Moms, Get Your Mammograms


Even though it is May, not October, when pink ribbons pervade everything everywhere, the topic of mammograms is still important.  Certainly to me, as May is my mammo month.  But breast cancer awareness should not be reserved for any singular time of year, it should be a regular, habitual occurrence.  (I don’t really think there should be specific cancer-awareness-months; every month should be all-cancers-awareness month, but now I’m off-topic).

It’s easy to think breast cancer affects “older women” and most often it does.  However, younger women are struck with the disease, too.  By younger women I mean mothers of young children…women in their 30’s and 40’s.  And these women aren’t anecdotal, faceless cases…they are friends, colleagues and fellow sorority sisters.  And if I know some of these women, chances are you do, too.

So moms, we need to get our mammograms.  The process may be physically uncomfortable, perhaps we feel a bit embarrassed.  Or we are simply scared to make the appointment, afraid of the results.  The media, pommelling the public with the graphics of breast cancer has certainly not helped us feel more comfortable about taking this important step in our healthcare.  But let’s put it this way:  early detection.  The sooner a lump is found, the better and more successful the treatment options.  And an important tool in the early detection process is the mammogram.  You are probably aware of the controversy over how and when this test should be used, but in reality, the mammogram is a good screening tool.  Then there is the when- and how-to-do breast exams, which has evolved as well.  It’s confusing.  The implications of doing (or not doing) either is scary.  So let’s reduce the information on both to what you need to know:

1)  When do I need to start getting mammograms?  Opinions vary.  The American Cancer Society and the American College of Surgeons both agree women should start getting mammograms at age 40 and be screened yearly after that.  However, the American College of Physicians and the U.S. Preventative Services Task Force beg to differ:  both recommend women start at age 50.  The rationale to starting a full decade later?  In a nutshell, the reason is monetary.  But there are costs more lofty than that:  the loss of productivity, of potential and sadly, of parenting.  And given the number of younger women I know who have breast cancer, I know I want regular mammograms in my 40’s.  And your gynecologist likely feels the same.  Get your first (baseline) mammogram at age 40.  Then discuss with your practitioner your risk for breast cancer…and agree on a screening plan based on your personal and family health history.

2)  Should I do a self breast exam (SBE)?  A decade ago, without exception, I taught all my female patients the SBE and told them, absolutely, do it.  Now, despite current thinking that SBE has only a small impact in finding breast cancers, I would still say, absolutely, do it.  You need to know how your breasts feel and look and the best way to become familiar with “normal you” is to check things out once a month, preferably a week after your period ends (there is less breast swelling at this point in the menstrual cycle).  If you know your “normal,” changes in your breasts will be easier for you to pick up on.

3)  When should a doctor do a breast exam for me?  A clinical breast exam (CBE) is typically done when you go for your annual pap and pelvic exam.  Recommendations say a CBE can be done just every three years for women in their 20’s and 30’s, then yearly once a woman turns 40.  But reassurance can go a long way…get a CBE every year even if you have not hit the big 4-0.  It’s just good, thorough healthcare.  And you are going in for your “annual” anyway.

4)  I’ve gotten my mammogram…but not my results.  Is no news good news?  Some medical practices operate under this pretense.  That’s not good care.  In fact, it is now required of your doctor’s office to send you a letter informing you of your results, no matter what.  So if you haven’t heard anything two weeks after you’ve had your mammogram, call your practitioner’s office.  Ask to hear the results of your mammogram over the phone and let the staff know you haven’t received anything in writing.  Then once you do receive your letter, keep it in your personal records.  Because if you should move or need to transfer your healthcare (as with an insurance change), you will want your previous mammograms transferred as well.  All the information to do so will be included in that letter.

Every October there is a deluge of media and merchandise to promote breast cancer awareness.  Then it all goes away as quickly as it appears.  But “don’t forget the pink:”  check out this site with some wonderfully concise information for year round breast health:



Your Child Needs the HPV Vaccine


A few years back I sat in a church basement with my parenting group and listened to a male OB-GYN describe how he discussed safe sex with his own kids.

Yes, that was a church basement.  Yes, that was a male gynecologist.  And the topic at that moment was, yes, kids and sex.

I hope I got your attention.  Because he sure got mine, especially as this seemed an unlikely and absurd senario.  But still, the topic was pertinent and this doctor’s message clear:  we as parents would be sorely amiss to assume our kids will honor abstinence at our request.   He rationalized that it is not “if” but “when” kids become sexually active (about a third of 16-year-olds are) and believed parents need to educate their children on the use of condoms and birth control pills.

But we as parents need some education as well.  A recent dialogue on Facebook prompted me to learn more about the HPV vaccine, which came into recommendation after I “retired” from medicine.  While some coming-of-age topics are pretty straightforward, such as “When can I get a credit card?” (age 35 seems about right), others…not so easy.  No one wants to consider their little girl (or boy) soon needing “protection.”  However, they likely will.  It is unrealistic to assume the opposite.  Before our kids seek methods of preventing pregnancy and STD’s on their own, we parents need to make an important decision for them in this regard.  And that is to vaccinate our children against HPV.

HPV (human papillomavirus) is the most common STD in the United States.  With over 40 subtypes, most sexually active persons will contract one or more strains during the course of their lives.  Really.  The good news is that 90 percent of infections resolve on their own, but it is the remaining 10 percent we need to be concerned about.  It is these more aggressive subtypes that can cause genital warts and cancers of the cervix, vulva, vagina, anus and penis.

So enter the HPV vaccines:  Cervarix, Gardasil and Gardasil 9.  And here’s what you need to know about protecting your child:

~Your child needs one of the Gardasil vaccines.  Cervarix only targets cervical cancer but the other two are approved for both girls and boys in the prevention of genital warts and the five cancers listed above.

~Your child should start the vaccine series at age 11 or 12.  This seems young, but there is a rationale.  The series of three shots (given over a period of six months) needs to be completed before your child is exposed to the HPV virus (in other words, before becoming sexually active) so a full immune response is attained.  In other words, the best protection against infections caused by HPV starts with the earliest possible vaccination.  So don’t put off starting the vaccine…studies have shown there is a better immune response in “tweens” than in young adults.  However:

~Your child should still get the HPV vaccine even if they are older than the recommended age.  Yes, the vaccine could be less effective but some protection is better than none at all.  All three HPV vaccines are approved for use in young women up to age 26 and in young men up to age 21 and can (and should) still be given even if your child is already sexually active.  

~The HPV vaccines are considered safe.  While there are possible side effects, such as pain and redness at the injection site, headache and fever, most vaccines can cause the same, temporary effects and these effects are easily remedied.  And a very small price to pay for protection against potentially life-threatening diseases.

~The HPV vaccines are effective.  Studies have shown a remarkable near-100 percent protection rate against precancerous cells and HPV 4 (the subtype that causes genital warts).  In fact, since 2006 there has been a 56 percent decrease in HPV infection in teenage girls.  Considering this in the light of less-than-ideal vaccination rates, this is quite promising.

~Don’t let your child become a statistic:

At any given time, one percent (or one of 100) adults has genital warts.

Each year, 9,300 men and 17,500 women have a cancer related to HPV.

The HPV vaccine has had a tough row to hoe.  No one likes to think about their child becoming sexually active too early, for the wrong reasons and against the values we have worked to help them internalize.  Which means whether or not to have children vaccinated with the HPV vaccination is often couched in a values debate:

“If I accept the series of shots for my child, that gives him or her license to have intercourse before the “right” time.”

The rebuttal is this:  no, protecting our children against serious illness is never the wrong decision.  In fact, providing our children with the HPV vaccine can open the door to further discussion about premarital sex, condoms and birth control pills and our family values and viewpoints on these topics.  These are difficult talks to have with our children, but as the vocal doctor who came to talk with my church-based parenting group said:  an honest, open dialogue is key to our children’s sexual health.  In fact:

It could save their lives.

Why I Won’t Homeschool My Kids


A year ago, I wrote about whether or not to homeschool my older son and his brother and sister (How About Homeschooling? Part One and How About Homeschooling? Part Two).  In those posts, I described my concerns, thoughts and feelings and was pleased to receive some wonderful feedback from readers.  To all of you who shared your perspectives and positive experiences with educating your children at home, I thank you for providing food for thought.   But I knew my husband and I were going to need more information before making a decision…and that meant sending our kids back to public school the following year.  As school budget cuts would be creating larger fourth grade classes, we needed to find out if being in a  25 percent-larger section would affect our sensitive son’s ability to learn.

Well, that year has nearly passed.  Our question has been answered.  And much more about our school has been realized.  So our decision is this:

We won’t be homeschooling our kids.

It isn’t right for our family.  It works wonderfully for others and my hat goes off to them for making such a huge commitment.  Those families have their reasons and the wiring to make the home a classroom.  But homeschooling is not for us.  And here’s why: Continue reading

One Tough Mother

First Mothers' Day!  Not feeling so much tough as tired but very, very happy!

First Mothers’ Day! Not feeling so much tough as tired but these two little guys are totally worth it!

I didn’t plan it this way.  But two weeks ago I realized this post, which I drafted specifically for Mothers’ Day, would be’s 100th.  Hitting the century mark with an entry honoring moms feels like good karma.  And I want you, all who have been reading PulseonParenting, to be a part of the good vibe.  Moms can handle most anything parenting throws their way…in fact, I’d put money on it that you all are Tough Mothers.  I’ll bet you have posted your most heroic, vulnerable, gross and/or hilarious maternal moments on Facebook or Twitter or your own blog.  But today consider sharing an example here, on PulseonParenting.  Or comment on PulseonParenting’s Facebook page.  Join moms from around the country in compiling “100 Tough Mother Moments” to honor Pulse’s big 1-0-0.  Share the moments that bind us moms together in a sisterhood like no other.  And invite your friends to do the same!

The following are examples of Tough Mother moments…some are my own, others belong to relatives, and perhaps some will resonate with you!  You may be One Tough Mother if: Continue reading

I’m Driving With Kids, Guess What’s In My Glovebox?

Now this is the ride we want on our next big adventure.  Barf bags a must!

Now this is the ride we want on our next big adventure. Barf bags a must!

This week:  a post on the lighter side inspired by a recent family road trip to California.  It was great fun and the kids did really well riding the 2,000-plus miles.  Which, pardon the pun, is a true milestone.  My kids are in grade school and at this wonderful age teachers send makeup work along and this helps pass the time.  It does so in theory, anyway.   Friends named Pixar, Mad Libs and Motel Swimming Pool were indispensable as my husband and I bribed the kids into getting homework done.  So in a nutshell, UN-caliber negotiations and movies and math got us from one destination to another with very little drama.

In January of 2014, I published I’m Flying With Kids, Guess What’s In My Quart Ziploc Bag?  Flying and driving seem like two very different propositions, but in many ways, doing either with kids involves much of the same process (homework bribes and in-flight videos).  There is crossover even in the smallest details, which can only be learned from experience.  And that is why it’s time for the sequel to I’m Flying With Kids.  So what do I keep in the glovebox on a road trip?

Stuff that I steal.

From the Friendly Skies, ironically.  Or from whatever airline can give us a “bargain” rate to take our brood to see the grandparents.  (Which is not so much a “bargain,” of course, and the reason we drove to California).  And why do I take stuff from airplanes?  Predictably my younger son goes so hard while on holiday and is so sleep-deprived, dehydrated and PUMPED UP that he spikes fevers and often barfs his brains out.  Then he collapses into a 13-hour sleep.  It’s a bit weird and scary but he pulls through every time, rarin’ to go by the time he wakes up.  Once on a trip to Colorado, he turned white as a sheet and we just managed to corral the sick in a torn plastic grocery bag that we happened to have in the van.  I was dressed up (a rare occurrence on a family trip) but managed to dump the semi-leaky bag in a nearby trash can without making a huge mess.


Vowing from that day forward to always be prepared for car sickness..I started raiding airline seat pockets.   On our flight home from that Colorado trip, and on every flight since then, I take the all the little white bags.  Well, not all, only the five we are totally justified in swiping.  No beverage service?  No problem.  Those wax-coated gems are more than just compensation:  we use a ton of them when we are on the ground.  The airline-of-choice can come after me if they want but my defense is air-line tight:   At least my child hasn’t gotten ill on the upholstery of your terribly uncomfortable seats, which he could have done because those bags are pretty small.  Your upholstery or your barf bags, your choice.  

So there.

I steal other stuff, too.  I have sticky fingers when it comes to extra napkins and handi-wipes so we don’t have the kid-sized version all over the van’s windows.  Sometimes I take a few feet of toilet paper (don’t ask).  Straws and sporks are nice, too.

But the true windfall is those plastic-lined bags that self-seal.  Even though my son seems to have outgrown the car sickness I still keep a few bags in the van to ward off its return.  Call it insurance.

Some people need their AmEx.  We need barf bags.

And never leave home without them.

What to Expect When Your Son Starts Puberty


When my husband and I learned we were expecting twin boys, I had two thoughts.  One was:

YES!  No weddings to pay for!

And the other was:

Whew.  I get out of doing “The Talk!”

With the former I “thought” too soon, as we now also have a daughter (wedding fund started).  With the latter, well, we’ll see.  Because when my older son, um, discovered himself at age three, I was giving him his bath.  Dad wasn’t even in the house.  That was the wake up call:  I knew I needed to be as knowledgeable about my boys’ pubertal changes as I do my daughter’s.  So Moms, here’s some info to help us all navigate our sons’ transition to adulthood: Continue reading

What to Expect When Your Daughter Starts Puberty


My daughter is eight years old.  She loves jigsaw puzzles, lip smackers, and American Girl everything.  A little girl.  So it’s hard to believe it’s time to have “The Talk.”   Yes, the recommended age is eight.  The thought of sitting down with my second grader to discuss birds-and-bees is, to say the least, unsettling.  When I read this advice I was relieved that age eight was a long, long, year away.

But  time flies.  My daughter just passed the halfway point to age nine.  I guess I need to get a move-on.

It was so much easier when I worked in family medicine.  I did exams and stated, yes, puberty has started, or no, it has not, and made general projections as to when my young female patients’ may start menstruating.  But when a tween is your own child, the issues are less perfunctory and more personal.  As parents, this “talk” is not just an anatomical one but one that delves into our family’s values about intimate topics and how to navigate the inevitable comparisons (and competition and teasing) when kids’ bodies start to become those of adults. Continue reading

I Love You…Quirks and All

The model "ski lift" my son and I built together out of cardboard, string and pipe cleaners.

The model “ski lift” my son and I built together out of cardboard, string and popsicle sticks.

I knew from the moment I laid eyes on my younger son, a preemie with dusky, lanugo-covered skin, that he was unique.  Others were scared to hold this fragile, funny-looking baby.  But to me, he was beautiful.  I could hold him and his twin brother for hours watching their tiny, newborn features.  While his brother’s round, pink face relaxed into a smile as he slept, his contorted into mesmerizing expressions, eyes a-flutter, as we listened to classical music in the nursery.

This little boy, whom we affectionately call “Bear,” has always been his own kid.  As a toddler, he would crawl in and out of his bedroom doorway, thumping his little legs before turning back.  Once he could walk, he became obsessed with doors, so much a compulsion we had to tear him away, kicking and screaming.  Oh, and there was the time in between when he stopped babbling. Continue reading

Winning: Is That What it’s All About?

My sons' cars.  And my daughter's pink "D1."  Hers wasn't the fastest on the track but it was the fastest built…20 minutes before the Derby.

My sons’ cars. And my daughter’s pink “D1.” Hers wasn’t the fastest on the track but it was the fastest built…wheels went on just an hour before the Derby.

Pinewood Derby Fever recently took command of our household.  As our boys’ searched the internet for design ideas, assisted Dad with the shaping and drilling of the wood and gleefully sprayed paint on their carefully cut creations, it was hard not to get caught up in their enthusiasm.  The best part was learning to fix mistakes, like the misplaced drill hole that was transformed into a brad-covered “gas cap.”  Parents and their boys, spending time together, building something by hand.

Isn’t that the point?

It should be.  But Pinewood Derby is a confusing combination of handshake agreement and paperwork.  It’s understood that the building of the cars begins when the wood, wheels and axels are passed out at a meeting a few weeks before the event.  It’s understood that the boys help craft their masterpieces.  It’s understood the race is just friendly competition.

Or is it?

This is the confusing part.  There are rules that govern the Derby, numbered and lettered like a legal document, more points than The Twelve Steps of Alcoholics Anonymous.  This says something:  given the rabidity with which some approach the Pinewood Derby, a simple dozen guidelines would not hold back those addicted to the idea of winning at all costs.

Everyone who participates is a winner, right?  The Cub Scout motto is “Do Your Best.”  Not “Winning is Everything.”  But it seems to me the rules of Pinewood Derby lend themselves toward the idea that yes, winning is everything, and we need painstaking details to keep those misguided by tall trophies from cheating.

What a sad reality.  It would be nice if the rules simply pertained to the construction timeframe, the weigh-in and the car dimensions…the guidelines that make the effort of building a fast, creatively-designed car a little more challenging.  It would be nice if the minutiae that embodies the rest of the guidelines didn’t need to exist.  But I guess there will always be participants who will miss the point:  to have fun, bond and

Do Your Best

Remind Me, Who is This For Again?

The cake freaked me out…so the decorating is my husband's handiwork.  He was Margarita-free.

The “tire” cake freaked me out…so the decorating is my husband’s handiwork. He was Margarita-free.

Take a look at Pinterest, she said.  There are some really cool ideas, she said.

Boy, were there ever.

I “pinned” five.  I liked even more.  That unsettling combo of excitement and stress started to bubble up from my stomach toward my chest and pulsed into my head, which began humming with white noise.  Then, in a rare moment of clarity, a voice said:

Stop.  This is ridiculous.

Who is this actually for???

It was time to plan the annual Cub Scout Pinewood Derby.  My boys’ den leader, whom I greatly admire, approached me and asked if I would help plan decorations and snacks with her.  She mentioned Pinterest, and I took the plunge.  There were ideas for free-form snacks (oreo “spare tires,”  pretzel “axel rods”), balloon arrangements taller than me in the shape of traffic lights, a three-tiered “tire” cake with perfectly-sculpted frosting “tread.”

That’s when I started to feel dizzy and buzzy and that only lead to the worst of all possible Mom emotions:  guilt.  Guilt at my apparent inadequacy in using a glue gun (which I keep in a holster on my hip, just in case) and my inability to write my sons’ names on a birthday cake unless I have had a Margarita.  Because, clearly there were fabulous moms in the stratosphere who can glue and frost…likely at the same time without mixing the two up.

I know I am not alone but I really try to keep my guilt to myself, or if I let someone in on it, my target is  my poor patient husband.  But I know moms who can’t help themselves and I hurt for them.  They are easy to spot because they are the ones who reply to the group email that asks for school treats with:  “I’ll bring a triple berry tart with a homemade almond flour crust!”

Darn it all if that doesn’t sound yummy.

Anyway, what stopped me from volunteering a lopsided three-“tire” cake, or a balloon arrangement that wouldn’t survive 5 minutes with a roomful of rambunctious cub scouts was this:  the event is for the kids.  Not the adults.  Why would I try to impress the adults?  Furthermore, why would I try to impress the kids?  Kids don’t expect anything fancy, they are happy with pretty basic party “stuff.”  Do they really think it clever if I  label a Tupperware full of Teddy Grahams “Pit Crew?”  No.  They are hungry and will see junk food and dig in.  (Ok, I confess I did label the Teddy Grahams.  Please believe me when I say it was a social experiment.)

So after my foray into a collage of amazing ideas, I slept on “Pins” and needles and the next day I returned to Pinterest and chose two reasonable projects to try, nixing the balloons in favor of a putzy, colorful snack idea and an idea for a flat tire cake (something I could goof up and would still look ok.  Hey, it’s a flat tire so it can’t be perfect, right?)  I decided to make “Pit Passes,” too.  I could have had them professionally printed, laminated and strung on fancy lanyards.  But for a mere few cents apiece, I used white notecards, stickers and a sharpie.

And you know what?  The kids still liked them.

Fruit and veggie "cars."  I can't glue but I am fierce with the toothpicks.

Fruit and veggie “cars.” I can’t glue but I am fierce with the toothpicks.