All the Cool Cowboys Eat Yogurt (or, Nutritional Soundbite #3)

Two of my patients came into the office today with their mother 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 and their mother that… they are dangerously overweight without wounding their young confidence? Without alienating their mother?
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 mom 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.

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.

 

2pooches

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.
image

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.

box

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

My 3 Words: Stretch, Focus and Learn.

33

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.

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!”

 

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.