The Trying Three Year Old Stage

Today is my second daughter's four year old birthday.  I'm thrilled to be done with the three year old stage.  That was definitely a tough stage... much worse than two's in my opinion.  Here are some characteristics that describe my #2.

Fiercely Independent...
This is where the child wants to do everything by themselves.  Actually, this characteristic starts around age two.  However, when the almost two year old starts displaying this stubborn independence, it is funny at first and I can't help but laugh.  It cracks me up to watch my two year old get off the chair and back on again because he wants to get on by himself without help.  However, at three this independence takes on a new level of determination and defiance even.  It is no longer funny and I find it extremely frustrating at times.  At the end of the day, it is all part of normal development though each kid may display this with varying degrees of seriousness.  My little A was such an easy child until she hit this stage.  I love her fearless spirit but I hope we are seeing an end to the dragged out morning battles of picking out clothes.  Her quest for independence makes even the simple routine of teeth brushing into such an ordeal.  It is great that she knows what she wants but it has been a challenge trying to teach her that sometimes you get what you get!

Oh So Mischievous!
Perhaps it is a second child thing, but A is definitely my sneaky "let me see if I can get away with it" one!  In September, my husband and I went away for a short trip and when we came back, this is what I discovered under my bed covers!  None of the caregivers had a clue.

 

Further more, I had to discover this myself and then it is like pulling teeth to get this one to confess whereas my older daughter would have burst into tears and confessed the minute we walked into the house!  Other examples of fun discoveries include a stash of food from our basement refrigerator that Miss A hid in her princess tent which we did not uncover until two days later.  Unfortunately, we had to throw away quite an amount of groceries since most of it was perishable.  Now only a few days prior to this episode she led an egg smashing adventure with my two year old who was more than thrilled to follow her example.  My husband came downstairs to a site of giggling hysterical kids surrounded by broken eggshells and eggyolk all over our basement carpet!  That was so not fun to clean up.  So as a result, we now have a lock on that refrigerator.

But despite all this... it is hard to stay angry at this little one because she is just so cute, smiley, and hugable!  So another characteristic that stands out above the rest...

Loving and Full of Affection

A's love language is physical touch (which I got from The 5 Love Languages of Children... great book by the way, if you haven't read it).  I treasure her spontaneous declarations of "I love you, mommy" followed by a hug and a kiss.  She almost always has a smile on her face and it is such a delight to hear her gleeful giggle.  My favorite moment with her is cuddling before bedtime.

I love you so much, A!  Sometimes, I wish I can slow down time when I watch how fast you are growing and becoming so self-reliant.  However, I'm thankful that God blessed us with you... my sweet, cuddly, playful girl.

The Six Year Old Stage

 

My oldest turns six today!  Since I wrote about all the things I love in the newborn stage, I feel I should also write about what I love in all these other stages that my kids are in...

I'll start with the six year old stage since it is her birthday today =)

Now... there may be some similarities in all six year olds, but I'll dedicate this post to what I love about my particular six year old...

Great Conversations...
First of all, I've got a talker!  Now, she was very talkative at a very young age and had quite a vocabulary before she even turned one.  However, at six she is much more expressive about her feelings and her insights on all situations have taken on a new level of sophistication.  I also love the wisdom she imparts.  Just the other day, I was making some comment on how tired I am because my newborn is waking me up pretty much every 1-2 hours at night.  "Well, mom, " she says with her hands on her hips.  "When I'm in school and the other two little ones are napping, you should go to your room and take a nap!"  Yes, I should!

Now, sometimes her chatter can get a bit exasperating... especially when it is during meal time and she is distracting the other kids from eating.  However, I love her energy and enthusiasm.  I love how her mind will go from topic to topic and she'll have boundless things to say about each and every topic.  I love how she can give me a detailed almost hour by hour description of everything that went on at school that day.  Her response is so different from my husband's typical guy response of "good" when I ask how his day went!

Physically More Independent...
My six year old is also now at a stage where she can do most things by herself.  Most mornings, she will get herself dressed and brush her own teeth.  Little things like this add up and can be physically draining especially with so many little ones, so it is huge that my oldest can do this for herself.  In fact, she can even help her younger sister get dressed and a few times I've seen her help with teeth brushing.  So my oldest is definitely at a stage now where she can actually be helpful with her brothers and sister... even if it is just entertaining them.  "I'm in training to be a babysitter," she said to me a couple of weeks ago.  With so many little siblings, she certainly is!

Fills My Emotional Cup...
Finally, my dear little girl is so sensitive and has such a tender heart.  On one hand, she is easily hurt and can become quite emotional at a drop of a hat.  At the same time, she has keen emotional insight and can often sense when I'm upset or hurt and offer a hug, a smile, an encouraging word that would warm my heart.  She cares deeply and loves with passion.  She thrives on verbal affirmation and gets ecstatic when receiving gifts.  We've had many heart to heart conversations and I'm sure there will be many more to come.  I love her innocent steadfast devotion to me and pray our relational bond will only grow stronger as the years go by and she is influenced more by her peers.

I love you so much, S.  It is hard to believe what a beautiful and amazing girl you are growing to be and I'm excited to share more precious moments with you!

Newborn Moments

I love this newborn period!  Savoring every precious moment... 

Soon I will miss these things and probably will only experience it again in small instants with someone else's newborn... or when I turn grandmother =)

I love watching...

• the random facial expressions he makes... 
• his mouth opening and closing in different configurations
• the spurts of  rapid quick breathing
• the way one arm and hand will wiggle out of his hospital white top when crying vigorously
• his head turn from side to side trying to suck on anything around when hungry

I love smelling...

• that newborn baby smell...
• the hospital pacifier... haha - it actually smells like chocolate!
• even the stinky diapers have a particular smell... not like the diapers later on when he starts solids

I love hearing...

• the tiny grunts and snorts he make while he sleeps
• the rhythmic slurp slurp gulp gulp during a good feed
• that newborn cry that is so particular... not loud or whiny.. just the 'wah wah wah' announcing his presence

I love touching... 

• his tiny teensy feet
• the small tight clutch of his little hand around my finger
• his smooth soft cheek against my cheek
• his itty bitty nose cool against my nose
• his fine sparse hair

Other random things I love and will miss...

• being able to hold him in the crook of one arm all bundled up like a burrito
• the little umbilical cord clip that will fall off soon
• even that black tarry poop that sticks to everything and takes rigorous rubbing to come off
• little tiny mittens and little tiny booties...
• the newborn hospital cap
• everything teensy weensy!
• finally... knowing I can leave him in a bassinet and he'll pretty much be in the same position when I come back

So in love right now... treasuring... wanting it to last... making the most of every second...

Postpartum Hospital Stay

Strange as it may sound, I actually was really looking forward to my postpartum stay at the hospital after delivering #4.  I was actually hoping to deliver earlier in the day so that I'd have more time there.  Haha.  Now that I am back home, "reality" of balancing the whole newborn routine with 3 little kiddos along with all the management responsibilities of "mom" and "wife" kick in!  At least, I'll have 6 weeks before having to add on my "doctor" role =)

So what was it about the hospital that I was looking forward to?  Ohh... so much!  It may be different per hospital but at least the one I deliver at has great maternity and postpartum care.  The food in the cafeteria is pretty good as well.

Here are some things I'll miss about the experience (since this will be my last time):

• Ordering room service and having food delivered to my bed anytime I want and as much as I want... 
• Beeping the nursing station for any little thing... drink of water... pain meds... a back rub (j/k)
• Electronic hospital bed to help get into sitting position or back down to lying position without having to use abdominal muscles
• Television with cable (I don't ever watch at home... didn't really watch there either actually but just nice it's there in case I want to =b)

Then there's the stuff you get to wear:

• Fuzzy wuzzy socks of varying colors with the non-slip grip on the bottom
• Fancy smancy snap gowns for easy nursing access  
• Large mesh throw-away underwear

But the #1 reason that I enjoy my postpartum stay the hospital...

• 48 hrs of just "me" time... (well and new baby time) but at least a little get away from all the busy-ness of life...

When Are You Coming, Baby?

So I've reached 39 weeks and I'm officially on maternity leave!  My last shift at work landed on Halloween and my staff were very creative and funny.  They dressed up as me and caused quite the chuckle with our patients.

Reading one of my old posts that I wrote when I was in my third trimester of pregnancy kinda cracks me up...  Gotta start trying to induce my own labor with the list...

Okay, baby... any day, now.  This tired momma is getting too big and would like to meet you face to face =)

Dress up and Trick or Treat Time!

I'm not a fan of the origins of this holiday nor am I a fan of any of the scary, glory, dark stuff...  however, I do see this time of year as an opportunity to socialize and interact with neighbors who will be knocking on our door and just be 'light'... not necessarily with tracks... but with genuine love.

I read this article which I felt had some pretty good points.  My husband was a little turned off by the tone of it and felt it was a bit harsh criticizing those who choose to celebrate in an alternative way with "harvest parties'.  I personally kind of see this whole "halloween controversial topic" as the "food for idols" passage in the new testament.  Let's not judge how others are convicted here... and let's also try not to cause our brothers to stumble.

So that is my 2 cents!  I debated on whether to post this... but hey... figured that's what blogs are for.  As my children grow older and just now entering the public school scene... these kind of topics come up and stir up deep discussions between my husband and I.  What a challenge and awesome privilege and responsibility to raise children!   

Lord, give us grace, cover over our mistakes, and pray we have some fun along the way!

Asthma

I was all ready to blog about lower back pain... which I'm experiencing quite a bit with this pregnancy especially during these last few weeks... however, this article about a 12 year old girl who died from an asthma attack that started in school caught my eye today and broke my heart.  Let's talk about asthma.

Here are some fast facts from the Asthma and Allergy Foundation:

In a single day:

• 44,000 people have an asthma attack
• 36,000 kids miss school due to asthma
• 27,000 adults miss work due to asthma
• 4,700 people visit the ER due to asthma
• 1,200 people are admitted to the hospital due to asthma
• 9 people die from asthma

Troubling fact:

• while most other chronic illnesses have decreased in death rate over time... there has been a 50% increase in death rate since 1980 for asthmatics across age, gender, and ethnic groups... the rate for children under 19 years old has increased by nearly 80%

So what is asthma?

• chronic condition in which the airways narrow and swell and produce extra mucous

Symptoms of asthma can include:

• coughing
• wheezing
• chest tightness
• shortness of breath

What can trigger asthma or make it worse?

• exercise (cold and dry air)
• environment (chemicals, fumes, gases, or dust)
• allergy (pet dander, cockroaches, pollen)

Treatments of asthma include:

• avoiding and removing triggers (second hand smoke, carpet, pets etc)
• treating allergies
• rescue inhaler or nebulizer for acute symptoms
• maintenance inhaler or other maintenance medications
• getting the flu shot during flu season

Asthma is not well controlled if:

• needing rescue inhaler more than twice a week due to symptoms
• waking up at night more than twice a month due to symptoms

It is important to see your physician if asthma is suspected and to routinely follow up to make sure it is well controlled.  There is a breathing test that can be performed to assess whether or not someone has asthma and also how severe the condition is.  Using a peak flow meter at home will help you know how severe your symptoms are.  Patients with asthma should discuss and develop an Asthma Action Plan with their physician.  Having a plan helps to decrease trips to the emergency room as well as need for inpatient hospitalization.

 

Pregnancy and Swimming

I'm nearing the end of this pregnancy and I'm looking forward to getting this weight off!  It has been increasingly hard to get comfortable especially laying down at night.  Overall, it has been a fairly uneventful pregnancy.  The first trimester is always hardest for me... I don't like the nausea and fatigue.  However, as I gained energy and appetite back during my second trimester, I started to swim.  Swimming is the best exercise for pregnant moms!  

Here are some physical reasons why...

• low impact
• good cardiovascular benefits
• improves circulation
• builds muscle tone and strength
• builds endurance 
• supports weight
• decreases burden on limbs and spine

Here are some other reasons I love swimming while pregnant...

• burns calories
• feel less fatigued
• helps with sleep
• helps with emotional coping

When I'm in the water, I feel light and happy.  As I do my laps back and forth, I can clear my mind and relax and I literally feel myself de-stress.  Swimming was what kept me sane this summer.

25 Lines to Honor Megan Garven

Today is a special day... missing a sweet girl...  To honor her on this 25th day of September on what would have been her 25th birthday, her parents came up with this brilliant idea for folks to do something with the number 25 to remember her.

So as I was thinking about this... I decided to write a poem with 25 lines.  Now I've always liked writing rhyming poems for fun while growing up.  Haven't done this in a long while so don't laugh at me... but this is what came to mind...

This is a poem

To tell a story

Of a lovely girl

Who’s gone to glory

Full of energy

Beautiful and bright

This child of God

Is pure delight

Touching so many

God’s love she’d share

Teaching children

With tender care

I’ll always remember

Her smiling face

Full of compassion

Full of grace

Up in heaven

I know she’s there

Partying with Jesus

A big fanfare

Heart of gold

Devoted and true

Megan Garven

We love you…

Miss you…

Meg was working at Santiago Christian School as a 3rd grade teacher when she got into a tragic car accident.  The school is planning on building a playground in her honor.  If interested in donating to this cause, you may click here for more info.

Kids and Nosebleeds

The other night, while husband was away on business trip (always seems to happen when he is away)... oldest daughter had a coughing fit in the middle of the night that resulted in throw up and a massive nosebleed all at the same time!  These are so much fun to clean up as you can imagine...

Daughter is not sick but she gets coughing fits in the middle of the night due to a combination of allergies and reflux... and may even have a component of asthma in there... poor child. I have to say this used to happen much more frequently when she was younger.  We seemed to have things pretty well controlled with an air filter in her room and combination of allergy and reflux meds.  So it has been a while... but prompted me to put together this post on nosebleeds.

Nosebleeds are very common in children but can can seem alarming.

Common Causes of Nosebleeds Include:

• nose picking
• dry air
• allergies / sinusitis / colds
• aspirin use / blood thinners / cocaine use
• side effect of nasal sprays
• trauma to nose / foreign body in nose
• deviated septum

How to Stop a Nosebleed

• stay calm and reassure the child
• keep child upright and tilt head slightly forward
• pinch soft part of nose with tissue or washcloth
• keep pressure for 10 minutes (try not to check too often)
• sometimes can add ice to bridge of nose
• avoid rough play or nose picking/rubbing/blowing immediately following

When to Call a Doctor

• not stopping after 30 minutes of direct pressure
• losing more blood than expected
• any difficulty breathing
• occurs after direct trauma / car accident
• has frequent nose bleeds
• bleeds from other places like the gums or bleeds heavily with minor cuts
• has something in the nose
• has recently started new medication

How to Prevent Nosebleeds

• use vaporizer (warm mist) in the room
• moisturize with saline mist nasal spray
• apply vaseline or lanolin ointment to tip of nose twice a day
• apply antibiotic ointment to red sore areas twice a day
• may need to see ENT to get exposed vessels cauterized

Starting Public School

Last week, my oldest daughter started her first day of public school.  There was much excitement and anticipation the night before.  The actual day did not disappoint and was filled with shouts of glee and boundless energy.

“Mommy, you can leave now,” she announced to me when she got to her bus stop and was surrounded by other kids from kindergarten to sixth grade.  It was a small crowd of eleven or so and the parents gathered in front to take bus stop photos.  I was a little nervous for her because I remember my own bus experience as a first grader and missing my stop coming home.  My mom had to run after the bus and pick me up at the next bus stop, which thankfully, was only 1 or 2 blocks away.  I was glad to discover that another little girl would be taking the same bus with my daughter and would even be in her same class.

Sending my daughter to public school reminded me of my own experience growing up.  I actually really loved school and going back to school after summer vacation was always a favorite time of year for me.  It was fun to discover who my teacher was going to be and which new classmates were going to be in my class.  However, it had its challenges, especially during the early elementary years because English was not my first language.  

As I attend these back to school welcome meetings and navigate through my daughter’s school computer site, I am struck by how much more challenging this must have been for my own parents when they had to send me to school for the first time.  Well, they did not have emails and websites back then that they had to log onto for information, however, I’m sure they still had to figure out how to get me to school and what I needed on the first day.  Being immigrants from Taiwan, my parents understood the English language some, but were nowhere near fluent in speaking.   

So this post is a “shout out” to my parents and to all immigrant parents out there who place value in education and sacrifice time, energy, money, and comfort… etc to get their kids through school!  Despite the disadvantages of not having fluent English speaking parents who were heavily involved with school or could help me with homework every night…(except for math.. they were brilliant with math)… I think I turned out okay =)

Pre-Boarding When Pregnant

Long time no write!  We just got back from a week long trip to San Diego for a cousins' family reunion.  They were all my cousins on my dad's side of the family and their little kids.  So all together we had 13 adults and 10 kids... of which 9 adults and 7 kids stayed under the same roof in a large vacation home rental.  The kids who were under the same roof were all under the age of 6 with the youngest being 1 month old!  So you can imagine, it was quite the adventure and never dull.    I have so many memories growing up of interacting and playing with my first cousins.  I loved that my kids got to meet and play with their second cousins.

As an extra plus, a couple of my mom side cousins live in San Diego so we got to meet up with my cousins on my mom's side as well.  My dad is one of six kids and my mom is one of eight kids... so I have a ton of cousins!  All in all, the trip was especially meaningful to me... I hope it was also for the rest of my family.

Being 3 hours jetlagged, it took us some time to adjust back to normal East Coast time.  The first morning back we all slept in to close to 11am!  I'm glad for this week before school starts up again.

So!  Different things I can blog about... but first I just want to throw in a plug for pre-boarding planes while pregnant.  Note to self and to readers out there travelling with small children who plan to fly while pregnant... ask airline if they will allow pre-boarding for being pregnant.   Especially if you are going to fly on Southwest where there are no assigned seats, it makes a world of a different to get on the plane first so that the kids can sit with you.  Plus if you are bringing a bulky carseat... you don't have to hold up the rest of the line trying to buckle it in.

Here's a glimpse of our airport experience.

Thankfully my mom dropped us off at the airport so I didn't have to be alone with the luggage and kids waiting for my husband to longterm park the car.

What we had to manage before we checked in bags:

• large roller suitcase
• large roller dufflebag 
• large carseat bag (filled with 1 carseat, 1 booster, and bunch of diaperes and other stuff we can stuff)
• stroller (where we strapped 2 of our 3 kid)
• older child with her bookbag that we had to carry or give back to her everytime she took it off
• larger bookbag that dad had full of electronics (mainly to entertain the kids w for the 7 hr flight)
• diaper bag

We checked the first three items (yay for no bag fees with Southwest) and was left with the last four items above to get through security and to our gate.

They changed the rules and we no longer have to take off kids shoes if they are under 12 years old... this saves time!  Can you imagine travelling on a business trip and being the annoyed adult who is behind my family in line?  I have to say though we have done this so much that we are pretty fast now and have a system down.

Now whether or not the security folks care to wave a stick over the sippy bottles that we brought depends on the airport and maybe person working security.  In our case... Phillly airport did it but San Diego did not.  I'm just thankful I did not have to bring a pumpbag this time around!

So back to the issue of pre-boarding while pregnant.  I did not know and did not ask about this.  Therefore, even though Southwest allows families with small children to board "early"... "early" means after all the pre-board folks, elite folks, and then all of the folks who are in zone A to board!  So by the time we were boarding, there was already a ton of folks ahead of us.  The challenge is folding up the stroller to check in at the gate, then to put the bags overhead... then finally to get the carseat buckled in place... all the while making sure the kids do not get into trouble or get hurt or lost.  Being 28 weeks pregnant just makes it harder for me to do a lot of the lifting so pre-boarding definitely would have helped my husband.  Too bad the agent didn't just allow us to just board with the other pre-boarders... instead she just commented to my husband that we could have pre-boarded if we had asked and gotten a blue slip.  Why follow the letter of the law instead of the heart of the law?  Anyways, I was annoyed and would have rather not known that fact... but I guess now I know.  So here's a tip to you other pregnant or pregnant to be mothers out there because I do not plan on flying anymore while pregnant!  No more pregnancies for me!

The actual flight itself was not that bad because the older two kids can be distracted with coloring, sticker activities, ipad stuff and movies.  The youngest had his own carseat and snacks was probably the number one distraction for him... I think I was much more stressed making this same flight out to San Diego 3 years ago when I only had two kids but under the age of 3.  I blogged about flying after that trip here.

So yes, it was a little nuts travelling cross country with three kids ages 5 1/2, 3 1/2, and 2... but personally I think it was worth it.

Hey cousins... let's plan a future family reunion in the East Coast please =)

The Seriousness of Peanut Allergies

Here is a sad article about a 13 year old girl with peanut allergy who dies after ingesting a snack that contained peanuts in it.  She died despite spitting out the snack right after tasting it and despite benadryl and multiple doses of epipen injection.

Food allergies have become more prevalent in this generation and as this article demonstrates, allergies to certain foods, especially peanuts, can be extremely serious.  

Thankfully, none of my kids currently have any serious food allergies but it is wise to be aware of the potential.

Dr Joann Lin, board certified in both Adult and Pediatric Allergy and Immunology and General Pediatrics shares some important facts:

1. Peanut allergy is separate from Tree nut allergies because peanuts are legumes and do not grow from trees.  People can be allergic to only peanuts, only tree nuts, or both.
2. There is high cross reactivity amongst tree nuts so it usually recommended that if you are allergic to one tree nut, avoid all tree nuts.
3. The likelihood of outgrowing a peanut or tree nut allergy is only about 20%.
4. Peanut and tree nut allergies can be acquired suddenly in adulthood.
5. It is recommended that an epinephrine autoinjector should be carried at all times.  They now come in 2-packs.  It is recommended that the packs stay together because the first injection might not work, or the reaction is persistent, and you might need the second one.
6. There are currently three types of epinephrine autoinjectors in the market: Epipen, AuviQ (provides audio instructions), and generic epinephrine autoinjector.  Each device works differently.  Physicians should "dispense as written" and train patients with the appropriate trainer because at time of emergency, people are usually in panic mode and don't have time to read the instructions.
7. If epinephrine autoinjector is used, seek immediate medical attention. The autoinjector basically "buys you time" to get to a doctor.  There is a risk of a persistent allergic reaction and the epinephrine does wear off in a few minutes.  Epinephrine is basically adrenaline so the biggest side effect would be a little jitteriness.
8. Any organ system can be affected with a severe allergic reaction. Skin = hives and swelling of lips, face, tongue, throat, Lungs = wheezing, cough, asthma attack, GI = vomiting, diarrhea, stomach cramping, Cardiovascular = headache, fainting, weakened pulses.
9. Use epinephrine autoinjector when there is more than a little rash - ie rapidly progressing rash, if you're not sure, or other organ systems are affected; Liquid Benadryl orally works the fastest, but it still takes 15-20 minutes for it to work. No one will ever fault you for using the epinephrine "too early."
10. Most at-risk population for bad reaction and possible death - preteens/ teens/ young adults.  Because they have "forgotten" how severe the reaction was and may forget to ask about foods, because they are now becoming more independent and doing sleepovers, and because they "want to be like" everyone else
11. Most peanut allergic individuals tolerate products cooked in peanut oil (think Chick fil a) because it is highly refined. Peanut oils that are cold-pressed, expelled, or extruded, however, still have the peanut allergen.     
12. Currently there is no cure for peanut or tree nut allergy.  Oral desensitization is mainly done in academic centers; it is still dangerous and should be discussed with your allergist.  
13. Great resource: Food Allergy Research and Education: www.foodallergy.org

Dr Joann Lin has a private practice in Texas.  You can read more about her and her office here.

Best Kept Secret Amusement Park... Knoebels

For those of you who have never heard of Knoebels... it is a true hidden gem in Pennsylvannia!  Shhh... don't tell too many folks because it is not super crowded and we want to keep it that way!

During 4th of July weekend, we went there with our three kiddos and even camped.  Yes... with my prego belly and all, I decided to brave the heat and discomfort and just do it for the sake of the kids.  They loved it and had a blast.

So Knoebels is an amusement park that is extremely family oriented.  There are many positive things to say about it but I'll just list a few here...

-  There is no admission fee!  You only pay per ride and most of the kiddie rides are around $1.  This is a huge money saver because most of the time, my husband and I are not riding any rides anyway.  In fact, this trip my husband and I went on zero rides.  Most other parks, adult tickets cost more than the children tickets.  So paying close to one hundred dollars per adult to just walk around the park and watch the small kiddos ride their small kiddie rides is pretty silly.  Maybe when our kids grow older, we can go on rides again.  Either that or we somehow find a way to take turns going on adult rides by ourselves but how fun is it to go on a rollercoaster alone?  

Next time we go, we need to go to a Weis Market where you can buy a $20 ticket book for $16!  They also have something called Bargain Nights where certain Wednesday and Friday nights, you can go on unlimited rides after 5pm for $7.50 per kid and $10 per adult.  We just bought for our kids and watched them have fun.

-  There is hardly a wait to get on rides!  At least this was the case for the kiddie rides that my kids went on (ages 5, 3, and just turned 2).  This is a gigantic plus... especially if you compare with Disney where you have to sometimes wait half an hour or longer.  Little kiddies (at least my little kiddies) are impatient and have a very hard time waiting in general.

-  The park food is great with very reasonable prices.  In fact, they are the 13 time winner of Amusement Today's Golden Ticket Award for Best Food.  I got a tip to try their perogies and hash browns.  $3 per order and very delicious.  They also have very yummy home made ice cream.  In addition to the food being pretty good and reasonable, this park allows you to bring outside food in.  I don't think I've ever been to any other amusement park where you can do that.  They all seem to want you to buy their overpriced food!  Knoebels also has lots of waterfountains where you can bring your own water bottle to fill instead of buying overpriced water bottles that you'd expect at other parks.

-  They have plenty of rides and even free entertainment.  Currently, the park has 60 rides and my kids love that they have so many little kiddie rides that they can go on by themselves.  Even little E who just turned two was having a blast riding by himself.  While waiting to go to dinner at the Alamo (the one sit-down air conditioned restaurant in the park) we were able to watch some singing/dancing shows.  It was all very entertaining.

-  The waterpark was great on a hot day.  They charged $4.50/child and $6.50/adult for full day of access to their pool and kiddie splash area.  My kids had a blast.  It was a great way to escape the heat.  In fact, we spent the majority of the day in the water park area and then did the bargain all-you-can-ride after 5pm.  Was a wonderful tiring day...

-  Camping at the park was icing on top for the kids.  My youngest was probably too young to really enjoy it, but the two older girls had fun sleeping in a tent and doing the whole smores and campfire thing.  Sure, it was hot and noisy... but overall the kids were so tired by the end of the day, they slept through the night.  I loved that we picked a site so close to the bathroom.  However, I did not love that other campers would constantly walk through our site to get to the bathroom.  We'll have to be more strategic next time and camp next to or diagonal to the bathroom or something instead of directly across.  Also... next time, I think we'll go in the fall.  Weather would be cooler then.  So in terms of campgrounds, this is not the nicest we've been to since it is so crowded and loud but it is fairly well kept and walking distance to the park.  We will likely make this a tradition and we'll be back!

Oh... I forgot to mention... parking is free, too!  I love this park.

Protecting kids' skin from the sun

How are you protecting your children from the sun this summer? This is from CNN where Holly Firfer reports on the measures parents can take to minimize sun damage to their children's skin.

Bug Phobia

Guess what daddy did with the three kids while I was away on my health conference in Boston?  Apparently, he was on a mission to desensitize them to bugs!  They went on a bug hunt around the house.  My oldest even had a magnifying glass and all three were very involved in searching, finding, and even touching them!  Bugs they found and touched included silver fish, stink bugs, and even spiders...  Well, daddy said they wouldn't touch the stink bugs but they touched all the others.  Ugh.

So I'm afraid of bugs.  I realize now it is probably because I was never really exposed to them in positive light when growing up.  So it's pretty ridiculous but there would be times where I would be standing 10 feet away with a shoe in my hand trying to swat at a little bug.  I realize that if I don't want all my kids growing up completely paralyzed and fearful of these little critters, I need to minimize my "freak out" response when I see them.  Between my au pair and myself, we are probably causing my little ones to fear and hate bugs.  So husband decided to take it upon himself to get them to like bugs!

Yuck... I'm having a hard time even looking at these pictures without feeling panicky... 

The treatment for phobia is actually exposure in a controlled setting with positive feedback.. something called "flooding".  Not sure if it will work for me unless I go through intense therapy but for the little kids since they are still young... probably easier to desensitize them.  We'll see...

Daddy actually has been catching all sorts of critters in our backyard for them to touch... frogs, a little turtle... he even considered bringing in a garter snake!  Reptiles... bugs... not really my thing...

Promoting Healthy Change: Stress Management

Just like how everyone knows that exercise and healthy diet is good… we all know that stress is bad. It is intuitive... but we also got presented with conclusive scientific proof! So I’ll break it down and summarize.

Conditions caused or exacerbated by stress include:

• High blood pressure
• Cardiac arrhythmias
• Chronic Pain
• Insomnia
• Anxiety
• Hostility
• Depression
• PMS
• Infertility
• Side effects of Cancer treatments
• Side effects of AIDS therapy
• Preparation for surgery and xray procedures

So if we can reduce stress, not only will it improve our health but there is even evidence of it affecting the aging of our cells! Apparently, our telomeres become more stable and degrade less.

Right... so how to accomplish this? One may have to take inventory of all the things on one's plate and rearrange to intentionally decrease the amount of stress that one is exposed to. Of course this is easier said than done... but if you truly believe it is a priority, you can make it happen. There are many websites out there offering self help guides to stress management. There are also professional therapists who are trained in helping one cope with stress... they use techniques such as biofeedback, cognitive-behavioral therapy, or even hypnosis. Ask your physician if you need help in this area.

The conference talked about a "relaxation response" that you can induce. You can read more about it here.

Two steps necessary to evoke the Relaxation Response:

1. repetition of a word, sound, prayer, thought, phrase, or muscular activity
2. passive return to the repetition when other thoughts intrude

Physiologically this is what happens to your body when you evoke this response:

• decrease oxygen cosumption
• decrease respiratory rate
• decrease heart rate
• increase slow brain waves
• decrease blood pressure

Many Christians probably induce this response without fully realizing it. I can recall back to times growing up... whether it was before piano competitions or exams when I'd get nervous and stressed. Praying before hand would always help me calm down and perform better. Now as a mom, I need to evoke this response more intentionally especially when feeling at wits end with my preschoolers and toddler!

I think it is neat to know that God programmed this biological response in our bodies when we turn our minds to Him and lift up our needs. They didn't address this part at the conference... but I think it is comforting to know that we have a powerful and loving Father who knows our needs and will respond. This is in addition to the physiologic calming effect that "praying" or "meditating" evokes.

Turn your eyes upon Jesus,
Look full in His wonderful face,
And the things of earth will grow strangely dim,
In the light of His glory and grace.

Promoting Healthy Change: Nutrition

NUTRITION

So here is another topic that is extensive to cover, but I’ll try to summarize the key take home points I got.  Just like the lack of counseling on exercise, we physicians do not adequately counsel our patients on nutrition.  Some sobering facts:

·      58% of adult obese patients do not report receiving any prior advice from physician about weight loss

·      patients who were told to lose weight were 3 times more likely to attempt weight loss

·      7 out of 10 patients would like to discuss diet

·      2/3 of patients would like to discuss weight loss

·      > 90% say they would make a change if advised by their primary care physician

Tops reasons why physicians neglect to address this topic:

·      time constraint

·      fear of offending

·      lack of medical school training on nutrition counseling

Well so let’s get talking!  I may have to come up with some brochures or fact sheets  or something because a 15min office visit is going to be tough to get into all the nitty gritty.  In a nutshell here are some simple tips…

Tips for Eating Better

·      Eat fruit before snacking

·      Use small plates

·      Never eat form a package (transfer food)

·      Eliminate the cookie jar and replace with fruit bowl

·      Control your environment

I also found these food rules amusing.  It is from Michael Pollan’s, FoodRules: An Eater’s Manual:

·      Eat food

·      It’s not food if it arrived through the window of your car

·      Don’t get your fuel from the same place your car does

·      Shop the peripheries of the supermarket

·      If it came from a plant, eat it; if it was made in a plant, don’t

·      Cook

To expound on that last point:

·      The average American spends 27 min/day on food preparation and another 4 minues cleaning up (less than half the time spent in 1960’s)

·      What are we doing with the extra time?  Watching cooking shows!

To see what is the current recommendation for food go to ChooseMyPlate.gov

I also like Harvard Public Health’s slight variation at Healthy Eating Plate

Promoting Healthy Change: Physical Activity

PHYSICAL ACTIVITY

The bottom line is we all need to get moving!  There are so many benefits to exercise.  Everyone probably already knows this but the evidence is so compelling that I’m recommitted to stress this more with my patients.  In fact, I’ve grown complacent and lazy myself and plan to start becoming more intentional about exercise myself.

Now when I use the word “exercise” everyone is probably imagining going to the gym to use the machines or treadmill or join an organized sport.  Those are all great but physical activity does not necessarily need to be time consuming or expensive.  Simple things we can do during the day can increase the amount of physical activity or “steps” we take in a day.  For example:

·      Park farther out to increase walking distance to a building

·      Take the stairs instead of the elevator

·      Take a 10 min break during lunch and just walk

·      Try walking meetings instead of just sitting and talking meetings with friends

·      Get up and walk to the tv instead of flipping with the remote

·      Etc!

Goal is 10,000 steps a day.  Get a pedometer and start keeping track.  In fact, the fitbit is gaining popularity.  The nice thing about it is you can do this with a bunch of friends and keep one another accountable.

So what are the specific benefits?

Physical activity will affect:

·      Strength and power

·      Cardiorespiratory fitness

·      Balance

·      Flexibility

·      Agility

Here are a few medical conditions exercise will help:

·      Decreases heart attacks

·      Decreases strokes

·      Decreases high blood pressure

·      Decreases diabetes

·      Decreases osteoporosis

·      Helps with sexual functioning

·      Helps with depression and anxiety

·      Decreases total morbidity and mortality

Now here is a sobering fact for us, physicians:

·      1/3 of patients with high blood pressure received counseling to engage in physical activity

·      71% of those patients who were counseled to exercise actually followed the recommendation and lowered their blood pressure

So what is the amount of physical activity we are to aim for?

·      150 minutes of moderate intensity physical activity per week

or

·      75 minutes of vigorous physical activity (in bouts of at least 10 min)

For more extensive health benefits aim for:

·      300 minutes of moderate intensity physical activity

or

·      150 minutes of vigorous physical activity

and

·      resistance (muscle strengthening) at least twice per week

Here is how you can differentiate how intensely you are exercising:

·      Light = can talk and sing while exercising

·      Moderate = can talk but cannot sing while exercising

·      Vigorous = cannot sing and cannot talk for prolonged time

Couple more important facts:

·      Cannot really lose weight by exercise alone but it is important to maintain weight loss achieved

·      Need to fuel appropriately before and after exercise

·      Hydrate!  Hydrate!  Hydrate!