Passed my RD exam!

So happy to have passed the RD exam today. It’s been a long 6 years (4 years undergrad, 2 years grad school/internship) and it is great to have the RD credential to show for all the hard work. Next on the agenda is paying the outrageous fee for being licensed by the state of Florida. 😉

I was pretty nervous for the exam, but it was surprisingly easier than I thought it would be!  I thought I might do a quick blog post about the study methods I used, in case some of you out there are wondering how to study.

1) Inman’s Review (CDs, Book, 1054 practice questions):  This was perhaps the most helpful review method I used. The cost is pricey ($380!) but I believe it was worth it, because it helped me pass the exam on the first try, and some of the practice questions were identical or very similar to the ones I had on the real exam.  You can attend an in-person session, or get the lecture on CDs. I chose the CD method because I figured it’d be easier for me to rewind the CD, pause the CD, etc in order to take notes. The book (3-ring binder) is lengthy (about 200 pages) but goes over all 4 domains: Principles of Dietetics, Nutrition Care for Individuals and Groups, Management of Food and Nutrition Programs and Services, and Foodservice Systems. And if you don’t know how a certain answer was reached in the practice questions, you can email them and get the explanation! So that is also a great service. I emailed about one of the practice questions and got the explanation less than 24 hours later.

2) RD Exam App, by MedPreps: This is a super awesome app for your phone or tablet!! It is $19.99 and I stumbled upon it while searching to see if there was an actual RD study app that existed. There are a few other ones, but I went with this for the design layout and the positive reviews.  Glad I got this!! It has over 1900 multiple-choice practice questions, and you can answer questions in random order (“quick start”), or just get questions from a certain domain/area of dietetics. The app also lets you check your results. It gives you a pie chart and percentages of your lifetime as well as the pie chart and percentages for your current session. Additionally, there is an “explain” button for each question, so after you answer it you can hit “explain” to get the reasoning.  GREAT for on-the-go studying while in waiting rooms, by the pool, during commercial breaks when you’re watching TV, and using when you are on an elliptical or stationary bicycle. It can be addicting, too.  Beware, however, that some of the words are spelled incorrectly, or a few of the explanations had nothing to do with that particular question, so there are mistakes in some of the questions/answers, which the makers of the app should fix!

3) Test Prep Review’s RD Exam Question of the Day Email Service:  This is a FREE question-of-the-day service that is sent directly to your email. The questions tended to be essay questions rather than multiple choice, so it’s not in the same format you will be tested on, but it does give great explanations and definitions that are helpful to know. I did notice that the email service ends after 31 days – so I imagine if you re-signed up after that, you’d get the same 31 questions again. But it is a nice service to take advantage of.

4) DietitianExam.com Question of the Week: This is another free email service, where you get a free multiple choice question per week, with a full explanation of the answer. The email gives you a link, so the question is only available for that week, and you won’t be able to access it after that week…so make sure you stay on top of it, otherwise you will lose that question. These questions were multiple-choice so they are in the same format you will be tested on. Worth it! Go sign up.

5) RDstudy.com Video of the Week: This is also a free email service you sign up for! You get a link emailed to you once a week, which you can open up and access that week (so the video is only available for 1 week, don’t get behind). The videos are short (a couple minutes) and are in power-point with voice-over format. At the end of the video is a small multiple-choice quiz (5 questions maybe) and you get scored at the end. You can watch the video and take the quiz as many times as you want. This is a great free study service for those of us that learn better from watching and listening to videos rather than reading black and white text. The videos I recently received talked about TPNs and FTEs.

So those are some suggestions to keep in mind when preparing for the RD exam…as you can see, there are a lot of different formats to fit any learning style — in-person lectures, smart phone apps, CDs, paper notes, videos, and emailed questions. I just touched on the 5 things I used, because there are a lot of other study materials available (including RD in a Flash flashcards). Hope you find what works for you!

Done with Rotations!!

Just when I thought I’d be an intern for the rest of my life, bam the last day of rotations comes and goes.  Today marked my last day of my dietetic internship rotations — the last of the 1200 (unpaid) hours.  Crazy how time flew by.  Looking back, I think I my rotations provided me with a wide variety of experiences in many different settings.

• Academia (creating lunch & learns, writing grants, designing a new online nutrition course)
• Community (nutrition lessons & activities for elementary kids at summer camp)
• Acute care facilities (424-bed hospital, women & children’s hospital, 189-bed hospital, 70-bed rural hospital)
• Rehabilitation facilities (80-bed rehab hospital)
• Group homes (6-8 residents, rural setting)
• Clinics (wound clinic, weight loss clinic, feeding & swallowing clinic, cleft palate clinic, cystic fibrosis clinic)
• Community/Government programs (WIC nutrition counseling, grocery store tour, creating educational materials)
• Foodservice (test trays, line temperatures, creating & implementing a smoothie bar, catering events, university dining hall, hospital foodservice, safety audits, in-services)
• Sports nutrition (nutrition counseling sessions, presentations to athletes, body composition testing, creating meal plans)
• Professional development (local, state-wide, & national meetings & conferences; giving many presentations in classes, seminars, and bootcamp)

The experience has certainly taught me a lot about the different roles of a dietitian and all the possible opportunities that are out there for those in the field of nutrition.  It’s going to be exciting to see where I end up in the next few years and beyond!

Storage Life of Fruits and Vegetables

Make that produce last!

If fruits and vegetables sit around too long before being served and eaten, they can quickly go bad. Throwing away bruised, moldy, or spoiled produce is like throwing away money…and nutrition!

Proper storage can help your fruit and veggies last the maximum number of days in your house.  You can also purchase fruits and vegetables that have a longer storage life, like apples and carrots. When you make an effort to eat fruits and vegetables each day and follow these storage tips, you may find that you aren’t throwing away produce anymore.

Fruits

Refrigerate your ripe fruits so they can last longer. Even bananas can be refrigerated — the peel will turn brown, but the inside will stay nice and ripe!

Also, store apples and grapes inside plastic bags and store any cut melon in air-tight containers.

How long can fruits be stored without going bad?

• 3+ weeks: apples, grapefruit, kiwi
• 2 weeks: bananas, blueberries, honeydew, lemon, lime, tangerine, cherries, orange
• 1 week: grapes
• 5 days: cantaloupe, watermelon, pears
• 2-3 days: nectarine, strawberries
• 1-2 days: mango, peach, raspberries

Vegetables

Most veggies need to be refrigerated. Exceptions include whole onions and sweet potatoes, which should be stored in a cool, dry, well-ventilated place.  Also, store your tomatoes at room temp, away from direct sunlight.

All veggies should be wrapped in a plastic bag in the fridge, and spinach, collard greens, and asparagus should also be wrapped in a damp paper towel within the plastic bag.  Store mushrooms in the original container or a sealed container.

How long can veggies be stored without going bad?

• 3-5 weeks: whole onions, sweet potatoes
• 2-3 weeks: rhubarb, carrots
• 1 week: artichokes, Brussels sprouts, cucumber, green beans, cabbage, lettuce, mushrooms, radishes, tomato
• 5 days: bell pepper, cauliflower
• 3-5 days: broccoli, spinach, asparagus
• 1-3 days: cut onions, collard greens
• ASAP: green onion, summer squash, corn (with husk)

On Rotation with West Virginia WIC

This week I have been on my dietetic internship rotation with WIC, the “Special Supplemental Nutrition Program for Women, Infants and Children”.  I have been familiar with the program for a while, but had never been inside a WIC clinic or really spoken with a WIC recipient before, so I have learned quite a bit about how it works in just the 3 days I’ve been there so far.

As you may know, WIC provides its participants with free monthly food vouchers that can be used at grocery stores (such as Walmart or Kroger) to receive specific food items.  In that way, WIC is not like SNAP (Food Stamps). SNAP benefits can be used on any food items, including junk food like chips, soda, cookies, ice cream, and candy bars.  WIC, instead, provides participants with the basic, healthy foods that can assure families they are getting the nutrition they need.

Not every WIC participant receives the same package — it can all vary based on whether an infant is breastfeed exclusively, partially, or is formula fed.  When a child reaches 6 months, age 1, and age 2, the food packages also change.  Examples of the foods on the various vouchers include:

• Canned fish (tuna, salmon)
• Eggs
• Peanut butter
• Beans (dried or canned)
• Milk (whole, 2% or less, depending on age of participant, as well as soy milk/lactaid in some cases)
• Cheese
• Infant formula
• Infant cereal, fruits, vegetables, meats
• Fresh produce
• Juices (apple, grape, grapefruit, tomato, vegetable, orange, pineapple)
• Whole grain breads
• Cereals (certain brands, such as Cheerios, Wheaties, Life, Corn Chex, Special K, and Honey Bunches of Oats)

WIC is far more than a program that provides food vouchers to women, infants, and children. Although that is a large part of what WIC does, it also has an incredible amount of valuable resources that families can utilize.

WIC clients can receive personalized nutrition education and counseling from RDs and WIC nutritionists.  International Board Certified Lactation Consultants are there to provide information about breastfeeding, hold breastfeeding classes, offer to weigh your baby pre/post nursing to find out exactly how much breastmilk the baby is receiving in a feeding, rent out breastpumps, and provide breastfeeding support and education.  Children can be immunized at the WIC center in Morgantown and hemoglobin levels can be checked.  The child’s height/length, weight, and BMI can also be measured over time in order to track the child’s development and growth.  At WIC, families can also receive referrals for other programs like Birth to Three and the WV Tobacco Quitline, and other medical professionals, such as local dentists who will see young children.

To be eligible to be a WIC participant, several criteria must be met.  Pregnant women, women who are breastfeeding an infant under 1 year of age, postpartum women to the 6th month after delivery (ie: moms who are formula feeding their 5.5 month old), and children from 0-5 years of age can qualify for WIC.  The participants must also exhibit nutritional risk, such as low iron levels or inadequate dietary intake.  Additionally, certain income guidelines must be followed.  A single mother of 2 children who makes less than $35,317 a year could qualify for WIC benefits.  A woman, pregnant with her first child, who makes less than $20,665 a year could also qualify.  Or, a family of 6 (mom, dad, and 4 kids) who makes less than $57,295 could also qualify. Full income guidelines, which are reviewed for updates each year can be found here.

I think WIC is a pretty great resource that provides nutrition and health education to a population that needs it.  By providing nutrition education and counseling, breastfeeding support and education, and other health screenings, it helps kids get off to a healthy start. And I think that’s something we can all agree is a great thing!

Cleft Lip/Palate

This week I was at the Center for Excellence in Disabilities for my dietetic internship. The dietitian at the CED sees children with various disabilities and diagnoses that can affect nutritional status, growth, and feeding/mealtime routine.  Examples of diagnoses include cerebral palsy, autism, cleft lip/palate, Treacher Collins syndrome, stickler syndrome, Pierre Robin Sequence, children with developmental delays, down syndrome, Prader-Willi syndrome, and more.

Although I didn’t see any patients with cleft lip/palate that week, I was able to read quite a bit about it and watch a few educational videos about how to feed infants with cleft lip/palate, and I thought I’d share a bit what I learned!

Cleft lip or palate both occur in the first 10 weeks gestation.  In these first 10 weeks, the left and right sides of the face and the roof of the mouth join together.  When these sides fail to join correctly, it results in an opening of the lip or the roof of the mouth.  These can be “unilateral” – just on the right or left side of the face or palate — or “bilateral” — on both sides of the face.  Cleft lip/palate can occur separately or together, and are present in 1 in 700-800 births.

Complete unilateral cleft lip and palate.

Children born with cleft lip or cleft palate or both, will almost always need surgery to correct this condition.  Cleft lip can be repaired in the first 3 months of a child’s life, and cleft palate  can be repaired after the first year of life, at about 12-18 months of age.  Surgery for cleft lip generally follows the “rule of 10” : The child must weigh at least 10 pounds, have a hemoglobin of at least 10, and be at least 10 weeks old.

Besides surgery to close the opening in the lip or palate, children may also need to see a team of professionals in order to get help with their eating, teeth, speech, ears and hearing (fluid buildup can lead to ear infections and hearing problems), and social/psychological development as the years go by. A team of professionals may include ENTs, pediatricians, orthodontists, oral and maxillofacial surgeons, plastic surgeons, prosthodontists, pediatric dentists, speech pathologists, audiologists, nurses, genetic counselors, psychologists, social workers, and dietitians.

Nutritionally, children born with cleft lip/palate at most at nutritional risk at 0-4 months of age.  It can be difficult for a child to be able to breastfeed, especially in those with cleft palate. Formula can spurt out the child’s nose, and the child can have difficulty forming a seal around a baby bottle and having proper suction.  These difficulties with feeding can lead to failure to thrive if not taken care of.

There are tips and tools that parents can use with their infants with cleft lip/palate to make sure their child is getting enough calories.  Holding the child in an upright/45 degree angle position can help limit the amount of formula that enters the nasal passage and comes out the nose.  Special baby bottles that are squeezable are a great aid for infants that need some extra help.  Formula can be squeezed into the baby’s mouth via a “pulse squeeze” pattern.  Babies with cleft lip/palate will also need to be burped more often because they swallow more air during feedings. In more serious cases, such as infants with exceptionally wide cleft palates, a G tube may be needed (feeding tube that delivers nutrition directly into the stomach).

Special bottles that can aid in successfully feeding an infant with cleft lip or cleft palate.

With the help of special feeders and appropriate care via a team of medical professionals, the child should grow normally and go on to lead healthy, happy, productive lives.

Sources:

• Cleft Palate Foundation “Cleft Surgery” brochure
• St. Louis Children’s Hospital “Tips for feeding an infant with cleft lip”
• New Mexico Cleft Palate Center “Feeding an infant with a cleft”