Allergy Management and Nutrition Education with Shaun Sawko


Hi Shaun thank you so much for coming on


Of course, of course.


So I'm really excited to connect with dietitians that are young and new-ish to the profession to get their take on what they think people who are totally new really need to know. Because sometimes when you're really experienced, you don't have the same take on what it's like to be on boarded as someone who recently went through the process. So, how did you get into school nutrition and how long have you been working in this area?


So, I am a dietitian. And just like every other dietitian, I had to do my internship. My internship was distance-based because I wanted to stay in Tampa and you know, do my rotations in Tampa and there weren't, there aren't really any besides the VA. Here there aren't any internships so I applied for a distance one and set up my own rotations. One of my rotations was with Hillsborough County Public Schools and with my current supervisor Heather D. Ambrozy and we started emailing probably two years prior to me actually beginning my rotation with her. And whenever it came to my rotation I originally wanted only, you know, I originally only scheduled out to do I think four or five weeks with her. I didn't know anything about school nutrition, and I just, I thought for some reason I needed to have school nutrition and hospital food service. I didn't know I can just combine them into one. So I separated the two


So you had to set up your own rotations in this program?


Yep, yep, had to set up my own rotations, which is a really good idea or a really good opportunity for me to get to know my preceptors prior to actually precepting with them. So, that was really great. I had a report going in- into the rotations, which is really nice compared to some other people who just kind of are thrown like you need to show to the hospital on this day.  So, I already had a rapport kind of built with Heather, and whenever I came to be her intern, I did for four or five weeks with her. I thoroughly enjoyed it. I didn't realize how much I would enjoy it. I immediately after that I went to hospital food service and I actually liked school nutrition so much more that in the middle of me, like maybe a week or two into hospital food service I emailed Heather asked if I can come back and finish the rest of my food service rotation with her and I left the hospital early just to come back.


Oh, now that is amazing to have that type of control over where you go during your internship. I'm jealous.


Yeah, yeah. So um, because I mean, I was, you know, I was not interested in hospital food service at all, but absolutely loved it here. So, she'll, she let me come back and I came back for an additional two weeks. And, you know, I was lucky enough that after I finished my internship, they had a position open around the same exact time so I was able to go from being an intern to immediately being an employee, which was a really nice, easy transition. With that there were some stipulations. So I, you know, I realized that this job is a lot of learning on the job. You, you know, with being an intern ahead of time, I feel like sometimes I was seen as you know, he's already trained, he's already well aware of the program and all that stuff. So sometimes, you know, other jobs where there's a little bit more of like, you know, walking you through it, or at least doing baby steps, you're just kind of more thrown into it. And of course, you know, my employer, as well as my co-workers are really great with training and developing you and all that stuff too. But I, I know myself, I don't like to ask for too much advice. I'd rather you know, try to do it on my own as much as possible and if I knew, I would seek it out. So there is a lot of, you know-


How have you navigated that? How did you approach kind of educating yourself or training yourself?


Um, well, it's really- so my current position, I'm a nutrition coordinator. So, my main focus is nutrition education, as well as I do a lot of special diets and special menus too. So, it was more of like trying to navigate what items that we can suit for each dietary need. So, I just learned basically all of our items on inventory, I learned the meal requirements and requirements for you know, special diets, too as far as documentation goes, and then from there, you know, I've also branched off because I feel like every single student nutrition employee has an asterisk next to their titles, because there's anything else underneath the sun that can be assigned to you, too. So there's been a lot of projects that, you know, I just kind of have to figure out on the go. So like, for example, before we hired someone specifically for breakfast in the classroom, one of my duties was the meet with principals and expand our Breakfast in the Classroom program. So, you know, learning how to talk to principals, how to negotiate with principals, how to persuade principals, learning about, you know, Breakfast in the Classroom, breakfast program, student or a National School Lunch Program, all those little additional, you know, FFEP, and all those other additional programs. I really just make sure that I just keep up to date with it. I have an entire binder of things that I just review on a constant basis just to make sure that I'm aware of the requirements for every single one of those programs kind of deal.


I'm so afraid of printing things out because I feel like


They changed so often.


Yes. So, what do you do, as far as keeping your digital life organized, or how do you keep track of things really? Like, what tips can you give us?


Um, I mean, I have a notebook that I have, I got for my internship. So, it's got, I mean, it's like one of those zip up file folder kind of deals. It's got a legal pad and I just review it as often as I can. I try to keep organized notes. Anytime I meet with anyone, anytime I meet with a parent, anytime that we're doing any kind of student engagement or anything like that, I try to take- take well notes or take notes really well so I can review them later on. So, I'm constantly just kind of looking through and I have, I usually use one notepad per year. So, I go through the entire notepad in a year and it's nice to have the change of year just to start a fresh new notepad. And then that way, it just kind of keep up to date with that.


Yeah. Yeah, that makes sense. I have so much trouble keeping up with where I wrote things down because I love notebooks and I always have way too many and then I don't know where I put my notes.


Yea, that's the issue.


So I've started putting them in One Note or in Google Keep or something or Evernote so I can just search for it, because I never know where anything is.


Yea, I wish I know I wish I was more organized where I can use electronic notepads and things like that. You should see my desk. It is a complete mess I have I mean-


I like the electronic ones because-


I mean my computer desktop, yeah.


Oh yeah, well at least you can search on there so at least there's that.


Yeah, yeah, there's that, at least. But yeah, I have I was the other day I was looking up because I was going to school site and setting up a show table there and I was trying to look up for my procedures for the share tables. And for some reason, they weren't in my procedure files for some reason they were in like my like special diets for- folder. I don't know it so it's, it's all kinds of a mess in there. I just save it to whatever.


When it comes to special diets management, have you found, how do you control costs while meeting everyone's needs? Like, do you end up purchasing a lot of special products? Or just building a menu out of whole food that happens to be low in common allergens?


Yeah, so we're actually this was part of my pre con and see we're doing a whole four hour like kind of workshop for special diets and special diet management. But, we are able to basically feed every single student with a special diet based on the many items that we already have on bid. So, what happens with special diet management? I have- we have, we do three week menu cycles. So, we have a master menu, a three week master menu and then we cycle through that three times a year for fall, spring and winter, or fall, winter and spring. And every single time we come out with one of those I come out with eight separate menus based on those menu cycles. And those eight menus reflect the eight major allergens. So, we have 200,000 students in our district and 240 school sites. So, I do not meet with as many parents as I could. So if it's just a single allergen, I empower my managers to utilize the allergen menu that I have already created for them, the little cheat sheets I've created for them, and in addition that too, I keep up an allergen database. So, just like we have any kind of nutrient database, I keep an allergen database but not only does it have menu items, but it also has recipes. So say for example, we have like an egg and cheese taco. I break down not only just you know, the entire menu or the entire recipe has, you know, the eggs, the wheat from the tortilla, and the milk from the cheese. But I'll break down to those menu items. So like, say, for example, the child only has a milk allergy. But you know, if you're trying to serve that child, that breakfast item, you can know that, "Okay, the cheese is the only thing that has that milk protein." So, if we mix that cheese from that recipe, that's still a viable item for that child kind of deal. So, I do that-


How long does that take to develop? Well, again, I guess you do it every year, because the cycle changes every year.


Yeah, yeah, I do it every year. I do it every three months. Because that's how often- well, I guess it's a little bit more often that every three months, I do that every change in cycle for the base menus. As far as the allergen cheat sheets or the little allergen database, I do that every single summer because we have new items every single summer. So like this year, we have, we're going to be getting Kellogg's for the first time in like 13 years versus we had General Mills before. So, I'll be updating those with all the Kellogg's cereal items that we have. And then the respective allergens on those, too.


And you mostly rely on rely on the product information sheets coming straight from the manufacturer?


Yeah, yeah. Because that's all I mean, that's the only way- I also look up- Yeah, I look up the product, I get the product information sheets, and then I look up nutritional labels too, to just verify it. But that's of course what we do anytime that we're putting in any nutrition information for those items, too. So-


I just wonder, since your district is so large, do you receive all your items like in a central location, and then you guys ship them out like you have a warehouse, or do y ‘all ship straight to your schools?


We ship straight to our schools. Where- we have a couple different school setups, so cafe- kitchen setups. So, we utilize GFS, Gordon Food Service, as our- as our distributor. So they also purchase for us, make sure that they get the lowest price for us and all that stuff too but they deliver to every single one of our school sites. But we also have a couple different forms of kitchens. So, we have the traditional kitchen where they cook everything on site, serve everything on site and do that. We also, attached to our district office is a production kitchen. And so that production kitchen- I can't tell you off the top my head how many schools that they service, but we have two different school sites that utilize that production kitchen. So, we have our satellite kitchens or our satellite sites which basically everything comes through the production kitchen and gets sent to those satellite sites. So, and then we have our finishing kitchens and those are the only thing that really gets, comes through the production kitchen to the finishing kitchens are more of like the casserole dish items, the chef-inspired items. The finishing kitchen still, you know, cook their own pizzas and cook their own like heat and serve items like that. And then they make their own- they make their own salads, they make their own cold items, too. So, like they'll do their own ham and cheese sandwiches and things like that, too. We have a unique building here where our building actually has our own office space and then attached to it as a production kitchen where we have- it's a huge production kitchen. And we also have like trucks that back into it and back out of it. And they ship the- I want to say it's somewhere around 30 school sites 30 or 40 school sites right now during the school year and of course, you know, there's about 8,000 meals that come out of it during the summertime.


So, with it being right there, have you ever found it necessary to go downstairs and physically look at the packages, do you save an actual label, like cut off from packages as they start coming in on your new bid or that's basically impossible?


Yeah, so- anytime that we get any new menu items, they there's, the forms that they have to submit with the menu items that not only do they have the stock number and what the items are called that they have to submit the child nutrition label as well as the same exact label that they would be putting on those items for the normal nutrition label with the normal ingredients, too. So, sometimes because I know those product information forms, sometimes they can leave out an allergen, like say for example, they only put milk and soy, but you look on it and it's clearly wheat on the ingredient list, too. So, I do dump that, too. But I'll occasionally do a spot check at the school sides but if they, if it were to be a discrepancy between the two, then I mean, we don't have that happen because they want to keep their business with us, kind of deal.


Right. So you guys have- you’re depending on the professionalism of the companies that you're working with. So, you pick reputable companies, so that's really a non-issue. I just worry there are so many people involved in the process, so many adults, you know, from mattering to shipping to service, that people are at risk if they believe like, 100%, if I read that it's allergen-free, I'm fine. But I guess, at the same time, you just must assume like if you're going through life with an allergy, there's always a million people in between you and where your food started, like-


I mean, just like you can't really depend on like a table being completely allergen-free because you don't know what items the kids bring from home or, you know if the kids eating a peanut butter and jelly sandwich and then rubs the table or touches something else. I mean, but what we can control is what's being shipped from the manufacturer and what the manufacturers telling us what's in there too. So, I mean, like, items that are going to be allergy-free, we already know that they're allergy free, just because they'll be like stuff like brown rice or frozen broccoli, or, you know, things like that wouldn't normally have allergens in it. But on the, on the pre-packaged items, or the more processed items, like for example, a pizza or something like that, yes, I go in and I check the ingredient list. I don't routinely check them unless there's something that has changed on it.


Right. And I know you mentioned this is the topic you're going to be covering it pre con. This will air after that's already happened. So I hope-


Well, hopefully some of- Yes, yes.


Because there's just so many questions around this topic. Yeah.


Oh, yeah. Yeah. And that and there's so much confusion as far as management of those because so that's done on a single allergen level, if it's a multiple allergen, then I make sure that I get involved. So, I have the managers contact me. And then I meet with the parents and I sit down with the parents, and we review menu items. And I already, I usually pre-make a menu for them, showing like, this is a menu that I would recommend, but we can work through if there's dislikes or anything like that. But, we do a really good job, make sure that we feed every single one of our kids to the best of our ability. As well as, I am always really impressed when I do go to a school site. And I see how well the cafeteria staff work with those special diet students.


Because there is so much anxiety around it that I am glad that at least in school nutrition, it seems like everybody takes it very seriously, even in the kitchen.


Oh, yeah.


So, you don't have to worry that people don't get the severity like they're checking the boxes when they arrive there, too.


Well, I so, I did a training for a new batch of managers that are graduating in about 30 minutes but um, you know, I told him that I see, you know, some people might see special diets or students with disabilities as a burden. I see it as an honor, the fact that, you know, they every single place that they go, no matter, you know, what restaurant they go to or anything like that they are concerned, you know, the parents are concerned, the students are concerned because they're not sure what they can have are safe for them. But we are here, and we are- we have the honor and the ability to create a safe environment for every single one of our students, whether that be a student who has, you know, dysphasia or view whether that be the student who has, you know, a peanut allergy or a milk allergy, you know. They're always afraid of what they're putting in their mouth. And they should be but at least when they're at a school site, and when they're at school, they can feel safe throughout the school, whether that be in their classroom or in the lunchroom.


Right. That's a really good framing. I love that. So, are you heavily involved in training the new managers or you do that with another employee in your department?


We're all heavily involved. Our districts, our district site, just because we're such a large districts we have... we have 14 admin district staff, and then probably about 60 of us, or 60 district staff in general. So, I'm part of the admin group, along with our district chef who does training with the new managers as well as our production team leader, my supervisor and the other dietitian who does trainings with her to- with them, too. We also have the training coordinator. We have you know, a, ancillary Program Manager, we have operations manager. So, all of those people are all involved with training, of course, our director to are all involved training, training the new managers that are new.


So, you said you guys have a chef there. How long has the district had a chef? Was he there when you got there?


Yeah, since before I got there. The current chef has been there for almost four years. And then they've had, again, I don't know how long they've had a chef, but they had two chefs before him, at least. So-


So what type of projects do you work on together?


So, so I think- I think one of the reasons why my focus is nutrition ed is whenever I was an intern, you know, I worked under my current supervisor, and she was my preceptor. And I mentioned to her that, you know, I was, I was, I was really hoping that they would have more geared towards nutrition education to students. And so one thing that whenever I came on board, the chef and I were, you know, discussing something or having a meeting about something and I propositioned chef demos, and you know, doing little cooking demos and introducing kids to culinary techniques as well as education, nutrition education about fruits and vegetables and other foods that they're consuming at the same time. So, we've really been able to kind of go from that and just expand it more and more. So, that's one thing that I've been really excited about working with the chef is the two of us will do a culinary demo, where it's half of it, 30 minutes of it as a nutrition education presentation that I do with the kids. And then the other 30 minutes is hands on cooking demos that the kids get to learn, whether it be something like making their own dressing or making their own dip for, you know, like carrot sticks or something like that, or we've gone in depth as far as having them make like fruit pizzas, the last group that we did they made like little fruit pearls, things like that, where we just try to have them be hands on. So, when we're doing this, we started this culinary class, our culinary camp in about three weeks. And so whenever we start this up, and I'm really excited, because it's just going to be, you know, an entire week of just really, really lot of fun. The kids love it.


How do these students get enrolled? Where are these kids coming from?


We send it out district wide, but we're only doing it as a pilot program this year. So, we only have eight students right now. We decided to choose third and fourth graders, well second graders going into third grade, third grade going into fourth grade as the age group. We don't want any older or any younger, just because we want them all to be on the same comprehension levels, but we're gonna- it's going to be a, because we only work four days a week in the summer, we do the 410s so it's going to be through groups broken up to each day so the first day is going to be fruits and vegetables and we're going to learn about different colors as well as we're going to have them make like rolls and they're going to make a rainbow wrap where it's going to have a whole bunch of different colors all wrapped together where they like gets to cut and slice their own veggies for it. We already bought kid-friendly knives for it so that they can't cut themselves and then kid-friendly peelers, too. Yeah, no. Already- we've been planning this stuff for a little bit. The second day is going to be a dairy where we're going to you know tell them about calcium and bones but then they're also going to be able to make their own ice cream which we're really excited about doing the whole- the you put, you know, a gallon freezer bag and then you put ice and rock salt and then you put the ingredients in a smaller bag and you shake it. So, it's a fun activity for the kids. But they can also see how ice cream is being made that way, too. And then of course, we're going to have them make their own mac and cheese that day and all kinds of other dairy things. I think, I know they're making smoothies on the first day, not the second day. And then the third day is about protein. So, they're going to be making their own hummus, we're going to teach them about how protein helps build their bodies. And then the last area is going to be grains, which we're going to discuss what a whole grain is, and then they're going to make their own pizza dough. And we're also going to tell them about how different ingredients work together and baking. So, we're going to have like all these different muffins and each muffins going to be missing an ingredient and we're going to be talking about, you know why those muffins came out that way so whether it's the muffins are mis-, yeah, so I'm really excited about it. I get to use some food science in it, which is my favorite thing to talk about with the kids as well as you know doing the new- and Tom's always really excited about teaching them culinary techniques, so they'll be all-


That's really smart combining the two because what good is the knowledge if you don't have the practical skills to use it.


Yeah, exactly. So, I'm really, really excited about this pilot program. And again, I'm really excited. I'm able to work with a chef who just loves kids as much. I mean, if you don't love kids, you really shouldn't be in this job.


That's true. It's hard not to love those little ones sometimes the bigger ones, well.




They make it a little more challenging, but like I could definitely work with that age group like all day. They're so-


Yeah, me too.


Enthusiastic and insightful, like, always surprisingly insightful and really honest and transparent.




They're my favorite. So, what are fruit pearls, exactly? I already googled it, so I know but for other people.


So fruit pearls is basically just using the melon baller and just turning them into a little, you know pearls, we decided to call them pearls instead of balls just because you know, we weren't sure about the maturity level of the kids if we start calling them fruit balls, but yes, a little fruit pearls and they're going to make their own glaze for it and stuff like that, too. So, it should be a really fun group but also the- the chef at work together, along with, you know, our team leader. With menu committee meetings, we get together and talk about menus a lot, especially whenever we're changing menu so frequently. We also do different culinary showcases, we had one that was a culinary experience, the Hillsborough County Student Nutrition Experience where we brought- we thought that there were my there was a disconnect with the school board to what we do. So, we actually brought what we do to the school board at a board meeting and we had everything kind of set up as if the school board members were going through a school lunch line. So, we had them try all of- all of our, I guess more popular chef-inspired entrees. And then I was there talking about the requirements. So, you know, the fact that we do serve whole grains and the fact that we offer fruits and vegetables every single day and, and portion sizes and things like that. And just doing-


So a lot of them hadn't eaten with y ‘all before?


Yeah, so I mean, again, I just feel like sometimes food service or, you know, school nutrition is kind of looked separately from the rest of, you know, education curriculum and stuff like that. So we're, you know, we're constantly just trying to change the perception of school nutrition. In fact, one of our slogans for it was, "It's not your square pizza anymore."


Oh, I like that. Even though I did the square pizza, but yeah, I've been wondering why are the trays necessary? That seems like another thing that visually sets our meals apart from every place else you eat. I just- I haven't seen anybody not dealing with the tray and I was just-


Well, well, so trays are functional. You know, if you ever see a student trying to choose a whole bunch of stuff and hold everything with their hands, they're just going to drop it everywhere. One thing that I'm really proud of with our trays is that there's actually a nutrition piece on our trays. We didn't want to just have a blank, like brown tray or blue tray or something like that. We knew that the students were going to be looking at the trays while they go through the lunch line. So, we want to make sure that they're aware of what they need to have and the importance of what they need to have. So, it's actually trademarked.


Oh, so did it originate there?


Yeah, so the trade that we utilize- it was 2014. So, it was before my time, but they trademarked our current tray so we have the fruits, vegetables, you know all the food groups on the trays and then along the side of the trays, it talks about, like say for example, it says grains for powerful energy, fruits and vegetables for brain fuel, protein for strong muscles and dairy for healthy bones. And what we- we are able to do is, we color the grains, protein, dairy fruits and vegetables with associated colors. So, you know the blue, the purple, the, the orange and then our menu items all have nutrition communication cards. So, as they're going through the lines, if they're standing in front of, say for example, I don't know a roasted chicken breast or something like that. The roasted chicken breast will be colored- the nutrition communication card that says the calories, carbohydrates, and protein on it will be colored purple so that they're able to see on their tray or they have a purple so this is purple so I can feel that piece. And same thing with the orange. Oh, there's you know a fresh baked roll. I need to have an orange, I'm missing an orange, the fruits and vegetables so they just know that you know the association as well as hopefully they're reading it, too.


Yeah that's neat, making the most of something that's already in use. Are those available for purchase for everyone else?


I believe Miami-Dade might be using them. It's through our- it's through our paper vendor.


Oh, wow. That's really neat. Okay, well that gives everybody an idea.




As far as new people, especially people in dietetics coming in to food service management, have you noticed that there's a little bit of resistance there? Like you maybe didn't interact with as many of your cohorts because it was long distance but were most people more interested in ha- Wow, how did I just forget the word?


Yeah, I feel like so we- we currently have interns that come through every single year. I feel like the main focus with most interns is always clinical, clinical always seen it before forefront versus food service, especially school nutrition, isn't really seen as this is what I want to do. I always feel like anytime that we have, because I'm, I'm sure that's drilled in their head too, in school and everyone sees the clinical experience as you know, the top tier or whatever. But I always try to change perception. So, you know, not only am I trying to change perceptions with our parents, and the rest of our stakeholders, but I'm also trying to change perception with you know, upcoming dietetics students, too. And one thing I tell them is, you know, we are a- where we're- what's the word I'm looking for? We're a profession that centers, you know, that works best on prevention. We're never going to your, I mean, you can lose weight, you can help manage your diabetes, but you're never going to cure diabetes with nutrition, you're never going to cure chronic diseases with nutrition because typically chronic diseases are built over time and they occur because of poor nutrition. Good nutrition is going to help manage it, it's never going to cure it. However, prevention is the thing that's going to really cure those diseases, prevention, preventing those diseases. That's what we're all about. And that's when our profession is working the best. We have the opportunity to touch every single student and every single student that goes through public schools. So, we have over 200,000 students that I potentially am able to alter their, their direction, if I'm able to influence you know, just a small percentage of those children to eat better now, it's going to prevent them from later on, so we're having its effect. I feel like school nutrition and student nutrition is the largest collective body of public health that there is in the United States just because we have the opportunity of affecting every single student in public schools, which is huge. I mean, when I worked in the health department, you know, I, I worked at WIC, and I was able to have one-on-one conversations, but, you know, that's just a fraction of the amount of- the amount of change that I can make here.


And this also I always feels more sustainable, for sure, because you don't have to see that person again and six months and hear about how life get in the way and they weren't able to implement the changes.




Which can be kind of discouraging.


Plus, I'm a little bitter against adults, I guess is the word for it. You know, it's hard to change. It's hard to change people's mindsets, concepts habits when they've been doing it for their entire life. It's easy when you have a child that you can now educate about, you know, why eating healthy keeps you strong, why eating healthy will help you do better in school better, and sports better, you know, have a better life. And that's when you can make the- they're young enough, their mind is pliable enough that if you, you know, instill these good messages, it's potentially something that they'll carry on for the rest of their lives. I mean, again, these little trays, you know, if you look at it one time, you might not- it might not click, but the fact that it's repetitive, that they see it every single day, they see that, you know, if they eat, if they eat dairy, they'll have healthy bones, if they see that they- if the grains they're going to have energy, if they see that every single day, that repetitive education piece, you know, eventually it will stick. So, you're able- you're able to have again, like you said, more sustainable messaging, as well as a bigger effect on the kids themselves.


And I really like how it's more interdisciplinary.


I absolutely love what I do. And I, I am grateful that I'm able to have some sort of influence on our future generations.


Yeah. I definitely think this is the best place to be. I mean, I guess I'm biased but it just feels like that our reaches massive. And then because we're interdisciplinary, like you have the chefs there and you have people you know, who actually work with the food every day and maybe have children, as well. I feel like you maybe approach food in more of a fun way than dietetics-


 Oh, yeah.


Often do in a clinical setting. If you make something fun for somebody, they can do it forever. So-


In addition to that, too- in addition that, too, in a clinical setting, you're constantly telling them what they can't have.




Where we're dealing with children, we're constantly telling them what they can have. So, I mean, it's a complete opposite perspective, when it comes to that too, you know, I'm not going to tell someone that they can never have, you know, a renal patient and can never have bananas again. I'm able to tell kids like, no, enjoy bananas, you know, because potassium is amazing for you. So it's, it's just a change in perception and for that, too, and, again, going from, from, you know, my clinical experience, you know, and when I was entering to now being able to do this, I absolutely love it. I don't see myself ever going back, kind of deal.


Clinical was so depressing to me. Like, like for it to be normal-


I know,


For your patients to just not come back because they passed on. I'm like, how do you guys- How do you motivate yourself to come to work every day knowing that people may be gone-


You know, someone was just diagnosed with diabetes or just diagnosed with whatever and they're not in the mindset to make any kind of change as far as their dietary habits Just got this, you know, life changing news. I just remember trying to try to getting, you know, consults to talk to patients about educating them about carb counting and meanwhile there may just, you know, got their leg amputated or something like that from uncontrolled diabetes and like, not the time this is not the time.


Thank so much for coming on the show.  Where can we find you online?

Sure Hillsborough County Student Nutrition Services