The No-Bottle Bean.

Two simultaneous sleeping babes = awesome.  "Would you like another cup of coffee, Mommy?"  "Oh, yes, please, Mommy.  Thank you!"

This past week was Nina's fourth at daycare.  After a couple of days of taking a "full" bottle (my full bottles these days are 3 oz since so much milk has been wasted--Elena would suck 5 oz down 4 times in a full day at daycare) once during the day, we've come to another standstill.  No more smiley faces following the ounces consumed on her daily report.  From what I understand, she flips out the minute she feels that artificial nipple graze her lip.  On Friday it took one of the women an hour to dribble in one single ounce.

I've been a little stressed by this situation, feeling obligated to keep her with me on half days that I am not in the office, or traveling back to daycare in the middle of the day to feed her if time allows.  That being said, she's goes 6-7 hours at night not infrequently, and she certainly has the fat stores to prove her staying power.  As a result, I'm not too bothered by the situation since I know that the perceived problem of Nina not taking a bottle is really just mine and those that are caring for her.  I asked two of them yesterday what the longest learning period was that they had seen for adapting to a bottle.  They both looked at me a bit with pinched smiles and agreed: "Um, she's the longest that I've seen."  Great.

Is one month of non-bottle accepting an absolute predictor of never-bottle accepting?  I'm beginning to think it's a pretty strong one, at the very least.  My over-analytical side has taken over a bit, and I've been doing some google searches this morning.  Google searches are, after all, the best way to get the most accurate information (that was a joke, in case you missed it).  So I read Dr. Sears' suggestions for getting baby to take a bottle, which, in true Dr. Sears fashion is lovely and touchy feely.  But I think they've done all of that at daycare, and it hasn't really paid off.  I did, however, feel deeply justified for not "training" Nina at home since that would mean me giving her a bottle--it was nice that Dr. Sears has deemed this task as not the mom's job.

I looked at some other sites, and was really looking for a blog or personal witness regarding this issue.  I stopped looking after reading some unhelpful piece of garbage that basically said it boils down to a "stand-off" or the baby accepting the bottle.  A little too much like cry-it-out for me, and I just don't think that provision of nourishment should be a battle or unpleasant in any way for the baby.

At the breastfeeding conference that I attended in August (with newborn Nina), Dr. Newman mentioned that the advice to exclusively breastfeed until 6 months before introducing solid foods was great as a public health policy, but neglected the needs of individual babies.  If a baby has the motor skills and the interest to safely eat solids, he argued, given him/her solids!  So that idea has been in my mind for some time, and I've been saying that perhaps this no-bottle issue might push us to start solids sooner.  But then I realized that in doing this, if Nina wasn't ready, we'd be ignoring more of her cues.  His section on feeding babies when mom isn't around really helped me with this realization, and will hopefully guide my stress levels over the next few months.  I love that he opens up the FAQ on this topic by saying in bold type, "This is no tragedy."

Basically, this bottle issue with Nina has been another lesson for me in listening to my intuition, which has always been saying, "She'll be fine.  The bottle is no big deal--she'll either learn, or she won't."  I LOVE reading about parenting and the wealth of information and experiences that are easily accessible on the internet.  I think in being raised Catholic, it has prepared me for handling this overabundance--I pick and choose what recommendations to follow as I see fit.  (Half-kidding, Mom!)  In all seriousness, the picking and choosing is really where that intuition comes into play.  What I've learned is that the easiest decisions to make are the ones that feel the most right.  It's incessant remembering of this lesson that continues to be the challenge. 

Okay, fine. It's not that bad.

I am reveling in the quiet that has enveloped my house tonight, and rejoicing in the tiny buzz that the mostly-full decanter of wine from dinner has given me.

Today we had meeting after meeting after meeting after meeting for work while the residents took their in-training exam.  "We" meaning my fellow residency "core faculty" and me.  We started the meeting with a "check in" (sorry for the overuse of quotes--I truly blame the wine), which was really nice.  It was so lovely to hear the faculty that trained me speak of their position in both their personal and professional lives.  I, of course, broke down after stating, "Well, I'm back.  And it's been hard to keep it together."  I couldn't really eek out more that that for a while, but was happy to witness the old adage of "this too will pass" through the lives of my colleagues.

A section of our meetings today focused on the mentor/mentee relationship.  I've always been attracted to the idea of having a mentor, and envied those that casually throw in the, "Well, my mentor so-and-so..."  The article we discussed was about how the onus should be on the mentee for the establishment and upkeep of the mentor/mentee relationship.  So I guess that's why I don't really have an established mentor, but rather a collection of faculty that I depend upon for professional advice and advancement prodding.  Though I lack the confidence to officially propose to a mentor, I was struck today at how so many in the room have mentored me over the past few years, and how grateful I am to their service and support.  Most of all, however, I am grateful for the gift of their friendship, and the freedom to share my tears over my current struggles knowing that when I am ready to regain the professional momentum that I had pre-second-baby, that support will still be there.

As an adolescent trying to find herself, I participated in countless retreats, turning inward again and again. Over the years, I have found great solace in my yoga practice as the same sort of introspection begins (and often ends) each asana practice.  But I am truly indebted to my professional life and the community that I have found through this residency program--including my integrative medicine fellows--for the obligatory retreats and self-evaluation that have fostered my growth not only as a physician but as a person and as a teacher.

I don't know why I'm so bad at asking for help.  When pondering the inherent nature of our daughters, I suggested that perhaps Nina would be like her Daddy--indefatigably happy.  Josh replied that he's not always happy, but rather doesn't "put my stress on other people."  That's really not my intent, and maybe this perception of my tendencies speaks more to the conversation I had with Julie a few weeks ago about the trend for women to overanalyze and underdiscuss until all sorts of shit hits the fan.  I think this scenario is where the verb "blurt" was born.

Anyway, I don't know what I'm trying to say, other than thanks for letting me vent, thanks to coming to my aide (when for instance my security door wouldn't open) and thanks to those who have let me know that I am not alone.  I appreciate all of your support because it helps me to move one foot in front of the other, and to see the light at the end of the tunnel.

Busted Up Mommy.

It's been a long three weeks since my last post.  Josh is working in the ICU at UMC (or UA Healthcare University Campus as it is now wordily known), which SUCKS.  It's always sucked, but now there are improvements, like the creation of a second ICU team and addition of a night float, which means he's working 13 hours days only every other day, and 10-11ish hour days the rest of the time.  This weekend was his first weekend off after working 12 days in a row of this nonsense in-the-hospital-by-6 am rotation.  That means Mommy has been in charge of morning time readiness for the past two weeks.  And also in charge of evening pickups.  And mid-day Nina drop off/pick ups as she's still not taking a bottle.  And breakfast/dinner preparation.  And most of the cleanup and laundry and food shopping.  And, not to mention, all the duties that go along with her job outside of the house.

When in residency, I think young physicians believe there is nothing worse than being a doctor in a training program.  Wrong.  Being a practicing physician married to a physician in a training program with two young children is WAY worse.  The only thing even worse would be to change the "married" to "separated" or "widowed".  So I guess there's a silver lining?

I feel totally and completely broken.  When I was home on maternity leave, I felt like I was able to be more nurturing to myself and my family.  Now I feel like I am barely holding on and have only the scanty support of a husband whose job doesn't leave nearly enough time to help out at home.  I was hoping to regain some of my sanity this weekend, booking a two hour yoga workshop for Saturday night.  Of course, minutes before I was walking out the door, I found Elena in the bathtub covered in conditioner that I had left in the shower after bathing her on a night Josh was late in getting home from work, Nina looking on from her car seat on the bathroom floor.  I almost lost it (again--at least this wasn't as bad as her squirting OxiClean in her mouth right before school on a morning I had to be at work), but instead hosed her down and left her dripping body for Josh to deal with.

The yoga workshop was good, and it was so nice to care for my body as opposed to having two beings incessantly hanging from it while alternatingly crying.  But it wasn't enough to mend two weeks of constantly tending to the demands of home and work.  Elena was up before 5 this morning, coming into our bed, nursing, waking Nina up, so I was turning between both girls all morning.  I snapped at my snot-covered toddler before 7 am--I just can't handle the whining and neediness that comes with a bad night's sleep.

Friday night I picked the girls up close to 6 pm after dropping them off at 7:30 in the morning.  Our plan was to swing home to pick up Josh, and then get beer and pizza.  Elena had to pee in the car, so I ran her in the house when we got home to quickly use the bathroom.  After that long of a day, she falls apart shortly after coming home... which she did Friday night.  She refused to use the toilet, but kept saying she had to pee, crying and getting increasingly snot-nosed the whole time.  Since I had been up since 4 am and at work in front of a computer screen ALL day (with the exception of staffing a circumcision over my lunch break), I lost it.  I got a glimpse of myself, my face contorted with rage, in the mirror.  It was sort of comical, but mostly just sad.  Sad that I had this reaction towards my daughter after being with her for just 20 minutes, when she was melting down after being separated from her family all day.

I know this isn't forever, that Josh's hours will get better at some point, and that our girls will eventually become more independent.  I feel sad that I am wishing away these days of our daughters' tiny innocence.  It was nice to have Sunday brunch with Josh while the girls were with his parents, but those two and a half hours alone weren't enough to keep me from feeling resentful that the girls' sheets for school were still wet in the washer, that he had made up only two bottles for Nina and didn't place the requisite labels on them, or that he had started but not completed Elena's lunch prep.  I know it's not fair--he is helping, but I still feel unevenly burdened.

I've learned that while I might be complex in some ways, what keeps me healthy and sane is rather simple: yoga, cooking, eating, sleeping, and reading.  What's depressing is that now that I have a morning to myself, I don't feel like doing any of it.  I've been trying to keep myself from looking so miserable, making use of my newly tailored pants and new tops, putting my makeup on quickly in the car while in the office parking lot.  But I've become perhaps a bit too honest when people ask me how I'm doing.  An intern innocently asked me last Friday, "How are you?" in a rhetorical way.  I looked at him, my face pale and pasty without makeup, eyebrows overdue for a wax, and said sadly, "It's been a rough week for our family."  Poor guy--he lowered his head and muttered, "Oh.  I'm sorry."  I mean, what do you really say to that?  He's an intern for crying out loud--his life sucks, too (just not as bad as mine... maybe).

Anyway, so that is me and my sorry-ass life.  Two more weeks of this crappy rotation that Josh is on, 12 more straight days of him leaving the house at 5:45, and not getting home until late most days.  The only difference between his last 12 days and the upcoming ones is that I started off in a better place.  Lord, help us all.

Got Grains?

I have a pet peeve.

*steps onto soapbox*

My pet peeve is the loose interpretation of the phrase "whole grains."  We've all heard how healthy whole grains are, and in an effort to appeal to consumers' desire to maximize health while minimizing effort, manufacturers have been adding bubbles and stars on boxes touting, "Made from whole grains!" and "XX grams of whole grains per serving!"

If you have fallen for this marketing ploy to pass off processed food as "whole", you are not alone.  But be fooled no longer!  Choose real whole grains, because they are delicious and nutritious (and use way less packaging).

Let's start with what is NOT a whole grain.  Bread, crackers, or anything else that includes grains that have been ground up is not a whole grain, even if it has bits of millet or seeds or nuts poking out at you to give the illusion of hearty.  I don't mean that a nice hearty bread doesn't have its place in a healthy diet, I just mean it's not a whole grain.  Anything puffed is not a whole grain, including cereals like Kashi which have a ton of dietary fiber (I think a lot of it comes from inulin, and just a little from its original yet now processed whole grains).  Minute Rice, Quaker Oatmeal packs, or any other grain-type product that cooks in a few minutes has been highly processed to allow for quick cooking time... and hence quick digestion time and quick blood sugar rise and insulin spike time.

And that is the problem with processed grains--their surface area is increased exponentially, aiding in their quick absorption, quick rise in blood sugar, and quick spike in insulin to compensate.  Most experts agree that keeping insulin levels steady rather than rising and crashing has a big effect on the body long term.  The concepts that go along with these ideas are glycemic index and glycemic load.  I prefer to use glycemic load, because it's a little more meaningful.  For quick reference, the guide to interpreting GL is as follows:

GL of <10 is low
GL 10-20 is medium
GL >20 is high

Low glycemic load foods help steady insulin levels, high make them rise quickly and/or to high levels.

These values are all per serving:
GL 1 slice rye/pumpernickel bread = 5
GL 1 slice white bread = 10
GL barley                  = 11
GL wheat berries      = 11
GL Cheerios             = 15
GL puffed rice cakes = 17
GL "porridge oats"   = 17 (steel cut oatmeal)
GL quinoa                = 18
GL brown rice          = 18
GL cornflakes           = 21
GL white rice            = 23
GL millet                  = 22-25
GL instant rice          = 28
GL pancake (no syrup!) = 39

Before justify choosing 3 rice cakes over a bowl of oatmeal for breakfast, stop and think about how satisfying rice cakes are compared to a bowl of steel cut oats.  What the glycemic load doesn't show, however, is what is missing from processed grains--fiber, vitamins, minerals.  Protein, even!  Before shunning millet, check out its nutrition information, including its manganese content.  In general, you cook the grains in a 1:2 ratio of grain to water.

And then make some Mexican Millet, modified from The Veganomicon:

1-2 T olive oil
1/4 tsp cumin
1 tsp salt, +/- more to taste
1 cup millet
1/2 cup canned fire roasted tomatoes with chiles
1 1/2 to 2 cups water, divided
Cilantro and lime to garnish

Add oil to heavy bottom pot on medium heat.
Add cumin, salt and millet to pot and stir, allowing millet to get toasty, about 5 minutes or until aromatic and/or golden.
Add 1 1/2 cups water and tomatoes, bring to boil.
Reduce heat and cover to simmer for 20 minutes, stirring occasionally.
After 20 minutes, check consistency--if too crunchy for you, add 1/4 to 1/2 cup more water.
Either way, turn off heat and let sit for 5-10 minutes.
Fluff millet, then serve alongside your favorite beans +/- sauce and top with cilantro and fresh lime juice if desired (I think they both make the dish!)


I promise whole grains can be fun and exciting.  What are your favorite ways to eat them?  Here are some of my favorites:


Wheat Berries with Pecans
Curried Millet, Shiitake, and Corn Salad Restey

1/2 white quinoa or millet, 1/2 red or black quinoa with fresh chopped veggies and herbs--good for cleaning out the fridge!