I promised more about the ultrasound from a few weeks ago. So we all went to the appointment which was entertaining with a four year old in tow. I think she was expecting to see pictures of the actual baby rather than the grainy ultrasound pictures, which immediately led to boredom. After listening to about five minutes of melodramatic Victorian-era sighing and 21st century whining, we got the iPad out to distract her.
As for the ultrasound, I let me enlighten you as to how a pediatrician (or probably anyone in the medical field) goes into the anatomy scan ultrasound. Most non-medical folks want everything to be okay but really want to know if it's a boy or a girl. Here is my internal monologue...
Oh good, there are the kidneys. Thank God! That means the lungs are probably okay (babies swallow their pee, which actually enters the lungs and makes them grow)...
Come on, heart. Please oh please oh please have four chambers... whew! No Fontan or BT shunts (heart defect surgeries) for us...
Where's the stomach? Is it in the abdomen? What? No diaphragmatic hernia? Nice. Below the diaphragm like we wanted.
Please be a boy OR a girl, and not something inbetween (just being honest)...
All fingers and toes, right? No amniotic bands? Good!
So you see how medicine gives you skewed perspective of an ultrasound. Of course, we would deal with any issues, but it is always amusing to me how much my medicine background makes me know too much, sometimes. It is an absolute miracle to me that the vast majority of babies and pregnancies turn out absolutely normal.
And here is an belly pic from last week.
20 weeks (sorry for the blurry pic)
J.Crew shirt, bracelet and flower pin
Banana Republic necklace
Old Navy skirt
Target watch
DSW shoes
How about you, does your professional background skew the way you view things?
Yesterday in clinic was the day from hell. I normally love my job, but there are certain days (particularly before holiday weekend and the start of school) that I dread, especially if we are short staffed, like we were yesterday.
Of course, I have never seen or done any of these, but I have heard of people doing this.
Fake paging yourself out of a room. I may have heard of people doing in this in residency.
Pretending to be on the phone to avoid talking to a parent who uses a well visit slot to talk for 45 minutes about EVERY. SINGLE. DAMN. ISSUE. that their child is experiencing, from dry skin to warts to a crooked toe to having bumped their head on the door three months ago. Ma'am, that is what sick visits are for.
Saying that their child seems to be a little slow to learn things. Really? Because I am about to have an aneurysm just asking you basic "yes or no" questions. There is a vein in my forehead throbbing like "The Tell-tale Heart" from Edgar Allen Poe's short story. Apple, meet tree.
Having to explain to the world's least bright tween-ager how to pee into a cup. Seriously? I fear for the youth of America. I may have almost had to draw a diagram of the male anatomy to explain what to do before I gave up and called for parental assistance.
Putting patients in time out. I may have been know to do that before.
If I was still a superstitious ex-ER doctor, I would have been tempted to blame it on a full moon.
Not that I actually witnessed/committed any of these.
I love what I do. I am one of those lucky people who doesn't just have a job, but a vocation. Being a physician is a calling (because why the heck else would anyone choose to be tortured in med school and residency?). I don't think I could be a full-time stay a home mom - God bless you if you do - because I would miss using the ability and passion that I have been given to help heal people and to invest myself in my patients' lives.
About 99% of the time, I am able to go to work, come home and leave my "work brain" at work. A useful skill to keep your brain sane. I would imagine that lawyers and therapists and people of the clergy out there would be able to identify with this. I hear all of the junk people have going on in their lives. I know which parents abuse their kids, which parents are drug addicts and alcoholics, which families have absolute brats and which families are on the brink of divorce. I find out when the teenagers are sexually active and which ones are contemplating suicide. I know which of my patients are scared of Winnie the Pooh and who still wets the bed (both usually completely normal, BTW). It is helpful to be able to tune that part of my brain off so that I can function.
However, there have been a couple of incidents where that was mentally impossible.
Incident #1: I was about 6 months pregnant and doing my third year peds ER rotation in residency and we had a trauma where the young patients had been in a car accident (I think they were about 2 years old and 6) and their mother was killed at the scene. The little one kept crying for Mommy and I spent the bulk of my shift trying to keep her calm until the extended family members were able to get there. I drove home that evening crying on the phone with my mother because I finally understood what the loss of a mother could do.
Incident #2: I was about 8 months pregnant (and very ungainly) and had an oncology patient who coded and died in the most unexpected, sudden and gruesome manner that I have ever seen. In the 30 seconds it took for me to run downstairs to the code, it was pretty much already too late. We continued to run the code for an hour, but death sometimes comes quickly. It still is difficult to think about.
Incident #3: Happened this past Monday in clinic during a routine checkup. The mother told me that her husband had been killed (beheaded) in Mexico for not wanting to comply with the drug gangs down there. She has two children my daughter's age and she asked me how to tell them that their father had died. I said I didn't know. It shook me to my core.
Regardless of how you feel about Mexico and the HUGE illegal immigration problem (99% of my patients are Latino), there are families being torn apart and fleeing from the violence there for the sake of their children.
Mi corazón es lleno de tristeza porque la violencia es demasiado.
The main occupational hazard of working with small people who are germ-ridden (and having a preschooler who is around other germ-ridden children) is the occasional infection with kiddie crud.
Kiddie Crud. noun. A generic term referring to all sorts of gastrointestinal, respiratory and dermatologic conditions that small germ-monsters (aka patients) infect unsuspecting pediatricians and their families with.
So my daughter and I are sick and under quarantine. I think it may be scurvy. Or consumption. Or even possibly fever n' ague. If I was a pioneer on the Oregon Trail computer game right now, I would certainly have to trade some of my bison for medicine.
What I have learned:
Doctors make sucky patients. Shocking, I know.
Sesame Street is still a genius show. They have a spoof for Mad Men. 'Nuff said.
Having a stash of assorted antibiotics and at home is a blessing when your kid has pneumonia.
Objectivity and science go out the window when it is your kid who is sick.
A sick three year old is the most heartbreaking thing ever.
Do you have any favorite staying home sick from school memories or remedies to share?
I am fortunate not to have had much more than regular "baby blues" and feelings of being exhausted and overwhelmed, but many women will have this at some point in their life. I have several good friends who have had severe post-partum depression (PPD). I wrote an article here explaining how a pediatrician approaches PPD and what to expect your pediatrician to do. If you are a mom reading this and your pediatrician doesn't screen for it in the first two months of well checks, ask why not.
Feel your boobs. Seriously, feel them. Notice anything?
I didn't, but my doctor did. Ironic, huh?
October is breast cancer awareness month. You start seeing the Yoplait containers with the pink lids, Race for the Cure sign-ups are everywhere and people start encouraging you to "think pink". I have always been aware of breast cancer (I ran an awareness campaign on it in college) and the relative importance of knowing what your boobies feel like so that you know what is normal for you. So imagine my surprise years ago during residency when I went for a long overdue check up with my physician and during the exam she asked me, "how long have you had this lump in your right breast?"
Cue dead silence and panic.
Turns out I had a cherry tomato-sized lump that I hadn't noticed. I got sent for an ultrasound and mammogram and they recommended a needle biopsy. It would give me a likely diagnosis. My personal hesitation to getting a needle biopsy was that you could get a portion that looked weird on pathology (I know too much medicine) and then have to go in again anyway for a lumpectomy. I was like, "um, no... cut the sucker out!"
I got scheduled for surgery, took a few days off work and went in. Worst part of surgery experience: not being able to wear any underwear. Best part: already knowing my anesthesiologist (I had worked with her in med school) and her giving me the fastest nap of my life (helloooo, Propofol!).
I was fortunate that the lump that was found was completely benign and with a lumpectomy would likely never recur. It does increase my chances slightly for getting breast cancer in the future, so you know I will be all over that mammogram machine like white on rice.
Save a life, feel your boobs. FWIW, self breast exams have not been shown to improve outcome, but they do make you familiar with your consistency of breast tissue so that you know what is normal and what isn't. Better yet, go to your doctor and get age appropriate screenings.
Stay tuned for a boobie (as my daughter calls them) related giveaway this week!
I always think it is HILARIOUS when anyone asks me for advice on how to get your child to sleep. I will explain why in a little bit.
I got an email from a reader as follows (edited for length):
Hi there,
I frequent your blog and have a totally random question for you, being that you are both a pediatrician and a mother I figured you'll have some fresh perspective to share. I have a two year old girl and a two month old boy. My daughter is having sleep issues. I'm not quite sure if I have too high expectations, but she refuses to sleep through the night in her bed in her room. We never really got her used to sleeping by herself at the "right time", but now with a baby, we need her to be in her room, fall asleep by herself (after a story or two, hugs, cuddles, kisses, whatever!!!) and stay asleep!! Is that too much to ask for??!?!?
Does your daughter sleep through the night in her room? Did she when she was two years old? I'm about to try a "strict" method that may involve a lot of crying on her part. I just need some neutral, real advice.
Thank you, Drbabymamadrama!!!
This is hilarious is because I could have written the exact same post when my daughter was two. I always wanted to slap those people that said "my kid has slept through the night since he/she was six weeks old". Really? I may have to throat punch you. Just kidding. Maybe.
My daughter has always been a horrendous sleeper since the day she was born. The child would wake up from a dead sleep if she had a wet or poopy diaper. No joke. Every damned (pardon my French) time. So that meant about waking up every 2 hours for the first two months. Hold me, baby Jesus.
I finally succumbed to co-sleeping (even though I swore up and down that I would never do that) from month 3-5 or so, based on some wise advice from some friends. My mom reminded me that in Nigeria, children rarely sleep in a room away from their parents for the first 3 years. Mommy guilt assuaged.
Around month 5-6, we tried "Ferberizing", which is the gradual prolonged intervals of letting your child cry until they fall asleep. Which worked for a few months and then she went through a viral stomach bug and learning to crawl and all sleep went to hell.
This was DEFINITELY complicated by the fact that my previous job had me working all kinds of crazy hours and there was a craptacular bedtime routine at that time and neither my husband nor myself have the best of sleep habits anyway (I am a notoriously light sleeper; my husband can survive on 5 hours of sleep a night!).
And the little bugger would sleep perfectly at day care, but when she new Mom or Dad were around, no such luck! I just smiled and lied through my teeth when my pediatrician asked how she was sleeping at well checks.
Dr: How is she sleeping?
Me: Heh, heh... fine... *avoiding eye contact*
We gave up and just did the co-sleeping thing for a while, letting her fall asleep in her crib (most overpriced, underused piece of furniture in our house) from the time she was about a year until about a little past two years old. We would take turns coaxing her to sleep because that is what worked for our family. It won't work for everyone.
And just after her second birthday, it just "clicked" with her. We hadn't changed anything with our nighttime routine of bath, books and snuggle time (and the occasional threat of hellfire and damnation -joking!- if she got out of bed). We just noticed one morning that we had both not heard a peep from her room and she didn't get up at all. She fell asleep and stayed asleep and all was right in the world again.
Not to say that we don't still have occasional requests for the bathroom and water at night, but it is better.
So that is a long answer to absolutely nothing. Yes, my daughter was still having sleep problems until she was past two and your situation is probably complicated by having a new sibling who is taking her parents' attention.
What I usually tell parents is that every kid is different and to try what works, be that "Ferberizing", a reward system, a small cot in her parents' room that she sleeps on, co-sleeping, whatever. There is no magic bullet. There are some great sleep books out there, including the No Cry Sleep Solution and Solve Your Baby's Sleep Problems and the Babycenter.com site. I once used to baby-sit for a VERY affluent family in college where the toddler, who had similar sleep issues to my daughter, slept in mom and dad's walk in-closet! He is now a normal, happy, healthy teenager.
Things that definitely help are having a consistent schedule, minimize TV/sugar drinks before bed, bedtime routine (bath, books, snuggle, prayers, whatever), and a cool, dark room. And lie through your teeth when someone asks you how your kid is sleeping.
I am lucky that one of my best friends from college is a child psychologist, specializing in neurodevelopment. We had lunch with her and her husband last month when we were passing through Cincinnati so that my husband could watch the World Cup. And so that I could lose my voice. But I digress.
While the men were watching the game at the pub and I was trying to pacify the Kid with a grilled cheese sandwich, I started asking her about toddler phobias. The Kid is scared of dogs and some swimming pools. Particularly getting her hair wet.
Which probably shouldn't be surprising given that most black women have an aversion to getting their hair wet at all. You will probably never see a black female Olympic swimmer. Weaves and braids are expensive and don't take well to chlorine. Just saying...
Mind you, if one of my patients asked me the same question about toddler phobias, I would say, "of course, dogs and water are normal fears", but a little reassurance from a friend never hurts. Which she proceeded to tell me were completely normal and VERY common fears. The Kid was snapped at once by a dog and ever since, most dogs will elicit high-pitched shrieking and her trying to climb up your leg like a squirrel. She did okay at the beach and in the small swimming pool, but absolutely refuses to get her hair and face wet. Which makes for very interesting scenes when I wash her hair.
But then I remembered my even more irrational phobias from when I was little.
Exhibit A: The Incredible Hulk.
Guaranteed to induce panicked hyperventilation and pleas for my dad to change the channel to this classic 80's show. He would usually laugh and tell me to go to my room. Parents just don't understand.
Exhibit B: Sam Donaldson. You know, the former news correspondent for ABC News?
Also guaranteed to induce panicked hyperventilation and pleas for my dad to change the channel. Cue more paternal laughter.
I think it was the eyebrows.
Any irrational fears from childhood? If you have kids, are they scared of anything completely off the wall like I was?
I figure that the people feel the most vulnerable and open with their priest, lawyer and doctor. Which is good. Because I can spot a patient who lies a mile away. Really, you brush their teeth twice a day, every day and they never watch TV and never drink juice? Hmmm...
However there is such a thing as too much honesty.
I don't want to hear or see that...
Your child's first words are "Mommy", "Daddy" and the Spanish word for "Lady of the night who does things to her mother". Not good.
You got tennis elbow/golfer's elbow from playing Wii.
In a related fashion, you broke your hand playing Guitar Hero.
The staples I am taking out of your head are from getting pistol-whipped. (I am guessing that me telling you to use your seat belt and always use sunscreen will fall on deaf ears.)
You tasted your child's vomit. Ever.
You let your child chew on the edge of the exam table.
Your child older is allowed to hit you.
Your teenager is allowed to swear at you or call you names.
Your child learned how to swear at church camp.
That "something" crawled into your child's ear and died last night.
If you ever hear me say this line during a visit to the office, it probably means that I am getting on my soapbox about pediatric obesity. Fifty years ago kids drank water and milk and the occasional sugary drink, meaning an 8-oz bottle of Coke, not the "medium" 32-oz behemoth of today.
Every pediatrician has their particular pet peeve: sunscreen, sleep, developmental concerns, etc. Mine is pediatric obesity. I would estimate about 20% of the patients I see for well visits are either overweight or obese. Quite frankly, if your child can't read or gets a million ear infections a year, I get less passionate about that than I do kids drinking too much juice and watching too much TV. I have had 30 minute screaming matches with parents in Spanish over this.
Why do I care? When my patients graduate high school and leave me *sniff* this is pretty much the only thing that I can treat when they are four that will have a significant impact on their quality of life when they are 40. It makes me sad to have kindergartners with high cholesterol and signs of adult diabetes.
Inevitably, the culprits almost always boil down to either a) hours in front of the TV/PlayStation, or b) too much juice/soda/sweet tea. Here is a chart I got from this website.
12 ounces of >>>>>>>
Coca-Cola
Orange Juice
Apple Juice
Cherry Juice
Grape Juice
Total carbohydrates
40 g
39 g
42 g
49.5 g
60 g
Carbs from sugar
40 g
33 g
39 g
37.5 g
58.5 g
Sugar (teaspoons)
10 tsp
8 tsp
10 tsp
9 tsp
15 tsp
Calories
145
165
165
210
240
Let's pick apple juice, since that is the most common and cheapest juice that most parents buy. BTW, all of these juices are 100% juice. None of that "juice drink" stuff or Lil' Hugs. In general stay away from any drink (or person) that has Lil' in it.
Two average-sized sippy cups of apple juice a day x seven days is 140 teaspoons of sugar in one week! Even if you water it down, that is between 50-70 teaspoons of sugar just from drinking. Imagine the dirty looks you would get from your loved ones if you let your child sit at a table with a cereal bowl and shovel spoonful after spoonful of sugar into their body. Makes you think twice. Grape juice is even more shocking.
And the TV. I have patients who watch more TV in a week than I spend working a full time job. My only exception to restricting TV/video games to no more than two hours a day is Wii. Wii is a pediatrician's best friend. Gets you up and moving. Unless you get Wii tennis elbow. True story.
Juice is not evil. I love juice. I am a former juice-aholic. But it is a treat. We went cold turkey last year and just stopped buying it all together. Water, milk and wine for the grown-ups. We may buy it for guests. That's it. We will drink juice or soda occasionally as treat when eating out and no one can come between the Kid and a coveted glass of pink lemonade at a restaurant (you could lose an arm). But we try our hardest to think before drinking a sugary drink.
This is where fashion meets science. I can tell you with relative accuracy, what a patient (or in my case a patient's parent) will be like based on their footwear alone. It isn't an exact science, but man, it is close.
(Disclaimer: this commentary is done in pure fun and obviously, I am not this shallow. Usually.)
Tory Burch Revas or other understated but equally overpriced shoe = you already Googled your diagnosis and God forbid if I don't agree. (I count myself as sometimes being in this category).
Shoes made of hemp = you don't believe in vaccines, antibiotics or evidence-based medicine but I will always learn a new herbal remedy. These are usually the only shoes that will make me cringe when I see them because there will be a lot of having to talk you into something.
Flip flops = low maintenance, go with the flow. Love these.
High heels (sorta cheapish, bought at "Razzles" in the mall which also sells wigs and fishnets) = your 3 year old still uses a bottle and your five year old may have conduct disorder.Which means I should just go ahead and give you the referral for the dentist and therapist now.
Wingtips (and other dress shoes for men) = high likelihood of you being on your Blackberry during the visit since your wife couldn't make it.
Top-siders = you are too young to remember when these originally came out when I was NINE and these are a cool trendy shoe. Also likely to be texting your friends during my exam. OMG.
Danskos = you work in the medical profession and I can explain things in medical-speak.
Light up shoes = you are easily manipulated by princess stickers and lollipops.
Next up, how having overly tweezed eyebrows is a 99% indicator of a borderline personality disorder...
Only will give stickers to (relatively) well behaved children. Or if I hurt you (i.e., gave shots, cleaned ears, etc.). If you are rude, badly behaved and are a typically developing child over four years of age and cannot sit still for 3.8 seconds... YOU. DO. NOT. GET. STICKERS.
And you especially won't get any of my secret stash of lollipops that I keep for bribery.
The haze in the picture is actually caused by a smudged fingerprint on my camera lens but rather the insane pollen that has hit Nashville in the past 3 weeks. Apparently the colder than average winter + 3 straight weeks of 70-85 degree sunny weather was enough to send all of the fruit trees into overdrive. Our normal April pollen count is between 700-1000. We have been hanging around 4000-5000 this month. Insane!
It has made me a very popular friend and much beloved wife, though (I have the good allergy medications at my house!). I hope you are allergy free wherever you are.
I have long been jealous of those people who got to do casual Fridays at work. In an academic medical setting the only people you ever saw wearing jeans were patients' families and the community pediatricians rounding on the weekend. Everyone else wore business casual wear or scrubs. I sometimes longed for my days as a camp counselor when dressing up meant your sparkly flip-flops and a non-holey t-shirt. Then again, it is probably good that we don't have an official casual Friday policy. We all saw what happened on the Office when they did that (warning: not intended for impressionable viewers).
Anyway, now I am one of those community pediatricians. I answer questions about funky rashes, baby poop and now I get to wear more fun stuff. One of the other doctors in our office and I decided to "go rogue", so to speak, about a month ago. We decided between ourselves to wear jeans on Friday! I have done it a couple of times since and it definitely breaks up the monotony of the winter wardrobe.
And for heaven's sake, make sure the rise isn't too low in the back (trust me, nobody needs to see that).
Next week for casual Friday - tube tops! Just kidding...and by the way, tube tops, flip flops and miniskirts are never appropriate for casual Fridays. Ever. Just in case you were wondering. Yeah, you.
This was a crazy weekend. I was on call and it was just about the best call weekend ever, since the snow and ice and subzero wind chill factor - in Nashville! - on Saturday kept all but 8 patients home (we normally average about 40-45 patients on a typical Saturday). I only had 2 patients each day to round on at the hospital, meaning that I didn't have to get up at the buttcrack of dawn to see people. From that standpoint, things were awesome.
On a personal level, while the Drama household is doing okay, we have had a lot of medical issues in our extended family (multiple miscarriages, sudden deaths, strokes...the list goes on...) within a very short span of a few weeks. I was struck by the contrast between life and death this weekend when I had just left the bedside of an absolutely precious little 12-hour old girl who was fresh to this world and met a man in the elevator whose 40-ish year old daughter was at that moment dying of cancer. I love what I do because it reminds me of how full and wonderful, yet how transient life is. I have stood at the bedside when new life enters and babies breathe for the first time and have been there when someone dies either suddenly or after a long illness.
What's the point? I been impressed with a few things recently.
*Call your parents and tell them you love them.
*Hug your kids, significant other, pets, whatever because they are what really matter. *Being silly is far more important than being cool. *If you know someone struggling with infertility, shut up and just be there.
I think that if someone wants to slowly torture me to get state secrets out of me, the best way would be to let me scratch myself to death. Forget waterboarding. Hives like these would make be rat out my own mother (love you, Mommy!). I have never had hives before this summer and now I have them again (the first incidence was from the ghetto insect repellent that I used, remember?). I have been racking my brain to figure out what could have caused this. Then I remember that about 40-60% of cases of hives are idiopathic, meaning that you never figure out what caused them. Here are the top four contenders:
The zoo - we were there for a birthday party this weekend. I have been there before, but who know what the giraffes may be trying to get me with.
The deli - I met up with a friend from college for an impromptu lunch and had a Reuben sandwich. I have had these before, but maybe they used something unusual to prepare it. Food allergy...say it ain't so!
Flu shot - got this last week at work. I get them every year and never had a problem before. Of course.
Exercise - I have been running more this week and now I am wondering if I am allergic to exercise, just as I have always suspected. Seriously, there is a condition where people get hives after exercising. At least I would have an excuse...
Something random. It would figure.
Anyway, luckily I have a armamentarium of all kinds of anti-allergy, antihistamine-y goodies at home (Claritin, Zyrtec, Benadryl, Atarax, Prednisone, Zantac...)
I am just now starting to recover from the spanking I got on call this past Labor Day weekend and let me tell you, I put the "Labor" in Labor Day. I think it was worse than the hazing that the sororities do at my undergrad aren't supposed to do anymore. After seeing close to 30 patients in the morning (how many I see in 1 whole day, usually), my pager blew up and every worried parent in the tri-state region started calling me about real (or often imagined) swine flu symptoms. And no, I will not prescribe you controlled substances over the phone! I won't bore you with the gory details, but I was averaging about a page every 45 minutes *shudder* - which is A LOT!
Had a much needed day off yesterday and now I am back and rejuvenated. Big plans for the upcoming few months...
Couch 2 5K - I have been totally slacking in this regard (more or less since July 4th weekend when my girls were in town), so I am entering the Dunkin Donuts 5K. A girl's gotta have some sort of motivation.
Cooking Weekend Extravaganzapallooza 2009 (the name needs work) - with one of my Pittsburgh buddies, the Spice Rack. Basically an excuse to cook, eat and drink wine for 3 days straight while trying to keep the toddlers corralled sans husbands.
Family trip to the wilds of Kentucky - cue the theme song to Deliverance...
And a giveaway.
I am giving away TWO Barefoot Contessa Back to Basics cookbooks. I have a little obsession with her books and I will read them like a novel (falling asleep to parting instructions, "serve warm with ice cream"...). This book has a bunch of recipes ideal for the upcoming fall/winter weather.
RULES:
You must be a follower AND you must leave a comment in the comments section. Let me repeat that for those who are using Google Reader.
You must be a follower (see the link in the sidebar) and also leave a comment.
If you like, let me know what is you favorite thing to cook/eat when the weather turns cooler. The giveaway ends at 11:59 PM, Central Standard Time on Friday, September 11th. I will announce the winner by Monday, September 14th. One entry per person please. You must live within the United States. If you comment anonymously, please leave your email address in the comment so that I can find you. If I don't hear from the winners within 48 hours of contacting them, I will move to the next person on the list, so check your email AND check back this weekend!
