Kelpball

Daily Tile

We are becoming increasingly aware that our children are in many cases, over scheduled, over stressed, over involved. As parents we feel overwhelmed by time pressures. The American Academy of Pediatrics has published several recent articles on how to help families with these challenges. One discussed the importance of play for kids themselves and also for us as parents. Play helps us maintain strong bonds with our kids.

As my kids are getting older I am increasingly listening to the little voice in my head telling me that they won’t be young for long. Now, when they ask to play or read I have begun dropping everything on my to-do list to jump up and join them. Rarer even than these requests for my time are pickup games of ball. Who just plays ball these days? Rarer still? Pickup games of kelpball on the beach at sunset.

#savoredmoment

Birthdays, Beets and Baby Carrots

I heard once that my influence over my kids’ final outcome ended when they turned five. By age five they had soaked up all the manners, values and habits they ever would from me. Now, on the occasion of my first child’s sixteenth birthday I find myself wondering if perhaps I have become dispensable.

His manners are for the most part lovely. Check. He is usually kind and generous. Check. He is clean and well dressed. Hmmm …clean – check. But do the pants around the buttocks count as well dressed? (before having kids there were several silly things I said in the category of “I’ll never”. “I’ll never let my boys wear their pants sagging” was one). He works hard in school – yes, and room to grow. He has commonsense. Um…. not always. This was demonstrated this week when he donated blood in the middle of lacrosse season and then wondered why he was so winded while running. Sigh. He understands the importance of physical fitness. Check! He understands the importance of good nutrition…. Uh oh. Wait, yes, I am sure he understands. This is where I see the wisdom of the five-year old rule.

As a mother there are household chores that I do happily, there are others that drive me slowly insane day after day. Making lunches leads the list of things making my hair go gray. One recent afternoon on the way to his lacrosse practice, my son asked if we could stop by his school locker to pick up something too big to carry on his bike. Indeed, the sack of old lunches filling his locker was big. And smelly. Turns out he wasn’t eating much of what I had packed. The carefully cut veggies, the fresh fruit, the whole grain bread all…moldy. Later that night I had one of those “Look out: Mom’s head is spinning!” moments that all children should see occasionally. Now I no longer make lunch, they do. I made some rules: each lunch must have a fruit, a veggie and some protein. It has worked well for the most part. Those were rules they knew by age five, right?

Yesterday my friend told me a story. She was at the grocery store during the high school lunch hour and happened to see our sons there. She quietly watched them go through the checkout aisle. My son had a 2 liter bottle of Mountain Dew. Her son, a family sized bag of Cheetos and their friend had a bag of Oreos. Well, I guess that explains the lunches in the locker. Why eat vegetables when you can eat your Cheetos with Mountain Dew? So, by age five he knew the food pyramid well enough to scold me when I crept up too high on it, but by age sixteen he is apparently very comfortable at its apex.

Now, I am left both looking back and hoping I taught him enough and gazing forward and hoping that the knowledge will resurface in time. His recent choice of a birthday dinner reflects this split in a way. He requested steak (“to replace the iron lost from donating blood this week so I can run better”), potatoes and … a vegetable. Great! Which one? Asparagus?

Ew, no.

Beets?

Are you kidding Mom?

How about roasted broccoli?

No mom, just carrots.

The endless stream of baby carrots was part of what made me hate making lunches so much. Maybe if I show him this article about how eating beets can make you run significantly faster he’ll change his mind? ©

Veggie Pizza

In my post on eating dinner with my teens I owned up to sometimes cutting corners by ordering pizza for dinner. During a recent interview with the group Thriving Schools I also referred to surviving the work-kid juggle by ordering pizza. I was asked about the wisdom of these admissions. Perhaps @KPKiddoc should be putting a healthier face on her slice of life?

Let’s face it – pizza is everywhere. Hard to raise kids without pizza. Schools serve it often. Every soccer team party features pizza. And yes, tired working moms depend on it. Pizza can indeed be a nutritional nightmare. Given this and its ubiquitous nature, it is not surprising that I might be warned to appear more health conscious.

We want to feed our kids well. We are looking out for tips on how to do so; a google search of “is pizza healthy?” generates 132,000,000 responses. My answer is yes – it can be.  Here’s how:

Have just one or two pieces. One piece is more than enough for a small child; consider cutting it in half. Two pieces are sufficient, even for my athletic teens. At the dinner table discuss the concept of moderation with your kids.

Fill the rest of their plate with salad. 

Have a whole wheat crust. And definitely don’t “stuff” it.

Order or use less cheese. You can order extra cheese right? (don’t do it!) Turns out you can order less cheese also.

Skip the meat. Your kids will be happy with pizza – they don’t need to pepperoni to bribe them into eating it… just say no.

Add veggies. Same concept – kids like pizza enough that they usually will choke down some veggies with it. It not – that’s what the salad is for.

Skip the fast food restaurant version.

Make your own. Ok, not for a night when you are tired but – definitely a fun family project. Try this healthy recipe from 9-year-old Kayla Wayman of Montana.

Given that 93% of Americans eat pizza once a month, 3 billion pizzas are sold annually in the U.S. and 350 slices of pizza are eaten each second – it seems that our love affair with this meal is here to stay. Let’s just work to make it a healthier message for our kids.

In Napoli where love is king
When boy meets girl
Here’s what they sing

When the moon hits your eye
Like a big pizza pie, that’s amore

- Jack Brooks

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Confessions of a Closet TV Diner

As we stood at my kitchen counter today my friend said

You ought to write about it. Makes you seem human, you know?

So in the spirit of self disclosure inspired by two recent articles by parents who admit their shortcomings, here I am doing the same. First John Sarrouf director of The Family Dinner Project, wrote about missing too many dinners with his family. Then fellow pediatrician Kathleen Berchelmann wrote about what happened when her daughter went to bed with an iPad.

Sometimes my kids and I eat dinner in front of the TV.

When I was a kid I watched very little TV. Except when I enjoyed summers with my grandparents. Then after spending the days outside, I spent the evenings watching TV. My grandmother was a well-educated, cultured Southern woman who believed in table manners and personal style (I spend a lot of time walking around with a book on my head for her.) So in retrospect, it surprises me that during those summer vacations we ate nearly every evening in front of the television. On a TV tray, with china and silver but while watching TV.

Hogan’s Heroes. Mash. Hee Haw (seriously.) The MacNeil/Lehrer Report. Lawrence Welk (they were my grandparents after all.) The Mary Tyler Moore Show. Watergate.

Was it wasted time? Dinners without conversation made therefore a loss? I think perhaps, not. Instead I remember that what we watched together united us around shared references. We had plenty to talk about after the shows were done.

So perhaps my friend was right when she told me to stop worrying. The occasional dinner in front of the television without attention to table manners and conversation won’t damage the kids.

As a pediatrician and a member of the American Academy of Pediatrics’ Council on Communications and Media I am passionate about helping parents navigate their families’ use of media in a healthy way. I support the AAP’s recommendations that we turn off our screens as much as possible – especially at the dinner table. Dinners eaten together are important to me. Conversation a priority.

However, parenting is a messy business and we are indeed human. Parents need to forgive themselves errors – be they missing meals, giving kids iPads or eating dinners in front of a screen. TV dinners are certainly not ideal but perhaps my kids will benefit from my bending the rules occasionally. Perhaps we will have some incredible dinner conversations about what we watched. Goodness knows, How I Met Your Mother provides loads of teachable moments.

Finish each day and be done with it. You have done what you could. Some blunders and absurdities no doubt crept in; forget them as soon as you can. Tomorrow is a new day. You shall begin it serenely and with too high a spirit to be encumbered with your old nonsense. -Ralph Waldo Emerson
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TV and your Teen – Ask Them to “Decide”.

‘The American Academy of Pediatrics has clear words for parents seeking advice about screen time limits for children. No screen time for kids under 2 and no more that 2 hours a day for kids over 2. Less is better and content matters. While I find these guidelines challenging in my office and in my home, my mother would have had no trouble enforcing these guidelines with me – for most of my childhood we did not have a television.

I remember mornings in junior high school as being rough. Not only those mornings too early, cold (N.Y. State in winter is COLD) but once I made it to school everyone around me was discussing last night’s episode of this or that show. I tried to look casual, preoccupied while they sounded so…. cool.

As a Pediatrician, I understand the social power that being up to date with the latest show, game  or video has. Being connected on each of the latest social media tools be they Instagram, Vine or Snapchat, matters on today’s Monday mornings. However, I want my teens and my teen patients to turn off their screens. I know that doing so will broaden their horizons and shrink their waistlines. They also on some level, get this. It is though, hard to translate advice and understanding into action.

So it is perhaps ironic that I found some words to inspire teens to turn off their screens from a recent episode of Grey’s Anatomy. They have just the right touch of inspirational simplicity that appeals to the Pinterest set:

Decide
We are all going to die. We don’t get to decide where or when.
But we do get to decide how we are going to live.
So do it.
Decide.
Is this the life you want to live?
Is this the person you want to love?
Is this the best you can be?
Can you be stronger, kinder, more compassionate?
Decide.
Breath in, breathe out and decide.

When you put it this way, few kids would choose to spend their time in front of a screen. And definitely not the average of seven hours a day on entertainment media, including televisions, computers, phones and other electronic devices that our kids are currently spending. Ask your kids to Decide.

Twenty Questions

Last week I tried something new. Something a bit out of my comfort zone and something I have long resisted doing. I enjoyed the experience largely because of its novelty; it felt good to stretch.

The real fun began though, when I started telling people what I had tried. The statement “You’ll never guess what I did on Wednesday” became an interesting litmus test for how my friends and family view me. You might try it with your circle.
Here are their answers:
“You went sky-diving?” Yeah, okay… that person obviously did not know me at all well.

“Rock-climbing?” Ditto.
“You rode a motorcycle?” Really, people?
“Yoga?” Hmmm…
“You got back on Rollerblades? No.
“Run?” Hey really, would that be so unusual?
“Shop?” Ew.
“Skip work?” Okay, that would be surprising.
“Add a day in to work?” Sadly but no, working extra would not shock.
And now, in upside down and backwards writing, the answer is:
Yoga.
It really did feel good to stretch.
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Teens and Table Talk

Before kids and when they were very small, I used to fear the teen years. Visions of my sweet cuddling tots turned goth, rude teens hiding in their rooms with ear-buds in danced through my brain. Now, with 2, nearly three teens at home I no longer fear. Their reality is a thing of wonder to me. They are not rude. Quiet at times but, not rude. I have to pull out the ear buds all too often but, they do not sulk behind closed doors. And most reassuring, they are still quite cuddly – when they want to be.
Given this reassuring state, I can be taken aback when they momentarily act like “real” teens.
I have held family dinnertime sacred in my house. Even through change, upheaval and redefinition of family itself, dinners together come first. Last night at dinner I asked the kids why they thought dinners together were so important. My middle child said with a snarky tone, “because they keep us connected at the heart.” Her hands acted this out with fingers first intertwined and then in the shape of a heart. Eyes rolled. But then, thankfully there came a smile.
The evidence continues to pour in. Eating meals with family is good for kids.  In 2010 a study of nearly 9,000 4 year-old children published in the journal Pediatrics concluded (in part) that young children who regularly ate the evening meal as a family had a significantly lower prevalence of obesity. Other studies recently published in the journal Obesity have supported the idea that teenagers who eat with their family are less likely to be obese at baseline. Then last month yet another group of researchers published data showing that teens who eat with their families have higher well-being, lower depression and fewer risk-taking behaviors. More work has shown frequent family meals were significantly associated with a lower likelihood of adolescent alcohol and tobacco use. In the May 2010 issue of Journal of Health Psychology teens’ experience at the mealtimes was found to be connected with this decreased rate of substance use.
Looking at all of this evidence makes it very clear. We need to eat dinner with our kids for the sake of their health. We need to cultivate ways to make our dinnertime conversations meaningful, interesting, thought-provoking. Sure, some of the research shows a benefit to simply sitting around the table together but, you might as well have fun while you sit there. Around my table we have through the years talked about almost everything. Any topic is acceptable if brought up with good intention and true curiosity. Politics, sex, religion? We have covered them all. We have played games. I have been repeatedly accused of being a pain about their manners. There have been giggles, anger and tears. We rate the meals so I know whether to cook the recipes again. Lots of meals have been rejected. And instead of cooking, many pizzas have been ordered.
Now with so many sports teams, part-time jobs, extracurricular activities and social engagements that my head spins keeping it all straight, we don’t all sit together every night. But, whomever is at home sits and talks. Sometimes I wait up and eat with the late-after-practice arrivers. Sundays we all meet – even if other invitations have to be turned down. I’d like to think this commitment has paid off through the years.
My eldest can be a bit quiet. I generalize this into fitting his teen boy status – they all keep to them selves a bit don’t they? Once not too long ago, I challenged him on his laconic nature. I asked if he would talk to me when it really mattered? He stopped, looked at me and said yes. I asked why? How could I be sure? He explained that he knew I could handle talking about anything. After all, we do just that on any given Sunday around the table.

The e-patient Paradigm Shift

A few years back, I hurt my leg. Badly. So badly, I wasn’t walking well at all, was predicted to never run, ski, swim competitively or, do what had injured me – skate. The injury was dramatically sudden, painful and scary in ways I had never experienced. My first doctor was unsure exactly what I had done. The next ordered the right test but told me there was no repair. The next consultant agreed.

Then a friend stepped in to help. He lives in Switzerland but even from that distance, managed to turn the tide for me. How? By going online and searching for doctors and surgeries related to my injury and by finding a support group of people who also had my unusual injury. He emailed me the link to the support group and I responded:

Thanks but, I’m not that kind of patient.

Don’t be silly, he told me. So I clicked the link and found a world of education and support. In that moment of clicking, I became an “e-patient”

This new term, “e-patient”, is meant to describe a patient who is involved in their healthcare as an equal partner to their physicians. e-patients use electronic tools. They are empowered, educated and engaged. They see the importance in being equipped with the tools to help make decisions about their care. These tools can give e-patients access to medical records, education about their condition, or the support of groups of patients like them. e-patients are producing a culture shift in medicine.

This culture shift is especially visible in the area of breast cancer care. It is perhaps best illustrated with the story of one specific support group. Two friends who are breast cancer survivors teamed up with a breast surgeon from L.A. to start the support group #BCSM. It is held every Monday night as an hour-long “tweetchat” on Twitter. These three women explain:

While other physicians and academics debated how health care could even be discussed in social media and patients were warned to “be careful with research on the Internet”, two important facts didn’t budge. The Internet was not going anywhere. Neither was cancer. This year, some 290,000 women in the US alone will be told they have breast cancer. The need for #BCSM was clear. The project was on.

The mission of this impressive group is to support, educate and empower patients diagnosed with breast cancer. Patients meet and discuss their situation online to come out of the isolation that cancer diagnosis and treatment can create. Last Monday, 156 people actively participated and through their discussion, sent 2,724,048 impressions to their Twitter followers. Every week, expert physicians are invited to add “perspective and clarity” by discussing evidence-based recommendations and research with the group. The #BCSM support group’s mission has been accomplished through this inspiring model of weekly collaboration between physicians and patients. Both benefit.

This shifting paradigm is one we physicians may respond to with trepidation. We can feel irritated and challenged by patient involvement. And our patients do not respond well to our irritation. We are highly trained and this expertise gives us the ability to make informed decisions. However, our patients, especially those with chronic or unusual conditions, are also experts. They know about their own unique experience and through research can often know more about their specific diagnosis than their generalist physicians do. Patients can have an expertise to contribute to our decisions.

While I did not face the sort of life-threatening illness that catapults many into their role of e-patient, my experience taught me much. I see clearly that a well-educated patient has much to offer us. Seeking, supporting and trusting that input will serve us all well.

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Fall and the Flu Vaccine: Believe.

I am tired. And, I’m not the only Pediatrician who is tired. It is fall, the traditional calm before the storm of sick patients that hits our offices every winter so why tired?
Because, visit after visit we hear parents tell us that they “Don’t believe in the flu vaccine.” Really?
  • In 1900 influenza was the leading cause of death.
  • In 1918 Influenza killed between 50-100 million people worldwide.
  • It is estimated by the WHO that in 2009 the H1N1 strain of influenza killed up to 575,400 people. 
So, I ask, what is there to “not believe in?”
The flu vaccine does not give you the flu.
Influenza is not a cold.
It is not the stomach flu
 
In 1918 every mother in town would have been beating down my office door to protect her child against influenza. They believed in its power. I have had influenza twice, once was H1N1 in 2009. I too believe in its power and yes, I get my flu shot and give the nasal vaccine to my three children every year.
As Seattle pediatrician Wendy Sue Swanson said:
In the medical community, we’ll work to undo myths around vaccine safety for the rest of our lives.
We may be tired but, it is a battle worth continuing.
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All the Cool Cowboys Eat Yogurt (or, Nutritional Soundbite #3: limit drinks that taste sweet)

Two of my patients came into the office recently with their parent for check ups. I was a bit late coming in to see them so, started of with the all too familiar apology. Then we chatted about the heat and then summer books, movies, camps and camping. I asked what questions they had and, they asked if they needed shots (one did, one did not – always awkward to explain, that one!) All the while I realized I was stalling, dancing around the issue at hand.
Both children have weight problems. Technically speaking, their body mass indexes or, BMIs  are well out of the normal range or, in the range we physicians rather horribly term “obese.” They are both attractive, happy, smart and one is really quite funny. They like each other, they are respectful and fun. How on earth am I to find the words to tell them they are dangerously overweight without wounding their young confidence? Without alienating their parent?
I breathed in and began with the usual questions and followed with a display of their growth charts. It turned out the family had already been discussing change. They were walking each night. They were trying new veggies and thinking about serving sizes. I asked about what they thought I wanted them to drink?
Water!
And, what do you drink?
Juice! Apple and orange!
Ah, there was the change to focus on. I offered the rule of thumb that one 8 oz cup of juice a day has enough calories to cause a 15 lb weight gain over a year. That one usually works. But the parent looked at me and said with an exhale
But, it is just so hard to say no.
I get it. My 17 y/o son has a close friend that I adore. They have know each other since preschool days. I have watched this boy move from sandbox play to stellar sports play,  through cowboy costumes to awkward gangsta-style hats and now to be a rather stunning, clean cut young man. He is at my house often and when he arrives he walks straight through the door, around to the kitchen and opens the refrigerator. Spoon in one hand, he then heads to the boy-den in the garage with his bounty. It makes me happy every time. There is something in my refrigerator that he wanted? Cool.
We get such joy out of feeding our children. I cook well, my kids eat well and usually healthfully. My refrigerator staples are rather boring from a kids perspective. But, every now and then I will head off to the store and come home with some major treats. Watching the glee that comes as the kids root around and find these treats is fun. I feel, oddly as if I have done a good job. But after a bit, I get a bad taste in my mouth (and it is not from the chips :-) )
In fact, doing the right thing by our children means being a bit tough. Don’t buy the juice. Definitely skip the soda. Cut up the apples and put them in a central location. Skip the chips. You’ll never know what they learn to like. My friend the cowboy-gangsta-lacrosse star? He devours, container after container, case by case, high-protein, low sugar greek yogurts. And, go figure, all this time I thought I needed to bribe them with junk.
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Love and “Non Sequitur” Defined (or, A Weekend Alone)

What does a working mother of three do when she finds herself home alone for three days? Well, true story, I can tell you the answer:

Bake, lots. Clean, prune and organize. And think. Lots.

Turns out though that I wasn’t completely alone. I had two rambunctious, trouble-generating puppies to keep me company.

Okay, I baked. First though, I started to clean the kitchen cabinets. As I cleaned I found bits and pieces of things that needed using up. The first was a jar of soy flour from… well, a while ago. So, I baked 8 dozen pumpkin muffins using the soy flour (there was more to use up than I thought.) Then I found a tube of almond paste left over from making stollen this Christmas so, I baked an almond pound cake. I found 3 half bags of chocolate chips. You guessed it – cookies.  Then a bag of golden raisins, a 1/2 box of currants, and some walnuts? Oatmeal cookies.

I thought about the meaning of love – after all, it was Valentines Day this week. Turns out, when you look on-line for a definition of love you may find out that

Love is patient, love is kind. It does not envy, it does not boast, it is not proud. It does not dishonor others, it is not self-seeking, it is not easily angered, it keeps no record of wrongs. Love does not delight in evil but rejoices with the truth. It always protects, always trusts, always hopes, always perseveres. 

The dogs certainly challenged this definition; I may not have been endlessly patient. I may have angered. I’m afraid I can list their wrongs (they got in the chicken coop – twice, vomited on the rug – once, peed on the rug – once, made a hole in the fence – once, escaped through their new hole in the fence – once, woke me at 530 – three times). And, I did boast a bit when a nice lady complimented my ability to walk two young labs at the same time (didn’t mention that I had run them in the fields for two hours before she saw us limping home.)

I watched TV and learned, from an episode of  “How I Met Your Mother”, that

opening yourself up to another person means opening yourself up to going a little insane

Okay, that definition of love I’ve got covered.

 

I looked up the meaning of the word non sequitur.

I did some laundry (I may have been alone but, I do have three kids.) Pruned the roses. Organized the freezer (to fit in all the baked goods) and then felt compelled to eat all the odd bits of frozen things there for breakfast, lunch and dinner. Read the NY Times all the way through. Looked at Twitter despite planning to take a “holiday” from social media. And there I found this definition of love:

Love, I’ve recently recognized, is that moment when you desperately need forgiveness from the one who inspires your best self for having just been, in some small, petty way, your base self.

I walked the dogs again. Made the beds. Cleaned a closet. Sorted through the CDs; listened to lots of Alexi Murdoch, Macy Gray and The Cure. And, spent several nice hours on the phone talking with a handsome man from Switzerland who has always inspired my best self. My Swiss friend asked me – It is hard to live alone isn’t it?

Its going to rain Tuesday.

 

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Puppies and Love (or seriously? you ate that?)

I’ve been struggling all week with what to write about. All that comes to mind is the vomiting dog. So be it.

Last Sunday I did not have to work. For a Pediatrician in flu season that is a big deal. On top of that I woke up early while the kids slept in. I let the puppy out, fed him, made coffee and let him out again. I got the papers from the driveway and proceeded to do the very, very uncommon thing for me, and go back to bed. I curled up with my coffee and started to read. Ah.
I heard the rustling but chose to ignore it.
So about the dog, it all starts about 2 years ago when a stray puppy poodlish thing showed up on our door step one night. Cute and without anyone to claim him he became ours. Now, I had never owned a dog before. I had owned mice, cats, gerbils, fish, an octopus, guinea pigs, many cats and 6 darn chickens. No dogs. They were nice but honestly, I did not understand them. Then “Percy” showed up. He was as much a pain as he was fabulous. Who knew how great a dog’s love could make you feel? It did not matter how hard the rest of life seemed, it did not matter how rough the day was, Percy was there at the door wagging, licking, sneezing in joy to greet us. He healed us and, one day, suddenly and wrenchingly he was gone.
Last summer a sweet friend offered us a chance to own a dog again. The financial cost was more than I was able to bite off. She arranged to have it lowered. The emotional risk felt huge. How could we love again? But, after much midnight thought and loads of dinnertime conversations with my kids we all decided to take the leap again. We now have wagging, licking, happy 4 month old  “Zeus”. He is jet black with soulful eyes and he is here teaching us all to trust again. Which brings this rubber band story back to the rustling sounds.
I was in bed enjoying some article about the terms “husband” and “wife” and looking forward to reading about the latest travel recommendations when I finally decided it was time to see what was going on below me. Good decision made too late. Zeus had by then devoured 1.5 pounds of dry rice with a side of corn meal.
The vet advised that I administer a chaser of hydrogen peroxide to induce vomiting. I did, Zeus didn’t. We looked at each other. He licked me. I threw the ball. We waited. Then the vomiting started. After an hour of cleaning up puppy-brewed risotto I heard my 13 year old wake up. She had been feeling ill the night before and now, suddenly felt rather queasy. So I ran a bowl up to her bedside while thinking to myself “Seriously?” She sleeps with one of the cats, a sweet, timid kitty who loves her more than Friskies. As I hugged my girlie and held the bowl, the tortoiseshell kitty on her bed started retching. I moved the cat to the floor just in time.
I mopped up the rice. The girl used her bowl. The dog? Well, he cleaned up after the cat.
The paper remained unread.
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Of Babies and Donuts

Some silliness unfolded this morning on Twitter. I think it began with this tweet (apparently sent by a tired pediatrician, early in the morning, after being called to a baby’s delivery):

Let’s play a game: what do babies and donuts have in common? #WhatDoTheyHaveInCommon

Let me explain a bit about Twitter. Somehow I, a fairly non-techy sort of gal have 3 Twitter feeds. Two for work: @KPHealthed and @KPBabydoctor. On these I try to be professionally focused. On my personal feed, @KateLandMD, I relax a bit more. My non-medical, non-tech savvy friends are completely mystified by Twitter let alone why a doctor would be using it. I explain that there can be power and value to the connection found in the space on Twitter. That it is important for doctors to be present for the discussion. That it is important to battle misinformation with truths; important to be accessible. I explain that we learn from each other; we stay current. I tried to explain that we make friends. Well, that last bit drew guffaws from one person recently. “Friends? Really?” she said with a sceptically arched brow.

Well yes, friends. Take this morning for example – we went on for quite some time making ourselves giggle by answering the question about babies and donuts. Here is a bit of the transcript:

You never want to squeeze too hard.

There is a powdered version of each.

Eventually, they both wind up stuck on your hips.

Oh good grief! You all crack me up! #giggleswithmycoffee Now I want a donut.

Now I want a baby and a doughnut.

Coffee is a good accompaniment.” And necessary!I just have to pause and say, I am cracking up over these tweets! #WhatDoTheyHaveInCommon

A dozen is probably too many.

Have U noticed, while we are being silly some folks here are still thinking big thoughts #classclowns

Silly is such an important part of life. I never want to forget how to have fun.

This fun question brought back two memories of babies and donuts that I couldn’t quite squeeze into 140 characters. First, from when I was pregnant with my middle child. I was a resident working way-to-many hours in the neonatal intensive care unit, not my favorite place to be even when not pregnant. The call nights were many and long; it was hard to talk myself through them at times. So, I developed a system: if I could make it through the night I earned a donut, an apple fritter to be specific. I had a lot of fritters. At birth she weighed in at 10 pounds – no surprise there.

The second memory, triggered by the Twitter silliness, was about this same donut-fed baby a bit older. In kindergarten she developed a problem with her blood cells. The diagnosis was at first unclear – she seemed quite ill;  and the treatment was very high dose steroid pills. These made her a bit  nutty and put her appetite off. In our state of worry we gave into the one food she would eat. Yes, donuts. Donuts for breakfast, lunch and dinner. Soon we got the news that her condition was benign and to be short-lived. So, we sat her down at dinner and explained that this was her last donut for a while. Later I found her talking in her sleep:

Pretty donut…pretty donut…

My time spent on Twitter can be hard to explain. Another pediatrician there, Bryan Vartabedian, often does a much better job in his infinitely readable blog 33 Charts. Recently when discussing physician’s roles in social media he said:

There are 50 ways to use something like Twitter to make your world, or the world of those around you, a better place.  YouTube’s potential application in health care is limited only by the imagination.  While no one has to use any of these tools, believing that Twitter is only a place to share what you’re eating for breakfast is to live with your head in the sand.

Ah yes but, while we explore Twitter’s more meaningful side, a bit of banter over breakfast with our friends is awfully good fun.

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Thanks for the fun to these and others: @rychoiMD,  @thegrandefinalle, @jensen_jessica@DNich09

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My 3 Words: Stretch, Focus and Learn.

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Using the concepts from the book Switch: How to Change Things When Change is Hard Chris Brogan came up with a refreshingly productive new approach to New Year’s Resolutions. In his blog post, My 3 Words for 2013, he walks us through identifying a goal, the barriers to obtaining it and then, identifying three trigger words to remind us how we need to change ourselves to reach the goal. He writes:

Switch, talked about needing three elements to bring about change: a rider (your plans and intents), the elephant (what your mood will do no matter what your plans say), and the path (the environment within which you intend to implement those changes). The concept of the three words is like the path.

I am resolution averse. However, I have had a measure of  success lately with resolutions:  in 2010 by not answering kids when they yell at me from some other room,  in 2011 by starting this blog and in 2012 by baking cookies. This year my goal feels fuzzier:  I want to write more or better or be read more widely. Hard to pin down; hard to define and therefore hard to accomplish. But, let’s see what I can do with Brogan’s technique.

So, I’d like to write. The elephants are crowding the room. I am too busy. I shoot down my efforts. I lack skills in grammar, style and writing technique. I get distracted. What is my path?

Stretch means to make myself a bit uncomfortable. I am short on time. I hate getting out of bed in the dark but, perhaps finding time to write means doing so. Writing regularly means writing less than perfect pieces at times. Or, asking for feedback. Or, writing about difficult topics. Stretching means risking.

Focus means remembering my goals. It is so easy to be swept away by the small pleasures and simple tasks of the day. Day after day until I realize a year is gone again. Focus means giving myself permission to put writing before laundry or phone calls or pleasant visits from neighbors

Learn is easy to define. I went to a liberal arts college which at the time had no general education requirements. I took political science, philosophy and science… no English. Therefore I have a load to learn. Starting with grammar; for example, how to use a semicolon.700206__large

At work I have two exam rooms. This card hangs in the one reserved for teen patients so that I can see it daily. Hopefully some of them read it and I’ll bet many of those that do wonder why on earth number 6 is on the list but, I know.

Thanks go to Bryan Vartabedian whose blog post at 33 Charts got me started with my 3.

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I Resolved To Bake Better Cookies – It Was a Tough Year

Yesterday I called a friend near the time his clock would tick over to 2013 to wish him Happy New Year’s. I was informed in so many words that, while happy to hear from me, he doesn’t buy into the whole New Year’s thing. This set me thinking.

Today resolutions abound. We all know that tomorrow most will be broken. In fact, one study from 2009 showed that a full 88% of resolution-makers fail. So, why keep trying? Why make such a big deal of New Year’s Eve and Day?

I too think they are overblown; you certainly won’t find me celebrating on Time’s Square. But, I do enjoy the chance to reflect backwards and to look forward. As I wrote, in my very first blog post on January 1st 2011, it seems better to assess our life’s path as we walk it rather than on one night a year. However, there is a nice symbolism to the passing of one year into the next that provides many of us the focus required to pause and reflect.

I have often resisted making a resolution. Last year I made one and succeeded gloriously! My resolution, broadcast far and wide, was to move through my cookbooks, recipe by recipe, to find, make and perfect my favorite cookie recipes. It took a lot of diligence; it was hard but now, my work has paid off: I have my perfect versions of chocolate chip, oatmeal, ginger, black and white, almond and snicker-doodle cookies. My kids loved it – they were thrilled by watching their possibly insane, semi-perfectionistic mother make batch after batch until she was happy. They, in turn, kept telling me more work needed to be done, that whatever one I had just produced wasn’t quite right, that I needed to try…just one more revision.

Was this resolution silly? Perhaps. It was a fun-loving way to make myself take more time to do something I love with and for those I care most about. Less work, more time with the kids. Who cares about the extra cookie weight? If I were a person who went in for making much of New Year’s Resolutions, that might be the one for 2013.

Postcards2CardsNewYearsResolution1915

 

 

 

 

 

 

And, now if I am ever asked if I ever made a NY’s resolution I kept, I can say “Yes!”

 

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The Rough Shifting of My Brain From “Mom” to “Doctor”

DSC_0885My favorite day of the year is December 26th. All work done, house a mess but, who cares – the kids are happy. No dinner to make. There’s enough left-over turkey for the apocalypse. I was sitting by the fire, new book in one hand, glass of Prosecco in the other. I never sit and haven’t read much this year so you’ll forgive me that I did not at first jump at the voice from upstairs.

Mom?

I am reading a good book, The Memoir Project. It is perhaps worth a blog post soon. I was sucked in by the promise of relaxation (fire, Prosecco) and uninterrupted creative thought (book). But then, there was something in the tone of voice that made me ask

Do you need me?

Yes!

Is someone …hurt ?

This last bit uttered as I ran, up the stairs, because by then I already knew.

The big brother sat wide-eyed by the crying, stiff little brother. They had been wrestling as bear-cub brothers will and, it had ended with the little guy crying out. Later, I asked his brother what made him stop the grip he had on his brother’s neck and he said simply that he said “ow.” Must have been a loud “Ow.”

And that is where the point of this story begins. They say that doctors should never practice on their families. There are good reasons and, dire examples. But how, I ask you, is a mother (doctor) supposed to not treat her kids? I don’t do their well checks. I don’t treat their colds. But I am present for their emergencies. At those , there is always a juncture when I have to wrench my mind out of motherhood and disassociate to be … a doctor. Sometimes it works.

This time it worked fine. I was able to calm the little guy, assess his sore neck (muscle spasm) and hug his sorry brother. Whew. But, don’t think that visions of quadriplegics weren’t dancing through my mind as I acted.

Other times it has been harder. I was an exhausted intern, coming home off a 36 hour stretch when I saw the rash. My firstborn (a.k.a. the big brother) was at a friend’s house when I picked him up. She calmly said that he had the strangest rash. I looked. He did. His rash was that I saw in the hospital on kids who died. My mind churned; it twisted – I had to be the doctor again?

Another day, one when I was supposed to be home recuperating from a big leg surgery I again, had to make that shift. The kids had gone kayak camping with their dad. They had paddled into a remote lake and broken camp, gone to bed and the next morning the sister felt ill. All their dad can tell me now a few years later, is that he just “knew”. So, he and her brothers packed it all up, boated everything out and then carried her out. She came home to me and they asked

is she okay?

Well, I will say I tried. I tried to make my mind turn from mommy to doctor. I tried to think clearly but.. it did not happen. Thankfully, her dad was wise and took his little girl with the near-ruptured appendix to the hospital.

I’ve also missed a few broken bones. Correctly pegged headaches as nothing to worry about. Ignored appropriately, several random stomach aches and, imagined cancer at least a half-dozen times.

The New England Journal of Medicine reports the dangers of treating our families. The American Medical Association advises against it. Many hospitals forbid it. I am a fine doctor. I am the best mother my kids have. I should not though, have to play both roles. But, I do at times and during those moments I hold my breath and try to avoid the worst while I summons a brain-shift from mommy to doctor.

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Real Friends Would Iron For Me

I am fortunate to have a wonderful group of women as friends. They form several overlapping and intermingling groups. My “birthday group” – six women who meet for dinner on the six birthdays. (Well really five, one gets slighted every year since her birthday is on 12/29; somehow we are all so relieved to have survived the holiday season and all of its joyful work, that we can never quite coordinate to meet on her day. She’s awfully sweet about it and teams up with our January birthday.) My book group, together since early 2000 with many additions and departures but with a core that has stayed from the beginning. I have a group from when our kids were all at the same parent-cooperative preschool. Our families meet for dinners, holidays, camping and gather to each others arms in times (too many lately) of loss.  My bunko group. Bunko? Really? Well, we haven’t actually played for years. We evolved instead, to host nice dinners monthly for each other. Then when that began to seem like an unnecessary amount of work added to our already too-busy lives, we started “Bunko-lite” meant to be just drinks and dessert. Last night, we had even better – just went out to a local pub! Perfect.

So, I do have two or three dear, close male friends. One recently asked me what all these women talk about when we get together. Men? Kids? Jobs? Sex (he said hopefully)? Hmmm… what do we talk about?

So, last night…. We did talk about men some. Sex was mentioned. Our kids too of course. And our parents, jobs, puppies and in-laws. But what captivated our attention? Ironing.

One wonderful woman, a skilled R.N. by training and super-mom by love, was telling us about how she had been inspired by my recent blog post How the Grinch Got it Right to let some things go. Like ironing the sheets. Ironing the sheets?! We giggled over that and decided that must be a nurse-thing since my mother does the same at times (and they both miter their corners nicely also). Then we all joined in the laughter as another friend told us about her son showing her an iron he had found in the closet once and asking what it was. A few of us remembered a comment one friend’s grandmother made: “I’d rather whore than iron” – a comment that has stuck firmly in my mind; it has such earthy wisdom about it. One gal then volunteered with a twinkle in her eye, that sometimes as she flat irons her hair, she touches up her shirt as well! We all liked that time-saving, practical,  modern-mom tip. Another remembered that her family had an ironing lady when she was a child. When I asked the friend next to me if she was an ironer she responded simply “no”. Ah, why would she… her husband irons. And cleans. (now that is a man to talk about).

I have ironed. I was able to say proudly, that in fact I ironed last month. And, almost exactly four years before that. I ironed while watching Obama’s inauguration and this year, while watching the election returns. Generally though, I subscribe to Erma Bombeck’s theory:

My second favorite household chore is ironing. My first being hitting my head on the top bunk bed until I faint.

Erma Bombeck was also wise about the value of friendships. As she suggested, I have friends who would tell me to eat dessert, never defend a husband who gets me an electric skillet for my birthday and who will definitely tell me that

they saw my old boyfriend and he is a priest.

I have friends who have brought me countless dinners when needed, cared for my children and held me while I cried. But, darn them, I just can’t get them to come over and iron!

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The Incredible Lightness of Self

On my far too long flight home from Zürich recently, I watched a dumb movie. I love unchallenging, predictable, movies. Best of all? Dumb romantic comedies. In this one a man and woman who are discovering that they care about one another, are out at lunch. He invites her “to spend some time getting to know each other better.” As they sit, leaning in together, she asks a question about his work. Then she asks another and, another. Then? One more. We know she is curious and cares to understand him; we can see she is nervous. He answers but, after a bit squirms and jests pointedly , that he feels as if he is being interviewed. She sits back abruptly.

Even in the best of relationships (romantic or parental) there pass small moments of strife. Socks on the floor again, toothpaste left in the sink set us on edge. A comment about what the partner is wearing or their hair color that  triggers some deeper insecurity. A word carelessly said. Or, not said. Most of these moments should be allowed to pass by; they are not worth making much of. But, so often we chase them down and chew them apart and, in doing so cause injury. Unintentional injury.
Often as they build, I can feel these moments creeping up on me. There hangs in the air a sense of tottering balance. I could respond with a not really meant vitriol that somehow in these stupid moments can fly out of me. Or, I could choose to walk by the moment without response and take a deep breath. A breath full with understanding that the little things are just that.
If I could wish, I would wish for a warm humor at those times. An ability to shrug my shoulders and laugh at myself and ask, “why take life so seriously?” Socks on the floor, toothpaste on the sink and questions about hair color are just socks, messes and curiosity. They are not more.
While watching the movie I momentarily held my breath. I could see myself there on screen (as the leading lady of my own life) and knew the response to his jest could go one of two ways. I would understand her hurt retreat back into the chair, her stiffened chin and internal kicking herself for going overboard in her attempt to understand him. I could see myself doing just the same defensive retreat.
It was a relief to see her pause, and then laugh and say that “yes, she had a way of going too far when she felt nervous!” What a gift – to accept and to lightly laugh at oneself! What lightness!
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How the Grinch Got it Right

I told my friend yesterday that I feel like The Grinch. Why does everyone feel compelled to fit their yearly entertaining into December? Why do we leave March so unattended to? What’s wrong with wine parties in say, September?

I have, no doubt been feeling enormously blue for each of our recent last Decembers. Life has conspired to make me so and, I have given in. Then, tonight I went to a lovely party thrown by a friend with far, far more than me to feel blue about. She confided that she almost did not hold her annual December party because she felt so weighed down by life’s challenges. Then she turned to herself (figuratively) and decided that perhaps that very ‘weight’ was exactly why she should after all, have 30 or so loud, chatty women drink wine at her house.
We chatted about mom-things. Moms-of-teens things: proms, colleges, careers (for us), exercise. Who looked good. Who had a nice sweater. We mentioned how stressful December is with its cards and cooking. One friend warmly told me to let the (damned) cards go; that the year she did so she stood 3 inches taller from the lightening of her load! I left feeling supported and calm.
I did not leave giving up on the (damn) cards though. The gathering (yet another in the many) made me see something. Our holidays can be hard for many. For me, change has made them difficult. For some, loss makes them lonely. Perhaps a wise person somewhere, someday, saw that filling the month with parties and cards gets us through if we are brave enough to be present and take part of them.
Maybe there is something to this insanity of cards and socializing after all,

And the Grinch, with his Grinch-feet ice cold in the snow, stood puzzling and puzzling, how could it be so? It came without ribbons. It came without tags. It came without packages, boxes or bags. And he puzzled and puzzled ’till his puzzler was sore. Then the Grinch thought of something he hadn’t before. What if Christmas, he thought, doesn’t come from a store. What if Christmas, perhaps, means a little bit more.”

― Dr. SeussHow the Grinch Stole Christmas