A little bit of stress can be good for us. It can perk us up, energize us, get the blood flowing, and push us to move forward. A body reacts to stress by releasing chemicals which cause, among other things, a rise in heart rate and blood pressure, which facilitates fight, flight, or, as the case may be, finishing a paper before a deadline.

But constant stress is not good for us. Those chemicals which facilitate our fight or flight response damage blood vessels over time, make us gain weight, and make us lose sleep. So it’s important to find ways to negate that stress: deep breathing, exercise, meditation – regularly practicing these techniques helps protect and heal both mind and body from the ravages of excess tension.

Of course it’s sometimes hard to remember to breathe deeply or to take a walk when someone ticks you off while you’re in the middle of doing something else. Just yesterday morning, I had difficulty remembering to breathe deeply or take a walk when one of my sons ticked me off while I was doing dishes. The off-ticking issue involved a cell phone and a snarky comment accusing me of an invasion of his privacy (which I had not, in fact, committed, although it would have been well within parental perogative to have done so), which progressed into a gruff, teeth-clenched, really-not-overly-polite-or-nice-on-either-of-our-parts exchange of words and glares. This exchange lasted about 20 seconds, at which point another son entered the room, heard the argument, and said, “Oh, the reason your text message had been opened is that you plugged your phone in my spot overnight and I thought it was mine.”

Brief exchange between the two boys. Smart-alec comment from the other son who had observed the whole thing. A “Sorry Mom, my bad,” from the originally obnoxious one. A few more sarcastic jabs and laughs among the three boys. I smiled a bit but was not yet ready to let go of my annoyance, so I went back to loading the dishwasher while continuing a tirade in my head.

And then the most beautiful sounds from the piano came wafting in from the living room. It was the kid with whom I was trading snarls just moments prior, playing a song he knows I love. And my anger melted away just as quickly as it had flared up. The lilting melody, the rich harmonies, the sheer beauty enveloped me. I turned off the water, walked into the living room, and watched my son’s fingers fly along the keys as his body leaned into the emotions of the song and swayed with the rhythm.

I sat and listened. And watched. And loved. And forgave. And my shoulder muscles relaxed. And my blood pressure returned to normal.

Damn, the kid’s good.

Once a Red Sox fan, always a Red Sox fan. But when you live your adult life in Metro Detroit, you grow to love the Tigers. Although I was too emotionally spent sports-wise on Saturday night from Michigan’s quadruple-overtime football loss against Penn State to worry much about the outcome of the first American League finals game, game two caused some dissonant feelings: I was thrilled that the Red Sox won, but also a little sad that the Tigers lost. That’s baseball. Someone wins, someone loses.

Sadly, our national discussion on healthcare reform has become a win-lose debate. People identify with one team or the other, there’s a “my guys versus your guys” mentality, and the fans on each side are trash-talking rather than engaging in constructive conversation. The goal has become beating an opponent. It’s the equivalent of “The Yankees stink” – no respect, just vilification of the “enemy” and a focus on winning as opposed to getting-it-right.

We all have our favorite teams. Our teams are part of our identity – we’re Red Sox fans or Tigers fans because we grew up in Boston or Detroit, or we love the Reds because they won the World Series when we first became interested in baseball. We’re proud of our teams and want them to do well because it feels like we win when they win. And when someone is playing against our team, they’re playing against us.

But even in baseball, where the loyalties run deep, there can be an appreciation of talent and skill that isn’t bound to team allegiance: the All-Star game. The best of the best. All working together. No, the All-Star teams don’t have the cohesiveness of the regular teams, but the members all respect one another and the fans recognize the expertise. There’s not really a rabid fervor over American League versus National League, but more of a communally shared admiration of an ideal.

If the discussion and forging of policy must be like a baseball game, let it be an All-Star game. There’s wheat and chaff on both sides. Get rid of the bad stuff. Glean the best. There is the potential for remarkable good to come out of this. Few would argue that it’s bad that no one can now be denied medical coverage because of pre-existing conditions. Few would argue that bureaucrats should make medical decisions for patients. Keep the good. Get rid of the bad. Tweak it as necessary – put in a relief pitcher when needed. Use a pinch-hitter. Use a pinch-runner.

The near-lifelong Red Sox fan in me and the adoptive Tigers fan in me want to share the glory of the AL title. Maybe not an equal share – probably around 60-40. That cannot happen in this case.

One team will win the American League series and one team will win the World Series. But our entire country stands to win (or lose) the battle for optimal healthcare. Let the battle be an All-Star game.

Turf wars. Power. Control. Even when everyone’s goal is the cultural enrichment experiences of children, these primal drives can rear their ugly heads.

Our school district is keen on music. Not only is the administration committed to top-notch music education programs, but the parent community gives generously of both manpower and financial support, and the community-at-large is monetarily supportive. Up until this school year, there has been a parent organization of instrumental boosters who dedicate significant time and money (through donations and fundraising efforts) to support the band and orchestra programs throughout the district. One big, happy, musical family – think “Partridge.”

But this year the orchestra has split from the instrumental boosters and started its own association. There is much snipping and moaning and complaining from a lot of families. Since our family has two kids in the band program and one in orchestra, I’ve been bouncing back and forth from various levels of “somewhat irked” to “significantly ticked off.” The two organizations are ostensibly still working together for a few of the major fundraisers, but there is bickering over the details of distribution. Families now have to decide whether they’re representing the band or the orchestra when they volunteer to take on a shift. What used to be one donation check to a big general pot (with occasional extra contributions to specific projects) now has to be divided, but it’s not exactly clear how to divide it.

I am well aware of how lucky I am to live in a community that is so supportive of arts education. And I am equally aware of how the current “problem” is insignificant in the grand scheme of things (or even in a much smaller scheme of things, for that matter). But this small-scale secession mirrors those on larger scales. It speaks to issues of money, power, control, self-interest, and perceived fairness. Such issues arise in families, schools, workplaces, government – pretty much anywhere you have more than one person and a finite supply of anything. They certainly come to play within the details of how the medical world functions. Who’s making medical decisions? Is it the primary care doctor? The specialist? The patient? The patient’s family? The insurance company? Who has how much say in each decision? How much does each provider of the care get compensated? Who pays for what and how much do they pay?

In our community, the friction (which, by the way, originated and is contained among a very small contingent) is an inconvenience. The overall music programs will retain their excellence, and although fundraising and allocations are at this point dividing, the music community as a whole is strong, and the kids and families are all friends, looking out for and supporting one another. We value our community. I would love for our elected government officials to reflect this overall good will towards their fellow humans as they work to resolve our federal budget conflicts.

Yes, we each need to be our own advocates. But “our own” includes more than just our selves. It includes our families. Our friends. Our block. Our neighborhood. Our school. Our school district. Our county. Our state. Our country. Our world.

My almost-three-year-old niece is just learning how to ride a bicycle. The overall balance issue doesn’t come too much into play yet since there are training wheels on her bike, but there’s still a lot involved. The pedaling needs to be done in a forward direction in order to move; that can be hard to start from certain pedal positions. A backward pedaling motion stops the bike but you need to remember to do it when you want to slow down or stop. And you need to remember not to do it when you want to keep going forward. That whole steering thing is a lot to think about as well, especially when you’re focusing on pedaling and trying to catch up to your older brother.

As the family went around the block, my niece drove my sister a little nuts as she alternated rapidly between asking for help and pushing my sister’s hand away. The child wanted to do it herself but kept getting stuck. The parent was happy to give her daughter assistance and independence, but the rapid cycling between the two wasn’t the easiest thing to deal with. So the bicycle balance issue that was covered by the training wheels was replaced with a parenting balance issue.

But it wasn’t a balancing issue for my niece. She knew exactly when she wanted help and when she wanted to do it by herself. When she got stuck and couldn’t move with a try or two, she wanted a little push. Then she wanted to be left alone. She didn’t necessarily want the occasional steering help to keep her from going into the middle of the street or a hand on her bike on a big downhill stretch, but those weren’t up for negotiation.

It gets harder to ask for help when we’re adults. Maybe a lot of that difficulty comes from a fear of loss of independence: If I ask for a little help with my finances, will I lose my financial control? If I ask for help with my project, will people think I can’t do it and give it to someone else? If I ask for help with my health issue, will someone else make my medical decisions for me and will I end up having to do things that aren’t right for me?

And we’re much more aware of others’ feelings than we are when we’re three years old. My niece had no problem pushing my sister’s hand off of her bike. As adults, we worry a little about hurting someone’s feelings by not following their advice or by rejecting their help. Since it’s hard to stop accepting the help, we may think it’s easier not to ask for it in the first place.

We can learn a lot from a toddler on a bicycle.

Training wheels are ok while you learn to pedal and steer. If you’re new to cooking, start by following recipes closely. If you are having difficulty managing your weight, ask your doctor for a specific plan to follow as you learn how your body specifically responds to certain ways of eating.

Sometimes you need a little push – ask for one. If you haven’t been able to stop smoking by yourself, ask your doctor for something to help you. Ask an expert for advice when you don’t know what to do or aren’t sure you’re taking the right step.

If someone has their hand on your steering mechanism for too long, ask them to remove it. If you are feeling pushed towards having a medical procedure done that you don’t feel comfortable with, stop and ask for a second opinion. Discuss your goals and your fears with your helath care team. Find what works for you. Grab your steering wheel back.

It was delightful to watch my niece and my sister do the self-sufficiency/reliance-on-others dance. The pride beaming from both of their faces, the love, the frustration, the achievement, the annoyance, the accomplishment – it was a marvelous first ride around the block. May they have a million more.

I was speaking with someone the other day who suggested I write about dealing with health insurance companies. He had just had a frustrating morning on the phone.

I’ve been there, on both the doctor’s side and the patient’s side of the phone call, albeit never on the insurer’s side. Fewer activities are more maddening, but in my personal experience they have tended to work out ok.

In general, I would rather get sunscreen in my eyes than have to call my health insurance carrier. However, since I’m really not given a choice between the phone call and the sunscreen, I have to make the call. There are some ways to make the experience a little better.

First, it always helps to be prepared. Have your insurance card with you so you have quick access to all the numbers you might need (contract number, group code, plan code, ID number, etc.). Also make sure you know the last four digits of the social security number of the primary enrollee (i.e. the person through whom you obtain your insurance – your self, your spouse, your parent…) since the person who eventually answers your call may not talk to you if you can’t confirm who you are with this number. They may also ask you to confirm your address, but most of us don’t find this too difficult to remember (unless, of course, we have steam coming out of our ears because we’ve been on hold for an hour…).

Why are you calling your health insurance company? Write down your questions and leave space between them to write down answers later. If your issue is that something was not covered that you had thought would be, have your EOB (Explanation of Benefits) statement from the insurance company in front of you that has the code or explanation on it regarding the issue of concern. Also have your billing statement from your doctor’s office or the hospital/clinic/etc. for this particular issue in front of you as well. Make sure the dates of service match, and you know what your bill was for in the first place. Many times, a quick call to your doctor’s office (or doctor’s biller) will clear things up, and they may be able to explain your insurance company’s response and figure out what the problem is. Write down the name of the person to whom you’ve spoken and what she has said regarding the situation. Date these notes.

If you still have not had your question answered or problem resolved after speaking with your doctor’s/hospital’s billing office, ask them the name of the specific person to whom you should refer your insurance company’s representative. Then it’s time to call your insurance company.

Never make that phone call to the insurance associates when you only have a few minutes before you need to leave for a meeting. You will never be done within a few minutes. Know that you will be sitting on hold for a long time and plan accordingly. Put your telephone on speaker phone and as you dial, put your relevant papers close by and hop on your treadmill or exercise bike. Work on other paperwork. Gather a few puzzles and work on them. Open another window on your computer and read through old DocThoughts blogs. Watch Youtube videos of puppies. Listen to some TED talks. After you’ve punched in your contract/ID number and made a few menu choices, you will be making good use of the time that you are stuck on hold.

It’s amazing the difference this makes in your blood pressure and overall ability to speak coherently once someone answers.

Speaking of someone answering, write down the name of the person who picks up your call. Ask each of your written questions and write down the answers that the insurance representative gives you. Ask for clarification of anything that is not crystal clear. If you are not receiving a satisfactory response to your questions or concerns, ask to be put through to a supervisor and then write down the name of the supervisor with whom you speak. Ask for and write down the name of any person with whom your doctor’s office needs to speak.

Medical billing is remarkably complicated. Do not feel stupid if you don’t understand it. Breathe deeply, and stay calm while you talk. Don’t view the person on the other end of the phone as your enemy – yes, your insurance company makes money, but it does so through providing help to its customers. Consider the person on the phone to be your ally – it will show through in your voice, the conversation will go more smoothly and pleasantly, and the person to whom you are speaking will be more genuinely interested in assisting you.

After you have received all of the relevant information from your insurance carrier, report it back to the appropriate person in your doctor’s office/hospital/etc.. In the rare cases that concerns or disputes are not able to be resolved, it may be helpful to engage the services of someone who specializes in such matters.

But most of the time, facilitating good communication among the involved parties will resolve your issues.

You don’t have to have a medical degree to know that people need to get enough sleep. It’s important for memory function, for problem solving ability, for the general ability to function, for children to grow and develop optimally, and for overall good health. It’s really important.

So why does my house, filled with growing teenagers and parents who need their minds to function well, have lights on later than anyone else on our block?

It’s not like we sleep in. We have places to go and things to do. Work, meetings, cross country practice, marching band camp, drama camp. And in a few weeks everything will start even earlier and stretch later.

During the school year, the lights are on late at night because of all the homework that needs to be completed after school, sports practices and meets, music practicing, music lessons, school concerts, rehearsals, meetings…

And then there are some nights when the obligations are over, and our family could catch up on a little of that precious sleep. Like tonight.

But I’m not telling my kids to hit the sack. The giggles coming from the living room, where my husband and our three boys are playing Euchre, are more precious than sleep.

I have no problem, late at night, telling the kids to get off of Facebook and go to bed. But I find it really difficult to tell them to stop making music together, either with their instruments or with their laughter.

They may end up an inch or two shorter than they would have if they had a childhood of adequate sleep. They may have a point or two lower on their ACTs.

But they will have the closeness with one another that I wish for them more than anything else in the world.

I have an early meeting tomorrow, so I’m going to stop writing. I’m going to go join my men in the living room – maybe I can talk them into a few hands of Hearts.

We just received an 11-word letter from son #3, who is away at a 12-day fine arts summer camp, playing bass in the jazz performance program.

You know how some people can go on and on and not really say much?  (Risky thing for a writer/speaker/blogger to point out, I know – something about stone-throwing and glass houses, or pots and kettles.  But I digress.)  My youngest son doesn’t have this problem.

Some narratives stretch on a little (or a lot) longer than they should.  Sometimes it’s because a person may be, like Dickens, effectively paid by the word.  In many circumstances, a person hasn’t yet learned what information to leave out for a particular audience.

You should watch the face of a general surgeon receiving a third year medical student’s verbal presentation of a patient.  That student has been taught to document every detail about a patient’s current medical situation, past medical history, family history, social history, positive and negative answers to a barrage of questions about symptoms across all body systems and state of mind, and every finding, including everything that is “normal,” on the physical exam.

What the surgeon wants to hear is: “14-year-old male with no significant past medical history presented to us with right lower abdominal pain and fever, has tenderness and guarding in this region, physical exam otherwise within normal limits, and ultrasound shows evidence of acute appendicitis.  There’s no personal or family history of reactions to anesthesia or of any bleeding or clotting problems.  He hasn’t had anything to eat or drink for over 12 hours.”  The surgeon may fire off a couple of questions on the phone, and she’ll ask anything else she needs to know when she goes to see the patient.  So when the medical student regales her with information about the patient’s mild acne, stage of puberty, visual acuity, dietary habits, or school activities, the surgeon’s eyes will glass over and may roll back far enough in her head that she can see her own brain.  This is why the emergency room residents don’t let medical students call the surgeon.

The surgeon in this example is being called to respond to a surgical emergency.  In this situation, the relevant information needs to be communicated in a clear, concise, and quick manner.  It needs to be complete as well, but complete within the realm of relevance.   The kid’s appendix could burst while the student is reporting on the child’s use of seat belts and bicycle helmets.  However, the above clinical description of the patient’s appendicitis presentation would be a woefully incomplete picture of that person during a well-child visit at a new pediatrician’s office six months later.

To communicate well, you need to tailor your communication to both audience and situation.  This is quite important within the field of medicine.  An internist generally needs a much broader and different knowledge of a patient than an orthopedist needs.  Both doctors and patients need to know what information to relay, the right way to phrase things, and the right questions to ask.  And that communication makes all the difference in the world.

So here is my child’s letter from camp, in its entirety:

“Dear People,

Birdland Combo.

Cabin’s awesome.

Kids cool.

Best counselor ever.”

He used fewer than a dozen words to convey: 1 – that he’s alive, 2 – which ensemble he’s in, which tells us how his audition went and enables us to look at the schedule to see what time his concert will be on pick-up day so we know when to show up at camp, 3 – that he’s happy.  Would I have liked maybe a little more detail?  Of course.  But he communicated what was important for us to know now.

Maybe my son thinks I’m a surgeon.  I think next year I’ll offer to pay him by the word for his camp letters.