Jul 31 2023

New Beginnings

Posted on by

I recently started a new pediatric position about 25 miles north of my home. The opportunity to help grow the pediatric section of a multi-specialty practice in a more rural area was a welcome change to the frenzied pace at which I had been seeing patients.  While it was difficult to leave my wonderful staff, colleagues, and patients, the move allowed me to spend more time with each of my families. I know that I am certainly not alone in my physician experience of staffing shortages, overbooked scheduling, and increasing documentation requirements, all of which became worse in the wake of the Covid pandemic. But I was beginning to feel that I couldn’t be the pediatrician I wanted to be when feeling rushed. With the heightened anxiety my patients needed more time, not less. My frustration led me to consider pivoting to non-clinical work until I realized that I enjoyed working with families and was not quite ready to give that up!

So, after months of onboarding and wrapping up issues at my former office.  I officially joined my new practice on July 1 exactly 25 years after completing my residency.

My first week was spent orienting to the new system, and I saw my first patient two weeks ago: a toddler with a few days of fever and congestion. As I walked into the exam room, I noticed the mother wore a Dexcom sensor on her upper left arm. The Dexcom, a continuous glucose monitor, has been the biggest game changer in the lives of Sam and Leo. This device inserts into their skin and is replaced every 10 days and updates their BG every 5 minutes and transmits the data to our phone. The Dexcom not only eliminates the 10-15 daily finger sticks but keeps us all aware of their BG’s wherever they are, even halfway across the world. So, after diagnosing my patient’s ear infection, I shared with the mother that my 2 sons also have Dexcoms. She told me her daughter had been so fussy the previous night that she actually checked her BG, out of fear that this could be the onset of diabetes. Thankfully, the girl’s BG was well within normal range, but the mother appeared so relieved that I appreciated her level of concern. I was also relieved that as a new doctor in the community, I was able to feel a connection with her. The ear infection was a simple medical diagnosis, but my familiarity with diabetes and the emotions of a parent’s concern about this chronic diagnosis was something that came from the experience of my own children.

I think back to 10 years ago when I re-entered pediatrics after my “endocrine sabbatical” when I was caring for Leo and Sam’s diabetes before the school nurse could take over. We are all in different stages now. Sam graduated college in May and will be starting to work in NYC in business consulting after he returns from a summer in Israel. Ben is taking classes and doing some research as he prepares to return to his senior year in college. Leo is working as a counselor in a local day camp. I still marvel at his independence. 10 years ago, day camps were not equipped to handle young diabetic children, and the only way for him to attend camp was if a caregiver was able to monitor and treat him. I vividly recall sitting on the side of the soccer field in the sweltering sun to watch him play, checking his BG every 2 hours, and treating his highs and lows as they occured. Now he drives himself and is responsible for his own campers.

This past decade has seen my family and me go through many challenges and changes. I look forward to this new step in my career and appreciate that my children’s independence has given me the ability to explore!

Mar 27 2022

An Auspicious Photo

Posted on by

Last week Leo returned from a trip to Israel with his ninth-grade class.  His school always sends the 8th graders on a 2-week B’nei Mitzvah trip which was delayed due to Covid. Now, if you had told me 14 years ago that Leo would be going on this trip without a parent, I would have had a hard time believing it. His diabetes caused such erratic and unpredictable blood sugar swings that he couldn’t go to a playdate unaccompanied by a trained caregiver until he was in third grade.

Sometimes a photo triggers such emotion, it stops you in your tracks and takes your breath away. This photo of Leo atop Masada with his friends did just that. But it wasn’t only the natural beauty: it represented hope and resilience.

Managing diabetes and asthma while on a gluten-free, nut-free diet is quite challenging. Add that to Covid risks and testing protocols, and it seemed formidable. At the very least, it required him to independently and accurately draw insulin up from a vial, change his insulin pump site by self-inserting a catheter in his buttocks, and self-inserting a continuous glucose monitor (CGM) into his stomach. The amazing advantage to the CGM is that we can track him via an app so we can notify him about dangerous blood sugars while he sleeps. While he had been at sleepaway camp for years, I was always there for the first week as a camp doc so I could train the staff.

 Part of our fear was based on his older brother Sam’s experience on his own 8th grade trip, when he became sick while he was there and hospitalized upon return. Although there were several other contributing factors , diabetes complicated everything. Thankfully, Sam regained confidence and was able to return a few times since then, including this past summer when he successfully completed an internship in Tel Aviv.

I remain stunned and grateful that Leo’s trip went so well!  Careful preparation was key for his long-awaited first experience in Israel. We ordered, gathered, and packed his supplies in separate areas for both ease and safety. Insulin pens, epi-pens, and asthma inhalers could withstand room temperature, while Growth Hormone and Insulin vials required refrigeration.  And we couldn’t forget the small plastic juice bottle we re-purposed as a sharps box! I was not, however, expecting the last-minute heated argument with the insurance company which delayed the approval of his increased insulin requirements by a week (nearly prompting a post titled “Why I Almost Cried in CVS this Morning”). There were, as expected, some difficult times such as frustration and discomfort related to high blood sugars and limited “safe” food options. There were a few rough nights where he was sleeping through our phone calls, once prompting us to call and awaken a chaperone in the middle of the night to knock on his door. Once awake, he knew to give more insulin or treat a low BG.

But back to the photo. Masada is an ancient fortress in the desert which has been a symbol of Jewish heroism, the last stand against the Romans after the Fall of Jerusalem. It is one of Israel’s most famous tourist destinations, for both historic significance and natural beauty.  Ironically, the summer after summer after his difficult trip, Sam played soccer for the Maccabee Games won a free trip to Israel by answering a question about Masada during an afternoon trivia game!

This candid photo at Masada appeared in my inbox in the middle of a busy workday. Someone had seen it uploaded to the school website. I was struck by its beauty, then flashbacked to the time of Leo’s diagnosis and the challenging, agonizing years which followed, and finally to this auspicious moment.  My brave boy, determined to have this experience half a world away from us, in this very special spot.

Next stop, Valencia Spain with his soccer team. Stay tuned.

May 10 2021

MDmommy in the Time of Corona

Posted on by

It has been a long 15 months. As a pediatrician in New Rochelle, mother to children with chronic health conditions, and daughter of parents initially reluctant to accept their own susceptibility, it has taken a while to process and reflect on the covid-19 pandemic.
The overwhelming sense of vulnerability and uncertainty was the hardest part in the early days, when everything unfolded in real time. Shortly after treating a young girl with an ear infection, I learned that she and her family had attended what was later to be known as a “super-spreader event” which put our epicenter of New Rochelle on the global map. Two days later, The Department of Health set up shop downstairs in our office building, secured by National Guard, making it difficult and somewhat intimidating to continue seeing our patients. Tensions ran high as we were committed to staying opened, which we did, we did not shut down for even one day throughout the pandemic! We adapted by scheduling different hours to separate well care and sick patients, offering telehealth visits, wearing PPE once we had them, and had bi-weekly zoom conferences with our head of Infectious Disease.
On the home front, Sam left his freshman college dorm room intact and flew home from Atlanta for his spring break, having no idea he would be told the following week that campus would not re-open until late August. Because he had diabetes and asthma we didn’t want him to fly round trip to pack up his room once the country went into lockdown. Fortunately, a good friend of mine who lives in Georgia cleared out his room, sent most to storage and the remainder home. Ben returned 3 weeks early from his long-awaited senior trip to Israel-Poland. Leo stayed home and learned remotely, happy to see his brothers but sad, among other things that soccer was cancelled, and that his best friend’s Bar Mitzvah was changed to a weekday zoom just a few days before the event.
I enjoyed having a full house a few months earlier than expected, and of course our dog Pepper was thrilled. Like everyone else, we took things one day at time, navigating food delivery and adjusting to the world of Zoom. The more serious issues were our concern for loved ones who lived far away, convincing our at-risk family members to remain hyper-vigilant, and trying to absorb the enormity of the expected mortality we feared while hearing news from Asia, then Europe. Within weeks, we knew the devastating losses that many families would face. My dear Uncle Lou passed away at the onset of Covid from unrelated health conditions, which my mother and cousins felt was a blessing because he would have hated the isolation. Within the coming months, several of my close friends lost their parents, and others waited anxiously as their friends/relatives recovered. We were lucky that our family remained healthy, and we made the most of our yards for the many birthday and graduation celebrations.
Workwise, while I knew we were essential as primary care doctors, I didn’t particularly feel like a health care hero. I wasn’t front-line in an ED or ICU setting. Sure, I was nervous about bringing Covid home to my family, since many of the patients’ parents were essential/front-line workers themselves. But our exposure was in a more controlled environment. The stress for hospital workers was unimaginable and took a terrible toll, both physically and emotionally. I was grateful to reconnect with friends from med school and residency in various specialties and time zones, via group chats and zoom. We shared best practices, but also supported each other, as we had done in our “pre-pandemic trenches.” But, I must say, I also felt a strong kinship with mothers everywhere, balancing home, work, and family during this incredibly difficult year. Covid is not over yet, and we will be feeling the ripple effects for a long time, but with many people vaccinated and spending more time outside, we’re getting there. Happy Mother’s Day, looking forward to bright year ahead!

Mar 11 2020

Skier’s Dilemma

Posted on by

Since I was a young girl, skiing has been my favorite activity. Our family started off skiing at my uncle’s house in Vermont, then we drove farther north to Canada for the guarantee of better snow and good exchange rates. My mom shared her love of skiing with me, and so when I was most stressed out during finals time in college and med school, she would say “I know it’s so hard right now…but you’ll get through this week. Close your eyes… and think about skiing.”  And it worked. From my cramped room or the crowded library, I would daydream about skiing. Somehow, the cold didn’t bother me nearly as much as it does now (or more likely, my parents wouldn’t allow us to complain as much as our children do).

Shortly after my second child was born, my parents bought a condo in Bromley Village, near Manchester Vermont. It has grown to be an indispensable part of our family’s world. Initially, I thought how great it would be that my children would ski consistently at such young ages and that they would become phenomenal skiers, much better than my sisters and me.

Then reality set in. Getting children dressed and out the door for skiing is brutal, particularly for children who have tactile sensitivities and want their gloves tucked into their jackets “just so” and, by the way, it’s impossible to find seamless ski socks. But we did it, sweating buckets, cursing, and hoping that it would pay off when they actually started to enjoy it.  And once they did, it was fun, even if there was a disproportionate ratio of work to fun. Honestly, the days we didn’t ski for whatever reason –moody boys, weather, etc., was ok with me. In some ways, a no ski day was a win as well: Less complaining, fewer ski injuries, not to mention less expensive, especially for the days when they would want to quit after a few runs because it was too cold.

After diabetes, skiing became incredibly challenging.

-insulin pumps are incompatible with ski bibs and most ski clothing

-cold weather requires a different candy/drink supply to treat low blood sugars. Juice packs, skittles, starbursts’ will freeze

– the glucometer will MALFUNCTION because it is too cold; need to go into lodge to warm it up

-once the glucometer has warmed up to work again, your child will have a meltdown because he can’t have a hot chocolate with a BG of 400, and the sugar-free hot cocoa is “awful”

-until recently, difficult to find GF food in the lodge

So, the skier’s dilemma: Why ski?  Now that my kids have grown into teenagers, it has been way more fun, and I enjoy every minute. The best days are when I can ski with my sister and their kids, and my parents will often snowshoe from the condo to meet us on the mountain. I am content with the fact that my children LOVE to ski, and still ski with me. Hands down, it’s the best family activity I can think of.

Why ski? After all, our family could certainly have done without the broken arm, finger, and, most seriously, my mom’s traumatic brain injury.

               -It can be exhilarating, breathtakingly beautiful, fun, and liberating

               -enjoying the break from our phones and other technology

               -many different chairlift groupings leading to spontaneous conversations

Although, I must admit, during my periods of greatest stress, I no longer think of skiing, I think of the beach…

Aug 1 2019

An Auspicious Season

Posted on by

So, are you excited for Sam to start college? I was finishing up my week as camp doc at my youngest son’s sleepaway camp when the camp director asked me this question, rather off-handedly. It sent a jolt through my body. In the past few weeks, I had celebrated my milestone 50th birthday and watched my oldest son Sam graduate high school. My summer would include preparation for his college launch, helping my rising senior Ben with his college applications and also planning Leo’s upcoming Bar Mitzvah in October.  All good things, I know, but these life events entail a remarkable amount of effort and emotion.

Being a camp doctor carries enormous responsibility and I am always happy to drive away after I have done my part to keep the campers and staff healthy. But now, there was no time for procrastination.  I had my work cut out for me.  When she asked me this question,  I felt a sense of overwhelming mix of nervous anticipation and nostalgia,  The thought bubble above my head asked “AM I SUPPOSED TO BE EXCITED?”

My loyal readers, you have shared my journey over the past 8 years, shortly after Sam was diagnosed with T1D at age 9. You have supported me as we navigated through his pre-teen and high school years which were complicated by medical challenges.  And here we are, less than a month before he leaves for college. I am so proud of what he has accomplished.  Sam will be attending Emory University in Atlanta which, yes, involves a flight but at least we share a time zone.

We had a trial run of his independence when he spent 2 months on a senior school trip to Poland and Israel, for which packed a small pharmacy and a lot of snacks free of gluten, flax, and nuts. We were all concerned because he became very sick on his 8th grade trip to Israel.  But luck was on his side, and he managed to have a wonderful and relatively healthy time, showing that he  (and we as parents ) could survive his travel in foreign countries with a busy agenda and little sleep. Of course, college will be different than a school trip. There will huge adjustment to new friendships, academic challenges, and independent living.  He knows that diabetes will inevitably throw curveballs,  altering his daily schedule for unexpected site and monitor changes, meal times,  efficient study times, even sleep ( due to a fear of sleeping through a low BG which is very dangerous). We can help him with his supplies, provided he lets us know when his supplies run low, which is not as automatic as it seems. We can also monitor his blood sugars from an app on our phones, but that only helps if he answers our calls or texts. Should we even be doing this, just because we have the technologic capability? After all, he is 18, and responsible up until a point.  These are tough questions.

And how am I preparing for this college launch? I have gone straight into planning mode, as this only a portion of tasks I need to accomplish this summer. I can distribute my stress between my work as a pediatrician, the college launch, the college search and applications, and the Bar Mitzvah. This way, no portion can become all-consuming.

I also learned last month that no amount of planning can prepare me for my emotions on move-in day. The sight of Sam in his cap and gown as he walked down the aisle at graduation rendered me speechless for the first time…ever.  Therefore, I will tackle our to-do list, enjoy our last few weeks together.  When I feel the lump in my throat as I hug him good-bye at Raoul Hall on Emory’s beautiful campus,   I will try to remember something I read along the way. As difficult as this is for us parents, this really is one of our finer moments. It’s now Sunday at 11:30 am, and I am about to wake Sam to finally start dorm shopping. So good luck to us as we head to Bed and Bath…and then of course, beyond.

Dec 9 2018

Decisions, decisions.

Posted on by

Senior year, fall semester for Sam, my oldest son. He is a serious student applying to selective colleges, and he is anxiously awaiting the decisions he will hear within the next few days. The college process started over a year ago and accelerated to maximum intensity by the end of October. I had read the books, watched friends, family and even patients go through it, but it’s a grueling and stressful time no matter how well you prepare, no matter how much you try to convince yourself to stay level-headed. As much as this is HIS preparation for HIS future, it is easy to see how it becomes a family group project.

As a mother of a child with chronic health conditions, I have my own fears. Of course, I have opinions about proximity (preferably within a 5-hour drive), size and style of school.  By end of junior year, the high school transcript and most testing is done, which leaves the summer and fall for students to write the essays. This was the most emotional part for me. It made sense that for his main (common app) essay, he would write about having diabetes. Not in a “pity me” way, of course, but how his many health challenges have helped him develop the fortitude to excel. He brainstormed and worked with his counselors to draft the essay. I was irritated that he was strongly advised to downplay the difficulties of living with diabetes, instead of just showing how it empowered him. We deferred to the recommendations of his experienced advisors, but I felt they weren’t getting the complete story. Forgetting the inherent physical dangers and symptoms of T1D, just the time and effort it takes is enormous, much more than his most time-consuming extra-curricular commitments. Micro-managing whatever he eats with the appropriate insulin dosage, and treating erratic blood sugars influenced by everything under the sun: weather, activity level, asthma medication, insulin pump site atrophy. Or the many nights when his blood sugar is too high for him to focus on studying, losing crucial hours (8-11pm). Of course, it is inappropriate and even detrimental to include or even allude to this, and yet it is all true.

“Everybody has something, trust me they have HEARD IT ALL before.” Many students have had more challenges. There are cancer survivors and children who have been destitute and homeless, and worse. I get it. Nevertheless, I was frustrated, even angry.   Why? Sam had an awful lot on his plate, and while this alone shouldn’t assure admission to a certain college, his ability to excel in school and contribute to his community is impressive.   Not even a sentence or two to just to describe how bad it can be, just so the admissions officers understand?  I even had a friend tell me “You’re lucky your kids have diabetes, they will have something to write about on college applications.” WHAT??!!

I called my friend Rebecca, an internist who knows my kids well and understands T1D.  She listened to me rant and replied softly “but look at how Sam has grown, his strength and determination.”

“I know, but that’s intangible.”

“I know, Deb. It will always be intangible, and it will always suck.”

She was right. Regardless of how the admissions committee received his essays, no one could ever take away his grit.

And that had to be enough for me. I had to put aside my bitterness about his health challenges, the days, nights and years I have spent worrying and managing his health and ensuring he had ample food which was safe for him to eat, and enough unexpired epi-pens, inhalers, and insulin. Clearly, my emotions were strongly tied to this known fact of letting go: within the year he would be taking responsibility for this. The reality is overwhelming.

So, applications are in, and we are in this limbo period of waiting, during which I have been reflecting on it all and supporting Sam while he braces himself for the decisions to arrive in his inbox. Most importantly, I think he will be all right, despite my inner angst. He is practical, he recognizes life is unfair, he is not unaccustomed to hearing bad news.  His yearbook quote by Joe Namath (he is an avid Jets fan)  reads “How you recover from what life’s throwing at you is what matters.”

That’s a great mantra or a prompt for another essay…We’ll know soon enough

Dec 23 2017

Thanksgiving 2017

Posted on by

Thanksgiving 2017 included many things for which I was grateful, but also an unwelcome reminder.

We always join our family at my parent’s home, on the small cul-de-sac in Suffern, New York where I grew up. There are 18 of us: my parents, my two sisters and me with our families,   including ten grandchildren. This year was especially significant since my dad was celebrating his 80th birthday, and also because my sister Alyse had just moved to Florida with her family, and we knew it would be a while before all 18 of us were together again.

We headed out to Suffern early afternoon with our dog Pepper and our gluten-free, dairy-free, nut-free, flax-free pumpkin pies. The boys had changed their insulin pump sites (catheter inserted and changed every 2-3 days) that morning specifically so that they would be fresh and working most effectively for the feast we would have later on.

On the way there I was thinking about a few other things. This Fall also marked our 10th anniversary of having diabetes in our family, which easily ranked third on our life-altering list after marriage and children. On Thanksgiving ten years ago, diabetes was our only focus. That weekend had also coincided with my 20 year high school reunion. I had missed my 10 year, and I was looking forward to seeing people I hadn’t seen in two decades. But also nervous. While I had been looking forward to sharing news about my “happily-married-doctor-with-children-life,” diabetes turned everything upside down. Parenting took on a whole new set of challenges.  I was filled with anguish and apprehension for how my son would grow, and how we would manage.

So when I turned around in the car and saw Leo’s cherubic face and mischevious expression as he tormented his teenage brothers, I smiled. In his 5th grade he was a superstar; fun-loving, smart, charming and kind.  Although his blood sugar fluctuated as much as ever, he was quite independent, giving us more freedom and confidence. In these 10 long years, we had come a long way.

We arrived in Suffern and enjoyed reuniting with my family. The kids alternated between playing in the yard and watching football inside. Until the alarm started beeping that Leo’s blood sugar was high He gave more insulin, but his body wasn’t responding. We hoped that perhaps it was higher because he had been sneaking some food. But within a short time, it was high-too high to actually register a number, despite all the extra insulin. Usually when this happened,  it meant he needed a site change, but we had just done this a few hours before. We should have had the insulin pen as a back-up, which I have them carry in camp or on vacation.  But we just didn’t have it with us that day.  Normally the life of the party, Leo lay on the couch, feeling miserable and nauseated. Dinner was just about to start.  We didn’t want to go back home, but we also didn’t want to end up in the emergency room. All I had with me were the syringes I had been using to give allergy shots to my other son, but they were different units of measurement, and so I reached the endocrinologist on call for instructions (a few units off could be a lethal dose), had my older son  Sam  draw it up from the insulin in  his own  pump, and gave it to Leo. It took hours to come down to a good level, during which we wrapped up his marshmallow-coated sweet potatoes and other special Thanksgiving treats for him to eat the following day.

This setback felt like a slap in the face, an unwelcome splash of freezing cold water. Initially I berated myself for not having brought the back-up pen or site change, but even with those, it would have taken a long time for his body to respond. It was just as unexpected as what happened at his friend’s sleepover party a month before, when his blood sugar kept dropping during the night, and I drove over at 3 am to stabilize him. These were the ugly reminders of the danger and unpredictability of diabetes.

But what have I learned over these ten years? The importance of bouncing back, and trying to heed my own advice about staying optimistic. When there is a reason to be happy, Be Happy. Period. (http://mdmommy.com/?m=201211). It was hard to be happy that Thanksgiving night. But the following day, after returning from work early to get ready for my 30 year high school reunion, my kids were genuinely glad to see me and laugh with me about my anticipation. And once alone on the 45 minute drive to the reunion (we all decided to go without spouses), I reflected on the frustrating past 24 hours, and our collective ability to be resourceful, and to bounce back. And at the reunion, I kept my promise to myself to not speak about diabetes, or else address in the briefest way if people asked me about it. A decade later, it was not my only focus.

Apr 23 2017

The Disney Dilemma

Posted on by

We all have moments when we are faced with the trade-off of good parenting versus family convenience. I was recently reminded of this when a colleague of mine was dreading her upcoming family trip to Disneyworld. Despite her detailed plans for the most useful Fast-Pass packages and the closest Disney Property lodging, she knew it would not be easy for her husband and her 2 young, rambunctious sons. She told me about her scheme to increase her child’s ADHD medication and pack many bribery snacks  in order to avoid major melt-downs while waiting for the rides.P1030692

Now, I know I am not alone in saying that Disney can sometimes be less than magical, and more of a necessary evil.

This brought me back to our recent trip to Disney, when my parents took my sisters’ and our families to Orlando for their 50th Anniversary two years ago. It was a wonderful trip, but as always, food presented a big challenge for us.  It was even harder this time because it was during Passover. We packed plenty of gluten-free food, and tried our best to keep kosher for the 8-day holiday.

My sister Jodi and I knew that we couldn’t coordinate the entire day together in the Magic Kingdom, due to different ages of the 7 kids. But we planned to finish the day at ROLLING THUNDER, their favorite ride. We managed to meet up a bit later than planned because my 10 year old nephew went “missing“ for a terrifying 28  minutes after going to the bathroom in Adventureland.  As we preparing for 6 of to go on the ride, a furious argument erupted between Leo and Ben, my two younger children. I don’t remember what caused the argument: we were all hot and exhausted. P1030711It may have had something to do with an ice-pop, but I could be mistaken, I am sure Leo’s blood sugar was high, since we had been detaching his insulin pump for the wet rides, and he was irritable.   I just remember it was loud, embarrassing, and physical.  I said  “That’s it-you are NOT coming on this ride with us” He was fuming when I left him with my sister and baby niece.

We had planned to use our Diabetes Passes, which at that time worked like a fast pass that allowed one diabetic person to bring two other passengers with them. While this may seem unfair to others with chronic conditions who don’t get special treatment, our family viewed it as one of the only perks of having this disease. So we went to our line, showed photo passes, at which point the attendants asked where Leo was. Clearly, we couldn’t use the Diabetes pass without him, and Sam’s pass wasn’t enough to get all the cousins on the ride. OOPS. I sheepishly mumbled “Uhh. He’s over there….bad behavior” The attendants glanced at each other and said “We heard. Well, he needs to ride if you want to use the pass.”  Adam and I looked at each other, knowing what was at stake. This was the fun roller coaster finale, and we didn’t want to ruin it for everyone. In a moment of weakness,  we told Leo to join us. So much for setting limits and teachable moments…

Disneyworld is magical, fun, and friendly. It can also be frustrating and anxiety –producing. My best advice to my colleague: Have as much fun as possible, expect many stressful situations, and remember that even the worst moments, in time, will be funny as well.

I’ll let you know how that worked out for her…

Jul 10 2016

MDMommy Goes to Reunion

Posted on by

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…

Mar 6 2016

Flax is a four letter word…

Posted on by

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.