MDMommy Goes to Reunion

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A few weeks ago, I went to my 25th college reunion. It was a hectic time of year, and there were so many reasons not to go: playoff/championship games for my sons, graduation prep, camp packing, and I was missing the Bat Mitzvah of the daughter of my dear college friend. But I had been looking forward to it for years, and I did not want to miss it. After a busy Friday morning at work, I drove to my friend’s house in Croton.  Prepared for the fickle weather in Ithaca, we both laughed at the huge quantity of clothing we brought for two days, and we were on our way.

The ride up was beautiful, and it gave me a dose of what I had been pining for: rolling green hills, endless blue sky, and long stretches with no buildings in sight. My heart skipped a beat as we drove towards downtown, passing the familiar street signs of our off-campus apartments.  It was a mixture of excitement, apprehension and curiosity about whom I would see, how I would feel when I saw them and vice-versa.

We had a great time. It was fun to see the people we both expected and did not expect to see, roam through Cornell’s gorgeous campus, buy clothes from the store to bring home for our kids, and eat, drink and laugh at our favorite places in Collegetown. Many of the alumni from our year did not bring family like they had done in the past, which allowed us to be more flexible and spontaneous.

For me, the most surprising part was the content of many conversations we had. I did not feel myself compelled to speak much about my family beyond a brief description, or even to show photos from my phone. I hadn’t seen many of these people in 25 years. Our conversations were often brief, because someone else would pop in from the side and we would start up another topic. During the past 25 years, we all had experienced successes and failures, we all faced challenges. Some of had spouses and children, but not everyone, and I did not want to probe. My readers know that I am 150% invested in my family, particularly the high-maintenance medical care of my children.   It was refreshing, for the first time in what seemed like forever, to answer questions about me. “Did you end up becoming a doctor? Where do you live now? How are your sisters? Remember that time when…”  It was me before MD, me before marriage, me before mommy, and notably, me before my childrens’ diabetes and other health issues. It was profoundly liberating.

This brief detachment from diabetes was therapeutic and unfamiliar. While our parents had watched our children for a weekend or two in order for my husband Adam and I to get away, we were constantly interrupted by the multiple phone calls about blood sugars and insulin dosing. The planning alone for these excursions was exhausting, and often created more stress. Leaving the children in Adam’s capable hands for 48 hours gave me the freedom I needed.

The MDmommy part of me has always known the importance of “Me” time, and I advise new mothers to leave their babies with a capable caregiver for brief periods when they can, to regain a sense of self. Diabetes is so tricky that the closest I have come to a real separation was my yoga class, when I notify the school nurse to contact Adam for emergencies.  For mothers, especially those with children who have chronic needs, do yourself a favor: take a break, longer than just a Girl’s Night Out, and don’t wait eight years from diagnosis/onset to do it…


Flax is a four letter word…

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That’s correct. Those tiny, nutritive brown specks found in so many foods trigger fear and danger both in and out of our home. My oldest son Sam is severely allergic to flax and has had a few anaphylactic reactions requiring the use of an epi-pen and, most recently, a very scary trip to the ER. A few weeks ago, I unintentionally “flaxed” my son. How did this happen? How did we even know he was allergic to flax?  Well, I am fairly certain he wasn’t born that way. He has been on a gluten-free (GF) diet for the past ten years, and flax/flaxseed is used to enrich many gluten-free products by adding fiber. It was hard to figure out, but a few years ago we noticed that after he ate certain foods, he developed writhing abdominal pain lasting 6-8 hours, often into the next day. The only common ingredient was the formerly innocent flaxseed.  Then, formal allergy testing showed he was severely allergic and would have to be very careful going forward. We knew that Sam had a milder allergy to tree nuts and some fruits (throat itchiness), but this was a whole new ball game.

Having a flax and tree nut allergy in a person who also has diabetes and celiac disease restricts food choices to about 20% of all GF foods. Shopping is often depressing, especially finding the ingredient in new products that you would otherwise want to try. FDA labeling laws have been enforced for products containing wheat and nuts, but finding the word flax can be like searching for a needle in a haystack. Nobody seems to care about it, and it can take a long time to get a definitive answer when eating anywhere in public, because only the chef knows the ingredients.

As a mother, I do what I have to do. But, what about Sam? It’s scary, annoying, and labor-intensive. He must question each food item and assume nothing is safe, because flax is increasingly being used in EVERYTHING. I stopped taking my children to GF fairs, which used to be better than Halloween for them: They enjoyed running from table to table, sampling delicious treats, including breads, pizza and dessert.  I didn’t even care about their blood sugars on those days.  We addressed that later. The last time I took them to one, Sam’s throat began to itch (probably from a tree nut) and he went to wash it down with some NAKED juice which, it turned out, unfortunately and ridiculously contained flax. This was followed by Benadryl and a trip home.

So, knowing all of this, how could I be so careless? He was on his way to soccer practice, and needed something to tide him over. I made him a sandwich with home-made bread I had been making for years, from Gluten-free Pantry flour mix.  My kids LOVED it. They affectionately called it “Mommy Bread”. Sam immediately reacted with throat itching and abdominal pain. I rummaged through the garbage for the flour package. With my hands shaking , I read it. There it was, the four letter word: FLAX. They changed the ingredients on what had become a cornerstone of my kids diet. We gave Benadryl, and the epi-pen. Sam’s symptoms started to subside. I initially brought him to my pediatric office, thinking I could monitor him there for a few hours, sparing him the drama of the Emergency Room. But, his abdominal pain recurred, and I drove him to the ER. This was terrifying. As he sat next to me in the front seat, his pain worsened to the point that he passed out. At that time, I was less than 10 minutes from the ER so  kept driving as I continually checked for his pulse, and yelled his name so he would mumble, or stir, which seemed to work.

When we arrived, he perked up, was given more Benadryl and Zantac, and stayed another 5 hours for observation. We were home in our beds before midnight.  Sam slept late the next morning, but made it in to school in time for math class.  He is a conscientious student, and he didn’t want to fall behind. For the next 48 hours, I was rocked by many emotions: Guilt, fear, exhaustion, and not the least of all, concern about the future. Having a delayed allergic reaction after an epi-pen administration is not so common, and it makes the future even more scary.

I have been told that I am a “super” mom. That my medically high-maintenance children are lucky to have me.  I have dealt with respiratory emergencies and life-threatening blood sugars; nothing is more unforgiving that an anaphylactic reaction. I gave him flax (Should I have read more carefully? Even though I had been using the same packaged flour for 10 years?). I drove to the ER instead of calling 911 because I wanted to bring him to the hospital of my choice, not necessarily the closest as mandated by EMS.  Was this a mistake? That car trip is seared in my memory as an experience that no parent should ever go through. In the end, all turned out well, and of course I am so grateful.

But what helps the most is the resiliency of my son Sam. We were able to joke in the ER about how I “poisoned” him by feeding him his favorite bread (which he can no longer have).  He insisted on going to school the next day where he told the necessary people about his reaction to some food he ate. No big deal he said. That, for me, is the biggest, best deal of all.


Five Years Better?

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Five years later.  My oldest son Sam was diagnosed with diabetes five years ago today.  I remember it vividly-that hazy, humid morning when Sam decided to impress his friends in the camp carpool by “playfully” checking his blood sugar in the car. The meter surprisingly read “400.” I kicked the four other boys from the car, and dealt with Sam’s condition as best I could: Phone calls to Adam and the endocrinologist, the trip down the Naomi Berrie Diabetes Center at Columbia.

Life, once again, interrupted by another medical diagnosis. Our family had just reached some degree of stability. Four year old Leo (who had been diabetic for almost three years) had a counselor to monitor his blood sugar at a day camp, Sam was returning to camp for the first day after a boating accident left him with 30 stitches above his eye. He was excited about his trip to the water park the following day.

We were about to put our house on the market- bigger home- one button push away that very morning. Contract with broker signed, photos taken, open house scheduled. Of course, health is paramount, this was canceled, indefinitely.

Five years older.No age is “good” to develop diabetes. The fluctuating blood sugars are not good for the human body. This we know.  When Leo was diagnosed with diabetes at 13 months, some people commented,  “Well, it’s better that he is young, he won’t know anything different” . Where did that leave Sam, a nine-year old already dealing with a diet restricted by celiac disease and multiple food allergies? He had already lived through almost three years of our meticulous carb-counting , blood testing and site-changing with his brother. He already hated diabetes.

Five years more exhausted. Diabetes is pervasive and all-encompassing. Other adjectives are relentless, unpredictable, inconvenient, and just plain hard. When it comes to multiple siblings in a family, one plus one is more than two. Although this shouldn’t happen, we sometimes forget who was bolused for breakfast, who checked most recently and was corrected, when was the last site change, etc…

I was already exhausted from the 24/7 care of a rambunctious little boy with brittle diabetes, and I could not imagine how I would manage two children. My energy was sapped, my mental faculties maximally challenged , my emotions drained. The well was dry. I dreaded the days and weeks ahead which I knew would involve:  more diligent monitoring, always anticipating, thinking like a pancreas. My friends and family, always supportive, offered encouragement “You can do it, you’ve already done it.”  “One foot in front of the other”. What else could they say?

But Still Standing…  Five years ago, there was no light at the end of the tunnel. But aging has its advantages. My children have become more independent and resourceful. Sam manages his own blood sugar and can change both his pump and monitor sites, except when he doesn’t.  Remember, he is a teenager. At sleepaway camp, he must do everything himself, while at home he prefers our assistance. Leo can both test himself and administer his own insulin. This is HUGE! At eight years old I can finally drop him off at play dates (although birthday parties are still tricky). It can be dangerous  because he now thinks he knows EVERYTHING. “Is there anything more I need to learn about my diabetes, Mom?”  He understands percentages and carb ratios more than most people understand multiplication, but too much insulin can cause scary low blood sugars, so he still needs adult supervision. The worry factor hasn’t changed. In fact perhaps it has increased, since they are beginning to make their own decisions.

As for me, aging stopped being fun a while ago, evident in my changing vision prescription, deepening crow’s feet and laugh lines, and more frequent trips to the hair salon. On the flip side, my children’s  growth has enabled me to go back to work, and spend more time with my husband and friends, as I begin to reclaim my life.

Five years later IS better, and diabetes research points to a more favorable future in next decade. In the meantime, I have three boys to get through adolescence. I brace myself for the odors, the mood swings, the heated arguments… But not before my power nap, followed by a large cup of coffee.  Definitely feeling five years older, but better as well.


Life’s Tough… get a helmet

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Several years ago, I bought this sign from a kitschy store in the small Pennsylvania town where my children attend sleepaway camp. It was half-way through my one week stint as a pediatrician, where I treat the injuries, illnesses, and psychosomatic pains of campers and staff. I laughed out loud when I read this sign, recognizing both the absurdity and appropriateness of the motto. As a general pediatrician for the past 17 years, I preach anticipatory guidance at most office visits.  As a mother, I do my very best to comply. Car seats, helmets, protection from sharp corners, outlets, and choking hazards.  A tragic case I saw in the ICU left me with a balloon phobia, so my children only had mylar balloons (no latex helium) until their fifth birthdays.

The sign rests in the most conspicuous part of my home, on my entry bureau as a daily reminder. What exactly does it mean? I both appreciate the sign and resent it. Chronic health conditions such as diabetes, the most difficult part of my children’s existence, could not have been prevented by a helmet, or full armor for that matter. Neither could they have been prevented by my meticulous pre-natal diet with food restrictions, followed by breast-feeding. A ski helmet did not protect my mother from a traumatic brain injury, which required surgery and prolonged rehabilitation. It clearly would not have helped Sam with his multiple injuries this past summer, for which he spent several weeks in a leg and arm cast. Most recently, a helmet did not protect little Leo from breaking his wrist while skiing last month.

Metaphorically, I love displaying the sign. The importance of developing a thick skin to deal with life’s challenges should not be lost on anyone, including myself. We prevent what we can, we hope for the best, we walk outside and face the many obstacles in our path. I have tried to teach my children that diabetes should not prevent them from doing or accomplishing anything. My 14 year old son just left for an eighth grade trip to Israel for two weeks. A year ago, even six months ago, we did not think this was possible. It was too complicated: diabetes, celiac disease, multiple food allergies, growth hormone deficiency and asthma. No helmet could protect from him the myriad complications which could occur from any of these while he was away.  Thanks to technology, we armed him with as many gadgets as possible: a continuous glucose monitor, an extra insulin pump, even a new incredible device called the Dexcom SHARE, which allows us to view his blood sugars  from our iPhone as he SLEEPS while he is half way around the world. Although it only works part of the time, it is an extra cushion to prevent the near disaster of what happened on his Washington DC trip in April (see: Not just a gadget).

More importantly, he is armed with the fortitude and problem-solving ability he has developed over the past few years. That’s his real helmet. Both he and we know that problems will arise. He is sharing this amazing experience in Israel among his closest friends, We hope he won’t let his frustration and discomfort (which we have read by text already) ruin his time. “It’s hard doing everything myself, being in charge of everything. I never get to relax.” This trip will empower him and help him realize he is able to accomplish all he sets out to do. That is what he and we want.

But dammit, he better tie his shoes on those long rugged hikes, and whenever necessary, he better wear an ACTUAL helmet…


Going the Distance

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This spring marked the 10th anniversary of the opening of the Maria Fareri Children’s Hospital. It’s a place which holds special importance to me as I have been there as a physician, a parent, and (since one of my children was born there), a patient. The hospital was built in memory of Maria Fareri, a 12 year old girl from Connecticut who succumbed to rabies, suspected from bats near her Greenwich home. Although she didn’t survive, her parents appreciated the exceptional care they received at the Westchester Medical Center, but also recognized the region’s need for a more family–centered hospital. In 2004, MFCH opened its doors, the “Disney of Hospitals” where patients are treated in child-friendly neighborhoods replete with fire-trucks, trains, and teen computer rooms. Visitors can enjoy a small baseball museum, doll collection and walk-through fish tank. It is a hospital with attractive amenities staffed by excellent clinicians: yet it is a hospital, and therefore a place that you never want to need.

Each spring, families and community members gather to walk in the “Go the Distance” fundraiser on the sprawling hospital campus. The many miracle children are there as well: from extreme-premature babies to children who have survived cancer or near-fatal accidents. When my kids were younger, I walked a few times with my double stroller.  I hadn’t returned for many years until this spring, when we joined a classmate of my older son whose accidental peanut aspiration landed him in the PICU for 7 precarious weeks.

For the years we did not walk, I felt a need to separate. Perhaps it was my hectic family life, my involvement in JDRF, or the intense familiarity of it all. Though I was incredibly grateful, so much of our family time is dedicated to medical care: 24/7 diabetes management, physician visits (at least 20 annual visits to sub-specialists…) it was the last place I wanted to be.

The first time a child of mine was hospitalized was when Leo was 4 months old. It was Christmas Day, I was on call, and he had been wheezing for several days. Despite home nebulizer treatments and steroids, he deteriorated overnight, and so I brought him with me to the hospital, had him stabilized in the ER, and went to round on my patients after Adam made arrangements for my other children and arrived to relieve me. Although it was distressing, I thought it was too early in the morning to call for help from my colleagues, and I knew he would be OK once given oxygen. I was asthmatic as a child, and I had treated hundreds of babies with respiratory viruses.  Of course, it feels different when it is your own child. I found myself  asking the pulmonologist questions like “how bad is it to have less oxygen going to the brain, even if it’s only for a short time?”, knowing full well he would be fine. I suppose it was sheer adrenaline that got me through those 24 hours until my colleagues took over. It was also helpful to have good coffee and muffins from Au Bon Pain in the hospital lobby, as well as the cooperative residents who came to my son’s room to run through the patient list and update me. What wasn’t helpful? The comment of a community physician when I called to update him on his patient and mentioned my son’s admission, he replied “well, now you know what it feels like from the other side” Really??  I was angry and hurt but in time, I knew that he meant well.

The next hospitalization was when Leo was diagnosed with diabetes and went straight to the PICU (see Diabetes Diagnosis ). It was completely unexpected and life changing. It was the first time I heard this phrase: Type 1 Diabetes is no longer a death sentence, but it is a life sentence. We spent the next week stabilizing his blood sugars, learning diabetes management, and adjusting to a new normal. There was a line out the door from visitors and hospital staff including clerks, nurses, and physicians. These were people who had worked with me for a decade.  They brought enough balloons, toys and stuffed animals for a classroom of kids. We felt loved and cared for, but I knew that my relationship with the hospital had changed forever.

Twenty months later, Ben (my middle son) was hospitalized for the dreaded swine flu. What began as cough and fever quickly developed into respiratory distress before our eyes. It was terrifying. We will never forget our panic as we watched his 6 year old body struggle to breathe like a fish out of water. Grateful to be in the hands of the PICU staff, we were relieved when he was put on a ventilator, and even more relieved when he could breathe on his own. It all happened so quickly, at baseline he was my healthiest child, and he improved over the course of a few days. My husband claims he still hasn’t recovered from this hospitalization. I still shut my eyes, shake my head and shudder when I recall that image of him struggling to breathe.  It was traumatic for both of us, and yet once he turned the corner, I was confident he would be fine.

The last hospitalization of my children was for Leo when he was 3 years old. He had a simple gastroenteritis which exacerbated his diabetic condition, and it took a few days to stabilize him in the hospital. We were relatively relaxed this time, there were no surprises, and Leo charmed the house staff by showing his independence while testing his own blood sugar and discussing the upcoming Superbowl.

Although it was a rather routine admission, I left the hospital more melancholy than ever. I thought back to the countless children with gastroenteritis whom I had treated and discharged, most of whom would never be admitted again. For hospital physicians, the pressure of discharge planning begins as soon as the physician examines the patient in the emergency room. In pediatrics, the patients and families are happy that they are healthy enough to leave, anxious to put this experience behind them. We certainly felt this way after Ben had the swine flu. A boy the same age in a neighboring town did not survive the same illness, and once again, we counted our blessings. We watched Leo grow from his initial admission, bigger and stronger before our eyes, and yet at certain times he was so fragile. I couldn’t keep him in a bubble, and yet a simple childhood illness landed him in hospital for nearly a week. Having two children with diabetes and other health issues, I knew our family was more likely than others to spend time in the hospital.

Aside from emergency room visits, we have avoided hospital admissions for the past four years, and we hope to continue this trend. As we walked in “Go the Distance”, I felt grateful for a few things: It was fulfilling to support the hospital and moreover, I was happy to join my former colleagues and update them on my family since our last “visit”. Now we were also healthy and walking. Most importantly, I was able deflect the focus away from our own pervasive medical issues and genuinely celebrate with the “miracle children” who were the Walk marshals. It reminded me of why I became a pediatrician long before I was ready to start a family: I was passionate about caring for children. It is relatively easy to admire their spirit and resilience. Working with these young patients and their families—especially the sickest and most fragile—helped me in an important way. They helped prepare and encourage me to get through my own family’s medical challenges. It is to them and the lessons they taught me that I truly express my gratitude.


Who Rescued Who?

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This is my favorite bumper sticker. I am not an animal rights activist. I have never been to an animal shelter. I am allergic to most domesticated animals with the exception of a few dog breeds. Still, I would not hesitate for a moment to discuss the merits of owning a pet. As a child, I begged my parents for years to get me a dog, and they brought one home for my tenth birthday.  As it turns out, she was a relatively unfriendly schnauzer who we couldn’t keep after she bit and drew blood from a few family members. From that point on, I needed to be satisfied with loving dogs from afar.

About a month after my older son was diagnosed with diabetes at age 9, my husband Adam suggested we get a dog. He had recently been taking the kids to the pet store to play with the puppies and saw how much they enjoyed it. My son was depressed about his diabetes diagnosis. He knew how diabetes impacted our family when his younger brother was diagnosed a few years previously. He HATED the fact that he too would have to deal with wide blood sugar swings, test his BG 12-15x daily, balance insulin dosages, and carefully monitor his already restricted GF and tree –nut free diet. A dog would bring love and distraction into our lives.

At first, I objected outright. Let’s face it; I was also depressed and angry about his diagnosis. Knowing how to manage diabetes in one child doesn’t make it any easier to have two. In fact, the responsibility increases exponentially: more details to remember, more emotions and worry, and more equipment to carry. Why on earth would we want to add a dog?

Adam acted strategically.  He brought me to the puppy store, where the woman brought out a beautiful chocolate brown whoodle (wheaten terrier and poodle, both hypoallergenic). My friend also had a whoodle, and we had spent a lot of time at their house. My son had slept over a few times and so we knew he wasn’t allergic.  As soon as I held the dark furry bundle in my arms, my face broke into an ear-splitting grin, perhaps my first genuine smile in a month. My entire body relaxed. Adam took photos of me with his phone and showed them to me daily to remind me of how happy I was while holding her. We brought Pepper home a few weeks later. Sam had expressed how a dog would make him happy, Leo begged endlessly and the timing coincided with his 3rd birthday. Ben was an animal lover so there no question how he felt.

Just to clarify, I realize we didn’t “rescue” her from the pet store, though I don’t know what happens to pet store dogs that remain unsold for 4 months. The timing was important, and we needed to know the specifics about the breed of dog we were getting. This information is not always available with a dog rescue. I knew that it would be hard, and any dog owner could appreciate this. More responsibility: feeding, walking, training, cleaning. With the exception of one or two friends, everyone thought we were CRAZY, shaking their heads in disbelief when they heard.  They were concerned that we were overwhelmed (which we were) and they were trying to protect us. Our pulmonologist (whom I have known for 25 years) was surprised that “someone who takes such meticulous medical care of her family” made this impulsive decision without consulting him. In truth, I was afraid he would discourage us, and I didn’t want any more disappointment.

Why now? A friend whose dog had recently died supported our decision, “Yes, it will be hard. But a dog can bring love and happiness into a home like nothing else can.” Over the past several years, our family had been through a lot. Although we could monitor the medical conditions (diabetes, celiac, growth hormone deficiency, food allergies), we certainly didn’t expect or welcome them.  Bringing Pepper into our home was a decision we could make. It felt good to make this choice.

We celebrate Pepper’s 4th birthday this week. There is no question as to “Who Rescued Who”. Each of us loves and is loved by Pepper in our own way. She is the first one to greet me when I enter the house and tilts her head sadly when I leave, her soulful brown eyes begging me to return soon. The boys argue over whose bed she will sleep in each night. She is a perfect combination of a coach potato when we want to relax inside, and she runs and jumps with the boys to share their excitement when they play.  Happy Birthday Pepper and thank you for the love, warmth and spirit you have brought into our home.  You were one of the best decisions we have made.   We know how lucky we are to have you.


A Hero to Me

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Nobody ever said it would be easy to raise a child. The exhausting infant and toddler years, the hectic school age years, sibling rivalry, work-life balance. Enter adolescence: the stormy hormonal swings, the autonomy issues, the escalating social and academic pressures. My oldest son is now thirteen. His plate is full with health conditions including diabetes, celiac disease, asthma, food allergies; he simply lacks room for anymore. It is so easy for me to become sad and angry after he screams at all of us and retreats to the cave in his room. I know that all teenagers do this (including him) , but right now he feels awful because his blood sugar is 400 and he is leaving in less than an hour for a Bar Mitzvah party, where there will probably not be any food he can eat. He is so tired of the power bars I send with him. After his bedroom door slams and shakes the foundation of the house, I stand downstairs, wringing my hands. I like to think about the super kid that we and the outside world often see in him: the bright, witty student, the competitive soccer player, the responsible older brother. Sometimes it helps me, but these images are fleeting because there is not much I can do to change the current situation.

On his Bar Mitzvah morning a few months ago, I had the opportunity to share my thoughts about him, to publicly recognize his strengths and celebrate the young man he is becoming. Since that special day, I have read it many times, and this does help me. It allows me recapture the atmosphere of that moment, and to recognize in my heart,  that for all of the times I see his sadness and anger surface, he is much more than that. He is the person I spoke of that morning.

“Before you were born, we didn’t know if we were having a boy or girl. We did know it would be during the Hanukkah season, and so we referred to you as Maccabi, after the brave family of brothers who fought the Syrian Greeks and re-dedicated the Temple.

From a young age you have demonstrated strength and integrity.  Your determination and inner drive is impressive, relentless and at times- exasperating. But it has served you well. In school, you are engaged and inquisitive. You always enhance the classroom experience.  You bring to your relationships a unique mix of compassion and humor:  you are a devoted and caring brother and cousin, and a loyal friend.

Becoming Bar Mitzvah is a transition to Jewish adulthood and a time to accept responsibility. You have not had it so easy up until this time in your life. We know that. We know that you face challenges that people decades older than you do not face. This has impacted you, and has often interfered with your life. But you have NEVER let it stop you. You tackle everything with passion: you may crash sometimes, but you land on your feet. That drive ..YOUR INNER DRIVE  pushes you forward.

So like the Maccabis, who scored a victory although they were far outnumbered, and Joseph in your Torah portion, who faced several obstacles  but managed to achieve so much. You  are a HERO to me. You are certainly an inspiration to many of us here today.

Mazel Tov, and may you continue to go from strength to strength. We love you.”


Coming of Age

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We are in final planning stages of Sam’s Bar Mitzvah. This milestone which represents the rite of passage to Jewish adulthood occurs when a boy turns thirteen years old. Traditionally, the Bar Mitzvah boy is called up in synagogue to read from the Torah.  It is a time when we are surrounded by our loved ones who have often travelled a long distance to share this special time. The celebration afterwards ranges from a simple luncheon to an over-the-top gala event and everything in between. People have been quite creative lately: a boat ride on the Hudson (also called the “Yacht Mitzvah”), a trip to a water park , rock-climbing, and car-racing. Regardless of which you choose, all are flooded with stress of guest lists, invites, favors, decorations and food. Ours will be a luncheon followed by a kids party with DJ and games. We are excited and anxious.

As with all milestone events, we are often struck by the juxtaposition of past events and how they affect  us as the time approaches.  I think back to my own Bat Mitzvah, how hard I worked, how excited I was, and how devastated I was when my grandmother passed away that very morning.  Thirty years later, I can still remember how I first heard the news: standing in the hallway behind my mother, who did not realize I was awake,  as she broke the news softly to someone over the phone. I was shocked and frozen with grief. As she slowly turned around I stared at her: my mother who had just lost her own mother and yet was with me, rather than at the hospital bed in Florida. My Grandma Jeannie had only been ill for a few months, but her long years of treatment for rheumatoid arthtitis had taken a toll on her heart and she deteriorated rapidly. Even so, nobody thought she would pass so quickly. Her final wish was that Grandpa Max would fly to New York for my Bat Mitzvah. He didn’t know he would never see her again.

Because my Bat Mitzvah was a Friday night service and Shabbat dinner we went ahead with our plans, and we rescheduled  the kid’s party a few months later. During the funeral that Sunday, we stood in the torrential rain, keenly aware how the skies opened up and cried for the loss of my dear grandmother .Thankfully, we were surrounded by our friends and family when we needed them the most, supporting us throughout that unforgettable weekend. To this day, I will never know how my mother and grandfather got through it, beside me the whole time. Reflecting back now, I see how my Bat Mitzvah was truly a “coming of age” experience. Although I could not process it then, this was the first time I learned that life made you take the good with the bad, the bitter with the sweet. It was the first time I needed to take a deep breath, summon all my strength, and move forward.

My Sam has had enough unpleasantness in his life, so much so that I really want him to enjoy his Bar Mitzvah. I know the important thing is that he feel prepared, confident, and proud that morning. When people have spoken to me over the years about how frazzled they become with Bar Mitzvah planning, I would think to myself “I know how bad things can get, I won’t get hung up on all the details.”  Hah. As my husband  says..the devil is in the details. I have never enjoyed entertaining or planning parties,  that is not my forte.  With Bar Mitzvah planning there are so many moving parts: the service itself, the preceding Friday night dinner, the kippot, the photos, the programs, the wardrobes, the menu, the out-of-town guests.  It is easy to become overwhelmed. Yet, I remember my promise to myself: enjoy the excitement, enjoy planning a celebration, focus on the significance of this day in Sam’s life. It’s all good.

Once again, I take a deep breath, feeling lucky that everyone is healthy , or at least status quo. That is huge. My biggest concerns are : how will Sam’s BG’s will be that morning. I don’t care so much about the number, but more about how he feels. Sometimes he feels fine when his BG’s are high, sometimes he feels so awful he wants to just crawl into bed (like last night). I am hoping that the adrenaline will boost his energy level regardless of his numbers. Also, how will their GF bagels taste since they are inedible at room temperature, will they be re-heated properly in the oven? Which leads me to the next, less important but still important..How will the centerpieces look?  Will people be happy with their seating arrangements? Will there be an early Noreaster? Will I like my hair? Let’s face it, on some level it all feels important.

15 days to go….   I’ll keep you posted…


Mid-Career Access Road

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The cover article of last week’s  New York Times magazine  “Mid-Career Time Out” (click here for article) by Judith Warner discussed the early 2000’s trend of highly educated women who left prestigious and lucrative careers in order to raise their families. Ten years later, the author discusses the challenges many of these women have faced: difficulty in work re-entry, stress on marital relationships from shifting balance of power and expectations, raising a family on a single, often reduced income due to the recession, and a change of identity and self-worth.

The article interested me because I was a full-time working mother who wanted to work less, especially after the birth my second child. Unable to reduce my hours because that would mean forfeiting our health insurance, I remained a “full-time conflicted working mother.”

My love for children had influenced my decision to become a pediatrician, and I was spending more time with my patients than with my own kids. Due to my hours, I was rarely there for pick-up or drop-off during Sam’s first year of pre-school. He was the youngest student in the school’s history to take a bus to school and back home to our babysitter. Knowing that thousands of women shared my experience  didn’t make it any less painful for me. I was sad that I was missing so much of this magical time in their lives. We made a family decision that after my third child, we would bite the bullet and I cut my work week to 3 days.

Nine months into this improved schedule (which made a huge difference in my quality of life), we found ourselves in the pediatric ICU with Leo in diabetic ketoacidosis. Type 1 Diabetes in an infant requires a degree of hypervigilance that is emotionally and physically exhausting.  Oct 1 2007 was my last day of work until I returned a few months ago. Relating it to the above mentioned article, I would call my experience a “Mid-Career Access Road” replete with potholes, construction zones, and broken traffic lights. For a while, it seemed liked more of an off-ramp, and I did not know when or if I could return to work.

Here is a list of experiences on the Access Road:

1.  Endocrinology sabbatical (still doing it)

2.  Gluten-free shopper and baker (still doing it)

3.  School lunch lady volunteer (cleaning tables and buttering sandwiches which my kids can’t eat-but I got to see them socialize during lunch)

4. Soccer mom

5. Elementary school art appreciation/history teacher (a program run by parent volunteers –don’t              worry-we had training sessions to make up for my lack of art history knowledge)

6. Fundraiser (not too shabby, our family’s team has raised over $150,000 for JDRF)

7. Lab courier (my least glamorous role, I brought a stool sample of my friend’s child to the hospital lab because it was time-sensitive and didn’t need to miss work)

8. Lobbyist (see MDmommy goes to Washington http://mdmommy.com/?p=447)

9. Class mom

10. Board Member (for JDRF and my children’s camp)

11. Mommy blogger

The silver lining is that I was able to be more present in my children’s lives than I initially thought I would. I am grateful for this. Make no mistake about it, I would have given up all these experiences in a heartbeat if it meant my children wouldn’t have to live with their health conditions. I have learned over time that we lack control over when and which challenges confront us. We do control how we react and what we do when they occur.

Not all women have control over their decision to opt-out of the work force. Certainly, no one can foresee all the sequelae of their decisions.

I am merging from the access road back onto the highway. Although the roadwork has followed me, I have become a better navigator. For all the times I may have asked “WHY” or said “ENOUGH”, the obstacle-ridden access road has prepared me for re-entry into my pediatric career.


Another Painful Anniversary

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“If another child of mine were to develop diabetes, I will no longer be a nice person.” I said this many times in the months and years after Leo was diagnosed with Type 1 shortly after his first birthday. I suppose this was part fear and part warning. This weekend marks the 3rd anniversary of my 12 year old son’s diabetes diagnosis.

It was an uncomfortably hot and humid day in early July, not unlike how it feels today. I was driving a carpool of six boys to camp. Since I was running late, I asked Sam to help me out by checking Leo’s blood sugar. After impressing his friends by checking him, he announced he was going to check himself. I told him not to do this. It was annoying and unnecessary, and it wasted more test strips which would ultimately end up on the seats of my already messy car. He checked anyway and said, “Mom, I’m 400.” Just like that. I felt my stomach sink, and somehow managed to calmly say “wash off your hands with your water bottle, maybe it’s the sunscreen. No such luck. “Ok mom, it’s 390, I’m coming down.”

It was so far from “okay”, this BG was quadruple that of a healthy nine year old boy. Sam had not been having a great summer. He had started nightly shots for Growth Hormone (GH) deficiency nine days before this. Three days later he had a head injury on a boat (the camp’s first emergency on opening day) and ended up with 30 stitches above his eyebrow. Who knows if either of these things triggered the diabetes?  I didn’t have time to think.  At the moment, I needed to remain calm during the last five minutes of the slow,bumpy road  into the camp parking lot. I drop-kicked the kids from the car and brought Sam and Leo with me to the water cooler outside of the main building. I washed off my hands, checked my own BG, hoping it was a problem with the meter. No, my BG was perfectly in range.

I called my husband Adam, who, just like me, was hoping it was a temporary side effect of the GH. The endocrinologist, sensing the panic in my voice, advised me to check his urine for ketones before deciding the next step. We went home, checked for ketones (he had none) and that’s when she told me what I feared. With numbers that high, it had to be Type 1, not just insulin resistance from the GH. Speaking to her from my bedroom, Adam remembers me slapping and digging my nails into my thighs until they were red and raw. It was the only way I could unleash my anger. Adam told Sam we needed to go, at which point he cried “I don’t want to have diabetes.” I hugged him, held back my tears , and I put  some  numbing EMLA cream to his arms for the impending blood draws.

Routine provides comfort. The car practically drove itself to the diabetes center at Columbia. The parking lot attendants knew us well and welcomed us, and we made a beeline for the registration table on the second floor. The whole staff greeted us, and we were grateful for the hospitality and familiarity. That was the only positive feeling we experienced all day. When Leo was diagnosed almost 3 years prior, I was shocked and overwhelmed. Now I was only seething with anger. When the diabetes nurse educator said “well, there are worse things” I shot her a look, eyes like daggers and replied “don’t  say that to me.” I let Adam call my mom and sisters-I didn’t want to hear their reactions. I saved my frustration for Janet, my friend who is also the mom of a diabetic and celiac son. She always answered her phone. But this time, she was in the basement of Target with bad cell service and didn’t return my call for hours.

How was Sam? He was miserable. Just like us, he knew that diabetes was an awful disease which had already altered the structure of our family life. It was difficult to comfort him. I myself had trouble with the onslaught of “well-intentioned but unhelpful comments” from friends in our community.  Well. you’re the experts now. At least you know what to do. At least you are a pediatrician.  I restrained myself from screaming “Why can’t you just say that sucks?”

We had some important decisions we needed to make immediately. Sometimes it’s good when life forces you to forge ahead, placing one foot in front of the other. One month from date of his diagnosis, I was planning to take my older two boys to Israel for my nephew’s Bar Mitzvah. We had been looking forward to this trip with my family for years.  How hard would it be to take a newly diagnosed diabetic and celiac, tree-nut allergic child to a foreign country? I had visions of dehydration in the desert heat of Masada. In the end, we did it. It was challenging, harder than I imagined, but we wanted Sam to get the message that diabetes should never hold him back from anything he wanted to do. The same went for his soccer. He had just made a new travel team in a neighboring town. The coach was also a podiatrist, a specialty all too familiar with diabetes, and he encouraged Sam to play right away starting from the day  after he was diagnosed. I will always be grateful for the enthusiastic support of his team.

Am I still a nice person?  I like to think so. But for those of you who have kindly commented  on my positive energy and grace, you should know that it has been a work in progress.  In between fingersticks, phone calls, and mood swings affected by extreme blood sugars and puberty, I work hard to focus on the snapshots of my kids which make me smile. That way, when people ask me,” How are you, and how are the kids?”  I can answer “they’re doing great.”