Wednesday, December 29, 2010


I have a lovely patient whose issues with her sexuality I understand. She has always been very sexually responsive, and this waned recently. For  her, it was most distressing. We tried a few things, and found the right balance to get things back on track. For this she is most appreciative. She gave me a bottle of
 KY Intense for Christmas. What a woman!

What I really like about this lady, is that she did not give up with the first try. She allowed me to work with her to get to her happy place. That is most unusual as we have been led to believe that answers, solutions, and cures are almost instantaneous with coming to a doctor's office. Testing sometimes is done in real time with immediate read outs of imaging and results of tests. Online access to results fast tracks communication.

Medical problems are usually not acute, and develop over time. Diagnosis and treatement sometimes takes time, as well as healing. Just some thoughts next time you go to the Doctor. Discuss time. Be explicit about your expectations for the visit, and make sure you and the doc communicate on the importance of your problems to you. We can then address the issues with you on a level that speaks to you clearly.

Hope this helps.

until next time..........................

Tuesday, December 14, 2010

The Unhappy Vagina or Something's Wrong Down There

OK, I have become an ambulatory gynecologist. What does that exactly mean? After doing annual womens' health screening, my number two most seen problem is the UNHAPPY VAGINA.

I just returned from a meeting of the American Society of Colposcopy and Cervical Patholgy. Otherwise known, as cervix , vagina and vulvar specialists. We wreaked havoc on the psychological health of the media guy who ran the slide shows. We were fascinated by all the varying lumps and bumps on the vulva, new and terrific diagnoses of "Unhappy Vagina Syndrome".

Many women come in to see the gyn with a "something's wrong down there" problem. It's up to me to figure it out and fix it. AND FAST. This is usually a problem that occurs on Friday and needs to be fixed by Friday night. Monday, hmmm somthing may not be quite right. Tuesday, OK maybe I should get something. Wednesday is a trip to the drugstore. Thursday, it's not gone, and getting worse. Friday gets a call to the gyn. GET ME IN NOW!

Most of what women self diagnose as yeast infections are not. They are a myriad of other problems, some infectious, and many are from irritants and allergens.

About one third are correctly self diagnosed and treated at home with over the counter medications. Of those that need the doctor, we never see anything uncomplicated. It can be from a week to years in the making. From normal cervical mucus, to a mixture of problems that envies an onion. After upteen years I have gotten pretty good at figuring this stuff out.

I have a secret weapon, Ladies Magic Cream. I have sent the secret formula to Clevland Clinic to see if it is worth commercializing. We'll see. In the mean time, it is always worth a trip to the gyn to figure out if it is an infection, what type, mixed or single. Irritant, allergen, hormonal, or normal.

Yeast grows in especially hot and humid conditions. For heaven's sake, lose the underwear at bedtime.
Cool and dry makes a happy vagina.

Bacterial Vaginosis is the newer name for nonspecific vaginitis, gardenerella, etc. This is an upset in the normal bacterial ecology. Someone other than the lactobacilli grow, and a stinky discharge with burning is the winner. This is treated with antibiotics. Over the counter stuff rarely works.

Irritants come in all types. The changes in your detergents, soaps, clothing, shampoo, pads, etc will make you red and on fire. The tip is to lose the irritant and soothe the unhappy vagina. It ususally takes a trip in to see the extent of the damage to Rx something to relieve inflammation and institute a regimen of healing.
The bathtub is your friend. No soap, just water.

Allergens are rare, and have a delayed reaction. That is the key difference between them and irritants. Again, discovery and avoidance is how it is managed.

All in all, my experience validated me as a major geek interested something that would get you in prison in several countries.

Until next time...........

Wednesday, December 8, 2010


Hello all
The Holidays are upon us, and cyber week was a grand success! I was minding my own business when...I browsed through to find a movie one of my sons's wanted. In the featured cyber week ads were TVs.

Hmmm I thought, wonder if one would like to find its way to my bedroom? Or maybe the spirit of Xmas will fill me and I will see if my Mom would like one to replace her ancient tube. Well I am on the Amazon page, and call Mom. No she says, her tiny kitchen TV is just right for her and that 32 inch flat screen won't fit. OK then, now I am still thinking about the bedroom, when the mouse wanders over to the upper right hand of the screen, and I click to close out the page.

At least that's what I thought I did. No, I find out on Tuesday next. I look up the " Where's My Stuff" part of Amazon to find the movie I purchased for sonny boy. It asks if I want to track my ORDERS, emphasis on the S.
Just what have I done? Well looks like that 32 inch flat screen is on a truck headed for Grandma's house. I have ONE CLICKED MY MOTHER A TV.

This is at 8:30 am. My Mother is a night owl and rarely wakes prior to 9am. I call her. Ma, Ma listen, I need your help. I accidently ordered a TV and it is headed to you NOW. It is on the truck for delivery. I have her attention.

She bolts out of her fog, and starts up with " I can't wait all day for UPS, I have a hair appointment" and I have to go to the doctor. My ride is going to pick me up at such and so. I am now begging her to help me out of my embarassing mess. I frantically look up the returns part of Amazon. Seems simple enough. Reason for return... hmmmm. stupidity is not listed. OK, not wanted anymore ( or ever, actually ). I click, the instructions say, not to worry, the UPS driver will come get this TV tomorrow with a return label. My cost can go up to a total of $18.86. Chump change for idiocy. I am so happy free shipping goes both ways. I am hoping that this will not be a disaster.

By now my mother has all her feathers ruffled, going on and on about the UPS driver, needing to be home, and having to go to her appointments. I am pleading, just let him push it in the door and wait for another nice man to come take it away......Please Please...... She is near hysterical thinking they will leave it in her hallway in a NYC apartment building. God no I hope, gone in 60 seconds flashes through my mind.

Now I am guilty thinking I am going to give some poor guy a hernia dragging the TV to her apartment just to have her tell them what a moron her daughter has been, then the next guy the same rant when he comes to pick it up. I am sunk.

OK Mom, its not going to be a little box. It's a 32 inch flat screen TV. Big Box. Ok, ok, hopefully they won't show up until 7pm when you are back from the doctor. Ok she says. I cross my fingers.
Give me the tracking number she asks. Ok, I whimper.

I am terrified to call her in the evening to see how things have gone. She has called UPS to track the package. On the truck, out for delivery they say. They advise her to refuse delivery. Return to sender.
The driver eventually drags the TV to her apartment. Its a woman. Worse than I feared. She pleads with my mother to keep the TV. Lady, its a 32 inch flat screen TV someone wants to GIVE YOU for Xmas!!

No, Mom insists, her little tube is just fine. TAKE IT BACK. Ok, the driver says and drags the thing back to the truck. Now my mother lives on the 19th floor of a high rise. This has not been a good day for the UPS lady. I am doubly guilty again hearing the tale.

Well, its back on the truck. I hope.

Hope your HOLIDAYS are filled with the joys of the season. I know mine are.

Until next time ................

Wednesday, November 17, 2010


This is not a disease. This is a curse, like diabetes. It robs people of their lives. Starts young and goes forever. Most cancers get better and more effective treatment. Most of you know that endometriosis is a benign gyn condition where uterine lining is found outside of the uterus. Lots of theories abound how this is possible. The most common theory is that menstrual lining refluxes through the tubes back into the abdomen and becomes like seeds on the sidewalk. A few take hold in the cracks and grow.
Another more recent theory is that of genetic predisposition and metaplasia of otherwise normal tissue turning into endometrium.

At any rate, either way, it is a bitch.
With each menstruation the uterine lining finds itself bleeding, which in the places where it shouldn't be, means pain. The fluid/tissue is irritating and causes moderate to severe pain on a monthly basis. Eventually it causes pain every day which can become debilitating. It sometimes leads to infertility as well.

Diagnosis is only by direct vision of the stuff in your abdomen by the doctor and sometimes a biopsy. No xray or blood test is helpful, however the story of painful menses leading to pain during more times in the cycle, painful intercourse is suggestive of endometriosis.

Treatment has centered around hormonal therapies simulating times when a woman is normal but not menstruating such as pregnancy, breastfeeding or postmenopause. These are commonly known as treatment with birth control pills, progestin only contraception such as Depo Provera, and GNRH analogs such as Lupron and now aromatase inhibitors such as Femara. They all work to some degree, but are temporary fixes.Conservative surgery has been the hallmark of diagnosis and treatment for some time, with hysterectomy being the final assault on the problem.

Conservative surgery includes laparoscopy with ablation/ cautery or excision of endometriosis lesions. The excision is the best therapy, however it can be tricky and sometimes technically impossible. There is always more, so hormonal therapy follow up is what I recommend.

When I was a medical student a million years ago, the professor taught us that young women with difficult periods needed to marry young and have their children early. Still good advice. A life plan is a critical part of this problem. Those words from the professor still ring true. For women with endometriosis, the sooner they complete their families the better. New and improved medical and surgical approaches are coming, but not soon enough for many women.

Until next time.........


Sunday, October 31, 2010

Second Childhoods

I am not sure that the Baby Boomer generation will be having a second childhood.
At least to me, I didn't leave the first one behind. Fun, excitement, living in the moment, and pleasure have been our trademarks. I see us beginning to "retire" but I don't see us stopping. Now one thing is for certain, we worked hard. There were lots of us, and competetion was stiff for just about everything from parking space to college entry. And, then of course, we came of age during the first oil crisis in the 70's, where there were no jobs and the economy went south. Then we picked ourselves up and enjoyed the prosperity of the 80's and 90's. Those of us who did well may still have a nest egg. The rest of us will continue to work, for a while at least.

Now I remeber hearing about old folks who had second childhoods. They stopped being stern and grumpy and started to enjoy the simple things all over again. They laughed, played and felt at home with themselves. I don't think the Baby Boomers, a la Dennis Hopper's Amex commercial, have left that behind. Just look at any highway on a Sunday. Grey haired bikers, convertible couples, and fun seekers with arthritis are all over the place. Of course, I am in Florida, but just the same.................

I just came back from a trip to Epcot this weekend. It was terrific! Sun, fun, grazing at the Food and Wine Festival, thrill rides, whew! Then plopping myself in the Lazy River in a tube for a few hours and hot tubbing with my Margarita.. Now that's my childhood........................................

I looked at the 30 somethings with the twins in the strollers, saddled with their overstuffed diaper bags, and backpacks. No thank you, been there and done that. If I ever have a grandchild, there will be no stopping us. Remember Auntie Mame? That woman is ME. Just one adventure after another tasting the delights life has to offer. So I say no to a second childhood.

My advice - don't give up the first one.

Thursday, October 21, 2010

Behind Closed Doors

Indiana University recently published  The National Survey of Sexual Health and Behavior.
Interesting reading for us gyn geeks. It seems that casual sex is bimodal, for those under 25 and those over 50. It's just riskier with a 50+ man. They only use condoms 25% of the time, while 18-19 year olds use condoms 80% of the time. Makes one wonder if the cougars know something.

This is not an unusual conversation I have with my over 50 patients. How to have that "how do we deal with std" conversation. See my earlier blog entries regarding herpes for some details.
It is now a fact, and will be a focus of public health efforts, that you should get the AIDS education along with your AARP card. Us old folks have been around the block. That means more time to accumulate little gifts that keep on giving. Again, see earlier blogs for the herpes virus heartbreak.

Now it seems that most of the sex is happening between ages 20-40. No big surprise. There is a progressive decline in reported sexual behavior with a partner after age 40 for women and men. The varieties of sexual behavior that was surveyed included solo and partnered masturbation, oral sex given and received by same and opposite sex partners, anal sex given and received , vaginal intercourse,  and condom use. It seems that most everyone has tried oral sex, but less than half anal intercourse.
Vaginal intercourse is still the mainstay of experience, however partnered masturbation was a surprise, at least to me. Non coital sex is an important part of the national repetoire.

The purpose of the study was to shed light on contemporary sex practices to focus on the future needs of public health campaigns. This surveys a  comprehensive statistically valid sample of Americans. The last such survey was about 1990. The survey was published in a supplement to the Journal of Sexual Medicine.

Until next time,

Sunday, October 10, 2010

In the confessional : GYN 101

Hello out there

After a few visits, and sometimes just one, women approach me with their deepest concerns, fears, and secrets.  Frequently it starts out as a question, but as the conversation flows, the information is shared. 
This is a challenge for me. I am not a priest. But I do have an oath of confidentiality sworn or go to HIPPA Hell.
I have never revealed a confidence, as many women reveal their secrets of past lovers, current amours, pregnancies lost or terminated,, sexual practices, I sometimes wonder if I were meant to hear all of this.

There are days I don't think I get paid enough to listen, or to share advice mother certainly should have done years ago, but here I am. Somehow I manage to maintain an open nonjudgmental attitude and discern what my patient wants and needs from me by the telling. Mostly acceptance, sometimes affirmation, sometimes just someone to listen. Then there are those who want intimate advice regarding their sexual function, and need pointers. Good luck if they are looking to me for help. I am a pretty straight shooter. 

I once had a woman reach into her purse and pull out a split of champagne and two glasses for us to share. She was wildly in love, but with a married man. Until he left his wife and was free to date openly, secrecy was necessary. We had known each other for years, and she wanted to share her unbridled joy. 
We drank a glass, hugged, and a year later she was a married woman, pregnant with her first child.

When I go, so do the details. I never write this down, its too intimate for insurance companies, however I always remember.
Until next time,

Wednesday, September 29, 2010

Attack of the Machines

This is the week that was.

It's only Wednesday and I feel as if I have been catapulted into the next century. Cleveland Clinic uses a wonderful Electronic Medical Record. As with every other hot program, it gets updates and upgrades.

Welcome to Monday morning 8am. 40,000 Cleveland Clinic employees are faced with a tennis racquet in the face with our latest upgrade. Yes, we were given classes ( weeks ago ) yes, they delayed implementation to give us more time to prepare ( we blew it off ) yes, we had mandatory computer based training ( we glossed it over ).

Reality hit just when the coffee was starting to perk. I expect by Friday, we may have more than a few fried employees.

How bad can it be? It's like taking all of your ABCD type files and then going to a numeric system. All the information is there, go find it. I am sure someone thought this was a good thing, and that it solved lots of user problems. It's just that if you look at my desk, to the casual observer, it is messy. I know where every piece of paper is located, albeit several layers deep. The very moment someone cleans up the desk, poof! I need one of those papers that I now cannot locate. Sound familiar?

Just like thowing away that coupon you are never going to use, you suddenly need the next day.

Well that's what life has been like at our place this week. Work has expanded to the point where I think the patients are getting the Swiss Rest Cure during their office visit while I fiddle with the program to close the visit encounter ( four attempts at least until the darn thing lets me out! ). I pride myself on running on time. Not this week. There are casualties everywhere on my schedule. Lunch has been nixed three days in a row, bathroom breaks are a thing of the past. Forget coffee. Idle gossip is history.
I am a one woman automaton stuck with that computer screen in my face. Waiting for the point where I can finally log out of a patient visit!

Tomorrow I am thinking about bringing in some flowers, incense and a rice bowl to place before the screen of terror. Perhaps an offering will help. It's like my son told me the summer he worked at my old office: The copy machine used to look at me and say" Give me toner, and the blood of innocents. "

So It is not late but I feel wrecked. The best part is that I am on call all weekend. :)

Tuesday, September 28, 2010

Low Desire, The Sexual Doldrums

First, let me say that women and men are different. 

To some people this comes as a surprise.

Sometimes it seems we expect men and women to think and act the same. We are wired differently for different reasons. In the evolution of the species, Darwin theorized that there was survival of the fittest. That meant that stronger, healthier, smarter individuals lived and reproduced. Males needed to be at the ready in case they came across a receptive female.Females chose who to allow to father their offspring, selecting the best male according to her criteria.

Fast forward to modern times. Women no longer need men. We are independent, educated and earning.
Want a baby? Order out from the sperm bank. However, WE WANT MEN. To have and to hold.

You get the idea.

 Now to sex.

Research tells us that the biggest turn on for a man or a woman is a new partner. Remember those days? Hot , hot, hot! Then things settle down, and after 15 years nothing new has happened in your bedroom. You get the come hither and know exactly how the next 20 minutes of your life will be spent.He does this, I do that, etc, etc.etc. 

NO NO! Boring sex is not something we look forward to.
It is something we endure. 

Now, the truth is that most men are terrified of women, and sexual rejection is about as bad as it gets for them. They will stick with the tried and true forever. Do they like your meatloaf? Will they eat it every day of the week? Will you throw the pan out the window by Thursday? You betcha.

Women thrive on variety and men on constancy. We live at cross purposes. You have to be the one to initiate novelty into the bedroom. How are you going to do that? 

Be the new partner.

FIND THAT Twenty something that is hiding inside you. You know, the one with the red hair , high heels, and tight black dress. She is some woman! Bring her out and let her loose. 

My late husband loved his cars. A trip to the car wash was worthy of a date. So one Valentine's Day we are driving home from work and he turns into the car wash. He plunks down his money, and we drive in. The bubbles spray over the windows, and the next thing you know, my bra is hanging from the rear view mirror.

I nearly killed him right there. WHAT ARE YOU DOING??? He asked. WHOOPEE in the CAR WASH, says I. 
You know, he never got into a car with me again without thinking twice, what I might do next. :)

So find your muse, she is there inside you. If your run out of whack o ideas, there are whole books written for seduction scenes with titles like 1001 nights of Great Sex, etc. You get it. Make sure your man knows that the sun rises and sets in his pants, and you will be one happy girl. NO more boring anything. You have given him the big green light to spice things up.

Monday, September 20, 2010

After 3 pm

There are days when I think that Central Scheduling makes an announcement:



 Heavens, it seems that way. I take pride that I take the time patients need during a visit. I run on time, almost all of the time, but there are days.........................

I retired from OB two years ago after about 4000 babies. Wheedoggies..that was a rollercoaster for me, the office staff, and my patients. When I entered the world of ambulatory GYN with Cleveland Clinic I thought the chaos was behind me. OH NO, not for me. You see, I am a gynechiatrist. That means that I dispense a healthy dose of psychiatry with each annual exam, consultation, and patient who is about to faint from fear.

This takes a certain amount of time, and finesse. Mostly I get it right the first time. Occasionally I have an abysmal flop, and read someone completely wrong. Oh well, lessons learned, apologies made, and then moving on.

Back to time. Lately I have noticed that the witching hour is 3pm. I suppose that the scheduling department starts at the 8am slot and fills accordingly. Somehow 3 pm and after is "bottom feeders only" time. That would be patients that need to get in "right away", have a time crunch for some other reason, or have kids they have to pick up in 30 minutes.

These patients come with predicatble problems.

For example, there are ladies who have seen three other physicians. All of  whom are of a single diagnostic opinion, offered all of the options, and they don't like it one bit. It is now going to be my job to figure out what they don't like, explain everything again, but this time they will get an explanation they understand ( or I die trying ). I help them get from confusion to a decision.

Other women haven't seen a doctor in years, and my name was on their insurance list. They decided to drop by for the afternoon. These good ladies have never heard of a primary care provider, let alone know what one does. They think everyone is Dr. Welby and does cardiac bypass surgery in the office while they have a pap. These folks need the Cliff Notes of managed care lesson, and I help them get a grip on reality.

Still others went to the family reunion last summer, found out someone's version of family medical history and have decided that their aches and pains are certain signs of the same thing Aunt Martha had just before she passed. They have had these symptoms for years, but today decided to "check out everything". These women get a lesson in what's inherited, and what's not.

Then there are the legions of the half informed. They come in and want "tests". Sometimes they want CAT Scans, MRIs, blood tests, ultrasounds, and all manner of breast imaging. When asked what diagnosis I should ascribe to the tens of thousands of health care dollars they propose to spend, they are not sure. I certainly should know. Doesn't everybody get "tests" ? They need some education in being a good steward of health care resources, and what sane health related maintenence entails.

So between the hours of 3pm and closing ( also known as TBD), I inform, assist, educate, reinforce, assure, diagnose, and explain my way through the day. By quittin time I am one pooped pup.

Until next time.................................:)

Thursday, September 16, 2010

Fibroids! Fibroids EVERYWHERE what is one to DO??

This is a daily issue for me in practice. I see a woman for the first time. I take her history, she has had heavy bleeding on and off for years. No big deal for her. I do her exam and ZOWIEE! I discover the enlarged fibroid uterus. Sometimes about the size of a five month pregnancy. Now you know she knew about this.

If I don't find it, it doesn't exist.

Why do women want to hide their heads in the sand?

BECAUSE someone once said the H word.


That is about as misunderstood and feared as Breast Cancer ( we'll go there another day ).

So, she has been suffering with heavy menstrual bleeding, urinating 15 times a day, constant pressure, having to put up with difficult bowel movements, and pressure, not to mention YOWSER cramps for YEARS.

All in the hopes that menopause will rescue her from the dreaded Hysterectomy.


Fibroids do not usually need the BIG H.

Fibroids are benign smooth muscle cell tumors of the uterus. The uterus is made up of the opening, the cervix which stretches ( dilates ) to allow a baby to be born, the lining ( the stuff that comes out as a period ) and the myometrium ( the muscle that is the body of the uterus that grows to accomodate the baby, and then contracts to deliver the baby ).

Fibroids can be on top of the muscle layer, in the muscle layer or protrude into the lining. At any rate many women will have them by age 40, and most don't need any treatment. They can be anywhere from the size of a corn kernel to a basketball. Most hang out and don't cause trouble. Some are some bad girls and cause bleeding and pain, not to mention the bulk symptoms of frequent urination, pressure and constipation. Oh, did I mention PAIN?
Yes, they can be bad.

So what is someone to do? There are many ways of evaluating and managing fibroids. Even when I practiced in rural America, I offered options.
So wherever you live, get the facts.

1. Women who no longer desire childbearing can have Uterine Artery Embolization.  Check it out with Dr. Google. It is a procedure done by a radiologist wherein the arteries feeding the individual tumors are injected with beads to reduce bloodflow and therefore shrink the beasts. No surgery, you get to keep your innards.

2. Myomectomy is for women who desire childbearing. It is done either as a traditional operation ( think C Section scar ) or as minimally invasive ( think through a Bic pen). We have some master gyn surgeons at Cleveland Clinic Florida who do these robotically. VERY SLICK. They remove the individual tumors and sew the swiss cheese back together. You keep the organs, you get to have periods and everything. They are good. No hysterectomy.

3. Removal of the body of the uterus only. This is called a supracervical hysterectomy. Hysterectomy is actually the name for removing the body of the uterus, not the ovaries, not the cervix ( that would be a total hysterectomy ). So you just get the part out that has the tumors. The advantage is shorter operating time and less blood loss. Great for women who never want children and don't want periods again. You keep the cervix and need Pap smears. You keep your ovaries and can continue to be as hormonal as you please. One day in the hospital and one week at home. EXCELLENT!

4. Sometimes hysteroscopy can help with a single fibroid that is in the lining causing heavy bleeding.

5. Sometimes the use of hormones or medication or a Mirena IUD will help for bleeding that is heavier than normal without much pain.

The Bottom Line is that you have OPTIONS. And OPTIONS are good :)

So the next time someone comes in with fibroids, hopefully they have read my blog and know I won't be recommending a hysterectomy any time soon................

Wednesday, September 15, 2010

Breaking Cycles

Have you ever noticed how everything breaks at the same time?

Mother taught me that if you have $10 you will soon have a $15 problem.
If you have $100 you will have a $300 problem, and so on. It's just life.

Breaking cycles are the ones where the dishwasher decides to spray water everywhere, the highest lighbulbs in the house go out, and the check engine warning lights up on your car all in the same day. It takes three months to get everything back to "normal" and pay off all the vendors.

I will see a patient a for her yearly exam who has gone through one of these cycles. The dog died, her gallbladder was removed a month later, and now she has some funky aches and pains. It's a breaking cycle. We will investigate, patch her up, and get her back in the game, but it takes months of doctor visits, tests, therapies, new medications, not to mention navigating the bills from hospitals, doctors, labs, etc. Just when you think you are A OK, its time to start up with the routine maintenence.

Oh joy.

Then you sit back and relax with the delusion it will not happen again. NOPE. You will have breaking cycles. They happen all the time. Life finds your weak spot and just for fun, pokes the heck out of it just to see you squirm.
Since I don't personally believe in hell, the universe must conspire to relieve its boredom from living in geologic time somehow. That's my theory of breaking cycles. Why do we go back into denial that now that everything is fixed, it will  always stay that way? Is that what our inner voice want us to hear? Is it a protective stance to shelter us from the inevitable?

Just my thoughts today about why mother told me there would be days like this...........

Until next time

Saturday, September 11, 2010

Customer Service, the Oxymoron

I have just spent 30 minutes of my Saturday with three "customer service reps" from AT&T. No, not from offshores,  these are native English speakers right here in the US of A.

I pay most of my bills on Auto Pay, direct debit from my bank account to pay in full for recurring bills like utilities. When I moved ( see earlier posts about the pain of moving ) I dutifully filed a change of address form with the Snail Mail, US Postal Service. My AT&T service was set up on auto pay. I moved in May. I switched to Vonage and terminated service with Ma Bell.  In July ( I moved about 1/2 mile BTW)  I get a paper bill stating I have a final balance of $27.17 with AT&T and they have sent my account to a collections agency.

I am not happy.

I call AT&T. I explain that I am registered for Auto Pay. They say when you close the account, the Auto pay is void, and they send out a final paper bill ( which through the magic of the postal service has taken six weeks to travel 1/2 mile ). I pay the bill over the phone. I think I am done. It was a final bill.

September 2010.I get a final EDITED bill for $5.00 for a convenience fee for paying over the phone.

Now I am PISSED. A charge for paying my bill.

I call AT&T again. I speak to Sharon. She doesn't really want to hear what I am saying and asks me to bear with her. I tell her I will after I am finished telling my tale. She cuts the conversation short and puts me on hold. For a long time.
I think this is designed as a cooling off period.

I am transferred to customer service rep #2. I go nowhere again.

She transfers me a third time to Danielle who asks if I want to save $45 on my next bill. I reply, no I want to save $5 now. She is confused. I tell her my story. She is unsympathetic. I have stopped being polite and tell her she will find a way to get this fixed. After all, if she is giving away $45 a pop, $5 should be chump change.

She takes my name and number and says she cannot help me today. She has entered in a "request" to have the $5 removed from the bill. Someone will call me in 24-48 hours. Am I expected to believe she doesn't have the authority to reverse a five dollar "convenience" fee for making my payment over the phone? And I remind her, there was no mention of an additional fee at the time of the phone call. Check the records, since you record all calls for qualtiy purposes. Right.

Does anyone think American Business has a chance?

Customer service and excellence was the business mantra of the 80's and 90's. The new millenium has seen our manufacturing disappear, brains are borrowed from India and China. I recently had to do a module about diversity and cultural sensitivity at work to find out that 43% of the American public reads at a 5th grade level or below. What a sad state of affairs. Any suggestions??

Tuesday, September 7, 2010

When did parenting start?

I am visiting my #2 son this weekend. He is making his third attempt at college. So far so good. This time he had to work through two semesters getting good grades to prove he was serious. Now he is admitted as a degree seeking student. Makes a parent happy:)

This is my tree hugging, friend of the earth, protector of the meek and small, part time vegetarian kid. He looks like Goliath, with the heart of a butterfly. He acts like a turtle. Moves slow and at the slightest sign of trouble, pulls in all fours and his head and waits for the perceived threat to pass. If you move him, he will pee on you. You get it, a turtle.Any obstacle in his path could lead to years of pondering what to do before action.
This he did not get from me, I am thinking. As his Mom, I love him and accept him for who he is. Understand him, now that's a different story. He is, and we are together, a work in progress.Somehow I thought the surroundings he would be living in would be brighter, cleaner, and somewhat more organized. No, not yet. That will come with time. Right now it looks like something from a pizza commercial for 20 somethings. Yuck.

So I am writing about parenting. In the old days, you just had kids, they popped out, you raised them. Now it is all about the fine art of parenting, being developmentally savvy and proactive in your approach to your kids. Add some guilt and a few hard earned bucks, and you are a modern parent. The conversations are an endless query of how did we do what we did at their age??? Why don't they grow up faster?? How did we let this happen? Will they return to the nest, and will we let them?

I have had this conversation many times in the last five years or so, as my children have made their fledgling flight from the nest. Others bemoan the fact that their children are once again on the parental payroll after going bust in this economy. Some are disappointed regarding their inability to cut the umbilical cord. That inability goes for the parent and the child. Some have taken to raising their grandchildren when the unions their children have made dissolve. It's a mess.

Parenting can be learned. I know, I went to school for it. Oklahoma State University Child Development Labs required any parent sending sonny or sissy to their daycare had to attend classes. Not bad, saved me from killing myself a couple of times when the kids were tots. They knew children and insisted that we did too. Fast forward fifteen years. They did not do this when the kids were teens. I was forearmed. I collected a stack of books in anticipation for their adolescence. Looking back, it was a great time, and I still enjoy teens. They are easy for me to understand.

Young adulthood came as a surprise..I thought I was done. Out of the house you go! Have a nice life. I am sandwiched between my mother's comments about how can I let "him" spend $4 on coffee and the puppy dog eyes of the kid needing something? This is a no win situation. Since they passed the 18 year old speed limit, they are more or less on their own. The success or failures they have are their own. I get to sit back and  (1) worry (2) relax (3) bask in their accomplishments (4) die of embarrassment when they do stupid stuff.

I was listening to NPR recently when they quoted a study showing the mental and physical health of parents suffered when they had one child they described as "struggling". It did not make any difference if they had a dozen more they decided were "doing well". This was decided by the parents. SO  I decided I am not going to let my health suffer. I would re-frame my children as "doing well". Nobody is an axe murderer, so far they have not tried to move in with me, I'm good. I can feel my blood pressure leveling out.....NOT.

So its back to the drawing board for me. Each one of my kids is unique and the lessons learned with the first one are not translating into an easy ride with the second. So I will bungle my way though their young adulthood. Perhaps there are more books out there for this one. Come to think of it, my mother is still learning with me:)

Until next time.............

Tuesday, August 31, 2010

Honeymoon Cystitis or Sex is Not Free

In the good old days when sex ( ok, is a lot more as we know) was delayed until the honeymoon, it took about three days for the new bride to show up with

or commonly known as an acute bladder infection.

It turns out  for women, that if you have sex, you will introduce bacteria into the bladder pretty much 100%. However most women don't get a bladder infection. They empty the bladder, and are fine. New brides had another problem.
The honeymoon period was reserved for newlyweds to invent sex.

After all that sex, the poor bladder gets overwhelmed and some women get HONEYMOON CYSTITIS. Ask cruise ship doctors. They have seen it all.

The evolution takes place with current sexual practice, which does not necessarily wait for benefit of clergy.

This is known as NEW MAN SYNDROME.

This presents as an unwelcome intrusion into your happy state of being after having clicked with a New Man. About a week later the bladder infection presents itself along with some strange odor "down there". You instantly worry about the dragon eggs prior lovers have graciously bestowed as a gift that keeps on giving.

For those of you who don't know about dragon eggs. A short aside. A dragon egg is something someone leaves behind to explode and catch fire after their departure. This is a phenomenon from an ex, a prior coworker, a relative, you get the idea. They are gone but not forgotten.

You scramble to see the gyn. She/he asks if there is a new partrner, at which time the lightbulb is visible above your head. YES you answer . Ah Ha, says the gyn. NEW MAN SYNDROME.

A urinalysis and std check is in order "just to be safe" and then treatment for the infection. A knowing nod from your gyn, letting you know that your new man is just that, new, and things tend to settle down, make you feel better.

So , for now, the notion that sex is free is slowly waning. You figure out he needs to wine and dine you, pay attention to you and perhaps wait some unwritten amount of time before he becomes your new man. You have various levels of upkeep, check ups, eyebrows, nails, hair and general gorgeous maintenence and make him wait the prescribed period of time. You get it.

Sex is not free.

Sunday, August 29, 2010

The Road Less Traveled

Someone asked me the other day what my GPA was in college. I answered  2.4. They couldn't believe it. "Don't you have to be a 4.0 or something to get into medical school? " they queried. Well, yes and no.

I did not go to medical school under the straight path that the US presents from HS to college to med school. In fact, I have a little axe to grind about that one.
In order for someone to have a 4.0 or close you have to do nothing but study. No social life, no tramping around the world to see its wonders and engage with its people, just nose to book seat of pants to seat of chair. As we all know those folks are so scared of not getting an A they will cut their grandmother's throat for a point. Fonts of compassion, and we wonder why the American public complains.

I was in college from 1967-1971. My papers said I was a biology major, but I secretly majored in MARCH ON WASHINGTON, along with hundreds of thousands of other people.

Three out the the four years I was in college, CCNY went Pass/ Fail in the Spring semester due to being shut down so often. This was the cauldron of societal change, and I was in the spoon! I was swirled this way and that, mixing, blending, feeling deeply about my cause to save my classmates, friends, and essentially any eligible male my age from being sent to certain death in Southeast Asia.

The day my grandmother, mother, and I locked arms down FIFTH AVENUE for a protest, now that was powerful. I didn't know whether to march under my college, church, or neighborhood banner. EVERYONE was there exercising our rights to let WASHINGTON know we had enough and wanted out of a dirty, pointless war.

Back to my story. I graduated in 1971. If you think the economy stinks now, try meatless Tuesdays, it was a national trend. We didn't eat grapes ( migrant worker sympathy ) or lettuce for a long time. Unemployment was 20%.

Now there were exactly NO jobs for a recent college grad that did not involve typing and answering telephones or waiting tables. And, the bigger your bra size, the better your chances at any job. I had been blessed in that department, so I got a typing job. And I was going to Grad school part time.
My 30 words a minute with mistakes were mitigated by my D cup and curvy figure. The boss ran me around his desk at quitting time a few times, but I had young legs and didn't get caught. It took me another 30+ years to figure out other girls ran slow and probably picked up a little extra in the pay envelope.

Grad school was an excuse for not knowing what to do with myself, so that was essentially a bust.

No boyfriend ( see above lack of available males due to draft ), and no real prospects, I spun my wheels for two years.

THEN ONE DAY, and I am NOT MAKING THIS UP, a young woman comes into the office where I am working relief at the reception desk over lunch. She is looking for a coworker who left the building but will be back later. We talk. She tells me how she is going to Medical School in Spain. Who knew?

Tells me, Ms. Gullible, that I can do this too! College is not a problem, all you need is a HS diploma!
Technically right, but not entirely truthful, I find this out 10 months later.

1pm, I march myself into the boss, quit my job, and grab the NY Times.


2pm, I have a better job, new lecher boss, but the money is more. I now work 5 days a week because I decide never to show up again to Grad School.

Fast Forward 9 months. I receive a letter in Spanish, a language I do not read or understand. I think it says I can go to MED SCHOOL.
I give the cat to my mother,possessions to friends, and my car to my brother. I board a plane for Spain, this also is not made up.

Arrive in Spain. Letter  actually says I can take the entrace exam in three weeks. I lean enough Spanish in three weeks to pass the academic part of the test. I flunk the Spanish for non native speakers test. School does not start for some odd reason until three months later. I retake test in three months. This time I pass the language exam. :)

I AM ADMITTED AND IN MEDICAL SCHOOL. Not just any school. This is one of the Universities that was around in the 1500's. I call that Tradition. It seems they are liberal about letting you in for the first year. Then the fun begins. You are weeded out during the process, and in the end the European system graduates about the same number of students/ year as the American system. Selection is different, acutally more democratic. Sink or swim, live or die. You get to be an academic grind for six years, but with some sanity instilled. First students didn't work, and workers didn't study. Choose one, so I could only study. They there were so many Catholic holidays where school was closed, you got a few breaks. Testing was done at the end of the academic year, a six week hellish round of final exams, so if you blinked somewhere in November you had a chance to catch up. No school during the summer, hey, its summer. It runs six years instead of four years, you are able to actually practice when you leave school. You can either be a GP immediately, or get a specialty after that.

I didn't come up for air for six years, but you know the end of the story!

So the next time you think the front door
to an opportunity is closed, try the side window.

Until next time................:)

Sunday, August 22, 2010

When the Tripmeter Resets to Zero

I had the opportunity to meet a new patient recently whose life had been turned upside down. This is a common occurrence, but since this was her first time, I took the opportunity to stick my nose in her business.

As a more experienced and wiser woman ( code for kicked around more, and OLD ) I let her know that life has simply pushed the reset button on her tripmeter. She is at Zero.

 Lots of opportunity at Zero.

Means you are no longer on the old path, but get to choose a different one. You are able to reflect, learn and sometimes avoid the mistakes of the past, and forge ahead in a direction of your choosing.

For too many people, they don't figure out this is the silver lining to their black cloud. They have choices, and are at a crossroad. They go down the familiar path leading to the same black cloud outcomes. I just simply informed her that the path she chooses, is just that, a choice. No guarantees, but the scenery changes.

Oddly enough, this seemed to give her some reassurance and help her in healing from being upended. Since my therapist pals tell me this is likely to occur 3-4 times in a lifetime, best to learn in round one.

So next time you come across someone whose life has been stopped or diverted, its' just that old tripmeter being reset to Zero.

Until next time.................

Thursday, August 12, 2010

No matter what, you will be a NEW BRIDE

Many years ago, my mother, the font of wisdom, told me that when I made dinner for my inlaws for the first time to make a chicken. "YOU CAN"T KILL A CHICKEN." she said. No matter how you make it, it always turns out!

Of course, I was going to make a chicken for my soon to be inlaws.
They drove up from Southern Missouri to Kansas City to join my indended and I for the trip BACK EAST for the wedding.

It was to be my first dinner for the in laws. The only problem was that I was scheduled to work the evening shift in the Emergergency Room, and I would not be there.


Thoroughly Modern Millie and Boy Wonder had purchased a MICROWAVE.
This was living. Dinners in minutes instead of hours! High tech for 1979.
I set the controls  with the delay feature for dinner to be ready when everyone arrived at my little apartment.


You guessed it. Rubber Chicken.
You could have ridden the damn thing back to NYC as a tire.

They had spaghetti my mother in law threw together from the pantry. New Bride syndrome in spades! And not even the bride yet. It's a wonder they didn't stop Boy Wonder from getting on the plane. I guess they thought somehow things might improve with time. I was actually a good cook, but had never owned a microwave until then.

OOPS. Note to self:
Don't try out a new technology, let alone a new recipe on guests.

Now I am the mother in law. My daughter in law is a great cook, but who cooks? All that matters is that my son is the happiest guy on the planet, and its all because of her. 

So for their first anniversary, I dedicate this entry.

Saturday, July 31, 2010

Good Sex Bad Sex No Sex

My colleagues asked me to enlighten them about the buzz surrounding

The new drug shot down by the FDA , and the upcoming testosterone gel for women, currently in trials made headlines about this complex topic.

As every gyn knows, this is a daily concern for women. Are they sexy enough? Once they have a partner, how come they don't want to have sex as often as they once did? Why after 43 years of marriage, don't they want to have sex like the first year of marriage? Their partners complain, or have retreated into quiet resignation.

Research shows us that normal women have spontaneous sexual thought about 2-4 times a month. Comparing that with men, its no wonder that we are left to think we are abnormal. We are just different.It is rare that we are allowed to just be, and allow sexual thoughts to creep into our conciousness. We require sexual triggers to get us "in the mood" more often.

Men are like an on off switch.

If there is an opportunity for sex, they are ready. Women are like the control panel of a 747. A bit more complex. The link above is a good reference and explanation of female sexuality. The female sexual response cycle has been remade a number of times, since Master and Johnson's work in the 1950's. Orgasm used to be the height of female sexual response, and the goal of a sexual encounter. Since women are a bit more complex than men, it seems now that concept has backed off a bit to include the emotional connection women desire.

OK then, if that's the goal, and men want physical sex, then why don't we get it? Have more physical sex to get more emotional connection to your partner! Most women tell me it is not their idea to have sex, but once they get started, they respond. Rebuking a partner rarely gets him to be more connected to you.

OH MY! We may have hit this jackpot.

And now you know the secret to being in a couple.

Make sure your man knows the sun rises and sets in his pants,
and you will be a very happy woman.............:)

Monday, July 19, 2010

Service after the Sale

This is a subject that comes and goes periodically. Usually it is when I hear a complaint from a patient whose expectations were not met.

When I have a new patient, I usually tell her that our process for patient communication of lab results is through the mail. Our system, with its Electronic Medical Record, allows us to generate a personalized letter regarding results of tests that we have ordered. Many women are surprised that I am not, nor my nurse personally call them for all their lab results. There is a new patient brochure that they receive that tells them all of this. I am sure they do not read that part.

It takes variable amounts of  time for the tests to return to the doctor, and a typical physician will have somewhere between 60-120 tests to respond to each day. Then there are the autofaxed prescription refill requests from the pharmacy. There are usually a dozen of those, and then the 15-30 patient phone calls that require a response. Since my patients also expect me to run on time, and spend time with them in the exam room, I need to squeeze all of this into my workday. Needless to say, lunch is a fairy tale my mother told me about.  Oh, and lest I forget, a ream of records sent from the old doctor for each new patient, to sort through to see if there is anything in there that is relevant. Did I mention I do ambulatory care, so I don't get the stream of hospital and Emergency Room phone calls?

I do not play golf, and I don't have a four day work week. The fat was rendered from medicine 20 years ago. Managed care and risk sharing saw to that. There is no army of medical secretaries to do this work. It now falls to the physician and nurse to manage the practice. The office staff generally makes appointments and takes the phone messages and forwards them to the clinical staff. The clincal staff (my nurse and me) then sorts through all of this, in between a busy work day of patient care, and responds to the tests, patient calls, and other demands such as " just phone in my prescription, so I don't have to make two trips to the pharmacy" " fax it to my mail order". Nice for you. Did you even bring in the address and phone number of the pharmacy? Find me something else that is cheaper. How do I know what is on your insurance plan's least cost list? It's like buying a car. Nobody pays the same thing for the same item. And I am going out of town so I need it right now.

The joys of dealing with the public.

Managing the expectations of the customer is a critical part of what we do. Much has been written about this subject in the business literature. It is a daily challenge, especially on the front lines of a large organization. The customer ( in this case the patient) has expectations from hearing the name Cleveland Clinic. It is a prestigious academic medical organization almost a century old. It has been in Florida over twenty years. Processes have been in place for years before I showed up. It is up to me, and each new hire to fit into the process and make it successful in his or her own way. Nobody teaches that to you. It is implied when you are hired, that you will become " a Cleveland Clinic" physician. So the trial and error process begins. I asked to help make the onboarding process easier for new physicians, that way they don't step in all of the holes that are out there, there is a map.

In a medical world where qualtity of care and service are determinants of the paycheck, service after the sale is becoming more important.

Tuesday, July 6, 2010

Mothers and Daughters

At some point, I think each young girl wants to be like her mother.

Then the game changes around age 12 and she wants NOTHING to be like her mother. Then at 32,42,52 she sees she is her mother. Hmmm,I have given this subject lots of thought.

I went to visit my mother over the holiday. She is now 84, and wanted to see both me and my brother together. This was THE TALK about where things are, what her final wishes are, and how she would like the end of life to unfold. She is in relatively good health, but figures that with a little of this, and a little of that, the wheels may fall off the bus anytime. She guides me in wisdom yet again.

My brother was all business. He has some paralegal background, and the paperwork of dying was his only agenda. He dictated what jobs he is going to do, and what he wants me to do. Mother really could care less, she just wanted us to know her wishes. I don't think he wanted to hear her real message of wanting to spare us as much pain as possible when she passes. She has lost a husband, and saw me lose one, and knows that these things can happen without warning, and family members can be tortured with the what ifs, if they have not been spoken in advance.

Not all children are trustworthy to fulfill their parents' wishes. I have seen awful fighting, rivalries, and "getting even" at the time of a parent's death. It is so very sad to see that the respect and reverance for a parent are not foremost in a child's mind, but petty egocentric behaviors prevail. Then there is the free for all for the loot. So very very sad.

Not my mother and me. We really are on the same page. I have come to know that I am rooted in her, but am my own person. She will always see me as her child, but then, I always see her as my mother. So we are even.

 I caught myself allowing her to cook and serve me, when it should have been the other way around. I rationalized that this made her feel good. Good and tired I think. I basked in the womb once more.............feeling very much loved and cared for. I know it helped her to feel our connection, which is deep and strong.  This trip, I helped her up and down, got things from the high shelf, and lifted her walker onto the curb. We went to a museum, and then shopping. I helped her try on clothes. It was good to be a helper again. We wore each other out, and left each other with a deep feeling of satisfaction for the visit. The business had been done, and no tears were shed. She still has insight and good advice for me, and made sure I didn't go out with anything dripping from my nose, or forget my lunchbox.

Until next time...........................

Sunday, June 27, 2010

Are Regular Periods Normal?

This is a non question for most of us, as we have been brought up in the era since 1960 when birth control was available and a woman expected to have a period every month of her adolescent and adult life save pregnancy.


LET ME EXPLAIN..............

Prior to reliable birth control women were paired ( married) soon after they were fertile. They did not have birth control available, and then bore six to ten children which they breastfed. Most of their adult lives were enmeshed with childrearing and they had few periods.

It was a decision to continue with monthly menses when birth control pills became available as a means for a woman to be certain she was not pregnant. Pregnancy testing was difficult and often unavailable at that time. For years now, pregnancy testing has become available is accurate, and is inexpensive.

That leaves us with the concept of extended cycling for birth control pills that has become recently available in an FDA labeled product. OB/ GYNs for years have been using regular birth control pills for the purpose of avoiding menses for decades. I used to call it the "honeymoon special" or the "cruise special". Someone would inevitably call and tell me that she would be on her 25th anniversary cruise when she expected her period, or that someone would calculate that she would have a period about the time for her honeymoon, and ask me to make a period not happen. That was OK. We are able to use birth control pills to help delay a period. Extended cycling via birth control pills is also safe. The pills are not just for birth control. They help with menstrual control to a degree. There is always some percentage of women who have "break through " bleeding which drives us all crazy.

Come to think of it, there's a lot about gyn practice that should have driven me crazy ( or crazier) years ago. Somehow I manage.

Anyway, extended cycling is safe and convenient. It can be done with the FDA prescribed pills or with regular birth control pills. Just make sure you take 84 active pills in a row, then one week off/ or the placebo pills. You get 4 periods a year. Whoopee!! Nothing is going to back up. It is safe. It is more natural than monthly menses. Now, there's a thought.

Until next time..............

Sunday, June 20, 2010

Thinking about Balance

Are you on pointe dancing as fast as you can?

Balance, balance, balance, that elusive prize..........

This is a topic that has been on my mind lately. I have spent the last several months consumed by moving. First packing, then moving, now unpacking. Deocorating and settling in lay ahead. I am out of balance. All work and no play make Claudia miserable.

And what about you? Can you find time to balance your life? Are you all play and no work? Didn't think so... Finding that elusive spot in life where ying and yang meet, and harmony exists is a hard one. I find that every now and then we achieve it, feeling at one with life and the world. It is not always when we have the best of times, it can be amisdst hardship and privation, but creating that balance is a wonder.

How do some people seem to always be "in the zone" while others are medicated beyond belief to get somewhere out of the ozone? I think it is a matter of philosophy of life and living a purposeful life.

 So to some degree I think it is under our control.
Now isn't that an empowering thought?

Actually taking the time to think about how you want to conduct yourself and your life is not something I was taught. To create the balance that is harmony with your surroundings is the key. Living life with purpose is important, but remembering balance allows you to live the days you are given.

So, work some, rest some, play some, do something for others, do something for yourself, and before you go to sleep tonight, see if you got closer to balance.............

Until next time.........

Friday, June 11, 2010

Routine Breast Imaging or Boob Attack!

Part of the GYN check up is an examination of the breasts.Lots of new controversy surrounding what to do, how to do it and when to get imaging. And what kind of imaging to do.

The young woman has a risk of a benign conditions and tumors. They are found either by the girl herself, or during a gyn visit. Most of the imaging that is done is through ultrasound, as that is helpful for a young (under 30) dense breast. After that the breast starts to accumulte fat, and therefore it is easier for the radiologist to differentiate normal tissue from abnormal. A screening baseline mammogram is done about age 35. From forty on, annual mammograms are still the best way to look at the breast.

What do we ask the radiologist for during these imaging examinations of the breast? We ask them for a consultation regarding your breast. Is there evidence that leads us to need a biopsy ( ie further investigation) or can this breast be evaluated in a normal or other interval? Now the radiologist takes this very seriously, and will ask for not just the routine two picture views, sometimes they will ask to add other modalities such as ultrasound, or other views, like standing on your head. This of course, is something that drives women crazy.

It's like this. You slam the car door on your finger. You go to the Emergency Dept to see if its broken. The radiology tech takes a picture of your finger. They take the film to the radiologist ( or if digital, send it) and ask if it is adequate. The radiologist says no, turn the finger this way and that until she/he decides it is broken or not. Same with the breasts only the radiologist is ususally not sitting there. These routine films take a number. And these days your radiologist may be in India or Austrailia with teleradiology.

At any rate if the views taken are not sufficient to answer the questions posed, they will request that the ordering physician go back and do it again, this way and that.They may want to do ultrasound, or recommend a biopsy either through ultrasound or needle biopsy. They will also compare the films to prior years to guide them what is normal for you.

So that's it. Don't panic if you need more films. Be thankful they are paying attention!

Until next time

Wednesday, June 9, 2010

Is there a lighter side to widowhood?

Who was the Merry Widow? Is she a woman who was in a lousy relationship?

 I don't think so. I think she is in the recovery phase .

After the first year, after the flashbacks, and after you have settled down, I think there may be a somewhat lighter side to widowhood.

It's kind of like being a  college grad  with the trauma of finals, papers, and projects behind you. The whole world laid open before you. Just take what you want.Pick this, leave that. Do what you want. Now I suppose this probably applies to those of us without little ones at home. At any rate, this has been my experience.

I am in an "exploration" phase of life.

 I was really set on what I wanted from life, and then it blew up in my face like a trick cigar. I have taken to saying that God thinks I am too much woman for just one man, so it is the divine plan for me, in my maturity,  to experience the pleasures and attention of men. And I mean men, plural.  I did not date much as a teen, and into my 20's. It took me until my late 20's to have a serious boyfriend. Since I have been widowed, I have dated men from 38 - 70. They have all filled a purpose, and a niche in my life. The most age appropriate guys seemed easiest to be with. The others are there for me to "stretch" and see how life plays out. My mother called me a cougar. What does she call me when I date the 70 year old, kitten?

So now everyone is very PC, and we are partners. No more boyfriends. Not PC enough. Have to say the man I am partner. Very snooty sounding to me, but don't want to step on any toes. Monogamy has always been important to me, but not now. Honesty remains key. I let everyone know I am seeing more than one guy, and they are OK with that or gone. Exploration deserves some perks.

Of course, there is not always sex involved, and there is STD testing. One of my office mates said I was the only person she knew that would have a date that included blood testing. Yep, that's me. I walk the walk.

Life is open to me, and because I was in a healthy, good relationship, I see the world as good. I know the risks posed, but as a mature woman without kids at home, risk is somewhat ok. Staying completely safe gets me nothing. Just hiding to me. Remember the story about the widow who joined the Knife and Hatchet throwing club? Well, the lesson learned is to go where the boys are.

For me it has been online. What a treasure trove of humanity! How do you advertise to hundreds of millions of people? I think online is key. There are many, many social networking avenues. I picked two or three and went for it. It is easy to screen people on the internet. Just ask a few penetrating questions.
What are penetrating questions? OK, like what frightens you? What were your parents like?
Look for values. Ask about stories that reveal sticky situations and see which side of the coin they fall.
Mostly ask about difficult times. If someone has lost a family member/spouse/child/buddy/job/etc, ask how they managed. Did they get mad, act childish? Did they take the moral high ground? What was important? Did they care for a dying spouse? Did they do right by an ex? That is how they are going to treat you. If you see any red flags, move on. It's easy to do online.

Back to widowhood. It whitewashes everything. You get all kinds of deference, and ascend to a higher plane. Of course, many men assume you were left in the lap of luxury and have lots of cash.
If you are a divorcee, it is assumed you were difficult to live with, and finally drove your husband off, and are desperate for a meal ticket. I have been both, so I know. However, as a working woman, it was obvious I am my own meal ticket, and was not left with a dime.

Why am I talking about men? It always gets back to this, because in the end life is better shared.
All of the pieces in the puzzle seem to come together when there is someone else. So I sit with my puzzle pieces on the floor, looking at them over and over trying to get something to match. Its a new game for me, that I have played before. This time I have the confidence that I can take my time to choose my direction and all will be well. Whether the man comes first, or the direction, no matter. Life is life, and this is my silver lining.

Until next time................

Thursday, June 3, 2010

I can't lose weight!

This is a daily concern from women. With many Americans overweight or obese, it is not hard to figure out the problem. Do one third of people all think they have a hidden illness that will magically make them drop 50 lbs with a pill overnight? I think that kind of delusional thinking or wishful thinking is the problem.

Warnings for decades from the Surgeon General on down have made it clear.

Americans eat too much, and of the wrong kind of food.

Our blessings are also our undoing. True, genetics has something to do with it. There are folks that just seemed destined to gain weight easily. There are those who will be lean.

Behavior has lots to do with this national epidemic.

As a medical student I was once quizzed about what could I name as a health problem. I stated
overnutrition. I was already noting in 1973 that there were more fat people out there, and that the abundance of food was driving a generation to the CABG patch.

Most of this tirade is fueled by an reintroduction to how the other half lives by way of a book
"The Poisonwood Bible" by Barbara Kingsolover. If you haven't read it, by all means, I recommend it.
It is a reminder of the toil people have just to feed themselves. We have become so used to having a drive through life of convenience, and busy ourselves with trivialities to fill the voids.

Paying to exercise? Yes, we have tried to balance our lives by paying good hard earned greenbacks so we can bend and stretch. Unbelieveable. Schools had more balance for children and taught good habits of daily physical activity. At least one hour a day was routine, and more if you liked. Kids are harnessed to computer monitors and have become sedentary. According to recent reports one third won't be able bodied enough to serve in the military, even after basic. Now it is a national security problem!

Back to women and weight. It has been my observation that by 18 a woman will have lived out her ability to lose weight easily. This is different for men. They hit the wall around 30.So that driver's license weight at 16 is about as low as you go without moderation in food intake, and physicial exercise, and women will start off as a 120 lb teenager but by age 30 will have put on the freshman 15, 15lbs for the first year of marriage and another 20lbs apiece for each baby. Now at 30 we have a woman who is teetering at 200 lbs.  This only accelerates after menopause. Not good. Increases in metabolic rate are only through physicial exercise.

This is now a lifetime problem that gets thrown in the GYN's  lap of "it must be my hormones". True a few people will be hypothyroid. I have been wishing for that my adult life. No such luck.

The moderation in food intake is where we commonly make all the mistakes. Portion sizes are out of control. Most women complain they only eat one meal a day,and it is a salad, and can't lose weight. The mathematics of weight make it simple to calculate. More is going in than being used. The extra is sticking to you. FIND IT and BANISH IT FOREVER! Look at how much salad dressing you are using. REALLY GIRLS, did you think the salad dressing was water?

Look at the cokes, crackers, chewing gum, snacks, and how your food is prepared. IT IS CREEPING UP ON YOU AND ALL AROUND YOU..........FLUSH IS OUT AND TURN YOUR BACK ON THAT LIFE. Don't be so busy you don't prepare your own meals. Mealtime with the family is a sacred event that should be attended on a daily basis. It is the glue that keeps a family together and healthy. It is where communication happens, and lives are shared. It is a cornerstone of the family.

Throwing a bag of take out on the table is just not right.

 It means high fat, high salt, and heart attack city for you and your family.It teaches your children you are too busy to care about nutrition for yourself or your family. Just quiet their bellies and get it out of the way.

Pay attention to caloric intake, physicial expenditure and you will open a new chapter of health and wellness in your life and those you love. Stay away from prepared foods as much as possible, and find fresh foods that need to be peeled,cut, washed and otherwise "prepped". Buy a good knife and a pair of sneakers.

Until next time..................