Dr. Thompson's Blog

Constipation in Older Individuals

A friend, who is in his late sixties, called me the other day saying he was having problems with constipation and did I have any ideas. He was away from his home and was unable or unwilling to reach his regular doctor. I told him that as people get older the movement or motility or the bowel slows down. Then as seniors get less exercise and often gain weight that can cause addition problems. The problem got so bad that the man went to an Urgent Care place near where he was staying. The young woman doctor neither did a rectal examination or ask him about his diet. Both of these are unacceptable and just bad medicine.I wonder if medical schools are even teaching their students to do rectal examinations these days. I have picked up quite a few unusual problems by insisting on doing a rectal examination when I did a regular physical examination or if there was a bowel problem. The young doctor suggested that the man eat flax seeds and something else I had never heard of. Obviously, her interest was in holistic or alternative medicine. I went over the man's diet with him and suggested adding prunes, more fiber, a stool softener, and if necessary a mild laxative, such as Puralax. (This also goes by other names.) Some people find Metamucil works, but I have not found this to be helpful for patients. I suggested the man drink lots of water and get more exercise. Also, I reminded him that bananas and apples are constipating, as is rice. Sadly, few doctors discuss diet with patients, I have found, so if you have an elderly family member in trouble with constipation, do ask what the individual is eating

The Terrible Tragedy of American Health Care if the Republicans Take Over

I have great concerns about what will happen to our American healthcare if Mr. Trump and Paul Ryan take over the government in November. Twenty million people will lose their healthcare, as the Affordable Healthcare Act is eliminated. So far, I have heard nothing from the Republicans about anything else that would replace healthcare for these twenty million people. Medicare would be placed on a voucher system that would be a disaster and Medicaid or Medi-Cal in California would all but be destroyed.  People with disabilities and low incomes would be in serious trouble. Having cared for hundreds of people with disabilities, I know what a terrible problem that would be. Seniors would be in real trouble if Social Security benefits were decreased. I do not understand why Mr. Trump and Paul Ryan care so little about people, who don't have their money, their education, or their good health. What has happened to compassion? When I was growing up in a small college town, we didn't have a lot of money, but we knew everyone and people took care of each other. I can remember my mother fixing a meal for someone in trouble and seeing that the individual received it, often as he sat on the steps at our back door. At Christmastime, we helped make neighborhood gifts that were delivered to many. As kids, we all had jobs, baby-sitting, doing errands for neighbors, and as teens waiting table or working in the college kitchens. I cannot imagine many of the rich Republicans doing these kinds of jobs. Many rich people believe if they made it, so can anyone, but what about a good education, family support and good health? Compassion seems to be a lost commodity with many politicians or perhaps they never had it? 

Problems with Nursing Home Care for the Elderly

I have visited nursing homes that were good and some that were pretty awful. Now that people are living longer and many doctors have problems with letting elderly patients die, nursing homes are BIG business. I did not realize until I read an article in the 11/15/15 New York Times that nursing homes receive more money if they feed elderly patients with feeding tubes. Many of these patients have multiple medical problems, plus dementia and yet have feeding tubes to keep them alive. A living patient means more money for the nursing homes. I believe this is immoral and no doctor should authorize it. Of course, some families want their elderly relatives kept alive at any cost,  but since many or probably most of these patients are on Medicare, the families are not paying for their care, but instead taxpayers are paying. 

One problem also is that doctors are taught to keep people healthy and alive. Few doctors do well with dying patients, because many feel a death is a mark against them. Dying should be a part of living and if a person has multiple medical problems and dementia, they  have no decent quality of life. There is a statement I have long remembered that when the pain of life outweighs the pleasure, something needs to change.

I have cared for many babies, little children, and older ones with severe, degenerative neuromuscular diseases. The most important thing I always tried to do was to support and  communicate daily with the parents and talk openly with the children who were old enough to know their disorder was slowly getting much worse. Usually the one question the older patients  asked was "Would they be in pain?" I always assured them that pain would be controlled if there was any and that I would be there. Only one Duchenne muscular dystrophy patient, who was developmentally delayed, ever asked to be put on life support machines. The others refused this kind of care to prolong their lives. One 22-year-old left a wonderful letter to be given to me after he died. He told me  how much he appreciated my helping him to have as normal a life as possible. He was a remarkable young man who left a wealth of friends and a wonderful family behind.

Rx for Summer Medical Problems

Most people look forward to summer as a time to relax, have a vacation, and some fun. Without careful planning and awareness and anticipation of possible medical problems, summer plans can be greatly disrupted. In thinking about the medical problems I have treated and those that friends have had, I have some suggestions.  Because our weather is getting warmer and warmer, sunblock is very  important for those who spend time outdoors. The only exception is babies under six months of age. Unfortunately, some dermatologists disregard this about infants, despite the urging of the American Academy of Pediatrics.

Walking on the beach can be a problem if someone has left a broken bottle or there is some other sharp object. A first-aid kit is always wise to carry. Swimming precautions are important, particularly about diving into shallow water or not being aware of strong ocean currents.

Spider and snakes bites can be a problem in the desert or in canyons. I had to hospitalize one child,  a visitor, because of a bad brown recluse spider bite. Fortunately, he did well.

There are some summer viruses that cause fever, headaches, and diarrhea. Good hydration and treatment of the diarrhea is important. The Hepatitis A vaccine is important for all to have and those traveling overseas should always check the CDC website to see what they advise for overseas travel. Taking along an antibiotic and some medicine for diarrhea, as well as asperin or tylenol for kids is always wise. Remember that most hotels have an M.D. they can call, so asking for help may be a good idea with an illness.

College Students and Drinking

I heard a startling statistic today that 1825 college students die of alcohol ingestion each year.  This is a terrible tragedy. I cannot imagine sending a child off to college and having him or her die because of drinking. I guess I was fortunate being brought up in a college town where alcohol was not allowed within the city limits. My father-in-law was greatly upset when I was married in the beautiful Little Bridges Hall at Pomona College and no champagne was allowed at the reception. It was fine with me because my college professor father could not have afforded it anyway for all the guests.

Whne I attended Stanford, there was a fair amount of drinking at the fraternity parties, but I never saw anyone pass out from drinking. I can remember finding a potted plant at one party that was the recipient of most of any drink my date gave me. I have never been able to handle much in the way of alcohol and knew it right from the beginning. I think parents have to teach their children about drinking fairly early. The French probably have one answer and that is to start their  children early with sips of wine, teach them what a good wine is, and the kids then grow up appreciating wine and don't use it to get drunk.

Children even in grade school these days are starting to drink. When there is lots of alcohol at home and little food or parenteral supervision, it is understandable. This particularly true if the  parents drink excessively. I had to take care of one patient who was about three-years-old and was  thirsty early on a Sunday morning and so emptied the half-filled cocktail glasses. He was a most unhappy drunk!

 

Cheap Heatlh Insurance May = Poor Medical Care

I am always amazed  how many people put good medical care at the bottom of their priorities. Whenever I have moved to a new area, I have always made finding the best doctors  at the top of my list. Of course, you a have to be willing to pay for the best health insurance you can afford, because doctors who are on many HMO lists get by with offering as little care as possible.

A woman told me recently of calling her physician because she felt so ill and he said "get in a taxi and go to the hospital emergency room." A friend took her to a  nearby hospital and after an eight hour wait, she was told she had bronchities. Now the doctor does not even answer his phone!

The woman has always lived in nice apartments, taken fun trips, and put health insurance way down on her list of priorities. I  have given up trying to get her to change.  Now after being really ill, I hope she will re-think how she spends her money. Nice places to live and fun trips are important, but if you don't have good medical care, you may pay a high price for this.

When you  have seen people who had bad medical care and never recovered, you want to scream at our current medical system. Many HMO's are for profit and make their money by offering the least care possible. I cannot imagine being either an HMO patient or doctor. The doctors make more money  by not ordering tests and not referring to specialists. I don't know how any physician could tolerate that. I certainly could not.

 

Holiday Safety for Children

As I watched the mad black Friday scramble on TV, I wondered where  parents had left their children ? Are their days now going to be  filled  with getting, but not having family fun and giving? If each day is going to be a mad scramble of buying, baking, and  entertaining, how many children will end up in the emergency room because they were hungry and chewed on a left-over cigarette butt, drank some alcohol left over after a  party, or swallowed a magnet or detachable part of a toy?

Autistic children are prone to run away and with all the hustle and bustle of the holidays, how easy it would be for a child to slip away.  Lighted candles can be  a real fire hazard if they are easy  for children to reach. Do your children know the three rules of fire protection---Stop, Drop, and Roll? Knowing how to use fire extinguishers is also important for older children. Mistletoe and poinsettias are poisonous if ingested, as are some holly plants.

If your days become too hectic, it is wise to hire some extra help or a baby-sitter if you are not able to keep your eyes on the children. Kids can get into trouble very quickly and when they are bored and not getting much attention, it is amazing the trouble they can get into.

Old fashioned holiday fun is much  easier on children  then all the hype that now seems to go along with the holidays. I hope the image of people grabbing for merchandise sends a chill down most  parents'  and grandparents' backs and they find some simple holiday pleasures for their families to enjoy.

Poverty Greatly Increases Medical Problems

As the rich get richer and the poor get poorer,  the medical problems of the poor have greatly increased. When someone does not have the money to buy fruits, vegetables and healthy proteins, the risks of diabetes and obesity increase, as do other health problems that are seen with a poor diet. Yet if the Republicans had their way, there would not be healthy lunches for poor kids, food stamps, aid  to mothers and infants or WIC and other safety net protections. Paul Ryan, who states he is a Christian, believes all of these are bad. His budgets take money from programs that help the poor, yet the wealthy oil companies get subsidies. Does this make any sense?

The lack of funds for education also contribute to poverty, because the students are not taught about healthy eating, managing money or anything else that would help lift them out of poverty. Tuberculosis can be found in low income areas, as can other treatable communicable diseases. Yet the Republicans are desperate to deny health care to the poor.  They have tried to have the Affordable Health Care Act repealed about 54 times.

Raising the minimum wage would be a good place to start, but once again the Republicans refuse to even vote on this. Instead, they will soon be off on another long vacation. This is the worst Congress we have ever had and yet those in power don't seem to care about their reputations. Those of us who care about the poor need to speak out, vote, and work hard to get rid of the  Republicans who are so uncaring.

Excessive Weight Gain During Pregnancy

I was appalled and amazed when a young woman told me her woman obstetrician told her it was O.K. to gain as much weight as she wanted during her pregnancy. I wondered where the doctor had received her OB training? I asked if the doctor was Board Certified in Obstetrics and the woman said she had checked and yes she was. Sadly, the young pregnant woman took the doctor at her word and  ballooned from 105 pounds at five feet one to 189 pounds!

What the OB doctor didn't know or didn't tell the mother was that a large weight gain during pregnancy can hurt not only the mother, but also the baby. Pregnant women who become obese can develop hypertension or increased blood pressure, diabetes, and pre-eclampsia that can hurt the kidneys. Infants of diabetic mothers are at increased risk of  being stillborn or having birth defects. The babies are generally quite large, over ten pounds, and thus may suffer birth injuries due to their size and also may have respiratory distress.

If the young woman had been my patient and was gaining weight rapidly, I would have had her check in to my office two or three times a week. My first job as a young doctor was working for a County Health Department and one of my clinics was an OB clinic. One  patient was  gaining weight too rapidly, so I saw her frequently.   The woman finally lost a few pounds and when i asked her what worked, she anwered "Everytime I go to the refrigerator, I see your face!"

 

 

Raw Food Diets Can Hurt Children

As a practicing pediatrician, I spent a geat deal of time talking with  parents about what their children were eating. This was particularly important if the children were anemic, underweight, or had a problem with constipation. Now it appears there is a new worry for pediatricians and family doctors. An article in yesterday's New York Times by Abby Ellin discussed a group of parents who feed their children only raw foods. I was appalled! No child should live on a diet of raw milk, raw vegetables and fruits without enough protein for growth and well-being. What could the parents possibly be thinking and where are their doctors? Do the doctors ever talk with the parents about the children's diets?

Not only do raw foods lack adequate proteon, but having a small child eat raw vegetables and fruits can be dangerous because the raw foods may be difficult or impossible for a little child to swallow. Some kids end up in the hospital or some have an obstruction and die.

Protein is very necessary for growth and development. If a child is raised on a strictly vegetarian diet, it takes five times the amount of food a child would normally eat to get adequate food for growth. That also means there has to be some source of protein, such as beans, nuts, eggs, and cheese. Raw milk can cause illness and anemia and poor weight gain can also be a problem. I certainly hope  parents will re-think what they are feeding their kids.