As many of you know, I have 3 children.

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We found out we were pregnant with my oldest son the first weekend we moved to Honolulu.  We had just taken over Honolulu Eye Clinic, and out of nowhere, I came up with the idea to have a nursery in our office.  My husband thought I was crazy, but I figured, we are the owners, we can do what we want!  And, I also predicted (correctly, as it turns out), that Hawaii is so family centric, so focused on ohana, that I didn’t think patients would mind.  Plus, since I am a pediatric ophthalmologist, there were going to be kids crying from dilating drops anyway, what’s one more kid?

At the back end of the office, there was this room which Dr. Edwards was just using as a storage space.  I told Jeff I thought this would be the perfect nursery.  He didn’t have the vision I did and had a hard time imagining it.  He said “We’re going to put our first born in a storage closet?”.

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It was definitely a bit of a mess.  The 2 nice things about the space was that it was pretty large and that it was right across the hall from the pediatric waiting room. (which we stayed up until midnight before our first day putting together).

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Pediatric waiting room at Honolulu Eye Clinic

 

So, after craig’s listing everything in the room and reorganizing it all, we had a blank slate.  The room is actually bigger than the nursery we have at home. I kept everything pretty simple.  Just some paint on the walls and I found a comfy chair to nurse in off of craig’s list.  I was given a second hand pack and play which fit better in the room than a crib.  Then off to Target for a couple rugs and a changing table.

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Hard to believe it’s the same room ,right? I made some green curtains from fabric from Walmart to hide all the storage we still needed to keep in the room.DSC_0178I cut the top off cardboard letters and filled them with fake flowers from Ben Franklin.

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Lots of books from garage sales! You can never have too many books

It was so wonderful to have my kids close by when I was nursing.  It really helped me go back to work sooner, because I wasn’t worried about who was watching my children.  We were so blessed to find a wonderful nanny, Gabi.  And, I just scheduled a block in my schedule mid-morning and mid-afternoon to breastfeed.  It was ideal.  I never had to pump or worry about not producing enough milk.  Though the downside was that none of my 3 kids ever learned to take a bottle, they were very spoiled!  Our nanny would take the kids for walks, and when they were older to activities like Wee Play, Ohana Music Together, Children’s Discover Center, Aquarium, Hawaii State Library, Honolulu Zoo.  Queen’s is so well centered, that a lot of things were walking distance.  So, as the babies got older, they weren’t actually in the office nursery for that long, but they would come back for lunch and nap, and just seeing them at those times was wonderful too.  Gabi moved to the mainland when Nikhil was a little over a year old, and we were blessed again with another amazing nanny, Shawna.  She truly loved our kids as if they were her own.

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The other plus side of having a nursery in our office was that my children grew up with the wonderful girls we have on staff.  They call them their “Clinic Aunties”.  Again, another reason they could have been a little spoiled.  My kids love coming to the office because not only do they see us, but they adore seeing their aunties too!

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And, that’s what is truly wonderful about Hawaii – my patients loved seeing my kids, they wanted to see the nursery and be updated on how they were doing.  I have one patient who even made her appointment times with me around my baby’s nap schedule so she could see him!

My youngest child juststarted preschool last week – hard to believe!  So we will no longer need the nursery in the office and the plan is to turn it into an exam room next month.  I know, kids growing up is all a part of life, but clearing out this nursery definitely tugs at my heart strings.  And, no, we’re are 100% not having any more children!

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And for any other DIYers out there, here are some pics of our nursery at home.  It’s the same room, just decorated differently.  For Taj’s nursery below, my mom made the crochet airplane mobile with sewed in musical buttons.  I painted the canvas with Taj’s name in Tamil and his Chinese name as well.

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Taj’s cultural/travel themed nursery.

When we had Arya, we moved Taj to another room and I really DIY’ed everything from the crib bedding (thanks Mom!), to the felt mermaid crib mobile (made that while sitting in the doctor’s office during my pregnancy), hand stenciled curtains for Arya’s room with a coral paisley (absolutely never again – want to get back pain? then hand stencil curtains when you’re 36 weeks pregnant and then sew them with black out liner), paint stick mirror, gallery wall from old frames that I got for free from Pictures Plus and spray painted gold.  For some reason, I really love designing and decorating kids spaces.  I think they’re just so much fun and are meant to be creative spaces for your little one to grow.  It’s my stress relief from work!

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Arya’s gold glam mermaid nursery

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I see a lot of styes in my practice as a pediatric ophthalmologist.  Adults and kids get them and they can be slightly painful, tender and look terrible.  Most patients are concerned that styes are an infection (which they are not) and want quick treatment for them.  Usually our adult patients come in for an appointment, having researched online (I admit it, I consult Dr. Google as well), and want the stye cut out.  Sometimes, that’s not am immediate option.

A stye is a term that people use to describe two different medical conditions interchangeably.  Sometimes, people are referring to a hordeolum.  And, sometimes, they mean a chalazion.  What’s the difference?  And, what is a stye anyway?  A chalazion is simply a blocked meibomian gland.  The meibomian glands are these tiny glands that secrete oil for your tears.  The oil is necessary for the proper composition of tears in your eyes and prevents your natural tears from evaporating too quickly.  You have about 40-50 meibomian glands along the upper and lower lids, right on the inside aspect of the lid, located next to the lashes.

Meibomian gland picture jpeg(Side note: you may have noticed that I have black and white diagrams for most of images now.  That’s because I hand draw all of the pictures for the blog so that I am sure I am not mistakenly using any copyrighted images.  So, please do not reproduce these images without my consent)

When the meibomian glands are blocked as in the picture below, people get symptoms of dryness, redness, inflammation, foreign body sensation, burning, itching and stinging.  You can see the oil squeezing out of the glands while the examiner is compressing the eyelid.  I’m going to warn you the next 2 pictures are a little graphic, you might not want to view these if you are eating right now.
The easiest way to unblock these oil glands is by performing hot compresses for 5 minutes twice a day.

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When a gland gets really obstructed and acutely inflamed, then it is a hordeolum.  It’s red, tender and slightly painful.  Again, it’s not an infection, but think of it almost like a pimple.  When the lid is still hot and red appearing like this, surgical excision should not be performed.  That’s because you can get scarring if it’s operated upon when the eye is inflamed.  Here this little boy who I saw a few months ago with a really large hordeolum on the left upper lid.

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Treatment for this includes hot compresses for 15 minutes three times a day.  Some kids (and adults) dislike doing hot compresses with hot water because of the wetness and the fact that it doesn’t stay hot for the full 15 minutes and must be continuously rewet.  So, often I will recommend  preparing the hot compress by using a clean athletic sock and filling it with one cup of uncooked rice.  You can also add flax seed which takes longer to heat than rice, but is also smoother and stays warmer longer.  Don’t pack it in tightly; leave some room for the grains to move around so that it will more easily conform to the area to be treated.  Use a thick athletic sock so that the grain will not poke through the sock.  Use a rubber band to close the top or if you are using a tube sock, you can knot it.  Place it in the microwave for 30-60 seconds.  Check the temperature on the back of your hand before placing it on your eye.  It should be warm, but not uncomfortably hot.  Place it on your closed eye for 15 minutes three times a day.

I have about 3 of these socks lying around – I use them whenever I feel the earliest start of a stye forming.

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If started early enough, hot compresses will be sufficient to resolve the hordeolum by opening up the oil gland.  Below is a picture of the head of the hordeolum.  Note the beefy red bump on the inner aspect of the lower lid.  The goal is for this to drain with the hot compresses.IMG_7518

 

Sometimes, a combination antibiotic/steroid drop (Tobradex, Maxitrol, Nepolydex) will be started at the same time as the hot compresses.  The steroid helps decrease the amount of inflammation surrounding the blocked oil gland.  The antibiotic helps to combat the bacterial infection of the oil gland.  If these treatments are not sufficient, then the hordeoleum can sometimes progress into a chalazion.  A chalazion is a granuloma – basically when the body has begun to wall off the infection.  Therefore, drops are not as effective in treating chalazion.  Often times, I will recommend omega three supplements or flaxseed oil for multiple chalazion.  And, there has also been some data that reducing milk in your diet may help decrease the incidence of chalazion as well.

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If none of these modalities are effective, then the only treatment left is surgery.  Basically, the chalazion is incised and drained after injecting local anesthetic along the eyelid for pain.  The clamp (pictured below) is used to evert the eyelid to gain better access to the chalazion.

Chalazion clamp applied to lower lid

For adults, this can be an in an office procedure.  For kids, I always do this in the operating room under general anesthesia.  Oral antibiotics are not necessary after the procedure, I only prescribe antibiotic ointment post-operatively.  Usually sutures are also not necessary, since typically the incision is made on the underside of the skin.  If a skin incision needs to be made, then sutures will probably be placed.

 

There you have it – styes and what to do to hopefully prevent them from requiring surgery.

 

 

 

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