Dr. Thompson's Blog

Treating Back Pain

Children can have back pain from curvature of the spine (scoliosis), as can adults, but when older adults have back pain it is often from lack of exercise and weak muscles or obesity. I am always puzzled when I am told about individuals who belong to HMOs and don't insist on seeing an orthopedist. I know one individual who is bright, has an advanced degree, and yet will see a physical therapist, but has not made any effort to see an orthopedist. In the past, a P.T could not see a patient with back pain without an Rx from an orthopedist. I am not sure this is still true in any state. I remember one man who was being treated by a P.T. for back pain  that was thought to be due to shingles or some kind of nerve problem. His pain turned out to cancer of the spine and he died in his fifties. I am not sure he ever saw an orthopedic surgeon and yet he could  have afforded the best of care. 

If you decide to see an orthopedist either for a child, teenager, or as an adult, it is important to be sure the orthopedist is board-certified and I would also want to be sure he or she is an M.D. and not a D.O. or a doctor of neuropathic medicine. There are many people these days who call themselves doctor, but they are not M.D.s or even osteopaths. If you put a doctor's name in Goggle you should be able to get their training and if they are board-certified and are an M.D. or something else.

Drug Interactions and Problems that Can Occur

When drugs are prescribed over the telephone or by someone who is not a an M.D. problems may occur. It is extremely important that patients and  parents know if there will be problems with a new drug when other medicines are being taken. Many of those who prescribe drugs do not ask what other drugs are being taken. The individual may also not check to see if the new drug will interact and cause problems with other drugs being taken. There was a wonderful pharmacist in the town where I had my pediatric practice. I could call him and check on any drug interaction. In San Francisco, I could call the UC Pharmacy hotline and get answers to my questions. I often had to do this for patients for drugs prescribed by other doctors. This was particularly true for neurologists who were seeing patients who had seizures. 

Now that many non- M.Ds are able to see patients without supervision by a physician, it is particularly important that patients and parents know if there are going to be side effects with a new drug or if the RX should be taken with food and if there is any drug interaction with other oral medications.

I had a friend whose mother was taking 26 different drugs and no one had checked for any interactions or problems with all the different drugs. It turned out that were when I called my local pharmacist.  

The Tragedy of the Children at the Border

I do not understand how Trump and his group could have put in place such a terrible policy affecting children at the border. I understand that separating  children from their parents was their way to keep those they did not like from coming into the U.S. We  have always been an inclusive country and trying to keep the country all white, as Trump has tried to do, is just wrong. The American Academy of Pediatrics has put out statements against the policy but I have not seen any real action. Many hundreds of these children will never see their parents again and thousands will  have long-lasting effects from this terrible policy. The effects will be both medical and psychological. When you  have to sleep on a concert floor in a cage with inadequate blankets, little medical or dental care how can a child not have long-term problems? Our children are our future. We already  have far too many homeless and foster children and yet the Republicans want to get rid of all abortions so we can have even more unwanted, hungry, homeless, and uncared for children.

Even if Biden wins the election, he will still probably have a Republican senate that can wreck damage. I certainly would not want to bring a child into this country with all the problems we now have.

Dangerous Medical Advice

I am greatly appalled at the medical advice that Trump and some of his group keep giving. First it was bleach that was going to cure the virus, then it was hydro-chloroquine which can be very deadly and now it is convalescent plasma. Trump even got the head of FDA to give an emergency authorization for the use of this plasma in patients with the corona virus. The  doctor was trained as an oncologist, but then became a hospital administrator. Even most medical students know you do not prescribe a new treatment that has not been put through standard double blind tests on thousands of people to show it would be effective and not dangerous. I guess it is more important for Trump to say there are new treatments for the virus, so he can be re-elected. In doing this he is putting people's lives in real danger. I wonder what will be the next wonder drug or treatment he will push?

If he tries to push a vaccine before it is safe, there will be illnesses and deaths. People will also be afraid to  have the vaccine if and when it is actually safe.  I certainly understand that. We have enough problem now with parents who will not let their children be vaccinated for diseases like measles, polio, tetanus and diphtheria and other illnesses. These children are being put at great risk. because of this. 

Be Aware of Medical Misinformation, Unnecessary Tests, or Medications

Medical misinformation or unnecessary tests can cause a lot of problems and hurt patients.  There are some excellent Internet sites such as the Mayo Clinic, but even medical books can have statements that are incorrect.  Several years ago an article of mine was published about a Duchenne muscular dystrophy patient who had a child. I had sent blood from the patient, his wife, and child to a prominent geneticist at USC Medical Center to ensure the child was the son of the father.  Probably still in medical books today you may read that Duchenne dystrophy males are unable to  have  children. The Internet has several websites that contain erroneous information, so it is always wise to check with a physician you trust if you have a medical question. When you see an M.D., it is also wise to ask why a specific medical procedure, X-ray, MRI or blood tests are needed. My  granddaughter saw an internist for a physical exam at a California medical school. However, the physician did not take a history or do a physical examination but instead ordered a bunch of lab tests, none of which were indicated. The one test she should have ordered was not ordered. She also never called my granddaughter to give the results of the tests.  So bad medicine exists even in medical schools. If a new medicine is prescribed, you want to be sure it does not interact with any other medication you may be taking. Too many physicians do not check about interactions. A good pharmacist can help if you have questions. Some medicines should not be taken on an empty stomach, so that is also wise to check. 

How Each Individual Can Make a Difference During This Pandemic

I now live in a beach town, which I do not like, and am constantly amazed at the behavior I see of far too many young people and adults. Few people wear masks and social distancing is not practiced. No wonder many of the beach and border states are seeing a great increase in the number of corona virus cases and deaths. No it is NOT cool to go without a mask and to attend parties or to carry on as though the pandemic did not exist. Being deprived of activities such as eating out, going to bars, and attending big parties seems to be intolerable to many. The virus is NOT a hoax, as Trump likes to insist. I do not know what bubble he lives in. Where are the courageous Senators and others when we need them. I applaud Senator Romney for being the only one to stand out against what the White House is saying. We must listen to the medical experts, such as the great patriot, Dr. Anthony Fauci. How lucky we are that he is still speaking  out and in practice. My friends in other countries, many of whom are in the medical professions, are puzzled about how this country got into such a mess. We can beat this virus, as we have others, such as polio and measles. However, we all have to help and those who think they are entitled to act however they wish are hurting  the rest of us.  If they have ever seen someone die of a serious illness, as I have, they would re-think what they are doing. At least we can HOPE!

 

Preventing Parasites in Pets from infecting your Children

Veterinarians can make a big difference if they are sure the parents of children who have dogs or  cats for playmates understand about the parasites that animals can transmit. The principal parasites are roundworms, tapeworms, and hookworms. Little children who  play in a yard barefoot are at risk for picking up parasites. If they play with their pets and then put  hands in their mouth, this can be a source of contamination. Some kids eat soil, grass or other areas contaminated by  parasites' eggs. 

One way to prevent infection is to have your pet or pets routinely dewormed. It is important to know that hookworm larvae can penetrate the skin. One study showed that 80% of parents had no idea that parasites were a problems with their children's pets. People who have pets spend billions of dollars on their animal which is far more money than is spent on children in the U.S.

One important fact is if pets are kept free from fleas, this can help prevent tapeworm infection. Also litter boxes need to be cleaned regularly  and hands washed afterwards. 

 

Questions to ask your Doctor about a new Rx

Now that many doctors are limited to 8.5 minutes to see a patient, it is important for all patients to make sure they understand what to do when a new medication is prescribed. Be sure you know the name of the medicine and why it is being prescribed. It is important to know when to take it, ie. one, two, or three times a day and in the a.m  or p.m.  Also,  should you take it on a full or empty stomach? Is alcohol O.K. to  drink  with the Rx or not at all?  If you have any reaction should you call the doctor or what do you do? Are there known side effects?  Also you want to know if there is a cheaper generic form because many doctors have no idea what a medication costs. I remember when my good, long-time eye doctor prescribed a lotion for my itchy eyes. It was over two hundred dollars for a small tube and I did not buy it. I am sure he had no idea of the cost. 

A major problem that often occurs, particularly when a patient is taking several different drugs is that there may be interactions and problems  with some of the drugs. I have called pharmacies many times when a new medication was prescribed for patient and found that it interacted badly with a drug they were taking. This was true for children with seizures and other disorders. Sometimes doctors don't bother to ask if a patient is taking other medications and  don't check with a pharmacist to be sure there  are no bad interactions. A friend's mother was taking over 20 medications, so she took all the drugs to an excellent pharmacist and he was appalled. It took a while to get the different doctors her mother saw to straighten it all out.

 

Overseas Travel and Medical Care

If you are planning to travel overseas, it is wise to think about what to do if you need medical care. This isn't just for older people but for all ages. Children may become ill, as well as teenagers. It is possible that your child's doctor may have contacts overseas, so I would want to at least ask. If you plan on staying in a hotel, a good hotel should be able to suggest a doctor. I've found that people in other countries are very helpful and glad to help.

There are several companies that offer travel insurance  you can take out before you leave. Some of these are On Call International, MedjetAssist, Insuremytrip and Totaltravelinsurance. If you  or a family member have a chronic condition, I would carry any needed prescriptions from your doctor or doctors and be sure you have plenty of medicine with you, not in any checked baggage. Suitcases do get lost or could take days to find you. You should be able to get lots of information about travel insurance on the Internet. If you wear glasses or have need of other devices, I would either carry a second one or have information about the device with you.

Medical care in England or Europe is reported to be at the top of medical care in the world. The U.S. is way down on the list. The American Hospital in Pairs has a wonderful reputation. Remember that there is still polio and childhood diseases in Asia, Mexico, Africa, and South America. I  have cared for many children from Mexico and was able to get some polio vaccine donated to clinics in Mexico when I saw patients in one several  years ago.  Travel is wonderful and should be worry free if you have made preparations ahead of time. 

 

 

 

Flu Precautions

This has been a bad flu season which is expected to continue into February. A grandmother told me the other day that her two grandchildren were just getting flu shots. I was surprised.  It was not a question of money or time. A good article in today's New York Times by Kate Murphy stated that the present flu immunization was reported to be just about 10% effective.  In people with  serious underlying health issues or children with poor immunity the risk of getting the flu is even greater. 

The article stated that drinking lots of fluids was important. That of course is always wise with a fever. If you have a cough, it is not wise to take medicine that suppresses coughs.  That can just create more problems. In this cold weather, I worry when I see people  wearing just thin T-shirts or children without adequate sweaters or warm hats. Often the  parents have on warm clothes and yet the children do not. 

Staying out of crowds and being a little less active is a good idea. I am amazed when I see runners in skimpy clothes in very cold weather. I guess they think they are indestructible.

If you have a fever, a persistent cough and are not getting better, a chest X-ray may be wise. I had two friends during one flu season who both ended  up with quite severe pneumonia. Both had seen doctors but chest X-rays were not done They paid a high price for this omission.