Extemporaneous Wandering

Dude Looks Like a Lady

2011-02-17T11:53:00.000-08:00

Wow, it’s been a whole year since my last posting. I need to get back on the horse… how about another diet review…

I've been hearing a recent diet fad lately is taking the hormone 'hCG'. In doing my research, I found, it’s actually not new, and has been around since the 1930s. hCG stands for Human Chorionic Gonadotropin. It is the hormone than women make when they are pregnant, and the one that is detected in the urine for pregnancy tests. The basic theory doesn't sound too crazy. It is based on the idea that women who are pregnant and don't eat enough for their fetus just burn fat and not muscle, so if you take it when you diet, you should burn fat more specifically. It also has claims that it decreases feelings of hunger. There are two ways to take it orally or injection. And the earth shattering surprise: in addition to the daily dosage it is recommended to have 500 cal/day diet!

Hmmm, where do we start on the issues with this one? First off, I don't know how many pregnant people you know, but appetite suppression isn't one of the things I use to describe them. In fact with my wife's last pregnancy, the moment I really knew she was pregnant was when she wanted 'Animal Style' french fries from In-N-Out several days in a row. One order every 6 months or so is usually enough for her.

Plus, there are very few hormone therapies that can survive digestion, so those of you who take it orally are basically just taking whatever products are left after it passes through your stomach, which likely don't resemble or act like hCG at that point.

Most importantly, multiple studies (some even 50 years old!) have been shown that there is no difference between those taking an injection of hCG or placebo as far as weight loss or hunger pains go. In other words... it just plain doesn't work. So why all the attention? A guy (Kevin Trudeau) wrote a book about it in 2007 entitled,The Weight Loss Cure 'They' Don't Want You to Know About. I'm not sure who 'they' are, but I'll tell you what HE (Trudeau) doesn't want you to know about... He has been investigated by the FTC (Federal Trade Commission) for promoting all kinds of fake medicines and as of 2004 has been banned by said Commission from appearing in any infomercials on TV. Source: http://articles.latimes.com/2009/nov/02/health/he-nutrition2/2

Ease of following: As easy to follow as any 500 calorie/day diet. Which should be read as = hard. In my dieting experience, the lowest I ever got was 1200 cal/day and at that point I was constantly hungry and bit anyones head off that crossed me. Throw in daily injections and I'd say its not that easy.

Medical safety: It probably won't cause any major problems, but some side effects that have been reported are: headaches, mood swings, depression, blood clots, confusion, and dizziness. Women who use this hormone can also develop Ovarian Hyperstimulation Syndrome (OHSS), which is usually mild, but ironically can result in weight gain. And if you are a guy you could start to look like this:

Or this:

I do have concerns of living with a prolonged diet of 500 calories. You are basically starving yourself, and if done for a prolonged time you could suffer similar consequences of those with anorexia nervosa. If you decide to stop the diet after a prolonged period, be very careful not to increase your intake suddenly, even to a normal level, as it may cause ‘refeeding syndrome’, which is a common cause of death among anorexics.

I generally would not recommend ever being on a diet of 500 calories for any amount of time, but some people like to do it to ‘kick start’ their diet, and if you feel so inclined, I wouldn’t do it longer than a month. Decreased calorie diets are not only recommended, but needed, but you can go too far. For the RIGHT way to do so see my previous post:

http://exwandering.blogspot.com/2009/03/dont-count-me-out.html

Check this one out, too (because diet can’t do it all):

http://exwandering.blogspot.com/2009/04/body-movin.html

Chance of keeping weight off:

Almost zero unless you add to this diet a long term diet/lifestyle change to keep your calories down (but obviously not this low)… FOREVER. If not, weight will be regained, plus more. Starvation diets such as this decrease metabolic rate, and therefore will cause you to gain MORE weight when you return to your old habits. Which most people do.

Conclusion:

A friend of mine in medical school used to sit around and make plans for a diet supplement we were planning on making that just consisted of lawn clippings in a capsule with the recommendation of: “Best results obtained when used with a combination of diet and exercise changes.” Apparently this diet beat us to the punch. It is a sham is just about every way possible.

But if you are the type of person who is sensitive to placebos and need a kick start to your diet, I guess you could do worse. But seriously, I can sell you some capsules with lawn clippings for a lot cheaper than you are probably paying for the hCG. And PLEASE do yourself a favor and make plans for what changes you are going to make in your life AFTER the diet, or you will end up heavier than when you started…

RSV - P

2010-02-10T14:11:00.001-08:00

Sorry, I've been on a bit of a hiatus from blogging. There were some crazy times around the extended Dr Jay family, and it's winter. Which makes pediatricians like me very busy. If this blog continues on for years and years, you will probably always see a slow down in the winter. Which brings me to my topic today, as it is the thing keeping me so busy right now: RSV.

Annoying call from emergency department or urgent care physicians (I know I disparage these poor folks, and most of them know better, but its the few that drive me crazy): I have a 2 year old kid here who has had several days of runny nose, cough, and fever. He looks great, but I tested him for RSV and it was positive, so we need to admit him.

Me: Doh! Where did you go to medical school?

There are many problems with what this ED/UC physician had to say, but its meant to illustrate that even many health professionals don't understand RSV all that well.

Lets have a little Q and A on the subject:

Q: What are the symptoms?

A: Most people who get RSV get a cold-like illness: runny nose, cough, fever, etc. This virus more than most other viruses produces TONS of snot. (I held back posting my snot pictures due to the reception they got last time). Some people, especially infants develop severe disease.

Q: What are the chances my baby will get RSV?

A: You should know that RSV is VERY common. Almost EVERY child will get it before they are two years old. VERY FEW of them are sick enough to need hospital admission.

Q: Which infants are a risk of getting severe disease?

A: The younger, the higher risk. Especially those who are premature (usually less than 35 weeks) or have significant congenital heart defects.

Q: How do you get it?

A: You mostly have to come in contact with the virus and then touch your eye/nose/etc. The virus can live on surfaces (doorknobs, shopping carts, etc) for many hours. There is some transmission by inhaling droplets, but you have to be within 3 feet of the sick one, and they basically have to cough in your face. Wash your hands!

Q: How long are you contagious?

A: The virus can be spread for a 3-4 weeks in nasal secretions after infection (but usually only for a week). Take home message #1 for this: if your child is in daycare they will get it. Take home message #2: Wash your hands!

Q: How can I prevent my kids from getting it?

A: Those high risk patients can get a very expensive vaccination once a month during RSV season, usually just premature babies and those with heart defects. If you think your baby may qualify, talk to your pediatrician. Wash your hands (and your kids')!

Q: I heard my child can only get this in the winter, is that true?

A: Kind of. It can happen at any time of the year, but for reasons not completely understood the VAST majority of cases happen within one month of the start of the outbreak. It seemed to hit here in California mid January, so we've got at least another week or so of the onslaught. If you child has had a cold the last few weeks or gets one the next few weeks, it is extremely likely that it is/was RSV.

Q: What do you feel is the most frustrating thing about RSV, Dr Jay?

A: Hmmm. This question doesn't sound spontaneous, a little forced. Almost as thought this conversation is scripted or something. RSV is one virus that DOES NOT confer lifelong immunity. So if you've had it once, congratulations, you can get it again. It is felt that we likely get RSV over and over again throughout life, but it isn't followed too much after childhood because it is usually mild disease from then on.

Q: My child was hospitalized for RSV, someone told me that it will give him asthma for the rest of his life, is that true doc?

A: Yes. I mean no. I mean I don't know. Babies that are hospitalized for RSV tend to develop asthma later in life. It really depends on if you are a fan of the chicken or the egg. I think I'm an egg fan, in that I think those kids who were going to get asthma anyway are likely the ones to get severe RSV, not that the RSV causes asthma. Or does that make me a chicken fan?

Q: What is the treatment?

A: You are going to love this: fluids, rest, etc - you know the old cold/flu/virus protocol. Infants only need hospitalization if they are having difficulty breathing, needing extra oxygen, or if they are so sick they are refusing to drink (and thus getting dehydrated).

I wanted to run, but she made me walk...

2009-10-31T14:06:00.000-07:00

Have you reached a plateau in your workout, weight loss routine? Do you just want to get 10 more pounds off? I've got a great suggestion for you... INTERVAL TRAINING.

Just a few months I was feeling stuck in my routine of running 30 minutes three times a week* (with weight training interspersed on other days). I substituted interval training for one of my 30 minute cardio workouts, and dropped 10 pounds quickly. My other runs during the week got faster, too.

The fitness guru pediatrician at my work says he tells marathon runners that they aren't really in shape unless they do anaerobic exercise. I wouldn't go that far, but it really does make a big difference.

Anaerobic exercise means it can't be sustained for extended periods of time without resting to breathe. (As opposed to aerobic exercise that theoretically can be maintained indefinitely - jogging, aerobics, etc). Here's where interval training comes in. Interval training is mixing in high intesity workouts sporadically (in intervals) with low intesity workouts. Some explanation and suggested workouts can be found here.

I personally run around a squarish park with 4 equal sides (not perfectly, but close). We'll say each side has distance of X. I sprint at about 80% of my max for 2X (two sides) and then walk one. I do this for 30 minutes and get a great workout.

If you haven't tried it, give it a try. It doesn't take any more time, just takes more calories.

*For the record, most health providers are recommending 5 cardio workouts a week (including myself). Yes, I usually only can make it to 3 a week, but I'm working on it, too!

Meat is Murder

2009-10-15T13:11:00.001-07:00

Now on to the next of my diet reviews. I'll just clump all of these in the same bunch: Protein diet, low carb diet, Atkins diet, South Beach diet, etc.

They are basically all built around a basic concept: increase the protein and decrease the carbs. What you do with 'fat' varies from one diet to the other. Here's the secret (and the thing you can really take away from these diets when coming up with your own personal diet): protein/meat has relatively low calorie density (compared to carbs and fat) but helps you feel satisfied sooner and stay full longer. So in other words, this is another low calorie diet 'in disguise'. You'll see that ALL weight loss diets are just way to get you to eat less calories.

Ease of following: In the short term, not too difficult, especially if you are a carnivore. Due to the popularity of these diets, there are tons of recipe books and frozen dinners available. In the long term, some people have hard time staying on a diet with so many rules. Some are more strict than others on the amount of carbs you can take. The 'no carb' diets can be very difficult, because carbs actually make up a high percentage of Americans' diets and are difficult to avoid.

Medical safety: Pretty safe. There are some concerns about the extreme diets that force your body into ketoacidosis (due to no carbs) which is basically a form of starvation. WARNING: any time your body thinks its starving the metabolism slows down, and you NEED exercise to keep it up. All weight loss diets cause your metabolism to go down to some extent, but these tend to do so a little more (theoretically). Also there are some that feel so much protein can be hard on the kidneys if the diet is maintained for an extended time, but I haven't heard that this has shown to be true when studied.

Chance of keeping weight off: If you stay on the diet, it will. But if you come off of the diet, you will likely gain the weight back and more (due to decreased metabolism) if the diet was done without exercise. The best practice would be to transition to a more 'regular' diet that still keeps the calories down enought to maintain your weight.

Conclusion: It works... But long term is rarely successful.

What you should take from this diet: LEARN about calorie content in your food. Eat foods you like, but limit your portions to limit your calories (see previous posts on this). But feel free to add some additional protein in if you are finding it difficult to stay satisfied/not hungry before your next meal.

Don't Look Back In Anger

2009-09-10T20:01:00.000-07:00

Parent complaint: "Everytime I ask my three year old to do something he doesn't want to do he flips out. He seems to be full of rage. I'm worried he will turn out to be a serial killer or something. Please FIX HIM."

Diagnosis: Normal

While I can't promise that any given three year old won't turn out to be a serial killer, this behavior definitely doesn't guarantee it.

You may also be worried that they will turn out like this woman:

Again, I can't make any promises. I do have some advice, though. The answer is the same one you hear when you go to therapy for any relationship: communication. Your child still has limited vocabulary and it can be frustrating to want to say something, but not know how. Plus, ever since they were a baby, the way they got attention was by crying. Here's a few tips to help your toddler/preschooler with their 'rage' issues (actually most of these work at any age):

- Help them identify their feelings by pointing them out yourself. Example, "It looks like you are really disappointed that you can't have any more red hot Cheetos."
- It is important that you remain unemotional in your exchange. It shows your child that emotions don't have to heightened for every trivial matter. Plus, yelling at them only seems to fuel the fire at times. (My wife will readily admit that this is one area I have the hardest time with)
- Encourage them to 'use their words' instead of tantruming. Only give them what they want when they ask in a calm voice. Example, "It seems like you want these red hot Cheetos, but you can only have them if you uses your words in a calm voice." If you give them what they are 'raging' over without improving their behavior, you are just rewarding their rage, and it will be harder to overcome later.... which leads to my next point.
- Ignore. We've heard this one from when we were kids. "Why can't you just ignore your little brother, he's only doing it to get attention." Well you'll find its even harder as a parent to ignore it. There may be a component of attention-getting to their behavior. The less attention they get, the less reward they get. My parents always tell a story of a preschooler tantrum I threw at a movie theater once laying on the floor and kicking. They said they just left me there and walked away. I stopped my tantrum, jumped up and ran after them. Apparently that was my last tantrum.
- Work on your own feeling communication. Explain to your child why you are doing what you are doing. Don't say, "because I'm the daddy, that's why." Say, "I don't want you to have any more red hot Cheetos because you've already eaten a lot, and we are going to eat dinner soon."
- Positive reinforcement. When they respond in a 'grown up' way give them a reward. A sticker. A healthy treat. While they usually won't choose it over the other things, physical affection (a hug, etc) seems to work best of all. "I'm so proud of you that you were able to talk in a big boy voice instead of whining" (accompanied with a hug). Kids are suckers for that crap.

The good news is most people grow out of it (ignore the woman in the airport above). Through your excellent parenting skills you can help them get there sooner rather than later.

Fell free to add any comments of methods you have used to share...

Flu update

2009-09-01T11:41:00.000-07:00

There have been many developments on the 'swine flu' front, so I thought I'd give my readers an update... I guess we are now calling it H1N1 to start off...

I'll be honest and admit that there was a much more significant outbreak this summer than I expected. It is still about equivalent to the regular flu for your average healthy individual. Here are some numbers you may be interested in: H1N1 deaths in the US = about 300. Number of deaths of regular flu per year in the US = 36,000.

We have learned a few things about this new strain of flu: It seems to be harder on pregnant women than previous strains of flu. There seem to be some concerns that it is easier to develop secondary infections (like pneumonia) from this strain than the average American strain. This risk seems to be increased in the teenage/20-something age group than 'regular' flu.

Things to do to protect yourself now, and during flu season
1) Get vaccinated (more on this later)
2) Be free with the hand sanitizer/hand washing especially before touching your eyes, nose or mouth (they both work!)
3) DO NOT wear a mask. There are very few masks (which are currently in low supply) that work for more than a few minutes against flu particles. In fact, wearing a mask in public may increase your risk of getting it, because it may make the flu particles get lodged between the mask and your face, increasing exposure time. You can wear a mask if you think you have swine flu to keep it from spreading to others, but do yourself and others a favor and just stay home (the CDC recommends staying home until your fever is gone for more than 24 hours).
4) Take antiviral medication. One of the antiviral medications appears to be more affective against this strain than others, but it is in short supply, so you may not be able to get it unless you are at high risk of developing severe disease. Ask your doctor if you are concerned.

5) Get plenty of rest, exercise and a healthy diet while you are well to keep your immune system up. Always good advice!

Should I vaccinate my family?
Unfortunately the regular flu shot isn't very affective against H1N1, and as of this year, the H1N1 strain is too new to be added to this year's flu shot. They are, however, feverishly working on developing an H1N1 flu shot. Which means this: you will have to get multiple shots to be protected from all strains of flu this year. It will likely be combined in the future, but not now.

Some people feel it isn't worthwhile to get vaccinated against something that probably won't kill you, since you are healthy. In fact, there's a good chance you won't even catch it. You may be right, unfortunately, your kids don't fit in that group. I highly recommend getting the flu shot (flu shot's' this year) if you are a kid or have kids. ESPECIALLY if you are pregnant or want to become pregnant. 6% of the swine flu deaths have been pregnant women. Here are the target groups the CDC gives for those who should be vaccinated this year:

- Pregnant women
- People who live with/provide care for infants besides being a pediatrician - and everyone knows pediatricians love to torture children with needles): kids are the vectors! Studies have shown that just vaccinating school age children signficantly decreases the load on ALL OTHER demographics. Kids spread germs. That's the reality. You decrease the germs amongst the kids, and everyone is better off.

For more info, see the CDC webpage on H1N1
http://www.cdc.gov/h1n1flu/

Senses working overtime

2009-08-25T13:26:00.001-07:00

"Doctor, my 3 year old totally has ADHD. He cannot sit still. He has a hard time concentrating and staying on task. Can I get something to help with him? Please FIX HIM!"

Diagnosis: normal 3 year old.

ADD/ADHD (I'll just refer to it as ADHD from here on out because I'm lazy) seemed to be all the rage in the 90's. Seems to now to have taken a back seat to 'Autistic Spectrum Disorders'. It is still relevant, and while it doesn't get the press/publicity of autism, it is definitely more common.

First question: Does it really exist, or is it just a reflection of a generation of bad parents?
First answer: Yes, it does exist.

There are many kids that seem to very obviously have this diagnosis. The medication to treat is consists of a group of stimulants. If you give someone a stimulant and it CALMS THEM DOWN, I'd say that's pretty good evidence that they have some 'crossed wires' so to speak. It is a highly genetic situation, so kids with it are likely to have parents that suffered similarly as a child (and some continue to as adults).

Second question: Does my child with ADHD need medication?
Second answer: Maybe.

Parenting plays a large roll in ADHD. No, a bad parent cannot make a child get ADHD. There is something that genetically predisposes these children to behave they way they do, but poor parenting can really bring it out. Parent training has found to be so beneficial that many kids not longer need medication after their parents learn the right way to 'parent' them. Most of this training focuses on teaching the child organizational skills including making daily schedules/routines, simple and CONSISTENT house rules, close supervision, and a reward system that focuses on effort, not necessarily results. Sleep schedule is extremely important, as lack of sleep really exacerbates the symptoms. In fact, sometimes obstructive sleep apnea is misdiagnosed as ADHD. So if you have a hyper child that snores, get that checked out. After all that, though, there will still be a quite a few children that will need medication to function well.

Third question: Isn't it just easier to give them a pill to pop than to learn how to be a better parent?
Third answer: Yes.

Studies clearly show that even with medication, proper parenting techniques are invaluable. Do your kid a favor and get the training you need in order to give them the best chance to succeed. I will admit, though, I have had some parents that are so disorganized and ADHD themselves (its genetic, remember) that I don't even bring up parent training, because I don't believe in exercises in futility.

Fourth question: If I eliminate sugar from his diet, will he be normal?
Fourth answer: Probably not.

There are may people out there trying to sell their diet plans to help with ADHD. There is very little scientific basis for this. Most of the time, it is the case of a person who wants to prey upon someone else who is desperate for help (which describes pretty much any parent of an ADHD child). That doesn't mean they don't help at all. There may be a diet component, but I think these dietary needs can vary wildly between children. I don't see any problem trying different diet routines, as long as it doesn't but an undue financial (or other) stress upon your family. NONE of the diets work for every child. The parenting techniques described above help to some extent for EVERY child. Start with those, then consider diet therapy, but keep your expectations low and your wallet tightly closed.

Brain of J.

2009-07-27T16:43:00.000-07:00

Ok, folks, I've officially emptied my brain of the original pediatric ideas I had for my initial blog postings (don't worry, more diet reviews to come). So I'd like to open it up for questions... Any recommendations for other subjects? What have you always wanted to ask your pediatrician but where afraid to ask?

There is an old adage, "There are no dumb questions." I'll be honest and say I don't believe in it. There are plenty of dumb questions, but don't worry, I won't tell you if your question is dumb. Plus the dumb ones may be the same things that everyone is wondering about, but doctors don't bring it up, becuase they think everyone knows it...

Jenny (867-5309)

2009-07-24T14:53:00.001-07:00

I thought I'd start a series of diet reviews to evaluate the pluses and minuses of each of the popular diets available.... I'll rate each on ease of following, medical safety, and chance of keeping the weight off.

The first 'diet' I'll start with are the prepared food plans (like Jenny Craig, Nutrisystem, Weight Watchers, etc).

***the funny thing about this ad, is it says 'results not typical'. I've seen that disclaimer on the 150 pound losers, but 30 lbs? It's not typical to lose 30 lbs?

The basic plan is to eat the food they have prepared for you, and if you only eat a certain amount of it, you will lose weight. Honestly, I'm sure it's clear that this is just a low calorie diet (as I have said previously is the best) where they count the calories for you. Most of these diet plans are based on an 1800 calorie a day intake. If you learned to count calories yourself and kept to 1800 calories a day, you would lose weight for free. But, yes, that does take a lot of work at first, and these companies eliminate that work for you.

Ease of following: Pretty easy, as long as you have to money to pay for it. You do have to buy food to eat anyway, so its probably not exorbitantly more expensive than regular food. In fact, if you eat a Claim Jumper for every meal, I'm sure it is cheaper. The big problem with its 'ease' is it is a little restrictive; ie, if you wanted to Taco Bell for lunch, you can't. And if you like fresh food from your garden, that's not part of the plan either. Its mostly frozen food from the microwave.

***mmm looks delicious

Medical safety: Very safe.

Chance of keeping the weight off: Good until the money runs out, or you get bored of their food. Actually, 80% of Jenny Craig's business is repeat. In fact, if she got everyone to lose weight and keep it off, she would go out of business. She wants you to depend on her. (I shouldn't be too hard on Jenny Craig keeping people fat, so she can have business, as my grandmother thinks doctors keep people sick, so they will have business!)

Conclusion: Learn about what you are putting in your mouth! Learn how to count calories yourself and plan your own meals with your own food (and even Taco Bell's food, if you'd like). Plus you develop a life long skill and habit (if you get really good at it) that will help you be healthy FOREVER (well at least until you die).

Blister in the Sun

2009-07-06T21:04:00.000-07:00

Alright, its summertime, and time to worship the sun god.

A very popular question we hear in the clinic is, "How much SPF do I need?" There's nothing America likes more than hysteria and overdoing it... Let me give you some data to chew on... the SPF of a 100% cotton shirt has been sited to have an SPF of somewhere in the range of 4-15. (Yes, don't you love the exact answers science likes to give us.) So if I'm being really honest with you, if you don't get a sunburn with a t-shirt on, you probably don't need anything more than SPF 15. But, doctor's aren't above the hysteria apparently, because I still recommend about SPF 30 for most kids. Anything over that really is overkill, so don't waste your money. Of course if the SPF 100 is on sale and cheaper, feel free, but I haven't heard of any real added benefit over SPF 30.

The next question of course is: Can I put sunscreen on my infant less than 12 months of age?

My answer to this question is avoidant and simple: The best sunscreen for a baby is SHADE. Please, people, does your baby really need to lay out in the sun? If your family is enjoying a day out in the sun keep your baby covered! Especially if they are less than 6 months. A sunburn can be very severe in this age group, so don't mess around. Plus, they'll probably end up sucking the sunscreen off of their hands anyway, which are probably the most exposed part of the baby's body. Keep your kids in the shade until they are old enough to move around and play in the sun on their own, then hit them with the SPF 30. If you don't think you can keep your baby in the shade there are a million baby sunscreens you can try, and they are probably fine, but just be really safe and stick with the shade.

Let's Go To Bed

2009-05-28T15:47:00.001-07:00

Just a quick post on a subject that bothers me because the danger of its practice still doesn't get universal acceptance in the pediatric community: co-sleeping. This is probably because a major pediatric celebrity (Dr Sears) still hold fast to the notion that it is alright, even beneficial. I will have to beg to differ on this subject. I spent a month in autopsy while in medical school. We would get about a baby a week, and most of the ones I had seen were victims of cosleeping. All of them were at least victims of being put to sleep in an adult bed.

Just to be clear: co-sleeping is having your baby sleep in bed with you. Most other doctors (besides Dr Sears) believe that adult beds are death traps for babies with or without an adult in them. Even when Dr Sears went on Dr Phil, Dr Phil had to 'respectfully disagree' with him on the subject. And Dr Phil usually slurps his celebrity guests, so to make a stand, I was impressed. If you read Dr Sears website, he will make some convincing arguments and even state some evidence. But trust me, the evidence to avoid adult beds for babies far outweighs any studies he quotes.

Since I've been at my current job, I've gone to 3 'codes' in which a baby arrived dead to the ER. Also, all three of these were in adult beds, some with other sleepers.

Without the risk of death, I have to admit I have other concerns of the baby interfering with the parents' relationship. Sometimes bedtime is the only time parents get a chance to converse and touch base. Throw a baby in the middle, and you get no alone time for the two.

Bottom line for me: leave the baby in the crib.

Who kissed the pig?

2009-04-28T21:50:00.000-07:00

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

2009-04-28T16:54:00.001-07:00

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'

2009-04-11T13:45:00.001-07:00

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.

And now deep thoughts...

2009-04-04T10:14:00.000-07:00

Deep thought to go along with the last post:

"The true essence of diversity and tolerance are the same: acceptance and even celebration of one another's DIFFERENCES; not ignoring those differences and pretending everyone is the same."

--Dr. Jay of the blog Extemporaneous Wandering on 4/4/2009

Lemme tell you 'bout a man named Gene

2009-04-01T22:01:00.000-07:00

OK, maybe I have a more controversial post in me than the one on vaccinations. Here is an allegory with a VERY subtle message. See if you can figure out what it is about. There might even be a children's book in here somewhere (if you know any publishers, let me know):

Let me tell you about a friend of mine named Gene. As a young child he was always told that blue should be his favorite color. He could never quite get on board with that. He knew all along that he preferred green. Somehow along the way, after being told he SHOULD like blue, he developed an affinity for the name 'blue' even though he felt nothing for the color itself. He just liked the name and what it seemed to stand for.

When Gene got into high school, he got even more confused about his feelings. He would occasionally share his feelings about about liking green, but wishing it was blue. This discussion was usually met with confused looks and stares. Occasionally, when he was met with really small minded "bully-thugs" that didn't like their mind being challenged, he would get beat up and be the victim of other violent outbursts.

Once Gene talked with his dad about these confusing feelings. His dad had never had such a strange notion, and could not understand, and seemed to distance himself afterward. Due to this Gene felt his dad didn't accept him, and wondered if he loved him anymore.

When Gene went off to college, he found some others who felt they way he did. They even had similar experiences when they were going up from friends and parents and bully-thugs. There were actually many more people who felt the way he did, they just needed to find each other. It seemed like the bigger the group got, the more people came out of the woodwork with the same feeling. People from all races and genders joined the group.

Some of these 'blue-green' people were very angry for what they'd been through. The had a lot of residual pain from the bully-thug abuse and the perceived emotional abandonment of their fathers. They had creative minds and, whether it was due to their pain or their naturally imaginative or creative abilities, many of this group became artists of various genres. Through this art they made friends with many people of celebrity that were always looking for someone to help. These celebrities felt guilty about their wealth and fame while others had less and were in pain, so they were always looking for causes as a balm for this guilt. These celebrities did all they could to help the blue-green people, even got some of their friends in the goverment (with simlar guilt issues) and the education system (these people just want to save everyone from any pain).

Then one day one of Gene's friends had a great idea that would make all the pain go away: We should be able to call anything we want blue! Why should the traditional blue be the only blue? They felt they had less legal rights than others, even though there was already a law that ensured these rights to all**. They encouraged their friends in government pass laws that all people must accept both blues, whether they were the traditional blue or green.

There were other people of color confusion that existed, but they were not embraced by the blue-green people. There were the red-yellow people, but they were weird. They dressed differently and no one could really understand how they could live thinking yellow was red. Then there was the orange-pink people that were a little gross, and their beliefs sometimes caused medical concerns. Of course you have the purple-gray people who were universally felt to be disgusting. Finally there were the indigo-brown people that would make some people want to kill someone just by bringing them up. So it wasn't really people of alternative color appreciation they were worried about, because there weren't many of the other kinds and those that did exist were universally despised.

After the legislation was passed by the government, the people of traditional color appreciation were a little perturbed. They never had a problem with the blue-green people. In fact they were mostly respected, appreciated, and even deeply loved by the traditional color people. But the general public was bothered by being forced to say that blue could be blue or the old green. Mostly because some of the more aggressive blue-green people threatened to sue them if they didn't publicly accept it.

The traditional people got together and placed a proposition on the ballot to allow people to call whatever colors whatever names they wanted, but not to force others to accept green as being blue(remember, this was really the only color they were concerned with). The vote passed by a narrow margin.

This only angered the blue-greens and their guilt crippled celebrity friends even more. "Nobody cares about the pain we've been through! They must all HATE US!" They didn't realize that before all this, hate was the furthest thing from most of the traditional peoples minds (though I can't speak for the bully-thugs, they are just hateful people). Nevertheless, they started working immediately to get the goverment to overturn this.

Privately, Gene and many of the blue-green people wondered if it was all worth it. When the blue label was forced upon all the citizens for the color green, it didn't really help their pain. They hadn't got any more rights than they'd had before**. The bully-thugs were still hateful and mean and their dads were still distant. And now 52% of the population were annoyed by them for forcing their labels upon them. Now even more people might be annoyed if the government overturns it, as the land where all these people lived was one that had much pride in its democracy and didn't look kindly on a government forcing things upon them.

"Choose your adventure" ending:

The government allowed the law to stay. Peace was more apparent, as the traditional people were more aware of the blue-green people's need for acceptance and were therefore more sensitive to their needs. But they were also not forced to call green blue, so they appreciated that, too.

OR:

The government overturned the traditional people's will despite their majority. Conflicts worsened. Litigation increased. The bully-thugs went on doing what they had done in the past, but their numbers grew. People who aren't allowed to voice their opinion in public and thus only allowed to stew privately in their annoyance tend to become bully-thugs. The blue-green people went along feeling about the same way they did previously. Sure now the government recognized them, so on the surface it felt a little better. But animosity of the tradtional public increased and they could feel it when the walked down the street. Their daily life didn't really change, as all the rights available to blue-blue people were already available to them prior to law being overturned**. So was it worth it? Gene didn't think so.

Footnote:
**This is the actual California law: California family code 297.5. (a) Registered domestic partners shall have the same rights, protections, and benefits, and shall be subject to the same responsibilities, obligations, and duties under law, whether they derive from statutes, administrative regulations, court rules, government policies, common law, or any other provisions or sources of law, as are granted to and imposed upon spouses.

Everything Counts

2009-03-27T15:01:00.000-07:00

Here's another post for you big kids (I didn't mean big as in BIG, I mean big, like grown up - gosh you're so sensitive) who are trying to lose weight:

You've heard a million times that the key to successful weight loss is including both diet and exercise changes. Sounds simple enough, right? Well the answer actually is pretty simple in an equation that I gave you in my last weight loss post:

Calories eaten - calories burned = weight loss or weight gain

Yeah, okay, I'll admit it, it may be a simple idea, but not simple in practice. When you are bombarded with all this diet information in the media: good carbs/bad carbs, high protein, fat free, etc, etc. I'm here to tell you it is actually pretty simple once you've had a little practice. It involves the scary step of calorie counting, but it gets easy after a while.

How many calories am I eating?
The first step to counting calories is transforming what is on your plate to a number on a piece of paper (or in your iPhone apps). Duh - look at the back of the Doritos bag. Yeah, I know not everything you eat comes out of the Doritos bag. Some of it comes from McDonalds, some from Papa Johns, and some from Taco Bell. Oh wait, those are all the places I eat. Here is a tool that is abosultely necessary to learn calorie counting (it makes it sooooo easy):

I actually have the program on my palm and I'm sure there are iPhone apps as well. In today's world, we eat out so much that its nice to have all those restaurants' calorie information in a easy to find source (it cost like $6 and is at pretty much every bookstore). You could check all the restaurants websites (this does work) but it is a lot of work. Do yourself a favor and buy this book. (Disclaimer: I am not recieving any financial benefit from Calorie King for endorsing this product.) If it doesn't have the exact item you are looking for, you can always find a similar one, it doesn't have to be an exact science.

All calories are created equal!

Despite much of what the media inundates us with, the scientific reasarch does not show any difference between one calorie of chocolate and one calorie of steak and one calorie of papaya. No matter how well written the book is and how smart the author sounds (cue pictorial example):

All calories are created equal! I'm not going to say this is an irrevocable truth of all eternity, we may uncover subtle differences in the years to come, but as far as the equation above goes, it doesn't matter. Just ask this young woman with the obviously great personality:

Let's not get crazy now, if all you eat all day is chocolate, you will be eating VERY little food and not getting many of the wonderful benefits that come with eating other things (vitamins, minerals, fiber, variety). I'm just saying this is part of the good news: you don't have to quit your favorite foods cold turkey (in fact cold turkey is delicious). Turns out the foods that are the most filling for the calorie toll they take are fruits and vegetables, so make friends with them. Also, lean protein tends to keep you satisfied longer, so make friends with those foods, too.

Another calorie inequality rumor that I don't buy in to is that calories are worse after 8PM. Your calorie metabolism is more a refection of how you have been eating over a few days, and late calories do not automatically become fat. I do, however, think that not eating after 8PM is a good idea, because if you are like me that is when you pound the treats. It is an easy way to stop some mindless eating (while you are watching American Idol) and thus the racking up of empty calories.

How many calories should I be shooting for?

This is a little more complicated, but again has some simple mathematical solutions. If you want to lose weight slowly (which is BY FAR the best way to do it, and the best way to ensure lasting weight loss): just take a week or two to calculate how many calories you are currently taking in. Sometimes just keeping track of what you are eating will result in weight loss. Lets face it, some of us are lazy, so eating that extra cookie is so much more work when you have to get up and write it down. After you've figured out what your average is per day, cut it by 25% and see how it goes. If you really eat a lot, it may need further trimming.

Want to lose weight fast? First calculate your basal metabolic rate (BMR), which can be done here . Your BMR is the amount of calories you would burn in a day if you were in a coma. In other words, sleeping all day without any exercise. For quicker weight loss, set your calorie goal at this level, but I wouldn't recommend going more than 200-300 less than your BMR. This calorie total is basically at an unsustainable level, so when you finally get back to a 'regular' diet don't let the numbers bounce up too high or all the pounds will come flying back.

Tip for success:

Give yourself a day off every week (I stole this from Body for Life - italics due to book title, not sarcasm). This will increase your chace of staying on your diet and give you a well deserved break. Don't be stupid about it, though. There is no point in eating 1500 calories a day for 6 days if you eat 10,000 calories on one day. Just relax the the reigns a little bit.

WARNING: USING THIS POST (AND ANY WEIGHT LOSS PROGRAM THAT IS JUST BASED ON DIET) AND NOTHING ELSE WILL RESULT IN FAILURE. Any diet that produces weight loss automatically sends the body into some state of starvation. The body's natural response is to turn down the metabolism. Thus decreasing your 'calories burned'. The ONLY HEALTHY way to increase metabolism is to exercise. Diet after diet with no exercise will just decrease your BMR so low that it is almost impossible to lose weight, and will make you gain weight back faster when you are eating a 'normal diet'.

Hey man, nice shot

2009-03-19T14:19:00.000-07:00

This will be my longest post, but it has to be. If I leave something out, I will be asked about it later. Before I get started on my opinions this is the bottom line: The parent is the boss and it is always their call on whether or not to administer vaccines. They (and their children) are the ones who have to live with their decision.

I am absolutely positive that I will offend someone with this post. Great. Sometimes the wicked taketh the truth to be hard. Sorry, I just have to call 'em as I see 'em and this blog is about the truth (or at least how I view the truth - which is obviously the right way). Remember I am trained in the art of pediatric medicine and work for a company where preventative medicine is a keystone, and vaccines are an important part of preventative medicine, so add your grain of salt as needed. And remember we are talking about vaccinations not your mom or your religion, so CALM DOWN.

Let me let you into the mind of a pediatrician and what is going on behind that cheesy grin...

You, the parent, say: "I've been doing some research..." That's all you have to say, your pediatrician knows what's coming next.

What the pediatrician hears: "My pride and/or insecurities and/or belief in misinformation is more important than my child's health." (whether this is fair or not, this is what they are thinking)

Then a discussion on vaccinations ensues. Usually it is either about how you want to avoid autism or how your read a book or website about how an 'alternative' vaccine schedule is more appropriate. Then your pediatrician says: "Well you are the parent, and you need to manage your child's health care according to your own conscience."

What your pediatrician is thinking: "You are an insane parent who has been manipulated or decieved by some outside influence and for some reason this information/influence is much more valuable than years and years and years of vaccine experience and vaccination of billions of children, and arguing with you is worthless since I have a waiting room full of patients and trying to convince you of your insanity would take more than the 15 minutes I have been allotted for you." I'm just being honest. That is really what they are thinking. All of them. Are they right? That is for you to decide.

Why do some parents want to avoid immunizations?

REASON 1: Scared of autism.
One study published about 10 years ago said there was a link between autism and the MMR. Since then study after study has shown this to be untrue. Some even show a protective benefit from autism by those who received vaccines. A HUGE study of the highest clinical power (a double blind placebo controlled trial) in Europe has shown no connection. Now the news has come out that the person who conducted the original study (that showed the connection) falsified information and is under investigation for misconduct (link). With all the evidence we have today, if you are not vaccinating your child for fear of autism you are putting your child at risk because you trust information that has been repeatedly found to be false and is now found to be one man's imagination from the start and no basis in reality.

REASON 2: Peer pressure

Unfortunately this is the most popular excuse these days, although there are few who are willing to admit it. **warning rascist comment follows**: I have never, ever, never had a mother decline vaccination who was not white. I've also never had a father (of any race) decline. These tend also to be part of the middle class. In my own experience, I've noticed as the family gets poorer and richer they are more open to vaccines. I have had a few mothers admit to me they had friends tell them, "I can't believe you are going to vaccinate your kids!" Then they go on to indoctrinate their friend with one of the other reasons listed. Just say no! I mean yes!

REASON 3: An 'alternative' schedule is better.
There are 101 theories on better ways to vaccinate your kids. Most of them are based upon the theory that an infant's immune system isn't ready to develop the maximal response at the age they are given. I may surprise you by my response to this one: this may be true. The one MAJOR problem with this thinking: several of the vaccinations protect infants (less than a year) from death. If you wait to vaccinate, the risk of death or severe illness has greatly declined. You are still preventing your child from an annoying illness, and the long term protection may be better, but I'd rather have slightly weaker protection from death than slightly stronger protection from an annoyance. Who needs vaccine protection more than an infant with an immature immune system? There are still MANY infants dying and getting serious illness each year due to illness that could have been prevented by vaccine (and the numbers are increasing due to decreasing immunization rates).

If you are choosing this reason for avoiding vaccines you are turning your child into one of these:

Calm down, Richard Gere, its a guinea pig, not a gerbal. The physicians/people who put forth these alternative schedules base their ideas on largely untested THEORIES. They all sound pretty good. They need to. They are trying to recruit unsuspecting parents (mothers, really - see above) to try their theories out for them without having to set up an actual study.

If the theorist is wrong, and their schedule increases infant death, they say, "Oh well, dang, I guess my theory was wrong." I'd imagine the mother of the child who died as a result of this schedule might be a little more disappointed. I'm not judging. I enrolled my son in a pharmaceutical study when he was less than 6 months old. Made some good money when we really needed it. But you are volunteering your guinea pig for free.

Another alternative is the 'spread the wealth' theory of only doing one or two vaccines at a time. This is another one that has no basis in scientific realilty. In my own personal opinion, I find this schedule as tantamount to child abuse. Instead of getting all the shots over in a span of about 60 seconds, a parents decides to spread the pain out over many months, mutiplying the number of traumatic days by up to 3-4 times for absolutely no medical benefit. You are a meanie and maybe a commie.

REASON 4: Various conspiracy theories, including pharmaceutical companies benefitting from this schedule

Dr Gregory House said it best when he was talking to a parent with the same concern. He basically said you can choose which company you want to support: the pharmaceutical company or the 'teeny tiny coffin' company.

Conspiracy theories are always a little off, and if you believe in one, you probably are a little off, too. Sorry to offend you, but if you do believe in the conspiracy, this post isn't going to change your mind anyway (because I'm obviously a part of it).

Take home messages: Is the current vaccine schedule perfect? Not likely.
Does someone have an alternative schedule that will work better? Maybe.
Did you pick the right person's thoery that will revolutionize vaccines? Not likely.

As for me and my house, we will participate in the most tried and true schedule available that protects babies when they really need it (when they are babies) - the one currently recommended by the American Academy of Pediatrics and the Centers for Disease Control. It will likely be changed many times over the years. This is good and healthy sign that we are striving for the best schedule availabe. I would be worried if it wasn't true.

Addendum: Are vaccines completely safe?
No. Usually just pain at the site of injection and fussiness and occasional fever are the only bad effects. Rarely there have been reports of seizure afterwards. Whether it is connected with fever (and thus the very benign febrile seizures of childhood) or purely from the vaccine, that remains to be seen. If you have had a child who had a seizure after a vaccine, it can be scary. The truth of the matter is, however, that seizures are typically benign despite how scary they look and are not life threatening. You still made the right decision, because you may have saved your childs life by protecting them through vaccination, even though they had a seizure.

More severe reactions? Vaccines have been blamed for all kinds of illnesses all the way to sudden unexplained death. Anyone with kids will tell you, they get shots every few months for the first couple of years. If something serious happens, there's always a recent round of shots that can be conveniently blamed for it. Did the vaccine cause it? Probably not. In the unfortunate event that a child suffers a severe illness, every parent asks the question "Why?" repeatedly. Sometimes its nice to have something to blame it on. Unfortunatley vaccines frequently take the scapegoat role.

It's a proven fact

2009-03-18T16:02:00.000-07:00

I guess its a good of time as any to post on my feelings on science in general. A friend of mine had a girlfriend in high school that used to drive me nuts. Whenever we had a disagreement, she would say, "Well its a proven fact!" and that would be the end of the conversation. I don't even remember what we were talking about, but that statement bothered me more than the argument itself.

Living in the scientific age, it is tempting to think we 'know' many things that we do not. True scientists have a hard time giving something the label of 'fact'. There are many strong ideas that have been tested and retested and still get the title 'theory' rather than 'law.'

This can be a challenge as a doctor, as many people want to come to the doctor and be told exactly what they have and exactly what to do to make it better. This is especially difficult when dealing with pediatrics as far less scientific studies are done on children compared with adults. I have a feeling 50 years from now we will look as silly as Theodoric of York looks to us today. I know this is a Saturday Night Live sketch, but its actually pretty historically accurate:

If you don't want to watch it, here's the best line:
"Why just 50 years ago we would have thought your daughter's illness was brought on by demonic possession or witchcraft. But nowadays we know that Isabelle is suffering from an imbalance of bodily humors perhaps caused by a toad or small dwarf living in her stomach."

The biggest problem I see is that there is so much research being done, that isn't properly interpreted. Especially if the media catches wind of something, a circus ensues. The basic problem is best shown in this cartoon:

The most common misinterpretation I see is when a study finds a correlation, and it is interpreted as a cause. Using that reasoning, I can prove tomatoes cause cancer. A study could easily show that 98% of those that developed cancer had eaten tomotoes in the last month. In this case the correlating elements have absolutely nothing to do with one another. This may sound like a ridiculous argument, but I've heard it many times (except substitute vaccinations and autism for tomatoes and cancer).

Some people hold their beliefs about certain things (vaccinations, global warming, bigfoot, etc) as dear to them as their religious beliefs, which can be dangerous. It can be devastating when something you hold as 'fact' gets proven wrong by the next study. We just need to do the best with the information we have, and roll with the punches when we get more.

Yes, this post is a preface to a post on vaccinations.... get ready...

I will try to fix you

2009-03-05T10:38:00.001-08:00

Annoying complaint #2: Doctor, you have to help me. My son got a runny nose and cough three days ago, and he STILL HAS IT! What do I do?!?!? Please FIX HIM.

What the doctor hears: "I'm not leaving here until I have a prescription for antibiotics in my hot little hand." I have to admit, this type of response on the doctors part is annoying, too. Almost as annoying as the complainer. Education is much better than a reluctant antibiotic prescription.

News Flash: There is still no cure for the common cold. And no, antibiotics still don't work.

What can I give my child to make them better? Sorry. Turns out, lots of fluid and lots of rest work the best. I know THAT'S SOOOO BORING. Most studies of cold formulations show that these medications do absolutely nothing for children under the age of 6. Most studies also show they do nothing for children over 6, either, even 35 year old children. I know there is a place for sudafed in adult care, and I personally am a HUGE fan of Nyquil when I am sick. But most groups who have a statement on is (American Academy of Pediatrics, American College of Chest Physicians) say you should avoid cold medications in children under 6 (ACCP goes as far as to set the age at 14). I know what you are thinking.. these medications work great for me, why not my kids? The answer: Kids are different. Imagine that.

Okay, there's more to do than just fluids and rest, but those are the only 'cure' we have. Here's some other things that can help:

Mom: A ton of good old fashioned TLC helps anyone feel a little better when they are sick. I try to convince my wife this is what I need when I am sick, but she says she will never be my mom. Apparently, I already have on of those.

Saline water: Nose drops for the babies. Full-fledged lavages for older kids. It's uncomforable, but it works like a charm. Even better than sudafed. Your at home recipe for a nice salt water lavage: 1 tsp of salt and 1 tsp baking soda to 2 cups water. Some recommend pickling/canning salt over table salt and distilled water to tap, but if you aren't going to do it because you don't have those things, just do it with table salt and tap water. They sell bottles to (gently) shoot the stuff up your nose at the store, or you can just use a bulb syringe.

Cool mist: Cool mist humidifier in the room tends to improve symptoms and help with more restful sleep.

Honey: Yes, honey.

No, not THAT honey, this honey:

There's actually good evidence to show that honey helps coughs much more than cough syrup (which should be no surprise, since cough syrup does nothing). There are some good studies to back it up, also. 1/2 tsp for age 2-6yo, 1 tsp 6-11yo, 2 tsp 12yo and over. DO NOT give this to babies Unless the baby is a terrorist and/or poses immediate danger to the safety of all Americans (in other words: unless you want to kill them).

Cough drops: My favorite when I am sick. Only for older than 4 years due to choking danger.

Medicines: Yes, there are some medicines I recommend to my patients. Of course you can use tylenol/motrin for fevers. Also I'm a big fan of using Benadryl/diphenhydramine at night before bed, and maybe again in the day if your child is still taking naps. Remember, I said rest was very important to recovery, and while benadryl may produce very marginal results with the symptoms, they have the perfect side effect for this situation: sleepiness. I am pretty free with it (but do not endorse benadryl use to put annoying kids to sleep).

What should I expect?

Cold and the flu can last a long time. Usually the first few days are the worst and include runny nose, cough, sore throat, and fever. After that, its totally unpredictable. The fever typically subsides, but the runny nose and cough can go on for weeks! I am personally sporting a mild cough that's been with me for 4 weeks.

What about this green snot?

No it, in and of itself, does not mean there is an infection present. It is the natural course of a viral illness to produce thicker/darker mucous as the body fights the illness. Many times is it a sign that you are almost over your illness. But if the dark thick stuff persists for a long time or is accompanied with a new fever (remember your original one went away), I would see a doc to evaluate for infection. Actually, I think any new fever after the initial one has been gone for 2 or more days should probably be evaluated as it could signify an early pneumonia/sinusitis/ear infection.

The secret to weight loss

2009-02-27T21:42:00.001-08:00

I thought I'd take a divergence from pediatrics for those of you who may be reading that don't have small kids and talk about something I have very intricate experience with... weight loss. Of course pediatricians don't have to deal with weight loss right? The sad truth is incidence of childhood obesity and diabetes increase every year. But more importantly, 3 years ago I was 50 pounds overweight, and decided I needed to change my habits. I lost 50 pounds in about 6 months (which I acutally don't really recommend).
Here was my 'after' photo:

Everyone asked what my secret was, but after I told them they always seemed disappointed. Its actually quite simple (conceptually at least).

Here it is:
Calories eaten - calories burned = weight loss or weight gain

Sorry, I know you were looking for an easier way. But the secret is, there are no shortcuts. When you are ready to accept this reality, you are ready to make some positive life changes that will help you lose weight and keep it off. If you are looking for a shortcut, you will continue to fight a losing battle. Don't get me wrong, I think there is a place in this world for crash diets.. a wedding coming up soon and you need to fit into your dress, the Oscars are coming up and you don't want Joan Rivers to mock your bulge, or you are appearing in the latest "Men on a Mission" Calendar:

But crash diets have no place in the quest for long term weight loss, and most of them will make you end up heavier than you were before you started. Its the truth!

A good friend of mine in medical school had a million dollar idea... He was going to mow his lawn and package it into capsules and sell it as a weight loss supplement. He was going to sell it as a 'doctor recommended' item. On the packaging of the supplement he was going to make sure to include the footnote *best results obtained when combined with low calorie diet and regular exercise. That is the basis of all the 'tricks' to lose weight... they work well if you exercise more and eat less.

I'll post more in the future (I'm trying - but not succeeding - to make my posts shorter) on the things I found to be the most helpful in my weight loss quest, and maybe they will help someone else. Just being the kind of person I am, I heavily researched it before I jumped in, and at the time felt I could write a book on it. But I figured no one wants to know that weight loss takes a little work, and there's actually a million books out there that already say that.

Here's a little tidbit of knowledge that can take you a long way: A 12 oz can of soda is about 150 calories. To cut one can out per day, you decrease your calorie intake by about 55,000 calories per year. For most people that would result in a 9-10 pound weight loss in a year. In fact, I lost my first 10 pounds by deciding to drink only water and lots of it (and an occasional glass of milk), but I ate pretty much the same. I lost 10 pounds in two months with just that change. Try it!

I've been waiting FOREVER

2009-02-24T13:32:00.000-08:00

Why do I have to wait soooo long when I get to the doctors office? The reasons are numerous. Many times you have a slow doctor that frequently gets behind. Many times (as is the usual problem with my personal clinics) the patients earlier in the day were late, thus putting the clinic behind for the rest of the day. I can't tell you how many times I've been twiddling my thumbs early, only to be totally slammed later. But probably the thing that backs up the clinic the most are lame complaints. (Is it still PC to use the word 'lame' or is is offensive to the weak and/or paralyzed members of the community?) Yes those complaints that really should have just stayed at home and saved the copay. Let me first say that I came from a family where you had to be dying to go to a doctor, and in fact I was once at home with a broken collar bone for a week before my parents took me to the doctor. I'll outline some of these complaints and we can all save some time together, starting today with:

My all time most annoying complaint:
Dr. Jay, my son woke up with a temp of 100.3 today, and I just wanted to bring him and make sure everything is okay. No he doesn't have any other symptoms. Can you please tell me what to expect?

Point 1 - The definition of a fever is 100.4 or higher. Some physicians are very strict about this and won't even listen to you unless it is measured rectally, as that is the most accurate way to measure. I for one, am not that picky (my wife will laugh because I used to be), and have never measured my childs temperature rectally, so wouldn't expect that to happen with my patients, either. The studies to compare rectal vs axillary (armpit) vs oral vs forehead/temple have all been done with pretty poor scientific reliability. So I don't usually subscribe to the add one degree here or 0.5 degrees there philosophy. Truthfully, the exact height of the temperature in kids doesn't really make that much difference until you get to the 106-107 range (unless you are dealing with a newborn - less than two months - in which case you want to let your pediatrician know about any fever over 100.3). Please don't use the kind of thermometer pictured below. It won't give you the desired results.

Point 2 - Lets assume the fever is for real (and not just due to overbundling a baby or running a mile); it just started. It is very difficult to determine where a fever is coming from on the first day, as it will most commonly just precede a cold. Just wait a day or two to see what happens. If cold symptoms develop, there you go... a cold. Some kids get a fever for a couple of days and nothing else and then a rash all over after the fever is gone. This is called roseola, and you definitely need to see the doctor for this right? Nope. The rash is the extent of the illness, and your baby doesn't notice it and it doesn't last long. I usually spend a significant amount of time preparing for the many things that could come up to save the next days annoying complaint: "Dr. Jay, my son has a runny nose, so now what do I do." We'll talk about annoying cold complaints in another post. I'll do it soon, as it is cold season and all.

Point 3 - Many times a parent says, "I just want to make sure the ears are okay," at this point. Ear infections typically come AFTER a cold or late in a cold, so this early of a check is usually completely worthless.

Point 4 - Coming in early in the course of a fever may result in more invasive evaluation that may not have been needed. If you bring a child that is less than 6 months with a fever and no other symptoms, many doctors will feel the need to find the source. This will include blood tests and urine tests. And since most 4 month olds aren't good at peeing in a cup it will buy him/her a catheterization of their bladder, which most people find uncomfortable. Two hours later they get a runny nose, and we say, "Now we know where the fever came from, too bad we did all those mean things to the baby." I personally won't usually chase a fever in a baby (unless less than 2 months old) on the first day unless it is high (>103) or the baby looks sick, but many doctors will. I won't ever chase it in a bigger child unless it is >105 or there is something else going on (but then I guess that takes away the fever with no other symptoms distinction).

This visit usually ends with me saying, "Your child looks perfectly fine. I can't tell you what's causing the fever, or if it is even a fever. I can't predict what's going to happen the next few days, but your child will likely be getting sick." This kind of answer is unsatisfying for the patient and the doctor, so please wait at least a couple of days before coming in (unless a newborn, but you already picked up on that). The only time I feel a fever, in and of itself, NEEDS to be seen is after 5 days with all other things being normal and the patient is >12 months old.

Bonus point: Q: At what temperature is it best to give tylenol/motrin? A: At the right temperature (or any other smart alec remark you want to insert). Stop getting hung up on numbers (this was actually hard for me personally to do). Give the medicine to your child, not to the temperature. If your kid's temp is 99.1 and they look miserable, give them the medicine. If your kid's temp is 102.5 and they are happy and running around like normal, don't give it to them. A fever is a good thing when you are sick and helps your body get better. There is no reason to bring it down unless your child is miserable.

Bonus bonus point: Tylenol/acetaminophen vs motrin/ibuprofen. Motrin works better for both pain and fevers, in my opinion, but comes with more side effects. These include stomach upset and, in rare cases, stomach bleeding. So if you give it to your child, give it with some food. I personally give my kids tylenol first and if it isn't cutting it, add the motrin. So, yes, you can give both. The most frequent you can give tylenol is every 4 hours, and motrin every 6 hours. Giving them both does not affect these frequencies. In other words, they don't interact, so you can still give tylenol every 4 hours counting from the last dose of tylenol, not the last dose of motrin. Some parents find it beneficial to alternate every 3 hours, so there is always new medicine coming in and each medicine is spaced from itself by 6 hours. I don't personally do this because, as above, I treat my child not the fever, and people who do this tend to be more obsessed with the actual the fever itself, rather than how their child looks/feels.

Pick a winner!!!

2009-02-22T22:03:00.001-08:00

Okay, well I decided to start blogging. I mainly did because I enjoy my cousin’s blog so much and hearing what he has to say on different issues. Since I’m attempting to remain somewhat anonymous, let’s just say his name is ‘Brian Smith’, which is a generic name that is nothing like his real name. I thought maybe someone might be interested in what I might have to say about things, too. Either that or I’m getting more and more narcissistic in my older age. Which could easily be the case because I’ve spent a lot of time around surgeons, and I did take that class in medical school, “How to act really important around non-physicians.”

I think I do have a unique perspective to add on a variety of subjects, but people are probably most interested in hearing what I have to say about kids. So I will post about anything that happens to be on my mind at the time, but most of my posts will probably center on being a pediatrician. And I’m sure a post or two will pop up about prop 8, since I am Mormon, even though the election is over, it seems to be an issue that will never go away.

You should listen to what I have to say, because I AM A DOCTOR! (please read sidenote about italics = sarcasm). Actually that leads to the first subject I thought I would post about… picking a doctor. I have been scared many times by parents in my office who disagree on a certain issue, and I come down on one side of the fence. Then one parent says to the other, “We need to listen to him, he is a doctor!”

Let me say, I have met many people along my trek in medical school and residency that I would not want near myself or any loved one of mine. And I picture these people telling patients (and their parents) what to do, and those people saying, “We need to listen to him/her, he/she is a doctor!”

So how do I know whether my doctor is a quack or stud? Well I know lots of people who go to him and everyone loves him! Nope. One of the scariest realizations I had in residency was that some of the worst doctors were the most popular ones. Their clinics were always full and their patients/parents LOVED them. I also know popular doctors that are good, too.

Here’s the point were I give you the solution to the problem, because I HATE when people bring up problems and no solutions. Oh wait, I guess I don’t really have one. If you have a doctor friend you can run things by them to see if what they say makes sense. But then again your friend may be a quack, too. You could check their malpractice record, but that is likely to be deceiving, as many of these docs are loved, and loved doctors don’t get sued.

Okay, here’s my take home message: Always keep your mind open. Don’t take everything your doctor says as gospel. I’m sure I will have a future post about ‘scientifically proven facts’, but here’s the readers digest version: there aren’t many out there. Do your homework and don’t be afraid to think for yourself. And if you are diagnosed with a something serious, or think you have something serious and your doctor is blowing it off, don’t be afraid to get a second opinion. But whatever happens, please don’t get your second opinion from Jenny McCarthy! (there will also be a future post re: vaccines and autism)

*** And if you are one of my former classmates and you are reading this, and you think I'm talking about you as one of the quacks, here is my response: No, I'm not talking about you. It's someone else. You are a wonderful doctor.