How and when to talk to your kids about sex. It might be sooner than you think!

I have been doing this blog for many years. I try to stay fresh with new thoughts and ideas, but I also continually update old posts. Things change, new information emerges, sometimes something will come along making headlines that feels like it is worth addressing. The ‘Talking to your kids about sex post” is one that I have posted several times over the years. I am updating it because there is a new resource that I want you all to know about. I have tacked information and the link to a brilliant playbook option on to the bottom of the post. Comes the moment in every family when it is time to have the talk about sex, but how and when? It varies with every child. There is a story about a young boy visiting his grandparents’ house one summer. He came rushing in from outside where he had been playing with some new friends from the neighborhood. “Grandma, what’s it called when two people are in bed, but one is on top of the other one?” Grandma was taken aback for a moment but sat him down and gave him a matter of fact talk about the birds and the bees, so to speak. The little boy listened carefully with his eyes open wide and then ran back out to join his friends. It wasn’t long before he ran back into the house saying, “Grandma, it’s called BUNK BEDS and Mrs. Wilson wants to talk to you!" The all important moral of this story is to make sure that when your child presents you with a question, you understand what they are actually asking before you launch into any complex explanations. You could start with a statement such as “ I am so glad that you asked me. I am always happy to help you find answers to things. Tell me more about what you are wondering about." My sister Amy has her own tale. She and her husband are National Park rangers and they moved to Utah when her oldest son was in 4th grade. Even when reading the Harry Potter series, my nephew Asher covered his ears when they were reading any scenes that involved kissing, but now that they were living in a new place, he had a question. “Mom, where do babies come from”? Amy paused and then followed up appropriately. “Is there something specific that you are wondering about?” “I heard that babies happen when a mommy and daddy love each other very much and their souls connect.” My sister's family was now living in the heart of Mormon country where most families were quite a bit larger than he was used to seeing. He knew that his mom and dad seemed to love each other a lot, but they just had 2 kids, Asher and his brother Ben. The math wasn’t adding up. Why didn’t their ‘souls connect’ as often as most of the neighbors. Amy went on to let him know that there was a little more to it than that, but it involved some more mechanics including some of that “Kissing stuff”. Nope, this wasn't his moment.There was no need to talk about it that day. Get yourself as comfortable as you can with the discussion. What do you call body parts? Does your family use a nickname (perfectly fine) or is your child able to rattle off the anatomical names for all of their “parts"? Of course having discussions about bodies usually comes long before discussions about sex. Many parents are a little shocked and uncomfortable when infant boys have erections or they notice young boys and girls masturbating. This is incredibly common (the human race is fortunate that masturbation doesn’t actually cause blindness.) While it is usually quite normal, if you notice that your child is constantly touching themselves to excess, I want to make sure there is no irritation or external cause. Maybe their underwear is too tight. Have they been running around in a wet bathing suit? That could be yeast. Itching could even be something like pinworms! If there is no obvious underlying issue, consider having a discussion about that fact that, yes it feels good, but our bodies are delicate and it is important not to touch so much that things can get sore. Some families have a talk about family rules and theirs might be that gentle touching is a private activity. Beware, a true story - one of my families who made a point of having accurate vocabulary was caught off guard one night when their 4 year old son made an announcement at a fairly formal dinner party with mom’s boss. “ I am going to go into my room now so that I can touch my penis in private.” This is also an important time to have a discussion about body ownership. No one should be able to touch any part of your child’s body without permission. Exceptions are parents and doctors (with parents present) and that should never be a secret! Empowering your child about their body early is important. And then they get a little bit older…. I remember driving a van loaded with carpool kids to school many many years ago. I caught a piece of the conversation that was going on in the back seat and my ears perked up a bit as I tuned in. “Yours have done it at least twice." “Yours have done it at least once” "Ours have done it at least twice...Oooh/Yuck” As soon as you feel that your child is curious and is possibly going to be picking up odd or skewed information from their friends or classmates, it is important that you make an opportunity to have a chat. It is essential that your child sees you as the trusted source of correct information and is comfortable asking you questions. Unfortunately in this high tech world, it is becoming increasingly easy for kids to be exposed to all sorts of things with very adult content at a very young age. You may want the help of a book. Amazon and libraries have an enormous amount of books that you can use as a resource. There are many good ones out there. I would suggest that you skim through several until you find one that feels like it is the right comfort level for you. You may want to do this research a little ahead of time. (At the end of this post is a new and worthwhile resource to check out.) Liesel Harris-Boundy from the West Portal Branch of the San Francisco Public Library was kind enough to come up with a list of good books on the subject that she is familiar with. Liesel shared that an ObGyn friend recounted that her 7-year old son asked her, "Mom, what's a vagina?" and though this woman talks about vaginas all day, she was unprepared to tell her son and excused herself from answering! That reserved part of her upbringing came through in spite of all her medical training! This is to remind you that we all have different comfort levels dealing with this, but gather your wits about you, it needs to be done. The following books should all be available through the library. Once the libraries reopen, go in and leaf through a few until you pick one that you like. Talk to Me First: Everything You Need to Know to Become Your Kids' "Go-To" Person about Sex by Deborah Roffman Talking to Your Kids About Sex: turning "the talk" into a conversation for life by Laura Berman Asking About Sex & Growing Up: A Question-and-Answer Book for Kids by Joanna Cole Everything You Never Wanted Your Kids to Know about Sex, (but Were Afraid They'd Ask): The Secrets to Surviving Your Child's Sexual Development from Birth to the Teens by Justin Richardson and Mark A. Schuster Talking to Your Kids About Sex: From Toddlers to Preteens by Lauri Berkenkamp, Steven C. Atkins, Charlie Woglom Sex Is a Funny Word: A Book about Bodies, Relationships, and YOU by Cory Silverberg It's Perfectly Normal: Changing Bodies, Growing Up, Sex, and Sexual Health (20th Anniv. Edition) by Robie H. Harris You want to make sure that the books are geared to the correct age. Some are guides for the parents and some are meant as a resource for the child. ****************************************************************** There are many different kinds of families, it isn’t always mommy plus daddy equals baby. I was happy to find out about the book below. http://corysilverberg.com/what-makes-a-baby/ What Makes a Baby is a children’s picture book about where babies come from that is written and illustrated to include all kinds of kids, adults, and families. Geared to readers from preschool to about 8 years old, it teaches curious kids about conception, gestation, and birth in a way that works regardless of whether or not the child in question was adopted, conceived using reproductive technologies at home or in a clinic, through surrogacy, or the old fashioned way; and regardless of how many people were involved, their orientation, gender and other identity, or family composition. Just as important, the story doesn’t gender identify people or body parts, so most parents and families will find that it leaves room for them to educate their child without having to erase their own experience. Once you do pick the book that you feel comfortable using as a resource, go ahead and buy a copy so that there isn’t a time limit. If your child is embarking on puberty and you are looking for something more interactive than a book, check out the Heart to Heart seminars hosted by Stanford. They hold these in multiple locations. The San Francisco class is held at CPMC on California street: https://www.stanfordchildrens.org/en/classes/community/pre-teen-teen-parent During this Covid quarantine, they are offering classes online! A list of other classes they offer are here: https://www.stanfordchildrens.org/en/classes One mom in our practice who went to the session thought it was very worthwhile, but she wished she had taken it earlier. She thought ten or eleven would have been perfect. So what’s new? Caricia, a local mom with two daughters was reading an article that included some disturbing statistics. Global estimates published by WHO indicate that about 1 in 3 (35%) of women worldwide have experienced either physical and/or sexual intimate-partner violence or non-partner violence in their lifetime. The sad fact is that these are the same statistics that existed 30 years ago. Knowing what we know, why haven’t we been able to improve this? She gathered together a group of other parents to take a deeper look. It turned out that the public school where her children attend does the standard 5th grade sex ed that we all probably remember. They actually still use a VHS tape from 1984. Woe unto them when the VCR breaks. This is perfectly adequate to teach kids about periods and erections, but this is no longer the same world. Kids these days need to learn more about consent and boundaries. They should be aware of gender identity. They need to be given tools that will help them be able to have healthy relationships. They need to be able to navigate the online world safely. Social media is a minefield. This group of parents embraced this project with a gusto. They traveled the world in search of information. The disparities between different countries was notable. The Netherlands is the country with the best health outcomes so they headed there to learn more. One of the successes that the Netherlands has achieved is the lowest incident of teen pregnancies and sexually transmitted diseases. If the data is to be believed, the kids wait. The first sexual intercourse was reported to be the age of 19 and, this is important, it was with someone they cared about. Contrast that with this country where the average age is 16 and the experience is more likely to be casual. Once they returned from their travels, they studied the curricula from leaders in the field here as well. The thinking is that we need to start our education earlier. Perhaps as young as 5 years old. At the very least, young children should be comfortable with their bodies. They should be given the rules that a surprise is okay, but a secret is not. This is a crazy scary world; we do NOT want porn or sexting to be our kids first introduction to sex. Parents need to be the ones to get there first with accurate information. How do we tackle this? You can thank this group of parents for creating a method that will help guide you through this. These educational activities focus on empathy and safety as well as biology. These are broken down into 3 age appropriate segments. 5-8 7-10 9-12 These are rough age ranges because they recognize individual differences in families and children. These are also directed to parental comfort. The books are spiral bound. If there is something a parent wants to avoid, a page can be removed. Hopefully there isn’t anything that you are too uncomfortable to talk about. The goal is normalizing this topic and keeping the conversations safe and open. The website is Bloomscience.org This goes well beyond simply reading a book to get necessary information. What they have is playbooks that include games and activities that can open dialogue opportunities. There is also a robust list of books and resources on the site ( some overlap with the list I have above). Bottom line, honesty and communication are essential. As awkward as this conversation may feel to some of you, you really don’t want your kids to be getting their sex education from the neighborhood kids (or even worse, the internet!) For your teens, you can act as a safe boundary from the nastier places on the internet. Make clear rules that as long as you are paying for the phone plan, you have access to the browsing history whenever you want (but don't abuse that right!) There might be the kid out there who feels saved by this. “Sorry, I can’t sent you a photo of my ‘whoozee whatsis’, my parents check my phone.” Don't force too much information on a younger child who isn't interested. Letting them know that you are always open and willing to talk about "grown up" stuff with them is a great start. These playbooks might be just this thing.   Click  to find more about and/or support this project

The impact of a single sentence

The impact of a single sentence

My Mother-in-Law’s birthday was this week. I have done several posts about her over the years. This week I am rerunning a short one that is always relevant. Social media in general and Facebook in particular have their benefits and drawbacks There is no doubt that it is way easier to reconnect with long lost friends than it used to be.   A few years ago my husband got tagged in a 6th grade class photo from his good old PS 32 in New York City. This started a flurry of conversation between people who hadn’t been in touch for many many (many) years. There is really nothing quite like an old friend who knew you when. I believe he may actually stay reconnected with some of these folks.   With all the catching up that was going on, there was a comment from a girl in his class that caught my attention. She wanted to let Sandy know that after all this time, she still thought about his mother.   It turns out that way back when, after a school performance, my mother-in-law had made a bee-line straight over to this girl just to tell her what a wonderful job she had done. It wasn’t the simple “good for you”; Elaine had told her how moved she had been and that this young lady should be very proud of the performance. Forty eight years later, this woman says that she still remembers how impacted she was by the interaction. Wow!   There are more people out there than we can count for whom a crumb of positive feedback is rare and important. Words, either kind ones or mean ones, are often put out there without much thought and the speaker moves on. This story illustrates how much a message can sometimes stick and make a profound impact. Update: I was taking a walk with Alana and I told her that I was re-running this old post. She thought it was worth mentioning that it isn’t only words that make a difference. As we walk along with our masks on, it is more important than ever to make socially distant but kind and pleasant acknowledgements to the people we pass. You never know when kind words or positive attention are exactly what someone might need to keep moving forward. Folks are so stressed right now. A nod of your head and a smile with your eyes can count. Even better is a “Hi, enjoy this lovely weather" or "Oh what a sweet doggy.” This simple interaction might be the only one that some people are getting these days. Only do this when it seems appropriate. There is no need to engage with someone who makes you feel uncomfortable.

The science of Hair Loss

Quarantine day 200001, or at least that's the way it feels. My hair is getting long. Easy enough to pop it into a ponytail; it will be long enough to donate when all of this is over. Sandy’s hair was driving him crazy and a ponytail was not an option. We actually looked online to see if we could procure a Flowbee. Remember those? It was a hair-cutting tool attached to a vacuum cleaner, a strange but brilliant concept from decades ago. Evidently we weren’t the only one with that idea and they are all sold out. With little option, Sandy trusted me with the scissors and for the first time in 44 year relationship, I gave him a haircut. It came out surprisingly well, but I will stick to writing and giving advice. The scissors will be turned over to more able hands as soon as we move into that phase of looser restrictions. In the meanwhile, health and safety are more important than lovely haircuts. Since hair was on my mind and I have also recently gotten some questions about it from my Juno chat groups, I thought I would address this topic in a post.

This week's topic The science of hair loss

When I was the advice nurse at Noe, I would get the occasional call from a parent who was worried that their kid's hair seemed to be falling out at an alarming rate. They seemed otherwise well. The parents were always surprised when I asked them to think back and see if there had been any stress or illness several months ago. Here is a little hair science to explain why. People typically lose about 100 hairs a day. This usually doesn't cause noticeable thinning of scalp hair because new hair is growing in at the same time. Hair has a growth stage and a resting stage. The growth stage usually lasts about three years. The resting phase ranges from one to six months, but three months is the most typical. During the resting phase, the hair remains in the follicle until the new hair starts to grow in. Roughly 5 to 15 percent of the hair on the scalp is in the resting phase at any one time.It starts to shed when the new growth stage starts. If you want to get technical and impress folks at your next Zoom happy hour, growing hairs are called anagen hair and resting hairs are referred to as telogen hair. If there is some hormonal changes or stress to the system, as many as 70% of the growing hairs become resting hairs which are poised to fall out. Those resting hairs don’t shed until the new hair coming in pushes them out. This happens a full 2 to 4 months after the triggering event. It is usually not something that has long term consequences and most of the time the hair grows back fully. I mentioned stress or illness. Hormones are another common cause. Mommies who recently gave birth, I am talking to you. Even in the throes of exhaustion with all of your shirts covered with spit up, it is hard not to notice all of those hairs on your pillow when you wake up. This is very very normal. Your hair will grow back. Pregnancy isn’t the only culprit. Hormonal changes from getting on or off various birth control methods can also trigger this reactive hair loss. Other common causes could be thyroid issues, certain medications, jet lag, nutritional deficiencies, eating disorders, excessive sun exposure. This list goes on and on. So, if you or your child are experiencing excessive hair shedding, see if you can figure out a cause, relax and give yourself some time for it to grow back. If it remains a mystery and doesn’t show signs of slowing down, it is time to check in with the dermatologist. Let's talk about your baby’s hair. Babies are born with their complete set of hair follicles. They just have wide variations in when the hair will actually grow in. Remember that babies are exposed to huge hormone fluctuations, so even those who are born with a full head of thick hair are likely to lose it within a few months. Interestingly, often the hair that grows back can be an entirely different color and texture. This is all normal. If there is only one area that seems to be thinning, that is often positional. Little ones who get plunked down on their backs (following the guidelines) often have a patch that has less hair. Aside from infants, if you or your older child has a distinct patch of hair loss, rather than general shedding, make sure it isn’t from something as obvious as tight ponytails or barrettes. If that isn’t the cause, it is worth checking with your doctor or dermatologist to make sure there isn’t an underlying issue. If the patch is scaly and circular, that could be ringworm.Dr Lawrence Cheung, my 'go to' dermatologist says that there is lots of clinical research going on that will hopefully help with future treatment for more serious hair loss conditions. If your child is pulling their hair out this might be because they are itchy! Check the scalp to make sure you don’t see any irritation. While you are there, check for nits. ( I know you hate me now and many of you are scratching your heads) If the head looks clean, hair pulling can be a simple habit ( blog post) . It could also be a condition called Trichotillomania (pronounced trik-o-till-o-MAY-nee-uh), or something that is stress related. It is worth talking to your doctor if this persists. Interesting Hair trivia Your hair can grow up to 0.5mm per day – that’s 6 inches per year!  When wet, a healthy strand of hair can stretch an additional 30% of its original length. Goosebumps from cold or fear are the result of hair follicles contracting, causing the hair and surrounding skin to bunch up. Balding only begins to become visible once you’ve lost over 50 percent of the hairs from your scalp. Anything that’s been in your bloodstream, including drugs, alcohol and minerals can be detected in your hair, which is why hair is most commonly used as forensic evidence. The only thing that cannot be identified by your hair is your gender – both men’s and women’s hair is identical in structure. Stress diagnostics can measure cortisol levels in hair. There are fascinating future implications for this that I will discuss in a future post.

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.

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!!

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???

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!