Agh, I’m so socially awkward”, and then we start to buy it. And we go, “Ugh, I can’t imagine going to a party mostly consisting of my roommate’s friends and show up on my own and make small talk and get tongue-tied” and then we miss out on experiences rather than risk that.

Fellow introverts, I am a party survivor and can confirm it was fun. I ended up running into a friend who I hadn’t seen since my planetarium days, who was so nice to see! I had a long chat with one of Alli’s friends- with whom I’ve always had great conversations and who I’ve tended to forget about!- about her cool new social work job. I even welcomed an uncomfortable person who was new in town and tried to make him feel welcome!

Also, not to brag or anything, but I was having a pretty incredible hair day. I had some Forever 21 store credit and got this coconut oil sea salt spray stuff and I’m still learning how to best utilize it but I had really hot beachy waves this particular evening.

Now, further discussion about being alone:

I have been alone a LOT recently. And I have had a LOT of time to fill recently. I have no interest in ranting about my job search. Ew. But I have been contemplating the state of my mental health in this phase of life, and I have to say… I’m proud of myself! In past liminal phases of my life, I’ve been, well… cuckoo. Depressed. Angry. Tense. Melodramatic. Binge eating-y <- need an adjective for that. And right now I’m not.

The weather, as previously stated, has been gorgeous, so I’ve made many a visit to the beautiful parks and gardens and so on in my vicinity.

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But honestly, the main thing pulling me through is HAVING A TRIBE!

I think of past phases in my life as being characterized by profound loneliness. I think it really kicked off in college, when for whatever reason I didn’t make the kinds of connections that so many other people do. Maybe it was the fact that I was in overflow student housing away from campus my freshman year and I didn’t get to do that initial bonding? Maybe it was the character of my rather dispersed urban school? Maybe it was the ascendency of the smart phone which meant that everyone was too busy making plans with people virtually to spontaneously interact with the real life breathing humans in their immediate vicinity? I remember feeling like something was horribly wrong with me. I was reading through an old journal and found an entry from right after I went and visited bestie (shoutout to Lydia) in Western Massachusetts. It said “Oh my God, I’m likeable! I am capable of interacting with other people! It’s my school! It’s not me!” But back in Boston, I spent a lot of lonely days wandering around the town, earbuds in, feeling like an outsider looking at all the people who were doing life properly. Incidentally, this was probably a contributing factor for the horrifically unhealthy eating habits I developed around that time. Calorie counting and meal planning and calorie-burning activities helped fill my empty, empty hours and were probably also an attempt at punishing myself. To be clear, I was headed for a showdown with my relationship with food before college- again, from reading old diary entries, I’m taken right back to an age where I was so filled with dissatisfaction with my body and disappointment and anger with myself for not making it beautiful like it ought to be. But, if that dissatisfaction (and genetics, and American culture, and blah blah blah) loaded the gun, the lonely college years may’ve pulled the trigger.

I felt like I got the college experience I wish I’d had in the first year after I graduated, when I did an Americorps year. I made really strong connections (some of which still persist today!) and had a built in group (including a boyfriend). Our time with kiddos was stressful and we really relied on each other for support. There were weekly potlucks!

But, when that year was done, I went to a rather stressful job at a food bank. Then I had a really disorganized time when I was a part-time student taking prerequisites for graduate school and cobbling together random and inconsistent income sources. The Americorps group had spread out all over the country. I still had the boyfriend, but our relationship was having growing pains.

And mentally (and physically), I was a MESS.

I just wrote and deleted and rewrote and redeleted various bits about how I was a mess, but there’s but so much I want to/should share on this public blog.

Let me just say this: the thing that pulled me out of that mental mess was getting help, outside of myself white-knuckling it (<- not an approach I recommend). The way that help happened was through my TRIBE. My sister, because she is a really good person and also because I was fairly horrible to be around because of all my issues, said, “Yes hello here is the number for a shrink. She is accepting new patients and expecting your call. Go see her; she will help you.” I don’t think I had the wherewithal or motivation to do that research myself and will be forever grateful to my sister for making that connection for me.

I learned a LOT the year-ish I was in therapy, and trying to summarize it would be silly. But the nice thing about therapy, which I do want to state, is that you carry it around with you after it has ended. You have a new language and a new way of expressing things (and it’s hilarious, you can immediately recognize that someone else has been in therapy by the way they speak. Listen to Jillian Michaels’ podcast, for example!) And, there are some lessons that you learn that seem particularly relevant at certain points in time. And right now, the thing keep saying to myself is, “You are not alone and don’t have to do everything alone. It’s important to utilize a support system.” Thank God!

So, I’ve been calling my mom. I’ve been babysitting my cousin’s little baby nugget on a weekly basis. I’ve been trying to connect with friends I haven’t seen in awhile, from past jobs and neighborhoods. I helped a friend move and appreciated the combination of socialization and strength training. I’m cultivating newer friendships. I’m sending spontaneous texts for folks to come join me to sit outside on a warm night. I’m exploring the idea of phone dates, even though it’s not my usual style (and I had a great chat with a graduate school friend who’s rocking life in DC!) I shadowed an RD at UNC’s eating disorders center to get a look at another specialty- making a connection and building skills/knowledge. I’m doing long, silly text conversations with my aunt. I’ve been scheduling roommate dates. I’ve been saying yes to more social opportunities. Also, I asked my hot exterminator to have a margarita with me in the backyard when I was his last client of the day 😉

Many things, not just friendship, have made this gap in my life more doable. For example, I don’t want to discount the antidepressant I take every morning! I was someone who benefited enormously from therapy and also reached a point where my neurotransmitters were preventing me from making progress and a small dose of medication was the right choice for me, and I’m grateful to have it and will evangelize about Zoloft to anyone who’s interested.

Also, I’m very grateful to the local public library for having a wonderful selection- right now I’m reading The Emperor of All Maladies. I have a cat who’s stoked to see me when I come home which is really astonishingly good for my mental health. I live in a state with a temperate climate, allowing me to get outside and get my endorphins on most days, without having to spend money on a gym or some such thing. I have my cousin’s HBO password 🙂

But, a tribe. A tribe is great. If you feel very very wrapped up your own mind and like you can’t escape a cycle of your own destructive thoughts (<- this is called rumination and I learned all about it in therapy!), just try calling someone. Or texting someone. Or emailing someone. Or chatting with someone at the grocery store. You don’t have to spew about your mental anguish, you just have to connect with someone.

I promise, that for me, though it started with just texting someone a “How are you?”, that helped. Talking about a funny cat video. Quoting a stupid movie. Analyzing red carpet looks. Stupid little conversations really can break a cycle. When I connected with someone, it made the nasty thoughts in my head less huge. And then I was more capable of having the really deep intense conversations because I had built connections.

Since that’s apparently the topic of the day, some other resources, that I’ve found helpful for mental health:

  • Book: Drinking, A Love Story. I bought this trying to understand a family member with a history of alcoholism. But then I read it and, go figure, it made me understand myself more. If you are someone who hates being home alone with your own thoughts, this is a good one, whatever your poison may be, alcohol or otherwise. Also, every time I reread it, it makes me think of a new person and helps me build some understanding for them. I think the whole literature of addiction is useful even if you are not an addict. First of all, you probably know someone who is (it’s real common!) And, the kinds of skills people use in recovery (giving proper apologies, learning coping skills, SUPPORT SYSTEMS!) are useful to allllll of us.
  • Book: Life Without Ed. Shadowing with an eating disorder dietitian made me want to reread this. My state of mind was very different this time reading it than the first time I did. I.e., the first time I read it my therapist had recommended it to use to attack my own disordered eating habits. The second time I read it, last week, it was from a place of being recovered (an amazing miracle I was never totally sure was possible til it actually happened). The purpose this time was to access a perspective of potential patients.
    This book is a memoir and workbook from a woman who’s recovered from anorexia. Some people may find her (and her therapist’s) approach to disordered eating helpful: she externalized her eating disorder as a separate person (named Ed, short for Eating Disorder; thus, the title of the book). She talks about analyzing the criticisms and suggestions from “Ed” (like “you’re the fattest person in this room!” “skip a meal!” “binge eat and you’ll feel better!”, etc.) and learning to disagree with and disobey those thoughts. That approach didn’t resonate with me when I was struggling with eating, but maybe it would resonate with some of yall?
    Aside from “Ed”, something I like about this book is that it discusses behaviors that don’t necessarily have to do with eating but still indicate disordered thoughts related to food and body image (something I feel a lot of people likely have, even if they don’t have a formally diagnosed eating disorder).
    For example, she has an anecdote about being a completely different person in the mirror from one day to the next. Linked to this, she talks about the value of (at least temporarily) ceding certain powers away from yourself to give yourself a chance to recover. She quit weighing herself and gave her doctor and medical professionals the power to decide whether her weight was appropriate, whether she needed to gain or lose, and whether her weight was healthy. She knew she couldn’t trust herself or her perception of the mirror to decide whether or not she was at an appropriate weight.
    My question, for you to think to yourself- are there any behaviors or viewpoints you think would be better outsourced to someone you trust and/or love instead of yourself right now? Can you take a break from being preoccupied by your appearance and just let someone you love assure you that it’s fine and you can take a break from the mirror? Can you take a break from deciding what to eat and make an appointment with a registered dietitian to get a meal plan from him/her?  Use your tribe!
  • Book: The Gift of Fear. I am soooooo not a fan of self help books but this book really isn’t. Unless by “self help” you mean “something that actually gives you skills and confidence in your own abilities”, rather than the usual dumb lists of platitudes. The whole thesis of this book is that our subconscious mind has years of evolution that have contributed to its savvy about people and situations and whether they are safe or unsafe. Or, if you don’t like the idea of evolutionary psychology, that our “gut instincts” and “gut reactions” are actually smart. I feel like particularly as women we are told to override our instincts in order to “be nice” and this book really combats that. It’s hard to really describe, but you can get an intro to the author in this interview from Lenny. I particularly recommend this book for women.
  • Website: You can find a therapist/counselor/psychologist/psychiatrist at Psychology Today. My old shrink recommended this as a resource [note that I and everyone in my family says “shrink”. Not at all using it to demean the profession- honestly, in part I find it helpful to lump together all the previously mentioned professions under the heading “shrink”. FYI, the person I saw was an LPC!]. There are all kinds of mental health experts listed here, and you can read descriptions about their counseling styles/specialties. Something I’ve found helpful is looking up who’s in-network in your insurance and then cross referencing those names with Psychology Today. Just please, please don’t be discouraged if you get bad vibes your first appointment with someone. It’s okay to hop around til you find someone you better click with! That being said, it’s helpful getting some preliminary details from this site since obviously if you need therapy you want to connect with someone good for you ASAP.
  • For students: dude, take advantage of student health! Your appointments there are probably free- get a physical! If you are experiencing mental health struggles, get counseling! If you’re having issues with food, see an RD! These resources are usually available at larger schools and usually free to students. Get them while you can!

Hope you have all enjoyed these deep thoughts 🙂 If anyone is in need of a tribe member, shoot me an email at leleinthesky@gmail.com ! I don’t have a job right now! I can converse with you!

life lately

After I passed the RD exam I felt a little bit sorry for myself to be single and have no one special who cared that much about it.

So the next day, after a job interview (ultimately unsuccessful, alas) in Durham, I bribed Colton to have brunch with me to celebrate. As in, I was like “Please have brunch with me so I feel special. I’ll pay.”

He was ecstatic.

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A fancier, funner celebration- with the seester! Malindi was kind enough to treat me to celebratory afternoon tea at the Carolina Inn!

I loved my polka dotted teacup so much.

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It was the perfect occasion! Pretty place to sit, lovely service (kind and relaxed and attentive without being hover-y) and yummy food!

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In the savory department, we got cucumber sandwiches, tiny little pimiento cheese biscuits, and little roast beef and asparagus toasties (I think? This was a few weeks ago so my memory is not perfect, hahaha).

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In the sweet department, mini red velvet cupcakes, mini key lime pies, and pistachio macarons

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Not pictured: chocolate covered strawberries on the top tier 😍

And of course there was the tea itself. I got a coconutty rooibos which was SO good!

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And the absolute highlight- these uhhhhhhmaaaaaaaazing miniature scones. Oh my goodness they were warm and light and crumbly and tender and delightful. They came in two lavors: plain, and cranberry-almond.

And we got homemade lemon curd, devonshire cream, and apricot jam on the side.

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I could have eaten 10,000 of these.

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It was suuuuuuch a treat! We were actually meant to go to tea for a birthday celebration for me (in October… but then there was a hurricane and various other dramas). But it felt more special celebrating my professional success than the day I just happened to be born 😀

Speaking of being born, here’s some pics of my favorite baby. He started eating solids LIKE A LITTLE BOSS!

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Hello yes I love bouncing too.

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Something not so fun- we had a rather dramatic water outage in Chapel Hill/Carrboro. Something happened with water being overfluoridated (?!) and also a water main break and it resulted in this situation:

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Driving to Durham to pick up a water stash because it was all quickly snapped up in CH.

It was rather unfortunate timing since I’d invited several friends over for dinner the night the water shortage began. Thank God I’d prepped a lot of the food in advance so that was less of an issue… but the bathroom situation was frustrating since we literally couldn’t flush the toilets and had to just dump in buckets of water… and then wash our hands with water bottles! Anyway, it was an adventure.

As usual, was too busy having fun with friends to take any pictures of the actual gathering (an impromptu celebration, once again, for me passing the RD exam. I have a lot of friends in the general health care field- an MD, an NP, a girl in social work school etc.- and they all understand the joys of licensing exams).

But the theme was breakfast for dinner and I made:

  • fruit salad
  • coconut blueberry baked oatmeal
  • this strata with bread, eggs (from my friend Steph’s chickens), brie, and roasted veggies

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There was also, of course, lots of wine.

Having wine corks around created a party for Lola Belle.

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By the next day I was kind of over not being able to flush a toilet so I went and hung out with the boys (Colton and Pranish) in Durham. We all ended up getting more brunch (hurray!) with another friend in Cary at the incredible La Farm. I got scrambled eggs with avocado and goat cheese and a cafe au lait. Here is Colton doing… something.

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A few days later, I had yet another celebratory dinner with my friends Dan and Bethany and their adorable little T, whose hand is in this picture- can you see it? She’s three now and HILARIOUS. Definitely a threenager prone to fits of sudden rage, but also articulate and hilarious.

It was gorgeous out so they grilled.

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Once Colton passed the RD exam, a theme having been established, we got brunch again. This time at Rise, where I got a King Cake donut. Excellent!

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As for the rest of the time, I’ve been maniacally applying for jobs and, for sanity, taking gazillions of long walks. Thank goodness for this good weather! Well, it’s a sign that our planet is horribly ill, so actually no. But the warmth has meant that I have a virtually limitless source of exercise for free, which is very very good for both my mental health and (frighteningly limited) budget.

I’ve been going to the UNC arboretum on basically a daily basis. The gardeners there are amazing- as one thing fades, another thing starts to bloom. Right now we’re having the ascent of the azaleas as we say goodbye to the magnolias.

The magnolias were amazing though!

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So many different varieties!

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What is the name of this flower, please? It is so sweet!

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Many many colors

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How is everyone’s life lately?

sadder days

So I had a bit of radio silence, obviously.

I spent several days trying to articulately put together a post about the death of someone without whom the world is a much darker place. But I didn’t get very far.

Suffice it to say that I’ve lost family, not related-by-blood family but related-by-godparenting and love and all the real family stuff family. Shortly after my parents’ divorce my mom, sister and I started attending a new church and met Susan and Joe and the rest was history- they’re the best people ever. They looked after Malindi and me (ages 5 and 8, respectively) while my mom sang in the church choir and ended up being invaluable friends to our whole family. We must have been practice children for them, because they now have two beautiful daughters. We got to watch them bring the girls home (they were adopted from India)  but then had to love their family from afar because their family up and moved to Saint Louis in 2005. My mom and Susan continue to have phone calls that are infrequent but legendary because they often top two hours in length. We got to see Joe in person when he made an occasional business trip to the DC area. We admired their oldest daughter’s Etsy store and bought some of her fabulous merch.

And then, because there is no justice in this world, Joe got a brain tumor that ended his life way, way too soon. All I can really say is that Joe was very, very kind. And gentle spirited. And funny. And dedicated. And took care of everybody. And was a walking embodiment of what a good Christian, a true Christian, is. And all the horrible human beings walking around in perfect health make me so so angry sometimes. But of course that is not kind.

Anyway, a silver lining to my current (seemingly terminal) state of unemployment is though I am broke as a joke the resource I do have available is time. Time I can use to be there for others.

So, I drove to Saint Louis to attend the funeral (my mom was there too for this part and I got- more silver lining- unexpected time with her). And then I stayed a few days extra to spend some time with the girls (now aged 14 and 16).

Obviously pictures were largely not appropriate, BUT I loved their cat, who was clearly just incensed at how many people had invaded her house. When I was sleeping on their fold out sofa, she came in and just stared at me with this hilarious expression on her face.

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My mom and I took one of the girls to the (remarkable) Saint Louis Zoo. I was reminded not for the first time that I am not even remotely spatially oriented, and it took us five-ever but we managed to find these penguins hidden in the back of the zoo. Worth it. I love penguins so stinkin’ much.

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And we also got manicures with teenage girl enthusiasm.

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Driving from NC to MO was quite the undertaking, and I’m proud of myself for being a capable 21st century woman and pulling it off. I thought I was so savvy checking both the NC and MO weather, but neglected to consider that I’d be driving through West Virginia mountains en route. Driving through the snow was quite intense, but honestly the gnarliest part was how disgustingly filthy my car got from snowfall and the nasty de-icing stuff they have on the road.

On the return trip, my sanity was tested when I was on what was supposed to be the last hour of my trek, near Winston Salem, NC, and for God knows what reason these four cop cars pulled out unexpectedly, lights on, and blocked every single lane, forcing us to drive behind them, no exaggeration, at five miles an hour. I guess it was meant to prepare us for construction and ultimately the highway’s narrowing to a single lane. But why we had to do this for 20 minutes before reaching the construction area I don’t know. Also, when it was first happening my first thought was that there was some kind of motorcade (I actually checked the POTUS twitter feed) and my second thought was that this was a punishment, a la Bridgegate, for one of the most liberal regions of North Carolina. Because in these dark times I am much more of a conspiracy theorist than I used to be. (We’d already had a suspicious water outage, JUST SAYIN).

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I returned from Saint Louis sick. Not really a surprise- one of the girls was sick (poor thing had been spending tons of time at the hospital with her dad, hadn’t been sleeping, had obviously been incredibly stressed) and traveling always does a number on your body.

The cat was so so precious and took good care of me. I was coughing lots and my whole chest was inflamed and having a sweet warm fluffy thing on it was amazing.

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My eating is APPALLING when I’m sick. All carbs all the time. Though actually there’s some evidence this may be adaptive when you have a virus (but not a bacterial infection!) But anyway my diet consisted of a lot of crackers and chips.

This popsicle (local company) was super great.

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And the first “meal” (<< loosely defined) I actually “cooked” was:

  • a Thai Kitchen soup packet
  • threw in some kale because then it’s healthy yeah sure
  • fried egg on top
  • hot sauce

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I spent too much money on fluids because my throat got unbearably dry if I went about 30 minutes without drinking something.

This is freaking delicious:

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Less-exciting iced tea. I finally got out for a walk and then had to stop for a few minutes to sit and get my air back at a coffee shop.

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And then once I was well I celebrated by making chili. Let’s be real, the best thing about making chili is the toppings. Cheddar, avocado, Greek yogurt (sour cream is more delicious but Greek yogurt is more versatile).

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And to apologize to my body for the days and days of chips and little else, I made a few green smoothies.

  • fruit: sometimes banana, sometimes clementine, sometimes both
  • milk
  • protein powder (I have chai spice flavored, mm)
  • kale

I have learned that an immersion blender does an astonishingly good job. You are volume limited, but I still find it waaaaaay better than the cheapo blenders I have traditionally owned. And more versatile, and so easy to use for soups and things.

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recent cooking- when winter acts like spring

A trip to the arboretum, whilst listening to review recordings for the RD exam.

You would never guess it was supposed to be winter, right?!

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All these blossoms are beautiful, but make me scared, one because there might be another frost and they’ll die and that’ll be sad, and two because eventually they will be everywhere and there will be pollen and North Carolina will again try to murder me via allergies.

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How I eat during fake winter with warm weather:

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A lovely breakfast- Trader Joe’s multigrain waffles with a chopped up pear and lite syrup on top.

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An egg delivery from my friend Steph! As you can see, her chickens are Nasty Women- yes, that is chicken sh** all over the eggs.

But no worries, once you wash them, they are delicious. Lola agrees.

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A common misperception is that eggs are fresh and high quality if they have bright orange yolks. While bright orange yolks can be from chickens out free ranging and eating a wide variety of nutritious eats, they can also be artificially made in feedlot chickens by giving them food with pigments in them, like marigolds.

To really tell if an egg is super fresh and high quality, look at how the yolk stays centered and upright in the white.

Like this exhibit- amazing, right?! A yolk mountain!

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A summery brunch (brunch, meaning once again I didn’t get my life together enough to eat breakfast, so this was an extra-big lunch that included components of both meals): tomato soup, roasted carrots and apples (I roasted them with some leftover hard cider poured on top- THAT was a tasty choice!), and a piece of toast topped with a fried egg and some smoked mozzarella.

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A less gigantic lunch: tomato soup with some leftover roasted potatoes mixed in, and a piece of avocado toast.

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THIS! THIS WAS GREAT!

So initially when my best friend convinced me to go to Sweetgreen in DC, I scoffed. I found it offensive to pay that kind of $$$ for salads.

Buttt, guuuyyys, Sweetgreen is so so delicious. And if like I do you like your salads with a gazillion toppings, it’s not all that cost-effective to make them at home, particularly if you live alone, because you have to buy big quantities of those toppings, the excess of which can end up going bad and being wasted. Wasted along with your money!

So I’m on board with getting Sweetgreen every once in awhile when I’m up visiting the fam. The last time I got in on that, I had a nice autumnal salad that, for once, seemed fairly easy to make at home because a lot of its ingredients were staples.

So once I was back in NC, I sought to recreate it! Here’s the mise en place.

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Toppings are: fresh basil (I’d already bought for some other recipes), fancy white cheddar (since I was only buying ~3 oz to make two batches of this salad, I went for it and got a local crumbly crystally raw milk cheddar that was freaking incredible), pecans, apples, and pears.

Plus a homemade balsamic vinaigrette made with dijon, maple syrup, balsamic (obvi), and olive oil, emulsified with my immersion blender.

At Sweetgreen they put this on top of  mix of kale and spring greens, but I just used kale. It’s much more of a staple for me because it is much slower to go bad.

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I think using a big mixing bowl for salad and using tongs to toss it makes it SO much more delicious. It evenly distributes the ingredients, makes sure everything is coated in the yummy dressing, etc. A little more work/dishes but a much bigger payoff.

Also, it’s always a good day to use my adorable pink pig tongs (thanks Malindi!)

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HIGHLY recommend this salad. Super delicious.

Another free-spirited meal.

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Shredded carrots with more of that balsamic vinaigrette, topped with poached eggs (a Mark Bittman suggestion that’s so much more than the sum of its parts).

Plus, less healthily, bread and pimiento cheese 😍😍😍

I made another batch of the carrot/poached egg mixture, and served it with some leftover eggplant cutlets (bought frozen at Trader Joe’s- delicious!)

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Despite the fact that I have literally never fed Lola from the table she is ALL OVER human food. Little punk.

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The eggplant cutlets were left over from THIS amazing creation:

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  • Eggplant cutlets, baked per package directions
  • Tomato sauce mixed with crumbled sauteed tempeh
  • fresh basil (more utilization of leftovers!)
  • Sprinkling of parmesan (without this, the recipe would be vegan, and still delicious. But of course with cheese it was even more delicious!)

Finally, I was quite inspired by this post in Cup of Jo and noted that quite a few readers gave a shoutout to this recipe for pasta with Greek yogurt and caramelized onions. So I made it (halved the recipe but otherwise pretty much followed it exactly), and enjoyed it for dinner with my sister. It was indeed delicious.

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So now that I’ve done all this sharing about my meals, what has everyone else been making lately?

recent cooking- when winter acts like winter

We had a North Carolina “blizzard” in January. The weather blokes forecasted all kinds of gloom and doom and 9-12 inches of snow and of course this is what we ended up with.

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Which was fine with me. It was pretty. And we didn’t lose power. I actually came to some pretty powerful self-realizations about my need for control because I get SO ANXIOUS about power outages! Like, what is the worst thing that will happen? You feel cold and have to throw food away. It’s hardly the end of the world. Yet it triggers powerful, even physical, anxiety symptoms. Something for me to think on further!

But power stayed. And we spent cozy days mostly in the house, staying warm.

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Plus occasional outings on foot so as to prevent cabin fever.

I admired the many species of nightly visitors to my front yard.

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This is as good a time as many to mention that my roommate received one of the funniest holiday cards I have ever beheld.

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As for the food- as promised, I have been doing more cooking at home and it’s been very good for me. It’s amazing how quick that mental reset happens if you just dedicate a few days to committed home cooking- your brain goes from “Where am I going to buy dinner?” to “What will I make for dinner?”

Which is a relief. Behavior change seems daunting as one contemplates it, but then doable once it’s begun.

Breakfasts:

Nothin’ wrong with oatmeal! This one with apples, almond milk, and pepitas on top.

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This one with banana, milk, and PB2 mixed in (I don’t think I’ll buy PB2 again. Not as fun as I thought it’d be)

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Truthfully I am not always the most reliable about breakfast. One day I went out and ran errands (actually maybe this was a babysitting day too? My post-graduation schedule has been so odd) and then I wanted to stop at the library because it was geographically convenient but I hadn’t eaten or had caffeine so I was a little woozy.

AND THEN THERE WAS A POP-UP COFFEE STAND AT THE LIBRARY.

Coffee. Plus free book rentals. The mother ship calling me home.

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Some typical lunches and dinners:

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English muffin with 1/2 an avocado mashed on top and (new favorite) Trader Joe’s all purpose seasoning. Plus a bowl of carrot/cashew/chickpea soup.

These way-too-expensive but way-too-good chips rounded out the meal.

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This meal was also Trader Joes’ fault.

I thought to myself, “It’s Thursday and the storm isn’t supposed to start til Friday night! I’ll go to Trader Joe’s after the dinner time rush and stock up! How crazy could it be!”

Well, I guess the teeming hordes had already passed through but the shelves had a rather Soviet Russia look to them. Everyone had already frantically gathered the ingredients for their all-important milk sandwiches.

HOWEVER. They still had samples. Samples of macaroni and cheese and hot dogs aaaagh!

Then I made my own and I added kale. So it was nutritious right. Right? Right. *wince* *salivate too though*

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This was not a combination I regularly received as a child but dang it made me feel safe and comforted nonetheless.

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Kiwi afterwords.

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Let’s be real, in the winter we want hot carbs. That is just life.

This night I had the oven on so I went all-out.

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Oven fries with olive oil and more TJ’s all purpose seasoning aaaand… cornbread in a cast iron pan ❤ I used this Cooking Light recipe and, per the advice of recipe commenters, added a few tablespoons of maple syrup to the mix to add a bit more moisture and sweetness.

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Grilled cheese and tomato soup for another meal. Classic for a reason!

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Have we gathered yet that this is a real carb parade?

Another day I legit ate stuffing for dinner. I semi-recreated a recipe I’d made for Thanksgiving that included roasted artichokes and parmesan. Added some extra veggies (lots of mushrooms, and carrots). Still pretty carb-y!

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This one below is definitely not the most appetizing looking thing I’ve ever made but it was pretty good:

  • First I made sauteed brussels sprouts (used frozen). But they were kind of mushy and I wasn’t wild about the seasoning mix I’d used.
  • Then I thought ooh! I’ll make brussels sprout tots! So I whirred them up with some potato/garlic/seasoning/kind of forget what else. But it still wasn’t so good.
  • So then I thought ooh! I’ll make tater tot nachos! So I topped the tots with Trader Joe’s veggie chili, sauteed mushrooms, reduced-fat shredded cheese, hot sauce, and plain greek yogurt. At that point it was pretty tasty. But that’s basically cause the original taste of the brussels sprouts was lost, hahaha.

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I’m a big fan of the TJ’s veggie chili.

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The day I made the recipe with avocado it was even better. Obviously.

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As for the treat department:

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Camille brought some of these yuuuummy ciders from her hometown when she was staying with me over graduation weekend. This one is made to be champagne-y (no idea how that works in the brewing process?) and is delicious.

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Claire brought me this cardamom chocolate bar from India.

Description on the back of it is freaking PRICELESS.

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Evening snack: I’ve been hanging out a lot with The Boys (Colton and Pranish). They give me a lot of sh** because, like so many men before them, they find me hysterically funny when I’m annoyed/offended. But occasionally they take their antics a bit far and I get genuinely mad at them. And then, like so many boys before them, one of them will go “Oh God, I’m sorry, can I cook you something?” Thus these scrambled eggs and this comically huge piece of buttered bread, made by Pranish. A tasty evening snack mid-Star Wars movie (Colton and I have watched the whole Original Trilogy plus The Force Awakens). I ate all the eggs but admitted defeat about a third of the way into the bread, and fed the rest of it to Colton.

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When I was home for the march, I ate lots of yummy meals and, as usual, regressed in many ways.

Here is some mashed squash to which I added (again!) Trader Joe’s all purpose seasoning, plus some cheddar. And for protein, Trader Joe’s frozen chicken-less nuggets, with honey mustard for dipping.

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This was a small meal, and my mom’s house always has tasty treats, so rest assured that I then got my snack on.

Granola bars bought in bulk from Costco.

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Choco caramel biscuits
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Etc.

On Inauguration Day I knew I wanted to spend time with good people and wholeheartedly avoid the TV.

Meanwhile, my friends were converging on DC. Claire and I were up for the march, Nate is living there and interning for the Academy of Nutrition and Dietetics (yay Nate!), and Colton rode up with me to see his bae, James.

So, I said, “Let’s all get Korean bbq in my wonderful hometown!”

So we did, at Il Mee, where the carnivores can get all the bulgogi their heart desires:

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And those of us with a more pescetarian bent can get all the sushi our heart desires.

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The crew:

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So those are some recent eats for cold and gloomy days. But North Carolina gave us about two days of real winter and now it’s in the 60s-70s. So more to come about eating inspiration for when the weather is warm (with the EPA on the chopping block and more climate change to come, probably more relevant! 😁)

trust me, I’m a dietitan!

OH HEYYYYYYY TODAY I PASSED MY RD EXAM! Registered Dietitian right here, hollaaaa! I haven’t wrapped my mind around it yet. So in the meantime, here is a long overdue post about my last internship, in which I interned in the Neonatal Intensive Care Unit (NICU) in a hospital in Winston-Salem, NC.

We’ll start with a lovely photo from the corporate lactation meeting I attended, as one does.

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To be clear, corporate lactation= meeting of lactation consultant managers from the various hospitals belonging to one corporation. Not some weird business milk-a-thon.

The meeting was really more of a retreat, at one of the lactation consultant’s lovely lake houses. So interesting to see all the complicated aspects of providing this care- both the science of helping mothers, and the management/business side of things of dealing with billing, charging for nursing supplies, etc.

Because the meeting took place in the South, there were of course complimentary meals. Say what you will about the South (and I have plenty to say, especially about the total nonsense that has been going on in NC), I really love the Southern tradition of hospitality. AKA feeding everyone who comes anywhere near your home/office, anytime resembling a meal time. It reminds me of my family’s Greek tradition 😀

This was chicken chili that was SO SO GOOD. Especially eaten by the lake.

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Okay so let’s talk life in the NICU. Here is a bed and an Elmo diaper awaiting a baby!

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Working with a NICU dietitian was SO interesting. To review my preceptor:

  1. Does nutrition assessments on the NICU babies and made recommendations to the medical team about feedings. For example, adding extra protein for a baby whose growth was poor, or adding MCT oil for a baby who seemed to be having trouble absorbing nutrients. Sometimes we had to fight with the doctors because they would “forget” about our policy not to ever use powdered formula in premature babies (here’s why) and do other silly things because doctors are sometimes silly.
  2. Conducts hospital based research in the NICU, mostly related to breast feeding.
  3. Serves as a lactation consultant for moms with a baby in the NICU (helping with breastfeeding and pumping).

I was especially lucky because my preceptor was honestly so busy she just let me work independently out of necessity, so I would get to go on rounds with the NICU medical team (attending physician; nurse practitioner and/or resident and/or medical student, who’d present each case; nurses; sometimes pharmacist; sometimes social worker).

Things you worry about in premies (obviously the neonatologists are thinking of a lot more things; managing ventilators and temperatures and crazy things like that. I’m concerned with the nutrition side of things, which is obviously also very important in premies):

  • Intake of the right nutrients. Breast is best, and that’s also true (though harder to document) in premature babies. However, premature infants aren’t really supposed to be out of the womb drinking milk- they’re supposed to be in a uterus, drinking amniotic fluid, not having to breathe, etc. So while human milk is the bomb, in the NICU, premature infants have to have their milk mixed with human milk fortifier, aka HMF, which adds extra nutrients, among them protein and bone-building elements like calcium. As someone crunchy it pains me to see HMF, a cow’s milk product going into a premature baby whose mother has abundant breast milk. Which is why it’s so exciting to see that there has now been a HMF developed that’s made using entirely breast milk!
  • Immature guts. You want to give them breast milk so they get the immune benefits (and because women’s bodies are amazing and worthy of awe, breast milk produced by mothers of premature infants is higher in protein and calories than the milk of mamas of term babies). However, feeding them too much too early can overwhelm the cells of the developing intestines, which can only absorb so much. Your worst case scenario is necrotizing enterocolitis, in which the cells of the intestines literally start to die. This can result in a baby needing surgery (and potentially getting a lot of their gut removed, resulting in short bowel syndrome or other issues with absorbing nutrients). This can also result in the baby’s death. The good news is that babies who get breast milk instead of formula are much less likely to get it (and in our hospital- and many others- we had the policy that preterm babies who were below the age of highest risk of NEC- about 34 weeks- qualified for donor breast milk if their mama couldn’t provide her own milk).
  • Immature brains- it FREAKED ME OUT how routine brain bleeds were. Like, they only treated them if they were severe. Like, wut?!
  • Reflux. I know that’s par for the course with term babies and is just an annoyance; but in preterm babies when they reflux they often stop *breathing*. This is obviously a real big problem.
  • There were babies on crazy amounts of antibiotics. Obviously an infection can decimate even a term baby’s immature immune system and kill them so so quickly, and premature babies are even more at risk- I am not at all critizing antibiotics use. However, it’s a little scary to think of the effects of removing all bacteria, good and bad, from these babies’ newly developing systems. It’s also scary seeing them on vancomycin and other antibiotics of last resort when they’re this little. What happens if they get older and get sick again and the antibiotics don’t work?!

In other news, I GOT TO SEE A C SECTION.

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A team from the NICU is always present during a C section (and also during vaginal deliveries when they see meconium in the amniotic fluid, and I’m sure other higher risk conditions too). Dude, C sections are INTENSE. I was pleased with myself that I still seem to have a solid tolerance for blood, cause it was all graphic! The incision is small (I mean it’s bigger than baby’s typical exit route- and seriously, GO MOMS FOR MAKING THAT HAPPEN) and it is pretty rough process on the baby- I saw one doctor kind of stick her hands behind this bump in the belly from the outside and start shoving HARD and the other doctor dig his hand inside the incision and yank the baby out by the head. After they announce the baby is out, a nurse hits a timer and they wait 30-45 seconds to clamp the cord (I thought delayed cord clamping was just a practice used for premies but they do it for all babies at this particular hospital). Then they bring baby around to see mama for a minute (they have a big sheet hanging up so mom doesn’t see the doctors cutting into her body, just like in the movies) and then they bring the baby over to the warming table. Ordinarily, this would be pretty much the end of the role for the NICU team- they smack the baby on the feet and rub the baby off with some towels and then the baby cries. BUT. This baby had to be revived and wasn’t breathing. It was amazing watching the NICU team at work- one had a stethoscope to the baby’s chest and would hold up her finger in time with the heartbeat, another put an oxygen mask on the baby and started CPAP, and they continued to try to stimulate and annoy the baby enough to start crying and breathing. But it ended up that the baby needed to be intubated! It all happened SO QUICKLY and SO EFFICIENTLY. I was really in awe of this team.

Fortunately, I followed that baby’s case and the baby was fine and was discharged fairly quickly. However, I’m sure it was terrifying for mom and dad (the mother’s first question was “Can I still breast feed?” because WOMEN ARE AMAZING. And she did!)

While there are circumstances you cannot control (as in the case above, in which they ended up thinking the baby had aspirated meconium and that’s why it was so difficult for the baby to start breathing), there are some you can.

How to keep your baby out of the NICU:

  • Know your STD status! Seriously. They can be managed beautifully, but only if we know about them and mama does what she needs to do to prevent transmission to her baby. I saw HIV positive mamas do a beautiful job with managing their medication during their pregnancy to prevent disease transmission to baby. However, I also saw babies in the NICU because mama had never gotten a herpes diagnosis. Yes, herpes is a drag as a grownup but if you are a baby delivered when there is an active outbreak, or without mom being treated with an antiviral, you are at HIGH RISK of getting encephalitis and dying. It is scary business. And unfortunately we saw a lot of cases where partners have not been honest about their status, so don’t rely on them for truthful information (isn’t that terrible?!)
  • Get your diabetes managed before pregnancy. That means get your sugars tested to make sure you aren’t diabetic before getting pregnant (in general, a pre-conception visit to your medical provider is a really great idea).
    • If your sugars are running high during your pregnancy they are going straight to the bebe. That means you can end up with a really really big baby and increased risk of all kinds of dangers at delivery (the baby getting stuck on the way out and getting shoulder dystocia, which can lead to permanent nerve damage; increased likelihood of a C section and all the attendant risks).
    • Also, glucose crosses the placenta but not insulin. That means that your baby gets a steady diet of SUGAR SUGAR SUGAR while they’re in the womb and their poor little pancreas has to work overtime to get the sugar out of their blood and into their cells. Then, when the baby is delivered and cut off from their mama’s blood supply, their SUGAR SUGAR SUGAR abruptly ends too, but they still have all this insulin. That leads to hypoglycemia, which can make a baby critically ill and mess up their brain. It also usually ends up with baby in the NICU to be observed, separating baby from mama and making establishment of a good breastfeeding relationship much harder.
    • But wait there’s more! Mamas with uncontrolled diabetes also deliver babies with more birth defects (major congenital anomalies occur two to four times more often in infants of diabetic mothers than in infants with non-diabetic mothers- things like mis-formed spinal cords- bad news!) The good news is that a lot of this risk seems to be associated with poor glucose control in the first trimester, so if you can get your diabetes under control before pregnancy, your baby is at much lower risk.
  • Be a healthy weight before pregnancy. Being obese increases your risk of all the dangers of a big baby discussed above. But being underweight is also a problem- it’s a risk factor for preterm birth.

A few other non-medical conclusions I came to in the NICU

  • Research is horribly difficult and I commend anyone who does it. Obviously it’s no secret that conducting a methodologically sound study requires a lot of attention to detail, but I was kind of blown away at quite how much there was when I helped my preceptor on her manuscript about human milk feeding in the NICU and brain development at 18 months. By the time I came on board the important decisions had already been made about how to track the data, what covariates to analyze, etc., but those decisions had taken relatively little time in the grand scheme of just the lengthy to do list for the project. Sometimes I feel like “Oooh, I’m so fancy, I have a masters degree, I know fancy things about biostatistics” and then I got very humbled doing the actual sausage-making of research. Also, there was a huge capacity for human error! I assume my preceptor will end up submitting spreadsheets we made along with the completed manuscript for publication, but the reviewers basically just have to trust us that we didn’t make up the numbers! That we didn’t make math errors (there is WAY TOO MUCH DATA to check each individual calculation- I did my best to check as I went but I wasn’t about to go back and go through everything!)
  • Breastfeeding is also difficult. Premature babies don’t at all have the reflexes to actually nurse at the breast until ~34 weeks gestation but even then, even at full term, it can be very very difficult! It’s a lot to ask of the baby (creating a vacuum with their mouth, which is impossible if there’s an anatomical defect; properly coordinating sucking and swallowing; staying latched on and in the right position; grabbing enough tissue with their mouth to effectively remove milk, etc.) and it’s a lot to ask of the mama (especially deciphering a baby’s hunger and fullness cues, and figuring out whether baby has actually gotten enough since the whole process is basically invisible). It’s amazing and beautiful and we need to give nursing mothers all the support we can. Everyone who wants the Affordable Care Act/”Obamacare” to be repealed- know that you’re taking away insurance coverage for breast pumps and lactation counseling for new moms.
  • Mothers still die in childbirth. We saw it happen once and it was awful awful awful. The NICU nurses (obvi amazing human beings) did everything they could to support the father and this new baby. And the hospital waived their usual policy not to give donor milk to older babies and gave this sweet little baby donor breast milk. But it is SO TERRIBLE that it happens. I think about everything my mother has been to me, for all 28 years of my life, and can’t imagine the kind of hole that leaves for the rest of a family to try to fill.
  • Watching a family together after the birth of a child gave me All The Feels. You look and you think, God, this should be such a perfect unit. Mama is this amazing baby-grower and milk-provider, and Daddy is there all supportive and anxious on behalf of mama, and they are both so so tired, and so so excited. I would think about how statistically in the coming years many of these unions would not stay intact, and many of these mothers would be left on their own (or fathers, as above). And it made me so, so sad. All these new humans avoided to be surrounded with this safe, protective love. There were lots of extended families at the hospital, which was beautiful and lovely, but honestly there were times I went into a family’s room and there was this exhausted woman who clearly wanted to just pass out and there were scads of relatives sitting on the bed and making noise. There’s something beautiful about just a baby and the two people who made it sharing this little space for awhile. (Caveats: the two people who made it can of course be two men or two women. It’s just so hard for someone to do it all alone, even if they have the support of more distant relatives!)
  • Now for a briefly horribly depressing note. One day I was taking the elevator upstairs to the NICU and sharing it with me were a pregnant woman in a prison uniform and the police officer accompanying her. My sincere hope was that she was there for a prenatal appointment and would be out of jail by the time she delivered. It still upset me- but that wasn’t even the part that I’m writing about. I told my preceptor how I’d winced seeing the woman. She said, “Yeah, what we see is typically that women who are victims of abuse are the ones who get in trouble with the law. They are in abusive situations and try to get out but don’t do a very good job.” Then she shared a horrifying story with me which you have permission to skip. So two new parents went and visited their brand new, preterm baby in the NICU. Then they walked back to return to the mother’s room in Mother Baby. As the mother walked through the door with her back to the father, he pulled out the gun he had brought to the hospital and shot and killed first her and then himself (story about the case here). I have actually struggled to talk to anyone about how much this upset me. At this point, my preceptor began explaining to me about the new safety precautions the hospital was taking since that incident (the NICU will be a locked unit, people will have to present their ID each time they want to come in, people with a criminal record will be banned. Though I heard no talk of metal detectors or anything preventing guns coming in, *sigh*). As my preceptor wisely pointed out, people in hospitals are VULNERABLE. They’re sick, they’re weak, they may have been hospitalized because they’d already been victimized in some way. I have unfortunately witnessed in my personal and professional life that domestic violence may come to a head during a pregnancy. When I was at Wake Forest (more on that later), there was a baby born with a brain bleed that was attributed to the physical abuse inflicted on his mother. SO. Public service announcement. Those of us who are RDs, or RNs, or anyone in health care, we come into contact with vulnerable populations EVERY DAY. Regardless of your setting, think of who you encounter: Older adults. Children. Pregnant women. People who are poor. People who are homeless. People with disabilities. If nothing else, we need to have the statistics in the back of our mind and we have to be aware that if it’s that common, we should be looking out for it. 1 in 3 women and 1 in 4 men are victims of some form of physical violence from a partner in their lifetime. In the last year tracked, there were 108 cases of domestic violence related homicide in North Carolina. The NC Coalition Against Domestic Violence has some warning signs to look for here. Let’s be real- it’s probably fairly easy to miss domestic violence in many patients. Yes, most hospitals work some kind of screening into the questions they ask a patient on admission (i.e. “Do you feel safe at home?”) but a bored looking CNA asking this question to someone who’s likely in physical pain and just wants to get to a doctor is not likely to elicit the most meaningful information (especially if the abusive partner has accompanied the victim to the hospital). Once the medical team gets to a patient, they’re very focused on the “Problem List” of physical ailments. Hopefully the nurses can catch something- Lord knows, they seem to know everything about patients! But I still maintain that if we’re going in to patients, we’re asking open-ended questions and coming across as sympathetic and like we may have more time to listen to someone than the average doctor who zooms in and out of their room, that we should pay attention if we end up getting a cry for help from a patient. However small. I’m not suggesting any of us go in and try to save the day, but a well-timed phone call to social work tipping them off that you got a weird vibe may be helpful. Other settings may have other things RDs can do which could help protect victims of domestic violence. Arranging for a ride for someone who has no car, who has been socially isolated by an abusive partner, who just wants to get to her mom’s house (which my preceptor did for a WIC mother last summer at the health department). Providing information on safety planning ( <— this site has really good information for pregnant women) for someone who may not be ready to leave an abusive relationship today but wants to maybe start taking steps toward doing it in the future (and needs to protect him/herself as much as possible in the meantime). Finding a pretense to get a patient alone to make sure there isn’t something that they want to say but are afraid to have an abusive partner witness.

More intense business: I also got an opportunity to spend a few days at Wake Forest’s hospital because they have a Level IV NICU. That means I got to see babies with more serious conditions such as:

  • Babies with congenital abnormalities that are beyond what can be addressed at a smaller hospital (there was a baby who they were wondering could’ve been affected by Zika aaagh!)
  • Babies who need ECMO. I did my case study on ECMO this summer and it’s crazy- like dialysis but it’s doing the job of your lungs and/or heart instead of the job of your kidneys.
  • Babies who needed surgery. Sometimes due to congenital abnormalities, sometimes due to complications they’ve suffered due to prematurity (like necrotizing enterocolitis, brain bleeds, retinopathy of prematurity etc.) Look at this gorgeous diagram below!

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Seeing the RD in action at Wake Forest was AMAZING. She was definitely practicing at the top of her field and they actually had HER teaching the MEDICAL RESIDENTS how to do things (this is a big deal; if you work in health care or know anyone who does you are probably aware of the many God Complexes on display in the medical field).

However, it was really intense seeing how sick these babies were. When trying to feed the babies, the dietitian and doctors have a LOT they are working against- fluid restriction is common with the lung complications many babies have, many of the babies end up fat restricted (we saw one baby whose triglycerides were over A THOUSAND- normal is 150 or less- so they quickly had fats removed from their IV for a few days), many end up dextrose restricted (because they end up with crazy high blood sugars and insulin in neonates doesn’t tend to support lean body mass growth, only the growth of fat cells; so they tend to try to restrict the dextrose rather than adding insulin), they have all kinds of acid-base imbalances which can only be addressed so much with manipulating the oxygen-carbon dioxide exchange in the ventilator and also involves manipulating what’s added to the IV. All of these things result in babies getting LESS nutrition, and it’s horrifying seeing these shrinking babies (there was one baby who did not gain any weight for a MONTH- the prognosis was very poor).

In the long run, I don’t know if it would be too sad working with these sick babies with such limitations in their recovery. But I know it was really energizing being in a teaching hospital where amazing research takes place. Seeing all the medical teams bustling around was really exciting (and let’s be honest, there were some extremely good looking surgical residents. Greys Anatomy in real life!)

Something else that stuck out to me about Wake Forest was their AWESOME cafeteria. Stealth health at its finest- check out this gorgey burrito bowl!

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So it looks pretty standard buttttt…

  • It contained a ton of veggies (I chose butternut squash and asparagus), lean protein (black beans and shrimp), tasty but heart-healthy toppings (hot peppers, corn salsa, and guacamole; and no cheese!), and portion controlled fatty stuff (just a wee bit of the chip strips was enough to give a satisfying crunch)

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The hospital where I was most of the rest of the time was much less exciting, and expensive, cafeteria-wise.

So I mostly went to the Starbucks and got too many pumpkin spice lattes and (SO GOOD, why had I not known about these before?!) bean chips.

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As for the ol’ social life, as I did this summer, I joined a gym just for the duration of my internship. Working out is so so good for mental health. Also, honestly, in a town with not that much to do in the vicinity of my housing, I might as well do something life-affirming (exercise) instead of something self destructive (watch Netflix every day from 6pm til I go to sleep).

Sometimes my legs die and I have to sit like this for awhile.

Photo on 10-10-16 at 5.47 PM

I didn’t super socialize with my roommates in my student housing- I was lucky enough to not have to share a bedroom the whole time, which was SO NICE and SO not a guarantee- I just got lucky. I did, however, learn that one of my roomies had a birthday two days apart from mine so we and our other roomie at that time embarked on an Italian cuisine adventure at Di Lisio’s.

I got the gnocchi with pesto which was BOMB and lasted me two delicious meals.

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Then one other night my friends Kyle and Shaylen were in town (Kyle was looking at Wake Forest Law School) and we met up for dinner. They asked me for a recommendation and I was like “Er, I mean the only place I’ve really gone is Krankie’s but I know it’s delicious and a fun hipster scene.” So I went again!

This was a hoppin’ john esque creation: rice, black eyed peas, greens, and YUMMY chow chow (kind of a tangy/sweet onion relish?) on top. Plus cornbread.

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