Nutrition Tool Box for the Deployed Dietitian

This past week I was at Fort Sam Houston (San Antonio, TX) attending a postgraduate course given by the Army for deploying dietitians. Over the three days we talked about sports nutrition, burns, trauma, critical care, humanitarian aide, and detainee nutrition care. For me it was a mix of validation of information I had figured out on my own (or with a few emails back and forth with one of the Army dietitians in Iraq), and some new information that I wish I had known before my deployment.



I hope I have the opportunity to share the knowledge from this program with other dietitians before they deploy. And with civilian dietitians working in trauma and burn units. The sports nutrition (we consider military folks to be athletes) will also come in handy in civilian private practice.

One of the other great things about this past week was meeting up with the Air Force dietitians in attendence - and that I actually knew them (since I haven't been around conferences or USAF dietitian symposiums I can't put faces to names when I look at the roster, because I just haven't had the opportunity to meet many folks in our career field). But I knew everyone else there. Some from working at Nellis AFB and some from Travis AFB.

Home at Last!

The long journey has come to an end. Obviously I'm a little busy right now.
1 load of laundry and 1 suitcase cleared.
2 boxes of mail & 4 boxes of shipped items to open (2 more on their way).
Still catching up on sleep.
Reporting up to the base tomorrow morning - I'm sure there is lots of paperwork and other stuff to do.
And pictures to load on here.

Thank you to everyone who has been reading this blog (loved hearing from you!!!).
It will continue to be updated with photos & musings until I have officially finished my active duty middle of next month.

Edit to add a couple of pictures:





This guy was hiding under the couch and came out to greet me. AAAAAAACCCCCCCCCCKKKKKKKKKKK!!







Gift from my husband, a much nicer surprise than the spider.

A Very Long Day - First Leg Home

Last morning in Iraq and I’m unable to sleep in (just kept waking up). Was it the anticipation of the beginning of the end?

Breakfast and phone call home. Happy anniversary Ray - my homecoming is my gift to you.

Early CrossFit workout on my own. Did the Col Dolan (our wing deputy commander) legacy WOD: 480m run, 13 hang cleans (65#), 16 pullups (graduated to the purple band), 22 burpees, 35 knees to elbows, 80 walking lunges, 332m rowing, repeat. Finished in 43:30 and took my shower wearing my PT gear in order to rinse out all the sweat (hung it outside and it was dry for packing in a couple of hours).

First time back in uniform since Sunday – it felt strange after wearing it virtually for six months straight. Our squadron’s Change of Command ceremony was at 10:30a– I was there when it started (January 15) and I was there at the end (July 15). Afterwards kept myself cool in the Rec Center and finished watching Survivor (thanks to Chixor & Spuds).

Show time to load up and final out processing was at 2:30p (only two trips to lug my stuff to the basketball court for pickup). Bus to the PAX and human chain to unload all the bags (didn’t know there would be a second workout this morning). Very hot, very sweaty – so much so that my socks and boots were soaked. After getting checked in and a Pizza for lunch I suffered the cigarette smoke outside in order to take off my boots and enjoy the benefit of hot air drying.

We loaded up in the C-17 and took off around 6p. By now I wasn’t feeling too great (should have had more water while I was in the terminal). However, I was better able to handle the dehydration than someone else. Almost an hour into the flight (and out of Iraqi airspace) someone a few rows behind me had a medical emergency. Passed out and had a seizure. Fortunately we had a plane full of nurses and a couple of doctors. Unfortunately no IV fluids so we diverted to the US base in Kuwait (now I can say I’ve been to Ali Al Salem AB). That delayed our trip by two hours. She’ll be okay and just be a couple of days late getting home.


Arrived in Qatar at Al Udeid around 10p. As I feared, the in processing was long, very long. I was fortunate to be on the first bus off the plane. First we had the immigration, then the briefing and notification of our mission out of here in a couple of days. Helped to unload all the luggage off the pallets while the second group got ready for their briefing. Moved slowly through customs and then the real slow down occurred: Before we could turn in our IBA (vests) and chem bags we had to break down and rebuild the padding and straps in our helmets. Problem was there were only four screwdrivers at the table. I was in line for 40 minutes (and this was considered the first group, it was now after 1a.

The bus from the PAX to the Coalition Compound took us all the way around to the transient tents instead of directly to the housing office – good thing I was already used to hoofing it all over the place (even in the dark). Got to the transient housing office and another wait (but at least they had ice cold water). Got a bunk around 3a - the shower felt so great! At that point I thought I’d just stay up and maybe nap at the pool in the afternoon, so I walked across the compound to the dining facility. Reading the newspaper I found I was trying too hard to not fall asleep in my breakfast. Yeah, better to go all the way back to the tent and get some Zzzzzzs. This is the part when I blessed the lucky stars that I was one of the first group off the plane, because at 5a there were still people waiting for their bed assignment.
[insert pictures]

Three hours later I’m sitting in the coffee shop and typing about my longest day. Traveling in big groups is never smooth, never fast. But from touchdown to bed down 6-8+ hours is ridiculous when it’s the middle of the night. On the plus side, I’m scheduled to be in the states in less than 72 hours!

Baladcation (Last Full Day in Balad)

My first real day off since I arrived 182 days ago.

Last night I played in the Monday night poker tournament at the Rec Center. I tried this once before but the last two tables get going around 11:30p and I was so tired that time when I went out in 11th place (made it difficult to get up the next morning so I didn't play again).

So I'm doing very well and make it to the final two tables again (wow, two tournaments in a row and both times I make it to the $1K/$2K blinds).

Yup, I got tired, and that lead to probably looser playing than I should, and my final hand I didn't even see the potential flush when I went all-in with two pair. Damn it, out in 11th (again!).

So it was 12:30a and I crawled into bed (sleeping in the top bunk since someone had moved into my spot in the room). First roommate's alarm was at 4:30a. Then mine went off at 5:00a (I forgot to hide it). Last, the new person's alarm hit at 5:3a. I gave up on sleeping in around 6:15a. Relaxed in bed, read the newspaper. Opened the door and was very pleasantly surprised to see SUN!!!!!

Strolled over to the main dining facility serving our housing area - wow! The breakfast bar options are amazing (this was only the second time eating breakfast in that place since I always just got mine at work, even on Sundays).

Checked in at the hospital - no new flight list yet. Walked to the BX, had a Cinnabon & mocha (yeah, "second breakfast"). Then a manicure. Back to housing and then to the gym. CrossFit workout (50 wall balls, 50 kettlebells, row 400m x 3 rounds). Back to the room to grab my bag and then off to the pool. Two hours with a light blowing dust but still blue skies above. Breezy enough to avoid excessive heat.

Around 2p Lisa walked across the pool deck and let me know that a pending list is circulating and tonight I'm going to get a show time for a flight out of here and back to Al Udeid - probably early tomorrow and thus ending my Baladcation (Balad + Vacation).

Headed back to housing and gathered stuff for laundry. Somehow I lost my dust buff (one of those Survivor buffs but in the military uniform colors that I wear around my neck and over my nose/mouth during dust storms). I was wearing it today and had it when I went to the laundry but didn't have it when I put the wash in the dryer. I think I put it in the wash and I know I double checked the washer so maybe someone snagged it :(

Took the clean clothes back to my CHU, threw everything on the floor and packed my 72hr bag (my backpack, leaving room for my computer) and my suitcase. Then I went to Muscle Therapy and got the best back massage I've had since I arrived - and there are still knots and crackles yet to be ironed out. But it's a start.

Got my last Mongolian BBQ of the deployment (wish I could take pictures in the DFAC). Hung out at the Rec Center, waiting for our chalk (the mission for our ride to Al Udeid). Watched Survivor episode 10 then walked over to the hospital to check the board.

Yay!!! Tomorrow I will have time to sleep in, have a leisurely breakfast, do the morning CrossFit workout, shower, and time to rinse & dry out my workout clothing, then even have lunch before our report time. However, it's going to be a long long day and I don't expect to get to bed until midnight (but that should help me sleep).

Hope the wifi at the Deid has improved connection strength.

New Crew in CrossFit

When you are on a deployed base the personnel change often. Now there are not many left from the 1500 (3p) CrossFit class from when I started (2 months ago). Many new people started this week and I happily helped out (watching form and encouraging everyone).

Carrying on the tradition, here's a picture after "Fran" (Thrusters then Pullups, 21 reps each, then 15 reps, and finally 9 reps). I used 65# for the Thrusters, orange band for the pullups - got 19 in a row in the first set.

Fingers Crossed the Weather Cooperates

We all hope that this "Dust Storm" is not a repeat of our Mars landing from the 4th of July weekend.

Replacements Arrived

Hanging out at the basketball court at 0330 waiting for our replacements to finish inprocessing and be brought into the housing area.


And here is the new AFTH Dietitian and OIC Nutritional Medicine, 1Lt Hyde.


Working with the new crew to get them up to speed, sending some boxes home tomorrow. More folks have been getting rides out of JBB.

Man Love Friday - The Final Chapter

I really like that the surgeons in this rotation are color coordinating their scrub pants with their tops. It's quite lovely. They insisted on being photographed in their 'natural setting'.

This should be my last vision of Man Love Friday at JBB. I hope I'm not here at the next one.

Troll's Legacy

Workout based on all the units where Troll has been assigned. Actual exercise for each number was added by one of our CrossFit instructors.
17 Snatch
77 Pull ups
35 Cleans
16 Thrusters
22 Dips
85 Push ups
27 Kettlebells
43 Wall Balls
94 Air Squats
332 Meters Rowed

Time for a day off!

Pack My Bags

Replacement is on his way. Yay! (But also sad at the soon-to-be-end of my deployment). I've had an amazing adventure. Incredible experience. And I know that I have made a small difference.

Not sure who/when is taking my bed but I have to get all my stuff into a suitcase/duffle and move my pillow to the top bunk tomorrow morning - making up the bed for a new person. Hopefully I can put together one more box for the mail (and get my suitcase as light as possible).

The hard part is not knowing how much longer I'll be here. But most don't have an itinerary (e-tickets home after we get back to the states).

Public thanks to a few very special folks who have forwarded to me DVDs with some favorite shows in the past month. Eric, Celina, Sally (and a couple of others). These really help pass the time and keep me caught up on some favorites. Don't worry, eventually I'll get the last season of "ER".

Todays CrossFit workout: Modified "Eva". Run 800 (I was crazy today, ran it OUTSIDE at 10:30a!!!), 30 kettlebell swings (graduated up to 12kg today), 12 clean/press (65#), and 12 pullups x 3 rounds. It took me 41 min because I stopped to help a new person with his kettlebells swings (don't want anyone to hurt themselves). The afternoon crew did 5 rounds (with 30 pulls ups and no clean/press). I'm trying to save myself for tomorrow when we are honoring an outgoing squadron commander from the EOSS; Troll's Legacy workout is going to be a doozy (he's a power lifter so most of our sets will involve the barbell).

And now the salsa music has gotten loud enough to chase me out of the Rec Center. That is definately something I will NOT miss.

Made it to the Pool for 30'

Not too hot, sort of hazy. Nice to have a chance to let my hair down.

CrossFit workout - "Tabata" (20 sec hard/10 sec rest) 8 rounds of each exercise: airsquats (last round did 16), pullups (7), pushups (5), situps (8).

Dust Dust Go Away!! And "Can You Really Wear a Two Piece in Iraq?"

Ack! The dust is coming back! NOOOOOOOOOOO!

I had this all planned. Patient rounds in the morning (check). Meal ordering and inpatient education (check). Morning CrossFit class (check), eat lunch (check), and then do a swim workout this afternoon (hence moving my CF class to morning). But now it's getting dusty again. Sigh.

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Some people have asked about wearing a "two piece" at the pool. Didn't know that it was now legal (for civilians and for Air Force).

In the Air Force the rule is that men wear baggy shorts/swim wear (no speedo suits) and women can wear one or two piece *conservative* suit (i.e. no thong or itty bitty bikinis). But the Army rules say "one piece" only.

Joint Base Balad is just that, "Joint", and when AFCENT (Air Force Central Command) took over the base, one concession was to the Army swim suit standards. The other claim about the "one piece" rule is that it is part of our respect for the host nation (that doesn't fly with me since women in our host nation would not be seen at a co-ed swimming pool in ANY suit that didn't cover up arms & legs). And that is why when I arrived the rule was "one piece" at the pool.

When you are working out, it makes perfect sense to wear a one piece. But the outdoor pool opened in April and has plenty of deck chairs for tanning. Brigader General Bishop, as one of his last policies prior to his change of command, changed the swim suit policy at the pool - allowing for a conservative two piece. Heck, no one was really enforcing the one piece policy for the civilians anyway (pool employees weren't allowed to, only military supervisors). And don't get me started on the definition of "conservative".

Interestingly enough, one hour after the 332 AEW Change of Command, the JBB Command Sergeant Major of the Army (highest ranking enlisted) sent out a "new MNF-I Uniform Policy" to all AEW folks. While it focused on Army uniform policies it also included Air Force & "all military" in many portions - including the "one piece" at the pool (along with mandatory reflector belts with PT gear which would be redundant for Air Force since our PT gear has reflection built into both the shirts & shorts; we don't have to wear a belt). That same afternoon we were emailed by AEW Headquarters that any change in uniform policy would come from AFCENT, and we should carry on with our previous instructions at this time.

Man, gotta love politics - especially when it comes out into the open like this.

The End of the Sand Storm

Finally a break in the dust and sand. And by this afternoon there was blue skies and the air was heating up again.

With the improved visibility the planes are flying. Jets are taking off again. The mail arrived. The shelves at the BX started filling back up. We had lettuce & tomatoes at dinner. And our redeploying hospital folks have started leaving. Just waiting for our replacements to leave the states and move closer to Iraq.

Maybe I'll finally get back to the pool this weekend - one last opportunity to get a photo in a two piece suit before leaving the desert.

Today's CrossFit workout: 12 one arm pushpress R arm (20#), 12 one arm deadlift L arm (50#), run 1/2 mile. Do it again with L arm/R arm and run another 1/2 mile. Repeat both. for time - 21:48 (got the treadmill up to 7 mph - fastest yet). 5 pullups at the end.

4th of July in Balad

Started with the "4th of July 5K" (ran on Friday July 3rd). PR 27:50 in the dusty early morning - preclude to more dust and crappy weather all weekend.

CrossFit workout kicked ass. The first time I did this workout (6 weeks ago ) I used jumping pullups, lighter weights and a shorter box. This time I finished 2 min faster.
The "300":
25 pullups (used the orange band)
50 single arm kettlebell press (25 ea arm) - 8 kg weight
50 box jump - 20" bench
50 floor sweeps - holding a 75# barbell over my chest, sweep straight legs from one end, down to the floor and back up to the other end of the barbell (25 to each side)
50 pushups
50 deadlifts - 95#
25 pullups (used the orange band)
24 min 20 seconds. Not bad for an old lady.

Still dusty and low visibility. No wifi at night (can't reach the satellite).

332d Air Expeditionary Wing Change of Command - 0632 hrs (332 Zulu)



I was the narrator so I had one of the best seats in the house for the show.














DFAC was set up for the holiday and we served BBQ ribs, chicken, fried scallops, crab legs, special soups, mac & cheese, green beans with mushrooms, corn on the cob, spring vegetables, baked beans (some at lunch, some of these at dinner). Oh, and the cake & ice cream at lunch.

Oh What a Morning

It was quiet and I wanted to capture the memory.

Giving Platelets - 8 Units Later

I started my donations in March. I got infiltrated once (the return blood wasn't going into the vein), and I was delayed once (my hemoglobin level was too low, so I started on iron supplement). Eight donations and you earn the coin. Just in time for the end of my deployment.



My first donation we took a picture. That same photo is now being used on a flyer distributed around the base looking for volunteers. I thought it would be fitting to take a last donation picture as well.

Starting to Say Goodbye

The NCOIC is the first to leave. His replacement and one of the new airmen arrived late last week. We've given gifts to our food service workers and their supervisors.

Today dawned beautiful and relatively cool (only 80 degrees). But soon another dust storm rolled in. That halts the convoys (no fresh produce) and our mail (no box from home). But, more importantly, it makes it difficult for the medical choppers to fly. So some folks get stuck at the Combat Surgical Hospitals (CSH) and have to wait there before we can move them forward to Germany.

The Medevac Unit here is known as "Dustoff". 2-641 AVN moved their operations to the helipad next to the hospital a few months ago. I helped them get things set up for on-call personnel to have their meals at the hospital DFAC (since they cannot be more than 10 min away from the choppers). As thanks their command chief presented me with one of the Commander's coins.
















Last Friday we hosted the final results of the second round for "Fit-2-Fight" (our weight lost competition). This time around we put emphasis on fitness and body composition rather than just weight. My team got 2nd place (average 5% fat loss amongst the four of us).



The hospital Commander called me up in front of the participants and presented me with his coin to thank me for all the work I have done at the hospital this year. He cited the remodel of the DFAC, bringing in some new food/beverage items; the Halal meal contract so our Iraqi patients would eat more (helps in wound healing and decreased length of stay), and the Medical Nutrition Therapy (clinical care, nutrition support, diet education).