Dr. Thompson's Blog

Parenting Medical and Other Information on Apps and the Web

I am having a hard time understanding why parents need to resort to Apps and the Internet to raise their children. Where are the family doctors and the pediatricians? Don't the doctors talk to their patients any more? I still hear from parents whose children I cared for when I first started my pediatric practice in 1963.

I think part of the problem is that parents are so busy these days that looking something up on their Smartphone or other gadget may be faster than trying to get in touch with a doctor. Unfortunately, there is a great deal of misinformation on the Internet. The New York Times today has an article stating that WebMD now has a parenting app. I have done interviews on WebMD and know they are more reliable than several other sources. However, once again if there is a problem with a child, the doctor should know about it.

Another reason I believe that parents are turning to all these artifical ways to get information is that most medical schools these days are not teaching practical pediatrics. Now it is all about theory and technology.   I think this is a tragedy. I had a classroom built onto my office where I held free monthly parenting classes. They were lots of fun and both the parents and I learned a lot.

Why Patients Settle for Inadequate or Poor Medical Care

I am always amazed and sad when intelligent people, who can afford the best medical care, settle for poor or even bad medical care. I've thought al lot about why this occurrs and think there are several reasons.  The first is probably that when a patient feels ill, he or she doesn't  have the energy to ask questions or do networking to find the best care. Often, too, a primary care doctor will make a referral to another physician, who is a friend or someone known through an organization or even a health club. This happens far too often, I am afraid. No patient should ever accept a referral without some investigating,  hopefully some networking, and asking several questions.

If you go to your state's medical board Web site and enter a doctor's name, you should be able to see if malpractice suits have occurred, the number of years in practice, training, and if the physician is board-certified or qualified. These are all important facts to discover. If a patient has a life threatening illness, metastatic cancer, or other bad prognosis, then often a second opinion should be obtained in another city or location. An example of this is if your treatment in your own city or location is not helping, then seeking care elsewhere could make the difference between life and death. Each adult patient or each parent must take control of their own health care or a family member's, if they are in charge. The days of the old family doctor, who had all the answers, are long gone and it is up to each of us to find the best  medical care for ourselves, our elderly parents, or children.

 

When Medical Students and Doctors Put $ and Life Style Above Patient Care

I was having a discussion last week with my wise twenty-one-year-old grandson and complaining about a young medical student who told me his life style was more important than getting the best medical training possible. I was appalled when the man said this. My grandson said, "I don't think he is much different from  many of the twenty and thirty-year-olds today. Many have been raised to think that money and position are more important than anything else."

I felt very sad that any physician or medical student would put good patient care at the bottom of their list of priorities. What is going to happen to patient care if money and life style become the overriding concerns? But if young people aspire to work at Goldman Sachs or similar companies because of the enormous salaries and bonuses, i guess greed has become the dominant force in our society. What about the kids who don't have financial backing or a good education? What do they do? If the Governor of Pennsylvania can keep public schools, in one part of his state, from receiving any money and the teachers are working without pay, we have major problems in our country. I heard one commentator say that by not educating kids, it gives the rich much more control over voters. That is tragic and we must start to make some changes or I feel that medical care and our lives in general will be in serious trouble.

Beware of Hypnotherapists who are not M.D.s or Psychologists

At a recent Christmas party, I was talking with a young woman who told me she was a hypnotherapist. I asked about her training and she said she had a few hours of training in hypnosis and then could start seeing patients.  I was startled and outraged  and said, "Don't you have to have a state license or a certificate of some kind.?" "No", she said. I was appalled and thought about the years of training  a psychiatrist or psychologist have to have and the state examinations they must pass. I did some research and found that in California these individuals are "self-regulated and don't qualify for state licensing". Also no specific number of hours are required for an individual to put out a sign and say he or she is a hypotherapist.

I think this is extremely dangerous and know of a case where this kind of therapy by a non-licensed individual, with no medical background, contributed greatly to an individual's death. When I discussed this case with an excellent psychiatrist, he was appalled and immediately wanted some action to be taken. In discussing this with another psychiatrist, he said that psychiatry is now so fragmented that people are unwilling to take on an issue like this, even when it may put a patient's life at stake. Something needs to be done. Hypnotherapists can cause irrevocable damage and should be reqirred to have years of training comparable to the training of an M.D. or psychologist.

Resources for Children with Special Needs

I was watching a news program the other day and saw a segment where the mother of a tiny baby, who had a severe heart problem, was fighting with Medicaid to have heart surgery done for her baby  at Boston Children's hospital. She was trying to get Medicaid to pay for transportation there and to receive approval to have the surgery done outside her state. At no time, was there mention of the  state's program for childen with special needs. I was puzzled becasue this is where the mother should have been putting her energy, not Medicaid. Each state has a program for chidlren with special needs. I have listed these, state by state, in three of my books: 101 Ways To The Best Medical Care, Raising a Child with a Neuromuscular Disorder, and Grandparenting a Child with Special Needs.

Unfortunately, doctors these days do not always refer parents to these programs. This should be done right after a baby is born, so that hospital bills can be covered, if necessary, and arrangements made for the best possible care. Yes, parents often have to  be very assertive to get through the bureaucratic maze, but the involved doctors should guide the way. I have done this countless times for patients and made many calls to the directors of  state programs.

In the past,  both Southwest Airlines and American Airlines have been willing to provide transportation for medical reasons, if a letter was sent by a child's physician. I have also done this many times and it is possible that these programs still exist. At least this is worth investigating.

Hospital Care versus Home Care

Far too many patients these days develop an infection when they are in the hospital that was not present when they were admitted. An excellent article in the December 5, 2011 New York Times by Dr. Jack Resnick talks about how "hospitals are expensive and dangerous."  He tells about a patient of his who was a quadriplegic and after being shot in a robbery was admitted to the hospital. The  man developed a bedsore which became infected and he did not survive.  Now Dr. Resnick says he tries every way possible to keep his patients at home. He mentions the Veterans Affairs' Home Based Primary Care Program which has both doctors and nurses. Hospital days were reduced by sixty-two percent and total health care costs decreased by twenty-four percent. The new health care law created Independence at Home Organizations. If the Republicans don't defeat the bill, what a great gift that would be for patients and for the national deficit. With all the terrible statemate now in Congress this provision of the health care law has not yet been implemented. We all need to fight hard to keep the Republicans from destroying a very good bill. Yes, there are some things that need to be changed, but already Seniors, those with pre-exisiting conditions, and young people, who can stay until they are 26 on their parents' health insurance, are reaping the benefit.           .              

Kidney Stones in Children and Teens

When children and teenagers have abdominal or stomach pains, most  parents and many doctors don't think of kidney stones. An article in the last Pediatric News by John Foreman, M.D. states that the "incidence of kidney stones is increasing dramatically, especially in teenagers."  The author says  that there has been a three to five-fold increase of kidney stones in the last fifteen years, especially in teenage girls. This is interesting because in adults, men have more kidney stones than women. it is also important to note that African-American kids have few kidney stones, unless they have a syndrome such as Lesch-Nyhan Syndorme. I cared for a teenager with this syndrome and Dr. Nyhan, whom I know, was great about guiding my hand in caring for this nice youth.

Dr. Foreman said that no one is quite sure why this increase in kidney stones has occurred. It could be due to the increase in obesity that we are seeing and also to the fast food diet that many families and kids live on. Unfortunately, kidney stones in kids may be hard to diagnose because fifty-percent of kids don't have localized abdominal pain or they may not have blood in their urine like adults. If a child is under the age of six, the stones may be associated with a urinary tract infection. I find that doctors who see chidlren do not check urines as frequently as they should, nor do they get urine cultures. These are simple tests that are very frequently overlooked. A smart parent may have to demand that these be done. The cause of a kidney stone should always be explored once it is removed because there could be an underlying metabolic disorder.

Misdiagnosis or Lack of Diagnosis of Rare Diseases

How frustrating it must be to not feel well and yet be unable to find a physician who can help. Even when doctors order an enormous battery of tests, as many do these days, the cause of a chronic problem may go undetected. I remember when I was doing some additonal training in neuromuscular disorders and the head of the unit asked me to see a child with hip pain. The child had been referred to him for a possible disorder of the muscles. After taking the history and doing a complete examination, I had no doubt that the child had juvenile rheumatoid arthritis (JRA) and should see a pediatric rheumatologist. The head physician didn't believe me and multiple tests, including a muscle  biopsy, were done. A year later, I received a call from the doctor who said, "Do you remember the child you thought had juvenile rheumatoid arthritis?" "Yes, I said. " "Well, you were right.", he said. Yet it took a year for the diagnosis to be made and it was a year when the child should have been receiving treatment. With JRA, as with the other collagen disoders, the faster treatment is started the better the results. In an article by Mary Fischer in the AARP magazine, she notes that the most commonly misdiagnosed diseases are; Lupus (a collagen disorder), Lyme disease, multiple sclerosis, fibromyalgia, celiac disease, Parkinson's disease, and chronic fatigue sysndrome. She says the NIH has a Undiagnosed Disease program and twenty-five million Americans have a rare disease. The Mayo Clinic has noted that twenty percent go undiagnosed. An excellent organiztion to consult is NORD, the National Organization of Rare Diseases at 1-800-999-NORD.

Holiday Safety Tips for Parents and Grandparents

December often becomes a very busy month for parents and grandparents with entertaining, baking, buying gifts, and trying to follow family traditions. Because the days can get pretty chaotic, it is important to  keep children's safety uppermost in your minds. One of the things to be particularly careful about are toys.  Remember some toys have detachable pieces which if swallowed can lodge in a child's throat.  Check also for sharp edges. Remember that magnets in toys are a problem because they can cause perforations or blockages in the intestines, if they are swallowed.

If you are decorating with Christmas or holiday plants, remember that the poinsettia and some holly and mistletoe plants are  poisonous. Candles can be beautiful, but you want to be sure that they are in a safe location and not near anything inflammable. If you forget and leave a candle burning, big trouble could result. Holiday lights should be checked for safety and turned off when you leave the house. 

Children need plenty of rest and routines, especially during the holidays. This is particularly true of those who fit into the autism spectrum. Hiring a baby sitter to help when you are stressed or overworked could make the difference in your life and your child's or grandchild's. A meltdown in the middle of shopping or entertaining can ruin things for everyone. Planning ahead for some extra help or trading childcare with a friend can help greatly.

If you have questions about the safety of toys or other gifts you are buying for children,  the Consumer Product Safety Web site can be checked at  www.cpsc.gov. Also, it is wise to always have the 800 number for the poison control center posted.  For California, it is 1-800-222-1222. There is also a Web site at www.poisonprevention,org.

Happy Holidays!

 

 

 

"Chicken Pox Parties"-What Could Parents Be Thinking?

If you have ever had to care for a patient with chicken pox encephalitis, as I have, or stayed home with  a child who had chicken pox, prior to the availability of the vaccine, you would shake your head.

According to an article in the New York Times by Anahad O'Connor on 11/17/11, people have  been trying to sell lollipops through the Internet on which children with chicken pox have sucked. I am astounded that anyone could be that dense. The article stated that prior to the vaccine about 100 children died each year from chicken pox. Encephalitis is not the only complication but pneumonia and  even Reye's Syndrome can develop. There is also a type of chicken pox where hemorrhage can occur. In addition, later on in life an individual who has had chicken pox can develop Shingles. I remember having Shingles near one of my eyes when a doctor friend said "Oh, I know an indiviual who lost vision in one eye from Shingles close to their eye." Not a pleasant thought!

Some parents are even going so far as to post notices on the Internet to find a child with chicken pox, so they can expose their child or children to the ill child. I agree there seem to be a lot of immunizations for kids these days, but there is absolutely no evidence that they cause autism. I understand that parents need something to blame when a child deveops a disorder on the autism spectrum, but there are obviously other causes and not immunizations.