Parenting

Structure Sunday: The Structure of Summer

Do you ever feel that summer comes and goes too quickly ? If you take some time and think about how you would like your summer to be, you could prevent this from happening again. You might actually make a summer wish list. Just make sure the things on your list are SMART. That is: 

SMART is an acronym for Specific, Measurable, Attainable, Relevant, and Time bound.

I remember thinking of summer as a vast expanse of relaxation, without the structure of the school year. I do think it is wonderful to have time set aside for doing absolutely nothing. But that is not a good way to knock things off your list. 

 

Need ideas for your list ? 

 

Create a summer reading list which must have some fiction and non-fiction. Check your local bookstore, Amazon.com, or Audible.com. Check you local library or the New York Times Bestsellers list. Check the Newberry and Caldecott award winners online for children's books. Check for the Hugo and Nebula awards for the best in science fiction. 

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Get out of doors with the family at least once per week. 

Keep a garden. You must grow something edible. 

Take a trip to the city. You must visit at least one museum. 

Take a trip to the countryside. You must visit one body of water. 

Make something, i.e. a table, or a pair of earrings. 

Learn something new, like French, gymnastics, or coding. 

Have friends over for dinner and board games. 

 

Summer is coming ! Don't miss it. 

 

Food Friday: Cooking With Family

You can't have enough cooks in the kitchen. 

I reflect back on having kids, now that all mine are grown and I have become a grandmother. One of the most gratifying family times for me has been cooking with my kids and their friends. I think I stumbled upon this as an awesome parenting strategy. It turns out that it gives you time to talk. Because it also keeps you occupied, it helps to keeps the tone light.

Cooking a meal teaches everyone tolerance, though slowly. It promotes cooperation, planning, safety skills... the list goes on. It settles people's energy back on the home life and shows how much fun you can have together. I cannot recommend it enough. 

Start early and be relaxed about messes. Having said that, don't be afraid to teach kids to tidy up before beginning to cook; The French call it  "Mise en Place", or to put in place. Likewise, don't be afraid to teach them enthusiasm in cleaning up. And in this matter, lead by example. And to help yourself, have a great collection of cookbooks or Pinterest Pins at the ready for inspiration. 

 

For a great guide on age appropriate cooking activities, click HERE. This is from Rutger's, entitled "Cooking Brings Kids and Families Together".

Cornell Cooperative Extension has a great article HERE, titled "Cooking Together as a Family has Multiple Rewards". 

And from WebMD, "Cooking With Your Children" HERE

 

Here are some books on the subject: 

"Cooking Time Is Family Time: Cooking Together, Eating Together, and Spending Time Together", by Lynn Fredericks 

"The Table Comes First, Family, France and the Meaning of Food", by Adam Gopnik

 

And here are some fun blog posts on the subject: 

The Kitchn

Playground Dad

Toca Boca

It's fun to start in the kitchen with small children. But the good news is, it's even more fun when your kids have grown.

Bon Appetite!

Structure Sunday: The Structure of Family

So much has changed in six weeks. Grandpa passed. His memorial brought a tide of family and friends together. And now our daughter  has delivered a baby girl named Emery Helena. 

Those tasks once reserved for adults have passed to those who still to my eye look like children. Our roles have changed and our titles have too. This morning I heard a call for grandpa, which sounded out of place, on account of his passing,  until I realized they were calling my husband. Mom, which was reserved for me, has passed to my daughter and I am becoming grandma. 

My exact title is still under discussion. I've been working a lot on labor and delivery lately, and the nurses are trying out different versions of grandma,  seeing which ones fit, and which ones will stick. 

I would like to think this is because I do not seem exactly like a grandma.   I think this is true for many women in my situation. Our culture has evolved in such a way as to allow women of my age to continue very active lifestyles. Many fifty something's are much healthier than their counterparts from decades past. The way we can live and the roles we can play at any given age are not nearly as limited as in the past. Perhaps we live less by convention or stereotype than in days gone by. 

That said, a grandmother is still a grandmother and she has a role to play. I and all the other members of my family, seem to have eased into our various new roles without much deliberation, just some common sense. However I would like to give my new role some thought in that I'd like to be a grandmother for the new age. I'd like to teach my granddaughter to code, and I'd  like to go to Zumba with her and my daughter. I'd like to keep what's good from grandmothers past while augmenting it for the present day. I'd like to be grandmother 2.0. 

Structure Sunday: The Structure of a Family Road Trip

Family road trips are traditionally fraught with stress. But yours doesn't have to be. The road trip season is upon us and you will want to prepare.

irst of all let the kids in on the plan. Get them involved in the preparations. It won't hurt them a bit to learn the organizational skills necessary for a small vacation. In fact you can delegate age appropriate chores to kids from 5 To 95 and that will make everyone all the more engaged. 

  • Pick a destination. 
  • Pick a route. 
  • Research attractions along the route and at the destination. 
  • Make sure everyone gets some say on the activities.
  • Go over the fine art of packing light and packing layers. 
  • Make sure everyone has a duffle and a backpack of their own.
  • Choose some activities for traveling. Choose a mix of electronic and paper content. 
  • Choose a mixture of packed food and culinary stops along the way. 
  • Always plan for minor illness and inclement weather. 
  • Plan your stops if there is any question of availability of lodging. 
  • Encourage each traveller to document the trip in their own way, i.e. Diary, sketchbook, iPhone, camera, etc. 
  • Confirm you have necessary charging and connectivity cords, batteries, etc. 
  • As the trip leader, personally confirm the travel arrangements from the condition of your car to the AAA membership.  
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What could go wrong? : ) We ourselves are on the road heading down to Missoula for the Lindsey Stirling concert. It is turning into a bit of a culinary tour since when I left home, I stopped by the natural food store and got a bag of healthy car foods and drinks. Then going past the lake, grandma offered us waffles with berries. In Ronan we stopped by a little red and white taco place and I just knew the tacos would be crispy and hot. They were. Our intentions were then set on a bakery further down the road whose reputation had preceded it. Alas it was closed, but it made a good picture. (See photo.)

 

 

Travelling is an important family activity when learning takes place and memories are made. Takes these steps to make sure that both are good. 

 

 

 
 




Medical Monday: Gardasil Gets an Upgrade

Most of you are familiar with Human Papilloma Virus, aka HPV. This is the very prevalent virus which causes precancer and cancer of the human anogenital area. When I first started training in gynecology, fighting HPV seems like such an uphill battle, since it spreads so easily and is so prevalent. And then came the idea of a vaccine. It seemed too good to be true. 

Gardasil was developed and released. I am proud to say one of my friends was involved. It protects against two strains of HPV known to cause cancer, and two which cause condyloma or warts. Physicians all over the world rejoiced, but adoption rates weren't what we had hoped. 

Gardasil was initially studied in girls and women since the disease caused in women is more common and more severe. And so it was initially approved only for women. I got all my children vaccinated, and even the boys before it was approved for boys. One of my sons did some research after he got his shot, and approached me later, asking, " Mom isn't this just for girls ? " I reassured him that nothing bad would happen. It works just as well in boys and men, who distribute the virus, usually without having any disease themselves.  It eventually was approved for boys. 

Now Gardasil has been expanded to cover NINE viruses ! It is worth noting who is eligible to receive it: 

Boys ages 9-15.

Girls and women ages 9-26. 

 I expect that the age differential in eligibility between boys and girls is simple a case of what groups have had validating studies done, and I anticipate that the boys group will be expanded to the same age group as girls eventually. 

Chilling statistics anyone? 

" In 2013, coverage of at least one dose of HPV vaccine was 57.3% among adolescent girls and 34.6% among adolescent boys2According to the CDC, for every year that coverage does not increase, an additional 4,400 women will develop cervical cancer3. Furthermore, if health care providers increase HPV vaccination coverage to 80%, it is estimated that an additional 53,000 cases of cervical cancer could be prevented during the lifetime of those younger than 12 years." 

reference: ACOG Clinical Practice: The 9-Valent HPV Vaccine 

Gardasil has had a very good side effect profile, with just some arm soreness at the site. We believe its benefits far outweigh the risks. 

To learn more about HPV, please see Pap Smears, HPV and Cervical Health

Structure Sunday: The Structure of Mothers

In my practice, we do gynecology, surgery, prenatal care and deliver babies.  However, sometimes I think we are helping to make mothers. Usually we spend 30 weeks with a woman and then go through some very intense and uplifting experiences with her. Along the way, we learn all about their background. We help them face challenges that arise. We try to address whatever needs addressing from eating habits to referrals for domestic violence. We try to uplift, we try to empower. We try to help them become good mothers. 

At the beginning, I tend to notice the things I need to address, the problems.  But as the weeks pass, I notice the things that are unique and special about each patient. Somehow, the problems and the virtues are all wound together. These complex dynamic women most always do their best, learn a great deal, and are sent home with a newborn, who will respond to everything they are, and the new world they inhabit.

These worlds are seldom perfect. I think back to my mother, the last of 8 children, born in 1917 in Oklahoma to a poor coal miner's family. Her father, once a foreman, had saved his team of men after an explosion deep in the mine. He suffered severe burns and disfigurement. Thereafter, the family descended into poverty. When she was 14, she was married off to an alcoholic older man. I later learned she endured extensive abuse. 

When I was adopted, she was already 45 and remarried to my dad. She was not easy to be with. Even as a young teen, I knew she was not like my friends' mothers. It was only as a young doctor that I began to understand what she had gone through, and the effect it had on her. Without a doubt, she had PTSD. She was angry, insecure and sold herself short. I could go on. I was angry and disappointed at her for not trying harder in life. 

As my medical career developed, I saw more women like her. As my role as their doctor taught me compassion, I developed a compassion for her. But of course, this was near the time she passed in 1990. At the time I lived with her, dealing with her difficult behaviors made it hard to experience the good things about her. Of course there were good things. I can see them better now.

I can remember the joy she had shopping for nice clothes for me, something she never had when she was a girl. I can remember how she liked high heels and going out to dinner. She made excellent pie crust. She admired Jackie O. She loved the sound of black women singing. She loved Christmas, and carols, and gave lots of gifts. She told me my education would make it so I would never have to rely on any man. 

After she escaped her first husband and before she married my dad, she worked in a factory assembling bombers. She was a real Rosie the Riveter. After that, she became a bookkeeper at a firm in Los Angeles. She looked ten years younger than her age, even though she picked up smoking as a young women in order to look elegant and independent. She quit smoking cold turkey on post op day one after her quadruple bypass, but died of heart disease anyway eight short years later. 

I am looking back through time so you can too. I am also looking back so perhaps you will look at the present differently. Your mother may not be perfect. But it is still incumbent upon you to see the good with the bad, to see her as a whole person with understanding, compassion, and appreciation.

I also write to remind us that there is a good mother inside all of us. She just may need a little help coming out. 

Food Friday : Breastfeeding

There are all kinds of peculiar myths about breastfeeding. You may have heard that it is difficult and painful. You may feel too bashful to do it. But I would like to encourage everyone to give it strong, evidence based consideration, because I think it is one of the most gratifying aspects of having a young baby. It does take a little learning, and a little getting used to, but it is more than worth effort. Most first timers take about 7-10 days to get used to it and then they have it down. It is best for babies nutrition, immunity, brain development, teeth, etc etc. For mom, it helps with minimizing post partum blood loss. It hastens return to pre pregnancy weight. Finally, it is convenient and cost effective.

Click HERE for a introduction to what you will want to know. 

MEDICAL MONDAY: The medical facts behind helmets and skiing.

This article is written in honor of my brave niece who is recovering from a ski accident. 

She is very athletic and very experienced. She is not reckless, and was wearing a helmet. Nonetheless, she caught an edge, lost a ski,  flew out of bounds, hit a tree, lost consciousness and went down a tree well. Luckily, a patrol just happened to be skiing right behind her and dashed down after her. She and my sister in law, who nearly passed by the single ski on the trail, hauled her out, and our awesome Alert Helicopter evacuated her. Her helmet suffered a big gash. She got a concussion and some hairline spine fractures. People keep saying she is so lucky that that she was wearing a helmet. 

It wasn't luck. The data and recommendations are crystal clear and their family follows them. I have summarized them here for you. They come from a review article which was published in the Journal of Trauma and Acute Care Surgery in April of 2014. This review combined the findings of 16 prior well designed studies which examined the effects of helmet wearing on both skiers and boarders. Here are some of their key findings: 

  • Injuries in boarders are more numerous and more serious.
  • Incidence of injuries are higher in males, and those under 17 years of age. 
  • A 1996 study showed the average inpatient cost of a skiing or boarding injury to be $22,000.
  • There are 600,000 ski and snow boarding related injuries per year in North America.
  • About a fifth of these are head injuries.
  • About a fifth of these head injuries are severe enough to cause loss of consciousness of concussion.
  • That's about 24,000 people per year losing consciousness or having a concussion with their head injury.
  • The 16 studies collectively showed anywhere between a 30%-60 % reduced incidence of head injury while wearing a helmet. 
  • They also showed decreased incidence of loss of consciousness upon striking a fixed object while wearing a helmet. 
  • Wearing a helmet is not associated with increased rates of other injuries, poorer responses to stimuli, or riskier behaviors. 

The authors concluded that helmets should be strongly recommended and that policies should be put into place to promote their usage. 

My niece is going to be fine. But she has a few challenging weeks ahead of her. She will miss her finals, miss her sports, and end up with lots of physical therapy and doctor visits instead. We are just grateful she is with us and, and still moving and smiling. 

 

 

Medical Monday: Infections by the numbers

Ebola is on everyone's mind. Worldwide the death toll is approximately 2000 people most of whom were in West Africa. People are not aware that it is not easily spread. The odds of getting it in United States are vanishingly small. Sadly there is not yet any vaccine for Ebola. 

To put the death toll from Ebola into perspective consider these numbers: 

9,700,000 children under five per year die from  preventable disease.

250,000 per year,  probably more from flu or flu related complications. 

100,000 per year die of measles of cholera 

1,500,000 per year die of diarrheal disease

Now let's consider our little corner of the world, Montana. Flu season officially started at the end of September. This year Montana has had 5 confirmed cases so far. However, in the previous reporting year we had a total of 3192 cases, 313 hospitalizations and eight deaths that attributed to influenza, with the bulk of cases being in December and January. 

What about Montana's other common preventable infectious disease ? It's Pertussis of course. It is also known as whooping cough. However in the previous reporting year we had a total of 661 conference cases. There were 361 hospitalizations and 15 deaths, mostly of people over 65.

Our scourges, flu and pertussis,  are vaccine preventable diseases. What about theGuillain-Barr syndrome (GBS) , or temporary paralysis ? It too has been studied and it's incidence in the US is around 3000-6000 cases per year whether or not a vaccine was or was not received. It has been determined that one is much more likely to get GBS after flu than after a flu vaccine.

 As I look at the disease rate time charts for prior seasons of each of these vaccine- preventable diseases, I see that we are right ahead of the big bumps in numbers of cases. I hope we get ahead of the curves this year. Pertussis and flu vaccines are available everywhere now. 

 

Ending Bullying; Changing the way we make change

As I write, many of my friends in California are reeling from the tragedy in Santa Barbara. I write to highlight that once again mental illness and bullying are at the bottom of it. 

Clearly we have not done enough to address these two issues. I don't have the answers. I do know a systematic evidence based approach is necessary to address the problems of both mental health and bullying. From my perspective as a physician, the mental health community already has a good grasp of the problem. I'm not so sure about the teaching community. More importantly, and sadly, whatever insights and interventions these communities possess, their implementation of them is sorely lacking.

I studied diffusion of innovation as an undergrad at Stanford. A new belief, outlook or a behavior is actually an innovation of sorts. Sometimes we call them memes, a repeating, or contagious entity.  I believe we ought to leverage our understanding of memes, innovation and behavior change to tackle the problem of bullying. We ought to bring in the experts in this field: ADVERTISERS. To really make inroads into the darkest corridors of middle school, or the supervisor's private meeting at work, knowledge of bullying and it's solutions must permeate our culture.

What work that has been done thus far, seems to have, perhaps of necessity,  focused on the victim, and the bully. However I feel, and this is not evidence based, we must turn now to the people who hold power: Teachers and popular children. In the literature of innovation, it has been found that  there are certain index figures, also called champions, influencers, or early adopters. It is these people that need to be identified and leveraged for this most important cause.  

Some helpful references :

stopbullying.gov

http://www.apa.org/topics/bullying/

http://www.thebullyproject.com

http://www.bullyingstatistics.org

http://www.nlm.nih.gov/medlineplus/bullying.html