Archive for January 2011

Monthly Archive

Changing The World: Gates’s 36 Cents

Posted on January 31, 2011 in: Doctoring & Healthcare3 Comments

Bill Gates recently said, “Not everyone can go into the field or donate. But every one of us can be an advocate for people whose voices are not heard.”

Ditto to what he said.

Watch Gates’s annual letter (below). This modality for telling stories is delicious and the message here is simple yet full of heart. However, like most things in life, it is not without controversy or a difference of opinion. As reported today in The New York Times, some feel Gates is off target.

I got a boost of energy listening to Gates today. It’s good to hear about progress. And even better to feel hope in the war-torn-rioting world in which we live.
Mr Gates describes efforts needed to complete polio eradication around the globe. He also points out the value of 36 (18+18) cents. Most vaccines are cheap. And although you can’t protect a child from measles for 36 cents in the United States (think co-payments and/or administrative fees), you can elsewhere. Particularly when Bill and Melinda Gates are picking up the tab.

I love to witness those with big dreams and lofty goals; it’s how and why our world progresses.

This video is worth the 4 minutes it takes to view. Both for its message and for the enjoyment that comes in watching the pictures unfold.

Baby Elephants & The Working Mom

Posted on January 28, 2011 in: Mama Doc Philosophies, Parenting9 Comments

Working-mommy crisis ensued again last night at the typical quarterly interval, yet in the most unusual form. It was my regular Thursday, a 14-hour work day away from my boys. I left the house before 7 and didn’t return home until nearly 9pm. I didn’t see the boys all day. But that wasn’t it. I was doing just fine with my day; I’d seen over 25 patients in clinic, made some inroads on work in social media and sincerely enjoyed the opportunities I had to help. The shift occurred after I decided to watch the first disc in The Planet Earth series. Have you seen it? I’d planned on finishing a post on Amy Chua (writing it feels like putting hot pokers in my eyes at this point) but realized my brain was fried. Decided to give in and stop working around 10. We got a new television for our basement this week; I popped in the DVD.

The show has nothing to do with women in the workforce. I don’t think the BBC producers thought once about inspiring a post on work-life-balance. Yet the series has everything to do with parenting, our connection to community, our space in nature, and our commitment to our children. The future of the health of our planet is dependent on our care now (of course). Our task in helping preserve the earth is really about more than the quantity of plastic that ends up in landfill. It’s really about how we learn to love and enjoy the woods and the wilderness, how we learn to live and travel without leaving large marks, and how our children understand what matters outside the walls of their home. And how they come to understand decision-making.

The BBC series highlights the earth from every contour and perspective while chronicling animals of all forms in their process of incubation (penguins=amazing), rearing, surviving, and dying.

I just kept watching the mothers. My stomach flipped at points as I watched a mother elephant help her young bull who’d walked right into a tree because he’d been blinded in a dust storm. Or the polar bear teaching her young cub to walk. These animals flanked their mothers. The babies would get tired during migration and sit down. Their mother urged them on… Even after the room was dark and I plopped into bed, I was eyes-wide-open thinking about those mothers. Read full post »

500 Words on a $5M Fine

Posted on January 25, 2011 in: Doctoring & Healthcare27 Comments

No photo for this post. You can imagine why.

I’m a little stunned by the news that a politician in Florida is trying to stifle pediatricians from asking questions about guns in the home. My reaction is utterly predictable. Should I YELL IT or write it down or leave it up to your genius (and imagination)?

(silence)

The Skinny on the Florida Proposal:

  • Florida Rep. Jason Brodeur said “he has heard about a number of cases in which doctors asked about guns. He thinks the topic should be off-limits.”
  • Brodeur says he’s concerned about doctors asking patients about guns in the home. He’s concerned that information could get into the hands of the government or insurance companies.
  • Under the proposed legislation, a doctor could face a fine of up to $5 million or be sent to prison for up to five years for asking about guns in the home.

The idea of blocking the right to advocate for children is preposterous. Clearly pediatricians don’t like censorship, particularly when it gets in the way of protecting the lives of children. We don’t even like censorship from our patients; we like it when adolescents tell us the truth about having sex, doing drugs, and self-tattooing. We like it when parents tell us what truly keeps them up at night. Really. Transparency and a lack of censorship is an imperative ingredient in the doctor-patient relationship. The exam room is a space and place where you’re not faulted for telling the truth. Read full post »

An Extra Wince In The Exam Room

Posted on January 21, 2011 in: Infant, School Age, Toddler26 Comments

Yesterday, results of a survey on beliefs about vaccines circulated on the internet. The survey conducted last week, asked over 2000 adults if they believed vaccines, or the MMR shot, caused autism. I’m not an expert on surveys and I don’t know how reproducible these results are to all parents in the US. But the news caught my eye (along with many others) when they reported: “Just a slim majority of Americans — 52 percent — think vaccines don’t cause autism” That’s a kind-of-odd-double-negative-type way to look at it, I suppose. Or maybe a hopeful one. The results reflect that nearly half of adults in America may suspect or worry that vaccines cause autism; 18% saying they believe a connection exists.

Whew.

The survey reminds us of some of the Why. It seems on some level, it’s a breakdown in our education. While only “69 percent of respondents said they had heard about the autism-vaccination theory — only half (47 percent) knew that the original Lancet study [that linked vaccines and autism] had been retracted, and that some of that research is now alleged to be fraudulent.” And, the details of all the research finding no link between autism and MMR is even more deeply buried, I suspect.

Even so, the numbers surprised me. In light of all the writing in the British Medical Journal this month on the scam behind Andrew Wakefield’s original paper in 1998 making the claim, I’ve been thinking about where we all stand in our understanding of immunizations, science, and trust. More on that next week. But I really wouldn’t have said 1/2 of my patient’s parents believed or suspected in a connection between autism and vaccines. What percentage would you have guessed? Read full post »

The Injustice of Immunization Interviews

Posted on January 17, 2011 in: Doctoring & Healthcare, Infant, School Age, Toddler, Vaccines17 Comments

When Dr Wakefield interviewed on Good Morning America today, an injustice occurred. For children, I mean. And it occurred inadvertently I suspect. But I believe this injustice happens all the time when it comes to childrens’ health and wellness. What the media covers really changes how we think and feel about protecting and parenting our children. The media’s effort to inform and educate, just like that of physicians and nurses, social workers and ancillary staff, researchers and students, can get lost and misconstrued. ABC worked hard to inform us of the accusations against Dr Andrew Wakefield with a 2 minute introduction by Dr Richard Besser, a pediatrician and medical editor/correspondent. Yet when the interview was over, I was left remembering the myth.

Today I awoke to the boys asking for breakfast. After getting them to the table with a bowl of Life (always strange to offer a cereal named after our existence), I poured milk in my own bowl. Suddenly I realized that I needed to get the recycling and garbage to the curb. I donned my boots and a coat, ready to haul the can and a number of collapsed boxes to the curb. But just as I headed out of the door, the phone rang. It’s when the day went from the typical day (“making” breakfast and moving garbage) to a day steeped in really trying to understand. My mom was calling, she said Andrew Wakefield was about to be on Good Morning America. I hit my personal fast forward button, flew to the curb with the garbage, and got back inside with enough time to hear the complete interview.

Dr Wakefield interviewed on GMA with George Stephanopoulos who later labeled the interview “combative.” Mr Stephanopoulos was given a terribly difficult task: he was interviewing Wakefield on one of the most complex, emotional, and loaded quandaries of the last few decades: vaccine-hesitancy and Wakefields’s purport linking vaccines to autism. When Wakefield failed to deny any allegations and failed to discuss the significant research that refutes his own work, Mr Stephanopoulos had to defend science. Alone. George Stephanopoulos isn’t gaining popularity (read the comments) with the anti-vaccine crowd and even some who doubt what Dr Wakefield claims. Yet ultimately, the 7 minute interview with Stephanopoulos and Wakefield simply stirs the pot. I trust it will have huge viewership. I worry that this is, in part, why it was done. Read full post »

Dirty Laundry

Posted on January 14, 2011 in: Mama Doc Philosophies, Parenting1 Comment

Obama said, “Our hearts have reason for fullness,” this week in Tucson. Yes, they do. Hope and love are always here. And although this sense of fullness can be buried or obscured by our sadness, each day offers a new chance at finding lightness. Understanding, insight, forgiveness, and love, too.

Recently I returned to an incredible article I read during the summer of 2009, What Makes Us Happy, in the Atlantic Monthly. The article highlights the work of Dr. George Vaillant, director of a 72-year Harvard study on aging and happiness, who explains “what makes people strive for fame and why dirty laundry symbolizes a perfect life,” (watch his interview). You have to read it to believe it (the laundry part), but the study follows men from the 1930′s during their college years until their death, determining ultimately what defines and exemplifies their happiness. JFK was one of the research subjects (wow). Dr Vaillant discovers, like most seem to, that happiness is neither rooted in money or fame, achievement or reward, cars or vacation homes. Ultimately, happiness comes from love. And the many piles of laundry that result from time together with the ones for whom we care the most.

I’m sharing this because today my mother-in-law turns 75. And well, she is blessed with wisdom and patience unmatched by many. And she is happy. She often speaks to me about happiness. And while once describing her sixth, as the most happy decade of her life, she gives us young-ens all hope! She is an uncommon model in maintaining incredible relationships with her children and by having 4 of them (and 8 grandchildren), she’s managed to form quite a tall pile of dirty laundry…

Happy Birthday, dear Lois. Thanks for doing the wash. We are so much happier because of you.

Treating Ear Infections With Antibiotics

Posted on January 14, 2011 in: Reader's Picks, School Age, Toddler10 Comments

New research on ear infections confronts a challenging conundrum: What should pediatricians do for a toddler with a real-deal ear infection? Treat with antibiotics or “watch and wait?” New research and a nice editorial published in The New England Journal of Medicine this week add to the stew of information about how to manage ear infections in young children. The new research confers benefit to using antibiotics at initial diagnosis of a true ear infection in children under age 2 or 3.

But wait. Seemingly simple, treatment decisions for ear infections are far from it. It can be easy for a pediatrician to prescribe antibiotics, yes. But those of us working hard to perfect how we care for children think long and hard prior to writing a prescription for the pink stuff. Current guidelines from the AAP (published in 2004) make us pause. The AAP recommendations embody the “watch and wait” approach in most children with uncomplicated, acute, middle ear infections between 2 months to 12 years of age. The AAP recommendations include:

  1. Proper inspection
  2. Pain control (Tylenol or Advil, etc). Ear infections hurt!
  3. Observation (waiting for 48-72 hours for relief)
  4. Treatment with high-dose Amoxicillin first and foremost if selected to treat.
  5. Return check after 48-72 hours if no improvement (then moving to treatment with Amoxicillin or changing to Augmentin if child on Amoxicillin)
  6. Prevention efforts (encouraging breast feeding, no bottle propping, working to decrease exposure to cigarette smoke)

But the “watch and wait” approach can be challenging for parents, pediatricians and family practitioners alike. Particularly with a child in pain, a gnarly looking eardrum, and/or a fever. Because of this, studies have found that the majority of physicians who see ear infections in the US don’t necessarily subscribe to these recommendations; we all really like to do something to make our kids feel better… Read full post »

The View: 5 Truths WhenTraveling With Children

Posted on January 12, 2011 in: Mama Doc Philosophies, Parenting, School Age, Toddler8 Comments

We arrived home late in the day Monday from Central America (hence the near silence around here). My family traveled to Costa Rica where we visited my father, old friends, my family’s ecolodge, and had some real honest-to-goodness time together. I remained essentially unplugged for the 10 days (except for a few brief moments online). Wondrous. Life really feels different without an iPhone in my pocket and a diaper in my purse while on the way to preschool. I didn’t have the iconic stethoscope along either. In the absence of routine and my typical tools, I was reminded that travel and how you deal with it is often about perspective. And optimism.

Time brushes your body differently when you’re out of the country, as if it attains a new temperature. Startling news like the shooting rampage in Arizona or the deeper disappointment in Andrew Wakefield hit me differently than I would have expected. Sometimes what we infer really depends on the view. When sitting in a country without an army, surrounded by family and wide open spaces, priorities came into focus, minutia disappeared, the resume of my life diminished in importance, and tragic news penetrated less deeply. For me, travel was a break from responsibility but also a break from the internet, the demands of the constant worry we can feel when taking care of others or bearing witness to the hydrant stream of ideas and news in the (social) media. While I was in Costa Rica, I really felt like a mom. Singularly at times. We were devoid of deadlines and while in the middle of the rain forest, the distance from technology was vast. Big trees, humid thick breeze, and the bazillions of bugs reminded me that there really was a time before my iPhone, Twitter, and e-mail. There can be time that is slow and uninterrupted.

Let me be clear, travel with children isn’t all rosy and relaxed. Travel with children is just that, travel. It’s not technically vacation. There remains little “down-time.” The diapers still get filled, the tantrums remain rampant, the sicknesses can still appear, and the room is usually crammed. And although travel through the eyes of children enlightens, it also exhausts. Which leads me to these 5 things. Read full post »

2011 Hopes, Dreams, Predictions

Posted on January 6, 2011 in: Mama Doc Philosophies, Parenting4 Comments

One year ago, I published a post about hopes, dreams, and predictions for 2010. Click on that link, there’s a 7 second video worth watching.

While we determined our hopes and predictions, a friend helped me determine the mathematical equation for ranking the likelihood of each coming true. We figured it went something like this: Predictions>hopes>dreams. That is, predictions are most likely to come true, dreams the least.

Here’s the 2010 list of predictions from a night one year ago with friends and neighbors. The results listed thereafter.

2010 PREDICTIONS: “2010 will be easier on all of us than 2009,” “Obama’s reputation will be saved by climate legislation,” “I’ll paint the trim in the house white.”

(No, I don’t think 2010 was easier. I don’t think Obama’s reputation was saved. Instead of painting the trim, we sold the house)

2010 HOPES: “Good health,” “My Dad can retire by 12/31/10,” “My mother-in-law’s cancer treatment is successful.”

(Good health, yes, thank goodness. Yes, her dad retired. Yes, my mom’s treatment has put her into remission for the time being).

2010 DREAMS: “F will be potty trained,” “Obama is as good of a man as we think he is,” “I work less,” “The Chevy Volt will save GM.”

(Yes, F potty trained in January of 2010 (YAHOO). I believe Obama is an amazing man. I worked more, not less. I don’t know about the Volt; the jury is still out. Thoughts?)

We were on, we were off. I do believe we all continued to dream big.

As I ended the year 2010, I was directed to a blog post entitled, “The Myth Of Work Life Balance” by Mitch Joel. I read it more than a week ago and have returned to it in my head many times. I agree with parts, disagree with others.

First things first, anyone who writes about work life balance doesn’t have it. Read full post »

Happy New Year!

Posted on January 3, 2011 in: Mama Doc Philosophies14 Comments