Full, Warm House

We moved in to our new place in early July and now feel quite settled!  Serena and Brad, residency friends, (and shih-tzu, Shabu) came up from the Bay Area to visit this weekend and were around for our Housewarming Party.

It was pretty tricky (and I was stressed) about preparing food for (around 50) guests while having a busy toddler (who totally deviated from his normal nap schedule on the day of the party, throwing another wrinkle into the preparation), but thankfully, we had help with food items (thanks especially to Lori/Craig and Ramona for contributing), as well as to Charmeka and Serena for some key babysitting.

Lori and Kelvin took most of the pictures from the afternoon/evening.

Iver has found a new buddy (Serena), to whom he stuck like glue during the event!

my former MA, Mandy, and big-sister-to-be, Baylie

The badminton on our back lawn was pretty popular 

  (Peggy and Mark)

Hanging out on the deck (I think the actual deck furniture was used sparingly!)

Iver with his favorite backyard tree (he particularly lies to eat the pinecones)

The food spread!

 The fruit skewers by Ramona were a HUGE hit, especially with the kids! Aren't they gorgeous?

S'mores bars I made turned out ok!

Taco bar...

... and wings

Noodle salad...

There was some karaoke-ing

With no children hurt and no wine (or play-doh) on our carpet or couch (and guests who said they enjoyed themselves and the food), we'd call it a successful gathering!  It was fun to have such a full house of friends. Thanks to everyone who came out to celebrate. Our hearts are full. 

Birth "plans"

*This is a post I wrote that my friend, Wendi, shared on her blog. I finally got around to posting it here on my own site, to be saved for my blog books later.*



I am a family physician and see patients of all ages in my practice, but my passion is delivering babies. I believe in and support women choosing natural childbirth if they wish (had one), breastfeeding if they desire (still going strong, after 20 months), and have even used essential oils on myself  (all while believing wholeheartedly in vaccines. You know what is natural?? Dying of smallpox and polio is "natural."). I am also an extensive planner.

That being said, it is my opinion that, effective immediately,  birth PLANS should be renamed "birth WISH LISTS." While we all have an "ideal," a good "birth wish list" might include:  spontaneous labor that is only a few hours long, with contractions that are strong enough to dilate you steadily and push a baby out without causing pain with which you can't cope, without any need for an IV, complications or antibiotics, and which ends in a vaginal birth without tears, this is not the norm. 

Sometimes preterm labor starts and gives you a 24-weeker who stays in the NICU for another five months.


Sometimes the water breaks preterm and you need to be on bedrest with monitoring in the hospital for weeks.

Sometimes the water breaks prematurely, before any signs of labor, and it's safer to induce labor than to, well, just hang out waiting for infection to set in.

Sometimes there is hypertension, or low amniotic fluid, or growth-restriction, or baby is late (42 + weeks), and it is safer (for the baby and/or mom) to induce labor than to wait.

Sometimes the body and the uterus (and the mind) get tired and there is need for medical "augmentation" (strengthening of contractions) with Pitocin or by rupturing the membranes artificially.

Sometimes there is (catastrophic) bleeding like an abruption, which can lead to maternal hemorrhage and/or fetal death if an emergency cesarean is not performed.

Sometimes there is a uterine rupture, or a cord prolapse, which requires the same, prompt action.

Sometimes the head is not down at term, and a safer delivery choice is an elective cesarean (if other maneuvers have failed).

Sometimes, after 6 hours of pushing, it's time to "call it" and have an abdominal delivery.

Just in the past five years, I have had many patients refuse many of the above recommended management plans, because they conflicted with their "birth plans."

I know I have an M.D. behind my name, and it may be tempting to feel threatened by hospitals or medical providers who learned their medical knowledge from Mayo Clinic and not Jenny McCarthy or Google University. However, please remember that I am also a moral person (and a mom), and that we are all wanting the same goal-- a healthy mom and a healthy baby, and that I would be devastated by the loss of or harm to either patient.  I feel that the only thing about labor and birth that is predictable and that you can "plan for," is that labor, birth, AND PARENTING, are inherently unpredictable. It is my opinion that birth plans need to go out the window because being flexible and relinquishing control is the first thing you need to learn about being a new parent.

I have seen babies, whose moms refuse antibiotics or didn't get adequately treated for group B strep, become septic, and need multiple lab draws, IV antibiotics, and hospital/NICU stays.  At my hospital, women still routinely refuse penicillin (or even screening for GBS), to my disbelief. 

I have not personally seen vitamin K-related bleeding in a neonate, because of widespread use of intramuscular vitamin K given at birth.  But another provider in my clinic had a case last year, because, in their birth plan, parents had decided to withhold this shot for their newborn (an alternative that some parents request, oral vitamin K, is not very effective. There is a good article, and more information on a variety of topics, on the website Evidence-Based Birth).

One of my pediatrics patients was a neonate who had to be hospitalized at UCSF NICU for apnea due to pertussis, which can be prevented, or its incidence drastically reduced, by maternal TDaP vaccination between 27-36 weeks with each pregnancy (this anti-vaxx mother had refused vaccines for her older child from birth, too, and continued to decline other vaccines for this infant as he grew older).

I support women's ability to walk, move, and eat and drink in labor and think that the advantage of position changes and gravity are helpful for labor progress and pushing; that being said, I fully support a woman who opts for an epidural in labor, because, if it helps her cope and helps her baby arrive safely, that's all that matters (even if the original "birth plan" says otherwise).

I catch babies underwater for those low-risk moms who want a water birth, even though the bodily fluids (and solids) in the tub sometimes gross me out, and I fear falling in, and of having back pain from crouching awkwardly.

I do delayed cord clamping routinely, because it has benefits for reducing infant anemia, even though it adds a few minutes to the third stage of labor, and often makes me late getting back to clinic (or to my family).

I support breastfeeding, but I also support moms who for whatever reason (they couldn't, it was too difficult, or they didn't want to) chose to formula-feed (a FED and growing baby is all that matters).

I have routinely been performing "Gentle Cesareans", where we drop the drape and hold up baby to let mom see the baby as he/she comes out, do delayed cord-clamping on the surgical field (if baby is vigorous), and promote skin-to-skin time (and breastfeeding) and with baby on mom's chest in the operating room until the case is finished, even if it's a bit harder for me to sew sometimes with mom's head of the bed up.

I allow women to do anything they want with their placenta, even though I tend to gag a little when I see them chugging down placenta smoothies in the delivery room (which definitely happens).
If parents want to deliver the placenta attached to baby ("Lotus-birth") and keep the baby connected for weeks, that's ok by me, because I don't have to smell it daily, and the baby is out... and presumably doing well.

I take care of moms who choose home births after weighing risks and benefits knowing that, for most low-risk women, it will go well, although it's still much safer for the baby to be born in a hospital.

I want women to make empowered and informed choices for themselves, and their children, but I want them to be safe choices.

I just want a healthy mom and a healthy baby.

So please, if you have a "birth plan," please rename it a "birth wish list," and know that obstetrics, birth, and parenting are unpredictable and, at times, even dangerous. We are on the same team.

For a bit of levity, please check out:

https://www.mcsweeneys.net/articles/jamie-and-jeffs-birth-plan

Rio Wrap Up

While I know that many people get into the Olympics, I know very few people who love watching sports as much as I do. Iver started sleeping better last month, and then I went and wasted my sleep on a fortnight of watching NBC Primetime Olympics until midnight (almost) every night! I'm sad that the 2016 Rio Games are over... but I'm glad that Tennis' U.S. Open and fall football are around the corner. And now maybe I can actually (finally) get some rest! :)

Occasionally, I fell asleep and forgot to DVR the coverage, which I intended to watch early the next morning (we are still a pre-6-a.m.-waking family)... but I caught most of the really big moments. There were definitely many heartwarming moments, and plenty of tears.

The Refugee Olympic Team, 2016

Gymnastics is just about my favorite sport to watch. I couldn't believe how strong the U.S. Women, "The Final Five" (last team of the dynasty of the Karolyis), were...

I've never seen anyone fly as high (or dominate the field) as did Simone Biles, and the veteran Aly Raisman, taking second to Simone in both the All-Around competition, and Floor Final, was fabulous and extremely poised.

It was really amazing to see so many of the "greatest of all time" athletes compete this year, for perhaps the last time. 

How will anyone ever top Michael Phelps' Medal Count?  28 medals (of which 23 are gold) is a higher count than many countries have won in their history! 

Allyson Felix is one of the most decorated female athletes, with 6 (track-and-field) golds! 

At 19, Katie Ledecky is a dominant, rising swimmer who is undefeated in big races

Usain Bolt, with 9 gold meals (winning "the triple-triple"), is surely one of the best sprinters of all time.

I loved watching Simone Manuel, an unlikely Gold Medalist in her first Olympics, win the 100-meter freestyle, and be the first African-American Woman to win an individual swimming event.

The U.S. Women trio of Brianna Rollins, Nia Ali, and Kristi Castlin, swept the 100-meter hurdles, the first country sweep in the history of the Olympics!

Brazil took home the soccer gold in a dramatic shoot-out with Germany, which must have been pretty special for their country (I still despise soccer, however, and only watched this highlight). 

Onto Tokyo (2020, and to travel for real in October!). 

Fun with "moo"s...

We checked out the Humboldt County Fair in Ferndale this weekend. Last year, we ventured there with Kelvin's family in town.  It was more fun for (animal-loving/naming) Iver this time around.

He was all over milking the (fake) cow "which he calls a "moo"!  

He also liked the goats, but we didn't take any pictures.

Iver indicated that he wanted to ride the (live) pony-go-round, but then balked when getting on one, so he had to settle for chilling on the stationary tractors.

Fun with chalk!

We enjoyed a yummy "Mangonada" Raspada (mango/chili/tamarind cold treat but, alas, no pictures), and a good afternoon in the "cow"/dairy town.

Iver is also 20 months today! Kelvin slicked his hair down for the photos, 

 

"fake smile"

What a ham!

Acting out one of his favorite books... 

He continues to be extremely "spirited," with frequent tantrums and testing our discipline, but is starting to say two-word phrases and his vocabulary is exploding exponentially. Can't wait to see more of him "using his words" (and saying animal names instead of only animal sounds).

The Spirited (/Wild) Child

I know I've written a fair deal on my blog about the challenges that parenting our son has presented to me.  I recently read Raising Your Spirited Child (a guide for parents whose child is more intense, sensitive, perceptive, persistent, and energetic), by Mary Sheedy Kurcinka, which I would recommend for any parent who'd describe their child as "strong-willed" (but who, the book suggests, we should re-label with perhaps more positive adjectives).

While I've thought, many times, "Is this how all children (?boys) are? I can't handle this. Why is he fighting me so hard?  Is he trying to make my life difficult/miserable?  I probably shouldn't have had children. I sure don't think I can have any more. How can other people handle/want more?," this book explains that children of a very "intense" or "spirited" temperament (maybe 10% of all children) can't help the way they were wired, and we can't change them, but we can learn to adapt to methods of transitioning, adjusting, and discipline, to help them cope with the world, and to help ourselves cope with being responsible for them.  I realized that, while I feel alone in my struggles most of the time (particularly when I'm alone and fighting the battles singlehandedly, as Iver is surprisingly very easygoing at daycare and with other babysitters, and less intense with Kelvin present in addition to, or instead of, me), this book reassures me that I am not alone. I am not the only parent who has cried  (sometimes daily) in frustration, wanting to give up.  There are other parents who have, to quote the book, found a way to "survive the penetrating intensity of spirited children."

If you have to wrestle a screaming child (fearing that someone is going to call the child protective services authorities) into the carseat anytime you want to go anywhere and have to add 15 minutes to the lead-time for leaving for any events due to the anticipated battle, you may have a spirited child.

If your "just won't quit" child has screamed for 120 minutes straight due to being restrained in a carseat on a highway, you may have a spirited child.

If you feel trapped and dread at leaving the house in a car due to the exhausting carseat and car-riding battles, and fear going to a public place where your unpredictable child may not be controllable, you may have a spirited child.

If cry-it-out and time-outs aren't very effective, since you have a child whose will is much stronger than yours (even if you, too are a persistent or spirited parent), and your spirit is broken after hearing screaming for hours, you may have a spirited child. (If I weren't a physician, I might have taken him to the hospital after an unexplained, 60-minute tantrum earlier this week, because after sweet-talking, soft touches, ignoring, bribery, and distraction, I was out of options. But then I thought about the carseat battle and a trip somewhere else didn't seem manageable.)

If you are exhausted for not sleeping through the night for approximately five hundred and sixty (or more) nights, due to a child that has irregular, frequent night wakings and is difficult to soothe (or if you spend an hour and forty-five minutes getting him to bed for naps or bedtime on a semi-regular basis), you may have a spirited child.

If you have felt more tired after a few hours of watching your child than you have after multiple consecutive up-all-night call nights, you may have a spirited child.

If you have thought about asking about the necessity of feeding tube placement, because your child fights eating food with a passion, and you don't have the energy to put up with mealtimes, then you may have a spirited child.

If putting on a diaper (every.single.time) or dressing is an aerobic activity or requires four-point restraints, then you may have a spirited child.

If your child has seemed to need less sleep than the average child his age (which is not necessarily the case; spirited children also have trouble winding down and so can fight naps/ sleep when overtired and wake up earlier), you may have a spirited child.

If you plan every day around your child's nap time(s) or bedtime because your life will be totally miserable if sleep routines are altered, and you don't have a flexible child, you may have a spirited child.

If you can't ever go to restaurants or events which require quiet sitting for more than 30 seconds (or if just thinking about upcoming plane trips causes immediate nausea) because your child needs to move, you may have a spirited child.

If you often cry yourself to sleep and wonder how you'll face another day of the exhaustive parenting your little one requires, and you (an introvert) feel that all your emotional energy is drained from taking care of your your energetic, extroverted, persistent, perceptive, intense little one,  so that you don't have any left for yourself, your spouse, your co-workers, your family, your friends, or your patients (some of whom have asked if you are "sick,") you may have a spirited child.

If you have your heart melted by your child's effusive hugs, kisses, passionate attachment, and are amazed by his mind, intelligence, compassion, and expressivity,  you may have a spirited child.



While children with tendencies/traits that Sheedy Kurcinka describes, and whose actions are mentioned above, are often described as "difficult," she notes that it is important to attempt to use more positive language, as these (currently maddening) traits often make them very successful adults and we need to tolerate (survive) these tough years, particularly those of the toddler time, even when it feels that things will never get any better.  This book gave me some tools, some perspective, and some hope that I might be able to make it through some more days with my spirited one.

Here is another great article  Challenge Accepted: Raising a Wild One, by Sarah Chase, whose text I have placed here, just because it's so well written (and there are many positives to be spelled out).

Raising a spirited child is a blessing and a challenge.

They have this beautiful resilience about them and we know in our hearts that this will be vital in adulthood, but we are caught in this balancing act we call parenting.
On the best of days, I am in awe of my wild one. He is imaginative, compassionate and downright determined. He says such profound things that fill my heart with joy and wonder.
On the days when my patience runs thin, I wonder if I’ll be strong enough for him. I breathe, and count and even walk into another room, but on the worst of days, I break down and yell, only causing a fight.
Butting heads with a wild one only causes them to push harder. On these days I want to pull my hair out in frustration.
This was not what I pictured parenting would be like.

Demand from a wild one, and they will demand from us. Teach a wild one, and they will teach us, too.

One day I realized that everything I want for my son already comes so naturally to him. His independence, determination, wit and deep compassion will help him navigate through adulthood in our society.
I realized that instead of trying to shape him it was my job to guide him. Guide him to better choices and morality, and away from harm. That is, after all, the meaning of discipline.
It is easier said than done with wild ones.
Redirecting and guiding is a process of trial and error. Validation and positive reinforcement may work one day and not another, and at times it seems we have to be three steps ahead so they don’t figure out our methods.
We have to think ahead, be quick to adapt and learn to roll with changes.
We must forget about any personal idea of perfection. I remember laughing when a mother in a breastfeeding group asked,

“How do we get them on a schedule?” 

What I didn’t realize then, is that I was raising a wild one.
His mind leads me to believe that he will do great things. He loves to learn and explore. Sometimes, I fear for him, though.
Will his energy levels be too much? Will his determination stay on the path of hard work and kindness? Will he transition into adulthood in the way I hope?
A wild one, like my son, wakes early and is instantly filled with energy. He’s jumping on the bed and running throughout the house before you’ve had a chance to say, “good morning.”
He is determined, throughout the day, to help people see what he sees and understand his wants and needs. He hugs tighter, laughs louder and stands firm in his stance on things for much, much longer.
All day he jumps, climbs, tells jokes and will firmly and without a filter tell you when he disapproves. He is outspoken and honest, and has to be moving or talking during all waking hours.
Not every wild one is this way. While they share certain traits, they are all unique.
A wild one, like my sister, will talk about her passions for hours and isn’t afraid to speak her mind.
The young girl who once sat on the steps to her friend’s house, refusing to leave with my mother for well over an hour, is the same girl who was accepted to and successfully attended a challenging college, and is now applying to grad school.
Growing up with her, I have experienced the same pride and frustration that I experience now with my son. She has more quiet moments as an introvert than my very extroverted son, but I see the same independence, determination, wit and resilience.
Seeing her success gives me such hope for my son’s future. It lets me know that with guidance, he will absolutely be capable of great things.

To the parents of these wonderfully wild children:

First, a big hug.
Self care is important when raising these beautifully spirited souls. We must remember to recharge, as we will need the energy. Coffee can only do so much.
We are exhausted, proud, frustrated and amazed—sometimes all in the same day.
Going out is a challenge, not knowing if they will melt down or act with kindness. Getting ready can take minutes or an hour.
Their minds blow us away. We cherish those little moments of peace and cry when our children decide that nap time is a thing of the past.
Let’s be thankful for the lessons. Let’s find and hold onto little moments to be grateful for, and remember that the wild ones can help shape and change our world.
We have been given this wonderful challenge.
Let’s say it together: Challenge accepted.

Pep turns Six!

This was then:

Pepper was our first child. We adopted her in 2011 when she was about 16 months old, and we had several years with her as our fur (and only) child before we welcomed Iver into the world. 

While my parenthood experience is getting somewhat better (I hit a really low point a few weeks ago and while I have bad days and bad parts of days, at least I'm better rested), I do really miss those weekend days that were spent relaxing on the couch with only a doggie at my feet and a book in my hand, without a toddler trying to launch himself off of or destroy everything in sight.

Pep, our first child, is allowed to co-sleep, as she's always been a good sleeper.

She is a sweet soul who is a good protector of our newer little one and who has not shown jealousy in the slightest even with her relative "demotion" in the family hierarchy.

When I hear about friends losing their pets, I can't fathom the grief. She is an amazing part of this family, and has taught me so much about love (even though she gets to be in rare pictures these days).

Here we are now-- with a 19-month-old human child, and a SIX-year-old furbaby. Here's to many more birthdays, sweet Pepper!

Sleep (FINALLY)!

I was in a low place when I wrote my last blog post, obviously exhausted, frustrated, irritable, and needing things to be different.  Thank you for all of your well-wishes, e-mails, comments, and virtual hugs, encouraging me in this crazy parenting journey.


I'm happy to be able to post a *positive* update (in the sleep department), for once.
With a combination of cry-it-out, night-weaning (i.e. no nursing between 8pm and 5:30 a.m.), socks to bed (we weren't sure if he was waking up cold?), and the toddler stoplight alarm clock ($33 on Amazon), within a week, we now have a toddler who is sleeping approximately 9.5 consecutive hours at night (or at least who did that for three nights...does that count as a pattern?).  I really don't know if it was any ONE of those things that "did it," or the combination, but I DON'T CARE. I was beginning to think our child would never "sleep through the night," which was a depressing thought.  We occasionally hear a peep out of him (and, on the video monitor, can see him glance at the clock, and go back to sleep if not "green", and had one 30-min crying spell last night that stopped without our intervention), but actually had THREE consecutive nights of him not waking us up.


One morning, we both woke up (with white noise on in our room) at 6 a.m., wondering "Oh my gosh. Is he alive?" In fact, he had been up probably about 15-20 minutes, crying, since the light turned "green" around 5:40 and there was a puddle of tears on the bed, but we hadn't heard him. Oops.


We also have close-to-finished off our bedroom, with our king-sized bed frame arriving from Macy's and being assembled to completion by Kelvin yesterday. While the mattress has been here a while (there were issues with the previous bed frame from Wayfair), one of us had been sleeping with Iver (or in the guest room) part of the night, and now we can enjoy sleep in our "adult" bed (my first "real" bed, complete with bedframe and headboard!) together in our own room, while he (with hope) sleeps through the night in his.

Parenting WIN! Let's hope it lasts!