Momwithastethoscope's Weblog

September 24, 2009

Loving Pediatric Medicine – the anti-rant

Filed under: Parenthood,pediatrics,positive medicine — momwithastethoscope @ 5:46 pm
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Reason Number 24:  New parents.  My primary hospital is a 120 bed community facility with an active labor and delivery unit.  Approximately 80 families add a new member there each month.  Despite the pushes and pulls of running a growing (outpatient) pediatric practice, I have maintained my hospital privileges to see the newborns and their families.  For most , a new baby is a very happy time, and I thrive on that optimism. 

Especially for first time parents, advice abounds.  From grandparents. From friends. From the medical staff. Even from the stranger ahead in the check-out line in Target.  With more access to information, parents are more well-read than ever.  Despite the amount of information or maybe because of the volumes of it, new parents have lots of questions.  The perinatal period opens a window in the minds of new parents, and they are often hungry for valid opinions.  My role is to coach – go through the pros and cons of a decision – help them test the waters of their new roles – with common sense and objectivity.

My own children have nurtured the coach in me.  They’ve taught me flexibility, and to see that they are people with opinions, too.  They’ve also taught me that realism and common sense.  Prior to my firstborn, I quoted all the statistics about the values of breastfeeding to my new parents.  The evidence was so clearly stacked that I bought a wiz bang breast pump anticipating my new role as working, breastfeeding mother.  That pump never left the box.  Firstborn Will came out with clear intentions that the claustrophobic work of nursing was not for him – he cried and cried every time I tried to latch him. I cried and cried, too, feeling my first taste of “failure” as a pediatrician/mom.  A weak milk supply didn’t help matters, either. 

That experience was the foundation of the spiel I give to new parents.  Each parent has an inner voice or gut feeling that tells them the right way to nurture their child – pay attention to that voice as it is rarely wrong. Watching and guiding parents to find their groove is a very rewarding part of my job.

September 21, 2009

Loving Pediatric Medicine – the anti-rant

Filed under: Office,Parenthood,pediatrics — momwithastethoscope @ 6:51 pm
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Nasal foreign body

Nasal foreign body

Reason Number 21:  foreign bodies

Once I had a patient who had been to several doctors over the period of two weeks.  His mother complained about the odor coming from his green, drippy nose.   Despite medication, the color and smell persisted.   In my office I noted something white in addition to ruby nasal mucosa, and purulent snot.  With a well placed tweezer, I located the white spot and pulled to reveal a sodden wad of foreign body – probably wadded up tissue, but hard to tell after a two week vacation in the nasal passages of a preschooler.  Viola!

Yes, I pick noses for a living – and that activity is personally satisfying.  Identify object.  Locate object.  Pull object out.  Problem solved. 

Not all objects are easily removed.  Play doh melts.  M & Ms melt.  Beads can be a challenge.  Foreign bodies in ears can be difficult, too.  Sometimes, those need to be referred down the street to the ENTs who can suction them out.  (There is a similar hint of glee in my ENT colleagues about foreign bodies.)  Splinters can be difficult.  Glass is a challenge, too. 

Picking pediatric noses is anything but glamorous.  Kids put objects in the darndest places including their nostrils.  However, I would take a whole day of picking noses for the instant gratification it beings me.

September 20, 2009

Loving Pediatric Medicine – the anti-rant

Filed under: Parenthood,pediatrics,positive medicine — momwithastethoscope @ 7:10 am
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google images

google images

Reason Number 20:  Concierge Medicine @ home

On more than one occasion, I have treated my own children.  The lines get a little blurry between when I doctor my children as a mom and when I work on them as a physician.  The afternoon that my then five year old discovered yellow jackets chase you  and stung him 13 times was a mom-treated incident.  Intuitively, I dunked my frightened son in a big tub of lukewarm water and baking soda while I whacked the straggling yellow jackets. 

On another occasion, I had my MD hat on firmly as I watched my youngest struggle with RSV (respiratory syncytial virus).  With his wheezing growing more and more audible from the rotten virus, Harry got more and more still as he worked harder to breathe.  I suspected this fourth night into his illness that we were in for a rough night,  and I borrowed the pulse oximeter from the office to watch his oxygen levels.  He hovered in the low 90% range for most of the night while his chest retracted around his ribcage.  I pulled out my mom care, too, with lots of humidity and pushing him to drink enough electrolyte solution so that he wouldn’t get dehydrated.  The next two nights were equally tough as I watched his oxygen level bounce close to the point where I thought we needed to go to the hospital for oxygen and further treatment. I kept my partners up to date on his progress since we knew he was on the bubble for admission.  Tired and second guessing myself , I noticed a pretty good improvement on the seventh night, and knew we were pulling through. 

Harry’s older brother, Will,  got a taste of mom in MD mode as a vacation at the beach was ending.  In a game of beat-the-clock, my husband and I were trying to get us packed up and checked out when we discovered that young Will had shoved one of my broken earrings up his nose.  Why he chose that moment we’ll never know, but I immediately went into action to avoid an ED visit and still check-out on time.  Will knew I meant business as I came after him with eyebrow tweezers and a headlock.  In retrospect, his cooperation was the key to the success of the earring-ectomy. We pulled away from our beach rental with minutes to spare as I gripped the pearl – a souvenir from the trip that I hadn’t anticipated.

The knack of concierge medicine at home is having second opinions close by.  My husband is an integral part of that equation as are my partners.  Even if I think I know the answer, I lean on this support system to validate my thoughts.  Occasionally I feel silly when I ask for back-up but it’s a small price to pay to do the right thing for my most important patients.

June 22, 2009

Car Chatter

Filed under: car chatter,Parenthood — momwithastethoscope @ 3:45 pm
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“I’m gonna buy a chihuahua when I go to college.” says my 12 going on 22 year old son from the backseat of the car.

“I’m gonna name it ‘Karma’, and every time it poops in the house I’ll say ‘Bad, Karma. Bad, Karma.'”

May 30, 2009

Pistols versus Paintbrushes

Filed under: Parenthood — momwithastethoscope @ 10:55 am
Freeform Painting by Harry

Freeform Painting by Harry

Will & Harry both have a gift for drawing.  This talent must have skipped a generation for me – my mother & son’s grandmother is also a talented artist.  While my mother believes that the ability to put pencil or paintbush to paper can be taught, I am not so certain that this is just hardwired in the DNA of my children.

The artwork of my two son’s reflects their personalities.  Will’s drawing are meticulous, detailed, renderings of cars, Iron Man, tanks.  Harry’s art is more abstract with big splashes of color.  Both seem to enjoy the process of creating, and I hope I can continue to cultivate their talent and interest in art. 

I have competition, though.  Being the XY creatures they are, my sons have a love affair with all things military – especially guns. Great wars take place in and round my yard and neighborhood.  Fellow neighbors ambush my sons with sprays of foam darts.  The carcasses litter the sidewalk.  My pediatric sensibilities limit their choices to Nerf and water guns with an occasional cap gun thrown in the mix.  No BB guns  – my past life as a medical student digging the small spheres out of the leg of a surgery clinic patient quashed that pursuit.  No airsoft. I can be quite the ogre when the subject comes up about the choices I’ve limited. 

Protecting their artistic talents from the testosterone battle fields is my duty as their mom.  Quiet creativity takes a backseat to the default setting of the military channel, and I keep pushing it further to the forefront.  On the surface, this conflict appears to by feminine ideals versus masculine, but that’s not what it is really all about for me.  In truth, I’m trying to perserve gifts and talents that have longevity and legacy far beyond the youthful pursuits of war.

December 23, 2008

5 Ways I know I am Not My Mother at Christmas

Filed under: Food,More about Me,Parenthood,Uncategorized — momwithastethoscope @ 6:25 am
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dough-boy

1. Cookies: My mother made dozens of cookies when I grew up: pecan sandies coated in powdered sugar, gingerbread cutouts, spritz, bourbon balls, fruitcake cookies, “painted cookies” (sugar cookies with glossy egg wash in corresponding colors) just to name a few. What we did with all of these cookies, I really don’t remember. Maybe we gave some away. We ate some for dessert nightly. We left a few for Santa. While I enjoy cooking, and cooking with my sons can be a lot of fun, I just don’t do it much. My mom gave me an appreciation for homemade baked goods, and I love that holiday tradition. But the boys & I don’t need the temptation of baked butter and sugar close by – Pilsbury, Duncan Hines, or my own.
2. Carrying a pager on 12/25/08: I’m on call for my partners and myself this year. The upside is that only the sickest of the sick children’s parents call that day. I’ll make rounds in the morning, and my kids are understanding about my leaving for an hour or two.
3. Stuffing things in bags at the last minute: I believe I have perfected the wrap in tissue and shove in snowman bag much as a quarterback throws a perfect spiral. It’s all in the wrist. My mom’s method is to wrap and then add beautiful ribbons and bows and embellishments. It also requires sitting. My method can be done as I am striding to the car on the way to a recital or party.
4. Looking forward to mother-in-law’s Christmas day because I don’t have to cook (much): My mom is an amazing cook. My family tradition is an English Christmas dinner with roast beef, Yorkshire pudding, parsnips and potatoes, and gravy. It makes my mouth water just to type those words. We lived overseas when I was in grade school, and adopted this tradition. I’ve alluded to my ability to juggle cooking and call – just not able to do it. I’m very grateful to my in-laws that they host the family for a covered dish get together. My husband makes his popular meatballs (another Crockpot winner!)
5. The internet: I shop (thank you, Amazon). I keep up with life, and blog: Where would I be without the ability to find and ship gifts to multiple places? My mother spent hours going from store to store searching for the perfect gift, packing them, and hauling the box to the post office. I do some of that, but the internet has streamlined the process so that I can continue to work full-time (a Pediatrician’s busy season) through the months of November & December.
A year ago, I didn’t know what a blog was let alone had an idea I would be writing on one with such an amazing group of women. Thank you. Mothers in Medicine! Thanks, KC, for giving me a chance to voice my opinion. Happy Holidays to you and your families & I look forward to the New Year!

November 12, 2008

Birdbrain

Filed under: Parenthood — momwithastethoscope @ 5:49 pm
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006 

 

A silent war is waging in our household right now.  On one side are the bird lovers and on the other, the bird phobes or phobe.  Our cockatiel was a gift from a grateful friend after we had helped her with some legal woes involving a sour real estate venture.  No formal meeting ever took place about this gift.  One day, our friend delivered him, cage, food, and all.  It was kind of a gift/favor.  Friend has a decent size aviary and ailing husband.  She was trying to downsize, and we were ok to upsize our pets.  Or so I thought.

The reaction from Husband was not good.  Bird likes to fly.  Husband likes to swat bird out of the sky.  He has Hitchcock type fantasies nightmares about birds.  Bird must have at least 15 lives, and has used about 7 or 8 of them in the past 2 years.  The two of them have their own private battle going.  Bird will fluff his wings and stretch aggressively.  Husband will try to startle bird, and has conversations with him about KFC, Bojangles, and Church’s Fried Chicken. 

Older and Younger sons adore this bird.  They are the first to let him out of the cage in the morning.  They walk him around on their shoulders, and make kissy noises to him.  Bird’s not dumb.  He knows who his friends are, and treats them accordingly.  Bouncing up and down the stairs is okay with him.  Sons’ friends are also social with bird.  A quiet agreement exists between them: if you’re gentle with me, I won’t bite you. I might even sing or cluck.

Lately, Bird has been a bit more vocal.  Maybe it’s all of the talking heads on political shows plumping their own feathers that has Bird saying more.  The result, I feel, is kind of cruel.  Husband banishes Bird to his cage under an old tablecloth to be quiet and still. 

I felt like it was time for a change, and end to the conflict of man and beast.  Being the modern peace keeper that I am, I put an ad on Craig’s List.  Free Bird – cage and all (to loving family who will shower affection and attention on a creature that deserves it.) I got 20+ replies in about 20 hours.  I guess the free part caught someone’s attention since cockatiels go for $120 at our local pet store and can live 20 or more years.  I narrowed the list down to two gracious takers.

Sons are not happy with the new plan for Bird. Despite my best efforts to convince them that Bird would be happier with other feathered friends and SAHM, my boys have resisted relocation efforts.  They lob tears and accusations at me that hurt.  I like Bird, too, but I also want harmony at my house.  There’s no Zen in my den right now, and I need some.  Mediation efforts between phobes and nonphobes will eventually result in some sort of treaty.  Until then, I’ll continue to walk my fine line between them.

 

November 5, 2008

Wrap Rage

Filed under: Parenthood — momwithastethoscope @ 4:16 pm
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One of the 6,500 Wrap Ragers?

One of the 6,500 Wrap Ragers?

My two sons wanted guns as part of their Halloween costumes this year.  I’m not a gun person. General surgery and trauma rotations as a medical student cemented my mindset.  But that’s probably left for a future post. I have some strict rules about what my boys can and cannot do with fake guns.  For the low. low price of $6.99 each, two fake AK-47s were all mine – including the $6.49 worth of cardboard, plastic coated wired, and industrial tape. I guess these measures are necessary to prevent shoplifting, or are they all marketing strategies meant to capture the imaginations of school age boys?

In years past we have needed a kit (screwdriver, scissors, hacksaws, needle nose pliers, and bandaids)  for all holidays involving presents for children and sometimes adults.  As we wrestle with clamshells and cardboard packaging screwed into the backs of trucks and cars, I wonder where all of this material will wind up besides my garbage can.  It seems that retailers are catching on to the “wrap rage” we’re suffering from.  

Amazon gets it – Jeff Bezos, CEO of one of my favorite websites, introduced “Frustration-Free Packaging” this week as part of an initiative to be more environmentally friendly.  According to the Consumer Product Safety Commission, the focus on easier to consume wrappings should reduce the 6,400 emergency department visits arising from opening injuries. (2004 stats).  That gets my safety radar (installed fifteen years ago when I started my career as a pediatrician) focused, and I can imagine the guaging laceration and penetrating wounds as frustrated children try very hard to get to the toy of their choice by any mean possible. 

Amazon is partnering with companies such as Mattel, Microsoft, and Fisher-Price to decrease the amount of time to entry, injuries, and wasteful packaging.  A case in point is the Fisher-Price Imaginext Adventures Pirate Ship:  3.5 square inches of ABS molded styrene, 175.25 square inches of PVC blister (whatever those are), 36.1 square inches of printed folding carton materials, 1,576.5 square inches of printed corrugated package inserts, and 36 inches of plastic coated wire ties.  That one deserves a Consumer Reports Oyster Award.

I understand that some things are safety wrapped and double wrapped for safety purposes.  The latest bottle of Tylenol I opened had a box, a plastic sealed cap and an additional tamper resistant seal over the top of the bottom – not to mention the cotton insert in the bottle before I actually got to the pills.  If I didn’t have a headache before I opened the bottle – the process certainly gave me one – but I understand the safety issues.  And while some of these changes are more amenable to internet shopping where shoplifting isn’t a problem, some retailers are following suit such as Costco’sreplacement of clamshells with a paperboard product called Natralock with a smaller plastic bubble.

So I look forward to seeing fewer wires, screws and plastic clamshells this holiday season.  Also I look forward to a more harmonious holiday morning with less “wrap rage” and more peace on earth.

October 14, 2008

Man Card

Filed under: helloween,lists,man card,Marriage,Parenthood,rules — momwithastethoscope @ 4:32 pm

It is time for the yearly stamping of the Man Card a.k.a Helloween weekend.  This is Husband’s annual beach trip with male counterparts seeking their own Man Card validation.  The rules to this venture are outlined below:

 

Helloween Rules

1.       Thou must discuss the event nonstop for six weeks prior to date – discussions may take place on social websites, e-mail, text, or with uninterested life partner

2.       Thou may not engage in sexual intercourse with life partner in the month of Feb as it may result in conception that would void Helloween for that year

3.       Thou must boast proudly to spouse regarding ability to pack efficiently

4.       Thou must consume large quantities of food that produce large amounts of flatus during the weekend – ie beer and chili

5.       Thou must not shave during weekend or take care of other hygiene related tasks

6.       Thou must carry evidence of bodily harm home after Helloween weekend – bruises, dark circles under the eyes fulfill criteria, partial liver failure also fulfills criteria

7.       Thou must attempt to make Helloween longer each year than a 3 day weekend

8.       Thou must stay in crappiest location away from all other potential vacation destinations (with spouse)

9.       Thou must maintain wireless contact with the outside world at all times during the weekend

10.   Thou may ignore all forms of wireless contact with the outside world during the weekend

11.   Thou must bring your Man Card to be stamped and verified to all Helloween weekends

12.   Thou must live vicariously through single members of Helloween crew

Spouse Rules

1.  Thou must feel free to call or text Helloween spouse with regular (minute to minute if necessary) updates of children’s progress through the weekend

2. Thou shall purchase new pair of expensive shoes as compensation for spouse-less weekend

3.  Thou shall forget how to record or TiVo requested sporting event – College Football, NASCAR, baseball playoff

4.  Thou shall experience one minor house or car related catastrophe during Helloween weekend

5.  Thou shall not show Helloween spouse sympathy when spouse shows up hung-over, bruised, hungry, or tired

6.  Thou shall deposit responsibility of children on spouse as soon as he walks in the door.

7.  Thou shall plan own girls’weekend week preferably in advance of Helloween weekend and preferably out of the country

September 18, 2008

OBTW

Filed under: Food,Office,Parenthood — momwithastethoscope @ 9:49 pm

Today’s news has presented us with two additional reasons to breastfeed:

1.  Melamine – chemical component found in Sanlu brand formula of children in China.   Melamine is used for several things including floor tiles, fire retardant fabrics and fertilizer.  Authorities blame melamine for the kidney stones and kidney failure of the afflicted children including 4 who have died in China.  How melamine tainted formula is unclear – the matter is still under investigation. 

Cans of Formula

Cans of Formula

 

2.  BPA – Back in the news from a new study published this week in the Journal of the American Medical Association.  As a component of baby bottles and plastics labeled as #7, BPA gave parents a reason to pause with previous studies linking it to cardiovascular disease and diabetes. #7 plastics may not necessarily contain BPA – confusing, huh?, as the 7 designation is a catch-all for different plastic compounds.  BPA is also a component in the lining of some cans including the cans of formula from the two major manufacturers:  Mead Johnson and Abbott Nutrition (formerly Ross). Per the Environmental Working Group, BPA can be found in “minute amounts” in the bottoms and lids of the cans of liquid formula. A more recent formula marketing strategy uses plastic bottles (large bottles are labeled 2) and containers, but cans can still be found on grocery store shelves.  Small 2 oz bottles commonly given to newborns in the hospital are #7 but do not contain BPA according to Consumer Relations at both companies.

2 ounce bottles used for newborns

2 ounce bottles used for newborns

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