Dinner of Champions/ Freebies From My New Book

Genmedmom here.

Yes, this lovely photo of walnuts, dark chocolate, and red wine against the backdrop of Christmas was my real dinner.

This was several weeks ago. Hubby was traveling. I'd worked a long clinic day, and had just picked the kids up from my mother's. My school-age kids ended up with yogurt, fruit, and cereal, while I ended up with this dinner of champions.

But it's not a bad dinner, from a nutrition standpoint. Actually, I was rather proud of what I'd put together, for cardiovascular reasons.

After all, I've done my research: I've just published a book on this! Healthy Habits for Your Heart is a behavior change focused evidence-based diet and lifestyle book for heart health. I was a bit insane about including the supporting science, so the references section is way larger than the publishers wanted. The first section of the book is all about how our behaviors impact our heart health, and how to approach habit change. Then, for each suggested diet and lifestyle habit, I've included tips to make it stick.

Want a free preview? Here you go! Pasted directly from the book, to you!

I hope folks find it helpful for them and for their patients.

From Chapter 5, Eat For Your Life: Nutrition Habits, here is the lowdown on nuts, chocolate, and wine:

#34: Eat Four Servings of Nuts Per Week
Nuts are good for your heart and your life. Research shows that eating four servings of nuts per week was associated with a significantly lower risk of having coronary heart disease (19 percent) or any type of cardiovascular disease (28 percent). ere was also a significantly lower risk of dying from coronary heart disease (22 percent), cardiovascular disease (22 percent), sudden cardiac death (75 percent), or anything at all (19 percent). e studies looked at tree nuts (which include almonds, walnuts, pistachios, and hazelnuts) as well as peanuts (which are technically a legume but nutritionally similar to tree nuts).

Another study found that for every one serving per week increase in nuts, there was a 10 percent lower risk of having coronary heart disease. is may be due to the fact that nuts are a rich source of healthy oils. Nuts also are great sources of both soluble and insoluble fiber, as well as vitamins and minerals. Nuts are an important part of the classic Mediterranean diet, which we know is a very good diet for heart health. (Allergies are a consideration here. For people who are allergic to nuts, this habit doesn’t apply. As a doctor, I’m going to remind you to update your epinephrine auto-injector and carry it with you at all times!)

What Does One Serving Size of Nuts Look Like?
Per the National Heart, Lung, and Blood Institute (NHLBI):

• 1⁄3 cup nuts (equal to 11⁄2 ounces)
• 2 tablespoons nut butter 

Tips to Make the Habit Stick:

• Regularly stock up on nuts, but keep budget in mind. Nuts are cheaper when bought in larger quantities or ordered online. Shop around for your favorite sources.
  
• Nuts can go rancid. Store them in airtight containers. Glass is ideal.
  
• Make a portion of your favorite nuts a regular go-to snack. Have
  some in your bag or desk at work at all times.
  
• Get in the habit of adding a handful of nuts to your meals, be it
  yogurt, oatmeal, salads, or stir-fries.
  
• Try these recipes: Apple Cinnamon Walnut Overnight Oats; Fill-
  ing Fruit and Nut Bowl with Greek Yogurt; Nutty Tabbouleh Salad (in Appendix A). 
  

#35: Enjoy Two To Three Servings of Dark Chocolate Per Week

Research has consistently shown that people who regularly eat chocolate have lower blood pressure, blood sugars, and less heart disease. Chocolate comes from the toasted seeds of the cacao plant, which is rich in healthy plant chemicals called flavonoids, specifically cocoa flavanols. Cocoa flavanols have beneficial effects on our blood vessels by neutralizing toxins, which helps prevent stiffness and plaque buildup, as well as promoting healing.
The darker the chocolate, the more cocoa flavanols it has. Milk chocolate sometimes has barely any (it can range from 10–50 percent) and also tends to have more unhealthy fat added. For this reason, I recommend only dark chocolate (at least 60 percent cacao, though the darker the better) and only a small amount. One serving is two small squares (about 50–60 grams total), and science suggests that two or three servings per week provide the most benefit.
Do you like chocolate, but not dark chocolate? It is less sweet but definitely much better for you than milk chocolate. e intense cocoa taste is what can help prevent us from overeating this calorie-dense treat. Start with a small amount and build up over time. The less milk chocolate you eat, the more dark chocolate will begin to taste like normal chocolate to you. 

Tips to Make the Habit Stick:

• Add a teaspoon of pure unsweetened cocoa powder to your co ee in the morning for a mocha treat.
  
• Use only dark chocolate chips or chunks (60 percent or higher cacao) in baking and cooking. 
• Try these recipes: Dark Chocolate–Dipped Strawberries; Orange Pistachio Dark Chocolate Bark; Cherry Chocolate Overnight Oats (in Appendix A).
• Use pure unsweetened cocoa powder in your savory cooking as well. Try the Antioxidant Chili recipe in Appendix A.
• If you have a tendency to eat more than a serving (two small squares), consider buying only small amounts at a time or dividing what you buy into serving sizes as soon as you get home. 

#42: Limit Alcohol, Although A Small Amount Daily Can Be Heart-Protective

People who drink a small amount of alcohol every day tend to have lower risk of coronary heart disease when compared to people who don’t drink or to people who drink heavily. Research shows that light drinking can lower the risk of developing heart disease a great deal (between 40 and 70 percent) and also lower the risk of related diseases such as strokes, aortic aneurysms, and peripheral arterial disease. Wine (red wine especially) seems to be the best choice, though the protective e ect is seen with all types of alcohol. e active component in red wine is thought to be an antioxidant plant nutrient called resveratrol, but studies that have isolated this compound and given it to participants as a supplement have not shown any promising results to date. (Of note, that seems to be the case with all supplements.)

But this doesn’t mean it’s advisable to pick up a drinking habit. Alco- hol won’t erase the risk brought on by other factors. Drinking any amount over what’s recommended will actually increase the risk of heart disease by causing high triglycerides (a form of cholesterol), high blood pressure, and weight gain. Alcohol can also be directly toxic to the heart and is asso- ciated with arrhythmias like atrial brillation. Drinking too much—even just a little too much—also increases the risk of cancer (particularly breast cancer), liver disease, and, obviously, alcohol addiction.
For all of these reasons, the American Heart Association recommends that people do not start drinking alcohol as a means to lower their heart disease risk.
For people who can safely drink, and who partake regularly, here is what is recommended:

Men: No more than one to two drinks per day 
Women: No more than one drink per day 

Definition of a Drink: 

• 5 ounces of wine
  
• 12 ounces of beer
  
• 11⁄2 ounces of 80-proof spirits
  
• 1 ounce of 100-proof spirits 

Tips to Make the Habit Stick:

0. Hydrate well before you have any alcohol. If you’re thirsty, you may unintentionally drink too much too quickly.
   
1. Measure out your drink (5 ounces of wine, 12 ounces of beer) and then put the bottle or six-pack away.
   
2. If you’re having mixed drinks, specify how much hard liquor you want and watch the bartender measure. Some bartenders are a lit- tle heavy-handed with the bottle.
   
3. If you’re entertaining, mix up a pitcher of a tempting mocktail and have plenty of healthy and delicious appetizers on hand. It’s good for you and everyone else as well.
   
4. Try the Bubbly Minty Mojito Mocktail recipe in Appendix A.
   

References: 

Research shows that (nuts)... A.J. Mayhew et al.: “A Systematic Review and Meta-analysis of Nut Consumption and Incident Risk of CVD and All-Cause Mortality,” e British Journal of Nutrition 115(2), 28 January 2016, pp. 212–225.
Another study found... Y.Q. Weng et al., “Association Between Nut Consumption and Coronary Heart Disease: A Meta-analysis,” Coronary Artery Disease 27(3), May 2016, pp. 227–232.
Research has consistently... E. Higginbotham and P.R. Taub, “Cardiovascular Bene ts of Dark Chocolate?,” Current Treatment Options in Cardiovascular Medicine 17(12), December 2015, p. 54 and S. Yuan et al., “Chocolate Consumption and Risk of Coronary Heart Disease, Stroke, and Diabetes: A Meta- analysis of Prospective Studies,” Nutrients 9(7), 2017, p. 688
and C.S. Kwok et al., “Habitual Chocolate Consumption and Risk of Cardiovascular Disease among Healthy Men and Women,”
Heart 101(16), August 2015, pp. 1,279–1,287.

Research shows that... and Drinking any amount (alcohol)... S. Bell et al., “Association Between Clinically Recorded Alcohol Consumption and Initial Presentation of 12 Cardiovascular Diseases: Population Based Cohort Study Using Linked Health Records,” e BMJ 356, 22 March 2017, p. j909 and
P.E. Ronksley et al., “Association of Alcohol Consumption with Selected Cardiovascular Disease Outcomes: A Systematic Review and Meta-analysis,” e BMJ 342, 22 February 2011, p. d671.
Alcohol can also... C. Tangney et al., “Cardiac Benefits and Risks
... UpToDate, updated March 2018, https://www.uptodate.com/ contents/cardiovascular-benefits- and-risks-of-moderate-alcohol- consumption.

Lift Those Weights, Ladies (and Let Your Patients Know!)

Genmedmom here.

I am officially closer to 50 than 40, and it shows.

If I didn't hear it all the time from my patients, I would be complaining: "I'm exercising the same and eating the same, but I'm gaining weight... around my middle!"

Yup, it's that middle-age middle-gain. Horrified that this was happening to me, despite having lost fifty pounds after two AMA pregnancies and religiously maintaining a healthy diet and exercise routine for years, I decided to fight back.

How do Type A M.D.s fight back? The evidence, baby. I hit the books big-time. My reading and research into this area have led to a newfound passion: Lifestyle Medicine. Everything from my personal life to my primary care practice to my writing has been impacted. I've even got a book coming out in December.

Back to the battle of the bulge. I learned all about sarcopenia, a well-known physiologic phenomenon of age. We simply lose muscle mass as we get older-- and women basically hemorrhage muscle mass around menopause. As we all know, muscle burns calories just by existing. When we lose muscle, our metabolism plummets, and we gain fat. Hence, that perimenopausal pudge.

This process, left unchecked, can lead to sarcopenic obesity: high adiposity coupled with low muscle mass, which is often associated with a deceivingly normal body mass index. 

There's more to it, of course. Sarcopenia is bad for so many reasons. As one Cambridge University Press research review points out, "Sarcopenia, the age-associated loss of skeletal muscle, is a major concern in ageing populations and has been associated with metabolic impairment, cardiovascular disease risk factors, physical disability and mortality." 

I was thrilled to see this topic covered in wonderful detail by Jane Brody, writer for the New York Times, in this and this article. She provides a wonderful review of the literature and expert opinion, along with some good suggestions. As she correctly points out, "few practicing physicians alert their older patients to this condition and tell them how to slow or reverse what is otherwise an inevitable decline that can seriously impair their physical and emotional well-being and ability to carry out the tasks of daily life." It may be that few practicing physicians are fully aware of how big a deal this is. I wasn't!

A review in the Journal of Family Practice describes sarcopenia as a known major cause of debility and frailty, but highlights that it can be effectively prevented or treated with a healthy high-protein diet and resistance training. 

And it's true: when we gain muscle, our metabolism increases. The more muscle we gain, the more fat we lose (and we can even tolerate a little dietary indiscretion). There's endless benefits to toning that muscle: a stronger core prevents back pain and protects against back injuries. Increased strength prevents falls and protects from injuries if falls occur. Strength and mobility promotes the ability to manage ADLs and extends independent living. 

For all of these reasons, I've taken up a simple resistance training regimen. I have zero time to be consulting personal trainers (who here can make any appointments and keep them? Not me) so I created my own plan, including a few key pilates moves I learned over the years, and alot of basic exercises using a pair of five-pound barbells I've had since literally 2005. That's it. Sometimes I'm on a yoga mat, sometimes on my daughter's rug (it's the softest one in the house). This routine takes me all of ten minutes, but has yielded visible results in four weeks. 

On the days that I have no time, I at least drop and do ten planky-pushups, meaning I hold the plank position between pushups, and aim for ten. I sometimes do this right before bed, and typically, this move leads to a few other basic yoga stretches that really help ease me into sleep. 

When I counsel women my age, I usually advise that they seek the advice of a trainer. Some women are former athletes and know their way around the weight room, and need only be educated, and then they're off and running. For elderly folks, especially those with prior injuries or who are really very frail, I recommend the official guidance of a physical therapist, with specific goals like "increased core strengthening and balance exercises for falls prevention". 

I know there's physical therapists and physiatrists and orthopedic surgeons in this audience, and I welcome your input. What advice do you provide to patients around sarcopenia and sarcopenic obesity? What training regimen do you follow? Any tips appreciated! 



Photo by Cyril Saulnier on Unsplash

Doctor-Moms, This Is Our Job

Finally, a cause we can all agree to take action on. We means everyone: Liberals and Conservatives, Democrats and Republicans, Christians and Jews and Muslims and Atheists and everyone in between. Follow to the end for specific, easy actions you as a physician and a mother can take to help stop this morally repugnant horror.

The issue? Around the world, we are seeing a horrific trend: children are increasingly being used as tools in political conflict. In Syria, children are used as human shields. In Afghanistan, children are recruited and used as soldiers. In Nigeria, children are recruited as suicide bombers. In Myanmar, children are tortured to send a political message.

Here in the United States, we take children as political hostages.

This is no exaggeration nor overstatement. This Saturday, our President stated that he is using  migrant children taken from their families as a political bargaining chip. Despite his repeated insistence, there is no law nor policy in place stating that migrant families should be separated at the border, only President Trump's personal mandate.

How could such a horrible thing happen here, in our democracy? In Spring 2017, Trump's Homeland Security Advisor John Kelly proposed separating all children from their parents as they sought shelter, “in order to deter more movement along this terribly dangerous network”, as reported in last week's New York Times.

More recently, Trump's senior policy advisor Stephen Miller reiterated that this is all Trump's doing: 

“It was a simple decision by the administration to have a zero tolerance policy for illegal entry, period. The message is that no one is exempt from immigration law.”
 
It is now well-documented for the world to see and judge. In using children as political hostages, our country has stooped to the same lows as terrorists and dictatorships in Syria, Afghanistan, Nigeria, Laos, and Myanmar.

Of course there is growing outrage against Trump's disgusting agenda. Many Republicans leaders are stepping forward to condemn this administration's inhumane actions, and not only moderate stalwarts like former First Lady Bush and Senator Susan Collins of Maine. Even Senator Lindsey Graham of South Carolina has gone on record, stating "President Trump could stop this policy with a phone call",  as Monday morning's New York Times reports.

While he is unlikely to take any action, we can.

We are mothers and doctors. We are uniquely positioned to comprehend the psychological damage inflicted upon children who are forcibly removed from their caregivers. The American Academy of Pediatrics has vehemently opposed this as policy since it was first mentioned by Trump's administration last Spring, based on the known grave consequences to child development. Pediatricians are speaking out. AAP president Colleen Kraft described the heartbreaking grief of a toddler she witnessed at one detention center, and explained the effects of harmful toxic stress on children.

As the AAP's formal statement on The Detention of Immigrant Children recognizes:

"In accordance with internationally accepted rights of the child, immigrant and refugee children should be treated with dignity and respect and should not be exposed to conditions that may harm or traumatize them. The Department of Homeland Security facilities do not meet the basic standards for the care of children in residential settings."

The American Psychological Association has also written a letter to the Trump administration in opposition to the policy:

"Families fleeing their homes to seek sanctuary in the United States are already under a tremendous amount of stress. Sudden and unexpected family separation, such as separating families at the border, can add to that stress, leading to emotional trauma in children. Research also suggests that the longer that parents and children are separated, the greater the reported symptoms of anxiety and depression are for children."

Yes, it's pretty clear that ripping innocent, frightened children from their parents and locking them in chain link cages is not in accordance with internationally accepted rights of the child. So what can we do about it?

As little or as much as you want. This can be simply clicking on a link to sign a petition or donate to a vetted charity, to calling your representatives, to writing an article for a local newspaper or blog... It's up to you. Here are some suggestions (and I personally did every single one of these this lovely Monday morning before my clinic started):

SIGN: 
Petition to Donald Trump to stop separating families at the border: https://actionnetwork.org/petitions/where-are-the-children

Petition to the Department of Homeland Security to stop separating families at the border: https://www.change.org/p/department-of-homeland-security-stop-tearing-families-apart

Petition to Secretary of the Department of Homeland Security to stop separating families at the border: https://www.change.org/p/keep-them-together-stop-separating-children-from-their-families-at-the-u-s-border

DONATE:
KIND (Kids In Need of Defense) is a nonprofit that provides legal assistance children who would otherwise stand in court alone. 

The Florence Project is a nonprofit that provides legal assistance to political detainees, including children, in Arizona.

The Asylum Seeker Advocacy Project is a nonprofit that provides legal assistance to refugees feeling violence seeking safety here int he U.S.

RAICES is a nonprofit that provides legal assistance to detainees and refugees, including children, in Texas.

Al Otro Lado is a binational nonprofit that provides legal assistance to families who have been separated, navigating the legal systems of Mexico and the United States to bring them back together. They also help deportees who have been abandoned in Mexico with resources including medical care.

PROTEST:
Families Belong Together is organizing rallies and protests in opposition to separating families at the border. Check out their website to see what's happening next near you.

CALL:
This is actually one of the most powerful things you can do. Call your representatives using any of the below easy methods. You'll probably get an answering machine, but if you get the machine or a person, say "My name is (your name) and I am opposed to separating families at the border. I am from (your zip code) in (your state). I do not need a response.":

Find your representatives in the House and then find their office phone number, and call.

Find your representatives in the Senate  and then find their office phone number, and call.

Or just call the Capitol operator: 202-224-3121. This number will direct you to the Capitol switchboard. When you call, ask to be connected to your senator or representative. The operator will direct your call to their office.

Pending Legislation on this includes The Keep Families Together Act and The Help Separated Children Act . 

SHARE: 
Whichever of these relatively small actions you take, TALK about it, SHARE on social media, PUBLICIZE the cause. This is really powerful.

WRITE: You are a doctor. You have a platform. Your voice is heard. Please consider writing a letter to your editor, even if it's a small town newspaper. Consider writing an op-ed for a news outlet. Consider posting on a political website, as Sanjiv Sriram, MD did. Consider writing a guest post for a blog. I accept guest posts at my own personal blog www.generallymedicine.com , and the editor here at Mothers in Medicine does as well. Kevin, MD is another great place for physicians to share their educated, intelligent thoughts.

Whatever you do, DO SOMETHING. The policy of using children as a political tool is morally repugnant, and we as doctor-moms know this better than anyone. Please help to stop this moral slide into evil.

Stumbling Through The March For Our Lives With Little Kids

Genmedmom here.

As a primary care physician with strong public health and clinical research roots, and as a politically engaged mom with serious concerns about our kids' futures, it made perfect sense to take our kids to the March 24th March for Our Lives Boston.

One complication: Hubby and I have been shielding them from the news, especially school shootings news. Babyboy is extremely sensitive to the topic of death, dying, and violence. He'll have "bad memories" for weeks after hearing or witnessing something along gun violence lines. This may be a normal little kid thing rather than an autism thing; they're only seven and six years old, after all.

Given all of this, it was actually very difficult to explain why were marching.

The Women's March and the March for Science were so, so much easier! Yesterday, Hubby and I found ourselves searching for explanatory phrases that didn't include references to school shooting deaths or the words "being shot" or "being killed". We ended up stammering, stumbling, and not successfully conveying the point.

Many organizations have offered guidance on how to talk to little kids about tragic events and disasters, such as the American Academy of Pediatrics and the American Psychological Institution. Major news outlets regularly publish advice about talking to children specifically about school shootings (which is definitely a statement about the states of affairs in this country). Two recent articles on TODAY.com and Cnn.com are actually pretty helpful.

So, this is something we clearly need to work on, as the kids' school runs lockdown drills and the #GunControlNow, #Enough, #Gunsense, and #MomsDemandAction movements spur debate and action.

Regardless, their taking part in a massive live social change movement is a powerful lesson. We emphasized that in many other countries, citizens aren't allowed to gather and protest, that we are very lucky to have this privilege, and we have to use it.

Overall, I'm glad that we took them and that they got to see freedom of speech, political activism, public health awareness, and social altruism, all at once and in person.

My DIY Kitchen Makeover: The Affair Is Over, But It Was Worth It!

Genmedmom here.

Last month, I posted about my crazy DIY kitchen makeover project. Well, we finished weeks ago, and we're thrilled. It just took me forever to figure out how to make before/ after photos. (FYI, the Scrapcollage app is fantastic, very easy to use.)

Our kitchen was perfectly nice. Nice and yellow. Honey oak cabinets and floors, yellow-beige walls. The overall effect was that anyone standing in our kitchen immediately developed jaundice.

Plus, we've lived here for almost ten years, and we've never painted the kitchen. It was time. Farmhouse is in, and so farmhouse we got.

So here we go, Benjamin Moore "Slate Gray" Cabinets and "Hardwood Putty" Walls. My uncle is a contractor who helped immensely with the priming and painting of the cabinets. Kudos to my mom as well, who did a whole lot of Ikea shopping and wall painting with me:

Our main entryway is the back door leading into the kitchen, and we have no closet there. The freestanding coatrack would get so heavy it fell down numerous times, so we were throwing overflow crap on the floor and a chair. That whole situation had to change. So I bought a cheap standing coat and hat rack at Ikea, which my uncle attached to the wall:

I also bought cheap Ikea bookcases which we made into storage benches, and my mom sewed removeable pillow covers out of the water-resistant fabric I'd bought on sale at Fabric.com. (Thanks again, mom!) These benches are game-changers: so super-sturdy, and useful:

We were sick of looking at the kitty litterbox, so I ordered a hideaway one on Amazon that's disguised as a little table, and stuck it under our new location for the message board (which is still a mess, but hey, it's the message board):

I repurposed a particleboard pantry I'd bought at Home Depot for sixty dollars like five years ago and was using to store all sorts of mishmosh. Painted it Benjamin Moore "Apollo Blue", changed the location, and now it holds cookware:

The best part about this makeover is it was mainly done for organization purposes, to help us to de-clutter. It certainly did that, and more. Overall, we are very happy!

We also did the dining room and bathroom, but those are posts for another day.

Got a project you want to tackle? Go for it!

Better Than An Affair: My DIY Budget Kitchen Makeover

Genmedmom here.

I'm nuts. But in a good, doctor-mom-nuts way. 

I just started a DIY budget kitchen reorganization and makeover, in the midst of Hubby's busiest time of his workyear, the kids' busiest time of the schoolyear, and my own perpetually crazy clinical/research/writing career life.

Yes, the kitchen looks like it blew up. Yes, my hands are covered with "Apollo Blue" paint. Yes, I've already gone over my $500 budget. Yes, Hubby is raising his eyebrows every time another package is delivered.

But I am having so much fun.

This has been such a delicious, decadent creative treat. The stolen time for planning and plotting, poring over colors with the Benjamin Moore guy at the local hardware store; guiltily perusing the Ikea website catalog during work hours; lying in bed after the kids are asleep sneaking peeks at Pinterest kitchen remodel pins... This is the type of affair for me!

I haven't for one second regretted tackling what is the largest household project I've ever undertaken. It's consuming every spare second of time I have, and there's not much.

I will be asking family for help, especially when it comes time to painting the walls and hanging heavy shelving, yes, that is true. Lucky for me, I'm related to several carpenters and contractors! But thus far, this project is MINE.

So, lately I've been wondering why it is that I'm so freaking happy about this craziness, and I think it's for several reasons:

One, the news cycle is so freaking depressing, this project helps me to focus on something over which I have actual control, and is actually positive.

Two, while Hubby is supportive (I did ask his opinion first), this kitchen makeover is essentially mine. It's visibly, tangibly, MINE. It's the first time in my life I've had a bit of extra cash to do something like this, and I am ecstatic. I can't go over $1000, but I'm ecstatic anyways.

Three, a large part of the undertaking is in order to get organized. Our family is so, so busy, and the kitchen is central station. Yes, it especially looks like it blew up lately, but, it always kind of looks like it blew up. My goal is to change that.

And four, I think it's a healthy doctor-mom thing to have a personal project on the side. I was reminded of an old post by Fresh, MD, a popular one titled "Ten Guidelines for Medicine-Life Balance", where she recommends having at least one non-medical creative project going on at all times. Usually I'm planning a birthday party or hosting a special meal, smaller stuff like that. This DIY thing is a bigger deal, but it is still just another personal, creative thing. I think she's totally right that we type-A intellectual overachieving dorks really need an outlet like this.

I'll definitely post about it when it's done, and let you all be the judge of my creative effort!

Panic on the Highway

Genmedmom here.

I'm like many physicians: a bit of a control freak. C'mon, admit it, it usually takes a Type A personality to push through all this bulls**t: Exams, applications, more exams, more applications, brutal working hours, exhaustion, fear, abject terror, hazing, insurmountable debt.

But sometimes, we're just not in control.

My very first panic attack, I was huddled in a sleeping bag on the cold floor of a medical outpost in El Salvador. It was 2001, the January earthquake. I was one of a small band of medical misfits on a disaster relief mission. I was a student, and my job was translator.

We were housed in the same clinic where we saw patients, on the concrete floor. That night, there were several aftershocks, but no one else on my team woke up. I imagined the ceiling and walls caving in. Some large bug landed on my face. Mosquito? Reduvid bug? Was I going to get Chagas disease? I began hyperventilating, I could not get enough air. I was panting and suffocating at the same time. Nausea overwhelmed. It was pitch black, no electricity. I would have had to crawl over my snoozing colleagues, or throw up all over them....

It was the idea of vomiting (and dealing with vomitus) that broke the spell. Even in my panicked state I had an idea that it was all in my head. Damned if I was going to puke on my attending.

Maybe it's not completely unreasonable to panic whilst in a bona fide disaster zone, although it would have been utterly humiliating, as well as inconvenient...

There have been a handful of episodes like this since, and none with such a good excuse.

This weekend, for example.

It was Labor Day weekend, and I was not on call. I was solo with the kids, and we went on a little road trip, to visit relatives a couple of hours away.

The ride home was ugly storming, the remnants of Hurricane Harvey. My kids are in this sibling rivalry phase, where rivalry means drawing blood by any means necessary. So I had the car VCR on for maximal distraction.

Still, they fought, and I fought to keep my full attention on the road as they yelled: "You wear poopy diapers on your head!" "Oh yeah, you smell like poopy and pee pee AND cat food!" "AAAUGH! MOM he kicked me!" "WAAAGH! MOM she pinched me!"

I was into a long sort of barren highway stretch when I realized that the gas tank was low. Really low. Sixteen miles of gas left low.

Hmmm. Miffed at myself that I hadn't noticed that earlier when we passed several rest stops, I paused the DVD and asked Siri "Where is the closet gas station?"

Siri paused and then ever-so-unhelpfully directed me to a gas station ten miles BEHIND us.

Okay. I kept driving South, looking for any evidence of a gas station at any of the very few exits coming up. They were all for major routes, not towns. No signs indicating restaurants, hotels, or gas stations.

The range dwindled. When the gauge read nine miles, I started to really freak out.

"Okay guys, I need to pause the show."

The kids actually quieted down. I explained that if we didn't find a gas station soon, we may need to pull over and call for help.

But I really, really did not want to do that, in the middle of a heavy late summer rainstorm and on a holiday weekend.

So I just kept driving-- like Dory, Just.. keep.. driving...

With SIX miles left, a lonely exit had a lone sign: "Gas: Mobil"

"Hallelujah!" I called, and gleefully flicked the blinkers on, aiming right, to salvation.

But: the signs then directed me to cut left, OVER the highway, towards the ramp going in the opposite direction. This required me to veer left. The car behind me honked loudly: They were going straight, and I had almost clipped them when I veered left.

Face burning (did I just almost cause an accident?) and heart pounding, I tried to sort out where the hell the goddamned gas station was. It looked like there was a small access road on the other side of the highway, but I would have to cut across two lanes of traffic getting on the highway going in the opposite direction to get there, with literally no wiggle room, just straight across.

There were so many cars! I couldn't make it! I was funneled back onto the interstate: going BACK from where we came.

I yelled, something unprintable, multiple times, banging the steering wheel, then "OH MY GOD WE ARE LITERALLY GOING TO RUN OUT OF GAS ON THE HIGHWAY IN THE RAIN! S--t S--t S---t F---k F---k..." I felt that familiar catch in my breath, that quick succession of gasps that means panic is beginning to overwhelm, except I was DRIVING on the HIGHWAY with my KIDS in the CAR.

The logical M.D. brain kicked in. Should I pull over now? But the shoulder isn't that wide, and the ground is soggy. Pulling over on the interstate could be really dangerous, and if I pull over onto the grass I might get stuck in the mud...

Hey, I can ask Siri! "Siri, where is the closest gas station?"

A Citgo twelve miles away popped up. What??? The Mobil we had tried to reach wasn't on Siri's radar. Maybe it had closed?


So there I was, speeding along the interstate, with five, then four miles left, not sure if there were any options... Crying. The kids were silent.

The next exit was coming up, for a busy route, no buildings, no towns anywhere nearby.

Deep breaths: "Okay, guys, I'm going to try to turn around and get back to the gas station that's supposed to be there that we just missed."

Blinking away tears, I managed to turn around, thinking Okay, at least if we have to pull over now, we're heading in the right direction, and I won't look like such an idiot.

Just.. keep.. driving... Three miles. Two.

I made it back to the same exit and the same veer left and over the highway and across those two lanes of traffic feeding onto the interstate... It was a miracle, there was a break in the cars, we zoomed across, and into the Mobil. With less than two miles of gas left.

As I pumped the gas, my legs shook. We took a little bathroom break. I splashed water on my face, and then felt silly for having had a truly unnecessary freakout in front of my kids.

I've since reviewed this whole incident with my husband, and we have some rules: ALWAYS gas up to the max before a long drive, and never freak out while driving. Pulling over and calling for help is way, way better than getting into an accident.

Still, another reminder that we are not always in control. (And neither is Siri, apparently.)

Photo credit Holly Mandarich: https://unsplash.com/photos/0317cop-0Ug

Great article on STAT on female leadership and health care reform.

Genmedmom here. I simply to call attention to a wonderful article on STAT written by a kick-ass healthcare administrator/ CEO and mother of SIX children (yes, six, and TEN grandchildren, per her profile) Annette Walker. It's titled More female leadership: a different kind of health care reform and it's spot-on.

She points out that "women hold only 26 percent of hospital CEO positions and 21 percent of executive positions at Fortune 500 health care companies even though they make up 78 percent of the health care work force". This despite the fact that "Study after study has demonstrated that organizations with gender-balanced leadership are more successful than their homogenous counterparts."

The best part of this short piece is her emphasis on solutions. What she has accomplished in her own hospital system can surely be adopted in others. She lists:

• Flexible work arrangements
• Training opportunities for women to build leadership skills
• Increased visibility of female role models
• Connecting junior employees with female senior-level mentors
• Transparent advancement opportunities and clearly charted pathways to leadership
• Shining a light on the challenges of balancing family and work needs
• Support for community programs that promote opportunities for women in our service areas
• Emphasizing STEM and academic programs for women

I love what she's saying and admire what she's accomplished. I mean, all this and SIX kids, I just can't even imagine. Two kids has almost put me over the edge. Holy cow.

This blog is certainly helping to "shine a light on the challenges of balancing family and work needs" of doctor-moms, so let's acknowledge what MiM brings to the battle! We can also take a look at this list and think of what may be applicable in our own practices, hospitals, and medical schools.

Ladies, let's take some inspiration and motivation from Annette Walker, impressive mama and hospital CEO.

On Quacks, and Cold Clinical Facts

Genmedmom here. 

We all have patients, friends, and family members who fervently believe that they have a diagnosis that we know doesn't exist. Or rather, for which there is no current reasonable believable scientific evidence.

I refuse to cite specific examples, because it's useless to refute someone's pet diagnosis. You may have examined a large body of research, read reams of textbook pathophysiology, spoken to respected specialists, but no matter what, if you attempt to disprove the entity they blame for all of their symptoms, and the treatment upon which they have pinned their hopes, they will hate you.

It's unfathomable to me that there are providers out there, some of them medical doctors, who blithely and blatantly practice non-evidence-based medicine on unsuspecting and vulnerable humans.

Infuriating.

And it sucks to sit there and listen to someone you care about describing quacky tests and (at best) useless and (at worst) potentially harmful charlatan treatments. Especially when they are paying dearly, and out-of-pocket.

Of course, I've tried to take down these totally false medical problems many times. It's what you do when you care about someone, right? And I've watched their faces shut down, as they mentally walk out the door. Or, saw them get red-faced and argumentative, unable to hear another word I said.

Sigh. So now, for the most part, I nod and smile and murmur something about how modern science can't answer all the questions and I hope that's working out for them.

After all, I can see why this is happening. Modern day M.D.'s are obviously missing something. Patients aren't getting what they need from us.

It used to be that folks had a local doctor who knew them well (and possibly also their families, neighbors, and friends). Office visits were longer, and paperwork was practically nonexistent. There was more listening, and less prescribing. The pace of the research world and life generally was slower, and slower to change. Hypotheses, explanations, and medications were more stable, things you could get your head around and use for a long stretch of time. The doctor-patient relationship was a real thing.

All that's a fever dream. Now, we docs are SO on the clock. Productivity numbers are in- you need to see more patients! And more! Twenty minutes to address all of your patient's medical problems and questions, examine, order, NEXT! Then, the deskwork. Administrative burden outmatches face-to-face clinical time two to one. It's a team of nurses doing callbacks, if the patient gets a call at all. Nowadays, it's mostly messaging through the "patient portal". The, the general public is fed research study after study after study. Papers and pundits contradict each other, data is manipulated, organizations release conflicting guidelines, medications get pulled. Textbooks aren't even printed anymore because they're outdated so fast. What a mess.

These are the cold clinical truths: There's no time to build trust. Our system prevents real connection. The scientific information world is fast-paced, chaotic, and confusing.

And so people are looking elsewhere.

Our medical system may or may not be headed in a better direction, what with the Patient Centered Medical Home movement and all. We'll see.

But meantime, behind the scenes, I am on a bit of a campaign. I recently wrote a patient-friendly article in support of evidence-based medicine for Harvard Health Blog that was well-received. At least, I didn't get any death threats.

Death threats, you say? Yes! Plenty of qualified critics of particularly trendy fake diagnoses suffer angry trolls throwing cyber-insults or writing letters with intent to harm, or kill.

So I'm trying to educate generally, not specifically. Trying to teach people how to tease apart the "fake news" from the safe news, how to be thoughtful, and consider several sides of a story. Their doctor sees it one way, but the internet says it another way. Okay, let's figure this out.

Doctors, we won't win the battle against the snake oil salesmen using facts and figures. We need to be gentle. Tread lightly. Nod and smile and murmur something about how modern science can't answer all the questions and you hope that's working out for them.

And then, if we can, listen. Try to cut through the requisite logistical bullshit and reach out to our patients. If they are feeling heard, they may trust. And if they trust, they may listen. It will take time, and open minds on both sides. But the patient may get the expert help they need, that the doctor is able to give.

We lost our s--t with the stranger who criticized our kid

Genmedmom here.

Hubby and I are not proud of our behavior. As a matter of fact, if anyone at the suburban quick- service restaurant managed to videotape us losing our sh-t, we'll be mortified.

Saturday was Earth Day as well as the March for Science, so we took our kids downtown to meet up with friends for breakfast and then show our support for our planet. Of course it was lovely and inspiring and all, so when we had to cut out early for a birthday party, we were a little bummed. On the other hand, the day was raw and rainy, so we were also a little relieved.

At the train station, a balloon man made a blue balloon sword for Babyboy and a pink poodle for Babygirl. Halfway home, rather predictably, Babyboy's sword popped. He wailed, then pouted, as Babygirl "helpfully" reminded him that HER balloon toy was still like new.

We didn't quite realize how upset he was about the balloon. And also, perhaps, how exhausted from our packed day thus far, dealing with new people at breakfast, trekking all over the downtown area, managing myriad sights and sounds and general chaos, then keeping it together on the train. Though he has autism, he handled it all incredibly well.

So we were probably pushing it when we decided to swing by a takeout salad place for a healthy late lunch just before the birthday party.

The restaurant was pretty crowded, and there were only a few tables open. Babyboy found a small table in one quiet corner, while Babygirl found a bigger table in the middle of the larger sitting room. Both refused to relocate.

Hubby ran to the men's room while I tried to resolve the table situation. Babyboy's table only fit two, while Babygirl's was for four, so, pretty straightforward: "Let's go over there where your sister is, honey, so we can all have a seat."

But Babyboy was done. Just DONE. He had draped himself over the tinier table, hugging it, not budging.

I gently touched his shoulder and leaned down, whispered in his ear: "Honey, we need four seats, or we won't all fit, okay? Let's go to that bigger table, okay?"

He whined: "I want to sit HERE! Why does SHE get to pick where we sit when MY balloon popped and I'm sad? I should pick because I'm SAD. I want to sit HERE."

I tried reasoning, then gentle tugging. While he did release the tabletop and shuffle grudgingly towards the larger space, he did so while whining VERY loudly:

"It's not FAIR! It's not FAIR! Why does SHE get to pick where we sit? Why does SHE get to pick? I'm the one who is sad! MY balloon popped, not HERS!"

Meantime I whispered reassuringly, soothingly: "Okay, okay, I understand, here, you can watch a show on my phone. Want to watch a show? Here, let's pick a show.." I was practically begging, but, to no avail.

The more I whispered/ begged, the more he whined, and loudly. People were watching us, with curiosity and annoyance, and I was acutely aware.

When offering SpongeBob on my iPhone didn't work, I knew we would have to leave, so I announced:

"Okay, this isn't going to work. Let's go home, guys, let's go outside, c'mon. We're leaving, right now." I said this out loud, as much for the other diners' benefit, as I herded our kids out the doors.

The kids were just ahead of me, already in the glass foyer, when I noticed a loud banging and clattering sound.

It was like a fist hammering on a table so hard, that it was making the silverware clatter.

Which is what it was.

An elderly man seated near the open door was bringing his closed fist down heavily on his table, again and again, HARD, so that his food and utensils jumped and rang out with every beat.

Only when I finally looked, did he stop. He then gestured angrily towards Babyboy, raised his finger to his lips, and made an exaggerated, furious, spitting SHHHHHH sound at me.

I froze, eyes locked with this angry old man who didn't seem to speak English.

The kids were already pushing at the outer set of doors.

Only a second passed, but this is what went through my head:

Are you kidding me, asshole?  My kid's autistic and exhausted and fixated on his silly balloon and I cannot do anything about that besides leave. Can't you see that we're leaving? We've only been here about three minutes total and we're LEAVING and you have to pull this shit? 

And then I did was something I don't think I have ever done in my entire life.

I leaned towards him from the doorway, leveled my middle finger right in his face, and said, as clearly and calmly as I could:

"FUCK YOU."

Then I followed my kids into the foyer and out the doors to the parking lot. Babygirl tripped and fell and I lifted her up, pulling Babyboy along with me as I made a beeline for the car.

Meantime, Hubby had just exited the men's room. He had heard Babyboy's whining and then the banging/ clattering ruckus. He had seen the old man pointing at Babyboy and shushing us. Somehow, he didn't catch my reaction, and thought that I had just fled.

So when he passed by that guy's table, he threw out:

"Have a nice day, sir, God bless you, and by the way, FUCK YOU!" and he ran to catch up with us in the parking lot.

In the car, I was shaking, almost crying. Hubby turned to me and shared that he'd given that guy a piece of him mind. I admitted that I had, as well.

We both smirked.

Now, Hubby and I are both well-educated working folks with professional reputations to protect. As such, neither of us uses the F-bomb, or any profanities, very often. And neither of us is in the habit of losing it with compete strangers. But we did both, and if given the chance for a do-over, I'm not sure that we would have done it any differently.

Of course, we didn't do much to advance the cause. Our classless behavior didn't help anyone to understand autism, empathize with struggling parents, or tolerate tantruming children.

I'm not sure if any of that would have even been possible, but we could have acted with more grace. So, we both feel ashamed.

We did end up going to the birthday party, where we shared our story with many very sympathetic parents. People shared their own experiences of child-behavior-shaming in public spaces, and how they reacted. It was therapeutic.

Still, I know for a fact that neither Hubby nor I will ever venture into that takeout restaurant again!

The doctor self-diagnoses again (a delightfully disgusting story)

Genmedmom here.

I've posted about my own recent miserable illnesses on my own site so often lately, I'm afraid to post anything else about being sick there. People will start to think I have some underlying issue, like an undiagnosed immunocompromised state.... or hypochondriasis.

But I have to share the gross details of my latest medical problem! I have to, because it's so disgusting, it's entertaining.

So my kids and I have been SO sick this winter. There was Norovirus at Christmas, and then the flu three weeks ago (despite being vaccinated), which for me, then triggered a horrible asthma exacerbation...

But last week, I was finally feeling better. I remember thinking, "Gee, I finally feel better..."  and probably jinxed myself.

By the end of the week I was really congested and feeling run-down. "Great, a cold coming on, this sucks," I thought.

Then Saturday afternoon, I was more congested, and the mucous was really green. I felt kind of woozy, with mild chills. I ignored it and went for a four-mile run in ten-degree weather. Weirdly, it was invigorating, and the hot shower afterwards was heavenly! The mucous drained and drained.

"Ha! I beat that one!" I congratulated myself.

But, Sunday: worsening congestion, thicker gray-green mucous, facial pressure... and then there was this smell.

I smelled it first in our kitchen. A warm, dirty dishwater smell, like when you open an old dishwasher before the heat cycle is done and all that steam with the hot-moist-food-particle odor hits you full in the face. WTF? I peeked all around trying to find the source.

Then at church, I smelled it again. The kids were running around and I was distracted, so I didn't think about it too much other than, "Yuck, what's that?"

Later, at home, still soooo stuffed up, I blew my nose for the millionth time, and got a huge glob of nasty slimy mucous. For some reason, I thought to sniff it.

And there it was. That smell. It was reminiscent of when I worked part-time in our college cafeteria and there was an immense sink for soaking all the pots and pans and serving dishes in super-hot water with some kind of toxic detergent, and the clouds of steam would waft up with the odor of all those food scraps: leftover meatloaf, cherry jello, brown gravy, pea-soup, and harsh industrial-strength cleaning solution all mixed up together in one nauseating and assaulting aroma...

I realized (with a shudder) that the source of that nasty smell was my own face, my own mucous. SO GROSS SO GROSS SO GROSS!!!!

Of course I googled this, trying to figure out what was the principal bacteria responsible for this gray-green discharge with the very particular odor... No luck. Needless to say, I'm on Augmentin and I feel alot better. 

How did you manage pregnancy symptoms at work? Share your stories!

Pregnancy is not an illness. It’s usually a joyful time in one’s life. But man, can it make you feel AWFUL. Morning sickness, fatigue, swelling, brain fog... Everyone experiences these things differently, but almost everyone is going to have something. Rare is the mom who can rosily exclaim “Gee, I felt WONDERFUL throughout my entire pregnancy!

Even in the same person, pregnancy can present differently. With Babyboy, I had very little nausea; rather, I had weird intense cravings for salty things (like sardines). So, when I learned I was pregnant with my second, I went out and bought cans and cans of sardines. Surprise! Not only did the mere whiff of sardines make me nauseated, that’s how I felt for the whole nine months.  

“Morning sickness”, which, in my experience, can last all day, is different for everyone. It can mean queasiness, or hurling. I have friends who required admission for hyperemesis gravidarum. All the ginger tea and Zofran on the planet doesn’t help, sometimes. 

I got through by only eating what I could tolerate: carbs. Sixty pounds later...

Swollen legs, incredible fatigue, brain fog... these are some of the other symptoms I experienced. I finagled "pregnancy parking" close by work at the end of my first pregnancy, when the summer heat made walking unbearable. I've heard of doctor-moms who managed to steal naps here and there... And for brain fog? I don't have any ideas what can help. 

What about you? Share what symptoms you had, and how you managed them. The info can help another doctor-mom!