Who kissed the pig?

So everyone's all in a tizzy about this swine flu business. Instead of writing about it I found a good resource for information that is frequently updated put up by Kaiser here. It takes you directly to patient instructions, but if you want even more info, just click on the home tab when you are there.

** This should not be construed as a endorsement of Kaiser of my blog. In fact, any perceived connection between Kaiser and this blog is purely coincidental.

Here's my bottom line: Flu by whatever name is still the flu. You have a greater chance of winning the lottery than being killed by the flu no matter if it is swine, avian, regular flu. If you caught it, you would get a fever, cough, sore throat, etc for a few days, just like the regular flu. In fact you should probably be more worried about catching the regular old flu, there's been more of it here in America. I guess its just not as fun to get all stressed out by boring old regular flu...

911 is a joke

It's my favorite thing... I'm on call overnight at the hospital and my pleasant slumber is interrupted by the ugly sound of my pager. I call down to the ER. They want me to consult on a patient who has been having a problem for two weeks. For some reason at 3 o'clock this morning was the time they had just HAD ENOUGH. Instead of waiting until the clinic opened the next morning, they needed answers NOW! So since the ER provider isn't used to dealing with such issues (they are EMERGENCY doctors), they get a 4AM personal pediatrics consult from me. Sure quick answers are great, until the bill comes in the mail.

If you have kids, you've been there... Its the middle of the night and something's not quite right with your little one. Is it an emergency? Should you wait until the morning? How about a compromise and just go to urgent care? I know, you try to get an appointment for your doctor and they don't have any openings for WEEKS. You can't wait that long.

There is a fairly new buzzword in the medical community called 'access'. Which just basically asks if your patients have access to your care in a reasonable amount of time. Most pediatrics clinics, as a result have put a high priority on getting same-day access to your physician. So hopefully the days of waiting days and weeks to get in to your child's doctor are over. In the busy winter months you may have to wait a day or so, but most clinics that are up to speed should be able accomodate.

I'll be honest. Most ER's and Urgent Cares don't have a guy like me (a pediatric guru/pediatrician)available to them, and when it comes to non-emergent cases, provide very poor care. Sure you may get your answer more quickly, but its likely to be the wrong one and you are going to pay more in copays,etc for it. Don't get me wrong, there are some excellent clinicians that work some of these late night places, but you, as a patient, aren't going to have any idea (see my first post ever). And, the numbers of good docs to bad docs in many of these places is pathetically low. To their credit, they are usually good in emergent situation, which is what they are trained for.

So I thought I'd give you a list of symptoms/situations your child may have and a breakdown of the severity in case one of these sneaks up on you in the middle of the night (this list is not exhaustive, but I tried to think of the most common - it may be a big mistake on my part to try it - remember disclaimer to the right):

Call 911:
Stops breathing/turns blue and stays blue
Seizure that doesn't stop
Passed out and not waking up
Difficulty breathing after contact with something they are allergic to
Concern that your child may have swine flu - PLEASE NOTE ITALICS HERE

ER:
Fever and stiff neck/baby's fontanelle(soft spot) is bulging
Persistant difficulty breathing (with asthma or otherwise) - this can be breathing fast that doesn't slow down, persistant skin sucking around the ribs, and/or difficulty getting out a few words
New or first seizure that stops on its own
Not very responsive, difficulty waking up.
Fever >105 (I might lower this to 104 for older kids >7-8 year old range)
A baby less than one month old with any fever (>100.4)
Your child is not acting like themself after having vomiting/diarrhea and being unable to take fluids
Fever and refusal to walk/excessive bone/joint pain
Lip/facial swelling after contact with something they are allergic to
Pain that is so intense it cannot wait for an appointment (wherever it is located)

Urgent care or ER:
Suspect a broken bone or may need stitches (actually these locations are probably better than your general pediatrician with these issues)
Head injury with loss of consciousness, but doing okay now
Persistant asthma that has difficulty breathing that comes back less than 3-4 hours after albuterol treatment.

**general note: Urgent Care facilities are good for injury-type complaints, but will otherwise usually give poor medical care for kids

Wait until the next day and see your pediatrician:
Almost anything else that is abnormal, but your child is eating, breathing, and acting normally otherwise
High fever, unless it gets above 105 or there are other symptoms you are concerned about
Anything that has been going or for days and didn't get suddenly much worse
Swollen lymph nodes
Persistant asthma but able to breath comfortably for several hours after breathing treatments
Baby is fussy and won't stop fussing (unless they really seem to be in great distress)
Your child is still acting like themself, but has been unable to keep and fluids down for >24 hours due to vomiting
Runny nose, cough, etc.

***If you have any additions/suggestions/questions feel free to comment, and I will try to update the list.

I am a big fan of mother's/woman's intuition, so if you REALLY think something is emergently wrong take your child to the ER, even if they don't fit a category above.

Body Movin'

How's the calorie counting going? Now that you've got that down, we're going to talk about a different calorie count: your calories burned... Don't stress! This kind of calorie counting is waaayy easier. If you remember our equation to losing/gaining weight:

Calories eaten - calories burned = weight loss or weight gain

BMR:
We already figured out what how many calories you burn just existing here. Remember that is an average of everyone, and we have all experienced that everyone has a different metabolism. Some people can eat anything, and not gain a pound. Some people eat a potato chip and sprout a 4th chin:

You probably have a good idea of what end of the spectrum you are on and can assume the actual number may be higher or lower.

There is one definite way to lower your BMR (which you don't want to do) is diet. People who get stuck in a diet cycle of dieting over and over again without exercise, just keep driving their BMR lower and lower, thus making it harder and harder to lose weight. This is because when you are dieting, your body thinks its starving, and slows its own metabolism.

Ways to raise your BMR:

1) Nicotine

2) Crystal methamphetamines or phenphen

3) Caffeine

4) Building your muscles

I have to say I do not recommend 1-3, but many people already are using method #3. And no, the caffeine from a soda doesn't increase your metabolism enough to burn the calories you drink with it (not even close). Even though traditionally weight lifting has gotten a bad rap when trying to lose weight, adding some to your exercise regimen can help. For every pound of muscle you gain, your BMR can increase in the range of 10-50 extra calories per day.

Exercise:

Any exercise you do is extra calories on top of your BMR to put in the 'burnt' column. This is even easier to figure out than food, because most of us only participate in a few different exercises (the more variety the better, but lets be real). Here is the calculator for a bunch of exercises based on your weight. If the one you like isn't there, you can probably find it somewhere online. Plus, after you exercise, your body's BMR can stay elevated for several hours afterward.

How much exercise? The recommendation used to be 3 days a week of 25-30 minutes of cardiovascular exercise, but now many are recommending 5 days a week. That can be tough, so shoot for 3 days a week at first and expand as you can. Try to mix in a couple days of strength/weight training a week, too.

I personally like the days I exercise because I tell myself I don't have to be as strict watching my calories eaten on those days.