Bright and Bad

Last week was one of transition.  It was the first week I had counseled in my new prenatal rotation clinic site and it was a very big change.  The expectations were different, the counseling styles were new, and the critique fresh.  Needless to say, it was a hard couple of days.  Bright spots included cookies and chocolate chip waffles while studying for the population genetics midterm (which I rocked by the way)…

…lots of great eats…

…several dates with my love, Jack…

…great HIIT workouts…

…red velvet lattes to even out all the critique I’ve been hearing, pick me up, pick me up…

…and good times with friends…

Like I said, good and bad.  Bright times and bad times.  I will get better.  I will learn from this.  I will make it through.  8 weeks and counting, ladies and gentlemen.  And with that, I have to go and continue my studying for the molecular genetic midterm next week.  One tune (an interesting cover) before I go:

Questions: How do you balance the good and the bad?
Any plans for spring break? It is coming FAST!

Scan Now? Scan Later?

The last two days have been some hard times in clinic.  It’s never easy to give bad news.  You can relish in the sessions you get to reassure patients and say your risk is less than 1 in 1000 but when they’re that one, the odds don’t matter.  Plus, the recent events have made me wonder whether, in the prenatal setting, it is better to have patients go to ultrasound first, counseling second…or to counsel them before their ultrasound.

There are some indications for referral that lend themselves easily to having the patient be scanned first.  For instance, if they’re coming to you because on a previous ultrasound the sonographer saw something abnormal, sure, it makes 100% sense to make darn sure that on the high level ultrasound we can see the abnormality too.  However, there are other things that seem a bit more ambiguous, like first trimester referrals.  Most people are aware that the first trimester can be a poignant time for miscarriage.  Lots of women don’t even tell anyone about their pregnancy until they are “out of the woods”, so to speak.  The risk of miscarriage never really goes away but it certainly decreases after the first trimester.  So when we counsel women during this time about their testing options and such, they sit through these sessions, are open and receptive to the information (most times), and make decisions about how they want to proceed.  Then, just as easy as not, they could go into ultrasound to find out that their baby has miscarried.  In that case, most everything we have just talked about is, sadly, a moot point.

So which is better: counseling first or counseling second?  I’m not sure, still, even after thinking about it for a while.  I do know that one of my prenatal rotations coming up later, as a rule, scans their patients first before talking to them.  It will be interesting to see how that type of appointment works on a across-the-board basis.  And, to be fair, counseling second exclusively also brings its own challenges.  Sometimes women come in for routine counseling sessions and end up having some sort of finding on ultrasound that you have to immediately talk to them about.  That means the counselor needs to be real up on their game and able to adapt easily.  Perhaps there really is no right or wrong answer in this…

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As far as eats go these past two days, they’ve been cheery.  Breakfast on Monday was a protein cake inhaled at the speed of light in order to get to class on time.  Today’s morning meal was a great oats in a jar experience.  Chocolate protein oats with chia seeds and bananas in a not-so-empty jar of PB.

Lunch on Monday was leftover chana masala with an apple in the car and today’s was a tuna salad sandwich (tuna, edamame hummus, chipotle mayo, green onions, garlic powder, salt, and pepper) with pepper jack cheese, pretzels, carrots, and an orange.  I ate with the counselors though, so no picture of today’s masterpiece.

I have found that snackage is key during prenatal.  Those afternoons are long without some pick me up in my system.  Sweet potato wedges and sunbutter = awesome letter writing fuel.

As for the last meal of the day, I have been developing a whole new outlook on it.  It’s a completely different experience to come home at 5:30 or 6p and just be utterly wiped from the day.  Then you realize that you have to make dinner.  Blah.  Who wants to do that?  The answer is, me, I do, sometimes.  Like last night I was craving salad hardcore so I made myself one with all sorts of veggies, beets, chickpeas, cranberries, and goat blue cheese with a honeyed greek yogurt dressing.

But then there are night’s when I just don’t have the energy for much of anything that takes longer than a minute in the microwave.  Today was one of those days so I heated up chana masala and mixed spinach with olive oil and lemon pepper seasoning.

Done and done.  Sadly, I wasn’t overly satisfied so I grabbed a banana, split it in two and then four, and had half with sun butter and half with almond butter.

Now with eats out of the way, let’s play the life update card.  It has been really wet around here lately.  I walked into the parking garage this morning and there was fog in the basement.  How weird?  I’m not sure the picture does it justice but I walked through the fog to get to my car only to see that the whole thing was covered and I couldn’t see.

So not only did my friend move to China but my cousin moved to Germany.  Another city added to my phone’s world clock.  And, I must admit it is very weird to be coming back from the gym at 6:45 in the morning and realize that your friend has already lived her entire day (that you’re just starting) and your cousin is eating lunch (when it isn’t even light outside where you live yet)!  Just so interesting…

Also in the news, gas prices were scheduled to shoot up today so I busted out a gift card and loaded up yesterday.  Paid with the $25 card and then added another $12 on my my pink credit card to top off my tank.  Good thing I did too, everything was a good 20+ cents more expensive today during my drive.

And finally, I have been obsessed with candles lately.  I lit a few last night and just stared at them.  Then I realized I should do work so I just let them backlight my homework session.  How soothing.

All told, I hope your first two weekdays were a little more encouraging than mine.  Tomorrow is hump day (Wednesday) and I have two patients as well as class.  I also have to give my presentation on AEDs and epilepsy in pregnancy to a bunch of pharma and MFM residents and doctors.  I’m a wee bit nervous about it.  In fact, I should really go and time myself.  I’ll make you a deal: dessert first, presentation second, bed third.  Ready, go!

Okay, well, Tune Tuesday first.  This week’s offering comes from my Vampire Diaries obsession as of late.  I seriously love this song.  It sounds like slow motion, like silk.  Enjoy it.

Question: How do you prepare for presentations?

Can’t Shake The Cold

Today’s morning temperature did not inspire much confidence.

Seriously, I was not in the mood to trek, on foot, to the gym.  Blah.  My bed was much too warm and comfy to leave.  However, I did it anyways.  I started Stage 5 today of NROLFW.  Sadly, it is a repeat of a previous stage that I didn’t love.  Its lower reps though so I take that as a “you’re supposed to increase your weights” and I will, after these first two workouts (one of each A and B workouts) at my ending weight from the earlier stage.  Warming up to it group, warming up. And speaking of, I was so cold today that I lifted in my long sleeve shirt and only took it off to do the cardio body weight matrix assigned at the end of 5A: 24 squats, 12 lunges per leg, 12 lunge jumps per leg, and 24 squat jumps.  Basically, do it as fast as you can, rest, then do it again.

Lap one was round one of the matrix, lap two the rest stage, and lap three the second round of the matrix.  Obviously slower toward the end. My legs were jelly.  However, you average the times and that comes out to 3:23 per matrix.  That is my finishing time from the last stage.  So I’m starting out where I ended the last time.  I’d say that’s fine.

Back across the arctic tundra of a parking garage and into my apartment I trudged.  I warmed up with a hot, hot, hot shower and then tackled a refueling breakfast.  I made a chocolate protein cake and topped it with sun butter and honey.

Nomnom. Shortly after I hopped into my car and headed to the hospital to see some patients.  Both of mine showed up today so that was great.  I felt like I did better this time around.  I thought I remembered some of the big, key criticisms that I had been receiving the last few days.  In between patients I tried to shake the chill by cranking the personal heater in the office I was borrowing for the day.

How much would you like to bet that I will have a super-powered one of these in my future office someday?  (Hint: Take the bet and go big.  You will win.)  Lunch came in between my patients and was courtesy of Jack’s freezer.  I had driven to work on Monday after visiting him and I hadn’t brought lunch so I nabbed a Lean Cuisine from his stash.  Yesterday turned out to be so busy that I didn’t eat lunch so I just left it in the work fridge for today.

Sesame chicken was the flavor and while it was alright taste-wise, it was small.  I had to eat the tiniest bites possible to get the whole thing to last all of five or seven minutes.  I was a wee bit dissatisfied.  So I thoughtfully reached for a small snack of chocolate with hazelnuts.  I could have eaten the entire bar but I was proud that I only had my two little squares.

Yummy.  Fueled my fire for the afternoon of counseling, prep, and critique-receiving I had in store for me.  I’m not really sure listening to critique ever gets easier.  I pray it does but I have a sinking feeling it won’t.  I think it is even harder when you’re a student and you don’t have a whole lot of say in the process.  You just have to be willing to do whatever it takes, all the time.  It’s quite draining but a necessary thing to go through to become what I want to be: a full-fledged genetic counselor.

My afternoon snack was a caramel and pineapple Chobani bite.  The sweetness served to keep me level during my supervisor review.  All in all, in terms of the yogurt, it was really delish but I think it could have used more pineapple.

After I left the hospital, I ran a few errands and picked up some food.  Produce mostly for salads but also some pudding for a binge-proof, pre-packaged dessert (especially with nut butter!) and some pickles…because a girl cannot ever have enough pickles.  haha.  When I arrived home, it was already 6:30 so I had to get my chop on.  In the end I combined romaine, celery, carrots, mushrooms, orange pepper, tomatoes, green onion, beets (oh how I missed you), cranberries, and goat blue cheese.  Dressed it with some lite balsamic vinaigrette.

Is anyone else out there totally ADD when it comes to salad dressing?  I swear I have a ton open at any given time.  Right now I have sweet and spicy French, lite southwest ranch, champagne vinaigrette, fat free ranch, and lite Caesar.  Seriously that’s probably fairly representative of any given day in my fridge.  Variety, variety, variety.  =D

Anyways, I am off to bed so I leave you with three smiles from recent days: 1) I rocked a word on Words With Friends.  I typically never score more than 30 some per word and then the perfect storm happened.  I managed a 108 point word.  Woot, woot!

2) Cuteness from a calendar at the clinic site I’m rotating at right now.  I love me some candy corn.

3) Tune Tuesday greatness since it is that day of the week.  This gem came from a long list of awesome songs from my Vampire Diaries overdose.  (I’m in season four now, only three episodes back from being all caught up to the live ones!)

Questions: What is your fav salad dressing?
What is your go to non-traditional salad topping?

Creeper Status, What?

Day two of my last semester down!  No classes today, just eight solid hours of prep, prep, prep.  I did all sorts of catch up work like editing letters, writing letters of medical necessity, doing insurance preauthorizations, and arranging meetings with committee members.  I also did a ton of prenatal prep work.  I wrote three template letters to get me started.  They were for three of the most common reasons for referral in the prenatal clinic: 1) advanced maternal age (by far the majority!), 2) positive quad screen for Down syndrome, and 3) positive quad screen for open neural tube defects.  Glad to have those out of the way, though there will be plenty of revisions I’m sure!  Another super important task I undertook today with my eight hours of dedication: my visual aids binder.  Boy did this thing need an overhaul.  I hadn’t touched most, if not all, of my prenatal visual aids since role plays back in first semester.  There were also things I knew I was missing like cell-free fetal DNA.

And some of the age-related risk charts you can also see in that picture.  Then there was the fun stuff –> infertility aids!!

I’m really not so sure I’ll ever get to use the ART and infertility aids in an actual prenatal session but I wasn’t going to pass up the chance to make them.  After all, I just got back from my internship at RGI and I’m all stock full of reproductive genetic counseling inspiration. All told, my visual aids binder stuffed by the end.  Yes, it was as large as my entire thumb.

I fueled myself appropriately all day.  After a cardio workout this morning, I showered and made myself some PB&J whole wheat waffles with a side of yummy orange by desk lamp light in the early morning.

I admit I tried to front load today’s calories, or at least I thought about it.  And then I ended up with this… Not so front loaded, though tasty.  I really should try to eat more earlier because I always end up under my calorie mark.  Pretty scared that my body thinks I’m starving it most days.  I wish it was easier to eat sometimes.  Anyways, I suppose I’ll keep trying.  For lunch, almost 5.5 hours later, I had some salad with cranberries and light Caesar dressing.  I also had some cheese and an apple that I spaced on taking a photo of.  I was in the visual aid groove.

After lunch, I achieved total nerd creeper status.  I saw an old acquaintance from undergrad announce her unplanned pregnancy.  The first thing I did was look at the rest of her page, past all the congrats and such, and saw a status in December that seemed a bit out of the ordinary: “Life surprises you sometimes.”  Oh really?  So, yea, I busted out the pregnancy wheel.

Turns out that comment was likely posted around the time she would have noticed a missed period and taken a pregnancy test.  Yes, I’m almost ashamed of how creeper-ish that was.  Ridiculous.  Haha.  So, after that little nerd break, I went back to visual aids and letters.  I had planned, and even packed, a fairly caloric snack for the afternoon to tide me over to dinner but ended up not being hungry at all.  By the time I rolled around to my home couch, though, I was getting a bit rumbly in the tummy.  I made myself some brown rice mixed with Trader Joe’s edamame hummus and lima beans with teriyaki tempeh on the top.

Drink of the night: cream soda.

Treat of the night: a truffle or two from my stocking loot.

And still, despite all of this yummy wholesome food, I was under calorie for the day.  Please body, don’t think I’m starving you, okay?  I’ll try to use more peanut butter, more avocado, more dense things to hit my number.  I’ll try and front load so I don’t end up with a thousand for dinner that I know I can’t bring myself to eat.  I’ll try, every single day.  Now I’m off to do some stretches to help me achieve the splits.  I’m trying to get a bit more flexible for when I tackle aerial silks.  I mean, let’s be honest, how awesome would this be to do?

Yea, that’s what I thought.  You can pick your chin up now, hehe.  =D  Have a good night group.  I leave you with a tune since it’s Tuesday!

Questions: Can you do the splits?
What are the best stretches to do?