learnin’

I made a big deal at the beginning of last semester about writing weekly updates. The idea was that I could look back and fondly reminisce about my grad school experience, and have an area where I had noted the new information I’d learned that really stuck out to me as important.

However, the inevitable craziness of grad school prevented that sort of meaningful reflection on a weekly basis. So instead I’m hoping to reflect on the semester as a whole. To that end, I took:

1. Nutrition through the Lifespan!

In case you couldn’t tell, this was probably my favorite class, thanks to getting to learn about MAMAS and BABIES.  (Also children, adolescents, and older adults, but what I really dug was MAMAS AND BABIES!)

placenta

Yeah son, that’s a placenta! Yeah it is awesome! If you want to learn more about how cool placentas are, watch this awesome Khan academy video.

This semester I’m working on a really cool project for one of the professors who taught that class- it’s all about mamas and babies, my favorite! It’s the Pregnancy Eating Attributes Study (PEAS!) So far, most of my responsibility has been calling pregnant women and reminding them to fill out their surveys- if possible, actually filling out their surveys for them. They are so, so happy and so, so nauseous. Bless them.

2. Nutrition Counseling, Communication and Culture

Key points I got were:

– 1 in 5 Americans are functionally illiterate! That means people across disciplines (not just in the nutrition and medical communities) need to get better at showing and not telling. We watched a really telling video from the American Medical Association about health literacy.
–  How to work with an interpreter (which is totally an art form)
– Cultural humility (a more advanced version of cultural competence)
– Motivational Interviewing, which is now my JAM! I already knew no one wanted unsolicited advice (ever. Don’t even bother.) but this included really helpful techniques for meeting people where they are and helping them make positive changes in their own lives, propelled by their own motivations. We used a lot of Molly Kellogg’s tips, some of which are listed here.
– Practice laws in North Carolina, which involved us learning about this craziness. (What that article doesn’t mention is that diabetics were arriving to Charlotte area hospitals with dangerously low blood sugar, and it turned out they were PAYING this guy for advice. Yeesh!)

3. Biostatistics… yeah. Not a lot to say about that one. Will note that Biostats and Epidemiology have both made me very very fond of the Spurious Correlations website.

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4. Health Behavior

Key thing: upstream matters a lot more than downstream. In other words, yelling at individual Americans about how they’re fat and lazy doesn’t do much to improve population level health. Despite the fact that we in America seem to love yelling at individual people and telling them to have willpower about any number of additional “failings” (poverty comes to mind). Instead, what helps for a healthier population (and thus a greater number of healthy individuals) is to make changes at the community, society, policy levels: ban smoking in public places, build neighborhoods with sidewalks and bike paths, give people a break on their insurance premiums for exercising, making sessions with dietitians affordable, etc.

5. Nutrition Policy Seminar

I took this class just for funsies! Some things we talked about included: school nutrition standards, GMOs, farm subsidies, food labels, and food waste, on which I’ll opine for a moment.

What sticks out to me is the HUGE amount of household food waste. It goes to show you, we think of restaurants as being so wasteful, throwing away anything leftover on our plates that we haven’t eaten, even if we don’t touch it, but we are so so so wasteful in our own homes! Our speaker noted that people speak promisingly about composting, but that’s not the best thing to do with food. Per the USDA, in descending order of efficiency, the best things to do to prevent food waste are:

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So now we’re caught up! Ish!

Now I’m working on:
– Epidemiology
– Environmental Health
– Health Policy Management
– Nutritional Biochemistry
– Medical Nutrition Therapy 1

So that last one: This semester, I’m taking my first (of two) Medical Nutrition Therapy class. MNT is the bread and butter, so to speak, of being a dietitian. You assess patients, give them a nutrition diagnosis, and work with them to make and implement an action plan to improve their nutritional status. Monitor, evaluate, then lather, rinse, repeat.

We recently learned something called the “9 Step Plan” which enables us to look at a patient’s needs for calories and protein (which we learn through calculations) and create a daily menu plan for them using the dietary exchanges (which were originally created for diabetics but are applicable to everyone- they’re actually the basis for the Weight Watchers points system).

Since I’d been at a funeral when we learned the Nine Step Method in class, my classmate Jenna was nice enough to give me an individual tutorial, so this is her (perfect) handwriting. This was a tall, fairly active man, so he got 2500 calories a day (sorry, ladies- you’d probably get less than this). As you can see, we opted to give this patient fairly standard macros: 50% of calories from carbohydrate, 20% from protein, and 30% from fat. If the person had a dietary condition, we may modify this.

First you convert calories from each of the macronutrients into grams (ex for this person, since he’s getting a 2500 calorie diet, he should get about 1250 calories of it from carbohydrates, which means about 313 grams)

Then you use the exchanges- there’s a pretty good explanation here. You first allot the patient’s servings of dairy (since that includes both carb, protein, and fat), then fruits and vegetables (to make sure they get lots of those healthy things!) then starch to fill in the remainder of the carbohydrate grams.

Then you count how many grams of protein you’ve included so much and add protein foods to make up the remainder (we did a mix of lean, medium and high fat proteins). Then you do the same thing with fats: count how many grams you’ve already given and give the amount of grams you have left with fat servings- preferably healthy ones like olive oil.

IMG_2017

Then you spread out those servings across meals. This person just wanted three meals a day. You could also include them in snacks, obviously.

IMG_2018

Another fun and educational thing we’ve done in MNT is use art to improve our clinical descriptive skills. It’s important to be able to accurately describe a patient’s appearance to others to better diagnose a patient. We’ve learned how to do anthropometric measurements (I can measure your tricep skinfold to assess body fat composition!) and how to use physical touch to assess for malnutrition (for example, when you run a finger along someone’s temple you should feel a toned muscle that gives resistance, rather than a squishy depression like a deflated balloon).

For an extra assignment, we went to the Ackland Museum of Art (on UNC’s campus) and split into groups. Each group was assigned a painting, and one person, the describer, looked at the painting and described it in as much detail as possible, and two other people, the drawers, stood with their back to the painting and did the best they could to recreate it.

My group was assigned this awesome Picasso.

picasso

And this is what I ended up drawing, based on the description of my excellent describer!

IMG_2009

Obviously, I took a lot of notes. Keys seemed to be:

– Starting with a big picture. As humans we remember the things we hear first the best, and any details that we add on later are more meaningful if we know them in the context of the big picture. Just having our describer saying, “It’s a Picasso” let us know that we wouldn’t necessarily be creating something that followed the normal rules of what a face looked like.
– Using analogy skillfully (“Her ear looks like a figure 8” is very helpful. Another group had someone say, “Her earring looks like a Lego piece”.)
– Being consistent about right and left (ex, “I’ll be talking from the perspective of looking at the patient. Her nose is on my left.”) Our professor reminded us how many people get surgery on the wrong side of their body because of right/left mixups!
– Using absolute measurements rather than relative measurements of where things are (for example, “Her nose is on the left side of the outline of her head” rather than “Her eye is above her mouth”)
– Avoiding making assumptions. We were confused when our describer said our person was sitting in a rocking chair, since we thought the painting was just from the shoulders up- how could she know it was a rocking chair? It turned out she had inferred that from the shape of the chair’s back, but it messed us up. It goes to show you, that old adage about what happens when you assume is pretty valid…

So that’s some of what I’m doing right now! I’m leaving out some complaints of biochem-induced suffering, and perhaps I’ll do a separate post about making the most of the Affordable Care Act. And another separate post about measles and autism, since we read the- NOW RETRACTED- original Lancet article that started that whole sh**storm. Anything else that people would like to hear about life in the best public school of public health in America? (Note that even though they are listed first alphabetically, we are TIED with Harvard and cost about 1/3 as much. Cha-ching!)

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