Archive for 2011

2011 Greatest Hits

I continue to feel privileged to share my thoughts here. Blogging has become a huge and stable part of my life. When I celebrated my 2-year blogging birthday back in November, I realized sharing insight online is a pillar in my job as a physician. I suspect providing insight and expertise will be more and more a part of the job of my peers as time unfolds. And I remain convinced that as long as patients are online, I must be, too. Reality is, I have more time online with some of my patients than I do in the exam room. I believe this experience is a peephole into the future of elegant, efficient health care. And I trust this is just the beginning. 268 posts and counting…

Here’s a line up of the “greatest hits” from 2011. I must admit I was somewhat surprised by the list, but these are the 10 posts that resonated most (as indicated by number of times viewed) over the calendar year although not all of them were written in 2011. Some recent posts were nearly in contention for the top 10 but just haven’t had the shelf life as those from early in 2011. From the Tsunami in Japan to the adventures in potty training to one incredible, heart felt guest post!

Thank you to all of you for joining me here and for teaching me so much. I am constantly and forever indebted to you…

Seattle Mama Doc 2011 Top 10 “Greatest Hits”

  1. Science Of The Soft Spot – Science of the soft spot in babies (anterior fontanelle) including a 3D CT scan reconstruction of an infant skull.
  2.  If It Were My Child, No Tylenol Before Shots – Some data behind why I believe there is no good reason to pre-medicate with acetaminophen prior to shots.
  3. Colic, Crying And The Period of PURPLE Crying — An overview of “colic” and baby crying in first few months as well as a link to a Good Morning America Health interview I did.
  4. Japan Tsunami: Reminder To Prepare – How to prepare your home and family for an unexpected catastrophic event.
  5. Fast Paced Media And Four Year-Olds: Cartoons On The Brain — A post about new research exploring the effects of fast-paced cartoons over slower ones on the executive function of 4 year-olds.
  6. If It Were My Child, No Baby Food Before 4 Months — Research finds early introduction of solid foods may increase risk of obesity.
  7. Four Hours On A School Bus — A guest blog from an incredible friend about the “food allergy tax” & how parents go well out of their way to protect their children with severe food allergies, over and over again.
  8. Radiation Disasters: No Potassium Iodide — After the horrific tragedy in Japan, many families worried about effects of radiation moving over the West Coast of the US. This is an overview of the risks of radiation and why I didn’t recommend using potassium iodide (KI) in children.
  9. Pull Ups & Potty Training — An overview (and video) on how and why to ditch the diapers at night as soon as you can…
  10. Treating Ear Infections With Antibiotics — New research (Jan 2011) on using antibiotics for ear infections. A reminder of how less really can be more.

So that was 2011. The blog has had a big spike in readership this last month and we’ve welcomed many new visitors. So I wonder, what do you want to hear about in 2012? I have a series of posts I have been working on about the HPV vaccine, another on sudden cardiac death screening, and one post brewing about IQ testing in children. But what else are you waiting for? Tell me and I’ll do my best to heed the call.

 

Pee, Patience, And Parenting At 35,000 Feet

Recently while on the plane, O wet his pants. Lovely really. He’d refused to pee prior to getting on the plane. Refused to pee at home. Essentially, O refused to pee “on command.” No surprise for a strong-willed-spirited just turned 3 year-old. And after he wet his pants, he then proceeded to have about 14 accidents (yes, I’m exaggerating) later that same day as we traveled to his grandparents’ home. Instead of being patient, supportive, and perfect, the husband and I realized we were just plain-old disappointed. And full of judgment.

Potty training takes patience, perseverance and a positive attitude. Many days we don’t have all three, all at once.

O had mastered his potty-trained world well over the last month or so and the wetting accidents weren’t on our to-do list. He’d been dry all day for a number of weeks. The frequency he was wetting on that particular Wednesday coupled with the inconvenience of it being a travel day just wasn’t my pleasure. Although he’d delayed pooping in the potty for a few months (also totally normal but uber-frustrating, too), that had all resolved some months back. The accidents felt like an inconvenience. And although as a pediatrician, I know how to lend advice in this area, it’s the taking advice part that is more of a challenge.

After age 3, when a child shows resistance to using the potty the “right” thing to do, is to carry on with a smile, stop providing reminders for your child, show that you’re unflappable and continue to praise success. Ignore potty failures, praise potty success.

But it is a seriously difficult task at 35,000 feet when surrounded by pee. Consequently, we spent part of the holiday nudging each other about how terrible we were and how we needed to move from D&J (disappointed and judging) to P&C (patient and compassionate).

Read full post »

7 Truths About The “Stomach Flu”

As we hit hour 40, heading into day 2 of vomitorium here at our house (O has been sick), I will suggest a couple of things I know as a mom and pediatrician about gastroenteritis or the “stomach flu”:

  1.  Hand-washing and keeping things clean is your best defense from getting ill with a stomach bug. Not surprisingly, this is particularly true after touching or supporting your child and when preparing food and/or eating. Some viruses will survive on surfaces for days. And some viruses can even survive hand-sanitizer. But even with ridiculous meticulous detail to hygiene, every parent knows that when the vomit if flying it’s hard to lasso every single errant particle. So simply commit to do you best. Change the sheets and clean up areas of vomit immediately after supporting your child. Soapy warm water is your friend. Wash surfaces immediately, use hot water for the wash, and use high heat in the dryer.
  2. 24 Hours (or so) In general most pediatricians will tell you that vomiting doesn’t exceed 24 hours with typical gastroenteritis. But really, it can. Many kids don’t follow the rules. Once a virus that causes gastroenteritis takes hold of a child, vomiting starts. Children tend to vomit more than adults but I’ve never read or learned why this is. With most viruses that cause the “stomach flu,” as the infection moves through the stomach and intestines, vomiting stops after about 24 hours. But not always. If you advance liquids too quickly, or a child eats more solids than they are ready for, even after the first meal 1-2 days into eating again, they may have a vomit encore. If you have one of those, start back where you started (sips of clear liquids) and go very very slow advancing their diet. If vomiting is accelerating at 24 hours, it is time to check in with your child’s doctor.
  3. Disgusting & Terrifying It’s creepy-eepy to take care of a child with vomiting. Read full post »

What Is A Foreskin? Mama Doc 101

Caring for your son’s foreskin is pretty much a hands-off job. But knowing what is normal and how your son’s foreskin develops and changes over time is essential for every parent to a boy with an uncircumcised penis.

In the beginning, during infancy, your son’s uncircumcised penis needs no special care. The foreskin is a piece of skin overlying the outside of your son’s penis. You never need to pull the foreskin back or detach it in any way. You clean it just like any other skin surface on his body.

Over the first 5 + years of your son’s life, the foreskin will gradually “retract” or pull away from the head of his penis. This happens without intervention as the connective tissue bonding the foreskin to the head of his penis dissolves on its own. As this happens, you can teach your son to wash the end of his penis with soap and water and rinse it well. Some boys will be able to fully retract or pull back their foreskin by the time they start Kindergarten while others may not fully retract it until puberty. Both are okay. Read full post »

5 Things I Say (In Clinic)

Five things I say in Clinic (in no particular order). After reading this, you’ll be all set for Family Feud when the category is Things Pediatricians Say.

Number One: I’m so sorry you’ve been waiting for me.

The reason is often varied. I’ve not been picking my nose or even doing something as productive as blogging. Usually I’m running behind because a patient or two arrived tardy for check-in or I’ve had to return a call to a doctor at the hospital or a family needed more time for an urgent health concern or a patient scheduled an appointment to talk about one thing (say a medication refill) and then wants to talk about three things like starting birth control or their struggle with obesity or a new challenge at school or a rash or because I needed to “double book” a sick infant who needs urgent care. The reasons are unpredictable, clearly, and I hate to make anyone wait, but I also hate to have families leave without comprehensive care. I work my tail off (as do my magical medical assistants) to stay on time, yet inevitably I am set up to fail. It’s an unusual doctor who never runs even a minute behind in a general pediatric practice. I sincerely hate to have people wait for me, as it’s a huge added stress for us all. Starting all visits with an apology makes for a terrible day. So next time you find yourself stuck in some waiting room with your toddler (+/- your 3 other children) and you’re going bananas, know that when your child needs the extra time or attention, they’ll get it, too. And if they never do—lucky you. Read full post »

Preventing Sexual Abuse: Seattle Mama Doc 101


With the Penn State tragedy and recent news out of Syracuse this past week, most parents have thought of, and/or worried about sexual abuse more than once this month. The wretched reality is, we will keep getting reminded about sexual abuse in children because it is so common. Thankfully, we can help our children define, get words for, protect against, and support them in their understanding about how to prevent sexual abuse. You can start this today.

If you’re worried or unsure how to proceed at any moment, it’s always okay to visit the pediatrician or clinician your child sees for support, help, and a check-up.

Open up channels of communication about preventing sexual abuse as early as age 3. Start by defining “good touch” from “bad touch.” Use anatomic terms (vagina or penis) and answer questions your children have. Return to these conversations occassionally, every few months, every single year. Always trust your instincts if something doesn’t feel right. Explore and ask questions if your child expresses concern, confusion, or fear.

Preventing Sexual Abuse

  • Trust your child. Children rarely will lie about sexual abuse.
  • A great overview on preventing sexual abuse including possible signs of sexual abuse (at the end)
  • A hand-out defining sexual abuse, some statistics, and characteristics of abusers composed by perpetrators of child sexual abuse while in recovery. A note on this–I found this upsetting to read but did gain insight from it.
  • HHS information about programs and curriculum for children (and adults) on preventing sexual abuse
Please share tips, strategies, research, or wisdom you have in helping educate parents and children in preventing sexual abuse here:

Plan B Back Behind The Counter

I was disappointed to hear the news that Kathleen Sebelius blocked the FDA’s recommendation to make Plan B available to all girls, over-the-counter (OTC). Plan B is an oral tablet containing hormones (similar to what is in a birth control pill) that when taken within 1 to 3 days of unprotected sex, can prevent an unwanted pregnancy. It is used as a back-up birth control. Primarily, Plan B works to delay ovulation thus making it less likely that a girl could be pregnant. Effectiveness increases the earlier a girl takes the pill after unprotected sex, so we want sexually-active teens to have it on-hand, just in case.

When it comes to Plan B, timing is everything.

Girls 17 and up can get Plan B for about $50 without a prescription. They can walk into any drug store, head back to the pharmacy counter, show an ID and purchase the pill to prevent a pregnancy. Those 16 years-old and under cannot; they must see a health provider to get Plan B. Trouble is, not every girl can see the physician when they want. Many girls at risk for an unwanted pregnancy may not have access to a clinician immediately or within a day or so. Further, girls may be too embarrassed or concerned about judgment to talk with their parent. And that’s where I start to worry; an unintended pregnancy can have significant physical and emotional health consequences.

Let me be very clear: I’m all for girls seeing their pediatrician for health advice. Read full post »

Getting It “Right”: Birthdays In Mommyland

My quarterly crisis is rearing its very ugly head. See, it’s birthday season around here and while the boys’ birthdays overlap with the holiday season, I tend to feel an irrepressible need to reflect. Holidays and birthdays are momentous moments, but also markers of time. Places on the calendar and spaces in my heart for subscribed reflection and perspective gathering.

So it is now, this time of year, where I seem to struggle the most with my choices as a mom and a doctor, a wife and a daughter, a community member and a girl just trying to get it all “right.”

I cry every year on my boys’ birthday. The tears well up both out of joy (wow-wow-wow my little boys love getting older & their joy with the special day grows annually) and also out of sadness. Sadness in my ongoing strife with the question of shifting balances, purpose, goals, and daily mindfulness. Am I working too much, am I missing something, am I as present as I can be? Should I be home more? Should I contribute and write more? Should I be seeing more patients? Can I help more people than I am helping today?

I’m torn. Shred up about what is “right” (for me) and on birth day, I’m nearly emulsified. This is tough stuff. As the years tick by and the acknowledgement of mortality grows as the days seem seep into the ether, I really want to have no regret. Sometimes, like most humans, I do.

Part of the trouble is the words of all the parents around me. They all say the exact same thing. And they have been saying it to me for over 5 years. I know they say it to you, too. The woman at the grocery, the mentor or peer, my good friend, the doctor across the country, the parents in my clinic, my mother, the barista, the man helping me at the parking garage…. They all say the exact same thing when they see my boys:

“It just goes too fast.”

 

Read full post »

How Much Salt Is Okay? Seattle Mama Doc 101


I’m a salt-fiend. I really really love it. I’d choose a pickle over a piece of cake any day. Problem is, I’m realizing my palate for the salt lick out ba

Happy And Thankful

Happy and thankful. The holiday served up a great reminder. Time offline, outside, and away from work is absolutely priceless. We should use all of our vacation time. We should fight fiercely to protect it. Thanksgiving reminded me that I am just so happy and thankful. For the holiday, we traveled to see F & O’s grandparents and the boys had some real deal time with their cousins. We played with a lot of balls (tennis, basket, bocce, foot). Little did I know that having two boys would ensure a deluge of round things.

We went to a high school football game an