Seattle Mama Doc

My mom starts chemotherapy tomorrow. It feels like my two feet are reaching to stand in four separate corners. Doctor, Daughter, Mom and Wife. Four corners. Except nothing about the sky looks like Utah right now.

I’m caught in the middle of a generational sandwich. I’ve started to understand that taking care of those older than me and those younger than me (while, at the same time, attempting to tend to myself) may define adulthood. This week I awoke to the sobering reality that I’m a real grown-up. Good morning, Sunday, meet me, Grown-Up number 221005. It seems I’ve finally earned the title.

Titles tend to follow set milestones in life. You finish your twelfth year and you’re a teenager. Eighteen and you're a voter. Finish college, you’re an adult. Finish Med school and they call you Doctor. Yet often, these titles are granted asynchronously from earnest accomplishment or achievement.

Take the example of being called, “Doctor.”

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Game changer in our house. Splurged on a fancy crockpot last week. Big news, I know. Should have sent out a flyer.
My beloved pot. Regal, able, and ready like any good army, boy scout, or Labrador Retriever.
This.crockpot.is.gonna.save.me.
Last week broke me a bit. We’ve not been sleeping again. Previous memo to the boys was received and then promptly forgotten. And I’ve been sick. After busy days seeing patients, I didn’t leave my office for more than 2 hours after I was done with appointments. Twice. Didn’t even make it home in time to kiss O before he was off to bed on my “early” day. Heartbreak city.
This.crockpot.is.gonna.save.me.
Buying it was one of those, “Ah-ha, this is how I am going to balance my life” moments. Do you buy those things? They can be anything from an orange pair of socks to a closet organizer to a jumbo bottle of Advil to a new can opener. They feel like triumphs in life when you find them. In my attempt to eat right, lower my cholesterol, and live a long time, I rationalized the purchase of the large pot now inhabiting my kitchen. Healthy food made easy. I remain hopeful this crockpot is worthy of its post.

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As promised, this is my first video post. It's 11:30pm Sunday night. It took a while to coordinate. This was take number 2. I waited for the sun (going against my previous post about when NOT to work) as that cloudy Friday light was too drab. Especially for sleep deprived parents. This afternoon it was sunny; proof that Seattle-ites really do see the sun.

This is a post about sleep. How to help your baby (and you!) get more of it. What to do when you don't know what sleep routine or method to follow. Which books to listen to and which to pass on to your friends.

There is no universal truth or method that is good for all parents. Rather, each sleep book or method caters to certain parenting styles and certain baby temperaments. The method you choose is less important than how you implement it. Consistency is essential in helping your baby sleep through the night. Pick a plan and follow through.

Read this summary of expert advice on interpreting sleep methods and talk with your pediatrician if you get confused. Or tired. Or both.

And watch this video (click on full post to see it).

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It's cloudy with a chance of clouds right now. Then a chance of rain. Then rain again this weekend. O is napping. F at school. It's still and cloudy here. Why not work?

I'm about to shoot my first ever, Seattle Mama Doc self-produced-self-filmed-self-created-video. Sounds a little like navel staring but will hopefully be more helpful than that. I'm turning a comment (about sleep) from this week into a video blog post. Stay tuned for the video. Production starts now. You can time me. (It may take me awhile...)

This photo from our trip to Deception Pass last weekend. A nice reminder of why we all live here in the Pacific Northwest. Homemade teeter totters. And a good reminder of when not to work.

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Flashback: fall of 2006 standing with my partner, Dr Jeff Bissey at The Everett Clinic. In some strange third trimester hormone cloud (or pregnancy delusion), I consented to a photo shoot when our new clinic was just opening. Rotund & posing at the new computer in exam room 12. After the Cindy Brady photo amalgam, I feel I've got little to hide. This photo is a fine example of all the things you can hide under a white coat. Even little boys!

For three years during residency, I nearly lived in that white coat and kept it buttoned up to the top. Some people criticize the white coat for it's role in establishing hierarchy in the doctor-patient relationship. Really though, sometimes we wear it just for the pockets. Sometimes for the things we hide (a sleeveless shirt mid-July?). Don't you wonder what your doc has hidden underneath that coat? As you can see here, late fall 2006 I was hiding something, indeed. Yes, F was born 3 weeks later.

Many pediatricians don't wear white coats claiming it scares children. I've never really found that; really, it seems I'm just as scary to an 18 month old with or without it on! I think some toddlers have made their opinion about me far before I show up in the room. Something about the smell of an exam room, maybe. You know those people who say they could never work in a hospital or clinic because of the smell. Well, those 18 month olds remember...

See him there, all tucked inside, but then simultaneously reaching for the keyboard? I remember the photographer saying, "Just pull the white coat out a little farther forward, Dr Swanson".

Click into the full post if you need help finding F in the photo.

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1 “Daddy!” This from O when I say (and coach him), “Say, Mommy, O. Say, Mommeeeee.”  Every time I walk in the door, same thing, “Daddddddeeeeeee!” He likes getting a rise out of me. Lovely little rug rat. Then F starts the day today clearing up what we call each other, “O calls you Daddy, I call you Mommy.”  True.

2 “Toddler Doula, where do I find one?” The husband said this to me after his cup of coffee on Sunday morning after another night of frequent awakenings in our house.

3 “Which brain did you put in this morning?” The husband to me, 7:43am today. I forgot where the oatmeal was after saying I forgot that I bought it while instantly forgetting what I was saying mid-sentence. I claimed I was distracted by all the sleep I got last night (8 straight hours, Sista). And a study this month said pregnancy or motherhood does not make us forgetful. What to blame then?

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We were in to see the pediatrician last month for F’s 3 year check up and back again last week for some booster shots for O. During both visits, the medical assistant asked me when the boys had received their H1N1 shots. She wanted to update the clinic’s record. I told her the 31st of October. She came back into the room puzzled,“The State of WA has them recorded on 10/24/10.”
Well, yes, she and the State of Washington were right, I was wrong. You’d think a pediatrician could keep this straight. Well, no, as it turns out. With my over-saturated and over-filled Mama brain, perfectly dated info on shots may be data points that may slip out my right ear. You too, yes? It took me 5 drawers and over a 1/2 hour to locate O's book (above) to snap that photo. Clearly, organization of personal shot cards is not listed on my CV.
A study last week points out carrying an immunization record for your child can improve their health by increasing the likelihood of staying up to date on shots. When the boys got their H1N1 shots, I didn’t bring their immunization record books. I was all hyped up and excited about getting them and forgot due to my relative glee. I was given a little card at the time, but didn’t transfer the dates into their official books.  After discussing and reviewing my trusty phone calendar, we figured it out. Not a big deal but it wasted precious time for the staff in the clinic.

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When the exam room door closes, most parents have some questions about how their child is developing or behaving. Competitive parenting abounds; everyone wants to prove or believe his or her child is above average. The he-did-what?-she’s-so-smart stories can strike fear in your heart when your child is nowhere near the same accomplishment and of similar age. These comparisons can sometimes lead to worry. A lightning bolt drove through my chest when my mom started to compare F to other children and expressed worry that he might never say, “Mama.” I waited impatiently and in unified worry until about 18 ½ months.

Even the mamas and papas who seem to brag at the supermarket, on the phone, or at book club about how much their child talks-walks-sleeps-eats worry. I mean it; they worry, too. Don’t let ‘em fool you. Worry may be just below sleep deprivation on the job description for parenthood. Being a pediatrician has proven this to me.

If you worry about what or how your child is doing, speak up. Let your pediatrician know. Don’t be intimidated by the length of the appointment, the reason for your worry (Joey is eating toe jam) or even if you’ve asked before. If you’ve previously discussed a problem, revisit your concern if worry remains in your heart. Your instincts matter.

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I’m going to be on TV tomorrow. Cross your fingers I don’t pull a Cindy Brady. Remember the Brady Bunch episode, “You Can’t Win Em All” where Cindy takes a test and wins the opportunity to go on live TV to compete in a game show? When the red light goes on she is rendered silent and freezes. She spends the entire time on TV staring hopelessly at the light. Please world, don’t let me freeze; don’t let me pull a Cindy Brady. Thank goodness it’s no game show…

Tomorrow morning, you can watch me discuss insights on toddlerhood and typical development, live (in Seattle) on local NBC. Gulp.

But just for the record, or maybe to provide merit to my personal don’t-pull-a-Cindy-Brady-pep-talk, what gives me insight on toddlerhood is probably not just my MD/pediatric board certification or the articles I read every day to write this blog. Rather, it might be the confluence of all these roles, my effort to understand medicine from the vantage point as mother to 2 boys. Being a parent helps me frame and understand the data, putting it into perspective. Maybe why I’m willing to talk about toddlerhood on TV.

When I finished residency, got pregnant and eventually had given birth to F, a long time family friend of the husband, Dr Arne Anderson, wrote a letter to congratulate us. He was a pioneering pediatrician with Minneapolis Children’s and practiced pediatrics for decades. In the letter he said, “And now the real Professor of Pediatrics moves in.”

Agreed. I learn a lot from my kids. Tune in tomorrow morning to see if you concur.

NBC Kong 6/16 around 8:15-8:20am, tomorrow, Thursday February 18th.

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Tell me, shall I re-use this little valentine? Part of my efforts to reduce, re-use, & recycle? See, I've got these little boys now...

I make the husband a valentine each year. The valentines of the past few years been less beautiful and wondrous as the first few, some decade ago. The distractions of the-making-of-a-pediatrician (residency) and the-making-of-a-family (two boys) have influenced this.This little valentine here was painted on a park bench halfway between the hospital and my afternoon clinic in South Seattle when I was an intern at Children's Hospital, 2004. No idea why I snapped the photo.

Re-use? Tempting. This particular valentine is so perfectly suited for these little boys I love. I'll just water color in an "s" after "boy" and slip it under their bedroom door Saturday night. We'll see how the husband takes it.

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Recently, one of my teenage patients was in to see me. I’ve seen him a lot this year. I think about him nearly every day because I’m desperately trying to help him. I’m just so stinking worried about the choices he’s making. At the end of the visit, I said, “We’ve got a lot of work to do so I’ll see you in 2 weeks.”  He responded, “You mean, because I’m fat?”

No, I didn’t. We hadn’t even talked about his obesity at the visit. We’d talked about all the other stuff clogging up his path to happiness, long life, good health, generous love and earnest support. He’s had a heap of trouble this past year. He’s run away from home about 4 times (once for over 40 days--his poor mom), he’s currently living in a shelter, he was using drugs, he was self-tattooing with an ink pen under her skin (eeeeep!), he stopped taking his daily medicines, he’s obese and gaining weight, he got an STD….it goes on and on. My worry is real and rationale, you see.

But his comment at the end of our visit reminded me about how hard I work to talk to children and their families about overweight in ways that don’t alienate them. And how I obviously need to work harder. A new study points out the importance of letting kids know they are overweight.

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Atta girl, Michelle Obama. Thank you for the personal, passionate and most excellent articulation of a big problem facing nearly 1/3 of all children in the US today.

Michelle Obama’s introduction of Let’s Move to end childhood obesity in one generation will do wonders.

Thank you, Michelle. I know we’re not personally friends but you do send me regular e-mails and sign them, “Michelle.” So we’ll go forth on a first name basis. And whenever you’re ready for a play date, I’m game.  Let’s meet at your house; we’ll introduce the husbands.

Let’s end the obesity challenge for our children, now. Speaking of now, now that about 1/3 of the children I see in the office are overweight, I spend hours (read: hours) every day in clinic talking about it. I worry our country's problem with obesity isn’t going away any time soon. As a pediatrician I can help my patients gain perspective and knowledge but I ultimately need my patients to help themselves move more, eat right and turn off the TV. They need help from their families and communities to do this. Hard to do. Like most things in my life, these kids (and all of us!) need a lot of help from our friends.

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F woke up with a wet bed. First time since the amazing transformation this past month where he decided to wear underwear. It felt like a miracle. New Year's hopes and dreams come true. Wait until you hear how it happened.

I just couldn’t bring myself to write about toilet training until now. Didn’t want to jinx it. Now with the wet bed this morning, I’m safe. Can’t blame the blog for any future wetting-messiness. You’re off the hook, SeattleMamaDoc.

There is some new data suggesting there is an ideal time for initiation of toilet training. A recent study suggests half way between age 2 and 3 years is the golden age. Ditch the diapers between 27-32 months, the urologists say.

Finally, a data-driven answer to the question of “When should I toilet train little Jane?”

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You’ll be pleased to know in response to the poor quality of sleep in our house, for 4 consecutive nights, due to colds and random screaming I’ve just sent a memo to the boys. It reads:

***********
Beloved Boys,

Sleep starts at 8pm and no later.

We rise around 7am in our home, just after Mommy and Daddy are ready for the day.

Thank you for adjusting your schedules accordingly.

I love you,

Mama
***********

I’m waiting for them to respond. A re-tweet or Facebook status update would suffice.

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Our nanny called in sick yesterday. I felt like a She-Woman (think gender equal of He-man circa 1988) after making it through the day. Maybe it's more, She-Ra. Between the hours of 7:50am when I got the call and 5:50pm when I sat down to dinner with my little boys
I :

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It turns out, I don’t think you do have to be careful what you wait for when it comes to swimming. A study published a few weeks ago suggested that children under the age of 2 were at higher risk for bronchiolitis, a common pediatric lung infection, if they swam in chlorinated pools when they were babies. I’ve mulled this over and done additional reading. If it were my child, I'd sign up for infant swimming lessons. Believe me, I’m not getting off any swim/pool wait list any time soon! Yet, I do think the study offers a chance to re-frame how we think about protecting our kids around the water.

Although O will be well over 2 years old when he gets off the decade long wait list for the pools in our area, he'll be swimming in chlorinated pools before then. From how I see it, chlorine exposure is only one side of the story when it comes to infant swimming and safety. It’s okay, maybe even wonderful if I dare say, to swim with an infant. The video we have from F swimming in the first time is hilarious. I am far more ecstatic than any normal human should be in a pool. It’s true; most babies simply love the water. So do plenty of adults (read: me).

Swimming if not only delightful, it is also dangerous. Worldwide, drowning while swimming is the 2nd most common injury that kills children under age of 14. Therefore how our infants and children come to know the water may be as important as how we think about using car seats.

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I had a great weekend. Nothing truly spectacular happened. I, for the most part, tucked the blog away in my top drawer. I wasn’t on call and didn’t connect into my clinic computer. I tried to be really present with all 3 boys in my house.

I played with my kids. We did the typical things that dress up weekends for normal people: errands, a grocery store trip, naps, dinner, test drove a car, met friends and their kids for lunch, met friends and their kids for dinner, went to IKEA, had dinner with grandma, took out the recycling, rearranged the living room.

Usually, that little “trip to IKEA” sandwiched in there would be a back/mood/weekend breaker. This time, no.

In the midst of this wholly normal yet stupendous weekend, I had mentioned to a friend how F was having a hard time with the concept of single digits forming greater numbers, especially in the teens. That is, he can count pretty easily from one to fifty, but when I point to the clock and ask what time it is, he says “seven, one, three.”

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Welcome to wait list country. That sounds like some bad pick-up truck ad. But it's true; Seattle is known for mountains, water, coffee, grunge, rain, evergreens, and the Space Needle. And then as it turns out, wait lists. I know what it feels like being stuck on one. Hip deep stuck. Somewhere between the Andersons and the Steins just above the Grahams on page 6. Buried with no chance for arrival or survival.

The wait list: are you on one of these lists?  Is your equivalent w-e-n-d-y-s-u-e-s-w-a-n-s-o-n spelled out and nestled nicely on some school, pool, or horseback-riding list? I think about these lists a lot more now that I have two kids. I generally let all people involved (the kids, the husband, the babysitter/nanny, the MIL, my own mother) down due to my inability to follow through and get on the list, let alone get off the list. Any list. I know you turbo moms and dads out there are really good at this. For me, it's usually well after the list is formed, a true tardy, and only with 3 people telling me about an activity, that I get on the list. Precisely why I'm at the bottom, I suppose.

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While I’m talking about the red/orange/yellow rainbow spectrum used on food packaging to lure you into eating more, let me mention one great new study published today that may change your world. Especially if you have someone living in your house who is a child. If you acknowledge the finding that about 1 out of 4 school age children between the age of 4- 8 years old eats fast-food on a typical day, this has relevance to at least about 1/4 of us all. Today!

A study published today in Pediatrics found that when parents are aware of the calorie count in McDonalds fast-food items, they order less caloric foods for their preschoolers (age 3-6). In a Seattle pediatric clinic, about 100 parents filled out McDonald’s menu choices for lunch for themselves and their preschooler. Families who had menus that included calorie content for each item listed selected meals that were about 100 less calories for their kids compared to families who didn’t have nutritional information (calorie count) on the menu. Just by having the number of calories listed for each food item on the menu, families made better choices for their child!

Brilliant and then seemingly simple, huh?  However, lots of fast-food chains don’t readily provide nutritional info. As menu-labeling laws may be incorporated into health care change and reform, this study helps define how important access to nutritional information is for all of us.

100 calories may not seem like a big deal. It is. Over time, just  eating an extra 100 calories every day can cause a child to get fat.

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Over the past 20 years, the amount of calories consumed by children from snacks has increased by 30%. Kids eat a third more calories everyday from snacks! What kids snack on certainly can reflect how their diet is shaped and how they grow. Plain and simple: snacks make us fatter by packing in lots of calories in relatively small bits of food, the definition of “calorie dense” foods. They also discourage our eating of things like fruit and veggies because they fill us all up. One recent study found it was our over-consumption of snacks more than our under-consumption of fruits and veggies that is getting us into trouble.

Beware of the foods in red/orange/yellow packaging; these are generally foods that are not very good for you. Research finds that these colors make you feel hungry, thus advertisers use the colors to increase the likelihood that you purchase (and eat) junk food. Think about food packaging like you think about the threat level at the airport. Red and orange are generally a no-go. Steering clear of this part of the ROYGBIV (red.orange.yellow.green.blue.indigo.violet) food isle is important. As snacks make up more of our entire diet, what we choose to snack on may be as important as what we make for dinner.

Whine with your snack?

Whine-fest 2010 continues in our house. Beautiful. I’ve gotten out my baton and I’m now conducting from a perch in the kitchen. All those years of band (yes, I played the oboe) and weekly orchestra practice are finally paying off. Play date sign-up for whine-fest in our house will be online soon. Guest conductors accepted.

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I had the fortune of seeing Dr Atul Gawande speak last week in Seattle. Truth be told, I entirely invited myself. I heard there was a group from the hospital going and I begged my way in. I sat in the corner.  Flashbacks to finding a seat in the junior high cafeteria. I made it through and forgot all about the awkward act of my self-inviting and seat-finding by the end. Despite my disrespect for Ms Manners and my loud mouth, my pushy ways afforded me the opportunity to witness a leader in medicine.

I enjoyed what Dr Gawande said about his work in using checklists to ultimately decrease complications and death in the surgical setting. I have read Dr Gawande's books (or parts of them, I admit) and many of his articles in the New Yorker (whole thing, thank you). I marvel at his skill and ease of writing, his ability to translate complicated problems and make you feel like you thought of them yourself due to their apparent simplicity. His assertions, however, are not simple. It's just that his skill in expressing his position, explaining the breakdowns in the system and offering opinion wed with solution puts us all at ease. His article, The Cost Conundrum, remains one of my favorite articles of all time. I have read it numerous times and think about it when caring for children on a weekly basis. He has affirmed the way I feel about over-testing in medicine. As I have said previously, in pediatrics so often less is more.

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Meet Luna, our dog. She looks overwhelmed this morning, doesn’t she? I think she is thinking about our short night of sleep sandwiched between a fine nighttime whine and an early morning whine. The whining in our house is overtaking me. Imagine me in a pile of virtual sound, covered up to my nose in noise. Underneath layers of scratchy screech and howl, whine and cry, loudness and complaining, my hands reaching for the sky. It’s loud here. Wanna come over and play?

I’m wondering when our dog will enter into the chorus and begin to howl. She’s a remarkably patient and mild mannered 7 year-old lab but you’d think this would inspire a little bark or something. Her calm alarms. She remains quiet and patient despite the racket, waiting on the sideline for the respite of nap time silence. Silence can feel very present and nearly tactile right now. The presence of something as opposed to the absence.

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The soft spot feels like an epicenter in O’s landscape. As every new parent gets to know their baby, the soft spot is just one of those places and spaces we come to know that makes our baby unique. I know O's little spot is about to go away. Just another thing for me to cry about at the two-year birthday party.

I took a phone call from the husband recently who is a pediatric radiologist and who was reading a head CT scan, inquiring when I thought the soft spot closed in infants, exactly. He knows a lot more anatomy, physiology and imaging of the skull than I do, but he had a common question: just when does it close?  Like so many things in medicine, I don’t think it’s entirely clear. There is no perfect answer. The short answer is around 1-2 year of life. But like so many things, the range of normal is expansive.

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Today while I was waiting for an elevator in downtown Seattle, a man whisked in front of me and another women to get in the elevator.  The woman had on a fancy coat and red, powdery lipstick. She stopped me as I was getting in and said, “Oh, it’s going down.” I stopped and waited and thanked her for alerting me to getting on the wrong elevator. I liked her. It didn’t really faze me that the man had pushed ahead of us a bit, but he had. The woman looked over at me and said, “what a man, can’t even wait for a woman to get on.”

I said, “well, chivalry really is dead.”  As if to state the obvious but also assert the okay-ness I had with it all. Then I said (maybe over-stepping my boundary with this stranger), “funny thing is, yesterday was January 11th and that marked the day that the first woman in the United States was awarded her MD.  And that was over 150 years ago.  So, if I lose the chivalry over those years and gain the opportunity to practice medicine as easily as I do, it seems a pretty good trade off.”

The woman just kind of looked at me, smiled, almost laughed a bit, and then stepped forward as the elevator re-opened. When we got in and headed up she said, “well, at least he’s not on our elevator.”

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One little thing that really gets under my skin if you must know is the title, “The Wife.”  When I hear it, it rings through me, moving and shifting my electrons in just the wrong way.  
I’m sure most of you wives or mothers out there on planet earth don’t really mind it. But I do.  

Here is how I often hear it. Let me set the scene:
Exam room, child center stage, father stage left.  Meaning no harm (or disrespect) the dad says, “Oh, and the wife wanted me to ask you about this rash.”

I remain calm, usually leaking no erratic response, remark, or expression.  This is my issue, I’m sure.   But the internal alarm goes off.  Just something about that woman being distilled to “the wife.”  

“My wife wanted me to ask you about this rash.”               No alarm.
“His mother wanted me to ask you about this rash.”          No alarm.

But,  “The wife wanted me to ask you about this rash.”     Alarm-tastic.

With permission, I’m going to refer to my partner and husband, father of my children, as The Husband. Just to even the field. For today and maybe tomorrow, too. He’s ok with it; I’ve cleared this.  
Thank you, husband, The Husband.

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The soft spot on the top of my baby’s head is one of my favorite places to run my hand.  I don’t know why exactly but it seems one of those places on him that truly represents his baby-hood.  One way I know that his infancy isn’t quite gone and my baby days aren’t over yet. O recently turned a year (so, yes, technically he's no infant) and I have felt his baby-ness slipping through my fingers. I keep saying that to my patients when they ask about him. I am hoping it will somehow prolong this period and I won’t have to wake up and find myself with two grown boys in the house.  

The emotional yo-yo between pure excitement about them growing up, with the simultaneous dread of losing these baby moments, remains real and palpable. The essence of parenthood I suppose is that stew of anxiety-thrill-dread-adoration-excitement as the days unfold and you hope for new things for your little baby while lamenting the loss of precious moments of who your baby is on a Monday in January.  So the soft spot is a good place to go to calm my inner anxiety about my toddlers walking out the door to college.  

As the first year unfolds, it is the soft spot (aka “fontanelle”) in the front/top portion of a baby’s head that parents ask about, the anterior fontanelle. Lots of new parents ask me about caring for the soft spot. I think we all conjure up crazy worries about an errant flying pencil landing in it.

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2 is the new1.

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

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

And you're in the car.

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

Listen up and tell your friends. Scream from the rooftops. 

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

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

My patient: "A really good one."

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

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

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

I had my go.

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

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Sometimes good health feels like magic.  Lately more than ever.  I've had a number of friends and family diagnosed with serious medical problems and medical set-backs in the last few weeks.  Like patients that I have been fortunate enough to care for with serious illness, it scares me, makes me sad, sometimes wakes me up at night. These episodes in illness are disorienting to the order of things. These diagnoses, uncertainties and realities are especially weighty this month amidst bags of gifts, holiday music, lit trees, and piped-in joy. Fear amidst cheer. Ultimately, these diagnoses and fears feel really real and make the rest of life blur.  I suppose I just feel more angular, vulnerable and then compassionate right now. Ever-aware of the good health that surrounds me, too. Perspective defined.

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Ouch. Another recall. But this time for the ouchless shot, the nasal mist H1N1 vaccine. The CDC announced last night that there is recall of about 4.7 million doses of nasal spray H1N1 immunizations. These are nasal spray vaccines used in children (and adults) over the age of 2 years. This is just a set-back in protecting our country (and the globe) from the harms of H1N1. No, not a safety concern. Not conspiracy. Rather, a concern that doses are losing potency over time. Think shelf-life. The issue or concern is that these shots may not have the potency level we want over time to remain effective. It's like that old watercolor you made for your mom in 5th grade fading in the sun.  Or when you run out of Kool-Aid mix and you stretch it to make more.  The worry is these doses may be less effective with time. 

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I heard about the recall of about 800,000 doses of H1N1 shots intended for children 6-35 months today.  The news doesn't scare me at all.  Zilch-o. Zippo. Zero. And I scare easily.  I jump in the seat in the movie theater when it's loud or dark or someone does something scary.  Really.

This recall does not affect how I will continue to encourage families to get their children immunized.  This is not a recall due to safety concerns.  I remain strongly in support of immunizing all children against H1N1, especially those with infant siblings, those under age 2 years, or those with underlying health conditions. 
I heard about the Canadian reports of fever in children after the second dose of H1N1, too.  None of this makes me hesitate.  The H1N1 shot is produced is the same way that the seasonal flu shot has been produced for 60 years. 

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3 year-old boy, overheard when talking to his dad:

"My penis! When I pull on it, I can make it longer and longer." Yes, this is real. Today, Dec 7, 2009. You heard it here first. This is my glamorous life.

Instant proof that curiosity about the body and sex is a normal part of your child’s development. Truth is, by 3 most children are showing keen interest in their own and others’ bodies, according to Seattle Children’s Hospital health educator, Heather Cooper. It’s the answering and talking about sex where we seem to get into trouble.

In January, a study in Pediatrics will be published with some sobering statistics; timing of parent and child communication about sexuality is off. Greater than 40% of children have intercourse before any discussion about sexually transmitted disease, condom use, choosing birth control or learning how to refuse their partner in a sexual act.

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Before O (my second baby boy) was born I couldn't really fathom loving him like I did, F (my first born).  I’m not alone in this, I know.  One of my friends recently told me she was so bewildered by the idea of number two that when she, her husband, her first son and her brand new baby were on the way home from the hospital, she leaned over from the passenger seat and whispered, “I’ll always love you best,” to her first born.  Whew.

It happened though.  Just like everybody told me.   I really love number 2.

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I’ve been quiet. Two reasons: we’ve been sick in our house and I didn’t like the posts I’d written.

It’s sunny in Seattle today.  This changes everything for those of us who inhabit this part of the globe.  It is goodness.  I’m finally feeling more than just battery powered.  So I’ll be speaking up again.

I also got some sleep last night.  All parents know how good this is after days of not having it.  It’s a zebra in the horse world when you live with and care for 2 boys who have colds.

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Today is being offered up as a day to set aside for listening.  Just after a day of thankfulness.  This is kind of a nice one-two punch. Especially when we're often around extended family on this particular Friday on the calendar.  I'd not heard of this until 10am today when NPR posted this on Facebook.

Thanksgiving Day then Listening Day. I like it.

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The holidays are here.  Someone just plopped thanksgiving in my to-do list. I like it. Celebrating with family and friends is one yummy thing in life even in the face of family dynamics-drama.  I know it doesn't feel yummy for everyone.  I'm not trying to sound Pollyanna-ey.  I've had the dark years of holidays, too.  When the being together made me feel lonelier than truly connected.  But, that's not where I find myself now, fortunately.  The people in my life who are less than 3 feet tall also decorate these times together and make it better and better.  Who knew you could get so excited about a little, "gobble, gobble."

The smallest in our family also make holidays more complicated though.  It's the over the river and through the woods part that can be really tough.

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Verbatim: a repeating entry of things overheard while taking care of kids in my clinic.

One of the best parts of my job is coming to know the families I care for.  It sounds trite. It's true.  Over the few years in practice, they have come to know my style, I suppose.  I'm direct.  I don't want families to have to guess what I'm thinking.  I share stories (both the mess-ups and successes) of raising my own kids.  I can be self-deprecating at times if I think it's important and true.  Like I said yesterday, it's hard to do this parenting thing, and hard to do it well and feel glamorously successful all the time.  We don't get a lot of thank-yous from our own children for the labors of providing safety, a roof, food, humor etc.  But we do get them.  Reward enough, of course.

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Evan is 4 ½.  His mom is a pediatrician.  So is his dad.  His mom and I were sharing stories of feeling like inept parents in the face of trying to help families with behavioral problems.  It’s hard to do what we say, and frankly, hard to master this whole parenting thing.  Does anyone?

We were having coffee, trying to get some work done when we downshift to talk about pee. 

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My story of 9 stitches, 2 parents who feel as deflated, flat and small as the bottom of your worn shoe, a near 3-year-old boy, and 1 orange Popsicle.  This is about our mistakes and the dangers of the events that followed moving day in my world, October 31, 2009.

But let's go back in time; history is supposed to be one of our most sage instructors.

Circa 2003.  I took care of a 3-year-old girl in the ER at Children's when I was an intern (my first year as a physician, while training in pediatrics, after medical school). In medical training, there are certain patients that stick out, jump off the exam-room-pages, of the hundreds of patients you can see in a month's time.  I know some will stay with me forever. 

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This blog caters to one principle I’ve learned along the way:  Parents just want to do what is right. The desperate love we have for our children can shock us into good and sometimes bad decisions.  I believe parents search for and sincerely desire simple answers to the How-What-Why–Who, the essence of doing right for their children.  Often it's not a simple, isolated situation, and/or one as complicated as it may feel.  And, the abundance of online noise invokes fear in all of us.  Over time, I hope to illuminate the reality that in pediatrics, doing less is often more.  Prevention reigns.

Parents just want to do what is right.

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Happy Birthday, Blog.  Welcome.  Welcome to Children's. I hope life unfolds easily for you.

We've been waiting for you.  Prepping the room, painting the walls, putting things in piles. We're hoping for great things from you.  I painted the walls yellow, not knowing what flavor you'd be.  I hope we can make you prosper.

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