Wednesday, December 26, 2007


Much has been made of the loss of tradition in the family and I think that loss is a bad thing. Ritual has a place and our children are none the better for its absence. Some ideas about ritual and tradition are:

Bedtime ritual: whether it's bath, book, and bed, or some other variation on this theme, it's a good idea to have a ritual that tells a child that bedtime is approaching. Then when the time changes or you're on vacation or some other unusual situation, that ritual adds a normal flavor to an abnormal circumstance, and kids and parents alike will benefit.
Mealtime traditions: my son's girlfriend's father has a rule against kids wearing hats at the dinner table. No matter where or when, it's not OK to have on a hat at a meal.
No phones, TV's, ipods, etc., at mealtime. That's a great tradition.
There is great support in family psychology literature for the importance of the family meal. I preach on this in my office regularly. Dinner is at a certain time, at a set place, or at least an agreed upon place, without distraction, every night or enough nights that when it is missed the kids will notice and miss it. The importance of this, starting when kids are very young, is hard to overstate.
Special traditions: ice cream after church or Friday night pizza. Good examples of "sins" that most of us would like to indulge in occasionally but need to keep to a minimum. If the family goes to church on Wed. night (i'm in Oklahoma!), then a trip to Braum's for ice cream is a reasonable tradition and one that gives the parents of an overweight child or a child that isn't always making the best food choices an "out" and a response to the request of that child for ice cream or other treat. It seems like a lot of successful weight loss/diet programs have a "free" day built in - we have to have ice cream sometimes! The point is that if there is a situation where a child is always wanting dessert or pizza or something that isn't good all the time, a tradition of Wed. night ice cream or Friday night pizza is a "safe" and "legal" opportunity to indulge that can be looked forward to by that child or the parent of that child when he/she asks. It's not just for that, though. The regularity of such tradition is reassuring to children and lends more credence to the family mentality so often missing in our soccer practice society (my pet peeve).
Be careful in establishing traditions or continuing traditions. Some traditions are best left in another generation. I won't mention any in particular, but the story of the women discussing why they cut the ends off the ham before cooking it is a nice illustration of tradition continuing without reason to continue. Just be sure the tradition is a good tradition, or at least is harmless.
respond with your traditions and idea for rituals and traditions.

birthday boxes

OK. I'm asking for help here. If anyone reads this and is interested, I've borrowed a concept/idea from somewhere, and if I find out where I will be glad to give credit, but here's the idea:
Birthday boxes: a box that a child opens each year. The box contains a list of privileges and responsibilities for that year or age. For instance, when can a child have a cell phone? a date? spend the night with a friend?
when should a child - empty the dishwasher? make their own bed? be responsible for their own laundry?

the idea is a good one and one that bears examination. i've ordered some books on development so i'll be an expert soon, but until then...i'd love the input of parents as to the answers to these and other things that might go in the boxes.

as far as sibling rivalry goes, this is a great concept. as far as the answer to that question your child asks at just the wrong time in just the wrong company, this will be helpful.
with siblings, the eldest is the one who "shovels the path" and then the others are coming up quickly behind and getting the benefit of the plowed road without the work, metaphorically. so when you decide that your 8 year old can spend the night with a friend but the friend has a 6 year old who is a friend of your 6 year old, it's pretty easy and tempting to let your 6 year old spend the night, too, right? but is that fair? ok, nothing is fair, but the birthday box idea puts down on paper these sticky questions and adds concrete to the ideas we have but so easily dismiss in the heat of the moment.
so...what can kids do at various ages? it's easy up to 5 years or so. but when do they get a cell phone, ipod, computer...? you might want to put "electronic/digital media device of current technological significance and popularity" to cover for the fact that my parents wouldn't have thought to put an ipod in my 48 year birthday box! you get my meaning. things are moving too fast to put the specifics down for certain things, but the basics will apply forever - spending the night, going to a movie, going on a date...
help! i'd love your comments.

Saturday, December 1, 2007

true love

I read an article in People magazine today. I know, my wife bought it, I wanted the National Enquirer that told whether this or that celebrity was gay or not. I'm not sure if the opinion is that it is a good or bad thing anymore, and as they say, any publicity is good publicity, but I hope I'm never on a cover with that title. Well, there was an article in the back, behind all the junk about stars and what they're wearing and who they're seeing and used to see and have procreated with and the progeny thereof, etc., that struck my fancy.
At first, from the title "Her Husband's New Love", I thought, "here we go again, a cheating husband, a scorned ex Supreme Court Justice. But the very short story, tucked between stupid crap like Wheel of Fortune's 25th anniversary and Wayne Newton's heart problem keeping him from "Dancing with the Stars" (funny, I thought it was his dancing that kept him out of that), was about Sandra Day O'Connor and her husband. He has Alzheimer's, she resigned from one of the most prestigious and unassailably secure jobs in the world to take care of him, her husband of 54 years. Wow. I'm a fan already. She deserves praise and recognition for that, more than on page 129. But since she didn't kill him or try to kill him, and since he didn't meet someone online and leave her, it's in the back. But it's a great story.
True love. Jesus said "Greater love hath no man than this, to lay down his life for his friends". At first you think He's talking about dying, and I suppose He was/is, but laying down a life while living is maybe harder. See my wife's blog at and read more of that on today's post. Well, Mrs. O'Connor's hubby, the one with Alzheimer's, has moved into a facility where he gets the care he needs around the clock. This is not a copout for her, to care for patients like this requires more than just a loving spouse, and I'm sure this place was well researched before she sent him there. And she visits him there a lot. Heck, she quit her job to help take care of him. So, when she visits, he doesn't remember her. Doesn't know they've been married for over half a century, or that she was one of the most powerful women in the world. She's just a lady who comes to visit. And he's got a girlfriend. Yes, that's probably why People picked up on it. He's got a girlfriend he met in this facility. When Justice O'Connor goes to dinner with him, he often brings the "other woman". Does the Judge go bonkers and demand separate facilities or a restraining order for this hussy? No, she approves of it. She understands that he doesn't know her and what he is doing, and she cares more about him than about herself. That is laying one's life down for a friend. That's true love. I'm sure there are many stories like this around, but unfortunately, they don't get publicity because we want "dirty laundry" as Glenn Frey or Don Henley sang, it was one of those Eagles.
True love. What a concept. What a visible example in this day of wanton selfishness of which I'm as guilty as the next guy to look at the car wrecks and divorces and arrests and addictions instead of the good stuff. Jack Johnson sings a song "Where did all the good people go". It's real good.
Way to go, Judge. If I published People, you'd be on the cover.


No wonder everybody's got ADD now. You can hardly go into a restaurant without a TV being visible from every seat. The distractions offered are often mundane reruns of football games now, but they are distracting nonetheless.
Unless you go to a pretty upscale restaurant you'll be assailed with the option of talking to your tablemates or watching the TV. Maybe it's ingrained in our brains now, but TV's are hard to ignore, harder than ignoring our spouses, it seems. Funny how it seemed the other night that if I asked to have the TV turned off I would be breaking some unwritten taboo of the restaurant, though the other tables nearby didn't seem any more interested in the rerun of the game than I was. Why was I so afraid to ask? Why don't I just tell them to turn off the TV by my table if everyone around agrees? Or if we're the only ones there?
Even when I make rounds in the hospital to see newborns, the TV is almost always on, regardless of the time of day or the program playing. It's just like background noise. It's a rare occurrence now that a mom or dad turns it off while I'm there. Some turn it down, rarely off. Maybe they don't have ADD like I do when I'm in a restaurant.
Now in a sports bar or a sport-oriented restaurant it's expected that a TV will be playing, and several games/sports may be offered at once depending on how one wants to be seated. I've even gone to specific restaurants to see specific sporting events. But when I'm going out to eat at a reasonably nice place, does there have to be a TV in every corner? Is it that the management is told from the owners that TV's were high on the opinion poll they did so they added them in response to the few people who fill out those surveys? Who knows? They are there and they are hard to ignore. If they weren't there, they'd be easier to ignore. Am I the only one who has noticed this or been annoyed by it? It seems to be a cultural trend to provide some sort of visual or auditory entertainment at all times and if one is left in the quiet with one's thoughts or one's spouse or friends it is an affront to societal norms. People might start talking about important stuff, make important decisions, have quality relationships, and who would that benefit? We might actually listen to each other, or read, if noise of an auditory and/or visual nature wasn't a constant presence. Is this subversive? Are they sending subliminal signals through ESPN? I doubt it. In fact, I'm pretty sure it's just because we swallow whatever they put in front of us most of the time without question and we watch because it's there, not necessarily in the same vein that people climb Mount Everest because it's there, but similar.
OK, off to watch TV.
Just kidding. In closing, I'll share my favorite 2 bumper stickers from a previous life in Boulder, Colorado, where things like this are debated on the editorial page as if they matter as much as who the next president is going to be (and maybe they're right, since TV will at least play a major role in that process): Subvert the dominant paradigm, and Question Authority. As long as it's not my authority you're questioning or my paradigm you're trying to subvert, these appeal to me. At least I'm honest.


OK. Another teaser title. I am definitely pro-life, make no mistake, but this is about other choices, not the life and death ones.
Parents want a say in their kid's medical care. I understand and respect, and even expect, that. They can go and get another opinion, they can challenge diagnoses and medication choices. In this day and age of insurance Nazi tactics, they are forced to do things they don't want to do to get to where they need to be. But that's another rant.
My wife likes to decorate and design, to put her "touch" on things to make them more beautiful or functional or both. She is very good at it. In buying or building a home, she has definite ideas. She knows what she wants and why she wants it. I've learned, at least most of the time, not to argue. The builder or tile-setter or painter or concrete guy or landscape designer or plumber can give her good reasons why her ideas can be done or cannot be done. And she's good at listening to them and usually agrees if they disagree. She doesn't, however, usually inspect the work of the guys who dig and lay the foundation and pour the slab, prepare the ground before these things occur, or have much input into the earliest stages, stages that make a house stand up to high winds and rain and tornadoes, etc. She trusts that they are doing that part right. They are experts, and she's chosen them because of that expertise, and her (and definitely my) lack of it in these areas.
To my point: Parents can participate in all decisions about their kids' healthcare if they like, but there are some areas in which the expertise of the physician should be trusted and left to faith since they (usually) chose this physician because of his or her expertise and reputation. Let them pick the wall colors and ceiling fan stuff. Stuff like which formula to feed, or whether to breast feed, but one must feed the baby. They can choose the crib and bedding, but let the doctor tell them how to let the baby sleep there. To school or not to school, fine. But you must teach. But it's interesting how people seem much more willing to argue with a doctor vs. a plumber over the best course to take to solve a certain problem. Granted, the parents live with the child. Well, at least one of them usually does, and when divorce happens, it's like two people whose interests couldn't be reconciled together trying to build a house apart and wondering why it looks like neither of them wanted. Once again, another rant. So, firsthand experience with the child and the behavior or illness is very important, and should be something the doc takes seriously. But then let the doctor tell you what to do some times. Not every time do you have to go with that, but the vast majority of times we know which ceiling fan will work in this room and why, and if you insist on the one you want because you heard about it on Oprah or the Today Show, don't come running to me when it falls out of the ceiling or gives you a buzz haircut because the ceiling isn't high enough for it. Parents are fearful, for instance, of steroids for asthma. Concerns about growth failure and immune suppression abound. Same with immunizations. But docs do have a little experience dealing with asthma and what works and why and why an inhaled steroid might work better for your kid than Singulair or vice versa regardless of what you read or saw or your neighbor told you or your good friend the urologist whose asthma expertise never materialized to begin with. Deep breath. It might do parents some good to listen to their docs more before putting in their two cents, and I agree the reverse is true as well, but if parents listened and did what the doc said, then if things don't work out as forecasted, it's the doc's fault. If I recommend a course of action and you take it and do it as I've prescribed, and it doesn't work, shame on me. I'll be doubly invested in finding another way that works for your child. If, however, you've already picked the road to take and I let you go down it, when it dead ends into failure, my first response is going to be outwardly, "gosh I'm sorry that didn't work out like you and Oprah thought it would", but inwardly know that I'm saying "if you had just listened to me this might have worked out differently". Those who know me recognize the "good luck" theory in practice, and I'm more than willing to be the "parent" in this scenario, but I hope that the "kids" learn from their mistakes.
I absolutely do not want total control of my patients. It scares me to think that some people go home and do things just like I told them to because I am so not used to that that most of my advice is 50% tougher than it needs to be to compensate for the 50% compliance rate expected of most parents. And I expect my parents to have, and use, brains. Theirs, or someone else's if need be. If they are seeing a problem that worries them, they are to call, or email. If it's a bad problem, like an allergic reaction to a medicine, they should stop it and call. But to follow my instructions blindly is not my intent. To tailor them to their liking is also not my intent. It's amazing how many constipated kids on miralax get better so guess what? Their parents stop the miralax, then they call and wonder what happened. Did you ever think the reason billy was better was the miralax? Or that the Singulair they've been taking is why they've not had any cough or wheezing? I'm all for keeping kids off medications if possible, but if not possible, and proven not possible, then just give it! It would be like me telling the builder that we haven't had any water problems yet so don't go ahead and put that roof on that we had planned, we don't seem to need it, and it really costs alot, even though there has been no rain! Or since we haven't had any burglaries we can just get rid of our security system - maybe that's why we haven't had any problems!
Enough on this. If the point isn't obvious, let me restate/summarize. The doctor is at least allegedly the expert in medicine, so let the doctor decide what's best, given your input, and go with what the doctor says, and see how things go. Your doctor might faint if you say "you're the doctor, just do what you think is best", but he/she will appreciate it. That may be why my dad, a pediatrician in another era, could see 80 patients in a day, and I'm busy with 40!

Thursday, November 22, 2007

the rant

Sometimes I see things better in word pictures. These come to me sometimes out of the blue and other times are provided for me by my observations. The current series of VISA checkcard commercials has given me a wonderful metaphor for our lives today. With all the people scurrying around in dancelike, trancelike harmony with everything and everyone juggling perfectly until someone chooses to pay cash or write a check, then everything goes to hell in a handbasket.
In our busy lives we are so much like this. We schedule things so closely that we need everything to go the way we planned or everything crashes down around us. We plan vacations for short school breaks to take our kids places that they only want to see because their parents think they need to, and they leave right after school and return the night before school starts back, and the "break" is definitely not a break for anyone but the bank. Why do we do these things? Why are we so busy? Another provided metaphor is from "Field of Dreams" with the famous line "if you build it, they will come". And come they did! If you offer it, they will sign up. Whether it's gymnastics or cheer or soccer or baseball, you name it, they'll come. They'll sign up and buy a uniform and commit a 3 year old to a year's worth of lessons when all she said was "I want to be a cheerleader, mommy". She doesn't have to start at 3 to be a cheerleader, or does she? Every parent thinks their child is going to be a professional at their activity, or at least get a college scholarship. The disappointment starts when Junior would rather climb a tree than kick a ball, or little Sally doesn't want to go to gymnastics anymore when she could be so good if she would just practice.
We've idolized sports. Not just sports figures, but sports in general. Parents are reprimanded by friends if they don't have their child signed up for at least one sport per season by the age of 3. Have you ever watched 3 year olds play soccer? Or play anything? Herding cats is easier than getting a 3 year old to figure out which goal he's supposed to kick the ball into or which way to run after he hits the ball off the tee (who invented tee ball, anyway?). The best that can come of such an activity is that you have the next Tiger Woods or Andre Agassi or Alex Rodriquez on your hands, you'll be set for life. But far more likely is you'll give up precious family time and freedom in your life and end up with a kid with a stomach ache or sore shoulder or chronic injury who was so good at baseball at 12 but now is either burned out or injured so that college scholarship is down the drain and you're stuck paying shrinks and orthopods to fix what you messed up.
Then there's school. Who doesn't want their child to excel in school? Let's start really early with Baby Einstein and teach her some Spanish and she'll be way ahead of the other kids. Guess what? She doesn't want to be way ahead of the other kids! She wants to be just like the other kids. So if you want your child to do some of the things you want her to do, and act the way you'd like her to act, don't send her to school until you have to. Once you let them have her, you're having to explain evolution and gay rights and tolerance and you don't even have solid opinions on these subjects yourself. You'll have to listen to "teachers" at preK tell you he has trouble focusing, or she can't sit still, or he seems uncoordinated. You'll bring them to me and I'll tell you they're fine but you'll have a friend who will tell you to take her to this or that doctor who will give them some therapy regimen and a diagnosis or medicine that then you want me to write the prescription for because otherwise your insurance won't pay for it and you'll say that you really trust me but you just felt like you had to pursue this, yada yada yada.
Face it, your child is probably not going to be a professional athlete or a national merit scholar. He or she is probably going to be just a normal person with normal intelligence and aspirations. If you set up your expectations in another way, you will be disappointed. You will also make your child crazy or depressed or anxious. They will sense your frustration with quitting soccer at 6 or not making the classic team or not wanting to spend 20 hours a week at the gym or ice rink to "go to the next level". Let them be kids! Enjoy them! Don't you remember? I do. I was the gifted piano player with perfect pitch but I wanted to climb the mimosa tree outside the piano teacher's house more than I wanted to play piano at age 6, so I quit, and now I wish I hadn't, but you know, it's OK, I'm OK with it. It would be great to know how to play piano, but not being able to play piano hasn't made life unbearable. I've made it just fine and found other things to do. I've channeled the tree climbing into more cerebral activities and I've been able to stick to some commitments long enough to see them pay off.
So...relax and let life come to you. You don't have to "grab for the gusto". Don't worry that you'll miss the chance for your child to excel at something. Rather, enjoy life. Enjoy your kids. Come home and kick the ball in the yard. Ride bikes. Teach them to hit a ball. No teams, no practice, no schedule. Do it because you like it, and they'll like it, too. You were not allowed by God to have children to schedule every minute of every day just right and if you don't you're going to hell. You were given children to enjoy, to instruct and train in what's right and in the truth about Who created them and this marvelous planet we live on and why we want to be nice to other people and let them ahead of us in line sometimes and share, and not be so tightly scheduled that if your kid breaks his arm or gets pneumonia you'll be more concerned about your child than the plans their misfortune messed up.

x rated

OK. Teaser title, I know. But it is about 'x's.
What season is upon us? Christmas, right? So when you see Xmas, the X stands for Christ, right? All my life I've avoided using this abbreviation. I'm sure someone told me it was wrong or bad or something, but whatever it was, it stuck and to this day I write out the whole thing, not wanting an 'X' to stand in place of Christ. It's kind of funny how there are things like that, things that have become a part of me of which I do not know the origin, but I feel very strongly about and would defend even without good reason because I grew up with that thought or belief. That's another topic too vast to study today.
Now I find I'm faced with another 'x' dilemma. It's been around a long time, too, but has just started burrowing into my conscience and consciousness. My address ends in Crossing, and the post office even abbreviates it 'Xing'. One could use the same logic I used with Christmas and say that the cross is what Christ came for to this earth, and it is no more appropriate to substitute an 'x' for it than for the name of Christ. But there were crosses and crossings long before Christ's death on the cross, and the word cross is used regularly without any blasphemy in describing a mood, a journey, a meeting of two roads, and so on.
I must admit that using 'x' instead of cross in crossing in my address is much easier, and since the post office seems to be approving of it, even encouraging, I'm tempted to continue.
But there is a difference. To substitute 'x' for Christ is not a good thing in my opinion. Maybe it makes sense in making signs, fewer letters, easier to spell. But the 'x' in xmas stands for Christ, and to my knowledge, there weren't any Christs before Jesus and none after, and the word means what it means and stands for the Savior of the world, so to leave it out for the sake of signage and spelling when it is the sole reason the holiday is celebrated is to insult the One who came and died on a cross, spelled out or 'x', for me and you, so I'm staying away from xmas in favor of Christmas, but if it's ok with the US Postal Service, who now seem not to even care about the city where one lives as much as the 5 or 9 digit zip code attached, I'll keep abbreviating Crossing as Xing.

Sunday, November 18, 2007

parent used to be a noun

When did "parent" become a verb? Sometime before I started pediatric practice 20 years ago, but not too long before. It used to be that you were a parent, it was something you were vs. something you did.I guess when you were a parent back in the day you did it, too, but maybe you weren't so conscious of the doing part, more just the being part. The realization of the daunting task of being a parent and doing the job of parenting has made for some interesting problems. Every decision we make could affect our children now or in the future. We hear about people whose lives were affected by things their parents did and said. Some of those people were damaged irreparably, others seem to have made lemonade out of their experiences. Some are nondrinkers because their dad was an alcoholic, others are alcoholics, too. It seems to depend less on the experience than on the person.
To look ahead as a parent of an infant and to think of the many decisions that will need to be made and the things that need to be done in order to make sure this child grows up to be a mature human being who is socially and fiscally responsible and God-fearing and a good wife/husband/mother/father, can make even the bravest person cringe in fear. I don't think God does things like that to us, we do it to ourselves. He hands us "bite size" pieces of life to handle, then He hands us the next thing, and so on throughout life. Maybe what we are doing to ourselves as "verb" parents who think we really control our child's destiny is to believe what the serpent told Eve in the Garden - that we can be gods, like God, and know right and wrong. To see, or to think we see, the future and what must be done, that's what the serpent was offering, and it probably sounded good to Eve at the time, and it still sounds good to us. Maybe nowhere does it become more obvious than in the anxiety of parents.

Saturday, November 17, 2007

it happened back then, too

I'm reading a book set in the 14th century when monks were the doctors and nuns were the nurses and people who needed medical attention were either treated by these monks and nuns or by the barber/surgeon who knew how to fix things like bad cuts and broken bones or the "wise women" who knew about potions for pain relief, bellyaches, etc.
Since the Church sanctioned the monks and nuns and not the barber surgeons and wise women, guess who were considered the experts? Of course, monks and nuns. But, just as today, as 80% of people in the US are using some sort of alternative or complementary medicine, like supplements and herbal treatments and chiropractors and naturopaths, and many others too numerous to mention, people in the 14th century had their own opinions about the experts and the braver or more rebellious of them voted with their feet and went to the alternatives for their fixes.
The monks at that time "bled" people and felt that would cure illnesses by releasing "bad humours" and probably like today, people got well despite their treatments, rather than as a result of them. Poultices with goat dung and other ingredients were applied to wounds and burns to "bring out the pus". It's so easy to criticize that ancient method of bad medicine. But it was the prevailing theory at that time. Some physicians from muslim countries were figuring out things like contagion and sanitation, but of course they were "heathen" and their treatments were regarded as such.
Fast forward to today, where the standard treatment for a common problem, high cholesterol, is a medicine which causes a deficiency of coq10 which weakens the heart muscle so the patients die of heart failure and not the high cholesterol. Or the medicine causes problems in thinking in the elderly, a population with enough problems thinking without the help of medicine. Superbugs are being "created" and then the hungry media eat it up and scare people into thinking every pimple is a deadly disease.
But the current medical establishment is very much in favor of a pill for every ailment and a test for every symptom, and even with no symptoms, a screening test to look for problems you might not know you have. All this with the assumption that man can fix all of his problems as long as he has a diagnosis. And that diagnosis can probably be blamed on someone or something which you can sue or at least blame for your condition.
So, 600 years ago the medical establishment offered bleeding and goat dung poultices in the name of science, and now we offer statin drugs and antibiotics and mri's and genetic screening tests in the same name. My wife is very wise and says that what we are doing is the best that we can do with the information available, but are we? John Mayer, a singer-songwriter of a younger generation, has a line in a song that says 'if you trust your television, what you get is what you got, 'cause when they own the information they can bend it all they want'. In the 14th century it was the church that owned the information, and today it's big medicine and the media, and together, wittingly or unwittingly, they are making people sicker, or so it seems to me, and the brave and rebellious are seeking help outside of the "normal" channels and are questioning what we, as medical practitioners, are doing. Are people getting well because of or in spite of what we do?
I like to tease a naturopathic doctor of mine that we have our box of treatments and tests, and that "they" have theirs, but that over the years we, as allopathic "western" physicians, have taken things out of their box and made them ours and take credit for them, whereas they are limited by the lack of prescriptive privileges from stealing anything out of our box (if they even wanted anything out of it!). Examples are probiotics, omega 3 fatty acids, antioxidants, just to name a few of the "newer" more popular things now touted by md's who a generation ago said they were hogwash. And I'm not innocent here, lest you think I've known this all along.
More to come on this most definitely radical thought.

tornado time outs

OK. I'll catch heck for this idea, but what's a blog for?
You know those "safe rooms" everybody seems to be putting in their houses? I'm really talking more about the concrete rooms above ground in the house than the "fraidy hole" basement rooms, but they could work, too.
How about making those rooms work for you year round and year in and year out instead of just when the weatherman says to "take cover".
When designing the room, put a drain in the center of the floor and slant the floor toward it for drainage. Pad the walls like in gym at school with something like wrestling mats. Splurge on a video monitoring system for the room if you like. A metal door with a small slot in it is a necessity, too.
So, in infancy, at the fussiest time of the evening and he won't quit crying and you've tried everything and you're beginning to understand how people could shake their babies, put the baby in that room in a nice crib or pack and play, shut the door, and go take a shower or weed the garden or listen to some music. Not neglect or punishment, just a little separation for sanity's sake.
Toddlers will do well in time out in such a room, with the drain and the padded walls and video surveillance, and making a child's room safe for time out is pretty hard and moms often wonder if they will associate their room with punishment, so this is the ticket. This technique will work through early childhood.
In the grade school years, maybe something could be put in there for a good study place. The distractions could be kept to a minimum and homework might be easier and more separate from the rest of the house. Staying on task would be easier away from the TV and the bustle of the home, and perhaps the child would be more likely to want to finish quicker to be able to join the family activities - not that homework is punishment, but that it needs to be done and done in a timely fashion, and distractibility is on the rise! I'll write my opinions on how much homework kids are asked to do in a later blog.
Now for the teenager: either a cool place to get away, listen to music and not bother the family, or a good place to do a more serious "time out" if needed. I've got friends and patients dealing with kids who are not bad enough or old enough to go to jail but are continually getting in trouble and causing the family anguish and endangering themselves. In these cases, the metal door and padded walls and the slot in the door would come in handy. This is probably illegal, and I'm sure many child psych folks could shoot holes in this idea for this age group, but it sounds good! Put him or her in there when they won't stay home or when they are threatening suicide, lovingly tell them it's for their own good, then shut the door and let them out to use the bathroom and you can put food through the door slot. Well, it sounded good.
Maybe it's a little much for the teenage "prison" but the quiet room and the time out room and the study room and the crash room are certainly things that aren't impossible to do. Give it a thought.


Parents, listen to me, save your money. One year olds, two year olds, even three year olds really couldn't care less about a big birthday party. They sense your tension to provide the perfect party, cake, gifts, place, guest list. I'm really concerned about what these kids' weddings will be like when the mom spends so much time and money on a toddler's birthday!
My crass, "guy" idea is that for the first birthday you tell people to pick out the gift they would have bought, then give the child the money instead, put it aside, save it. Do the same for the second and third birthdays. By the 4th, the child may actually care about some of the aspects of the party, so spend some of the cash you've saved on a cool place or party or gift, or all of the above. There will be money left over. Continue having most of the relatives give money. Oh, 3 year olds seem to care more about the cake than the gifts or the party, so splurge on that at 3, otherwise keep it simple. By the grade school years, there will be friends from school, church, etc., so some sort of party is probably necessary, but this is not a "keep up with the joneses" deal. A simple party is plenty. Watch MTV "My Sweet 16" to see what kind of brats are being created by some parents with more money (or credit) than brains.
If you know my teachings, you know the concept of Frontier City before Six Flags and Six Flags before Disneyworld. Think of birthdays like this. You will always tend to try to top the last birthday so don't take your three year old to Disneyworld without considering you're going to have to get passports to go to Jamaica or Europe or something once you've set that precedent. And you may have more than one child, so think about "remember what you did for ....'s birthday?". There is a limit. Be kind to other parents. Maybe you should get together with your friends and discuss this subject before susie's mom has a princess party for her at the Disney on Ice performance and you're scrambling for something to top that!
Enough on this, just a final summation and admonition: Think about the long term, not just this year or this child. Think of other parents perhaps less fortunate who may well be pressured to go into debt to satisfy their little susie.
And one idea - as kids get older, try doing "giving" things for birthdays, such as organizing a yard cleanup for a little widow in your church or town, or picking up trash at a park and having pizza afterward. You'd be amazed at how memorable such a party would be, and not just to the kids and your wallet. Let your faith shine, especially to your kids. We tend, at least I do, to profess a faith that too quickly gets tossed aside when such things are facing us. Be creative

why every mom should spend a day with me

Every day, moms come in and it is obvious that they think they are the only moms with the concerns they have. Whether it is an illness or a behavior problem, to them it seems that their kid is the only one with the problem or illness. Many problems are not things moms admit to each other at the gym or the soccer field or at school or work with other moms - things like bedwetting or suspected depression or drug use in a teenager, or a toddler whose fits are bringing her to tears. To show weakness in our world today is considered poor form. To not have all the answers and all things under control in your world is somehow a sin.
So, if it weren't for the almighty privacy laws, which could probably be waived under the right conditions, I wish moms would spend just one day with me. Some might need more, some less. But about the 3rd checkup where the baby isn't sleeping or is sleeping with the parents or the toddler keeps getting up and coming into the parents' room or the child is always sick when he goes to his dad's house or the grandma is driving her crazy pressuring her about the potty training or the child not eating get the picture. I think it would be enlightening for them. Freeing in the way that finding out other people struggle with the same problems and thoughts that you do is freeing. This is not to say that I can solve the problems, but as I get older I realize that the acknowledgment of the existence of the problem and that it may suck, but it's shared by many others, is better than a quick fix. The visiting mom may gain insight from another mom's ideas, or have an idea about the problem that the other hasn't considered.
It's just an idea, one that may never materialize, but I think there's merit in the thought. Parent groups meeting after hours meet some of the need. But so many "regular" people don't come to those, only those who recognize or admit they have big problems, and are willing to seek help from others. I would love to have well child check counseling sessions for different age groups as a group format, to teach and answer questions and let the moms answer each other's questions. Just an idea.

Friday, November 16, 2007

small thoughts

it's amazing how people didn't mind taking so much medicine until they started having to pay for it.
when you feel forced to do something, you look for ways to sabotage the situation. (remember this, moms and dads, your kids do this everyday)
We can all see God in exceptional things, but it requires the culture of spiritual discipline to see God in every detail. Never allow that the haphazard is anything less than God's appointed order, and be ready to discover the Divine designs anywhere. that's an oswald chambers' quote.

Wednesday, November 14, 2007

rule out

Let me tell those of you who are not physicians a little bit about medical school.
Those big thick books about anatomy and physiology and biochemistry and pathology and lots of other things are full of information. When I was in med school, I think computers had been invented, but I'd never seen one and never dreamed of owning one. Nor did I dream that all the information in those big thick books would fit on a piece of plastic the size of my fingernail, and it never dawned on me that this information would be of interest to anyone besides a physician and perhaps the patient with the problem described in the book.
That said, the 2nd year of med school is pretty much all about what can go wrong with your body - pathology. I distinctly remember going home every night pretty sure that I had some strange tropical disease that was very rare but whose symptoms were headache and fatigue, things that are common to the average person. But I attached those symptoms to the disease I had just studied. Every night, pretty much, no lie. Later, as a pediatric resident, my wife would ask me at what age our children would need to be before she could stop worrying about the diseases I came home and talked about having just seen in the hospital or clinic that day - cancer, meningitis, cystic fibrosis, you name it.
Well, the thing that helped was something we are taught, or at least we used to be taught, in med school. The differential diagnosis is a list of the possible things that could cause the symptoms and findings in a person a doctor is seeing. If you watch House, that's what he writes on the board, weird ones and all. Then the most difficult and gratifying part begins, ruling out various things on the list that the patient doesn't have. "Rule out" used to be a diagnosis, actually, or we used it as one. It was a temporary diagnosis if you thought they had it but the test wasn't in yet, like "rule out strep throat" or "rule out meningitis". Then there are the times it was used to mean you didn't really think they had something but they, or someone else, thought they did. "Rule out brain tumor" was a justification for a ct scan for a headache. It gave the reason for the test, but was more often code for "I don't think he's got one but I have to test for it".
Now we aren't allowed to use "rule out" as a diagnosis, we have to list the symptoms or signs, or we have to say "suspect", like "sepsis suspect" instead of "rule out sepsis". Sounds legal, or illegal.
But the "rule out" is what the average person Googling his or her symptoms on the computer doesn't have. One gets a list of the differential diagnosis, admittedly longer than one I would come up with generally, but doesn't help with the "rule out". Why you DON'T have MRSA. Why your headaches are not likely to be from a brain tumor. Why your fatigue is lack of sleep rather than African sleeping sickness, or even West Nile virus. Ruling out is very important. It's as much an exercise in common sense as anything. Discernment might be a better word. And a base of knowledge is necessary to "rule out" things. One doesn't always have to have a degree in medicine to do most of the "ruling out". An experienced mom or grandma can do it quickly and efficiently. Unfortunately, many have lost their common sense in the face of the daunting amount of possible diagnoses that exist. It was so much simpler when all we knew was appendicitis or strep throat or earache. Now there's intussusception, MRSA, and cholesteatoma to add to the list. There's IBS, IBD, CRAP, UC, CD, and a host of other acronyms to consider when a kid has a belly ache. There's mono and sleep apnea to consider with big tonsils, and auditory nerve gliomas to account for when considering the cause of hearing loss.
The best thing I learned in med school is "common things occur commonly". I've heard preachers use a variation on this when telling people how to study the Bible - "the plain things are the main things, and the main things are the plain things". Another adage that has helped is "when you hear hoofbeats, you should think of horses, not zebras".
I'm not advocating for patients to quit researching their problems, believe me I've been bailed out plenty of times by a patient whose interest opened up an area I hadn't considered. And patients should be more informed about diseases that they have, even more so than the doctor in some cases.
Finally, and in summary, having information in the form of lists of possible diseases whose symptoms matched the search criteria you listed dumped on you like a load of rock for you to sift through hoping to find something meaningful is not particularly helpful. You need to learn the art of "ruling out" certain things. This requires work, and can be helped along by your local medical doctor (LMD). But to learn it, regardless of the work, and even if it involves trusting someone else's expertise, is a source of peace for many.

Tuesday, November 13, 2007

the answer

On this same blog there is another, "feeding the spirit". My lovely wife has summarized the answer to the questions and problems I posed in my first blog, tmi. The solution is so simple, and it cuts to the cause of the original problem. With more info we think we will be able to solve problems, but the real problem is that it is like peeling an onion, there is always another layer underneath, and it brings tears to our eyes. We must get to the Source, and surrender to the Creator of all, who promises to bear our burdens with us (read "for us") if we will but give them to Him. But we want control! And knowledge is control, right? Wrong.
It is the willing surrender of the "need to know" that allows God to give us the information we need, in a form we need to see it, at the time we need it, and perfect for the situation. As it is always with God, once we surrender, He works it out perfectly. Today's "feeding the spirit" references an event where Abraham allowed God to guide him, without all the "info", and by his surrender and willingness, he was blessed, and subsequently so are we.
Is this scientific? Medical? Psychological? No. But to quote Dr. Phil, "how's that working for you?". Has the "onion" of science or medicine or psychology been successfully peeled and revealed the answers and solutions? No. Only more layers and more tears. At some point, as parents reading this blog, we come to a point where we must take our own "Isaac" and present him/her to God. He will take it from there.
The willingness to not know is a very freeing thing. And when in the "not knowing" we are trusting God, we will truly be free..

Friday, November 9, 2007


You've heard of TMI, right? Well, it's real. scary real. With the internet, news on tv, in the paper, on the radio, it's nearly impossible to avoid being overloaded with information. Fear is easily awakened and hard to put to rest. Many people, especially children, exposed to unfiltered, unexplained "facts" presented as truth or just as pieces of information, are unable to decide which to believe, which to worry about.
Many people feel that they need to know as much about everything as possible. Search engines, like Google, have made such knowledge readily available with little effort on our part. In the past, one had to really seek out that much information, whether relevant or tangential to the subject. That effort generally required a desire that was born of some passion or need to know, vs. a casual curiosity about something that showed up on the news or was discussed at the soccer game. The level of ability to interpret the facts discovered in such a search is very important, as information can be very frightening without filters and help with interpretation. Not censors, but filters, where the context of the information is understood or at least sought, and not just facts thrown out for public consumption with no explanation. Pure shoveling of facts onto the public, as is the practice of the news media very often, is like getting flour and egg and oil and water thrown out onto a table and expecting people to make a cake. Certainly the idea of making a cake from the ingredients appeals to many, but the ability to do so is predicated on the fact that a person has a recipe or experience with the ingredients and their parts and importance to the outcome. To toss random facts, or "factoids" as they are called sometimes, out for public use without a "recipe" is to ask for disaster, as the information may be used incorrectly and the outcome may not be what was intended, or what was possible given the ingredients.
Albert Einstein, a man with a lot of knowledge, said "I've discovered that the men who know the most are the most miserable". Think of King Solomon in the Bible. He had wisdom beyond that of any person and he blew it big time! He couldn't or wouldn't be happy.
I'm not saying we should be ignorant, though the adage "ignorance is bliss", comes to my lips regularly as I answer questions from parents, questions I would never have known to ask and thankfully didn't need to know the answer. The availability of raw information is not a bad thing, just a potentially dangerous thing, especially if it leads to general disquiet and stress in the recipients. In my practice, the worried well are the vast majority. They have been worried by an ultrasound done during pregnancy that showed fluid somewhere it shouldn't be or no fluid where there should be some. They are worried because they read or heard or saw something on tv, or from a neighbor or relative or heaven forbid, at Walmart. A casual comment from someone can precipitate a major worry in some, i'd say many, people, especially parents (read moms).
I don't recommend watching the news regularly - if something happens that you need to know about, someone will call you or a siren will go off. It's amazing how much stress can be reduced by that simple step. Now, ironically, since you are reading a blog, I recommend staying off the internet. I promise nothing will happen or be discovered about which you won't hear from someone within the next 24 hours. Some people are more stressed that they will miss something, but most are stressed by hearing something over which they have no control and then obsessing on it.
We are addicted to information.
The more you know, the better, right? I don't think it's better to know more, necessarily. We've all used the phrase "a little knowledge is dangerous". If a little is dangerous, what is a lot? more dangerous, I propose. so what do we do? Do we hide our heads in the sand and stop watching and reading and searching? Do we let others interpret facts for us? Do we strive for understanding in every area of geopolitics, history, medicine, science, language, art, religion,and culture? Yes to all, with a caveat. Balance is the key. For some, the ostrich method will work. I'm amazed at the amount of peace I have when I'm not bombarded by news all the time. I feel no withdrawal symptoms. However, some may not be so lucky. Others, myself again included, are content to leave interpretation up to others, at least most of the time. The more personal a subject becomes, the less I'm willing to delegate the responsibility, but it makes sense to me to let experts collate and review and present the information in a form I can digest. Sort of like having a cake made for me vs. having to make it myself. And to do one's own study, to go deeper into a subject or area, to become an expert or at least more informed than the average citizen, is gratifying in certain instances where the topic is of special interest or concern.
it is unlikely that we will stop the overflow of information that comes our way. it will probably only come faster. we must learn how to deal with it, using common sense and balance.
that's enough information for now.