The enormous impact of seemingly trivial decisions



The enormous impact of seemingly trivial decisions A few years ago, Sandy and I were taking a hike in the San Bruno mountains, in a last minute decision we decided to stop at a nearby Trader Joes on our way home. As we were approaching a large intersection, an out of control car came speeding through, crashing into several vehicles, including the one just in front of us. If we had been seconds ahead, we would have been seriously injured or possibly killed. Seconds. As we sat there stunned, surrounded by sirens and wreckage, I couldn’t help the thoughts swirling through my mind. Had we walked any faster, if I hadn’t stopped to pee, if we zigged when we could have zagged, could we have been in the intersection when the crash happened? Have you ever considered how being in the right place at the right time or a small decision that feels inconsequential at the time, can have an enormous impact on your life's path. Perhaps selecting a certain class in college, where you meet someone who becomes an important friend. That person introduces you to your husband, or helps you get a job...etc. Is it random? Are there some karmic forces at work? I find it fascinating. Today, August 28th is our 37th wedding anniversary. It got me pondering about all the factors that were involved in my meeting Sandy. I grew up in Pittsburgh, He was from New York. I was a year younger. We weren’t simply likely to run into each other. We officially met on an airplane going from Kennedy airport to Israel on September 2nd, 1976. I was seventeen. Sandy likes to tell the story of how he spotted me in line behind him and asked the agent. “ Do you see that little red head a few people back? Can you please put her next to me?" Back in the olden days, there were no computers assigning seats. Instead there was a diagram of the seating chart with little stickers. The agent was happy to help and when I got to the front of the line, he took the sticker next to Sandy’s seat and put it on my boarding pass. The rest is history. So, how is it that we were both on that same flight?  On my end, this path started several years earlier with my brilliant friend Steven B. He was my classmate at a private Jewish Day School back in Pittsburgh, PA. I didn’t love the school, but was content enough, coasting along, surrounded by good friends. Steven was much more serious minded. Religion was one of the subjects that was taught. We were in 10th grade when it occurred to Steve that if you believe in God and God gives you commandments, then you are a fool if you don’t follow them all. You can’t pick and choose. Steven began to live his life trying his best to adhere to the letters of the law. His baffled parents probably didn’t know quite what to make of it. The rabbis were thrilled. They considered him a bit of a trophy student. And then one day, Steven came up with some inconsistencies that in his mind, “disproved” the possibility of the existence of God. He sat debating with the rabbis for hours, but they weren’t able to give him the answers he sought. It didn’t seem to occur to any of them that faith isn’t something that anyone can prove or disprove, but that isn’t what this post is about. He was done being in that school and wanted out. Two more years seemed like an eternity. With the same energy that Steve had been putting into following the rules, he now put into relishing his freedom. Indeed, he figured out a system. It turned out that all that was missing to graduate after 3 years was just one English credit. He convinced some of his best friends, myself included, to chip in to hire a teacher for one after-school class and we could all graduate after 11th grade and skip our senior year. I was all for it. My parents were supportive. The school was horrified. This was a private school and losing a dozen kids was not something they were happy about, but there was little that they could do other than change the rules, so that future students couldn’t avail themselves of that option. But, I was out after 3 years of high school. I was accepted and deferred to nursing school at the University of Pittsburgh and decided to spend a gap year doing an organized program called “year course” in Israel. That was what got me to the airport that day. Sandy was there because a dear friend of his convinced him to do the same program. Organized “anything” wasn’t (and still isn't) Sandy’s typical modus operandi. This was a big shift for him. I am somehow convinced that he was there because we were meant to meet. The first week we were all on a kibbutz. We were being assigned to various relatively menial jobs. The question was posed, “Does anyone here know how to drive a tractor?” Really? We were a group of urban kids who had just graduated high school. A tractor? But there was Sandy (who was raised in NYC and had never been on a tractor, thank you very much), who had no interest in cleaning up after livestock, or picking olives, raising his hand! He faked it well, thankfully without harming himself or others. He mastered it quickly and absolutely loved getting to know the real ins and outs of the kibbutz. I ended up picking olives.  In fact, after realizing that this organized program was not for him, he bowed out and left the program after about a month. We remained together on the kibbutz for several months, before I headed off for other parts of the country; Sandy stayed behind riding his tractor, and became an adopted "member" of the kibbutz. But our connection had been made and was set! Sandy and I spent seven years in a long distance relationship before we ended up getting married. During those years I was back in Pittsburgh. Sandy was at Cornell, then Boston and then NYC. That was before cell phones. I remember waiting for our nightly call at 11:01 pm when the rates would go down. Of course, there were turbulent times peppered throughout. If any couple tells you that things are always easy, then they are either delusional or they are lying. Relationships take work. Sandy and I got through the choppy waters to a place that I wish for all of you. Complete trust, lots of laughing, lots of love, respect and actual deep friendship. We also are comfortable with the fact that we are very different and have many varied interests. If I want to go to a musical, or do a "Sound of Music" tour in Salzburg, Sandy won’t be the person that I bring with me, any more than he would bring me on his mountain climbs. We are okay with that! He remains my perfect travel companion. I can't wait until we can get back to more adventures. So if you are reading this? If I hadn’t met Sandy, I would not have moved to San Francisco. Honestly I may have stayed in Pittsburgh. I would not have answered a little ad in the paper that I happened to randomly see, on a day that I was half heartedly thinking it might be nice to get a job that wasn’t hospital based, thus ending up at Noe Valley Pediatrics. While working at Noe, during the H1N1 crisis 12 years ago, a mom in the practice encouraged me to start blogging in order to give up to date information on the availability of the vaccine; and this blog was born. For all of you who made lifelong friendships when you met each other at my baby boot camp sessions, think of all the little forces at play. I look at our kids, who are such a combination of both Sandy and me, and bless those forces that got us together and helped us navigate the bumps. Steven may have disproved the standard biblical God, but for me, I think there were some divine powers at work.

Ergonomic tips. Make sure your home/school work station is optimal

Ergonomic tips



I have a wonky shoulder. The issue most likely stemmed from a combination of doing something dumb a few months ago and age (sigh). With all of the quarantine stuff going on, I ignored it as long as I could, but finally ended up at the orthopedist (shout out to the amazing Dr. James Chen). Thanks to a cortisone shot (that I was a little nervous about, but it barely hurt) I am now getting some of my movement back. I am also starting physical therapy.

One of the things the PT was reviewing with me was my body mechanics when I am in front of the computer. I am tasked with having Sandy take a candid photo of me when I am working so that they can take a look at my habits and see if I am aggravating things with the way I am sitting. He hasn’t done it yet, but I know that I won’t need a photo to point out that I am probably not following the rules.

With more and more families working from home and many kids doing school through 'distance learning' we all need to be paying attention to our body mechanics.

Extensive time in front of the screen can lead to back, shoulder, and neck strain. When looking at the screen, your eye line should be level with the address bar on your web browser.

It may be easier to get a proper position if you can use an external monitor or laptop stand to prop up your screen. Have your kids sit in front of their device and see if their head is straight or if they need to tilt up or down. 

Elbows should naturally fall flush with your table/desk height. An external keyboard and mouse as part of your work station will promote better wrist alignment. Trust me, if you can avoid carpal tunnel stress, it is worth the effort! Kids are not spared from getting wrist issues from over use.

Make sure the chair you are using gives adequate support. If you don’t have a supportive office chair, putting a firm cushion or folded towel under your tush will raise your hips and increase the curve of your spine, This should make sitting more comfortable.

Your feet should not be dangling! I have been guilty about this.

Place your feet on a few books or boxes under your desk, so that your thighs are nearly parallel to the floor and your hips are slightly higher than your knees (the squatty potty is probably a little too high for an adult, but might be just the thing for your child).

If you are on the couch, hunching over your laptop, I am betting that you are NOT in a good position.

My son-in-law says that getting a standing desk was an absolute game changer for him. They are available from Costco and are fairly affordable.

Here is a CDC checklist for making sure your workstation is optimal

For those of you on the phone for much of the day, use a phone headset if you have one. Constant cradling the phone between your neck and shoulder can cause trouble.

Think of the 20/20 rule. For every 20 minutes spent looking at a computer screen, you should spend at least 20 seconds looking at something else 20 feet away. This gives your eye muscles a break and helps reduce eye strain. Even better, get up and move. My fit-bit gives me a reminder to move and then a little buzz if I get 250 steps every hour.

I have been on zoom meetings a lot lately. For at least a few minutes every hour, I turn off my video and get up and stretch when I get that nudge from my device. Set up some type of incentive or alarm to remind you to move. It is amazing how effective that can be.

Even more importantly, get outside! My awesome colleagues have identified some meetings that don’t really require us to be in front of the computer at all. We go outside and connect via phone while we walk. Be creative.

Kids need recess too!

Beyond the simple body mechanics, make your work station an easy place to concentrate. Having a television on in the background is not ideal.

Be mindful of glare.

Glasses that can protect folks from blue light have become popular.

I reached out to my favorite optometrist Dr. Vincent Penza to see if they were a worthy investment. He forwarded me this article.

My takeaway was that blue lights from screens are not actually dangerous. While some people feel like the glasses make their eyes feel less tired, the science behind that is lacking.There is certainly no harm in wearing them. The blue light experienced from the outdoor sunlight greatly exceeds what any device gives off. Please don't minimize the importance of wearing sunglasses when you or your kids are outside! Blue light does impact melatonin which is connected to your sleep rhythm. This is why most experts strongly recommend avoiding screen time for the period of time before you go to bed.

If you are wearing headphones, make sure the volume is not set too loud. Here is one of my blog posts that tells you have loud things are and when it becomes hazardous.

Happy Birthday Lauren

This week's topic  Personal Musings: Happy Birthday Lauren

I was going to write about the fact that August is national vaccine awareness month. Immunization rates are lower than they should be, mostly due to the quarantine. Other things such as the importance of ergonomics now that we are slouching over our computers so much were on the list of possible topics to tackle, but I just wasn’t getting motivated. I considered skipping a week altogether, but writing the weekly posts has been one of the ways I have been keeping some normal routines intact during the quarantine. So please indulge me as I do another post that is mostly personal musing. Both of my kids have summer birthdays. That means I got to waddle around with an enormously pregnant belly in August for my first daughter and July for my second. This gave me an enduring love of San Francisco weather and the delicious fog. I couldn’t have stood the heat and humidity of the east coast. Last month I wrote about my July baby Alana when she turned 30. I had no qualms about her reaction to getting showered with some birthday love and attention. This week it is my daughter Lauren’s birthday. 33! Even though she is my actress who is quite comfortable on stage, she otherwise does not seek to be the center of attention. Lauren would tend to ignore her birthday if given the choice. Between her amazing husband Adam and the rest of the family, we won’t allow that to happen. Before Lauren was born, there was no crossword puzzle with answers confirming the baby’s gender and name But…. Right before I gave birth, my mother in law and I were having tea at the Japanese tea garden in Golden Gate Park and the fortune in my cookie was “ a short stranger will soon enter your life!” I am in complete awe of this oldest daughter of mine. She is an adventure seeker. This is the daughter who successfully guided her dad and she to the summit of Mount Kilimanjaro and then to Everest Base Camp a couple of years later. They both would have liked to try to go higher, but fortunately they were wise enough not to cross me! Before their first climb someone asked about their training. Sandy talked about how he was in the gym daily and hiking our local mountains while wearing increasingly heavy packs. Lauren, who was living in NY at the time, paused and responded that she was too busy to do any hiking but she was practicing learning how to pee standing up. Aside from the mountains, she has been skydiving twice (that I know of...), is certified to scuba dive and has flown a plane. She loves to travel and actually spent weeks traveling solo through Europe. She does try to protect me, so there may be things here that I simply was never told about! She is hands down the funniest person I know. She is a remarkable mimic. She had her Lowell high school teachers voices and mannerisms down pat, and would imitate them so perfectly that when I would go to the open houses and meet the teachers in person, I could barely keep a straight face. She can make a stand-up routine out of little every day events that will have everyone in the room hanging onto her every word and howling with laughter. Her brain has little savant traits that even she agrees are off the charts. She can unscramble the jumble in the paper instantly, no pen needed. There is a game called Set, that is based on pattern recognition. I haven’t met a person who can match her. She has been beating me at scrabble for years, and I am pretty good! She has always been musical. She was singing all of the Disney and Rodgers and Hammerstein show tunes with perfect pitch at an age where most kids are simply learning to talk. My favorite thing is still to listen to her sing and/or play piano. She and I play piano duets, as I used to do with my mom. Most of the time we sound pretty good, but full disclosure, there are plenty of times when one person is ready to turn the page and the other person is still playing because somehow they ended up a few measures behind. She and her dad play guitar together. She is one of the lucky people who has discovered the career path that they are meant to be on. She changes children's and young adults' lives by exposing the neuro-diverse to the joys and benefits of theater. Families leave her students' performances in awe, and frequently in tears, of what their children have accomplished. She is a teacher of drama and improv, and has been sought out by world renown theater companies to help them reach this population with their work. In 2019, she was the first ever recipient of the San Francisco Arts Learning Achievement Award, presented to her by Mayor Breed.  I am constantly learning from her. All you parents out there. Savor every single stage, but it is okay when they grow up and turn into amazing people who make the world a better place. Happy birthday Yaya!

2020-2025 dietary guidelines/Highlights

2020-2025 dietary guidelines/Highlights

https://www.dietaryguidelines.gov/sites/default/files/2020-07/ScientificReport_of_the_2020DietaryGuidelinesAdvisoryCommittee_first-print.pdf Every Five years the USDA (United States Department of Agriculture) and the HHS (Health and Human Services) come out with updated dietary guidelines. Many times when these come out foods get tossed from the good guy list over to the bad guy list and vice versa. The 2020 was just released. I was pleased to see that for the first time they include guidelines for babies and toddlers. Pregnant women get a mention as well. The study is independent and heavily researched based. Unfortunately for the first time in 40 years the federal government had some impact on which questions and issues actually made it to the current study.  https://www.washingtonpost.com/business/2019/08/30/how-trump-administration-limited-scope-usdas-dietary-guidelines/ There were some concerns about important topics that were not addressed, such as salt intake and the importance of organic and sustainable food. In general there are no shocking revelations in the report. It feels like a lot of common sense. I am happy to say that the new guidelines are pretty consistent with the approaches that I have followed for years when I teach parents about solid foods. The report is 835 pages. I have the link above for those of you who are inclined to read it. For the rest of you, here are some of the takeaways (you're welcome!) One of the biggest headlines that this report is generating is that for babies and toddlers under the age of two they are stating that ALL added sugar should be avoided. Wow! Is that even possible? Based on this report, it is certainly worth being much more conscious about it. Sugar is lurking in so many places. On a food label, added sugars can include "brown sugar, corn sweetener, corn syrup, dextrose, fructose, glucose, high-fructose corn syrup, honey, lactose, malt syrup, maltose, molasses, raw sugar, and sucrose. I do wonder if any of the authors of this study actually have kids... Take a deep breath. We are simply referring to ADDED sugars.  Natural sugar in foods is fine. Breast milk has sugar, but it is the perfect combination of fats, proteins, carbohydrates and vitamins for a baby's needs. Fruit and some veggies have plenty of natural sugar but are balanced by fiber and other nutritional benefits. Apiece of fruit put in one of those mesh bags is still considered fruit, even though it feels like they just are sucking the juice out of it. The report also reinforced the benefits of breastfeeding. The conclusion is that if you can make it at least 6 months, that is stellar and there is a long list of positive health impacts! But one of the things that stood out to me is that there are some findings that a baby who gets even some breast milk at all is getting some potential benefit. Any amount of breastfeeding is good. Given this information, I strongly recommend giving nursing a try. Get as much support as possible to make it a success. If you are one of the moms for whom it simply isn’t a good fit, then at least know that those efforts weren’t wasted if your baby got some of your milk early on. Fish should be an important part of the diet. Eating at least 8 to 12 ounces each week of a variety of seafood high in omega-3 and low in methlymercury may boost cognitive development and language and communication development in children. Pregnant women should be making fish a part of their diet as well. Sorry moms, it should to be cooked. Check out this excellent post about how to choose the safest fish : https://anglers.com/news/mercury-in-fish/ The committee confirmed what I had been mentioning for years - that introducing peanuts and eggs, "in an age appropriate form," after 4 months of age may reduce the risk of food allergy to these foods. The evidence wasn't quite as strong for other allergens such as nuts and seafood, but there was also no harm in introducing these other potentially allergic foods on the early side. The only food on the no no list at this point for babies under a year is honey. (For eggs I would still start with the yolk and make sure they do well with that before introducing the white) When you do try the higher risk foods, do it in the morning when you are closely watching your child. Have Zyrtec or Benadryl on hand just in case. I also like putting a touch of the food topically on their cheek to make sure there is no local reaction ( that is not part of the report.) The guidelines do not recommend the strict low carb diets that come in and out of popularity. It found that those are actually associated with poorer health long term. The report suggests that about ¾ of the daily calories should come from healthy carbohydrates such as fruits, vegetables, grains and legumes.  Vitamin D is important and they agree that all breastfed babies should continue to get 400 units/day.  The study mentions the importance of iron and zinc for normal neurological development and immune function. Since these levels decline at around 6 months, make sure your kids are getting adequate levels from their solid foods intake. These minerals need to be a consideration in your food choices. And this isn’t in that study, but I found it interesting!! Fermented food rocks! https://www.donga.com/en/article/all/20200717/2122953/1/Kimchi-protects-against-COVID-19-a-study-says One last thing, sorry to all the men out there, but the study decreased the amount of alcohol that is considered healthy. The previous version suggested that men limit themselves to two drinks per day, defined as a 12-ounce bottle of beer, a five-ounce glass of wine, or a 1.5-ounce shot of liquor. For women, one drink per day has been advised. The new report lowers the recommendation for men to one drink per day and keeps the same recommendation for women. It also eliminates the suggestion that moderate drinking could actually have some health benefits including cognitive function. That always did feel a bit like wishful thinking, but who knows, in 5 years when they do this again, it might be back. Along with alcohol, the study makes the conclusion that processed meat should be avoided. That comes as a shock to no one. Has that ever been on the healthy food list?? To close, I know of no one who can follow any guidelines to the letter of the law. Be aware, read labels and do the best you can.

Nail clipping. It doesn't need to be a nightmare!

Nail Care/ It doesn't need to be a nightmare! The world is full of enormous challenges right now; big ones! But for many new parents who are focusing on issues that are impacting their own personal, daily lives, they might confess that trimming baby’s nails ranks as one of their most prevalent first world problems. I have honestly had parents actually offer me bribes to cut their infant's sharp little nails. Sorry folks. Guess what? I hate it just as much as anyone else. Nail clipping (as well as splinter removal) are among those things that I don’t excel at (understatement!)   I will tell you a secret. In my family the task of nail clipping belonged completely to my husband Sandy. Our kids referred to it as "snip snip." Daddy cut their nails when they were babies and if he accidentally cut them and drew blood at any point, I have blocked that out of my memory and in any case, they survived. He got to continue this job as they got older, clipping nails and applying polish on request to his daughters' fingers and toes, until they learned about spa pedicures with mom, and that put daddy out of business. Babies have sharp nails that grow quickly. These are thinner than the nails of an adult, but that doesn’t make them any less able to cause damage. It is not uncommon for them to leave scratch marks on themselves if you don't keep those nails short. Some babies actually manage to scratch their eyes, leaving little red marks in the sclera. Those marks on the whites of the eye fade away without any intervention. If there is a worrisome scratch to the eye it would cause watering and obvious discomfort. To deal with the scratching issue, I know some parents who put little mittens on the hands, but really, as tempting as it is to keep those on, it is not a realistic long term solution. Some people actually used to nibble the nails down even while medical sources were giving a resounding yuck to this unhygienic practice.     Fortunately there are special tools for the job.    Some clippers even come with a magnifying glass attached. The special kid scissors have rounded tips that can help avoid injury if your baby moves suddenly. Dr. Anne of Noe Valley Pediatrics used to recommend the Piyo brand for her twins. She says that she used them for at least six years without any nicks. https://www.bestproducts.com/parenting/baby/g363/baby-nail-clippers-and-trimmers/   I recently became aware that there have been new products to come on the market since I last updated this post. In the startup where I am currently working, we have chat groups of moms who share their wisdom with each other. They talk about everything under the sun. Recently in one of the chats, one of the little cuties did a number on her face by scratching herself with her very sharp little nails. In another group one of the dads had caused some bleeding when he was trying to take on the nail trimming task. With all the conversations circulating about nails I learned about the new options linked below.  Becky likes https://www.amazon.com/NailFrida-SnipperClipper-Set-Fridababy-essential/dp/B01644OCVS   Maya and Pariya absolutely love https://www.amazon.com/dp/B01IC6RD4O?ref=ppx_pop_mob_ap_share They call this product an absolute game changer and worth the cost of the replacement files.   Please don't be tempted to use adult clippers or scissors. These are often quite a bit sharper and therefore not as safe.  Regardless of which product you use, consider doing the nail trimming right after a bath when they tend to be softer. You might also tend to the baby’s nails when the infants are in a deep sleep cycle. You can identify this sleep stage because the baby is completely limp and relaxed, the hands are usually unclenched. If you choose this option consider keeping a little pair of nail clippers with you in your diaper bag as you go on outings. If your baby is asleep in the car seat, you can seize the moment. The wise Doctor Schwanke who I worked with for more than 30 years says that the most important thing to do with any nail clipping or filing is to push down on the finger pad to make sure you get a little space between the nail and the finger. At some point as your child gets a bit older, it is reasonable to simply want and expect cooperation. You may have to work towards this goal. When we got our puppy many years ago, we were advised to handle her all over so that she didn't have any areas that were "off limits". I would do that with your baby. Get in the habit of doing a gentle, relaxing little hand and foot massage that includes all the fingers and toes so that they get used to you handling the nails. Do a little rhyme or song as you do it. Think "my little piggy". Of course you are only clipping the nails some of the time, but they may stay more relaxed when it is actually nail clipping time if they are used to the fingers being manipulated. Who doesn't enjoy a little hand or foot rub! If you do accidentally cut a finger or toe, (very unlikely with the new little battery operated file) just hold pressure for a few minutes. You can apply a dab of Neosporin if it seems like more than just a superficial little nick. Hopefully the little cut doesn't need more than a few minutes of pressure but if you need to apply pressure for a bit longer, you can put a band-aid on a finger or toe and then put a sock over the hand or foot so that your baby doesn't pull it off. Band- Aids can be choking hazards so you need to be wary. Toe nails should be cut straight across, fingernails can be rounded a bit. If your child does develop an ingrown nail, try to soak it or apply a warm compress. A warm, moist black tea bag makes an excellent compress. Apply Neosporin a few times a day. Infections on fingers and toes can actually get pretty nasty, so if it doesn't look like it is improving have your doctor take a look. Any red streaks running down the finger or toe need same day medical attention.   For your older children it is lovely to have the grownup treat of a manicure or pedicure at a local salon. We will need to wait a bit until things normalize before considering this, but when we are free to get back to salons, do your due diligence and make sure that you use a place that sterilizes the equipment. Fungal infections acquired from a dirty salon can be a nightmare to get rid of. Be a label reader when it comes to the polish. Three very common ingredients that are found in many nail polishes are Toluene, Dibutyl Phthalate ( DBP) and Formaldehyde. These are actually carcinogenic. Formaldehyde Resin and Camphor are two other ingredients to avoid. It is worth checking online for a list of non toxic nail polish brands. With more awareness these days, safer nail polish is becoming more widely available. If you google kid safe polish brands you will find a robust assortment. Some are even safe for those nail nibblers.

Blink. My baby is turning 30!

Recipe for creating a birthday monster - Ingredients One first born child who like her father, thinks that birthdays are just another day and require very little attention. One mother who wants to make a fuss. One second child who thinks that birthdays are wonderful and should be celebrated for the entire month. Don’t leave out half birthdays! Stir Happy Birthday Alana!! Somehow my baby is turning 30 this week. Alas, with the quarantine it won’t have all the bells and whistles that it should have.This week’s post was written in honor of the auspicious occasion This week's topic My Baby is Turning 30 Lauren and I are a team. We take a daily nap with her holding tight to my hair while I hold her foot. Blink  she is going to be a big sister Blink It is July. It is hot. I have no clothes that will fit over my enormous belly. It turns out that when you let your almost 3 year old girl pick out your new maternity clothes, you spend the several weeks switching between several florid pink flowery dresses until delivery. The days before she is born, the names have been chosen, but the baby’s gender is still unknown to us. Alana if it is a girl, Adam if a boy. My mother in law is doing the Sunday crossword puzzle and calls me over in amazement with the following two answers in the puzzle: 103 Across: It’s a girl. 34 Down: Alana (actual puzzle appears below) Alana is born weighing 9 pounds/8 ounces. She is so big that she looks like she can eat all of the other little babies in the nursery. My father in law had always been a bit cautious handling a small infant. Finally here was one that was solid enough that he wasn’t afraid to hold her. From the start he would repeat to us, “There is something special about this one”  Lauren is thrilled with the baby.She is not quite willing to share her Nanya, but other than that she makes room for her sister in her heart and in our family She is the older sibling that every parent wishes for - gentle and loving. Almost immediately Alana is her best audience. No one gets the giggles and smiles that Lauren can elicit. Later on, she is the only person who can understand what Alana is trying to say and acts as a translator. Blink  I am sitting in the dark in the middle of the night nursing my baby Alana, I nuzzle her head and take a big sniff. Does anything smell as wonderful as a baby’s head?  Sleep deprived, but these moments are magic. Blink  We are at a park and Alana is crawling at record speed across the grass. We can barely catch her. What is her target? A dog of course. Five times her size. The bigger the better. She makes a bee-line towards anything with fur. The adoration is mutual. I have not yet met an animal who doesn’t immediately fall in love with her. Blink Alana is growing and doing things at her own pace.The lesson that you can’t compare sibling milestones turns out to be a gift that I am able to share with other concerned parents over the course of my career. Walking? Talking? Toilet training? Lauren broke the curve on the early side. Alana, on the other hand, was in no hurry to do anything. I shouldn’t have been surprised. Aunt Marjie forecast this tendency while checking out Alana’s astrological chart before she was even born. “She will take her time and then instantly master things when she is ready”. When she finally walked, her first steps involved her picking up a small chair and carrying it. Perhaps she was practicing when no one was around? Her poking along on her own relaxed timeline ended up giving me subject matter for many blog posts. The lesson? They get there when they get there. Kids are all different. Relax! Blink Alana is three and we are cuddling in bed reading a library book. It is a silly story about a bunch of different animals. One of the characters was a naughty hyena who played malicious tricks on the other animals. These animals were getting fed up. One day they overhead the hyena plotting his next caper. He was planning to pretend to be in trouble, call for help and lure the other animals into a car-wash where he would trap them and get them all wet. They decided to turn the tables and the book ended as they got their revenge by making the trick backfire. The hyena ends up wet and sad. Most people reading this book would be left with a “well, he got what he deserved.” Not Alana. I look down and her and she is stricken. “The good animals turned bad, they shouldn’t have done that” Blink  Alana is in preschool. She starts her collection of lifelong friends. One day I am late picking her up and we create the “what would you do if..” problem solving game(https://nursejudynvp.blogspot.com/2014/11/problem-solving-skills.html) She excels at it. Her sister doesn’t like it at all. Blink  We are in a teacher conference with her first grade teacher. Dear Ms. Eisenhower is telling us about a group activity. There were multiple choice questions that needed to be answered following reading a story. Everyone else in the group thought the answer was A. They pushed and cajoled, but Alana stuck with the answer B and would not be swayed. She was the only one who was correct. The teacher watched with pride as this one little girl was impervious to peer pressure.  Blink  Alana is in high school at Lowell. She has kept all of her friends from preschool and grade school and is now gathering new ones who she will continue to hold dear. She is a peer helper. One day she is in the principal's office just chatting with Mr I. They lost track of time and she is now late for class. He gives her a note to give to the teacher. “Please excuse Alana from being late, she was counseling me.” She is going back and forth between several bonfires at the beach. She arrives at one right as the police come. They are not acting at their finest and are forcing the kids in attendance to do push ups down on the sand. She sees people terrified and in tears. Alana insists that the officers show her their badge numbers and she reports them. Blink  Alana has learned to make things work in her favor. We all watch it happen over and over. The family refers to it as Alana-Land. She wins raffles. Restaurants offer her free food. She gets upgraded on flights. The burrito man at Gordos knows her order and has it ready for her as soon as she enters. No need to stand in line.  She presented an expired membership card to the museum. “I am afraid your card is expired” “It isn’t a problem. And I have 3 friends with me that I will be bringing in with me” “Uh, okay...here are your tickets” Blink Blink Blink UC Santa Cruz, she ends up being one of the rare undergrad teaching assistants for the chair of the department. Another professor refuses to allow her into a section that would work with her schedule. He gets a scathing call from the department chair warning him to rethink his position. “Oh, it must have been a misunderstanding, Of course Alana can be in any section that works for her” and then asks Alana if she would be willing to be a TA for him as well. After finishing her undergrad, she works at the SF suicide hotline. One night when walking to muni after a late night shift, I am keeping her company on the phone as she walks. What is that sound? A dixieland band accompanies her down Market Street and then tips their hats and she heads underground. When not volunteering at the hotline, during the day she does an internship at UCSF where she ends up co-authoring published research papers. Now it is time for grad school. She gets in to all the schools she applies to. She and her dad do an epic road trip cross country where she earns her MSW from the University of Michigan. As Sandy likes to say, she graduated at the top of her class at the #1 graduate school of social work, making her the #1 graduate student in her field in the country. She then does a few years working at a community mental health clinic until she is fully licensed. Blink The family is on a trip in Wadi Rum in Jordan. Lauren and Sandy are clambering up cliffs and sliding down sand dunes. Where is Alana? Oh, there she is, in a tent. She is drinking tea. There is a cat on her lap. A young Bedouin fellow is giving her a henna tattoo A cancelled flight from Detroit to Pittsburgh where she is flying to meet me. No worries. A group of new friends that she met at an airport bar rent a car and drive her door to door. AlanaLand! Blink She continues to collect lifelong friends. Now she is living back in San Francisco where she belongs. Wise, kind, funny, compassionate, creative, passionate about right and wrong with a quiet backbone made of steel. Making the world a better place, one starfish at a time. I couldn’t be more proud of the adult she has become. ---------------------------------------------------------------------------- For anyone interested, here is the speech that Sandy made about Alana on the occasion of her Bat Mitzvah when she was 13. She was already well on the road to becoming the awesome woman she is today!   My Darling Alana, As an infant, you were, well, slow. You weren’t particularly quick to turn over, or quick to crawl, or quick to walk, or quick to talk. As mommy just said, one day my father, your papa, held you, looked into your eyes, and said, “This one – she’s going to be very special.” Rarely have such prophetic words been spoken. To everyone sitting here today who knows you, you are indeed special. Whether it's as a granddaughter, niece, cousin, friend, student, sister, or daughter, you have established that specialness to all of us. But the fascinating thing is that no 2 of us understand that to mean the same thing. You of all people I have ever known have a rare ability to find that unique essence of each of us as individuals, and focus in on it, nurture it, respect it, and use it to form a relationship that is truly distinct from any you would have with anyone else. And intuitively, we all recognize that; you make us feel special as a result of it, and we are better off because of it. You have amazing talents in many areas – writing, the arts, mathematics, and you’ve heard over and over that you can do anything you want to in life, because you have the talent, and the will. But for as long as you can remember, you’ve always heard me tell you that you would be the world’s greatest diplomat. Many years ago, your dear friend Yael went to a new school, and came home one day very upset. She told her mom that everyone was being mean to her, teasing her, ... hurting her feelings. Jodi told her that occasionally friends could turn on you and do that. And Yael’s response: “Not Alana. She doesn’t know how to be mean.” In 4th grade, your friend Zachary would never eat his lunch at school. Melanie, his mom had exhausted all her motherly tactics to get him to eat. So what did she do? She turned to you and asked you to make sure Zach ate his lunch. And so you sat with him every day, and we don’t know what you did or how you did it, but sure enough, he ate his lunch. A few years ago in school, you had a new teacher, and after a few weeks, she approached your teacher from the previous year and asked if everything was all right with Alana. "She seems kind of quiet, reserved, shy, keeps to herself, and doesn’t participate much in class." And she just wanted to know if there were any special considerations she needed to be aware of. Your previous teacher told us that she smiled, laughed, and replied by saying “In a few weeks, Alana will let you get to know her, and then you’ll wish you had a classful of Alana’s.” But there isn’t a classful of Alana’s. There is only one. And while others are lucky enough to have a little bit of you in their lives, your mom and I are the luckiest of all, because Papa (You listening dad? Because you won’t hear me say this too often) was right – this is a special one. And we’re not the only ones who think so. I’ll close with one sentence from a letter you received just yesterday from your 4th grade teacher, who wrote “You’re so very special Alana, the world needs your kindness and your brilliance.” I am so very proud of you and I love you dearly.

Drowning Prevention: Appoint a Water Guardian!

Drowning Prevention: Appoint a Water Guardian!

Somehow it is already summer. This year feels so different, but many families are figuring out how to do a bit of traveling even in the midst of the Covid virus. As long as you take reasonable precautions, getting a change of scenery can be a wonderful thing. Anytime you are away from home, there are a range of safety issues that can arise. When you get to your vacation destination, do a basic assessment as soon as you arrive. Are there smoke and carbon monoxide detectors? Do you know where the fire extinguisher is? If you are visiting older relatives, are any of their medications safety out of reach? Are any unfamiliar pets comfortable with children? Have you asked to make certain that there are no unsecured firearms?   Think like a toddler. What type of trouble can they get into? Can they open the doors on their own?   Water danger is one of the more essential considerations. If you are going anywhere that has a pool or is near water of any sort, you need to be aware that drowning can happen in just a few inches of water and it can happen quickly!!! According to the CDC drowning is now the most common cause of death in children under the age of four (excluding congenital issues)   Here is a true story from one of my patients. Several adults and children were enjoying a day at a friend's pool in the East bay. They got out of the pool to have some lunch. Some of the oldest kids started to bicker. While the adults turned their attention to the squabble, a one year old got back into the pool unnoticed and submerged. Thank goodness another of the adults looked up, noticed, and was able to get her out and perform CPR. The little girl is perfectly fine, but this was terrifying for everyone.  Just this week my friend Dr. Ted from Oath Pediatrics, fresh from his overnight shift in the hospital, was telling me about a close call, near drowning from a family pool in Walnut Creek. Just a moment of taking their eyes off of the kids almost led to tragedy. Sometimes having a lot of adults around lends a false sense of security. If kids are near a pool, the adults must take turns being on a shift as the designated lifeguard.   It is so important to be aware that a person who is drowning usually does not thrash about and call attention to the fact that they are having trouble. They can slip silently under the water without being noticed until it is too late. Even if your child has proven themselves to be solid swimmers, you need to stay actively focused and engaged on watching them like a hawk while they are in the water.   When I sent this post a couple of years ago, I became aware of Levi's Legacy https://www.levislegacy.com/ and I am going to continue to do my part to spread the word. Many parents are doing a good job of staying on high alert when they are actively at a poolside but the danger doesn’t end when you leave the pool area.   Levi's Legacy tells a heartbreaking story of a child who slipped out of the vacation home, made it out to the pool and drowned as the parents were busy doing some preparation for a family evening outing.   The important message here is that the lifeguard shift does NOT end when you go inside.   If you are staying anywhere with a pool, make certain that your child has absolutely no access to the pool area when there is no adult present. Hotels or apartments with fountains need to be treated with caution as well. If you do have pool access, there are a variety of pool alarms and safety monitors on the market. Some devices are little gadgets that your child wears around their wrist. Alarms and monitors may add a layer of safety but nothing takes the place of direct supervision. Someone needs to be on duty. Take turns. Appoint a water guardian. On duty mean no distractions (that means your cell phone. Put it down, you can do it.)