Friday, April 24, 2020

Finding Humor in this time of quarantine

Finding Humor
Last week we were running low on groceries and were exploring delivery options to help us avoid facing the ‘hazards of the supermarket’. We had unsuccessfully tried several stores to get a delivery option. The answer that we could get our shopping done and delivered in early June wasn’t the outcome we were looking for. Someone had told Sandy to give Smart and Final a try.

We made up a comprehensive list and with growing excitement watched as things went into the cart. Alas, when it was time to schedule the delivery, all the available times slots were blacked out. Since he wasn’t otherwise occupied aside from watching the same news cycles repeat over and over, Sandy kept trying. The list and check-out were done, so it was simply a matter of going back in and clicking.

Eureka! This was a Tuesday.The food would be delivered on Thursday morning. Thursday morning we got the text that it would come in the afternoon. In the afternoon, it was pushed to the evening. In the evening we were told that we would get the delivery on Friday morning.

The following day, it was actually going to happen. We got a confirmation and the credit card was charged. But hey, wait a minute. We were only charged $30, the original order was $150+.

The Instacart employee came and brought us our bag. We peeked inside. It contained butter, margarine, whipped cream cheese, and a bag of Oreos. Yup, that was it.

It reminded me of those cooking shows that give the contestants an odd assortment of ingredients and they have to create a meal. This could be the COVID cooking show. “You have anchovies, a bag of polenta that you never figured out what to do with and a pint of blueberries.....GO!”

When Sandy and I were doing our shopping list, we were given the option to substitute for items that were out of stock. We had clicked NO. It turns out that that was probably wise.

Alana had me cracking up when she told me that she had allowed substitution on her most recent instacart order. She had the “use your best judgement option.” Her shopper ended up taking full advantage of that. His best judgement consisted of substituting 3 unrelated items - ground turkey, gluten free pasta and some nuts (none of which were available) - with flaming hot Cheetos. One bag for each. Fortunately Alana loves her flaming hot Cheetos, but…….

Dr Anne's father in law got beer and a cake from instacart on his 87th birthday. That wasn't part of his order, but he enjoyed the mistake. Sometimes things work out.

My friend Miriam had paper towels substituted for the toilet paper she had requested. Uh, no.
On the other hand, Dr Anne ran out of paper towels. She ended up using the rarely brought out cloth napkins. Her kids were not used to those and tossed them in the trash when they were finished with them. Fortunately she retrieved them.

Last week, I put out a request for people to share anything positive or funny that is going on in their lives. I also posted on my Facebook page. Anybody laughing about anything???
I was mostly met with silence. Alana came through once again. She had me in stitches as she described a situation that happened to her this week. As I am sure many of you have found out, working from home has its challenges. Alana’s cats have made themselves known to her clients, by pussyfooting across the keyboards and meowing at the screen. In this case, in the middle of a session at an especially emotional moment, Taco Cat appeared in the home office, direct from the litter box, with a piece of poop hanging from his butt. Lani was not in the position to do much. She tried to stay engaged with the client as she watched in yuck while Taco managed to clear himself of the poop, lick it up and then promptly throw up!

Sandy is keeping me amused by toying with the telemarketers. Happily the number of those calls has dramatically decreased, but when they call about the car warranty or the fact that we are wanted by the IRS he keeps them engaged for a bit.

Without humor we can slip into a muddy place. Hopefully from wherever you are you can find something to giggle at.

Friday, April 17, 2020

Poison Oak: Recognize/Avoid/treatment options

Poison Oak: Recognize/Avoid/treatment options

I know a lot of people in other cities and countries who are literally stuck inside during this period of quarantine. We are fortunate in the Bay Area that we are allowed outside for air and exercise. On all of your excursions, you should have a mask handy in case social distancing is the least bit tricky. Pee before you go and bring along a little bottle of hand sanitizer.

Last week I was taking a walk with my brother-in-law Richard. I am fortunate enough to have him on my ‘quaranteam’. We don’t get to hug, but we do go on nice long walks together. We make sure to pay attention to all the beautiful flowers, birds and views along the way. We lovingly swear at each other when the one who was leading the way takes a route that ends up requiring us to climb up some absurdly steep hills. So there we were, maintaining a proper single file along some trails. I usually follow the advice that warns to stay in the center of the trail, but in this new climate of social distance, when anyone comes by in the other direction, everyone politely pushes against the bushes alongside to give people space. As we moved as far to the side as we could to make room for a passing bike rider, Richard asked, “What does poison oak look like”? Yikes. We got lucky. The greenery in this particular location was innocent, but it occurred to me that this might be a timely reminder for everyone to brush up on their knowledge about poison oak (so that they don’t brush up on the plant….)

The weather is just getting warmer and when I was still working as the advice nurse at Noe Valley Pediatrics, this was the typical time of year for me to get multiple calls about poor little patients with probable poison oak. Nearby Glen Park is a common culprit, but by no means the only one.

The symptoms start with a small itchy rash that then spreads over the next several days into weepy, nasty blisters. The rash can begin within a few hours of contact, but it might not actually show up for several days. It usually takes about 2 weeks to clear up. At least three out of four people coming into contact with the plant will end up with a problem, but some folks are much more sensitive than others. As with most allergies, the reaction tends to get worse with each exposure.

The substance that the skin is reacting to is an oil called urushiol (ooh-roo-she-all). Urushiol is found in all parts of the poison ivy, oak and sumac plants. When urushiol gets on the skin it binds to the skin within 10-20 minutes. At that point the urushiol becomes extremely difficult, if not impossible, to get off the skin with simple soap and water. The oil can linger under the fingernails. The rash itself is NOT contagious, but if you still have oil under the nails, it can be spread from the scratching. The key is to wash any possible areas that came in contact with the plant immediately after any possible contact. If you are spending time outdoors please keep a product called Tecnu in your backpack. Simply apply Tecnu to dry skin, rub vigorously for two minutes, and rinse with cool water or wipe off with a cloth. When used within 2-8 hours after exposure to poison oak, ivy or sumac, Tecnu can remove urushiol oil before the rash begins. Once a poison plant rash has started, washing with Tecnu is still somewhat useful because it helps remove any free oil on the skin allowing the natural healing process to begin without the possible spreading of poison ivy or oak (re-contamination). If you don’t have that, an alcohol based hand sanitizer is helpful. You probably all have little bottles of that in every one of your pockets! Once you are home from your walk, some folks use dishwashing detergent. Dawn is especially good at removing oil. Avoid using warm water because that will enhance the penetration of the oil.
Poison ivy and oak oil can also spread from contaminated clothing, shoes (don't ignore the laces), backpacks, gloves, tools and pets. Sports equipment such as golf bags and gardening tools are other possible sources. Since urushiol oil does not evaporate, it can remain on these items for months or even years at a time. Get in the habit of washing any suspicious objects before storing them so that they don’t cause trouble later on. All exposed clothes should be removed and soaked in a pan with Tecnu prior to being washed.

Pets are actually a pretty common culprit for spreading poison oak. If you have a dog, try to keep them on the paths if you are out hiking; dogs can get the oil on their fur and it will transfer to humans when you snuggle them. Pets can be wiped off with tecnu prior to being washed off with a pet shampoo. If you aren’t the dog owner, but can’t resist petting all the dogs that you pass, make sure you wash your hands!

It is a good idea to learn how to recognize poison oak even though the plant can spread the oil when there are no leaves, so nature isn’t making it all that easy to avoid. Most of the time there are three leaves. At some points there may be little flowers and berries. During some seasons the leaves turn red. If there are thorns it isn’t poison oak (of course now you will be calling me about thorn issues. Stay on the path!)

It is rampant all over the Bay Area, but if you are heading up to the mountains you can take some comfort in knowing that poison oak does not grow above 4300 feet. If you are in the vicinity where Poison oak is being burned, be careful, burning can cause irritated airways, eyes...etc. Know your area. Many places will have warning signs posted that there is poison oak in the area but don’t rely on that.

If the time for prevention has passed and you or your child has poison oak, it usually takes a couple of weeks until it clears. Dr. Ted from Oath Pediatrics wants to remind people that it is self limiting and will eventually go away.

For a mild case, taking Zyrtec or Benadryl, oatmeal baths and topical steroid creams can give some relief. There is also a good product called Domeboro gel. Dr. Schwanke strongly preferred Zyrtec to Benadryl as an oral antihistamine because it lasts longer and won't "turn your kid into a zombie". Of course if you are looking for a little Zombie at night, you might do Zyrtec in the morning and Benadryl for the night time dose.

Dr. Fast, my ‘go to’ allergist, strongly recommends hitting any poison oak hard and fast with oral steroids. Be aware that while most people tolerate them with absolutely no issues, others may get a bit hyper. My daughter Alana was on a course of steroids once and that week she got out the trusty sewing machine that Sandy’s dad had bought for her. She ended up spending entire days sewing pairs of pajamas, one after another, because she didn't seem to know what else to do with her body. (This was many years ago, but since it seems that you are not permitted to throw away something that your daughter makes for you, Sandy still has his pair and has been wearing them this month.) Steroids can make you feel weird but a short term course is not dangerous. A less than 10 day course does not need to be weaned down although many pediatricians have their own favorite method of prescribing them. 
Dr. Hurd has a more cautious approach with the steroids so if the rash is mild enough, she would rather stick with the topical symptomatic relief remedies. If the rash has spread to the face or genitals (with boys, that is pretty much a given) then the oral steroids are likely needed. If your child is a repeat offender and has moderate to severe reactions with poison oak exposures, don’t waste your time. Get the treatment started soon to avoid misery.

Be prepared. Stay on the paths. Wash of any areas of skin that have had potential exposure. Most importantly, make sure to scrub your hands especially under the nails, when coming in from a hike.
Knowledge is power and prevention is key! 

Good for you for getting outside!!

Friday, April 10, 2020

It's okay not to be right all of the time

“It is very unnerving to be proven wrong, particularly when you are really right and the person who is really wrong is proving you wrong and proving himself, wrongly, right.”
― Lemony Snicket, The Blank Book

As you strive to get along with your partner and children during this unprecedented quarantine, one lesson that we can likely all use some help with is on how to be accountable for when we slip up and make a bad choice. I suggest that as long as we gather wisdom along the way, and have goals of creating outcomes that are beneficial to the majority, then being right or wrong should not really matter all that much. These are stressful times. If you are not perfect. That's okay. Don't be so hard on yourself.

Imagine two people. Person number one fully understands that they are not perfect. They try their best. If they make a wrong choice they accept that and try to learn the lessons of the moment so that they don’t repeat the mistake. They rarely try to place blame on others. They take responsibility for any mistakes that they made.

Person number two refuses to accept that they are ever wrong. Anyone who suggests that this paragon might be incorrect in any action or statement will be called a nasty name or accused of making up a false narrative.This person will not accept that there could even be a remote possibility that they could be mistaken about anything. Someone else is always to blame.

How refreshing to deal with person number one. How aggravating to have to have dealings with person number two. Unfortunately, people are hard wired with the need to be right. There is some basic caveman biology going on here. 

Your good parenting can have a huge impact on which model you are raising. It starts with children who know with their full being that they are loved unconditionally. It is safe for them to mess up. We NEED our kids to understand that absolutely no one is perfect.

Making a mistake is often the way to learn.  As Albert Einstein said, “A person who never made a mistake never tried anything new.” My brother in law is a superintendent in the National Park Service. He says to his employees, "it is okay to make a little mistake every day. Just don’t ever make the same one."

Consider this interchange with your child
“Oops I made a mistake”

“I am proud of you for being aware of it and being brave enough to say it out loud. Let's go through the checklist.”

  • Was anybody physically injured?
  • Was anybody’s feeling hurt?
  • Was anything damaged?
  • Was it an accident?
  • Was there something you could have done to avoid it?
  • Are there any lessons that we can learn?

If somebody was injured that gets tended to first. Everything else can wait a bit until everyone is calm and ready to problem solve.

How do we have that conversation with our kids? Get out the stuffed animals, Play through it - how one of them screws up and the other one reacts. Tell a story about someone who makes a mistake or is wrong about something. Make that checklist something they are familiar with so that it is a natural reference when an accident or mistake happens in real life. If you find yourself making a mistake, point it out and have your kids see that you go through the checklist as well.

It’s important that we find the balancing act between enforcing consequence when necessary, and showing compassion even when things don’t go as planned.

Right and wrong isn’t simple. Many issues have multiple truths and are not really black and white. Like the optical illusion above, two people can look at the same thing and come up with completely different interpretations. 

Holding onto one way of thinking without allowing that others can have a different point of view that is equally valid can create unnecessary conflict. Sometimes agreeing to disagree is the best you will get. Teaching your child to try to see something from someone else's viewpoint is such an important lesson. 

Even if something seems to be completely straightforward, being able to see past the simple right and wrong is a trait that we should encourage in our kids.

Imagine you are driving from point A to point B. There are probably many ways to get to the destination. In San Francisco, I know that to be the case. One way might be a bit longer, but have nicer views. Some routes might avoid having to go up the steeper hills. Traffic could show up in unexpected places. It is typical to have some bickering. “You should have turned left at that corner.” There doesn’t need to be one right way to get there. The goal is getting where you are going safely.

Am I right???

Friday, April 3, 2020

Tips for dealing with too much togetherness

Yesterday was my birthday. Yes I am old enough to take advantage of the early shopping hours at the supermarkets. I spent the day feeling very grateful for my small corner of the universe. My family is healthy, I have a safe home and plenty of food. I am not at risk from running out of toilet paper. I am able to get outside to walk. I am also baking, and my son in law is working on perfecting his sour dough bread so the scale is probably not my friend.

In honor of my birthday week please help me spread positive energy out into this troubled time. Smile at the people you pass, even from a distance. Reach out to people who you know are isolated. Be kind to each other, but most importantly please be kind to yourself.

This will pass. No one will be unchanged from this period of time, but my hope is that people will be able stay united from the distance and when the time comes,help each other with the recovery process.

This week's topic
Tips for dealing with too much togetherness
Ah togetherness!

How are you all doing with it? My husband Sandy says that he and I trained for this last fall when we spent two months wandering through Europe. We were together constantly; I mean that! The only 4 hour break we had was when I did a Sound of Music tour in Salzburg. Sandy decided he was “busy”, and he would catch up with me later. For me, it was one of my favorite things. With all that together time, we actually did great. 

We stayed in a variety of lodging, quaint little inns, Airbnbs and hotels. Some were roomy apartments. Other times we were stuck in one tiny room. Since we were booking rooms at the last minute, we scored some amazing deals.

Mid way through our travels, at one such upscale hotel that furnished us with robes, I made the cardinal sin of leaving the belt from the bathrobe haphazardly on the bathroom floor.
Sandy picked it up and started his lecture.. “Bathrobes have belt loops. The belt goes in the loop. The belt doesn’t go on the floor.” (Sandy commenting here - she's been doing that for 44 years!)

Yeah Yeah…

I did sympathize. In our odd couple relationship, I am certainly the Oscar; he is Felix. (For those of you too young for this reference, Oscar is the slob.) On our last night in Europe as we wandered along the canals in Amsterdam, I commented on how well we had managed together during our epic journey. The only bickering that I could recall was when I left the bathrobe belt on the floor. Sandy started up…."Well, there are belt loops for a reason..." Oops, evidently it was too soon to bring up such a touchy topic. It may still be and I take the risk of getting another lecture on belt loops.

So here we are, at the 3 week mark of our stay at home mandate here in the Bay Area and it looks like we have another month ahead at the very least. It is time for an assessment of how you are managing and to see if there are changes that you can make to keep your sanity and relationships intact.

In normal times having family together time is a cherished commodity, but of course too much of a good thing can become wearing.

Remember why you are doing this. You are keeping your family safe and doing your part to stem the spread of this horrid virus. Many of my friends are alone in their homes trying to deal with this enforced separation from their communities.
For some of you cooped up with entire families, that isolation might seem like a dream until you really think it through.

The fact is, this quarantine is tougher on some people than others. Many people really need some alone time as an essential component of their self care. Others simply don’t. This doesn't even necessarily correlate with being an introvert or an extrovert.

Figure out which category you fall under. No apologies necessary. This is essentially being self aware. Your need for a bit of solitude does not mean that you don’t love your partner and family.

Communication is essential. Hopefully you and your partner can do some problem solving without anyone feeling defensive.

What are the options? Do you have a space in your home where you can go and close a door? If not, find a corner where you can put on some headphones and a sign that says “pretend I am not here.”

My mom loved her family with all of her heart, but she recognized that having some quiet time without everyone around was imperative to her well being. For years she solved this by waking up at the crack of dawn. She savored having the house essentially to herself while the rest of us were still sleeping. See if you can find your own time and space to recharge.

Many of you are also learning that working from home while still tending to the kids effectively requires communication and problem solving. If it is at all possible, I strongly suggest that you actively figure out a way for each parent to have a shift of being off duty. It doesn’t have to be long. Even thirty minutes can be a blessing. If both parents are trying to work from home, look at your schedules, talk about what you need and see what you can cobble together. Taking care of the kids is its own job. You need shifts for that as well.

Cooking, laundry, and cleaning should be addressed too. Make sure that it feels equitable. (Sandy again - what???) Stewing about how it doesn’t feel fair is not good for anyone. Don’t expect your partner to know how they might be annoying you or how they can best support you right now. We are all stressed out and our mind reading capabilities are probably not working properly.

Talk to each other!

Here is a little assignment. Take a minute to think about your answer to this questions. If there was ONE thing that you need the most right now, what is it? It has to be something that is realistically achievable; wishing for a trip to a spa retreat doesn’t count. Each person in the family should try to figure out the answer and see if the family can support you in making it happen. Maybe it is alone time. Maybe it is taking a break from cooking. For the kids, it might be a family activity or game.

The needs might change week to week. See if the family can make it a priority to support each other with at least this one 'ask'.

Regardless if you have recognized this as a priority or not, make sure you all get outdoors at least for a few minutes a day. Until you actually get out, feel some fresh air and some sun on your face, you won’t realize how much you needed it. 
I have found that people I encounter on my walks have been very respectful about keeping social distance, but of course you need to avoid any crowded areas. Some of my international friends report that they are not allowed to leave their homes. Be grateful that we can go out for air.

Those folks that I mentioned earlier who are more isolated? Perhaps they are willing to set up a zoom call and have a regular storytelling session with your kids. Use this time that they are otherwise engaged to be semi off duty for a bit.. Better even than reading a book, how about telling stories! If these are family members, relatives telling stories about when they were young or tales about when mom and dad were young, are golden. Maybe they can even help the older kids with their school work.

My amazing cousins Avi and Barbara living in western Massachusetts have taken it to a new level. Known to their grandchildren as Yogi and Bubu, the favorite game is "find Bubu". Avi wanders through the house while on a video call with the little ones:

Is this Bubu?
No, that's a pot!
Is this Bubu?
No silly yogi, that's a plant.

There are plenty of giggles until she is found.

For the older kids they all have versions of some games that can be played together.
Guess Who and Battleship are the favorites. You could also play Yahtzee.

They are delighted to spend this time with the grandkids, even though it isn't in person. Their kids are also happy to get a littler break. This is a win win.

In my world, Facetime, Zoom, Google Hangout interaction with family and friends do not count as part of the screen time allotment. But still keep track. Too much screen time is not healthy. I know several people investing in glasses that block the blue light.

We will get through this. Savor this moment of togetherness. It won’t last forever.

Be kind to your partner. Pick up the belt that you left on the floor!