Breastfeeding is definitely not basic!

The past two days my fellow MSU dietetic interns and I were required to attend a “Breastfeeding Basics” class held by WIC.  Honestly, I thought it was extremely interesting but I think I might be more overwhelmed now than before!  We started out discussing the attitudes about breastfeeding.  While I was not breastfed (and I do rag on my mother for not doing so), many in my family have breastfed so it is not a new concept to me.  In fact both of my nephews and my niece were breastfed for some time.  I also hope that when it’s my turn to start having children, that I am blessed enough to be able to breastfeed too.  But not everyone has the same belief and attitude about breastfeeding as I do.  I know that there are people who are very uncomfortable with it, especially about the whole “breastfeeding in public” thing.  I mean seriously, if the woman is doing it discreetly then don’t have a hissy fit about it. Just my opinion. So no one better give me trouble when it’s me .  Newsflash – my breast is not some sexual object when I’m feeding my child. Grow up.

Our second topic of discussion was the consequences of NOT breastfeeding.  This one is huge.  Breast milk and formula are not equal. Not even close.  Here’s a quote from the Surgeon General’s Call to Action to Support Breastfeeding 2011: “There are health risks associated with formula feeding and early weaning from breastfeeding.”  You read that right – “RISKS.”  In fact, infants who are NOT BREASTFED are at INCREASED risk for:

• Otitis Media (Ear Infections)
• Gastroenteritis (Diarrhea)
• Severe lower respiratory infections
• Atopic dermatitis (Eczema)
• Asthma
• Allergies
• Childhood obesity
• Type 2 diabetes
• Childhood Leukemia
• SIDS
• Necrotizing enterocolitis (NEC)

But it’s not just baby who gets the short end of the stick.  Mothers who do NOT BREASTFEED are at INCREASED risk for:

• Breast cancer
• Ovarian cancer
• Postpartum depression

There are also non-health related consequences.  Formula feeding means more laundry stains, more bottles and nipples to wash, and more prep time.  There’s increased environmental waste (formula canisters end up in landfills + transportation costs).  The big hitter is the economic impact.  Formula costs about $1200-$1500 per year not including more doctor’s visits, prescriptions, hospitalizations, and wages lost due to staying home with a sick baby.  You know how much you hear how obesity costs our health care system?  It’s not alone.  “If 90% of US families could breastfeed exclusively for 6 months, the US would save $13 billion per year. 

We also learned about the anatomy and physiology surrounding breastfeeding.  I won’t go into too much detail about this one but basically a huge hormone party going on.  And we learned the importance of the first milk produced, Colostrum.  It’s low in volume but has high levels of antibodies for the baby, more protein and vitamins and less fat and carbohydrates than mature milk, and it coats the baby’s gut to keep out proteins that are too large and may cause allergies.  After the baby is born, the hormones prolactin and oxytocin help to produce mature milk by day 3 to 5.  I guess  a lot of mother’s get nervous when they are not producing a high volume of milk as soon as the baby is born.  This is actually not a big deal, the colostrum is enough for baby in the very beginning.  On Day 1, the baby’s stomach can only hold 5-7ml (size of a shooter marble).  By Day 3 it increases to 22-27ml (size of a ping pong ball) and by Day 10 it increases to 60-81ml (size of a large chicken egg).  We got these things called belly balls for examples.

If you’re worried about milk production, frequent feedings in the first few days helps milk production increase.  Some risk factors that may delay production include:

• Cesarean delivery
• Obesity
• Type 1 diabetes
• Hypothyroidism
• Mothers in their 40s
• Retained placental fragments

Using a breast pump might be a good idea to keep the milk flowing as well.

Another part of the class was about mother and baby together.  Here we talked about the importance of skin-to-skin.  I had no idea about this prior to taking this class.  Apparently if the mother holds her baby skin-to-skin after giving birth it

• Warms baby
• Decreases pain and stress
• Helps immune system
• Reduces infant crying
• Improves attachment and breastfeeding

Baby has been attached to Mommy for 9 months, they don’t want to be abruptly taken away and passed around with all sorts of weird smells and sounds and scary surroundings.  This is something I plan on demanding when I have children.  Nurse you are not taking my baby away to complete your little checklist of to-do’s.  I’m going to hold my baby close to me, no ifs, ands, or buts.

Another one of the big things that I got from this training was that baby knows what its doing.  They have an inborn ability to know how to breastfeed.  It’s pretty amazing if you think about it.  However, a good latch is the key to success here and mommy can help baby with that.  There are different positions and techniques so you just have to figure out what works best for you and baby together.

The last thing I’ll discuss is our review of nutrition.  Our breast milk is unique and the composition is constantly changing. If you compare breast milk with formula the differences are pretty vast.

Breast Milk	Formula
Water	Water
Protein	Protein
Carbohydrates	Carbohydrates
DHA/ARA	DHA/ARA
Fat	Fat
Vitamins	Vitamins
Minerals	Minerals
Enzymes
Growth Factors
Anti-Parasites
Anti-Allergies
Anti-Viruses
Hormones
Antibodies

For optimal nutrition, mommy should take prenatal vitamins.  However those who are very restrictive vegetarians, have Crohn’s disease or other malabsorption disorders, or have a history of gastric bypass/bariatric surgery, should see a dietitian.  Baby is going to need some supplemental nutrition as well.  When they are first born they will get a shot of vitamin K.  Those babies who are exclusively breastfed should also be given 400 IU of vitamin D per day because it is highly likely that mommy is deficient and already has a low supply.  Fluoride may need to be supplemented in babies older than 6 months if it is not in the water supply and Iron will be in solid foods starting at 6 months of age.

There is a lot more information but I think this post is long enough and you get the picture.

While I am neither pregnant nor breastfeeding, I’d say my nutrition was pretty good the past two days.  The Kellogg Center in East Lansing has some really good food!  For breakfasts I had oatmeal with berries, extra fruit on the side (pineapple and grapes), a couple eggs, and coffee.  I was too hungry for pictures at that point in the morning!  Lunches were very colorful and delicious as well.

DAY 1 – Caeser Salad, White Bean Salad, & Sundried Tomato, Zucchini, & Goat Cheese Pizza. (Dessert unpictured: a mini éclair!)

DAY 2 – Caprese Salad, Caeser Salad, Veggie Mix (mostly zucchini), Penne w/ spinach, & Garlic bread (Dessert unpictured: tiramisu!)

It’s okay that I had dessert at lunch two days in a row. Not only did I go to the gym, I also danced my booty off with the other interns on Tuesday night. Oh the memories!!! I’m sure those pictures will be up on Facebook later hahaha

 

Hope you found some of the information today to be as interesting as I thought it was.  *Fingers crossed* that I have no problems breastfeeding when I have children!

The Great Turtle Run on Mackinac Island

On Saturday I ran the furthest I’ve ever done at one time. It was a huge accomplishment for me. It wasn’t quite a 10k but almost.  My aunt had invited my to join her on the Great Turtle Run up on Mackinac Island (in Michigan by the upper peninsula).  She did it last year and wanted to show me the island anyway.  So even though I had previously only done two 5ks (Run Like Dickens in December 2010 and the Warrior Dash in August 2011) I wanted to see if I could make it.  We stayed overnight on the mainland and took the ferry over in the morning since it is such a quick ride.  We knew it was going to be a beautiful day when we woke up to this:

At first I was really cold but we waited inside until it was about to start.  I was extremely nervous because I really hadn’t been training.  Either I said I didn’t have time or the weather was bad.  I think I ran maybe 3 times in the past two weeks.  Either way, I was going for it now.  Someone else was going for it too I guess.  Let’s play a little game of I spy in the photo below hehe.

The course was 5.7 miles with the first half weaving up and down and around the trails of the interior of the island and the second half running along the coast of the island.  I was unprepared in that I did not double check my gear before we left. Both my Garmin and my MP3 player had low batteries! The Garmin died first, about 1/2 mile into the run and then my MP3 player died shortly thereafter.  It was my own fault but still disappointing.  I had to find something else to pass the time and make it not seem like I was going to die just as my electronics did.  About halfway through I remembered the saying “You are stronger than you think” from a running video I had watched on youtube the previous day.  I kept repeating this in my head, and you know what? It made me feel so much better.  I powered through those woods with the most positive attitude I’ve ever had while running.  Usually I’m pretty much a Debby Downer because I think I’m too slow and not a good runner and I know that is not the attitude to have.  I ended up keeping pace with this girl named Sarah and we pushed each other to the very end.  My knees were a disaster and her feet was aching but we supported each other the whole way.  Once we finished, I was elated. My time was 1 hour and 11 minutes, far better than what I was expecting.  I really thought it was going to take me almost an hour and a half.

My aunt finished a few minutes before me so she was there at the end to cheer me on.  As you can see, everybody got a medal (YAY!).  As for my knees, well they were completely busted after that and still hurt today.  But it was completely worth it.

Afterwards, we spent the rest of the day exploring the island.  We rented bikes and biked the whole perimeter which is about 8 miles.  We also stopped at Arch Rock which was very cool but the 200 steps to get up were painful.

The view down from the rock was yet another beautiful sight.

Oh I should also tell you that cars are not allowed on the island. You can travel by horse and carriage, bikes, or walking. I love that!

You can kind of see the Mackinac Bridge in the background there. That connects the UP with the Mitten.

That’s Fort Mackinac.  We didn’t have time to go up to it but I don’t think I would have made it up the steps at that time anyway LOL.

It was an absolutely amazing day and I’m so proud of myself! Next up…..Run Like the Dickens 5k in December

Hey Look I Found a Trader Joe’s!

It turns out that there is a Trader Joe’s and a Whole Foods right next to each other.  They are about a half hour away from me which means it won’t be a frequent stop but it’s nice to know they are there if I feel like the trip.  I went to the Whole Foods with my aunt last week so this week I decided to check out Trader Joe’s on my own.

And of course I got myself some goodies!

In my trip, I came out with Ezekiel bread, a pack of organic bell peppers, organic eggs, organic gala apples, bananas, tofu, brown rice sushi, light string cheese (rBST free), light cream cheese, a yellow onion and a red onion. All for $29!! I thought that was a pretty good deal.

Speaking of prices, I’m under the opinion that Trader Joe’s has better prices but less selection while Whole Foods has worse prices but more selection. Does anyone else think TJ’s prices are better than WF? I don’t go to either very frequently so I’m not sure if that is an accurate assumption.

I used the tofu tonight to make stir fry. I cooked it up with some broccoli and orange bell pepper, coated it with a little teriyaki sauce and put it over brown rice. Yummy in my tummy.

Now it’s time to pack for this weekend. Tomorrow night my aunt and I are heading up to Mackinaw Island for a 10k on Saturday morning. It’s going to be so rough because I either haven’t had time to run or the weather has been crappy or I just couldn’t get my lazy butt out there for a run. Plus the weather is going to be pretty cold! Oh well, I’m sure it will still be fun 

What it’s like to work at a small community hospital

First, thanks for the birthday wishes I can’t believe it’s been 3 years since my 21st birthday. How depressing LOL. Though I may be getting older, there is an upside: The other day someone asked me if I was in high school. Haha still young lookin’ I guess!

So right now my rotation is in a small community hospital (I’ve only got a week left there).  They only have one dietitian for the whole place and she does both the clinical side as well as managing the food service. Lots of responsibilities and no time to do them is what I’ve discovered with her job.  Typically they only have an average of 8 in-patients on the Med/Surg floor but there is plenty of other components to the hospital. They do a lot of outpatient services where people are in and out of the hospital in the same day so that keeps the in-patient population low.

I’m enjoying the small town atmosphere, probably because it reminds me of home (even though this hospital is smaller than the one I was born in! Well I’m pretty sure there is no maternity floor at this hospital LOL). I’ve gotten to assess several patients on my own by now.  Basically before I even go in their room I get background information from their chart: height, weight, diagnosis, current diet order, past medical history, tobacco/alcohol/drug use, medications, labs, etc…..anything else that’s important.  Then when I go in to talk to the patient I find out their usual weight, any recent weight changes, how’s their appetite, how much of their trays have they eaten since being admitted, n/v/d/c (that means nausea, vomiting, diarrhea, constipation. yeah I have to be a little personal with them), any chewing or swallowing problems, food allergies/intolerances, and diet history.  After all that I can write up my own assessment in their chart and determine their Calorie, protein, and fluid needs as well as determine if they are on the proper diet order.  Like today I had to switch someone from a regular diet to a cardiac diet because they had a history of hypertension.  I also have to see if the patients need a nutritional supplement if they aren’t eating well or have a poor appetite – proper nutrition is important for healing!  That’s the basics of my assessments at least. It is a little more complicated but you get the picture.

Today I was also lucky enough to do my first outpatient nutrition counseling.  The outpatient counseling is much different because the people come in either because they want to or their doctor referred them in and you spend an hour going in depth into counseling them on whatever they are there for.  Last week I observed one person that came in because their doctor wanted them to learn about a heart healthy diet but they were also interested in losing weight.  Another person I saw came in because of bulimia, among other health conditions.  The person I got to work with today was a diabetic so I talked to them about carb counting, blood sugar goals, symptoms of hypo- and hyperglycemia, and laid out a meal plan with them determining how many carb servings they should aim for at each meal in order to be consistent throughout the day.  It went really well and I thoroughly enjoyed the experience!

I’m excited for next week because I’ll be spending a morning at their wellness center and I’m also making a presentation for a diabetes support group. Loving life right now!

And just so I can include a picture with this post (I’ve been really bad about taking pictures lately), I’ll show you the awesome dinner I had the other night.

I got this stuffed sandwich from an client of the MSU Product Center. Lauren runs Ope’s where she makes organic vegan stuffed sandwiches and veggie burgers as well as cookies! The cookies are totally awesome and I wish I had more! She was so kind to give me samples of two sandwiches (pizza and veggie) and 3 cookies (chocolate chip, cranberry chip, and oatmeal raisin). This was my last of it all and now I’m sad LOL. She sells her products mainly around Michigan to hospitals and some schools.  Basically you wouldn’t be able to get them but you CAN get the cookies! They just started selling them online so you can order them through www.opescookies.com. I highly recommend them .

A Very Merry UnBirthday

Well real birthday actually. I’m 24 today. Getting old

Made my mini bruschetta pizzas with a side salad for dinner. yum yum!

Now it’s off to bed and ready for another work day.

Spontaneity is not a word I know well

I’m a planner. I admit that freely. So while I think being spontaneous can be a good thing, it’s usually not something I consider doing. I plan, I make lists, I like routine. When things don’t go according to my plan, I usually freak out.

So last Friday (September 30th) I ended up having the day off because I finished my rotation a day early. I started my day with one of my favorite things – sleeping in! I’ve had to get up usually between 5-6 lately since my commute is over an hour so sleeping in is even more awesome now. Anyway, I just planned to use the day to relax, maybe start my 4 page paper on obesity in the long term care setting. At lunch time, I talked to my boyfriend who is now down in D.C. working on his PhD. He left in the beginning of August so it had been 2 months since we’d seen each other.  Somehow amidst our discussion, he ended up buying me a plane ticket for that afternoon! I was freaking out. Could I seriously just pack a bag and go to D.C. on a whim? Well that’s what I ended up doing. And I survived. Luckily I had about 2.5 hours to prepare myself before heading to the airport, which on a side note I don’t really like the Detroit Airport (this was my first time there). The flight was short, just over an hour, and then I landed at BWI where Raf was waiting for me! I was so happy to be there with him.

By next summer, I will be living right around the corner from this:

I can’t wait!!!!!!!!

PS – decorating and furnishing is a lot harder than I thought! The condo is a work in progress LOL

A little look inside my internship

So I wish I had starting blogging again earlier because it’s much easier to write as you go than to try to re-cap what I’ve done.  But I’ll try.

I’ve actually already completed one rotation! I spent 5 weeks at Sparrow Hospital in Lansing working in their food service department.  Like many interns, I was not thrilled at first.  Food service (especially hospital food service) is one of those rotations that the interns are usually least interested in.  However, I really lucked out and had an amazing preceptor.  She actually made it fun!

In the food service rotation, you are required to conduct a “theme meal” which ties in many of the competencies learned in the rotation, like purchasing, pricing, and prep.  For my meal I chose to focus on local foods.  The recipes I chose were Mini Bruschetta Pizzas and Greek Salad so the ingredients I chose to get locally were Basil, Chives, Parsley, Tomatoes, Garlic, Onions, and Feta cheese.  I even was able to make a video demo, kind of like my own 7 minute cooking show! My preceptor’s husband makes commercials so he filmed and edited the footage for me.  After 3 weeks of planning, I successfully served my theme meal! It was a hit and I got a ton of compliments – the supervisor even wanted me to have another one before I left! Unfortunately I wasn’t able to serve the second “local meal” but it is planned for mid-October and the recipes I chose are Turkey, Apple, and Cheddar Paninis with Roasted Butternut Squash and Apple Soup.

So this week I started my second rotation – Community Hospital. I’ll be spending 3 weeks with inpatients and outpatients.

I’ll leave you with my Mini Bruschetta Pizza recipe. Serves 4.

Ingredients

3 large tomatoes, seeded and chopped 2 tbsp chopped fresh parsley 2 tbsp chopped fresh chives 4 tbsp minced fresh basil 2 cloves garlic, minced 1/3 cup olive oil Salt and pepper to taste ½ cup feta cheese 4 pita flatbreads

 

Directions

In a medium bowl combine tomatoes, parsley, chives, garlic, basil, olive oil, salt and pepper. Set bruschetta aside while preparing the pizza base. Brush pitas with olive oil and broil for 1-2 minutes, approximately 4 inches from the heat source. Remove pitas from oven and top with bruschetta and feta cheese. Broil for 2-3 more minutes.

 

 

And a little sneak peak at the setup I had for my theme meal. Nutrition Facts, copies of the recipes, and information about the farmer’s I got my ingredients from.