Posted by: drrozkaplan | January 23, 2011

Achtung, Your Plane is on Fire

On Monday, I forced my 17-year-old daughter to drink 64 ounces of Gatorade laced with 14 doses of Miralax.  Those of you who have had colonoscopies will recognize this as the standard prep, and realize that I was not trying to poison her.  She was compliant, though miserable.  She felt horrible all day, and was in the bathroom all evening.

On Tuesday, I took her to the endoscopy suite at the hospital, where she was sedated for a colonoscopy and upper endoscopy.  In comparison to Monday, this was a breeze.  She’d been having chronic ‘stomach aches’ for at least a couple years, and it was suspected that she had celiac disease, or gluten enteropathy.  This is an intolerance to gluten, a component of wheat and certain other grains, in which ingestion of gluten causes the body to make antibodies against its own gastrointestinal tract.  Some of the lining of the small bowel gets destroyed, and the patient starts to be unable to absorb certain nutrients.  Symptoms can be mild or severe and can range from stomachaches to neurological symptoms.  The treatment is a gluten-free diet, which essentially solves the problem, but has to be adhered to for life.  A blood test will usually be suggestive of the disease, and my daughter had a positive blood test.  Then the diagnosis is confirmed by upper endoscopy with biopsies.  She’d already had this test once, and the biopsies were normal.  But her symptoms continued.  Since the disease can be ‘patchy’, the biopsies could have missed abnormal tissue.  So she was getting a second test.  The doctor decided to do the colonoscopy, too, in case the upper endoscopy was normal again and we still had no diagnosis.  Plus there is family history of inflammatory bowel disease, so that was another possibility.  After the test, the biopsies take a couple days.

On Tuesday afternoon, while my daughter was sleeping off her anesthesia, I helped my 20-year-old son pack for his extremely long semester abroad.  He was leaving for Germany for 7 months, a trip sponsored by his college, so there are other American students.  There is a month of intensive language, a month to travel, and then a semester, IN GERMAN.  ACH!!!!  His room in our house looked like a bomb had hit as he started packing- we had brought everything he owned home from Wesleyan, and he also had taken a little 10-day jaunt to Israel on Birthright, from which he had just returned on Sunday. He, and his possessions, were turned upside down.  He did get packed.  I took note of the unusual things I found in his room, most of which had to do with his art classes (paint cans, turpentine, lighter fluid from a project that involved burning some cloth) but decided that I would discreetly remove these after he left, rather than argue with him about the fact that it was not safe, much less civilized, to keep such things in one’s bedroom.

On Wednesday, my son and I made the drive to JFK so he could get on his flight to Germany.  I let him drive and choose the music.  After all, it was our last time together for a long time, and these were his requests.  These were mistakes.  I never take back promises.  Instead, I gripped my seat (he drives like his father- with an assured aggressiveness- but without all the years of experience) and wished I had earplugs (his music of choice is Dubstep (you look that up, as I find it hard t explain- in my very un-hip, old lady mind, it is disco with way too much bass) and a strange mix of Reggae and Rap  (I like Reggae and hate Rap- this just didn’t make sense to me).  When we got to JFK, we paid hundreds of dollars extra for his overweight bags to go, and then stood saying goodbye.  He suddenly looked like my little boy, a way he hasn’t looked in years, sweet and vulnerable and, well, scared.  “It’s a long time, Mom.”  he said.  “I know.  But you always adapt.  You are so good at adapting.  I know you’ll be fine.” I replied.   “I know.”  And then he was gone.

He started his own blog yesterday.  And in his usual way, he is glib, and funny and smart.  But reading between the lines, I’m not sure he’s fine yet.  He will be.  But not yet.  He’s living in a dorm unit with 4 people who don’t speak English.  One doesn’t speak… at all.  They call her ‘The Phantom”.  I suggested to him in an email that perhaps she’s a mime.  It’s freezing in Reggensburg- much  colder than here.  And he describes the culture in the area as sort of like the ‘deep South’-  his way of saying bigoted and insular, I believe… Everything about the situation would make me want to run away- but he’s there for the long haul, barring any disaster.  He should be speaking very good German pretty quickly, at least.  The only phrase he taught me before he left was ‘Achtung, Hauptman, dein floog brent’- which means ‘Attention, Captain, your plane is on fire.’  This will be very useful for me in my future life, I’m sure.

Meanwhile, we got my daughter’s biopsy results back, and she does, indeed, have celiac disease.  So the gluten-free diet has begun.  She has been a bit down about it, mourning croissants and muffins and soft pretzels… Though we are educating ourselves on the very large variety of gluten-free options- recipes, baked goods, pasta, restaurants, even pizza.  It’s a tough adjustment for a 17-year-old, particularly one who is a pasta and pizza lover.  Her incredibly supportive and loving friends have rallied around her, baking her gluten-free cookies, showing her apps on the i-phone that tell you where the closest gluten-free pizza can be obtained, and connecting her with other friends with celiac.  And today, I had a real silver-lining-in-the-cloud experience.  I was in Trader Joe’s and had just asked for a list of gluten-free foods, which they happily provided.  I was standing in an aisle, reading the list and trying to understand the labeling on some of the packages, feeling a little overwhelmed and teary-eyed, when a Trader Joe’s employee, a young woman named Clare, walked over, looked in my basket, and said, “You’ll want to buy the Udi’s gluten-free bread with the green label.  It’s much better than this one you have.”  She asked me if she could help, and told me she had celiac and knew a lot of products and ‘tricks’ for shopping gluten-free.  I told her about my daughter, and in five minutes, I knew all about labeling, which baked goods and pastas and cereals tasted best, how to make my own gluten-free bread crumbs trouble-free instead of paying the outrageous prices for the pre-made ones, and much, much more.  She and another, older woman named Karen,  also a gluten-free foods expert,  invited me to bring my daughter in for a tutorial, and I left feeling much, much lighter, even though my basket was much, much heavier.

The good news is this.  My plane is NOT on fire.  Yes I’m hoping for this to be a less eventful week. Still, I am grateful that my children are, overall, healthy and resilient.  They will roll with the punches, perhaps better than I.  I ran into a patient this morning, an older woman who has grandchildren and great grandchildren.  She said this to me:  “When I was younger,an older woman who worked for me told me this, and I will pass it to you.  It’s hard for us as our children get older.  When they are little, we can hold them in our arms.  But when they are older, we can only hold them in our hearts.”

Posted by: drrozkaplan | January 12, 2011

The Decluttering Project: Day 12

I’m no longer sure what the goal of this project is.  I set out to clear out my house a little bit- get rid of junk, give away things I no longer use.  I had the idea it wuld help my mind.  It is definitely having that effect.  I find myself delving into much more than cleaning now.  It’s as though I’ve ‘taken myself on’ and I won’t take excuses from myself about things anymore.  I guess getting organized has freed up brain space for other things.  For example, I made a list of friends I haven’t seen in a while and I’d like to see.  I’m contacting them and making plans.  As I mentioned in a previous post, I found my ballroom dance shoes, and Larry and I took our first Argentinian Tango lesson last Friday.  We had a blast.  I’m not lying on my bed anymore, feeling defeated by all the things that should be done but are just too much effort.

The last few days of cleaning out stuff have generated all kinds of insights and inquiries as well.  For one thing, I notice that, as practical as I am on some levels, I am a more sentimental mother than I’d realized.  Sunday’s New York Times Style section had an article on a home organizer who goes into the apartments and brownstowns of monied manhattanites and, for $150/hour, ruthlessly disposes of everything not currently usefull.  She allows for one small box of art projects and school momentos for each child.  She notes that she disposes of her own children’s sports trophies of they are just ‘participatory’ and not indicative of special status or talent.  She says ‘your children won’t love you less’ and that they are ‘unlikely to be the next Picasso or make it to the NHL’.  Well, phooey to that!  I find that practice abhorrent, and I kept, among other things, my daughter’s sculpture of a rosebush from first grade, my son’s renderings of his favorite hockey players, circa age 8, all of their report cards (even I had trouble justifying this, as I never much respected the idea of report cards), every trophy, ribbon and momento of achievement, and 8 homemade Hanukkah menorahs, each hideously ugly in its own way.

     Apparently, there is also more than one ditz-brained person in my household.  Perhaps one of them is me, but there are others.  In the cabinet below the double sinks in the bathroom our children share (or at least did before my son left for college), I found 4 empty shaving cream cans.  As far as I’m aware, there is no use for these.  I found 2 broken hairdryers and 6 bottles of the moisturizer that comes with my daughter’s acne cream (guess she doesn’t like that particular moisturizer).  All of these things went into my trash bag. 

     I was in the dining room, philosophizing over a cupboard full of my mother’s good china, packed away in quilted plastic zipper cases.  I don’t use these dishes.  I think perhaps one day I will give them to one of my children when they settle into a household- although these days, young people don’t often register for good china and crystal, sterling flatware and silver trays- they really are throwbacks to a time when women ran households and had servants to polish all that silver and wash all that bone china by hand.  So maybe my kids won’t want these dishes.  Anyway, since I don’t use this set of dishes, I haven’t looked in this cupboard for years, and I was just thinking all this when I saw it:  a can of Reddi-whip.  What was it doing there, in that cabinet?  I picked it up.  I stared at it, not quite recognizing it for what it was at first.  It was mostly empty, and the expiration date read 2005.  I could not for the life of me imagine what it was doing in that cabinet.  I threw it out, realizing its presence would remain a mystery.

The can opener has been missing for over a week now.  It’s not that I am so attached to that particular can opener.  I did go buy a new one.  But I’ve searched and cleaned the entire kitchen and dining areas.  Every drawer, closet and cupboard.  Where could it have gone?  The man who works at Kitchen Kapers, where I purchased the new one, immediately implicated my children.  “Look for the open can of spaghettios or tuna fish in their rooms,” he told me.  But no, that’s not their style.  Perhaps my son did take it, but more likely to use the bottle opener part to open beer bottles with his friends.  I looked in the upstairs den, where they were hanging out before he left for Israel, and it’s not there.  I doubt very much he took it with him.  It could be in his room.  That, however, is one place I’m not about to go. 

 I glanced into his room, just in case the can opener was right there, wanting to announce itself.  I didn’t see it.  What I did see was his trophy shelf, lined with his wrestling trophies, some participatory, others ranging from third place ina middle school match to first place in Semifinals in high school to third place in States, finally sending him to Nationals in his Senior year.  I could never dream of disposing of one of his trophies.  He earned each one with his sweat, sometimes his blood, and occasionally his tears.  What belongs to him is his.  My decluttering project is mine, and I will keep my boundaries.   (But I still want to know where the can opener is.)

Posted by: drrozkaplan | January 7, 2011

The Decluttering Project – Day 7

Still working on my environment.  It’s become more than housecleaning, though.  I think I mentioned before that I used to go into cleaning frenzies for a day or two, get things looking better and a little more organized in my house, but exhaust myself in the process and then just fall back into the same pattern of letting everything go back to disarray and have to do it all over again.  Sort of like crash dieting and then gaining the weight back.   In truth, it is the same thing to clear things out and then just reaccumulate.

So this time, I’m trying to do it differently.  It’s a much slower process, just a little bit each day, and a much more thoughtful process of what needs to go, what needs to stay, what needs to be repaired or refurbished or replaced.  And in doing so, I am feeling lighter, as though I actually am losing a sort of weight.  This process is helping me clear my head a lot; I’m figuring things out and worrying less.  I think it’s even helped my chronic headaches over the last few days!

Today I had the day off from work, so I took care of a couple of kitchen drawers and cabinets.  I disposed of a truly disgusting broiler pan and two cookie sheets that have seen better days.  I realized that it was not my imagination that the can opener was missing- I looked in every drawer and cabinet, and it really HAS disappeared.  It is odd, and I could think that I’m losing my mind or that a burglar was in the house and took only the can opener, but I choose to believe that it is more likely that my older adolescent has been using it as a bottle opener and it has been swallowed into the dark cave of his room, or that it broke and someone threw it away and forgot to tell me.  In any case, the pans and can opener had to be replaced, so I took a trip to Bed, Bath, and Beyond (with all the coupons I’ve been saving up for such an event).  I cleaned my oven and cleared out the drawers that hold all the odd cooking items, like the garlic press and the rolling pin.  I found out I have a lot of cooking utensils I haven’t used because I didn’t know they were there.

Tonight I worked on a much more stressful cleanup- that of my laptop computer.  I have not cleaned up my files in a very long time, and there were dozens of files on the desktop, which makes it run slow.  I started moving files and found myself deleting tremendous amounts of junk left over from the last several years.  Somehow, multiple copies of the same files had found their way into multiple folder, and my data was just in a general state of disarray.  In the midst of trying to organize my powerpoint presentations, my husband came in, and decided to help me move them all into a new folder.  He is a true computer geek, but somehow, his plan failed, and the files were all accidentally deleted.  No problem, because a true geek can alway retrieve them; we have ‘Time Capsule’, a nice little backup feature of our Mac network, which allowed us to go back to right before the accident and retrieve the powerpoints.  The mission was accomplished, though with a little more upset than we’d hoped.  I still have a lot of work to do to clean up the computer, but I see the direction for organization and control.  And I found a couple dozen writing projects that have been started and not finished, so I can start looking through them and deciding what’s worth salvaging.

Funny thing is that as I am working through all my messes, other family members are following suit.  We haven’t really talked about it, and I’m being really low key- I haven’t even mentioned what I’m doing, but of course, people are noticing.  Suddenly, my daughter is cleaning out some of her drawers and making lists of things she needs to get done.  My husband is recycling some of his magazines and keeping his desk clearer.  I heard the paper shredder running for a long time the other day.  My son, well, he is traveling right now, and frankly, I am afraid to enter his room.  I don’t think he’s ready for a decluttering experience yet.

I’ll keep you posted.  Even though this is work, I am finding it freeing.  I’m not sure yet where it ends.

Posted by: drrozkaplan | January 3, 2011

The Decluttering Project- Day 3

I am so far going through with my resolution to remove clutter from my life.  I know, it’s only January 2nd, so if I’d already given up, it would be pretty pathetic.  But I’ve actually gotten quite a bit done, since I’ve been home and had time on my hands.   I’m trying not to do this in a super-compulsive, manic way.  Sometimes I can get like that- I start cleaning and then have to clean EVERY closet RIGHT NOW and I exhaust myself, but I end up just rearranging the clutter, and not thinking through what stays and what goes and why.  I want this to be a longer-term process, one that is more thoughtful and useful, and one that perhaps allows me to clear my head while I’m clearing space.

I’m controlling myself pretty well.  For instance, today, we grocery shopped, so before we shopped, Larry cleaned out the refrigerator, and when we were unpacking, I rearranged cabinets that had become messy, and I threw out a few things that were stale.  I cooked, and used spices, so I straightened out the spice cabinet.  No crazy stuff.

Yesterday, I cleaned out our main coat closet.  That closet is a constant source of agita for me.  I’ve straightened it out a hundred times, but it always ends up a mess.  This time, I sorted through all the coats and jackets.  There were a few things that hadn’t been worn in years.  Into the give-away pile.  Then came the big purge of the hats.  Somehow, over the last 20 years, the family had collected several dozen baseball caps, souvenirs from trips and games and college visits, gifts from relatives from different towns, emergency sun protection purchased on the fly.  These hats have cluttered this closet and tortured me for years, but in the past,  I’ve simply found different ways to store them- at one point a special ‘system’ for hats composed of a rope and clips, another time a big box to stuff them in.  Somehow, they always ended up scattered all over the closet, no matter what I did.  And the truth is, the only one who regularly wears baseball caps is Larry, and he has a few favorites.  I occasionally don one in the spring if we are riding in the convertible or I need sun protection on a walk, but there are only two or three that I like to wear- one acquired when we had to visit medical clinic in Yellowstone Park (an adventure all its own), a black one with a tiny red Mickey Mouse head embroidered on it,  and occasionally a tan one from a rafting trip.

I took all of the dozens of hats and laid them out on the kitchen table.  I gave all family members an opportunity to choose any they wanted to keep.  I took my three.  Larry chose six or seven he didn’t want to part with, including a couple of hockey team hats.  The kids rejected them all.  Any not chosen went in the give-away bag.

There’s still a lot of stuff in the coat closet:  shells, fleeces, wool coats, down jackets, rain gear, boots, winter hats, sun hats, dog leashes, back packs, gloves, scarves….but now there are only 10 baseball caps.  A manageable number.  Still more that one family would ever need.  Right now, you could find whatever you were looking for in there, too.  We’ll see how long that lasts.

The most interesting project was the decluttering of one of the bureaus in our spare bedroom.  This bureau has, over the years, become a receptacle for items of clothing from everyone in the family, things that aren’t needed right now, but that we feel we will need at some point.  For the most part, these items have to do with sports or other activities requiring specific clothing.  And nobody has looked in it carefully for years until now.  Here’s what I found:

1.  All of the family’s long underwear, ski sweaters, and ski socks.  We haven’t skied in several years, due to a combination of factors.  Larry had both knees reconstructed due to ski injuries, which took us out of the yearly ski trips we used to go on a few years back, but also our daughter stopped enjoying the sport, finding it more alarming than exhilarating as she got older, and our son was too busy and then went off to college and we just never had the ‘family time’ during ski season.  But I loved skiing, and seeing all those things reminded me what we’ve been missing.

2.  My ballet slippers and leotards and leggings and practice skirts.  I feel nostalgia for my days at the barre. Do I want to go back to ballet lessons?  Probably not.  But dance in some form?  Ballet exercises as part of my fitness routine?  Maybe.  And…

3.   My ballroom dance shoes.  That’s something I really miss. Larry and I still use our skills at Bar Mitzvahs and weddings, but why did we stop taking lessons and going to practice parties?  Was that because of his knees, too?  I asked him if he’d think about taking a class- maybe Argentine Tango, or just review of Latin dances.  He was all for it. Now let’s see if we follow through.

4.  My tennis clothes.  I really sucked at tennis.  And my right arm and shoulder are permanently damaged. I can do most things, but tennis would take that shoulder over the edge.  Not going back to that.  But somehow I’m not ready to give the tennis clothes away yet.  I should.  I really should. But my denial is strong on this one.   I put the tennis clothes separately in a small drawer.  I will have to work on admitting my limitations. Another thing to check back in on later.

There is still lots and lots of clutter to tackle.  The basement is a frightening part of this project, one that I’m not ready for yet.  I might look through unfinished writing projects next and see what I want to save and work on and what I want to trash.  In any case, this project is definitely producing more than clean drawers and cabinets.


Posted by: drrozkaplan | December 31, 2010

Another New Year

So what’s it going to be this year?  New Year’s Eve is tomorrow and I haven’t come up with my resolution yet.  Hmmm.  I know what a lot of people will be doing.  Vowing to exercise and eat healthier.  As usual, this holiday season has come with lots of dietary indiscretions and many boxes of chocolate are sitting in both my kitchen and my office.  I’m no saint; I’m indulging like everyone else.  Of course, I resolve to exercise more and eat right.  But that’s an ongoing issue for me- not the BIG RESOLUTION.  I’ll be in the gym tomorrow and probably on Jan. 1 as well.  Tomorrow, the gym will be empty.  On Jan 1, it will be packed.  By Jan. 14, it will be at the usual capacity with mostly just the regulars there again. So much for the exercise/eat healthy resolution.

A group of my friends are planning to quit smoking for their resolution.  That is a very fine goal, in my opinion, and I am planning to help them in any way I can.  Probably a couple will succeed and the rest will not.  Smoking is a tough addiction.

This year, I am thinking, ‘what should a New Year’s resolution consist of?’  Should it be about bettering myself?  About bettering the world?  Something that will make me happy? Healthy?  Something that will make me more productive?  Hopefully, all of the above.  I have plenty of flaws I can work on.  But which ones are priority?  What is most important to tackle now? What can I tackle that I actually have some hope of succeeding at, that will not just be an empty promise?

What things can I do to be healthier?  Well, of course, eat better and exercise more… but also, I think, try to find the best balance possible between work and play and rest.  Always a tough act.  Really, almost impossible when work is taking care of other people, and family includes kids who, no matter how independent they may want to be, still need parenting (usually at the most inopportune moments), and life is just, well, unpredictable.  But I can work on that, I guess, scheduling in recreation and downtime.  Maybe that will actually make me more productive when I’m working.  That’s what’s supposed to happen.

What about happiness?  What is is that a person can do to increase their happiness?  I’ve read the studies that show that we have happiness ‘set points’, which implies that there really isn’t much that can change how happy we are.  Some people are just more content and take things easier than others, apparently.  But that doesn’t mean that there isn’t some play in the system.  Well-being is increased by doing things for others, by being with pets, by exercising (damn, not that again)…. Happiness apparently cannot be bought, as studies show that once a modest level of income above subsistence is reached, people are not happier.  And material items don’t bring happiness, in general.  It seems we get a brief lift from finding and purchasing things we want, but once we have them, our happiness quotients go back to baseline.  However, experiences, such as travel, cultural pursuits, and adventure, may actually increase happiness.  So what should I do about that?  I already have as many pets as I can handle, but I might look into working on a cause.  Not just giving a contribution here and there, and not sitting on a board, as I’ve done in the past, but maybe doing something where I get my hands a little dirty.  Something that will count for doing good for others and also experience?   I’m going to think about that.

Meanwhile, I have one other idea.  Something I know has made me feel happier and more productive in the past has been to declutter.  In the past, I’ve gone on cleaning tears, going from room to room and closet to closet, exhausting myself over a couple of days, purging all the accumulated junk.  I’m not going to do it that way this time.  I’m going to make it a longterm project.  Each time I go to a drawer, I’ll clean it out if I have time.  On weekends, I’ll pick one closet or a bureau and clean that out.  It will be a slow and methodical decluttering, clearing out my environment and maybe my mind as well.  I’ll see how it affects me.

I’ll report back to you on all this. No empty promises this year.  See you in the gym?

Posted by: drrozkaplan | December 22, 2010

The Darkest Day

Today, December 21, 2010, is not only Winter Solstice, the shortest day of the year, the official beginning of winter.  Early this morning we also had a total lunar eclipse, further darkening our night sky.  It was the first time that a lunar eclipse coincided with Winter Solstice since 1638, making this truly the darkest day in 372 years.

What difference does that make, you might wonder, except as a piece of useless trivia, a geeky factoid?  It is, to me, kind of wild to live through a natural phenomenon that nobody alive has experienced before, so I guess that matters.  Also, as anyone who deals with people, particularly in health care, will tell you, natural phenomena do seem to have some effect on people.  And darkness certainly affects people.  Those with true Seasonal Affective Disorder (SADS) are surely hitting a low, but even many  who don’t have SADS seem to be feeling a little low on energy, a little melancholy.  And to top it all off, we have a full moon tonight, which makes for all kinds of strange behaviors and events (those of us who have worked in Emergency Rooms or Crisis Centers can vouch for that…).

The good news is this.  Every day after today gets longer until Summer Solstice.  We’ve hit the low, and it gets better from here.  One of my patients said it best today- simply and beautifully.  We were talking about how difficult things have been for her recently, and then we touched on the fact that today was the darkest day of the year.

“I see that as hope,” she said.  I think she’s right.

Posted by: drrozkaplan | December 16, 2010

Speaking Truth

Maybe it’s age, turning 50.  Or the impending emptying of my nest, or the nearing of menopause, or having published a memoir, putting a lot of personal truth out into the universe and finding out that only good has come from it so far.  But something in the way I’m looking at ‘the truth’ is changing.  something has shaken loose, and I’m finding myself trusting my intuition  and judgment more and more.  And beyond that, being unwilling to stay silent when I have an important truth to speak.

I’m not saying that I am impulsively blurting out everything I think.  Or that I’ve gotten the idea that I’m right all the time.  On the contrary, I actually am much more settled, too, able to sit with things and think them over, consider different facets, and bide my time, than I ever was before.  But if, after all that consideration, I have something to say, I am much less likely to hold my tongue for fear of repercussion. I don’t want to remain silent on all the difficult and uncomfortable issues that arise in life anymore.  There’s toxic waste in all the material that gets stuffed and bottled and never spoken of, and I don’t want to be a toxic waste dump.

I’ve always trusted my intuition in my work, and that has served me well.  No, I can’t ‘intuit’ a complicated diagnosis, but the part of medicine that is art, as opposed to science, depends on immediate perceptions that are not always backed up by hard evidence.  Of course I use signs and symptoms and test results.  But I also just ‘know’ certain things.  Here’s an example:  A patient I’ve known for a number of years has been declining treatment for a condition that is not life-threatening, but that decreases the quality of his life, because he has heard negative things about the medication he would need to take.  While I disagree with what he has heard, pushing him on the topic made him angry in the past, so we discuss it each visit but I stopped pushing him some time ago.  On his last visit, we had the same conversation that we always have about his symptoms.  But I just had a feeling that something had shifted, so I was more forceful with him about the need for medication.  And this time, he accepted the prescription.  I can’t even put my finger on what was different.  I just knew.

In other areas of my life, however, I can sometimes flip-flop.  My inner voice will tell me one thing, but ‘evidence’, or other people, will sway me in another direction.  I was having a falling-out with my son, who is at college,  recently.  Not a complete rift; we were talking but we both knew things weren’t right.  We’d argued and he’d said some hurtful things.  We ended a phone conversation without resolving things, and I was hurt and angry.  I knew in my heart that I needed to talk to him face-to-face and that for it to be okay, he would have to apologize for crossing a line into disrespect before we could rehash and repair the actual argument.  But my husband said, “maybe you should forget it; I just remember how clueless I was about my parents at that age and I don’t think he’s capable of understanding.”   A therapist friend said, “You’ll only make things worse; he needs to feel angry at you.”  Another friend said, “Don’t hold your breath; they NEVER apologize.”  I almost listened.  And I’m sure plenty of people would fault me for holding onto my hurt.  But I know myself and I know my son. I also know the power of the words “I’m sorry” for both the giver and the receiver.  So I held out for that conversation at Thanksgiving, and it was worth it.

My daughter has told me that she thinks I’m a witch.  Not because of how mean I am, although she may think that too.  But because I know things she hasn’t told me, and that nobody else has told me either.  This is not because I’ve been snooping on her Facebook page or going through her possessions, either; I wouldn’t do that.  And honestly, I don’t need to.  I’m just in tune with her enough that I often know when something’s going on with her without her saying so.  The thing is, I’ve stopped telling her what I know, unless it’s absolutely necessary, because she finds it intrusive.  I’m trying to stop noticing some of it.  It would be better for both of us. Good thing she’s going to college next year.

Just because I know the truth doesn’t mean I always have to say it.  There are lots of times it’s fine just to keep stuff to myself.  But trusting myself to know when it’s time to speak up, for my own good or someone else’s, is a good thing.  And then doing at the right time and in the right way- that really makes a difference.  I know there will be mistakes.  Like everything else, it’s a work in progress.

Posted by: drrozkaplan | November 28, 2010

On Having ‘One of Those Days’

‘Finish each day and be done with it.  You have done what you could.  Some blunders and absurdities no doubt crept in:  forget them as soon as you can.  Tomorrow is a new day: begin it well and serenely and with too high a spirit to be encumbered with your old nonsense.’  – Ralph Waldo Emerson

If you are me, a typical day may involve more than a few blunders and absurdities.  Sometimes I wonder if I am a magnet for trouble, or if the universe has it in for me.  Then I remember that I lead a complicated, sometimes messy, often wonderful and rich life, and that the many people and activities in my life leave more opportunities for good, bad, and, yes, absurd things to happen.

I woke up with pink eye today.  Yuck.  Doubtless a result of imperfect hygiene with all the sickness I’ve been around in my office.  Luckily it is a weekend and I have a bottle of Sulfacetamide eyedrops in my bathroom drawer.  Except for some reason, nothing is coming out of the bottle, despite the fact that it is full.  I sterilize a needle to stick through the dropper part of the bottle.  Then I drop the needle on the floor before I finish the task.  I light another match and re-sterilize, this time burning my finger.  Shit.  Oh well.  Now I have pink eye and a burnt finger.  But I get the eye drops working.  And I put a hot compress on my eye, as I tell my patients to do.  Hygeine is everything.  I throw the washcloth in the hamper and wash my hands 14 times.

I tried to log onto Facebook and got a message saying that someone tried to access my account in Orange County,  California last night.  I don’t know anybody in Orange County, California.  I reset my password like they told me to, but I felt unsettled.  Last year, I spent months cleaning up my credit after my identity was stolen by someone in Culver City, California.  Strangely, a detective called me about a month into that ordeal, and told me that they were working on arresting someone for stealing my identity and the identities of 7 other female physicians, most of whom reside in the Philadelphia area.  The group of us have all been in contact, and the whole thing wreaked havoc with all of our lives.  They finally arrested some woman in California, someone who is doubtless the bottom of the food chain, and the police out there still have no idea how they got our information.  We were all subpoenaed countless times to go out to California and testify, but in the end, none of us ever actually had to appear:  the case was pled out, and for all that, the woman got 5 years of probation.  This all just wrapped up a couple of weeks ago.  So when someone in California hacked into my Facebook account, I couldn’t help but wonder if it was related.  I called the detective in Culver City.  They think it’s a coincidence.  My son tells me that hacking into Facebook accounts is common, and is done for the purpose of obtaining as many cyber contacts as possible to send out annoying ads or possible viruses…  so I’m forgetting about it.

I noticed a huge new dent in my car this afternoon.  I have no idea how it got there.  But there was already a big dent near it that my son put in the car when he backed it out of the garage and was too close to a wheelbarrow that was inside the garage.  What’s one more dent?

I can’t find the manuscripts that I read and wrote extensive comments on for writing workshop tomorrow night.  This is not uncommon for me.  I will have to rip apart all the papers that are strewn on my desk and in my bag to mind them.  Truth be told, I am NOT a disorganized person.  It’s just that the manuscripts are one of 20 or so activities I have been participating in this week.  I suppose I could be a more organized person.  I could color-code and categorize and sanitize and re-strategize and have a place for everything and put everything in its place. I could be more careful to park in places where nobody will put dents in my car.  Or just not go to as many places.   But then all I’d be doing is figuring out how not to make mistakes and lose things and get into situations.   And that would be kind of sterile and dry and pathetic.

Instead, since this is just post-Thanksgiving, I’m going to be grateful.  Grateful for all the amazing people I meet in my work, all the patients I see who give me the opportunity to catch a cold or get pink eye now and then, grateful for all the places I have to go and things I have to do and the manuscripts I get to read and misplace, and yes, grateful that I HAVE an identity, even one that can be stolen.  I’ll worry about the consequences of all of this as they come along.  If that sounds reckless, consider me reckless.  I wouldn’t have it any other way.

Posted by: drrozkaplan | November 24, 2010

Nobody’s Perfect

I just finished reading Courtney Martin’s book, ‘Perfect Girls, Starving Daughters’, and I am fired up.  If you haven’t read this book, and you are a young woman under 30, or you have a daughter, or you are a person concerned about eating disorders or just about the well-being of young women in this country, I strongly recommend this book.  I won’t say it’s the best-written piece of non-fiction I’ve read lately, nor do I buy into everything that Ms. Martin, a young journalist, has to say.  But having treated eating disordered patients for most of my career, a lot of what she writes rings true, and feels right, and seems particularly to apply to some of the young women I happen to be seeing right now.

One of the important messages of this book is that eating disorders are quite multifactorial, but that societally we have an incredile set-up for young women to be body-obsessed and to have a complicated, dichotomous relationship with food and eating, so that it is the rare high school girl, college girl, or post-college young woman who simply eats to fuel her body’s needs and sometimes to enjoy food, exercises for health and enjoyment, and expends the rest of her energy on other pursuits.  Instead, almost every one of the many urban, suburban, white, black, Latina, girls and women and women from every part of the country and every socioeconomic sector recounted struggling with food, exercise, and body image.  I know that Ms. Martin’s sample was not random, and yet it was broad and deep.  I feel terribly disheartened when I realize that I have heard almost every woman I can think of in my life, too, across the board- friends, relatives,  colleagues, patients, women I write with, exercise with, walk dogs with and chit-chat with in the line to get coffee, say negative things about their bodies or comment that they shouldn’t be eating something they are about to eat.

I can’t give a synopsis of everything Ms. Martin had to say in ‘Perfect Girls, Starving Daughters.’  What I can share is the basic premise that young women are in an especially precarious position in society.  They have been told in the ‘post feminist’ era -(I say this loosely- I have much to say about feminism that could comprise another post, and it pains me that most of the young women I know do not clearly identify themselves as ‘feminists’- I see this as a terrible lack of dialogue between younger and older women, dialogue that could benefit both age groups, and I hardly see that we are ‘done’ with the whole issue of gender equality- there are still old problems to solve, there is backlash, and there are new problems that need to be tackled as well)- anyway, young women have been told that ‘they can be anything they want to be’, but for various reasons have interpreted this as they ‘have to be everything.’  By ‘everything’, I am saying successful, brilliant, driven, athletic, efficient, and powerful, as well as beautiful, sexy, glamorous- and of course THIN and IN CONTROL.

As parents and as a society, we have given our girls the message that they can, and should, reach for the stars.  And they should.  But somehow this has come to mean ‘being the best.’  At everything.  The ‘Perfect Girl’.  Not just being good at some things.  Not just doing their best each day and calling it a day.  It means the A’s, the trophies, the road to ‘the best’ colleges.  And since not everyone can be the winner, and there are only so many spots at those elite schools, it pits girls against each other, making each other girl competition instead of potential ally.  And girls don’t just leave it at that.  It’s also who is prettiest, most popular, and gets the most attention from boys as well as from other girls.  But if you’re at the top, nobody really likes you-they just fear you. Plus you’re always at risk for a fall from grace.  And if you’re closer to the bottom, you’re a loser and to be avoided.  The only thing this seems to add up to is isolation.  And a feeling of emptiness.  The ‘Starving Daughter.’  Nothing is ever good enough or perfect enough, because no matter how you slice it, this is a bad deal.

Okay, step back.  It’s not all dire.  Despite this culture, plenty of our girls seem to be doing fine.  But a good question to ask about any given girl is, ‘Is she doing fine, or does she SEEM to be doing fine?’   Because the real catch-22 in this is that most of these girls will not develop full-blown eating disorders.  They will soldier on and look happy most of the time. Many of them may BE happy much of the time.  But is that happiness true, internal contentment, or is it happiness that is contingent on what accomplishments they have achieved that day or that week, whether their grades are high enough, their athletic performance good enough?  Will they still believe in themselves when the rejection letter comes from the school they had their heart set on?  Is it a real sense of self-worth, or is it dictated by whether they have a boyfriend, or the right set of girlfriends, or what they weigh, or whether they were able to resist eating the donut and get in 45 minutes on the elliptical machine today?  If they start to slip, and get a B on a big test, or gain 5 pounds, or get injured and become unable to play on the team or even exercise for 2 months, are they going to have the resilience to still believe it will all be okay?

I think the real issue here is exactly that:  resilience.  We have done a great job getting our girls motivated to achieve, to enter the intellectual and athletic and social arenas.  We have taught them to compete and to win.  But in our zeal to propel them to the top,  we haven’t really taught them much about the benefits of losing, of failing, of making mistakes, of screwing up and regrouping and moving on.  We’ve just given them the message that they mustn’t do those things, that the stakes are too high to screw up.  I don’t just mean ‘us’ as parents.  I mean ‘us’ as a society.  Let’s face it:  it really is set up that way.  It’s really too bad.

Think about this:  in a lot of schools, there is ‘tracking.’  So poor academic performance, even early on, even a few bad test grades, a midterm that a kid doesn’t study for appropriately, can have far-reaching academic effects.  So they better not make mistakes in school.  Any behavior errors:  one suspension, a few detentions, go on a ‘permanent record’- so kids better behave from the get-go.  Experimentation with drugs or sexuality get kids ‘reputations’-  throwbacks to decades ago-  for example, girls get called ‘sluts’ fairly easily if they ‘hook up’ with the wrong boy.  So better not make any behavior mistakes, even when you’re 14.  Oh, and don’t hang out with the ‘wrong people’, or wear the wrong clothes.  That can mean ‘social death.’  And since colleges are oh-so-competetive these days, you better start participating and committing to your sport and some other extra-curriculars.  If you find you’re not interested, well, really, too bad, stick with it, or it might look like you’re not ‘committed’.  These are just a few of the messages high school kids get.  I remember my son, now a sophomore at an elite liberal arts college, being told by his teachers and college counselor that it was a big mistake for him not to take the extra science class and the 5th year of Latin, in order to pursue Studio Art in his last two years of high school, though he’d burnt out on Latin and visual arts was a strong passion.  He didn’t listen, and his father and I supported that.  It turned out not to be a mistake.   But again, these are the messages.  So where is the opportunity to take a chance, take a wrong turn, discover something about oneself, make a mistake, take a fall?  How does anyone learn to say, “well, that didn’t work, guess I should try the other direction.”?  How do kids learn to pick themselves up, dust themselves off, and keep going, without feeling that there are dire consequences when the stakes seem so high all the time?

When I was in high school, I was perfectionistic about my schoolwork, and I tended to over-study for tests.  I remember my mother, a clinical psychologist,  telling me, “It would be good for you to fail a test.”  I thought she was crazy.  Fail?  An F?  I wouldn’t even accept a B, back in those days.  But the day came when I did fail a test.  Calculus, in my senior year of high school, after a break-up with my boyfriend, who’d gone off to college and left me behind, and a few days of feeling sorry for myself.  I didn’t have time to study for the calculus test once I finished my pity party and the two papers that were due that week.  Guess what?  The world didn’t end.  I didn’t turn into stone.  My calc teacher looked at me a little funny when he handed the test back. My ego was slightly bruised.  But I picked myself up, brushed myself off, and studied for the next test.

That was 1977.  A different world.  But not really.  It honestly is good to get lessons in resilience, and without them, many girls go out into the world with the feeling that they must maintain that ‘perfect girl’ record, or something terrible will happen.  Problem is, there’s only so many things a girl has control over.  Sickness, injury, interpersonal crises, family issues- it can’t all be controlled.  It’s no wonder that she’s going to make absolutely certain that she controls the things she can- including weight and food and exercise.

So what am I proposing?  To be honest, I know a lot more about the problem than about the solution.  Should we tell our children to fail tests and make mistakes?  Clearly that is not a sensible answer.  But beginning a dialogue about the pitfalls of perfection is a start.  And allowing our daughters to make their own mistakes and learn from both the natural consequences and the imposed consequences of those mistakes is another piece of the puzzle.  But a larger part lies not just within the family, but between girls and women, and in the schools, and on sports teams, and in our culture as a whole.   It can’t change unless we as a culture buy into a new ideal- one not of ‘perfection’, or attaining the unattainable, which drains women of their physical, intellectual, and emotional resources, fosters competition between women, leads to self-hate, and is ultimately unhealthy; but one of ‘resilience’ and ‘resourcefulness’- which leads to collaboration, increases energy, and fosters self-esteem and wellness.

Posted by: drrozkaplan | October 23, 2010

Doctor, Why Am I So Tired?

I took an extra day off from work today, giving me a 4-day weekend, since I don’t work on Thursdays.  At least, that is, I don’t work in my medical practice.  I really needed this extra day to do some errands, take my daughter to an appointment, and get some control over chores in my house.  I’m also really, really tired.  And I figure that if I can get some of these tasks done today, maybe I can actually get some rest over the weekend.  I have been unusually tired the past couple of weeks, to the point that I fall asleep in the middle of the evening reading or watching TV, way before I planned to go to bed, on some nights.  I even started wondering if there could be something wrong with me, since this is a different degree of fatigue than I usually live with.

But then I thought about what I’ve actually been DOING, and the word that comes to mind is ‘duh’.  Of COURSE I’m tired!  This fall has been a crazy marathon.  I’m seeing patients fours days a week, with a full schedule every day that I’m in the office.  I’ve been accompanying my daughter on her college visits many weekends. Monday evenings I’m at writing workshop until 10 pm.  I spend a good part of Thursdays in the Pilates studio, observing and teaching.   I’m attempting to promote a book, albeit rather incompetently (thank G-d, now I’ve got some help, but I’m still networking, sending out packets, setting up readings and talking, talking talking it up…), and I turned 50, which makes me tired just on principle.  Oh, and there was the 9 hour car trip to Toronto a couple of weekends ago for a family event, and there were the out-of-town visitors last weekend, and the college kid coming home for fall break, and….. Well, you get the idea.   And through it all there is the constant drumbeat of  laundry that  has to be washed and groceries that need to be bought and meals that need to be cooked and relationships that need to be tended and I don’t think I need to have anything wrong with me to be tired.

I’m not very much different than a lot of the people who come in to see me because they are fatigued and want to know why.  Do I need more exercise? Less exercise? Different diet? Vitamins? Iron? Or am I sick?  Anemic? Hypothyroid? Do I have heart disease? Cancer? Depression? Marchiafava-Bignami Syndrome?

Here’s the bottom line on the fatigue issue.  It is possible for illness to present simply as fatigue.  Viruses, including the hepatitis C I once had, can have only fatigue as a symptom.  So can leukemia, since it causes a low red blood count (anemia), which can cause fatigue. Liver disease, kidney disease and heart disease can all cause tiredness.  But these are not LIKELY causes of ongoing fatigue in someone without other symptoms.  In the otherwise asymptomatic person, I do an examination, and if there are no obvious signs of illness, I’ll check a blood count and a thyroid level.  But more importantly, we’ll talk about lifestyle and sleep.  Over 90% of patients complaining only of fatigue have no explanation for it other than lifestyle factors.

I can’t believe the number of people who tell me they sleep 6 hours or less.  Some of them have insomnia.  But many just aren’t going to bed.  There are parents who come home from work at 7, manage dinner,  help with homework, do laundry, put kids to bed, make lunches for the next day, and still have emails to answer and paperwork to do after all that.  There are teenagers who have sports practice until 6 pm, wolf down their dinners, and start on 5 hours of homework for their multiple advanced placement classes.  There are also people who start surfing the net at 10 pm and find themselves still awake and overstimulated at 2:30 am.  Whatever the reason, many Americans are working on a serious sleep deficit.

Not only is sleep deprivation a huge issue, but general lack of self-care is something I commonly note among patients who complain of fatigue.  I will plead guilty to sometimes falling into this trap.  We need sleep, but we also need proper fuel, in the form of regular, healthy meals.  Running on caffeine and sugar, or skipping meals, or restricting calories excessively, is a certain path to exhaustion.  Just like a car would sputter and stop if it ran out of gas, our bodies can’t keep running without regular infusions of appropriate fuel.  Every meal needs to contain some amount of (preferably complex) carbohydrate for immediate energy, some protein to get us to the 4-hour-later mark, and a little bit of fat (preferably heart-healthy fat from nuts or olive oil or fish,etc.) in case there is not another feeding until the 6-hour point.  Smaller, more frequent feedings are better for some people, but however the food is going in, it needs to be consistent for our bodies to trust us and keep our metabolism running smoothly- and thus feeling optimally energetic.  Like many people, I sometimes let myself get too hungry, and then I eat too much, which makes me feel more sluggish.  Or I use caffeine to wake me up when I’m tired.  But the result of that is needing more caffeine later, and if I have caffeine after lunch, it might keep me awake at night, and then…. I’m TIRED!!!!  Sugar has that same effect of providing quick energy, but then causing a ‘crash’ an hour later, causing more sugar craving.  Bad cycle to be in if you’re trying to keep your energy up.

Then there’s the whole issue of exercise and energy.  If I’m tired, how am I going to exercise?  In fact, if I have no energy, isn’t it a bad idea to exercise?  Trick question, of course.  The whole thing is a trick with exercise.  Many of us are so busy that finding time for exercise in our lives, much less the energy,  seems an impossible task.  Yet having a regular exercise routine, the right regular exercise routine, actually seems to create both time and energy for me.  Yes, I know, it’s magic.  It has to be the right balance.  I can’t over-exercise, or it does wear me out and make me hurt.  Every once in a while I do some weekend warrior thing- a long bike trip or an excessive climb- and I FEEL it.  I can’t get away with that anymore like I used to.  I might do it occasionally because it’s fun, but for the most part, I stick to a few reasonable 45 minute aerobic sessions- walking, elliptical, biking, or a Zumba class, and a few Pilates or Yoga sessions each week.  If I do too little, I feel stiff and sluggish.  As far as where to fit this into my schedule, well, let’s just say the weekends are top-heavy with exercise, and also that it is alot easier now that my kids are older and more self-sufficient.  Having equipment in the house helps, and using the great outdoors for walking is very convenient (it’s also multi-tasking- I can take a dog or two).

Okay, now let’s get down to the toughest issue:  stress.  Lots of people are just plain worn out from stress.  Too much work, financial worries, family concerns, trying to multitask like crazy… and chaos just seems to reign no matter how hard we try to stay on top of everything.  Living in an eternal adrenaline rush, waiting for the next disaster.  Sound familiar?  I think all of us have gone through periods of time like this, and some people are stuck there for longer stretches than others.  It is exhausting.  If you are living like this, you can easily become depressed.  And if you are actually depressed, that is an illness in itself that requires treatment.  But if you are just exhausted from plain old stress, you might assume there’s nothing to be done.  And that’s not really true.  The thing to do is attend to your self-care.  It is more important than ever.  Proper nutrition and moderate exercise does help to manage stress.  If you don’t have insomnia, make sure you are getting to bed as early as possible and getting a little more sleep.  If you can’t fall asleep or can’t stay asleep, talk to your doctor about it.  Medication might help, but it’s not the only solution for sleeplessness.  Think about a stress management program- such as a mindfulness-meditation based stress-management class or a yoga-based class.  Talk to your friends and/or family about your stress, if you can.  Even if they don’t have solutions, it helps to avoid isolation.  And finally, consider writing about your stress- keep a journal, or make a list of your worries and then put it aside.  I’m a little biased on the writing thing, but I know it helps me.

So if you’re tired, I hope this helps you sort out the reasons a little.  And if you weren’t tired before reading this, you’re probably tired now, after reading it.  I know I’m exhausted, so I’m going to turn off my computer before I’m tempted to stay up half the night surfing the net.



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