September 6, 2017

So Much More

Posted in Dietitian, Journal tagged , at 7:40 pm by Jenn

Day to day I struggle with being called “Dietary” by various members of the healthcare team.  I spend a lot of time an energy correcting this when it happens…”I’m sorry, do you mean Food Service or Clinical Nutrition?”  People don’t realize how hard we work to become Registered Dietitians.  Years ago Registered Dietitians did spend a lot of time…most of their time in the Food Service department.  Over the years the practice has advanced and Clinical Nutrition has really come a long way.  Our clinical expertise is being acknowledged by the interdisciplinary team and we are FINALLY becoming recognized as experts in our field.  We use stethoscopes, we perform physical examinations, we conduct a detailed interview with patients and family members and our assessments form the foundation for the diagnosis of malnutrition.  Did you know that 1 in 3 patients is admitted to the hospital already malnourished?  I saw 8 patients today and 2 of them met the criteria for malnutrition.  One was likely deficient in B vitamins based on the clinical presentation.

As a dietitian I get excited about all sorts of strange things…deficiency is one of them. Really looking at the patient from head to toe is my job.  It isn’t all about telling someone what to eat or telling them they need to lose weight (most people already know they are overweight you know), it’s about looking at the person, listening to their story and putting the puzzle together.

This patient had angular cheilitis (red, irritated cracks at the side of the mouth), lips were a deep pink reddish color), poor dentition (loose, cracked and broken teeth, many cavities), the patient gave the description of “teeth going bad quickly”.  It was reported that the patient had been taking iron supplements in the past but had run out recently. The patient had lost 6% of body weight in the past 2 months and had mild to moderate fat wasting on physical exam.  I felt there was a high likelihood that there was some nutrient deficiency.  It wasn’t until I was typing my note and entering the past medical history that it hit me – B6.  This patient had a history of seizure disorder and had been on long term Keppra.

I placed a call to the MD and discussed my findings.  I recommended that the patient be worked up for B vitamin deficiency.  The provider agreed.  THIS is what I went to school for, THIS is the reason I attend conferences and continue my education.  THIS is reason that I correct people when the call me dietary.  I am so much more, I AM a Clinical Dietitian.

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September 4, 2017

Summer School

Posted in ADHD, Journal tagged at 8:15 pm by Jenn

My son is an only child.  He attends Pre-K and daycare but doesn’t have neighborhood friends to hang out with.  I have friends with kids his age but we don’t get invited to the weekend get togethers or get aways.  It makes me sad for him…and me.  We try so very hard to stick to our routine but sometimes I wonder if I’m making the right decisions for him.  Changes to his routine and schedule make him unbearable and just lead to less invitations down the road.  But people don’t seem to get it, or us and we are finding ourselves being loners.

He and I took a road trip over Spring Break to visit friends who live out-of-town.  We both had a wonderful time.  I kept him on his schedule during that trip as much as possible.  Bed at 8:30, melatonin, fairly decent diet.  We were invited back this summer. Once we were there, I almost immediately started regretting my decision.  Diet was out the window – literally eating a yellow food dye popsicle before I even unpacked the car.   Sleep wasn’t happening – no naps, 10:00pm was early.   By the end of the second day the kids weren’t wanting to play with him.  I had run out of clothes because he wasn’t focusing on using the bathroom and was peeing and pooping in his pants.  He wasn’t listening and I was at my wit’s end.  There was birthday party for a neighbors child, they made slime…which for my guy was a disaster.  I spent an hour cleaning it up off the porch.  The cake – the food dye…let’s just say I fucking hate artificial food dye!

By the end of the party I was in tears.  I was regretting making the trip.  I was tired of washing laundry and finding my kid playing alone.  I was tired of peeling him out of trees and  ending up covered in poop.   I was tired of everyone telling me he was fine, when he wasn’t.  All the progress I had made had been unmade in less than 48 hours and I was a mess.  All I could think about was that I didn’t have the strength and the courage to do all of this again…I felt alone.  I sat on the couch in a room full of people with a mimosa and felt 100% alone.

Someone noticed that I’d been crying and asked if I was ok and I lost it.  I wasn’t ok.  I was sick and tired and I was tired of being tired.  I was tired of people (adults and kids) not getting it…thinking my kid is like other kids and not getting why I watch him the way I do.  I was tired of hearing it’s ok.  Let him have just one, or he’s fine, let him play.

School starts tomorrow and for that I’m thankful.  The past two weeks I’ve tried to get back on schedule with wake up, diet and bedtime.  It has been rough.  Potty training is for the most part back on track.  Pre K 4 is 1/2 days in the afternoon so that means no nap – which is not a good thing.  He really hasn’t napped in 3 weeks so I’m not worried about him falling to sleep at school, I’m worried about him being an asshole. This kid can be a bear when he doesn’t have enough sleep.  I decided to move up bedtime by 30 minutes and spend that time winding down with books.  We’ll see how that goes.

Oh, and we’re back on melatonin until he’s back on track and settled in to this school year.  As for out-of-town trips.  We will continue to visit friends, but we will stay in a rental house or hotel so that we can have more control on food and sleep.  Many lessons learned this summer.

August 22, 2017

Post Eclipse Reflection

Posted in Journal, life tagged , at 10:10 am by Jenn

eclipse

I didn’t get eclipse glasses.  I couldn’t see spending the money when people were giving them away for free.  I couldn’t see standing in line for free glasses when you could make your own viewer out of common household items – cereal box, aluminum foil and white paper.  I made two – one out of a cereal box and one out of  regular box.  I was ready.

I tested it, it worked.  I decided to make the pin hole bigger so that I could see a bigger image of the eclipse…because I need new glasses and I needed a bigger image.

My sister came over and I convinced her to make her hole bigger too.

We missed the eclipse.

Lesson learned.  Pinhole viewer probably means the hole should be pin sized.  Oh well, now we know.  I will be prepared next time.  I will buy ISO certified eclipse glasses well in advance of the event.  I’m setting a reminder for myself for 2024.

 

August 6, 2017

Calvert Rocks

Posted in geocaching, Journal tagged , , , , , at 9:08 am by Jenn

New craze.  We have joined the #calvertrocks craze.  I saw my first one on Wednesday night and thought how pretty it was.  I left it where I saw it.  Friday night we went out with some friends for dinner and I was telling them about the rock.  We decided to go back to see if it was still there…it wasn’t but I did find a pretty “Shine” rock and decided to relocate it to the local Sheriff’s Department to spread a little cheer over the there.  I posted on Facebook about my find and my sister suggested I join the Calvert Rocks Facebook group.  There sure are a lot of people finding, painting and hiding rocks in Calvert County!  I was inspired to create my own rocks.  I painted them yesterday.  They just need a coat of clear spray and then we are heading out to place them in our local community for others to find.  We will be traveling to North Carolina to visit friends at the end of the month.  I’m saving my flip flop rock to place on that trip and hoping to find an #onslowrocks to bring home to place locally.  This is a great family fun activity that promotes getting outdoors, being together and having fun!  If you paint, hide and find rocks in your local community please post a picture of one of your finds in the comments below.  Happy Hunting!

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July 30, 2017

Tomorrow

Posted in ADHD, Journal at 9:18 pm by Jenn

It was one of those days.  A day where there was too much energy to be gotten out and not enough getting out being done.  No one was listening.  By noon I was tired of repeating myself.  Thankfully, I did get an hour of peace and quiet during nap time.  The afternoon and evening were much the same.  We played in the pool, played in the yard,  played on the scooter, played with the neighbors, etc.

When we got in to bed to read books this evening my son said to me, “Mommy, I will try to listen tomorrow.”  It breaks my heart and makes me happy all at the same time.  I know he hears me…now I just have to figure out how to get him to stop AND listen at the same time.  Until then, tomorrow will just be another today.

July 29, 2017

Alphabet Soup

Posted in ADHD, Journal at 8:41 pm by Jenn

When my son was 18 months old I started getting complaints about his behavior from daycare.  Biting, temper tantrums, not listening, not following instructions, etc.  I wasn’t sure what was going on.  I went to the pediatrician, they told me this was normal.  I talked to friends and family.  Everyone said it was normal. We did end up getting tubes in his ears because of frequent fluid and ear infections and thought maybe some of the not listening and not following instructions was because he simply wasn’t hearing.  Problems persisted at daycare and it just got to be too stressful for me to pick him up everyday and hear about how “bad” my child had been.  I switched daycare.  I went from a large center to a home provider.

After a few months the new provider expressed concerns that something was wrong – speech not on level with other children his age, not able to stay on task, frequent need for redirection….back to the pediatrician. We had an evaluation by our local Infant and Toddler program and they expressed no developmental concerns, all of the pediatrician’s testing came back normal.

Fast forward to age 3 at our well child check.  My son was his displaying his “normal” behavior at the appointment, this time the pediatrician wanted to know more….is this what the daycare provider sees?  Is this typical?  Does it get worse?  Yes, Yes, Yes.  He suggested we return to the local resource but also get on the waiting list to be seen at Kennedy Krieger.   He said, I don’t know that there is a problem, this could be typical tired 3 year old behavior, if you don’t need the appointment then you are fine, but in 6 months when/if this behavior is escalating then you don’t want to have to get on the list then….

4 months later we were being seen at Kennedy Krieger, we answered a LOT of questions, we filled out a LOT of paperwork.  We met with 2 different providers on two different DAY long appointments…the diagnosis, ADHD at age 3 in addition to a Speech and Language delay which was diagnosed on the re-evaluation by the local resources.  What did all this mean?   Preschool at age 3, an IEP, behavioral health visits and a LOT more unanswered questions.

The provider wanted to start my son on medication at the age of 3.  I declined.  My reasoning, his behavior is not out of control.  He is 3, he is growing, he has a speech delay and if the medication is making him feel bad he won’t be able to tell me.  No meds.  What other option do we have.

Being a Dietitian I know the power of a good diet and I know that for many of these kids there is a dietary component.  We don’t eat poorly in our house but I could make some changes for sure.

Today I made the appointment for our annual check up….one year later.  We still aren’t on meds, we have eliminated red, blue and yellow dye.  We use melatonin to help get a good night sleep and we had a successful first year of school with NO COMPLAINTS from the school at all about behavior or lack of attention and the IEP is progressing nicely.

I do feel the behaviors are escalating, but I feel it is just with me.  I get nothing but praise about behavior when he is in public, at other people’s homes, etc.  With me, he is a baby monster.  The tantrums seem constant, the whining is unbearable, the not listening, the hearing “You’re Mean”, I am at my wits end.

I think a lot of this is just simply a kid who has not had to deal with consequences for his actions.  I know it’s not too late to reign him in…I hope it’s not too late.  The doctor told me a year ago, “pick your battles and win what you pick”.  I think I picked the wrong things.   Sometimes I feel like he acts this way because of something I’ve done (or not done), but then I remember that he really can’t help his actions sometimes.  The hard part is telling the difference.

 

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