this interruption brought to you by…

There are certain things that really help you mark time. It’s easy for me to forget how long it’s been since I was a student or a newlywed, or a brand new mom. But then you get glimpses of how oh so long it’s been.

Yesterday I attended a graduation party. Today I will attend a baby shower.  The graduate and the expectant mom were the ages of my kids are now the first time the Pastor and I watched them while their parents were away.  Which means I’m now the age their parents were back then.  And I’m now the person who can’t use snapchat and has to ask what certain words mean. So the moral of the story is, well, more time has passed than I’d like to admit.  (Insert grandma emoji.) Screen Shot 2017-04-24 at 9.55.24 PM

One of the biggest issues I discuss in my patients who have the benefit of the tincture of time is menopause.  By definition, menopause is the permanent cessation of the menstrual period.  Get it?  Men-opause.  It usually occurs around age 51 and the time just before menopause is referred to the menopausal transition. As has been so famously penned, the menstral cycle “does not go gentle into that good night.”  The menopause transition can be torturous for some.  Up to 80% of women experience bothersome symptoms of menopause.  One of the most common is what is known as the hot flush.  I haven’t been through menopause but I have been pregnant and had some similar hot flushing experiences. Imagine you are sitting at work and someone just moves the surface of the sun about 2 feet from your head. Your head, your face, your neck feels like you have entered the portal to hell for about 3 minutes. They can happen daily and often times women experience hot flushes for 3 or more years. Additionally, as estrogen declines women can experience severe symptoms of vaginal atrophy.  (Sorry friends, you know a gynecologist is going to write the word vagina in her blog at some point right?) The point is that menopause isn’t just the joyful absence of a monthly cycle, it is a transition into a new phase of life that can be, well, painful.

Fear not my faithful reader.  If you have made it this far I have good news for you.  The symptoms associated with the menopausal transition can be managed.  Your doctor can offer you different types of medication along with non-prescription therapy to alleviate your symptoms. We will also talk to you about what to expect during and after the transition and how best to care for your body.  For example, women in menopause are at increased risk for osteoporosis and associated complications so we might gently remind you to take your calcium and vitamin D and get your weight bearing exercise done.

I have big plans for the last stages of my life. Like just telling everyone what I think all the time.  I know some of you are thinking…don’t you do that already?  But really, just let all the thoughts come out.  Pretty sure there is an age at which I can get away with that. The point is that you are not alone in your transition.  Ladies, don’t let the menopausal transition get in the way of your big plans.  See your favorite gynecologist.  Talk about your symptoms.  Listen to what they have to say.  And then get on with your big plans.

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(photo credit to the twitter, the emojis and the someecards who are always full of delightful things)


in plain sight

It was Holy Week.  The week of Easter. The mother of all weeks in the church. There was preparing, cleaning, cooking, shopping, eating, egg hunting and so much more.  Frankly, as fun as it is, it is exhausting.  So I won’t belabor the point today.

This Easter I cannot let go of the words from Luke 24:5.  “…why do you look for the living amongst the dead?”  I think now, more than ever, we are looking for signs of life. We are flooded with images of death and destruction from our own country and around the world.  Mothers and children in war torn countries, live streaming videos of crime or self harm, the dropping of bombs, all the way down to angry emails and rants on social media.  It’s enough to make you feel withered and dry and near dead.

Where are signs of life?  I think it’s tempting to say that we will find them in our beautiful pictures on social media of our well dressed slightly less well behaving children on Easter or in our waxing on about our job, house, or whatever new or exciting thing has come our way.  I would argue that there isn’t true life found here. Where then, will we find signs of life? For me it’s in those text messages from friends far and near who understand the daily struggle to balance all things work and church and home.  It’s sending a note to remind someone that they are loved and prayed for.  It should be obvious to those of us who have spent most of our lives wandering in and out of the church doors.  If you lose your life you gain it.  We find signs of life when we extend ourselves to another.

I sent a giving key to a fellow pastor’s wife.  One of the tribe.  If you don’t know about giving keys they are necklaces, with a key on them, and a word inscribed in the key. Someone who tak51412342510__07BB8511-CA17-4486-9560-2002B6474851.JPGes the time to remind me to breathe and relax sent me one. The word I sent was “hope.” It was a promise to hold out hope for my friend on the days where it didn’t seem like hope was possible. When the problems in life, the problems in church, the problems in the world seem too much.

So when you find yourself overwhelmed by all the death and deathly news that surrounds you, give away part of yourself. Make a phone call, write a note, sit down for coffee, send a token of care. Find signs of life and share them with those around you.

i’m not making this up.

A few months ago I was at dinner with friends, one of whom is pregnant. The topic of drinking in pregnancy came up and someone said to me “you just tell people not to drink because you have to, not because it’s really harmful right?” Um…I made that face. That face.  You know. The one where  you couldn’t possibly believe what you heard but, then again, you heard it.  The one where your eyes are big and your mouth is open.  After a pregnant pause I explained that national and now international guidelines recommend against any alcohol consumption in pregnancy.


We all know that you are never going to get more unsolicited advice than when you are pregnant.  What you can and can’t do including raising your hands above your head or eating peanut butter in the bathtub along with what your baby should eat, how it should sleep, what it should wear and where it should go to college.  Whether or not you should consume alcohol in pregnancy is among that advice.  However, drinking during pregnancy is the most common cause of birth defects in the United States. And while these birth defects are most common among women who drink heavily, there is no safe amount of alcohol consumption for a pregnant woman.  Alcohol use in pregnancy is associated with low birth weight, preterm birth, birth defects and developmental disabilities.  Health care providers are encouraged to discuss discontinuation of alcohol for women who are pregnant and those actively trying to get pregnant.

April is alcohol awareness month. It was established to reduce the stigma associated with alcoholism and increase awareness about alcohol abuse, treatment and recovery.  Excess alcohol use costs the United States about 250 billion dollars per year.  About 5 billion of that is related to alcohol use in pregnancy.  So no, as gynecologists we don’t just say these things because “we have to.”  We say them because we truly want the best outcome for you and your baby.  So if you should find yourself with two lines on that pregnancy test, congrats!  It’s time to take a break from alcohol.  If you are already pregnant and haven’t stopped drinking I would urge you to do so now.  You can tell your grandmother, your best friend, the lady at the grocery store and the dude at the gas station that you are doing everything you can to take care of yourself and your baby.  Really.  We’re not making this up.

to my friends in white.

Thursday was Doctor’s day. It has been celebrated since the 1930’s when handwritten notes were mailed to physicians and flowers were placed on the graves of doctors who had passed. Today Doctor’s day is usually celebrated with free breakfast in the hospital and snacks and cards from office staff.

I have the privilege of helping to educate medical students and residents.  Doctors to be and doctors in training. When you’re in medical school or residency I think you try to keep your eyes forward, always looking toward the next step, the next goal.  Don’t think about the mountain you are climbing, just put one foot in front of the other. Looking back, for me, it would have seemed insurmountable to approach it in any other way. There is more to learn, more work to do, more complicated patients to care for today than ever before. The long hours and hard work don’t stop. The struggle to balance education, work, family and your own health never ends.

My youngest loves to sing. She can learn the words to most songs pretty quickly. Which means you can’t let her listen to anything you don’t want repeated.  That being said today she was singing songs from the Disney movie “Moana” at the top of her lungs in the car. “and the call isn’t out there at all it’s inside me…like the tide always falling and rising.”  Every time she sings the words they stick with me. Medicine is a calling. Yes, while it is often exciting, intellectually stimulating and on most days rewarding, none of those extrinsic things will be enough to keep you in it long term.  It seems like it should be, I know. But the pressure, the paperwork, the volume, the hours add up to some grueling days. We know that physician burnout rates are more than 50%. We lose the equivalent of a class of medical students to suicide every year. Conferences for physician educators are now filled with sessions on how to increase resilience in our trainees. We have committees on how to promote wellness in our profession. We desperately are seeking ways to make medicine meaningful again and redeem what has been lost in our profession.

So for my friends in white coats both short and long, in wrinkled scrubs, sitting behind books and laptops and electronic medical records and paperwork of all kinds. For you, every day is doctor’s day. You will get up early and pour yourself into your work and the lives of your patients, your coworkers, your students. Remember to be kind to yourself. Some days the call to medicine will feel far away and you will struggle to remember how and why you got here and why you should stay.  Other days you will celebrate the work you did, the people you met, the things you accomplished and the calling will be close to your heart. But never forget that your white coat does not ultimately define who you are. Last week I had the opportunity to hear Friar Richard Rohr speak at a conference the Pastor hosted.  He will tell you that in the second half of life you really only learn anything from your suffering and from love; not from your successes. I have come to agree with him. I know more about who I am by listening to those who love me and experiencing the suffering that life brings.

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When I think about how to foster wellness and resilience for my friends in white, I think maybe we can do best by reminding them, reminding ourselves, that while your work is meaningful and important…that YOU are meaningful and important. Without your white coat, without the initials behind your name. Medicine will be a huge part of who you are. But it will not be who you are. You are more than medicine.