Monday, July 14, 2014

Our Experience with Au Pairs

So for the past four years around this time, we welcome a new member to our family.  This time I'm not talking about a new baby!  Working part-time hours as a family doc and caring for four kids six and under would be a much more challenging task without the help of our live-in au pair.  July is when we started our contract and we're now on our fourth.

I had written an entry about why we were considering going with an au pair for childcare back in 2011.  All those reasons are still true... the cross cultural experience, availability, and finances... however, it became much more than that.

Granted, it is difficult initially transitioning and getting to know and live with someone new every year.  We're in the process of getting to know our new au pair right now.  There is much adjustment from their end to a different culture, way of thinking and caring for young kids while we adjust to another personality.  However, overall our experience has been very positive and rewarding.  Thankfully, our kids have taken to all our different au pairs and they often refer to our previous au pairs with much fondness and love.

Our past au pairs have each brought something different to our family with the varying talents and personalities they have.  Our kids have learned a lot of the Chinese language because of their interactions with them.  My oldest, especially, is very fluent in mandarin Chinese because of them.

Last month, we threw a reunion and 'goodbye' party for our au pairs.  All three au pairs from previous years were here!

We are excited to see what this year will bring with our current au pair.  It is no easy task to help care for our four young children but we hope the experience can be fun and rewarding for both parties.

Monday, June 16, 2014

Little Kids and All-You-Can-Eat Buffets

Recently I had a good laugh reading this circulating blog about people at the beach either with kids versus without kids.  Got me thinking there are many things that fall into this category... including eating at buffets!

We just got back from a trip out to Lancaster.  Those of you who've been out there will know what a smorgasbord is.  Well, we went to a huge smorgasbord for dinner the first night at Shady Maple.  There is no way you can walk out of a all-you-can-eat place like this feeling hungry shortly after... unless you have little kids!  Well, maybe if you have one or two and if they are older... different story.  But I have four and my oldest is six years old... so no wonder I was still hungry looking for ramen noodles about two hours after we got back to our vacation rental and the kids were finally sleeping!

Seriously... the first ten minutes was just taking each kid to the bathroom to potty and wash hands.  Then while one adult is watching the baby the other is getting the kids' food one or two plates at a time.  Now once the kids are all sitting and eating... my turn to get food!  However, after like two bites, this kid needs a drink... that kid wants more mac n cheese... the other one wants some soup.  It is just non-stop back and forth to the HUGE buffet spread.  Uh-oh... need more napkins... dropped a fork... need to potty again... ready for ice cream!  I think I burned more calories just running back and forth from the table to the buffet spread than I actually ate that night.  And if it weren't for eating dinner with other adults, I'd probably not get to eat at all.  I get why some folks just prefer the sit down and just serve me places!

Sunday, June 15, 2014

Happy Father's Day!

Shout out to all the dads out there... especially you, Joseph Kim!  You are awesome.  It takes great sacrifice, character, and perseverance to be a good father...

I can only manage a link to Dove's dad commercial this year... made me tear...
OK... trying to catch up on sleep... but have a few things I plan to write about this week...

Sunday, May 25, 2014

Family Medicine

I’m returning home from a conference for continuing medical education.  Schooling never ends for a doc.  It’s a good thing because as medical advances are made, standard of care and treatments change with new research and discoveries.  Practices based in tradition are challenged to see if there is real evidence to support their continued use.

So anyways, as I sat in a room full of family medicine physicians reviewing basic dermatology issues often seen in primary care, I was struck with many thoughts… thus prompting this post.

It takes an average of 3 to 6 months to get my patients in to see a dermatologist.  Everyday, at least 30% of my patients come to see me for dermatology related issues.  The better I am at recognizing and treating various rashes and recognizing skin cancer, the more I can help my patients save time and money.  In fact, it probably helps overall health care costs for the country.

This applies to other fields as well… such as ortho, cardiology, endocrinology, etc.  So this is a shameless plug for medical students to consider entering this field.  Minus all the paperwork stuff that we get bogged down with… I find it extremely rewarding.  It is never boring and there is such a variety of things we do everyday…  like taking skin biopsies, suturing wound closures, incising and draining abscesses, injecting cortisone into joint spaces, or just being there to listen when someone is having an emotional personal life crisis!  In fact, psychiatry is the other field that I find very difficult to get my patients in to see.

There is so much to know to be a competent primary care physician but it also takes a calm, warm bedside manner.  This is often challenging in the midst of pressures to see more patients in less and less time.  Whether the recent healthcare law changes will affect the quality of care given is for a whole other post.

So I worry when I read things about more mid-level providers (nurse practitioners and physician assistants) taking over the role of primary care physicians.  Nothing against mid-levels, I’m sure there are many very competent folks out there… but the amount of time spent in schooling and the type of schooling is just different.  Why are there so few US medical student graduates going into primary care?  Well that is for another post as well, but it is all sadly related to money.  Our dermatology and psychiatry colleagues make twice or sometimes even more the amount the salary of an average primary care physician and medical school debt is medical school debt.

Well, if I had to do it again, I would not change fields.  For my type of personality, I like having the variety of things I come across everyday.   And unlike our emergency room colleagues (who also make about twice the salary) I also like the potential to cultivate relationships with my patients.
So for what it is worth, I love family medicine!  I think there is a very important role family docs can play in helping patients achieve overall good health without breaking the bank.

Tuesday, April 29, 2014


Last night, my two and a half year old woke up in the middle of the night crying.  This is unusual for him because he usually sleeps from 7p to 7a.  Going in there, he tearfully cries, "mommy, I'm sick".  Poor kid felt hot.  Moms just know when their child has a fever... no need for thermometer.. you are in skin contact with these kids almost all the time so when their skin feels hot, you know.  I tried to measure it to be scientific and to prove to daddy that this warrants tylenol but E would not let me.  But daddy trusted my judgement, so we just gave him tylenol.  In fact, I had to get up four hours later because he was crying and was all hot again.  Then this morning, he woke up before his usual wake time crying and hard to console.  He was so loud I was worried he would wake up the other three kids.  I had just finished nursing little L and had just put him down again for another short nap hoping to sleep a little more till it was time to get up.  Nope.. not this morning.  So what actually worked was laying next to my little buddy and just soothing him with "shhhhhhh".  He eventually stopped sobbing... stuck his thumb in his mouth... and layed back down again.  I actually love moments like these... just laying there soothing my baby and knowing that just my presence was all that he needs.  After a while, I told him I was going to go back to my big bed.  "Ok, mommy...  I love you, mommy."  Melts my heart...  now to keep the others from getting sick!

So few things on fever...

  • not a fever unless over 100.4 degrees
  • fevers are actually a sign that the immune system is working
  • lower fevers with tylenol or motrin mainly for comfort
  • need to find source of fever if persistent... can be viral, strep, ear infection, etc.
  • rule of thumb is if fever persists despite tylenol, motrin call your doctor for further evaluation

Monday, April 28, 2014

Cradle Cap in Babies

Yay!  We have just passed the cradle cap stage... but thought I'd throw in a few things about it since two of my kids had it pretty severely and I don't think I've blogged about it yet...

What is it?
Scaly flakes that covers the scalp that can thicken into yellow crusty patches.  It can also be around the ears, eyelids, or around the nose.  Sometimes it can itch.

Who gets it?
Babies.  It usually starts by 3 months and resolves on its own by 6 months or so

Why does it happen?
No clear cause is known.  Some believe it is due to hormones that cross the placenta from mom to baby before birth.  It is not due to poor hygiene.

How do you treat it?
It will resolve on its own.  However, washing with mild shampoo can loosen the scales.  There are some oily cradle cap shampoos out there that some have found useful.  Combing the flakes with a baby comb after shampooing helps to remove the scales.

As always, when in doubt or if severe and persistent, see your physician!

Monday, April 21, 2014

Full Plate

Hope all had a wonderful Easter weekend!

Wow... everyday I feel like I'm playing catchup... who has time to blog?

My oldest is in the swing of elementary school. Conversations about friends and school and life has gotten so much more in depth lately. What a tremendous privilege and responsibility to guide her during this precious stage of growth and maturity.

My second is largely over her terribly independent and defiant stage and is back to being sweet and huggable. When the two of girls are together, they are non-stop chattering away. Every now and then we have to step in and sort out hurt feelings.

Big brother E is pretty hilarious with the things he says these days. He totally likes to copy his sisters. He seems to admire and follow along with the oldest but battles fiercely with the second. He is always banging on something with this toy or that... and fighting imaginary bad guys. Of all my kids, this kid is accident prone! Scraped knee here... banged up head there... cut lip... oh I'm just waiting for the stitches and broken bones!

Little L is my cute cuddly little man who has developed quite the chuckle. Poop has gotten more smelly as we've introduced real foods into his diet. Only issue is sleep, little buddy... mommy needs sleep!

Juggling when this one eats and that one needs to sit on the potty... this one has a sore thumb... that one needs homework help... I'm blogging here but I still need to make the lunches for tomorrow... print out pictures for another's homework project... piles and piles of laundry... figure out when my helpers need to come help... Ack! My plate is just full right now... but it's a good full.
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