Dr. Thompson's Blog

Carbon Monoxide Poisoning

Today I called the neighbor of an old friend, who lives in the South, because of my concern that her telephone seemed to be out of order for the last two days. My friend had said that she would be away for only a few days and since she was a fairly recent widow I was concerned that  the woman might be injured and home alone. Her neighbor said that my friend wasn't due back until next week, but apparently the phone was out of order. I asked if the security system wasn't connected to the telephone line? The  neighbor said my friend had a security system, but never used it. I remarked that  my security system is tied in with smoke detectors which makes me feel comfortable when I am asleep or out of town. The neighbor, who is elderly, said she didn't have a security system and no smoke detectors. I asked if she had carbon monoxide detectors and she said "No". I was horrified since I knew it wasn't a question of money and that the woman was intelligent, having  been a teacher.  

I told her of a teenage patient I had had who at one visit complained of severe headaches. These started occurring a few days prior to his office visit. I couldn't find anything unusual when I examined the youth and for some reason asked if other family members had been having  headaches. "Yes", he said' "Everyone is having headaches." I immediatly thought of carbon monoxide poisoning and insisted the parents call the gas company right.  In calling the next day, I found out that the house had been filled with carbon monoxide and the family was lucky to be alive. A gas heater was defective and  caused the carbon monoxide poisoning. So smoke detectors and carbon monoxide detectors could save your life, as well as the life of anyone who lives in your house or apartment.  

 

Fatigue in Children

I had an e-mail from a  parent asking if I had any thoughts about why her child always seemed so tired. The mother said the child had trouble staying awake in school and she didn't  think it was a lack of food because she said that she sent packets of dried food for the child to eat during the day and the little girl ate a good breakfast.

I thought about the mother's e-mail for a while and then sent back a message with several questions. First, I wanted to know if the child had had a recent physical examination and whether this had been a complete exam and if a CBC or complete blood count and urinalysis had been done.  Anemia can cause excessive tiredness. Also I wondered about the family history and particularly about diabetes and thyroid problems. Both of these disorders should be considered. In addition, I asked if the child had had a recent eye or hearing exam. If children are not hearing or seeing well, they can get tired trying to understand what is going on in the classroom.

Another thing that I wanted the mother to consider was if all the above tests were  negative, was that there might be a learning disability. If a child is having trouble understanding either by reading or by listening that can be very fatiguing. In addition, a child could be very bright and just be very bored. A good evaluation by an experienced child psychologist with some special tests should help sort this out.

Getting Good Medical Care in an HMO

A friend called a few days ago about an elderly friend to tell me of  the trouble the woman  was having in getting adequate medical care for her husband. The husband had had a badly infected toe for several days and the only appointment  her husband could get in their HMO was with a nurse practitioner. Both my friend and I shuddered thinking how easily the man could lose his foot, his leg, or his life. Diabetes had not been a consideration, nor a staph resistant infection, or even a blood stream infection. Cultures should have been taken and lab tests done.

I thought back to a two-year-old with severe spinal muscular atrophy who did not have a pediatrician, but was being cared for by a nurse practitioner. The child had the lethal form of spinal atrophy and died a few weeks after I saw him. I was appalled that the little boy's care had been so bad. The parents were lovely people who simply didn't know how to fight the HMO and were overwhelmed by  what was happening to their child.

My recommendation to my friend and to anyone who needs to fight for good medical care in an HMO is to insist that care must be given by a board-certified physician. To do this a patient  may need to send a certified letter with a return receipt  to the CEO of the HMO. He or she may be leaving all the decisions to clerks or nurses. In the letter I would state that you are willing to consult an attorney if you are not given the care you need. The mention of an attorney will most likely catch the CEO's        attention and a qualified doctor or specialist will immediatly become available. It is sad that patients have to go to this extreme to get decent medical care, but no one should ever accept care by other than a board-certified physician. Your life may well be at stake if you do. One other resource is to find a patient advocate and a good resource is www.patientadvocate. org or www.patientadvocacy.org.

Health Care Solutions

I had a call from a relative yesterday suggesting that I use my friendship with a high-ranking democrat to have my name submitted to President Obama to be on his health care advisory team. I said. "Thank you for your belief that I could make a difference, but it would not be something I would do well."

I explained that I believed the only way we could have an adequate health plan in this country is to get rid of the health insurance industry, the health care lobbyists, and to regulate the drug companies. With the rich, conservative group in this country who are very invested in these huge industries, I don't see this as happening. In a June 19th letter to the editor of the New York Times,  David Balto pointed out that "Between 2000 and 2007, the ten largest publicly traded insurance companies increased their profits 428 percent, from $2.4 billion to $12.9 billion."  With this kind of profit, the insurance companies wield tremendous political influence.

A single payer health plan that would allow doctors, hospitals and other health care providers to negotiate their own fees would save a tremendous amount of money. How can this happen when greed seems to be the dominant force in so many companies and people's lives today?  Medical students are choosing high income specialties rather than primary care, internal medicine, and pediatrics. These are the least lucrative of the medical specialties. A surgeon can make more in a day than I could make in a month caring for children with disabilites or even when I  practiced general pediatrics. There have to be some answers, but regulation of the lucrative health insurance and drug industries must be the first step.

Children with Disabilities and Horseback Riding

I have just finished listening to the author of "The Horse Boy" read the first two chapters of his book.The promotional CD was given to me at the recent Book Expo. Having cared for kids with special needs for fifty years as a pediatrician, I looked forward to hearing the CD. It is a remarkable story about parents who sought every possible treatment for their autistic son. As I listened to the father's wonderful British accent, I thought how special it would be if every parent with a disabled child could take the time and have the money and energy to do what these parents have done. I don't think parents have to go all the way to India to see important changes in their children, no matter what the disability. There are many resources available in the U.S. if considerable networking and research is done.

Horeseback riding has long been a routine prescritption for Duchenne muscular dystrophy boys in Denmark. Because the heel cords are the first tendon to develop contractures, horseback riding helps stretch these out.  A wonderful sense of freedom, contact with a beautiful animal, and a feeling of  increasing competance are additional benefits.

There are many horseback riding programs for children with special needs in the United States. The father of a Duchene dystrophy boy I cared for was the president of the local horseback riding organization for children with disabilities. I well remember the special time I had visiting the stable and seeing the kids ride. Children not only had muscle diseases, but also cerebral palsy, spina bifida, emotional problems, developmental delay, and mutiple handicaps. Later, I was invited to dinner with this outstanding family.

Health Insurance CEO' Outrageous Salaries Despite Cuts

i was listening to the news early this morning and heard a Republican Senator say he didn't like the idea of a public insurance plan along with private insurance plans becasue the administrative costs were higher than for private insurance. The Senator has not done his homework. He quoted the administrative costs for Medicare as 21% and said that it was lower for private insurance companies. It is well doctumented that their administrative costs are 33%. The Senator's math is poor.  Part of the reason that the private insurance plans have such high administrative costs is that their CEO's make outrageous salaries.

An article in the recent AMA News by Emily Berry noted that despite a cut in some CEOs' pay that Jay Gellert, president and CEO of HealthNet had an increase in pay from $3.6 million to $4.4 million and Angela Braly, of WellPoint had her salary increased from $9 million t0 $9.8 million. The president and CEO of UnitedHealth had his "meager" salary cut from $13.1 million to $3.2 million in 2008. I wonder how these CEO's are going to suvive on so little money? How they can live with themselves when so many people are losing their homes due to medical bills is beyond me. i wonder how they sleep at night? 

Eye Problems in Children

It is very important to be sure that little children do not have problems with a "lazy eye" or strabismus. Unfortunately these days, medical students and pediatrics residents don't seem to be taught how to look for strabismus. If a child has a eye that is not focusing properly and  wandering off to one side of the other, then the child's brain will start suppressing the vision in one eye, so that  double vision does not occur.

I met a couple and their beautiful toddler one afternoon and was concerned that the little child was squinting. First she closed one eye and then the other. When I asked the doctor parent why the little child was squinting, the parent said she thought it was just something the toddler did. When I asked what the pediatrician said, the reply was that "Nothing was said about the eye."

I took the liberty of calling a wonderful retired opthalmologist who said he thought the child was probably having double vision and was closing one eye to prevent that. Fortunately, the good parents had the little girl seen by a pediatric opthalmologist and the diagnosis of strabismus was made. Hopefully, patching witll correct the problem, so surgery will not be needed. Thank goodness this little girl will not end up with a blind eye which could easily have happened. Strabismus must be picked up and treated before age five to six to prevent amblyopia or the suppression of vision in one eye.

Tuberculosis in Third World Countries

Last week I was talking to a woman at the Book Expo in New York. She told me that one of her daughters was in the Peace Corp and  going to work in a small, very poor third world country. The young woman had already served in another poor country. I could see how proud the mother was of her daughter and I agreed that the young woman sounded like a caring, remarkable person.

"I would want to be sure", I said, "that your daughter has a yearly TB skin test and wonder if the Peace Corp does that?" The mother said  she didn't know the answer and wondered about my concern. I explained that as a pediatrician, even in a small, affluent town,  I had picked up two active cases of tuberculosis. I told her that the incidence of TB in poor countries is high and if a screening skin test for TB is performed only every two years, a fresh case may be missed for over a year. Treatment should always be started as soon as possible.

I saw a ten-year-old boy with Duchenne muscular dystrophy a few years ago. He had just come from Asia and the referring doctor had found a fresh, untreated case of tuberculosis. When I was a pediatric resident I had a little child one night as a patient who was found at autopsy to have widespread TB, as well as congenital heart disease. The girl had been in the Los Angeles Children's Hospital for a few days and the TB had not been diagnosed. The child was not one of my patients, but died the night I  was on duty in her ward.  Fortunately, my TB skin test remained negative although the hospital doctors had wanted me to be treated for a year with anti-TB drugs. I was very lucky.