Doctoring & Healthcare

All Articles in the Category ‘Doctoring & Healthcare’

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

Marissa Mayer Back To Work

Yesterday I started to see a number of tweets from parents and fellow pediatricians on Twitter criticizing Marissa Mayer for announcing that she’d return to work within 1-2 weeks of the delivery of her first child.

First off, I’ll start with my assumptions:

I’m authoring this post in the belief that Ms Mayer has access to quality health care–that is, she has the ear of a board-certified obstetrician, a board-certified pediatrician, and access to a lactation consultant as needed. My hunch is that if she needs info on evidence-based ramifications, from a health perspective, of going back to work 1-2 weeks postpartum, she can get the data she needs. Since she used to work at Google, I suspect she understands how to find what she needs online as well.

Assumptions acknowledged, I’d like to give Ms Mayer the respect she deserves. Faulting her for not making a traditional choice is devoid of context. She is lauded for her enormously successful career at a young age. She is the youngest CEO of any Fortune 500 company. To me it appears she has savvy and skill, invention and grit. Thanks in part to Ms Mayer as the first-female engineer at Google, we enjoy an entirely different electronic world with Gmail, Google search, maps, and images.

As we expect and work to have women hold an increased share of leadership jobs, academic or not, we must acknowledge we can’t have it both ways. “Women are still missing from medicine’s top ranks,” for example. We can’t want and wait for more and more women to have their hands at the wheels of powerful companies and organizations, only to question their commitment to their personal and their children’s health and well-being when they return to work. One week or 6 months postpartum… Read full post »

Antibiotic Use May Increase Risk For IBD

We’re surrounded by bacteria– literally. They live on the surface our skin and set up camp in our intestines immediately after birth. The complexity of the colonies that live there diversifies throughout our lives–many sticking around for the duration. And we’re dependent on the ka-billions of bacteria that co-exist with us to maintain our health. Without them, things can go off-kilter as bacteria really are a part of our wellness–supporting digestion and maintaining harmony on our skin. Of course, some bacteria come in that we’d really rather not have. That’s when we use antibiotics.

As cough and cold season returns, a study published today serves up a needed reminder. Antibiotics can cause significant changes to our body. Because many infections are caused by viruses (not bacteria) antibiotics are often unnecessary. When we take antibiotics by mouth (or IV/injection) they may kill the bacteria causing a troubling or painful infection yes, but they can also kill the desired “good bacteria,” too. This is a side effect all antibiotics carry. Often we witness this in our children by changes in their poop—after a course of antibiotics they get really runny poop or diarrhea or it will smell entirely different. You really are witnessing the change of colonies in their intestines when you see this.

Sometimes antibiotics are absolutely necessary and life-saving. But recent research has found that antibiotics are prescribed in 1 out of 5 pediatric acute-care visits. And of the 49 million prescriptions for antibiotics given annually, some researchers estimate that 10 million of those are unnecessary. Avoiding those unnecessary courses is up to all of us–parents and clinicians.

I really do think the tide is changing in this regard. It’s rare that a family requests or urges for antibiotics in clinic.

New research is looking at how altering bacteria in our bodies may change our life-long health. It’s not just the alteration in our poop immediately after antibiotics that changes. A new study shows antibiotic use may set us up for chronic disease. And this may be especially true when antibiotics are used in infants and young children.

Research Finds Antibiotics May Be Associated With IBD Diagnosis

  • Dr Matthew Kronman and colleagues studied over 1 million patient records in the UK. They evaluated the infant and childhood exposures to certain antibiotics and the later development of Inflammatory Bowel Disease (IBD). The causes of IBD are incompletely understood; Dr Kronman wanted to understand if bacterial changes in the intestines at young ages affected inflammation that could potentially increase the likelihood of being diagnosed with IBD (Crohn’s disease or Ulcerative Colitis). They studied medical charts of a huge group of patients to determine if children prescribed common oral antibiotics in outpatient clinics (penicillin, amoxicillin, Augmentin, clindamycin, metronidazole, for example) had increased rates of IBD later in life. Read full post »

Fear Of Needles

Vaccine hesitancy comes in all flavors. It’s not always concerns about safety that causes children, teens, and parents to hesitate or even refuse vaccines. Sometimes it’s about pain. Or simply discomfort. Or anxiety. It’s perfectly natural, of course, to have a fear of needles. It’s rare that a child enjoys the pain of an injection (although those kids, even at young ages, are out there).

Sometimes the fear and anxiety of needles really can manifest itself as a sincere phobia. In those cases, the fear is so overwhelming that it changes family decision-making around vaccinations and leaves children unprotected. It can torture parents when they have to scoop their kids up from under the chair. And parents get embarrassed when their child/teen becomes combative with shots. Sometimes they avoid coming back to clinic simply to avoid the conflict. Makes sense in a hectic world.

However recently in clinic I took care of a teen soon after she’d had a terrible experience with Influenza (the “flu”) and it’s changed how I care for my patients. She was an asthmatic, high school student. Because of her asthma, her doctor had recommended a flu shot. Even though doctors recommend flu shots for all children between 6 months of age and 18 years, we work very hard to get high-risk patients protected. Children and teens with asthma are more likely to have a severe pneumonia after contracting Influenza. We worry about children who wheeze and have asthma (even mild asthma) because it can land them in the hospital and/or can cause a life-threatening illness.

Most parents with asthmatic children get flu shots yearly, early in the season. But not all.

When I saw the girl in clinic she was exhausted and stressed, confused and scared. Through the course of her Influenza illness she had missed 2 weeks of school and lost over 15 pounds. She was still coughing a few weeks later. I looked back to the chart note visit prior to her infection where her pediatrician had recommended the flu shot. “She’d declined,” it said.

“Why?” I asked.

Read full post »

Sick Day

I had an unexpected gift this week: a not-so-sick sick day with my 5 year-old. And it really couldn’t have come at a better time.

We’ve never had a sick day like this before and he’s off to Kindergarten in September so the days were running out for preschool stolen-away sick leave.

In the past when he’s been ill he’s been well enough for me to head off to clinic or work and he’s been home with my mom or his nanny. I’ve ached in the absence but pushed through knowing it really wasn’t me he needed but rest and time away from school. Previously I knew that my patients needed me more.

This time he spooked me. Late Sunday night he developed a booming fever and complained about significant abdominal pain. He skipped dinner, plodded off to bed, and made a series of sweat circles on the sheets. My husband and I were both sitting on the edge of his bed hovering near midnight negotiating the logistics of heading to the ER. I went through the lists of the different diagnoses I imagined could cause his symptoms. I worried. We made plans for his brother, figured out who would go to the ER, and started solidifying next steps. Just then, he stopped complaining of pain and went back to sleep.

I didn’t lose my worry. I tossed and turned. I got up and organized my closet late into the night and tidied little piles repeatedly. I didn’t really sleep.

By morning, the fever was gone. The pain had improved and he joined us at the breakfast table. He downed his breakfast so we took his brother to school. And me? I got the day with my boy all to myself, I got to be home with him–worry changes everything. Read full post »

Affordable Care

It’s hard to write about anything else today with news from The Supreme Court: the decision to uphold the Affordable Care Act. As a pediatrician and mom this isn’t about politics for me. It’s about the assurance that pediatric patients (my children included) can get the care they need. And that we work to make care affordable. Below are a few thoughts & quotes that have helped me understand how the decision will affect care for our children in the United States.

First off, more children will have access to health care. Children will maintain insurance for longer periods of time. And children who have congenital and chronic health conditions won’t lose their care. The majority ruling preserves key child health provisions including the law’s protections against pre-existing condition exclusions. Dr Robert Block, President of the American Academy of Pediatrics said:

Since the Affordable Care Act took effect, millions of children with pre-existing conditions gained health care coverage; 14 million children with private insurance received preventive health services with no co-pay; and 3.1 million more young adults gained coverage through their parents’ plans. These are just a few of the law’s investments in child health, with many more set to take effect over the next few years as affirmed by today’s decision. Read full post »

Every Illness A Love Story

One magical thing I see while working in health care is the love story. Each and every child who encounters a diagnosis or illness spawns a collection of love stories around them. The stories come spontaneously from parents, siblings, friends, nurses, doctors, community, and peers. It all happens organically and sometimes it happens without notice. Babies cling to their parents when they ache; parents cling to their children when they worry. And the acknowledgement of mortality can stun us into living in the present moment–a miraculous gift. With the onset of an illness or injury, a series of love stories begin in earnest around every child as we all seem to fall in love again.

It may be innate, I think it’s impossible to stop these love stories from unfolding when a child is ill.

A physician colleague once pointed out to me that only two things bring you to the doctor: one, anxiety about an illness (or wanting to prevent one) and two, pain. With children, when either (anxiety or pain) are present, a love story erupts around them. Immediately and passionately, those who care for children and witness their lives will work tirelessly to ease pain and suffering. In it, their love unfolds.

I’ve just realized a love story is always a part of the history of present illness. Here’s why: Read full post »

Idaho: Vaccine Safety, A Desert, And A Networked Community

I’ve just returned from a week in Idaho where I had the privilege to do a series of talks for the Idaho Department of Health (DOH) about using social media to communicate about vaccines. The best part of the week was all of the education I received. I traveled around the state (see those photos!), witnessed the DOH at work, connected with Idaho physicians & politicians & advocates & volunteers, and talked with many Idahoans about changing the understanding of vaccine science. Three times I heard Dr Melinda Wharton from the CDC present on vaccine safety. And more, in a matter of 4 days we talked with a clinician, nurse, or medical assistant from every single office in the state that provides vaccines to children. I mean, that’s a wow–a sincerely networked community circa 2012.

If all states had the opportunity to convene like they do in Idaho we’d really improve understanding, communication, and opportunities in health care surrounding vaccine safety and decision-making.

After arriving home to my boys, I’m compelled to share 3 things I learned in Idaho:


I think it’s essential that we talk about the risks associated with vaccines when we give them–each and every time. Dr Wharton discussed known risks to vaccines and the science to support those risks. She also talked about inferred risks that aren’t backed up with science (autism, for example).

Take fainting: we know teens faint after shots sometimes. Read full post »

Ode To My Medical Assistant

I feel really connected to my medical assistant at clinic. The most incredible thing about her is she just “gets it.” She gets the pace of parenthood, the pace necessary to keep patient care moving in clinic, and the pace of my patient–even the very little ones and the big ones. She’s compassionate. She’s invested in being kind. She really treats children like children. When, for example, she doesn’t trust her gut on how a child is completing their screening vision exam, she’ll wait until end of the visit and repeat it. She’ll switch out letters for pictures, she’ll grab stickers to incentivize. This week, she was solving problems before I even noticed they were slowing us down.

She remembers patients like I do. The details, some health related, and some not. Glittery shoes, a nickname, a chronic ear infection, a mother’s need for extra time, a worry that a parent repeats. She says things like, “Did you hear about Angela’s CT at Children’s”” randomly on a Thursday two weeks after we last saw Angela.

She worries like a mom. She performs like a professional. She calls children by their name.

Not everyone in health care delivery is invested in what matters most. Unfortunately, it can be very easy to lose sight of patients in health care, however bizarre and inane that sounds. And so it’s an utter privilege to work with my MA. But more, it’s just so nice to have such an incredible partner. It’s, of course, teams of people that care for patients, not just doctors and the nurses you see. But teams of receptionists, labs techs, schedulers, assistants, insurers, leadership, specialists, nurses, generalists, and so many more.

Teams are good. But sincere, tactile partnerships change everything. Sometimes I feel very alone in my work–right now thanks to my MA, I don’t. To you, Katie, I say thank you so much for making 2011 far better and for all of the hope you bring to 2012…

2011 Greatest Hits

I continue to feel privileged to share my thoughts here. Blogging has become a huge and stable part of my life. When I celebrated my 2-year blogging birthday back in November, I realized sharing insight online is a pillar in my job as a physician. I suspect providing insight and expertise will be more and more a part of the job of my peers as time unfolds. And I remain convinced that as long as patients are online, I must be, too. Reality is, I have more time online with some of my patients than I do in the exam room. I believe this experience is a peephole into the future of elegant, efficient health care. And I trust this is just the beginning. 268 posts and counting…

Here’s a line up of the “greatest hits” from 2011. I must admit I was somewhat surprised by the list, but these are the 10 posts that resonated most (as indicated by number of times viewed) over the calendar year although not all of them were written in 2011. Some recent posts were nearly in contention for the top 10 but just haven’t had the shelf life as those from early in 2011. From the Tsunami in Japan to the adventures in potty training to one incredible, heart felt guest post!

Thank you to all of you for joining me here and for teaching me so much. I am constantly and forever indebted to you…

Seattle Mama Doc 2011 Top 10 “Greatest Hits”

  1. Science Of The Soft Spot — Science of the soft spot in babies (anterior fontanelle) including a 3D CT scan reconstruction of an infant skull.
  2.  If It Were My Child, No Tylenol Before Shots — Some data behind why I believe there is no good reason to pre-medicate with acetaminophen prior to shots.
  3. Colic, Crying And The Period of PURPLE Crying — An overview of “colic” and baby crying in first few months as well as a link to a Good Morning America Health interview I did.
  4. Japan Tsunami: Reminder To Prepare — How to prepare your home and family for an unexpected catastrophic event.
  5. Fast Paced Media And Four Year-Olds: Cartoons On The Brain — A post about new research exploring the effects of fast-paced cartoons over slower ones on the executive function of 4 year-olds.
  6. If It Were My Child, No Baby Food Before 4 Months — Research finds early introduction of solid foods may increase risk of obesity.
  7. Four Hours On A School Bus — A guest blog from an incredible friend about the “food allergy tax” & how parents go well out of their way to protect their children with severe food allergies, over and over again.
  8. Radiation Disasters: No Potassium Iodide — After the horrific tragedy in Japan, many families worried about effects of radiation moving over the West Coast of the US. This is an overview of the risks of radiation and why I didn’t recommend using potassium iodide (KI) in children.
  9. Pull Ups & Potty Training — An overview (and video) on how and why to ditch the diapers at night as soon as you can…
  10. Treating Ear Infections With Antibiotics — New research (Jan 2011) on using antibiotics for ear infections. A reminder of how less really can be more.

So that was 2011. The blog has had a big spike in readership this last month and we’ve welcomed many new visitors. So I wonder, what do you want to hear about in 2012? I have a series of posts I have been working on about the HPV vaccine, another on sudden cardiac death screening, and one post brewing about IQ testing in children. But what else are you waiting for? Tell me and I’ll do my best to heed the call.