Showing posts with label fitness. Show all posts
Showing posts with label fitness. Show all posts

Friday, September 8, 2017

lamentations of a community pediatrician

I am tired of hot cheetos. I am tired of juice and kool-aid for toddlers. I am tired of pizza or and wings from the local takeout. I am tired of 1 month olds being given 4 ounces of formula with cereal in it to “help them sleep” and the school aged children drinking milk or chocolate milk with every school meal even though they don’t really like the taste of it. I am beginning to see more and more 200 pound 12 year olds and 80 pound 6 year olds.

It is Well Child Check season in the land of pediatric primary care. As a private practice Pediatrician in Washington, DC I don’t actually eat those foods myself or feed them to my child (though I do love pizza and wings once a month) almost every single patient I see with elevated body mass index or abnormal increased weight gain has had or currently has some part of this in their diet.

I am beginning to worry every day I am in my office about all of the premature heart disease we are going to see in 20 year olds because I now have seen close to 10 school aged children with abnormal lipid panels due solely to their poor diet, I have seen more than my share of toddlers and school aged children with developing Blounts Disease (this is a disorder kind of like deforming kiddie-arthritis where the bones in a part of one or both knees begins breaking down due to excess weight, causing deformity of the knee), I have seen countless young women with metabolic disorder and polycystic ovarian syndrome (think bad cystic acne, hirsutism, abnormal and often heavy periods). I have seen more than my share of rotting teeth due to prolonged bottle use, inadequate teeth brushing, and poor diet high in sugar-laden beverages.

Every day I say or type in my instructions to countless children and parents “no juice, soda, sweet tea, or koolaid, it’s bad for your child’s teeth and behavior” and I cannot tell you the number of children and parents who argue that juice must be good because “WIC (Women, Infants and Childrens Program) gives it to me”. Or the kids that say “I don’t even like milk, but school gives it to me at breakfast and lunch so I just drink it”. Ohhhhh WIC and schools! If only we could divest ourselves of the sugar and milk lobby and give these kids what they need - gasp, WATER! Water, the only drink that other countries, with much lower rates of childhood obesity than the United States I might add, allow in their schools. It literally takes me a several minutes in most visits to share with parents that no juice is definitely not healthy even though it has “vitamins and minerals” and that no it’s not the same as eating a piece of fruit. And no, if your child doesn’t like milk they don’t actually have to drink it and they can just drink water and get their calcium from things like yogurt or cheese. And no, chocolate or strawberry flavored milk isn’t needed because if your kid doesn’t like milk he/ she really doesn’t have to drink it. And yes, the sugar in juice and chocolate milk is just as bad in it as the sugar in soda is and nope I don’t allow my 6 year old to drink juice, soda, sweet tea, or koolaid (except at the random birthday party or when he is with my family who simply won’t listen to me) and nope my 6 year old doesn’t drink cow’s milk. Seriously, I can recite these points in my sleep because I say them every day countless times.

My heart hurts. The ICD 10 codes: abnormal weight gain, childhood obesity, pediatric BMI greater than 95%ile dot the majority of my notes. Cutting out the “juice, soda, sweet tea, and koolaid”, cutting back on the take out, increasing the time outside or dancing and playing, and cutting out the cow’s milk would be enough in most cases to curb this trend.

We had a new neighbor in his mid-30s die of heart disease this summer. His obituary showed a child who has struggled with his weight since early childhood and multiple relatives with obesity. His story includes hypertension and pre-diabetes in his 30s. This story is going to be more frequent if there isn’t major policy and cultural change in America.

Thankfully I have had a handful of success stories and they keep me inspired to share healthy diet and exercise with all because honestly so many of my patients just don’t know. The toddlers who I have done intensive intervention with in my office and referred to our local childhood obesity program whose entire families have adjusted their diets and their weight gain has slowed and can run and play more. The adolescents who have lost weight since their last visit who walk in with their parents who are looking mighty healthy too and tell me about the weight they lost and how they no longer drink sweet tea every day and do take out much less. The mothers who breastfed for a few more months even though it was hard. The families who stopped giving their 2 month olds rice cereal in their formula (of note, the current recommendation is exclusive breastfeeding until 6 months old unless medically contraindicated. No supplemental foods - that includes rice/oatmeal cereal until the kiddo can sit up on his/her own usually between 4-6 months).

So while I lament, I press on because there is so so so much work to do. Now off to find a healthy early morning and I can’t sleep blogging snack for this 4 month old growing fetus of mine.

Monday, January 23, 2017

G2 P1011: life after loss and D&C

This post may be a trigger for those who have had an abortion, miscarriage, or fetal loss. I wanted to share my experiences because in the weeks following our fetal demise, I read several blogs by mothers but couldn’t find a single post written by a physician mother. This post is also part of my healing process. In it, I will share some of my challenges and also will explain my D&C*. I have found over the past months that many of my friends and colleagues have experienced pregnancy loss. Almost every single friend I shared it with have experienced their own loss. We are not alone. I hope that this post helps someone in need.
____________________________________________________________________________

It’s been 2 weeks since my D&C, over a month since we learned that our little kidney bean sized fetus-baby had died, and 3 months after finding out we were pregnant with our second child.

Thankfully, the nausea has resolved, the fatigue has ended, and the waves of grief are less intense and less severe. But sometimes the grief washes over me and I can’t breathe. And I fall into my husband’s arms or I call him or my mother or my best friend A and I weep. And then I wipe my face and I go on.

Zo asked enough questions for us to know that we needed to tell him something. So, I recalled my time during residency with the Palliative Care Team and did my best at providing a 5-year-old appropriate explanation of miscarriage. “Mama, there is no baby anymore.” “No, there was a baby growing but it stopped growing and then it died and the doctors helped my belly feel better and now I’m feeling a lot better.” He pauses, looks around. Says “okay” with a smile and a hug and then “I’m going to go find my Wolverine so we can play.” And then we move on. Now that my belly has started to rapidly deflate, I’m not exhausted or nauseous anymore, his questions have become less frequent. He is satisfied with our answers.

One of the hardest parts of this process has been all of the changes my body underwent that feel downright wasted. Big old breasts that won’t nourish a baby and that sadly have deflated just like my belly. A big old belly that poked out immediately and still makes some strangers pause. I pray incessantly that no well meaning elder asks “are you pregnant?” because I have stopped telling friends about our miscarriage (I am allowing the message to be passed by osmosis because at this point, I’m tired of retelling it and everyone who needed to know now knows) and I’m not sure I won’t either curse them out or start crying. New stretch marks that show my body underwent a change and unlike my breasts and belly, they are permanent. They will always be with me.

The hardest places to go for me have been the gym and the Ob-Gyn office. The gym because all of the mirrors show me exactly what I look like. I tend to sit in the car for 30 minutes before going in. I usually have my worst cries there building up the courage to go inside to work out. Losing weight after having Zo was so easy. He nursed like a champ and I weighed less than my pre-pregnancy weight within 4 weeks. This time. No such luck. At the gym there is no cute baby to tell other people about. I see the eyes on my belly (folks probably thinking “this pregnant lady knows she needs to be at home). I see the bulge in my shirt. The popped out belly button. The widened hips. I know I have to work extra hard to fight the flub without the help from breastfeeding. It hurts. All of this good chunk and no cute baby to show for it.

The Ob-Gyn office because there are cute waddling pregnant women. After finding about about the demise, I transferred my care from a midwife community practice to an Ob-Gyn practice recommended by one of my friends. I literally could not go back to the old practice; when the office called to follow up, I quickly thanked them and hustled them off of the phone. I had to let them go, they are the practice where I was hoping for a happy, uncomplicated pregnancy. I just can’t go back there.

And now with the new Ob, I don’t want to go for my follow up visit (but I do, on time!) because I know I’ll have to tell the Tech who gets my vitals that we had a miscarriage. And then the sad response, the averted eyes. I want to yell “I’m not a leper” but all I say with a smile to make her feel better is “we are okay! I’m feeling much better and the procedure went great!”. And I don’t want to hear the Ob tell me “you can start trying again next month.” And when I say “we are taking a break, this was a lot to handle” he says “yeah, yeah, yeah, you’ll be back soon pregnant with the next one. You two are healthy, you can have 3 or 5 more kids if you’d like” I have such complex emotions that I can’t mount a response. I just sit and nod. I literally am too scared right now to think about getting pregnant again. So I read books and I read blogs and I talk to friends who have lost babies and they tell me I am feeling exactly how I should feel right now. Confused. Scared. Hopeful. Encouraged. Sensitive. Fearful. Apprehensive. Angry. Loved.

It is 1pm and I have been putting off going to the gym since 9am. It’s time to get up and go. Hopefully writing this post means that I won’t spend any time sitting in the parking lot. Time to work on this belly bump.

_____________________________________________________________________________
G2 P1011. Gravid 2 (meaning I have been pregnant twice), Parity: 1 term infant delivered, 0 preterm infants delivered, 1 abortion/miscarriage, 1 living child.

*D&C - dilation and curettage. This is a procedure where the cervix is dilated and a curette, almost like a spoon or a scraper, is used to remove contents from the uterus.


My D&C:
  • In my D&C a small vacuum was also used.

  • I received conscious sedation during my procedure, meaning I did not require respiratory support. I was in the pre-operative area for several hours until a c-section was completed and then I was taken to the Operating Room and it was over within 15 minutes. The Anesthesiologist provided midazolam and propofol and I was awake within minutes after with no cramping. I was very hungry and ate lots of yummy snacks and a big lunch and then came home and was promptly sent to bed by my family.
  • The Obstetrician performed an ultrasound before to confirm the demise and an ultrasound after to show that the products of conception had been removed. I asked for them and have them in my files.  
  • I had light spotting for 3 days after. Then only spotting with exertion (embarrassing but this means after pooping) for 2 weeks, then it stopped.
  • I have had intermittent cramping and just like my Ob promised, I dind’t need any medication stronger than ibuprofen 600mg as needed.
  • I had a follow up appointment 10 days later and was cleared for all activities.

Sunday, March 30, 2014

The Day I was Nearly Arrested on Assault Charges {subtitle: How I'm Finding Time to Train for a Marathon}



Earlier this week I found myself stuck at a “doctor-y” event. As I made small talk with a colleague, I mentioned that I was training for a marathon. Despite that fact that I am currently blogging about running and training consumes most of my thoughts, I promise I don’t talk about it incessantly to random people, but in this instance it did come up in conversation.
After I mentioned my training, her face contorted into what can only be described as a scoff. She then replied, quite condescendingly, “Must be nice to have THAT kind of time.”
My face turned beet red and my blood began to boil. Then without thinking I pulled my hand back and smacked her right across the face, leaving a bright red hand print on her left cheek. She was was stunned at first, but then her instincts took over and she kneed me in the gut. Before I knew it, we were in an all out fist fight in the middle of a cocktail party. My husband broke up the fight, but not before someone called the cops. I am currently writing this from jail. 
Ok. So, nothing in italics ACTUALLY happened (except in mind. repeatedly. for about a week). In reality I smiled and walk away, like a good girl, who didn’t want to have to explain a criminal record.
Obviously in a state of pure boredom, I decided since there was nothing else going on in my life, I would run a marathon. I’m busy and so are my running mates. The expenditure of my time is not something  I take lightly. We all have a lot on our plates, but like all things that are important to us, we are finding the time for this marathon.
How do I find the time for this?
5. Follow a Plan
We are following Hal Hidgon’s Novice 2 training program. The best way to avoid injury and reach my goal is to stick to the plan as close as possible. Each week I check off my boxes as I pound out each mile.
4. Run When I Can
The only time that works for me is mornings. Some mornings have been painfully early and cold, but nevertheless I’m out there. 
3. Accountability
When my alarm goes off at 5:30 and I check the temperature and it’s 13 degrees, knowing that my friends are out in the Arctic air waiting for me is what gets me out of my cozy bed. There are 6 of us training in my neighborhood. Though we can’t do every run together, we are each other’s cheerleaders.
2. Giving Myself some Grace
I have missed a few workouts. If I’ve been at the hospital all night delivering babies and I have to choose between running and sleep, then I choose sleep. I don’t make up my runs in the evening, because that’s my family time. Yes, my Type A personality would like to follow the plan to perfectly, but life happens and that’s OK.
1. Have an Awesome Husband
Obviously, somebody has to get the kiddos ready in the morning while I’m out torturing myself, and that somebody is my super husband. You need your spouse to be supportive (or a least tolerant) of your crazy hobby when you start logging this many hours.
Despite being a runner for the last 17 years, I have never ran a full marathon. In my early 20′s, I did races all the time, but never more than a 15 K (The Tulsa Run, which is still my favorite race). Over the years the responsibilities of life kept my running to 3-4 miles a couple of times a week, barely enough to stay fit. 
As my kids have gotten older, life has gotten a little smoother. I've decided this is my year to check "26.2" of my bucket list. Wish me luck, I'm a month away from my goal and I can't wait to cross that finish line. 
Haters gonna hate. But I'm gonna run.
originally posted at drheatherrupe.com

Wednesday, April 10, 2013

Muffin tops, belly jiggles, and other mommy "war scars"

Zo will be 2 years old in a few months. I was very healthy prior to and during pregnancy; I regularly did prenatal yoga videos, walked daily, and even did Zumba until I was 5 months pregnant. Sometime during my 8th month, I developed an abdominal hernia. I knew it needed to be assessed, so 8 weeks post partum, I went to see one of my favorite Professors. He is a round-bellied, wonderfully abrasive Surgeon with a penchant for throwing things in the Operating Room. He’s a no-nonsense type of guy with a plethora of jokes and a desk with an ample candy jar. He is an excellent Surgeon and his patients love him, and I guess at the end of the day that’s the important part.

During my appointment, he examined my hernia and said “just wait until you pop another one out before doing anything with this.” I asked about the extra flub and stretch marks and he said “give yourself a year, things should tighten up by then”.

18 months into the game and although I dropped the baby weight quickly (another perk of nonstop breastfeeding, a healthy diet, and frequent stroller walks), these muffin-top-wiggle-jiggle and hip flub-shakes just does not want to budge. My various corsets and girdles help to camouflage it when I want to appear shapely, but nothing helps when I am naked or even worse when I am at my beloved Zumba class shaking it up in workout gear with all of the skinny-minis.

I started working out again (ie, getting in a once a week Zumba class or some core strengthening training on Youtube while Zo is asleep) a few months ago. I looked at my bulging belly and hips and cringed. O is happy that I no longer look as malnourished as I did between 4 to 6 months of nursing, but neither of us loves the extra jiggles and low self esteem that come with them. I began to understand how folks slowly become overweight and out of shape. It’s like a slow decay creeping in. One day you skip a workout and then a few weeks later you realize you haven’t worked out since God-knows-when. You see your morphing shape and think (through my Pediatrician’s lens), I am soo tired, who has time to work out when I am trying to feed my family and cuddle my baby before going back into the NICU to keep really sick babies alive?!?

But it is important. And I do have to make time. I realized during undergrad that I need to work out. My body, mind, and spirit need it. When I am in shape and feeling good about my body, it is amazing. When I don’t exercise I feel downright yucky. Add replacing my beloved six-pack abs with this stretch-marked-middle-jiggle and you get the picture. Folks (my mother) who have seen the immediate post-partum belly and what I have now say it’s not soo bad, but to me it is.

I have vowed to continue to shake my mommy-bulge at Zumba and try to step up my efforts. I am planning on tightening up what I have so that I can feel better about the new mommy-me. These are my war scars. I’m in the trenches. Mommy-pouch boot camp begins now!!!

Saturday, June 2, 2012

My Postpartum Overhaul: First Physical, and Now Mental

OK, It's a rainy Saturday. I am not on call. My husband is watching our 2 kids (under 2 years old) so I can work out. I just jumped on our Spinning bike and banged out 15 minutes of hard up-down cycling, while watching Cupcake Wars (It makes the time go really fast, and I vicariously enjoy the cupcakes, while actually burning calories!).

I thought up this post in the midst of the workout, and I jumped off the bike. Now I'm sitting here, sweaty, trying to bang out the writing. Meantime I can hear my toddler boy yelling. He's got a cold and is just  cranky, and he wants me. The baby is whimpering, and Hubby will have to make her a bottle one-handed, while our toddler howls and hurls things around the living room.

So let me be brief.

Quick backstory: I'm a part-time internist in group practice, and I had my second baby 5 months ago. My last few posts here on Mothers in Medicine have focused on my journey back to fitness after baby #2. I was 4 weeks postpartum, and realized that at 5' 2" and 163 pounds, I was officially obese. In spite of the fact that I was breastfeeding exclusively, I was gaining weight (and yes, that is common). It was my eating habits. Carbs, carbs, carbs. Bowl of Cheerios here, toast with butter and jam there.

I was shocked, but motivated. I got on the South Beach Diet and I lost a ton of weight. Listen, folks, the low-carb diets work. (I get no endorsement monies from them, BTW) (Though I would take some in a second, if they offered :)

I also started exercising again. For the first 3 months, I just ran outside when I could (though to call it running would be exaggerating. More like jog-walking) and did some Pilates on the floor before bedtime. This month I added back the gym.

And in 4 months, I have lost 30 pounds, down to 133 pounds, only 10 pounds away from my goal. I am well out of obese BMI range, and I feel great. Physically.

However, mentally, I am sagging. Now, Babygirl is still not sleeping through the night. My husband travels for work, alot. Though we have great family support, it is just a hectic schedule. My reserve is low.

But, some days, I find myself just suffering through clinic. The day will start out OK and manageable, and then, as happens not infrequently, I will encounter a difficult patient, and I will just get so down. I mean, so down that I come home and start surfing the net for non-clinical doctor jobs.

Now, the vast majority of my patients are absolutely lovely. Honestly. I have been so boosted, even blown away, by the interest people take in me and my family; by the unsolicited support for my working part-time; by thoughtful cards or baby gifts; by positive feedback on my clinical work

But just one angry/ blaming/ abusive/ demanding patient, and I am just crushed. Even when I am in the right (like in diagnosing an alcohol problem, or not prescribing narcotics). Even when I know the patient has psychological issues, and is only acting out at me because I happen to be sitting there. The negativity will get to me, even if there is no overt confrontation, or raised voices, or complaints. If a patient is unhappy, I feel like a failure. I get shaken, even to the point of physically shaking. I feel like I will have a panic attack in the office.

Colleagues are supportive. We all see many patients a week, and we all have similar experiences, day in and day out. There is plenty of camaraderie, and I can always find someone with whom to vent, and feel validated.

But, at the end of the day, I hate these negative encounters. They make me want to quit my job.

I'm trying to look into this, to see what steps I can take to build resilience so that I don't feel like I need to please everyone; so that I don't feel a failure when a patient is unhappy. I used to be much better at this.

I'm currently looking at the concept of Compassion Fatigue. This is new territory for me. What do other MiM know about this? Is this something that applies? Or am I just an exhausted new mom with little reserve in a demanding profession having a normal experience?


Sunday, May 13, 2012

Run Like a Mother


A couple weeks ago, as I was reading the Sunday paper (yes, how 1989 of me),  I saw an ad for a Mother's Day 5 K called "Run Like a Mother."  A Race for 'women only' to celebrate health and motherhood, on Mother's Day. This seemed like an awesome idea, so I called up my running buddies and we made it a date.

The race was happening in a beautiful horse farm that has been converted to a park. What a great way to spend Mother's Day morning, we thought.

Last night as we began to check the weather though, we got a little concerned.  The forecast called for heavy rains.

Whatever.  A little rain wasn't going to slow us down.  I've run many races in the rain, as long as you avoid the big puddles, it's really not a big deal.

As I pulled into the park this morning, I began to have my doubts.  As we gathered at the staring line,  a downpour began.  Next I realized that we weren't running on pavement, we were running through the field.

A boggy field. Wet slippery grass. Mud. Awesome.

My shoes were sloshing, my socks soaked to the core as I rounded the first turn.  At times, I was running in 6 inches of water.

This was not what I had signed up for.

As me, my friends and 200 other crazy moms continued the race, we found our stride. The scenery was beautiful even in the rain. Faithful dads and tots stood with their umbrellas, cheering us on at the halfway mark.

It was definitely a unique experience: how often do I run through a horse field in a downpour?
As I rounded the final stretch with the finish line in sight, I realized that even in my cold, soggy state I was having a blast.

This race to celebrate Mother's Day turned in to a perfect analogy for motherhood itself: it's  messy, much harder than I thought I'd be, but exhilarating and totally worth it in the end.

What was the best part of your Mother's Day?

crossposted at thepregnancycompanion.com

Saturday, March 31, 2012

Kicking My Own Butt: 2 Months, 20 Pounds Lost

So here I am, an Internist and a mom, with a 3 month old baby girl and a 22 month old toddler boy, and with all that there is plenty of fodder for writing. All the priceless, precious wacky and aggravating moments that make up parenthood; all the touching, challenging, annoying moments that are doctoring. That's why we write, right? There's just SO MUCH.

But today, this is a simple update on my own journey back to my own body. Two babies in less than two years (plus a bit of an addiction to really dark chocolate) put alot of extra weight on me. I fell off my own fitness wagon. My runner's body gave way to... Obesity.

At 4 weeks postpartum with Babygirl, I realized I was at BMI 30. I kind of freaked out. I started a modified South Beach Diet. I lost alot of weight really fast, I think because I was breastfeeding. Then, when Babygirl was 6 weeks old, my husband was hospitalized with diverticulitis for a week. My plan went by the wayside. There were many days of like, Cheerios for dinner. My breast milk dried up. We went into Survival Mode.

Now, he's fine, I'm back at work, and life goes on, I picked up the free weights again. I started running: 1, 2 miles. Today, I ran 3 1/2 miles. Whoo-hoo!!!

And, even with my schedule and the kids, I have managed to lose 20 pounds in 2 months. I am now at BMI 27 (I'm pretty short.) It's hard, damn hard, but I can't give in to excuses or laziness. (Well, maybe sometimes...)

But if I expect to see change, I have to do the work. That means making myself get up at 5:30 a.m. on a Saturday to go for a run BEFORE the kids wake up. And taking the time to do abs work before going to bed. And planning meals: buying the healthy food, packing it up for myself the night before an early office day. It means resisting desserts. Most of the time.

So, while I am not perfect at all of this, I am persisting. My goal is to lose 20 more pounds, to get back to my pre-pregnancy weight. I find myself empathizing with my patients. Commiserating. Coaching.

So much of my work with patients is in trying, desperately trying, to help people help themselves to get fit. If I can use myself as an example, I will. I know how it is, I'm living it.

I can share with patients about how it's tempting to declare "Diet over!" after giving in to a little indulgence. But this is a HUGE pitfall. I'll talk with patients about how, for me recently, one chocolate-dipped strawberry led to another... and could have led to more and more, but I physically got up from the table and got it back together, and now am seeing results. I'll talk about the merits of hot herbal tea after dinner in lieu of dessert; the handiness of packaged mozzarella cheese stick snacks; the necessity of Truvia.

I can share with patients how hard it is to get in exercise when you work and have kids. How I need to make it a priority, and stay on top of it. Can't go to the gym? Me neither. I haven't re-joined my gym, because I'm not sure I would ever get there. Try running. Jumping rope is excellent exercise. I also discovered hundreds of free fitness videos On Demand. I do abs work at night before bed. I run after my toddler and lift him like weights. And there are stretches of days when I don't move much, and that's OK. It's tempting to declare, Game Over. But that's a common error. Just Keep Going, I tell people.

And I will keep going. Persisting, Resisting. Eyes on the prize.

Next week: 4 miles.