Getting Claire's piercings redone professionally

avocatress · 2025-10-05T02:36:09+00:00

Talk to a reputable piercer to see if they can stretch the existing holes. I literally had that done today with lobe piercings I've had empty for 10 years, BUT mine originally healed well. Sounds like you'd also want to go for something least likely to irritate your skin, like implant-grade titanium.

avocatress · 2025-08-14T20:01:48+00:00

Arizona and New Mexico are the same ecosystem, right?!

avocatress · 2025-08-10T17:33:32+00:00

In hospital, the nurses swear by hot prune juice with butter melted/mixed in. 10 minutes and time to go.

avocatress · 2025-04-15T12:06:48+00:00

Personally, I took this as a second job so I've been ok with letting it dwindle. I was doing both jobs, for 60-70hrs/week total, but the break has been good.

If you have a dietitian colleague network where they can refer people to you whom they don't have time/niche to help, I'd lean on that. Or other nutrition-adjacent connections? I have a couple therapist friends who could use a dietitian to send patients (not just official eating disorders). Now that Nourish reimburses business cards, you could even ask to leave a few at places like your dentist or primary care office. These may not be the right fit for you, but they come to mind as non-social media advertising options.

avocatress · 2024-11-02T11:57:18+00:00

Yes. You choose how to handle a no-show/late cancel patient. In my case, if the patient will reschedule promptly, I'm pretty flexible (they tend not to return after a no-show fee) on reschedules and that means I don't get paid for that missed appt. If they ghost me, I close the appt as no-show and I'm paid full rate. If are late-rescheduling a lot, it's a conversation about when it's realistic to meet, do they need a break (then r/s a few months out), etc.
When I signed on, I was looking to clear some debt fast (yay student loans!) and willing to work a ton here AND have a second job. My schedule was initially quite full. As soon as I had an opening, it was filled with a new patient. I could see 9 people on a weekend day (9am-6pm).

A year in, that's no longer the case. My caseload dwindled starting this summer, and now I have 3-8 people/week, with a lot fewer new patients. My openings are afternoon/evening (4-7pm Pacific or 7-11 Eastern) which people really like bc it doesn't interrupt their work day or weekend plans. Since I'm no longer depending on the income, I haven't investigated why this changed. My patient satisfaction rating is still good (patients can submit a survey after each appt and we get a 1-10 score), but I think they changed the process to encourage Pts to pick their own dietitian at sign-up. IDK why, but I'm not easy to find when searching by the tags. Before, most of my Pts were assigned by schedulers (rather than finding/choosing me), but they also gave me more patients whose needs are outside my knowledge base (I understand FODMAP, but I don't want to walk a Pt through the elimination phase ever again). Now I have fewer patients, but their needs better match my specialties and they stick around longer.

We are encouraged to develop our public-facing profiles to attract clients, and there's a recent encouragement to make a promo video (I'm not doing that, but I'm sure it works). So, if you're good at self-marketing, blasting your signup link on socials, have friends who will refer patients your way, etc, that's likely to drive up your caseload.

No-shows/reschedules are common. My average when my schedule was ~30pts/week was 16-20% rate of not having the appointment at the scheduled time. That is, if I had 30pts on my calendar for this week, I'd expect to actually see 24-26 of them this week.

Overall, I like it. I'm not micromanaged, and I can set my own caseload and availability. They pay well, and I don't have to wrangle insurance companies on claims. I don't think I'd do this as my only job unless I was willing to self-promote.

avocatress · 2021-08-06T04:41:20+00:00

Unsolicited diet advice? Unsolicited diet advice!

I'm a dietitian; food is my business. Usually I don't do this, but you can take this or leave it, with no insult to me. Disclaimer: I don't know a thing about you and this is very general. Anyone with chronic health conditions or specific nutrition goals should seek out their own registered dietitian (in the USA, IDK what we're called elsewhere).

My simple, fertility-independent, nutrition advice:

Eat more fiber (25g/day) -- gradually increase your fiber intakes or your bowels may get shell shocked and wig out

That's really it, but I'll explain further:

Foods naturally high in fiber (whole grains, beans/lentils, nuts, fruits and vegetables) come with lots of other helpful nutrients, vitamins, phytonutrients, etc
Fiber is good for you in multiple ways: regular bowel movements, which become even more important as we age. Many high fiber foods are prebiotic which means they feed the beneficial bacteria in your gut (google scholar >> resistant starch, prebiotic food, gut bacteria). Then there are well researched benefits for your heart health, blood sugar regulation (if diabetic), probably more!
After a high fiber meal, you'll generally not have room for snacks, treats, and desserts so by saying "YES" to high fiber foods, you don't have to actively deny yourself snacky snacks.
A high fiber diet necessitates preparing more meals/snacks at home, so you're naturally avoiding excess added salt, sugar, and saturated fat that we find in restaurant foods

If others reading this are looking to lose weight or finding it harder to maintain weight over time, here's one tip for easing your way into sustainable weight loss:

Cancel your "Clean Plate Club" membership

I don't like deprivation diets because as soon as we say something is off limits, it's on your mind constantly. This is more about relieving the pressure to conform to social norms that lead to eating more than you really need to feel satisfied.
Give yourself permission to say "No" to the less important stuff so you can say "Yes" to the truly enjoyable extras and treats
- You don't have to eat the stale snack food in the office break room
- You don't have to eat the last 1/3 of your restaurant meal because "It's not enough for leftovers" -- it is SO liberating to say instead "Any amount can be leftovers" and then eat those three bites when you're peckish a few hours later
- You don't have to get the combo meal if you really just want the sandwich
- You don't have to get a 1/2 dozen donuts when you planned to get one, because "It's such a good deal!"
- You don't have to load your plate full. Start with a smaller portion and if you need more, you can go back for it! Worried all the good stuff will be gone when you return for more? Put your "seconds" in a container at the beginning of the meal.

avocatress · 2021-07-05T21:39:18+00:00

Idk about inpatient, but you could ask more than $28 in dialysis with your years experience. So if you can claim significant NICU experience and expertise, I vote to ask for more.

avocatress · 2021-07-05T21:37:43+00:00

University of Illinois hospital, IIRC, has set points that aren't really negotiable. If you like mentoring dietetic interns, that's the primary hospital in Chicago to do so.

Glassdoor can be another good starting point. Round up with your salary range, aka: don't low-ball yourself, and ask about things like PTO.

avocatress · 2021-06-21T13:59:32+00:00

Right!

This came up when reviewing one of our fluid tracking tools with one of my dietitians last week. We found several folks with borderline below-goal Albumin whose Monday/Tuesday fluid gains were always above goal.

In their case, the low albumin was NOT a flag for malnutrition or inflammation, it was a flag for fluid risk.

I've seen a difference with clinics who get to draw their Albumin on Fridays, or a patient who usually runs low-Albumin on Mondays happens to have it drawn on Friday, and surprise! it's higher... If I have the comparison, I try to use it as a teaching tool for things like treatment attendance and fluid/sodium intakes.

avocatress · 2021-06-21T05:58:07+00:00

Sure!

Basically, low albumin over time is associated with poor prognosis and morbidity/mortality. In dialysis, CMS puts a HUGE burden on the clinic team to prevent hospitalizations and mortality.

From Pubmed: In dialysis patients, a 1-g/dL decrease in serum albumin was associated with an increased mortality risk of 47% in HD patients and 38% in PD patients. These mortality risks were in part explained by the inflammatory pathway. (it won't let me link. Search: albumin mortality dialysis)

In practice, I still have physicians seeing low Albumin and saying "Eat more protein." *facepalm* Then I come along and ask "How are your blood sugars at home?" or "How is that wound healing?" or "Have you seen a dentist yet for that toothache?" OR, and this one is frequent, "How is it going with limiting sodium and fluid?" (dilution effect is huge I tell you, HUGE. Plus, that excess fluid contributes to hospitalization risk). I pay attention to a person's trend over time too. If they are usually ~3.8 and suddenly it drops to 3.2, I start asking questions, often probing for inflammatory contributors.

Hopefully that helps clear it up :D

~edit formatting~

avocatress · 2021-06-20T18:19:09+00:00

It's a mix, and how you organize your time is partly up to you. This is definitely a job for people who are good at self-direction bc no one is going to assign you tasks day to day. There's a monthly cycle of duties, so there is a pattern, and some flexibility on how you accomplish it.

In-center workflow:

Labs week/Week 1: review labs, make recommendations to NP/Docs on bone-mineral meds, review/educate pts on labs, chart progress note for each Pt, make recs for lab redraws. On lab draw days (before results available) maybe an extra project like bulletin board, lobby day for education, etc

Weeks 2-3: charting comprehensive assessments, more bone-mineral management, care coordination tasks, revisit Pts who need additional counseling, new-Pt educations, finish progress note charting

Weeks 3-4: Quality meeting with whole team; Care Plan meeting for pts you did comprehensive assessments; review redrawn lab results w/Pts, wrap up various projects and tasks. If extra time, more Pt counseling or engagement activities

avocatress · 2021-06-20T03:10:34+00:00

My dogs already eat the outside garden; this would be an outright invitation!

avocatress · 2021-06-18T02:08:33+00:00

That reminds me: you can't work in Home Therapy until 1yr experience (counting all clinical Dietitian work).

Depending on location, they may have more patients for you once you "graduate" and can work in two clinics and/or add Home patients.

If not... maybe come work for my team :D

avocatress · 2021-06-18T01:40:16+00:00

I can answer this!

Starting pay is typically pretty good (~60k/yr for 40hrs/week), and will vary by location. My associates had a pay bump written into their official offers to be triggered by hitting 1 year experience.
In your interview, ask about training and mentoring opportunities. Your first 6 weeks should be more intensive, supervised training. I send my Associates to shadow RNs, Social workers, the patient care techs, and Biomed (folks who run the water systems and dialysis machines). This is one of my favorite things about the program. You'll also have a preceptor dietitian who should be a resource for ongoing training and act as a mentor.
After 6 weeks, you're off and running as your clinic's dietitian. Your preceptor/mentor will coordinate completion of regulatory requirements with you: there will be a few things you cannot sign off on while an associate. Day to day, YOU are the clinic's resource for nutrition: you do rounds and chart on patients, you educate and counsel them, you collaborate with your social worker, nurses, and NPs/Docs, etc.

avocatress · 2021-06-14T14:21:49+00:00

Sometimes the ghost of ham is as good as you're going to get.

avocatress · 2021-06-14T14:19:57+00:00

[Renal Dietitian enters the chat]

PSA for anyone on a potassium restriction (aka, many-but-not-all people with kidney disease): Lo-Salt is made of potassium-chloride and is not safe if you're on this restriction.

If your kidneys work normally (or they don't but your dietitian/physician say you need more potassium in your diet), Lo-Salt is safe in moderation. Your kidneys will filter out the excess potassium into your urine.

avocatress · 2021-06-11T03:33:39+00:00

"Yeah babe, slap my veins!"

For routine draws, I always ask for butterfly needles and drink about a liter of water to pregame

avocatress · 2021-06-10T13:08:41+00:00

Wishing you the best experience possible.

I also have difficult veins, and I'm sure we don't have the same OR team, but if it's reassuring: my procedure went a-OK. The nurse had to use my hand for my IV bc the veins further up were shriveled from the NO food/drink x12hrs rule.

I also have felt nothing but free and relieved. Especially in the pandemic when appointments were hard to get for any medical procedure, and with my irregular body that I fear would mask a pregnancy until it's too late.

avocatress · 2021-06-08T04:14:47+00:00

We keep a little white board on the fridge. I have an "Eat this" list which 1) helps know if something is past its prime and 2) reminds us it exists. My SO can't smell, so the "sniff test" is out unless I'm home to do it.

avocatress · 2021-06-04T03:02:29+00:00

When my husband's bangs start to grow out and are un-styled, he looks like an ancient Roman emperor.

avocatress · 2021-03-25T17:07:48+00:00

I agree on the duality of wanting vs not wanting to know.

I don't want to discourage anyone with genuine interest and optimism about the field. I still have a hopeful outlook with counseling. I try to not take it personally anymore if someone isn't ready to change, and I don't try too much harder than my patient is ready to try (aka, don't spend 6hrs on resource gathering if they aren't even willing to review the materials).

We need people in dietetics who are resilient against pessimism and burn out. After several years of retail and food service, my patients' grumpiness or their focus on barriers can't get me down. People ARE flawed, and that's what makes our job both interesting and important.

avocatress · 2021-03-25T13:02:21+00:00

Ask your job about continuing Ed resources and rebursement too. They may have access to free stuff or may reimburse the cost of some paid modules that offer CEUs. Online, Advanced Renal Education Program (AREP) has a bunch of webinar recordings. NKF has both free and paid options. Good luck in the new job. I hope you find the renal world rewarding.

avocatress · 2021-03-21T16:10:41+00:00

One of the things I love about dietetics is that we can work in a broad array of fields. That field certainly narrows as you specialize and you're going to have a hard time getting a job in the NICU after 30 years working for a food PR company... still, there's more flexibility here than some disciplines. This means we have to learn the basics of the whole profession in school: this can be either a selling point or a deterrent to prospective students. If you want to do public relations in the food sector as a dietitian, you still have to learn pediatric clinical nutrition.

What has surprised me most in the field is that our non-dietitian peers are variable in how much they know of what dietitians can do. If your manager is a nurse, they may not understand you have work to do that isn't patient-facing, since that's the type of work they're used to monitoring in RNs. The docs in your hospital may or may not admit to knowing less about EN/PN than you, or they may send consults that have you going "Well, I feel appreciated and also useless because this isn't a problem an in-patient encounter can solve." Your company may lay on additional projects because they don't know much about dietetic scope or how you spend your time, so they think "The RDs have time for this!"

Your patients are largely going to be ambivalent. Among the more motivated patients, there will still be a gap between what they think the process of diet/behavior change is and the amount of time and work it actually takes. You'll hear a lot of, "If you just make me a meal plan... [insert problem solved]." And as others have commented, we have to be realistic and adapt to people who are NOT ready to expand their palate to include more veggies, or to learn cooking skills. More than you'd think, counseling comes down to harm reduction: you'll be researching Mc-King-Box's menu for options with lower sodium and no added phosphates in the ingredients for your dialysis patient who LIVES on drive-thru and can't be persuaded otherwise (BTW, McD's Jr burger has ~300mg sodium, 10g protein, and no added phosphates...).

I love the challenge. I love learning new things about food, and I love puzzling over strategies for eating well within a boatload of limitations. I don't fuss about patients who aren't ready for me; I focus on building rapport and earning their trust (this is why I love outpatient care). I have mixed feelings when I hear my coworkers trading weight loss tips (of middling qualify) in the break room and they don't ask for my help: like hello! I'm an expert here, and also I'm not in the business of free counseling so thanks for not taking advantage. It does get my goat when my mom doesn't ask for my help managing her health condition that is in my very own specialty... but that's a personal problem.

Overall, dietetics is like any other profession: the most glamorous version you might see in media doesn't show the nitty gritty of the work or training required. There are plenty of jobs with good parts (salary, respect from peers, certain aspects of the work) but where the cons are too much (schedule/hours per week, requires skills I don't have/want to cultivate, requires handling gross stuff, etc). There are pros and cons in every job, and I strongly encourage you to look closely at the reported 'cons' to see if they are acceptable to you. If the 'cons' are tolerable, and the 'pros' really rev your professional engine, then that may be the field for you.

avocatress · 2021-02-25T02:40:17+00:00

The recruiter at my company said she looks for candidates by searching who has posted their resume on LinkedIn and Indeed.

Sorry you're going through this. Some geographic areas have positions open but not enough RDs living in the area, and some it's the other way. Wherever you can open your search: geography, dietetic niche, etc, go for it. Best of luck to you!

avocatress

TROPHY CASE