Before My Heart Stops

I just read this amazing book. I saw it at Deseret Book on Saturday, bought it, and finished it Sunday afternoon. Paul Cardall is a pianist who records LDS songs and hymns that he's arranged, along with his own music. I really like his music that I've heard. In his memoir he tells his story of being born with a congenital heart defect, and his journey while waiting for a heart transplant. He shares many quotes by church leaders, and his story is so inspiring (at least to me). I found it a little repetitive at times, but the story was still interesting and helpful to me in my life. Even when we go through trials, or should I say especially when we go through trials, Heavenly Father blesses us and definitely does not forget about us.

His book is filled with blog posts that he wrote while waiting for his heart, which you can find here: http://mytricuspidatresia.blogspot.com/. He has now moved his blog here: http://beforemyheartstops.blogspot.com/, and his website here: http://paulcardall.com/

Life...

...is so frustrating sometimes. But it teaches us patience. Which I need to learn. About a month ago I started not feeling so great. Which was frustrating. I had just been thinking how nice it was to feel GOOD. I had actually felt better than I had felt in a LONG time...Then it started again. I had an appointment with Dr. Smith for a checkup so I just dealt with it for a couple weeks until my appointment. I was having a lot of stomach pain and feeling sick. So I went and saw Dr. Smith and he suspected I had some sort of infection.

He thought that since I had C. diff a few months ago, that I could have it again and that could be what was making me feel so crummy. If it wasn't that he thought it was probably just my normal bout of pouchitis. Either way I needed an antibiotic, but he needed to know what it was before he could give me one. So I got tested and it came back positive for C. diff. Well no wonder I didn't feel good. (C diff. is a bacteria that gets in the gut when there's not a lot of good bacteria there-this can happen when you take a lot of antibiotics, like me.) I had a few days before Thanksgiving especially where I was exausted, wasn't sleeping well, and just plain didn't feel well. My mom kept asking me if I was ok. It took about a week before I got the results because of the holiday and everything, which was frustrating. I was calling Dr. Smith's office every day and they never had an answer for me. So finally I got an antibiotic which I have been on for 5 days and I already feel much better. I'm still tired all the time which is frustrating, but at least I feel better.

In the couple weeks that I wasn't feeling well, I realized that I lost about 6 pounds. Which was frustrating. For me that's a lot to lose when you can't really afford to lose any weight. Dr. Smith and his nurse seemed a bit frusrated by this as well. Last time I was in there they were so proud of me for being up to 96 pounds...It takes me months to gain 5 pounds. Which is frustrating. I have been trying to gain some weight since then but I just havn't had a good appetite. Nothing ever sounds good. Which is frustrating.

I was also having a lot of joint pain. Before just my knees were hurting, but then my hands starting to become sore as well. Which was frustrating. Dr. Smith actually suspected rheumatoid arthritis. About a year and a half ago when the knee pain started he tested my ANA which was high, so he said that indicated arthritis. (ANA is a blood test that can identify an autoimmune disease). Now because it's getting worse and because of the high ANA test, he wants me to see a Rheumatologist. I couldn't get an appointment until the middle of January. Which was frustrating.

I had also been feeling very short of breath at times, for no reason at all. I would be sleeping and roll over in bed and suddenly my heart woud start racing and I would feel like I had just run a marathon. Or I would just sit up and feel like I couldn't catch my breath. Which didn't make sense...and was frustrating. I opened my big mouth and told this to Dr. Smith as well. He listened to my lungs and then told me I needed to get a chest X-ray and an EKG. He seemed a little concerned about my history of a blood clot in my lungs. Kind of scary, but they actually came back normal and I stopped having any problems. So that was one thing that was NOT frustrating. :)

I don't mean this to sound whiny because it really isn't nearly as bad as it sounds. It's more annoying, really. But when things like this happen it gives me a chance to really stop and be thankful for what I have. I have an excellent Dr. who is very thorough, cares about me, and knows what he's doing. I have a good job with health insurance., which can make a $300 antibiotic cost only $80. I have a wonderful mother who takes care of me. I also have an amazing little brother serving a mission who in his last letter to me wrote, "Tell yourself each morning that you are awesome and it will come true. Pray for the well-being of those around you and work to serve God-this will make you happy. Learn something new from the scriptures each day, this will help you progress. Magnify your calling-that will fulfill your purpose." I am continually trying to be patient and not get frustrated so easily, and remembering the good things in my life are what get me through.

One of my favorite quotes is from a talk by Julie B. Beck in 2009, "Women who know love the Lord and bear testimony of Him. They are strong and immoveable and do not give up during difficult and discouraging times." So even though sometimes I get discouraged (or frustrated), I keep telling myself that life is good and things are going to be ok, or as Kyler says...that I'm awesome! :)

Thanksgiving 2010

We had a really good Thanksgiving. It started off with me bringing Jenna, Kade, and Kalan home with me from Twin Wednesday night. Jenna and I went to Harry Potter because neither of us had gotten to see it yet, and the boys stayed home with Grandma. Jenna and I both really enjoyed Harry Potter! Tysi and Chad both came Thursday morning. Thursday morning Jenna and the boys had fun playing out in the snow and building a snowman. Thursday afternoon we ate a yummy dinner and just relaxed. My aunt Bev and her kids Sam, Zach, and Sydney came over. Sydney, Kelsi, Jenna, and I watched Back to the Future. Poor deprived Kelsi and Jenna had never seen it. Friday I had to work :( and everyone else stayed home and did some more relaxing, with a little bit of Black Friday shopping mixed in there I think. That night some of us girls watched a chick flick, and we all snacked on pie, popcorn, and muddy buddies. mmm... Saturday we went up in the mountains and cut down some Christmas trees. We got one for Chad, one for Tysi, and one for my mom and I. I had never done it before and I always here the stories from my siblings of how they used to cut down a tree every year before I was born and how fun it was. I have to say I was a little dissapointed because I ended up sitting a lot in the snow and sitting a lot in the car with some little kids, but it was still fun to all be together. I think all the little boys had a blast sledding. Halli and Landon weren't that impressed either I don't think. I don't think they loved being so bundled up and out in the cold. Anyway, it still turned out to be a good day. We went home and all watched yet another movie. There was a lot of football watching going on throughout the weekend as well. Tysi and Ron left Saturday night and Chad and Fran left Sunday morning. I went to my branch correlation meeting and then went to church with my mom, which was a nice change. Sunday night a bunch of family came over for dinner. My aunt Shirley, and cousins Alisen, Lizzie, and Brandon were stuck here on their way back to Utah because of the roads, and my Uncle Kevin and Aunt Beverly were here visiting from Arizona. All of us cousins played a rousing game of pit and then of course played some Super Mario Brothers Wii. My nephews will be glad to here we passed the whole 7th world. :) It was really fun seeing everyone. Halli and Landon are both at such fun ages and as an added bonus, they both adore me. :)
Here are just some fun pics from the weekend:

We had a very nice Thanksgiving and I am so thankful for my wonderful family. We missed Kelby and Amy who couldn't travel because Amy is so close to having her baby, Brock and Kris who thankfully will be home from Boston for Thanksgiving next year, and of course good ol' Kyler, who says he had a great Thanksgiving in the great state of Texas.

Jon Schmidt Concert

On November 6th my friend Amy and I went to the Jon Schmidt concert that was in Blackfoot. I drove to Pocatello and we went out to eat, and then went to the concert. I had always wanted to see him in concert. He is pretty amazing. I have three of his books but can only play like 3 of his songs. Someday I'll sit down and learn some more. He is pretty much my hero. He was a great entertainer and very funny. Here's a video I took of him playing his Love Story meets Vida la Vida song. I think there's a better video of this song on YouTube. We were in the very last row so I zoomed in as much as I could. Sorry it's kind of shaky, there were some little girls in front of me who kept getting in the way. Anyway, I hadn't seen Amy since the beginning of the summer, so it was really good to hang out with just the two of us. Sadly I failed to get a picture of us though. But it was a fun night. I was not dissapointed!

A little bit of fall

Here's just a few recent pictures:

My cousin Danielle, her husband Brandt, and my cousin Sam (who's not in the picture) came to watch Zach play in the Homecoming game. It was fun to see them. Afterwards we went out to eat at Pizza Hut.

My friends from High School Tayli, Carrie, Liz, and I...Tayli, Liz and I threw Carrie a baby shower last week. It was really fun to see all of them again. Liz is having a baby the end of this month too (her second).

I made Carrie this rag quilt.

My 7-year old nephew Kalan and I carved this pumpkin, and yes we used a pattern. He carved
around the whole circle by himself.

Cute little Halli in her Halloween costume. I have pictures of Tysi's other kids too, but I was having trouble getting them to load and face the right direction. If you want to see them you can look on my Facebook page.

Hope you enjoyed!

A day in the life of a clinical dietitian...

Ok, maybe this isn't that interesting, but I have had SEVERAL people ask me the question, "So what exactly do you DO?" I usually don't have a very good answer for them, so I decided to post it on here.

At St. Luke's we see ALL the patients (medical floor, surgical floor, pediatrics, inpatient rehabilitation, ICU, Cancer Center, labor and delivery, NICU, and even Canyon View patients.) Each dietitian is assigned certain floors and units they cover, but I'm kind of the fill in person. I help whoever is really busy, and cover for whoever takes a day off, so I get a little dose of everything.

There is a process that we go through when we see patients. First, we have Diet Techs who screen all the new patients that come into the hospital. They see every patient and ask them a slew of questions that helps determine if they are at nutrition risk. (Do you have any food allergies, how's your appetite, have you lost/gained weight lately, have you had nausea, vomiting, or diarrhea, do you have problems chewing or swallowing, etc, etc.) Then depending on their answers, they get a certain score. Other things are also taken into consideration like their age, diagnosis, and albumin level. If they score 6-10, they are of "moderate" nutrition risk, anything over 10 is "high" nutrition risk, anything below 6 is "low" risk. We (the dietitians) see all the moderate and high risk patients.

So when I get a patient there are several things I do. First I go through their records on the computer and write down any pertinent, helpful information. I read their history and physical that is dictated by the doctor, where I can find out what brought them into the hospital, their past medical history, if they're married, if they came from a nursing home, what the plan for their treatment is, etc. Then I look at their labs and write down abnormal nutrition related ones (Sodium, Potassium, BUN, Creatinine, Glucose, etc, etc.) I look at their medications and do the same. Some medications have food interactions so they are good to know (for example Coumadin and Vitamin K, Cipro affecting calcium absorption, etc.) Others (like antibiotics) can cause diarrhea, so they are good to write down so that if your patient who's on tube feeding comes down with diarrhea (sorry I'm using that word so much :) and the nurse comes to you and says that you need to change the formula or slow down the rate, you can say, well they're also on 5 antibiotics, that's probably causing the problem. (Not that I like to argue with nurses). I can also look at weights, in's and out's (to see their fluid balance) what diet they're on, and how much of their meals their eating. I also look at the Diet Tech's screen and see what they screened out for so that I can address those things with the patient (for example if it says they have problems chewing, I can ask them if they want a mechanical soft diet.) I also look at previous dietitian's notes if they have already been seen this hospital stay.

Once I have all my information I go down to talk to the patient. I always flip through their chart and look at the doctor's orders first. Sometimes I can find updated information in there about meds or diet, or even find a consult for us that we havn't received yet. I then talk to them about their appetite. If it's not good I might try to come up with something that sounds good to them. I will offer them snacks, supplements (like Carnation Instant Breakfast or Ensure), or sometimes even offer them the cafeteria menu (depending on their diet) to peak their interest. If I'm really worried about a patient I can start a calorie count, which is where every single thing they eat is recorded for 3 days and then we know exactly how many calories and how much protein they are eating. From there I can determine if maybe I need to add more calories to their diet, like adding extra protein to every meal, extra butter and gravy, whole milk, etc, or I can see that they are actually doing ok. We also educate patients on different diets. I always ask my diabetic patients what they do to control their diabetes (count carbs, watch portion sizes, etc.) and how often they check their blood sugars, etc. If they have any questions I answer them. Sometimes we get consults from the doctor to educate a patient (could be on anything-diabetes, weight loss, etc,) or to add more calories to a diet, write a tube feeding order, etc. Sometimes I will talk to the nurse to get any information. Especially if the patient is obviously confused and cannot answer my questions appropriately.

Once I've talked to the patient, I write my note. I document what we talked about, their labs, medications, and anything else I find pertinent. I estimate their calorie and protein needs. I identify a nutrition related problem (there's a standardized list to pick from that the whole dietetics community is supposed to be using, for example: Inadequate oral intake) and write a specific goal to overcome this problem (for example: Patient will consume 75% of most meals and snacks x length of stay.) Then I list any interventions I did ( for example if I sent them snacks or a supplement, gave any education or handouts, and the things I'm going to monitor like labs, weights, and appetite. Then I make any recommendations to the doctor (if any). A recommendation I might make would be to start a multivitamin, or liberalize the diet (say from a low sodium to just a no added salt diet to increase the patient's intake), or this is where I would write my tube feeding recommendations. We also see patient's with a low or high BMI and offer information on gaining or losing weight, and must get the doctor's signature agreeing with us that they have a low or high BMI (for billing purposes I think.) Once my note's done I stick it in the chart, and write any orders in the chart that I want to do (downgrade the texture of the diet, send supplements, or start a calorie count.) If I write any orders I fax it to the nurse's station so it gets put in the computer.

At the end of my note I put a follow up date. Moderate risk patients must be followed up with in 5-7 days and high risk patients must be followed up with in 3-5 days. If we see a low risk patient for any reason (i.e. high BMI) it can be 7 days. It can be sooner too, if you think it needs to be sooner. Most of the patients go home before they have to be followed up on, but if not, we go see them again...and again, and so on until they go home. Sometimes you might have to change your nutrition problem(s), or change your interventions (for example, if they get really tired of being sent Ensure three times a day, you might want to change it to something else.) Every now and again you might get a patient that doesn't really have a nutrition problem. (For example, they told the Diet Tech that they don't have a good appetite, but by the time you see them, they are eating really well, their labs are good, etc, then you can say that no nutrition problems are identified at this time.)

So basically that's what I do. I think people think I write menus all day or something, but a clinical dietitian doesn't really deal with that very much. Our job can actually be very complicated. Tube feeding and TPN patients are serious business, and there are some pretty malnurished patients that come into the hospital. Studies show that the better nourished a person is, the better and faster they will heal. We have all kinds of formulas and references to help us when we get stuck on something, and when all else fails, we "use our clinical judgement."

I am also going to be doing some outpatient counseling. These patients are usually referred to us by their doctor and need counseling on weight loss, or even things like ulcerative colitis or celiac disease. These patients just come to the hospital and meet with us. It also looks like I'm going to start doing some home health. I will go into patient's homes and visit them. Both of these things will give me more hours, so I'm excited!

So that's what I do in a nutshell, let me know if you have anymore questions. :)

25 Things About Me...

In honor of me reaching 25 posts here are 25 things about me:

1. I can sleep any time of day, it's my favorite thing to do.

2. I am not really an animal person...I miss my dog Tim, but that's about it. Of course, I was bit by a dog on the face when I was little, so that might have something to do with it.

3. I could eat cereal or pizza 3 time a day...what a good example of a dietitian I am, right?

4. I have played the piano since I was 7 and the flute since I was 11...

5. I am addicted to TV and obsessed with Gilmore Girls and Psych.

6. I have had my blood drawn close to 100 times.

7. My mom is my best friend.

8. I cannot stand tomatoes...I don't think I will ever reach a point where I can eat a raw tomato.

9. I am not really into sweets...I have to be in the mood for chocolate or ice cream, and I don't really like cake. If you give me a candy bar it might take me days to eat it, and my Easter candy always goes bad.

10. I am obsessed with pink...but most people already know that. My brothers just need to get used to the fact that they WILL be wearing pink ties or flowers at my wedding. One day my brother went to the library at ISU and saw a pink phone, pink backpack, pink purse, pink calculator and pink coat, and knew I must be there!

11. I have a talent for quoting movies and shows. I can see it once and repeat exactly what was said...and it bugs me when people quote something wrong. :)

12. I love to do puzzles, especially Disney puzzles (see number 13) and I have a collection of Disney Movie Poster puzzles but am always looking for more. 300-500 pieces are my favorite because you can do them in one day.

12. I love anything Disney-I went to Disney on Ice and am pretty sure I enjoyed it way more than the little kids...and Disneyland is my favorite place ever!

13. I have had the same car for 7 years, ever since I got my license. and even though it sometimes gives me trouble, I will be very sad when it is time to get a new one.

14. I have been to the Price Is Right.

15. I'm pro at Donkey Kong on Super Nintendo...ok, I'm sure there are lots of people way better than me, but I enjoy playing it.

16. I broke my left arm at the elbow in 4th grade a week before school got out when I jumped out of a swing...it was YEARS before I was brave enough to jump out of a swing again.

17. I am a sucker for a good card or board game...especially the Farming Game. :)

18. I love to read, especially at night. But not sappy love story stuff-it has to be intense.

19. I love to look up random things on the internet. I find myself reading for hours about some medical term or condition online all the time.

20. I love to be alone...I definitely like my alone time and need it everyday. That's probably why I don't mind long drives by myself.

21. I like to do laundry and clean the bathroom, don't know why.

22. I have pretty much the best pillow ever and NEVER go without it...I love my pillow!

23. I LOVE big roller coasters...it's my dream to someday go on a road trip and ride all the great roller coasters across America! So far I've been to Lagoon (which does not qualify as big roller coasters, contrary to what you may think,) Disneyland, California Adventure, Six Flags, Knott's Berry Farm, Cedar Point (AMAZING!) and have also ridden some pretty cool rides in Las Vegas.

24. I am afraid of being outside alone at night...and people who appear out of nowhere give me the heeby jeebies.

25. I own every season of Saved By The Bell...and watch them often. I know, embarrassing, right?