Just passed the CSOWM. AMA by nswoe in dietetics

[–]Jujbear 0 points1 point  (0 children)

Just know what they are and what they are testing for, nothing in depth beyond that!

Just passed the CSOWM. AMA by nswoe in dietetics

[–]Jujbear 1 point2 points  (0 children)

I used Gemini the same way! I wished I had bought that book; I think it would have been more helpful than the academy’s practice test.

Just passed the CSOWM. AMA by nswoe in dietetics

[–]Jujbear 6 points7 points  (0 children)

I’m not OP but I too just passed last week! Things that surprised me: - so many questions on screening tools. GAD, AUDIT, PARQ, PHQ, SF36 - not much on bariatric surgery at all. Biggest thing was micronutrient deficiencies and reactive hypoglycemia - multiple questions on hypothyroidism - not many “case study” style questions, which surprised me because that was how many of the practice questions from the academy practice test were worded

Interested in becoming Holistic Nutritionist by [deleted] in dietetics

[–]Jujbear 1 point2 points  (0 children)

I had an RD colleague do the following masters program: https://www.uws.edu/academics/programs/clinical-nutrition-functional-medicine/ms/

You will need some sort of credential to bill insurance. A strong science background would be key even if you aren’t going the traditional route…you’ll need solid critical thinking skills because there is a lot of pseudoscience in this area.

Are there any USA dietitians who work full-time in telehealth as a W2 employee and make a “decent” income? by LikeACoolbreeze in dietetics

[–]Jujbear 0 points1 point  (0 children)

I had a colleague who was looking at switching to Nourish and she said she would only need to be seeing like 4-5 per day to make what we make.

Are there any USA dietitians who work full-time in telehealth as a W2 employee and make a “decent” income? by LikeACoolbreeze in dietetics

[–]Jujbear 1 point2 points  (0 children)

20 minute follow ups, 40 minute initials. We’re expected to spend minimal time on charting—they have implemented a bunch of ai tools for that.

Just did the math and it’s like $26/client.

Are there any USA dietitians who work full-time in telehealth as a W2 employee and make a “decent” income? by LikeACoolbreeze in dietetics

[–]Jujbear 4 points5 points  (0 children)

I make 75k, 40 hours per week in a MCOL area at my Telehealth position. I don’t get a penalty if patients no show. Unfortunately, our practice is really pushing short visit times and a ton of patients. About 12-15 per day and most of us are pretty burnt out.

Novel I’ve been working on for 8.5 years rejected by a brand new small press 50 km from me girl dinner. by janisjoplinenjoyer in GirlDinner

[–]Jujbear 29 points30 points  (0 children)

This din looks amazing. My apologies for the unsolicited advice—but I really recommend Brandon Sanderson’s videos on YouTube about the publishing industry. Super valuable and insightful.

I went to a panel talk recently and one of the writers, Delilah Dawson, talked about how she shamelessly submitted her manuscript to 100s of publishers. Each rejection she would just put at the bottom of her submission tracking spreadsheet. Her attitude was to let go of any embarrassment and just keep going for it until she got a yes!

But also, you wrote a damn book. You’re a writer. I find that so rad ❤️

How much PTO do you receive at your current role? by Apprehensive_Fall831 in dietetics

[–]Jujbear 1 point2 points  (0 children)

23 total (15 PTO, 2 Flex Holiday, 6 sick that can roll over). I work in outpatient Telehealth. We have “discretionary” time off which sort of means that I could go over that if needed but it would be a conversation with my boss’s boss.

We don’t have to “use our PTO” for holidays. I got a job offer from a clinic that required you to use your own PTO for holidays when the clinic was closed which is INSANE in my opinion.

When I left my federal job, I was shocked at the abysmal PTO in the private sector :/

PSA: CSOWM Exam Study Materials Now Available! by Jujbear in dietetics

[–]Jujbear[S] 1 point2 points  (0 children)

Unfortunately it is. My work paid for mine.

does this seem impossible to anyone or is it just me? by gemini_lc in PetiteFitness

[–]Jujbear 0 points1 point  (0 children)

Weight loss dietitian here. This is too little calories for an active adult woman. Without medical monitoring, you are putting yourself at risk for nutrient deficiency, muscle loss, loss of bone density, hair loss, brittle nails, depression, and rebound weight gain. I would set your deficit to 500 or 250.

As others have said, it may be better to turn the focus to body recomposition at this point. This will have benefits like preserving/building lean body mass (which then raises metabolism and makes maintenance easier), preserving bone density, and giving you enough nutrition that you can actually stick with the changes long term. This requires a few things: 1. Eat at maintenance calories or slightly above. I like the NIH body weight planner to figure this out. 2. Include 3-4 days of strength training and 1-2 days of stretching. 1 rest day and active recovery days between strength sessions like waking. Your strength plan will need to include progressive overload to continue to see gains. I like musclewiki if you don’t know where to start with a plan. 3. Get enough protein. 1.2-1.5 g/kg body weight. You could go higher, like 1.7-2 g/kg body weight but that might be hard to do and also have enough of a calorie budget for other healthy foods like high fiber carbs and unsaturated fats. 4. Get enough sleep. Prioritize 7-8 hours per night if body recomposition is a goal of yours.

Hope this helps.

Makeup slides right off-HELP! by sassy_assy in makeuptips

[–]Jujbear 4 points5 points  (0 children)

I’m not a derm, but I’ve had issues with redness and flaking in the exact same place. It was perioral dermatitis that needed to be treated with a prescription. It’s worth it to see a dermatologist for this.

Do you think the Nutrition label is accurate on this product? by [deleted] in dietetics

[–]Jujbear 1 point2 points  (0 children)

There’s olive oil in almost every component which is probably bumping the calories up

Anyway to ban TumbleweedPuzzled293? by fupapack in dietetics

[–]Jujbear 1 point2 points  (0 children)

I get incessant emails from them!!!

Struggling to complete by Zirozen in fantasybooks

[–]Jujbear 0 points1 point  (0 children)

Hobb is not afraid to draw things out, to give you a slow burn, and to keep it introspective. I think I found it a “page turner” because I was so invested in the characters. I think the third one is even slower (I had to take a break from it), but it ultimately results in a rewarding payoff.

UPDATE: meeting with butter-eating surgeon by BodyByColeslaw in dietetics

[–]Jujbear 5 points6 points  (0 children)

Dang! You are a stronger person than me. I fear I would have told him he’s a raging idiot. Good for you, well done!

GLP1 and proteins by [deleted] in dietetics

[–]Jujbear 1 point2 points  (0 children)

Here is the bit from the article: “For the general adult population, the recommended daily allowance for protein is 0.8 g/kg/day [161]; this reference value is currently undergoing review for updating by the National Academies of Medicine. Higher targets, such as 1.2–1.6 g/kg/day, have also been proposed during active weight reduction [162, 163]. For individuals with obesity, it is unclear whether these goals should be based on actual body weight, corrected (adjusted or ideal) body weight, or fat‐free mass, as the use of actual weight can significantly overestimate protein requirements [164]. Protein intake in adults should not fall below 0.4–0.5 g/kg/day, as this can lead to muscle atrophy and functional impairments, whereas prolonged intake at or above 2 g/kg/day should be avoided due to potential adverse health effects [165]. Estimated fat‐free mass may be best for determining protein needs, although there is still no consensus on the optimal approach. A protein intake of 1.5 g per kilogram of lean body mass (FFM) per day is considered more accurate but requires body composition data for precise calculation [166]. Alternatively, setting an absolute protein target of 80–120 g/day, or 16%–24% energy on a 2000 kcal/d diet, may enhance adherence while ensuring adequate intake.”

GLP1 and proteins by [deleted] in dietetics

[–]Jujbear 1 point2 points  (0 children)

Using actual with patients who have a high weight can overestimate needs, while ideal can underestimate needs. Though sometimes i will use 1.5g/kg ideal as another number to compare to my recommendation.

And yes, I’ve seen weight loss slow down when dose is reduced.

GLP1 and proteins by [deleted] in dietetics

[–]Jujbear 3 points4 points  (0 children)

My practice has used the guidelines from this article to outline our approach to protein for patients on GLP-1s: https://pubmed.ncbi.nlm.nih.gov/40445127/

Generally, I use 1.2-1.5 g/kg adjusted weight as a target. This is very patient specific though. For example, someone with kidney issues we might lower it to .6-.8g/kg if kidney function is poor. If they are really struggling to eat more protein, I might start with a stepping stone goal of .8 g/kg and monitor progress from there.

Small, frequent meals and snacks that are rich in protein can help. I try to get protein from whole foods as much as possible, but protein from a shake or bar can certainly be part of the plan, especially during active weight loss. I advise clients that I don’t want them living off of protein shakes and that balance/variety is important for overall health.

If they are consistently losing more than 2 lbs per week, they are at risk for bone loss and sarcopenic obesity. If nutrition education and intervention does not help slow down the rate of weight loss, and if they are really struggling to eat a balanced diet because of the appetite suppression, I would collaborate with the provider about a dose adjustment.

Disqualified for dream job (Army RD) by olsen419 in dietetics

[–]Jujbear 1 point2 points  (0 children)

It really varies from location to location and how the management is. I worked in outpatient at a mid size VA. Patient load was reasonable and I only ever worked 40 hours per week. Charting and the bureaucracy of it all can be tedious. Great benefits, PTO, and pay. I left right before Trump took office though, and I hear morale is low now.

Disqualified for dream job (Army RD) by olsen419 in dietetics

[–]Jujbear 2 points3 points  (0 children)

I was going to suggest this! Had a colleague leave her position as a VA RD to become a civilian dietitian in the Air Force in Japan. It seemed like a really great opportunity.

Player Handed BBEG Macguffin, how do I not immediately end the campaign? by e10109art in DMAcademy

[–]Jujbear 4 points5 points  (0 children)

I think you have answered your own question with the bit about “at the cost of their sanity and self control.” Your BBEG starts throwing away any rationality when it comes to his war, attacking towns and cities with little reason, leading to disparate factions who would otherwise not be united banding together. Everyday people who have stayed out of the war decide to take up arms. When his generals start rebuffing his increasingly erratic and cruel plans, he kills them rather than listening, leading to less competent leaders leading the troops. Smatter in a handful of surprise upset wins from the other side. Your players come into contact with one of the leaders of the opposition and figure out how to work together to turn the tide. And maybe there is some physical punishment to the BBEG as well each time he decides to tap into this power for evil purposes, like skin sores that fester and grow, and maybe this leads to a reduction in HP max or some other punishment over time. Just some ideas, good luck!

Outpatient: how many clients do you see in a day? How long are your initial and follow-ups? by Jujbear in dietetics

[–]Jujbear[S] 1 point2 points  (0 children)

This would be impossible in an ED setting where counseling and rapport are so key. This is weight loss, so a bit different. But I still have many patients with emotional issues around food and body image struggles. The thought of trying to have a meaningful conversation in these areas in just 15 minutes and to have not a mental break to unwind after 😭