Author name: Diane

pregnant woman
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When Should I Go to the Hospital During Labor?

This is one of the first questions most moms-to-be ask when they reach 37 weeks and become full term. The big problem is that television and movies have led us to believe that labor begins when your water breaks, and then after a grueling hour, the baby is born. However, this is not an accurate portrayal of the labor process, and if you take yourself to the hospital at the first sign of labor, you will likely be sent home. So, how do you know when to go to the hospital? Early Labor Early labor can be difficult to determine. Once you understand what the difference is between Braxton Hicks and real contractions, you’ll know when real labor has begun. Yet, even if you have determined that you are in the early phase of labor, it is still not time to go to the hospital. Labor is a long process, so the longer you can spend in the comfort of your home, the better. During this phase, your cervix is effacing and dilating to about three centimeters. As this is a gradual process, the contractions are fairly mild and easily managed without the use of any pain management techniques. Use this time to get some rest because you are going to need it. This is also the time to enjoy a final meal since you won’t be able to eat or drink anything in the hospital until after the baby is born. Active Labor Once your contractions get to be about five minutes apart, you have successfully transitioned into the active phase of labor and this is when you want to go to the hospital. At this point in the labor process, the contractions have likely become more painful, making it uncomfortable to labor at home. We would love to be able to tell you that since you are now in the active phase of labor, the baby will be arriving shortly. However, this is not usually the case. While this phase of labor is much shorter than early labor, it can last up to eight hours or even more. As the pain has become more severe, it is during this phase when you will get an epidural, if you want one. When Does My Water Break? As far as the breaking of the water goes, it varies from person to person. Typically speaking, it will break when your cervix is almost fully dilated. It is funny that pop culture has portrayed the breaking of the water as something that signifies labor has begun, when in reality it is something that happens near the end of labor. Of course, there are circumstances in which the water does break before labor begins, and in these situations we recommend you call your obstetrician or midwife immediately for advice on when to go to the hospital. Since your water has broken, you do not need to wait until active labor has begun. If you have any other questions about labor, do not hesitate to ask your midwife or obstetrician at your next prenatal appointment.

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Eating Fish During Pregnancy: What’s Safe and What Isn’t

In slight continuation of our “Is it Safe to…” blog post from last week, one main question on lots of mamas-to-be minds is getting enough omega-3’s to help with baby’s development. Omega-3’s have been reported to help promote healthy fetal brain development, and reported benefits include fewer behavior problems, better verbal skills, and even higher IQ’s. However, understandably, some pregnant mamas are concerned with the levels of mercury in certain fish, and knowing which fish to eat to gain this important nutrient and which to avoid can be tricky. Cherokee Women’s Health shares some important facts on which fish are safe to eat and which fish you should avoid until after your delivery. Happy Fish, Sad Fish, Good Fish, Bad Fish The FDA and EPA say pregnant women can safely eat up to 12 ounces of seafood a week. So which fish is best for pregnant moms? Ideally, you want to shop for or order fish low in mercury but high in omega-3’s. Salmon makes for an excellent choice in both categories (whether wild-caught or farm-raised). Herring, trout and sardines are are low-mercury, high-omega-3 options. Other safe choices include shrimp, pollock, catfish and canned light tuna, but you should limit albacore tuna and tuna steak to no more than 6 ounces a week. The fish found to have higher levels of mercury include shark, swordfish, escolar, marlin, and orange roughy. Pregnant women are advised to limit these to twice per month. Other Safety Guidelines Of course, when eating any type of fish, you want to make sure it’s cooked to an internal temperature of 145 F. As a general rule, the fish is done with it separates into flakes and appears opaque throughout. For shrimp, lobster and scallops, cook until they’re milky white, and don’t eat any clams, mussels and oysters until their shells open. (And discard any unopen shells.) If you aren’t sure about the best way to prepare it, Pinterest has a ton of delicious-looking options that are sure to whet any pregnant mom’s appetite. If fish has you thinking “yuck,” don’t worry – there are other ways to get omega-3 fatty acids. Flaxseed, walnuts, sunflower seeds, pine nuts and soybeans are all good sources of omega-3’s, and other foods have been fortified with this nutrient, including yogurt, milk, and eggs. Additionally, you can talk to your obstetrician or midwife about an omega-3 supplement at your next prenatal checkup.    

woman with gestational diabetes
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What is Gestational Diabetes?

Gestational diabetes, a high blood sugar condition that some women get during pregnancy, can occur sometime between the 24th and 28th week of pregnancy. Most women will come in for their glucose screening and glucose tolerance tests, which determine if you have gestational diabetes. If you have been diagnosed with gestational diabetes, this article will help shed some light on what it means for you and your baby. What Causes Gestational Diabetes? Gestational diabetes occurs as a result of hormonal changes during pregnancy. Increased levels of certain hormones interfere with the body’s ability to manage blood sugar. This condition is known as insulin resistance, and as the placenta grows larger during pregnancy, it produces more hormones, increasing the resistance to insulin. If a pregnant woman’s pancreas is unable to produce more insulin to overcome the effects of additional hormones in the body, blood sugar levels will rise, resulting in gestational diabetes. Treatment for Gestational Diabetes For women who test positive for gestational diabetes, there is extra treatment and doctor’s visits required, with the goal of making sure that blood glucose levels remain at a normal level. Treatment will most likely involve special care when it comes to diet and exercise, and checking your blood sugar levels daily.  We Can Help If you’re diagnosed with gestational diabetes, it’s important to maintain regularly scheduled prenatal checkups. Your provider will check your blood pressure and test a sample of your urine, as well as discuss your blood sugar levels, your diet and exercise routine and how much weight you’ve gained. If you’re due for your next prenatal visit or are concerned about gestational diabetes, call us at 770.720.7733 or schedule an appointment online at either our Canton or Woodstock location.

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“Is it Safe to…” During Pregnancy: Common Questions

Whether you’ve been trying to get pregnant for a long time or you discovered a happy accident, the moment a woman realizes she’s pregnant, she often begins to think of all the things she once did or likes to do, wondering if they’re still OK to continue during a pregnancy. The good news is, your list of pregnancy “don’ts” is much smaller than you might think, and there’s still a lot you can do during the next nine to ten months. Cherokee Women’s Health Specialists has compiled a few of our most asked “Is it safe?” questions here on our blog this week. Read up and know that you’ve got an exciting nine months ahead! Is it safe to color your hair while pregnant? Many women begin coloring their hair long before pregnancy, and often wonder if it’s still safe to do so once they see those two little lines. For these women, the good news is that very little chemicals in the hair dye are actually absorbed into your system, and as long as you’re coloring your hair in a well-ventilated area and using protective gloves (if you’re doing it yourself), you should be perfectly fine. If the idea of coloring your hair during pregnancy still concerns you, you can wait until your second trimester when baby is less vulnerable. Is it safe to be around paint while pregnant? One of the most exciting things for a pregnant mother can be decorating a new nursery. Naturally, selecting a wall color for baby’s room is one of the first steps in creating the mother’s ideal space, but what about painting it? The type of paint used is the key here. Latex, or acrylic paint, is the most common and is generally considered safe to be around while you’re pregnant as long as you’re in a well-ventilated area. If you start to feel sick or nauseous at all, get some fresh air and have someone else finish the job. It’s best if you avoid using oil-based paints on your own, but you can let someone else do this for you as long as you’re not around while they’re doing the work. Lead-based paints are a strict no-no, and if you have to have some removed, make sure you’re not home during the process. Afterward, you should be fine to return to the home. How much caffeine consumption is OK? If you’re used to waking up with a cup of coffee or have to have a soda in the afternoon to help with that afternoon crash, there’s no reason for you to give caffeine up entirely during pregnancy unless you’d like to. Experts have stated that moderate levels of caffeine have not been found to have a negative effect on pregnancy, with the definition of moderate varying between 150mg-300mg a day. For reference, there’s about 259mg of caffeine in a 16oz Starbucks House Blend Coffee. If you’re concerned about caffeine intake during pregnancy, you can always talk to your provider at your next prenatal checkup. What medications are off limits during pregnancy? Another concern of newly pregnant mothers is making sure that if needed, they’re taking only the medications that have been cleared by their doctor during pregnancy. At your first pregnancy checkup, your provider will send you home with a complete list of medications that are generally thought as safe to use, including treatments for pain like Tylenol, treatment for nausea, cough and cold, and other symptoms. If at any point in your pregnancy you’re unsure about a medication, it’s always best to ask your doctor before taking it. While these questions are just a sampling of the many questions we hear from patients during prenatal visits, we urge our patients never to be shy about asking questions. Having an open communication with your doctor or midwife during your pregnancy is the key to having a safe and healthy pregnancy. To schedule a prenatal visit at either our Woodstock or Canton office, contact our office by calling 770-720-7733.        

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What’s the Best Advice for New Parents?

Bringing a new baby home is one of the most exciting exciting experiences new parents can have. Understandably, new parents may feel overwhelmed with all of the advice and information available, and trying to get a feel for what works best for you and your new family member can be daunting. In the spirit of Valentine’s week, the Cherokee Women’s Health team wishes to share some of the most helpful advice for new parents that we know to be true: Quite simply, love each other, as this models a healthy relationship for your new child as they learn and grow. Need a Relationship Pick-Me-Up? If the upcoming romantic holiday has you thinking that your relationship (whether it involves a new baby or your children have flown the nest) could use a little pick-me-up, why not try one of these ideas that don’t have to end with Valentine’s Day: Try something new together. Test out a new restaurant, sign up for a cooking or dancing class, or see if you can steal away a night from the kids in the Georgia mountains. Laugh. Laughter is of the essentials to building a strong, healthy relationship. It brings people closer together, creates intimacy, and helps resolve conflict. Eat healthy. A colorful diet full of fruits, veggies and plenty of protein will not only help you feel better, it might help put you in “the mood.” Common aphrodisiacs include oysters, figs, almonds, and avocados. Take a walk. Exercising together, even if taking a quick 30-minute stroll, can help increase blood flow, which helps boost mood, reduces stress, and can lead to a bigger desire in the bedroom. Remember that you’re a team. If anyone can attest to the trials and tribulations of family and marriage, it’s Dr. Litrel and his wife, Ann. Try to remember that you’re not alone in your struggles, and that if you can work as a team, your entire family will benefit. If your family is growing this month, we hope that you have the love and support needed to help inspire your children to grow up and experience healthy relationships. If you’re done adding to your family, what other advice would you give to new parents about starting a family? Share with us by leaving a comment below.

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Maintaining a Healthy Weight During Pregnancy

Moderate weight gain during pregnancy is absolutely normal – after all, you are growing a tiny person in your uterus! However, making sure that you’re gaining the right amount of weight for your body type is important. Gaining too much weight during pregnancy poses health problems including an increased risk of gestational diabetes, hypertension, and other serious complications. How Much is Too Much? At your first prenatal visit, ask your OB/GYN how much weight gain is appropriate for your current weight. For example, a woman who was average weight before getting pregnant should gain 25 to 35 pounds after becoming pregnant. Underweight women should gain 28 to 40 pounds. And overweight women may need to gain only 15 to 25 pounds during pregnancy. Tips on Keeping a Healthy Weight During Pregnancy To make sure you’re staying on track with a weight gain that’s right for your body type, here some ideas on maintaining a healthy weight during pregnancy. Contrary to popular belief, there’s no need to “eat for two.” In your first trimester, you only need about 30 extra calories per day, and in the third trimester, only 300 extra calories a day. Adding a healthy, filling snack into your normal routine should cover the need for these extra calories. If you were exercising before your pregnancy, it’s normally OK to maintain your current workout routine (Although make sure you’re cleared by your doctor first). Reduce consumption of sugar, fat and salt. Sugar and fatty foods pack on unwanted extra pounds quickly, and too much salt can increase swelling in your hands and feet. Make sure you’re getting enough sleep. Plenty of sleep allows for healthier weight gain, improved mood, and may help for easier weight loss after pregnancy. If you have any concerns about how much weight gain is recommended during your pregnancy, be sure to discuss them with your provider at your next visit. To set up your next prenatal visit at either our Woodstock or Canton location, you can contact our office.

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C-Section – What to Expect

When pregnant women hear the word cesarean, fear can build up not knowing what to expect. Here, we explain why you might need one and what to expect during the procedure. Why You Might Need a C-Section Your OB/GYN might need to perform a scheduled or unscheduled C-section, depending on the health of you and your baby. Some, but not all, reasons to need a scheduled C-section include: An illness or congenital condition in your baby that might make delivering vaginally more difficult. If your baby is too large to move safely through the birth canal If your baby is in the breech position and can’t be moved You’re having triplets or more Placentia previa, or when the placenta is blocking the cervical opening or abruptio placenta, when it has separated from the uterine wall. If you develop pre-eclampsia, which is pregnancy-induced high blood pressure, and treatment isn’t working. In addition to these situations, your doctor might decide that the safest route for you and your baby is an unscheduled C-section. This might happen if you were laboring normally in the early stages of labor and then quit progressing, or if you or your baby start showing signs of distress or have other complications. What to Expect During the C-Section Procedure One of the first things to happen before a C-section is anesthesia. This is usually either an epidural or spinal block so the lower half of your body is numb but you will remain awake. Next, you will be prepped by shaving your abdomen and pubic hair in the area of the incision, and and the operating room staff will insert a catheter into your bladder. They’ll also place sterile drapes on your stomach to cover the actual incision. Once you’re completely numb, the doctor will make a horizontal incision about the length of your middle finger just above your pubic hair line. Then, the doctor makes another incision in the lower part of your uterus, and you will probably feel a fair amount of tugging as the operating room staff move your baby into position so that the doctor can safely and gently pull your baby’s head out. Next, the umbilical cord is cut and the surgeon removes your placenta, followed by the process of stitching you back up, starting with your uterus then the outer layers and skin are realigned and stitched back up either with dissolving stitches or staples. Most new Moms rarely notice this part however, as they’re bonding with their newest addition to the family. Watch this short video from the Mayo Clinic to see what to expect during a C-section procedure. (Please note: Certain parts of this video are graphic). After a C-Section Women can expect many of the same symptoms during the recovery from a C-section as they would have from a vaginal delivery, including afterpains as your uterus contracts, postpartum bleeding, discomfort in the perinal area, and exhaustion. On the second day, they will remove the catheter, and you’ll be able to try and walk around and go to the bathroom. The typical hospital stay for a C-section is 3-4 days so the hospital staff can effectively monitor you post-surgery. After two weeks, you will have a follow-up appointment with your doctor to check the incision, and at six weeks you’ll have a postpartum visit. Communicating With Your Doctor If you’re concerned about having a C-section delivery, talk to your doctor or midwife about your labor preferences and have a clear plan in place. Discuss any concerns about your pregnancy that might affect your ability to deliver vaginally and talk to your doctor about your thoughts on C-section. By having an open dialogue during your last few prenatal visits, you can be sure you’re on the same page to providing the best care for you and your little one.

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What’s the Difference Between Braxton Hicks Contractions and Real Contractions?

Contractions are a part of the rising action in pregnancy that lead up to the climax of birth. In the anticipation prior to delivery, many women wonder if they are experiencing true or false contractions. False contractions, or Braxton Hicks contractions, are a common part of pregnancy. While no mom wants to arrive at the hospital too early, you also don’t want to risk giving birth in a car. Here’s a quick rundown on what they are and how to tell if you’re experiencing Braxton Hicks contractions or if you’re truly going into labor. What are Braxton Hicks Contractions? Braxton Hicks contractions are experienced when the uterus irregularly contracts, typically during the third trimester. Also known as “practice contractions,” they are considered the body’s warm-up or rehearsal for actual labor. They can be triggered if mother or baby are very active, if someone touches the mother’s belly, when the bladder is full, after sex or because of dehydration. How do I Know if I’m Having Braxton Hicks Contractions? Generally, Braxton Hicks contractions are weak and irregular, while true contractions will get stronger and closer together. In an effort to help determine if your contractions are Braxton Hicks or the real deal, there are a few things to look for: Time between contractions: You can time your contractions from the beginning of one contraction to the beginning of the next contraction. If the time between contractions is inconsistent, or if it does not get shorter, then you are most likely experiencing Braxton Hicks contractions. If you are experiencing more than four contractions in a one hour period, it is a good idea to contact your OB/GYN or midwife. Varying strength of contractions: If the contractions that you are experiencing are not consistently getting stronger, that is another sign to point you away from actual labor contractions. True contractions will get stronger as your body prepares for delivery. What if I’m Still Unsure? If you are still unsure as to whether or not the contractions you are experiencing are true contractions or Braxton Hicks contractions, it’s a good idea to call your doctor just to make sure. Here are a few additional resources regarding Braxton Hicks contractions: The Bump-Braxton Hicks Contractions What to Expect – Braxton Hicks Contractions The American College of Obstetricians and Gynecologists – How to Tell When Labor Begins

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Hospital Bag Must-Haves

  One of the things that new moms-to-be can do to help with any pre-delivery jitters is getting their hospital bag packed and ready to go at a moment’s notice. Most experts agree that pre-packing around week 34 or 35 will ensure that you still have plenty of time before you need to grab it and go. Packing some of the “comforts of home” items will help keep you calm and minimize unwanted stress when it comes time to the actual delivery. We researched some of the best Mom blogs on the Internet and Pinterest and here’s a list of some of of the absolute must-haves when packing your hospital bag. Documents & Paperwork While not terribly exciting, be sure that you have all the necessary documents and paperwork you might need, such as: Identification Insurance information Birth plan Toiletries That first shower post-delivery will feel oh-so-good. Bringing a travel size bottle of your favorite body wash can really bring a small comfort of home into your hospital room. Here some other toiletry items to pack: Travel bottles of shampoo & condition Travel size bottles of skincare items like face wash and moisturizer Deodorant Hair ties or headband to keep hair out of your face Make-up, if you want it Clothing After delivery, your wardrobe should be all about comfort. Don’t forget the following: Comfy robe Pajamas with open-front top Nursing bra(s) 2-3 pairs of comfy, non-skid socks Loose, comfortable outfit to wear home 2-3 pairs of loose maternity underwear, preferably those that you don’t mind if they get ruined. Slippers / comfortable shoes Change of clothes for your partner and/or siblings Electronics & Miscellaneous Cell phone and charger Camera Snacks (in case the hospital’s kitchen is closed) Tablet (For dad and for you, in case your labor is long) Baby Items Approved car seat A coming-home outfit 2-3 warm blankets Season-appropriate clothing like hats, mittens and coat And a few other helpful resources: Daily Mom – Hospital Bag Necessities The Bump: Packing a Hospital Bag Parents.com – The Ultimate Hospital Packing List What other items do you plan on packing in your hospital bag? If you’re done having babies, is there an item that you’d recommend to new moms? Share with us by leaving a comment below!  

Nutrition and Weight Loss

Managing Realistic New Year’s Resolutions

Once the dust from the Christmas holiday begins to settle, lots of people use the days in between to begin thinking about their resolutions for the upcoming year. A common theme for New Year’s Resolutions are health-related, whether it’s losing a few pounds, starting an exercise routine, or adding more healthy foods to your diet. With everything they have to juggle each day, many women make health-related new year’s resolutions with good intentions, only to stall due to family obligations, a lack of time and energy, career demands or other culprits. Allowing a little wiggle room in your resolutions can help you stick to them easier while managing everything else in your schedule. Here are a few suggestions: 1.) Instead of going on a diet, resolve to maintain healthy portion sizes and add more fruits and vegetables. Women are known for vowing to try the “next big thing” in dieting, and crashing and burning because their bodies aren’t conditioned to such rapid changes. Instead of a diet, opt for portion control. Instead of banning all things sweet, indulge in a treat once in a while to reward yourself for good choices throughout the week. Focus on getting adequate amounts of whole grains, fruits, vegetables, calcium and fiber. 2.) Getting more physically fit. If getting to the gym more often is one of your goals for 2014, you can help achieve your goals by making simple changes. According to Saralyn Mark, MD senior medical adviser for the Office on Women’s Health in the U.S. Department of Health and Human Services, “walking a little bit further in the parking lot, using the stairs, or raking leaves (and other yardwork)” will offer some of the exercise your body needs. Setting realistic goals that are well-defined will lead to greater success over making a goal to lose 20 pounds.  3.) Make time for self-care. Taking a little time for yourself (massage, anyone?) can vastly improve stress levels. Many women find themselves in the role of mom, spouse, sister, daughter and so many others that they forget to take time for themselves to regroup. Stress can affect the body in a number of ways, including anxiety, depression, digestive problems, heart disease, sleep problems, weight gain, and memory problems. Managing stress can help keep you healthy, and has been shown to link to diet and exercise in terms of maintaining overall health. In addition to these important resolutions, make sure you visit your OB/GYN for your annual well visit. This is a perfect time to talk to your doctor regarding your overall health and to discuss any issues you may have. Contact one of our offices to schedule your next visit. Happy New Year from Cherokee Women’s Health Specialists!

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Surviving Holiday Travel With a Baby

  Holiday travel – two words that can incite overwhelming fear into the hearts of new mothers everywhere. How will your baby react on an airplane? Can you spend 6 hours in a car with an infant? What if junior doesn’t nap well over at grandma’s house? All these thoughts are enough to make a new mother stay home, but with a little planning and a lot of patience, you can enjoy visiting during the holidays without losing your mind. Here are are few of Cherokee Women’s Health‘s favorite tips and tricks to surviving holiday travel with a new baby. Traveling with a Baby Expect delays. Even during regular holiday travel, not everything runs as smoothly as it should. This is especially true when it comes to traveling with a baby. Pack extra finger foods or bottles in the event of a delay. If you’re formula feeding, pack more formula than you think you’ll need (but be mindful of the restrictions of liquids allowed – bring the powder to mix up as-needed). Pack extra diapers, wipes, and a change of clothes for baby and for you. You never know when a blowout might occur, leaving you stranded without an extra set of clothes. For older babies who might be newly mobile, plan for plenty of rest stops if you’re traveling by car or allow for some time in the airport before you board to exert some of that curious crawling. To ease ear pain often caused by airplane takeoff and landing, offer your baby a pacifier, bottle or sippy cup. Here’s a helpful link offering even more tips on airplane travel with a baby. Maintaining a Sleep Schedule One of the toughest things about traveling with a baby or toddler is maintaining their normal sleep schedule. No nap or a night filled with more wake-ups than usual can make even the sweetest babies cranky. If at all possible, don’t plan activities during your baby’s normal nap time. If you have a baby that naps once in the morning and once in the afternoon, try to plan a holiday lunch gathering to accommodate the sleep schedule. If you’re traveling, pack all of baby’s favorite sleep essentials. Maybe a blanket or a soft toy that will help soothe them, even in a new space. Books, favorite music or a sound machine can also work wonders to help get baby to sleep in a new place. A few days before you leave, set your baby to sleep in the pack n’ play where she’ll be sleeping during the visit. This will help her adjust to a new sleeping space, and it won’t be such a shock when you arrive at your destination. If you’re crossing time zones, get your baby used to the different sleep times by slowly inching up naps and bedtime a few days before leaving. If you’ve already “been there, done that” as far as holiday travel with kids, what other suggestions would you recommend? Share by leaving a comment below, and safe travels to all from Cherokee Women’s Health.

Dr. Litrel's Blog

Holiday Stress Can Be Hazardous To Your Health

We listen to our patients! And we can say with certainty that women feel the stress of the holidays more than men. Many of the activities that make the holidays special are carried out by the woman – gifts for loved ones, holiday cooking and celebrations, hosting guests and family in your home. Those responsibilities can lead to a sense of being overwhelmed, and even take a toll on your health. Here are three important but easy tips to keep in mind during your holiday celebrations:  1. Don’t abandon healthy habits. Don’t let the holidays become a free-for-all. Overindulgence adds to your stress and guilt. Have a healthy snack before parties so you don’t go overboard on sweets, cheese or drinks. Continue to get plenty of sleep and physical activity. 2. Take a breather. Make some time for yourself. Spending just 15 minutes alone, without distractions, may refresh you enough to handle everything you need to do. A short walk outside can do wonders. Look around at what you see to get “out of your head”. You will be amazed at what this simple action can do!  3. Be realistic. The holidays don’t have to be perfect or just like last year. As families change and grow, traditions and rituals often change as well. Choose to hold on to a few, and be open to creating new ones. For example, holiday dinners can be potlucks, with shared responsibilities; they don’t have to be an exercise in perfect decorations and menus. Dr. Litrel talks about a family holiday celebration that didn’t start off in quite the right way in this excerpt from his new book “Family – A MisMatch Made In Heaven: Surviving True Love, Children, and Other Blessings In Disguise“.  Holiday Crackers My doctor partners and I take turns being on call for the holidays: one of us has to be ready to run to the hospital if needed. Last year, my turn fell on Thanksgiving, but with no patient emergencies, I found myself, to my surprise, sitting down to the big dinner with my friends and family. As I looked across the table at my loved ones and listened to their loud and animated conversation, I noticed they all seemed to be in various states of inebriation. I was not joining in the festivities of the fermented grape. No, I was on call and had responsibilities. After a while, I began to wish that the hospital would actually call me. Nothing is more annoying than being the only sober one at the dinner table. Particularly when you paid for all the wine. I sat at the table and thought about my unhappiness. The way I saw it, I had three choices… One, I could make sure I wasn’t on call the following year so I could join in the frivolity worry-free. Two, I could cultivate new friends and family relations, ones less inclined to intoxicate themselves at holiday meals. Or three, I could view this moment of unhappiness as a spiritual lesson and walk more strongly the path of Love, steadfastly refusing to experience unworthy, lesser emotions. It was a no-brainer; I decided just not to be on call again. Holidays are stressful, but particularly so for women. Women are more aware of the subtleties of celebration. They put effort into esthetic touches that would never dawn on a man. The intention, I believe, is to manifest beauty. But occasionally the result is marital conflict instead. Every Thanksgiving, Ann makes six dozen homemade crackers called Cheddar Crisps. They come in three flavors: cracked blacked pepper, caraway seed, and something called nigella seed. I never heard of nigella seed either; she orders it special online. After watchfully monitoring the baking time and removing these handmade creations from the oven to cool, Ann carefully sequesters them in a tin box to be doled out at the proper moment. She serves them with a small bowl of homemade butternut squash soup – right after we say grace, and before we sit down for the main meal. Every guest is given three crackers, one of each flavor. You feel yourself handling each one as though it’s Great Grandma’s favorite antique tea cup. As far as crackers go, the Cheddar Crisps are delicious. Unfortunately, I am more a Ritz cracker kind of guy, accustomed to shoveling large quantities of whatever I am eating into my mouth until I am full. So for me, this cracker moment represents holiday stress. How do I express genuine appreciation for the work my wife has put into this pre-Thanksgiving snack, without conveying my true thoughts? Stop wasting so much time already – they’re just crackers! So I channel Effete Cracker Connoisseur and solemnly critique the subtleties of each flavor – how the steam from the soup opens up the palate so one can fully appreciate the differences. The next year I finally got my wish. I was not on call, and there were no homemade crackers to be found! I noticed a few things that surprised me. Free to imbibe a glass of wine now that I wasn’t working, I found I did not want any, but chose instead sparkling water. I also noticed that my holiday guests were not the sodden idiots inclined to boorish conversation that I remembered from the year before.  They were actually beautiful people I am blessed to have in my life. Perhaps the previous Thanksgiving I had been just a tad bit grumpy. But the thing that surprised me most was that I actually missed Ann’s homemade crackers. It’s not always easy for a man to appreciate the attention to detail an effortful woman brings into her family’s life. Sometimes what she does seems frivolous. And God knows, sometimes it’s expensive. But there is a reason for a woman’s efforts, and this I understand – as a father, as a husband of twenty-five years, and also as a physician who has listened to so many of his extra effortful patients over

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