Monday, February 28, 2011

Digging Deeper

**In not finding the toy he was looking for, he threw his hands up in the air.**

"Drat!" I thought. Because when I looked next to the patient's lab result, I was hoping to see a yellow triangle that would indicate that something on the labwork was flagged as abnormal. But I saw nothing. And while I generally hope for good news and clean reports, sometimes I am looking for something to explain the situation. I am looking for the answer. And no yellow triangle means no easy answer.

When the symptoms are particularly nebulous, and the question of where to go next is somewhat daunting, it is easy to want to give up. To say, "Well, your blood work looks fine." The end. But, of course, you can't do that.

So, we wait, my patients and I, to see how the problem evolves. We keep digging. We 'monitor symptoms.' I re-examine them. I ask more questions. I ask specialists for their opinions. We re-check the blood, looking for other possibilities.

And usually, one of two things happens:

1)The problem resolves itself. Tincture of time, or change of situation, or the body just healing itself.

2)Our further investigation yields the result. And the harder it was to find, the more satisfying it is to fix. Or to understand. Or what-have-you.

And I think the same type of thing happens in life outside the doctor's office. Sometimes there is a problem we can't quite put our finger on, but something feels off: a relationship, a child, or a mood. And upon our initial scan of possible root causes, nothing obvious comes up.

It is tempting, I think, to say, 'well, whatever. I guess we just aren't clicking.' Or, 'I guess I'm just feeling off.' Or, 'I guess my kid is just in a phase.' But I've learned that it is worth it to press on in our search to understand why we are feeling how we are, or why we are relating to others the way we are, so we can heal those relationships and heal those parts of ourselves.

Because even just the exercise of looking for solutions, shows that you think the cause is worthy of your time and concern. And just as a patient appreciates when I don't brush them off when their issues have become difficult to understand, those we love do too.

Sometimes, I think, just taking that time to understand is what opens up the way for things to heal themselves. But other times we ultimately stumbles across that yellow triangle, and with a sigh of relief and satisfaction, set about fixing the problem.

*If you are getting frustrated in your quest for answers, try a little pit-stop for Mickey Mouse Pancakes. They do wonders in our household.**

P.S. I love this talk on healing given by a former dean of nursing.

Friday, February 25, 2011

This and That

**This smile is one I rarely see in front of the camera from Tiny. Normally she srunches her eyes nearly closed. Apparently it takes my fabulous BFF, Nancy, to bring it out in her. Which means, clearly, that Nancy will have to be in all of our family photos from now on. Too bad she takes most of them. :)


**That concert was amazing. Seriously, if you haven't heard of "The Avett Brother", check them out. They move my soul. Rockstar laughs when I say this, but there is no irony in my voice!

**Does this phase look familiar to anyone else? Experiments in gravity!!




**This article certainly warrants consideration. I've long tried to avoid holding my cell phone close to my head, despite no consensus in the research about whether this is dangerous. This study quantified that something is happening, even if we don't know yet quite what. Part of why we keep our landline is so that we don't always have to use our cell phones for longer conversations at home. Until we know for sure what we're dealing with, it doesn't hurt to take precautions.

**That Rockstar is such a good breakfast-maker. If we have extra bread from dinner (like the whole wheat sourdough from last night), Rockstar likes to turn it into french toast instead of letting it turn to a too-hard-to-use waste.


**This one friend of mine gave me a great tip. She puts whipped cream on her kids' french toast or pancakes instead of syrup. It has way less sugar than syrup and seems just as exciting. We prefer to layer peanut butter, applesauce, and whipped cream.


**That kind of exuberance is what I want to aim for next week. And, you know, just in general.


**This face melts me into a puddle. And if you are wondering why most of my pictures of Lil' Drummer take place in his highchair, it might be because that's the only time he sits still long enough for me to snap a decent one. :)


Happy Weekend!

Wednesday, February 23, 2011

Decisions, Decisions

"Please, Mom?"

Every mom has to make choices about how she uses her time. Because I work as a physician part-time, I have to give some of my time to work. So I try to be very intentional about giving my non-work time to my kiddos. I try not to multi-task. That generally works out quite well. But on the day where I only work in the afternoon, it can get a little dicey. The specter of the afternoon's work is always in the background, and while I usually ignore it until it's time to go-be-a-doctor, that can be hard.

I like to keep a handle on my 'tasks' (our version of an inbox...which gets filled with lab results, consult letters, prescription requests and patient messages) because I'm a little OCD that way. So this morning after our breakfast routine was through, while Lil Drummer was down for a nap, and Tiny Dancer was playing downstairs, I surveyed my time. I wanted to play with Tiny for a while, then take her on a 'mommy-daughter' date. Because the babysitter can stay with Lil Drummer while he sleeps, this is great little time for us. I love that as long as a trip to the library or lunch out is tacked on the end, she doesn't mind if our dates include Target, Trader Joe's or other errands. Today I was aiming for Target and TJ's as part of our date.

But then I logged onto the our work system. "Just really quick!" I thought, "I'll complete a few tasks, and then we'll head out." I don't like showing up to work and finding that my cup runneth over with messages.

And what's that law Murphy wrote? Cause there were a lot of tasks to be dealt with. So I did. Time kept ticking away, and E was playing on the floor next to me. 'Just a few more.' Then we were down to enough time for TJ's but no Target. 'Just a few more.' And then it was down to a quick stop at the library. 'Just a few more.' And then it was, 'My tasks are finally done, but I should really leave for work in 25 minutes.' Which doesn't leave room for much of anything at all.

I closed up my computer and she looked up at me. "Are we ready for our mommy-daughter date now?" Oh, the look of anticipation on her face!

In that moment, I made up my mind. "Yes, we're ready. C'mon, let's get in the car!"

"Can we got to the Library, then Target, then Trader Joes?"

"Um, I think we just have time for lunch. Is that okay?"

She smiled. "Yeah, that's okay."

We dashed to a nearby Starbucks where we split a panini and a bagel with cream cheese. She told me about her Primary lessons last Sunday, observed our fellow cafe-goers, and insisted on spreading the cream cheese all by herself.

When my clock read only a minute or two until I had to leave for work, I handed her the last bit of her bagel to carry, and we walked hand in hand back to the car. I dropped her off at home, where she gave me a kiss and told me to 'be safe' on the way to work.

I made it on time. By the skin of my teeth.

And as I drove, I thought about how there will never be enough time. With more than one kid, or with a job and a kid, or with any amount of demands on your time, it will feel like there is never the ability to give everyone their due.

But maybe I need to re-think what is enough.

Because for today, a stolen moment at a starbucks table, making up silly stories over a bagel and cream cheese, seemed like enough time.

Like just the right amount of time.

Tuesday, February 22, 2011

Office Talk: Over-the-Counter pain medicines

Question: So, I know I'm not supposed to take too much Tylenol, right? It's gonna kill my kidneys.

This is an area in which I see a lot of confusion. Many patients have a vague sense that Tylenol and Motrin can cause problems, but more than half the time, they are mixing up which is which. Since taking these medicines unsafely or indiscriminately can have serious consequences, and since the fact that they are OTC can lull people into a false sense of security, I figured I'd clear this up.

1)Tylenol (a.k.a. Acetaminophen)


Tylenol is a great medicine, and very safe when used properly. It can reduce fever and pain. It's safe in babies and pregnant women. It isn't the strongest pain reliever in the world, but it works. What makes Tylenol so great is that if taken in proper doses (no more than 4 grams in a 24 hour period), it's something that can be taken daily for a long time (years even...which some of my patients with arthritis do). It doesn't have a cumulative damaging effect on the liver over time, assuming you have a normal, functioning liver. The danger? It doesn't take much extra Tylenol to cause a serious overdose. It seems like such a harmless drug, that some people figure popping a few extra at at time won't hurt. But if you look at the graphs of how easily you can get into the danger zone, there isn't a lot of room for error. So stick to the doses as prescribed on the bottle. If you need more pain relief? Try a different type of drug. And remember that 'acetaminophen' is a common ingredient in most cold/cough formulations and even narcotic painkillers. So check for that, and don't double up!

2)Ibuprofen (Which belongs to the NSAID class of medicines. This includes motrin, advil, aleve, naprosyn).


Ibuprofen can also reduce pain and fever. It does have some anti-inflammatory properties, though we as physicians tend to overstate the anti-inflammatory effects. It's anti-inflammatory effects can be quite useful for sore throats, period cramps, and acute tendonitis/bursitis. For many people, the pain relief they get from NSAIDS is more potent than that which they get from Tylenol. I know that's how I feel (which is why I miss it so much when I'm pregnant!) And unlike Tylenol, it's probably fine to take a few extra than what it says to on the bottle. In fact, we frequently prescribe such doses for severe pain. And it's a lot harder to overdose with these medicines (thought it is possible). The real problem is when people start taking them on a regular basis over weeks, months, or years. That's when you run into erosion of the stomach lining (and possible bleeding ulcers), kidney dysfunction (which thereby increases blood pressure), and increased risk of bleeding in general. I actually had a patient while I was a resident who was on dialysis from prolonged, heavy use of NSAIDS. So, they are great short-term meds, but poor long-term ones.

So, to recap:
Tylenol: good for long-term use if used in proper doses. Affects the liver.
Motrin: okay to increase the dose in the short-term. Hard on the stomach and kidneys long-term.

Consider yourself informed! :)

Monday, February 21, 2011

Shhhh...It's a Secret


**Weekend Happenings: Waffles and Sticker Books. Rockstar and Tiny Dancer like to make breakfast together. I like to benefit from the tradition.**

Do you remember that book 'The Secret'? I heard about it on the radio, back when Oprah was going to discuss it on her show. From what I understand, the basic premise is that you send out a wish into the Universe for something you want(a soulmate, a million dollars), and somehow by desiring it, wishing for it, picturing it, it will come to you.

As 'power of positive thinking' as I am, this seems rather hocus pocus-ey. However. I have my own medical version of 'The Secret' going. It goes something like this:

Randomly one day while I was a resident, it occurred to me that I hadn't done an anoscopy in a while. And if you are green with envy at the thought that I get to do anoscopies, I totally understand. But I'm funny like that, and not much grosses me out anymore.

So when within a day or two of thinking that, a patient with hemorrhoids was on my schedule, and needed an anoscopy, I thought, "Huh. How funny...I was just thinking about that!"

And then it happened again and again and again.

"Gee, I haven't had to remove a toenail in a while."
"Hmm...I haven't had to admit someone to the hospital from the office recently."

Poof! A toenail removal. Poof! A hospital admission. etc., etc.,

So last week, as I was sitting there in my office, just letting my mind wander, there came one of those thoughts, "Huh...I haven't had to do stitches in a while."

I don't have to tell you where this is going.

I was working the Saturday morning "acute care" clinic this last weekend. And when I saw on the schedule that someone was coming in with a cut finger, possibly requiring stitches, I knew which doctor(me) would end up getting to see that patient. When I say 'getting to see', I mean that. My colleagues and I all enjoy procedures.

Sure enough, I was the next doc up for a patient when the injured hand was ready to be seen.

I took a look at the cut and said, "Yup, we're going to need to stitch this."

I gathered my needle and thread, and set about closing up the wound. (Incidentally, as I was tying my knots, I thought, 'Who says I'm not crafty?!?' A different medium, perhaps...)

The difference between me and 'The Secret', I suppose, is the fact that I'm not being intentional about it. So maybe I should change that? Maybe when I'm craving the chance to do a biopsy, an IUD placement, or a certain medical work-up, I should send that wish that out into the universe and see what ends up on my schedule.

On second thought, I'd probably be better served trying this on my kiddos. i.e., "I'm visualizing a toddler who always shares with her baby brother." "I'm wishing for a baby who never wakes up teething."

Ha! I doubt it works if you can't even do it with a straight face. Cause I don't think I can. "The Secret: Medical Version" notwithstanding. :)

**What about you ever have any 'The Secret' moments?**

Friday, February 18, 2011

This and That

*This is what the inside of my brain feels like for a few months after I have a baby:


It takes a while to clear out spaces amongst all the thoughts and between all the fatigue that come swirling in with a new person (as it obviously takes me a while to surface from the hurricane of the morning routine and breakfast dishes). So when I went back to work when Lil' Drummer was 3 months old, you can understand that this was still a work in progress. Come to think of it, it still is. But I need an excuse for the following anecdote, as you will see.

A 3rd year medical student was shadowing me one morning. And running on a little sleep, I kept forgetting to grab my stethoscope off the nurses station before I went into a room. So as we'd go to examine a patient, I'd exclaim to the medical student, "Oh! I keep forgetting my stethoscope. Can I borrow yours?" "Sure," he'd say, and hand it over. This went on for 2 or 3 patient's. Finally, while we were standing outside of a room, he said to me, "You know, you're welcome to keep using my stethoscope, but yours is right there. In your pocket."

I looked down and sure enough, the stethoscope that I kept claiming not have, was sitting right there.

"Oh, right!" I said. And trying not to blush, I also decided not to think of what my patient's thought of my borrowing another stethoscope when mine was so obviously available. Maybe they thought it was some other piece of medical equipment sticking out of my pocket? One can only hope.

*That Lil' Drummer has required a lot of this today:Photobucket

His teeth are bugging him and causing us to have a few nighttime interruptions the last few nights. But you know what? There's still no one I'd rather share a few cheerios with:



*This Valentine's Day Banner (or something akin to a banner...Tiny Dancer and I lost steam when it came to connecting our paper our hearts) makes my mantle so cheery. I'd like those hearts and those Tulips up for months. Can we pretend it's still 'Valentine's Day Season'?



*That party was rockin'. Too bad no one was invited except for me. The chef is divine--she serves innovative combinations like raw onion and green apple. Maple syrup is the key ingredient in everything.

*This article is a wake-up call for parents. It's really scary to hear how many crib related accidents and deaths there are. I know we'll be checking ours to make sure it's safe, and lowering it in an attempt keep Lil' Drummer inside. This little dude is already scaling his baby gates. And it gives me heartburn. :)

*Happy Weekend!*

Thursday, February 17, 2011

Office Talk: Just a Virus!

Question:Is my upper respiratory infection really ‘just a virus’?

Answer: Probably.

Oh, the war on the unnecessary use of antibiotics. I get exhausted just thinking about it. And if I said everything I wanted to on the subject, this post would take all day. But seeing as I’m working this afternoon, where I’ll probably need to talk a few people off of the antibiotic ledge, I don’t have the luxury of doing that. But I do want to touch on a few myths while we’re still in the midst of cold/flu season. Most people have accepted that antibiotics won't treat the common cold. But beyond that? Skipping the antibiotics can still be a hard sell.

1)If my cold turns into a sinus infection, I definitely need antibiotics: Not so! One recent study estimated that only 2% of acute sinusitis episodes are caused by a bacteria. Most often, the same viruses that can cause the common cold, invade the sinuses. How can you be rid of viral sinus infections? Saline nasal rinse (the unsung hero of the nose), Decongestants (Claritin-D, Zyrtec-D or plain Sudafed--which is the ‘–D’ in other products), Nasal steroid sprays (like flonase, which is often used for allergies) and time. And when I mention saline nasal rinse, I’m talking about the RINSE, not the mist. It has to go up one side and out the other. Sound fun? It’s a party. A party that works.

I don’t want to downplay that there are occasionally circumstances where sinus infections can get serious and cause complications as the infection spreads. Or that there are times you would use antibiotics. If you have that cluster of symptoms (facial pressure, headache, upper teeth pain, ear pain and congestion) that so often heralds sinusitis, here are a few of the points of history we use to determine if you might need antibiotics:
-duration of symptoms for greater than two weeks
-initial improvement, followed be re-worsening
-Purulent nasal discharge (no, this does not mean green drainage. Viruses are just as capable of producing green drainage. I’m talking pus-like drainage.)
-True fevers over 100.4
-One-sided symptoms (one sinus is more painful or tender than the rest)
-You are getting married in a few days. Kidding! Sort of. We joke that the bride always gets antibiotics.

If you are unsure, or are worried that things are getting worse, always check with your doctor.

2)If my cold turns into bronchitis, I definitely need antibiotics: Wrong again! Most of these infections are viral. But most people don’t realize that viral bronchitis lasts three weeks. Three whole weeks. This is a long time to be coughing, and most people get fed up after 5 or 6 days and figure it must be time for antibiotics. There is a supplement called pelargonium (found in a product called Umcka and sold at whole foods) that has actually been shown to shorten the duration of viral infections like bronchitis. I recommend that to most of my patients. It’s sort of like Zinc for the common cold. One of the few things that actually has some efficacy.

There are a few exceptions to the viral rule: A)Pertussis, or whooping cough, which is making a resurgence in communities. And, oh, what a nasty bug it is. Made nastier by the fact that it acts like a run of the mill cold during the first few days that are the only time treatment will reduce symptom duration. B)Mycoplasma (a.k.a walking pneumonia) and Chlamydia Pneumonia(a.k.a. not the STD) Infections. These too can seem like a cold in the early stages, which also makes them harder to recognize and treat early. Always talk to your doctor if you are feeling short of breath, are coughing to the point of throwing up (which can be indicative of pertussis) or just aren’t sure if you need to be concerned.

Also, if a fever is present, this may actually indicate flu or pneumonia, because bronchitis doesn’t usually cause a fever.

3)Antibiotics would help me, but you are withholding them to protect communities against bacterial resistance.

This is another one I see a lot. I get the feeling that people think we’re holding back effective treatment so that we don’t hasten bacteria’s goal of outpacing our research to kill them. I can see how this would breed resentment. But the truth is that our primary interest is our patient. We generally don't prescribe them because we know that in the majority of cases, they don't work better than placebo. They don't kill viruses. Additionally, there are plenty of possible harms for the patient as well. Among them: diarrhea (sometimes a potentially dangerous variant called C. Diff that has moved from the hospital to the community), allergic reactions, and a wiping out of your good gut flora. I know that I avoid them for me and my kids unless it’s really necessary.

I am very grateful that we live in an era where we have antibiotics. There are times when antibiotics are necessary. And life-saving. And so I don’t mind a bit if people come in when they feel sick to find out if this might be one of those cases. In fact, I think that’s totally appropriate. Frequently I have other prescriptions to help alleviate their symptoms while the body fights the infections. But if your doctor advises that you don’t need antibiotics for your upper respiratory infection, or asks you to wait a few days before taking antibiotics, at least remember that the odds are in favor of their being right and that they probably have your best interests at heart. And that since it is by far the easier thing to just quickly hand out the drugs, a 'no antibiotic' discussion that takes twice as long may actually indicates that your doctor cares more about your health!

**So, what about you? Do you feel annoyed when your doctor tells you that you don't need antibiotics?**

Tuesday, February 15, 2011

Cutting the Curls

*The Curls circa 2009*

My mom is not a sentimental person. At all. She gave away most of my childhood dolls and dance costumes without so much as a backward glance, sent most of my old papers into the recycling bin, and didn’t cry when dropping me off at college (though I know she missed me desperately!)

So you will understand that when she does hold onto something, you take note.

As a toddler, I had ringlets. Beautiful, big, bouncy golden-brown ringlets. And for as long as I can remember, they have been sitting in an envelope in my baby book. So, I guess they meant a lot to her. Even after they were shorn, she couldn’t part with them.

Which made me feel better about my resistance to the idea of cutting Tiny Dancer’s curls. You should’ve seen her adorable curls. Oh, they were adorable. The summer humidity which wreaks havoc on my own hair, turned hers into a halo of bouncy ringlets.

But with the advent of fall and the exit of the sticky heat, her hair fell straight along with the leaves. Long and increasingly scraggly. The ringlets were still hidden under the straight pieces. Just enough to tease me. I knew if I cut them, they would not come back. If we could just make it until the return of the humidity, I thought, I could see those beautiful curls one more time! But two factors conspired against me:

1)She twirls her hair just like I have since I was a baby. Twirls it into fine, tiny knots that take an eternity (and a Beauty and the Beast showing) to comb out.

2)Her hair started growing like wildfire.

The knots were so hard to get out, and the hair so wild, I ended up putting it into a ponytail or a bun most of the time. But who cares that her hair hadn’t looked angelic, let alone cute, in months. I could not.let.go. My baby girl’s curls! I am the opposite of my mother in this respect. I breathe wistfulness and I daily feel the ache of moments I’ll never have again.

So the curls remained.

Through gentle hints from my mother-in-law, my good friends, my sister, and the mothers at her ballet class, I remained firm.

We will wait until summer.

The knots, though. They grew worse. And on Saturday I told her we weren’t moving from the TV until I could take a fine tooth combed through her entire mane. It took a while. I made Rockstar promise if anything ever happened to me, he would do this weekly. I’m not sure anyone else would have the patience.

And as I stared at her wet hair, nearly touching her hip bones, I heard that voice inside of me:

“It’s time to let go.”

And so before I could think twice, and craving the bouncy, healthy look I knew was just a few snips away, I grabbed the scissors.

Snip, snip.

It was good that her hair was wet. I could hardly tell how much of the curl I was cutting.

Snip, snip.

I layered the front a little and shaped it a little in the back.

Snip, snip.

We’re okay. We’re doing this.

‘What are you doing, mommy?” she asked while watching, “Be Our Guest.”

“I’m cutting your hair, baby. It’s going to look really pretty.”

“Okay.” Her eyes hardly left the television. So unruffled by the cataclysmic change going on around her.

And then there they were: a pile of brown curls, unceremoniously sitting on my coffee table.

I gathered them up, and stuffed them into a white envelope. “Tiny Dancer’s Curls. February 2011.” I wrote. I’ll keep them just like my mom did.

She and I walked upstairs and I blow dried her hair. It was swingy and adorable. She smiled an enormous smile as she looked at her reflection. I put in a new bow and smiled at my little cutie. It felt good.

But moments later, that nostalgia would creep up on me.

“I want to cry. She’s growing up! The symbol of her babyhood is gone.”

Then a few minutes later:

“It’s okay! She looks lovely. It was time.”

The ping and the ponging of emotions that comes as we face the inevitable march of time and bittersweet milestones.

But as the hours and days have passed since the cut, I feel myself pinging less and ponging more. Which is to say, I feel happy as I watch her gladly swinging around her now shoulder length hair.

And it looks good. Really, really good. A million sincere compliments from friends and family reinforce this.

I am reminded that whenever we let go, there is always something good on the other side.

I am reminded that I will fight this battle over and over in my tenure of mother. And that the right choice is always to let go. To bravely accept that things are changing and that it’s okay. That it’s useless to hold on to knots and scraggly strands in an effort to slow down the passage of time.

So much changes. And that can be hard. But I know that just like the girl without the curls is still my precious daughter, the most important things will always stay the same.

*The Finished Product*

Monday, February 14, 2011

From the Headlines

Here are a few interesting health related articles that made the news this week:

1)Narcolepsy and H1N1:

I mostly find this interesting because it underscores how little we still know about an individual's genetic makeup. We don't know who's going to have the (very odd) vaccine reaction or the medicine side effect. And really, wouldn't that be the next frontier? To know these things before we prescribe and administer meds? I had a teenage girl tell me she wouldn't take birth control pills unless I could tell her which one wouldn't make her gain weight. And I said, "Oh darlin', if I could predict that, I probably wouldn't be sitting here right now." Did I really call her darlin'? Or do I remember all my anecdotes with a southern twang? Hmmmm... Anyway, she should ask me that question again in 20 years, because maybe by then we'll be able to do just that.

2)Speaking of Nutrition:

Yikes! The researchers found that the diet of a 3 year old is paramount. And even if the diet was changed when they got older, the IQ difference stuck to those who'd had lousy diets as toddlers. As if we didn't have enough mommy guilt! I think Tiny
Dancer eats a pretty good diet overall, but you know, she's a toddler. And of course this article had to come out during girl scout cookie season. ;) You know what kills me? Lil Drummer (at 9 months) will eat pureed spinach, broccoli, sweet potatoes, bananas, apples..and even rutabegas! Anything, basically. It's all baby food to him. So, why oh why does this have to change?
Why do kids so effortlessly age out of such accepting palates? My friend, Sunny, is trying more of the 'deceptively delicious' route, which seems like a good idea. Anyone have experience with this?

3)Dangerous Diet Sodas:

But, really people, do we need a study to tell us that diet sodas probably aren't good for us? I guess the question is simply how bad. No, it's not a perfect study. Nor was the one that came out last year possibly linking heavy intake to pancreatic cancer. But when you start to see several studies pointing to possible bad outcomes, you start to take notice. It causes me to wonder what's coming down the pipeline. But the main reason I like this article, is that I like to see these industries get all hopping mad when science like this comes out. They point out every flaw in the study, they say it overreaches in its conclusions, etc., They can't STAND to think that the bad press might affect their bottom line. But since I don't really trust the food industry to have my best interests at heart, I sort of love that this information can be out there for people to read and analyze for themselves.

Oh...and Happy Valentine's Day! I know I'll be claiming temporary amnesia from aforementioned nutritional advice, and eating lots of chocolate! (And, one could argue that maybe some chocolate is part of good nutrition anyway!) MUAH! :)

Friday, February 11, 2011

To Antler or Not To Antler

She was a peppy, middle-aged blonde woman who spoke mostly in buzz words, and was there to teach our practice how to take ‘customer service’ to the next level. And even though such seminars can’t help but take a turn towards cheesy street (“we’re creating Magic Moments for patients!”), I still love them. I think it’s the same part of me that likes QVC and Infomercials.

But when she started taking about professionalism, she said something that made me go, ‘huh’? In discussing how we need to be professional in our presentation, she mentioned that she’d seen a car in the hospital parking lot that had reindeer antlers affixed on the sides of the car. Seeing as it was Christmas season, I didn’t think this was particularly odd.

“Which is fine,” she said, “but if I saw that my doctor was riding in that car, I might start to know...” And her voice trailed off.

I was left to think, “No, I don’t know. What do you wonder? Where else is my doctor wearing reindeer antlers?”

I wished I’d taken the time to have her clarify. “So, you’re saying reindeer antlers is to a car as what is to a doctor?” Inappropriate levity? I’m not sure what she was getting at.

Then I started thinking that it was a good thing she hadn't been at our office a few weeks prior. There was this time when I was having a terrible, horrible, no good, very bad hair day. Post-partum hair woes? Don’t get me started. So as I rushed around in the morning, trying to look put together and make it out the door on time, I knew I needed help. My outside-work accessory collection leans toward whimsical. But I’m conscious of what I wear here and what I where there.

As I surveyed my headband collection, though, the one that would cover the most fly-away surface area was a black & white number with a flower/bow on top. Not a super showy flower, but you know…a touch of whimsy. And as I grabbed it and put it on my head, I thought, “to heck with it! My patient’s won’t care if I have a bow in my hair.”

But sitting in my customer service meeting, I had to re-think that. Surely someone who takes exception to antlers on a doctor's car might think similarly of a bow on a doctor's head!

And then a few weeks later, while shopping for the residents’ Christmas presents with fellow female faculty members, one of them mentioned that a resident had seen such headband and cited me as her inspiration to wear more feminine hair accessories at work. Great. “I take no responsibility for anyone else’s fashion decisions,” I laughed. “Besides, it was just a bad hair day.”

Was I leading a poor, unsuspecting resident down the road to doctor fashion faux paus? Away from professionalism? Upon further consideration, I think not!

I understand the basic principles of professionalism and of course I endorse modesty, respect and avoidance of extreme clothing in the workplace. But when I walk into a room I like to think that whatever headgear I have on, or whatever I choose to put on my car, my patients know that I’m serious about my doctoring. That the way I carry myself, the questions I ask, the way I listen, and the advice I give are the things that determine a patient’s assessment of my doctoring skill. And I hope that my patient's know that I always take them seriously, even if I don't always take myself so seriously. Meaning, not so serious as to be opposed to a bow in my hair or flowers on my ears. Or, the occasional sassy pair of shoes.

So if I had my comment card to fill out again, I might politely suggest a different example for her professionalism lecture. Thigh-high boots or tie-dyed shirts perhaps?

But antlers on a car (not even a head!) as a cause for concern? Come on now, doctors should be allowed to have a little fun.

**I’d love to hear your thoughts...if you’d seen your doctor in that festive car, would you have high tailed it outta there?**

Tuesday, February 8, 2011

Office Talk: Multivitamins

**I'm going to include posts where I'll answer a question that I frequently get asked by my patient's. If you have any questions you'd like to see answered, comment or send me an email. I can't guarantee they'll get answered right away, but I'll keep them in mind. :)**

Question: Should I be taking a multivitamin?

When people admit to me that they aren't taking a multivitamin, they have a look of guilt that is probably similar to the look on my face when I admit to my denist that I don't floss as religiously as I should. But while my dentist always (appropriately) reinforces my guilt upon such a confession, this is one area where I can let people off the hook.

I don't care if you take a multivitamin. Ha!

But. There is a caveat.

I don't care if you take a multivitamin as long as you are doing the more important thing: trying to get the nutrients through a diet rich in fruits, vegetables and whole grains.

It's funny that we're all on the multivitamin bandwagon. Did you know that there's no real evidence that taking a multivitamin does anything important for you at all? Which is not to say that we don't have good reason to recommend certain supplements: Folic acid is critical for pregnant women. Vitamin D can prevent osteoporosis (and possibly a whole host of other things...jury is still out). Vitamin B2 might prevent migraines in high doses. Fish oils can reduce cholesterol and may promote healthy brain development in babies. There are others that I believe strongly in, but that is a post for another day.

This is about most of our nutrients for the day being wrapped up in a convenient little tablet. Easy? Certainly. Efficacious? I'm not convinced.

We all know that the national recommendations are for 5 servings of fruits/veggies daily. I think I've talked to one patient in the last few weeks who is even coming close to that guideline. Some of them ARE taking a multivitamin. And I think it's giving them a false sense of security.

We know nutrition works (heck, Johns Hopkins recently published a report about how we need to get back to a focus on the power of nutrition in health). Replacing something central to our health with an untested substitute, seems less than an ideal proposition.

I believe we'd all do a lot better by our bodies if we focused on getting our nutrients through our diet. A pill can't reproduce the fiber, the anti-oxidants, the minerals, the absorptive process of whole food.

I will be the first to say that my diet is NOT perfect. But I really try to keep up with the fresh foods. Here's what I aim for and what I recommend to patients:

1)Eat a piece of fruit with breakfast. A banana or berries on your cereal, an orange, whatever. This comes naturally to a lot of people.

2)Eat 2-3 servings of fruit and veggies during your day. This does NOT come naturally to a lot of people. But it can be so simple. Maybe pack a bag of baby carrots, a small apple and a pear. Or a small serving of sunsweet prunes. Or a clementine. You get it. :) If you bring them (or keep them in your fridge), you'll snack on them. If you have a Trader Joes by you, buy their bags of organic apples or pears. They are super well-priced, well-sized, and easy to stock up on. If you're a salad person at lunch, all the better!

3)Eat a vegetable with dinner. Again, this usually comes pretty easily to people. If you don't like to get creative with vegetables, stock your freezer with some peas or green beans or roasted corn. They are SO easy to defrost. And I'm all about easy. Rockstar likes to buy unusual vegetables and put them in our fridge. When I'm cooking, I mostly avoid them. He, on the other hand, knows that his drive to let nothing go unused is strong. So having it there motivates him to find recipes that revolve around them, and then--wammo!--more vegetables.

4)Ever get munchy while watching 'The Office'? Me too. I grab another apple. Now, I might wash it down with a small(ish) handful of guittard chocolate chips, but by golly, I ate my apple! And Heavens to Betsy, if I do that--I'm now at SIX servings/day. Now if that's not overachieving, I don't know what is.

5)Switch white for whole wheat. I think we all mostly know this by now, but the nutritional superiority of whole wheat over white is vast. Switching to whole wheat pasta can add nutritional benefit to a meal that otherwise has next to none! I still reserve my right to flour tortillas, though. Just sayin'.

Life is busy, and sometimes it's hard to focus on things like 5 servings of fruits and vegetables when we're just trying to get ONE serving into the mouth of a stubborn toddler. But I believe that it matters. That it really does add up to something in the longterm. My mom always told me: if you don't make deposits in your 'health bank account' as you go, when you someday try to withdraw, you're going to come up short.

Amen, sister. Or, you know, Mother.

So, here's to getting Fresh! (sorry...I couldn't resist).

*Feel free to share any tips you have on working fresh foods or whole grains into your diet!*

Sunday, February 6, 2011

On Doctors Running Behind

It was the third time she mentioned that she’d ‘been under a lot of stress’ that I finally realized that maybe I needed to take notice.

I mean, people frequently offhandedly mention that, you know, ‘I’m under a lot of stress.’

And Mona*, always a chipper and well put together woman in her 70’s, was much the same. “Well, the symptoms did start when I was under a lot of stress.” Etc., etc., etc.,

I’ve known her for a few years, and didn’t initially pick up on the fact that anything was off. She had kindly inquired about Lil Drummer and congratulated me on his arrival. We had talked about the Holidays. We had discussed her medical conditions.

But then on the third reference to this vague ‘stress’, I stopped her.

“Is everything okay? Is something going on?”

In the millisecond that followed, her carefully composed, cheerful exterior melted into wracking sobs.

“Dr. *, my sister died on New Years.”

I grabbed some tissues for her and moved my chair to sit next to hers. I should’ve grabbed one for myself, because my eyes were tearing up too. The weight of her grief veiled the room—my heart included. Hand resting on her knee, I asked her a few questions, and then mainly let her talk.

She detailed how things had unfolded. Her regrets. Her sadness. Her desperate wish that she’d had the foresight to know how near the end was.

And knowing I was powerless to heal her grief, but hopeful that at least I could be a safe space for her to share it, I listened. Sometimes reassuring. Mostly, just listening.

After she’d shared the story, we re-visited some of her medical concerns and agreed to check-in soon.

As she stood up to go she said, “I feel like I should apologize to the other patients who are waiting for you. But thank you for taking the time.”

And she was right: there were two patients waiting in rooms. Both who ended up waiting about 45 minutes to see me after their appointment times. Both who were so gracious about it. I was grateful for that.

There are a lot of reasons why doctors run behind and it can be hard on everyone: sometimes patients come late. The system demands we see more patients/session than is probably a good idea in many cases. Some people have more concerns than can fit in a 15 minute visit, and understandably don’t want to come back and back again to discuss them all. Sometimes someone is just really sick. And most often, someone just needs you to hear them. To hear about their grief and their triumphs, their divorces and their babies. Their lost jobs and their lost opportunities. Their good days and their bad ones. Because as any good doctor will tell you, these stories are woven into the whole picture, and failing to understand them impairs a doctor’s ability to fully heal.

But stories take time. Time, time, time.

So, next time you are stuck in a waiting room, frustrated at the delay, maybe this story will come to mind. Maybe you’ll remember Mona, and that when you offer up patience in such a situation, you are paying it forward. Because there may come a day when you are sitting on an exam table, emotions swirling just under the surface, hoping someone will take the time to ask and to listen.

And I hope that they do.