BOO! and Flu! October 31, 2008

Happy Haunting everyone!  We couldn’t have asked for better weather tonight.  The papas and the boys and I ventured out around 6:30 and we strolled over to Conall’s best friend’s house where we picked up Dom, Martin, Mia and their dad, Vince to join our crew as we went begging.  The kids loved seeing the decorated houses, getting the occasional full sized candy bar and even getting a little scare here and there and I loved strolling through the neighborhood watching them.  

I would love to make a collage page on the blog of as many of your kids in their costumes soooo email me photos of your kids and I will create a Halloween Page as the photos come in.  Email them to drmolly@birminhgampediatrics.com.  I won’t use anybody’s name so it will remain anonymous but cute!

Tomorrow morning from 9-11 the first of two flu clinics will happen at the office (the second is Saturday, Nov. 8th from 9-11).  My kids will be there to help with paperwork and insurance card and drivers license photocopying and we have a plan to make everything go smoothly.  I will have two people doing the vaccines (in addition to me) so the process should go quickly.  See the Flu Info page on the blog for more info!

To all you parents out there who are stuffed with chocolate tonight, enjoy your sugar high and your full stomach…I know I am!

Happy Halloween, sneak into your kids’ candy and enjoy yourself a little and each day will be your best!

Molly O’Shea, MD  Birmingham Pediatrics + Wellness Center

www.birminghampediatrics.com

Running and cooking October 29, 2008

Two of my favorite things in the world are running and cooking.  Today I got to do both.  This was the third day in a row I have made a run a part of my day and I can’t tell you how good it feels to be active and feeling good!  Of course the M&Ms that I have been scarfing at the office will mean that all this exercise will once again NOT result in any weight loss for me.  But that’s fine….I love running and M&Ms and having both in one day makes for a great one!

Every Halloween the O’Shea family has a tradition of having all the grandparents over for dinner and then the Papas and I take the kids out trick or treating.  I am psyched that Halloween is falling on a Friday this year….and it will be another year of nice weather to boot!  In the past, I have ended my appointments by 4:30 to be home in time to have dinner with the crew and take the kids out but this year, I am not sure I will be home in time for the dinner portion of the evening.  Soooo tonight I made some of the dinner….a fantastic meat sauce with ground sirloin and hot italian sausage, tomatoes, onions, garlic, fresh basil, spinach and oregano and a loaf of sweet cranberry bread.  Nice!  I love the process of chopping the onions and licking the batter off the spatula and tonight was no exception.  I enjoyed a glass of wine while I worked and Mairen kept popping in and telling me tidbits about her day.  Very nice indeed.

On a side note, I have had several questions about Vitamin D….here’s the scoop….not all cod liver oil is made the same.  Sometimes in the purification process the Vitamin D is actually extracted (?!) so look at the label to confirm it is rich in Vitamin D.  

Run 3 miles a day and cook up a storm and have an occasional glass of wine and each day will be your best!

Molly O’Shea, MD   Birmingham Pediatrics + Wellness Center

www.birminghampediatrics.com

Having fun at the office but missing my mom October 28, 2008

Last week Ashley and Ryan came to the office to visit and found in room 13 the fun of a wall hanging with holes in the spot for the faces.  Despite feeling under the weather, they left with smiles on their faces and enjoyed the activity packs and the decor.  

Today, I had a bunch of kids in to get flu vaccines and a bunch in for sick visits and even with the shots given and fevers and coughs, the kids left with their prize from the treasure box and smiles on their faces.  Sophia even wanted to stay longer (and the TV wasn’t even on the room!).  She loved the ’spy scopes,’ as she called the binoculars, in some the activity packs and the dog phone too.  

I even have fun at the office these days.  I am getting busier again and running every day on the treadmill either before work or at lunchtime.  I am appreciating my staff more and more every day.  Paula has really hit her stride.  She not only manages the phone calls and appointments but is now expert at entering insurance info in the system and even held her cool when a young boy passed out in the waiting room after getting his blood drawn!  Tom has gotten the nuts and bolts of insurance posting down and despite the ongoing frustrations with United Healthcare and Gateway (my billing clearinghouse) we have a good cash flow and he is the reason for that.  My nurses now know everything there is to know about me, my quirks and love of chocolate and even my bathroom schedule!  They know I like my infants weighed naked, that I never recommend over the counter cough and cold medicines, and that if I don’t get my run in, I eat all afternoon.  

The only thing that is missing is my mom.  A few weeks ago, my mom got sick.  An occupational hazard to be sure but one she can’t weather on a regular basis.  She was too sick to even get out of bed for a couple of days and is, a couple of weeks later, still recovering.  After a long, hard give and take, she and I decided that she shouldn’t return to work.  I wouldn’t be able to live with myself if the next illness she got was more severe.  She was fantastic at helping get me off and running.  Her sunny disposition and attention to parents and children alike really set a wonderful tone for me.  She greeted everyone with warmth and even shared some stories about me or Tom or Chuck with all of you as you filled out your paperwork.  Ok, that I might not miss quite so much!  It was terrific to have someone I knew had my best interests at heart every single day and really understood my desire to make families the center of my office, not me or my scheduling needs.  She is missed by Paula and the families and my brothers and my nurses and me.  

Embrace change, run every single day, and eat chocolate Halloween candy and each day will be your best!

Molly O’Shea, MD  Birmingham Pediatrics + Wellness Center

www.birminghampediatrics.com

 

Grandma was right! Cod liver oil ROCKS! October 27, 2008

About 2 weeks ago, the American Academy of Pediatrics announced a major change in the recommended daily intake of Vitamin D from 200 IU to 400 IU for children under 18.  The reason for the change is especially interesting.  Over the last couple of years, much research has shown that Vitamin D plays a big role not only in bone health (helping laying down strong, calcium rich bones) but its deficiency is associated with everything from some cancers to psoriasis to type 2 diabetes to auto immune disease.  Sources of Vitamin D in our everyday diets are few…..milk (about a quart/day to meet the requirement), enriched breakfast cereals, and fatty fish.  We also get Vitamin D from sun exposure but the number of minutes needed depends a lot on your skin tone (the darker the skin tone, the more time in the sun it takes to make Vitamin D) and the intensity of the sun.  That makes it hard to estimate how much time is enough especially since sunscreen impairs the skin’s ability to synthesize it.  

Given all of this new data, the AAP adjusted its recommendations dramatically.  400 IU is clearly safe in many studies and is probably the minimum amount needed to ensure bone health in children.  Soooo if your child isn’t a milk lover or a huge cereal eater, you are left with the decision of which supplement to choose.  The least expensive and most bioavailable form is cod liver oil.  One teaspoon daily is all it takes to meet this requirement and has other benefits including omega 3 fatty acids.  Cod liver oil also comes in capsule form for the kids who can swallow pills.  The only kids who shouldn’t take it are infants with reflux since it could end up in their lungs when they reflux.  Of course not all kids will take cod liver oil (although if you mix it with yogurt it isn’t that bad), so there are other ways to get Vitamin D.  Most multivitamins have 400 IU in a single chewable and there are liquid versions like Poly vi sol and Tri vi sol and of course you can make milk a major part of life too, making sure that your child drinks 32 ounces a day to get the 400 IU.  

I haven’t always been on the Vitamin D bandwagon, as many of you breast feeding moms know.  The old data showed that although rickets was increasing in breast fed infants, especially African-American infants, most of the moms in my practice eat really healthy diets and since Vitamin D can be transferred in small amounts in breast milk, I didn’t see the urgent need for supplements.  I am changing my recommendation now that we have this new data.  I will now recommend all of my patients take Vitamin D supplements either in the form of a vitamin or cod liver oil.  

Read the literature, be open minded and share what you learn and each day will be your best!

Molly O’Shea, MD  Birmingham Pediatrics + Wellness Center

www.birminghampediatrics.com

Happy Birthday! October 22, 2008

Today my oldest child, Mairen, turned 12.  She had a terrific day and is a gem of a girl.  Her friends decorated her locker at school, she took a couple of tests that she felt really good about and she was nominated by her principal for a Birmingham Optimist Award.  Tonight, Kevin made dinner for the grandparents and we all shared salmon and asparagus and rice with squash soup for dinner.  For dessert, I made a yellow cake with chocolate frosting.  It was a very grown up affair.

I remember not too long ago, when I would be up late into the night before her birthday crafting and decorating her elaborate birthday cakes in 3-D shapes like a circus train or a soccer ball or a big bed with eight girls sleeping in it.  We have always done in home birthday parties for the kids with cheeky, old fashioned games, a craft, usually a meal, and always cake and ice cream.  We have always enjoyed the process of finding a theme, designing the invitations and making them, choosing the games and food and I have always made the cake. 

I love to bake.  I have always loved it from the time I was in 3rd grade and was allowed to use the oven and mixer on my own.  Each year for each child’s birthday, I would make two cakes: one for the family party and one for the friends party.  No corner cutting though….if I was making a 3-D monster cake on a ramp, I did it twice.  It became a sort of badge of honor and a gift of sorts to each of the kids.  They loved to see their cake in evolution and really enjoyed the final product.  At some point though, and I am still not sure exactly when it happened, Mairen got too old for this sort of thing.  She wants a cake of course, but needs nothing fancy, nothing elaborate, nothing challenging for me to make.  Last year when she wanted a ‘normal’ cake it was a relief.  The pressure was off and I could just enjoy making a plain cake.  This year though, I am missing it.  I am missing putting energy and thought into a creation made just for her.  However fleeting, these cakes were a physical representation of my affection, a labor of love.  I missed showing her in this concrete way how I feel about her.  Other gifts are great but the cake was always MY present to her. 

She is growing up of course and our relationship is changing.  In many ways for the better.  We are growing closer and sharing more and more with each other.  Sometimes I think I don’t need the cake to show her how much I love her and yet making the elaborate cake is an easy way to do that.  Sharing more of myself is harder in some ways but as she is telling me in a very concrete way that she is growing up, I must too and embrace a new phase in this mother-daughter relationship.  Sometimes making a cake seems a lot easier.

Share yourself, embrace your kids and evolve and each day will be your best!

Molly O’Shea, MD  Birmingham Pediatrics + Wellness Center

www.birminghampediatrics.com

Bedtime ritual October 21, 2008

Remember the first moment you knew you were going to become a parent?  For most of us it was filled with excitement and happiness.  For a few, it was a time of surprise and anxiety.  For me it was a hugely happy moment.  I got a call at work from my doctor’s office telling me my test was indeed positive and I was going to be a parent.  I squealed with delight and called my husband and had never been happier.  After a night like tonight with my boys, I look back on that day and wonder what the h— i was thinking!  

We have a routine every night.  Mairen is too old for all of this hooha but the boys thrive on it.  At 6:30, the boys straighten up their stuff, put toys away, get their folders ready for their backpacks and then we settle in and watch a half hour of a dvd.  We usually watch old stuff like ‘Green Acres’ or ‘Gilligan’s Island’ or ‘The Brady Bunch’ and occasionally a ‘Suite Life of Zack and Cody’ or ‘Drake and Josh’ and then the boys head upstairs to take their showers, brush their teeth, take their nightly meds and then we can read together or snuggle until 8.  Sounds wonderful doesn’t it?  It usually is.  Tonight however…..

Every Tuesday Mairen and Kevin are gone for this ritual at Mairen’s clarinet lesson and usually things still go without a hitch.  Tonight though someone replaced my boys with exact duplicates who were actually their evil twins!  I had entered a soap opera and didn’t even know it!  They dawdled and disobeyed.  They refused to get ready for bed or shower.  They goofed around and yakked their heads off and it seemed as if the more sternly I talked the worse it got.  Finally I lowered the boom.  I told them that they had a choice: either be ready for bed by 8 or give up their evening video for a couple of days and no reading after 8 for a week and then I promptly left them and went into my room.  As I lounged on the bed, I just got angrier and angrier.  Not only were they not getting ready for bed, they were having fun!  How dare they!  They were laughing and chatting and I sat in the other room feeling like an absolutely impotent parent.  My threats meant nothing!  Their desire to make Lego battleships outweighed their desire to please me!  What sort of lousy parent was I anyway?  Finally at 8:05 I strolled into the kids’ bathroom as if I had just been happily reading and announced that they had clearly made their choice and that their privileges were revoked.  A big part of me wanted them to be upset and beg me to give them another chance (which I wouldn’t have but at least it would have proved that I was still the one in control here) but instead they just shrugged and finished getting ready for bed as I stood there glaring at them. 

Several things about tonight ticked me off.  First, this sort of thing NEVER happens with Kevin.  That just ticks me off.  Second, I hate it when I am not in control.  Not that I am a complete freak about it, but times like this just tick me off.  Third, I really hate getting angry, especially at the kids.  A therapist would have a field day with all this but that’s just the way it is.  I feel that I have failed if a situation with the kids results in getting angry with them.  How stupid is that?!  Sometimes they actually deserve it!  Sometimes they are actually making choices that break the rules or disrespect me or WHATEVER and yet I am the one who feels guilty when the situation goes awry.  Tonight though I was just ticked off at their disregard.  No guilt.  

Hey, maybe that’s progress…..

Hold the line, follow through, and know you aren’t the center of the universe and each day will be your best!

Molly O’Shea, MD  Birmingham Pediatrics + Wellness Center

www.birminghampediatrics.com

The mettle of a mother October 20, 2008

Today I had a fantastic new mom in the office who is having a really rough time with a colicky baby daughter.  She is breast feeding, is a vegetarian, and has already removed all sources of dairy, soy and nuts from her diet due to her daughter’s sensitive stomach.  Today, she brought her daughter in after a long week of fussiness, worsening nasal congestion, and crying (both mom and daughter).  Reflux medications are already on board and with an already stripped down diet, I was hoping for an ear infection…I know I shouldn’t be hoping for an ear infection but as all parents know sometimes it is a gift to have something that can be treated…..

It was late in the afternoon when I walked in the room and it was clear that neither mom nor daughter had slept much over the last several days.  The baby was fussy, squirming and crying.  The mom was using all tools in her arsenal to help….pacifier, gently rocking, quiet talking….everything to no avail.  The mom and I had been in email communication over the last week fine tuning diet and medication and so I had already been aware of the happenings over the course of the week.  I held the baby and noticed a rash on her face and trunk, a very congested nose, and a tummy that was somewhat distended from air.  I looked her over, head to toe, and found nothing more….no ear infection, no diaper rash, no sores or thrush in her mouth.  I decided to look at her snot under the microscope and found exactly what I didn’t want to find: allergy cells.  Despite following an incredibly rigid and restricted diet and even venturing back into the world of eating meat, this mother’s breast milk was the cause of her daughter’s distress.  

When this mom became pregnant and then had her daughter, she wanted to do everything she possibly could to make her daughter healthy and happy.  She exercised and ate well during pregnancy, tried hard for a natural birth, and then chose to nurse her baby.  She gave her daughter probiotics to aid in digestion, tried gripe water and finally zantac to quell her daughter’s upset stomach.  She tried scheduling feedings, feeding on demand, co-sleeping, crib sleeping, swings, bouncy seats, driving, craniosacral therapy…everything.  Nothing consistently worked.  As time went on, this mother began to feel more and more sadness over her daughter’s plight and her inability to meet her daughter’s needs. 

New parents are often critical and over anxious.  This woman was neither.  She was amazingly patient and willing to try different things.  She remained close and connected to her daughter even when this was difficult.  When I came back into the room after seeing all the allergy cells, I had a difficult plan to put forward….I wanted to encourage this mom to stop nursing and use Nutramigen formula instead.  I felt that the apparent intolerance of the foods in mom’s diet, coupled with the extreme discomfort for the baby, along with the heroic but unsuccessful attempts to modify her diet conspired to make continuing to breastfeed a near impossibility.  

I decided that since there was no easy way to tell her, I would just do it.  And I did.  I am not sure what I expected but when this mother responded not in anger but in sadness, mourning the loss of her vision of being able to nurse her baby, and accepted this outcome as both logical and in her daughter’s best interest, I knew that I was in the room with a very special woman.  Even though she had a vision, a dream of nursing her baby, even though she had tried as hard as she could in every way to make it work, giving it up came easier than I expected it to.  She wasn’t breast feeding for herself, she was nursing for her daughter and since it became clear that wasn’t the best thing for her daughter, she accepted it.  Of course she was sad and shed some tears and had a lot of questions but seeing her response to a very difficult situation gave me strength and joy.  She loves her daughter unconditionally and even though she feels a failure in some ways because of the way this all turned out she is far from it.  She is one of the best moms I have ever dealt with and her daughter is lucky to have her.  Giving up her dream of nursing may seem like a small thing to many but it is huge.  She put her daughter’s needs far above her own.  Now that is the mettle of a mother.

This experience will be the first of many she will have adjusting to the reality that her child is an independent person, one who will influence how the story of life is written.  It is just hard to learn that lesson so early, on so little sleep, with having tried everything to encourage a different reality.  

Do your best, love your children, and accept them for who they are and each day will be your best!

Molly O’Shea, MD  Birmingham Pediatrics + Wellness Center

www.birminghampediatrics.com

Ghosted October 19, 2008

When I was a kid the week before Halloween was filled with mischief.  I was one of those kids who was actually afraid on Devil’s Night even though I lived about 20 miles from the fires and gunshots of Detroit.  I remember going out on October 30th when I was in seventh or eighth grade.  Devil’s Night fell on a weekend that year and some kids in my class had an impromptu party.  A bunch of guys and girls went out after dark and put toilet paper in trees and some of the more mischievous kids egged houses.  I was scared to death the whole time but went anyway because I didn’t want to seem any more nerdy than I already was.  Of course nothing bad happened, no grand theft auto, no destruction of property, but it highlights how different life is now for my kids.

On Friday night, while we were sitting in the den, the doorbell rang and when we got to the door, no one was there.  Instead there was a bag of candy with a piece of paper with a picture of a ghost on it.  The note said to tape the ghost to our door and then ‘ghost’ three other houses in the neighborhood.  If your door has a paper ghost, you’ve been hit and you won’t be ghosted again.  My kids had fun trying to figure out who ghosted us and then on Saturday night, Declan, Conall, Kevin and I went out after dark and ghosted our kids’ friends.  The night was gorgeous with the stars shining and the air crisp.  We walked about a mile overall and watching the boys sneaking up on the doorsteps, ringing and running.  It was terrific.  

There is something magical about the fall with its cool nights and sunny, crisp, clear days.  Playing football in the yard, raking leaves, even cleaning the garage out for the coming winter feels refreshing.  It is the season of candy and apples and sweatshirts and hot chocolate and rustling leaves.  I am cooking a lot, knitting some and watching the new season of ‘Chuck’ and ‘The Amazing Race’ and loving the change of seasons.  I had two more newborns this weekend, one at each of the two hospitals, and as I drove between them, the colors of the leaves were bright and happy and kept me smiling as I sung along to Jason Mraz.  

Tomorrow I am mailing out my first patient statements…..another business milestone!  

Enjoy the leaves, sleep soundly, and drink hot chocolate and each day will be your best!

Molly O’Shea, MD  Birmingham Pediatrics + Wellness Center

www.birminghampediatrics.com

The joy of scheduling October 17, 2008

Today I had another terrific and busy day.  I rounded at both hospitals and then arrived at the office just after nine to find my schedule delightfully full.  I really got to test my new scheduling plan today and it worked well!  The only time I got behind was when I had to take a phone call near the end of the day that took well over 15 minutes and put me back.  I love my EMR, e-MDs.  The degree of control I have over the schedule is unlike anything I have had before.  I can make appointment durations as short as 5 minutes (for a child needing an ear recheck or vaccine only) or as long as an hour (for the new Downs Syndrome baby with the complex heart defect I will be seeing next Tuesday).  Being able to massage and adjust and manipulate the schedule makes for a very smooth day.  Sure there will be the surprise patient who calls claiming to have a cold (short visit) who actually is there to talk about his depression (really long visit) but in general, it will work very very well. 

Many of you have asked if I will ever do walk in hours….I debated this long and hard.  I had implemented the idea at my former practice and although it had its ups and downs and pros and cons, it met a real need and was very successful.  The challenges were that the walk in hours were either empty or swamped and since I am on my own, I worry about both ends of that spectrum.  For that reason, I have implemented what I have coined “Call ahead scheduling.”  If you are up at 2 am with a sick infant or discover at 7 am your middle schooler has a bad stomach ache, you can call the office and leave a message and my staff will call you back between 8 and 830 and get you on the schedule in the morning.  Never worry that your sick child will not be able to be seen.  As the fall and winter illnesses evolve, I will be setting aside more time for these same day appointments and everyone will be seen who needs to be.  Of course there may be times when you need to take your child to an urgent care or the ER but if the problem is one that can make it through the night, I will see your child the next morning, rest assured.

In order to have the scheduling continue to go so smoothly and run on time, it is really important that when you call to make a same day appointment for your child’s cold but you know you also want to address his depression or back pain or headaches or chronic stomach aches or ADD be sure to tell the scheduler about the more chronic issue so we can allot the correct amount of time.  Also, if you want me to look at more than one child, even if it is just to ‘peek at her ears’ let my staff know.  I expect many sick visit appointments will have an extra simple question or two added on but if the issues are many or long standing or complex, just let us know so we can continue to run smoothly.  I love being able to see everyone AND run on time and I am sure you will appreciate that too!

Get your flu vaccine, call ahead for same day sick appointments and drink hot chocolate and each day will be your best!

Molly O’Shea, MD  Birmingham Pediatrics + Wellness Center

www.birminghampediatrics.com

Full moon October 16, 2008

 

There’s folklore everywhere about the effect of the full moon on everything from werewolves to pregnant women and you know what, I am, just maybe, starting to believe it.  Over the last 48 hours, I have had seven newborns to see at Troy and Royal Oak Beaumont and that is AMAZING!  I have had a steady stream of newborns since the office opened, one to three each week and never more than two at a time and then the floodgates opened (or the waters broke) and a truckload of new babies were born.  It has been fun to reconnect with the nurses at the hospital and the clerks too since I was out of commission for a while between jobs and today I ran into three of the nurses who helped me after my kids were born.  NICE!

Today was also terrific because I got a little break from the hubbub of work.  I decided a few weeks ago to take a few hours off this afternoon and originally I had planned to go hiking through Stony Creek Metropark but with the Incredible Hulk that I am on steroids due to my asthma, I decided that a stroll through the leaf mold, however beautiful, was not in my best interest.  Instead, I spent a few hours resting and getting my tire fixed and having sinfully fattening mexican food.  Very very nice!  

I am starting to feel a bit less like the steroid-crazed hulk and more like myself today too.  I am sassy and fat from fluid retention but at least I am not crying 24/7.  I still have about 5 more days to go but I can see the light at the end of the tunnel.  This weekend will be filled with birthday preparations for Mairen’s 12th along with riding and football and sleep!  The way I figure it, all the babies have been born so I am in the clear!

Eat chips and salsa, take a nap and enjoy an afternoon of relaxation and each day will be your best!

Molly O’Shea, MD  Birmingham Pediatrics + Wellness Center

www.birminghampediatrics.com