Regular exercise? Yeah right!

A couple weeks ago, I realized I needed an attitude adjustment. I was getting to work late probably 2 of 3 days a week because I kept trying to read novels while getting ready in the morning. After the kids were in bed I'd immediately hit the couch with a book and some ice cream. When that treat was gone I'd eat raisins out of the box. Then I'd go to bed at 10:30 or later - no wonder I couldn't get up earlier.

I talked to M about it and got some helpful support. I've been getting as much as I can ready the night before - setting up the coffee pot and starting to pack my lunch. I've practiced more moderation with the novels. Also, I signed up for SparkPeople, which I've been recommending to my patients for a while. I have always had good success when I track my diet and exercise. Entering the stuff in motivates me to make healthier choices, and at the end of the day I can see if I have wiggle room for a treat or not. This really helps me avoid the mindless eating.

This site is crazy! There are so many resources. I'm focusing on just a few. I've been doing a great job with the water, probably enough that I gained a couple pounds in the first week as my body rehydrated. Also, I've been tracking my hours of sleep, which helps me go to bed a little earlier. I have even been getting up at 5am some days to exercise. Usually yoga, sometimes a little Dance Dance Revolution action!

I feel great when I exercise! But there are really a lot of barriers. If one or both kids wakes up at 4:45, I really do not want to spend any effort getting them back to sleep just to wake up myself 15 min later, so I tend to bring them to our bed just so I can spend some time horizontal. Really hard to get up for the alarm when there is a sweet cuddly body next to me - also hard if it is a squirmy kicking body. Is there any data on restless leg syndrome in toddlers? On the days when I do get up at 5, there is a good chance that little guy will wake up at 5:30. I have no idea how long I'll get for my workout, so the 60 minute Pilates video has been right out.

It seems crazy that I have to get up at 5:00 when I don't have to be at work until 9:00. But these mornings are NOT easy. M leaves by 6 to beat the traffic into the city so I am on my own. This is an area where two is harder than the sum of one plus one. W used to be pretty easy - he was pretty passive during changes, and he'd stay where I put him while I struggled with T through getting dressed and using the potty. Now W is in a phase of active resistance. On the changing table he squirms, rolls over, tries to grab everything else and throw it on the floor - we've had some close calls with the lamp. Also tries to shimmy off the table into the clothes hamper. I think his thoughts have far surpassed the signs and words he has for communication, so when he wants something and can't express it he goes right into back arching and boneless tantrums, usually bonking his skull on something or other, often lying on the floor and screeching. So I have one doing these shenanigans, while the almost 4 year old still needs adult supervision to keep him goal-oriented all morning long. I try to give him some time to redirect by counting - if we get to 10 he has to spend a little time in .
-Time to take off your jammies.
-But Mom, I'm just doing this.
-You can do that after you get dressed - 1, 2, 3 ...
-Mom! listen to my words!
- 4, 5, 6 ...
-But Mom I have to tell you something!
- 7, 8 ...
- OKAY!!

I do often listen to his words - but around the third time he delays the task with some random idea I really start to lose patience. The books say that if they get undivided attention for 15 or so minutes a day, they will cooperate better all the other time. I don't know. This kid gets a lot of attention and still wants more - wants to be 100% observed every time he taps the balloon with his hand, puts two Legos together, or swings up on his swing. And as awful as it may be, it is wearing on me. I want so much just to have some alone time to knit, read, or weed completely uninterrupted. It feels like an internal drive to do something other than watch my children, somehow, which may be normal but sometimes feels kind of scary.

And now I have just spent 30 minutes on this stream of consciousness, when I could have been knitting, or getting ready for bed, or packing my lunch for tomorrow.

Despite My Best Efforts

Here are some books I have read:

• The Happiest Baby on the Block (Karp)
• Solve Your Child's Sleep Problems (Ferber)
• The No-Cry Sleep Solution (Pantley)
• Super Baby Food (Yaron)
• Feeding The Kids (Gould)
• The Sneaky Chef (Lapine)
• Deceptively Delicious (Seinfeld)
• How To Talk So Kids Will Listen and Listen So Kids Will Talk (Faber & Mazlish)

Here is how much it feels like this has helped me:

• -zero-

I have one kid who sleeps and one who eats, and the morning routine to get out the door still involves cajoling, dealing, begging, threatening. Sometimes all I can do is laugh. Other times I get up for the baby for the 4th time that night, or look at my preschooler's skinny legs, or call (again) to say I'll be a little late to work and I think, how does ANYONE manage this?

A couple days ago I thought we'd had a breakthrough. T was playing with a plush penguin. It was time to get dressed. He said "Pip-Pip wants to get dressed." In a flash of inspiration, I said "I'm not sure he knows how. Can you show him?" Every step got done spontaneously or with only a reminder like "wow, you sure make taking your jammies off look easy. Now can you show Pip-Pip how you put on your shirt?" We were out the door in record time. It lasted a full -one- morning. The next day we were back to

• "T, it's time to get dressed."
• "T, I said it's time to get dressed."
• "But Mom, I'm just playing with my truck."
• "T, I have asked you twice and this is the third time. It's time to get dressed. Do you want to be a good listener or do you want to sit in the naughty chair?"
• "But Mom ..."
• "ONE. TWO."
• "OKAY I'm doing it!"

Repeat for each step of the process.

Dinner is another almost daily struggle. T will fairly consistently eat Eggos with peanut butter and syrup (but he wants the "little" syrup, the pure stuff in the small jug, as opposed to the "big" syrup, the tall plastic bottle of sugar-free maple flavored substitute), PB&J, Annie's mac & cheese, dino nuggets. French fries are now questionable since the revelation "MOM these french fries have POTATOES in them!" Tonight he had a complete meltdown because we put plain penne on his plate. He refused butter, cheese, or any other adornment. To him, noodles means the purple box; that was what he had expected, and anything else was completely unacceptable. After a few minutes to calm down on the couch, we told him he didn't have to eat his dinner, but he wouldn't be able to have any treat or snack before bed. Suddenly the noodles didn't look so bad and he wolfed down most of them, duly rewarded with a scoop of strawberry ice cream.

Then there is W. Not yet old enough or ambulatory enough to put up much of a struggle in the morning, and never a problem with eating for this one. Tonight's penne were mixed in a bowl with shredded mozzarella, some chunks of sourdough, and a few little bits of broccoli, all of which were shoveled double-fisted into the gaping almost-toothless maw. (One lower incisor is just starting to peek out at the grand old age of 12 months.) But despite a full belly, he will not sleep through the night. If I go in, the screams escalate until we nurse for a little in the rocker. Usually one breast won't do - though he fairly routinely passes out after the second and can be put back in the crib, sated for another few hours at least. If M goes in, he can get W to settle with the pacifier and blanket, but at least half the time he wakes up again 30 minutes later anyway. I've read the books. I know he has this sleep association. M has managed to get him past it before by spending a few nights in the downstairs guest room with a modified Ferber strategy. But eventually he realizes that the milk source just insulted him with a binky, and he shifts from fussy and half-asleep to fully awake and loudly agitated yet again.

All this will pass. Then we will be on to new struggles: homework, pimples, drivers' licenses. Then they will be gone. So we just continue to try to do the best we can, enjoying every step for what it is. And hey, I saw a couple more books the other day that look promising ...

The Winter Has Begun

I am confronted with how different it is to care care of other people's sick kids than to take care of one's own. What seems strangest to me is that I have so much trouble establishing a diagnosis. When a parent brings a child to my office, I listen to the story, ask a few questions to clarify, and often have a diagnosis in mind that is then confirmed or changed based on the exam. When our kids get sick, M looks to me to do the same sort of thing. I go through the process - try to ask myself the questions I would ask a parent in the office, and the details always seem fuzzy. Then I do the most focused of exams - just look in the ears, or just listen with the steth - and if something seems amiss I call the doctor. But I am hesitant to say "T has pneumonia" or "W has an ear infection." Even if the breathing sounds asymmetric or the eardrum looks red, I somehow don't believe my exam on my own kids; then also I don't want our doctor to feel obliged to treat based on the diagnosis I presented, rather I want her to come to her own clinical decision.

Monday night W had a fever. One ear looked yucky to me, the other was blocked with wax. He seemed okay other than the perpetual runny nose so I just kept him home from school. When the fever came back early afternoon, I called and brought him to our doctor. She said that one ear looked yucky and the other was blocked with wax. (Imagine!) Now he is on a cephalosporin, since he just had amoxicillin for an ear infection 5 weeks ago, and it gives him loose poo. Great. He continues to have copious nasal drainage and occasional low grade temps, has less appetite than usual, and is extra whiny. He probably has some viral bronchiolitis too, since every so often his breathing is a little wheezy and fast, and Dr. T said he had squeaky breath sounds, so he's been getting Tylenol, Motrin, Benadryl, and some nebs overnight in addition to the Omnicef.

Now T has a cough and also with a low grade temp yesterday, so he was home from school today. Also extra whiny. Not nearly as sick as when he had pneumonia in September, though.

These are the times when I see so many of my failings as a mom. I keep thinking how M and I have time off this week, and I had all these things I wanted to do, and now my sick kids "won't let me" do them. I get frustrated with them for fussing and whining, but they're sick - of course they are fussy and whiny, and I'm the jerk for wishing they would just play happily by themselves.

Counting Blessings

After I posted a recent Facebook status update, "C is feeling really blessed lately," my dear cousin suggested that I count the blessings.

1. I am blessed financially.
True - we owe more than our house is worth.
True - we just had to do some major plumbing work. Oh Honey, a new hot water heater! I love it - just what I wanted! And Merry Christmas, I hope you like the new boiler I got you. And for your stocking, several hours of skilled plumbing work to bypass a leaky copper pipe.
True - I took a hefty paycut for my new job.
But more importantly, we are able to make our mortgage payments thanks to a fixed rate loan, we continue to contribute to long-term investments, our kids go to an incredible private daycare center, our trusty Subarus are in good shape, and we do not worry about whether we will be able to afford milk this week.

2. I am blessed professionally.
After 3 years of residency and 3 years at my first practice position, I have been in my new position for over a month. I work with 4 other physicians in a practice built on the philosophy that quality of care is more important than quantity, and that it is worth making less money to do good work. We all have active family lives and agree that we can work together to provide good care in the office and hospital while protecting time at home. My hours are 9am to 4pm, M/W/F, and I have no work to do at home. I have found my new colleagues to be intelligent, compassionate, devoted women. The collegiality of the atmosphere is unlike anything I have experienced before. After focusing on how I could find a job in which I could continue to do EVERYTHING, I am so thankful that this position fell in my lap. A necessary part of my job transition was recognizing that I can be a strong feminist mother and wife without having to give 100% in every aspect of everything. That just put my family on the sacrificial altar of my ideals. By stopping obstetrics (for now) and limiting my scope of practice, I have so much more to give at home and at work, and everyone benefits. What a powerful lesson I have learned.

3. I am blessed in my marriage.
M and I endured 6 years of living apart while we attended graduate and medical school. When we were reunited geographically, I was still in residency, then T was born, then I started my demanding job. I know neither of us are perfect - but I have asked a lot of M. He has stood by me, never faltering in his belief in my character, and allowing me to figure out hard lessons on my own - since I could not, or would not, hear it from him. A wise and prescient dorm-mate commented "it's a yin-yang!" when we first started dating, as there was such a contrast between my bright and shiny persona (and no, I wasn't on meth) and M's reserved realism. While this contrast leads to most of our disagreements, it also is what makes us a strong team. I do not think either of us could survive without the other. M, I love you more and more each day.

4. I am blessed by my children, in so many ways.
The two most incredible days of my life were the days my children were born. I was blessed to be able to experience unmedicated childbirth. I am blessed with an ample and abundant supply of breastmilk. And every day my boys do some new, remarkable thing. This is not a blessing unique to me - in fact, so much of it has been said so many times before that it has become a cliche. Having children means to forever walk around with your heart outside your body, and all that. I cry at least once a week thinking of how much I love them. I know I can't protect them from the world, but I can still enjoy every moment I have with them. Thank you, T and W, for reminding me constantly of what is truly important in life.

The View From The Other Side (Sort Of)

About a week ago, we awoke at 4:30am to some real cries from T's room. I opened his door to find him standing on the other side, sobbing. "I fall out of bed, Mama." Points to his shoulder as the boo-boo site. I gave him some ice (rejected) and Motrin (accepted - mmm, berry) and we let him finish the night in our bed. I had tried to find a sore spot in the shoulder or arm but wasn't successful. Range of motion seemed to be okay. So we decided nothing was broken, maybe just bruised, and carried on with our lives.

Since then, though, he hasn't been quite right. He cries if we pick him up under the arms and when we tighten the straps in his car seat. "I no want you to hurt my shoulder, Mama." Heartbreaking. Usually a rightie, he has been passing a ball from right to left to throw it. He got a baseball tee for his birthday, but runs crying to Dad after a few swings. And at his birthday party other parents noticed that he was holding his right arm bent at the elbow by his side while running.

Time for an intervention. Yesterday I called my favorite orthopedics office. "Hello, this is Dr. K. May I speak to one of the surgeons about a pediatric patient?" I should point out that I do not usually do this for our own things - when I call our family doctor or the ENT who put in T's tubes, I always go through the secretary, and never say I'm Dr. K. But this is a big ortho office and I just wanted to talk to someone and see if I should be concerned.

Dr. G was on call - they put me through to his nurse. "I'll just get him out of a room." I tried to leave a message but she was already on her way to knock on the door. Dr. G on the phone - "It's about my son, he fell out of bed a week ago and he's holding his arm funny." "When can I see him? Can you bring him tomorrow?" Patches me back to the secretary who finds me a noon appt. I'm sure he's double/triple booked - but the thing about ortho and other surgical specialties is that most of the time they can just focus on the problem at hand. They don't have to spend 15 minutes getting a history like I do and the exam is usually pretty focused, too.

Armed with snacks, we spend 30 min or so in the waiting room. Baby W entertains the other patients. Good old T - usually he clams up around new people and especially at doctors' offices, but Dr. G is so kind and gentle. "Where's your boo-boo?" (shyly points to the top of his shoulder) "What happened?" (quietly) "I fell out of bed." Gentle hands touch the shoulder then move to the collar bone, T pulls away. "He might have fractured his clavicle." The lovely X-ray tech takes us back for some pictures. She has toddlers of her own and used to work at the big childrens' hospital in the city. Knows just how to get T to sit still for 3 shots of the shoulder and collarbone, then lets him take an X-ray of his matchbook car. The films come out - even I can see the fracture, right in the middle of the clavicle.

We are sent home with a special strap that goes over both collarbones and fastens in the back - T calls it his backpack - and a sling, which is quickly rejected since he just takes his arm out of it to suck his thumb anyway. Also the X-ray of the car, a bright blue squeeze ball (a birthday present from Dr. G), and a stack of business cards to replenish the supply at my office. We have a follow-up appointment in 3 weeks and instructions to avoid contact sports. Isn't being 3 a contact sport? But anyway no climbing on the playground structure, no slides, no tee-ball. :( Happily it should heal nicely and in 3 years even the bump at the fracture site will have remodeled away.

All this nice care, good staff, gentle and reassuring doctor, and they refused to take my copay. It's never easy to see your kid suffer - but I guess there are some perks to being a MommyDoc.

My Life as a MommyDoc

This is my life:


M's alarm goes off at 5:00. He promptly gets up and goes to take a shower - having carefully set everything out for himself the night before, he is able to leave by 5:30 to drive to town.

I work Mon/Wed/Thu. My alarm goes off at 5:03. Unless I thought it was the monitor overnight and turned it off when I went to check on the baby. I change the alarm to the radio and promptly fall back asleep.

Around 6:00 my NPR-infused dreams transition to alertness. Usually this is because T yells "Mama! I wake up!" rapidly followed by "I wanna watch a movie!" He usually gets his wish so I can shower - breaking my heart when he says sweetly "wanna watch a movie with me?" I try to nurse W on one breast and pump the other to get him some food for the day.


Daycare dropoff is at 7 but I'm usually there 7:30 or 8. T always wants me to stay and play, and likes to show me around his classroom. It's always hard to leave W too - he just looks up and grins his toothless grin.


I see patients all day - I wish I could remember funny stories but more often they seem sad. I like seeing patients and our schedule is not overbooked. Between appointments I answer questions from nurses and NPs, send lab result letters, fill out various forms, etc. I try to get out the door of the office by 5:30.

M and the boys are home when I get there. I nurse W, talk to T a little, we heat up some leftovers. At 7 we start winding down with jammies and stories, maybe a bath, and 8 is bedtime. Then I try to do office work (writing notes on my patients) which usually keeps me up until 10 or 11 when I fall into bed by M.

Tue/Fri are days off so I keep T home for a few hours and go for a walk with the boys in the stroller. Then take T to school, get a shower, try to do some more notes but usually W wants to eat and play, maybe I take a nap with him, run errands, think about cleaning up clutter. 5:30 comes so fast and then it's time to make dinner. I try to cook on Tue/Fri so we'll have good leftovers on my work days.

Sat/Sun we play, get stuff done around the house, groceries and laundry. Half the time I'm on call and usually I have a patient or two at the hospital.

All the time I am thinking about those office notes - it's hard to get them done the day of the visits, so they weigh on my mind, and I am always behind. Today M was watching baseball - had T & W with him - but T decided he wanted me down there too. It is really hard to turn down a sweet three year old asking "wanna play ball with me, mama?" If I turn him down too often I will lose his childhood. So the notes go unwritten again.

When I'm going to work I wish I could stay with my kids. When I'm home with my kids I'm thinking about work. It's the age old story of all parents, I think. Not that the world needs another self-absorbed blog, but I wonder if maybe writing about it will help me adjust, even if I never find true balance. So stay tuned.