Archive for December 2010

Monthly Archive

Greatest “Hits” of 2010

2010 was good to me. See the picture; see my boys? Was it good to you? Life was out of balance, but full, vibrant, meaty, and dynamic. I met amazing people. Work and time with family has been very textured; I feel saturated. Writing and maintaining this blog has ultimately caused me to pause and think about medicine, and my choices, quite a bit more than I used to. I chew on the things people say in comments and in response to what I write over and over again. I’ve learned a lot.

I’m indebted to many. Primarily, to my husband, who has read e-v-e-r-y-s-i-n-g-l-e-p-o-s-t. And for all but about 5 of them, he’s read them prior to them being published. It turns out he is incredibly committed to communicating about pediatric health as well, but goes about things quietly. Clearly, we’re very different (thank goodness). I remain so thankful that someone believes in what I say like he does. My mom also reads nearly every post. She’s been known to scold me about typos and grammatical errors yet ultimately keeps me in check. When an older relative watched a television interview I did recently on obesity, he said, “Well, she speaks too quickly.” My mom apparently responded, “You need to learn to listen more rapidly.” So genuine support abounds at home and at work. I’m entirely indebted to those with whom I work at Children’s, my peers, and my friends in medicine. You’ve all bolstered me this past year. As I said in an interview today, “I am just so lucky to partner with an organization that believes in innovation.” Thank you, all.

So a quick greatest hits. Here’s a breakdown, strictly by the data (pageviews), of the posts that were read most frequently in 2010. Read full post »

Lice Infestation

I’m not trying to ruin your holidays (or your appetite). I really couldn’t and wouldn’t make this stuff up. But yes, we have had a lice infestation for the holidays. Last Thursday we flew to California to be with family for Christmas. Before that, I was in the midst of typical holiday madness, but I also felt this year, in particular, I’d managed not to get stressed. While in clinic on Wednesday, I made a conscious decision that I wasn’t going to stress about the to-do list awaiting me at home. The perspective I get while seeing patients often helps me frame my own stress. Compared to a broken arm or a bout of RSV, a packing list is really nothing. My husband was on call on Wednesday, so when I returned home from clinic around 6:30pm, the to-do list was mine alone. I needed to pack the family for the holiday, finish off some writing, wrap some gifts, and find something for dinner while completing the Christmas cards. I had about 12 hours before we needed to leave for the airport. But this is the life of nearly every parent at one time or another, particularly around the holidays. Then it hit.

Just before our nanny left, she mentioned F was complaining of an itchy scalp. The rest goes something like this:

Me: “Really? F, Lovie, come here, let me look at your head.” Pause. Gulp…….wait for it……..”You’ve got to be kidding me, lice for Christmas.”

F had lice. Yes, we’d received a letter the week prior that a “sibling” of one of the preschoolers had lice. The letter seriously sounded like the stories we hear from others about a “friend” with an STD or a “neighbor’s child” who bites. I figured one of the kids in school really did have lice and yes, the threat was there, but then blew it off and went on with life. New recommendations from the AAP this past fall encouraged schools not to send children home with lice or keep them away from school. I tend to agree with the recommendations as having families leave work and sending kids home seems an enormous interruption for a “non-health issue.” Maybe because of this, I was just about to have a front row seat in a major infestation.

Just then, the doorbell rang. Does this sound like a sitcom? One of our new neighbors was at the door, huge warm smile on her face. She was inviting us to a quick impromptu holiday party next door. Would I like to come? One of the older children had been offered up to watch the kids so I could head over and have a glass of wine. Pâté. Meet the neighbors, embrace the holidays.

I faked it; I smiled. I don’t eat pâté, but the wine sure sounded good. I didn’t tell this holiday-cheer-infused welcoming neighbor what was going on. I mean, when someone is standing in your home, for the first time, meeting your family and offering pâté and wine, do you tell them your child is covered in bugs?

I shut the door, said I would try to make it (that was the truth), and planned my attack. Read full post »

Getting

Getting is an important part of our holiday tradition, too, even though most of us over age 18 naturally subscribe to the insight that, “We get far more when giving than when getting gifts.” Children feel differently, of course; when you’re young, holidays and celebrations are all about the getting. Part innocence, part their time and space, part their developmental stage (it’s normal for preschoolers to believe everything is about them); the recipe for being a child includes wanting more toys. But using Santa (or his elves) as a behavioral tool is never going to work. Naughty or nice is a total hoax.

Our maturation from focusing on getting to focusing on giving is the sustenance in this cycle. All in balance, most of us seem to want less material goods as we grow old. Wisdom, aging, or idiocy–you decide. As I age, my Christmas list has started to sound more and more like my mother’s :”time with my children,” towels for the bathroom, and appliances for the kitchen. It all used to sound so lame. Is it my simple understanding of the bank account, the distillation of my limited free time, or something else? Like most, no longer does gift receiving highlight my holiday; what I like most about this time of year is the ultimate sense of anticipation and the giving. As one friend recently said, “It’s hard not to want to spoil your kids.” It’s just so fun to give them things they like and want. Read full post »

Giving

I’ve been slightly dented by the bad news I’ve heard this year. In 2010, more parents have told me about losing their jobs, having a hard time paying the bills, losing their health insurance (this makes me insane/incensed!!), and losing their homes while I’ve been in clinic than I ever imagined. I’ve always had the fortune of financial support, either from my family as a child and young adult, or through loans for college and med school. My entire life, I’ve always had a place to sleep. In this down market, I’ve thought more about my good luck than ever before. I still have plenty of educational debt (like most doctors), but previously while living on educational loans or in medical training, I lived paycheck to paycheck. Therefore I didn’t have the luxury to give to charity. Or I didn’t choose to (that’s another way to look at it). Now as I get farther away from my training, I have more opportunity to give.

An utter privilege. Dent remover.

When my husband and I discussed giving to charity this month, we were slightly clueless about how to proceed. With our busy careers and with two young children this year, we haven’t had (or taken) time to volunteer outside of the institutions in which we work. We don’t have any new experiences to help guide where we should give. I’ve given to my schools previously and to organizations that I listen to regularly or have affected my own life. But others–those who reach out to children I don’t know? It dawned on me I should survey the Twitterscape. Lots of communities (read: medicine) remain skeptical about Twitter. I find it an irreplaceable tool in medicine, and in life. My list for its utility flourishes. And I’m not alone; a recent Pew research survey suggests 8% of all Americans use Twitter…

Twitter can offer an incredible marketplace of thought, emotion, opinion, and fact. For those skeptical, yes, it does offer falsehoods, inflation, myth, and blatant un-truths. Just like any other situation–on the street, in the hallway, or at the water cooler–you still have to use your brain when consuming on Twitter. But one great thing about Twitter is that it’s a perfect place to crowdsource. That is, aggregating peoples’ minds and experience to answer a question easily. When I grab my partners in clinic to “eye-ball” a rash or discuss a patient case where I have some indecision, I often tell families “Four eyes are better than two” because most often, it’s true. Even if those two sets of eyes don’t agree, the reasoning for disagreement is entirely useful in making clinical decisions and in guiding families in a plan. Collective insight, wisdom, and experience will always improve advice in health care. And in solving everyday-type problems. Hence crowd-sourcing on Twitter to determine where best to give…

I sent out a tweet a little over a week ago: Read full post »

Crib Climbing: 4 Reasons To Leave The Crib

Speaking of cribs, I started this post on November 17th. I quickly abandoned it for no good reason. I realized tonight it was due to an unbelievable heap of procrastination. No, I wasn’t procrastinating about the writing. It was the act of moving O from crib to toddler bed. We’ve done this before, about 2 years ago. It wasn’t pretty. F had climbed out of the crib one day during his nap and greeted our nanny. I was on strict bed-rest with O. 3 weeks later I delivered and we had a newborn at home in concert with daily 2 hour stand-offs with F at bedtime. Staying in bed wasn’t his plan. He’d empty his entire closet, climb on top the chairs, look out the window, ask for water. Sing his repertoire of songs. Repeat his repertoire of songs. Consequently, for about 6 months we agonized in the reality that we’d moved F to a “big” boy bed prior to him transitioning into a “big” boy. Toddler-two’s-torture. Crib jail had been so nice.

For O, I knew it was time to move him to a bed back in November. Just couldn’t bring myself to follow through. Toooooooo, tired. A fairly lame and indefensible (yet understandable?) excuse. We got away with it. Sans a trip to the ER, we took off the front of the crib today. He’s been out of his bed all evening tonight. Let the games begin.

We still shouldn’t have waited. I wasn’t taking my own advice. I’m here to confess… Read full post »

Ban on Drop-Side Cribs

The Consumer Product Safety Commission (CPSC) officially banned manufacturing, sale, and resale on all drop-side cribs today. Laws will go in place June 2011. These cribs, with movable sides that come down to make it easier to place your baby or toddler in the crib, have been under scrutiny for years due to safety concerns. Previous CPSC warnings and recalls have been loudly amplified in the media. Many parents have had concerns.

Here is a nice summary of the announcement. If you have a crib with moving or drop-sides, check out these suggestions for ensuring your crib is safe by doing routine checks. Ensure the crib isn’t wobbly, that joints for the sides of the crib are secure, that there is not excess space between the mattress and the side of the crib (no more than 2 fingers should fit), and that parts are intact and unbroken. If any parts are broken, replace parts by following manufacturer recommendations by looking online at their site or calling the company who made the crib.

This is another great step in protecting our children. What’s your experience with drop-side cribs? Have any of you had experiences raising concerns while using them?

Here’s additional tips from the AAP on choosing a crib (hasn’t been updated to include today’s information).

(And yes, I look like I’m attacking the screen or eager to eat a large drumstick in the still above; I know. No comments necessary :-))

Dosing Liquid OTC Medications

Over the counter (OTC) liquid medications for children are packaged with a diverse set of various measuring tools. The dropper that comes with liquid acetaminophen (Tylenol) will look very different than the dropper that comes with liquid Vitamin D or infant multivitamins. Even more discrepant are all the various caps for medications used in older children like liquid Motrin or Benadryl. If your cabinet looks anything like mine, caps and syringes are scattered about and distant from the bottle with which they were originally packaged. Because of this, many of us get confused when dosing medications for children. It’s time OTC liquid medications for children were packaged with a universal dosing device. And….time that pediatricians and all physicians be required to use only one unit of measurement (whenever possible) to avoid ongoing confusion for prescription medications, too. A new study functions as a wake-up call for drug makers and pediatricians alike; we need to do a better job helping families learn how to safely dose OTC liquid medications for infants and children. Current practice isn’t going to cut it.

A recent study in JAMA found… Read full post »

A Living Mommy-Daddy Will

I’ve been struck by the death of Elizabeth Edwards. I keep coming back to thoughts about her. Like most Americans, on Monday I learned she was advancing to hospice care. After a long day in clinic on Tuesday, spent, I listened to NPR in the car on my commute home. It was dumping rain in Seattle, it was dark, the cars were moving slowly. NPR announced she’d passed away. What? Pause. Swallow. Take a right turn at the light…

I thought she had weeks. Tears welled up in my eyes; I felt caught off guard. I can only imagine the sadness of those who have known her.

I’ve been thinking of her, her children, and her life experience. I don’t know her, so of course my vantage point into her life is one similar to most–I only know what the media shared with me and what she chose to share with the public. I trust her texture is expansive and far more pronounced in person. I know so little about her, but I have heard her story and it is memorable. I am taken by her death likely because so often, she was identified as a mother.

Today in NYT’s Motherlode blog, Lisa Belkin writes about Ms Edward’s “Dying Letter,” a letter she composed for her children as she faced her mortality. People magazine reported on the letter while the Edwards family was on the campaign trail. I suspect like any letter from a mother, her letter is filled with story, memory, advice, wisdom, and legacy. Fortunately, we’ll never know. Only her children will.

But it got me thinking. Why don’t we all write this? Why don’t we all share, journal, and jot down our thoughts and ideas for our children before we face a mortal diagnosis or worse, an unexpected death. Why not collect thoughts/ideas/moments in time throughout our lives for our children. After I wrote a letter to F last year for his preschool emergency preparedness, I felt better. I know that if today an earthquake occurred while my son was at school, that while separated, he’d at least have my words and a photo. This task could function like a living will but not for our own end, rather for our childrens’ future. Today, a living-Mommy (or Daddy)-will makes a lot of sense to me, despite the onerous task of composing it.

Does it make sense to you to start an ongoing letter to your children? If you don’t feel like much a writer, how about a list of ideas/wishes/advice placed in bullet points? I suspect if any of us start this, we’ll never regret it. Neither will our children.

Will you do this?

Verbatim: Be A Dad

Recently I saw a patient for his 7 year old well child check. He was in the office with his entire family for an evening appointment. My medical assistant got his weight, height, blood pressure, and completed his screening exams. In the hall, she mentioned to me that he said he was going to be a scientist when he grew up. She was charmed (clearly) and I was weak in the knees when I entered the exam room. I mean, endearing and sweet, robust and proactive, his dreams exceeded the typical 7 year old. I suppose I thought this partly because of my path in life (science-y and full of many years of science education). Of course there is nothing ultimately graded about dreaming to be a scientist when compared to dreaming to be an astronaut, a carpenter, a designer, a gardener, a botanist, an artist, or a teacher (this list goes on and on). What we want for children is far wider than their title–what we want is contentment and enjoyment in their career.  Most of us often love when people tell us they want to be “us” when they grow up. It’s affirming, right? One reason you have to be careful from whom you seek career advice. For most, it will often sound a lot like a transcript of what they have done. I’ve been thinking about this since the visit because of what happened next… Read full post »

Do You Believe in Vaccines? (Part III: Experience)

Helping families make decisions about their child’s health takes training, expertise, and experience. The training is standardized (medical school, residency, fellowship), and the expertise confirmed by passing board examinations and maintaining yearly CME (continuing med education). But the experience piece is ultimately unique for each physician. With each day in clinical care, patients teach, instruct, and shape how we understand wellness and illness. Through individual experiences with patients, physicians ultimately become who they are in the exam room. In medicine, despite the huge push to standardization everything from centralized phone calls to how much (or little) time we get with patients, individual doctors will fortunately remain unique. As patients, we still get to enjoy our physicians as people helping us through illness and injury.

This week has been intense. Wednesday, I spent the morning as a patient in the care of my incredible doctor. (I’m fine). She’s entirely instructive for me as a patient and as a physician; her bedside manner astounds. I believe she’s just very good at her job, partly because she’s uniquely experienced. I believe her experience being a nurse for many years before becoming a doctor really colors how she provides care–she gets it.

The week has also been intense because of this series. I’ve been thinking about immunizations, reading comments here on the blog, writing, and witnessing my patients’ responses. I’ve received many e-mails. Yesterday, I was at clinic for over 10 hours and like most days, immunizations were a huge part of my day. But I said things I’ve never said before…True synergy between my clinical self (doctor) and my writer self (Mama Doc), this experience is shaping who I am, in and out of the exam room.

Of course, experiences in clinical care (and living on planet earth) shapes how all pediatricians discuss and listen to families when discussing immunizations. Here’s the final segment in my series on asking pediatricians if they “believe” in vaccines. The 20 or so pediatricians who responded, talked about their experiences in representing vaccines. Additional comments are included in part 1 (emotion) and part 2 (evidence).

Experience:

Dr Kronman, a pediatrician and infectious disease fellow:

We don’t see these diseases anymore. I work at a premier tertiary/quarternary care facility for children. I have seen children die of influenza (seasonal, H1N1), pneumococcus, meningococcus, the late sequelae of measles, pertussis; I have seen Hib meningitis, tetanus, severe debilitating outcomes with varicella, cervical cancer caused by HPV, and severe rotavirus. This list goes on. But most people haven’t seen these things anymore. People don’t have to panic about their children in the summer becoming permanently paralyzed from polio, because we don’t see it anymore. And the reason? Vaccines. Read full post »