Saturday, December 13, 2014

Shannon & Dr. Shapiro

Today, I'm doing something a little different.
I'm going to tell a story. A true story.
This happened about 20 years ago.

Shannon & Dr. Shapiro
By Michele Carlon, MD
     As a resident physician at Michael Reese Hospital in Chicago from 1988-1991, I had an extraordinary teacher. His name was Charles Shapiro, MD.
     Picture a gentleman in his sixties with white hair in a comb over. He was about 5 feet 6 inches tall, and slender to my recollection. He pilfered flowers from patients daily to wear in his lapel. It was his signature and patients vied to give Dr. Shapiro a flower for his lapel.
     Dr. Shapiro was an oncologist and of the “old school.” To be a great diagnostician, he believed one needed to use his memory and reason and to develop extraordinary history taking and physical exam skills. He would spy into patient’s rooms while I was examining them and yell things like, “Never listen through someone’s gown!” as he passed by.
     Dr. Shapiro taught us to be thorough. I recall him running into a Tumor Board meeting (Tumor board is where all of the specialties involved in the care of a cancer patient meet to discuss the cases and make plans for the patient’s care, and to teach each other). The case was of man in his twenties with a cancer that had spread. No one knew where the tumor had originated, where the “primary” was from. Dr. Shapiro came flying into the meeting, breathless and late, his white hair and coat flying behind him in his rush.
     “I know where the primary is! I thought I’d take a look to see if someone had missed something,” he announced, standing at the back of the conference room, near the door.
     Everyone sat in stunned silence as he stated, “It’s testicular cancer.”
     “How did you find it?” asked the lead physician running the meeting.
     “I simply lifted up his gown. No one had looked at his testicles. He had a grapefruit sized testicular tumor.”
     He proceeded to lecture the group of residents and students in the room on the importance of NEVER forgoing a genital examination out of embarrassment or modesty, yours or the patient’s. At that meeting he said the words that have stuck with me all of these years:

“If you don’t look, you won’t find it.”

     Fast forward to the mid 1990’s.
     I grabbed the chart from the pocket on the door outside of the examination room and quickly perused it. 
     Shannon, a 16 year-old female. Here for sports physical.
     “This should be pretty quick,” I thought to myself. I assembled my features into a welcoming smile and opened the door to the exam room.
    ."Hi, I'm Dr. Carlon."  I grabbed the round stool hidden underneath the desk and settled myself down upon it.
     "I understand you’re here for a sports physical, Shannon?" I asked, looking up from the chart.
     It was late summer and the high school volleyball season was ramping up. The girl before me looked fit with long blonde hair pulled back into a messy ponytail. She was wearing a t-shirt and and sweatpants. She had freckles sprinkled across her nose and cheeks and blue eyes framed by long lashes covered with mascara too dark for her coloring. She smiled and shook my hand. “Hi Doc.”
     I exchanged a few pleasantries with Shannon and her mother and then said, "Okay, I need to have you change into this gown so that I can examine you properly. I'll also need to ask you and your mother a series of questions."
     Shannon looked at me askance. "Dr. X never makes me put on a gown. He just signs the form for me."
     "I need to do a proper exam to do my job correctly. That means that you need to take off your clothes and put on a gown. You can leave on your underpants but I need to do an examination."
     Her mother gave me a sidelong glance of parental exasperation with her offspring, and repeated to Shannon what I had said. I stepped out of the room while they duked it out. I knew for a fact that Dr. X ALWAYS did an exam. Teenagers love to exaggerate, and are very modest as a rule, and this girl was no exception.
     I heard the paper stop crinkling, signaling that she was in the gown and atop the examination table. I knocked.
     “You ready?” I asked.
    I heard a sullen, “Yeah, I guess so.” I opened the door and entered the room. Shannon was sitting atop the examination table in a blue cloth gown, hands across her chest in a closed posture. I decided to draw her out a little.
   "So you're playing volleyball this year?" I asked as I sat down on my stool and started taking notes. "What year are you?"
     "I'm a sophomore. This is my second year playing volleyball." She seemed to relax and told me about what position she played, how she served, (overhand) and how the team did last year.
     I decided to move forward with the history taking, now that she was less upset. When we do physicals, there are a series of questions called the “Review of Systems” we use so that we don’t miss anything. Generally we start at the top of the body and work our way down the body or “systems”. Each doctor has their own ways of asking these questions. They are often abbreviated for the problem the patient comes in for. I asked all about the head and neck, next coming to the respiratory and cardiac systems.
     "Have you been having any shortness of breath, coughing, or wheezing? Any chest pain or palpitations?” I asked.
     "Well I'm out of shape after not doing much this summer. I've been working out really hard lately, but I’m pretty tired after doing my ladders and lunges. More than I should be."
     "Are you wheezing? Do you have asthma or lung disease? Do you smoke cigarettes or marijuana?"
     I realized my error as the girl glanced at her mother. I had forgotten to ask her mother to leave the room. I corrected myself and asked her mother to step out for a while. Her mother agreed and left to go read a magazine in the waiting room.
      I again asked the girl, "So, about those cigarettes and marijuana?”
    Incensed, Shannon huffed, “I don't smoke. Smoking is for idiots."
     "I'm glad to hear you say that. It certainly wouldn't help your volleyball game."
    I asked her a few more questions and went through my litany of Review of Systems questions. After I finished, I asked, "Shannon, do you mind if I examine you now?"
     I usually ask permission before starting to examine someone. It surprises them, but I find that it improves rapport and trust. . She nodded assent.
     “Okay I'm going to start at the top and work my way down," I explained, as I reached for the oto-opthalmoscope, an instrument with a strong light and various heads on it, used to peer into ears, eyes, nose, and throat.
     I did just that and then I examined her neck for swollen glands and for thyroid enlargement. I listened to her lungs to see if she had any wheezing or decreased breath sounds, which she did not.
    “Okay, please lie back now. I'm going to listen to your heart, do a breast exam, and examine your abdomen." Shannon dutifully followed my instructions and lay back on the exam table.
     I did a breast exam querying her as to whether she had been taught how to do it herself. She blushed bright red, and shook her head. I explained what I was doing, and why, and how she should do a self breast exam.
      Next I placed my stethoscope on her chest to listen to her heart sounds.
A very troubling abnormality in the heart sounds caught my attention immediately. Normally there is a comforting “Lub-dub, lub-dub” sound emanating from the heart.
Her heart made a loud and harsh shooshing noise, a murmur. I kept my facial expression even and flat, so I wouldn’t alarm her, but felt my own heart rate pick up as the possibilities raced through my mind. I considered all of the valvular abnormalities and their consequences, and asked her to do some special maneuvers; breath holding, bearing down like with a bowel movement, squatting, and fist gripping. These maneuvers can make the sounds louder or softer and help physicians to figure out which valve is damaged. In this case, I was having difficulty figuring out which valve was involved.
     I finished examining her abdomen, then checked for lymph nodes in the groin. I examined her hips and knees and watched her walk and duck walk, checking her gait.
     After I was finished, I asked Shannon to dress, and I stepped out.
Her mother was sitting in the waiting room, reading. I asked the staff to bring her back.
I knocked on the exam room door to see if Shannon was dressed. She was and her mother and I walked in.
    Giving bad news is never easy, and I have found that it is better to spit it out and let it be absorbed. Once absorbed, you can continue and explain.
     "I heard an unusual heart sound in Shannon’s chest," I said looking first at her mother, then at Shannon. "Has anyone ever told you that your daughter has a heart murmur?" I asked, looking back at her mother.
     "No.” She paused, then asked, “What’s a heart murmur? Should I be concerned?"
     “A heart murmur is a noise heard with a stethoscope when blood flows with turbulence through the heart valves. Normally the blood goes through smoothly and makes no noise.” I continued, "Shannon’s is a loud heart murmur and I don't know what's causing it. The fact that she has never been told she had a heart murmur in the past makes it more concerning. We need to do some more testing on her."
     "What kind of testing?" they asked simultaneously.
     I spoke directly to Shannon. "We don't have a Pediatric Cardiologist here in this town. We’ll need to send you down to the large medical center an hour away to get the testing done.”  I turned to her mother. “She needs a special ultrasound of her heart called an ‘echocardiogram.’ It doesn't hurt. They just rub some goo and a microphone around on your chest and take a picture of the heart with sound," I explained.
     “What about playing sports?”  asked Shannon’s mother.
     "Until we know what's going on, I don't want her playing any sports. I don't want her exercising either. No running, no jump-roping, no biking, no weight lifting. Nothing.”
     "Why can't you just sign the stupid form like Dr. X does? I'm fine! If I don't start practicing with my team I won't be able to play for the season!" sputtered Shannon.
     "I understand your frustration, Shannon, but this might be a very serious heart problem and I don't want you to die."
     Sometime shocking people into understanding the seriousness of a problem is the only thing that works. Her mother got the message though. Initially, her mother had also been concerned that her daughter wouldn't make the team.
     I gave Shannon’s mother the order slips to get the echocardiogram at the medical center.
     A few days later I got a phone call from a doctor who identified himself as a Pediatric Cardiologist from the medical center.
     "Are you the Doc who ordered the echocardiogram on Shannon?" he asked. "What made you order the test?"
     "Well, she had an extremely loud murmur that I was quite concerned about. She came in for a sports physical and this was new. Also, she was having shortness of breath with exertion.” I went into more history and examination findings with him.
     "Well, it's a good thing that you did order it because she has a large mass in her chest pressing on her pulmonic outflow tract,” stated the doctor, excitedly.
     I stopped. She had a big mass in her chest that was pressing on the arteries that emptied the right side of her heart going to her lungs. No wonder she had been short winded.
     "I'd like you to refer her down here to get further testing done. Do you mind if I take over the case?" He asked me.
     "Of course not," I stated. “We couldn't handle it here anyway.”
     "Well I'm first going to order a CT scan of her chest. We'll go from there, but the most common cause of this is a lymphoma I'm afraid,” he stated, grimly.
     I hung up the phone feeling depressed. If this was lymphoma, it was likely curable, depending on the type, but she’d run the risk of other cancers later in life, and side effects from the treatment. She’d never be the same.
     Several weeks went by. I was in the middle of a busy afternoon of clinic when Shannon’s mother came into the back escorted by one of my staff. She was holding a bouquet of dried flowers wrapped with purple tissue paper.
     "Hi, Dr. Carlon. Sorry to interrupt, but I just wanted to tell you what happened to Shannon. Had you heard?"
     "No. I hadn't heard anything. Last I heard, they thought she might have lymphoma."
     "Well that's what we all thought. They did a CAT scan and found a huge mass in her chest that had almost completely shut off the blood supply from the right side of her heart. They took it out and you'll never believe what it was!" exclaimed Shannon’s mother.
     I braced myself.
     “It was a teratoma. It wasn't cancer! They were able to get the whole thing out and you saved her life!” exclaimed her beaming mother. She handed me the bouquet of dried flowers and hugged me.
     I was stunned. A teratoma? A teratoma is a usually non-cancerous tumor that is a disorganized mass full of hair and teeth and skin and bone and other organ fragments. It's a very odd, usually benign tumor but it can grow. Often one is born with it but it is not detected until it gets big enough to compress organs near it, causing symptoms. At any rate, it’s fairly uncommon.
     "I wanted to give you these flowers as a token of our family’s thanks. Nothing I could do or say would express how grateful we are to you. You saved her life. We just wanted to say thank you as a family."
     I took the flowers home and put them in a vase in my bedroom where I could see them. I kept those flowers until they literally disintegrated into dust. I threw them away, reluctantly, ten years after recieving them.
     I thought of Dr. Shapiro’s words, every time I looked at those flowers.
“If you don’t look, you won’t find it.”
     Shannon had not wanted me to do an examination, but I did it anyway. How often did a sixteen year old have something seriously wrong, enough to keep them from playing sports? Not often. I could see how someone might be tempted to take a shortcut and just look at previous exams and sign the form without doing a physical.
     I work with medical students and residents. What I teach them will ripple out from me and through them affecting their care of others. Although the flowers are long gone, I think often about Shannon and the fact that she will have a long and healthy future, because I looked.
     Thank you Dr. Shapiro.

Michele Carlon

December 7, 2014

Wednesday, November 19, 2014

My Mom's Cornbread and Sausage Dressing Recipe.

Okay DoctorDiva Fans.

I am going to give you the "secret" recipe for my Mother's Dressing.

Consider yourselves blessed.

This is the best southern cornbread dressing recipe in Chicago.

(We always called it DRESSING, not STUFFING)

I just figured it was DRESSING because my mother was from down South and it was  more fancy there than good ol' New Jersey STUFFING.

Turns out, STUFFING is cooked in the turkey and DRESSING is cooked in a baking dish.

Weirdly, we always stuffed the turkey with Mom's dressing, with some left over to put in a casserole to cook outside the bird.

We never got Salmonella. Not. Even. Once.

My husband INSISTS on cooking the dressing outside of the bird.

I usually get the bird in the oven before he wakes up and Muuhhaaawwaaww....stuff the bird.

And guess what?
We've Never. Gotten. Salmonella. EVER.

Part of the reason we've never gotten sick is that my Mother and I both obsessively checked the temperature of the bird in multiple spots, away from the bones (which conduct heat very well and may falsely elevate the temperature near the thermometer).  165 degrees Farhenheit internal temperature, baby!

That said, my family members are often heard to say things like, "Oh, it's okay if you dropped the turkey on the floor. The heat will kill any germs."

Personally, I have washed the turkey with soap and water first and THEN said those words. BTW, if you do that, please rinse it really, really, REALLY well. Soap tastes terrible. Just sayin'.

Okay. so here goes. And remember, measurements are approximate. Taste it as you go.

Mom's Cornbread and Sausage Dressing
 (along with words of caution and admonition from my memories of making it with Mom)

  • 2 boxes of  Jiffy Cornbread Mix (NOT Martha White. It isn't sweet enough).
  • 1 tube of Jimmy Dean Mild breakfast sausage and 1 tube of Spicy/Hot Jimmy Dean breakfast sausage
  • (and another tube of sausage because the family will raid the sausage and if you want to have enough to make the dressing, you have to make enough to satisfy the hoarding Mongols)
  • Stale Italian bread or white bread--one loaf
  • 1 cup of chopped celery and 2 cups of chopped onion. (don't put too much celery in--my Mom said it is too overpowering if you do.)
  • chicken broth (canned/boxed is fine) usually about 2-3 qts if you like it moist.
  • Poultry seasoning. LOTS of it.
  • Sage (My Mom hated sage. She said it tasted like soap. We weren't allowed to use extra, but frankly, she smoked and I don't know how she tasted anything. I LOVE sage and grow a ton every year for just this purpose.)
  • salt
  • white pepper
  • red pepper flakes
  • eggs --but it increases the risk of salmonella. I use pasteurized eggs, myself.

Cook the cornbread the night before and let it sit out overnight to get stale. (Not if you have mice though--Put it in the fridge then. Seriously. It could be a disaster otherwise.)

Partially freeze the sausage. Cut right through the plastic tubing and make patties of sausage and cook 'em up in some vegetable oil.(of course take them out of the plastic rings you've cut!)
 Drain on paper towels.

Slap marauding hands vigorously as they steal the cooked sausage. Make a good show of it and don't let on that you made enough for them to steal. It helps with getting them to do the dishes later. Guilt. My secret ingredient.

Brown the onions and celery in the oil from the sausages. Drain the oil off the onions and celery (unless you want wicked heartburn).

In a vat (we use an old Tupperware Cake thingy-- It's huge):

crumble the cornbread and the white bread.
Crumble and add the sausage
Add the drained onions and celery
Cover the entire top of the dressing mix with a layer of poultry seasoning. (It should look greenish brown from all of the poultry seasoning. Add extra sage here if you want. There is sage in poultry seasoning already, though)
Add salt and pepper and red pepper flakes.

Now. Take off your rings, roll up your sleeves and get ready.

Pour chicken broth over and mix it up with your hands.(This is a good job for the kids)
Keep adding broth until it's moist (for stuffing) or really moist for dressing. It will get more moist in the bird, and dry out in the casserole dish.
TASTE IT before you add the eggs.
Adjust seasonings.
(Add the eggs if you want.)

IF you put it in the bird, stuff the neck cavity as well as the chest. Use skewers or twine to close it up.
If you put it in a casserole dish, then cover it tightly with aluminum foil to bake so it doesn't dry out too much.
Bake in a 350-375 degree F oven for about an hour.
Bake to an internal temp of 165 degrees F in the bird. Check in multiple spots with an instant read thermometer.

You're welcome.

DoctorDiva 11/18/14

Tuesday, November 11, 2014

Hypothermia and Early Motherhood

I went camping recently with the Boy Scouts and it was  freezing. I thought I'd better brush up my knowledge of hypothermia, since I was the resident expert on the trip.

As I started reviewing the symptoms of hypothermia, I realized the symptoms are very similar to the first several months of motherhood. And the last couple of months of motherhood. Heck, Motherhood.

Here is from the MayoClinic's website:

Moderate to severe hypothermia

As your body temperature drops, signs and symptoms of moderate to severe hypothermia include:
  • Shivering, although as hypothermia worsens, shivering stops
  • Clumsiness or lack of coordination
  • Slurred speech or mumbling
  • Confusion and poor decision-making, such as trying to remove warm clothes
  • Drowsiness or very low energy
  • Lack of concern about one's condition
  • Progressive loss of consciousness
  • Weak pulse
  • Slow, shallow breathing"

Treatment of Hypothermia:

  • call 911
  • Warm the person up by getting them indoors.
  • Put the person in dry clothes and blankets.
  • Warm their bodies/trunks, not the hands and feet. that can put them into shock.
  • Don't immerse in warm water -that can cause arrhythmias.
  • Give warm fluids to drink-not coffee or alcohol
  • If the heart stops, start CPR and keep going until Assistance arrives in the way of paramedics.

We have a saying in medicine when referring to cardiac arrest in a hypothermic patient:

A hypothermic person isn't good and dead until they're warm and dead.

Cold persons can maintain brain function for a lot longer than a warm person and the cold temperature may prevent the CPR from working right away. You need to warm the person up and keep doing CPR before you call the code off.


Motherhood is not so different from hypothermia:

  • Confusion
  • Exhaustion, fatigue and low energy
  • Slurred speech
  • Loss of concern about one's condition 
  • Loss of consciousness (at every opportunity available--few and far between)
  • Clumsiness and lack of coordination (usually from trying to carry a baby and perform activities of daily living at the same time)

The treatment however, is often the exact opposite of the treatment of hypothermia.

  • Call in every favor ever owed you and get out of the house and away from the baby for a while
  • Get outside into the sunlight
  • Take a long, long, LONG HOT shower. Shave and groom and do it all in PRIVACY. 
  • Take in coffee, alcohol, or whatever your favorite beverage is. Add in chocolate and all the foods you've been avoiding while breast feeding. 
  • If your heart stops in shock of some actual private time, don't worry. It won't happen again for a long while. 

And remember Moms:

Mothers are never TRULY asleep until their child decides Naptime is over. It never fails.

November 11, 2014

 photo credit:

Thursday, October 30, 2014

Why Teens Need Parents

Recently a company that provides In-Home Care slipped a brochure into my mailbox at the hospital.

It was a beautiful 4 color pamphlet with an explanation of all the services they provide. They provided a helpful list of questions to ask to help determine whether or not you needed the services they provided.

As I read through this list, I realized how many of these applied to teenagers.
Teenagers want their independence in the worst way. Older people who need help will do anything to maintain their independence.  It struck me that maybe teenagers need more help than we give them.

These were some of the questions they posed:

  • Has there been a recent emotional or medical crisis?
There is ALWAYS some kind of crisis with a teen. Not a day goes by that they're not  having some emotional melt down or needing stitches, or physicals
  • Does the individual bathe less often or not at all?
Any mother of a teenager will tell you what a battle it is to get them to shower.
  • Are pills left over or running out too soon?
Getting teens to take their medications is like pulling teeth. Asthma, allergies, depression, ADHD, etc.  It's a daily battle. We resorted to pill boxes and checking.
  • Does the individual need help walking?
Okay, Do all mothers feel like glorified chauffeurs, or is it just me? Oh, and walking the dog? That is a battle royale.
  • is he/she verbally or physically abusive?
Well, calling your parents "lame," "stupid," "fat," etc., seemed like normal teen behavior to me. Not necessarily abusive. Besides, I just ignore them..
  • is he/she becoming more forgetful?
  "I didn't KNOW I had homework!"  "I didn't know I had a TEST today!"
  "I forgot it was my turn to empty the dishwasher!" 
 "You didn't TELL me that I had to do my laundry!"
  • Have there been recent falls?
Read my blog post on concussions. Scared the bejeebers out of me.
  • Is your loved one having problems sleeping?
If staying up until 2 a.m. playing MineCraft and then arguing about being too tired to get up in the morning is problems sleeping, then yes.
  • Has there been recent weight loss?
Okay, NOT in my household. My kids eat  me out of house and home. My food bill is 1/4 of the GNP.
  • is his/her hearing or vision affecting the ability to function?
 "I didn't hear you call me" (for the four thousand six hundredth time).
 "I didn't SEE the garbage all over the kitchen floor from the dog knocking over the can!"
  • if he/she smokes, are there burn marks on clothes or bedsheets?
 Thank God for this=NO. Their father is a pulmonologist and there would be hell to pay if they started smoking.
  • is your loved one able to do errands alone?
Able is a relative term.  Willing? There's the crux of the question.
  • is clothing being changed daily?
HAH!!! Seriously? Not.
  • are there scorch marks on the pot holders or dish towels?
Teenagers learning to cook require a working smoke alarm and team parenting.
  • are there signs of burnt pans on the stove?
  Um, Yes.  But that was MY bad. (Looking down embarrassed.) I was trying to dry the cast iron skillet, and forgot it was on when I went to binge watch something on Netflix.
  • Is routine house cleaning not being done?
They do it. Under duress. Badly. I just close the door to their rooms. I insist they "re-do" if they don't do a good job in the family areas though.
  • Have social activities stopped or diminished?
We have a rule. No screens when family is over. Period. It helps.
If you checked even one of these questions, perhaps it is time to consider in-home care. But before you select your care provider, make sure you ask the right questions.


  • When is cocktail hour in this place?

  • Did I really sign up for this?

  • What was I thinking?

I deserve my portion of the Halloween candy. It's a parenting tax.
photo credit:

Saturday, October 18, 2014


Okay, so EVERYBODY is talking about Ebola. 

Nobody is talking about influenza. 

I had a patient yesterday who refused to take the flu vaccine because she said, "I don't know what shit the government is putting in those vaccines. I might get Ebola from it. Nuh-Uh. I am NOT getting Ebola from the flu shot." 

NOTHING I said would change her mind. She really believed this. 

I am sorry, but this is the stupidest thing ANYONE has ever said to me. EVER. 

I have heard a lot of excuses for not getting the flu vaccine. 
  • "My next door neighbor's cousin's son got sick from the flu shot." 
  • "I get sick EVERY TIME I get the flu shot." 
  • "Nothing you say will convince me to take it." 
  • "I never get sick." 
  • "I've never gotten the flu. I don't need it." 

Okay people. You are freaking out about 3 cases of Ebola and yet you don't want to protect yourself against something that is WAY more common and can also kill you? 

Few of us have been in car accidents. We all hope that we won't be, and we wear our seat belts to protect ourselves from dying in a car accident-- EVEN IF WE'VE NEVER BEEN IN A CAR ACCIDENT.  Seatbelts PREVENT death in a car accident. 
Accidents aren't predictable. 


MORE IMPORTANT. If you have any sense of caring for those around you, get the flu vaccine. 

You are contagious the day before you get sick with the flu. 

That means that when you visit your elderly mother or father, or your cousin on chemo, or your best friend whose sister had a bone marrow transplant, you've JUST EXPOSED THEM AND PUT THEM AT RISK OF DEATH FROM INFLUENZA, YOU SELFISH JERK! 

Children, old people, diabetics, asthmatics, people with emphysema or autoimmune diseases, and people who are on chemo, radiation therapy or who've had bone marrow transplants:

You don't know who you are affecting by making the decision not to take the flu vaccine. 

You could infect someone at the grocery store. They go home and a couple of days later infect their baby, spouse, cousin, best friend. They die. YOU JUST CAUSED A PREVENTABLE DEATH. 

Yes, it's harsh. 
Life is not fair. 
You live in a society and have an obligation to it's members to keep them safe. 
There's a reason they call it "public health."

Do you realize how freaking lucky we are to have safe and effective vaccines? 

Do you think the people in Africa would refuse an Ebola vaccine if it were available?

Saturday, October 4, 2014

Moms of Teens: I'm Good Enough....

 Teenagers:  The Battle Lines Have Changed.

I read a lot of blogs written by Mothers of babies and toddlers. Not as many are out there by Mothers of Teenagers. I think it's because teenagers are like another species. They make us feel like we've lost our "cool" factor--- Our "je ne sais quoi." 

I don't know about you, but according to MY teens, I'm fat, out of shape, out of touch with what's cool (just using the word "cool" is an illustration), and embarrassing to be seen with.

 I think that's why Moms of Teenagers don't blog as much. Teens infect you with Low Self Esteem as a human being, much less a parent. Who wants to blog about THAT?

Having teens is a whole new parenting paradigm for me.
I am accustomed to the paternal/maternal decision tree method of parenting. 

I tell them what to do. 
       They (theoretically) do it. 

Now, with teens, I'm learning there is a subtle shift in the power arc. 

I tell them what to wear to stay warm/dry. 
       They refuse and tell me "I've got this, Mom." Or they lie about the umbrella/poncho/sweater they
       have in their backpack for later.

I tell them they have to get up to go to school, if they want a ride. 
       They ignore me and I have to call them four hundred zillion times to get them out of bed.

I tell them I want the dishwasher emptied and the dog walked before I get home so I can cook dinner as soon as I get home.

       They have learned to be passive aggressive and "forget" that I told them this (every single day
       for the last year and a half) and I scream until they do it.. Then I make dinner after they do the     
       When called to eat: "I'm not hungry, Mom. I ate a sandwich before you got home."

Clearly, a new tack is required. 

My husband is a champion at this. He is the eldest of five. His responses are more of the "give them enough rope to hang themselves" sort. Learn by screwing up. Make mistakes and live with them. 

He also knows what motivates a teenager. I have a lot to learn. 

He puts his iPad with LOUD OBNOXIOUS Classical music/Marching Anthems/Peruvian Dance Music on the stairs after he calls them to get up, until they get mad, get up and turn it off on the way to the kitchen.

He leaves and lets them take the bus or walk to school if they don't get up.

He tempts them with a yummy breakfast like french toast or bacon, and then threatens to eat it if they don't get up RIGHT NOW! Then, he follows through. 

He lets them get wet/cold/hungry if they decide our safety/dressing "advice" is stupid and unnecessary. (unless personal safety is at real risk-like camping in 30 degree weather with no long johns, extra layers, etc.)

He yells much less frequently than I do so that when he does, it's more effective.

I asked him his philosophy on raising teens. He said: 

     Lead by Example
     Teens JUMP on hypocrisy or inconsistency and throw it back into your face. 
     (You have to obey your own rules which is difficult to do at times)

     Then he sighed. 

     "Survival. That's what it really is. You simply have to survive their teen years (and so do they). Once they become young adults, they metamorphose back into pleasant beings."

So there you have it. 
Lead by Example. Be Consistent. Don't be a Hypocrite. Follow your own rules. 

And don't drink the Kool-Aid of teenager's insults. 
 I AM cool. 
I AM hip,
 and as Stuart Smiley says:
"I'm good enough, I'm smart enough and doggone It! People Like Me!"

Okay, there's a lot more to it than this. There are leadership skills, faith, kindness and compassion, etc. BUT all of them will spring forth from the above. I hope I'm good enough. 

DoctorDiva  10/4/14

Thursday, October 2, 2014

Broken Toes and Mondays Always Get Me Down

OR:  Do As I Say, Not As I Do

My son has inherited the slob gene (and jeans). He undresses and leaves shoes, socks, underwear (seriously? dude!) and clothing, books, bookbags, dropped wrappers, plates, utensils... all over the house.

I like to walk barefoot in my own house despite my klutzy tendencies.

This is a recipe for DISASTER.

One of the things we tell our older patients is to make sure that the pathways in the house are clear of detritus, scatter rugs, books, etc. and are well lit to prevent falls and accidents.

While running around preparing for a plane trip while barefoot, sans eyeglasses, with no lights turned on:

I whacked my little toe up against my son's perfectly mis-placed shoe.

I know what you're thinking."So What? It's just a shoe!"

Okay. Picture this. Said shoe is pushed up against a basket meant for clutter, across from the closet meant for shoes and coats, and sticking out in the pathway from living room to dining room, meant for walking through.
I hit said shoe at just the correct angle with my baby toe so that the shoe got shoved up against the immovable basket.

I heard a snap.
I assumed it was the basket.
I screamed.
I waited for the pain to stop.
It didn't stop.

The snap wasn't the basket.

Then 3 days later, I broke it AGAIN against the kitchen table leg.  It bent out at a weird angle and I had to put it back in place. I, stupidly, was barefoot and uncaffeinated at the time.

(I'll wait for you to stop cringing and open your eyes again.)

When you limp, it messes up your body mechanics all the way up. My hips, knees, back, shoulders and neck are all hurting.

SOOOoooo....4 weeks have gone by and my toe is still in pain because I am a doctor and have to walk all over the hospital, from the parking lot 2 blocks away to my office, etc. and it was not getting better. In fact, it was getting worse. Every night it would be swollen and purple and painful when I took off my sneakers. (I wore sneakers hoping they would be good enough to let it heal) (They weren't)

I am now wearing a walking boot to fully immobilize the darn toe. I feel like Frankenstein, except that I don't have the cool neck electrodes, flat head and scar on my forehead.
My toe, however, feels better.

I wrote this on a Monday, hence the title.

  • So, don't let your kids clutter up the floor
  • Wear your glasses while you stumble around in the mornings.
  • Put the coffee on the night before and drink some before attempting anything dangerous, like walking.
  • Put shoes or slippers on for goodness sake.
  • Turn the lights on before you walk around.

This has been your public service announcement for the week.

Thursday, September 4, 2014

Why I Volunteer

I am a Boy Scout. 

Yup. You read that right. I, DoctorDiva, am a card carrying Boy Scout.

When my son joined a few years ago, I told my husband that this was HIS gig. I'd done the Girl Scout bit with my daughter, even volunteering as an assistant leader for two years.

Well, my husband's job didn't let him participate. He works more insane hours than I. So, it fell to me.

Little did I know what I was getting myself into.

I am now the Troop Committee Chairman. I help plan and organize the troop for events and trips and campouts.

I help the Scouts get their Merit Badge as a Merit Badge Counselor for the Personal Fitness Badge. I am the Popcorn Kernal this year.

I am helping with organizing drivers for trips.

I WANT my troop to succeed. 
It's hard work. 
I do this in my spare time. The little I have.

I'm not great at it yet, but I'm learning. 

I give my time, and get:

  • TO CAMP!! 
  • I get to give back to my community and help steer kids in a program aimed at leadership, community, responsibility.
  • I get to wear a uniform (the pants are just not meant for women of a certain age and size though..)
  • I get the satisfaction of knowing that I'm doing something good. 
  • I get out of the house and away from the TV or computer, or the refrigerator. 
  • I meet all kinds of cool and interesting people who are ALSO giving their time. 
  • I strongly recommend finding volunteer positions for yourself. 

There is an article: 
"The Health Benefits of Volunteering: A Review of Recent Research" which can be downloaded at

  • It states briefly, that OLDER volunteers are most likely to benefit from volunteering. (60 years +)
  • It improves physical, social, and mental health. 
  • You have to volunteer over 100 hours a year to benefit from the health improvements. It's called, "considerable volunteering".  
  • Volunteering improves life satisfaction and lowers rates of depression. 
  • It self reinforces the physical well-being 
  • Individuals who volunteer live longer. 

SO, Get healthy and volunteer. It's WAY more fun than dieting and exercise, and you will live better and longer.

DoctorDiva 9/2/14

Saturday, August 23, 2014

I'm Jammin'! Bob Marley and Peach Jam.

This has been the year for canning. I am now a canning expert. I've scalded myself, figured out that you need  filtered water for lactofermentation, decided that homemade jam is a gift worth giving.

There is comfort in receiving a homemade gift.  I think it's the realization of the time put in, the fact that the gift is not perfect, and that it's personal. I made potholders for Christmas last year as gifts. People loved them. I give jam and pickles as "I appreciate you" gifts, or for housewarming gifts, or for hostess gifts when I'm invited to someone's home. Usually the people who receive the homemade gift are blown away.

I think homemade things make one think of their grandmother's kitchens, snapping beans and shelling peas on the front porch, sweating in the kitchen while the water bath is sterilizing/canning the pickles and jams and chutneys that are being put up for the winter. Comfort. Warmth.

Listening to a patient and letting them talk is akin to a homemade gift. 

Most patients have a story to tell around their illness. Not all of the details are important to the doctor, but if the story is interrupted, important details may be lost. We doctors are taught to let the patient talk, to tell their story, and if we do, it should only take about 3 minutes. Then we are asked to say, "Is there anything else? "

I hope to give you the homemade gift of a few minutes to tell me your story.


Tuesday, July 22, 2014

How To Count Your Period Cycle Length or "Am I normal?"

"DoctorDiva, I think there's something wrong with me. I've been getting my period twice a month some months."

"What was the first day of your last two menstrual cycles?"
"Well, DoctorDiva, I came on in the beginning of the month, went off a week later and came on again at the end of the month! There must be something wrong!"

"How many days do you bleed?"

"Well, I bled heavily for two or three days, then I spotted for another five days. Then I got my period again two and half weeks after that! What's wrong with me?"

"There is absolutely nothing wrong with you. You are completely and totally normal. Do you know how to count your cycle length?"
"Well, no. I mean, you should only get your period once a month, right?"
"Well, do you keep track of the first day of your period?" 
"I thought you counted from the END of your period."

I have this conversation more than twice a week.

WHO should CARE?

Well, if you want to know when you're going to ovulate, (when the egg pops out of the ovary and is ready for Mr. Sperm to sweep in and fertilize it), or don't want to get pregnant, or want to know if you ARE pregnant, you need to know when your period started.

See the picture up there. Yeah, I know. Ugh. Science. Right?

Look at the uterus picture. There's blood in there, and all the hormones, estrogen, and progesterone are low. That's your period. The blood comes out and the uterus is empty.

Then the estrogen goes up and then LH and FSH from the brain tell the ovary to pop out an egg. POP!! Out comes the egg, and it moves into the fallopian tube.

The blood starts to build up again and forms a really cushy nutrient rich lining inside the uterus where  the fertilized egg can set up house.

 If no sperm succeeds in it's quest to fertilize the egg, the progesterone levels and estrogen levels drop and BAM! Your period. Again.

If you know how long the time is from the first day of your period, to the next first day, you have your "cycle length."

Again, Who Cares?

YOU DO.  If you know that your period cycles are pretty regular, like 28 days or 32 days or similar, You can predict when your next period is going to be by counting forward from the first day of your period by your cycle length.

Also, if you want to know when you're ovulating, you count backwards by fourteen days from when your NEXT EXPECTED PERIOD is due and Bam!

Knowing the first day of your period is also how we figure out your due date for pregnancy.

 Now with so many people having smart phones with calendar apps, it should be fairly easy to keep track of your menstrual cycles.There are APPS for that!.

In general, that we talk about a 28 day cycle being "normal" but in reality,
"Normal" is a range.
 "Normal" is different for different people.

 Some people bleed every 21 days, some every 35 days, and some vary all over the place from 28 to 21 to 35 days or even skipping. That's not normal, and might be caused by a medical condition.

So, Are you normal?
Ask your Doctor.

July 22, 2014


Wednesday, July 16, 2014

This is An Important Camping/Hiking with Children Post

 ThrillWriting: Hug-a-Tree: Keeping Our Youngest Characters (and our real-life kiddos) Alive in the Woods with Jacquie Beveridge

I am following an amazing writer, Fiona Quinn, on Twitter.
She writes a blog on how to write. She researches specific situations and becomes an expert. Then she educates writers so they write more accurately. 

Many of you know I am involved in Boy Scouts and LOVE to camp. 
I have never run across this technique of pre-hike preparation. 
This is simply brilliant and will save lives. I thought it was too important not to share.
Please click on the link below:

ThrillWriting: Hug-a-Tree: Keeping Our Youngest Characters (and our real-life kiddos) Alive in the Woods with Jacquie Beveridge

Saturday, July 12, 2014

Grief Pickles

I'm on another culinary bender.

I cook and craft when I'm stressed. It's safer and healthier than drinking.

My Father passed away July 1st, exactly 14 weeks after my mother died. My sister was the main caregiver and is an amazing person. I live half way across the country, and last saw them right before my mother died. 

My kids were off at camp when he died. While picking them up I stopped at a roadside farm market and bought 5 lbs of blueberries and several pounds of pickling cucumbers. I needed to cook.

Cooking to Cope. Should be a separate blog, eh?

 I've made about 10 pints of blueberry preserves since that first disastrous episode of  "scalding while sterilizing." I'm big on alliteration today.
(see previous blog post on Blueberry preserves)

Since then, I've learned a few things: 

1.) The canning rack will sit up on it's handles on the sides of the canning pot and so I don't need to reach deep into the pot to take out my sterile jars. There is less risk of dropping them and splashing myself with boiling water.

2.)  I have two different types of jar tongs. I can grab a jar sitting on its side easily without dropping it. 

3.) I use a candy thermometer to gauge the temperature of the jam

4.) I use a very tall pot to cook the jam so it doesn't foam up and boil over the top

But now: 


I've always wanted to make pickles. As a child, one of my favorite memories was going to Ernie's deli in Rutherford, New Jersey. He had a barrel of sour dill pickles behind the counter. My sister, friends, and I would save up to buy a pickle (25 cents each pickle) and have Ernie slice it up into the requisite number of slices. We amused him to no end. Most kids bought chips, cookies, gum, and candy. 

We bought pickles. 

I miss them. I can't get really good sour dill pickles in a barrel easily here in Chicago. 
Yes, I miss my parents too, even with all the baggage, and this is a way to remember my childhood and cope. A weird substitute?---- Yes. I'm not apologizing or explaining.

SO, I purchased perfect pickle cucumbers at the grocery store and decided I was going to try my hand at making CANNED pickles. I read a bunch of recipes and made a batch of bread-and-butter pickles and a batch of garlic dill pickles. 

Bread and butter pickles

The bread and butter pickles were AWESOME. 
The dill pickles were good but they were soft, and not exactly what I was looking for.

 Next, I made refrigerator garlic dill pickles with other vegetables as well as cucumbers.  My favorite pickled vegetable turned out to be the carrots. They were similar to Lalo's Mexican Restaurant's pickled veggies. I've also tried pickled cauliflower and I'd like to try pickled peppers.

The refrigerator pickles were close to what I was jonesing for, but no cigar. They were crisp and garlicky, but not the same as the sour dill pickles in the barrel from Ernie's Deli.

 So I've taken a plunge and have purchased a fermenting jar.

I've been reading all about making fermented sour dill pickles and since the weather's going to be cool next week, (Thank you Polar Vortex-the weather pattern that just keeps on giving)  I think this is as good a time as any to make them. If the weather gets too warm, pickles ferment too quickly and go bad.

 Wish me luck.

I hope I don't give myself Ptomaine poisoning. 

Saturday, June 21, 2014

#BanBossy--Teaching my Daughter How to Resolve Conflict

I got a call from my daughter's Bestie's  Mom, C. "Did you know that E and M are not speaking to each other?"

"No. What gives?" I asked.

"I'm not sure," said C. "I think it has something to do with a misunderstanding about the movie last week."

A little background here.

E asked me if I could take her and M to the movie on Sunday. There were a group of girls going to see "A Fault in Our Stars."
I said, "Yes, but I'm going too. You're too young to be unaccompanied by an adult."

Saturday afternoon, some of the girls were on Skype and informed E that the movie activity had been moved to THAT night, Saturday. E asked me if she could still go.

"What about M? Have you called her to see if she can go too?"

"No, but I'm going to do that right now."

E tried to call M but was unable to reach her. She left a message. We went to the movie. It was a gaggle of teenage girls watching a tear-jerking movie that I was unprepared for and ended up sobbing into my popcorn  butter laced napkin. The girls were comforting each other as one of the main characters died a tragic young death.

Back to the phone call:
C was concerned because her daughter, M, wasn't supposed to walk home alone from school (E & M walk home together), and E and M weren't speaking and so M went to the library so C could pick her up after school.

 "What should we do?" She asked

"I think the girls simply don't know what to do to resolve this and so they're doing nothing, which means not speaking to each other. What are you doing tonight?" I asked.

We made arrangements to have dinner together with the two girls. I decided I better read a little bit about conflict resolution with teenagers and girls. I found this cool thing called #BanBossy. It's about teaching girls how to be assertive-instead of aggressive. It teaches using "I" statements when one is trying to resolve a disagreement or conflict.

For example, "I feel (insert emotion) when you (insert action other person has done to offend). Please (insert solution to said problem).

The Girl Scouts  have an entire lesson plan on this that is in a PDF form. Here is a brochure for leaders:

Here is the lesson plan: 

 I looked at it quickly and threw off an email to C asking her whether she thought this was a good thing to use with the girls.  We texted and emailed and decided to try it.

Dinner went well. We chit-chatted but the girls were not really looking at each other or saying much. C and I were asking questions and engaging each others child in conversation. After we had finished eating I whipped out the Girl Scout lesson plan and so did C.

We  started talking about how sometimes it's really hard to talk to someone when you're upset with them.  Learning how to argue fairly is a skill.

 We reminded the girls that there are going to be days when they don't even like each other but friendship is a commitment and requires work. You don't just abandon a friendship because of a disagreement. 

C & I opened the lesson plan. Part of it was to engage the girls by asking them about instances where they've had problems at home or at school and how they could use this new technique of using "I" statements to resolve the issues.

The floodgates opened as the girls relayed to us that they had been having a conflict with one particular girl all school year long. They had brought it to their teachers attention during a special session called "Advisory," but things had not changed.

We were able to practice, doing some role playing and the girls spoke to each other respectfully about their misunderstanding, and resolved the problem.

We reminded them that this is going to be something they have to practice. It doesn't come naturally to talk to each other this way, but learning how to resolve conflict is a skill set that needs to be taught, and learned. 

I was reminded that my daughter, although she is a young woman, still needs me to teach her life skills.

I was also grateful that C felt comfortable calling me and bring up the problem. Without her intervention, neither girl would have learned the other's side of the story, and it would have been a tragic loss of friendship.

Doctor Diva 6/21/14