Friday, November 30, 2018

Holiday safety checklist 2018

Holiday safety checklist

Have you thought of everything?
The lights are twinkling and the radios are playing the holiday tunes. People are putting up the holiday decorations. It is time for the holiday safety post.

For most people, holidays are a time for celebration. That means more cooking, home decorating, entertaining, and an increased risk of fire and accidents.

Call me a Debbie Downer if you must, but the mind of an advice nurse is a skewed one. For every aspect of holiday celebrations, I can tell you the story of a patient who called with a related accident. It is not my intent to scare folks with my tales. As I tell parents who attend my safety class, if you know ahead of time what accidents can happen, you have a way better chance of avoiding them.

Baking cookies is just one example. A patient's mom called to tell me that her 10 month old had sustained a burn on his hand. She was holding him in the crook of one arm as she removed the cookie sheets from the oven. As she recounted, he turned into a cartoon character with a telescoping reach and he was able to stretch across her body and grab a hold of the piping hot tray. Simple solution: don't hold your child when you are working with hot stuff in the kitchen. Their arms are longer than you think. If even one accident has been prevented, this post was worth it.

Candles are another hazard. It was a winter evening several years ago in a cabin at Lake Tahoe. Dr. Jessica and family lit some holiday candles and went to sleep. Somehow one of the candles ended up burning a hole through a plastic mat that was on the table. Luckily the smell of burning plastic woke them up before any real damage was done, but it was a frightening lesson. This was a vacation rental. In this instance there seemed to be no working smoke detector. She had no idea if and where there was a fire extinguisher. There are several obvious lessons here. Never go to sleep with candles or a fireplace still burning. Get acquainted with the safety features of any place your family is staying.  
Below are some safety considerations for dealing with the holiday season ahead. Some of these may seem like common sense but there might be a few tidbits in here that I am betting you haven't thought about.

Beware of button batteries. They are everywhere nowadays in all sorts of small electronics (and musical cards) and can be quite hazardous if swallowed. Take time in advance to do a mental inventory of items that you have around that may be powered by these. Put a piece of duct tape over the battery compartments to make sure they can't fall out.

Certain holiday plants like poinsettias can be mildly toxic (especially to someone with a latex allergy). You may not have them in your own house, but if you are visiting a friend or even a supermarket make sure little hands don't grab the pretty red leaves and put them in their mouths.

Be very careful transporting hot food to a holiday potluck. I have patients who have been burned from hot food spilling on them in a car.

We had a tragedy last year. An eight year old healthy dog got into a wrapped package that was filled with chocolate. The amount ingested proved to be too toxic for this little dog to handle and they didn't make it. Please don't let this happen to you. Make sure that any mystery packages are nowhere near where a pet can get to them.

Christmas tree checklist:

  • When purchasing a live tree, check for freshness. A fresh tree is less of a fire hazard
  • Cut 1-2 inches from the base of the trunk immediately before placing the tree in the stand and filling with water to ensure absorption. Don’t add chemicals that might be toxic to kids or pets. A dash of plain 7 up can help keep the tree healthy.
  • check the water level daily to avoid the tree drying out
  • When purchasing an artificial tree, look for the label "Fire Resistant"
  • Never use electric lights on a metallic tree. The tree can become charged with electricity from faulty lights and a person touching a branch could be electrocuted.
  • Place your tree at least 3 feet away from all heat sources, including fireplaces, radiators and space heaters
  • Make sure the tree is steady enough that it can't be pulled over by a toddler. You may need to fasten it to something solid. Trust me, trees get knocked or pulled over. Older kids running around can cause this issue, it isn’t just toddlers.
  • Trim your tree with non-combustible or flame resistant materials.
  • Before using lights outdoors, check labels to make sure they have been certified for outdoor use.
  • Make sure all bulbs work and that there are no frayed wires, broken sockets or loose connections.
  • Plug all outdoor electric decorations into circuits with ground-fault circuit interrupters to avoid potential shocks.
  • Strings of lights and garlands are a staple of holiday decorating, but they can also pose a strangulation hazard.
  • Avoid trimming the tree with things that look like candy which may pose a temptation to the kids.
  • Keep sharp, glass or breakable ornaments out of reach of small children.
  • Holly berries and other small decorations can be choking hazards.
  • Don't overload extension cords; make sure that your extension cords are high quality.
  • If you are going to use your fireplace, make sure that you have the chimney checked and cleaned if it has been awhile since you built your last fire. (make sure that it isn’t a spare the air day)
  • Nurse Lainey actually has TWO trees. One has the beautiful hand crafted glass ornaments. That one is OFF limits. Her other tree in the tv room where people hang out is kid and pet safe.

This is not a safety issue, but it is worth mentioning:
Is your child exhibiting any new allergy symptoms? Take a minute to consider whether or not they started during the holiday season. Trees, scented candles and other seasonal extras can trigger some allergies.

Hanukkah doesn’t fall on the same date every year since it is based on a lunar calendar. Many folks laughingly refer to it as coming either “early or late”. It also has more spelling variations than any other holiday. This season it is on the early side and the first candle will be lit on the evening of December 2nd.

  • Make sure that all candles are safely out of harm's way
  • the menorah should be on a glass tray or aluminum foil
  • Make sure candles are not close to wrapping paper
  • Don't go to sleep with candles still burning
  • Don't leave the matches or lighters hanging around
  • If you are frying latkes (fried potato pancakes that are a holiday tradition, yum) make sure that no one gets splattered by oil
  • Never leave the hot oil unattended

Remember that adding water to a grease fire will make it worse! Baking soda is okay, but a fire extinguisher is best. Make sure you know where it is and how to use it.

Kwanzaa may be the safest of the holidays, (no hot oil or stressing the electrical outlets) but there are still candles involved, so make sure they are placed in a safe place and toddlers don't have access.

If I missed any holidays, let me know! I will add them to this post in the future.

This is a great time to test your smoke alarms and carbon monoxide detectors!!!

Stay safe and have a wonderful holiday season.

Friday, November 23, 2018

Assessing the impact of the recent smoke exposure

Assessing the impact of the recent smoke exposure
Everyone living in the Bay Area or anyplace within 100 miles of the recent fires has been exposed to unprecedented poor air these past couple of weeks.

Aside from dealing with the tight lungs, burning eyes, sore throats and stir crazy kids and pets, families are worried about potential lasting impact that this might have on their children’s health.
Chronic exposure to pollution can lead to issues with our hearts, our bones, and our lungs among other things. There are some anxiety provoking studies out there suggest that a fetus is not immune even though they are not directly breathing the air. I tend not to let different studies cause too much of a stir. Studies on things that we have no control over can get people spinning. One headline this week claimed that exposure to this unhealthy air was the equivalent of smoking 10 cigarettes. Gee, thanks for that extra dose of terror. Of course we would have had to have been outside, without a mask for an extended period of time to be affected like that.

Please keep in mind:

Millions of people live in large cities where this terrible air is the norm. Here in Northern California, we only had to deal with it for just a few weeks. I imagine that we all breathed some nasty air, but hopefully most of us were able to limit our outdoor exposure.

Assuming that the air quality index is no longer in the red zone, take a deep breath and prepare to review an important life lesson;
my mom had a saying that she would repeat frequently “It is what it is. You do the best you can.”

There are some things that are within our control and some things that are not. We need to be able to identify which is which

Lets focus on things that are in our control.

  • Being kind
  • Being honest
  • Friends we choose
  • Taking care of ourselves
  • Working hard
  • Apologizing
  • Asking for help
  • How we respond to others
  • What we do in our free time

Things Out of our control

  • Others being kind
  • Others being honest
  • Others forgiving us
  • Who likes us
  • The family we were born into
  • The color of our skin
  • Past mistakes
  • Natural disasters
  • Death
  • Taxes

Are you beating yourself up because you stayed in town? Really? Assuming you had the time, the money, the ability and the fortune telling magic to know how long this bad air was lingering, was hightailing it out of here the right solution?

Are you feeling like a terrible parent because you couldn’t stand being cooped up and you let your kids run around outside for a bit and now you are worried? It’s easy enough to be the Monday morning quarterback. ‘Woulda Coulda Shoulda’ are simply not worth much. My husband was an executive for many years and his employees knew that after bitching about something or another that had happened, they would inevitably hear him say: “you can’t manage the past”

My daughter Alana who is now a therapist here in SF taught me that Dialectical Behavior Therapy (DBT) refers to my mom’s “it is what it is” as radical acceptance. There are an infinite number of things that cause pain, suffering and anxiety, but only 4 different actions that we can take:

  • Problem solve: Is there something within your control that you can do?

  • Find the silver lining or lesson :There is always a lesson but sometimes the silver lining doesn’t become apparent until sometime in the future, if at all. If you look hard enough there is usually at least a sliver.

  • Practice radical acceptance: It is what it is and you do the best you can (Just like mom...repeat this frequently) , or

  • Stay stuck

While we can’t problem solve past exposure to poor air quality away, what we can do is learn any lessons that may come in handy in the future. It is safe to say that this could happen again. We need to make sure that we are prepared.

Order masks in advance so that you have them on hand if the need arises. Have a HEPA air cleaner (change the filter periodically. We just changed ours and it was beyond gross). My sister-in-law and brother-in-law just purchased one of the newer ones that gives you a reading of the air quality in the area of the machine. Before they even plugged in it, the air in their house rated just fine. Being inside does make a huge difference.

Have an evacuation plan for your family. Earthquakes are just as much an issue as fire. Now is the time to check your earthquake kit and update it as needed.

Get familiar with local resources that can help you out in an emergency. For those of you in the Bay Area, this is an important site for guidance in case of all sorts of emergency situation:

If you are looking for some more benign and possibly helpful actions?

  • Lets tend to our bodies.
  • Stay hydrated
  • Decrease mucus producing foods (Dairy products are often the biggest offenders)
  • There are multiple sources that claim different foods can help keep lungs healthy. That list includes pineapple, garlic, ginger, turmeric, dried figs, tomatoes, apples, green tea
  • A steamy shower with essential oil (like eucalyptus)
  • Get or give a massage with warm oil. This will relax and open the airways
  • Do some good deep belly breathing

Be a voice for to help protect our ailing planet from climate changes. This should not be a partisan issue. If there are tangible, sensible things that we can do to minimize pollution everyone should be on the same page. I reached out to my dear friend Brenda Ekwurzel who is a senior climate scientist and the director of climate science at the Union of Concerned Scientists and asked her for advice on a good fund to donate to. She suggested theNature Conservancy

Climate Changes Everything is another good site to check out. This is a friend of a friend who has taken on climate change as his personal mission. Check it out.

Or you might give money to folks impacted. Charity Navigator can help you research effective organizations to make donations to.

In any event, taking some sort of positive action can help us not 'stay stuck.' Don’t be afraid to have conversations with your kids.
Here is the situation. These are the things we can do.

The review of things in and out of our control is an important one. It is the rare child under 5 who will get it, but you are the model. They will learn by example.

Friday, November 16, 2018

Food Safety Guidelines/Just in time for turkey leftovers

Food Safety guidelines/Just in time for Turkey leftovers

Thanksgiving is a holiday associated with lots of yummy leftovers so it's usually my signal to update my food safety post. If you ever watch the news you know that food contamination issues can happen all year round. This post will give you some safe guidelines for foods that you buy and cook. If you do a lot of eating out, restaurants are supposed to have their cleanliness rating publicly displayed. Check the bottom of the article for some great links on food storage guidelines; everything from egg safety and turkey leftovers to breastmilk storage.

It is certainly not a sterile world. As soon as they are able, your baby will start putting anything that they can reach into their mouths. You can't even begin to imagine the phone calls we get about the more disgusting items that some of our little patients have managed to get their hands and mouths on. Just this week we talked to parents of various kids who had possibly had a nibble or taste of the following things:

  • chap-stick
  • essential oils
  • particles from an exploded cold/hot pack
  • kitty litter

So yes, the world is full of germs, and while I don't generally get too concerned about a little dirt here or a big sloppy dog kiss there, foodborne bacteria can be nasty, and we need to minimize any exposure.There were over 300,000 reports of children under the age of five being impacted by tainted food last year alone.

Infants and young children are particularly vulnerable to foodborne illness because their immune systems are not developed enough to fight off infections. This is especially important for infants under 6 months of age. Extra care should be taken when handling and preparing their food and formula. Here are some basic food safety guidelines:

Wash hands for at least 20 seconds before food preparation. Soap is best. Hand sanitizer will do. Re-wash as needed after handling food that might carry germs. The most common offenders are poultry, meat, raw eggs.

Make sure kitchen towels and sponges are changed and cleaned frequently. Sponges can go through the dishwasher. Cloth can get easily contaminated and then spread germs. Watch out for potholders or other cloth items that come into contact with raw food.

Keep your refrigerator temperature at 40 degrees or colder. It is worth investing in an appliance thermometer so that you can keep track. All the science says that the 40 degree number is essential for keeping the bacteria from multiplying.

Your freezer should be below 0 degrees. To ensure the safety of your frozen food, you need to be sure that it has been actually kept constantly frozen. One clever trick to make sure of this is to keep a baggie filled with ice cubes in the freezer. If they remain cubes, you are in good shape; if they melt and refreeze as a block of ice that means that at some point your freezer was not cold enough. This can happen in a power outage or even if the door wasn't kept tightly closed. I am sad to say that if there was stored breastmilk in there that has thawed and refrozen, I would no longer consider it safe. Label things in your freezer and rotate so that you are using up older stuff first.

Check the dates of baby food jars and make sure the lid pops when you open them.

Don't put baby food back in the refrigerator if your child doesn't finish it and you used the "used" spoon to take the food directly from the jar. Your best bet - simply don't feed your baby directly from the jar. Instead, put a small serving of food on a clean dish. Add more as needed with a clean spoon. Remember that once saliva has come into contact with the food it is no longer sterile and some bacteria can grow quickly.

Powdered formula is NOT sterile. Don't mix up more than you need in advance. If the infant is less than 4 months, I would mix it with boiling water and let it cool.

Don't leave open containers of liquid or pureed baby food out at room temperature for more than two hours. Bacteria thrive in temperatures between 40-140 degrees

Don't store opened baby food in the refrigerator for more than three days. If you are not sure that the food is still safe, remember this saying: "If in doubt, throw it out." See links below for guidelines on how long food stays safe.

Make sure that foods are properly cooked. A food thermometer is the best tool for this.

  •  Beef...160
  •  Chicken ( white meat/ dark meat)...170/180
  •  Fish......160
  •  Eggs....not runny

For all of you "older kids" who will be baking this holiday season, watch out for the batter (I am a notorious offender.), Even one lick from raw food containing a contaminated egg can get you ill.

For all of you travelers: RESIST THE TEMPTATION. This is not an ideal time to have your baby try all sorts of new foods. This time of year we get calls from around the country from 'Pecan pie gone wrong' It is best to take your time with new foods in the comfort of your own home.( and emergency room)
"They had a taste of stuffing"
"What was in it?"
" I have no idea, oysters? chestnuts? eggs?"

You get the idea.....

Myth: Freezing food kills harmful bacteria that can cause food poisoning.

Fact: bacteria can survive freezing temperatures. When food is thawed, bacteria can still be present and can begin to multiply. Cooking food to the proper internal temperature is the best way to make sure any bacteria is killed.

Myth: vegetarians don't need to worry about food poisoning.

Fact: Fruits and vegetables are an important part of a healthy diet, but like other foods they may carry a risk of foodborne illness. Always rinse produce well under running tap water. Never eat the pre-washed 'ready to eat' greens if they are past their freshness date or if they appear slimy.

Myth: Plastic or glass cutting boards don't hold harmful bacteria on their surfaces like wooden cutting boards do
Fact: Any type of cutting board can hold harmful bacteria on its surface. Regardless of the type of cutting board you use, it should be washed and sanitized after each use. Solid plastic, tempered glass, sealed granite, and hardwood cutting boards are dishwasher safe. However, wood laminates don't hold up well in the dishwasher. Once cutting boards of any type become excessively worn or develop hard-to-clean grooves, they should be discarded.

Myth: Locally-grown, organic foods will never give you food poisoning.

Fact: Any food, whether organic or conventional, could become unsafe with illness-causing foodborne bacteria at any point during the chain from the farm to the table. Consumers in their homes can take action to keep their families safe. That is why it is important to reduce your risk of foodborne illness by practicing the four steps: Clean, Separate, Cook, and Chill.

Some excellent resources for food safety tips can be found at:  This site keeps track of any food recalls  This is as great site for seeing how long food will last. I used it just this week to figure out if an open can of chickpeas was still good. (After a week, the answer was no)   This site has loads of kid friendly activities

Enjoy your Thanksgiving!

Air Quality update November 2018

Air Quality Update

Wishing all of you a happy and healthy Thanksgiving.
I was all set with my Thanksgiving topic on how to deal with turkey leftovers and general food safety, but all the calls I have gotten in the office today prompted me to add a bit of focus on the air.

What would make us all jump for joy is a bit of rain. For those of you not in the Bay Area, go outside and take a deep breath of air for all of us. Today our air quality moved into the purple range. Very unhealthy for everyone. If you are traveling, I would think hard before returning home until things start to clear.

It is Horrid. It is eerie. It is scary. It is claustrophobic. As bad as it is for us with our scratchy throats, tight lungs and irritated eyes, my heart goes out to all those thousands of people who have lost loved ones, homes and are even closer to the fire. This feels even worse than last October, and those fires were weren't even as far away.

What can we do to deal with this smoke?

  • Stay indoors as much as possible!

  • If kids are stir crazy, consider a mall like Stonestown (especially if you can park underneath and avoid walking outdoors) Consider creating an indoor activity there like a scavenger hunt or bring a pad of paper and colored pencils; practice drawing

  • Sometimes we just need to turn on the tv or watch some videos on our ipads. Do what you need to do to get through this smokey period. As long as you control it and use tech time as a tool it's okay to make some exceptions and allow a little more than you might in normal circumstances. Your sanity counts for something.

  • After two years in a row, I fear that this seems like the new normal. I suggest ordering some extra N95 masks to keep on hand so that you are always prepared.

  • Avoid ANY strenuous activity.

  • If you are in your car, keep the air on recirculate.

  • Avoid adding to indoor pollution. Don't light candles or vacuum. No Smoking!!! DUH

  • Pets shouldn't be exposed to the smoke any more than we should. ( I know, try explaining that to them!)Toss the ball a little bit more indoors, but limit their outdoor time as much as possible.

  • Be aware that food delivery services are being impacted. Today, many of the couriers were not delivering due to safety concerns. Plan ahead with your meals.

Smoke is bad enough, but if we are ever in the situation that we need to be dealing with actual fire, I am sharing this essential information from a friend of mine who lives in Santa Barbara and has been through this a number of times.

Home Evacuation Checklist – How to Prepare for Evacuation:

Inside the House
  • Shut all windows and doors, leaving them unlocked.
  • unlatch the garage door
  • Remove flammable window shades, curtains and close metal shutters.
  • Remove lightweight curtains.
  • Move flammable furniture to the center of the room, away from windows and doors.
  • Shut off gas at the meter; turn off pilot lights.
  • Leave your lights on so firefighters can see your house under smoky conditions.
  • Shut off the air conditioning

  • Gather up flammable items from the exterior of the house and bring them inside (patio furniture, children’s toys, door mats, trash cans, etc.) or place them in your pool.
  • Turn off propane tanks.
  • Move propane BBQ appliances away from structures.
  • Connect garden hoses to outside water valves or spigots for use by firefighters. Fill water buckets and place them around the house.
  • Don’t leave sprinklers on or water running, they can affect critical water pressure.
  • Leave exterior lights on so your home is visible to firefighters in the smoke or darkness of night.
  • Put your Emergency Supply Kit in your vehicle.
  • Back your car into the driveway with vehicle loaded and all doors and windows closed. Carry your car keys with you.
  • Have a ladder available and place it at the corner of the house for firefighters to quickly access your roof.
  • Seal attic and ground vents with pre-cut plywood or commercial seals.
  • Patrol your property and monitor the fire situation. Don’t wait for an evacuation order if you feel threatened.
  • Check on neighbors and make sure they are preparing to leave.

Friday, November 9, 2018

The Pie Theory of life 2018/ Nurse Judy's Pie shifts

Somehow or other I currently have 2,400 subscribers who now get my weekly posts. The blog has had 270,000 visits which astonishes me. Thanks to all of you who read them and share them. Writing these has been a pleasure. I am always learning. Your feedback has been something that I cherish. In honor of this being my 100th post since starting the weekly emails on Constant Contact I am running one of my all time favorite posts. My kids and I live by the “pie theory.” My personal pie is going through some shifting pieces. Detail are at the bottom of the post.
This week's Topic

Finding Balance/ The pie theory of life
Here is an update of one of my top ten favorite posts.
Scroll to the end of the post for an update in the shift in my personal PIE

The "pie theory" got its inception many years ago. For a number of years (many years ago) I was the Parent Association president at my daughters' elementary school. It took an inordinate amount of my spare time, including meetings several times a week. On many levels it was rewarding being so involved but I assure you, I was delighted to pass the reins when my stint was over. Though I was really genuinely relieved to have my time back, I felt off balance by all the sudden free time in my schedule, and at first I couldn't figure out why I was so unsettled. I finally realized that although the new empty hours were welcome, they had created a bit of a vacuum. I filled it quickly (started taking up karate a few evenings a week), but it was right around that transition period that the "pie theory" helped me make sense of things.

Imagine that your identity is a circle (or whole pie). Who you are is divided into many pieces; some pieces are large, some small, some temporary. Some are constants that are with you life long, some are optional, some are good for your soul, while still others are energy sappers that give you little in return.

Are you:

  • Daughter?
  • Son?
  • Sibling?
  • Friend?
  • Spouse?
  • Ex spouse?
  • Grandparent?
  • Student?
  • Volunteer?
  • Pet owner?
  • In a job/occupation or seeking one?
  • Doing a hobby that takes time and energy?
  • Member of a book club or any club for that matter?
  • Churchgoer?
  • Exerciser?
  • House cleaner?
  • Carpool driver?
  • Event planner?
  • Adventure seeker?
  • and of course last but not least....Parent?

The list goes on and on. What activities make up your day, your week, your month, your year? What pieces make up your pie? Take a few moments to figure it out. Get a piece of paper and a working pen (if you can find one) and create your pie.

It's interesting to think how you can be identified in different ways by the various pieces of pie. Many folks recognize me as Nurse Judy. More than once I have actually looked at a rash, or given advice from a restaurant table (as my patient husband rolls his eyes.) There was a time years ago when I came to work one day and saw a construction worker on the roof of a neighboring building. He looked awfully familiar and I was struggling to place him; was he a parent from the practice? Someone from school? I could see that he recognized me as well; we kept looking at each other and a moment passed. I could see that he had figured it out first. He gave a big grin and called out "Ahoy there Java's mom!" Of course! I ran into him several times a week with his pack of dogs when I walked my dog Java. Not only did being a dog owner dictate my daily schedule and get me out walking rain or shine, it also included me as a member of a distinct social network in the neighborhood for many years. All the dog owners knew each other by sight and all the dogs by name. Being "Java's mom" was a wonderful piece of my "pie" for 12 years. If you are a pet owner, that piece has a very special place allotted to it. I am now proud to be grandma to my daughter's giant puppy Bowie.

Your pie is finite. You can only do and be so much, as there are only so many hours in the day. Some folks have too many things competing for time and attention, and figuring out which pieces can be compressed can be quite stressful. Sometimes we make poor choices.

For busy working parents this might be a foreign concept, but some folks don't actually have enough pieces to begin to fill the shell. A big empty pie can be just as unsettling as a full one. Have you ever noticed that when you are super busy you can manage to get through an entire to-do list very efficiently? On the other hand, on a quiet day you may have only one or two things on the list but somehow nothing gets done.

A healthy pie has plenty of interesting pieces that can grow and shrink according to your needs. The more forgiving and elastic the pieces, the easier time you will have finding a good balance.
Your pie will naturally change from year to year, but some changes are enormous. Some people are comfortable having a very crowded pie, while others are quite fine and happy doing nothing at all. Part of this is figuring out what your ideal is, and work towards that.

Any large sudden changes to your pie will make you feel unsettled, way less so if you have a glimmer of what is going on; hence this theory. Both of my daughters have taken this to heart. In fact Alana has permitted me to share her own blog post on the Pie Theory that she wrote several years ago:

(Blogging runs in the family I guess)

When there is a large shift in your pieces my girls and I refer to this as "pie disequilibrium." Common culprits might include:

Event planner:
Folks planning a wedding or large event can spend months dealing with all the fun details. When the event is over, that planner piece is gone, your pie has a gap.

Sports Fan:
My daughter Alana has a twinge of "Pie Disequilibrium" every October when baseball season is over.

My daughter Lauren had to learn how to deal with the extra time that appears after a show run is over.
Folks that spend much of their time and energy tending to someone else’s needs might find themselves suddenly with a large vacuum when that person is gone or no longer needs them.

As your children grow up it can be a tough adjustment (don't worry, they still love you.) Luckily this happens in stages. Kindergarten...a full day of Parents who have the "parent piece" taking up the entire pie may feel a twinge when their kids don't need them in quite the same capacity.

Huge life changes will create seismic shifts. Nothing will ever match the huge transitions that take place when you add the parent piece to your pie. My best advice to you as you shuffle all your pie pieces and see how things fit comfortably is to identify pieces that need to be protected so that they don't get too small.

Protect that piece. Get creative and make sure that you have time for the two of you; have some moments being a couple.

Being the best parent that you can be includes living by example. Let your kids have parents that are multifaceted and not consumed by any one thing (be that parenting or a job.)

Best of luck finding a balanced, interesting, and fulfilling pie!

Nurse Judy's shifting pie:

As many of you know, I have been working at Noe Valley Pediatrics for over 30 years. In July of this year I opted to remove the office manager slice of my pie. I am continuing with the parts of the job that I love, which are teaching parents, giving advice and writing.
I am now in the office Mondays and Thursdays. I am fortunate to be enlarging my mom piece, as both of my daughters and now my son-in-law, live several minutes away from me.

My travel piece gets to stretch a bit in December. My husband and I will be doing an exciting trip to Southeast Asia. I don’t do the mountain climbing with him; this is his turn to do some tamer traveling with the wife.

But the big news is that I am planning to expand the “piece of pie” that involves my writing. I have been encouraged by many, (gently nagged by a few) to go beyond the blog and write a book. I am at the very beginning of the process. I would love to hear from folks who are writers, or are in the business. I am currently gathering info and advice and would appreciate any wisdom or tips that you are willing to share.

Friday, November 2, 2018



It is all well and good to want your children to tell the truth, but until they have reached a certain age, don’t let yourself get too disappointed when you realize they have been less than honest. Many young kids can actually convince themselves that what they are telling you is the absolutely as real as can be. When they get a bit older they are simply calculating which outcome will get them in less trouble.

I had to learn this the hard way with my older daughter Lauren. Even back in her earliest years, she was an actress.

The earliest whopper that I found out about happened a day after the Northridge earthquake in LA. Lauren was in 1st grade.
When I went to school to pick her up, I was surprised when multiple people came up to give me consolation hugs.
“Judy, we are so sorry” “What a tragedy” “How old was the baby cousin that died in the earthquake?”

HUH? I was more than confused. I assured them that as far as I knew, everything was fine. We didn’t have family in LA.

“Hmm, but Lauren said…”

More confusion ensued. I picked Lauren up and asked her why on earth people were coming up to me and offering sympathy.
She looked genuinely puzzled. Actress, remember...she was going for her first academy award.

“Oh, I think I know” she said, “At recess we were playing some pretend games and someone must have overheard and thought it was real.” I accepted that without a second thought.

The next morning at school I bumped into her teacher.

“Oh Judy, that is so sad about the baby”

“Oh dear” I responded, “That is all a misunderstanding. People must have overheard kids playing and thought it was real.”

Mrs Calhoun paused, and then gently informed me that in fact, in ‘sharing’ yesterday when everyone was going around the circle telling their news, Lauren stole the thunder by announcing that her baby cousin had died in the Northridge earthquake. There was no misunderstanding or overhearing recess pretend games.

My daughter had given me a ‘look you in the eyes bald faced lie’ and I was mad.

We had a talk that evening about the importance of honesty (which likely went right over her head.) She continued to be caught in little lies, and promises meant little.

That week Goldie the fish was found floating. You might be disappointed to know that sweet Nurse Judy’s initial response was “Maybe if she thinks that breaking promises has consequences that isn’t such a bad thing

Fortunately, her daddy took it upon himself to make sure that she wouldn’t have to feel the guilt of having killed her fish with a lie. In fact there would be no mourning needed this time around. He took the dead fish to a pet store that kept late hours, found a fish that matched the general look and size, and Goldie II started her reign in the tank. Lauren was none the wiser.

The irony that this fish tale in included on a post about honesty is not lost on me. It is complicated. While my opinion might be tossed out in a court of law, I maintain that shielding someone from a difficult truth is sometimes the action that feels like the right thing to do. If Lauren had asked me directly about Goldie, I would have insisted on telling her the truth.

Scroll on down for a bonus tale of Lauren and her lying phase.

Children and adults might lie for a variety of reasons. These include trying to get out of trouble, attempting to impress someone or even to be polite. At the age of five, trying to avoid a punishment is often going to take precedence over the concept of honesty.

It is so important to let them know that you put more emphasis on their telling the truth than on the consequence for their dishonest behavior.

What can you do?

Model honesty.
“Tell them I’m not home” is a good example of an easy lie that we call can get trapped in. Be thoughtful enough to tweak it to “I’m not available.” If your kids catch you lying, there is no reason to expect them to act differently from the adults in their lives.

Talk about how being truthful often takes a lot of courage.
Read some of the great books out there that are all about telling the truth. Books are a good launching point for further discussion.

Help them avoid the lie by not asking questions that will get them into a defensive situation; instead state what you see:

Rather than “ Did you eat a cookie after I told you not to?”


A cookie is missing. I see crumbs on your face. I will be more disappointed in you not telling the truth, than I would be about the missing cookie

Help them avoid the lie by not asking questions that will get them into a defensive situation:

Rather than “did you break that vase?”


“I see that the vase is broken. Do you want to tell me what happened? Remember that telling the truth is more important to me than the broken vase.”

If you get through the years without a lying phase, wow! Most likely there will be a time when your children are not going to tell you the truth. Take a moment to figure out if there is an obvious cause for the lie and form your response based on that. Please don’t ever label your child a liar, even if they have some lapses.

Let’s be real. The true value of honest communication and trust between you and your child goes way beyond the missing cookies. It is essential to be able to be truthful with each other when your child becomes a teenager. They need to know that they can call you for a pick up, no questions asked, when they find themselves in a tricky situation. Hopefully they can feel free to talk to you about important issues and ask you difficult questions.This won’t happen without a trust that goes both ways. Consistent message about how you value honesty will hopefully help foster the trusting relationship that we are striving for, now and in the future.


Here is the bonus Lauren story that went down in family lore.
This was soon after my 'family tragedy' in the earthquake.
Lauren got a new teaching assistant who she adored. He had very long hair that he wore in a ponytail. His first name was Sotweed. His last name was also odd enough that when she first told me his entire name, I thought she was making it up.
I giggled and she admonished me “It isn’t nice to laugh at someone’s name”

You are right, I shouldn’t laugh

Shame on me though, when she would say his name over the next few weeks, I confess to an occasional giggle. Okay, so there we were in the car on our way to a school event where I was going to meet the famous Mr. S for the first time.

I told Mr S that you laugh every time I say his name.”

Let’s describe me as annoyed. ” Lauren, you are right that I shouldn’t have laughed at his name, but if it only happened in private, nobody’s feelings were hurt. Now I am embarrassed and perhaps Mr S feels badly about it. I am upset that you told him this”

Lauren mulled this over, you could see the wheels turning. She was clearly trying to figure out which path was going to get her in less trouble.

“I am just kidding, Of course I didn’t tell him”

I looked at her for a bit.

“I don’t know if you are telling me the truth. I am going to have to ask Mr. S if you said something to him or not. This is your opportunity to tell me what is true” (I was sorely tempted to threaten her new fish, but that was still a secret.)

Pause, more thinking...

“I did tell him that you laugh”

“Thank you for telling me the truth”


Hello Mr. S, I am afraid I owe you an apology.

Mr S immediately let me off the hook.
I have the kookiest name in the world, of course it makes people laugh.”

Mr. S, if you are reading this post, thank you for being such a great guy!