Archive for 2010

If It Were My Child: No Feeding The Dog

“If it were my child: No kids feeding the dog.” Don’t allow kids to play, handle, or touch the dog bowls, dog treats, or supplements, either. You have to be vigilant and organized. I’m not always both, or either, for that matter. I have found my boys basically bathing in dog water, and dipping their hands/face/sippy cup into our dog food bin many times. News today informed me to change the rules around here.

Pet owners, be aware. Not, “beware.” I’m not trying to scare. A study published yesterday in Pediatrics found that a large number of salmonella infections between 2006-2008 were linked to contaminated dry dog/cat food.  Salmonella infections cause abdominal cramping, bloody stools, and in some (often the very young), more severe infections. I read about dog food as a possible cause of infection back in 2007 when my son (4 months at the time) came down with Salmonella gastroenteritis. Yes, it’s a real story. Bloody diarrhea, cramping pain, lots and lots of crying–poor little guy. I felt it was all my fault. He was an infant and I was controlling everything he ate, after all.

But F didn’t get Salmonella from dog food, he got it from a more predictable route. Read full post »

Parenting, As Seen On TV

I’ve had some recent indiscretions; I’ve been watching multiple episodes (near seasons) of Weeds and Mad Men on my computer. All in one sitting. It’s been a a perfect retreat. While others are off camping in the mountains, I’ve been holed up, late at night staring at a screen. I’m not a big TV person, but watching the torrid lives of fictional families is good for some little piece of me.

Because of my recent over-consumption, I’ve been a little skewed, off kilter, and stuck between TV and real life. Fact: last Tuesday, I opened the door to a patient’s room and jumped (as in startled) when I thought one of my patients was a character out of Weeds (crazy resemblance). True, and scary, I know…Too much TV.

The great thing about all of this time spent sedentary is that the worse the parenting model I observe, the better and more relaxed I feel about my real life. These shows puts the, “Well my children are good listeners” type comments from other parents in perspective, especially while your child tantrums. And yes, this is why we watch television. To be off the hook, off duty, non-eligible. This working-our-butts-off-to-parent -as-perfectly-as-possible-while-earning-wages-to-save-extra-money-for-kids’-college-while-also-cleaning-and-grocery-shopping life, is Ex-haust-ing.

So I have turned to the boob tube. And have focused on two women, in particular: Betty Draper (now Betty Francis) and Nancy Botwin. They are both remarkably flawed. And they make no apologies. It’s wonderful. Read full post »

Navel Gazing?

You want navel gazing? Read a Blog-ter-view of my experience working in social media and medicine.

If It Were My Child: No Tylenol Before Shots

Earlier this year there was a massive Tylenol recall. The recall included Infant Tylenol drops, Children’s Tylenol, as well as many other children’s medications. I’m not exaggerating when I say massive, but generic medications (liquid acetaminophen made by Walgreens or CVS, for example) were not included. The recall was a great reminder that generics are just as good as brand-name medications.

The recall also serves as a great reminder that giving medications to children is never risk-free. Recalls like this remind us to use medications only when absolutely necessary. There is always risk when you intervene.

Tylenol (acetaminophen) is a great medication. It has a place in our medicine cabinets and in keeping children comfortable in the face of fever or pain. Teething, viral infections, ear infections, and minor injuries are great times to use Tylenol. But prior to shots is not. Or afterward, as it turns out. After shots, Tylenol will help prevent fever, but may also prevent the desired immune response. There is new data to support this that has changed the way I think and counsel families about Tylenol. Now when parents ask, I say,“If it were my child, no Tylenol before shots.”

Fever is a “normal” immune response to a trigger (medical school and residency taught me this). But being a mom has certainly shown me that fevers in my babies don’t feel “normal.” When we pediatricians say it’s “normal,”we neglect to connect with the experience of parenting a feverish child. I understand why so many parents reach for the Tylenol. I did; after F’s 2 month shots, he developed a low-grade fever and cried his little face off. I gave him Tylenol twice that night. I wouldn’t have, had I known this: Read full post »

A Divide Between Doctor And Patient: Protocol

There are things we (the providers) do to health care that are hurtful. We make protocols and rules that divide us from our patients. Protocols that sometimes make patients feel alone, distant, and disconnected from their doctors. I don’t mean algorithms of care (safe, standardized ways of how and why to treat pneumonia, for example), I mean clinic rules for helping patients schedule and get in to see doctors appropriately. Triage pathways, if you will.

I hear about these protocol-type irritations from patients all the time. Because I’m a part-time practicing pediatrician, it’s often hard for families to see me when they want. Yesterday, a patient informed me about calling one time while in route to her daughter’s appointment. She had been at a trauma hospital with a family member who was receiving care for a life-threatening condition. She was trying to make it on time to the appointment, but wanted me to know she’d be a few minutes late. She called the clinic and the receptionist said, “No, Doctor Swanson won’t see you.” Of course, this is untrue on some level. In her state of stress, I would always love to make allowances. I work in clinic to help families, precisely when life is upside down. But because of a script and protocol, she was pushed away. Of course, if we saw everyone who arrived late, we’d never be on time or reliable, ultimately rendering us less useful. Protocols do make sense. But they don’t take outliers (life) or individual patients into account.

Many things clinics do in efforts to improve care for all, hurt individuals. The utilitarian-like clinic doctrines I tend to hate. I think of these protocols as walls. Tall structures built up to protect us all from the abuse that only a few people will commit. On occasion, these walls break down the relationship that exists between doctors and patients. Read full post »

“Guns In Your House?”

Asking friends about guns is like asking about their underwear. Not in the pediatric office, but at home, on the street, and in the neighborhood. Hear me out…

My next-door-neighbor (NDN) is a stay at home dad (SAHD). On most days, he runs his household and wrangles 8 and 6 year-old boys until his wife joins him after work. The three (or four) of them seem to weave and pedal through life, on and off their bikes. I can see them coming and going throughout the day; it’s my crystal ball of sorts as to what life with 2 boys may look like about 5 years from now…

Last Friday, NDN approached me from his porch. We often talk, porch-to-porch, about life, the trees, our favorite noodle shop, or the weather. Last Friday, it was different. He said, “You should write a post about gun violence.” I said, “Yah, I know, I should write about 2 million posts…”

But then he framed the issue for me. And I knew he was right.
Read full post »

A Sunday Drive

Out for a Sunday drive. Just two little boys and the open road…

“Eeeeee” My New Favorite Syllable

O has added some syllables to his vocabulary over the last 10 days. And they are simply delightful. Precious, really.

Warning: this post sounds like it’s written by his mom.

O has been embellishing his sentences with a little “eeeee” at the end of words. The Popsicle is now “cold-eeee” when he grabs it. The stove is “hot-eeee.” And when “Momm-eee” and “Dad-eee” walk in the door, it’s, “Hi-eeee!”

I love it. The error, the innocence, and the experimenting. It’s as if he’s trying English on and adding accessories. A belt here, an extra bracelet there. He’s learning how to use his language rather than just repeat it and mix it up. When people say, “Gosh O looks like you,” or “O looks just like _____,” I usually say, “To me, he looks like O.” Because that’s how I see it. But now he sounds like O, too. A pattern and change that are all his own. Just like when F used to say, “kokay.”

It’s one of those delectable little things your toddler says in error that you hold on to for dear life. I know that like grasping at time or holding onto air, it’s senseless. Too soon, the “eeeee” is going to vanish. So for now, I’m holding on as tightly as I can while trapeeeeezing through time.

Drowning: Quieter, Faster, & Closer Than You Think

Two teenagers died in New York yesterday. Not from a gun shot, a car crash, or suicides. Rather, they drowned in a popular swimming hole in the Bronx river on a hot summer day. I hate stories like that. Hate hearing it, hate seeing the headline. A total failure for prevention efforts.

I talk about drowning in clinic every day I see patients. I should probably talk about it more often. As I said in my earlier post outlining the new AAP Prevention of Drowning guidelines (& swimming lessons between age 1-4 yrs), drowning is the second leading cause of injury related death in children 1 to 19 years of age. And most drownings in the US happen this time of year. When it’s hot outside, the lake, stream, or pool can look really gooood. Even to those who don’t know how to swim.

I talk about drowning mostly with the parents of toddlers. But I should spend more time talking with adolescents. I get distracted by all the drugs, sex, and rock-and-roll stuff I talk about. Today, I am reminded of the importance of talking with teens about drowning, because of those teens but also this perspective about drowning.

See drowning isn’t what you think it is. It’s not loud and splashy and outrageous. It’s not like it looks in the movies… Read full post »

The Working Mom Wonders, “What Am I Doing?”

I’ve been caught in a recurring cloud this week even though the sky has been essentially spotless. It’s been one of those weeks where I find myself spinning around to grab the cup of milk or the steering wheel, muttering, “What am I doing?”

I am back perseverating on how to do this right. Life, I mean.

The issue of balance between work and parenting while trying to contribute to the world and use my skills (read: loaded issue) bubbles up at times. I never quite know what will trip me up, triggering a re-evaluation. But it comes up. Quarterly, let’s say, like state taxes…

There are days I am astonished by my opportunities and the children I get to take care of. And days where I am so delighted by my kids, I cry when I leave for work. And days I question if I have the stamina to endure. Last night by the end of clinic, I was so tired and my eyes so bloodshot (no idea why), that my medical assistant took my temperature. It was normal. But, point is, it happens; I do get really tired.

The real trouble is this: I liked my day in clinic yesterday and the things I discovered: the broken bone I found in a 2 week old, the teenager I helped with depression, the 20+ check ups I completed. But tired and missing my boys, yes. See, this would be far easier if I was only pulled in one direction. It’s not how it works for me; I have tugs on each limb. Read full post »