be safe this summer ladies.

Summer is in full swing and yesterday was the first Sunday of the Pastor’s sabbatical. For as long as we have been married he has worked at our church.  16 years.  For most of those years his weekly day off was my longest day of the work IMG_3307week.  And my days off after being on call overnight were the Pastor’s busiest days.  So this year he gets to take two months off to rest, recover and reconnect.  For the next 8 weeks, Sundays and postcall days will be filled with brunch, swimming, day trips and, hopefully, some other fun adventures as a family.

 

In honor of all things summer….here are the gynecologist’s list of “Summer DOs and DON’Ts”

DON’T go without sunscreen.  Especially you pregnant ladies.  I know what you’re thinking…”sunscreen is for people who look like you and those red headed kids of yours.” WRONG.  Sunscreen is for everyone.  That is, everyone who doesn’t want to get skin cancer or look super wrinkly when they are old.  And, sunscreen is for year round. I thought my dermatologist was going to whack me when she found out I wasn’t using a moisturizer with SPF.  Don’t worry, I do now…every day…I’d like to avoid looking 100 before I retire.  I used to know someone who used hand sanitizer on her kids like a zillion times every day but then those same kids would swim for hours at the peak times of sun exposure turning brown, brown, brown all summer.  Just because you don’t get red doesn’t mean your skin is safe friends.  Tips for everyone: use broad spectrum SPF 30 or higher; reapply every 2 hours; find water resistant formulas.  Pregnant women should opt for oil free (your skin is more prone to break out) and opt for a lotion instead of a spray.  (Never spray anyone’s face…esp your kids and remember sprays make it easier to miss spots!).   And when your baby comes ask your pediatrician about how best to protect that brand new skin from the sun.

DO wear your seatbelt. This seems obvious to me. The Pastor and I took a recent road trip and you’ll be surprised to know that Missouri and Indiana will tell you how many people died in auto accidents that month.  The 10 year old reading road signs alerted us to the number.  Ouch.   But lots of pregnant patients choose to go without.  I wish you could hear how loud I am screaming this at you.  Pregnant ladies!  For the love of all things including your baby!!!  Wear your seatbelts!  Put the lap belt UNDER your belly and the shoulder strap across your chest. Auto accidents are a leading cause of death for pregnant women.  Your uterus, placenta and fetus were not made to sustain direct or indirect trauma from an accident and you can imagine the increase in magnitude if you are thrown from your vehicle because you failed to wear your seatbelt. A quick search of the CDC will tell you that those without a seatbelt are 30 times more likely to be ejected from the car during an accident and 3 out of 4 ejected individuals will die as a result of their injuries.  So let’s all just buckle up, ok friends?

DO use insect repellent. I have no problem with blood and guts.  You know this.  If you follow along, you also know that I think bugs are the worst!  Actual conversation with my dad.  Me: Dad, killed a spider outside.  It was like the size of my face, I promise.  Pastor is out of town, can you spray my house?  Dad:  If it was outside it was one of the good ones. His death will be on your conscience.  But yes, I will come and spray.  (end scene). However, as terrifying as spiders are…mosquitos carry all sorts of diseases including zika virus and west nile virus.  Then there are ticks.  I don’t know if you have seen a tick up close but this image is not for the faint of heart.  Tick borne disease are the ones you learn about in med school that have the cool names and then you learn about them and are terrified. Tips: Use your bug spray with DEET (even you pregnant ladies), cover exposed skin, avoid standing water and if you are out doing some crazy activity like sleeping in a tent (no thank you) make sure you check your skin for ticks.

DON’T overgroom. I’m not even sure overgrooming is a word.  But for today I am making it one and asking you ladies, pregnant or not, to stop it.  Summer is a hassle. Shaving your legs and armpits all the time, wearing a swimsuit; I get it. But let’s not go overboard. Not only are there literally THOUSANDS of grooming related injuries each year, the good Lord gave you pubic hair for a reason.  (I know, commence freaking out that the gynecologist said pubic hair in her blog.  Resume reading when over freak out moment).  And while none of us know the exact reason, it is most likely to keep dirt and other stuff out of your vagina and to reduce irritation of that sensitive skin.  So be swimsuit ready.  But overdoing can result in lots of skin irritation or even infection.

So there you have it.  Summer safety tips from the gyno.  Oh, and in case you were thinking about blowing off one of your fingers with fireworks, here’s an OBGYN joke just for you…

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Summer of fun.

I’m back!  It has been almost a month since my last post.  In that month I have felt TERRIBLE.  At one point I thought I would never stop coughing and that I would get diabetes from my cough drop consumption.  Don’t worry, I switched to sugar free. But now I’m about 89.32% better and have found the time to write again.  (Which is code for I can stay up late and finish things).  And so here we are.

It’s July.  For most people July represents the middle of summer.  Vacations, lazy days at the pool, short days at work.  In medicine July means ALL THINGS NEW.  As in, all the things are new.  New medical students, new residents, new academic calendar. You see, I work in Academic Medicine.  Which means that I work at an institution of higher education where we train medical students to become competent, caring, ethical physicians and then train physicians to be competent, caring, ethical specialists in their chosen field.  Sounds easy, right?  I will try to briefly introduce you to what the summer is like for those of us insane enough to participate in this great adventure of education.

Medical school is 4 years long and almost exclusively completed after a 4 year bachelors degree is achieved.  In the first 2 years students spend their time in courses learning anatomy, the complexity of each organ system, structure and function of the body and its cellular systems, human behavior and so much more.  They come to class, have small group sessions, read and read and read some more and take lots of exams. By the time they come to the third year they are ready to see how all they have learned can be applied to patients and diseases.  Oh and did I mention they also have to pass the first step of the 3 step medical licensing exam? In the third year our goal for a student is to be able to see a patient, perform a basic physical exam and formulate a differential diagnosis.  What that means is that when they hear a patient’s symptoms and know their history they can think about what diseases they are most at risk for and/or most likely to screen-shot-2016-09-25-at-6-38-08-pmhave.  Only once that is done can we as physicians begin to think about what testing and treatment someone might need.  Medical students don’t do anything without supervision.  Sometimes patients will ask if the medical student is going to perform their surgery or deliver their baby. I can answer that with a resounding NOPE.  What a medical student will do is participate in surgery with me where they will learn the hows and whys of that specific operation.  They will check on their patients in the hospital and often serve as an extra set of eyes, ears or hands to ensure that all the details of patient care are taken care of and nothing has been overlooked in making sure a patient makes it safely home after surgery.  In addition to all this they are reading, going to lectures, taking tests.  At the end of the third year we hope they have chosen a medical specialty.  Then they spend their final year of medical school spending time in areas of their chosen specialty, as well as interviewing for a residency position and taking the 2nd step of that all important medical licensing exam series I mentioned before.  So for me July means making sure the syllabus and all the materials our third year students get and use equip them to learn the most they can about women’s health.  It means making sure those 4th year students who have chosen my specialty have the best opportunity to train at the institution of their choice for residency.

July 1st also marks the day new residents begin their training.  These are recent medical school graduates who have gone through a very competitive process to secure their place in a residency training program. Each specialty in medicine has residency training and each specialty decides how long that training should be.  For example, OBGYN residency is four years long. Neurosurgery residency is 8 years long. (no thank you).  While in residency these doctors have a focused practice where they will learn every detail of their specialty.  It is also the time when they are trained to perform procedures and surgeries all in a supervised environment with the intention that at the end of their training they are ready to care for patients on their own.  In the meantime they will spend up to 80 hours a week in the hospital where supervising physicians will provide guidance, support, and supervision.  At the end of those at least 10,000 hours of training each resident will decide whether to join a private or hospital based practice, become an academic physician or, for those brave/crazy enough, pursue even more specialized training.  One of our greatest privileges is to watch those residents graduate and know that they will provide the kind of patient care you would want for your family and friends.

It’s a long journey into a career as a physician.  It can consume more than a decade of your life.  In truth the learning never stops.  For those in OBGYN we have a written and then oral exam to become board certified after residency.  To maintain our specialty certification we read articles and participate in chart reviews each year. We attend conferences and workshops to learn from one another and maintain and improve our skills. We read articles and travel across the country and collaborate to find the most effective ways to educate our medical students and residents.

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So if you see a medical student or a resident, give them a hug or a handshake or a pat on the back.  During a time when there is a lot of uncertainty in healthcare they have made the choice to commit their lives to the service of others. When no one can seem to agree who should have access to care or who will pay for that care, they have dedicated a huge chunk of their lives to ensure that care is available no matter what.  Now if you’ll excuse me, it’s July so I need a nap.

 

march madness.

Talking to patients about disease prevention and improving their health isn’t always easy. It’s like when your mom told you to eat your fruits and vegetables and you would roll your eyes…or was that just me?  Every day doctors are faced with the challenge of not only caring for the patient’s immediate issues but reminding them to exercise, nudging them to lose weight and recommending appropriate screening tests. For me, I often get to recommend the ultimate trifecta: a mammogram, pap test and colonoscopy.  Patients look at me like I have offered them a few hours locked in a small room with screaming children.  Seriously.

March is colorectal cancer awareness month. Despite being a preventable disease, it is the second leading cause of cancer death in our country.  Colon cancer screening is recommended for everyone age 50 and above. The polyps that become colon cancer usually don’t have symptoms which means you need a colonoscopy to find them and remove them.  Some patients are at an increased risk of colorectal cancer above the rest of the population.  Patients with inflammatory bowel diseases or a family history of colon cancer are at increased risk. About 5% of patients with colorectal cancer will have a genetic predisposition for the disease, such as Lynch syndrome, which is a genetic condition associated with an increased risk of colon, uterine and other cancers. Patients who are overweight or have poor diets may be at increased risk.

Therefore, your favorite gynecologist gets to recommend such tests and you get to roll your eyes at me.  See the pattern here? In all seriousness, about 1/3 of adults who need colon cancer screening don’t get it.  And I understand the eye rolling, I really do. It’s not like IMG_6422people look forward to having a colonoscopy.  Or going to the gynecologist at that.  I tell my patients that at least when I go to the dentist I feel like I’m a bright, cleaner person at the end of the visit.  I’m not sure anyone leaves my office, or their mammogram or colonoscopy with the same thoughts. So I get it.

But here’s the deal.  We don’t recommend these uncomfortable tests because we like seeing you squirm around on the exam table.  We do it because cancer screening saves lives.  March for myself and the pastor means lots of basketball and brackets and yelling at the tv. We love the madness. But when you think of march, think about reducing your risk of cancer.  Know your family history.  Eat your fruits and veggies and go to the gym. See your doctor.  And get your colorectal cancer screening. It won’t be the best day of your life, but it just might be the day that saves it.

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stay in your own lane people.

We’ve all done it, right?  Veered into another lane of traffic.  Oh, you haven’t?  Yeah right. Anyhoo, moving into another lane of traffic can be no big deal or a giant disaster.  And while I hope we all can agree that we should put down our phones and ignore our children in the backseat and pay attention to the road I’m not really here to discuss actual driving habits.  To stay in your own lane is to stick to what you know.

For the past 3 Sundays I have awoken to the desperate need for a cinnamon roll.  Not the kind you can get at a donut shop on a Sunday morning but a warm iced homemade cinnamon roll.  Guess how many weeks I happened upon said delicious breakfast treat?  ZERO.  So this weekend I decided I would make my own cinnamon rolls.  That’s right. I can perform surgery so certainly I should be able to follow a recipe and make these rolls. With great pride I proceeded to gather all my ingredients from the grocery store along with three other food projects I decided to create for our Super Bowl party.  Yes, you read that correctly.  Not only did I decide to make cinnamon rolls from scratch I figured adding a few img_7732other new recipes in the kitchen certainly wouldn’t add to my angst.  Um, oops.  Moving on, I made those cinnamon rolls.  I mixed up the dough and let it rise and put it in the fridge ready to complete my creation.  It was only then that I noticed the recipe I was using said clearly at the top: “Makes 40-50 Cinnamon Rolls.”  You have got to be kidding me. What am I going to do with 50 cinnamon rolls?  At this point I panicked and frantically phoned one of my best church girls who also happens to whip up homemade cakes and pies and other fancies in her kitchen on a daily basis.  My exact text: “WHAT HAVE I GOTTEN MYSELF IN TO?”  Clearly I had veered from my own lane. Fortunately for me cinnamon rolls can be made ahead of time, they can be frozen and they can be shared with those you are lucky enough to attend Sunday School with.

In this case moving out of my comfort zone, my lane, didn’t turn out so bad. It could have turned out worse.  Sometimes we decide to swiftly move into territory in which we have no education or experience. This has the potential to be disastrous. I won’t be trying my hand at teaching kindergarten, flying a plane or operating any heavy machinery.  Our culture too often tells us we know as much as the experts. And why not? We have access to all sorts of information through the power of the internet. Exactly.  All sorts of information.  The good, the bad, the ugly.  It’s too much. In my arena we use what we call “evidence based medicine” as best we can to direct patient care and research efforts.  We are taught to examine the evidence and decide what the full body of research has concluded, if anything, on a subject. And while I have a good deal of experience reviewing medical literature it doesn’t mean I can easily read the law, interpret scripture or solve complex math problems. At other times knowledge in one area transfers easily to another. Take surgery, for example. When we plan for a gynecologic surgery our team anticipates possible deviations from the norm we might encounter based on the patient’s problem, their medical and surgical history and the procedure being performed.  We create a plan to minimize risk and maximize benefit to the patient.  Does being a gynecologic surgeon mean I should volunteer to operate on your brain or in your nose?  Well, first of all, gross. Secondly, while some principles of surgery carry over from one specialty to another like sterile technique or attempting to minimize blood loss and restore normal anatomy, a gyn surgeon does not have the expert knowledge and experience a neurosurgeon might have. If you ask me the best treatment for say, your eye disease, I’m going to tell you to go to your ophthalmologist, ask some questions about the risks and benefits of each treatment and some others on success rates, etc and then make an informed choice on what to do with the help of your physician.  On the other hand, many more of the techniques used in general surgery would apply in gynecology and vice versa.  So, should natural disaster strike, general surgeons and gynecologists would operate side by side to save life and limb.  But let’s hope it doesn’t come to that.  There are lots of other examples.  Have kids in school?  Swerve into the other lane because you must know how education works!  Voted? Swerve into the other lane because you can run the government.  Been going to church awhile?  You probably know the Bible better than most. The truth is we are all stakeholders in these issues: whether it’s our own health, education, the government or theology.

So what is the best way to change lanes?  Well, we check our blind spot, we put on our signal and then deliberately move over.  Life should be much the same. How do we improve education?  We find our best educators and the best available evidence on education and then create your best practices.  I know exactly who I would approach if I want to figure out how to make low income kids succeed in the classroom.  How about government?  Well, until about 4 months ago I didn’t actually know how the electoral college works.  Or really much else about government.  Who knew those things would matter when I was ignoring them to focus on my science and math classes way back when? So I find those whom I trust who have done their homework and who will, more importantly, discuss all sides of the issue with me. And when it comes to theology, well, I’ve been learning from the Pastor for almost 16 years.  And trust me when I say he knows what he is doing people.  So let’s check our blind spots.  Let’s figure out where we have assumed we know best and admit that we don’t know best.

Here’s another “if you know me” moment.  If you know me, you know I love being right. But I’ve learned that being loud and persistent doesn’t mean you’re right.  So now I’m learning to signal to the people around me and learn about what they have to offer.  So join me in checking our blind spots. Let’s figure out where we have assumed we know best and admit we don’t know best. Otherwise we should just stay in our own lane people.

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Schooled.

Last Friday I had the privilege of leading our resident education session.  We spent 2 hours together learning how to become better educators.  I say ‘we’ because, despite being in medical education for the last 12 years, I still have a lot to learn about teaching.

I think for a long time I bought into the myth that anyone can teach.  And that anyone can be an excellent teacher.  Like once you have mastered a subject, let’s say addition, that you will be great at teaching addition.  Well, you’re not.  Or at least I’m not.  I can distinctly remember my oldest child attending preschool and being sent home with a packet of sight words.  Until that time I had no idea how children would get from having a cry or smile as the only method of communication to speaking, reading and writing complex words.  Thankfully my child’s teacher knew the path.  In fact, her 2nd and 3rd grade teachers have more experience teaching than I have in being alive.  They knew where she had been and where she was headed in her educational journey.  And her 4th grade teacher will as well.

I teach adult learners.  Medical students and residents.  Medical Education is wonderful and also amazingly challenging.  When a new 3rd year medical student begins with us they have literally spent about 25 hours per week in the classroom in addition to the dozens of hours a week they spend studying in the library.  They soak up all the knowledge you give them.  They are early in their journey toward their final career goals and eager to learn all that medicine has to offer.  They want to know their patients and help create tangible positive outcomes for them.  My residents spend even more hours at work and in the learning environment than the medical students.  They are responsible for patient care as well as a huge chunk of the medical student education as well as making sure they learn all they can before leaving the training environment.  It’s a lot to accomplish.

What I have learned in medical education is that being a teacher is a huge responsibility.  It isn’t enough for me to have passion for the subject matter.  I have to translate that passion into meaningful experiences and into a format they can understand and retain.  It means more than just making sure the medical students know the basics about caring for women; it means that we have taught them how to have respect for their patients, to care deeply for the broken and hurting around them and to find a way to always have compassion.  The challenges come when you are consumed with your own work and you find it hard to stop and teach someone else.

I think this is a challenge for everyone in education.  Teaching is hard.  Being an excellent teacher is even harder.  For me, I stay in the Medical Education environment through the struggles because I remember the faces of the teachers that taught me empathy and compassion, because I still have a lot to learn and those medical students and residents challenge me daily to be better than my best, and because I hope that my community and my state are healthier and better cared for through the work we do in our teaching institution.

Hug a teacher you know. Hug all the teachers you know.  Or bring them a snack or send them a note of encouragement.  They leave each day having given all they can to some who will receive and some who might not.  They are not only teaching subject IMG_2943matter they are often teaching the life lessons of respect, empathy, compassion and kindness even when their own runs low.  They are the feet with which He is to go about doing good.  They are caring in places many of us would not dare to invest.

And if you know a medical student or a resident physician, give them a hug too.  Or maybe a cup of coffee.  They are always being challenged to learn more and do better. They spend themselves each day to do their best for others, using their hands and their heads and their hearts to care.    They teach me something every day and for that I am grateful.

 

listen…to…your mother.

Listen…to…your mother.   It’s a phrase I utter about seven thousand times on a Sunday morning.  When I can’t seem to get the girls to find their shoes, brush their teeth, get in the car and a multitude of other things on the way to church I emphatically state “listen…to..your mother.”  They think it’s hilarious to repeat the phrase over and over to each other and giggle about how crazy I sound.

A dear friend said to me this morning: “Mother’s Day..sometimes it just seems like too much.”  And I get that.  Mothers feeling overwhelmed at a day to celebrate them, yet unable to escape the responsibilities of the daily routine.  Women who wish they were mothers but are unable.  Women who mourn the loss of their child or their own mother.  Families who need reconciliation on these celebratory days.

So what to write about on this “too much” day.  After much thought (kidding…I was napping this afternoon), I thought I would make a list of what your mother would want you to know if she was an OBGYN married to a Pastor.

  1. Educate your kids about their bodies: My kids remind each other to “wash around your vagina” in the tub.  When BK was born, Mc said breastfeeding was “weird.”  To which I replied, “yes dear, it’s only the beginning of weird stuff your body does.”  Kids who know how their bodies function can express when they are injured, uncomfortable or, God forbid, touched inappropriately.
  2. Vaccinate your kids against HPV: People, it’s not a conspiracy theory.  It’s a vaccine that has the potential to eliminate or nearly eliminate cervical cancer and significantly reduce HPV related diseases.  Trust me.  I deal with this, literally, every day.  Does every vaccine have a small risk of complications?  Yes, but significantly less likely than me seeing your kid later in life for an abnormal Pap test or some other problem.  Plus, there’s more formaldehyde in pears and bacon than in vaccines. (mic drop).
  3. Make sure your kid has a trusted adult they can talk to that’s NOT YOU.  As parents we think we want or need to know everything that is happening in our kids lives.  The reality is that we can’t do much about it.  I can tell you everything your kid says to me in the office but then she wouldn’t trust me and she already doesn’t listen to you.  What I can do is encourage them to be safe, be healthy, see the consequences of their actions before they happen and be honest with you.  So make sure they have a pastor, a doctor, a coach or a mentor you trust.
  4. Let your kid be honest with you.  When they do something dumb and are brave enough to tell you about it be sure to remind them how glad you are they were honest with you amidst the lecture about how disappointed you are.
  5. And finally, be easy on yourself.  I am reminded weekly by Pastor Jon and Pastor Jason that God has already made His mind up about you and the news is good.  It’s okay to be stressed, sad or overwhelmed on Mother’s day.  Or any day.  Forgive others, forgive yourself.  Love people more than they deserve and let yourself be loved more than you deserve.  And don’t forget to see your Gynecologist and go to Church.

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