Office Talk: Benadryl on the Airplane

Question: Can I give my child some Benadryl to her sleep on our upcoming airplane trip?

Answer: Speaking of kids and airplane travel, many parents ask me about whether they should give their child Benadryl before a flight. As a doctor, there isn’t a whole lot of evidence upon which to base this recommendation. Research in the pediatric population is pretty lacking. Anecdotally, I definitely have parents who tell me it works for them. I also have parents who say that it doesn’t. Personally, I don’t have strong feelings about it. My sister tried it with her firstborn, and her son was one of those kids who actually gets wired on Benadryl. I was on that flight. Let me tell you, it was fun. Maybe that’s why I’ve never tried it with my own littles.

Or it might be because I’ve read the one good study that does look at a similar situation. The researchers studied whether using Benadryl at night would improve infant sleep habits or improve parental satisfaction with infant sleep (and can I just say, this strikes me as the most important endpoint to look at. :)) Parents didn’t know if they were giving their children the placebo or the Benadryl. Did it make any difference? Nope. They even stopped the study early because it was so clear that Benadryl wasn’t having an effect. {Go here to read a more detailed report.} And if the medicine doesn’t work? I’m not going to risk the chance of side effects.

So if you decide to try it, check with your doctor about the proper dose and if your child is old enough to have Benadryl. On the package insert, it says not to use it under age 2, but we certainly do use it at times in younger children.

**Ha! You think you can medicate me to stay still on an airplane?**

MacGyver Mom

In the land before kids, I didn't think a whole lot about what I brought onto an airplane. Running out the door, I'd throw my ipod and a few books into my purse, and call it good. Sometimes a fashion magazine and a bottle of water would make its way into the mix once I got to the airport. But really? That's about it.

Once I read a magazine article about things husbands found endearing about their wives. One guy, I recall clearly, loved that his wife was super prepared when they traveled. "She's like Macgyver,", he said, "anything that comes up, she's ready for. 3 hour delay? Here are some sandwiches I made. Headache? Tylenol and advil, here for the taking. A small cut? Here's my portable first aid kid."

I read that in awe, wishing I could be as uber prepared for every travel eevntuality as that woman. But the truth was, I didn't really see the need in most instances (my credit card and airport convenience stores seemed to fill the void) and I didn't have the energy.

But since being a mom?

I'm now a certified travel Macgyver. A Macgyver mom.

Packing the clothes part of a trip is still important. But this is not where I focus my energies. Since I realized that having the right equipment can avert on-board meltdowns, I focus on: the plane bag (dun, dun, dunnnnn.)

Travel with little ones can be crazy, and to me it, it is like a game to figure out which of their numerous needs may need to be met from the skies, and how I can plan the best way to efficiently meet them. In most aspects of my life, I'm a regular mix of organized and disorganized. But here? I've realized how mad preparation can benefit me, and I go for it.

I start with a list a few days before, listing out everything from changes of clothes, to baby Tylenol, to snacks, to toys, to reading books, to surprise coloring books, to rented Itune movies, to extra pacifiers, to sippy cups, to first aid kits, to diapers, to infinity and beyond. Yes.

Then when the packing begins, I temporarily abandon my efforts to reduce use of plastic bags and I go a little crazy. There's a 'Tiny Snacks' bag and a 'Drummer Snacks' bag. There's a 'medicine for the plane' and 'medicine for the suitcase' bag. There's a bag within a bag within a bag to keep it all straight and organized. And its all labeled. It helps me to easily reach what I need inside a big bag full of stuff.

I choose each thing carefully, and pack it just so. I feel like a mama warrior, preparing for travel battle.

The possibilities for things that can go haywire with kids while traveling are endless. And I think being a little OCD about my 'plane bag' helps me to feel a little more control. Obviously, I'm not. But it gives the illusion, and has helped things to go more smoothly.

And then when I'm able to be at the ready with some small thing I've packed? Oh, the satisfaction.

Hmmm....do I spy a dirty tray table? Excuse me while I just whip out my antibacterial wet wipes.

**what about you...what are your favorite tips for traveling with kids?***

A Launch Party and A Little Archivery

I was happy to be in town for the Coco Penny launch party this last Friday.







If you like: talented entrepreneurs, delicious food, flip book photo booths, and fabulous hair accessories, you'd have been happy. It was a great party and I'm so thrilled for my sister and her business partner. The flowers looked like candy all spread out on the table. I buy more every time I see them. You should too.

***

I found this while looking through some of my old residency stuff. I wrote it as an intern, and it struck me that a lot of it applies to new mommy-dom. n'est-ce pas?

****

"I don't always look this good."


I stumbled out of my call room the other morning, after having stolen a blessed hour or two of sleep before arising again to do morning rounds, and made my way to the sink. I brushed my teeth, tried to massage out the 'pillow lines' from my face, and smoothed over my fly-aways escaping from the bun I'd done up the morning before. I started to head out towards the floor to see my patients when I stopped. I looked in the mirror again. I re-evaluated my appearance. If the role is an exhausted resident, I looked the part. I took in the smudged mascara underneath my eyes, the day old hair-do and the slightly rumpled scrub top I was wearing. What other professional, I thought, would ever go out to meet clients looking like this?

Medicine does many things, one of which is to test the limits of what you consider an acceptable public appearance. I realized while staring in the mirror how long it had been since I'd even noticed or cared that we have to be seen by our colleagues and patients in such a manner. You just adjust to it and move on.

When I had jaw surgery in high school, I ended up with a post-op bleed into my right cheek. That half of my face quadrupled in size (a walking experiment in the elasticity of skin), and along with the extensive bruising, I looked like a circus freak (and I'm not exaggerating). After the swelling had gone down a bit, I remember looking in the mirror and thinking, "I should have taken a picture when the swelling was really pronounced so I could have remembered how crazy I looked. Now I look almost normal! Oh well, I'll take a picture anyway." I found that picture years later, tucked into a book. The disfigured person in that picture had the craziest swollen half-face I'd ever seen. And I had thought I'd looked practically normal! So maybe that's how we deal with it. We lose perspective on what we really look like post-call because we're so used to seeing other people and ourselves look that way.

I do have one vanity that I still stake-out, however. Every call, I still wear earrings and a necklace. Usually the star earrings my lovely in-laws brought back from Spain, and a star necklace that my parents brought back from Hawaii. Good luck charms. Like a cotton ball at a speeding train, perhaps, but it's my reminder that underneath the pajama-like outfit and the big, clunky clogs, there is still some femininity to be found.

Incidentally, the worst thing is when someone asks you, "Are you post-call?", when you have just come into the hospital, freshly showered and all. Really? That's really how I look right now? Thanks for the morning boost. ;)

****

Happy Monday!

Office Talk: Baby Food and Allergies

Question: I know I shouldn't start most solid foods until my baby is six months old. But there is a bunch of stuff I have to avoid until he turns one or two, right?


Answer: Not necessarily. Once upon a time, we told parents to wait to introduce many foods until at least age 1 (peanuts, strawberries, eggs and cow’s milk for example.) The thought behind this was that waiting until later to introduce such foods, might prevent food allergies. Well, in case you hadn't heard, a couple years ago, these recommendations by the AAP (American Academy of Pediatrics) were changed. Why were they changed? It was not that we found that introducing these foods sooner prevented allergies (though there is some evidence leaning this way). But after reviewing the research, the AAP didn’t find any evidence that delaying introduction to such foods beyond 6 months prevents the development of allergies either. There were other recommendations pertaining to children at high risk for developing allergies—namely that for such children, exclusive breastfeeding or use of hydrolyzed formulas in the first four months might prevent eczema, cow’s milk allergy and wheezing in childhood.

There is still one food off limits—Honey! Never give this to a child under the age of one because of the risk of Botulism, a potentially serious infection.

I know I’m loving these new recommendations for Drummer. He’s a big fan of a little PB on a spoon and it's an easy way for me to get a little extra protein/good fat in his diet. Since he's under doctor's orders to gain a little weight, eggs and PB are quite useful. So if you've got a little one six months or older, make sure to talk to your pediatrician or family doc about the new ways you have to entertain your baby's palate. :)

**Always check with your doctor to make sure your own families' allergy history doesn't alter these recommendations at all.**

Go here for a more detailed report.

The Saga Continues

After my aforementioned day in the ER, we were looking forward to a productive Saturday out in nice weather.

Again the universe said: Psych!

We put Lil’ Drummer (who had been in completely good health—no cold symptoms or what not) down for his morning nap, and anticipated that when he woke up, we’d hit the road to run a long list of errands. He woke up early from his nap, but didn’t seem too out of sorts initially. Rockstar took him downstairs so I could finish getting ready, but I soon heard him crying. A lot.


**back to his chill self**


I walked downstairs to see what was going on. Initially, I was annoyed, thinking, ‘why aren’t you helping this poor kid who is obviously in distress?’ Except when I got down there, I saw that Rockstar was holding Lil’ Drummer, trying to give him a pacifier, but nothing doing.

Huh. Drummer is a pretty chill little guy. He gets fussy at all the normal baby things (Hungry! Tired! Dirty diaper!), but otherwise, can generally be talked out of crying spells. So it struck me as odd right away. I reached for him, assuming the crying would cease as soon as he was wrapped in mama’s arms. But, you know, it didn’t.

I should note: There is a difference between normal baby crying and panicked, red in the face, high-pitched screaming. This was the latter.

And nothing made it go away. We tried getting him in his carseat and on the road, because he generally responds well to being on the go. Nope.


**on the go**


We tried walking him outside in the wind. It helped only a little.

We tried feeding him—he wouldn’t have any of it. He wouldn’t nurse, he wouldn’t eat, he wouldn’t take his paci.

We tried changing him, rocking him, distracting him. We tried Motrin. We tried Tylenol. N.O.T.H.I.N.G. worked. After my own ordeal the day before, my nerves were already shot. So Rockstar and I were on edge. There was no way on God’s green earth that I was going back to the ER unless I really had to, but I was starting to get nervous.

Being a mom and doctor can be a double edged sword when it comes to taking care of your own kids. Even though I think on the whole it is helpful, there are times when your mind takes you to the worst case scenario, because you’ve seen it. So my mind was thinking of intussuception (an uncommon, but serious bowel problem that inconsolable crying can be a sign of), since he’d demonstrated no other sick symptoms that would indicate an ear infection, hand/foot/mouth, or some other virus. And at a certain point, you want a third party to come in and look at the situation, since your intense motherly concern can make it hard to be objective.

So, we scheduled a visit with the pediatrician, who mercifully still had Saturday afternoon appointments available.


**this week finally brought a chance to go exploring**

We loaded both kids in the car (because neither of us wanted to go it alone) and made our way there.

Within 10 minutes of walking the hallways outside the pediatrician’s office, Drummer’s hours of crying had softened into whimpers, and then into silence. Oh, blessed silence.

By the time we saw the doctor, he had decided he was willing to eat, and looked the part of a normal, healthy baby. Do you ever feel going to the doctor is like taking your car to the mechanic? The car never makes that weird sound you ‘swear it’s been making’ when the professional is listening.

I told the doc his symptoms, and he agreed that intussuception had to be considered, but set about examining him for other problems.

His exam was entirely normal. He advised me to head to the ER if he had 2 or more uncontrolled crying episodes.

We have both been fine ever since.

Can I just say: Dude, we are so over the mystery syndromes round these parts.


**enjoying open spaces**


p.s. A few people have asked if I think mine and drummer’s episodes were related. The timing was awfully strange, but there were no symptoms to indicate either of us had anything infectious. I’m still thinking mine might have been related to some type of small abdominal wall hernia that went back into place before it was imaged, and I don’t know what was going on with my little man.

I guess this drives home the point that medicine is not an exact science. There will be questions that we will never be able to answer, despite our best efforts. Frustrating and Humbling? You better believe it. But I'm learning that life is more about the process than the definitive solutions and answers we crave.

Being the Patient

Speaking of wanderlust, this last weekend held some pretty great possibilities. My wonderful mother is in town, and so we had discussed taking some day trips on Friday and Saturday. But sometimes life needs to remind us that things don’t always go as planned. I’d had an inkling that something would interrupt our plans.

Friday morning I woke up with a few mild stomach pains. “Hmm…that’s odd,” I thought. In absence of other symptoms to indicate infection, I brushed them off. An hour later, the pain had progressed. Soon, I was in tears and Rockstar had decided to cancel his meetings. He encouraged me to let him take me to the ER.

“No! They’re just going to give me a CT and I don’t want unnecessary radiation. I’m sure it will go away.”

Only it didn’t. So, finally I gave in. I’d run through potential problems (gallstones, appendicitis, kidney stones, ulcers, acid reflux, gastritis, pancreatitis) in my mind, but nothing quite fit the bill.

We arrived at the ER in time to get the last available bed. Hallelujah! They mentioned that I had a TV to myself. And if this gives you any indication of my pain, I couldn’t even enjoy the prospect of an HGTV marathon. The techs and registration aid mentioned once or twice that the doctor would be “right with me”. Because I know that that does not necessarily mean anything except for ‘eventually, the doctor will be with you’, I didn’t get my hopes up. Rightly so.

Two hours passed and the pain was on the rise again. I was squeezing the dickens out of Rockstar’s hand, and rocking back and forth on the bed. All I could think was that no one had even come in to eyeball me—to evaluate if I could safely wait for two hours in an ER bay. At least I had the medical knowledge to know that that was probably fine, but I thought about how helpless this wait must feel to most patients.

And as the pain rose, I started to feel helpless myself. The nurse and doctor finally came in. They were very nice, very caring, and I appreciated that. Normally I take pains not to mention that I am a doctor, because I don’t want people to feel awkward taking care of me or like I am demanding special treatment. But the hours of pain changed this, and so I found a way to work into the conversation that I was a doctor, desperate for something to speed up the process to relief.

The nurse told me she’d be right back with the pain medicine, and she left.




45 minutes later, I was without medicine and the pain marched on.

Rockstar looked at me writhing. “Honey, just push your call button. Tell them you need the pain medicine.”

“No…I’ll wait just one more minute. I know how annoyed they can get at pushy patients. And I don’t want them to think I’m a drug seeker.”
I sat there and weighed being the pushy patient vs. enduring pain.

I stared at the red call button. And as a wave of pain came over me, I finally groaned in pain, and pushed it. The nurse came in. “I’m so sorry,” she said, “I had to take a patient to the ICU.”

“No problem, I totally get that. But I could really use something for pain.”

She delivered the morphine through my IV, and the relief spread through my body rapidly. In that moment, my gratitude for modern medicine was immense. And finally, I was able to enjoy HGTV.

Then came the tests: blood work: normal. Ultrasound: normal.

The doc came back: “I know you don’t want a CT scan, but this is pretty strange pain, and I’m worried if I send you home and we’re missing something…”

I consented.

**but perhaps I should have run away!**



Then it was off to the radiation suite, for an injection of IV contrast. ‘Sweet’, I thought, “Now I’m going to have to pump and dump for at least 24 hours’.

They wheeled me back to my room after the scan. It had been hours since the morphine, now, and still no pain had returned.

A while later, the doctor came in.

“Well, the CT scan was normal.”

Of course.

We discussed my mysterious pain, she dispensed some back up pain meds, and I walked out of the ER. I walked past dozens of other patients in beds, feeling lucky to be walking out of there, back to the golden light of the evening, and to my family.

After all was said and done, I was sad to have lost the 74 degree day of adventure I’d so been craving.
But I was glad for many things:
To remember what it is like to be the patient: to be sitting in a room, having no idea what the timeline is and wondering when you’ll get relief. To be scared of not knowing the answer, but worried about the effects of testing.

To remember what it’s like to have to tell many people the same set of information, and to be poked and prodded by multiple strangers.

That I’d been the recipient of kind medical staff.

That I'd had my husband next to me during the ordeal.

To be ultimately okay. To have my pain taken away.

To know there will be other 74 degree days.

I’m grateful that I can take this experience, and use it.
That I can remember what it’s like to be on the other side of things.
That I can take off that soft, worn hospital gown, replace it with a crisp white coat, and with additional understanding in my pockets, continue in my efforts to heal.

**Maybe next weekend, there will be more of this.**

Wanderlust (and this and that)

As I left the office today, the sun was still relatively high in the sky, and the weather was warm. I hardly needed my coat. I started the car, and a catchy, summery tune came on the radio. Driving down the road, where signs of life are starting to emerge from the barren shrubbery, it seemed Spring had actually decided to arrive. It was then that I felt a familiar high coming on.

Spring unleashes my wanderlust.

The winter months bring with them the urge to hunker down. To drink hot chocolate, read stories, and sit by the (usually metaphorical) fire. They bring the gathering of holidays, comfort foods, and coziness.

But the spring and summer months? Oh, they bring on the urge to take the scenic route, to go on an unexpected weekend trip, to explore something new and to let my favorite music provide a soundtrack to the whole thing.

During my second year of medical school, I found myself exploring some of the quaint streets near my row-house with good music as company. The touch of warmer weather had awakened that adventurous spirit in me, and I recall that I wanted so badly to just fly to London and wander. To see, to experience, to think. Finals, be darned! "How," I would think, "will I manage to keep myself on lockdown in a hospital for the next bazillion years, when all I want to do is go outside and wander?"

I never have liked to feel too boxed in. It is no wonder that the medical training road (which is very rigid) chafed against that part of myself. But I should thank it for teaching me mad amounts of self-discipline. After Lil' Drummer's birth, when we were still in the every-two-hour-waking phase, I remember thinking that I just needed a good road trip. I needed to get out of dodge, and then sleep or no sleep, all would be manageable with the world.

On the evenings when the prospect of another sleepless night brought on those new mother anxieties, I would strap Drummer to my chest, and wander the neighborhood with my ipod in. "Cheaper than prozac" I used to say to Rockstar upon returning home(a line I shamelessly stole from Robin Williams after his Oscar win). It felt so good to just be out there with my thoughts. And my baby. :)

And I guess that's how my wanderlust has changed. Back in the day, I was a solo explorer, content to go it alone. Now? I can't imagine going on life's adventures without my family.**

What about you...how does the change in seasons affect you?

**(a baby-free trip here or there excepted). :)



*This week was 'Observation week' for Tiny Dancer's ballet class. It's fun to see them up close and personal, but the parents serve as a constant distraction. Tiny is now one of the two oldest dancer's in the class, and she is begging me to move up to the older class.

*That little yellow pinafore is adorable. They make the cutest costumes for the girls.


*This Lil' guy has been a champ sitting through big sister's dance classes.

*That certificate of achievement made her so happy.


*This is what a table looks like after two toddlers, two mamas, and one baby boy are done with it. I love Nordies cafe, and I love lunch out with friends.


*That article gives me one more reason to love fish more than I already do. It's good for your eyes!

Happy Weekend! xo

Office Talk: UTI Relief

Question: If I start feel UTI symptoms, but the over-the-counter medicines (like Azo, or Urostat) make the pain go away, does that mean the infection is gone?

Answer: Most likely, it does not. Pyridium, which is the active ingredient in those medicines, is nothing but a painkiller. It does not kill the infection, but it does mask the burning. I've talked to many patients who assume that since the pain is gone, they probably don't need to come in and get there symptoms checked out. Usually, however, the infection lives on and this delay just gives it more time to take hold. There are times where a lot of cranberry extract and increased hydration might head off an early infection, but make sure you don't assume the painkillers are doing the same thing.

Incidentally, one of my patient's asked me once if she might be having a 'Yootie'. And by 'Yootie' she meant "U.T.I.". I loved this newfound slang so much, I've coined it as office talk in my practice. :)

What Makes a Doctor Tick

**


Today I was examining a 6 month old patient of mine. He is such a little cutie, with delectable fat rolls in all the right places. After we finished up, mom asked if I could take a look in his older brother's ear. Older brother had had a cold for almost two weeks, and in the last few days, had been complaining of right ear pain.

I was glad to oblige, and pulled my my otoscope off the wall. When I looked in his ear, there was a roadblock. "Cerumen Impaction Ahead!" So, if I was going to get a look at the ear to evaluate for infection, I was going to have to remove the wax.

I hunted down an ear curette. Big brother was a champ and held very still while I used the curette to clean his ear. It didn't take long before a large wax plug came neatly out.

Simultaneously, mom and I said, "Ewww!" and "Yes!"

Guess which exclamation was mine?

I don't know much, but I know I find strange things satisfying.

Once I had a clear view of his ear drum, I could see the infection easily. And what I could see, I could fix.

Wishing you a clearer perspective in all your endeavors this week. :)

**We think clearer with bows in our hair. And apparently for Tiny, the more the better. We get our bows at Coco Penny, the brainchild of my fabulously talented sister and her fabulously talented friend, Marianne. Check it out! We can't get enough.

This and That

*This morning was gray and rainy. Tiny woke up and crawled into bed just a few minutes before my alarm went off. And since there would be nothing better than letting her snuggle between us for an extra half an hour of sleep on a rainy morning, I was more disappointed than usual when my phone went off moments later. Especially since I was supposed to be in half an hour earlier than normal to staff the walk-in clinic.

I Eeyeor'ed my way through my get-ready routine, and kissed the family goodbye. I tried to keep my pack mule self (laptop bag, lunch bag, Medela pump bag, gift bag) dry as I darted through the raindrops to my car.

When I walked in to my office, I was surprised to see that no one waiting to be seen. I guess the rain, or rather the dramatic forecasts for the rain, had kept them all home for an extra hour or two. So, my nurse and I put our feet up and talked about life, her upcoming move, and the office happenings.

I'd rather have snuggled my littles, but a slow start and a nice conversation with my nurse, were good consolation prizes on this cozy day.

*That photo shoot with my talented friend, Tab, was a lot of fun. As a mom, I feel like I rarely end up in the shot with my kids, so I'm so happy to have some of me with them.




*This week a lot of patients have been asking me what I think of the Atkins diet. Seeing as I don't think much of it, I should direct them to this article. The Mediterranean diet has much to recommend it--including good science!

*That Lil' Drummer is a sweet natured little guy. He is particularly sweet natured when you don't try to prevent him from the following types of activities:




*This weekend, Rockstar and I have two dates planned, and I'm pretty happy about it. I figure we're just making up for lost time, since those first six or seven months after a baby are kind of a wasteland that way.
Happy Weekend!

Danskos in Danger (and other thoughts on sleep deprivation)

Between medical training and motherhood, I have become very acquainted with sleep deprivation. I've written before about my preference for a cute baby being the waking agent over a plastic pager.

And upon further consideration, I've decided that, indeed, I handle motherhood sleep deprivation better than the medical sort. Here's my evidence:

During my third year of medical training, I was spending one particularly brutal Saturday night at the hospital. Brutal because we had been working from sun-up to sun-down, and seemingly on to sun-up again without a break. Super fun.

But then after midnight, the stream of patients to admit had slowed, and it appeared that everything was temporarily wrapped up.

"Go lie down for an hour", my resident said. I didn't need to be told twice. I made my way down to the abandoned wing of the hospital they let us sleep in, and found an empty room. I sat down and heaved a heavy sigh. Oh, I was tired.

My clogs were just laid next to my bed, my white coat barely having been dropped on the floor, and my head almost touching the pillow when, 'beep beep! Beep beep!' I stared at it in disbelief. Was I hallucinating? I called the number back, hoping it was a nurse who had just forgotten she needed an order for pain meds, or some small matter that could be handled on the phone. But no. It was my resident.

"I'm so sorry, but the ICU needs an extra bed, so they've decided to transfer out one of their less acute patients to us on the medical floor. I need you to come do the transfer.'

Well, now that's just.so.awesome.

Probably I should've reminded myself that the night would end eventually (though at the time that seemed like an impossible dream). Probably I should've counted to ten. Probably I should have said, 'serenity now.' But instead, I wanted to scream. And If I hadn't been worried about waking up any other nearby (and very lucky) sleeping students or residents, I probably would have.

But my anger at my situation felt like a heat, radiating out of me from head to toe, and demanding release of some sort. So I picked up my dansko clog and threw it against the wall. Hard. I didn't know what else to do with my anger, so I threw it. And then I picked up the other one and threw it as well.

Yup, in case you missed that, I definitely threw my shoes at the wall. "Take that, you stupid hospital wall! That'll show you to deprive me of even a moment's rest!" Misdirected frustration, to be sure. But my options were limited. And it kind of helped.

Then I went and did my work.

In comparison, I have never, not ever, thrown anything when my children have woken up crying in the night.

Have I shaken my fist at the universe in supreme frustration at my lack of sleep during the baby phase? Many a time. But just so you know, my shoes have always remained firmly planted on the ground.

And I think that's got to count for something.

{Incidentally, upon retelling this story during residency, one of our attendings overhead. "Wait, You threw a show against the wall? Wow. I can't see you doing that." My co-resident asked, "What, but you can see one of the rest of us doing that?" Ha!
I am glad that people don't immediately get a shoe-throwing vibe off of me}.

A Little Prescription

Tip: Try to limit screen time in the hour before bed.



Instead of posting this last night, I decided to take my own advice. :)

I enjoyed reading the results of this recent study, because this is advice I've been giving my patients for a while. It seems intuitive to me.

In the pre-electronic era, there were natural signals to your body that it was time to start slowing down and preparing for sleep. The sun went down, lights became dim, and your body started producing the melatonin necessary to fall asleep. Now we go, go, go--watching TV, texting, typing--until the moment it is time to go to bed. And our bodies never get the message that they need to start winding down. We hit the off switch, close our eyes, and then wonder why we're not getting the type or amount of restful sleep we need.

I'm not going to argue that this isn't hard. I'm frequently on my laptop, finishing up charts from the day, until bedtime. But I believe that sleep is a key thing to our long-term health, so I'm all about trying to make small adjustments. If we can only start by avoiding screen time for half an hour before bed, I believe it will make a difference. Try dimming the other lights in your house in the hours before bedtime. I know I'm returning to reading in bed before I snooze: a novel, my scriptures, a magazine, whatever.

I read a similar study about the effect of screen time in the evenings on kids' sleep. I monitor Tiny's screen time closely, and have been doing it in the morning, when I'm not as worried about it disrupting her sleep.

So here's a little prescription for this week: Make a goal to turn off your screens at least a little before bed than you would have normally.

Baby steps, right?

Happy Zzzz's everyone! :)

This and That

**If you want to talk to my mom, you're going to have to get through me first!"


1)This week I realized how much I appreciate the support of the people I work with:
Not that I don't love all of my patients, but there are certainly ones who tax more of the office staff's, um, resources.

And this week I was in the position to see one of those patient's. This patient had taxed about as much as he could tax without people (in every department) getting pretty hot under the collar. So when he was coming in on my schedule, and a certain foot needed to be put down about office policies, I had more back up than I could've hoped for.

It started with a text from one of our front desk people: "Hey, just a heads up, but so and so is on your schedule today." I was glad to know I wouldn't be blindsided by it that afternoon. Then as I walked in, the two unit secretaries let me know that they'd adjusted my schedule to help me deal with what would probably be an extended appointment.

As I stood on the nurses station, a few employees came over and rehearsed with me the best way to handle the situation. A fellow physician saw one of my patient's for me so that I had more time to get my game face on. My nurse offered to come knock on the door at an appointed time to see if I needed backup (I hope you are sensing that this was not a typical office visit...in fact, I don't think I've ever seen a patient who was so widely known by the staff!). Etc., etc., It felt like I was a gladiator being prepped for battle. And so by the time I was sitting across from the patient, I didn't feel stressed or anxious at all. Because it felt so good to know that outside my office door, there were dozens of people pulling for me and hoping it was going all right. That I had on the armor of goodwill and solidarity, and that everything would be just fine.

And it was.

2)That is how we spent our morning.

Both kids had their well-child visits today. Lil' Drummer didn't make a peep while his ears were examined (I enjoy this victory since I know how hard it can be to be the examiner) and Tiny Dancer impressed the doc with her knowledge of fairy tales. He declared Tiny dancer precocious and Lil' Drummer a lightweight. We need to get more meat on that kids' bones. And you know what's funny? Even though my office feels like a second home, I still have some of the same anxieties that everyone else does when I'm on the other side of the coin. I'll have to write more about that sometime.

3)This little darling is pretty fun to take shopping. I had a couple returns to make, and she wanted to carry my bags, and stop at every.single.bench (of which there were many) on the way out, to snap iphone pictures. I'm glad that her mall fascination right now centers around their escalators, and not their product lines. This is something that I know is bound to change in the coming years.





4)That article about dirty shopping carts makes me feel better. I mean, it makes me feel worse about the state of shopping carts, but better about my slightly OCD habits. Because you better believe that whenever I schlep the kids into Target or Trader Joe's with me, I wip out my personal supply of anti-bacterial wet wipes, and scrub the handles down. I try to do so as unobtrusively as possible, always wary that people think I'm some kind of crazy. But then I read this and I think, "I am NOT the crazy one!" So, ponder that next time you are at the grocery store, okay?

5)This dress that she's wearing?



Well, it's actually a tanktop, but the company accidentally sent me a size 6-7. I said to her, "Sweetie, It's too big. It's for a six year old." "No, Mom, it fits perfectly and it's for a three year old." She was devastated that I might exchange it for the proper size. And they're sold out of it now, so it's either, go with it as a tank dress, or abandon it altogether! What would you do?

Happy Weekend!

Office Talk: Dry Hands

Question: My skin gets really dry in the winter. Some doctors have suggested I might have a mild case of eczema. What is the best moisturizer to use?

Answer: Seeing as I am a mega dry-hand sufferer myself, I've thought a lot about this question, and tried a lot of products. Hardly anything seems to be able to keep up with my schedule of constant handwashing (we are supposed to do it before and after every patient!), so I often slack when it comes to frequent reapplication. But then living with cracked and bleeding hands starts to get on my nerves, and I look for relief again.

Here's the deal: You need a lotion that has a lower water content and a higher oil content. Lotions that are high on the water content can actually worsen the problem, especially in the setting of eczema. Even more useful? Ointments, which boast zero water content. People often skip the ointments because they feel they are too oily, but if you can get past that, boy do they work!

Among heavier lotions/creams, here are a few of the best: Eucerin, Nutraderm, Cetaphil, CeraVe, Aveeno.

Among ointments, I recommend: Aquaphor, petroleum jelly (that's right--Vaseline!)

I posted a picture of CeraVe at the top of this post, because this has really made a difference for me. On the advice of some local, trusted dermatologists, I'd recommended the product to many patients, but never tried it myself. I thought nothing could fully heal my skin (except for summer's delightful humidity), but the morning after my first application, I was impressed. My skin was noticeably less dry and rough, and the effect lasted. Score! CeraVe says that its products have a sustained release formula to help it keep on working over the course of hours. Whatever it does, consider me impressed. Most of the products I've mentioned can be found at any drugstore. CeraVe, however, is not always at my local stores. I turned to soap.com instead, and had it delivered right to my door. :)

My sister also swears by this California Baby Calming cream. I don't know much about it, but I'm a fan of many other California Baby products, so you might want to give it a go!

I'll cross my (less dry) fingers for you that you find something on this list that works for you. :)

**This is not a sponsored post!