Monday, May 1, 2017

More on Stress... and Tips for Sleep Improvement

Hello, everyone! It has been a very long time. I can write today because I am on a getaway trip to meet up with my college roommate. How refreshing to be able to hear one’s own thoughts!

Since this blog is very much a personal diary with some medical facts thrown in, today's topic is stress. A lot of this is probably common sense but I shall illustrate with a peak into my life.

So a couple of weeks ago, I had to take my medical boards which is required for certification every 7 to 10 years. It sure has been a long time since I’ve had to study for a test that counts and I’ve never had to do this while being responsible for 4 other individuals other than myself… and actually, it is even more individuals if you count my husband, extended family members, and patients that I feel responsible for every day. To say that I was stressed the week before my test is probably the understatement of the year. So aside from my increased irritability and lack of patience with everyone (I was going to write “my kids” but I think my snappy-ness applied to everyone who crossed my path)... I also developed some medical issues. Being stricken with a canker sore sandwiched between my upper gums and upper lips was uncomfortable and troublesome but getting TMJ was new and surprisingly more painful and debilitating than I ever imagined. I have new found empathy for all the patients I’ve treated in the past with this. I also realized I had taken for granted the ability to chew and even yawn. Boy, was it difficult to yawn without triggering sharp shooting pains and locking of my jaw. Thankfully, my symptoms eventually subsided when I finally gave in and took some Aleve and slowly resolved a couple of weeks after my exam.

You would be bored if I rattled off all the things that were stressing me out. However, I do think it is a good exercise to write it all down, stick it in a box, and give it all up to the Lord. My lengthy list included some unexpected added inconveniences and annoyances that I’ll save for another post.

This trip was a treat for me away from the kids and my usual routine… to catch up and spend time with my friend. It was a well needed time of rest and restoration for my body, mind, and soul. As I am finishing this blog on my flight back to real life, I can tell you that I am in a healthier frame of mind.

For a glimpse of the state of my mind before the trip… here is a snapshot of an interaction that happened on the way there.

First, I had to leave home very early at around 230am to catch my flight, so I pretty much pulled an all-nighter. Maybe I got in 2-3 hours of interrupted sleep during the first leg of my flight. When I arrived at my connecting city, I stopped at the gate counter to ask the agent how I can get to Terminal F.

“There is no terminal F” she says to me puzzled. “Where are you going?”

I show her the boarding pass I had pulled up on my phone from the e-wallet app. She looked it and wrinkled her brow. “Wait… this pass is from Philadelphia going to Bangor.” I then started to panic. Gasp. What if I booked it wrong? This is a total possible scenario given my recent track record. Another agent walks over holding a sheet of connections in his hand to try to help, “Where are you going, Miss?” he asks me. I hesitate as I rack my brains trying to answer. “Uhh… hold on… “ I frantically search my emails for the info.

“What city are you going to?” he asks again. When I still failed to answer, he responds incredulously, “Lady, you don’t even know what city you are going to?!” The original female agent I was talking to looked at me sympathetically, “Oh, the poor lady!”

Aiyayaieee!! This is exactly why I needed a getaway… my brain was overloaded and needed a reboot. But in my defense, my friend picked the location and the name of the city we were going to was unfamiliar to me so it never stuck and I didn’t want to answer “some city in Mexico”. Finally, the agent asked me for my name and proof that I am who I say I am… then pulled out a boarding pass for me from under the counter. She had that the whole time? Turns out I am to go to Terminal D. Apparently, I had pulled up an old boarding pass and it just didn’t register.

So I’ve been advocating the importance of sleep to my patients. Our human brains need sleep like computers need to be routinely shut down. If you leave your computer on too long, programs start to crash. Same with the human brain… we start to crash in all different levels. I also believe that natural sleep when your brain goes through all the four stages of sleep and REM sleep is very important and not the same as sleep induced by meds (like Ambien). These sleep aids only shut down our brain physically and give us physical rest but not the mental rest that is also needed. Sometimes sleep aids are needed to reset the sleep cycle but it is important to get back on a routine regular sleep cycle. This can be very tricky especially if it has become routine and the brain has become dependent on the sleep aid to initiate sleep. However, it is not impossible and may require persistent therapy and support from different medical professionals to work through this important issue. I’ve mentioned it before in a previous post, but here are some basic tips on how to improve sleep.

  • routine routine routine... develop a bedtime routine about 1 hour before bedtime to wind down

other important factors include:

  • induce physical relaxation
    • take a hot shower or soak in a warm bath to relax the muscles
    • give yourself a body rub with a moisturizer that has a pleasing but not super strong scent
    • can try lavendar scented candle, room spray or essential oil
  • avoid increasing stress right before bed
    • avoid the news right before bed
    • avoid hard conversations
    • write down your worries and put it in a box if need be to address in the morning
    • shut down all electronics at least 30min but the longer the better before bedtime
  • minimize sound
    • use white noise if needed
    • try ear plugs
    • go to bed and fall asleep before the person snores next to you
  • exposure to light
    • flood yourself with natural sunlight during the day
    • avoid blue light at night (computers, cell phones, ipads etc)
    • if need to use night light, use red light
  • exercise
    • don't do it too close to bedtime
    • but regular exercise during the day helps
  • watch what you eat
    • certain foods actually may help (like cherries, milk, bananas, turkey, and even not too sugary carbs)
    • avoid foods that cause heartburn (like burgers and tomato based foods or spicy foods)
    • avoid foods that are high in sugar
  • watch what you drink
    • avoid caffeine of any type past 4pm
    • avoid alcohol too close to bedtime (less than 2-3 hrs prior) as this may initiate sleep but disrupts the maintenance of sleep
    • avoid too many drinks of any type past dinner as this may cause the need to go to the bathroom during the night
    • in small quantities certain herbal teas may help
  • minimize disrutions
    • avoid sleeping with a pet

Improving sleep in adults is pretty much the same concept as improving sleep in babies. It requires some sleep training which may look different from person to person and also may take a few days to even a few weeks. Consistency is key and once disrupted, it takes some work to get it back.

Sleep is what I did get on this trip! 8am (because I had to catch a flight today) was the earliest I’ve woken up these past 3 days and I've been going to bed pretty much before 11pm every night. I plan to make more effort to keep a strict bedtime routine and follow my own advice when I get back.

Eating plenty of good food was another treat that helped me feel refreshed this weekend. Now the food was amazing!

best tuna cerviche ever

scrumptious shrimp tacos...

magnificient open fire grilled fish...

Although it is not practical to get the same kind of gourmet food when I get back, I do need to make more of an effort to eat regularly.

Exercising these past few days included walking on the beach...

trying out these bicycles...

and swimming...

And even though I may not have this kind of beautiful scenery to relax to everyday…

…I can make more effort to take a minute to breathe on a consistent basis.

So sleep, food, exercise, and relaxation… though I don't have to travel so far away to get these basics for a healthy body, soul, mind… it sure doesn’t hurt to do so every now and then. Thanks to everyone who made this trip possible!

Monday, January 2, 2017

Making Memories

Happy New Year!

2016 flew by and as I looked through pictures to make my annual calendar to give as gifts to the grandparents, I thought about all the memories being made. Usually I pick the happy moments to reminisce and re-live... however, I realized that no matter how grand or small.. how awesomely joyful or hair pulling stressful... precious memories are still being made.

"How was your Christmas?" was a common question I got asked the week following the holiday. This year, I had to chuckle and I actually struggled to answer. One would never be able to guess based on the handful of pictures I chose to post on facebook for extended families and friends...  but it didn't capture the full extent of emotions that erupted that day.

So we were hosting Christmas dinner this year and during the start of the night when everybody was just getting into the meal, my oldest throws up in front of everyone. In the nick of time, dad caught on that she wasn't feeling well and fervently urged me to grab a bucket. We got it just in time and headed over to the bathroom where everyone can still hear her retching. I then ushered her upstairs to get showered and changed and a speedy goodnight to all... at this point we were not sure if this was infectious as she had no signs of illness prior to this. Later that night, was not so fortunate for her dad and me as we had to do several rounds of laundry and bed sheet changes.

But back to the Christmas party... it was now gift exchange time and my #3 kid decided to have a melt down because he "didn't like his gift".  Now understand, if this gift was given to him in isolation he would have loved it. In fact, even as I write this I can say that he has played this game several times since that day and absolutely loves it.  However, the combination of being overtired and probably comparing at the time with what he might perceive as more glamorous gifts being opened at the time... he cried. So second kid to be ushered upstairs with an early goodnight to all.

I then wearily climbed down the stairs thinking "Whew!  Now, I can have a decent conversation with my aunt who flew all the way from Houston to visit." But wait... is that another kid crying I hear?  Why of course... what was I thinking that my night would end so easy? So down to the basement I go to find my #2 kid hysterically sobbing and holding her head. Big huge egg on her forehead because kid #4 threw a frying pan at her.  A toy frying pan you may ask?  Oh no... this is a solid iron medium size frying pan. Why is a frying pan in the basement you may be wondering... well... not to throw anyone under the bus...  but let's just say we all make poor judgement calls at times... and yes, my youngest shouldn't be throwing things at people.. but why is a frying pan in the basement with all the toys??!

Ok. So take frying pan away from kid #4 and now kid #4 joins in the screaming because he wants it back. O what a night! So you can understand why I got a little emotional when aunt then gets whisked away by my dad before I had any decent conversation with her...

Now Christmas 2016 is going down in the Kim books as one memorable Christmas... one day when these kids are older... and maybe their significant others are also sitting around... we'll go around the table saying "remember that one Christmas where you threw up... and you had a fit because you didn't like your gift... and you threw a frying pan at you??!!!"  ...and then... we'll all laugh...

Wednesday, October 12, 2016

Doc, I Need an Antibiotic!

We are nearing that time of year again where our phones ring off the hook and our waiting room overflows with sick patients. Our medical staff are fielding calls insisting for same day appointments or demanding antibiotics. So I just want to blog a little about what we see and treat this time of year. Let's start with sinusitis.


What are the common symptoms?
  • purulent nasal discharge ("gross yellow/green mucous")
  • nasal obstruction ("can't breathe")
  • facial pain, pressure, or fullness
  • can also get cough from the mucous and postnasal drip
What causes it?
  • viruses are most common (antibiotics don't help here)
  • bacteria 0.5-2% of cases
How do you know if you may need an antibiotic for treatment?  
See your doctor and let your doctor weigh your history and physical exam to determine. Usually these are the indicators:
  • symptoms are lasting for 7 or more days
  • symptoms are worsening, especially if after initial improvement
  • fever greater than 101
  • moderate to severe facial pain
Well, what happens if you take an antibiotic when really you did not need one?
  • you will get better no faster than if you did not take the antibiotic (you will never know)
  • you risk side effects of the antibiotics like diarrhea which may worsen your course
  • you are increasing the incidence of antibiotic resistant bacteria (like MRSA)
So what can you do if you don't need an antibiotic?
  • rest and drink lots of fluids
  • motrin or tylenol for pain
  • saline nasal spray to irrigate or use neti pot to irrigate
  • topical nasal steroids (like flonase) may help
  • topical atrovent (requires prescription)
  • guaifenesin (AKA Mucinex) can break up/thin out the mucous
What to avoid?
  • antihistamines (like benadryl, claritin, or zyrtec) may over dry and increase discomfort
  • zinc preparations show no benefit
How to prevent in the future?
So next time you get sick, you may want to try some of these remedies and give your body a fighting chance for a few days before you pick up the phone to call your doc. Now if you have been sick for 1 week and not improving, call your doc.

One more last pearl... coughs can linger and linger... according to one recent study the average duration of cough is 18 days!  However, if you are wheezing or short of breath with your cough... or it is just getting worse... go see your doctor.

Saturday, October 8, 2016

Probiotics and Colic

Few years back I blogged here about how probiotics can help reduce the severity of viral gastroenteritis (stomach flu) and even prevent antibiotic induced diarrhea in kids.  Well, now there is even a small but randomized, double-blind, placebo-controlled trial that showed how probiotics help colicky babies. You can read the full study here. For 21 days, breastfed Canadian babies who were given lactobacillus had significantly improved reduction in length of crying and fussing times based on recorded diaries and maternal questionnaires. Granted this investigation only involved 52 infants (very small sample). However, for tired parents looking for relief why not give this a whirl? Note that the study was only done with breastfed babies and not formula fed babies so it is unclear whether the same would hold true with the latter. But again, it wouldn’t hurt to try if parents are struggling for relief.

So the official definition of colic is uncontrolled crying for more than three hours per day, more than 3 days per week, and for longer than 3 weeks.... AND infant needs to have appropriate weight gain and a normal physical exam. This is very important! Therefore, if you are suspecting colic in your baby please do not just add yogurt to your infant's diet in hopes that the crying will stop. Consult your doctor first!  Other more significant medical causes need to be ruled out.  Some examples:

  • An infection
  • Acid reflux or stomach problems
  • Pressure or inflammation of the brain and nervous system
  • Eye trouble, like a scratch or increased pressure
  • Irregular heartbeat
  • Injury to bones, muscles, or fingers

If your doctor does confirm the diagnosis of colic in your infant then you can try giving lactobacillus via infant drops.  Here are some other tips that may help:

  • Eliminate all allergens (cow's milk, eggs, fish, peanuts, soy, tree nuts, wheat) from the diet of the breastfeeding mom
  • Switch formula-fed infants to hydrolyzed formula

Majority of infants outgrow colic by 6 months. That may seem like a long time so if you are feeling like you are at the end of your rope, please seek help. It is overwhelming and stressful enough to care for a brand new baby, let alone one that cries often. Having a good support system is critical and knowing when to seek help is just as important.

Tuesday, October 4, 2016


Hello folks! It’s back to school and routine. I actually love this time of year. I love making schedules… color coding all the different activities per kid… typing up excel sheets to figure out how best to maximize time… and yet… and yet… we are warned not to overbook… not too overstimulate… Kids still need to be kids and have down time and play time. Yes, it’s all a balancing act. Parents are encouraged to be involved but not hover like helicopters…

So this year we have 3 kids in the public school system and 1 who just started preschool. We are sliding into a totally different phase of life. Before it was all about diapers, sleep hygiene, food intake… Now we still do keep track of the kids’ input, output and sleep…  but we also have to figure out how to attend Back to School Night for 3 kids at the same time... know when library books are due (...and of course all three kids have different library days)... as well as whether to dress our youngest in orange or black or yellow for whatever color of the day it is at preschool. Helping with homework, driving to activities, talking about friends… our days are full…
How not to get overwhelmed and stressed? Stress is a good topic to chew on for a while. I believe a lot of medical illnesses likely stem and definitely is exacerbated by stress. In fact, a couple of years ago I blogged about it here, how lifestyle modification can prevent/alleviate disease and stress being one of those factors. So what is stress?  It seems like such an overused term. Google defines it as “a state of mental or emotional strain or tension resulting from adverse or very demanding circumstances” Well, “very demanding circumstances” may vary in meaning from person to person. Seems to me like a very broad and nonspecific description. Bottom line is your emotions and mental state is feeling strain and tension. So let’s look at this from two perspectives… prevention and treatment.

Easier said than done… but may start with knowing your limits and learning to say “no”. If possible, make choices that avoid those difficult circumstances. Too bad there is no vaccine for stress! But you know how if you are healthier to begin with, you have a better chance of fighting sickness? So you exercise, eat right and sleep right to make sure your immune system is strong to fight when sickness may fall and you may not be as sick. Similarly, I think if you exercise, eat right, sleep right, and have a good support system you will be more equipped to handle stress when it hits.

So the treatment for certain medical illnesses are supportive measures such as fluids, rest and time. Just as nutritious food, sleep, and even exercise help the body fight the bug, the same can help relieve stress. But you know what else? I think laughter is the best medicine for reducing tension. I think after having kids, I forgot how to laugh. Instead of laughing with them, I find myself often annoyed at the silly giggles and ridiculous cackling. O to discover my sense of humor again! Now there is also something called the Relaxation Response that I’ve blogged about before which also combats stress… but I’m telling ya… I’m going to be more intentional about laughing! Finally, just like with sickness, we need a prescription antibiotic to recover if the symptoms become severe and we become infected with a bacteria, we may need a prescription if the stress symptoms become severe and turn into something else. Do talk to your doctor if you are wondering if your stress level requires further intervention.

OK.. going to end with a video I found online that made me tear… Michael McIntyre and his stand up comedy about "people with no kids don't know"...

Monday, July 25, 2016

Zika Virus

Alright, so I gotta tie my vacation post to a medical one. Last year we went to Yosemite where there was news of the bubonic plague. I blogged about it here. This year we were just in the Carribean... and I have a TON of mosquito bites... so guess what I'm going to talk about?  That's right... here's a little 101 on the Zika Virus.

How do you get it?
Transmission is mainly from a mosquito bite. Other ways of getting this virus include:

  • mother to fetus
  • sex
  • blood transfusion.

What are the symptoms?
Most people will have no symptoms at all or get very mild symptoms.  Symptoms incude:

  • fever
  • rash
  • joint pain
  • conjunctivitis
  • muscle pain
  • headache
How do you treat it?
Treatment is usually aimed towards alleviating symptoms.  Rest, fluids, and tylenol as needed for pain or fever.

So what is the big deal?
If a pregnant woman becomes infected with the zika virus, the virus can cause a birth defect of the brain in the fetus. This can lead to a miscarriage or still birth. According to the WHO (World Health Organization), the Zika virus is spreading very rampantly in the Americas and in January had declared birth defect due to Zika as an international public health emergency.

Areas with active mosquito-born Zika virus transmission include:
  • Americas
  • Pacific Islands
  • Africa
You can go to the cdc website for more detailed listings. 

Hm.. I don't see Turks and Caicos on the list. But no chance I'm pregnant anyway... so worse case scenario I'd just be sick with a flu-like illness for a week or so.

How do you prevent getting it?
There is no vaccine currently so best prevention is just protecting against mosquito bites with repellent, long sleeves, long pants etc. If pregnant, would avoid traveling to areas that have active transmission.

Friday, July 22, 2016

All-Inclusive Vacation With Little Kids

For the first time, we decided to go on an all-inclusive beach vacation with the kids. We’ve been on cruises and to amusement parks, national parks... but not this. So what did we think?

First of all, location is key… not sure how other all-inclusives compare but we went to Turks and Caicos and since I love the beach… this is the place to go to for a beach! Talk about soft white sand and crystal clear water!

Additionally, this place is only a 3 hour non-stop flight away from PHL. So getting here was a piece of cake. Just need to get passports for everyone. But unlike our 6 hour flights cross country the last 2 summers for family weddings… this 3 hour plane ride went by in a blink of an eye. 

Now the return flight with a layover in Miami and customs etc was not so fun... but still worth it. Just have to find ways to entertain. This was at the Turks and Caicos airport waiting to board our plane coming back...

Since our four kids are 8 and under… vacations are usually super draining for us.  Not just physically tiring (I literally got up five times during dinner one night just shuttling different kids to the bathroom)… but mentally as well (playing referee and judge for squabbles among the older ones especially)… 

Marvelously, this all-inclusive at Beaches includes watching the kids in different kid camp settings for all different ages! Even our youngest who is 2 ½ years old was able to be dropped off. Camps were open from 830a to 10p though I’m not sure if any parent would drop off their kids for all that time. We just use the camps for a couple of hours here or there throughout the day. There was a calendar of events for the different age groups and we basically picked the times to drop them off based on what activities were going on matched with our kids’ interests. 

The waterpark was a hit with our girls. 

Snorkeling lessons, bonfire with smores, pinata party, structured arts and crafts as well as the xbox game room more than entertained the older girls. The younger ones got story times, letter of the day with Elmo, Big Bird or one of the other Sesame characters. Baking cookies with Cookie Monster was a big hit... as well as the ride on the choo choo train that circled the property. In fact, all four kids got to sit on the train and parade with the Sesame Street Parade one evening. Overall, I thought the whole kids camp was pretty well organized. Though at first I felt guilty for dropping off the kids when we were technically on “family vacation”... the positive feedback from the kids was all I needed to convince me to do it again the next day.

We were able to correspond the times so that my husband and I got to go kayaking, sailing, and even go on a snorkeling trip without the kids. We also enjoyed 2 lunches and 1 dinner on our own! Our view while dining at Sky Restaurant...

Hey, a more relaxed and happy momma will make for better family time anyway when we are all six together! I really only need one to two hours here or there in my day to reset my happy meter… especially if it is on white sand with crystal clear water lapping my feet!

Not only did the camp give us adult time but also some quality one on one kid time. It was a useful way for us to divide and conquer. For example, while the youngest napped in the afternoon, one parent could spend some one on one time with another child while two others were entertained at camp. On another day we would flip flop. It would be hard for me to go snorkeling with my older two if I had to also watch my third child who cannot swim well, so he got dropped off for story time with Elmo while we snorkeled.

Now a few other things...

Besides the waterpark, there were lots of swimming pools. My kids love water so they were here a lot... even at night.

In fact, they love the pools more than the beach... but not I... no... beach for me...

And what about the food? This part felt like a cruise ship except many more choices. There were lots and lots of restaurants to choose from. The restaurants all have different themes, ambiences, and serve different types of foods. In fact, there were so many restaurants we were unable to try them all. The kids' favorite restaurant was the hibachi style restaurant called Kimono. Here the chefs cook Japanese hibachi in front of you but the entertainment was different than what we’ve experienced in the States. These guys can sing! Food was just mediocre in my opinion as far as Japanese hibachi food goes… but the entertainment value made up for it. Here is our chef singing and cooking for us!

Hesitations in coming back? Mainly cost… with four kids, we had no choice but to book one of their bigger rooms with concierge service. 

Great room that walked out to the pool... but I don’t think we used the service very much and neither my husband or I are very big alcohol consumers. I wish they would offer a no alcohol package but I guess it would be too hard to enforce. I suppose it was nice to order fruity drinks by the pool and even the kids were able to order virgin drinks which they got a real kick out of… 

Nonetheless, I’m pretty sure if we were to add up all the tab we spent way under what we paid. Well, maybe the childcare made up for the rest of the cost...  

All in all… my kids thought this vacation was “awesome” and I would have to agree. This trip was a nice combo of family time and some adult rest and relaxation time. We found this tree with this sign on it which basically sums up our feelings.

But... back home to reality...
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