Worth Losing Friends Over — Doctor Enough

Today, I hurt. I’ve been talking about this pandemic for well over a month. My friend list is dwindling, and there are several people I don’t plan on catching up with when this pandemic is over—and now entire communities. America’s privilege is showing, in a terrible way. Rural areas that have been luckily unaffected are […]

via Worth Losing Friends Over — Doctor Enough

Leadership

From HBR:

People never forget how managers treated them when they were facing loss. And we will remember how our institutions, managers, and peers, held us through this crisis — or failed to. We also see the consequences of past failures of holding, in those institutions struggling to mobilize an already depleted pool of resources. It is tempting to resort to command and control in a crisis, but it is leaders who hold instead that help us work through it.  And it is to those leaders, I believe, that we’ll turn to when time comes to articulate a vision for the future.
When I ask managers to reflect a bit more on the leaders whose visions they find most compelling and enduring, they usually realize that none of those leaders started from a vision or stopped there. Instead the leader started with a sincere concern for a group of people, and as they held those people and their concerns, a vision emerged. They then held people through the change it took to realize that vision, together. Their vision may be how we remember leaders because it can hold us captive. But it is their hold that truly sets us free.

Toxins

Who knew that toxins exist EVERYWHERE? I certainly wasn’t cognizant of my exposure to toxins. Teflon, PABAs, air, water, food, etc. But, I have learned so much and am constantly learning of the dangers of these toxins in our everyday lives. Most recently, all the soaps, lotions, and cleaning products have been updated in our house.

From Union-Bulletin.com

We use (all can be found on Amazon):

  • Puracy natural dish soap
  • Everyone Soap: hand soap and lotion
  • Nature Clean dishwasher detergent
  • Everyone 3 in 1 soap (adult and kids)
  • Everyone lotion
  • Attitude natural shampoo

EWG:

EWG: Skin DEEP:

  • ThinkSport spf 50+ sunscreen
  • Super Goop Play 50+ spf face sunscreen (currently a 3; would consider a better option)
  • Ilia, RMS Beauty, Lawless, Aether Beauty makeups

EWG: Food Scores:

  • Baby purees: Beech Nut, Earth’s Best Organic
From The Good Human

Profound Documentaries on Toxins/Food Industry:

Current Favorite Reads Regarding Health:

Whole Food Plant-Based Diet

I’ve been hearing more and more about a whole food plant-based diet. There’s definitely data out there that shows this lifestyle is the key to longevity and protective from illness and disease. My curiosity first started when I had our first child. It was important to me to learn more about nutrition because I wanted to learn how and what to prepare food for my kids. From this curiosity, I stumbled upon a book called Genius Foods. Then, I listened to the Audible version of The Obesity Code. Most recently, I’ve been embracing How Not to Die and Eat to Live. Add Fiber Fueled to this list and I’m for certain that WFPB is the way to go. And add The Starch Solution for more evidence toward a whole food plant based lifestyle. I’m working on it.

From DanielleBelardoMD.com

Am I vegan? No. Am I a vegetarian? No. Am I here to save the animals? If saving the animals is a positive side effect, then absolutely! My main goal is to have the l o n g e s t quality of time with my kids as well as teach them how to incorporate nutrition into their lives. As a parent, I want to make my kids’ lives easier, more meaningful, and more fun. Aside from financial freedom and responsible parenting, the next best gift I can give to my kids is the power of nutrition. I wish I knew this information when I was a kid and grew up knowing what was helpful to fuel my body.

CME for healthcare workers:

Sleep Schedules for 13.5 month old

Since January 2019, Arden has been waking up 1-2x/night for milk.  She turned 12 months old in February 2019.  We’re not sure why she started doing this as she used to sleep through the night.  So, I’m gathering some info and seeing what we can do to improve her nighttime sleep.

Screenshot_20190405-093303
From Getting Your Baby to Sleep the Baby Sleep Trainer Way by Natalie Wiles

From Natalie Wiles book, Getting Your Baby to Sleep the Baby Sleep Trainer Way:

  • 7-14 mo old babies need only 2 naps/day (around 9a, 1:30p)
  • Most babies should not need a night feed unless per pediatrician

Sample schedule for 2 nap day:

6:30-7a — wake, milk feed

8a — breakfast solids

9a — nap –> wake, milk feed

12p — milk feed or lunch solids

1:30p — nap –> wake, milk feed

5p — dinner solids

6:30 — final milk feed, bedtime prep

7p — bedtime

  • > 14mo –> 1 nap/day (around 11:30a-1p and lasting 1.5-3hours
  • Know when to switch from 2 naps to 1 nap/day:
  1. Your child is >14mo and has consistently fought one of their two naps each day for 2 weeks straight or longer.
  2. Your child naps easily 2x/day, but struggles to fall asleep before 9p or 10p each night, or beings to wake up in the middle of the night.
  • If toddler doesn’t fall asleep, offer them up to 2 more attempts.
    • For example, 11a-12p: nap attempt 1.
    • 12:30-1:30p: nap attempt 2
    • 2-3p: nap attempt 3
    • Early bedtime if no successful naps
  • Toddlers who only nap 1/day should be allowed to sleep up to 3 hrs, but naptime should end no later than 3:30p
  • Do not go back and forth between 1 and 2 naps if toddler is ready for 1 nap/day.

Other Resources:

The First 100 Days Postpartum

My mom, aunt, and mother-in-law have been coming on the weekends to help meal prep for the week and also help look after the littles (2 under 2 years old).  My aunt mentioned something in Chinese culture re: the first 100 days after a baby as being a time for healing for the mother.  I had heard of this in Korean culture, but didn’t realize it was in my own culture!  Apparently, it’s in other cultures as well (see the wikipedia link below).  Today, I’m on day 18 postpartum and it’s been a roller coaster of emotions, thoughts, lethargy, soreness, and fatigue.

Wikipedia: Postpartum Confinement

NPR: For Chinese Moms, Birth Means 30 Days in Pajamas

Working Mother: I Tried the Chinese Tradition of Postpartum Confinement, and It was SO Worth It. Here’s why other working moms should too.

Nourishing Postpartum: The 40 Day Sacred Window

“‘Doing the Month’: Confinement and Convalescence of Chinese Women After Childbirth” (1978), by Barbara L.K. Pillsbury

After reading several of these articles, I definitely think there should be more pampering and healing in Western culture after the arrival of a baby.  While I disagree with just sitting around without showers… I do believe in having extra help (house chores, cooking, etc) and allowing the mother to bond with baby without these distractions.

 

What do you think?  Have you hired new help or had family members stay for an extended time to help with chores and cooking so you can focus on bonding with your baby?

Introducing a 13 month old to newborn sibling

We weren’t really sure how to do an introduction.  Arden is very observant and we didn’t want to cause a bunch of anxiety or jealousy with bringing home a new baby.  I don’t think she’s old enough to understand the concept of a baby brother, but I could be wrong.  So, we’re introducing her slowly to her lil sibling.  At first, she was very curious and _____________ (surprised? shocked? curious?).  She wanted to touch him.  It also seems like she wants to be held more and we want to giver her that love just as we always have.  More and more, we have Garrett in the same space as Arden and she seems to be ok with it.  She fought her naps the day after we brought G home from the hospital…. skipped them all.  That was new.  So maybe she feels the difference?  Arden is my OG, my Bug.  I’d feel terrible if she felt any less or even threatened with a new baby that requires more attention.

Tips that I received from friends, teachers, moms of multiples:

  • Make her feel like she’s helping with caring for lil brother.  This will distract any anxiety and confusion.
  • Arden. Don’t worry. In no time you will be trying to “help” your baby brother!  Replacing dropped bottles and pacifiers, returning rattles, sharing your food (shhhh, don’t tell anyone I kept handing noodles to my nanny’s grandbaby).
  • Early on before Evie, I taught Sam to be by himself and play, etc.  when I had both at home by myself, Sam knew I was taking care of Evie so we read together and played as soon as she napped.  Big thing is getting Bug involved, simple things, grab a rag, grab a wipe, make a big deal of it.  Sam loved being the helper.  Thankfully Evie was super chill her first 3-4 months, eat poop sleep…that was her routine.  She even slept 6+ hours a night from the minute we brought her home.  Even Debbie got to sleep.
  • We did a few things to prepare Jacob.  We told him that he was going to have a new friend come and play with him.  when we brought Dos home, we had gifts ready for Jacob that we said were from Dos.  We also tried to get Jacob involved – like why do you think Dos is crying?  Do you think he’s hungry?  Do you want to help me change his diaper?  etc.  And thank and acknowledge when they are helping out.  Also, make time for someone with Arden – it’s so  hard in the beginning when you’re tired/nursing frequently but hand G to grandma or dad and cuddle/nap/walk with Arden.  You got this, mama!!!
  • When people came to visit or Facetime, have them greet/chat with Arden first about her.  And keep it about Arden instead of asking “how’s it feel to be a big sister” or “how do you like your baby brother”.  I felt like Jacob was too young to understand what big bro/lil bro meant but he did know about someone new being in my lap.  It’s a work in progress still, but Arden and you guys are doing great!!
  • Mana is 18 months older than her “Tita”.  we modeled gentle touching and interactions, and said: “This is your Tita” to help her understand it’s her tiny baby sister.  Ownership of that special relationship helped, I think.  But I can relate to feeling so sad and guilty that I had a little less to give the OG girl.  It turns out just fine.
  • Love on Arden – let everyone else love on Garret – he just needs someone to hold him doesn’t matter who!!!
  • Don’t worry, kids adjust very fast.  They are at a very young age.  Just shower both with love and they will love each other.

 

Week 1

Arden as slowly adjusted.  She was a bit more sensitive at school and was challenging with her naps while there as well.  At night, it would take around 30 minutes to calm her to get her to go to sleep.  We have slowly incorporated G into daily life.  He’s around when we do dinner.  Now, when Arden gets home, I take her and play with her and hold her and papa takes care of G.  For some reason, Arden is clingy to me even though Bear/papa takes her to school and picks her up and does most of her diaper changes.  Even during the last month of my pregnancy, Arden would be picked up and held by her papa more and more bc she was just getting too heavy for me to lift and hold.  Over this week, she has slowly adjusted and has gotten better about going down for “night night” at night.  The last 3 nights, she has gone to sleep easily without a fight.  We lay her in her crib and she rolls over onto her stomach and goes to sleep.

New changes we’ve incorporated:

  • Mama greets and holds Arden when she gets home from school
  • Wash her hands (tons of germs from school)
  • Mama holds and plays just with Arden before dinner
  • Dinner time, mama/papa/G are present (usually I wear G or breastfeed him at same time
  • After dinner, we clean up and Papa plays and reads with Arden
  • Getting ready for bed, we do a nighttime diaper change… get her into her sleep sack… have milk.  G is present for this depending upon how Arden is doing.  If she’s super frustrated, then I will take him separately and either feed him or put him down.  We both will be with Arden for her last nightly milk feed, teethbrushing, hugs/kisses/cuddles before papa puts her down in her crib.

 

Why eat organic?

I wasn’t always a huge supporter of eating organic.  I was a poor college student… a poor medical student… and a poor resident.  In fact, I didn’t start thinking about my health seriously until my husband and I were planning to get pregnant.  Maybe this was a little late in the game at 37 years old… but better late than never, right?

In college, I lived off of lean cuisine microwaveable meals with plastic and drinking 3 diet dr. peppers a day.  In medical school, I survived off a protein bar, sandwich, and microwaveable dinners as well.  Did I mention that I experimented with smoking to help me study?  Ick, what horrible habits!  In residency, I continued with protein bars, microwaveable meals, and hospital food that was free for residents around 9p.  Not to forget, that I made sure I went to a bunch of residency interview dinners to meet potential incoming residents.  Fast forward to getting ready for my wedding day, I went 3 months on a paleo diet and felt incredible and saw real changes in my body without feeling deprived or hungry.  We went organic during my first pregnancy.  We’ve placed more importance on sustaining our baby and helping her maximize her growth and learning with a more nutritious diet.  During my second pregnancy, I again ate organic.  But, I was diagnosed with gestational diabetes and moved to a more Whole30 diet — eliminating processed foods as well as sweets.  I was able to really control my blood sugars with diet alone, and I feel better without all the processed food and sweets in my system.

Why do I think about this now?  More and more, I feel the impact of a well-balanced diet on my body.  My AGING body.  Perhaps in our youth, we can fake it and make it by eating crap food and maintaining an unhealthy lifestyle.  But as I’m aging, I feel the effects more and definitely sooner.  Additionally, I care more now about what I put into my body and in my family’s.  I would love to teach my kids the importance of healthy eating and what good food tastes like.  So, enter my quest to eat organic as well as grass-fed, hormone-free meats as well as going more plant-based.


Resources:

HelpGuide – Organic Foods: What You Need to Know

HelpGuide – Healthy Food for Kids

Mayo Foundation for Medical Education and Research – Organic vs. Non-Organic PDF

MindBodyGreen – A Doctor’s Top 4 Reasons to Eat Organic

Dr. Axe – Dirty Dozen

EWG – EWG’s 2018 Shopper’s Guide to Pesticides in Produce

Dirty-Dozen-Clean-Fifteen

Time – 4 Science-Backed Health Benefits of Eating Organic

The Organic Center – Bringing you the science behind organic

Food Safety Magazine – 2018 Dirty Dozen and Clean Fifteen Lists Rank Produce Items by Pesticide Level

Association between organic food consumption and metabolic syndrome: cross-sectional results from the NutriNet-Santé study. Eur J Nutr. 2018 Oct;57(7):2477-2488.

Human health implications of organic food and organic agriculture: a comprehensive review.  Environ Health. 2017; 16: 111. 

Organic Food in the Diet: Exposure and Health Implications. Annu Rev Public Health. 2017 Mar 20;38:295-313.

Are organic foods safer or healthier than conventional alternatives?: a systematic review.  Ann Intern Med. 2012 Sep 4;157(5):348-66.

Nutrition-related health effects of organic foods: a systematic review. Am J Clin Nutr. 2010 Jul;92(1):203-10.

blog_image_food

Clean Label Project: Methodology

Center for Ecogenetics and Environmental Health: Health Risks of Pesticides in Food

U.S. Right To Know: Monsanto Papers

U.S. Right To Know: Pesticides

Time: Why Organic is the Right Choice for Parents

NBC News: What a nutritionist wants you to know about pesticides and produce

EH_VENN_GRAPHIC_sm
U of Washington Center for Ecogenetics & Environmental Health


Key Points

  • Eat organic and free-range/cage-free/grass-fed/hormone-free when possible
  • Pesticides are toxic and can lead to health problems later in life
  • Choose organic alternatives to the Dirty Dozen
  • Babies, young children, pregnant women, and breastfeeding women are more susceptible to pesticides and toxins in food.
  • Research the labels and get the facts
  • Consider these Netflix documentaries on Health and Nutrition

Arden’s 1st birthday


Written Jan 2, 2019

I can’t believe Arden is almost a year old! Where did the year go?! I’ve got to start getting ideas for her bday as well as invites, food, party favors, location, etc.
Brainstorming:

The number ‘1’ photo collage of Arden: Ribbet, ShapeCollage, Shutterfly

Electronic invites: Paperless Post

Catering: Yelp Taco catering, Yelp food truck catering

Location: Carmel Valley parks

Carmel Valley Community Park and Recreation Center
3777 Townsgate Drive
San Diego, CA 92130
(858) 552-1616

** Insurance for caterers/vendors/food trucks needed. No glass containers. Alcohol is permitted. If >50 people, then $175 for day use. Tables 1st come, 1st serve.
Things to get:

  • Inflatable swimming pool: Amazon
  • Balls to fill pool: Amazon
  • Bubbles: Amazon
  • Gluten-free Cupcakes
  • sheet cake – Costco?
  • one small cake for Arden
  • decor for Arden high chair: Amazon
  • Plates, silverware, napkins
  • alcohol
  • 529 gifting: https://gift.my529.org/1RU6HD
  • Party favors: bubbles, pinwheels, Amazon
  • Photographer?

Paid Maternity Leave

I had just written a response to a partner’s email regarding outpatient coverage and the focus of work-life balance.  I think it’s a great initiative that she is tackling while brainstorming what could help the group with flexibility as well as some normalcy while raising a family.
This made me think of changes to antiquated practices we currently have in our work environment… primarily, paid maternity leave as well as paid sick leave.  Many of my male colleagues can continue to work and can take as little or much leave as they would like for family bonding or vacation time to spend with their newborns.  This is their option.  Unfortunately, the women physicians in our group are not afforded that same luxury.  There is a 6 week medical leave of absence with a vaginal delivery or an 8 week leave of absence with a C/S as proposed by the OBs.  During this time, we are not paid.  State disability is a joke bc it’s not even enough to cover a mortgage payment.  Look at other large companies, there’s often paid leave or sick leave available to the employees.  Therefore, women who choose to have kids while working as a physician in our group are penalized, especially if they are the breadwinner.
Not only that, even while off on medical leave, we are required to pay into the trust and pay ridiculously high premiums to cover the wide age gap of partners in our practice.  I would be happy to look elsewhere for my medical coverage, but I simply cannot come off our medical insurance plan.
Therefore, I propose there be a fund set aside to create a pool or trust for persons creating families (just as we do for our more distinguished and elderly physician population with our health insurance plans and exorbitant premiums) who will have families and work in our group.
Here are some examples in the news of what is and has been in the pipelines….
Here are examples of companies getting it right:
Please consider updating some or all of the policies for paid maternity leave.  I am open to your thoughts and considerations.

 

Poll on Maternity Leave

What it’s like to be a female anesthesiologist…