Archive | Articles RSS feed for this section

3 Simple Questions to ask about Bullying

25 Dec
Anti Bully

Smelly?

I punched a boy in the face when I was in the 5th grade. The principle made me sit in his office for the rest of the afternoon.   This was my punishment for trying to stop bullying at my elementary school.  I remember the principle teaching me adult concepts–concepts, that my little eyes totally glazed over.

All I knew was the following: Some punk-ass kid just called my friend fat and smelly.

Yeah, she was fat. And smelly, too.  But, NO ONE says that aloud in an attempt to hurt her feelings.   That was the only concept I really cared about.

Then came high school, repeated lesions of “conflict resolution” were recited to us ad nauseum.   Like a little good girl, I listened.   But have always rolled my eyes at such things.  Then came medical residency training: a young attending called me “A bad physician,” and said that I was “careless” in front of the entire 2nd floor.    My senior resident, told me to just be quiet and nod my head in agreement.   But, my instinct was to say,  “I do not want to be a bad doctor, so teach me how to be a better resident.”  I said this with my most  honest and sincere desire to improve my clinical skills.

I was looking for an honest critique and tools to improve myself.  But, as my senior resident said—the norm, in situations such as this is just  to “be quiet” &  let the person in authority rant, and you move on.   This was the status-quo, my senior resident taught me.  Just don’t take it personally, he guided me.    This is the norm, I thought to myself,  if ones wants to be among the status-quo.   Is this the adult version of “conflict resolution?”  Do we just now let bullies in positions of authority just rant?

I thought back to the little guy I punched back in the day.   From childhood to adulthood we are given tools by our authority figures that help us  navigate “Conflict Resolution.”      But, why are we not provided with tools  for conflict prevention?    As a family medicine physician, prevention is an essential part of my profession.    Yet, even my training as a family medicine physician has not always  been rooted in that concept.  I am a very analytical person, but somewhere in the bottom of “my gut” this pedagogy just does not seem correct.

I was reading the Journal of Pediatrics, from which, two leading studies regarding bullying and food allergies stand out in my mind.  In one, Dr. Shemesh from the Mount Sinai Medical Center in New York and his colleagues surveyed 251 kids who were seen at an allergy clinic with their parents. The children were all between age 8 and 17 and with a diagnosed food allergy.

“Just over 45 percent of them said they’d been bullied or harassed for any reason, and 32 percent reported being bullied because of their allergy in particular.”

Studies suggest between one in ten and one in three of all kids and teens are bullied.  The kids in the study were mostly white and well-off, this group is less likely to experience bullying.  So, then bullying, in general,  may be more common in poorer and minority children. 

We cannot encourage our young children to master their punching skills and become more like Mike Tyson.  Nor can we ask our children to “just be quite and look the other way.”  We must not only focus on conflict resolution, the conversation needs to switch to conflict prevention.  The lead authors of this study and the many pediatricians that I work with collectively stress that “we need to get the dialogue started with our children.”

Similar to Yael Cohen’s non-profit  Fuck Cancer which is a platform that  urges teenagers to ask their parents about cancer screening, we need to embrace that same message—Fuck Bullying!  We just need to get the conversation started with our children.    Some of us will be shy to use the F word, yes.  And I am not requesting that you use the F word with your children.  Pay attention, it’s a beautiful concept 🙂

A tool that I have used very consistently in my clinical experience is made up of three simple questions that I ask my adolescent patients.   Our children need their parents to be their allies in their lives.

‘START THE CONVERSATION’

So, Ask your kids these questions on a biweekly basis: 

1.  Do you feel down, depressed, or hopeless?

2.  Do you have little interest in doing things you like?

3.   Is someone bullying you in school right now?

As parents you can help your kids feel strong, without punching like Tyson or having them feel like they need to turn the other cheek.

Soldiers Face a Tough Battle with Gluten

1 Nov
IDF Logo

Kicking Ass AND Gluten Free

I came across a rather fascinating article in the Israeli newspaper: Haaretz Daily. For those that may not know, Israel has a requirement that all able bodied men AND women be drafted and serve a set period of time as soldiers within the Israel Defence Forces (IDF). I’m not quite aware of all the issues that would or could defer a young man or woman from serving–but it would make sense that it would be for such things as severe asthma, severe chronic diseases, etc. As I was going through the article, I find that a rather peculiar problem is now being encountered.

Combat units refuse to take celiac patients who volunteer for the Israel Defense Forces due to “logistic” problems supplying appropriate, gluten-free food – in direct contradiction of army directives forbidding rejection of soldiers who have the disease. IDF sources admit the problem exists and explain that they cannot guarantee suitable food in field conditions. However, a celiac patient serving in such conditions told Haaretz: “There’s no problem getting along with battle rations.” In the past, all celiac patients were exempted from army service, until 2008, when an effort was made to draft them. After a number of soldiers complained of unsuitable food, the policy was again altered and at present, the IDF drafts only celiac patients who express a will to volunteer.  At first, celiac patients were allowed to serve in combat units that guaranteed a supply of gluten-free food, but soon after, all combat units were informed that they could not reject celiac patients because of logistical difficulties in supplying the right food. However, Haaretz has learned that various combat units still refuse to supply proper food, thus, in effect, rejecting celiac patients…

So the issue is:

  1. Soldiers with Celiac Disease can volunteer but they will not be automatically drafted.
  2. The IDF is not able to logistically supply–ie, feed CD soldiers that do volunteer.

So the brave soldiers that do end up volunteering are probably spending more time in the bathroom than on the gun range! (Yes, I know that Celiac Disease manifests beyond just GI issues). Joking aside, this is indeed a serious problem. If a large organization such as a Tier I army is unable to properly provide stable GF rations to their soldiers–what hope is there for us mere mortals that spend time walking up and down the aisles of Trader Joe’s or Better Health? What hope do we have that smaller organizations such as schools or offices be able to provide proper gluten free meals when required?

The answer, sadly, at the moment is still: NONE.

It is important that the CD community work as a whole, so that we could and should be able to expect that kids, loved ones, and ourselves are eating food without the risk of complications. The idea for a nutritionally sound untainted meal should not be a mirage.

———-

HAARETZ.COM has a paywall. As such, I’ve posted the article below. All copyrights remain with the HAARETZ on the article below.

Contrary to orders, IDF combat units refuse to accept celiac patients
Celiac sufferers are exempt from service, but may volunteer. But combat units won’t take them.
By Gili Cohen | Oct.30, 2012 | 12:58 AM

Combat units refuse to take celiac patients who volunteer for the Israel Defense Forces due to “logistic” problems supplying appropriate, gluten-free food – in direct contradiction of army directives forbidding rejection of soldiers who have the disease.

IDF sources admit the problem exists and explain that they cannot guarantee suitable food in field conditions. However, a celiac patient serving in such conditions told Haaretz: “There’s no problem getting along with battle rations.”

In the past, all celiac patients were exempted from army service, until 2008, when an effort was made to draft them. After a number of soldiers complained of unsuitable food, the policy was again altered and at present, the IDF drafts only celiac patients who express a will to volunteer.

At first, celiac patients were allowed to serve in combat units that guaranteed a supply of gluten-free food, but soon after, all combat units were informed that they could not reject celiac patients because of logistical difficulties in supplying the right food.

However, Haaretz has learned that various combat units still refuse to supply proper food, thus, in effect, rejecting celiac patients.

One such soldier was told officially by the IDF that he cannot be accepted by the Givati Brigade due to logistical problems. The soldier insisted, and was then told that “the disease cannot be a reason for not being stationed in a particular unit. If they claim that it’s because you’re a celiac patient, it is in contradiction to proper conduct.”

IDF sources said a problem indeed exists, and that the soldier was refused because appropriate food could not be guaranteed. Still, another combat soldier suffering from the ailment told Haaretz: “I get along fine in field conditions. The battle rations include tuna and stuffed vine leaves, and I eat more of these, or concentrate on vegetables. Actually, It’s harder to find suitable food in the base than in field conditions.”

In September 2011, a celiac patient seeking to enroll in the Israel Air Force flight academy was refused, but after appealing the decision was accepted to the academy.

Celiac patients can choose between receiving a monthly allowance of NIS 500, or five gluten-free meals and two gluten-free loaves of bread per week. The IDF Spokesman said: “The issue is being examined and the problem does exist. Staff work is carried out at present with the intention of guaranteeing the supply of suitable food to all army units. Due to the partial details supplied by the journalist, we cannot comment on the specific case.”

Hunting for Tiramisu

16 Oct

I am a professional young woman, highly educated, quite self-sufficient, and even cried at the end of “The Note-Book.”

On a daily basis, my job in the hospital gives me the opportunity to interact with people of varied ages, backgrounds, and socioeconomic groups. Yes, even Republicans.

Being a medical resident is like being at a cocktail party. You’re always meeting and interacting with new people, running into people you’ve known for years. And, then, there are those, few, that quickly after 2 seconds of reconnecting—you are quickly reminded of why the two of you are only Facebook friends. I’m finding that, like a cocktail party, there’s one other thing in common among all my interactions in the hospital. And, no it’s not Sick people.

Cakes are Nice Too

Everybody always makes the following statement to me: “…so, you’re single.” This comment is always said in a very nice and respectable way. Kind of in such a manner as not to offend me or others around me. I excitedly wait to hear: “…so, I know this young chap that I’d like you to meet.” This, of course, never happens! And, I’ve come to realize, alas, that such an interaction will never happen at the hospital.

The women’s liberation movement has, indeed made many great strides. And, at a workplace, where pride is taken in professionalism, such conversations would not end well, I suppose. So, I am not entirely sure where Grey’s Anatomy gets their weekly inspiration for their racey story lines. Since, I am a self-sufficient woman, I’ve read the works of Virginia Wolf and NY Times’ fiery redhead, Maureen Dowd. I’ve decided to act in a very proactive, self-sufficient manner. After all, my medical specialty of Family Medicine is all about being proactive. We try to prevent chronic diseases such as Type II Diabetes, High Blood Pressure, and Obesity by focusing on preventative measures that a patient can take to improve their health outcomes.

With a professional mindset, previously described, I boldly treaded forward to bring a proactively directed method to the matters of the heart. I can accomplish such a mission through the only one possible vehicle known to generation Y and Z—it’s online dating.

In theory, it is such a proactive and sound concept. There could be no flaws. You put up a picture of yourself, write a few paragraphs about yourself, what you like to do, and whom you’d like to meet. It seems analogous to a social “Resume” or a professional Curriculum Vitae. It makes so much logical sense, that I have high-fived myself.

As a physician, we are ingrained to look for patterns in most everything we observe. Diseases, people I meet, and even the clouds in the sky—all have patterns. My first few blind dates were rather nice and cordial. The men looked quite dapper in their corduroy pants. Yes, I like the preppy look. Most of my dates seem to be follow the following pattern:

I spoke about myself, the young gentleman spoke about himself. I usually ordered a Pinot, sometimes a dirty-martini depending on how big or late lunch I had earlier in the day. And, then we ordered dinner. Or, at least, “talked” about ordering dinner. It generally takes me 10 seconds to figure out what I wanted to order. Come on, I am a girl; I know what I want. Of course, I don’t tell the date that I already checked the dinner menu on-line before joining my date for dinner. And, it’s not because I hate spontaneity or am a control freak.

To my surprise, each gentleman would before ordering dinner spend a lot of time trying to “problem solve” my diet restrictions secondary to Celiac Disease. Some would go through the entire menu: naming each entrée and understanding why I could not eat it. I was always a little uncomfortable asking the managers and chefs; and, some of my dates preferred to do that on my behalf! Some chefs would come to our table and wanted to learn more about the specifics of my dietary restrictions. But, only after they found out I was a physician. Prior to knowing that I was a physician, I got the sense that I was viewed as “the high- maintenance ” date who was a rather picky eater

Once they realized I’m not snobby snot, I was made to feel special by the wait staff, my dates, and the general public around me. I was not made to feel apologetic for causing a disruption. In medicine, you decide how to get tasks done

Very Nice!

quickly and then, do not reinvent the wheel. Thus, my decision to pre call the restaurants. But, medicine also forces you to change in the face of new evidence.

I came to accept the attention as endearing. Most of my dates would ask questions about my life-style. They asked questions about Lipstick to toothpaste. After all, I couldn’t simply pluck off the bread accidentally placed on my meal, and, then call it a gluten free meal. So, no harm in not sharing this part of my life with my dates.

As time went on, though, I started to get a little annoyed. The spark wasn’t there for me. I kind of want to talk about me, my quirks and not just my disdain for bread. I was more than my disease process. I am not defined by having celiac disease. In my clinics, I usually tell my patients, that they are not defined by the disease. It could be, or share a part of your identity; but, never serve as the foundation of it.

But, my dates remained enthralled! Piercing eye-contact was maintained the entire time. Which slowly lead to the usual courtship ritual seen among the human “mating dance.” Men display certain patterns, here, too. Self grooming gestures were being thrown my direction—left and right, fixing of their hair, adjusting of ties, shoulder brushes, and eventually the gaze of “Come Hither” was flashed towards me. It was GAME-ON!

I would always get a little tired by dessert time. I caught myself numerous times politely, repeatedly having to say “No” to dessert. I forgot to read the dessert menu before hand. Thus, I was always blind sided by bready deliciousness.

Since, dessert is a must in our dating culture. I didn’t have time to completely prep for my entire meal. I have other obligations in my life–like the responsibilities of a resident at a hospital. Yes, this being-a-doctor thing is quite time consuming But, after a while, all hunting for the right desert started getting cute. I liked observing the hunter-gather instinct kicking in. My dates were hunting or at least trying to hunt and spear for some gluten free Tiramisu. So chivalrous!

As, I began to express my choice of foods to my blind dates, most were really excited to learn about the details of celiac disease and the gluten free lifestyle: from the diagnosis to the parts per million (ppm) guidelines the FDA has set on foods so that they can be classified as GF. Their interest wasn’t just about the current task at hand: dinner. I found myself talking about the non-GI symptoms of Celiac disease. No, not all of us “poop” a lot. Some of us can actually get cancer, infertility, anemia, and balance problems because of Celiac Disease.

My dates were finally turning into the cocktail parties I knew at the hospital. I felt like myself, and felt free to share myself. I could kid around, be goofy, and just talk about normal blind date things. They say you don’t find soul-mates, but you learn to become each other’s soul-mates. I even talked about some of my feelings and fears about having Celiac Disease, these dates were now full of emotion and feelings for me. Now, it was GAME-ON for me!

Then came John. And a few other non-corduroy wearing, non tiramisu-hunting men. John was a young physician as well. We never professionally worked together. He was an orthopedic surgeon, who personally thought that he was the grand-son of the first dude to have ever eaten an organic vegetable. And, probably—John also, owned a lot of stock in the Organic Food Stock Market. Okay, that maybe a bit of a little lie. There’s no such thing as the Organic Stock Market.

Things NOT always Equal

John was exceptionally Zealous of the Organics food lifestyle. He felt, I could immediately relate to his food habits because I’m GF. I, too, am a believer, though a cautious believer. I think it’s wise to know what goes into our bodies. As someone with Celiac Disease, you don’t always need to focus on what comes out of your body!

As a physician, and with the latest landmark Stanford meta-analysis study: I tell all my patients that Organic foods are not safer or healthier. They have not shown to reduce certain types of cancer. The only things that we can conclude about organic foods is: they have less pesticides, organic chicken and pork have less exposure to antibiotic resistant bacteria, they taste better, and they generally are kinder to the animals and help local farmers. This is what we know right now. That may change tomorrow.

Many years ago, we didn’t believe that Wheat, the staple of most of the entire world could cause disease. And, now we’re finding that dogs also have Celiac Disease! CD among humans was first described by Samuel Gee in 1888 in a report entitled “On the Coeliac Affection“, a similar description of a chronic, malabsorptive disorder by Aretaeus from Cappadocia (now Turkey) is traced as far back as 2nd century AD.

The specific cause of celiac disease was unexplained until the Dutch pediatrician Willem K Dicke recognized an association between the consumption of bread and cereals and relapsing diarrhea. This observation was corroborated, when, during periods of food shortage, during the Second World War, there would be a normalization of diarrhea symptoms. We are still learning about the specific genetic dance that must be orchestrated in order for a patient to develop such auto-immune diseases.

An essential tenant of clinical medicine, and the fundamental nature of science is that medical recommendations change in the face of new evidence. What’s constant is our analytical framework and the ability change in the face of new evidence.

After the Stanford study came out, I still saw many of my patients continue to eat Organic Foods. They saw it as a form of exercise in power, which transitioned from “it’s healthier” to “it’s environmentally friendlier, to, it is better for the farming community, and it just tastes better.” As, I sometime force my patients not to identify themselves with disease, I see many patients who form their identity with health.

Change Happens

It’s a choice. America is based on choice, given that one’s choice does not harm others. My patients that eat Organic Foods don’t harm anyone. Rather, they take great pride in their bodies. Their choice is a stark comparison to the majority of my patients who are morbidly obese and crippled with chronic life-style diseases such as high blood pressure, high cholesterol, and diabetes. As a family medicine physician, I am happy when someone CHOOSES to take an active role in their health. Specifically, in their eating choices.

My colleagues and I spend countless hours teaching patients about the perils of foods with a high glycemic index. Foods that are scientifically proven to cause heart attacks, liver disease, and
cancer. There are times that I imagine myself wearing amazing shoulder pads, as I punt my patents’ sprinkled doughnut into the ground, which obviously would then be followed by me doing a little victory dance at the goal post. That would be my super-bowl victory.

Speaking of football, my date, John played college football. That’s what he said, at least. If you ask me, his shoulders were kinda tiny. No, I did not see the size of his feet.

No, as a doctor, I do not have a medical opinion if a man’s shoe size accurately correlated to the size of his you know what. Our dinner progressed along. I enjoyed his company over hot sake and sushi rolls. The conversation drifted with a natural ebb and flow. I smiled, I laughed, and was totally captivated. I was having a great time. Then, John said something really stupid. “Don’t you think black pepper can replace a rescue inhaler when someone is having an asthma attack. You know, because black pepper naturally has amazing anti-inflammatory properties?”

For those of you not in the medical field: Orthopedic Surgeons are victims to a stereotype that precedes them. How do I say this nicely, they are known as the Jocks of our profession. Not the brightest, nor the most articulate. Shear brute strength which obviously is necessary to manually correct a dislocated bone. That’s a stereotype, kind of like a pattern.

Though to be fair: I have friends that are orthopods. I like orthopods. If an orthopedic surgeon ran for president, I would vote for him or her.

But poor John was just plain stupid. He took an amazing leap of faith with me. He whispered this correlation to me, knowing that if he raised this question in the hospital, or in a louder voice he might be ridiculed. I am surprised that I did not ridicule him. But, this did result in John not getting date #2. He, like millions of Americans was making an innumeric conclusion. John’s question is perfect in theory, similar to my acceptance and excitement of the theory of on-line dating. Both make perfect logical sense. Though, both fall apart because in real there are always exceptions. There are always Johns.

There’s a stereotype of people with Celiac Disease, too. A pattern that’s beginning to develop in mainstream America. I am not shy to call it out. It sort of goes like this: We inherently believe that a gluten free diet can cure many diseases: Multiple Sclerosis, Autism, and World Hunger. A gluten free can even cure the stupid out of Snookie and Kim Kardashian. Those are the imagined powers of a gluten free diet. Nothing more.

Some Disclaimers:

  1. Yes. In our present day society: hunting and gathering are not gender specific tasks. No, I do not know if females or males are the better hunter.
  2. No. No, animals were hurt in the process of hunting for tiramisu.

Gluten Free, Soy Free, AND Dairy Free Coffee…

15 Jul Funny Horse

So, I left  for the hospital an hour earlier than usual.  I wanted to stop by a local horse ranch to see the horses graze.   I love horses, from their demur gallop to their intense distant gaze when a stranger approaches.   They capture majesty & power; elegance & composure–all at once.    Not like Mr. ED.

Funny Horse

Um….something like that…

The picket fence on the stabble  has a sign which always makes me giggle:

“Don’t feed the horses. They don’t know the difference between carrots and your fingers.”

Obviously, I couldn’t break the law and risk my little fingers–so, I did the most logical thing:  I brought cucumbers from home.  Whole cucumbers.   I didn’t have time to chop them up finely.   I’m no Julia Child or Rachel Ray.

It was a beautiful day.  The sun was shining and I could feel its generous embrace.  As the horses enjoyed their breakfast, I too was enjoying my breakfast.  I was  “eating”  a medium black coffee from Starbucks. Pike Blend. No sugar. No creamer.

My Starbucks’ cashier, Nick–who by the way is a very handsome gentleman whose voice  rivals that of  Tom Brokaw–jokingly asks me every single day:  “so,  you just want a plain black coffee?  I think you would like x, y, or z.”   I roll my eyes, as my stomach  clenches up—I think to myself, just like the last 12 months since I have been coming here–“Yes,  my order will be the same,  Nick.”

Does Starbucks  train all of their employees to be so nosey, or is it an innate skill of the food/service industry?

This has been going on for over 12 months! He always follows up his initial line of questioning, with  “So, you must be on a diet. You know you look great, and don’t need to be on one.” Or, “How about a free sample of some freakin frapichiano, mochachino.” And, my fav: “Do you really like black coffee? What does it taste like?”   Funny thing is that I tell nick every single time why I prefer my coffee black.  And, it’s not because I’m cheap.

I kinda feel defensive at times.

We live in such a culinary advanced world of fancy sounding gourmet coffees and foods:  foods from the far east  to the local organic farmers from my neighbor’s yard.  Btw, half of them I cannot pronounce & half of them, I pretend to know how to pronounce.  My favorite ever:  Legume or is it Legume’.   Lima Beans should do.

I drink this many…

Or maybe Nick is forced to ask personal questions because I am so charming. Whatever the case, he is as annoying as the little sister that I never had.

I giggle to myself the most when  the service staff thinks I’m on a diet.   I have always been the cool chick, a “guy’s guy” of chicks if you will.   The kind of woman who uses the word chick without repercussions from stern feminists.   The one who will eat pizza and chase it down it with a beer after a kick-ass game of beer-pong.   This new persona of being viewed as  a High-Maintenance chick scares me at times.

You are what you eat, they say.  It’s the American way of forming an identity.  These days it seems like there’s an added variable to that identity. You are perceived by the way you refuse something or by the way your request is perceived as a demand when you order out.  And this was just coffee.   The lady at Denny’s thinks I’m very cultured and snotty.   Um, I choose to come to Denny’s for breakfast.  I eat quickly while reading the newspaper, then have to put the paper away because I break out in a rash or a hive, and then I can’t breathe because they give me asthma.  I am allergic to everything, also.  Joy.

At least my rescue inhaler isn’t blinged out with the word “Bling” plastered on the sides.     How snotty can I be, lady;  I dream of eating freakin’ tator tots!?!

I always explain to  Nick why I can’t have anything else on their grand menu.  I always explain the difference between food allergies, celiac disease, and gluten intolerance.  Knowing full well Nick would ask again tomorrow.  And he too will apologize tomorrow morning for asking another presuming question about my personality.

Good thing he can’t see my four inch stiletto heels.  That could suggest high-maintenance.    As a young doctor, I think it’s my duty to educate every-person that I come in contact with.  It’s like my super-power.   But sometimes, a girl just wants to eat.

As a highly experienced  coffee snot, I always ask for a coffee stopper for my coffee.  OMG! I am so happy they are gluten free.