i live here too.

It is one of the most clear memories I have from early on in my career.  Some friends were over and asked how long we had lived in our home.  When I answered, my eldest, in the sincerest of voices proclaimed “Mom, that’s not true.  Dad and I live here and you live at the hospital!”  It’s pretty hilarious now but at the time I was crushed.  CRUSHED.  I remember the days in residency when I felt like I hadn’t been home in forever.  Let’s be honest. Sometimes it still seems that way.  Home in time to eat and sleep and then back up before everyone else and off to work.

September is designated as Women in Medicine month by the American Medical Association. One third of our nation’s physicians are women. Many of these women chose medicine as a career during a time when they had very few role models who were women.  Many of them delayed starting their own families to learn to care for the families of their community. I have the privilege of training with, working with and knowing some incredible women physicians. These women spend many years training for a career in which they will give countless hours to improve the health of others. Most do it for a salary that is less than their male counterparts.  They juggle rounding and homework and office visits and basketball practice and charting and so much more.

Women are under-represented in leadership in medicine; and a recent survey of physician mothers revealed that most women have felt discriminated against because of pregnancy, breastfeeding or motherhood. Does this make men at fault?  Certainly not. But we work in systems that have long overlooked that its workforce is changing. Fortunately, physician moms are working to improve policies and procedures so the women that come into medicine after us have the opportunities to lead their communities to better health.

So here’s my shout out to women in medicine.  You are some of the toughest, smartest, most caring and passionate women I know. You will change the future of health. And you are unstoppable.

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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.

 

you’ve got a friend (in me).

As many of you know from the rest of my social media presence, my youngest graduated from PreK this week.  It was all the gloriousness you would imagine.  There were caps and gowns, diplomas, pictures, refreshments.  For part of the program her class sang the song “You’ve got a friend in me” from the movie Toy Story®.  It was, as you can imagine, adorable.  And then the big one had her first acting gig in the church musical.  She nailed it. And back to the little’s ballet recital.  Killed it.  And now we ready ourselves for the last week of school. Of course, you can’t go through this time of year, full of its transitions, without some reflection on the months that have passed.

It was a little over a year ago.  I was listening to some music on a run and for some reason I started thinking about what it meant to be merciful. I was quick to realize that I didn’t really have any idea how to describe or understand or even think about mercy. This, of course, was disconcerting to me having been married to the Pastor for almost 15 years at that point. I was at a loss.  So I decided I would spend some time trying to figure out what mercy was, where it was present, how it happened.  And turns out, mercy showed up in all sorts of places. What I discovered is that mercy might be hard to understand because it is that sneaky thing that is always around but not obvious.  But when you start looking for it, when you take the time to seek it out, you will find it’s all around. In the last year I have been enveloped in mercy.

Mercy is your best friend from long ago and also today getting up before the sun does to go to the YMCA with you.  Even though she could go later…because you can’t.  It is a new friend who came along just at the right time and always tells the truth even when it’s not nice.  And reminds you they are there to stick through the best of times and the worst of times. You can feel it when you sit for coffee with someone who has been in your shoes and nods their head in understanding.  You feel it when that call or text arrives at the exact perfect moment from someone you don’t often get to see but the friendship remains none the less.

Mercy shows up in a big blue van driven by a teensy twenty something year old who picks up kids, who look nothing like mine, after school and nourishes them with food, education and love four days a week.  It’s there when those same kids are on stage at your church next to your own reciting lines in the cheesy kids musical that makes you tear up because you know that this demonstration of inclusion and unity is what God intended. And soon those kids aren’t those kids at all.  They are just kids like mine and yours, showing up every week.

Mercy happens when that person who thought she’d never have a baby sees that face on the ultrasound, or even better, holds that person in their arms. But it is also there when you hold someone’s hand as you give them bad news or grieve with them in the losses great and small.

Mercy happens when the Pastor does a funeral for what can only be described as a tragedy and reminds us that the gospel is an unconventional story and we have an unconventional Savior.  And so is mercy.  It’s there in the loud and in the quiet.  In the wins and in the losses.  It’s wherever we show up and remind each other that there’s mercy enough for each of us.

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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.

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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.

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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