You can never be “too Allen.”

Image result for Friends

With the launch of HBOmax the other day, my world was rocked to discover that Friends had jumped ship to HBO after disappearing from Netflix. Life was whole again! I, like much of America, still hold on to my love for that bunch of 20 somethings who modulated flawlessly into 30 somethings while still looking fabulous and maintaining a lifetime of friendships. I started with episode 1 and just kept going…for the 100th time. I go to the episode when Monica finally was dating a guy named Allen that the whole group liked…a little too much for Monica’s comfort. They couldn’t get enough of him and even hung out with him when Monica was not around. This should have made Monica ecstatic right? She had been saying for years( as far as we know, because this was only 3 episodes in…lol), that she really wanted to find someone that her friends liked. Instead, she broke up with him right away, devastating her friends and then went on to her next series of unhealthy, unhappy relationships. It seemed like she was so intent to take complete ownership of her relationship decision that she was willing to sacrifice potential happiness rather than give her friends credit for perhaps seeing something that she wasn’t able to.

This brings up several questions. Do we really want the approval of our friends as much as we say that we do? Does that outweigh our own need to make our own decisions? Are we always able to make healthy decisions for ourselves without input? Do we sometimes make a bad decision intentionally just to say that we did it on our own? Do our friends know us better than we know ourselves? Do our emotions rule our decisions?

Ok, that is a lot of questions. Let’s break this down. All human beings have an innate inclination toward having some kind of control over our lives. We like to be in charge of our own decisions, no matter how trivial they may seem. We say we want our friends’ input, but really our natural impulse is to ultimately make the decision of our choice, not theirs, regardless of the consequences, just to say that we did it. That’s who we are. Even the most collegial of humans have a need to have the final say in the topic of choice.

Psychologists all over the world have studied human decision making. There are multiple theories about the decision making process. One theory says that the decision making process involves 7 steps: 1) Identify the decision to be made, 2) Gather relevant information, 3) Identify the alternatives, 4) Weigh the evidence, 5) Choose among alternatives, 6) Take action, and 7) Review your decision. Other theories do not break down decisions into steps. They say that there are only two types of decisions: Habit decisions and Goal-directed decisions. Habit decisions are made on a more impulse-based process. Goal-directed decisions are made based on information and logical thinking, but research shows that you can’t give a person more than four pieces of information to evaluate without actually slowing down the decision making process or stopping it all together.

We like to think that we are logical in our decisions and that we carefully weigh the alternatives, we gather info and look at our options. However, it is just not possible that we are logical in all of our decisions. Our brain actually makes hundreds of decisions per day without any kind of logical think through. Here I go bringing up research again, but, it shows that the bulk of our decisions are actually unconscious and actually involve emotion over logic. Researchers have studied brain activity during decision making. They were actually able to determine what choice the subjects were going to make on average of 7 to 10 seconds before they even realized that they made a decision or verbalized it. Let’s take a look at the emotional component of decision-making. The somatic marker hypothesis also suggests that decision making is a process that depends on emotion. We know that the ventromedial prefrontal cortex (vmPFC) of our brain is key in processing emotional signals that are essential for guiding our decisions to our advantage. The vmPFC helps regulate fear. and stops you from continuing to be afraid in certain situations. It modulates conditioned fear and helps you let go of it and be able to make a decision. Our amygdala is also a key component in processing emotional signals but it’s role differs slightly from our prefrontal cortex. The amygdala is where conditioned fear responses are created and continued. Damage to either of these areas affects decision- making. There you go: more evidence that decision making depends on emotion. I will take this a step further and add that emotion plays a role in helping others with their decisions. For example, you can’t effectively help someone change their mind about something unless you begin to truly understand how they feel about it in the first place. Otherwise, you cannot really make any arguments of influence. It makes sense, doesn’t it?

I am glad that we have established that we are not robots and that we do not make cold, calculating emotionless decisions every day. I personally view this as a positive but I am in the minority. It is interesting to me that the concept of emotionally -influenced decision making is still vastly greeted with skepticism and negativity. This is exemplified in phrases like “clouded by emotion.” Gender discrimination in the work place abounds based in large part by the misconception that women are more inclined to utilize emotionally based decision making more often than men. Therefore, women are often looked over for high powered management positions if a male candidate is available. This has a negative connotation implying that the weighing of emotional factors implies a sense of weakness or irrationality somehow. Based upon what I’ve told you this bias does not make any sense. All humans make decisions based on emotional input, regardless of chromosomes and regardless of whether they are aware of it or not. It is a scientific fact. Does emotional have to equal irrational? Absolutely not. Emotions are just part of what makes us human. Emotions and decisions are intertwined and not likely to become untangled anytime soon and that’s what makes life interesting and unpredictable. Have a fantastic day everyone!

Dr. Katz

I am so over being productive.

Image result for Frustration

This whole pandemic has definitely been a test of strength, fear, ingenuity, and self-direction. Ever since that fateful day in March when the governor issued the stay-at- home order, life has changed. I have to admit that initially I mentally greeted the stay-at- home order with a positive spirit and a can-do attitude. I got creative at home. I spent more time with my kids. I told myself that having less patients meant more ME time that I could do with as I pleased. I cleaned rooms and reorganized, creating soothing spaces for each of my family members. I tried to read more. I tried to get to each and every project that had been hanging over my head..sometimes for years I spent more time with all of our pets… probably too much so for my dogs’ liking. I think they have not been on their recommended nap schedule for months. My overzealous attempts to lavish them with affection 24 hours a day amd dress ridiculous outfits seem welcome on the surface, but I think they are just humoring me. They would really rather be getting their 15 plus hours of sleep a day. Or, they are just too tired to fight me over dress up time…lol.

I have a vegetable garden for the first time in years. I was always too afraid that I would mess up the over the top landscaping the previous owners put in. Now, I have thrown caution to the wind and dared to add my own accents and a raised garden on our deck. This is all fine a good until I eventually get to return to a regular office schedule and have to rely on my 16 year old to water it.

Once the back and forth conflicting executive orders stabilized, we were able to enjoy our quaint little cottage as well. By little I literally mean small..800 square feet. It is not a clever euphemism. It is our little patch of Heaven. I literally find my mood magically transformed just by getting in the car to go there. That is the special magic that it has. Despite the close quarters, I think we all get along just a little better when we are there.

All these things sound great….and they are, but they don’t paint the whole picture of pandemic life. The work side is crazy, but maybe not in the way that you would think. I am either at the hospital 4 hours or 25 hours and everything in between. Between asymptomatic carriers and everyone else, we are potentially exposed every day without knowing it. We dutifully take all precautions daily. I take note of all the accolades for front line workers and sing their praises also. I think that people only think of frontline workers as those in the ER or in the ICU, but truly they are everywhere. We need to recognize that. The frontline is potentially everywhere.. That’s why we all need to do our part. Please do not misunderstand. Clearly those working with the sickest of patients deserve the lion’s share of the praise. Those situations are by far the scariest. I just mean that all of us in Healthcare or in any situation that deals with the public are facing risks as well.

The office is stressful not just because of potential exposures. It is also stressful because of lack of activity. Arbitrary decisions by outside forces have attempted to render me non-essential, therefore driving patients away from my practice. I can barely fill two days of office per week but spend my days not in the office answering patient questions and offering reassurance. I spent a lot of time on social media, trying to offer support and reaffirm my presence for patients and friends. I also try desperately to come up with that perfect ad that straddles the line between reassuring and tacky to remind people to please start utilizing my business when it’s allowed. My goal is to not only survive this virus but also the potential economic ruin it leaves ( or at least the government leaves) in it’s wake.

I feel for every small business out there. I am an independent business person as well. There is no hospital backing or unemployment for me to fall back on. I have one business at 0 percent since March and one business at 20 percent. It won’t be enough if we have to hold back much longer. And yet, some equipment lenders still want their blood from this turnip. It’s as if threatening me will magically add some numbers to the zero in my bank account so that I can immediately give it to them. Go ahead. Knock yourself out I guess. I feel like a worldwide pandemic with a side of economic ruin is a legitimate excuse as any for not being able to pay all your bills right now, but who am I to say? I mean, that one has to rank pretty high up there, doesn’t it? I didn’t make it up. I am not that creative. I get it, they want their money too. However, I feel like their millions and billions of dollars in potential resources just might allow them to hold out a bit longer than I can.

I am not ready to give up. On the contrary. I am ready to snap my fingers and have this be all over. I want my staff back in the office every day, but I can’t blame them for enjoying their unemployment and I can’t blame them for not being cognizant of all of the potential overdue projects spinning around in my head if I don’t tell them. It’s just that sometimes I run out of energy to keep fighting to keep myself and everybody else motivated to keep going. I get tired of fending off everyone’s misdirected frustrations. Sometimes the perceived uneven pressure seems unfair. Sometimes I get resentful and childish and decide that no one understands like I do the potential full ramifications of this pandemic. This is ridiculous and egocentric thinking of course, but I fall prey to it from time to time. Those are the days that I find myself completely “over it” and absolutely done with coming up with new business survival ideas. Those are the days when I am definitively uninterested in being productive or putting on a brave face. Those are the days when the weight of the entire world seems to be on my proverbial back.. I feel the urge to pout or cry or yell and let the cork that is barely holding my emotions in to go flying. Sometimes the tears just start coming and I cannot stop them. Then, when it is just about too late, I stop and check myself. It really is no one’s job but mine to worry about my business or my future and it is unfair of me to even expect other people or employees to help carry the weight of all my worries. It just doesn’t work that way. I just have to figure it out myself…..and I will. This thing is NOT going to get me. Have a fantastic day!

Dr. Katz

Seeing the Animal Out of it’s Cage

Image result for person seeing a celebrity pic

I was at the grocery store awhile ago, maskless and reckless before the days of COVID. I was innocently browsing in the fresh vegetable section when I suddenly heard a loud OHMIGOD! What are YOU doing here?! I swear I almost jumped a foot. I then turned around to see a patient of mine, smiling broadly with a look of general astonishment. It was as if she had just seen an exotic animal out of it’s cage for the first time. I chuckled inside. Was she serious? Was there more than one reason for someone to go to the grocery store? I struggled for a minute to come up with a clever and quippy answer like “It’s my butler’s day off” or something otherwise brilliant. Instead, I merely fired back with a mundane “Well, I needed groceries I guess, ” somewhat disappointed in myself. She definitely seemed disappointed. I am not sure what answer she expected, but, whatever it was, it was a better one than I gave. I felt like I really let her down somehow. It was as if I killed my celebrity status with one sentence. Celebrity?! Me?! Sorry. No celebrities here. I am just a regular gal with no servants or accessory personnel to help me plod through the day to day. I still cook, clean, do yardwork, maintain a full time job, the whole shebang.

I guess the question really is, are doctors supposed to be celebrities? I don’t mean the actual celebrities like Dr. Oz or the cast of The Doctors. Those are obvious. I mean the rest of us. What does the word celebrity even mean? According to Webster’s dictionary, the term celebrity refers to the fame and wide pubic recognition of an individual, group, or a particular animal as a result of the attention given to them by the mass media. Celebrity status is often associated with having wealth. It also says that people may become celebrities due to media attention on their lifestyle, wealth, controversial actions, or for a connection to a famous person. If this is the criteria that we are using, then I definitely do not qualify. To date, I have no mass media attention, (for anything good or bad), I have not been the pinnacle of controversy, and I definitely do not possess any excess of wealth(lol), and I do not know anyone famous. Somehow, I find that reassuring. I am just fine with being a regular person. I do not walk around thinking of myself as better than anybody. I think this makes me more relatable to patients. I actually find it concerning when physicians start to become consumed with recognition and status. I think that it detracts from the true purpose of our position as caregivers. How can we possibly do our jobs to the best of our ability if we are constantly plotting our path to fame? The answer is: we can’t. It is my personal belief that the best quality physicians do what they do just because they love it. Let me be clear. I am not saying it’s a terrible thing to get recognized for doing something well. I am only saying that the possibility of recognition shouldn’t be the only motivation for doing it. Have a fantastic day!

Dr. Katz

It’s Time to Say Goodbye to the Playset

Today we sold the huge playset in our back yard. We have had it for 15 years. It has swings, a trapeze, monkey bars, a slide, a sandbox, and a fort. We have been complaining about it for years because it was taking up space in our yard. Our youngest child is now 16 and no one has used it consistently since I can remember. And yet, we have held off from selling it….until now. Why? Were we waiting for grandkids someday? Did we think that we were suddenly going to get the urge to swing non stop? We finally listed it on Facebook and it was gone within 24 hours. Just the thought of it sent my 16 year old running to the swings and swinging as if her life depended on it, telling us how much she will miss it and how we will be depriving future grandchildren of its pleasures.

Suddenly we were all waxing poetic about the first time we bought it at the Monroe County Fair and reminiscing about the day we set it up. Why was it suddenly so important? Now that I think about it, it was important for so many reasons. It is the last remnant of our old house that we brought with us to this one. It is one of the last ties to a former life when the kids were little and innocent. That swing set was the setting for multiple milestones and countless important private conversations. It held our metaphorical as well as physical highs and lows, just like the swings that hung there. It listened quietly to devastating news and terrific recounts of joy with no judgement, offering comfort in the swings, lifting us to the heavens either to celebrate or to work through grief. It was a staple in our lives for years. It won’t be leaving for another few days yet. Maybe we’ll just make some time for a little more swinging.

Dr. Katz

Corona doesn’t just invade bodies. It invades conversations too.

Wow this is so true! I am finding that there is no situation or conversation setting that is risk free of the corona topic. It just creeps in somehow no matter what. I am willing to bet that part of the culprit there is that people realize that I am a physician, but I cannot change that. It’s just that I need a break from talking about it every now and then. It comes up in the most bizarre situations though. It even came up when our farrier was over working on our horses and the llama guys were over shearing the llamas. Heh? Llama corona? Corona and horse feet? Although I also have to admit that I seem to wait with baited breath in every conversation for the corona lead in and on the rare times that it doesn’t present itself, I find myself bringing it up. I seem to have a multitude of strategies pre-prepared just in case. So, I guess I have to embrace a lion’s share of blame in that regard. I am not sure why I do that. I think part of it is that I am determined to share a logical, fact-based viewpoint about the whole situation, as opposed to the barrage of half-truths and conspiracy theories that I hear everyday. I also sense that people just need to hash it over and talk about it still until life resumes some sense of normality so why fight it? I have to admit tho, I do wax poetic, dreaming about the days when I used to talk about something else: books, tv shows, kids, pets, politics( yuck, rarely), and even OTHER world events. Those were the days weren’t they? In the spirit of the return to normal life, let’s make a pact: Have at least one conversation a day without discussing corona virus. Come on! Who’s with me? Cheers to talking about……anything else! Have a fantastic day everybody!

Dr. Katz

And now…on today’s episode of brows gone wild

See the source image

Anybody else getting slapped in the face with all of the things that you took for granted before? Me too! Brows gone wild is definitely high up on the list. I dream of the perfect arch, somewhere in between thoughtfully skeptical and permanent surprise, only to find myself looking like some sort of shaggy Groucho Marx…ugh. You would think that someone who can reconstruct pelvic organs ought to be able to handle a tweezer with some expertise, but nay nay my friends. It is just not so.

Let’s not forget the new trendy grey and silver caterpillar that is now snaking it’s way across my scalp. It is like my new best friend, waiting to tauntingly greet me every morning in the mirror as if to say, ” I will always be here waiting for you”….followed by an evil laugh of some kind that only I can hear. I know what you’re thinking. Dye your own damn hair. I just can’t do it. I feel like it would be some kind of unforgivable betrayal to my hairdresser. I mean. They are struggling too, right? No. I feel like it is my duty to stick it out and wait for her. Just wondering when I need to just cut it off? Do I have to wait until the gray is at least half of my hair? Enough for a bowl cut? What are the guidelines? Can I just say that I am experimenting with some kind of reverse hombre situation? Who knows?

Does anyone else miss nice looking nails? I have no particular skill in this area either, although I have finally discovered the Sally Hansen Miracle Gel and managed to apply it for the first time without screwing it up. However, the cuticle trimming and actually filing them into a consistent and respectable shape? Nope. Not so much. Cathy was more of a miracle worker than I realized at the time. Between being a doctor and being a musician, the whole beautiful nails thing is kind of doomed from the start without some extra help. I do at least keep them clean. That I can manage. Maybe I will just wear gloves even when I am not seeing patients at work. Hmm. I will definitely wait for my nail lady too.

Let’s not forget the whole lack of waxing options scenario. I would like to meet the woman that can do her own bikini wax. Yikes! I get that shaving is still available, but the process is tedious and the results are just not the same. Now fortunately, I own a laser hair removal medical spa, but the staff and I are not taking advantage out of principle! We feel like we should wait like the rest of the world so bring on the big foot vulvas for now. We can hit the ground running when the world opens back up again.

Ok, while I am on the whining path, I actually miss dental cleanings. I am a fair hand with a toothbrush, floss and mouthwash but there is nothing quite like the clean you feel after the dentist. You know what I’m sayin? I get it. NO ONE loves going to the dentist, but I think it’s one of those you don’t realize what you had until it’s gone kind of scenarios.

I get it, all of these things are incredibly minor in the grand scheme of what’s going on right now. None of the are “essential,” at least according to the government. Life can go on without them…for now. So let’s all embrace our yellow teeth, grey hair, shitty nails, groucho brows and hairy hinterlands together! Have a fantastic day wilderness girls! We can do this!

Dr. Katz

Don’t you wish your gyno was hot like mine?

See the source image

Initial disclaimer: Before you read this, please understand that this is intended for humor only.

So, I hear from men all the time that I must have the greatest job in the world! This leads me to believe that, in their mind, I spend my days with hot, sexy, naked women and their perfect bodies and private parts all day long to my heart’s desire. In addition, I am sure that these same fine gentleman wish that they were a hot, male gynecologist like in the 1989 SNL sketch Mel Gibson: Dream Gynecologist. (Yes it’s real. Look it up. )

I hate to burst your bubble gentleman, but first of all…Ewww….and COME ON! These kind of comments just exemplify ignorance regarding what I actually do and what attracts women to a particular physician. First of all, let me clear up what I do all day long. I see women of all body types, ages and colors for every kind of health and pelvic issue that you could imagine from incontinence to infections to cancer. Yes that’s right gentleman. It is much harder to get them in for routine maintenance when everything is perfect ” down there” like the vaginas you are dreaming about as opposed to when something is “amiss.” That includes elderly women who bring me their crusty underwear, wondering what that discharge is all about and women with STDs that have gone untreated for a long time. It’s not all fun and games gentleman. This is a serious job, not some endless beauty pageant of genitalia. You may not believe this, but once you stare at anything consistently for a long time, day in and day out, the excitement wains. I guarantee it.

Now let’s deconstruct the hot male gynecologist ideal. Be prepared to have your mind blown. Did you know that multiple patient surveys have been conducted regarding possible gender bias in patient selection of a gynecologist? Most patients said that they picked their gynecologist based upon experience, not gender. Those that did pick based on gender usually picked a female because they felt that a female would be better capable of understanding what they were going through. There were still a few that picked a male, yearning back for the days of 1950’s patriarchal medicine, but they were not the majority. Now add on top of that the fact that patients have said that they would feel too intimidated if they picked a gynecologist that was too good looking. In other words, the odds may be ever NOT in your favor if you are a hottie. Sorry.

Well, I hope that I was able to clear up some of your misconceptions about the real world of gynecology. For now, I will just keep on keepin on with my frumpy, female badass self. Cheers!

Dr. Katz

The Art of Slogging

See the source image

OK, now that I have your attention. What the hell is slogging? The word slog is a verb meaning to work hard over a period of time. It also means to hit forcefully and typically wildly, especially in boxing. For the purposes of this blog, we are going to stick with the first definition. Personally, I also find the word imbued with a trace of difficulty or struggle as well, as if the work being done is innately more challenging than usual and that more effort is required. I also think that it implies a certain lack of joy in the task to be completed. Even the word itself has a heaviness to it, at least mentally and emotionally. I don’t find myself using it unless I am referring to a state in which I am struggling to get the basic requirements completed day to day. One final potentially positive component of the word slog is the implication of a necessary process, like slogging to get somewhere.

I think that this word perfectly describes the world at large today with all of the changes in restrictions, work environments, and day to day life. The level of unpredictability and the lack of control has brought out the worst in some and brought out the best and most altruistic in others. I even find myself struggling to get up, get dressed, and get psyched up to face the day, not knowing if I am going to be at the hospital for 25 hours or 4 hours, or if anyone is even going to show up. It is a conscious, sometimes burdensome mental effort to go to work and strive each day. This is by no means a reflection of how much I love my job. I LOVE MY JOB. I always will. I LOVE MY PATIENTS. I am grateful to even have a job. I have always embraced the role of the uplifting, caring, compassionate superhero to women. It’s my favorite thing in the whole world to help save someones life, make it better or bring new life into the world. It’s just that the positive level of variety that first attracted me is not the same. The variety I now encounter has more to do wondering who if anyone is going to show up on a given day. On top of that, my hands are tied with regard to what services I am ALLOWED to provide for patients. Some of the best aspects of my job in terms of preventative care and early diagnosis are severely limited right now because I do not have a crystal ball to predict what a patient needs without a procedure, exam or surgery. It is very frustrating to go to work every day knowing that I am not able to give patients everything they need. I worry every day about what I am potentially missing because of these limitations. Last, but not least, let’s not forget the mental burden of economic insecurity. There is no unemployment for bosses and business owners. There are some loans with a mountain of paperwork and extensive stipulations, but even those have no guarantee of ensuring the survival of your business of 20+ years. There you go, slogging at it’s best. I am getting through every day and working hard, but it is a struggle and the joy factor is more limited, not because I don’t love what I do, but because I am not allowed to completely do what I do. And yet, I keep slogging away in order to be able to eventually get back to running my practice as I see fit.

I get the same kind of feeling at home too. Most days, I manage to get myself motivated to at least attempt a project that has been hanging over my head( sometimes for years) and then other times I feel like I would rather scream than clean one more thing and I just don’t feel like doing anything. The difficulty rating of just going to the store has now been elevated to a ten out of ten between masking, gloving, making lists and figuring out a strategy to get the most with the least trips, knowing that I might not leave the house for an errand for another few weeks at best. Then there is the daily feeling hanging over your head that leaves you wondering if this truly is the new normal? On top of that is the constant barrage of input from all directions of conspiracy and control theories that only serve to add to the overall panic and disrupt any logical progression of thought. You cannot get away from them. You turn off the news and they appear on you social media instead. You turn away from social media and just listening to music and your broadcast is interrupted with another update. Whew! It’s a bit much. Again, slogging at it’s best. But, right now, there is no other choice. I have to keep slogging through on my way back to the way things used to be. It’s part of the process right now. It’s part of the process of doing my part in order to flatten the pandemic curve. If I quit or rebel, I am not making anything go any faster. Maybe if we all slog together, we may just get to the end of this thing a little faster. Let me leave you with this quote from Walter Annenberg, philanthropist, businessman, and ambassador:

” I want to remind you that success in life is based on hard slogging. There will be periods when discouragement is great and upsetting, and the antidote for this is calmness and fortitude and a modest yet firm belief in your competence. Be sure that your priorities are in order so that you can proceed in a logical manner, and be ever mindful that nothing will take the place of persistence.”

Dr. Katz