Monday, February 26, 2018

Flu Season May Have Peaked

So this article was in my inbox this morning from AMA Rounds (American Medical Association) and caught my eye...
CDC: flu season may have reached peak
ABC World News Tonight (2/23, story 9, 0:25, Muir) reported the flu season has led to “a disturbing number” of child deaths – 13 more have died, bringing the national season total to 97 – as infections remain at high levels in 39 states. However, “visits to doctors and” emergency departments “did tick down” according to recent reports.
        NBC Nightly News (2/23, story 6, 1:40, Holt) reported data from the US Centers for Disease Control and Prevention suggest the “season may have finally peaked.” Medical correspondent John Torres, MD, explained the CDC says “doctor visits and hospitalizations for flu are down,” a sign “that the worst is over.”
        USA Today (2/23, O'Donnell) reported CDC spokeswoman Kristin Nordlund said the new data are “encouraging,” considering the decline in visits to physicians and child deaths, down from 22 the week prior. She added, “It looks like we may have reached the peak of flu season,” but added that “it looks like we still have many more weeks of flu season to go.”
        CDC relies on network of surveillance methods to track flu The Wall Street Journal (2/23, McGinty, Subscription Publication) reported on the CDC’s flu surveillance data collection process, saying the agency relies on a network of hospitals, labs, and outpatient facilities to track the virus. This surveillance tends to capture only a portion of flu cases, and includes categories such as outpatient surveillance, hospitalizations, and mortality. Lynnette Brammer, head of domestic influenza surveillance for the CDC, discussed the agency’s use of surveillance and how effective these methods are. 

===
Great!  It sure has been unlike other winters from not just the number of patients coming in but also how long the illness lingers and the severity of the symptoms.  For example, I treated many folks who normally never needed inhalers who were now wheezing and needing neb treatments.

Since we are not totally out of the woods yet, please continue to wash your hands and practice good hygiene.  Easier said than done for little ones who love to put everything and anything in their mouths... but grownups do it, too.


Also, do not underestimate the importance of a good night's sleep and stress reduction.  The minute your sleep is disrupted or you are stressed... your immune system is lowered and that is when you may find yourself sick.


Some practical advice when you find yourself starting to get sick. Your throat usually starts to hurt and you get that "malaise" feeling.



  • take it easy and REST. 
  • drink LOTS of fluids (water... not just caffeinated beverages which dehydrates you... so coffee but also soda or tea has caffeine.  alcohol dehydrates you too!)
  • make sure you are eating nutritious meals... don't skip meals.  chicken broth if you are losing your appetite. stay hydrated and think about how to make the most of what you are taking in especially if you don't feel like eating
  • probiotics and vitamins if you don't think you are covering all your basics with your diet
  • do not give up exercising completely if you normally exercise... but maybe cut down on intensity based on how you are feeling. the better in shape you are the better chance you have of fighting it off quicker...
  • if needed can take Tylenol or Motrin for fever and aches and over the counter cough medicine to help relieve coughing so you can get rest
  • call your doctor if you feel you are not improving.. or if you improve then get worse again
And I wrote about the flu vaccine in previous posts.... but given our recent Superbowl Eagles win... (Go Eagles!) ...here's my analogy I've been using with my patients...
  • You are the Eagles team (or whatever team of your choice)...
  • The flu virus is the other team...
  • Getting the vaccine is like getting a sneak peak at the other team's plays...
  • You may not know exactly which one they will do when... but you will have more of an advantage than another team who did not see the plays
  • So... even if you do get sick after getting the flu shot... imagine how sick you'd be if you didn't get the flu shot...
That is why I always get the flu shot (to protect not just myself but my older and younger patients as well as my family)... and I try to get all my family members to get the shot.

This flu season is going down as the worse season since 2009 when Swine Flu was around. I did get the Swine Flu in 2009 and I was pregnant.  That year, we did not have the vaccine in time and I got exposed in August and was sick until November. I've never been so sick in my life before! Flu can be very serious... so glad this flu season is almost over...

Thursday, February 15, 2018

When Tragedy Hits...

So you know... I wrote that other blog the night before Valentines Day... sent it last night... but all day yesterday in the midst of the parties and fun... in the background... my heart really was in a knot . I heard the news and thought "another one??" ... but knowing this was a school setting was even more troubling to me.  I was afraid to read the details because honestly... I didn't think my brain/heart/soul could process it yet... I just needed to compartmentalize this news until I got done what I had to get done...

But last night and even this morning... I did read... and I am struck... I'm still processing...


Part of me feels a little like this is unreal...  there have been too many stories... but at a school again? It's frightening to think how little actual control we have over what happens really... and now having kids of my own it's even more frightening to me... 


My brain can't even begin to process the horror and grief that these parents must be going through...

So... I just wanted to share my "go to" verses when my mind starts to panic and worry and... basically "freak out"...


Do not be anxious about anything, but in every situation, by prayer and petition, with thanksgiving, present your requests to God. And the peace of God, which transcends all understanding, will guard your hearts and your minds in Christ Jesus. (Philippians 4:6-7)

Trust in the LORD with all your heart and lean not on your own understanding; in all your ways submit to him, and he will make your paths straight. (Proverbs 3:5-6)

I sought the Lord, and he answered me;he delivered me from all my fears. (Psalm 34:4)

Happy Valentines Day!

So, yes we are now out of the nursing, changing diaper, spoon feeding, wiping bottoms phase... well... no, there is still some bottom wiping... but we are out of the more physically taxing stage of parenthood! Now, we are sliding into the more... let's say... emotionally taxing aspect of parenthood.  We are also smack in the middle of elementary school years and I actually am loving this stage!

Today was Valentines Day. For us, this means parties at school and since all 4 of my kids are now either in preschool or in elementary school... (when do these parties end? 6th grade maybe?) last night I was up finishing like 80 valentines. LOL. Good thing for google and pinterest!







It really was a lot of fun looking up ideas and getting my kids' input on what they wanted to do. They wrote their classmates names and signed them. The older kids helped more with the making of the valentine. Past years, I think I just bought a box from the store because honestly, I had neither time nor energy. This year, I truly wanted to avoid sweets. It helped that the principle sent out a reminder about their school's "no candy" policy. There really is just way too many excuses for sugar and candy.

Speaking of which... here's little medical tidbit on sugar. Now there is a plethora of information on this subject so this is not at all an in-depth analyzation or discussion. However, as both a family doc and as a mom of four, here is my two cents:


1) Moderation is key... don't completely deprive...

This is not rocket science, but I feel this cliche is very true...
See intaking sugar is not all bad, but binging on sugar may lead to very similar type of cravings and withdrawals that is often seen in addictions. Therefore, the trick is to not to be super duper crazy limiting... (which might lead to unhealthy cravings and binging) but maybe to offer more choices and more opportunities of well rounded foods... and sugars can happen to be one of them...

2)  Don't put it on a pedestal and offer as a "reward"

I think the bigger obstacle is to debunk sugar from this high glorious position... See if we treat sugar/candy as this "trophy" for whatever good behavior etc.  then the kids too will see it as this awesome unattainable.  Now this concept is harder than I thought it'd be. I was surprised to find myself offering candy as a bribe when feeling desperate! So discovering what to replace this "treat" with may take some creative thinking since every kid is different. But the idea is to not make "candy" the prize... offer a better alternative. There has gotta be one out there!

Alright... go enjoy your sweets! Happy Valentines Day, everyone.

Sunday, February 4, 2018

Go Eagles!!!!!



Happy 2018, everybody!  

I realize I am only a month late... it sure has been a while since I've blogged.  2017 is a bit of a blur... to give you an example of the state of my scattered mind... one of my so called "resolutions" for 2018 was to get my youngest to preschool with his shoes on!  Twice in 2017, I believe, this failed to happen... so he went to school in socks and another family member had to bring the shoes before recess... So as I was happily announcing this 2018 resolution to his preschool teacher... proudly showing her that he has had his shoes everyday so far and we were on week 2 of 2018... she kindly points out... " love your shirt! I have the same one... it's on backwards by the way..."

Progress not Perfection!!!

Okay... 2 huge milestones to catch you all up...
  • My oldest has now lost ALL her baby teeth
  • My youngest has been diaper free for some time now...

Now, I thought we would throw a HUGE party once we were diaper free because it really has been like 10 years of diapers.  But no... came and went... all a blur... but yay!!

Alright... keeping this short and sweet...  let's make some history...


GO EAGLES!!!!!


Thursday, August 10, 2017

Stepping into Tween Years

I just got back from a very special mother daughter weekend trip with our oldest. She will be entering fifth grade this fall and going to public school... and so it's time for "the talk". Actually, since this daughter is scientifically minded and I'm comfortable talking about biology, we actually already had the nuts and bolts of "the talk" a few months back. It kinda came up while we were driving home one night from her basketball practice. One thing led to another and I just decided to lay it all out... 23 chromosomes + 23 chromosomes = 46 chromosomes and etc!

However, I remember being recommended to go through this series called Passport2Purity. I liked the idea of going away one on one to go through this project and having a structure to talk about issues that may be coming up in her life soon.

The idea is we would listen to these audio cd's together and pause to discuss the topics. I did some prep work before hand to gather materials needed for the projects at the end of each session (there were 5 sessions total).


Since dad wasn't going on the trip, he wrote in the travel journal that we presented to our daughter so that she could read it before we started listening to the sessions. It was a chance for him to speak from his heart and offer words of encouragement as she begins this journey into adolescence and adulthood. I wrote in it as well but after the trip to sandwich her experience. Hoping she will refer to this journal often as she continues to grow as I threw in there many of my favorite "go to" verses. Here are a few:
 I can do all this through him who gives me strength. (Philippians 4:13)  

Do not be anxious about anything, but in every situation, by prayer and petition, with thanksgiving, present your requests to God. And the peace of God, which transcends all understanding, will guard your hearts and your minds in Christ Jesus. (Philippians 4:6-7)

Rejoice in the Lord always. I will say it again: Rejoice! (Philippians 4:4)

The audio cd's were actually pretty interesting and fun to listen to. We listen to a lot of books on tape so this had some similarity. Parts of the audio had kids play out storylines and other parts the authors would bring up the points and ask questions. We paused many times in each session to review, answer questions, as well as hash out anything that needed to be hashed out. Each session took a little over an hour to listen to. The project itself took about 5-10 minutes and was pretty fun to do. Here's a picture of project #1:


She had to put together the harder puzzle without the box showing the final picture, while racing me tackling the easier puzzle with a box to refer to. This illustrates how hard it can be to maneuver life without a "map" to lead us. The Bible is the map, Jesus is the compass, and parents are the guides!

Topics covered includes peer pressure, sex, and dating. It is a LOT of material and all of it may or may not be appropriate or relevant at the given moment.

I did choose to complete the entire series.  We did sessions 1, 2, and 3 driving up and then 4 and 5 on the drive back. However, I did tell my daughter that we would re-visit some of the topics later when it becomes more relevant. I thought it was ok to at least go through it all so that she is aware of what is to come... but I do not expect her to fully understand or apply all of it right now.

Now for our weekend getaway... I had signed up months ago for this Masters Field Hockey Tournament (players over 35 years old) that was going to take place in Boston. I thought it'd be perfect because Boston is where my husband and I met... AND my daughter had just started playing field hockey so I thought it'd be fun for her to come up with  me and watch me play. Great idea until it dawned on me super late that it has been like 20 years since I've really played... and... I'm sorely out of shape.  Plus, I'm unfamiliar with all the new rules... and... have an obsolete stick!! LOL. Well... a lot achey and sore and humbling what this body can and cannot do anymore... BUT I had a ton of fun!


At the very end of the trip, we involved dad again. He met us as we were coming into the house to welcome her home with a hug and present her with a small gift to remember the weekend by.  We got her a little cross necklace to wear.


We also plan to finish the 500 piece puzzle together as a family and then frame it as another token to remember the weekend by. Since we are planning on going through this with each of our 4 kids, I went ahead and ordered the replacement travel journals in case they come up with later editions and the travel journals no longer match up.

So overall I'm glad we had our weekend away and I enjoyed the structure that the cd's provided. The topics were relevant and the material presented in a non-threatening... not too embarrassing way. Ultimately, it is still up to the parent how they want to use the material... what to listen to... what to skip.. but the key is to have these conversations with the child and to keep an open dialogue. I don't see this as a once and done deal... but as a springboard for ongoing discussions as things come up. It provides a solid biblical base.. and the key is biblical... so obviously this series would only work for you if you believe that the Bible is indeed the inspired Word of God.

Saturday, May 27, 2017

Celebrating 15 Years Being Married!

So what does marriage look like for us 15 years and 4 kids later?





shoes scattered… different sizes.. shapes… types… (not necessarily on the shoe rack)…

a random sock here or there…


miscellaneous toys in places that don’t always make sense… a toy police car here… darth maul light saber there… a Barbie shoe… glittery sand like material…


listening to ear piercing three year old tantrums... 

but other times surprised by deliciously hilarious grown-up like sayings…

some clinginess… and some independent explorations and triumphs…


soft kisses and cuddly hugs...


sticky hands and smelly feet…


lots of negotiations... and sometimes bribery...


too tired for words many nights… 

and learning to communicate through s-p-e-l-l-i-n-g

still your typical men are from mars and women are from venus moments…




and actually men are also like waffles and women like spaghetti...


but learning adaptation… give and take… picking battles… 

silence is golden…


a full dishwasher...


loads and loads of laundry...


going through paper toilet rolls...


buying gallons of milk...


scheduling our schedules around our schedules…


touching base about the “plan”...


there will be hurtful accusations… and tender moments of healing…


times we need to forgive… times we apologize humbly…


prideful stubbornness... and some things we find just... annoying...


but accepting... accommodating... learning...


lots of dividing and conquering…


not always agreeing on method… style… or the nuances of daily life… but fundamentally on same page… that’s important


remembering what used to make us laugh… finding new things to tickle us...


falling… getting up…


failing… not giving up…


despair... hope... it's the whole gammit of emotions...


watching one another grow… stretch… struggle… overcome…


frustrating but worthwhile…


thankful for the past… 

cherishing the present… 
building together towards the future…

15 years of holy matrimony and counting...



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!
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