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.

Two summers ago, my family discovered trekking poles. We were out west, hiking in the grandeur of our national parks, and noticed early on in our travels that a lot of folks were using what looked like ski poles. We asked the pole wielders about them, and they all answered that they were extraordinarily helpful.  So when we stopped in at a Wal Mart for supplies and noticed that they carried these items, we purchased a pair for each of us. We never realized that we had been missing them until we had them. Aside from the National Park pass itself, the poles were probably the best $100 we spent on that trip.

I’ll show you why.  Try this:

Stand in your kitchen with the counter about six inches to the side of you.  Lift one foot slightly off the ground, and try to balance on the other.  If this is difficult for you, put one finger on the counter as you try to balance.  If the one foot balance is easy for you, hold your hand up over the counter, and then try the one foot balance with your eyes closed (and catch yourself by grabbing the counter and opening your eyes when you start to fall).  Now try the eyes-closed balance with one finger touching the counter.

It’s pretty amazing how that one finger, that tiny bit of sensory input, helps, is it not?

When you are hiking, you need to look ahead (to the future) and down (to the present).  When you walk with the poles, you swing each one alternately out ahead, and gently hold on as you take a step to catch up with the pole, which ends its cycle at your side before you swing it out ahead again. Each pole touches the future and transmits information back to you so that your steps are adjusted accordingly.  Even if you’ve never had any difficulty with balance, it’s fantastic how much more in-balance the poles allow you to be.

Most of the time, you swing your poles lightly, and hold them very lightly, as you move easily ahead.  At times you need to hold them a bit more tightly and to put a bit of weight on them.  Generally, you place your poles ahead of you by a step.  But sometimes, like when you are stepping over a log, it’s more helpful to have one pole stay back and take a little of your weight as you lift your leading foot and pole over the log.  Then you transfer your weight forward from your trailing pole and foot to the lead pole and foot after you’ve cleared the obstacle.

Although your poles help you, you always direct them.  It wouldn’t work if someone else directed them.  You point them in the direction you want to go, and they help check the stability of the ground ahead, the change in grade, the hardness of the ground.  Your trekking poles can act as brakes when you feel you are losing control or gaining too much speed down a hill.  They can help you catch yourself and stop a fall.  They can help you pull yourself up a hill.  But you are in control, you guide yourself, you plan your steps, and you carry yourself.

There are some times when the poles get in the way.  When they do, when you want to stop and take pictures, when you are at a place where you need to hold onto railings with both hands, or when you just don’t want to walk with them, you can collapse your poles and stick them in your backpack.  And you can pull them out when you need them again.

I cannot help but liken a hike to a medical journey, and a pair of trekking poles to your doctors, your personal medical advocate, and the rest of your healthcare team, when that team is working as it should be.  Try reading this piece again with this analogy in mind, and please let me know what you think.

In celebration of our recent 20^th wedding anniversary, my husband and I spent a romantic (read: “without kids”) three days in the beautiful mountains of western Pennsylvania.  We hiked, kayaked, hiked, and hiked some more.  It was warm and fairly muggy, but breezy enough to make it pleasant.  The smell of the pines, the sounds of the forest and river and their creatures, the pleasant cooling raindrops on our skin (just enough to soothe, but not enough to drench), the beauty of the colors surrounding us, and the just-tired-enough-ness of our muscles, combined with nightly soaks in our room’s fireside Jacuzzi to allow stress to slip away quite nicely.  And my husband knows me well enough at this point that the fact that I had brought along Lysol wipes to use on said Jacuzzi tub prior to our first night’s soak evoked in him only a slightly bemused smile.

Cell coverage in the area was very limited, so we were not bombarded with constant texts, e-mail notices, or Facebook updates.  There was no TV in our room, so we sat out on the balcony at night (second story – high enough we didn’t have to worry about hungry, wandering bears) and smelled the faint wafts of smoke from a nearby fireplace.

And there was no clock in our room, nor was there any clock in any of the public areas of the rustic, log-constructed lodge.

Was this lack of official timekeeping devices a throwback to earlier, simpler times, or a nod to the fact that we were in the woods and close to nature?  I don’t think so – that wouldn’t be consistent with in-room Jacuzzis and gas fireplaces.  I think the clock-less-ness of the place was a symbol of both luxury and freedom.

In my own life, I frequently do not have the luxury of time nor freedom from schedules.  With my client and meeting schedules, my husband’s work schedule, the kids’ school, sports, and music lesson schedules, deadlines, committee meetings, community events, social engagements, kids’ rehearsals and concerts – our family calendar looks like a Jackson Pollock painting.

So the lack of a clock makes a powerful philosophical statement: you are on vacation and are here to relax.  You do not have a schedule.  Go to bed when you’re tired.  Eat when you’re hungry.  Of course this is not consistent with the lodge’s policy of having you sign up for a specific time slot for breakfast each morning, but to paraphrase Emerson, to demand consistency is to lack imagination.  Our creative response to this discrepancy was to ignore the rule and show up whenever we wanted to.

Of course our cellphones have clocks and alarms on them, and these work even when there is no cell signal and the phones are on “airplane mode” to conserve battery.  But you have to purposefully look down at your phone and turn on the display to see the time, and you must purposefully set any needed alarms.  We chose not to set any alarms.  We went to bed when it was dark and we were tired.  We got up when we felt rested, which turned out to be about 8 hours after going to sleep.

Certain health conditions can tie you to a clock a little more – someone with esophageal reflux needs to time their eating so that it’s not too close to when they lie down.  Someone who uses insulin needs to time their injections and meals precisely.  Anyone on medications needs to time them consistently and evenly.  But aside from clock-dependent requirements such as these, it does a body good to lose the watch for a bit and listen to your own internal clocks.

I wonder how long it would take to find your own time groove.  I wonder if a loss of clocks would decrease overeating – there certainly wouldn’t be any “it’s lunch time, so I’d better eat a lot now, since dinner isn’t for several hours.”  I wonder if we’d get the ideal amount of sleep, with our own internal signals and a little input from the sun.

If anyone knows of a study like that going on, please let me know – I’ll volunteer!