Doctoring & Healthcare

All Articles in the Category ‘Doctoring & Healthcare’

CT Scans And Cancer Risk

T8--approx CT scan” Yesterday’s news,” my husband said when I shared a study published, well, yesterday. Yet what we do with yesterday’s information is of course the news today. A JAMA Pediatrics article found that the use of pediatric CT scans rose in the late 1990’s and early 2000’s. Further, research shows that these CT scans can increase risk for future cancer diagnoses. Authors calculated the risk: they estimate that for every 4 million pediatric CT scans preformed annually, some 4800 children will go on to develop cancer as a result. Like many studies published this decade, the study came with warnings for radiologists, pediatricians, and parents.  I have tips for parents and doctors included below.

CT scans use radiation and radiation exposure is linked to cancer.

That being said, CT scans also save lives and we’re learning to use them more judiciously. Since 2007, rates of CT scans in children are declining. Don’t let these risks and media reports today cause you refuse or forego diagnostic CT scans your children need. We just have to be strong advocates and smarter about how we use CT scans. Read full post »

Emergency Preparedness: Make A Communication Plan

Screen Shot 2013-05-20 at 4.19.56 PMThe news from Oklahoma today is heart wrenching and terrifying. Often we feel helpless when we’re far away from a disaster. A donation to The Red Cross is a good use of your time.

Today, in addition to providing donations and support for those suffering the loss and tragedy in Oklahoma, do something really productive to counter the sense of unease and alarm we all get. Prepare your own family. Buddy up with a friend and get part of this done today and tomorrow.

I suggest you make a 3-day disaster kit. Here’s an article I wrote for Parents Magazine that details how to make a kit. If the work of storing water and emergency supplies seems daunting today, start with something equally as important:

Make An Emergency Communication Plan

  1. Teach your child one parent’s cell-phone number or a good contact number for you or your partner. Starting at around age 5, kids are developmentally able to memorize a 7- or 10-digit number. Practice with your child today and tomorrow. Get that number locked in. Experience has taught me to re-visit these numbers as my 6 year-old proves every once and awhile that numbers slip away from memory!
  2. Designate an out-of-state contact. Chose a family or friend distant from your home who answers their phone regularly. This will be a resource and point person for your family to call during an emergency.
  3. Choose a safe location. Designate a location other than your home where your family can meet in case of danger or unsafe conditions in your home. This is the kind of place you may need to go there in case of a fire, tornado, or an earthquake. Your meeting place might be a local park, school, or shelter. Walk to the site with your child so he knows exactly how to get there. Read full post »

Beads Of Courage

beads of courageI met Lowie backstage, about an hour before my own talk earlier this month. I had butterflies in my stomach for all sorts of reasons. I’d read about him prior to arriving and perused the blog he’s written about his daughter’s cancer and his family’s journey during her life and death (you can have Google translate it into English). It was so nice to meet him.

I was really looking forward to his talk although a part of me knew I’d need to brace myself, dig fingernails deep into my legs and let my throat tighten when he started to speak. I knew his words would fill my eyes with tears.

His story detailing Guusje’s voice and needs during her cancer treatment did, of course, cause me to cry. But the images he shared also gave me great hope. Learning about his daughter’s life implored me to share his lessons. I realized we could share the beads of courage widely and put these beads in the hands of other families everywhere. You know we can learn a lot from those in the Netherlands — they did just top this list from UNICEF for child well-being for the wealthiest countries on planet Earth.

Beads of Courage

In the Netherlands when a child is diagnosed with cancer, they immediately spell out their name with beads and then chronicle their courage each and every day in order on a string. Each day of chemo, each radiation treatment, each terrible, bad day (green), and each good day gets documented, strung up in line, and valued. A ledger and journal of the courage a child maintains as they fight for life.

To me it seems obvious that these beads of courage can represent a child’s endurance, perseverance, experience, and will. A hand-held way for a child to see where they are and where they’ve been. Yet reflecting on and re-watching Lowie’s talk I realized that more, these beads can represent the wishes and life experience of a child who courageously fights for life during a chronic or life-threatening disease in a health care environment.

These beads can be a tactile acknowledgement of  humanism  in health care. Read full post »

Chickenpox Parties

pox party de-identifiedToday a Seattle mom advertised on an online parenting community that both of her children had chickenpox and then invited (non-vaccinated) children over for exposure. That’s the invite from 1:19pm today.

It turns out people are still having chickenpox parties.

Part of this makes my head spin. I just don’t get it, despite having had many families in my practice decline or hesitate or delay the chickenpox shot. I don’t think parents know what virus they are dealing with. After I posted this invitation on Twitter, I had physicians all over the country sharing stories (some included below).

Chickenpox can cause serious infection complications and rarely it can be lethal. Before the vaccine was approved and put into use in 1995, hundreds of children and adults died in this country every year from chickenpox and thousands were hospitalized. Although most young children get chickenpox and recover (only left with pox or scars) some children develop life-threatening secondary infections. Some children develop severe pneumonia (1 in 1000 children), some develop brain infections, and some children develop flesh-eating bacterial infections in their scabs that can even be fatal.

There is a safe, highly effective vaccine for chickenpox: Varicella Vaccine.

After I saw the pox party invite this afternoon I became slightly enraged. I mean, there are NUMEROUS children and adults in our community immunosuppressed and/or on chemo that could develop life-ending complications if exposed to varicella. And some families are intentionally exposing their children to a potentially harmful infection. After 2 doses of the chickenpox shot (varicella) 99% of patients are immune to chickenpox. Although some children can get chicken pox once vaccinated, they typically only have a few pox and do not develop severe side effects or die.

The pox party just shows me how much work we have to do to build trust in vaccines and vaccine-safety. My boys have both had 2 doses of the varicella vaccine. I’m thrilled they are protected and unlikely to ever get chickenpox or spread it to a community member who could be more at risk. They likely won’t get shingles, either.

Chickenpox Facts & Stats:

  • Varicella shots hurt upon injection (children tell me it really stings). We give the shot twice, once at 1 year of age and once at 4 years of age. The shot can commonly cause arm soreness and lowgrade fever. In less than 5% of children, a small rash develops, often around the site of the shot. That’s a good sign the immune system is being triggered to fight off future infections. The rash that can develop after the shot is not contagious. Read full post »

Children With Gay Parents

http://www.people-press.org/2013/03/20/growing-support-for-gay-marriage-changed-minds-and-changing-demographics/

Headlines like, “Children Do Better with Committed Parents,” excite me. I feel proud to live in a time where we’re advancing understanding and safety for children and their health–I love being a part of it. Over the past decade(s) there have been big shifts here in the US. The Pew Research Center published data today that there has been a notable change in public opinion when it comes to the nation’s support of gay marriage: more people support gay marriage (49%) than oppose it (44%). In particular, 70% of “millennials” (people age 18-32) support gay marriage. Today, The American Academy of Pediatrics (AAP) stepped forward in support of gay marriage in hopes of improving child well-being nationwide. The AAP, a group that represents 60,000 pediatricians who care for families all over the US, did so not just for politics, but for children. There are mounting piles of research that the estimated 2 million children being raised by gay or lesbian parents are doing beautifully. In fact, the AAP says, Read full post »

The New Norovirus

Screen Shot 2013-02-12 at 10.27.08 AMNorovirus is a nasty one. It’s the leading cause of epidemics of vomiting/diarrhea and causes over 20 million cases of gastrointestinal disease (“stomach flu” with vomiting, diarrhea, abdominal pain, fever and achiness) in the US each year. Our experience with Norovirus historically is worse in years with “novel” or new strains of infection. Unfortunately there’s an new strain circulating around the globe. “Sydney 2012” was discovered in Australia last March and just last month the CDC officially announced it’s causing the majority of Norovirus infections. Over 1.2 million people in the United Kingdom have had it and the FDA reports this strain may potentially cause more hospitalizations. Time will tell if we have more Norovirus this year, too.

When new strains arrive, we tend to see a 50% increase in the number of cases of “stomach flu.” Norovirus is remarkably potent and contagious. It often isn’t killed by hand sanitizer (see #3 below). You touch the virus and touch your mouth and you could get it. We can get Norovirus multiple times in our lives because our immunity wanes after infection and new viral strains develop which cause unique disease. We get Norovirus from contaminated food, contaminated surfaces we touch, and from other people who vomit or have diarrhea and spread the virus. This is the cause of the stomach bug that you often associate with cruise ship outbreaks or daycare outbreaks when everyone starts vomiting one afternoon…

Around the holidays a stomach bug swept through our home. It did so for many of my patients, too. During the first week of January, I had a day in clinic where approximately 75% of the families I saw in clinic mentioned someone in their home had been vomiting over the past week. Unusual. I can’t tell you what virus it was (I didn’t test any child’s stool or vomit in the lab), but my bet is on Norovirus… Read full post »

Using Your Phone To Diagnose Skin Cancer

Screen Shot 2013-01-23 at 3.23.43 PMYou know me, I’m enthusiastic about apps and online health content and innovating health care delivery. But we do have to be thoughtful about how we use and integrate new technology.

One in 5 smart phone users in the US has a health app on their phone. With over 50% of American adults owning a smartphone, that’s a lot of people with health apps walking around. Although the most common apps that people download typically tracks the food they eat or the exercise they complete, the over $700 million-dollar-a-year generating industry is teeming with new health products every day. In pediatrics, I see more phones out during the first newborn check and subsequent weight and feeding appointments than at any other time.

Most new parents that come to see me are tracking their baby’s poop, pee, feeding, diapers, or new milestones–and many are doing so using their phone. Subsequently, most of the children coming into our society today are not only tracked with technology, they will grow up with parents who use tools to help protect and support their lives. Using applications to prevent, diagnose, treat, and ultimately cure disease is not really just a dream anymore. It turns out these applications to support our own health are clearly becoming a part of the health care of the present-future.

The effectiveness of these apps remains imperfectly proven. Just last week, a study published in JAMA Dermatology found that apps advertised to improve diagnosis of cancer highly variable in their ability to help patients.  Researchers and doctors at the University of Pittsburgh set out to study popular mobile and web-based apps designed to help patients identify potential skin cancers. Specifically, they evaluated apps advertised to pick up the most deadly type of skin cancer, malignant melanoma.

Skin Cancer Apps: Unreliable But Quick

  • Researchers acted like patients, they searched app stores with search terms: “skin, skin cancer, melanoma, mole” to identify applications on the market.
  • They then selected 4 apps to study that allowed the users to upload photos of moles. Researchers used 188 photos obtained in clinic from patients just prior to mole removal. The researchers had the benefit of knowing the ultimate diagnosis of all the 188 moles they uploaded to the applications. Of those 188 moles, 60 ended up being diagnosed as malignant melanoma.
  •  3 apps worked by evaluating the photo and providing feedback (“atypical” versus “typical” or “problematic” versus “okay”).  One app included in the study sent the uploaded mole photo for review to a board certified dermatologist. Read full post »

Have You Been In To See Dr. Google?

Screen Shot 2013-01-15 at 9.45.29 AMFor practicing physicians, there’s a tricky balance in believing that the internet can help save lives.

I’m a doctor who encourages families to look up health info online and one who believes technology will afford improved partnerships. Yet, when we’re in the old-fashioned exam room, there isn’t always a place for the internet. Many clinics block video-streaming sites and don’t allow for traditional email exchanges between clinicians and patients. It’s hard to “send” patients information discussed during the visit. In the 10 or 20 minutes we have together, time is precious. Truth be told, health care remains wary of doctors and patients communicating when they’re not in exam room. Most insurers won’t reimburse or pay for electronic communication between patients and their clinicians. So doctors are often forced to bring you into the office to provide expertise. New data today may help change this paradigm. Reality is, many of us are using the internet as a tool for health care.

For at least 1/3 of American adults, the internet is a diagnostic tool

Yet, it’s not just insurers who may be wary of online info. Recently I read a patient review (online) from a parent who was frustrated I’d encouraged them to read the content on this blog. The comment implied that perhaps I was “pushing it.” And that’s the tricky part–when I first started writing this blog I was bashful to mention it in clinic. I wanted patients to feel comfortable NOT pressured. But now that I have over 350 blog posts showcasing research and pediatric health information it’s tantamount that I share it.  I mean, if I’m in the midst of a 15-minute visit and we touch on topics like getting a carbon monoxide monitor, the choking game, the Tdap shot, and the effects of TV on their kid’s developing brain, how could I not augment a parent or teens’ understanding by offering more information online?

Numerous studies find that what parents learn in the exam room with doctors isn’t retained. That’s where Dr Google comes in. Read full post »

McClinic? Drive-Thru Health Care

I can’t stop thinking about a drive-thru. Not the one for burgers and shakes but the one for ear checks, sports forms, quick med refill visits or a lingering rash. For those things you just want to know fast or need done now, but don’t want to spend 2 hours resolving. For those things that really make you worry as a parent. Instead of the millisecond-mall-type clinic, we all want our doctors, our clinics, and our child’s team to provide health care. In my opinion, parents and pediatricians both believe in the medical home.

McClinic?

Imagine if you knew your doctor did the drive-thru on Tuesday afternoons. Would you swing by to ask about that rash you’re worried about or to check in on your child’s ears? Follow up on a new seizure medication? What if it didn’t even require a call ahead of time? What if tight time restraints were agreed upon (say 7 minute visits or so) in advance so the patient/physician agenda was aligned? Swing by on your way to daycare?

We want quality, trust, and mobility when it comes to health care. We want easy access, too. Of course we must fight for improved electronic visits and online advice. We want comprehensive, compassionate preventative care. We will need in-office visits, yes. And sometimes we need hands-on more urgent care, too. Now the “kwik-clinic” idea isn’t new, I know. Even hospitals are opening urgent-care clinics throughout the country. But your pediatrician often isn’t involved.  So what about that drive-thru: Read full post »

Ways To Decrease Risk Of Breast Cancer

When we have children, many of us slip in the self-care department. We may not eat as well, not exercise like we did “pre-baby,” and don’t have time to go and see our own doctors. Simply put, our own care doesn’t come first. Parenthood immediately demotes our status…

All fine in some ways. It’s astonishingly wonderful to care so deeply about our children. That devotion still catches me off guard.

But we have to keep on top of our preventative screening. No reason not to when it may allow us a longer time to parent our children! So that’s where I come to breast cancer screening. As women, breast cancer will affect about 1 in 8 of us during our lifetime, the most common cancer in women after non-melanoma skin cancer. It can be highly curable if detected and treated early. Most women diagnosed with breast cancer are over age 50, but many are younger and some are new moms. There are some risks we need to know and scientific evidence that can help us do a better job caring for ourselves.

Share this widely, please.

Yesterday I teamed up with Dr Julie Gralow, the head of breast cancer oncology at the Seattle Cancer Care Alliance (SCCA) and the UW on Twitter for a 1 hour conversation about moms and breast cancer— lifestyle choices, genetic risks, screening, & coping with breast cancer. I learned a ton preparing for the chat and have already tried to think about changes I’ll make in my own life. When I finished the fast-paced hour conversation I sent a note to a friend on Twitter  that I now had to head out for a run, pour out the wine in the house, call my friends to schedule mammography, and ask about a breast MRI. You’ll see why:

Lifestyle Choices May Decrease Breast Cancer Risk