Sunday, March 26, 2006

What a Woman

For those of us who occasionally have foot in mouth disease, check out the faux pas that a St. Louis DJ committed:
  • Uh-Oh

  • That Dr. Rice not only publicly forgives the man, but also draws a larger lesson from it, is nothing short of amazing grace.

    Saturday, March 25, 2006

    I Know You'll Listen To Me

    As my loyal readers know, I’ve been counting down the days until September 9, after which I’ll be able to sleep in most weekdays and get more regular exercise. Recent events have helped me realize that maybe I should look at my remaining time on the job from a different point of view.

    Several mornings ago I asked my first patient if she had any particular concerns. She said that she had a list of questions for me. Before proceeding with my own agenda, I asked her what the questions were. It turned out that she’s had a history of false positive test results for an STD and wanted to know if that could indicate some further problem.

    Once I understood the nature of her questions, I proceeded with my usual yearly questions and exam. I stepped out of the room while she was dressing and discussed my hunch with one of my other early-rising colleagues. She confirmed my thoughts and so I suggested to my patient that we do a screening test for auto-immune diseases such as Lupus and Rheumatoid Arthritis.

    As she was leaving, she said to me, “My mom has been after me to talk to my primary doctor about this, but I said to her, ‘I’m going to ask Rosellen; I know she’ll listen to me.’”

    I know you’ll listen to me. Several patients have said that when I've told them that they won’t see me for their annual exam next year. I’ve decided that instead of counting down the days, I’ll try to approach each new day at work as an opportunity to better understand how I can make a difference for each person on my schedule.

    Saturday, March 11, 2006

    It Was a Very Bad Surprise

    I like to think that I carry little pieces of other people’s perspectives around with me, that knowing someone and appreciating appealing pieces of their personalities is a gift that I can continue to cherish, even if they’re no longer in my life.

    When we lived in Detroit, in the late 60’s-early 70’s, I became great friends with Vicki G. We had lots in common: we lived in the same high-rise apartment on the edge of downtown and our husbands were young professionals, overworked, struggling to achieve, and away from their families many more hours than most men their ages. But most of all, Vicki and I had our darling children: her Davey was several months older than my daughter, A, so we would often babysit for each other, giving each of us time away from otherwise cooped-up lives.

    Vicki had a great sense of humor and liked to find special girley presents for A. Perhaps the best one was the pink plastic teething toy that Davey gave A. It was a giant engagement ring, replete with an encased liquid filled sparkley "diamond.” We’d put the 6-month-old infants down on their tummies to stare at each other and make great exertions to reach their shared assortment of toys; the engagement ring was one of their favorites.

    It was from Vicki that I picked up using the term, “trick” to describe new developmental milestones. For example, “Davey’s newest trick is turning over on his belly!” or “Guess what? A has a new trick: she grabbed the ring away from Davey for a change!”

    Since then, I’ve found that all new parents connect with that term and I often ask a woman at her 6-week-postpartum check what new tricks her baby is doing. Inevitably, she understands the shorthand and happily launches into great detail about the "clever” (another Vicki term) things that her baby does.

    But the Vicki-ism that applies to my life today is “It was a very bad surprise.” Vicki would use that whenever Davey or A hurt themselves. I continued to use it with both A and P and even use it with Johan now. (Although I’ve discovered that he doesn’t even want me to characterize his bad experience, as though he needs to own it all himself.)

    The very bad surprise in my world today is that our splendid University of Illinois Basketball Team lost to Michigan State last night at the Big Ten Tournament in Indianapolis. Dennis and I were there to witness the ignominy. If there were ever a perfect depiction of the expression, “Third time is a charm,” this was it, as the Illini defeated the Spartans twice in the last few months. Michigan State finally figured out a great defense that worked. Of course, it didn’t help the U of I’s cause that there were several crucial fumbles, miscues and general inattention to the game plan, as all of the above contributed to the unexpected loss.

    However, Tom Izzo is one of my favorite coaches and his team has had an unusually frustrating season, so this truly was a case of the best team winning.

    Dennis and I were fortunate enough to unload our remaining tournament tickets for $50 under face value and then had the delightful surprise that our hotel wouldn’t charge us a cancellation fee, so we came back home this morning. I’m getting ready to watch Michigan State take on Iowa in a little while, simultaneously doing loads of laundry, so it’s turned out to be a perfectly OK Saturday.

    Nevertheless, it was a very bad surprise.

    Monday, March 06, 2006

    Another Life-Time Skill

    If you’re offended by intimate female information, read no further. What follows is medical information that may benefit you or someone near and dear to you.


    I’ve mentioned before that some of the skills one learns in Prepared Childbirth classes will serve in unexpected ways. One of the most useful instructions is how to do the Kegel (pronounced kay-gill) Exercise.

    Named after a Los Angeles Obstetrician/Gynecologist, Arnold Kegel, who practiced in the 1950’s and who was in the vanguard of the U.S. adaptation of Lamaze Childbirth techniques, the Kegel Exercise is a life-time skill. Don’t worry—I’m not going to wade into explicit details of how to do them—but it’s a way of understanding how to control the Pubococcygeal muscles, which are the base of support for the pelvic floor.

    The medical folks refer to the Pubococcygeals as the P-C muscles, which gives a whole new slant on the term PC. Both sexes are usually capable of developing good P-C control, with the most gratifying use being the tetanic-like contractions that one experiences with orgasm. The challenge for many women, though, is that often they have no idea as to how to do the Kegel Exercise in a productive manner. I sometimes examine a woman who thinks that she has good P-C control, but in reality, all she’s doing is some weird abdominal maneuver.

    The reason that the Kegel Exercise is taught in childbirth classes is that good P-C control allows one to release the pelvic floor muscles, hopefully so fully that the baby’s head will rotate down on to the perineum. If the woman is fortunate enough to have a patient birth attendant, as the baby is pushing through the complex pelvic floor, the muscles will release enough to not tear or require the attendant to cut them, allowing the baby’s passage. That cutting procedure has various medical codes to describe how deeply the cut had to be made and is called an episiotomy.

    A second reason for doing Kegels is improved toleration of every woman’s least favorite activity: the yearly pelvic exam. When I was in Grad School, I developed a handy little “How to Do Kegel Exercises” handout, replete with a simplified illustration of the intricate pelvic floor muscles. We still use it in our department and refer to it as the “Pink Kegel Sheet;” it’s helpful for someone who has trouble tolerating pelvic exams, because tight P-C muscles make for a very uncomfortable pelvic exam. The good examiner will usually be able to help a fearful patient release her P-C muscles, enabling her to work with the examiner rather than against him/her.

    It’s the third and most useful reason for doing Kegel Exercises that I believe has potential to be the best reason for good pelvic muscle control. We’ve all seen the TV ads for Poise pads or some other “feminine protection” product that tries to present urinary incontinence as an expected consequence of aging. I’ve found that if a woman has good P-C control, she typically will not have difficulty with leaking when she coughs, sneezes or laughs. It’s not unusual for me to encounter a woman whose youngest child is 20+ years and who has been putting up with constant leaking since that child’s birth. The P-C muscles, not surprisingly, can be damaged during birth either by being stretched or torn. An associated cause for poor P-C control after birth can sometimes be traced to damaged nerves caused by a traumatic delivery. And, of course when a woman is post-menopausal, the decreased estrogen level can cause drooping pelvic muscle support.

    Poor P-C control is an equal opportunity medical problem. Men can develop leaking when the muscle control is damaged during pelvic surgery, such as prostate removal. Certain medical conditions can cause incontinence for both sexes: Diabetes, Multiple Sclerosis, to name a few.

    If you or your loved one isn’t sure that they’re doing the Kegel Exercise adequately, I highly recommend a health care provider’s assessment. If he/she doesn’t seem to know how to help you, move on to someone else. Sometimes there is an underlying medical problem that interferes with one’s ability to control the muscles, and a good examiner will refer patients to a specialist when needed.

    But if it seems that the problem is simply related to inability to recognize the right muscles to tighten, one can have great fun getting them toned up. For women, the British call Kegels “The Internal Kiss,” and I tell my patients to enlist their partners’ assistance in their practice sessions.

    As I say, Kegels are a great life-time skill.