Seattle Mama Doc

A blog by Dr. Wendy Sue Swanson.

A mom, a pediatrician, and her insights about keeping your kids healthy.

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 »

2 Is The New 1: Rear-Facing Car Seats Until At Least Age 2

rear-facing until age 22 is the new1.

This is kind of like, “brown is the new black.” But different and more important.

Two is the new one. When you’re a toddler. And when you’re at least 20 pounds.

And you’re in the car.

Let me explain. This is important for a number of reasons. One, not a lot of people (even pediatricians) know this yet because new data hasn’t been incorporated into policy statements. And two, it could save lives. Three and four: it could save lives.

Listen up and tell your friends. Scream from the rooftops. Read full post »

Verbatim: Pink Ones, White Ones, Good Ones

PinkWhiteExam room 3. Me at the computer, a 16 year old patient sitting on the exam table. We’re discussing her starting oral contraceptive pills for birth control. After her exam and a lengthy discussion, we talk about the pink ones, the white ones, the row of green ones, the ring, the depo shot, and the patch. I’m reminded of my mentors in pediatric gynecology who taught me that if you choose birth control that a girl is interested in trying (if it is the appropriate dose and safe for her) often her compliance in using it improves and her reports/experiences of side effects lessen. Translation: girls are more likely to take the pill correctly and continue to take it if they are motivated to use it. A dangerous reality when it comes to marketing directed at teens. But a good reality if you’re working to help teens avoid unwanted pregnancies. She has her mind set on the pill. I move on to the choice of what pill she has in mind, if any. I uncover concrete sincerity. One of the best responses to my question yet.

Me: “Is there a particular birth control pill you want to start with?”

My patient: “A really good one.”

Hopes, Dreams, And Predictions

Twenty Ten, Two Thousand Ten. However you say it, we have arrived. Welcome back to school days. The rigor of productivity. We had the tantrum of the century this AM at our house which we’ve decided to include in our new in-home, Swanson special list of “mega-tantrums.” In medicine, mega is inserted into terminology as if to clarify like in, “mega meatus.” Translation: a big meatus. Re-entry to real life is mega-tough stuff. In the hope that we can continue to live out our previous week’s break from the route schedule that is upon us, I’ll hit rewind and go back 3 days. Read full post »

The Juggle: Working And Breastfeeding

ShadowA study in Pediatrics highlighting the importance of breastfeeding and the challenges for working moms was published earlier in 2009. Today, it circulated through a business journal and got some more attention.

I read the study today for the first time. Then I re-read it a number of times. I talk about breastfeeding with moms and parents in clinic on a daily basis. I certainly know the challenges of trying to breastfeed through a transition back to work. I also know how hard it is not to be able to do what you set out to do.

I had my go. With my first son, I saw about 9 lactation consultants in the first week. I am not exaggerating. Me with those women hovering over me trying to help while my little man screamed his head off. The beginnings of motherhood. I breast fed, finger fed, pumped breast milk, finger fed, breast fed, then pumped my way into a sleepless oblivion. Read full post »