Dr. Thompson's Blog

Many College Heatlh Services Provide Greatly Inadequate Medical Care

I was angry when I read the account today by Alan Schwarz in the New York Times about the Harvard  University freshman who committed suicide after receiving medication prescribed by a nurse in the student heatlh service. The woman diagnosed ADHD, which is a disorder that should be diagnosed in a child's early years. In a college student, I would have thought of several other diagnoses. Nurses do not have the training to make this diagnosis and many doctors also lack the experience and training to make the diagnosis. Did the nurse take an adequate history? Did she ask about the student's sleep pattern, diet, alchohol or other fluid intake, the amount of exercise, or fun he had each day? Did she order a thyroid panel, blood count and urinalysis or did she just do a quick examination and write a prescription? I am appallled that the state of Massachusetts allows nurses to work without supervison by a physician and to also write prescriptions. That should not happen and I hope the law will be repealed before more unnecessry deaths occur.

I  have had to get very assertive with several college student health services in different states for my own children and former patients. Pneumonia, mononucleosis, and other serious medical problems have been missed and the outcomes could have been tragic. I always advise parents to get the name of a good internist or family physician in the town where their children will be enrolled in college. This way the young people can have a doctor they can call and in many cases this has been lifesaving.

Sex Education and Abortions

In watching the news, it almost seems as if the United States is regressing rather than moving forward. Many Repulbicans seem to want to take us back to the 1930's or 40's. When I heard that Texas, North Dakota, and Arkansaw legislators wre introducing bills to get rid of sex education and abortions, I found it hard to believe they could be so ignorant. I wondered what these men would do if there own daughters became pregnant at thirteen or fourteen? Would they insist the girl carry the pregnancy to term and then have the child adopted? Sex education is very important in these days of early sexual activity. The churches may preach that sex without marriage is wrong, but that has little or no impact on many teens. Many girls don't think they can get pregnant because they have no true idea of how a pregnancy is conceived. i know this becasue I have taught many sex edication classes in both public and private schools. I have always been amazed at  some of the girls' ignorance about sex, even the girls who were sexually active.

I had no problem in writing contrasceptive prescriptions for girls who were sexually active.  Yes, I always tried to tell them all the problems that could occur if they were having sex. Some did get pelvic inflamatory disease (PID) and one or two even contracted gonorrhea. A few became pregnant and had abortions. These were principally girls from affluent homes. Many of their parents were too busy with social activities or working to have any idea of what was going on with their daughters. I hope the mothers and doctors in Texas, North Dakota, and Arkansas  put pressure on the legislators, so the bills do not pass.

Interesting Articles for Parents on the Internet

Several individuals have sent me articles they thought would be of interest to parents who read my Blog. One that Sonny Griffin sent me is how to prevent choking in children. In reviewing it, I told her I disagreed about letting little children have hot dogs, even if they are sliced. i think hot dogs can be dangerous and would  not have them in the house if you have a small child. The Web site she sent is www.nannywebsites.com/blog/pop-quiz-how-you-can-prevent-choking-in-children.

Sophia Nelson kindly sent me a Web site about how kids are ruining their hearing with their loud music. I agree with this, but also wish that more doctors treated ear infections appropriately. If a child is having frequent ear infections, I would urge parents to see a pediatric ear, nose, and throat doctor. I always opened and drained bulging, infected ear drums and always got a lot of pus.  Many parents are convinced I saved their children's hearing. The Web site about hearing is www.herzan.com/resources/articles/hearing-loss-and-musicians.html.

The third article  was sent by Rosa Ray about what parents should know about TV time. The link is www.onlinecollegecources.com/2012/02/28/the-truth-about-tv-time-15-findings-every-parent-should-know/ Another good site to check is Up and Away. This site discusses Keeping Young Children Safe Around Medicine. Michelle, Valerie, and Kendra kindly sent this information. My thanks to all and I hope the articles will be helpful.

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Checking for Dangerous Drug Interactions

I was talking with an old friend recently who was concerned about her husband. He was in his late seventies and had had heart surgery a year ago. She was noticing that he fell asleep easily during the day and yet his doctor said he couldn't find anything wrong. A neurologist was not seen and no sleep apnea test was done. His doctor gave the man a new heart medicine and I found out that the husband was taking quite a few medications. I asked if the physician had checked to be sure there were no drug interactions and my friend didn't think the doctor had done this. I told her how often I found problems with drug interactions in patients when different doctors were seen and no one had called a phamacist to check that all the drugs could be given together. It takes time to do this and I find that unfortunately few physcians do it.

I was fortunate to have access to a special doctor's line at the UC School of Pharmacy in San Francisco and often found that the various drugs prescribed by other doctors for my patients should not be given together or had bad side effects. These can be dangerous and if your doctor does not check for drug interactions, I would suggest that each patient find a good pharmacist who will check drug interactions for you. You could save your own life or that of a family member or prevent some bad, often dangerous, side effects. 

Teenage Pregnancies and Texas

I was astounded to learn today that Texas leads the nation in the number of babies born yearly to teenage girls. The current statistic is that 130 babies are born to teenage girls each day in Texas. How ignorant some Texans must be to prevent schools from giving sex education in 50% of their schools and closing 50 Planned Parenthood clinics. Do these people have any idea what they are doing to the babies and their mothers? A baby born to a teenage mother may also then become a teenage mother and many will be on welfare for the rest of their lives. Not only is there a terrible cost to the girls and their babies, but the cost to tax payers in Texas will be enormous. I have cared for pregnant teenagers and also given many sex education talks. I was always surprised at how little the girls knew about how babies were conceived and most had no idea of what the future would hold for them if they became pregnant. Marian Wright Edelman of the Children's Defense Fund is often quoted as saying that these girls "have written their life script" by becoming pregnant.

Another problem with teenage girls becoming pregnant is that their diet is usually bad and they also don't get adequate medical care or take vitamins. Thus the incidence of  disabilities is higher than in other age groups. Once again society will pay a high price, as will the girls. I hope that pediatricians and family doctors in Texas will band together and protest the closure of the clinics and the lack of sex education in the schools.

Emergency Care and Personal Medical Information

I was talking to a man the other day who told me the tragic account of a young man in his extended family who went into shock after eating something he was allergic to when he was out to lunch with friends. He had always been highly allergic, I was told, but apparently something was in the food he ate he didn't know about. The para-medics were there within two minutes, but when they called the ER doctor at the local hospital, they were told not to give epinephrine until the doctor saw the man. The young man died on the way to the hospital. Epinephrine could have saved his life.

As I thought about this very sad account, I wondered  if the young man was wearing a Medic Alert  bracelet or carrying any kind of information that could have saved his life. My patients have always had a good experience with the company that sells MedicAlert bracklets or neck chains. Anyone with severe allergies or problems, such as Malignant hyperthermia that occurs with some muscle diseases, diabetes or heart  disease that might need emergency care should have such identification. I am sure there are other companies that also sell bracelts etc. These are engraved with vital information.

If an individual lives alone and has no close neighbors or relatives, there is a form that can be printed from the Internet called a Vial of Life. This lists emergency information and can be posted on the refirgerator or in an obvious place for an ambulance driver to see.

Certificate Health and Nutrition Practitioners

A friend sent me a new book a neighbor had written about what we should eat based on Biblical sayings. The friend knew how concerned I was about people who acted as experts without adequate medical training because we had had many long discussions about this. I had also shared with her accounts of the great harm some practitoners' advice had caused; some patients even dying. 

I think patients must be extremely careful not be be taken in by an indiviual who offers advice when they have had, for example, just a few weeks course leading to a certificate, but not the many years that physicians or dietiticans spend in training. A two weeks certificate, plus time spent working with a practitioner of alternative medicine does not equip anyone to give advice about medical treatments or diet. In glancing through this new book, I was appalled at some of the recomendations. They were exceedingly dangerous. Yes, there are far too many physicians who don't practice good medicine, don't listen to patients, and don't seem to care. I think the answer for patients is to always get a second opinion if there is any doubt about medical care and not to rely on people  who have just a certificate from a questionable training program. There is also a great deal of misinformation on the Internet, though there is also some good information. So by asking lots of questions and finding an M.D. you  trust and who knows you and your family, you should  get the best care.

Treating a Persistent Low Grade Fever in a Child

I am constanly amazed at the way some doctors care or don't care for their patients. Yesterday, I had a call from a father saying his little child had had a low grade fever for six days. The pediatrician said just to give the child Tylenol and didn't suggest seeing the child or having any tests done. I was appalled. I told the father that certainly the child should have been examined by the doctor and a urine should be checked and a urine culture done. Little girls easily get urinary infections if they don't clean themselves well when they go to the bathroom. I also said a blood count should  be done. If the child showed no signs of illness, I would want to see her at least every two days, plus have a daily telephone report. If she was not getting well and the above tests were negative, I would want a chest X-ray. Silent pneumonias can occur with few respiratory symptons. If the low grade fever persisted, I would think of more serious problems, but I would first look for a common problem, particularly with the bad flu bug that is going around.

Ear infections are very common in little chidlren and may not be painful. If a child has impacted wax in the ear canal and the doctor does not clean out the wax or doesn't know how, as seems to be more and more the case these days, then the ear infection will be missed and could lead to mastoiditis and even meningitis. I also suggested to this father that they would be wide to change doctors!.

Symptons and Treatment of the "Flu"

I have just had a very early morning call from a friend who now lives in Texas. The woman is in her seventies and has moved recently, so hasn't found an internist or general doctor. She said she had the flu and her head was splitting. A doctor at an urgent care had given her Tamuiflu that cost over $100, but he had not listened to her lungs or looked at her throat or ears. It is hard to diagnose someone by phone or by not examining the patient and when I was in private pediatric practice I always insisted on seeing a child because there could be problems a parent had not described or didn't know of their significance. My advice to this friend was to insist on an antibiotic since it sounded as if she had sinusits and to take either tylenol or aspirin every four hours. Also I urged her to get a flu shot next year which she did not get this year. If she was not getting better by this evening or tomorrow morning, I urged her to go to an ER where she could have a chest X-ray to look for pneumonia. Remember everything that is called flu may not be flu and ear infections and pneumonia are common complicatations of so-called flu.

Some people are having diarrhea or intestinal problems with the bug that is going around. My son and I have both had the "flu" except he had a very bad cough and some inflammation in his ear drums; mine has been much milder except for some fullness in my ears with mild inflammation of the ear drums. So with any flu epidemic, it is important that a doctor does a good examination. If  you are getting worse or feel terrible, as does my friend, and a doctor does not examine you,  insist he or she does or go elsewhere for medical care.

Gun Violence, Tom Selleck, and the NRA

With all the emphasis now on gun violence and the 1300 gun deaths since the massacre at Sandy Hook Elementry School, I was appalled to learn that Tom Selleck was on the Board of the NRA. The NRA does not represent gun owners, but represents gun manufacturers who make 12 billion dollars a year. I have always been a fan of Tom Selleck's and wonder if he has children and grandchildren? If so, how could he possibly represent gun makers?

I was delighted to see that a group has been formed to represent  Mothers Against Gun Violence. Hopefully, they will have as much lobbying power as the mothers had against drunk drivers. We have had 1300 gun deaths since the Newtown shooting. When we had the assult weapon ban under President Clinton, there were sixty to seventy percent fewer gun deaths. Doesn't that make a lot of sense? No one needs to be able to shoot off 30 bullets in a matter of minutes with an assult weapon. Now the NRA is trying to start Junior Shooting Clubs, so kids will start using guns before they get out of high school or is it elementary school? Don't the gun makers have a conscience? As mothers, grandmothers, physicians, and parents, we must stand up to the NRA and let our members in Congress know we do not want any more gun deahts, particularly from assult weapons.