Birth vs. Adoption; Child vs Animal

 

15 years ago this month I was agonizing over the delay in travel plans to China where we would meet our soon to be 2-year-old daughter for the first time. Fast forward to last week when that same daughter, now 17, lamented that the rescue puppy we were adopting was getting older without her. Although we have had 3 dogs over the past 29 years, this is the first dog that we have obtained thru a rescue agency. I am impressed with the thoroughness that is provided to make sure that each dog goes to a home where they will be loved and well taken care of.  I am saddened that we as a society do not do as good of a job with children – both those who are born into a family and those who are adopted. Over the past month we have been made aware of the family in California who kept their children hostages in their own home while using  home-school as the cover and the father in Texas who disciplined his newly adopted daughter so severely that she died.  I was struck with the similarities between adoption of an animal and a child and believe that we would make lives better for our country’s children if we borrowed some of the same guidelines.

  1. Home Study – Thankfully we passed both the child and dog home study. Slightly different requirements each time. We didn’t need a fenced in yard for a child, but did for a dog. All family members required an interview for the child but not the dog. Fifteen years ago the house was large enough to add a fifth child; today the house is too empty and we are adding a dog. In contrast, no home study was required when I became pregnant with each of our first three children. In my job as an ob/gyn,  I often recite a silent prayer when discharging infants to a parent that I feel is living in a dangerous situation or has had difficulty taking care of  herself during pregnancy. The lives of many children could be remarkably improved if we were proactive in helping families provide a safe living situation.
  2. Cost – The cost of a child adoption, whether domestic or international, is something that many families are not able to afford or need to take on additional debt to accomplish.  The cost of a rescue dog adoption is considerably less but still significant.  Creating a child is free. I wish there was a warning before conception similar to the one on the rescue dog webpage. “If you don’t think you can afford the adoption fee, you probably shouldn’t consider adopting a dog”.  Access to free birth control and improved contraceptive education would help to reduce the incidence of unplanned human pregnancies – currently at 50%.  And when you plan a pregnancy, you are much more likely to be able to afford the costs of raising a child.
  3. Parenting – As part of the child adoption classes we attended, we heard from parenting counselors about problem solving and resources for seeking help. We agreed to puppy obedience classes as part of the dog adoption and were instructed in how to perform redirection type of discipline. No formal parenting training was provided for my birth children. I quickly learned with boys that parenting is similar to dog training – short, repetitive commands with frequent redirection and lots of love. We could help break the cycle of child abuse if we required basic parenting classes of both birth moms and dads and resources for follow-up support.
  4. Healthcare –  We needed proof of medical insurance with the adoption of a child and were encouraged to purchase pet insurance for the puppy adoption. Many children in this country don’t have health insurance because their parents can’t afford it. Needed childhood immunizations and check-ups are put off, only to incur greater healthcare costs later in life. This is only one of the litany of reasons why our healthcare system needs to change.
  5. Food – The multitude of choices for puppy chow is overwhelming – organic, high protein, vitamin supplemented, minimally processed.  We were instructed in portion control and not overfeeding.  Putting a priority on feeding children similar quality food in appropriate amounts would pay dividends in reducing the epidemic of obesity and diabetes. If I wouldn’t give my dog a Happy Meal with a Coke, why should I feed it to my children?

Our puppy has now been home a week and has settled into a routine. That process took much longer for the Chinese 2-year-old. Different language, food, smells and faces, in addition to grieving for her foster family, required 3-4 months to produce a child who slept thru the night and allowed her dad to hold her. Giving her wings this fall as she moves on to college will likely dredge up memories of those first few months; sleeping beside her so she could fall off to sleep, sharing a meal @ 3am as she recovered from jet lag, listening as she lost her Cantonese language and formed a new vocabulary in English. Tears will be shed on that day – mine for sending off the last child to college, hers for missing her dog.  But she has assured us she will facetime weekly – if only to see her dog.

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The Search for Happiness in 2018

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With the upcoming New Year, most of us will make resolutions that we seldom are able to keep beyond January. Many of those resolutions revolve around changes in diet and exercise. Because if we are more fit and weigh 10 lbs less we will be happier.  Health clubs depend on the uptick in memberships in January, but they would not be able to sustain those memberships if everyone that signed up continued to attend on a weekly basis. So what can make us happy beyond January 2018? Dan Buettner, a native Minnesotan and author of “The Blue Zones of Happiness”,  has studied cultures around the world that live successfully into old age with the greatest degrees of happiness. Membership in a health club was not on the list of lessons for longer living, but an active lifestyle was. The other lessons included:

  1. Socialization – face to face communication, not work related and not social media. The happiest people socialize 6-8 hours a day with positive minded people and often use humor in their conversations.
  2. Financial Security – but more money does not always buy happiness and usually has the opposite effect.
  3. Buy experiences, not things. A good experience gains luster with time.
  4. Eat more fruits and vegetables, less meat. Eat less processed food. Share meals with friends, especially friends who laugh.
  5. Find a purpose in your life – whether that be at work or in volunteer efforts.
  6. Pursue an inquisitive life by learning and trying new things.

I recently had the opportunity to check a box on my bucket list and unknowingly incorporated all of the above into my 10 day journey. It involved a trip to the tip of South America and an awe inspiring 5 day trek in Torres del Paine National Park, Patagonia. We had the opportunity to sample the local cuisine – grains, vegetables and seafood in plentiful supply. We became acquainted with new friends that were part of our trekking group and shared stories of families and work as well as the events that occurred during our daily travels. Each day was a new adventure and involved learning about the history, flora and fauna of Chile while laughing, fording glacier fed streams and climbing rock fields.  I was able to put aside the divisive culture that has become so prevalent in our country as I didn’t have internet access.  My time was spent framing pictures for my camera while laughing at the stories from my fellow trekkers. All of this for me invokes true happiness. So it was no surprise when I realized that the National Geographic magazine that I had purchase just before we left was the “Happiness” issue and included many of the above items that I have come to believe can make us all happier if we are only willing to listen.

I believe that a large part of my job as a doctor is to help patients stay healthy thru improved lifestyle and circumstances. As detailed in the National Geographic article, happiness doesn’t come thru reading the latest self help book or making a New Years resolution. The best way to be happy is to not worry about being happy but surround yourself with the right environment and relationships. Pictures can often be more informative than words, so enjoy some of the many pictures that help to explain the above.

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Humor as we dressed for our zodiac ride

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It is easy to be happy when this is your trekking view.

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The camera that never left my neck, even over water.

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My crazy friends from Germany, Chile, UK and US.

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My personal stairmaster

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Sharing food, drink and conversation after a long day on the trail.

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Quinoa, radishes and mushrooms.

#MeToo in Women’s Healthcare

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The #MeToo Movement, in regards to sexual harassment, has created a great awakening in our country as to what we have tolerated in the past and what we are willing to tolerate in the future. This powerful movement needs to extend beyond just sexual harassment and into other platforms that are unique to women but have been controlled by men. One of these areas is women’s healthcare policy, a sphere that has been traditionally dictated by men as the people in positions of power in government  that make the decisions around funding and laws.

Two conversations with patients this week made me realize how far we have come in women’s healthcare over the past 10 years …. and how far we have backtracked in the last year. A new patient in her early 20’s presented for discussion of contraceptive options. After reviewing the pluses and minuses of each contraception method, I realized that her job was with Hobby Lobby. This is one of the businesses that have used the religious objections to birth control by their founders to justify that they will not provide coverage of contraception to employees who use employer-provided healthcare. Although many forms of hormonal contraception are used for non-contraception reasons, these are also not covered. Luckily the patient was well aware of these limitations and had remained on her parents insurance plan for this reason.

The second patient was an immigrant from Liberia and delivering her first child. When the baby was born she and her husband informed the delivery room staff and their family that the baby was being named after the husband’s sister – a woman who had died in her late 20’s of an illegal abortion in Liberia, leaving behind 3 small children. That same week, CNN published an article with the statistics that only 1 abortion clinic exists in Kentucky and the governor is working hard to outlaw abortion in the state. With 47% of pregnancies in Kentucky being unplanned and the teen birth rate 68% higher than the rest of the country, it does not seem that the women of Kentucky are being served well by their male governor.

The most effective way to prevent abortions and reduce the teen pregnancy rate is providing education and free or reduced cost access to contraception. Statistics prove that contraceptive education does not increase teenage sexual encounters but does reduce the teenage pregnancy rate.  When teens in a rural area of Colorado were provided with contraception education and free access to long-term contraception (Nexplanon or IUD), both the teenage pregnancy and abortion rate declined by almost 50%, saving the state $70 million in public assistance.

The current administration is attempting to take away the gains that were made in women’s health care over the previous 8 years by limiting funding for sex education, removing contraception as a required insurance benefit and pushing the anti-abortion agenda to include the persistent attempts at de-funding Planned Parenthood. This affects not only women but also their partners. We need to use the tidal wave of the #MeToo movement to include a push back against the current culture of anti-women healthcare policies that have been put into place by male legislators. Speak out, call and write your legislators, donate money. But don’t be SILENT. We have seen the power of our words changing a culture of sexual harrassment and we know that a long history of silence didn’t effect such a change.

What Women consider “Sexy”

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I have been seeing female patients for 27 years and we frequently discuss difficulties with intimacy. Topics can include decrease in libido, vaginal dryness causing pain, body image after childbirth or cancer treatment and the list goes on. I jokingly tell my patients that God messed up when he created sexuality since 90% of male libido is between the legs and 90% of female libido is between the ears.  We work together to try and problem solve both physical and emotional issues, sometimes with medication and other times with support and understanding. We discuss what it takes to “get in the mood” for intimacy. Which brings me to many of the revelations of male behavior that have appeared in news headlines over the past month. These are powerful men trying to create intimacy with co-workers and strangers.

Given my experience, I think I can speak for a great majority of women. We don’t find a picture of a man’s naked body or his genitalia sent to us via text “sexy”. We don’t appreciate sex toys given as gifts. We don’t find it “sexy” when more attention is paid to our bodies/clothing than to our work performance. We avoid friendly hugs that may turn into grabbing other body parts.

You may ask what is left? What do women consider sexy?  Here is my non-scientific report from what I hear from women ages 18-80.

  1. Love and Intimacy.  When a couple is having relationship difficulties outside the bedroom, low libido in the bedroom is often a side effect for women. We have a hard time separating our brain/emotions from intimacy.  Male libido can thrive despite relationship conflict, which often makes women even angrier.
  2. Contributions made to childcare and household chores. There is nothing better to kill a woman’s libido than doing 3 loads of laundry, cleaning up the kitchen and putting a few kids to bed while their partner watches a sporting event on tv, only to have that same partner try to initiate intimacy as she is falling asleep while brushing her teeth. A partner that volunteers to clean up the kitchen while the woman puts the children to bed stands a much better chance.
  3. Exercising with your partner increases endorphins, the feel good substances that the brain produces, which also increase libido.
  4. Taking the initiative to arrange a date night (planning childcare is a bonus). Women are better able to separate from their household duties when they are OUT of the house.

The majority of men in this country are much different from the men that have made headlines in the last few weeks. They may need a bit of guidance to improve their game, but they can learn from others mistakes and make life better for themselves and their partners.

Why you need to check the donor box

In the past month I have had the opportunity to witness the incredible benefits that one person can make when they decide to donate their organs at the time of death. Most of us don’t like to think of the day when we will no longer be on this earth, much less consider that eventuality when we are standing in front of the drivers license registrar and asked if we would like to become an organ donor on our drivers license. As each of my children have completed drivers ed and then successfully passed the behind the wheel test, I have urged them to check that box on their forms. Just imagine your mother telling you what to do even when you are dead!

Last month one of my friends from medical residency received a new heart and kidney as hers had been slowly failing due to previous chemo and radiation from Hodgkins lymphoma. She was fortunate to find a match within a few months of being placed on the transplant list as her heart was tiring quickly and wouldn’t have lasted for the usual 8-10 month wait. Someone had to die for her to receive an extension on her life. She has always been a person who fights for the under-served and I would like to think that this life extension allows many more individuals to benefit from her new and improved heart.

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Marie one week post heart/kidney transplant

A short time later, my daughter had the misfortune to get tackled in the Homecoming powder-puff football game and tore one of the ligaments in her knee, the ACL She required surgery and the decision was made to use her hamstring tendon as her new ACL as it is stronger than a cadaver tendon. During surgery, it was discovered that she had very short and narrow hamstring tendons and they would not suffice to repair her ACL. Luckily, cadaver tendon was available and the surgeon was able to augment the repair to ensure that she has the strongest knee possible for skiing and soccer in the future. IMG_6154

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Torn knee ligament

While 95% of Americans support organ donation, only 54% sign up as donors. 117,000 people are currently waiting for a transplant and 20 people die each day while waiting. We can’t control when we lose our lives, but we can control how we want to be remembered.  Marie and Molly have a new heart, kidney and knee due to the generosity of others. Please consider signing up to be an organ donor.

Why domestic violence needs to be a “guy” issue

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Although I have never been the victim of physical/sexual/verbal abuse, I see the consequences of these actions in many of my patients. I try to listen, not judge and provide resources for women who are either in an abusive relationship or suffering mental/physical repercussions of a previous relationship. But more than a few times I have thought, “Why doesn’t this woman just leave?”.

Over the past few weeks, two seemingly disparate articles have made me rethink this statement. The Star Tribune newspaper published an investigative article on sex trafficking, highlighting the customers of prostitution rather than the female victims. Efforts have succeeded in many states to prosecute the pimps and sex customers and not the female victims, as the majority of these young women are the victims of violence and feel enslaved and unable to leave. They often start as teenage runaways trying to escape an abusive home life, only to find themselves picked up by an older male who seems to provide safety and love. It doesn’t take long until these young women are enslaved in a different way – to drugs, sex work and physical violence from their pimps. Leaving is not an option as they have no family to go home to, no friends who can help and they carry the societal shame of what they have done. With this in mind, new initiatives have begun to educate and prosecute the male customers of the sex trade. If demand can be decreased, there will not be a need for supply.

The second article appeared on the blog  of a former neighbor and friend. This independent, opinionated, musically and athletically talented young woman had been the victim of domestic violence dealt by her boyfriend. Her story was horrifying as she came close to death a few times while also being  psychologically abused and estranged from her close and loving family.  Why didn’t she leave?  Why did she continue to make excuses for someone who left bruises on her body? But what if we changed the “blame” game? What if we asked, similar to the prostitution story above, why is the abuser abusive? What led him to believe that he has the right to choke and punch someone that he loves? Where has he learned the words that can systematically wear down a person’s self-esteem?  Why isn’t his family recognizing the bruises, put down words and unhealthy control he exerts?

The majority of our current resources around domestic violence are geared to protecting women once they leave an abusive relationship; providing a safe place to stay, legal services and job training. This is important but will never effectively change the behavior that led to the situation. We need research to find out what exists in our society that allows men to believe that this is acceptable behavior. Only when we understand that this is a “guy” issue and not a female victim issue, will we be able to effect change.

 

My Day of Confusion at Work as an Ob/Gyn

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During the delivery of a baby last week, the parents informed me that they had decided not to know the sex of the baby prior to delivery. I joked that I would need to watch a You Tube video prior to the momentous event so that I would be reminded of how to correctly identify the “parts” as either boy or girl. Luckily, I got it correct under pressure of both the delivery and the gender identification and disaster was averted. But it did allow me to reflect on how important this subject has become for the newest generation of parents.

When I first started in practice 25 years ago, routine ultrasound at 20 weeks gestation was not standard practice. The quality of ultrasound was far inferior to current imaging and even when looking for gender, you could be mistaken or not obtain a clear picture. Although not evidence based, routine ultrasound at 20 weeks gestation is now the norm and anticipated from the time of the first OB appointment. The purpose of the scan is to rule out major structural abnormalities but expectant moms see it as “finding out the sex of the baby”. Relatives and siblings are invited to view the unveiling and crowd into the small, darkened room for the 45 minute procedure.

Reveal events have now become the mid-pregnancy social occasion. The sex of the child is concealed in some way and the expectant parents “reveal” boy or girl status to invited guests. A competition seems to have started for favorite You Tube video/creativity with these events. Subsequently, our office has been swept up into the planning process for the Reveal. Following are just a few of the duties that our Ultrasound Techs have been asked to perform.
1. Call the Bakery and note boy or girl for the couple so that a cake can be baked with either a blue or pink interior frosting, revealed when the cake is cut.
2. Stuff the appropriate color golf balls into a box so that when the balls are hit they emit either a blue or pink cloud of dust.
3. Stuff a pinata with either blue or pink candy.
4. Write the sex of the baby on a piece of paper and fold in such a way that prying eyes can’t deduce the writing. That paper is then given to a favored family member to see, while everyone else stays in the dark until the day of arrival.

Studies have shown that parents bond better with their newborn when they are aware of the sex of the baby prior to delivery. It would also make sense that they would have a name for the baby at delivery, but this seldom seems to be the case. With the current generation of parents, planning how events will unfold during the delivery as well as in the first days post-partum is a priority so it only follows that knowing the sex of the baby would be part of the plan. It is only when they have parented for a few weeks or months, that they come to realize that this wonderful journey is full of detours and bends in the road and not a straight path.

Here’s hoping that I will get the sex correct the next time I am under pressure to perform. I have the You Tube video bookmarked for quick reference.