Archive for January 2010

Monthly Archive

Tape Measuring Time

I had a great weekend. Nothing truly spectacular happened. I, for the most part, tucked the blog away in my top drawer. I wasn’t on call and didn’t connect into my clinic computer. I tried to be really present with all 3 boys in my house.

I played with my kids. We did the typical things that dress up weekends for normal people: errands, a grocery store trip, naps, dinner, test drove a car, met friends and their kids for lunch, met friends and their kids for dinner, went to IKEA, had dinner with grandma, took out the recycling, rearranged the living room.

Usually, that little “trip to IKEA” sandwiched in there would be a back/mood/weekend breaker. This time, no.

In the midst of this wholly normal yet stupendous weekend, I had mentioned to a friend how F was having a hard time with the concept of single digits forming greater numbers, especially in the teens. That is, he can count pretty easily from one to fifty, but when I point to the clock and ask what time it is, he says “seven, one, three.” Read full post »

Wait lists: Be Careful What You Wait For?

Luna waitingWelcome to wait list country. That sounds like some bad pick-up truck ad. But it’s true; Seattle is known for mountains, water, coffee, grunge, rain, evergreens, and the Space Needle. And then as it turns out, wait lists. I know what it feels like being stuck on a list. Hip deep stuck. Somewhere between the Andersons and the Steins just above the Grahams on page 6. Buried with no chance for arrival or survival.

The wait list: are you on one of these lists?  Is your equivalent w-e-n-d-y-s-u-e-s-w-a-n-s-o-n spelled out and nestled nicely on some school, pool, or horseback-riding list? I think about these lists a lot more now that I have two kids. I generally let all people involved (the kids, the husband, the babysitter/nanny, the MIL, my own mother) down due to my inability to follow through and get on the list, let alone get off the list. Any list. I know you turbo moms and dads out there are really good at this. For me, it’s usually well after the list is formed, a true tardy, and only with 3 people telling me about an activity, that I get on the list. Precisely why I’m at the bottom, I suppose. Read full post »

100 Calories

Rainbow WalkWhile I’m talking about the red/orange/yellow rainbow spectrum used on food packaging to lure you into eating more, let me mention one great new study published today that may change your world. Especially if you have a child living in your house. If you acknowledge the finding that about 1 out of every 4 children between the age of 4- 8 years old eats fast-food on a typical day, this has relevance to at least about 1/4 of us. Today!

A study published today in Pediatrics found that when parents are aware of the calorie count in McDonalds fast-food items, they order less caloric foods for their preschoolers (age 3-6). In a Seattle pediatric clinic, about 100 parents filled out McDonald’s menu choices for lunch for themselves and their preschooler. Families who had menus that included calorie content for each item listed selected meals that were about 100 less calories for their kids compared to families who didn’t have nutritional information (calorie count) on the menu. Just by having the number of calories listed for each food item on the menu, families made better choices for their child!

Brilliant and then seemingly simple, huh?  However, lots of fast-food chains don’t readily provide nutritional info. As menu-labeling laws may be incorporated into health care change and reform, this study helps define how important access to nutritional information is for all of us.

100 Calories may not seem like a big deal. It is. Over time, just eating an excess of 100 calories every day can cause a child to get fat. Read full post »

Constructing Snacks into Mini-Meals

Over the past 20 years, the amount of calories consumed by children from snacks has increased by 30%. Kids eat a third more calories everyday from snacks! What kids snack on certainly can reflect how their diet is shaped and how they grow. Plain and simple: snacks make us fatter by packing in lots of calories in relatively small bits of food, the definition of “calorie dense” foods. They also discourage our eating of things like fruit and veggies because they fill us all up. One recent study found it was our over-consumption of snacks more than our under-consumption of fruits and veggies that is getting us into trouble.

Beware of the foods in red/orange/yellow packaging; these are generally foods that are not very good for you. Research finds that these colors make you feel hungry, thus advertisers use the colors to increase the likelihood that you purchase (and eat) junk food. Think about food packaging like you think about the threat level at the airport. Red and orange are generally a no-go. Steering clear of this part of the ROYGBIV (red.orange.yellow.green.blue.indigo.violet) food isle is important. As snacks make up more of our entire diet, what we choose to snack on may be as important as what we make for dinner.

Whine with your snack?
Whine-fest 2010 continues in our house. Beautiful. I’ve gotten out my baton and I’m now conducting from a perch in the kitchen. All those years of band (yes, I played the oboe) and weekly orchestra practice are finally paying off. Play date sign-up for whine-fest in our house will be online soon. Guest conductors accepted. Read full post »

Complex Problem: Raising A Child

I had the fortune of seeing Dr Atul Gawande speak last week in Seattle. Truth be told, I entirely invited myself. I heard there was a group from the hospital going and I begged my way in. I sat in the corner.  Flashbacks to finding a seat in the junior high cafeteria. I made it through and forgot all about the awkward act of my self-inviting and seat-finding by the end. Despite my disrespect for Ms Manners and my loud mouth, my pushy ways afforded me the opportunity to witness a leader in medicine.

I enjoyed what Dr Gawande said about his work in using checklists to ultimately decrease complications and death in the surgical setting. I have read Dr Gawande’s books (or parts of them, I admit) and many of his articles in the New Yorker (whole thing, thank you). I marvel at his skill and ease of writing, his ability to translate complicated problems and make you feel like you thought of them yourself due to their apparent simplicity. His assertions, however, are not simple. It’s just that his skill in expressing his position, explaining the breakdowns in the system and offering opinion wed with solution puts us all at ease. His article, The Cost Conundrum, remains one of my favorite articles of all time. I have read it numerous times and think about it when caring for children on a weekly basis. He has affirmed the way I feel about over-testing in medicine. As I have said previously, in pediatrics so often less is more. Read full post »

The Whine: Up To My Nose In Noise

Meet Luna, our dog. She looks overwhelmed this morning, doesn’t she? I think she is thinking about our short night of sleep sandwiched between a fine nighttime whine and an early morning whine. The whining in our house is overtaking me. Imagine me in a pile of virtual sound, covered up to my nose in noise. Underneath layers of scratchy screech and howl, whine and cry, loudness and complaining, my hands reaching for the sky. It’s loud here. Wanna come over and play?

I’m wondering when our dog will enter into the chorus and begin to howl. She’s a remarkably patient and mild mannered 7 year-old lab but you’d think this would inspire a little bark or something. Her calm alarms. She remains quiet and patient despite the racket, waiting on the sideline for the respite of nap time silence. Silence can feel very present and nearly tactile right now. The presence of something as opposed to the absence. Read full post »

See Spot Run? Anterior Fontanelle, Part 2

seespotThe soft spot feels like an epicenter in O’s landscape. As every new parent gets to know their baby, the soft spot is just one of those places and spaces we come to know that makes our baby unique. I know O’s little spot is about to go away. Just another thing for me to cry about at the two-year birthday party.

I took a phone call from the husband recently who is a pediatric radiologist and who was reading a head CT scan, inquiring when I thought the soft spot closed in infants, exactly. He knows a lot more anatomy, physiology and imaging of the skull than I do, but he had a common question: just when does it close? Like so many things in medicine, I don’t think it’s entirely clear. There is no perfect answer.  The short answer is around 1-2 year of life. But like so many things, the range of normal is expansive. Read full post »

161 Years Later

Elizabeth Blackwell, MDToday while I was waiting for an elevator in downtown Seattle, a man whisked in front of me and another women to get in the elevator.  The woman had on a fancy coat and red, powdery lipstick. She stopped me as I was getting in and said, “Oh, it’s going down.” I stopped and waited and thanked her for alerting me to getting on the wrong elevator. I liked her. It didn’t really faze me that the man had pushed ahead of us a bit, but he had. The woman looked over at me and said, “what a man, can’t even wait for a woman to get on.”

I said, “well, chivalry really is dead.”  As if to state the obvious but also assert the okay-ness I had with it all. Then I said (maybe over-stepping my boundary with this stranger), “funny thing is, yesterday was January 11th and that marked the day that the first woman in the United States was awarded her MD.  And that was over 150 years ago.  So, if I lose the chivalry over those years and gain the opportunity to practice medicine as easily as I do, it seems a pretty good trade off.”

The woman just kind of looked at me, smiled, almost laughed a bit, and then stepped forward as the elevator re-opened. When we got in and headed up she said, “well, at least he’s not on our elevator.” Read full post »

Verbatim: The Wife

One little thing that really gets under my skin if you must know is the title, “The Wife.” When I hear it, it rings through me, moving and shifting my electrons in just the wrong way.

I’m sure most of you wives or mothers out there on planet earth don’t really mind it. But I do.

Here is how I often hear it. Let me set the scene:
Exam room, child center stage, father stage left.  Meaning no harm (or disrespect) the dad says, “Oh, and the wife wanted me to ask you about this rash.”

I remain calm, usually leaking no erratic response, remark, or expression. This is my issue, I’m sure. But the internal alarm goes off.  Just something about that woman being distilled to “the wife.”

“My wife wanted me to ask you about this rash.”               No alarm.
“His mother wanted me to ask you about this rash.”          No alarm.

But,“The wife wanted me to ask you about this rash.”     Alarm-tastic.

With permission, I’m going to refer to my partner and husband, father of my children, as The Husband. Just to even the field. For today and maybe tomorrow, too. He’s ok with it; I’ve cleared this.
Thank you, husband, The Husband.

Science Of The Soft Spot: The Anterior Fontanelle, Part 1

The soft spot on the top of my baby’s head is one of my favorite places to run my hand.  I don’t know why exactly but it seems one of those places on him that truly represents his baby-hood.  One way I know that his infancy isn’t quite gone and my baby days aren’t over yet. O recently turned a year (so, yes, technically he’s no infant) and I have felt his baby-ness slipping through my fingers. I keep saying that to my patients when they ask about him. I am hoping it will somehow prolong this period and I won’t have to wake up and find myself with two grown boys in the house.

The emotional yo-yo between pure excitement about them growing up, with the simultaneous dread of losing these baby moments, remains real and palpable. The essence of parenthood I suppose is that stew of anxiety-thrill-dread-adoration-excitement as the days unfold and you hope for new things for your little baby while lamenting the loss of precious moments of who your baby is on a Monday in January.  So the soft spot is a good place to go to calm my inner anxiety about my toddlers walking out the door to college.

Lots of new parents ask me about caring for the soft spot. As the first year unfolds, it is the soft spot (aka “fontanelle”) in the front/top portion of a baby’s head that parents ask about, the anterior fontanelle. I think we all conjure up crazy worries about an errant flying pencil landing in it. Read full post »