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!

Just over 4 years ago, my brother and his family moved to a hot, desert climate in the Southwest.  We visit yearly, usually during the summer, since that’s when the kids in both states are out of school.  So my family just spent the past five days in Las Vegas.  108 degrees Fahrenheit.

It’s a dry heat.  Like my convection oven, only bigger.

Not even a wisp of a cloud in the sky the entire time we were there.  And that sun is brutal.  So I listened to my own advice, and when it wasn’t possible to stay in the shade, I used a strong sunscreen.  Personally, I love the Neutrogena Ultra Sheer stuff – it absorbs really quickly, and doesn’t feel at all slimy or greasy.  But whatever you do, for the love of all that is holy, do NOT allow that substance to get in your eyes.

When I splashed into the pool at the bottom of a lovely, meandering water slide, it took about 4-and-a-half seconds for the sunscreen to get from the skin around my eyes to the surface of my eyes.  And I thought my corneas might actually catch on fire.

So, when you get sunscreen in your eyes, rinse them immediately with lots of clean water.  Use soap and water to wash your whole upper face, so that more doesn’t drip in again later when you start to sweat or when you jump in the pool again.  Wear a hat.  Get in the shade.  And find a sunscreen made for faces, or a tear-free one.

Oh, and here’s another first-aid tip (this one’s not really my field, but I figured I’d share information learned) :  When you realize a few minutes after jumping into a swimming pool that your cell phone is in your pocket, pop out the battery immediately (to avoid short circuits that’ll completely fry the inside of the phone), dry off what you can, and stick the phone in a zip-lock baggie with a bunch of uncooked rice and leave it overnight.  The rice absorbs water vapor, helping to draw moisture out of the cell phone.  This trick made for a mostly-functioning phone and a very grateful teenager (one who will likely not put a cell phone in his bathing suit pocket again).

We had an absolutely fabulous visit with my brother and his family.  It was laid-back, yet fun-filled.  Everyone, from the 7-year-old to the 45-year-old, enjoyed swimming, pinball, four square, laser tag, walks, a rock music show, restaurants, ping pong, air hockey, card games (we were, after all, in Vegas), and just being together.

And then it was time to come home.  It’s painful saying goodbye, since it’ll be about 10 months until we’re together again, but we consoled one another with talk of the modern wonder that is Skype, and then the five of us went to the airport.  For an 11:45 p.m. flight.  Also painful.

The price differential between a redeye flight and one at a decent hour is big enough that you can’t ignore it when you’re purchasing five plane tickets.  Hydrate well prior to one of these flights, because if you snooze through the drink cart’s procession, you’ll feel like you’re back in the desert by the time the three-and-a-half hour flight is over.

Once home, it’s amazing the good a brief nap can do.

Please forgive any sleep deprivation-induced typos or grammatical errors in today’s post.  And keep sunscreen out of your eyes, keep your cell phone out of the pool, and keep making memories, even when you have to fly all night to do so.

When circumstances allow, I like to give myself a little time to breathe and reflect before reacting to something that angers me.  So this post relates to a news item from a little over three-and-a-half weeks ago.  I’m still mad.  I read the following headline: “(Prominent Politician) Gets Secret Weight Loss Surgery!”  (*Note: the “secret” here does not refer to a prototype or not-available-to-the-public procedure, but to the fact that the person who had the procedure done didn’t announce it to the world when he had it done.)  Since the headline ticked me off, I figured I’d read the article.  Annoyance was confirmed.  And each time I’ve looked back at the article over the past few weeks, I’ve fumed.

A person’s medical decisions, when not made public, are not “secret.”  Secrecy implies that someone is hiding something, and implies that other people have a right to know about it.  “Secret” is not the correct word here.  The proper term in this situation is “private,” as in “none of anyone else’s business.”  HIPAA covers “privacy” rules, not “secrecy” rules.  A medical decision is a private matter, concerning a patient and his or her doctors, and only those other individuals that the patient chooses to include.  A person certainly has a right to publicly share his medical information if he so chooses, but there is certainly no onus upon him to do so.

The article includes references to multiple public questions and comments about private health concerns, including a public comment from a prominent physician, who had never examined, met, nor even spoken with this politician.  I am well aware of today’s general erosion of privacy, but at times the presumptuousness of people simply blows me away.  Unless they are either the patient or the physician of record in regard to a specific medical issue, any politician, member of the press, and anyone else, for that matter, needs to get out of that doctor’s office.

I feel a little better now.  Maybe I shouldn’t have held that in for almost a month.

(*Unrelated note: I would love to build my readership reach.  If you receive my posts via e-mail, and know of others who you think might enjoy my posts, please pass along my blog link to them.  If you are on Facebook, please “like” my Practical Medical Insights page and please feel free to re-post my blog links or suggest my page to others.  Thank you!)

My eldest son, currently finishing his junior year, went to his high school prom this past week.  He had purchased a corsage for his date with ribbons to match her dress, and his date had purchased him a bow tie in the same color.  Cute, yes?

My son gathered all the elements of his outfit for the big evening a day ahead of time, to make sure there was no last minute black-sock-finding crisis or any other such problem.  On prom day afternoon, he started getting ready early.  Plenty of time to spare.  My husband was on his way home, and I went out to pick up the other two boys in time for everyone to head over together to his date’s house to pick her up and walk over to Prom Park (it has a real name, but this park has been used in our community for so many years as a gathering place for pictures before the yearly dance that everyone just calls it Prom Park).

My cell phone rang.  “Hi Mom.  I’m on that how-to-tie-a-bow-tie website, but I can’t get it to work.  This might be a problem.”  “Don’t worry, Sweetie, I’m on my way home.  I’ll figure it out.”  No problem.  I know how to tie a regular tie – how difficult could it be to tie a bow tie?

Apparently, it could be quite difficult.

There were plenty of websites with directions.  And directions were in the box that the tie came in.  And they all described the process in the same way, which involved exquisite detail on how to cross one end over the other and pull it through (the same first step used to tie a shoe), and then going to an incomprehensible step involving six simultaneous movements requiring three hands and a degree in mechanical engineering.  Unfortunately, our mechanical engineer was still on his way home from work, and he also had never actually tied a bow tie.

As this wardrobe step that we had assumed would take five minutes stretched to 25 minutes, I sent the other boys to find a neighbor who knew how to tie one.  No luck.  A few texts to see if anyone at his date’s house knew how to do it.  Also no luck.

But as we were seeking outside consultation, we stayed in front of the computer, looking at different instruction pictures and videos, and kept trying.  It started getting a little closer.  We figured out the first half of the bow.  At this point, we were close to running late.  The second half of the bow wasn’t right – it was folded kind of backwards.  My husband arrived home.  He grabbed the prom tickets from the counter, my middle son grabbed the corsage from the fridge, my youngest son grabbed the camera, and we all went to the car, with me not letting go of the half-bow around my eldest son’s neck.  Still not letting go, I maneuvered into the back seat next to him.  My youngest son buckled my seat belt for me as I folded the second bow half the other way and pulled the end through the knot loop in front.  And it looked like a bow tie.

And I tightened it.  And it stayed.

We worked on evening it out and centering it during the mile-and-a-half ride, with everyone giving input and opinions as to whether it should be under or over the little folded points on the tuxedo shirt collar.  We pulled up at my son’s date’s house and clambered out of the car.  Lots of pictures.  Corsage and boutonniere exchanged.  More pictures.

Two block walk to Prom Park.  Hundreds of very well-dressed juniors and seniors with familial paparazzi following them around, the kids posing in various combinations and permutations with friends met this year, friends from infancy, and friends from everywhere in between.  One classmate, who always wears bow ties (there’s always one, isn’t there?), looked at my son and said “good job on the tie!”  Any lingering doubts my son may have had on the quality of the bow work disappeared with that one line.

The park picture frenzy went on for well over an hour-and-a-half, and then the kiddos piled onto limo buses and were off for an evening of dinner and dancing.  And I had time to reflect on the events of just a couple hours earlier.

In the grand scheme of things, a bow tie is nothing.  Not a big deal.  Even by prom standards, it’s a small thing.  But the saga of this particular accessory can teach, and it can be tied in (get it – tied?) to other life areas, including the medical realm.

Aside from the obvious life lesson that one should practice new things ahead of time, the difficulty of this accessorial knot reminded me of aspects of the art of practicing medicine and of the art of navigating a personal health issue.  When confronted with difficulty, keeping calm and breathing deeply helps significantly.  Panic won’t get you anywhere.  Look for sources of help.  If an expert consultant is not immediately available, read and re-read available writings on the subject.  Look at different pictures, read descriptions, and watch some video.  Looking at a situation from different angles can help you see the whole picture.

If you don’t understand something, don’t give up.  Keep asking questions.  As you’re focusing on the problem at hand, have others around you help with the other details of your life.  If something seems really wrong, it’s ok to start over.  As you get closer to figuring out a solution or plan, keep a tight hold on what you’ve already figured out.  Confirmation from an expert that you’re doing the right thing can be quite powerful.

And remember to enjoy the dance with those around you.

Today, I am in pain.  Here’s the story:

There are many things that I’m good at.  Horticulture is not one of them.  Generally, I kill plants.  It’s genetic.  My mom has generally killed plants, too.  Her explanation is the same as mine:  plants, unlike children and pets, don’t make noise when they need something.  So they will at some point become too dehydrated to make it back to health when I finally see the shrivelled, cracked leaves and dump water on them.  In recent years, my mother has been successful with some tomato plants, and I have had success with some herbs – the power of the food incentive is also apparently genetic.

However, a glaring exception to my horticulturally challenged life is my extreme talent for cultivating weeds in our yard.  There’s actually no mystery here.  We don’t have the fertilizer/herbicide/pesticide truck come to our home.  These chemicals run off lawns and into our ground water supply.  While there may be times when use of some of these synthetic chemicals in moderation may be helpful to our human population, for our family the risks and environmental costs far outweigh the benefit of a pristine lawn.  We’ve looked into organic methods of weed control, and it sounds like corn gluten works reasonably, but apparently it can attract rats, and I’d WAY rather have weeds than rats.  Spraying a mixture of vodka, vinegar and dish soap on the weeds doesn’t work at all.

So we have a really horrible lawn.  In other respects, we are decent neighbors (we share when we bake or when we go apple picking, we return dogs who get out of fenced-in yards, we watch out for things when neighbors are away, etc.), so I generally try not to allow myself too much guilt over the mown-weed look of our yard.  But when the dandelions bloom in the spring, I feel bad.  So yesterday morning, I went outside with a couple of trowels and a dandelion-removing contraption (doesn’t work so well, but switching tools every once in awhile helps break up the monotony and spreads the work to different muscle groups).  And I started pulling out dandelions.

And I kept pulling dandelions.  My husband helped for a few hours.  My 12-year-old helped for a bit.  My 15 and 17-year-olds made fun of my hat, pointed out the futility of my endeavor, and made me lunch.

And I kept pulling.  Different positions.  Switching hands.  Sitting, standing, squatting.  Filled up two yard waste bags.  Like shoveling snow, there was a meditative quality to the work.  There was also a bizarre feeling of triumph with each yanked root.   I cleared about 25% of our front lawn and stopped due to physical exhaustion and the need to pick up groceries.

Which brings me back to today’s soreness.  Apparently, pulling dandelions is an incredible workout.  I hurt in most of the places that personal trainers and exercise videos target.  Muscles in my abdomen, thighs (mostly back, some front, also inner and outer), shoulders, buttocks, upper arms (front and back), upper back and flank are all speaking to me today.  It really was a full-body workout.  And much cheaper than a gym membership.

The dandelions are already growing back this morning in the cleared areas, so I’m set with the muscle-building part of my fitness plan for the summer!