radical thoughts

ISL (infant soccer league)

2012-02-01T16:52:00.000-08:00

i say if you can't beat em, join em.
i'm proposing an infant soccer league. why make parents wait til their kids can walk to be able to enjoy the joys of team sports?
i'm thinking only crawling infants in one league and new walkers in another. the rules would have to be adjusted, of course. use of hands might be allowed, especially in the crawler league.
i'm sure we'd have to watch for those kids whose parents have 'adjusted' their development in a chemical fashion to enhance their performance, but urine drug screens should be easy...just pick the diaper out of the trash can and test it. and the pubic hair noticed during the diaper change might be a hint.
there would have to be age limits, at least on the top end. a 3 year old toddler? come on. early crawlers could be accepted, but after 18 months (when even i get a little worried if kids can't walk) they would have to go into the toddler league (and the peer pressure would be equivalent to the nonpottytrained 3 year old at the MDO that only accepts kids who are potty trained...in a couple of days they will figure it out or be shunned for life by their class/teammates).
you could fit a lot of fields in a small space. i'm thinking indoors, too, because an outdoor league would be subject to the howling winds and freezing temperatures so prevalent on 9 am on saturday mornings at the soccer fields, no matter the time of year.
my friend who is a marketing genius began coming up with ideas for secondary markets: helmets, duh, they're crawling around bashing each other and the ball, talk about a header! a new type of diaper designed for the 'crawling athlete', sleek, light, complete with team insignia/colors. that brings up uniforms. the onesie would be the most sensible, but maybe something with pants with padded knees and feet in them to prevent riding up and ankle exposure.
the ball itself would perhaps have to be redesigned or just use a smaller ball. one with limited motion might make it easier.
as for performance enhancing drugs, i alluded to anabolic steroids above, but perhaps stimulants would be helpful to keep the 'picking the daisies' phenomenon to a minimum. if your baby was focused, he or she could pretty much rule the field when playing with kids whose attention was distracted by bright shiny objects, or the pacifier dropped by a teammate or opponent. that brings up mouthguards...not hard to have since many babies suck pacifiers regularly anyway. but thumbsuckers would be at a distinct disadvantage.

so...forget my usual tirades against team sports before middle school. let's go for infant soccer and throw caution to the wind!

truth in advertising

2011-07-16T05:50:00.000-07:00

the truth hurts. recent ads for a medicine for gout picture a man carrying a big glass container of green liquid with him wherever he goes. he's got gout, caused by high levels of uric acid in his blood. along comes the medicine, uloric, and voila! he is now carrying around a smaller, though still substantial, glass container of green liquid. i'm sorry, but that's not reassuring. it would be like a cancer center ad showing people who added a couple of painful days to their lives instead of years of joyous living.
this truth alongside the 'two bathtubs on a deck' commercials for cialis. seems that cialis makes you go from mowing the yard or changing a lightbulb to having sex in a tent in your (now gorgeous manicured) back yard or a (where did that come from?) waterfall in the woods that just showed up in your living room. not so much truth there, i think.
give me the days of the PF Flyer shoes. they said they made you run faster and jump higher and by golly, i ran faster and jumped higher when i got a new pair, every time, as far as i knew. it sure felt like it. in the movie Sandlot, Benny "the jet" Rodriguez dons a pair of brand new PF Flyers before his monumental battle with/run from 'The Beast'. they worked for him, too. that 'truth' was a little easier to swallow than the previous examples. one is too much truth, the other pure fantasy (get inside and take a shower, you're all sweaty from mowing the yard!).
the most recent addition to the 'too much truth' category is the T mobile ad. and the worst part is, they are marketing the too much truth part and i don't know if they realize it.
in the ad a dad and mom and a kid are carrying huge piles of books, tv's, dvd players and dvds, computers, etc., etc. they are bowing under the pressure of all that stuff and the pretty T mobile girl wonders why they don't have a phone that could have all that stuff inside it instead of carrying it all with them. well...if they get the phone, sure, no more big physical load of stuff, but still the same pile of junk, only now electronically stored for access whenever they want it. the irony of the whole thing to me is that they don't need to carry around all that junk all the time, even if they can (yes, i carry an iphone 4), and the fact that one can advertise as if being able to cram all that junk into a phone (smart phone is an oxymoron in my book) is a good thing that people should strive for, is an indictment of our culture and one that someday may be our undoing. we seem to think there is, or should be, an app for everything, and that by having that app we can do anything.
they need to make an app for the guy with the glass container of green liquid, maybe then instead of a lesser of two evils type of ad it could be just one more thing the guy has piled up on his junk pile of stuff that he's going to be able to put on his phone.

is anybody else reading this stuff?

2011-02-03T04:04:00.000-08:00

it's funny when i set my mind on something, in this case looking for things for the 'duh' files or looking for things that disagree with the prevailing thoughts on medicine/healthcare, that something just jumps up at me from a sort of unlikely source. in this case it's newsweek magazine - the january 31, 2011, issue. under 'scope, health matters, science+: why almost everything you hear about medicine is wrong.
that's the headline of the article. so, of course i read it.
seems that 'the very framework of medical investigation may be off-kilter, leading time and again to findings that are at least unproved and at worst dangerously wrong'.
we used to think (or, let's say i used to think, as i had been trained to think, with most of my western medicine trained colleagues) that medical trials were rigorously controlled and that the outcomes couldn't be compromised by the authors or the companies paying for the studies of whatever drug or treatment or test was being studied. it was only 'those nonmedical, no fda-approved, non double blind placebo controlled studies' that were suspect. how stupid was that? apparently pretty stupid. i don't know whether to believe the ones i wasn't supposed to believe or just disbelieve the ones that were supposedly done right.
the effect on the practice of medicine in the western world, where drugs cost everybody so much, could be tremendous. tremendous in a good way, as far as i'm concerned. yes, pediatrics is 'safe' in many ways from the statins and the diabetes drugs and the antidepressants and psa tests, etc., but they are still used. and then, after all, pediatricians are people, too, and some are of an age where these medicines and tests are being recommended to us.
what if, instead of overhauling healthcare the way it is, it's overhauled pretty much from the inside out? cut about a trillion (a trillion is a million million, just for you math folks) in drug cost from the national healthcare bill and wow, it's not so bad! instead of figuring out how to pay for all those 'necessary' meds and treatments that studies show are good and safe and effective, and that we now know may not be any of those things, we just pay for the stuff that's really helpful. that should be easy to figure out...not. who's going to do the study to prove which treatments and drugs and tests are really needed? but at least it's not now in a rationing of care sense so much as in a safe/effective sense. until now (and maybe past now if i'm the only person who reads newsweek) it's been counted on that there will be somebody somewhere whose case requires drug A or treatment B and for some reason theirs is unique and therefore the drug or treatment should be available to everyone regardless of whether they meet the same criteria, because this is the u.s. of a and by golly we should be free to get treated in any way we want whether it makes sense of not, and by the way, our insurance should be forced to pay for it.
so now it can be said that nobody needs this medicine or this treatment. that the only effect that the antidepressant that so famously worked by fixing a chemical imbalance (i lost count of how many people wanted a chemistry test done to see if they were out of balance...there is no such test, though i guess i should have faked one and sold it and made a mint before this deal came out!) was a placebo effect. and now, God is so good in the order that He revealed these things to my tiny little mind, since we know that the placebo effect works even though we know it's a placebo, we can cut down our drug costs and side effects tremendously!
quick, someone open a drug company specializing in placebos...oh, wait, there are several, but they thought they were making real drugs!
so, a few quotes and i'll finish this parcel of radical thought.
from a guy who questions the doctor who is calling all this research into question: he worries that the 'most-research-is-wrong claim "could promote an unhealthy skepticism about medical research, which is being used to fuel anti-science fervor'". and on how statistical flukes affect studies: "when you do thousands of tests, statistics says you'll have some false winners(or, even a blind hog finds an acorn every once in a while - my words)...drug companies make a mint on such dicey statistics...by testing an approved drug for other uses, they get hits by chance, and 'doctors use that as the basis to prescribe the drug for this new use. i think that's wrong.'"
the caveat: the last paragraph. "of course, not all conventional health wisdom is wrong. smoking kills, being morbidly obese or severely underweight makes you more likely to die before your time, processed meat raises the risk of some cancers, and controlling blood pressure reduces the risk of stroke. the upshot for consumers: medical wisdom that has stood the test of time - and large, randomized, controlled trials - is more likely to be right than the latest news flash about a single food or drug.'
ok. nuff said. so, what are all those internal medicine/family medicine docs going to do with all those medicare patients on all those drugs? and what are we going to do about this information? be skeptical of medical research? look at the emperor's clothing real closely, he may need viagra.

the 'duh' factor

2011-01-22T06:37:00.000-08:00

here are my first 2 duh factor entries.

TEENS WHO SAW TOBACCO ADS ARE MORE LIKELY TO SMOKE (DUH)

A study of German teens finds that those who were exposed to more cigarette advertisements during a nine-month observation period were more likely to take up smoking. The study is published in the journal Pediatrics.

Researchers looked at the role that any kind of advertising, including cigarette advertising, plays in influencing teens to begin smoking. Researchers showed advertisements to 2,102 German teens who had never smoked. The ads included six cigarette advertisements, and eight ads for other products including candy, clothes, cell phones and cars.

Students also answered surveys about how frequently they had seen each ad, as well as questions about smoking behaviors among their parents, peers, and their attitudes toward rebellious and sensation-seeking behaviors.

Initially, 47% of students reported one or more parents who smoked and 27% reported having peers who smoked.

During the nine-month observation period, 13% of students started smoking, the researchers reported. Increased incidence of smoking was associated with increased exposure to cigarette advertisements, according to the study. Other factors tied to taking up smoking included older age, lower socioeconomic status, having friends who smoked, and higher levels of sensation-seeking behavior.

The study authors say their research shows that adolescent exposure to cigarette advertising, but not to other advertisements, is tied,at least in part, to the initiation of smoking. The study points out that while some countries, including Italy, Finland and New Zealand have strong anti-tobacco marketing regulations, other countries, including the United States and Germany, have “considerably weaker tobacco-marketing policies.”

Almost 90% of smokers began the habit when they were teens, according to theAmerican Association of Pediatrics. Each puff of a cigarette exposes the body to more than 400 toxic substances including cyanide, benzene, formaldehyde, acetylene, ammonia, carbon monoxide, as well as nicotine, the substance that makes smoking so highly addictive.

BOOSTER SHOTS: ODDITIES, MUSINGS AND NEWS FROM THE HEALTH WORLD

'Healthy' kids' foods usually aren't, study finds (DUH)

Just because a box of cereal claims to be nutritious doesn't mean it's actually healthy, researchers warn. (Photo courtesy of Marion Nestle)

By Karen Kaplan, Los Angeles Times

January 19, 2011, 4:30 a.m.

E-mail
Print
Share
Text Size

If the foods we ate were actually as healthy as their packages would have us believe, Americans certainly wouldn’t be spending $168 billion a year on obesity-related healthcare costs. So it shouldn’t exactly be shocking to learn that yet another study has found that the front-of-package labels on processed food items are misleading (to put it kindly).

Even judging by these low standards, the new report out Wednesday from the Prevention Institute manages to evoke some distress.

The report focuses on the claims made on packages of certain cereals, meals, beverages and snacks that are marketed to kids. Researchers zeroed in on 58 products that were deemed healthy by an industry group and that also made nutritional claims on their front-of-package labels. Among the 58 items were such staples as Campbell’s Tomato Soup, Skippy Super Chunk Peanut Butter and Rice Krispies.

The researchers examined the "nutrition facts" panels of all 58 items to determine how much sodium and fiber they contained, and to calculate the percentage of total calories that came from sugar, fat and saturated fat. Then they checked to see how many of the items measured up to nutrient criteria derived from the federal government's "Dietary Guidelines for Americans." To qualify as healthy, foods had to:

Derive less than 35% of their total calories from fat (exceptions were made for nuts, nut butters and seeds) and less than 10% from saturated fat;
Get less than 25% of their total calories from sugar;
Contain at least 1.25 grams of fiber per serving (milk products and 100% fruit juices got a pass); and
Contain less than 480 milligrams per serving of sodium (for snacks) or less than 600 milligrams per serving of sodium (for meals).

Care to guess how many of the 58 items failed to meet at least one of these criteria and were judged “unhealthy” by the Prevention Institute researchers? Would you believe 49?

RELATED: The FDA should put an end to bogus health claims on packaged foods, experts say

That’s right -- 84% of the items declared healthy by an industry group called the Children’s Food and Beverage Advertising Initiative actually weren’t, including the tomato soup, peanut butter and Rice Krispies.

Among the other findings:

95% of all products in the study contained added sugars, including high fructose corn syrup and healthy-sounding alternatives such as honey and fruit juice concentrate.
17% of the items contained “no whole food ingredients.”
Only one of the 58 products contained a green vegetable (peas).

The study concludes that it’s time to call in the food police -- otherwise known as the Food and Drug Administration -- to create a rational, uniform and honest system for conveying nutritional information on food packages, as is already done in Canada, Sweden and the Netherlands:

“Key nutrition information, including calories, saturated fat (and trans fat), added sugar, and sodium should be listed in easy-to-read type, on the front of packaging. Nutrients associated with health, including vitamins A, C, D, calcium, and fiber, should not be included since they have the potential to mislead shoppers into believing that foods with a poor overall nutritional profile are healthful.”

Those who disagree with this will probably point out that the study was commissioned by an advocacy group that calls itself the Strategic Alliance for Healthy Food and Activity Environments. Some may say that self-regulation by the food industry and greater parental responsibility can lead to healthier choices.

Just keep in mind, under this laissez-faire approach, added sugars and unhealthy fats have come to account for almost 40% of the calories eaten by kids and teens, according to a study published last year in the Journal of the American Dietetic Assn.

ok, sorry. tell me if you want the whole article posted or just the title. these just came across my desktop this week and are representative of the 'news' in healthcare these days, or at least some of it.

people are getting money, money i say, to study these things. and both entries are pure advertising 101. 'let em see it, think it looks good or sounds good, and they'll buy it/do it'.

we are so gullible. not sure which is more indicative of gullibility, the fact that people didn't know this already or that they paid people to study them!

healthcare rant

2011-01-22T06:25:00.000-08:00

listening to intelligence squared u.s. debate on 'should obamacare be repealed?' and had to respond…my take on the healthcare debate is that they are all missing the point. People shouldn’t go to the doctor so much, shouldn’t be screened for so much that generates rx’s that are expensive and cause side effects for which more rx’s are given…this occurs in kids some, but big time in adults, and adults with the most access to healthcare easily get…more healthcare. Not better, just more. And more tests and more meds and more to talk about how bad they feel on fb and at coffee club or work and it’s a status symbol to be on the ‘you need to be wound up like a friggin doll’ medicine or the ed drug that could make your penis fall off…

Sorry, it’s just that more healthcare isn’t better healthcare. But if someone shows up in the office with anything as an adult they get everything screened increasing the stress level and therefore the blood pressure, etc., etc., and instead of saying, ‘hey, fatso, lose some weight’ they say ‘here’s your medicine for your type 2 diabetes, hypertension, and high cholesterol, hope you don’t die of the side effects’ and when the government gets involved if the adult docs DON’T do that they will get in trouble.

just like the financial crisis (for which intelligence squared u.s. - npr - has an excellent debate from a couple of months ago) we want something we don't want to pay for. so we dump it off on the government. then we don't want our taxes raised and we don't want to go into debt with china any further but we...want our cake and we want to eat it too. we just can't have it like that. but the debate is about those people who can't afford healthcare or have preexisting conditions and whether they deserve better treatment by insurance companies. yes, they do. we all do. insurance companies are making the lives of doctors, hospitals, pharmacies, and patients miserable while they cash in because 'gasp' what if they didn't?

Ok, I’m through. Thanks for listening.

sorry, i must have RDS

2011-01-15T08:42:00.000-08:00

RDS, it sounds more official and takes less time to say than 'reward deficiency syndrome'. never mind that it also means 'respiratory distress syndrome', not to be confused with RSD, which is 'reflex sympathetic dystrophy'. it's also 'radio data system' or 'relational database system'. these acronyms DMC! (drive me crazy).
but i guess i'm addicted to blogging right this moment, i can't stop! i've been mindful of the fact that i sometimes feel the need to share my thoughts with other people, and for some reason, i think they should care. i guess that's a typical blogger mentality (TBM?). but then God shows me that the thing i thought was so important that had occurred to me or that i heard that i thought others should hear was just important to me and just for that one moment and that other people probably didn't really need that information filed away in their brains under 'things that somebody thought would be interesting' because that storage unit is already full and taking up space that could be used for things like, remembering directions (oh, wait, there's GPS) or phone numbers (oh wait, they're stored in my phone) or friend's names (oh wait, they're on facebook if they're really my friends) or important passwords to secure websites (now that one calls to mind a quandary - can you store them safely in one place and if so, what if you forget that password?). so, i'm going to quit blogging now. someday, maybe i'll look back to all the blogs i've done, all the crap i've committed to the blogosphere and other digital media, and write a book. not that anyone would want to read a compilation of the stuff i thought was important any more than they would want it handed to them a piece at a time.

placebos revisited

2011-01-15T08:29:00.000-08:00

can you get addicted to a placebo? i was searching for a definition of reward with google (easier than finding and thumbing through the dictionary) and one of the reasons i love and hate the internet popped up. when i put 'reward' in the google search box, 'reward deficiency syndrome' came up as an option. now i've seen it all. it's supposed to explain addiction by showing how people need positive strokes or rewards and when they don't get them they look to temporary 'cures' like alcohol, drugs, sex, gambling, etc., to help assuage the deficiency.
there's a diagnosis for everything.
and do you know why a diagnosis is important? other than that it gives people the ability to say 'i have reward deficiency syndrome' instead of 'i can't control myself'? it allows doctors to put its number in a box beside which said doctor can put an order for a medicine or a treatment for that diagnosis and then the insurance company is supposed to pay for it. no diagnosis, no payment.

put mercury back in vaccines

2011-01-15T08:22:00.000-08:00

10 years ago thimerosal, the mercury-containing preservative used in many multiple dose vials of vaccines, was removed due to the thought (not proof, just idea of possibility) that it contributed to the rising incidence of autism. since then, thankfully, autism is now nonexistent....no, it's not, autism diagnoses are rising even faster. makes me wonder if we should put the mercury back into the vaccines?

beware of false studies

2011-01-15T08:18:00.000-08:00

the temptation to jump on the bandwagon against andrew wakefield and his study about MMR and autism being false (pretty much proven already) and even (collective gasp) motivated by monetary gain is strong. but if that same critical eye is aimed at many pharmaceutical studies sponsored by the company who stands to profit, we find that it's easy to point fingers when the villain is our enemy but not so easy when they are feeding us lunch every day. ouch.

placebos

2011-01-15T08:12:00.000-08:00

a new study shows that placebos work...duh...that's what they're supposed to do. but they work even when we know they are placebos. we always, at least i always, assumed that they worked as a tactic to fool people into thinking they were getting something that they really weren't getting, and that it proved that it was not the medicine that worked but that the person thought they were getting better so they did. and that may be true, but now it seems that we don't even have to be fooled to believe stuff works even without any reason to believe it will. this makes me think at several different levels.
first, it explains why babies get better with pretty much any kind of drop you put in their mouths when they are fussy. after a dose or two, just the touch of the dropper to their lips makes them calm down. sometimes. truly sick babies believe less in the placebo effect than others.
it explains why babies seem to get sleepy when given tylenol by their parents. seems that the placebo effect is transferable. if the parents believe it, the kid gets sleepy.
it explains why antibiotics work. and it explains why colloidal silver works. and ear drops with vinegar. and pretty much anything else you do with the belief that it's going to help. because usually the ear infection will go away in a couple of weeks regardless of what you do.
but it doesn't explain why people continue to take medicines whose list of side effects is longer than the list of good effects. why not just take a placebo? it's got about as good a chance as any to work, without the side effects.
so this study both explains why pharmaceutical companies are making so much money, and asks why? at the same time. maybe it's the side effects that make you know it isn't a placebo.

prairie voles and songbirds

2010-12-22T18:09:00.000-08:00

just got a newsletter/fundraising letter from OSU dept. of zoology (my alma mater, my major). two professors each got grants of over $300K to study songbirds and prairie voles. the songbird study will see if growing up in a good environment affects adult zebra finches vs. those growing up in bad environments (not sure what that would be, maybe lots of cats around), and the prairie vole study is what really caught my eye. these little creatures are 'monogamous animals that form long-term pairbonds and exhibit behaviors that appear very similar to those that we humans might call 'love' for both a mate and for offspring'. the guy is going to look at their brains and see what hormones make them 'love' and especially look at the males and their attachment to their offspring 'to provide a better understanding of what controls monogamy and offspring care by fathers'.
hey, save your money and quit looking at tiny animal brains and read the bible, numbnuts! 'Start children off on the way they should go, and even when they are old they will not turn from it.', and 'That is why a man leaves his father and mother and is united to his wife, and they become one flesh.'
we get angry when people waste their money on frivolous stuff but welcome it, almost worship it, when it's in the name of science. especially in the name of 'developmental origins of adult disease' and 'understanding the causes of dysfunction in social attachment, such as.........autism'.
words of wisdom from my lovely bride: 'you find what you're looking for in the last place that you look'. and it seems that scientists have the bible buried pretty deep in their piles while looking elsewhere for answers to life's questions. but i guess you don't get much grant money for studying 'why people don't pay attention to what God says despite continually suffering the consequences of such behavior'. oh, well.

need a doctor?

2010-11-10T04:00:00.000-08:00

¹² On hearing this, Jesus said, “It is not the healthy who need a doctor, but the sick.
in matthew 9:12, mark 2:17, and luke 5:31 Jesus makes it pretty clear that it is the sick who need a doctor, not the healthy. man's response to this? the healthcare industry, with us (i'm sure i'm as guilty as the next "health care provider") as its minions, is out to make everyone think they are sick. so they'll need a doctor. God forbid that people figure out that most of their sickness is self-induced or just plain made up out of thin air, drug advertisements, and webmd. not to tout my knowledge or that of the medical profession so much as to help lay persons figure out why when they search symptoms on the internet and find weird stuff that it's not the long list of things that could cause the symptoms they are having that we need to learn in med school, but which ones on the list we can mark off without a lot of unnecessary expensive tests and treatments. the 2nd year of med school, pathology was the course, was a whole year of being pretty darn sure i had every disease about which we learned because they all had fatigue, headache, irritability, or some other random symptom common to every disease in the world, including not getting enough sleep, but surely it's something way more interesting than just that i'm staying up too late and not eating right and not exercising and working too hard and generally ignoring the common sense signals my body gives me, has to be. i must be sick. so i must need a doctor. Jesus said so. so i still have a job. so what started as a rant against webmd and people thinking they are sick all the time ends up as thankfulness that i have a job that benefits from this! wow. sometimes you just gotta think/write things through. i forgot how much fun this blogging stuff was.

a cynical look at john chapter 11

2010-01-06T19:48:00.000-08:00

in studying john 11 for a bible study there were a couple of questions asked that brought out my cynical side. ok, it's always out, but it was provoked.

one was about which of the sisters martha and mary and which one was more responsive to Jesus. i'm pretty sure the answer according to the 'experts' is going to be martha. but i'm going with mary because she chilled at the house until Jesus called for her, then she went to Him and talked with Him, while martha had been on webmd looking for a cure for lazarus all the time Jesus was waiting to come and it's pretty obvious she was a bit ticked at Our Savior for taking so long, making me wonder if He needed malpractice insurance or something. so our american way is to go with the aggressive out front ask the questions regardless of the fact that you know what Jesus is going to say and things are going to work out ok in the end because after all it's Jesus after all and you trust Him and everything but you just have these couple of questions you really need to get answers to so that you can understand even though you understanding really adds nothing to the situation other than making you look like an impatient wench and then you argue with Him when he wants the tomb opened because you're afraid it's going to stink and you'll be embarrassed because nobody in this family has ever been stinky in public if martha had anything to do with it. ok, enough on martha.

next, the whole lazarus thing had to happen back then because now old martha would have had him bundled up and taken him to an urgent care or er where they would have done $5000 worth of tests on him to diagnose and then treat his problem and he would have never died and the book of john would have been one chapter short. and the shortest verse in the bible wouldn't be there. john 11:35 'Jesus wept'.

radical thought

2009-10-22T03:48:00.001-07:00

humility is when you're still surprised when you're right.

conspiracy?

2009-08-17T20:25:00.000-07:00

would anybody really think this kind of thing up? did it happen accidentally? did we pig out our way into this mess and now we need help to get out? i hope it's not a conspiracy, because if it is, whoever did it is brilliant, and evil.

get people to eat more by supersizing everything, make fast food and junk food and processed food cheaper and easier to get, advertise it all out the wazoo, and watch as people get diabetes predictably, high cholesterol and obesity become the norm, and strokes and heart attacks are commonplace. and cancer, pretty much everybody's going to get it somewhere sometime, right? now most people take at least a prescription drug or two. health care costs more and more because more and more people need to see the doctor more often and need more tests for more problems caused by more drugs and nobody seems to pay attention to the last 45 seconds of the drug commercials because they're so snowed by the promise of more hair, less weight, better attitude, less depression, better sex and they don't hear the part about your penis falling off or your anus losing control.

fast forward to the near future: people are begging for help paying for or even getting health insurance and are willing to gamble on about anything to get them out of the mess that they don't even know that they got themselves in. they want fast food, fast track healthcare when they want it and they want the drugs they want and they are blind to the reality that they have sold their healthcare souls to the drug companies and the medical walmarts of the world.

when the government offers 'cash for clunkers' but they're asking for your grandmother instead of your gas guzzler, what are you going to do?

a conspiracy? sometimes i hope so, at least that would mean we were duped instead of just greedy, lazy, and stupid.

cash for clunkers, part 2

2009-08-14T03:12:00.000-07:00

got an email forwarded to me today...'cash for codgers'. man, i thought i'd come up with this idea myself, but once again, i've either stolen it or synthesized it from many ideas floating around in the air and in my head.

if a couple wants to have a baby and wants the government healthcare system to assist them in covering the expenses, they apply for permission and have to turn in an old person in exchange for the new baby. the exchange rate is on a sliding scale, with the highest values given to the old person with the most healthcare problems, on the most medicines, smokers, alcoholics, the obese, and republicans. the old person is taken care of with a toxic injection that guarantees that they can't be resold or their body parts reused.

i really and truly had this idea and was on my way to blogging it when i got this email. i want you to believe that, for some sick reason. but i was missing the key ingredient: exchanging the old for the new - what was i (not) thinking?

this seems orwellian, i know. but so many things that seemed so 'out there' a few years ago are now occurring on a regular basis, that i'd make sure your 'value' for exchange is pretty low as you get older, or your kids might just come visit and say, 'dad, i've been thinking...'.

talk about incentive to stay healthy! gives new meaning to the statement 'i'm worth more dead than alive'.

big brother

2009-07-12T16:06:00.000-07:00

good news, bad news. there are cameras everywhere and that's good if you're looking for a criminal like on csi or law and order or ncis. i guess that's good if you can watch your kid while at daycare and you're at work, though if you have time to watch them on the computer...never mind, i digress. good news if you're a wannabe singer/star who gets discovered on some tv show. bad news if you're watching your brother play the final at wimbledon and you're caught picking your nose. ouch. how is ou going to spin this to make it go away?

filters

2009-07-03T05:35:00.000-07:00

our minds are like filters - stuff goes through all the time. some stuff gets stuck. like in the dryer, the lint you have to clean off. you don't keep it, you throw it away (or at least i haven't heard of anyone recycling lint...yet).let's say that something that is allowed through is gone, forgotten, not considered, out the vent. the stuff that is filtered out is to be mulled over, considered. in our world today there are so many floating pieces of information, advice, opinion, and b.s., that our brains get clogged quickly and our options are to get rid of some stuff or to get lost in all the crap that is trapped. the latter option is where so many people live, worried about seemingly (to me, at least) nonsensical stuff and obsessing about things that in the big picture are really just fluff that got stuck in the filter.

so how do we clean the filter? dump the crap? one thing we can do is pray. go to God and give it to Him and let Him deal with it. one is to just forget it. that's not easy, and those forgotten memories tend to resurface at inopportune times. some people can 'rinse off' their filters by talking about stuff with other people, like counselors, therapists, and the like. my personal opinion is that talking things over with counselors just keeps the fluff circulating and sticking back in the filter. i'm not a fan of counseling.

i'm for praying and giving it to God. then pray again that you don't go back to the pile at His feet and pick your junk up for another round.

oh, one other way to at least help with the crap we have to filter through? don't go looking for it! on the internet, with your friends, on tv (oprah produces a ton of lint every day!). sure, everyone diagnosed anymore with any illness will go home and research it on the internet. at least it seems so. but don't believe it all. do you think they put the boring stuff on there? like on tv, the medical shows, law shows, cop shows - they distill out the boring 99% and give you the gunfight in the er between two lawyers! 99% of most of the stuff i see could be listed under "it will go away pretty much no matter what, so don't worry", or "it's a phase many kids go through and is normal and will resolve without treatment, but if you hurry and get him in therapy you could make it a big deal and spend a lot of money on it". notice how everything has a name now? you don't just have crappy eyelashes (like brooke shields, yeah right she's got crappy eyelashes!) you have hypotrichosis. no longer can you be in a bad mood sometimes, you're bipolar, you're depressed if you cry, obsessed if you think too much. ok, that's it.

summer accidents

2009-06-24T16:20:00.000-07:00

read an article in the oklahoman this week about how the writer doesn't think kids play outside enough and they're just sitting around playing video games and facebooking and twittering. well, that may be true, but i still see, and generally comment positively on, kids who have the kinds of summer accidents we used to have. like stepping on a piece of glass in the creek that's usually dried up but it had rained recently and there were some crawdads and tadpoles and we were catching them and then we started playing swordfight with some sticks we found and maybe somebody got poked in the eye but then we used the sticks like rifles and played army for a while and then got into some poison ivy but the shot doesn't hurt that much and besides i kinda like that pink stuff and we went on a hike because we had these cool walking sticks/swords/rifles and nothing else to do but have fun and imagine ourselves as adventurers like lewis and whoever and we found all kinds of cool stuff and almost caught a lizard and threw rocks at a sign and one kid got hit in the head but we don't think he will need stitches and decided not to swim in the deep part of the creek because there were some bubbles that kinda looked like pee up by the edge and that was gross and then we climbed a tree and that was cool until another kid fell out and i hope he doesn't have his cast for the whole summer but man, we had fun.

those were the days. and they're not gone. just to reassure you. kids are still kids if their parents will let them and i know you can't just let them wander around like you used to when you were a kid and there are infections and perverts and toxins in the water and west nile virus and rocky mountain spotted fever ticks and any number of other scary things out there, but kids need to play in puddles and swordfight and play army and throw rocks and not have plans all the time like soccer practice and be kids.

one of the first blogs in this long line was 'the rant' and it's this exact mood i'm getting at here. i'd love to see a few more sets of stitches and the occasional piece of glass in the foot and poison ivy and maybe a broken arm instead of chronic stomachaches and headaches and trouble sleeping and trouble concentrating and (now i'm going to offend, sorry) fights over what johnny gets to do at dad's house that he isn't allowed to do at mom's and maybe the stomachache is from worrying whether he can tell his 'primary custodial parent' how much fun he had at his 'noncustodial parent's' house over the weekend without hurting her feelings or getting his noncustodial parent in trouble with mom's lawyer. there, i feel better.

and this is a good time to rant on something else. today's paper has two articles, both about dead kids, one who drowned and one who was shaken to death. both kids were allegedly killed by men in their mothers' lives, one was actually the father, one her boyfriend. the one who was the father had already abused a kid, but hey, it was over 10 years ago 'and he's changed'. and i'm sure there were protests of 'but i love him'. oh please, ladies! i'm sure there are boyfriends out there who won't kill your kids, but be careful. and the ex-wife of the drowned kid is defending her ex, and in a move that actually made sense for once, dhs took her other kid away.

this story plays out over and over. i caution guys - if you've got a girlfriend with a child, be careful. first, don't kill them. but seriously, don't be left alone with the child and consider every potential problem with every situation when you are with that child. statistically you are the prime suspect if that kid is abused or killed or if anything happens. apparently (and here i'm going to get in trouble again) girls don't think too clearly when it comes to guys.

heat index

2009-06-24T16:16:00.001-07:00

i know the heat index has something to do with the temperature and the humidity, sort of a reverse of the wind chill, but is there an age-adjusted heat index? i remember 100 degree days where it didn't feel like my brain was melting. and cindy thinks it's because i was driving her convertible with the top down! i'm thinking maybe temp plus humidity plus age plus amount of hair* (*or lack of it) and plug it into some formula and it comes out to...HOT.

oh, by the way

2009-06-24T16:10:00.000-07:00

the dinner i just mentioned was not just me and some lady. it was my wife and i and this lady and her husband. i even remember their names! but how we had dinner together was sort of 'european' or something like that.

we had just sat down at an outside table at interurban and they came onto the patio and there were no more tables. there were 2 chairs left at our table and 2 people who needed to sit down so we invited them to join us. what a concept! no pressure, no expectations, we all just talked and enjoyed the meal and the conversating (at least we did, i think they did). i showed her my 'fat kelly' pics and of course we had to talk weight loss for a while...but i really liked the concept of saving points and how it relates to kids and eating. and we enjoyed their company and if we had been our usual selves with our blinders on then we would have missed the opportunity.

saving up points

2009-06-24T16:04:00.000-07:00

had dinner with a weight watchers instructor (?leader, coach?) and i noticed she had a couple of glasses of wine and i asked about that and weight watchers. she said she just saved up points if she knew she was going to be going out and then she could use the points on alcohol or dessert or whatever. so...kids are really smart. they've been doing this for centuries. 'you didn't eat your dinner.' 'i'm saving room for dessert.' 'if you don't eat your dinner you can't have dessert.' 'but mom, if i eat my dinner i won't be hungry for dessert!'

kids are brilliant! now when will parents catch on?

modern innovation

2009-06-15T18:59:00.000-07:00

in a time magazine article about how 'twitter' is going to change our lives, i found a very interesting and enlightening and gratifying few sentences. sure, i'll probably learn to twitter like i've learned to (at least an old man attempt at) facebook. i may not use it like i do my texting skills, and not to the degree professionally that i use email, but i'll probably learn to twitter. but, the article contains some of the best news for america that i've seen in a long time.

the author is discussing the innovations that have happened to twitter after it was released and how amazing they are, and just sort of throws in this part: " ...Since the mid-'80's, a long progression of doomsayers have warned that our (the U.S.) declining market share in the patents and Ph.D.'s business augurs dark times for American innovation. The specific threats have changed. It was the Japanese who would destroy us in the '80's; now it's China and India.

"But what actually happened to American innovation during that period? We came up with America Online, Netscape, Amazon, Google, Blogger, Wikipedia, Craigslist, TiVo, Netflix, eBay, the iPod and iPhone, Xbox, Facebook, and Twitter itself. Sure, we didn't build the Prius or the Wii, but if you measure global innovation in terms of actual lifestyle-changing hit products and not just grad students, the U.S. has been lapping the field for the past 20 years."

i'm encouraged. the kids i encounter regularly are quite brilliant and are good thinkers. they may learn a little differently. they may need a little pharmaceutical help occasionally to turn their D battery flashlight/not so focused brains into the laser beams they were capable of, but dadgummit, we're still the good ol US of A and we kick butt, and don't let the ninnies at npr tell you otherwise!

glad i'm not in school anymore

2009-06-10T19:25:00.000-07:00

at a meeting recently i started thinking...i'm glad i'm not in high school. if there had been texting while i was in school, i would have been the worst! i could listen to the speaker and still text friends, coworkers, relatives, spouse. multitasking is easy. thank goodness i don't have enough time for it now!

maybe it's just me...

2009-06-10T19:20:00.000-07:00

maybe it's just me, but i love my routine. sure, it gets old sometimes, but i love it. i've been on more vacations lately than i can ever remember taking, and i have loved each of them. however, when i get back home i find myself craving the regular, the routine. it's a stabilizer, this routine. it's something to look forward to, to anticipate, not to dread.

so...maybe it's just me, but - enjoy your routines.

cell phone sex

2009-05-20T20:40:00.001-07:00

ok. i hooked you with the title. this, however, is a true story from this week.

i took a call from mercy hospital monday afternoon while in the room with a patient in the office. they were calling to tell me that i had 2 new babies just born that afternoon. they usually give me the name, time of birth, weight, length, apgar scores, hep b and group b strep status, and whether the baby is a boy or a girl. that takes a while, and i was in a hurry due to needing to answer some questions the patient's mom had. so when the nurse asked me if i wanted all the information on the babies, i said 'just give me the sex, that will be enough for now'. needless to say, i backpeddled a little pretty quickly and said, 'i mean the gender...not sex, oh well...'. i'm sure the mom, who had no idea of what was being said on the other end of the call, was wondering exactly what was going on when i answered my phone 'this is dr. stephens', then the next thing i said was 'just give me the sex...'.

that's why cell phones in offices should be outlawed. or maybe the hospital should text me with baby info...

new mantra

2009-05-12T03:23:00.000-07:00

recently it hit me that as parents we may be creating little puppy dogs that perform for treats vs. children who grow up with love as a covering for their lives. kids, like puppies, know what gets praise from their parents, and if they are praised for those specific things, that's what they will do. but that may limit them. they may not be confident enough to go 'outside the box' to do other things, to grow, because the parents' praise is necessary for them to take the next step. so...instead of making life one 'trick' after another, one to be noticed ('look what i can do!) and commended, we should make our praise, our positive comments, more general. this is sort of like "i love you" as a general statement vs. "i love it when you...".

in the same vein, we should not criticize so generally, but more on a 'per event' basis, so that the child knows what he did to transgress. much the opposite of many parents' styles today.

so...praise generally, criticize specifically. instead of each act getting a nod, the nod goes to the whole day or week as 'man, you kids have been really great today, i really appreciate it, let's go to the park and have a picnic'. and 'tristan, we don't bite/hit/pull hair/scream/throw food/pee on the floor/etc.'

that's the mantra - praise generally, criticize specifically.

when is it ok?

2009-05-10T17:42:00.000-07:00

signs meet me on hospital room doors, telling me to wash my hands, avoid going in if i'm sick, don't sneeze or cough on anyone, etc., etc. because of the recent potential H1N1 flu pandemic. so...when is it ok to not wash my hands, to go in sick, to sneeze and/or cough on people? these are things we should do (and that we do, hopefully) every day regardless of the presence or absence of a potentially serious pathogen.

i have seen this scenario played out recently in at least one other area. when the economy crashed, all of a sudden business were cutting back - no more corporate jets or flying everyone to the main office for meetings, instead they teleconference. no more frills and extras. i can't even think of all the things i've seen 'cut back' (i'm not talking about employees losing jobs here), but my point is: why were they doing these wasteful things in the first place?

it seems that if we can, we will, then when things get tough and we can't, we're surprised. or we're mad.

ok, now that's off my chest.

recent radical thought

2009-05-09T13:29:00.000-07:00

why do we like babies to be fat but adults to be thin?

why is that it's ok, even preferred, for babies to be distractible, but it's ADHD when it happens when we're older?

you're sensible people...

2009-05-08T05:34:00.001-07:00

i get scared when people follow all my advice all the time without question. mind you, i do like it when people take my suggestions/commands, but like everyone, i have been known to be wrong from time to time.

you're sensible people. if you get advice from me that sounds wacky or doesn't work for you, check it out. ask others, look it up, try some other stuff. maintain a healthy skepticism about any advice, even from me.

that's like handing a machine gun to a serial killer for some parents, as they don't believe even themselves most of the time, asking questions almost to hear themselves talk, but for the vast majority of you, you're sensible people, as far as i know given the information and experience i have at this time, my advice is good and timely, or at least not bad and harmful - though some would argue. just don't consider me the source of all medical knowledge - or i will most definitely disappoint both of us.

the illness formerly known as...

2009-05-08T05:33:00.001-07:00

since president obama was criticized by the pork industry over the name of the current influenza media frenzy/pseudo pandemic, it has come to my attention that there is a group that has a gripe with it being called H1N1 flu.

press release from jim henson productions: sesame street and its sponsors would like to lodge a complaint against the cdc and whoever else decided to call this strain of influenza H1N1 flu. on behalf of the letters H and N, and the number 1, we protest that this nomenclature dishonors these letters and this number and should be changed immediately. why should miss piggy get her way just because she's a swine? big bird hasn't said anything about the 'bird flu'. our recommendation is that it be called 'the illness formerly known as...' and given a symbol - preferably one that doesn't resemble anything of this earth or this universe or any subsidiary thereof, so as to prevent further confusion when it has to be renamed once again.

thank you.

this protest was brought to you by the letter A, the letter Y, the letter K, and the letter M - as in Are You Kidding Me?

the ferrari

2009-04-16T03:21:00.001-07:00

sometimes parents don't appreciate how good their children are. really. i had some great 2 year olds yesterday, i mean really nice, non-fit-throwing, polite, fun 2 year olds. the parents of these kids didn't see many problems with the behavior of the children but they (i think) failed to grasp the absolute delightfulness of them.

it's kind of like if someone gave you a ferrari for your first car and you'd never had any other car, and you didn't know much about cars. people would comment on your car regularly - 'wow, cool car', etc. but to you it was just a car. it started in the morning when you needed it to and hadn't left you stranded at any time.

these kids were ferraris. they were exceptional but due to no point of reference to compare with, the parents just took for granted that all kids were like this. didn't everyone have a ferrari? are ferraris cooler than other cars?

maybe you had really wanted a pickup or a suburban and all you see is the lack of space to store stuff. maybe you're scared of driving fast and all this thing seems to do is accelerate.

appreciate your ferraris. recognize them. praise the good stuff generally and generously (you are the coolest kid around! i think you're great! thanks for such a great day/week!) and criticize specifically (i can't allow you to do/say that. we don't hit/bite, etc.). so you're creating an ambience of positivity with this general 'gee, you're super' and in that context you are able to work on the fact that your ferrari doesn't have much trunk space more specifically without losing sight of its 'ferrariness'.

addendum: some days we all think we have a ferrari, or if we told him or her enough good stuff that he or she would become a ferrari. don't lie to your kids to improve their self esteem. just honestly enjoy them, whatever they may be. that is the truest form of love, to love without condition, just because you 'own' this kid you love him, because she's yours you will never not love her. so i guess i'm looking for that balance: of positivity and truth, of appreciation with no conditions - i love you because you're you. this level of contentment is a blessing i wish i could instill/inject/impart into so many parents - it's not what they do or where they go or how well they do - if they are yours, you love them, and i know it, so let them know it, then all the rest, like growing up and being good kids and getting good grades and going to a good school and marrying the right person and having you some grandkids...that's all just icing on the cake.

immune tire change

2009-04-15T19:04:00.000-07:00

God does work in mysterious ways. He showed me a couple of things as I was changing my tire in the snow a couple of weeks ago, then He added to it today, again while changing a tire. Different tire, same car, though. This car has had more than its share of flat tires.

The first lesson: think of vitamin/mineral/antioxidant/omega 3/probiotic supplements as tools needed to change a tire - like the jack, the lug wrench, the actual spare - real or donut. If you've been taking in enough supplements or have been getting these items in your regular diet then when you get a flat tire - catch a cold, tummy bug, strep throat - you can change that tire without too much trouble. Your body can fight off that cold with the appropriate weapons at its disposal. However, if you're short on any or all of these things, you may have to call for help in changing that tire. You might even have to get a tow. So, instead of a cold that's zapped by the immune system quickly, it turns into an ear infection or bronchitis, or you get dehydrated from the stomach flu. So...got that? Keep plenty of tools stocked up so when the inevitable occurs you can fight it off like it's no worse than a flat tire.

Lesson #2: the 2nd flat tire in just a few weeks on the same car. Think of the car as the body, the tires as a part of that body. Think of the law of chance. One flat tire is bad luck, a 2nd is either really bad luck or there's a problem with the tires or the car or the road or something. So...the more flat tires the more likely it's not 'just a cold' and may be allergies, or it may be that there is a food intolerance causing the diarrhea, not 'just a stomach flu'. This is one of the ways we, as physicians, can either tell you 'it's just a cold' because lots of kids have come in with the same thing, or can reassure you that kids this age get ear infections every so often and unless they don't get better in a couple of months, the child will 'fix his own flat'. But weird things happen and when we see either a lot of flats in a certain neighborhood we investigate for nails in the road or a vandal slashing tires. If this is the only car that keeps having flats then the problem is probably with the car itself - the child may have an underlying problem that needs to be addressed.

So, flat tires are common. Most cars come equipped with a kit that has all the things required to change a tire. However, if one has to change the tire quite often, some of the tools may wear out, break, or the spare tire may become damaged. Kids come with a 'kit' that has all the necessary 'tools' to get him or her over the common cold or stomach flu. However, after a few of these 'bugs' the 'tool kit/immune system' gets tired, gets used up, needs repair or replacement. Things like daycare centers, schools, poor diets, lots of siblings - any extra 'nails' around that can puncture a tire often - cause the depletion of the 'tool kit' and require more vigilance on the part of the 'owner' of the 'car' to keep it running well and not requiring visits to the 'mechanic'.

that's about it, so far.

miracle drug?

2009-04-12T17:45:00.000-07:00

there is a new combination of drugs that is being studied. it's much the same as nyquil only it's for heart problems and not cold symptoms. currently it's being called the 'polypill' or 'polycap'. it contains 3 different types of blood pressure medicines, a cholesterol lowering drug, and aspirin. my comment when i first heard about it was "you won't know which one made you better", but my wife, tainted as she has been by years of living with and listening to me, said, "or, you won't know which one killed you".

brilliant!

2009-04-10T04:38:00.000-07:00

i'm going to run for some congressional seat or another, and my first bill to propose will be a slam dunk. it's going to make both sides happy and solve all our problems with healthcare spending, at least for prescription drug coverage.

i'll put forth a bill that will make the government pay for all prescription drugs, then, inside the bill, there will be legislation to make almost all current prescription drugs over the counter.

brilliant, eh? at least for a few seconds it seems that way. no telling what would happen. i'm worried that too many people would be taking too many medicines they don't need for problems they don't have. oh wait, that's already happening...only it's us (the doctors) to blame.

thank you

2009-04-10T03:13:00.001-07:00

i shouldn't be allowed to read the paper. i come up with weird random radical thoughts.

so, if a group of people today volunteered to die 10 years early compared to the rest of the population, therefore consuming fewer resources, leaving a smaller carbon footprint, using less of their social security, easing the population explosion, all while increasing the income of both private industry and the federal government, wouldn't we congratulate them for that? give them a party? medals? their own memorial? i mean, this is a group who is willingly choosing to check out early from this hotel california, leaving more for the rest of us. they must be, depending on your worldview, either true christians for their selflessness, true environmentalists for their grasp of the big picture as it relates to humans being the biggest reason it's getting harder for the earth to sustain more humans, or the highest order of animal if you're a peta person who, while considering animals and humans equal in their worth, knows that animals who can contemplate their impact on the world around them further than their next meal would of course decide to move over and let others have more room to exist. any way you spin it, this is a good deal, right? i mean, these folks are knowingly going to give up 10 years of potential life.

so i propose that we change a few of our signs. first, not 'thank you for not smoking', but 'thank you for smoking - just don't do it right here'. a new one, 'smoking saves lives - just not yours'.

there are more, i'm sure. my affection for reverse psychology is irresistible here - by promoting smoking (like big tobacco doesn't already do that, by reverse psychology) we would be actually decreasing the number of new smokers. by encouraging kids to smoke, they'd come home from school saying 'are you trying to kill me? don't you know what this does to your lungs?' instead of 'i know that happens to everybody else who smokes, but it won't happen to me'.

we could, after seeing the success of the reverse psychology campaign for smoking, venture into other areas - i envision the teacher taking the condom off of a banana, demonstrating how to properly tourniquet one's arm to shoot up heroin, of course using a dirty shared needle, while drinking a fifth of jack daniels and driving down the highway. it could work!

addendum: the article in the paper said that while smokers cost more in healthcare dollars than nonsmokers BUT they died on average 10 years earlier so the total 'lifetime' cost was actually lower. this was my 'inspiration'.

wal mart mentality?

2009-03-27T05:19:00.000-07:00

someone's gotta do it, right? actually, someone is already doing it. and more are joining in every year it seems. i'm talking about urgent care, after hours, etc.

it's being done, so instead of fighting against it, i should use the aikido strategy and take the opponent's strength and turn it to my advantage, right? i cringe when a mom takes a baby or a child to an urgent care center. why? two reasons: 1) i'm not the one seeing them so i don't know what they really had and whether the treatment was correct/appropriate, and 2) it means i wasn't able to see them. both reasons show my control freak nature, and my insidious pride - like they would've been diagnosed and treated correctly if i had seen them because of course i always make the correct diagnosis and prescribe the correct treatment. right.

so...now that we've established that...i can't work 24/7 - at least not for long, and i have to trust that there are other physicians/np's/pa's who can take good care of my patients after hours - of course i trust cathy - hello - so why do i resist it?

1) it's really not necessary. ok, neither is it necessary to be able to buy eggs at 2 in the morning, but if someone offers it, someone will take them up on the offer. need is not the issue. this is a drive thru world and by gosh, my kid got a fever an hour ago and i want him seen now. truly i understand this with work/school/fears of serious disease/too much information available to make people worry, etc.

2) it's an extra expense. it costs more after hours. and then many parents bring the child in within hours to days of the after hours visit for me (or their pcp if they aren't mine) to see them and to confirm the diagnosis and treatment. 2 visits, one problem, could've waited but didn't have to (see #1).

the solution? an urgent care where a trustworthy person over whom i have at least some control in hiring/supervising/advising/backing up is going to see that patient after hours. someday, maybe. but i think i have to give up trying to buck the current mentality of parents and go with it. but doing what the people want is not always the best thing for the people. how does one convince the people of that?

just ask your doctor

2009-03-26T04:15:00.000-07:00

man, i hate commercials for medicine! 'just ask your doctor' puts you in a position where you are forced to ask permission for something and me in the position to either grant or deny you that permission. it puts me, as the doctor, in the role of power over you, the patient. and it shouldn't be this way. the drug companies make it sound and look as if there is a perfect life out there waiting for you if your doctor will just let you have this medicine. the same thing happens with various tests, especially mri's. we laugh at 'therapeutic' ct's and mri's - once a patient goes through the whole deal of getting one of these tests, even if it's not necessary, it seems that they get better. was it just the attention paid to the problem? your doctor watches the same stupid commercials you do, and he or she gets bombarded daily in journals and in person with other advertisements for drugs or treatments - each with articles 'proving' how much better their particular treatment is than the one they were selling last week.

don't assume you have a disease just because you have the symptoms on the commercial. most diseases have symptoms that are similar to common problems like the flu or other viral illness, and these are way more common than the diseases they are advertising the treatment for. sure, everyone's depressed or anxious or fatigued or whatever - some of the time - but if it took a commercial to make you realize it was it really that bad? open your eyes! these people are selling something! they don't care about you and your health and your family. they care about making money.

don't let their advertising put me in a false position of power over you - holding in my hands the pen that can write you the prescription that will be the answer to all your problems. the drug companies have put the patient and the doctor in an adversarial position and they are capitalizing on it. don't let it work. be smarter than that. new is not always better. expensive is not always better.

consider the source of the advertising and their ultimate motive - $.

sure, they have drugs that can help problems. but just because they have a great commercial doesn't mean they have a great treatment. listen to the end of the commercial. unless it's for an erectile dysfunction drug, then the side effects sell the drug.

be very careful

2009-02-26T18:54:00.000-08:00

even when the best doctors and the best hospitals try to come up with guidelines for the best ways to treat various diseases, they have difficulty. why? well, not everybody's the same. that's one reason. but arguably the biggest reason is that there are no studies to show how one drug performs against another or how choosing not to treat a specific disease compares with aggressive treatment of that problem. and why do these studies not exist, or why were they never published, which is a better question? because it is the drug companies that pay for the studies. they aren't going to publish a study, or even complete a study, if their drug or treatment isn't going to look good. if doing nothing is as good as doing something, are they going to tell you? heck no. they'll use statistics (there is a 14% chance that a person with this problem taking this drug will improve more quickly and have a better life with more money and more happiness and basically just turn out to be a better person than someone who chooses to try a good diet and some lifestyle changes to achieve the same goal).

pharmaceutical ads are just like automobile ads, the glitz is up front then comes all the 'fine print'. but in car ads the guy on the commercial pretty much auctioneers his way through the interest rate, payments due at beginning and end of lease, with approved credit, may not apply to certain people on certain days ending in 'y', etc. in the drug ads they seem quite proud of the fact that their drug could cause liver and kidney damage and pretty much make your life a living hell, but you should still 'ask your doctor' about it because dadgummit you want it, don't you?

best marketing for viagra? jack nicholson in 'something's gotta give' when he's taking viagra and nitrates for chest pain and tries to deny it. it's an unforgettable scene and one which sold more viagra than any 'ask your doctor' commercial.

see the blog a few back on marketable side effects. are we a gullible society or what? just because it's new or newly indicated for something doesn't make it necessary or even a good idea.

shame on you

2009-02-26T18:46:00.000-08:00

integris has a commercial that is so representative of the new fear tactic method of marketing that i have to comment. not that any of their sappy tear jerking commercials are really promoting health and just look like they're promoting integris. i mean, the look the wife gives her husband in the infertility commercial is so real it's scary, but then everything is peachy once they get pregnant and have a baby. show them in 6 weeks and i'll show you a look! i can't listen to roy orbison without trying to drive to baptist anymore.

no, i'm talking about the sleep commercial. which ends with the doctor saying "80% of sleep problems go undiagnosed, and some can be deadly". who can sleep after hearing that?!

OCD for profit?

2009-02-26T18:19:00.001-08:00

Pharmaceutical companies have perfected the American dream. They have created a market and are now capitalizing on it. They work hard to get people obsessed about a 'disease' and then they charge them for the cure. And now they've either run out of new medicines to invent to treat new diseases they've invented (or legitimized - see ED and fibromyalgia ) or they're just getting greedy (or have they always been and I'm just now noticing!) or maybe they are smelling the fires of 'the barbarians at the gate' - a la government-sponsored healthcare. In any instance, they certainly are capitalizing on 'unintended positive consequences', aka side effects that can be marketed. Used to be Viagra, by another name, was a drug to help with pulmonary hypertension. A disease, for sure, but not one with enough victims to really make a buck. But guess what happened on the way to improving the circulation in your lungs? Voila! Viagra. The rest is history - they've already done the research and development and proven that it's at least safe enough to try, if not use regularly, on humans. So now it's all about marketing. And you think I use reverse psychology? When did we get so gullible that a warning of a four hour erection is used to sell something? How hard was that? No pun intended.

There are others - recently the drug for hair loss, Propecia, was mentioned as a prevention for prostate cancer, sort of a reverse of the Viagra story, going from cosmetic to internal medicine. Now there is a glaucoma treatment with a curious side effect - it makes eyelashes grow thick and dark. Which is reminiscent of the first marketable side effect of which I was aware - Minoxidil, a blood pressure drug, had the nasty side effect of making patients grow hair in places both good and bad. But applied topically to specific areas it caused hair growth in just that area. And what do you get? Rogaine.

OK - so they have created markets from discontent, usually over appearance or performance. Is that really bad? Doesn't everyone have the right to be pain-free, have a full head of hair, an erection and great lashes? This is America, after all.

what if...?

2009-02-08T19:02:00.000-08:00

the new stephen king book is a collection of short stories. i'm a bigtime stephen king fan, so of course i got it as soon as it came out, then i kept it as a carrot in front of me while i finished a couple of other books that weren't so exciting. now i'm halfway through, but one of the stories, 'stationary bike', hit a nerve. the protagonist finds out that his cholesterol is high and his health is in danger and he sets out on a stationary bike to fix the problem, but in the process he makes enemies of his own 'lipid company', 4 guys who he has ?dreamed up/created with the help of his doctor's explanation of his problem, because by losing weight and eating right and exercising he has put these guys out of work. and they have houses and families and mortgages and lives.

so i got to thinking about my life and the impact i've had on certain economies and people by my lifestyle choices and changes. like what's the bartender at interurban going to do with all that smithwick's he ordered special for me? what about the carhops at sonic? do they miss me? are they mad? have they had a surplus of iced tea and route 44 cups and straws?

once, on the way to a mission trip, i was waxing philosophical to the person next to me about how all of us americans were living in luxury and we were wasteful and gluttonous and we should stay home and eat in more often, be happy with our houses and cars and forget 'keeping up with the joneses' because even the joneses were reining in their spending. who needs a lexus or a mercedes? who needs a 3 million dollar house? a $100,000 pool? why do people keep buying these stupid clothes and toys for their kids? why do they insist on making a trip to disneyworld a lifelong goal?

then i realized i was talking to a bartender at a restaurant in bricktown whose living depended on people who lived the lives i had just railed against.

yes, we're gluttons and we're spoiled. but does the world not count on us to be this way? are we not pretty much singlehandedly supporting economies in countries where hopefully at least some people aren't being abused and exploited?

one more random thought: why, in tough economic times do we cut back on stuff? on people? were these things or services or people superfluous to the business or the community? were they just extras, like whipped cream and nuts on a sundae or creamer in coffee? like onions and pickles on a burger? why do we start getting things or getting used to things that we can apparently do without? and how many of us are expendable if the economy gets 'tougher'?

the mirror

2009-02-08T18:20:00.000-08:00

i saw somebody this week that i haven't seen in a while. i try to avoid him if i can, when i hear him coming, i go the other way. i don't like this guy. not even a little bit. he is very selfish. he is very prideful, feels like everything should go his way, and watch out if his car doesn't start or his alarm doesn't wake him up or his schedule's too full or too empty or he's wrong about something or his pants are too long or too short or his shirts aren't clean or his laundry's not ready or his eggs don't cook right or his kids don't call or they call while he's busy...pretty much his outward persona is a house of cards. he is so blessed and he takes the credit as if he had something to do with it. he lets people continue in their positive misconceptions of him and does nothing to disabuse them of their erroneous notions. he is kind when it suits him and mean when it doesn't. he can say nice things and his tongue can slice with sarcasm in the same moment, even in the same sentence. you can see why i don't like him. there's only one problem: he's the man in the mirror. sometimes you believe your own press clippings. sometimes i get a sore arm patting myself on the back.

i'm happy to do stuff for others if...everything goes right for me.

i saw myself this week and i didn't like what i saw.

and i'm definitely getting old. watching the grammys tonight, i'm feeling very old. but old is good in my book if it means that you're not excited about a lesbian celebratory song followed by unintelligible (c)rap by 4 guys with more hyphens than vowels and consonants in their names while a hugely pregnant ?singer prances gravidly around on the stage making a fool of herself. i'll take old any day.

even more

2009-01-31T06:33:00.000-08:00

when you hear hoofbeats, look for horses (or, common things occur commonly)(this is a standard medical saying). meaning: if you didn't already figure it out, it's ain't some weird thing usually. it's more common for common illnesses to present in a weird way than for a weird illness to present at all (or to mimic a common illness). reader's digest is not a medical textbook, nor is the internet - but wikipedia has most medical textbooks on it!

the shortest route is not always the best route, because it can bypass some of the most precious lessons in life. (ravi zacharias)

some people seem to need to define their lives by their hardships, whether they be illnesses or other types, death in the family, financial hardship. look in the bible at aaron and nadab and abihu. sometimes you need to work through things, not live for them.

the lessons learned the hard way, the long way, are often the best, but man, that's not how they feel when you're going through them. think of this for your kids.

when my children get the 'i wants' and 'i needs' it's time for them (and me) to 'serve, serve, serve'(my lovely bride)

God gives where He finds empty hands - (St. Augustine)

sometimes you are the answer to the prayer you pray. (steve brown)

we think that helplessness is a liability - and it may be if you're a soldier or a policeman or a teacher - but in spiritual matters, just the opposite is true. (steve brown)

ok, i know these were random. each could have had a whole blog to itself, and who knows? maybe they will someday, but right now, hopefully this will do.

more radical thoughts

2009-01-27T11:41:00.001-08:00

well, not necessarily more radical, but more thoughts. some are mine, some belong to others. i'll try to differentiate if you can't tell.

Nothing good happens after 10 pm. (many people, me, my wife, my parents, your parents...) well, it's true to this day.

Just because you can doesn't mean you should. (again, many people, including all of the above) if people took this to heart life would be less hectic and more peaceful. especially after 10 pm.

God makes complex things simple and man turns around and makes simple things complex. ok, this one's on me. as i'm continually faced with our tendency to make things harder and more complicated than they need to be. my friend Greg says "Christians shouldn't be into the details, because the devil is in the details."

First come up with a drug, and if necessary, we'll invent a disease. ok, this is me again, but i had help. all the big pharmaceutical companies are doing this, whether they admit it or not. there are many 'diseases' and 'disorders' out there today that didn't exist before. a variation on this would be 'come up with a test and we'll come up with something to call the results if they're positive'.

35 miles or $35 will weed out most unnecessary doctor visits. ok, this is mine, too. not that i mind seeing lots of kids who aren't too sick, just that availability has become almost detrimental to some people. for instance: we are closed today due to weather, and this is a lose-lose situation - if open, we would have had people risk their lives on bad roads to bring in kids who don't need to be seen, and since we're closed we aren't serving our patients well.

It is easier to die for Jesus than to live for Him. a paraphrase of Oswald Chambers.

It is what it is...unless it isn't. Greg Poland. this can serve for many things and situations. when people want a definitive answer on some medical question that has not definitive answer, this works well.

Don't do the test if the result isn't going to change what you would do. me again. the healthcare consumer wants tests. they want them because they think the result is the answer to their problem, and some even think the test is the answer to their problem. i can't tell you how many times i've heard people say 'after that cat scan, i haven't had any more headaches' or variations on that theme. suggests a psychosomatic etiology to me, but hey...

It's amazing how many people survived before there were all these medicines and tests! me again. just in 25 years of finishing med school, the increase in the amount of knowledge and the numbers of tests and treatments is phenomenal. but simple things are still simple and common things still happen commonly.

i'll come up with some more later. i just hadn't posted in a while.

new analogy

2008-12-17T04:14:00.000-08:00

for those of you who know me, you know i think in metaphor. analogies are a way of life for me. so this morning i thought of another one.

i refresh my podcasts daily, it's a ritual. then i sync my phone and my ipod to update them. if any new software is available i find out. if there is a problem, i find that out, too.

if i 'sync' with God on a daily, allow Him to refresh my spirit, hopefully even minute to minute, but at least regularly at least daily, i stay in touch with Him and what He wants me to do and He reminds me through His word how He wants me to act and what His nature is, so He pretty much 'updates' me and notifies me of problems, etc.

by studying the bible, reading devotionals, meditating (or is that snoozing?), praying, all these are ways to 'sync' with God. somehow it takes on a different tone than the sanctimonious 'i have my quiet time' or 'i read my bible every morning' that i hear in christian circles so often and brings it down to reality and really more what it is - a relationship. i cannot 'sync' my ipod and iphone with my computer if they are not connected, nor can i sync with God if i'm not connected, or in a relationship, with Him.

just a thought, one of the random ones that roll around in my head!

it's all about me

2008-12-17T03:09:00.000-08:00

it really is all about me. no matter how i act or seem, how good or bad, how selfish or selfless, it's still all about me. maybe this is the 'sinful nature' we are born with that is so much a subject of the bible and its writings, the 'old man', the 'flesh'. it makes sense, since that is a broad enough definition to include all the things the new testament writers include as manifestations of this 'old self', all the way from seemingly (now) trivial things like gossip and not respecting parents to murder and really bad stuff everybody knows are wrong to do.

in les miserables, jean valjean, aka monsieur madeleine at this point, faces this issue after javert discovers who he really is. victor hugo's description of valjean's thoughts and torment at this juncture are an excellent description of what happens when one is 'good', at least outwardly and perhaps inwardly as well, but that the 'good' he is and does is really just trying to make up for the bad he was before, to hide who he really is in his heart. when faced with the dilemma, valjean at first considers doing the 'right thing', the selfless thing. that is his first instinct, which i think tells of who he really is, not who he thinks he is, but who he has become. but self preservation takes over and he doesn't do exactly what he first thought to do. he looks for a way to get what we would call a 'win-win' outcome. why? because it really wasn't all about him anymore, not in his heart. his good actions were not just window dressing. sometimes we tell ourselves or other people to 'fake it til you make it', and that's what jean valjean had been doing. and at least for a moment, he had 'made it'.

it may be like learning a new language. i could speak a little spanish, but i could never 'think' in spanish. apparently, immersion in the language and culture helps this process, and i'm sure the longer you soak the better. so he was soaking in goodness and selflessness long enough for at least his first short slight inclination was to do the unselfish thing. so all those years of soaking produced what? a momentary glimpse of what he 'should' do or be? then conflict between the angel on one shoulder and devil on the other? well, pretty much.

we tend to idolize heroes who do the right thing the right way the first time, reflexly it seems, so that there is no time between action and reaction, and their reaction is always right. the 'tortured soul' who is left with a choice between doing what is best for him and what is best for his family or his town or his country or his world or whatever is the stuff of many movies, though, and these appeal at a different level. the heroes who are so decisive and always right are usually icons, cutouts in cardboard and characters in comic books, like superman. funny how right now superman has taken a back seat to the more contemplative batman and spiderman whose angst is so palpable and they struggle with the real questions of life in their superhero ways. this is just real life blown up really big so we can look at it closely, dressed up enough to make it fantasy.

i was reminded that it's all about me once again when i had managed to make a decision that i wanted to make despite the objections of others. by gosh, i wanted to do it, it was of no real consequence (it wasn't, at least the act wasn't) and i could do it if i wanted! how very much like a two year old that sounds! maybe we're all just big two year olds with a thin veneer of humanity covering a selfish core? is that it? ouch!

so what's the answer? the current worldview would tell you that this is just the way you are and you should just do what you want and it's ok unless someone else is hurt, and you can't help it and if you want to change you should go to a counselor and maybe get some medicine that will help you live with the two, the angel and the devil, so that you're always so conflicted that you can't carry on a normal life, and if you do enough good stuff a la jean valjean, that the good will outweigh the bad so if there really is a God and a heaven and hell then you're covered and your account will have a positive balance, because the positive balance is what counts and we all know that with enough drugs and the right diet we could be good for long enough to overcome any of the bad stuff we did before and balance out any current bad stuff we're doing and what we're thinking doesn't count because we didn't do it so we can go about doing nice things with selfish motive and look good and people will be impressed and blessed when in reality, deep down, we know we're doing it all because we know it's all about us but we're too proud to realize that our balance is and will be positive only if we let go and let Jesus' balance replace ours but that would mean it's not all about us but it's about Him and then where would we be but in a better place to treat others the way we want to be treated and to be more likely to be forgiving and merciful when people mess up and to look on people as Jesus did, with God's perspective and to realize that just like us, everybody's living life the same way except it's about them and not us in their worlds so it looks different to me but when i look at it that way it really helps get a perspective on things. deep breath.

this idea started with someone very close to me telling me 'you always have to be right' or 'you always have to do what you want' or something to that effect. that person was really teasing, but as my father always said, 'many a truth is said in jest'. there was a backhanded compliment at the end of the 'you're selfish and you think the world revolves around you' slam, when the person said 'but you hide it better than some people'. at least i took it as a compliment!

how's this for reverse psychology? the only way to be in control is to give up control of yourself to God, so as you 'soak' in Him you become more like Him, as kids become more like their parents over time, and to increase true self esteem you realize how really selfish and sinful you are and that there is nothing you, by yourself, can do to fix that, so you trust Christ to give you His goodness so you can relax, and that's the bottom line for me - to relax in Christ, letting Him fly the plane, knowing that He lived a perfect life and so i don't have to be perfect (i couldn't even if i wanted) and when i get to that point i can much more easily look at other people, acting as selfishly as we all do, and understand with empathy that they are living the same life i am except that unless they have relinquished control and perfection to Christ, their world has a very different look from mine because now mine at least some of the time has Christ as the Center and me sort of revolving around Him instead of me as the center or them at the center and God sort of a cosmic slot machine or magic 8 ball to pull out and see what we can get when we feel like it and i can understand better their anxiety and stress and anger and impatience (and my own, this ain't a 'done deal', this sanctification thing, it's a process, not a magic wand and poof you're now holy and can leave behind selfishness and forget about it and now you're speaking spanish and thinking spanish and your old ways/language never come back under duress or any other situation) because i can remember when i felt the same way (earlier today?!) and how it felt so like in hebrews the writer (don't you like that, we don't know who wrote one of the books of the bible? what's up with that?) says we have a high priest who lived a life like ours with all the temptation yet was perfect - He saw things through our eyes and He knows what we're going through which makes it so cool, well we can be like that (except the perfect part) and see things through His eyes and the eyes of the person freaking out in front of us or on the phone with us because their kid is sick and it's christmas and how could this happen and we're flying tomorrow or there's a wedding/play/test/initiation/class/family reunion/tryout and instead of saying 'relax, you're way too anxious and you need to calm down' we can take the hit, empathize, help in whatever way we can while looking through God's eyes and not necessarily our own and not necessarily enable or be amateur providence or rescue them (one of my favorite sayings is 'a lack of planning on your part does not constitute an emergency on my part' - until i realize i'm the other end of that phrase sometimes when it's about me so i try to be kind!) but listen and let them talk it through and not be another problem in their world at that moment, doing our best to get along with all persons to the extent that it's up to us (heb 12:14, 2tim 2:23+, titus 2:8, 1peter 2:11) and live and act as if we're on the other end of the line or our mom or kid is on the other end of the line and how would we want to be treated in that situation and to know that we act right not just because we're told to but because it's becoming part of our nature to act right and be kind and that with time and prayer and 'soaking' in God we find it an unconscious 'reflex' in us and that at least sometimes, when the veneer is not getting too thin, we resemble our Father. there's no better compliment for me than to be told that i'm at all like my earthly father except if it's that i'm at all like my heavenly Father. and as my kids grow and leave and live their own lives, my hope is that someday they will be proud to hear that they are like their father, because he is like his Father. see, i told you, it's all about me!

anxiety

2008-11-28T06:10:00.000-08:00

ok, i'm going lower case for this one, maybe to blunt its powerful commentary on our current worldview and the state of affairs in just about everything in america, but definitely in the area where i 'live', pediatric medicine. and for a deeper spiritual assessment of anxiety, look for my wife's blog on this subject to be added today at feedingthespirit.blogspot.com.

lots of anxiety exists when it comes to taking care of children.

i was sharing in this anxiety until recently, or at least sharing more in it, i can't just drop it completely any easier than you can. but i sure got a different perspective on it after listening to my favorite radio pastor, alistair begg, on november 7, 2008. much of what i'm writing he says in his podcast. no, i'm not putting myself in the place of God, trust me. i'm not qualified and i definitely don't want that job. i'm more in the ballpark with the airline pilot alistair mentions. it is this part that resounded with me so much.

if you are anxious on an airline flight, worried about crashing or the landing gear engaging or the weather or anything, to some extent you are thinking that you could do a better job than the pilot. despite no pilot training, you are at least, and probably/hopefully unconsciously, acting as if you could handle this situation better than the pilot. do you understand this concept? you have 'submitted' to the expertise of that pilot at least implicitly and once again possibly unconsciously. you know that, given the stick or the wheel or whatever they have to fly a plane, you couldn't handle it. sure, there are safeguards, like in the movies where someone comes from seat 23B and saves the day by landing the plane. but that's a movie.

i know the analogy breaks down when i translate it into patients as passengers and doctors as pilots. but hopefully you see the analogy to the degree that it applies.

the patients (i.e., the parents of the patients) often (very respectfully in general) question everything that i'm doing and recommending and have specific guidelines that they want to follow for their child/ren. these are often scenarios where i can easily say 'good luck' with an 'i'm sorry' ready for later when my advice should have been followed. i envy dr. phil his 'how's that working for you?'

i want to let you know that i really and truly share your concerns about your child/ren. and i really and truly do not want to harm your child or have anything i do or recommend turn out badly for you or your child. there can be times when i'm wrong. i admit it, i've been wrong in the past, i'll be wrong in the future. i don't mind having my judgment questioned at times, and i understand the anxiety created by our current worldview that we are in control of everything and we have to get it all right every time or awful things will happen.

this is the most important piece of information i want you to grasp. you're not in control of things. i'm not in control of things. God is in control of things. regardless of how it looks at times, in the big picture, He's got it covered. we are supposed to rest in that. yes, you have to get up and feed and dress your kids and take care of them and yourself. i have to get up and go to the hospital and the office and give my advice and my prescriptions and you still have to go to the pharmacy and get and give the medicine, but God is in control. sometimes He concerns Himself with the tiny details of things - have you looked at your child lately and wondered how he/she started as a sperm and egg and ended up with ten fingers and ten toes and an attitude? He 'formed that child in your womb' it says in psalms. but as a society, as a world pretty much to one degree or another, we've stopped believing in a God who does all this and takes care of both little and big things, and guess who that leaves to handle everything? us! and that's scary! so i understand from whence the anxiety comes. listen to the world. read the world's opinions on things. but think of yourself as looking from sort of a google earth perspective, looking from a distance, and realize that you aren't in control and then be very grateful that you aren't supposed to be in control. and be very thankful that i'm not in control. i'm constantly looking to God, believe it or not, because i am very aware of my lack of control over things. regardless of what the world's wisdom tries to tell you, man's greatest wisdom is foolishness to God. if you can reset your worldview, and i have to do it daily, and recognize that we're all here because He wants us to be, and we're all doing what He would have us be doing, you will sleep easier tonight. you won't worry so much about sleep position and introducing solid food and bisphenol a and melamine and autism, you'll be more content with the stuff you've got to do, like the mundane 'get up, feed the baby, change the diaper, clean up the spitup, take a shower...repeat'.

in over 20 years of practice i've seen the number of concerns rise exponentially. it's amazing what people can be concerned about. some are given to this mentality from the start, and that's almost understandable, but sad, but many otherwise confident people become overconcerned lunatics where their children are concerned.

to summarize: i see myself as the pilot. i have the training, the expertise, and the skills to do the job for which i've been called, and for which i've been hired by my patients' parents. most have picked me from a very good lineup of possibilities, so that says hopefully that my expertise is appreciated somewhere. i know Who is in the real pilot's seat. He's not my copilot, by the way, i always thought that was a very prideful statement.

i don't begin to think i know everything. as my daughter, who is a first year med student, was told as her year started, 'half of what we teach you will be wrong in the future, we just don't know which half'. i understand that sentiment completely and could state it categorically at each visit. anyone who says or even thinks he/she knows it all at any given moment is seriously deluded and should be avoided. i have opinions, i have experiences that have taught me certain things i hold as truths, sort of like the pilot keeping the plane in the air and landing it safely. i also have areas where i question myself, my thoughts and practices, my feelings about how to accomplish certain goals and whether or not those goals are even important. much like the pilot who could choose more than one route from new york to los angeles, he has flown many of them many times and has picked the one he thinks is best based on his experience and guidelines he must follow. the takeoff and landing he knows will not differ much from airport to airport but the air in between could be clear or choppy or downright turbulent. in my case i 'take off' with many of you each time a new baby comes. 'landing' is way in the future, so we're stuck with all the air in between, and for the most part, as long as we don't crash, it's going to be fine. the time from takeoff to landing will differ, the route taken will differ, the pilot (with trust in a God who is in ultimate control) knows that he's going to get them where they're going in the best shape and in the best time possible. but the passengers must trust the pilot when he says 'sit back, relax, and enjoy the flight'.

melamine

2008-11-27T09:15:00.001-08:00

OK, what should we worry about? Is my kid (or am I) making little plastic pellet kidney stones as we speak? Why didn't someone keep this from happening? Why didn't they tell us sooner?

First, it's likely that some amount of melamine or similar contaminant(s) has been in our food supply for quite a while and we are just now finding out about it. Last year it was cats and dogs, now babies who may suffer. One big lesson - look really hard at things 'made in china'. Sure, there are lots of good things made in china, and we probably couldn't get along in our current society without many of them. Another last year thing that had a 'china connection' (isn't it funny how 'last year' is so 'last year'?) was lead in the paint on toys. That passed, not too many people are asking about that lately. But still, consider whether you want to put something in your mouth if it's made in china. Just a warning.

Second, related to the previous sentence, this will be 'last year' next year, so don't freak. I'm not envisioning kids peeing plastic pellets out at their parents during diaper changes.

Third, what else is there in our food and environment that's not good for us? Back to a paraphrase of a friend's quote about whether we should be concerned about the plastic in water bottles, etc., "when people aren't eating junk and getting obese and having diabetes and high blood pressure from doing stuff they know isn't good for them, then we can start worrying about the stuff we aren't so sure about...". Good, no great, point.

A story that I've used with my kids from time to time comes to mind as regards things that are present in things we are consuming (eating, watching, listening to, you name it): When her kids were watching movies that had 'just a little bit' of bad language and some sexual innuendo in them, a mom decided to teach them a little lesson. She baked them some brownies, and before they had eaten any she told them that she had put a little extra ingredient in the brownies. When they asked what she had put in, she replied "canine fecal matter" (which I will henceforth refer to as d.s. for those of you with sensitive eyes and I'll let the rest of you figure it out). She said she had put in 'just a little bit of d.s.' and that they wouldn't even notice that it was in there. Then she asked them if they wanted to eat the brownies. They wouldn't eat any. They said that 'just a little bit' of d.s. spoiled the whole batch. After an appropriate period of time, during which they ranted and raved that she was nuts and they couldn't believe she had put d.s. in the brownies, she asked why 'just a little bit' of d.s. bothered them so much. They continued their protest until she asked if they knew where she had gotten the phrase 'just a little bit'. When reminded of their use of the phrase regarding their choice of movies, they were forced to admit that 'just a little bit' of bad can definitely spoil some things, and maybe it would spoil anything, especially once they were made aware of its presence.

OK, sorry, long story, but even 'just a little bit' of dog poop in anything is generally unacceptable. Well, I'll take that back, we've been told there are 'acceptable amounts' of insect parts in some of our meat products for years and we still eat hot dogs, so I'll give you that one. But in today's culture in America, we're all about full disclosure and responsibility so we agonize over shots with mercury in them and bisphenol A in plastic cups and bottles and now we have melamine in baby formula. Thank you, FDA. Or is ignorance bliss? Once informed, we're determined to get rid of whatever we've just discovered is present, and we're also quite inclined to blame everything from autism to global warming on whatever is this year's dog poop.

I guess one response would be to pull all baby formula off the shelves immediately. Hopefully you can see the problem inherent in this solution. We could vilify the makers of the 'tainted' formulas, except it seems that not all of their formula lines had melamine, just some.

We could switch to 'safe' formulas, and I guess for now this is the best solution. When the next d.s. discovery is made, another group will be taken off (or put on) the list. Interestingly, one formula from each of the 'big 3' makers of formula contained some melamine or its byproducts, so no one was innocent, except maybe the Target and Walmart generic brands made by Wyeth Labs. Man, I wish they'd found some in the Walmart brand! The evil empire. The antichrist. Well, I really don't wish that because I have lots of patients on that formula and recommend it to patients often, so my interests shouldn't be put above the health of those babies.

My overall point is: remember lead paint in toys and bpa in bottles, they're pretty much 'old news'. 'Last year'. You can take it two ways. One, we are a 'what's in front of us is important regardless of its importance' society, so don't forget 'last year' stuff. Or, we are obsessed with our perceived control of everything and are disappointed when it gets proven that there are things beyond our knowledge and control, so don't worry too much and remember how many things have failed to live up to their gloom and doom predictions and have become 'last year's' concerns.

Stay tuned for my (maybe) next blog about how anxiety reveals the absence of humility and how we should 'sit back, relax, and enjoy the flight' rather than trying to fly the plane from 23B. For an audio on this from Alistair Begg on Truth for Life, where I stole these phrases and ideas, go to truthforlife.com or .org, I can't remember which, and go to November 7 "a Biblical approach to anxiety". For the whole deal, go back to the 6th and listen to it all. I'm praying for a kind heart as I write this blog!

'new' old parenting book

2008-11-06T05:29:00.000-08:00

i have always remembered - and taught patients - the parenting lessons taught me by barbara coloroso in 'kids are worth it', but when i was learning these, they were available only as tapes, and they were very good, and very funny, and obviously made a great impression on me and my parenting style and teaching of parenting. so i 'rediscovered' the book version of this book and i was scanning it this morning and wow! it's everything i remember and more. i highly recommend going to amazon or wherever you go and search 'barbara coloroso' and 'kids are worth it' and get it. it's old enough that the shipping is more than the book, but it's very worth it, and will reveal to those of you who are patients of mine where i've stolen a great deal of my material. i'm going to add it to the bibliography of recommended books on my handouts, but i thought i'd share it in this venue first, for those of you blog-savvy moms and dads who check out 'radical thoughts' every once in a while.

fall colors

2008-11-05T16:51:00.000-08:00

Regardless of whether your guy won or lost yesterday, you will be happy to know that the trees are still beautiful this fall, not seeming to really care who the president-elect is or what his stance is on health care and other social issues. So nice to see that at least part of my world doesn't fret about gas prices or wars or the economy or autism and vaccines and plastics and sleep positions and antibiotics and yeast overgrowth or to spank or not to spank - you see that I need something to look at that is not commenting on or asking me about or for something. This year, and I probably will be told that I say this every year, the trees are the most beautiful I can remember.

Not being a real outdoor person, I still love the fall. It is my favorite season, and it has nothing to do with football. The colors that come from green leaves amaze me every year. Even though the wind pretty much blew away the gorgeous reds of the maples yesterday, I have discovered a new favorite tree for this season. In the windy line to vote yesterday, I was told that this tree is the Chinese pistachio, but I don't know for sure, the guy who told me looked like he spent as much time in his yard as I did this year. Whatever it is, it has replaced the Bradford pear as the "parking lot tree", and I guess I was blind to it until this year.

Here in Edmond, the most beautiful tree, or at least it's in the top 5, is on an ugly corner by a gas station at 2nd and Coltrane. It is the type of tree I was describing previously, so if anyone knows what it is, let me know. But it is so many colors that I couldn't even describe it adequately. It goes from orange and yellow to red and some leftover green, and pretty much every color in between.

Just driving on the turnpike is a feast for the eyes right now. I'm impressed that someone was thinking enough to plan the trees along the Kilpatrick, especially at the intersections, especially at I-35 coming from the north.

The wind didn't spoil all the beauty at all, and maybe it even helped get rid of some old stuff that was in the way of new beauty. Even the cloudy/rainy skies this afternoon provided a backlight for some of the most orange/yellow trees that they seemed as if they were on fire but not being consumed a la Moses on the mountain.

So, to end this rambling, I am reminded that whatever happens, happens because the Creator made it happen, whether it be trees or presidents-elect. He's got our best interests in mind, regardless of how it may look at times. I've heard it said that He lets us see the back of the tapestry He is weaving, and I'm pretty pleased with the fall colors He's put in this year's addition to that tapestry.

8 important words for parents

2008-10-28T04:04:00.000-07:00

Once again, I stole this material, this time I think it's from Parenting with Love and Logic, by Foster Cline and Jim Fay. An excellent book, worth reading several times. An aside: these guys are Christians and their parenting philosophy is Christian, but they forgot to mention that in their book and just set forth the principles and guess what? Their material is used in the public schools and teachers are trained in this philosophy! In our Godless public schools which by the way both my kids attended and maintained their faith and got an education, but that's another blog.

1) "Good luck"

By the time your child is 3 or 4 years of age, if you've been using this phrase and philosophy from the first birthday, he/she will know that they are getting ready to mess up, or maybe mess up, or take a harder way than necessary, or be uncomfortable. It is a method of 'detachment' as a parent that as an observer of your child you are commenting on something he or she is getting ready to do. As long as the consequence or cost of the poor choice they are making is not illegal, immoral, or life threatening, 'good luck' is a very effective couple of words. You can start anytime, but the earlier the better.

2) "I'm sorry"

You (or at least I) have to watch the tendency toward sarcasm when using this powerful phrase. When your child is hungry, cold, hot, when he has failed a test or been allowed to forget to turn in a project and gets a '0', these words come in very handy. The mental mother in your head is standing there shaking her finger saying "if you had just done what I said, this wouldn't have happened". But don't succumb to her influence. It is far more effective to empathize sincerely and allow the child to come up with the "if I had listened to...". By the time the choices have illegal, immoral, or life threatening consequences, your 'good luck' should bring to mind many 'I'm sorry's' and perhaps a better decision.

3) "Nice try"

Instead of crushing your child's spirit when he throws a fit or makes an argument you can give him credit for the effort and keep the part of him that was passionate about and willing to sacrifice time and effort to get what he wanted. Jesus has a couple of parables with a 'nice try' in them: the parable of the wicked (or shrewd) servant where the guy is getting fired and he knows it and he makes deals with businessmen who owe his boss money so maybe he can get a job when he gets his pink slip. the other is the persistent widow who just pretty much bugs a judge who finally makes a ruling in her favor to get her to quit pestering him. In these cases, the effort is rewarded, and in the case of the widow, the 'nice try' even works. This can be accomplished with your kids in several ways. I've always thought that parents should have a set of flash cards with numbers on them, like 7.5, 9.0, 9,5, etc., to give kids a visual 'score' for their 'effort', whether it's a tantrum or just an argument. Just the acknowledgment that you noticed and appreciated their effort will go far toward changing behavior while maintaining 'spirit' and 'spunk'. I'm not recommending tolerating bad behavior, but I see and hear parents squelch their child's 'fire' when a 'nice try' would have been appropriate. Such a tactic can be hard in the day to day activity of dealing with kids, but it is worth the effort.

4) "Regardless"

This, along with #5, is a "stopper". Use this when you've exhausted all the other tricks, when a 'good luck' won't work. When you have to say 'no'. After you've said 'no', and the argument/tantrum is going, you could give them a 'nice try' but still you have to stay 'no'. That's when 'regardless' comes in handy. "Regardless of the fact that all your friends' parents have bought them cell phones, we are not buying you one."

5) "Nevertheless"

Another "stopper", this word takes into account all the arguments, acknowledges the effort put into changing your mind, and comes close to agreeing that your position is hard to explain or defend. It is maybe a longer and wittier version of "because I said so"."Nevertheless, you are in the 2nd grade and you may not get a tattoo."

Most parenting scenarios can be handled using these words or variations on this theme. Practice them when your kids are young, and when they are a little older, they will give up and beg you not to say 'nevertheless'!

rolling billboards

2008-10-27T21:09:00.000-07:00

I truly cannot stand seeing those bumper stickers that say "my child is an honor student at...". Who cares but you? And the grandparents? What if the kid now is pressured to stay in honor society because you've put their achievement on a rolling billboard. But those aren't the worst things I see that really irk me. It's the baseball or soccer ball or batter or football player or gymnast or name your sport and its image. Now picture the kid's name under or beside that image. Besides the fact that I'm philosophically opposed to kids in team sports before middle school, these window dressings are a gross form of pride. As if the parent has no identity other than the chauffeur of their little Jack and Jill to and from practice and games all the time. "Look at me, my kids are on the *&^%^&'s and I get to drive them back and forth and probably yell at the coach and the ref or ump and make a general nuisance of myself while wondering why I have no life". Are these window stickers fundraising materials? I hope so. I truly hope they don't decorate/desecrate their $50,000 Escalade just to be able to find theirs in the parking lot along with all the other high dollar SUV's, even, God forbid, Porsche SUV's! Maybe the kid should have a sticker on his bat or bat bag or maybe his soccer ball that has a picture of the Escalade, or maybe the Cadillac symbol, and his dad's name under it! How about on their book bag or school desk "my parents apparently love me more because I'm in the honor society".

I really don't think most parents' love is conditional, I really don't, but man, it sure seems that way. "Son, you need to join a team with a cool logo because I've still got a little space in the back window of the Hummer". "I have no life, I didn't achieve much, but I'm going to make sure you do, and to help you along, I'm going to give as much attention to your achievements in first grade as I will to you graduating from high school or college or making it into law school or med school or whatever. I've set the bar so high right up front that there is no way to distinguish the big achievements from the little ones." It's like I've blogged about birthday parties - don't make their first few birthdays such big affairs that you're going to have to go to Disneyworld to celebrate #5 because you blew it so big early on. Save yourself. Chill.

Acknowledge privately your happiness that Susie is on the honor roll or that Bobby plays on a baseball team that is successful. The bumper sticker just adds a cheesy note to the whole accomplishment or activity and is embarrassing. Maybe grandmothers should be exempt from my recommended ban on child-praising bumper stickers and window decals. Kids are way too self-focused today as it is without their parents confirming their lofty opinions of themselves so blatantly and without tact. Put the sticker on the refrigerator with the finger painting and other 'gifted' artwork and accomplishments. Then don't drive your refrigerator around town. You will like your kids a lot more if you don't put them on pedestals at all, but definitely not at young ages and for achievements of dubious merit or significance. I think I'll take a poll of kids and ask them how they feel about all these 'isn't my kid great' displays. My bet: they agree with me!

i'm in a hurry

2008-10-27T20:52:00.000-07:00

I get this reality reinforced regularly, but I think it bears mentioning. maybe it will be a gas saver or even a life saver, certainly a stress saver. There is an Alabama song called "I'm in a hurry (and don't know why)" and it came out a number of years ago. True then, it remains true today.

I was on my way to the hospital this morning and an elderly man pulled out in front of me on a stretch of road where the speed limit is 55 and the usual speed at this area is 10 or miles per hour higher than that. He was going maybe 35 and showing no sign of increasing that turtle pace, despite the fact that the light was at least 1/2 mile away. I passed him, on the right, because he also was a left lane loser, and continued on to the light. Guess who pulled up right behind me at the red light? You guessed it. Tortoise and the hare, and despite my jackrabbity move he plodded right up to where I was waiting and we made the turns together and entered the hospital parking almost simultaneously.

This is not even close to the first time such a thing has happened. It happens on I-35 when I pass somebody doing less than the speed limit, zip merrily on my way only to find them exiting and/or getting to the destination at the same time I do. It is not worth it to stress over who's slow and who's fast. We all get to our destinations at nearly the same time, more safely, less stressed, and maybe the 'slow' guy even gets a little lift when he sees me stuck at the light with him after I had blown his doors off with my Volvo precision racing machine (well, it is a Volvo).

I find the same thing happening with patients in the office. The more hurried I get the more 'by the way' questions I get, and against all ethical and patient satisfaction advice, my hand is gripping the door handle throughout most of these encounters. That's a big no-no. And it always backfires. If I can go in each room with the idea that I'm there for that patient at that time and take care of their needs and answer their questions readily and ask at the end of the visit "did we cover everything you wanted to have checked?", I'm happier, they're happier, and it took no longer, and arguably less time, than it would have had I been rushed.

So, take a deep breath, go the speed limit, pay attention to the people passing you and seeming to be in a hurry, then look for them at the next stop light and smile, maybe give a thumbs up sign. Especially if you have a fish on the back of your car. God's not a fan of bad advertising.

an answer to reverend mom

2008-10-18T18:42:00.000-07:00

there is a place in heaven for people like reverend mom. her comment on 'my real healthcare plan' brings up an excellent question. children or adults with multiple medical problems pose the biggest problems for and biggest burdens on the current system. obviously not everyone is healthy. disclaimer: i am not a politician or an expert in healthcare policy or funding.

to be candid, i have mixed feelings about this particular case, but it brings to light issues that need to be addressed. i admire all the reverend moms out there, people who are willing to adopt children who have multiple medical problems are truly being 'religious' as defined in the book of james in the bible - caring for widows and orphans. under the plan i laid out, her daughter would cost her quite a bit of money in flexible spending account funds and it is possible her major medical policy would have a higher cost as well. certainly there needs to be some way to make such adoptions more financially feasible for those families willing to take on the responsibility. i don't know who should provide the funds to help. it seems to me that it is not the state or federal government. perhaps the christian community could facilitate such sacrifices of time and love. i may be wrong, but it seems that it's usually christians who do such things. i hope i'm right. maybe some of that money that goes to 'art' or all the money used to advertise tobacco while telling people they need to quit smoking, that would be a start. some of the private funding for the campaigns of politicians could be redirected and more than pay for it, given there is a commercial starting or ending with 'i am ............ and i approve this message' competing with the 'mattress brothers'.

people with multiple medical problems need health care. if such a person is a child with no family, it takes a special person to even become involved in their life, much less adopt them. it shouldn't bear a penalty, but it will come at a cost. but here are my 'mixed feelings'. the person who is willing to adopt this child needs to know what they have to look forward to in the way of health care costs. yes, it may be a deterrent to said adoption. a family needs to know up front the financial costs involved and make the decision to adopt with eyes wide open.

so, having a system where the costs of care are known as i have mentioned would allow there to be a forecast of future expectations of the financial aspects of such an adoption.

as for those families whose children or parents or brothers or sisters have these problems, but who are not up for adoption, or even for those people who have these problems themselves, there should be a way that they can live without their health consuming all of their assets. i'm talking about things that people have no control over - to provide aid for those with all the 21st century ills representative of our lifestyle would break any bank.

i still don't think the government is responsible for these problems. the government shouldn't penalize people for doing the right thing, but subsidizing them? i don't think so. there should be ways to not tax the money used for healthcare that's legit. much like where insurance pays for your gallbladder surgery but not your boob job, pre-tax dollars could be used for the former but not the latter.

so...rambling, i don't have an answer for people who, by doing the right thing, have added burdens to themselves that are not 'fair'. i really think many would do the same thing regardless of who pays for it. they would find a way. it may be the government involvement in health care that has caused the problems we have currently. without their 'help', the 'church' as a whole would have been responsible and it would have had to step up and show that the 'true religion' is their true goal. regardless of how these things turn out, He knows what He's doing, we don't have to worry. we have to work, we have to be active and we have to pray, but we don't have to worry. i suspect that many of our health problems would be gone, and others more easily managed, if we stopped worrying. but that's another blog.

mirrors 2

2008-10-12T19:04:00.000-07:00

ok. this may be a little deep and maybe i'm going down a rabbit trail or rabbit hole or whatever, but i thought of another angle on mirrors. here goes.

as parents, our children are mirrors. they do reflect what we do more than what we say, that is true. and it has been said that most of our beliefs are in place by the time we are 8 years old. 8 years old. our 'programs', if you will, are up and running, including our world view, the way we treat other people, and many things of which i'm not certain, but i'm pretty sure there's more. that should make us pretty nervous if our kids are under 8 and very observant if they're older. we should take care of what our children see and hear. we should teach them the values we want them to have. they are like clay that hasn't hardened, cement we can put our handprints in, a blank slate we get to write on. we too often delegate this to others. i'm not talking about schools, because most of the time before 8 is gone before kindergarten starts, so even though some can make homeschooling work, not everyone can, and public school won't ruin your children any more than homeschooling or christian school will fix them. you are the most important teacher your child has, even if he spends a good portion of his day at school. your influence will reach through that of the teacher and the principal and the friends. your attitude toward others, how you treat them, what you say about them when they are there and when they are not, how your actions look when people are watching line up with those when you're alone, all these things will show up in 'the mirror'. your mirror.

do you know those microphones that seem to have a delay between what is said and when you hear it? or those keyboards that have you typing for several characters before you can view what you've written? multiply that delay by a lot. what you do today with your kids may not show up for a long time. a very long time. the bible says 'train up a child in the way he should go and when he grows old he will not depart from it.' i had trouble with that verse in proverbs for a long time. i know plenty of people who are good people whose kids have turned out not so good. and i know the opposite occurs as well. but someone clarified it for me - it doesn't necessarily mean that they won't depart from it but it also means it won't depart from them. hence the discussion about programs that are running. and mirrors. mirrors with delay. so thinking about our kids as mirrors should sober us and make us consider our actions. but there is a danger in this mirror philosophy. some people, many i would say, see these mirrors as something different.

when we treat our kids like mirrors that are reflecting back on us, we make a mistake. we can't let this occur. by doing this we don't let our kids fail because we don't want to be seen as failures as parents. mistakes, poor choices, are good teachers if we allow them to occur and go to their logical end. when they are toddlers, we should let them be hungry when they don't want to eat what we've prepared for them. but she's so thin! if i take away her bottle she won't eat anything! the lady at walmart says she thinks my child has malnutrition! maybe even a vitamin deficiency!

it gets worse when they go to school. teachers and school counselors are either witting or unwitting (is witting a word?) participants in this phenomenon. 'he's gifted, you need to get him into a special program after school' ' she's not performing up to her potential' ' he's our best player' 'she's not turning in her homework' ' he doesn't seem to care about his grades'. you name it, you may have heard one or more of these. the undertone of such comments is 'you're not a good parent' or 'you can succeed through your child'. both are bad. moms seem to be more susceptible to the former, dads the latter. so you do their homework, put them in the special program, let them join the traveling soccer team, whatever. but so you look good in the mirror, you will do it. it often shows up as mom saying things like 'we have a lot of trouble in school' or 'we're not eating very well' or 'we're so busy going from practice to practice'. when moms say 'we', i cringe. in this setting, this means she is taking over for the child, and the child will be damaged by it. what is that mirror (the delayed one) going to look like when she grows up? when he goes to college? gets a job? never having been allowed to fail or quit the gifted/ap class or take time off or not perform at full steam all the time, he will have unreasonable expectations of himself, not knowing that he never did it alone when he was younger. she may be distressed, depressed, stressed. he may keep it up and pass it on to his kids, like the mirror that he is. his programs are telling him that to rescue his children is the right thing to do and that he would be a bad father if he lets them fail so he goes against what his education/religion/faith/psychology class/pediatrician tells him to do, and goes ahead and does what his mother/father did, almost without thinking. so the cycle continues ad infinitum. i see it daily on both sides, the 'bad mom' side at least as often as the 'dad living through his child's success' side. of course the 'bad mom' victims come to me for help for their 'poor eaters' and 'underachievers', while the stress fractures and misuse/overuse injuries of the latter group are their ticket into my office. it's amazing what one can see when one looks for it. you just have to look in the mirror.

mirrors

2008-10-04T16:38:00.001-07:00

the only thing worse than having televisions (and loud music bothers me, too, but that may be my age) in restaurants is having mirrors. big mirrors, along the walls, where one can't help but look. it may be tempting to some to watch a sporting event while eating if the tv is within easy view. it truly is a temptation, no doubt, and for me, at least, it doesn't matter what's on, just that something is on. and i don't even watch that much in the way of tv sports at home on my own tv!

ok, though, mirrors are worse. it's nearly impossible not to look at oneself in a mirror that's within view. am i looking good? bad? do i have something in my teeth? is my fly unzipped? is somebody watching me watch myself in the mirror? it's a big problem. humans are drawn to mirrors like flies to ...

my favorite preacher on the radio, alistair begg, recently said "the value of the mirror is not narcissism so that we can congratulate ourselves, the value of the mirror is in order for us to see our predicament and do what we can to fix it." well, in a restaurant, beyond fixing a hair that's out of place or an unzipped zipper, we're faced with either narcissism or seeing our predicament. it always looks to others like narcissism, trust me. but to me, unless i happen to be in some place where i can compare myself favorably to the others in the mirror, i'm faced with a predicament, and that predicament isn't going to be helped by eating in that restaurant. i'm overweight, slouching toward obese. i'd like to be thinner. maybe they should put skinny mirrors in restaurants as they allegedly do in clothing store dressing rooms. then narcissism could at least have a turn. as it is, the mirror that i can't help but look at is showing me this guy looking back who's not the guy i picture in my mind's eye. and i hate the mirror for that. for showing the truth.

my wife recently gave a great statement - "our bodies are older than our minds are willing to admit". ouch. what happened to "you're as young as you feel?"

in the bible in 2 corinthians 10:12, paul says "we do not dare to classify or compare ourselves with some who commend themselves. When they measure themselves by themselves and compare themselves with themselves, they are not wise." so really a mirror is just a way to compare ourselves with ourselves of the past or some other "themselves" who are svelte and fit and look great. we are not to do that. sure, we are to see our predicament and look for a way out of it, whether it be physical or spiritual.

but the real fault is not with the mirror or the restaurant, they are just players. the fault is that i, like many of us, spend too much time, whether in front of a mirror or not, looking at myself. not in aristotle's "an unexamined life is not worth living" way, but in a "what about me?" "why me?" "what am i going to do?" "what do they think of me?" "what can i do to make them like me/love me/keep coming to me/keep working for me/keep paying me/keep being my friend?" way. those things are not for me to consider regularly. sure, a brief check in the mirror is fine, but to get lost in it considering the person in it is wrong. we are called to consider others more than ourselves. humility is not thinking less of oneself, it is not thinking of oneself. what a goal! in 2kings there's a king named hezekiah and he shows off his "stuff" - all the treasures of judah and the temple - to some people, in a "look at me and what i've got" way. God wasn't happy with that and so isaiah (i think it was him) told him that he would be punished and that the punishment was that his children and his children's children, yada yada, would never be kings and would suffer all kinds of stuff and the country was going down after he was gone. his response? "but nothing's going to happen to ME?" we are hezekiah, or at least i am. more concerned about us and now and what i've got or don't have than about my ancestors and neighbors and those around me every day at work or school or wherever and what my actions and words do to them or for them beyond what they get me and to heck with the budget deficit and the environment and social security and medicare and world hunger and the war in wherever and my church and my pastor and the lady who's ministering to inner city kids and my friends who are in pain from divorce or their kids and the effects on them and ... i can't go on. i feel like the teenage girl in boulder, colorado, from early in my practice when "mall bangs" were all the rage and cans of hair spray were used daily and 'green' boulder began to broadcast the depleted ozone message and the effects of aerosol cans and global warming and all that when it was new and news and her response was "to heck with the ozone, i've got to have my bangs!" ouch.

my real healthcare plan

2008-09-01T08:31:00.000-07:00

Everyone should take out a high deductible major medical policy to cover catastrophic stuff, big stuff, then have enough money available either liquid or line of credit, to cover that deductible should it be needed. Then we should pay out of pocket for our "incidental" stuff like sinus infections, bronchitis, sprained ankles, prescriptions, shots, checkups, etc. We could use a health savings account, use pretax dollars, and be able to "roll over" unused balances from each year if available. Then we would become better consumers of healthcare and not the entitled brats we've become. We would think more carefully about the MRI that's ordered, the prescription that's given, whether we should get generic, etc., and be responsible for our own healthcare costs. For families having kids, they might save up a few years' worth of savings from their good health to cover the costs of a new baby, and then the catastrophic plan would cover a premie with big needs or a high risk pregnancy. We would be more likely to have mom come move in with us, maybe we would even build on an addition for her and hire a nurse/aide to care for her at her home or ours, if we compared the costs of a nursing home and the heartaches of such an arrangement with this "radical" though time-tested method of caring for the aged.

Sure, you could go with the car insurance idea to decide how much insurance you could get for the money, but the idea of using the difference between the premium on your major medical policy and your "cover it all including prescriptions" plan to put into a health savings account with the ability to roll it over and even get interest on the money would help the elderly pay for their long term care since they've been paying into this for years and haven't been counting on the government to manage it, they've been managing it, and if they want to go to the Bahamas to retire to a seaside village "nursing home" and they can afford it, so be it.

I'm not political enough to know who's for this, if either of the candidates is, but I'm pretty sure it's not Barack Obama.

As a physician, I should become more like our colleagues, the veterinarians, and know how much things cost and be able to give people a reasonable idea of how much things will cost and let them help in the choice. If there's a cost difference for the same procedure at one place vs. another, they should know. We would have a big element of change on our hands, both physicians and patients. For this generation, which has grown up saying "sure, go ahead, I've got insurance" to find out how much something is going to cost and decide if they should get it or do it, is going to be uncomfortable at first. It's going to affect malpractice because if I recommend something and the patient doesn't want to do it (like vaccines now!) then has a bad outcome as a result of choosing not to do it, I'm liable under the current system, even if I was adamant about them needing to do it or get it or whatever, and documented my advice. Maybe videotaping of consent will help this. You get taped turning down my advice. Now of course if my advice results in a bad outcome...I'm still liable and should be. And many things aren't black and white, and the definition of a bad outcome will have to be ironed out. Oh, so many things, but our consumer economy can get through it, we just have to quit being ostriches as far as how much things cost (physicians and patients) and be willing to present and accept options.

Unlike our friends the veterinarians, though, one of our options (at least currently) isn't going to be "or for this amount, we can put X to sleep". I'm a little afraid that time may not be far in the future, especially if humanist atheists are running the system. But I digress...

But I need to know!

2008-07-20T06:05:00.000-07:00

Very often, in the course of a day, a mom will bring a baby who is fussy. Or who has a fever, or isn't sleeping. It's amazing how happy they are when I find something wrong! Or rather, how disappointed they are when I don't. It's better for the child to have an ear infection to explain the problems than it is to have some viral thing without a specific name causing all the trouble. Regardless of the fact that the virus will pass without treatment and the ear infection will likely require antibiotics (for more on this, see future blogs about antibiotic use). Oswald Chambers, in My Utmost for His Highest, my favorite daily devotional, said on July 18 "We command what we are able to explain, consequently it is natural to seek to explain". In this instance, I think his words ring true. An ear infection is a known entity. Viruses are not. Some people will say "it's just a virus" and be happy or disgusted that their child was lucky enough not to get some infection that had a name or a treatment. The truly paranoid, of which there are a growing number, think of all the viruses that strike fear into the hearts of parents, like West Nile virus, or measles or mumps, or HIV, to name a few. A balance between disgust and fear is a reasonable position. It just is interesting that parents, especially closer to the weekend, are happy that their child has a "known" problem, rather than a nebulous one that is not as predictable or treatable, even though their child will live through it and be fine after.

a behavior management metaphor

2008-07-13T10:58:00.000-07:00

OK. I talk to parents daily and discuss behavior management. I try to teach to ignore certain things that aren't good if they aren't trends in that child's behavior but are more just episodes. But I couldn't/hadn't come up with an analogy until just the other day. And it really applies in several areas.

Our new employee lives in an apartment complex. They have assigned parking spots. They have the right to call a number and have a car towed that is in their spot. They pay for that right in their rent. So, someone parked in her spot. Once. It was a big truck. She debated calling the number for the tow, but decided against it for a couple of reasons. One, it may have been a mistake or ignorance on the part of the big truck owner. Maybe he wasn't informed of the policy, maybe he had an emergency and the seriousness of that superceded the importance of the policy at that point. Maybe, if she talked to that person, she would find out. Her choice was to call or just deal with it and park somewhere else. But, even though she considered the possibilities above and chose not to call, another reason for not calling was that she was afraid of the response of the person driving the truck. He would know who called because the spots are assigned, and he might cause her some trouble if she exercised her rights. So, she didn't report it and let it go. And it's only happened once. Did she make the right choice? Yes. Were her motives good? Yes and no. Or maybe just yes. However, if the truck continued parking in her spot because of her lack of response, if it became a trend rather than an episode, she needs to report it and take it to the next level. Regardless of the possible ramifications? Maybe. She should definitely consider these and make plans to control them to the best of her ability, and she should find out who this big truck's owner is and why he's parking in her spot. Then, if he is just doing it because he can, and he refuses to cease and desist, she must exercise her right to the spot and take the necessary actions.

Can you see the analogy between this and a child's behavior? Maybe he forgot to take out the trash like you told him to. Maybe she didn't remember to make her bed, or to call when she got to her friend's house. But if these things continue, and the rules are spelled out and communication has occurred and the behavior begins to be a trend rather than an episode, the parent must take action. Action taken when it truly is an oversight or accident is counterproductive and often results in the attitude of "heck, I get in trouble no matter what I do, so I'll just do what I want because my parents are controlling jerks and yell at me when I make a little mistake". Whereas, if the episode is overlooked and the child later realizes it, and is remorseful ( I know I'm asking a lot of the imagination), then great strides in trust and relationship have been made.

So...it's ok to find another place to park every once in a while, even though it is your spot and you have every right to claim it for yourself. You may end up with a new friend or a relationship that you didn't expect, because the owner of the truck really didn't mean to park in your place and he's really surprised and grateful that you treated him with respect despite his behavior, or his perceived behavior. Motive is the key. Many are looking for reasons to get mad, to exercise their rights, because they see the affront as being toward them vs. an honest mistake or an episode of behavior. Parents have to be grown up enough to distinguish between episodes and trends, to be willing to park elsewhere if needed, or to call for a tow truck if needed, and to not be afraid of the child's response to this and the damage that child could do if called to account for the behavior. But boy it's easier to call for that tow truck if you'd made every effort to communicate with the child and only have them towed if they are unwilling to fix their problem. Maybe on another blog we'll discuss what to do when the tow truck is called.

"be like a child..."

2008-06-22T08:26:00.000-07:00

Being like a child seems to be getting harder these days. It's always been hard for adults to be like children, but now it's hard for kids, too.

I saw a first grader last month with a "to do" list. Anxiety related problems are more common than ever in children in my practice. GERD, breathing problems, stomach aches, headaches, they are all at least potentially and in part anxiety related disorders.

Kids have been told to have good self esteem, and the trouble is that with self esteem comes self awareness, and with self awareness comes the awareness that they're not as good/perfect as they've been brought up to believe, and that stresses kids out. What's the answer to this problem? Should parents stop praising their children? Should we stop preaching self esteem and be more honest in our appraisal of our kids while emphasizing unconditional love? What would that look like?

"I love you no matter what, so you don't have to worry about that. No matter what you do, I can't NOT love you, so chill and rest in that assurance. Now, about that...grade, performance, attitude, behavior, etc..." Kids know they're not perfect, but as my wife quotes often, "a lie told often enough becomes a truth, even if it is a lie". So, a realistic view of our children is now considered demeaning and limiting and "not allowing them to realize their potential or explore their boundaries". Pretty much you're bucking the trend if you try to raise your children with a true self awareness that includes their moles and warts and accepts those as a part of a loved person but that some people are better at some things than others and not all kids are really as "special" as they've been taught in school - just by breathing they automatically get credit for being the next rocket scientist or Tiger Woods and people push them to expect things from themselves that are unreasonable, then they're stressed and depressed and they go into therapy where they're told that no matter how broken they are it's not their fault and there's medicine to help their alleged chemical imbalance and when that doesn't fix the problem they again go to therapy where another diagnosis is made to justify another unnecessary and dangerous drug and the cycle continues until they either grow up and become realistic or grow up and become more unrealistic and expect others to adjust to their weirdnesses since it's obviously the other people that have the problems, not them, because they're "special", their parents and teachers told them so a long time ago and dadgummit, they believe it. Whew! My high school English teacher would dissect that sentence and use a whole red pencil just to mark the errors, but it felt good to vent.

OK, childhood does still exist, but I just found out about it. A 13 year old friend of mine described staying out til 10:30 the other night playing dodge ball and hide and seek with other kids in the neighborhood. Thank goodness that still happens. Amazing how I don't have those kids in my office for stress-related disorders like the kids who just got back from their soccer tournament at 10:30 and fell into bed to get up and travel to another tournament tomorrow where they're likely to get yelled at for not playing as hard as they can or not played at all because they aren't scoring like another kid on the team. Oh, don't get me wrong, to play everyone on the team for the exact same amount of time without regard to performance is to play into the above self esteem game, but I'm talking about the kid who comes and practices and tries and has a good attitude, but needs a chance to prove himself but can't get it because every game is too important to risk losing to give a kid a break. Enough on that, most of you know my opinions of youth soccer, or any team sport in young kids for that matter. But childhood is still out there to be had, and I'm glad, because the lightning bugs are still there and the woods are there and the imaginations are there to build the fort and make the club and we, as adults, must let kids do these things more, even if it's a little scary, because if every minute of every day of your kids' summer is planned with camps and lessons and tournaments and trips to Disneyworld where they better have fun because it cost you a bundle and they better not mess it up and it's more about you than it is about them because you're trying to be a super parent so you can talk to other super parents about how super you all are, while leaving your kids in planned activities because God forbid they should have any free time or they might not realize their potentials, then you're going to have Harry Chapin's "Cat's in the Cradle" playing at your funeral and your kids are going to send flowers but they're too busy maximizing every opportunity to come to pay respects and say goodbye. Ouch, that hurt. Sorry. No, I'm really not. I'm making a point. Sometimes one has to go over the edge to make the point, but the point needs to be made that kids need to have time to be kids, lest we begin needing to put prozac and adderall and nexium in the water supply because we're all depressed, distracted, and have indigestion.

healthcare plan 2

2008-04-27T09:15:00.000-07:00

OK, I know it won't work to make health insurance just like car insurance. You can drive safer and have lower rates, or have wrecks and tickets and get kicked off your insurance, and even if you're "innocent" in a wreck or problem, your rates still seem to go up. That doesn't seem feasible for health insurance. Too many things are "innocent", especially with kids, who are at the mercy of their parents, and to be too restrictive in the care that some parents seek for their children would be to invite disaster. So we probably shouldn't punish people for health problems but...and in this I'm the one I'm talking about...the health problems we bring upon ourselves by doing things we shouldn't do and know better, those might need to be grounds for raising our premiums. These are the tickets, speeding, reckless driving, DUI, etc. Some are forgivable if only in their commonality, but some are downright bad not only for the person doing them but also for those around him.

I obviously wax philosophical at times, quit laughing, and I need to be grounded by wisdom vs. overthinking. A friend did this for me yesterday. We were discussing (I was spouting off, he was apparently listening) whether the chemicals in plastic were a concern since we're all drinking from plastic of some sort all the time, it seems. He said "until people aren't obese and they are exercising at least a little and they take care of their type 2 diabetes and high blood pressure and high cholesterol, I think it's stupid to worry if the chemicals in plastic are harming us. We're harming us!" I took liberty with the quote, his was more pithy than mine and I don't recall the exact words but the message was loud and clear. We strain at a gnat and swallow a camel as Jesus said. The chemical issue is the gnat, the obesity "epidemic" is the camel. Sorry, but some need the explanation of the metaphor.

So...perhaps the equivalent of "points" in the car insurance industry - where our records reflect our wrongdoings like speeding tickets and the like and our premiums are up and down commensurate with the number of points - should be our weight, waist size, BMI, you pick the measurement, and make it broad (no pun intended) to account for those of us who are "big boned" but not really obese (yeah, right). Truly there are persons whose weights or BMI's look to be out of whack but they are in shape, etc., and need not be punished. Perhaps to justify one's size, one must come up with laboratory results that reflect the state of one's health - so if your BMI is over 30, but your cholesterol and triglycerides and hemoglobin A1c are in acceptable range, you're exempt from the premium increase. Life insurance companies sure don't mind raising premiums if you're high risk. So, if your weight or BMI is OK, you're good to go on the "no points" premium, but you're rated higher for obesity, etc., if you are, in fact, obese and can't provide good evidence that your obesity hasn't apparently endangered your health yet. I guess you'd have less money to spend on food if your premiums were high, then you'd lose weight, right? Wrong. Because good, healthy food, unless you grow it yourself, is at least allegedly more expensive and doesn't keep as long as the frozen tv dinner with 40g of trans fat per serving.

This little aside is to let people know that I realize you can't just penalize people for having bad health by charging them more for health insurance. Too many illnesses are not directly the cause of anything we know anything about. Babies born with birth defects through no fault of the mother or father. Premature babies who just happened to be born a few weeks early and had to spend expensive time in the intensive care unit. Someone gets run over or into by a drunk driver.

Realize that anytime we begin to discuss such things the issue of euthanasia or "letting someone die" or attaching quality of life potentials as parameters for who lives and who dies begin to surface, since an entity, likely the government but just as easily Blue Cross and Blue Shield, will be determining who pays what for health care and how much should any one person get, etc. Tough questions. Not for us to decide. For God to decide, but God, though He hasn't been consulted on these issues in our science for quite some time, often has different ideas than our human wisdom. We've taken Him out of the equation, and what's funny, even sometimes I, as a Christian who should know better, forget that He is sovereign over all. I have a parenting technique I tell parents about called the "good luck" theory, I think I stole it from Foster Cline and Jim Fay of Parenting with Love and Logic, but oh well. I think God knows about the "good luck" theory. He's saying "good luck", go ahead and try to decide who lives and who dies and who has what cancer or disease and try to cure it and screen for it and delve down into the human DNA code and see what you think you can do with it - I created the whole thing! Try to make things perfect here on earth by eliminating disease and suffering and starvation and toxins and try to have your cake and eat it too by flying and driving everywhere and using food for fuel and...good luck. The next line after "good luck" is "I'm sorry" when things turn out the way the parent knew they would. God has infinite patience, and I think He's saying "I'm sorry" to lots of things right now. There was a good Dilbert recently where the boss presented an idea that we could turn fresh water into oil - and thankfully Dilbert saw through the solution to the problem and asked "wouldn't that turn the world into an uninhabitable wasteland in the long run?" Someone needs to follow several lines of medical and other scientific "logic" out to the long run.

My point there was that we really have no ultimate control over things, we just think we do. We play around with genes and chromosomes and talk about stem cells and cures for diseases, but in reality, we're kids playing in the sandbox while the One who made the whole beach is just watching and waiting and letting us think we can do it our way, and what's worse, that our way is better. At least that's what many think. That the way God's had it going for several millenia is a bad deal and that we, as humans, are here to save the day! We've got a better plan.

Back to health insurance, sorry. We need to quit requiring every test for every thing there is before we act on anything. I'm all for making sure a diagnosis is correct, but did you know that there was disease before the MRI was invented? And people somehow managed? Doctors made diagnoses by taking histories and doing physical examinations and thinking and studying, whereas now even if we do the H and P and actually think and study, we have to have our decisions backed up by test after test, so after a while, it's easier just to do the test and forget the first part. That's where much of medicine is, and the public is partly responsible. It's like depending on a calculator vs. learning simple math. Sure, the calculator's nice, but if the basics behind it aren't known, a vital piece is lost. Or even more pertinent and current, keeping phone numbers in our brains vs. our phones - once we start using the phone to store numbers under peoples' names, etc., we lose the memory of that number and rely on the machine vs. the mind. In medicine, the public currently is bowing to the prowess of the equivalent of a synthesized computerized piece of music over the art of a gifted performer. We want the test, not the doctor's opinion. But what's funny is, the patient wants the doctor, too. They want to know what I would do if it was my kid. Or my dad or mom. They can search out the diagnosis on webmd and they still want the doctor to confirm it or refute it.

So, as far as I'm concerned, we still need doctors. We still need hospitals and medicines and tests. Don't get me wrong. I like storing numbers in my phone. I just don't want to lose the ability to remember them myself. The art of medicine is to decide when to go with the obvious diagnosis instead of covering one's ass with a zillion dollars' worth of tests. And this is where both doctors and patients will benefit in a good healthcare system. The doctor who is able to practice good medicine, I mean good medicine, with a minimum of testing and treating, would be rewarded, and the patient who goes to the doctor for a real problem vs. a problem they think they might have and demands a bunch of tests is penalized with the doctor who orders a CT scan for every headache and a CBC for every fever. Just because one can order and do a test doesn't mean the test is needed. We've lost the doctor/patient relationship over the past 2 decades due to insurance rules and tests.

So...we need to remember Who created us and that He has a plan. We are apparently being forced into at least discussing a "new" health care plan, and depending on the winner of the November election, the discussion will differ, but the outcome likely will not be that different. We are talking about doctors and patients here, and neither handles change well, especially change that feels like it's forced upon us. It's amazing that no insurance or government entity forced the concept of the "urgent care center" upon us, but I would venture that these "docs in the box" are the fastest growing healthcare providers around. Obviously, the drug companies and the doctors who write for their products are paying no attention to the fact that people are having to spend more and more at the pharmacy for their medicine. And as newer tests become available, patients demand and doctors order (or is it the other way around) ultrasounds so expectant parents can have daily cell counts on their new embryo! Or MRI's on joints that are sprained, and then instead of a "sprain", which sounds mundane and survivable, they have a "torn ligament" or a "stress fracture", which sounds (and is) more expensive. And guess what? The insurance company will pay for more physical therapy for "stress fractures" than shin splints. So, we're shooting ourselves in the foot, and we probably should stop. It's going to be hard, it's hard for us to give us something then tell us we can't have it anymore. There will be so many loopholes in any new healthcare plan that it may need to be administered by the IRS!

OK, that's enough. Just rambling. Maybe I can take off on one of these thoughts and go for another hour or two, but I'm done for now.

my healthcare plan

2008-04-08T04:40:00.000-07:00

OK, I'm not running for office here, I'm just ranting and putting some thoughts together formed from 20+ years in healthcare.

Why can't health insurance be like car insurance? Or homeowner's? You have to get it, by law, at the car insurance. To get a tag for your car you have to show proof of insurance. Sure, some fake it or lie about it, but most (I think) really have it.

So make it a law that people have to have some level of health insurance. If they qualify by income level like for DHS support, they can get it for free. But they still have to have it. I have told people for years that they should buy a major medical health insurance policy with a high deductible, to cover catastrophic stuff, and then use the money they save vs. a full coverage policy with prescription drug coverage, etc., to pay for their occasional doctor visits and medicines.

You may say, "but people won't be able to get the drugs they need or the tests they need or the medical care they need...". Here is where "need" needs to be defined as true need and not "want" or "expect".

The proliferation of prescription drugs to "fix" all our social and personal ills is a good sign that there's money to be made in this business. It's like all the restaurants going up all around, people want to eat out, and they do it a lot. And people want pills, a lot of them. Driving through town today I saw evidence of so many things that are "wants" and not "needs" and they are unashamedly marketed out there on the street for people to see and "want" some more. Before I go on, I should tell you that I'm like the guy in the AA meeting standing up and saying, "hi, I'm Kelly, and I'm a 'wantaholic'". I see these things because I'm looking for them and they tempt me. Maybe if I was closer to the "need" stage, if I had little kids, especially, I'd be less likely to be going off on these things, but I don't so I am. Exotic play grounds for the backyard, all redwood and bright plastic with slides and faux rockclimbing attachments, the kind you used to only see in neighborhood playgrounds or God forbid, school playgrounds. I'm talking big monstrosities that look like they'd take a crane to get them in the backyard or several weeks of putting tab A in slot B and then screwing it all together, a nightmare in my opinion. Well, I digress. Well, except for pets. Like kids, there are things available for pets that someone visiting our country from even 20 years ago would have laughed at in amazement. Play groups for pets, dog parks, and supermarkets with only pet stuff, most of which no pet would even care about, much like much of the junk available for kids who'd rather just have a stick and some dirt and maybe a tree to climb and a bike to ride, but we "need" this stuff - because it's available and for sale.

Back to the health insurance issue, after my rabbit trail and segue back in - most of the medicines and tests like MRI and 4D ultrasound and designer blood pressure/cholesterol reducing drugs, reflux medicines, antidepressants, stimulants for ADD, etc., are really "wants" disguised as "needs". They are available, we know someone who has had one or takes one and so we think we must need one, too. And besides, they're for sale and all you have to have is a doctor's order, or at least that's what the commercials say. Commercials for medical stuff - another thing that a visitor from the not so distant past would find amusing, until he saw how well it works. Sure, the drug companies used to buy doctors by buying lunch or golf trips or whatever, and they still do, only mostly with food now, and "consulting fees" or "speaker fees" by having one of us review an article about their drug and then talk to our colleagues about them at a fancy restaurant. And this is paying off, I have no doubt. But nothing has paid off as well as "just ask your doctor about...". The 4 hour erection on the ED drug commercials is the best way I've ever seen a drug's potential side effects sold as a subliminal tease. I remember a show on "commercials you'll probably never see" and there were these 2 boys about 8 years old who are talking about what they're saving their money for and are overheard by their mother when one says "I'm saving up to buy OB tampons" and the other one says, "OB tampons, why?" and the first one says, "I saw on TV that if you buy OB tampons you can go swimming and skiing and biking and hiking..." and of course the mother cracks up quietly laughing. Commercials affect different people differently. And instead of eating right and exercising, I'd like a pill to make me get in shape and lose weight or lower my cholesterol and make me smarter without studying and a procedure to erase the wrinkles of aging and suck the cellulite out of my thighs and...

So we're now selling medical care as a "need" when most of it is really just a "want". That a CT or MRI is "standard" care for a painful shoulder or knee or for a headache is a recent phenomenon. To some degree driven by malpractice fears, doctors are able to justify an "overevaluation" of fairly common problems. The thought process of diagnosis is often short circuited by all the tests. That's a different topic, sorry. But the idea that our insurance should pay for whatever whenever is a fallacy that has gotten us to this point, and we're going to have a hard time getting off this high center of expectations from the public. I'm not going to argue that healthcare is a 'right' in our society. It is, because we say it is. But how much is 'right' when it comes to healthcare? Is there such a thing as too much? I think we all would like to think that at least some healthcare is a good thing, so there is such a thing as too little, but too much? The way I see it, we're well into a 'too much' phase right now. Too much medicine, too many opportunities for elective procedures, too much screening (in the name of health, but in reality a ploy, many times, to generate business for a particular segment of the healthcare industry), too many required tests, too many lawsuits for too much money. But we've come to expect this level of 'care' and it's going to be hard to cut back. I tell parents all the time to start small and work up with praise and rewards, etc., or they may get to the point where there is no reward large enough to make a child want to do something to get it, because the child already has it all. We are those children, and in fact, we have watched this thing grow right in front of our eyes since most of us were children. I can't tell you how many times a parent says something like "my mom never took us to the doctor unless we were dying". So why didn't she? Was there not a doctor around? I don't think so, because then they'd say, "we never got to go to the doctor when I was a kid because the nearest doctor was too far away". Was there not enough money? My dad was a doctor. I remember him charging $10 for an office visit and taking items for barter if the patient couldn't pay. Money for a doctor may have been somewhat of a luxury for some, but it wasn't the astronomical figure we see now, even with inflation. What is responsible for this rise in cost? You don't have to pay for it anymore. You pay for insurance and your insurance pays the doctor. It's like going out to dinner and not having to pay. Or, more realistically, you don't have to pay while you're there, you may get a bill for part of the meal later, but it's distant from the actual meal so it seems separate. Which gives rise to people forgetting how good the meal was and how they ordered dessert and an extra drink at the time because they wanted it and it didn't cost them anything anyway, so when the bill comes, they argue about paying it. I could run this analogy's legs off if I desired, like how you could go to certain restaurants and have dinner and have it paid for, but for others you had to pay, or at least pay more of the bill. And you could only order certain things unless you had prior approval. But I won't.

Automobile insurance is different. The expectations are different from the outset. If you want, you can only pay for liability insurance that covers any damage to others but doesn't fix your car. You don't expect insurance to pay for filling up with gas or getting an oil change or a brake job or even a new transmission. You have insurance to pay for damage done in accidents. And you don't even want to turn in many claims for that unless you want your premiums to go up. So you pay for the repairs out of pocket. How would this look in health insurance?

Maybe we could buy an insurance policy that would cover big stuff, like accidents or severe illnesses. Then we could pay for the incidental stuff out of our own pockets. I'm cutting my own throat here, so be nice. If you had to pay for your baby's checkups and shots, you'd be looking for the best deal you could get. Sure, you want the best for your child, but if Dr. X charges 25% less for his checkups than Dr. Y, you're at least going to go see for yourself. This is the WalMart mentality. The best for less, or something like that. So, Dr. Y either has to convince you that his fees are reasonable due to better service or something else he provides that Dr. X doesn't, or you're going to change doctors. The same thing goes for procedures, and medicine, and vaccinations, and on and on. Capitalism at its finest. Ouch! No longer would there be this built in fee schedule based on what the government will pay for things. This is a pretty easy thing to see, I think. Competition is good for a business. It makes the consumer the driver of cost more than the government or big business. There is a place for the profession to police itself and the consumer needs to know that he doesn't know as much as the professional in some instances. In the same way that I take my car in to be fixed and I don't know what's wrong or I don't know how to fix it or have the equipment to diagnose and repair it, I have to rely on the expertise of the expert in this area. To some degree, I am at his mercy. But one develops relationships which are built on the assumption that the mechanic can do the job I'm paying him to do. If he does it well and charges a reasonable price, I'm usually happy to pay it. Sure, I could go to a different mechanic for every problem, but having one who knows my car, and knows me and the way I drive and what I use a car for, that's important. In healthcare, as I'm sure in car care, there are many opinions out there that the 'experts' are ripping you off, making you sick, not doing you right. This lack of trust is natural when one is spending money on something that isn't always tangible. Like the story of the electrician who comes to a house to fix some appliance and all he has to do is push some button or tighten a screw, and when he gives the homeowner the bill, the homeowner gripes that "all you had to do was..." and the electrician responds by saying that the homeowner is paying him for the knowledge of which button to push or which screw to tighten, not the actual work.

So, as a pediatrician, I would need to be competitive in my fees or provide something special that others didn't, in order to have higher fees than the guy down the street. It's the steak dinner at Denny's vs. the steak dinner at Outback vs. the steak dinner at Boulevard Steakhouse. There's a difference. Yes, it's all steak, it's all cooked and served to you, but some prefer to move up a notch or two in quality or service and are willing to pay for that difference. So there will be doctors who do the basics and ones who provide a level of care above the basics. One would hope that each would be reasonably similar in their ability to diagnose and treat common problems, and the difference might come in the amount of time one spent with the doctor or the waiting time was less or the office was nicer and cleaner and friendlier. There will be, and already are in some places, doctors who provide a 'concierge' level of service. They don't accept insurance payments and are pretty much on retainer for a certain number of patients who have access to this physician when they want it and don't have to put up with the 'regular' stuff the 'regular' patients deal with. This will become more common.

So, we are not cars. We don't just decide not to fix someone and sell them or scrap them. That's illegal, immoral, and generally distasteful. We don't get a 'lemon protection plan' and we can't just get a new kid when the old one 'wears out'. And we're not pets. We can't just decide to put our kid to sleep if he's got some illness that's going to be difficult or painful or expensive or all of the above. But there are similarities. We can use 'premium' gas and extra long life motor oil and the best spark plugs and really pamper our kids just like our cars. We can buy the best dog or cat food and have them groomed regularly. But those are our choices and we pay for them.

We get diseases that must be treated. We have accidents. We need doctors and nurses and hospitals for some things. We need MRI sometimes. We need medicines sometimes. But do we need them as much as we think we do? What if we paid for it? Out of pocket, prices listed on the 'menu' at the desk, optional extras like prescriptions called in or faxed vs. written, shots with clean needles (just kidding), phone calls returned the same day for one charge, within a week, different charge, sort of like shipping charges.

This is all well and good for most of my population of patients. I think they'd find that they need me far less than they think when they had to pay out of pocket. They'd be less demanding in some ways, more in others. They probably wouldn't come in for a cold as often. They'd wait and see if a child actually got sick before they came in, and they'd have an opinion as to what drugs we used to treat the child (more than they do already). This shift of responsibility to the patient would cause many changes in my behavior and that of my patients. Do you want to see the doctor? That's this much. If you want to see the nurse practitioner, that's this much. If you want to see the NP but have her consult with the doctor, that's this much. Would you like an estimate to fix your problem or do you want us to fix it while you're here? This is already happening in consultations with some specialists. It would be a different world. I would have to earn your business because there's another doctor's office that you pass on your way to mine and she's pretty good. This already happens with urgent care centers, but when people figure out that they're paying double to have their kid checked by a doc in a box and then come see us the next day or two for followup when they could have/should have just waited until the next morning and visited us once. But this is America and I want to be seen now! Even if it's by someone I don't know and don't trust and now that I'm here I'm wondering if this is the right thing to do and I think I'll go see my doctor tomorrow anyway. Enough on that. That's not the future, that's the present.

For patients with jobs and some money, those not on welfare, it would be a requirement to have a major medical policy to cover catastrophic illnesses/accidents so you don't go bankrupt paying for this problem. This should be pretty cheap compared to what most insurers charge for 'full coverage' currently. Flexible spending accounts or health savings accounts could provide the cushion for the 'regular' stuff like checkups and ear infections and the occasional stitches, etc., and you'd still save money. I've told people this for a long time. I even said it several paragraphs ago. But to do this we would, doctors and patients alike, have to change. Quite a bit. But it's amazing how money is a catalyst for change. Many things we have now would decrease or go away. It might go back to where only the rich and famous could have cosmetic surgery. Where only professional athletes had their knees MRI'd 'just in case'. Psychotherapy would be the domain of the rich and famous (maybe the ones who didn't get their cosmetic surgeries, or maybe the ones that did). We would observe mild viral infections and see how our child fared, seeking care only if things were not progressing normally. We wouldn't screen our 2 year old boy for autism because he isn't talking yet even though the reason he won't talk is that he doesn't have to because you do everything for him and talking would just complicate life. We might go back to the 'old days' where an illness was allowed to 'run its course' and we'd all seen one do it and the kid survived even an ear infection without an antibiotic and an antihistamine/decongestant and alternating tylenol and motrin every 3 hours to make sure he doesn't have a fever even though the fever is what God gave us to help fight the stinking infection to start with...I digress. Again.

OK, enough about how wonderful life would be if people had to pay for their own oil changes and fillups. How only major crashes would involve insurance companies and capitalism would reshape the healthcare industry. What about the poor? Those zillions of uninsured or underinsured?

Well, for starters, in today's world, if we adopted my 'car insurance' plan above, we'd all be considered underinsured.

But for the truly poor, one of a couple of things would happen. What would likely happen is that the state would pay the premium for this 'major medical' policy and there would be state clinics and hospitals contracted to care for the incidentals like checkups and earaches and stitches and those contracted providers would be paid a lump sum by the state to care for those for whom they are responsible. This payment would likely not be very much. It isn't now. That's why it's hard to find doctors willing to care for patients on state insurance. There's no good answer here, and the idea of healthcare as a 'right' has to be defined. How much? How soon? How good? Depending on the income qualification for the state insurance, one could envision a plan where the only difference one would experience would be at the hospital level, where a state hospital would go back to the status of a teaching hospital maybe with either altruistic doctors who love to teach and care for people regardless of their ability to pay or doctors willing to work for less because they can't make it in the 'real world', or they're honing their skills to make it 'out'. At the outpatient level, this population could pick their healthcare provider like everyone else and use a health savings plan or plain old cash and shop for 'the best for less'.

The other scenario would be that doctors would care for the people unable to pay along with those who are able to pay, and either charge them reduced fees on a sliding scale, or be really Christian and just see them for free. If everybody (docs, I mean) had a few of these patients, it wouldn't be so burdensome.

But none of this is going to happen, because of American politics and expectations. We're all going to be forced to pay more for healthcare, whether we need it or not, and the government is going to dictate the prices and who gets what tests and really it's not going to be a whole lot different from the sorry state it's in now where people want prime beef steaks for Denny's prices and are upset when they get a bill for the difference. I don't see it going to a Canadian system or a British system where if they run out of money before they run out of year, all the surgeries and tests scheduled get put off until the new year begins, unless you die before that in which case, they're sorry but someone gets moved up on the list. We have too much invested in our healthcare economy to dismantle it completely to go to the Canadian system, where I've heard there's maybe one or two MRI machines in the country and there's not a 'heart hospital' where you just check in and get your stents placed because of your 'cardiac screening' results the day before. There will be a 'concierge' level of healthcare pretty much regardless of how the elections go and what he or she does to Medicare and Medicaid and what the FDA does to streamline drugs into the system and whether third party payors will continue being more and more restrictive on where they'll spend your money. They may try to put everyone on a 'diet' of less fancy stuff, but I bet, given the lobby power of the pharmaceutical companies and big business medicine, they will continue to treat healthcare as an inalienable right whether you need it or not, but they'll try to ratchet down the cost by just paying less for it, and the doctor is supposed to sit still and be happy he still has a job. That's when the quality will go down, even further than it has, and medicine will be a job and not a calling for most people, and docs will just leave at 4:30 because their shift is over and they don't feel any accountability to the patient because they're just a government employee in a white coat. And then, like some who choose to pay for private education for their children even though they still have to pay their 'fair' share of the tax for the public school, people will be willing to pay for a level of care that stands out from the government clinic or hospital and is not as accountable to the government but is instead accountable to the patient. It's a slippery slope, and it's been slipping since the concept of HMO was born. Can you imagine a CMO - car maintenance organization? Where you are told where to take your car for gas and oil changes and who can work on it and how often it can be worked on and you get in line for a transmission overhaul or a new set of spark plugs because there's a waiting list and the mechanics get paid by the number of cars under their contract and not by the number of cars they actually work on? And we ate it up when Hillary made it the topic of her first 'presidency'.

OK, I'm through, sorry for the rambling.

an inconvenient truth?

2008-04-05T07:56:00.001-07:00

For a while now it's been getting worse. Parents asking about immunizations, are they necessary, what diseases are they preventing, how effective are they, and #1 on the hit parade - what's my opinion on immunizations and autism? Anyone who knows me knows that my opinions are usually pretty wordy to say the least, so I'm going to have to come up with a concise statement on this subject in general and this question in particular. It's not going to be easy, but I'm going to try to "flesh it out" here on the blog and compile my thoughts and put them into manageable piles.

Al Gore gets credit or crap for a lot of stuff, but he certainly is the poster child for global warming. And global warming is a good example of the effect of media/internet hype on a controversial topic. A subject where both sides have impressive information and both can wow you with their glitz and glamorous proponents. Admittedly, the vaccine controversy doesn't have quite the red carpet support as global warming but lately Jenny McCarthy has been one of the more visible celebrity faces of the vaccine/autism question, and Doug Flutie before her was one of the first, though since he appealed to guys, his effect was not as profound. In our media saturated and influenced culture, science takes a back seat to celebrity. "Don't confuse me with the facts" is a phrase I hear (and use) often. Gut feeling and quasi common sense have replaced data and expert opinion. I'm not immune to this, as I've alluded to above.

It has been said that the louder and longer one says something the more people will believe it's true. Especially if the ones saying it are pretty, famous, pretty famous, or wealthy (that never hurts). Take evolution as an example. You might think, evolution? That's a done deal, right? We learned it in school, it is understood that it is true, except by some wacky fringe element. Well, go back 150 years and that's not the case. Even 100 years. Evolution was the global warming of the early 20th century, and Charles Darwin was Al Gore. Or something like that. Consider, if you believe in biblical Creation, by God, in 6 days or 6 million years, or if you believe in intelligent design even, the "lite" version of Creation, you are bombarded by conflicting information daily, even hourly, and you even may fall prey to this at times. I use "survival of the fittest" as a metaphor quite often, and "natural selection" rolls off my tongue like any other solid method of reasoning out some line of thinking. We are creatures of our culture, and like it or not, it influences us at many levels.

So, we buy a hybrid to decrease our "carbon footprint" despite the people who tell us that the factories that make the batteries that make our cars "green" are emitting more pollutants than the semi that just passed you on the highway. Tradeoffs are a given in our world.

Unfortunately, the question of vaccines affects children, and that means it affects me. Global warming means I bought a Prius and had less guilt. Giving vaccines with the possibility that they cause autism or other problems is a difficult thing. Not giving vaccines with the possibility that the diseases prevented will reoccur and cause untold agony? A less likely evil? As long as most people still vaccinate their kids? The concept of "herd" immunity. Where it is said that if most of the "herd" is immune to a particular disease, the rest benefits from this protection.

So...global warming, evolution, vaccines cause autism. Which is true? Which is just media hype? Are these questions with absolute answers of yes or no? In the case of evolution, I am a strong believer in Creation by God in however long He decided to take to do it, He says 6 days and a day off on the 7th, so I'm going with that. Slam dunk yes. Global warming? Vaccines? I'm less certain that there is a black "yes" and a white "no" on either topic. Unfortunately, most of the "easy" yes and no questions have been settled - not always the same for everyone, but they're settled in the minds of the people. Are we affecting our environment with carbon fuels and pollution? But does the good outweigh the bad? Does the ability to travel by car or plane make our lives easier and is the tradeoff worth it? Is technology worth it? Are we giving our kids chances that previous generations didn't have by vaccinating against killer diseases? Are we causing problems that are worse by preventing unlikely but deadly infections? There are few people still alive who have experienced polio firsthand, but even someone my age, in medicine, remembers Hemophilus influenza, type B. The ten or more days in the hospital on IV antibiotics. The great possibility of deafness if the child survived.

Suffice it to say, this generation has not suffered the effects of the infectious diseases endured by the previous ages. The proponents of vaccines can show graphs of the prevalence of a disease and the controversy over vaccine and the inverse relationship between the two - i.e., if the disease is common, there is little controversy over the vaccination, and if the disease is seen as historical, the vaccine side effects become the subject of controversy, not the disease. Though I don't want to see it, if a measles outbreak occurs, the whole autism/MMR vaccine issue will be a moot point for a while. But we do need to revisit the issue of vaccines and side effects and whether the good outweighs the bad. There are few people without obvious agendas who are taking sides on this question. That is a huge problem - those with personal involvement weigh in on their particular side and then facts take a back seat to emotion, or at least "spun" facts. Statistics can be "spun" to make anyone's point.

Are we causing harm to our children by immunizing them against diseases that most people have never seen?

To those who are totally in favor of vaccines, for all diseases, in every kid, at any time, the picture portrayed is of a world where the diseases prevented by immunization are lurking just outside the door, waiting for us to let our guard down and let them back in to kill and maim our beloved children in minutes.

To those who believe that vaccines have caused more problems than solutions, the picture is a world where things would be fine if doctors and vaccines and medicines didn't exist and if people would just eat right and exercise, things would be fine.

OK - neither one is right, which takes me back to the earlier comment about no "black and white" answer.

I find myself sitting on the fence. In terms of diseases, I've experienced HIB meningitis personally and professionally. When I say that the worry caused by a phone call about a child with a fever is much less now that it was 20 years ago, it is an understatement. To say the least. I have put the early years of practice behind me. When, after a 2 A.M. phone call about a child with a fever, my wife would say "do you think it could be meningitis?". And I couldn't sleep after that. That's pretty much gone. As gone as something that used to happen but hasn't happened in a long time can be gone. I wouldn't wish it back in a million years.

So...some doctor can say the same about diphtheria, tetanus, polio, measles, etc.

We are a society of convenience. We vaccinate against chickenpox because it costs the mother a week off of work and that costs a lot. Of course, there is the justification of MRSA and the secondary infection of the chickenpox lesions that could cause worse problems than just the itchy rash. We would like to see rotavirus disappear. My first rotavirus experience was a funny episode in my first year of med school where my roommate got it and couldn't decide whether to sit on the toilet and throw up in the bathtub or sit on the tub to evacuate his bowels there and vomit in the toilet. It was a one or two day thing. And still is for most kids. But it can mean hospitalization and for God's sake, that's an inconvenience to say the least. Kids in Africa die of rotavirus, but here in the US of A, that shouldn't happen. So we immunize to save lives and to save jobs and lifestyles. Where do we draw the line?

Reading history, I find that smallpox may have been the deciding factor in the conquering of the New World. We have been taught that it was guns or education or desire or something purposeful or controllable that helped Europe conquer the Americas, but as I read history, it was smallpox. Or some other infectious disease/s.

So...I'm in favor of immunization. I can be tolerant of parents wanting to spread out the vaccines over a longer period of time, while laughing at the fact that the multiple ingredient vaccines that today's parents are scared of were created to meet consumer demand from 15-20 years ago.

We; doctors, scientists, researchers, should review the data, devoid of emotion and secondary gain, and come up with a reasonable approach to achieve the necessary coverage for children for diseases that are still present and active, and propose this with acquiescence to those opposed, and win them over with our data and dry information and not with bullying and laws and requirements.

And those who are opposed should look beyond their own personal experience to the big picture and the possibility that they were the victims of cruel fate or divine providence, or maybe to the power of the almighty dollar and the whims of drug companies.

No one is right. No one is wrong. It's not clear, at least in my mind, like the evolution controversy is clear. God created this world.

But we should begin to face the problem of vaccines and autism with the idea that both sides have reasonable, defensible ideas and data. That there is no one right answer to the question. That both sides together, with cooperation and collaboration, may come up with a safe and effective plan. However, until both sides can discuss the issue without emotion and personal baggage, without millions of dollars helping to decide the outcome, this seems an unlikely dream.

I want to place myself squarely in the middle of this controversy. I see the need, and I see the concern. I'm not smart enough to know everything about everything. I will continue to encourage complete vaccination for every child while respecting the decisions of those parents who do not want to immunize or who want to delay or spread out vaccination. It's uncomfortable up here on the fence.

addiction

2008-03-19T15:52:00.000-07:00

It's probably the new "energy drink" phenomenon that really caught my attention, but other than being a legal addiction, caffeine is a great example of the concept of addiction itself. One can put many other things in the same boat, like meth, cocaine, heroine, prescription pain killers, narcotic cough syrups, money, attention, the list goes on. When one is addicted to something, they have to have that thing, and once they get it, they want more. I remember when Mountain Dew had the most caffeine of any drink, now it's hardly comparable to Monster and Red Bull. I have even heard of water with caffeine in it, and if you made coffee with it, you increased the caffeine content.

So what's the big deal? Sure, some of the list above are illegal, some bad for you but legal, like caffeine, and some allegedly good for you, like money, or attention. Who ever heard of anybody younger than mid 50's dreaming of a smaller house? Fewer clothes? Less to do? I've spent my life wanting more, more money, more fame, more house, more car, more everything. And once I get what used to seem like "more", it becomes the norm and I again want "more". That's addiction. The bar keeps getting higher, what once was considered satisfactory just no longer makes the grade. So...what about attention? That's not bad, is it?

Consider your first child. That child got a level of attention that you won't be able to provide for any subsequent children. And is it enough? Is that child ready to share that attention when #2 comes along? Or is that child asking for more attention? The level you previously provided is not enough anymore. Always more. As humans, we must be built this way. So what's my point? Other than to tell you not to get into illegal or harmful addictions?

I want you to look at reality, accept the fact that with your kids, whatever level of attention you currently provide won't be enough for them in a year. No matter how much you give. No matter how big a deal you make of how well he colors in the lines or she recites her abc's, they will each want more attention and recognition than you gave previously. It's human nature. So start low! When they're babies, meet their needs. Feed, change, burp. Hold them and look at them and count their toes and fingers, but only because you want to. When you find yourself holding the child because if you don't he or she will scream and cry, you're witnessing addiction at one of its earliest levels. So start low. Don't neglect, I'm absolutely not saying that. But don't overcelebrate early success, because you're always going to have to top your last celebration or "you don't like it, daddy?". Once again, I'm not speaking of meeting needs. I'm talking about that basic human right as far as the liberal educators are concerned, "building self esteem". Be very careful here. Self esteem is built in. That's why the 2nd great commandment according to Jesus is "love your neighbor as yourself". He didn't tell us we had to love ourselves. That's a given. Back to your kids - rip off the "my child is an honor student at..." bumper sticker, peel off the cheesy baseball icons or cheer icons with your kids' names beneath them on the back window of your SUV. For whom do you do this? Do the kids say, "mom, you don't have my name on the back of your Escalade and that hurts my self esteem"? No! To tell the truth, they are likely embarrassed that you've messed up a perfectly good - though overpriced and a gas hog, with 4 more seats than you have people to put in them - vehicle (I digress, sorry, hard to not run down rabbit holes). Do you need to go to all their games? From the time they're 3 and chasing butterflies instead of pop flies? NO! Hell, no! You're creating an addiction. In you and in them. You're setting their expectations for your attendance and attention so high that by the time it really matters, you'll be the rabid dad who comes out of the stands to tackle the coach because your kid didn't play enough or hit the kid who hit your kid in the football game. You are getting them addicted to you being there all the time. OK, if it's fun for you, just like holding the baby in the illustration above, that's different. But I'm talking about the mandatory attendance at anything your kid does anytime, anywhere, because somewhere you've been convinced that to NOT attend all those events you will crush that fragile thing labelled as self esteem and your kid is going to be the next "troubled youth" who shoots up a school or a mall. Stop now, before it's too late.

Realize that the level of attention that you give your child now, whether for reading a certain number of books or peeing in the pot or showing up at the soccer game or making good grades or being in the school musical or drawing a picture that got chosen to be shown in the mall with a bazillion other pictures that look like 3rd graders drew them, will set the level of expectation for the future of attention in your child's life. So, set the bar low. Love your kids. Don't worship them. Be with your kids, but not always at an "event". Have dinner together, skip soccer practice, show your child that you treasure the time with him or her more than the commitment you made for him or her. Relax. Enjoy your children. I'm not telling you to neglect or fail to notice accomplishments. But only to the level that those accomplishments deserve. Making the honor roll in middle school doesn't deserve a bumper sticker. In fact, have you ever seen a bumper sticker that says "my kid got into Harvard"? NO. You celebrate more personally and less publicly, more appropriate for the level of accomplishment. I think something of this thought is in my "birthday party" blog from a while back. Just remember, you are growing a kid who someday will expect a medal for showing up to work everyday if you reward the normal, expected things in life. Show some restraint. Just because everybody else on the block is touting their kid's accomplishments, you don't have to. Your kids will know that you love them by your attention in the areas that matter, and by your attendance at things like - baths, bedtime prayers, dinner, church, impromptu fishing trips to the neighborhood pond, Braum's runs after dinner "just because" - that's what they'll remember.

Save something for the big stuff later. Don't throw all your good pitches too early in the game. Remember, they will always want more, so if you start low, you can peak at the right time.

surfing

2008-03-09T16:21:00.000-07:00

OK, I'm going to get "religious" on you for a minute. I want to try to tie together the concept of trials and tribulations in life as Jesus speaks of them, and the troubles we have with our kids, and make a point. Wish me luck. For excellent spiritual advice and discussion, please see my wife's blog at feedingthespirit.blogspot.com.

My wife references Oswald Chambers a lot. I read his devotional, My Utmost for His Highest, almost every day. He's got some cool insight into how God works. I like it, maybe you will, too. In Bible Study Fellowship, we are studying Matthew, and this week there's a part where Jesus tells the disciples that things aren't going to be easy, and that they will have to drink His cup, too, and that it's going to be tough, but for all the tough stuff they endure, it will be worth it both here on earth and definitely in heaven, where eternal life is the prize. He tells them not to be surprised when trials come.

So...trials and troubles don't sound fun, do they? But, basically, no pain, no gain.

How do we handle them? How are we supposed to handle them? Are the answers to these two questions the same? I doubt it. I know it's not that way for me.

Here's where Oswald Chambers comes in with a quite hip (for the 1910's) analogy that I think illustrates the point and the correct handling of trials and tribulations. He references the verse in Romans where Paul says "in all these things, we are more than conquerors through Him that loved us". Oswald then goes on to say that "the surf that distresses the ordinary swimmer produces in the [surfer] the super-joy of going clean through it". So, picture Hawaii and the big waves and you don't see people swimming and splashing around at the beach, you see the surfers paddling out and waiting for the best, the biggest, wave they can find to ride in as far and as fast as they can. Never having been there, I'm just guessing, but I'm thinking that swimming in that kind of surf is dangerous to say the least. In fact, people probably drown all the time there. But they travel there to surf. The waves that would drown a swimmer are the exact things that make it fun for the surfer.

So...the waves are the trials and tribulations. The swimmer is the person who tries to plow through the surf on his own strength and he drowns. The surfer is the one who sees the problems as opportunities that can provide fun (rejoicing) if one has the Holy Spirit (surfboard). I really like that metaphor. It hits me where I live. When I'm swallowing a lot of water trying to swim, I try to conjure this idea up in my mind, rise above it with God's help, and surf. This is probably what I mean when I say parents should be "detached" from their kids' lives some of the time. If all you see are waves one after another, and all you're trying to do is swim, you're going to drown. So surf! If it weren't for the waves, you wouldn't know what it was like when the waves were quiet. You might even (gulp) wish for some waves!

We expect things to be easy. We sure hope they're going to be easy. We get a baby and that baby should be perfectly healthy at all times and present no problems to us, and maybe an hour goes by and something goes wrong. The baby spits up, has a stuffy nose, is constipated, has a rash, breathes funny. And you haven't even left the hospital with your newborn! Then there are ear infections, colds, stomach bugs, strep throat, 5th disease, shots, fussiness, biting, temper tantrums, defiant behaviors, the list is endless. We should not be surprised at these problems. In fact, if we are "surfers" we should really be looking for the next wave, and in my experience, if you're looking for a wave, one doesn't usually come! Reverse psychology! The last shall be first and all that stuff that Jesus talked about.

My point? Don't be surprised when bad things happen. They're going to happen. If they didn't, you wouldn't be able to enjoy things when they're going well. You wouldn't know any difference. Sort of like a "Twilight Zone" episode where the guy died and thought he'd gone to heaven because he got everything he wanted right away and always won when he gambled and always got the girl he wanted, then he found out it was really hell. With no down, up can't be appreciated, with no sound, silence can't be enjoyed, etc.

So, surf! You don't have to enjoy your kid being sick, just realize that you're in Hawaii (it's a metaphor!) and there are going to be waves and you should expect them and you've got the Holy Spirit to help you surf, so detach from those waves, stand on them and ride! You might find that when things are going great, you get kind of bored. Maybe, maybe not.

Last point: waves are going to come. Don't be surprised or overwhelmed by them. In fact, if you do it right, you might be surprised at your attitude when your kid doesn't have as many problems you thought they would. Not that you look forward to problems, but in a way, you really do. And in the same vein, you enjoy the lack of problems that would overwhelm you, and you might even be able to help people who are trying to swim and about to drown!

stating the obvious

2008-02-23T11:45:00.000-08:00

just got a "news flash" from some pediatric journal: caregivers should not "pre-chew" the food for a child because they could get aids from it. wow, glad they told me that one. i'm going to have to put up a sign or something to make sure my patients aren't doing this. forget that food grinder, that blender, do it the "natural" way and chew it for them! oh, and you shouldn't do it especially if you have any open sores in your mouth. please! i've heard many stupid things that parents have done, but this takes the cake. at least there's a reason not to do it now, besides the fact that it's disgusting and i can't even imagine being on either end of that activity! sorry, just had to share that with you.

seems there needs to be a statement to tell people not to do stupid stuff, like the coffee may be hot, and don't put this plastic bag over your head, or don't stick this knife in your eye, or don't swallow this little bag of sand in your medicine bottle, and on and on. one hopes that people who can actually read the warning labels (or can interpret the symbols on the warnings that are supposed to tell people who can't read not to do the stupid stuff) should have the common sense not to do those things, and that the warnings would be unnecessary, but no. sort of like the statement on the airline safety handouts that say "if you can't read this, ask someone to read it to you"...well, if you can't read, how do you know to ask?

i tell parents not to tell the older siblings of a new baby not to do something they haven't already done, like "you can't carry the baby", and things like that, because to do so might give the child the idea. so, if attorneys are responsible for these warnings, and we are a society of idiots, as it seems, is it better to tell us not to do these stupid things or should they not mention them in hopes we won't think of them ourselves? time will tell.

letters vs. words

2008-02-17T11:10:00.000-08:00

We have become increasingly comfortable in recent years in the area of assigning acronyms to diseases and disorders or viruses and bacteria. This makes them easier to refer to and maybe less scary. Or are they less scary? Is something we can't pronounce or understand more or less scary than the letters that represent it? Is the IRS more or less scary because we have relegated it to the status of acronym? I should actually change the word from acronym to initialism. Acronyms are supposed to actually spell a word that can be pronounced, like NOW for the National Organization of Women, etc., whereas initialisms are things like IRS which take some or all of the initials of something and make it a common phrase or almost a word. I looked that up, are you impressed?

What's funny is now that I know that, the whole MRSA thing has really got me going! What do you call an initialism (MRSA) that people, usually on the news, have begun to pronounce as a word, like MeRSA, or MaRSA, when the 'e' or 'a' is nonexistent, not just silent? You call it an attention-getter, a catch phrase, a buzz word, a lead-in, a hype...One would conclude from watching the news (another acronym, by the by) that if you don't die from the flu this year you're bound to succumb to MeRSA or RSV or AIDS. The FDA is making a new PI for the old AD's and NSAID's because of AE's noted in RS's of UD. I made most of that up, but it's jargon for the fact that the FDA is "re-looking" at old drugs based on retrospective studies of usage data. The news talking head doesn't know that, he or she just knows the initials and leaves the rest to you to decipher.

So, is methicillin resistant staphylococcus aureus more or less scary than MRSA? Would Kelly Ogle be able to repeatedly say the "non-initialism" and therefore it would be the problem that it is vs. the BREAKING NEWS STORY it has become?

The lay (nonmedical) public's understanding of microbiology is pretty minimal, and if I wasn't a doctor, mine would be, too, I'm sure. But THE FLU is a virus (not, "I hope it's just a virus and not THE FLU."). RSV, initialized from respiratory syncytial virus, is also a virus, obviously, hence the name and the 'v' on the end of the initialism. Viruses are myriad - there's a gazillion of them, more or less. From the common cold (rhinovirus most often) to the stomach "flu" (another misconception - "I thought he had the flu, but he wasn't throwing up", the real live influenza virus isn't known for causing vomiting as much as high fever, body aches, sore throat, cough, so stomach "flu" is a misnomer, but the most famous in kids is rotavirus, another, famous on cruise ships, is the Norwalk virus), some are petty and to be endured until they go away, while others, like herpes simplex, to quote Eddie Murphy, you keep "like luggage". Then there are the scary viruses, like HIV, an initialism for human immunodeficiency virus, which causes AIDS, an acronym for acquired immunodeficiency syndrome. It can kill you. Some are more in the middle, like hepatitis A, which you get and get over, not to be confused with hepatitis B, which again is like luggage, and even like HIV, can kill.

One must not only differentiate between viruses and bacteria, but between diseases and their causes. AIDS is the disease caused by HIV. Hepatitis is a liver disease caused by a few different viruses, typically, but can be caused by drugs and other toxins that are not infectious agents. Pneumonia is a lung infection and can be caused by viruses or bacteria. We typically think of it as a bacterial infection and in this case the public lack of knowledge is fed by the medical community's consistent use of antibiotics for pneumonia and bronchitis while studies continue to show that most cases are caused by viruses and no antibiotic treatment is needed. I'm guilty here, too, but hey, how do we know? To find out specific causes takes a lot of time and a decent amount of money, and the public hears pneumonia and has an expectation of at least an antibiotic, hopefully a shot, and if grandma hears about it, she thinks it means hospitals and possible death.

So, pneumonia isn't one thing, nor is hepatitis. RSV is one thing, a virus, but it causes several other things, like bronchiolitis, bronchitis, pneumonia, pneumonitis, ear infections, etc. MRSA is technically one thing, or a group of similar things.

To further clarify (?), viruses are viruses, and bacteria are bacteria. There don't seem to be as many famous bacteria as viruses lately, but MRSA is an exception. Maybe E. coli is another. There are bunches of bacteria, too, but some of them are good and play a part in our health, whereas viruses are pretty much always a nuisance if not a problem, though most of us have had exposure to way more viruses than we know. Point: there aren't any "good" viruses, only ones that don't cause problems, where there are some "good" bacteria, like probiotics, which actually help us. I may get corrected for saying there are no good viruses, maybe I just can't think of any.

Bacteria are things like streptococcus, which causes strep throat, but others with that first name can cause pneumonia, meningitis, flesh-eating diseases, etc. Staphylococcus is a bacterial first name, and here's a place for another clarification. Germs, viruses and bacteria, often have a first and last name, and some even have some letters and numbers after that. The strep of strep throat is different from the strep of meningitis and pneumonia, the first names are the same but the last name is different. Sort of the opposite of the way we are named here in the US and elsewhere. Strep is more like Smith or Jones, and the word after it tells which Smith or Jones you're talking about.

Bacteria are killed by antibiotics, or antimicrobials, to be exact, because guns could be said to be antibiotics, since it means to be against living things. When we use antibiotics for a while, the bacteria get smart and some get resistant to that antibiotic. When a bacteria gets resistant, we switch to a different antibiotic, and on and on, until something like MRSA shows up, or some strains of tuberculosis, which are "multiple drug resistant", meaning they are not killed by the usual antibiotics, and we have to pick specific ones, and then...nothing works. Or so it seems, but God didn't create us to be wiped out by a bacteria so He made our immune systems so that we can kill most bacteria on our own given time and a decent immune system, but boy oh boy, having antibiotics to help sure has made things better for the most part, or so it seems.

Viruses are not killed by antibiotics, in fact, they laugh at them. By using antibiotics in a viral infection, we have selected resistant bacteria to cause secondary infections, so that's why the first antibiotic your kid took for his "cold" didn't work and now you're on to the $100 one.

Secondary bacterial infections, ones that occur on the tail end of a viral infection, are the problem which we, as physicians, face daily. "Yes, today my child has a "cold", but I know that tomorrow it will be an ear infection, can't we just put him on something now to keep that from happening?" I'd love to be able to do that, but the timing is of the essence. If I put him on an antibiotic before a bacteria has decided it wants to cause a secondary infection, then the antibiotic will kill all the bacteria it can, leaving perhaps, and increasingly commonly, one or more that aren't killed by that antibiotic. So, I've guaranteed that the first drug won't work. How do we know when to treat with an antibiotic? We don't, always. However, a good rule of thumb is that it is better to be a little late than a little early with an antibiotic. Let one settle in a bit, and let it get rid of its rival bacteria, then go in and kill it with an antibiotic. It seems to be increasingly less common for a child to actually have a bacterial infection in the office. Moms are acutely aware of the early warning signs and perceive themselves as bad mothers if they are unable to anticipate an ear infection or strep throat and the child actually gets sick. This is a challenge daily.

Viruses, at least some of them, can be treated, but they aren't really killed like some bacteria are killed by antibiotics, they are just kept from replicating or reproducing. So you've got whatever symptoms you've got for however long that particular viral generation lasts, then you get over it. Tamiflu, for instance, works that way with influenza A and B. If you've already got the flu virus, you can start it but you won't get well in a day, it will take a couple or more to let the virus die off and since it can't replicate, it's over at that point. You can also take tamiflu to keep from getting the flu if you've been exposed. Viral resistance to drugs happens, too, and they shift pretty quickly, making the little boogers hard to hit sometimes, hence the flu shot only working on 40% of the flu virus present in the US this year.

To finish, don't be scared of bugs with initials. They are no more scary than when they had long names that were hard to pronounce. Conversely, they aren't tamed when they've been initialized either. Learn the difference between a virus and a bacteria, an initial infection and a secondary infection, and then you can make better choices as to when to take your child or yourself to the doctor and when and if an antibiotic is indicated. Antibiotics aren't all bad or all good, they are tools, and when used properly, work pretty well. When they become overused, whether by the physician or based on the demands of a patient (sometimes it's hard to separate the two, but healthcare is a consumer driven business to a great extent, and the customer has to leave satisfied...), bad things can happen. Remember, better to wait an extra day or so on an antibiotic than to start too early. There are few bacterial infections out there that are exceptions, like meningococcal meningitis, but 99.9% of the time, this caveat holds true.

Wow, I started off on acronyms and ended up with a microbiology lesson. Sorry. LOL (I don't even know for sure what that initialism means!) but it's a pretty common one in the text business. Have you seen the commercial where the mom, grandma, and daughter are playing Scrabble and they're using initialisms from texting for words? PFF (pretty fricking funny).

obesity in children

2008-02-10T16:40:00.001-08:00

Just finished reading an article that even an optimist like me can't find too many things good to say about. It reviews the literature on the role of the mother in a child's eating and the role of the child in eating and then the combination of the two. You can pretty much guess how it turned out. If it was all the mom, she could change, maybe. If it was all the kid, the kid could change or be changed. If it was all genetic, we're getting there. If it was all psychological, well...but it's all those things and more. It's the mom, it's the kid, it's the two of them together, it's the genes and the environment and whether the mother was overweight and whether they're poor or of low socioeconomic status. It's the grandma, surprise, and where she came from and whether she had plenty of food or not enough. It's the culture, it's where you grow up and the sizes of the kids around you. It's whether your kid tends to eat in the absence of hunger, something they've coined EAH, which I find amusing in our world of 3 and 4 letter confusion. I have EAH. Please forgive my obesity. I can't help it. I really do. I eat because it's time to eat more than because I'm hungry. I eat because there's food there to eat, often without regard to whether or not I'm hungry. My wife on the other hand forgets to eat. What's that? NEPH? Not eating in the presence of hunger? Maybe ADD of hunger? I just didn't pay attention to my hunger. That's never happened to me.

My advice for parents for many years, learned from experts and observation, is that if you have healthy food around the house, present it at regular times and in measured quantities (another paper I just read says that kids don't want more of a snack if it's presented in a small quantity and they can't see the whole sack of cookies, etc. ) and don't get too wrapped up in whether or not your child ate or didn't eat, you will be less likely to have an overweight child. Or an underweight child. Detach from your child's eating except as it is your job to provide it. There are two good articles to read: one from Contemporary Pediatrics on "Mother Knows Best", vol. 25, no. 1, and one from Wondertime magazine, 3/08, on "natural selection", and no, it's not by Charles Darwin, it's by Catherine Newman. The "heady" one from Contemporary Peds is the more depressing of the two, basically coming to the conclusion that it's all a crapshoot and we have no answers for you, and the other is very funny and well-written and I think speaks to most moms who either are naturally relaxed and have some common sense and faith or who take their xanax regularly, saying that you know what's healthy and just because it's organic doesn't mean you can eat more of it and don't fall prey to the "green" advertising ploys out there that make you think there's a healthy ice cream or potato chip! Good reading.

These, and many other, articles continue to make me aware that the more we know the less we understand, and I go back to Genesis where the tree of the knowledge of good and evil was the one we weren't supposed to take a bite of, but who in today's world wouldn't have done what Eve did way back then? I know I would have, at least if I'd gotten my lazy overweight butt over to it and the fruit wasn't too high up or too hard to pick or clean or cook or...

packing

2008-02-10T16:31:00.000-08:00

OK, random thought while opening a package recently: most of life is packing "peanuts" and they are there to protect the real product inside. Many, if not most, of life's experiences are packing nuts. Newspaper. Those new air bladders that I suspect are cheaper since they keep showing up more and more. Actually, the air bladders pretty much make the metaphor more nebulous and unfortunately more realistic. Most of life is just air, a la Solomon in Ecclesiastes. Our package, our life, has but one precious content, our Savior, our faith in God, our worship of Him, and all the other stuff is just packing - nuts, newspaper, air, bubbles - either protecting that precious cargo or just obscuring it from view. The more room the actual contents of the package takes up, the less packing material is needed, right? Are we the kind of package I saw at Christmas this year where one keeps opening another and another box until the tiny box is finally opened at the end? Or are we open packages, showing the contents for the world to see our God and the faith we have in a way that they can touch and feel and not just hear and wonder if it's the real thing?

OK, that's my random thought of the day. Radical, maybe. Do I do it the way I've suggested? Probably not. I'm pretty much a big old air bladder with just that tiny nugget of faith inside, hidden from all but the most curious of observers, but it's there, trust me, it's there.

who are "they"?

2008-02-09T15:49:00.000-08:00

"They say you're not supposed to let a baby sleep on his belly". "They say that you're supposed to keep a baby on formula until a year of age". "They say that kids need to be socialized earlier than school age".

Who are "they"?

They most often are people with an agenda. With the 2nd and 3rd ones above, the agenda is a fairly simple and straightforward marketing one. They want you to buy more formula, maybe you're even duped into buying a "toddler" formula. They want you to sign your kid up to go to daycare, preschool, mother's day out, or some other form of high cost babysitting and feel you're doing the right thing, and people who aren't doing it are very wrong.

The belly sleeping thing is a harder nut to crack. I can't find an agenda there. Sure, the studies show a 50% decrease in SIDS when babies sleep on their backs. They have gone so far as to say that if you really want to prevent SIDS, the baby should sleep in his crib, on his back, with a pacifier, in your room. Now who sleeps? No one. But at least you don't die of SIDS. Don't get me wrong. SIDS is a scary thing. It's the ultimate "what if". If I'm wrong on an ACL tear or pneumonia your kid's not going to die as a result.

One of my friends is fond of saying "to the best of the current knowledge" as the answer to the changes we accept as the norm in our lives today. Meaning: don't get too used to doing things a certain way, they're going to change the advice soon. Sort of like the weather, if you don't like it right now, just wait. That's the point with the back sleep thing. When I was raising kids we weren't supposed to let them sleep on their backs because they'd spit up, choke, and die. Seriously, that was pretty much the "current" thinking. Until 15 years ago when they ("they" in this case were some docs in Seattle) showed that SIDS occurred in about 12 kids out of a thousand if they slept on their bellies or sides, and only 6 or so out of a thousand if they were on their backs. Big deal if you're one of the 6 whose life was saved, but statistics have been used very cunningly in this "back to sleep" push, saying, rightfully so, that there is a 50% decrease in

SIDS if your kid sleeps on his back. But looking at it from a reverse angle, that means a kid is not likely to die of SIDS on his belly 99.988% of the time vs. 99.994% of the time if he's on his back. Does it impress you as much? I didn't think so. It's like those Lysol cans that say "kills 99.99% of germs". Well, since there are billions and billions of germs, that leaves plenty of germs around to do harm if they want. It's all in how you use statistics and the point you want to make.

Trust me, I don't want even 1 child in a billion to die of SIDS. If I came up with a cure for it, I'd be touting it, too. But we have to look at the bigger picture and consider the ramifications of a change in something. Remember the movie "The Jerk" with Steve Martin? Everybody loved his invention until they all started going crosseyed as a result of it. Actions have consequences. Nobody wants to admit that back sleeping has had bad consequences, but it has. Are they as bad as death? Doubtful. Are there many more "morbidities" (harmful outcomes short of deaths) from back sleeping than "mortalities" (deaths) from sleeping on the belly? When death is in the equation, as a parent, you don't want to take the risk. So you take out the bumper pads and you buy a positioner and you watch the news to make sure there's not something else "they" found that could kill your kid since yesterday's Oprah.

So, who are "they"? They are the nebulous "experts" that purport things on the TV or the internet or in old wives' tales and get enough exposure through the grapevine that their word becomes gospel and who are you to question "them". Well, look hard at them before you buy their line of bs. Sometimes it's just that. Sure, sometimes it's real and dangerous and if you keep doing this or don't start doing that you will be endangering your child, but the existence of people out there without scruples who will spout nonsense just to see if someone is listening makes me cynical about "them" and "they". To listen to all the stuff that's out on "health watch" and other tv news fillers one should really be surprised that people still are alive and kicking on the earth given all the dangers. We tend to forget that we were created, "fearfully and wonderfully made" I think it says, and that until God decides to put His foot down, the myriad "theys" out there are for the most part just noisemakers in a party they're trying to crash. So, go with your heart, not "theirs". There's no set of absolute rules of sleeping position, no sleep police, no formula police (though formula reps would love pediatricians to espouse their notions and some do, as well as for sleep), no preK hit squad going door to door to make sure your child is being socialized in the (currently and politically) "correct" fashion. You do what seems right and reasonable to you given your experience and gut. Remember, you can find someone on the internet to tell you that everything you are doing is wrong or right at any given time. Forget Oprah. Maybe a little Dr. Phil is OK. But quit worrying about "them" and what "they" say. You're the only "they" your kids really care about, their parents. Look for the hidden agenda in fad thinking about childrearing.

what if...?

2008-02-09T15:29:00.001-08:00

OK, I've dealt with tmi (too much information) as a subject before, but I have to return. Now it's the "what if" factor. Parents can find out so many things on the internet. They get way more information than they are ready to digest, but they don't often know that. They have no filters.

So, "what if" is a common question. One I didn't used to get 15-20 years ago, and one I bet my dad never got. What if it's pneumonia? What if it's cancer? Leukemia? Broken? Rotator cuff? Autism? So many my head swims some days. Not that the questions are always unwarranted, but they sort of take me off my "groove". I have a sort of script in my head sometimes for a visit and how I'd like it to go and when I'd like to share information about "ruling out" certain things. It really has more to do with me than with the patient, so I guess I shouldn't be so conscious of the rhythm or the tone of the visit if I answer the questions and help solve the problems to the best of my ability and to the patient's satisfaction. But the "what if's" are sort of scary in a way. What if I don't have an answer? What if it is meningitis and I didn't consider that? It is entirely possible that I haven't considered every single possibility.

When I get a "what if" it's a challenge to me and my professional demeanor and expertise, whether the patient knows it or not. Maybe I have considered this or that diagnosis, but haven't mentioned it because it is so unlikely or I'm waiting to go down my list of "what I think it is" before I get to that one and the reasons I don't think it's that. Maybe I don't even want to mention my own complete list of things I'm "ruling out" (see blog of similar name previously) to try not to scare the parents or make them think of something more ominous than they are currently thinking. Aside: we get this in screening tests in newborns fairly often. A positive screen for cystic fibrosis with a nice comment on the bottom of the sheet from the health department that though this screen was positive, it's probably nothing. Then why did you report it to me? And what am I supposed to do about it? Like the heart murmurs so often heard in newborns; if I tell the parents about it, the kid's got it forever! "What if" it's his heart? Remember he had a murmur!? How much information should one share? I'm trying not to be a facilitator of the info overload, but in this day of webmd and google, it's not like parents are blissfully ignorant unless they really want to be, and even then, they have some friend or relative who surfs the web and shares her findings with them, often using a bludgeon rather than a pillow to posit her own theories on what's wrong based on her exhaustive, though completely uneducated, research. Sorry for the sidebar. And, sexist that I must be, I did say the friend or relative who researched everything and shared it with no thought of the effect was a "she" and I did that partly by eenie meenie minie moe and partly by design, since it seems that, from well-meaning aunts and grandmothers to the lady you've never seen before in walmart, it's rarely, rarely, a man who does this. Why? I don't know. Maybe guys don't care enough to search the very best. Have you ever heard of a grandfather causing a ruckus in a family due to his opinions if he was not suffering from dementia in some form? 'Nuff said. Oh, one more. If a dad who isn't the primary caretaker of the child brings a boy, infant or otherwise, to see me, I can bet the problem is about the penis. That's pretty much what we care about! This observation has held true for many years.

More people want more tests these days to cover for the "what ifs" and there are vultures out there willing to suck you dry to allegedly make you feel better because now you know it is or isn't a torn ACL or a brain tumor or it's just that he isn't talking yet and it's not autism. Sure, I could do lots of tests on lots of patients, and I'd probably get some information I didn't have before the test, but in my experience, most tests lead to more tests rather than more answers. If all a doctor did was order tests, which it seems is occurring more and more, then why do you need the doctor? You could go to Google, type in your list of symptoms, get the tests to figure out which thing it is, then order your treatment from the online pharmacy without a prescription. I'd best not give Hillary any ideas, so I'll quit this line of thinking, but suffice it to say, we physicians have allowed ourselves to be test-orderers and pill-prescribers instead of diagnosticians and allies in health, and it's our loss and yours.

So, what if things were different? If insurance companies weren't our biggest source of income and we listened to and treated patients the way we wanted and they needed instead of the way the insurance companies and pharmaceutical companies say we should? If you didn't know about ED and Viagra unless you went to the doctor and told him your problem? If you hadn't heard of ADD and if it didn't seem to be such a convenient explanation for Billy's problems at school and what was the name of that new medicine on the back cover of Newsweek?

What if? What if we ate better and lived better, rather than longer, lives? What if we rested on the Sabbath rather than cram all our activity outside of work into that day? What if we just did nothing sometimes and didn't feel guilty? What if we let our batteries recharge and paid less attention to the crazies on Oprah and at walmart and if we trusted our Creator to know what's going on and to have a plan for us and that we don't always have to know all the answers though science/medicine is doing its best to convince us they (we?) know everything but they/we change it every once in a while to keep you guessing and to keep our profit margin healthy with a new drug or treatment? What if?

Sorry, I know it rambled, but hey...

be amused

2008-02-02T07:15:00.000-08:00

A mom the other day used a phrase that got me thinking about parenting in general. She was in with her second child, a 3 year old girl, and when I asked about how she was doing, she said "I'm amused by her sometimes".

To be amused is a good thing. It can be a bad thing if one is amused by worthless endeavors like TV, video games, and other activities that further no cause other than to take up time. In fact, "amuse" comes from the greek word muse, which means to think, and the a is added up front to make it a negative, or to not think. So, in digression and to end said digression, sometimes amuse isn't a good thing, or is at least a thing that should be done with care and with limits. However, in this case, amuse is a good thing in my opinion.

To be amused, we are usually watching something or someone, though sometimes we are participating, but that takes it to enjoy vs. amuse, so for my point, I would use amuse as a spectating word. I like to tell parents that they need to detach from their kids every once in a while, in certain situations. Step back. Look from afar. Spectate. Not on a soccer field or basketball court or baseball diamond or gym floor or any number of places where you go and expect to watch, though watching seems far from many parents' minds in these situations as they yell and scream at players and refs and kids while making fools of themselves for others to spectate.

Distance is a good thing in some cases. It allows us to appreciate things in perspective. Sometimes we have trouble seeing the forest for the trees if we're in the middle of a situation that some distance would clarify. This is not an easy thing to do, however. We are sometimes said to be "too close" to a situation, so I guess some distance or detachment is a good thing. Sure, we can get too far away, uninvolved to any extent. If I haven't blogged about it before, it's all about balance. This is one of those situations. You can be too close or too far away. Only you can decide the right distance or closeness for a given circumstance.

There is a great article by Brett Paesel in Wondertime magazine (March 2008) called in praise of lazy parenting, and it summarizes the amusement/detachment issue succinctly and humorously and is in agreement with my own laissez faire attitude to parenting toddlers and up.

So...go be amused by your kids. Enjoy them for who and what they are. Don't spend all your time trying to make them who you think they should be. If you're not amused by your 2 and 3 year olds, you are really going to hate the teenage years.

the mind of a child

2008-01-01T16:56:00.000-08:00

I learned somewhere that the mind of a child can hold two conflicting thoughts without a problem. The child does not need a reason to believe something. My childhood, and maybe yours, was filled with belief absent obvious reason other than faith or trust. I didn't ever worry that my dad didn't know where we were going on vacation, I just got in the car and went. I didn't question whether he had checked the oil or the tires or anything else. I trusted him. And he never gave me reason to not trust him.
When parents would come to visit me in the past about a child being afraid of monsters, I would tell them that it was a bad idea to put a fake label on a can of Lysol and call it Monster Spray and spray under the bed before the child went to sleep. If you were telling the child during the day that there was no such thing as monsters, how could you justify spraying for them at night? But I was thinking like an adult. Kids can handle those kinds of things. Things don't have to "make sense". Now my advice is different, and I hope that day by day I can think more like a child.
I don't need to be "faked out" to believe in God. But in our world system, there is much "evidence" that God is not real, and in a twist of the monster story above, we are asked to NOT believe in something that we know is real. The child will grow out of belief in monsters, and there are those that think that people should grow out of their belief in God as well. To put these two ideas in the same paragraph seems almost sinful, but for many people in this world, the beliefs in God and monsters are on the same level. They are wrong.
God is not limited by our reasoning. Our wisdom is foolishness to Him. We don't have to know everything, and not everything has to make sense. This may sound trite and childish, and I'll take the latter and hope to convince you that the former isn't true. I get very uncomfortable when Christians try to put God in a box and explain His miracles and put His Word into neat little outlines that fit our minds. There is a God and He is the Creator of the universe, I'm convinced of that just like I was convinced my dad had enough money for vacation and that we wouldn't run out of gas before the next stop. I had no reason, only trust and experience. And that's enough for me. When those who wish to prove or disprove the existence of God look for evidence to support their ideas, they are looking with adult minds, minds that don't believe in things they can't see, touch, hear, and examine. But they swallow things they want to believe much easier.
We choose to believe or not to believe things. Most things that we believe are things of which we really have no intellectual understanding. We believe because we are told to believe, that others believe it, others that are smarter or prettier or richer than we are. So it must be true. Belief in global warming, global cooling, recessions, the big bang theory, evolution, how kids grow up good or bad, all these are things most people have no earthly knowledge of, but most have a belief voiced as an opinion. Why do we put belief in God, in Creation, in Jesus, the cross, the resurrection, to a tougher test than the stuff Al Gore, Michael Moore, etc., put out as truth? Maybe God needs a PR person? Someone to convince people He did what He says He did, that He's in charge and that we shouldn't worry. I don't think so. Read the book of Job in the Bible and near the end, after 4 friends of Job try to explain God with adult minds and mess it up royally, God pretty much does His own PR. He says "where were you when I..." and proceeds to list many things that He created, things that have no easy scientific explanation other than that they "are", and then puts down the microphone and leaves it up to us to believe or not believe. All belief is based to some extent on faith, whether we think of it that way or not - I believe this chair is going to hold my weight, that this computer is hooked up to the internet, that I will get in my car later and it will start and take me where I steer it, etc. I trust that these things are true, not necessarily from any great knowledge of furniture or computer or automotive design, but from experience and observation. So we live our lives on the basis of belief and trust, but then when belief and trust in God are raised as questions, we tend to scrutinize and "need to know more" in order to believe, instead of just going with experience and observation, and even what other people tell us is true. Does God need a PR person? Need? No. Want? Yes. And it's me and you. We should live lives that make it easier for people to experience and observe God firsthand. If there is no basis for trust in God in a person's life, if they couldn't trust their dad like I could, then we need to be God to that person. Point out where He's working and how He's working. Not with a heavy hand, but with a helping hand, a loving hand. And maybe not even with God on our lips all the time, but inferred by our actions that will make this person wonder what is different about you. Not with an agenda of being God's PR person, but by living a life spent in communion with Him all the time, so that out of our actions it will be obvious that God is there. Try to go back to when you had the mind of a child, talk to a child, listen to a child. If you look for God, you will see Him.

choices

2008-01-01T08:30:00.000-08:00

there is a sense of entitlement in our culture. no kidding. you may not have noticed, and if you haven't, don't read any further.

the entitlement we feel we have is that we should have choices. i've written on choice before, but i was just struck again at the mess we've made in society by demanding and offering too many choices. i do understand that the things that i want to choose and the things you want to choose are going to be different, but at some point there is general agreement and beyond that it just creates chaos.

so where did choice begin? it began several thousand years ago with eve, the serpent, and the garden of eden. how long were adam and eve in the garden before this event occurred? once God told them NOT to eat of the fruit of the tree of the knowledge of good and evil, reverse psychology as a human characteristic was uncovered. i suspect it was there, but it showed its face at that point.
i really hadn't given it too much thought, but sometimes i'd wonder "what's wrong with knowing good and evil?" well, good was the "default" mode of humans until this point. there was no evil as far as adam and eve were concerned. they were truly innocent and in a good way, ignorant. evil didn't exist, so they never "chose" evil. it wasn't on the list of things to choose. so once eve ate the apple, so to speak, we were doomed to continue to add choices and choices to life until we've arrived at today.
i think i've written on my favorite bumper stickers before, but one is "question authority" and the other is "subvert the dominant paradigm". both are dependent on authority, someone or some entity to rebel against. of course, God is the ultimate authority we question, and HIs is the paradigm we so try to subvert. but we've tossed God out, sometime in the 60's or 70's, and now all we have are our own authority and paradigms on which to exercise our opposition.
at least when God was the ultimate authority, there was pretty much no question as to where He stood on most subjects. sure, we could muddy the waters on some issues, but the 10 commandments are pretty much written in stone. therefore, to try to subvert God's paradigm or question His authority one was limited to His Word as the "other" opinion.
today we have many authorities to question and many paradigms to subvert. some should be questioned and subverted, true, but to state the idea that one must always find problems with any authority or paradigm has led to the lack of any true authority in the world. there is no expert who cannot be found wrong on some point, no good idea that doesn't have a down side. there is no diet, no health food, no new drug, no government, no doctor, no procedure, against which there can be no question. and once questioned, subversion often follows.
my point? like growth charts for children, our current society, politically, morally, philosophically, is built on shifting sand. one is compared against another, like "curving" a test in school. if everyone did poorly, but you didn't do as poorly as the next guy, your grade is still good, regardless of the fact that you don't know the material well enough to pass. as long as we compare ourselves to ourselves, we will always find someone worse off than we are, and that makes what we do, the choice we make, ok, since they made a worse choice than us (based on our definition of good and bad). so...we need a point that doesn't shift. but we've decided (made a choice) to leave Him out, to pay no attention, to ignore the Creator of the universe. so we drift with our own ideas and choices, our own fallible authorities and paradigms to question and subvert. what was once considered vulgar is now commonplace, what was decidedly good is now illegal by the twisting of our constitution.
we have too many choices because we have chosen to have so many. before the garden, humans couldn't choose anything but good but there was no evil on the list of choices, but because we (i don't think we would do any better than eve) want choices, we have them. now we have to choose to do good. maybe when the dominant paradigm is evil, and the authorities all bad, our subversion and questioning will be justified.

rituals

2007-12-26T16:35:00.000-08:00

Much has been made of the loss of tradition in the family and I think that loss is a bad thing. Ritual has a place and our children are none the better for its absence. Some ideas about ritual and tradition are:

Bedtime ritual: whether it's bath, book, and bed, or some other variation on this theme, it's a good idea to have a ritual that tells a child that bedtime is approaching. Then when the time changes or you're on vacation or some other unusual situation, that ritual adds a normal flavor to an abnormal circumstance, and kids and parents alike will benefit.
Mealtime traditions: my son's girlfriend's father has a rule against kids wearing hats at the dinner table. No matter where or when, it's not OK to have on a hat at a meal.
No phones, TV's, ipods, etc., at mealtime. That's a great tradition.
There is great support in family psychology literature for the importance of the family meal. I preach on this in my office regularly. Dinner is at a certain time, at a set place, or at least an agreed upon place, without distraction, every night or enough nights that when it is missed the kids will notice and miss it. The importance of this, starting when kids are very young, is hard to overstate.
Special traditions: ice cream after church or Friday night pizza. Good examples of "sins" that most of us would like to indulge in occasionally but need to keep to a minimum. If the family goes to church on Wed. night (i'm in Oklahoma!), then a trip to Braum's for ice cream is a reasonable tradition and one that gives the parents of an overweight child or a child that isn't always making the best food choices an "out" and a response to the request of that child for ice cream or other treat. It seems like a lot of successful weight loss/diet programs have a "free" day built in - we have to have ice cream sometimes! The point is that if there is a situation where a child is always wanting dessert or pizza or something that isn't good all the time, a tradition of Wed. night ice cream or Friday night pizza is a "safe" and "legal" opportunity to indulge that can be looked forward to by that child or the parent of that child when he/she asks. It's not just for that, though. The regularity of such tradition is reassuring to children and lends more credence to the family mentality so often missing in our soccer practice society (my pet peeve).
Be careful in establishing traditions or continuing traditions. Some traditions are best left in another generation. I won't mention any in particular, but the story of the women discussing why they cut the ends off the ham before cooking it is a nice illustration of tradition continuing without reason to continue. Just be sure the tradition is a good tradition, or at least is harmless.
respond with your traditions and idea for rituals and traditions.

birthday boxes

2007-12-26T16:22:00.000-08:00

OK. I'm asking for help here. If anyone reads this and is interested, I've borrowed a concept/idea from somewhere, and if I find out where I will be glad to give credit, but here's the idea:
Birthday boxes: a box that a child opens each year. The box contains a list of privileges and responsibilities for that year or age. For instance, when can a child have a cell phone? a date? spend the night with a friend?
when should a child - empty the dishwasher? make their own bed? be responsible for their own laundry?

the idea is a good one and one that bears examination. i've ordered some books on development so i'll be an expert soon, but until then...i'd love the input of parents as to the answers to these and other things that might go in the boxes.

as far as sibling rivalry goes, this is a great concept. as far as the answer to that question your child asks at just the wrong time in just the wrong company, this will be helpful.
with siblings, the eldest is the one who "shovels the path" and then the others are coming up quickly behind and getting the benefit of the plowed road without the work, metaphorically. so when you decide that your 8 year old can spend the night with a friend but the friend has a 6 year old who is a friend of your 6 year old, it's pretty easy and tempting to let your 6 year old spend the night, too, right? but is that fair? ok, nothing is fair, but the birthday box idea puts down on paper these sticky questions and adds concrete to the ideas we have but so easily dismiss in the heat of the moment.
so...what can kids do at various ages? it's easy up to 5 years or so. but when do they get a cell phone, ipod, computer...? you might want to put "electronic/digital media device of current technological significance and popularity" to cover for the fact that my parents wouldn't have thought to put an ipod in my 48 year birthday box! you get my meaning. things are moving too fast to put the specifics down for certain things, but the basics will apply forever - spending the night, going to a movie, going on a date...
help! i'd love your comments.

true love

2007-12-01T15:44:00.000-08:00

I read an article in People magazine today. I know, my wife bought it, I wanted the National Enquirer that told whether this or that celebrity was gay or not. I'm not sure if the opinion is that it is a good or bad thing anymore, and as they say, any publicity is good publicity, but I hope I'm never on a cover with that title. Well, there was an article in the back, behind all the junk about stars and what they're wearing and who they're seeing and used to see and have procreated with and the progeny thereof, etc., that struck my fancy.
At first, from the title "Her Husband's New Love", I thought, "here we go again, a cheating husband, a scorned ex Supreme Court Justice. But the very short story, tucked between stupid crap like Wheel of Fortune's 25th anniversary and Wayne Newton's heart problem keeping him from "Dancing with the Stars" (funny, I thought it was his dancing that kept him out of that), was about Sandra Day O'Connor and her husband. He has Alzheimer's, she resigned from one of the most prestigious and unassailably secure jobs in the world to take care of him, her husband of 54 years. Wow. I'm a fan already. She deserves praise and recognition for that, more than on page 129. But since she didn't kill him or try to kill him, and since he didn't meet someone online and leave her, it's in the back. But it's a great story.
True love. Jesus said "Greater love hath no man than this, to lay down his life for his friends". At first you think He's talking about dying, and I suppose He was/is, but laying down a life while living is maybe harder. See my wife's blog at feedingthespirit.blogspot.com and read more of that on today's post. Well, Mrs. O'Connor's hubby, the one with Alzheimer's, has moved into a facility where he gets the care he needs around the clock. This is not a copout for her, to care for patients like this requires more than just a loving spouse, and I'm sure this place was well researched before she sent him there. And she visits him there a lot. Heck, she quit her job to help take care of him. So, when she visits, he doesn't remember her. Doesn't know they've been married for over half a century, or that she was one of the most powerful women in the world. She's just a lady who comes to visit. And he's got a girlfriend. Yes, that's probably why People picked up on it. He's got a girlfriend he met in this facility. When Justice O'Connor goes to dinner with him, he often brings the "other woman". Does the Judge go bonkers and demand separate facilities or a restraining order for this hussy? No, she approves of it. She understands that he doesn't know her and what he is doing, and she cares more about him than about herself. That is laying one's life down for a friend. That's true love. I'm sure there are many stories like this around, but unfortunately, they don't get publicity because we want "dirty laundry" as Glenn Frey or Don Henley sang, it was one of those Eagles.
True love. What a concept. What a visible example in this day of wanton selfishness of which I'm as guilty as the next guy to look at the car wrecks and divorces and arrests and addictions instead of the good stuff. Jack Johnson sings a song "Where did all the good people go". It's real good.
Way to go, Judge. If I published People, you'd be on the cover.

ADD

2007-12-01T09:22:00.000-08:00

No wonder everybody's got ADD now. You can hardly go into a restaurant without a TV being visible from every seat. The distractions offered are often mundane reruns of football games now, but they are distracting nonetheless.
Unless you go to a pretty upscale restaurant you'll be assailed with the option of talking to your tablemates or watching the TV. Maybe it's ingrained in our brains now, but TV's are hard to ignore, harder than ignoring our spouses, it seems. Funny how it seemed the other night that if I asked to have the TV turned off I would be breaking some unwritten taboo of the restaurant, though the other tables nearby didn't seem any more interested in the rerun of the game than I was. Why was I so afraid to ask? Why don't I just tell them to turn off the TV by my table if everyone around agrees? Or if we're the only ones there?
Even when I make rounds in the hospital to see newborns, the TV is almost always on, regardless of the time of day or the program playing. It's just like background noise. It's a rare occurrence now that a mom or dad turns it off while I'm there. Some turn it down, rarely off. Maybe they don't have ADD like I do when I'm in a restaurant.
Now in a sports bar or a sport-oriented restaurant it's expected that a TV will be playing, and several games/sports may be offered at once depending on how one wants to be seated. I've even gone to specific restaurants to see specific sporting events. But when I'm going out to eat at a reasonably nice place, does there have to be a TV in every corner? Is it that the management is told from the owners that TV's were high on the opinion poll they did so they added them in response to the few people who fill out those surveys? Who knows? They are there and they are hard to ignore. If they weren't there, they'd be easier to ignore. Am I the only one who has noticed this or been annoyed by it? It seems to be a cultural trend to provide some sort of visual or auditory entertainment at all times and if one is left in the quiet with one's thoughts or one's spouse or friends it is an affront to societal norms. People might start talking about important stuff, make important decisions, have quality relationships, and who would that benefit? We might actually listen to each other, or read, if noise of an auditory and/or visual nature wasn't a constant presence. Is this subversive? Are they sending subliminal signals through ESPN? I doubt it. In fact, I'm pretty sure it's just because we swallow whatever they put in front of us most of the time without question and we watch because it's there, not necessarily in the same vein that people climb Mount Everest because it's there, but similar.
OK, off to watch TV.
Just kidding. In closing, I'll share my favorite 2 bumper stickers from a previous life in Boulder, Colorado, where things like this are debated on the editorial page as if they matter as much as who the next president is going to be (and maybe they're right, since TV will at least play a major role in that process): Subvert the dominant paradigm, and Question Authority. As long as it's not my authority you're questioning or my paradigm you're trying to subvert, these appeal to me. At least I'm honest.

pro-choice

2007-12-01T06:57:00.000-08:00

OK. Another teaser title. I am definitely pro-life, make no mistake, but this is about other choices, not the life and death ones.
Parents want a say in their kid's medical care. I understand and respect, and even expect, that. They can go and get another opinion, they can challenge diagnoses and medication choices. In this day and age of insurance Nazi tactics, they are forced to do things they don't want to do to get to where they need to be. But that's another rant.
My wife likes to decorate and design, to put her "touch" on things to make them more beautiful or functional or both. She is very good at it. In buying or building a home, she has definite ideas. She knows what she wants and why she wants it. I've learned, at least most of the time, not to argue. The builder or tile-setter or painter or concrete guy or landscape designer or plumber can give her good reasons why her ideas can be done or cannot be done. And she's good at listening to them and usually agrees if they disagree. She doesn't, however, usually inspect the work of the guys who dig and lay the foundation and pour the slab, prepare the ground before these things occur, or have much input into the earliest stages, stages that make a house stand up to high winds and rain and tornadoes, etc. She trusts that they are doing that part right. They are experts, and she's chosen them because of that expertise, and her (and definitely my) lack of it in these areas.
To my point: Parents can participate in all decisions about their kids' healthcare if they like, but there are some areas in which the expertise of the physician should be trusted and left to faith since they (usually) chose this physician because of his or her expertise and reputation. Let them pick the wall colors and ceiling fan stuff. Stuff like which formula to feed, or whether to breast feed, but one must feed the baby. They can choose the crib and bedding, but let the doctor tell them how to let the baby sleep there. To school or not to school, fine. But you must teach. But it's interesting how people seem much more willing to argue with a doctor vs. a plumber over the best course to take to solve a certain problem. Granted, the parents live with the child. Well, at least one of them usually does, and when divorce happens, it's like two people whose interests couldn't be reconciled together trying to build a house apart and wondering why it looks like neither of them wanted. Once again, another rant. So, firsthand experience with the child and the behavior or illness is very important, and should be something the doc takes seriously. But then let the doctor tell you what to do some times. Not every time do you have to go with that, but the vast majority of times we know which ceiling fan will work in this room and why, and if you insist on the one you want because you heard about it on Oprah or the Today Show, don't come running to me when it falls out of the ceiling or gives you a buzz haircut because the ceiling isn't high enough for it. Parents are fearful, for instance, of steroids for asthma. Concerns about growth failure and immune suppression abound. Same with immunizations. But docs do have a little experience dealing with asthma and what works and why and why an inhaled steroid might work better for your kid than Singulair or vice versa regardless of what you read or saw or your neighbor told you or your good friend the urologist whose asthma expertise never materialized to begin with. Deep breath. It might do parents some good to listen to their docs more before putting in their two cents, and I agree the reverse is true as well, but if parents listened and did what the doc said, then if things don't work out as forecasted, it's the doc's fault. If I recommend a course of action and you take it and do it as I've prescribed, and it doesn't work, shame on me. I'll be doubly invested in finding another way that works for your child. If, however, you've already picked the road to take and I let you go down it, when it dead ends into failure, my first response is going to be outwardly, "gosh I'm sorry that didn't work out like you and Oprah thought it would", but inwardly know that I'm saying "if you had just listened to me this might have worked out differently". Those who know me recognize the "good luck" theory in practice, and I'm more than willing to be the "parent" in this scenario, but I hope that the "kids" learn from their mistakes.
I absolutely do not want total control of my patients. It scares me to think that some people go home and do things just like I told them to because I am so not used to that that most of my advice is 50% tougher than it needs to be to compensate for the 50% compliance rate expected of most parents. And I expect my parents to have, and use, brains. Theirs, or someone else's if need be. If they are seeing a problem that worries them, they are to call, or email. If it's a bad problem, like an allergic reaction to a medicine, they should stop it and call. But to follow my instructions blindly is not my intent. To tailor them to their liking is also not my intent. It's amazing how many constipated kids on miralax get better so guess what? Their parents stop the miralax, then they call and wonder what happened. Did you ever think the reason billy was better was the miralax? Or that the Singulair they've been taking is why they've not had any cough or wheezing? I'm all for keeping kids off medications if possible, but if not possible, and proven not possible, then just give it! It would be like me telling the builder that we haven't had any water problems yet so don't go ahead and put that roof on that we had planned, we don't seem to need it, and it really costs alot, even though there has been no rain! Or since we haven't had any burglaries we can just get rid of our security system - maybe that's why we haven't had any problems!
Enough on this. If the point isn't obvious, let me restate/summarize. The doctor is at least allegedly the expert in medicine, so let the doctor decide what's best, given your input, and go with what the doctor says, and see how things go. Your doctor might faint if you say "you're the doctor, just do what you think is best", but he/she will appreciate it. That may be why my dad, a pediatrician in another era, could see 80 patients in a day, and I'm busy with 40!

the rant

2007-11-22T08:13:00.001-08:00

Sometimes I see things better in word pictures. These come to me sometimes out of the blue and other times are provided for me by my observations. The current series of VISA checkcard commercials has given me a wonderful metaphor for our lives today. With all the people scurrying around in dancelike, trancelike harmony with everything and everyone juggling perfectly until someone chooses to pay cash or write a check, then everything goes to hell in a handbasket.
In our busy lives we are so much like this. We schedule things so closely that we need everything to go the way we planned or everything crashes down around us. We plan vacations for short school breaks to take our kids places that they only want to see because their parents think they need to, and they leave right after school and return the night before school starts back, and the "break" is definitely not a break for anyone but the bank. Why do we do these things? Why are we so busy? Another provided metaphor is from "Field of Dreams" with the famous line "if you build it, they will come". And come they did! If you offer it, they will sign up. Whether it's gymnastics or cheer or soccer or baseball, you name it, they'll come. They'll sign up and buy a uniform and commit a 3 year old to a year's worth of lessons when all she said was "I want to be a cheerleader, mommy". She doesn't have to start at 3 to be a cheerleader, or does she? Every parent thinks their child is going to be a professional at their activity, or at least get a college scholarship. The disappointment starts when Junior would rather climb a tree than kick a ball, or little Sally doesn't want to go to gymnastics anymore when she could be so good if she would just practice.
We've idolized sports. Not just sports figures, but sports in general. Parents are reprimanded by friends if they don't have their child signed up for at least one sport per season by the age of 3. Have you ever watched 3 year olds play soccer? Or play anything? Herding cats is easier than getting a 3 year old to figure out which goal he's supposed to kick the ball into or which way to run after he hits the ball off the tee (who invented tee ball, anyway?). The best that can come of such an activity is that you have the next Tiger Woods or Andre Agassi or Alex Rodriquez on your hands, you'll be set for life. But far more likely is you'll give up precious family time and freedom in your life and end up with a kid with a stomach ache or sore shoulder or chronic injury who was so good at baseball at 12 but now is either burned out or injured so that college scholarship is down the drain and you're stuck paying shrinks and orthopods to fix what you messed up.
Then there's school. Who doesn't want their child to excel in school? Let's start really early with Baby Einstein and teach her some Spanish and she'll be way ahead of the other kids. Guess what? She doesn't want to be way ahead of the other kids! She wants to be just like the other kids. So if you want your child to do some of the things you want her to do, and act the way you'd like her to act, don't send her to school until you have to. Once you let them have her, you're having to explain evolution and gay rights and tolerance and you don't even have solid opinions on these subjects yourself. You'll have to listen to "teachers" at preK tell you he has trouble focusing, or she can't sit still, or he seems uncoordinated. You'll bring them to me and I'll tell you they're fine but you'll have a friend who will tell you to take her to this or that doctor who will give them some therapy regimen and a diagnosis or medicine that then you want me to write the prescription for because otherwise your insurance won't pay for it and you'll say that you really trust me but you just felt like you had to pursue this, yada yada yada.
Face it, your child is probably not going to be a professional athlete or a national merit scholar. He or she is probably going to be just a normal person with normal intelligence and aspirations. If you set up your expectations in another way, you will be disappointed. You will also make your child crazy or depressed or anxious. They will sense your frustration with quitting soccer at 6 or not making the classic team or not wanting to spend 20 hours a week at the gym or ice rink to "go to the next level". Let them be kids! Enjoy them! Don't you remember? I do. I was the gifted piano player with perfect pitch but I wanted to climb the mimosa tree outside the piano teacher's house more than I wanted to play piano at age 6, so I quit, and now I wish I hadn't, but you know, it's OK, I'm OK with it. It would be great to know how to play piano, but not being able to play piano hasn't made life unbearable. I've made it just fine and found other things to do. I've channeled the tree climbing into more cerebral activities and I've been able to stick to some commitments long enough to see them pay off.
So...relax and let life come to you. You don't have to "grab for the gusto". Don't worry that you'll miss the chance for your child to excel at something. Rather, enjoy life. Enjoy your kids. Come home and kick the ball in the yard. Ride bikes. Teach them to hit a ball. No teams, no practice, no schedule. Do it because you like it, and they'll like it, too. You were not allowed by God to have children to schedule every minute of every day just right and if you don't you're going to hell. You were given children to enjoy, to instruct and train in what's right and in the truth about Who created them and this marvelous planet we live on and why we want to be nice to other people and let them ahead of us in line sometimes and share, and not be so tightly scheduled that if your kid breaks his arm or gets pneumonia you'll be more concerned about your child than the plans their misfortune messed up.

x rated

2007-11-22T06:05:00.000-08:00

OK. Teaser title, I know. But it is about 'x's.
What season is upon us? Christmas, right? So when you see Xmas, the X stands for Christ, right? All my life I've avoided using this abbreviation. I'm sure someone told me it was wrong or bad or something, but whatever it was, it stuck and to this day I write out the whole thing, not wanting an 'X' to stand in place of Christ. It's kind of funny how there are things like that, things that have become a part of me of which I do not know the origin, but I feel very strongly about and would defend even without good reason because I grew up with that thought or belief. That's another topic too vast to study today.
Now I find I'm faced with another 'x' dilemma. It's been around a long time, too, but has just started burrowing into my conscience and consciousness. My address ends in Crossing, and the post office even abbreviates it 'Xing'. One could use the same logic I used with Christmas and say that the cross is what Christ came for to this earth, and it is no more appropriate to substitute an 'x' for it than for the name of Christ. But there were crosses and crossings long before Christ's death on the cross, and the word cross is used regularly without any blasphemy in describing a mood, a journey, a meeting of two roads, and so on.
I must admit that using 'x' instead of cross in crossing in my address is much easier, and since the post office seems to be approving of it, even encouraging, I'm tempted to continue.
But there is a difference. To substitute 'x' for Christ is not a good thing in my opinion. Maybe it makes sense in making signs, fewer letters, easier to spell. But the 'x' in xmas stands for Christ, and to my knowledge, there weren't any Christs before Jesus and none after, and the word means what it means and stands for the Savior of the world, so to leave it out for the sake of signage and spelling when it is the sole reason the holiday is celebrated is to insult the One who came and died on a cross, spelled out or 'x', for me and you, so I'm staying away from xmas in favor of Christmas, but if it's ok with the US Postal Service, who now seem not to even care about the city where one lives as much as the 5 or 9 digit zip code attached, I'll keep abbreviating Crossing as Xing.

parent used to be a noun

2007-11-18T07:18:00.000-08:00

When did "parent" become a verb? Sometime before I started pediatric practice 20 years ago, but not too long before. It used to be that you were a parent, it was something you were vs. something you did.I guess when you were a parent back in the day you did it, too, but maybe you weren't so conscious of the doing part, more just the being part. The realization of the daunting task of being a parent and doing the job of parenting has made for some interesting problems. Every decision we make could affect our children now or in the future. We hear about people whose lives were affected by things their parents did and said. Some of those people were damaged irreparably, others seem to have made lemonade out of their experiences. Some are nondrinkers because their dad was an alcoholic, others are alcoholics, too. It seems to depend less on the experience than on the person.
To look ahead as a parent of an infant and to think of the many decisions that will need to be made and the things that need to be done in order to make sure this child grows up to be a mature human being who is socially and fiscally responsible and God-fearing and a good wife/husband/mother/father, can make even the bravest person cringe in fear. I don't think God does things like that to us, we do it to ourselves. He hands us "bite size" pieces of life to handle, then He hands us the next thing, and so on throughout life. Maybe what we are doing to ourselves as "verb" parents who think we really control our child's destiny is to believe what the serpent told Eve in the Garden - that we can be gods, like God, and know right and wrong. To see, or to think we see, the future and what must be done, that's what the serpent was offering, and it probably sounded good to Eve at the time, and it still sounds good to us. Maybe nowhere does it become more obvious than in the anxiety of parents.

it happened back then, too

2007-11-17T15:56:00.000-08:00

I'm reading a book set in the 14th century when monks were the doctors and nuns were the nurses and people who needed medical attention were either treated by these monks and nuns or by the barber/surgeon who knew how to fix things like bad cuts and broken bones or the "wise women" who knew about potions for pain relief, bellyaches, etc.
Since the Church sanctioned the monks and nuns and not the barber surgeons and wise women, guess who were considered the experts? Of course, monks and nuns. But, just as today, as 80% of people in the US are using some sort of alternative or complementary medicine, like supplements and herbal treatments and chiropractors and naturopaths, and many others too numerous to mention, people in the 14th century had their own opinions about the experts and the braver or more rebellious of them voted with their feet and went to the alternatives for their fixes.
The monks at that time "bled" people and felt that would cure illnesses by releasing "bad humours" and probably like today, people got well despite their treatments, rather than as a result of them. Poultices with goat dung and other ingredients were applied to wounds and burns to "bring out the pus". It's so easy to criticize that ancient method of bad medicine. But it was the prevailing theory at that time. Some physicians from muslim countries were figuring out things like contagion and sanitation, but of course they were "heathen" and their treatments were regarded as such.
Fast forward to today, where the standard treatment for a common problem, high cholesterol, is a medicine which causes a deficiency of coq10 which weakens the heart muscle so the patients die of heart failure and not the high cholesterol. Or the medicine causes problems in thinking in the elderly, a population with enough problems thinking without the help of medicine. Superbugs are being "created" and then the hungry media eat it up and scare people into thinking every pimple is a deadly disease.
But the current medical establishment is very much in favor of a pill for every ailment and a test for every symptom, and even with no symptoms, a screening test to look for problems you might not know you have. All this with the assumption that man can fix all of his problems as long as he has a diagnosis. And that diagnosis can probably be blamed on someone or something which you can sue or at least blame for your condition.
So, 600 years ago the medical establishment offered bleeding and goat dung poultices in the name of science, and now we offer statin drugs and antibiotics and mri's and genetic screening tests in the same name. My wife is very wise and says that what we are doing is the best that we can do with the information available, but are we? John Mayer, a singer-songwriter of a younger generation, has a line in a song that says 'if you trust your television, what you get is what you got, 'cause when they own the information they can bend it all they want'. In the 14th century it was the church that owned the information, and today it's big medicine and the media, and together, wittingly or unwittingly, they are making people sicker, or so it seems to me, and the brave and rebellious are seeking help outside of the "normal" channels and are questioning what we, as medical practitioners, are doing. Are people getting well because of or in spite of what we do?
I like to tease a naturopathic doctor of mine that we have our box of treatments and tests, and that "they" have theirs, but that over the years we, as allopathic "western" physicians, have taken things out of their box and made them ours and take credit for them, whereas they are limited by the lack of prescriptive privileges from stealing anything out of our box (if they even wanted anything out of it!). Examples are probiotics, omega 3 fatty acids, antioxidants, just to name a few of the "newer" more popular things now touted by md's who a generation ago said they were hogwash. And I'm not innocent here, lest you think I've known this all along.
More to come on this most definitely radical thought.

tornado time outs

2007-11-17T14:59:00.000-08:00

OK. I'll catch heck for this idea, but what's a blog for?
You know those "safe rooms" everybody seems to be putting in their houses? I'm really talking more about the concrete rooms above ground in the house than the "fraidy hole" basement rooms, but they could work, too.
How about making those rooms work for you year round and year in and year out instead of just when the weatherman says to "take cover".
When designing the room, put a drain in the center of the floor and slant the floor toward it for drainage. Pad the walls like in gym at school with something like wrestling mats. Splurge on a video monitoring system for the room if you like. A metal door with a small slot in it is a necessity, too.
So, in infancy, at the fussiest time of the evening and he won't quit crying and you've tried everything and you're beginning to understand how people could shake their babies, put the baby in that room in a nice crib or pack and play, shut the door, and go take a shower or weed the garden or listen to some music. Not neglect or punishment, just a little separation for sanity's sake.
Toddlers will do well in time out in such a room, with the drain and the padded walls and video surveillance, and making a child's room safe for time out is pretty hard and moms often wonder if they will associate their room with punishment, so this is the ticket. This technique will work through early childhood.
In the grade school years, maybe something could be put in there for a good study place. The distractions could be kept to a minimum and homework might be easier and more separate from the rest of the house. Staying on task would be easier away from the TV and the bustle of the home, and perhaps the child would be more likely to want to finish quicker to be able to join the family activities - not that homework is punishment, but that it needs to be done and done in a timely fashion, and distractibility is on the rise! I'll write my opinions on how much homework kids are asked to do in a later blog.
Now for the teenager: either a cool place to get away, listen to music and not bother the family, or a good place to do a more serious "time out" if needed. I've got friends and patients dealing with kids who are not bad enough or old enough to go to jail but are continually getting in trouble and causing the family anguish and endangering themselves. In these cases, the metal door and padded walls and the slot in the door would come in handy. This is probably illegal, and I'm sure many child psych folks could shoot holes in this idea for this age group, but it sounds good! Put him or her in there when they won't stay home or when they are threatening suicide, lovingly tell them it's for their own good, then shut the door and let them out to use the bathroom and you can put food through the door slot. Well, it sounded good.
Maybe it's a little much for the teenage "prison" but the quiet room and the time out room and the study room and the crash room are certainly things that aren't impossible to do. Give it a thought.

birthdays

2007-11-17T14:38:00.000-08:00

Parents, listen to me, save your money. One year olds, two year olds, even three year olds really couldn't care less about a big birthday party. They sense your tension to provide the perfect party, cake, gifts, place, guest list. I'm really concerned about what these kids' weddings will be like when the mom spends so much time and money on a toddler's birthday!
My crass, "guy" idea is that for the first birthday you tell people to pick out the gift they would have bought, then give the child the money instead, put it aside, save it. Do the same for the second and third birthdays. By the 4th, the child may actually care about some of the aspects of the party, so spend some of the cash you've saved on a cool place or party or gift, or all of the above. There will be money left over. Continue having most of the relatives give money. Oh, 3 year olds seem to care more about the cake than the gifts or the party, so splurge on that at 3, otherwise keep it simple. By the grade school years, there will be friends from school, church, etc., so some sort of party is probably necessary, but this is not a "keep up with the joneses" deal. A simple party is plenty. Watch MTV "My Sweet 16" to see what kind of brats are being created by some parents with more money (or credit) than brains.
If you know my teachings, you know the concept of Frontier City before Six Flags and Six Flags before Disneyworld. Think of birthdays like this. You will always tend to try to top the last birthday so don't take your three year old to Disneyworld without considering you're going to have to get passports to go to Jamaica or Europe or something once you've set that precedent. And you may have more than one child, so think about "remember what you did for ....'s birthday?". There is a limit. Be kind to other parents. Maybe you should get together with your friends and discuss this subject before susie's mom has a princess party for her at the Disney on Ice performance and you're scrambling for something to top that!
Enough on this, just a final summation and admonition: Think about the long term, not just this year or this child. Think of other parents perhaps less fortunate who may well be pressured to go into debt to satisfy their little susie.
And one idea - as kids get older, try doing "giving" things for birthdays, such as organizing a yard cleanup for a little widow in your church or town, or picking up trash at a park and having pizza afterward. You'd be amazed at how memorable such a party would be, and not just to the kids and your wallet. Let your faith shine, especially to your kids. We tend, at least I do, to profess a faith that too quickly gets tossed aside when such things are facing us. Be creative

why every mom should spend a day with me

2007-11-17T14:14:00.000-08:00

Every day, moms come in and it is obvious that they think they are the only moms with the concerns they have. Whether it is an illness or a behavior problem, to them it seems that their kid is the only one with the problem or illness. Many problems are not things moms admit to each other at the gym or the soccer field or at school or work with other moms - things like bedwetting or suspected depression or drug use in a teenager, or a toddler whose fits are bringing her to tears. To show weakness in our world today is considered poor form. To not have all the answers and all things under control in your world is somehow a sin.
So, if it weren't for the almighty privacy laws, which could probably be waived under the right conditions, I wish moms would spend just one day with me. Some might need more, some less. But about the 3rd checkup where the baby isn't sleeping or is sleeping with the parents or the toddler keeps getting up and coming into the parents' room or the child is always sick when he goes to his dad's house or the grandma is driving her crazy pressuring her about the potty training or the child not eating or...you get the picture. I think it would be enlightening for them. Freeing in the way that finding out other people struggle with the same problems and thoughts that you do is freeing. This is not to say that I can solve the problems, but as I get older I realize that the acknowledgment of the existence of the problem and that it may suck, but it's shared by many others, is better than a quick fix. The visiting mom may gain insight from another mom's ideas, or have an idea about the problem that the other hasn't considered.
It's just an idea, one that may never materialize, but I think there's merit in the thought. Parent groups meeting after hours meet some of the need. But so many "regular" people don't come to those, only those who recognize or admit they have big problems, and are willing to seek help from others. I would love to have well child check counseling sessions for different age groups as a group format, to teach and answer questions and let the moms answer each other's questions. Just an idea.

small thoughts

2007-11-16T06:34:00.000-08:00

it's amazing how people didn't mind taking so much medicine until they started having to pay for it.
when you feel forced to do something, you look for ways to sabotage the situation. (remember this, moms and dads, your kids do this everyday)
We can all see God in exceptional things, but it requires the culture of spiritual discipline to see God in every detail. Never allow that the haphazard is anything less than God's appointed order, and be ready to discover the Divine designs anywhere. that's an oswald chambers' quote.

rule out

2007-11-14T04:39:00.000-08:00

Let me tell those of you who are not physicians a little bit about medical school.
Those big thick books about anatomy and physiology and biochemistry and pathology and lots of other things are full of information. When I was in med school, I think computers had been invented, but I'd never seen one and never dreamed of owning one. Nor did I dream that all the information in those big thick books would fit on a piece of plastic the size of my fingernail, and it never dawned on me that this information would be of interest to anyone besides a physician and perhaps the patient with the problem described in the book.
That said, the 2nd year of med school is pretty much all about what can go wrong with your body - pathology. I distinctly remember going home every night pretty sure that I had some strange tropical disease that was very rare but whose symptoms were headache and fatigue, things that are common to the average person. But I attached those symptoms to the disease I had just studied. Every night, pretty much, no lie. Later, as a pediatric resident, my wife would ask me at what age our children would need to be before she could stop worrying about the diseases I came home and talked about having just seen in the hospital or clinic that day - cancer, meningitis, cystic fibrosis, you name it.
Well, the thing that helped was something we are taught, or at least we used to be taught, in med school. The differential diagnosis is a list of the possible things that could cause the symptoms and findings in a person a doctor is seeing. If you watch House, that's what he writes on the board, weird ones and all. Then the most difficult and gratifying part begins, ruling out various things on the list that the patient doesn't have. "Rule out" used to be a diagnosis, actually, or we used it as one. It was a temporary diagnosis if you thought they had it but the test wasn't in yet, like "rule out strep throat" or "rule out meningitis". Then there are the times it was used to mean you didn't really think they had something but they, or someone else, thought they did. "Rule out brain tumor" was a justification for a ct scan for a headache. It gave the reason for the test, but was more often code for "I don't think he's got one but I have to test for it".
Now we aren't allowed to use "rule out" as a diagnosis, we have to list the symptoms or signs, or we have to say "suspect", like "sepsis suspect" instead of "rule out sepsis". Sounds legal, or illegal.
But the "rule out" is what the average person Googling his or her symptoms on the computer doesn't have. One gets a list of the differential diagnosis, admittedly longer than one I would come up with generally, but doesn't help with the "rule out". Why you DON'T have MRSA. Why your headaches are not likely to be from a brain tumor. Why your fatigue is lack of sleep rather than African sleeping sickness, or even West Nile virus. Ruling out is very important. It's as much an exercise in common sense as anything. Discernment might be a better word. And a base of knowledge is necessary to "rule out" things. One doesn't always have to have a degree in medicine to do most of the "ruling out". An experienced mom or grandma can do it quickly and efficiently. Unfortunately, many have lost their common sense in the face of the daunting amount of possible diagnoses that exist. It was so much simpler when all we knew was appendicitis or strep throat or earache. Now there's intussusception, MRSA, and cholesteatoma to add to the list. There's IBS, IBD, CRAP, UC, CD, and a host of other acronyms to consider when a kid has a belly ache. There's mono and sleep apnea to consider with big tonsils, and auditory nerve gliomas to account for when considering the cause of hearing loss.
The best thing I learned in med school is "common things occur commonly". I've heard preachers use a variation on this when telling people how to study the Bible - "the plain things are the main things, and the main things are the plain things". Another adage that has helped is "when you hear hoofbeats, you should think of horses, not zebras".
I'm not advocating for patients to quit researching their problems, believe me I've been bailed out plenty of times by a patient whose interest opened up an area I hadn't considered. And patients should be more informed about diseases that they have, even more so than the doctor in some cases.
Finally, and in summary, having information in the form of lists of possible diseases whose symptoms matched the search criteria you listed dumped on you like a load of rock for you to sift through hoping to find something meaningful is not particularly helpful. You need to learn the art of "ruling out" certain things. This requires work, and can be helped along by your local medical doctor (LMD). But to learn it, regardless of the work, and even if it involves trusting someone else's expertise, is a source of peace for many.

the answer

2007-11-13T05:25:00.000-08:00

On this same blog there is another, "feeding the spirit". My lovely wife has summarized the answer to the questions and problems I posed in my first blog, tmi. The solution is so simple, and it cuts to the cause of the original problem. With more info we think we will be able to solve problems, but the real problem is that it is like peeling an onion, there is always another layer underneath, and it brings tears to our eyes. We must get to the Source, and surrender to the Creator of all, who promises to bear our burdens with us (read "for us") if we will but give them to Him. But we want control! And knowledge is control, right? Wrong.
It is the willing surrender of the "need to know" that allows God to give us the information we need, in a form we need to see it, at the time we need it, and perfect for the situation. As it is always with God, once we surrender, He works it out perfectly. Today's "feeding the spirit" references an event where Abraham allowed God to guide him, without all the "info", and by his surrender and willingness, he was blessed, and subsequently so are we.
Is this scientific? Medical? Psychological? No. But to quote Dr. Phil, "how's that working for you?". Has the "onion" of science or medicine or psychology been successfully peeled and revealed the answers and solutions? No. Only more layers and more tears. At some point, as parents reading this blog, we come to a point where we must take our own "Isaac" and present him/her to God. He will take it from there.
The willingness to not know is a very freeing thing. And when in the "not knowing" we are trusting God, we will truly be free..

tmi

2007-11-09T19:20:00.000-08:00

You've heard of TMI, right? Well, it's real. scary real. With the internet, news on tv, in the paper, on the radio, it's nearly impossible to avoid being overloaded with information. Fear is easily awakened and hard to put to rest. Many people, especially children, exposed to unfiltered, unexplained "facts" presented as truth or just as pieces of information, are unable to decide which to believe, which to worry about.
Many people feel that they need to know as much about everything as possible. Search engines, like Google, have made such knowledge readily available with little effort on our part. In the past, one had to really seek out that much information, whether relevant or tangential to the subject. That effort generally required a desire that was born of some passion or need to know, vs. a casual curiosity about something that showed up on the news or was discussed at the soccer game. The level of ability to interpret the facts discovered in such a search is very important, as information can be very frightening without filters and help with interpretation. Not censors, but filters, where the context of the information is understood or at least sought, and not just facts thrown out for public consumption with no explanation. Pure shoveling of facts onto the public, as is the practice of the news media very often, is like getting flour and egg and oil and water thrown out onto a table and expecting people to make a cake. Certainly the idea of making a cake from the ingredients appeals to many, but the ability to do so is predicated on the fact that a person has a recipe or experience with the ingredients and their parts and importance to the outcome. To toss random facts, or "factoids" as they are called sometimes, out for public use without a "recipe" is to ask for disaster, as the information may be used incorrectly and the outcome may not be what was intended, or what was possible given the ingredients.
Albert Einstein, a man with a lot of knowledge, said "I've discovered that the men who know the most are the most miserable". Think of King Solomon in the Bible. He had wisdom beyond that of any person and he blew it big time! He couldn't or wouldn't be happy.
I'm not saying we should be ignorant, though the adage "ignorance is bliss", comes to my lips regularly as I answer questions from parents, questions I would never have known to ask and thankfully didn't need to know the answer. The availability of raw information is not a bad thing, just a potentially dangerous thing, especially if it leads to general disquiet and stress in the recipients. In my practice, the worried well are the vast majority. They have been worried by an ultrasound done during pregnancy that showed fluid somewhere it shouldn't be or no fluid where there should be some. They are worried because they read or heard or saw something on tv, or from a neighbor or relative or heaven forbid, at Walmart. A casual comment from someone can precipitate a major worry in some, i'd say many, people, especially parents (read moms).
I don't recommend watching the news regularly - if something happens that you need to know about, someone will call you or a siren will go off. It's amazing how much stress can be reduced by that simple step. Now, ironically, since you are reading a blog, I recommend staying off the internet. I promise nothing will happen or be discovered about which you won't hear from someone within the next 24 hours. Some people are more stressed that they will miss something, but most are stressed by hearing something over which they have no control and then obsessing on it.
We are addicted to information.
The more you know, the better, right? I don't think it's better to know more, necessarily. We've all used the phrase "a little knowledge is dangerous". If a little is dangerous, what is a lot? more dangerous, I propose. so what do we do? Do we hide our heads in the sand and stop watching and reading and searching? Do we let others interpret facts for us? Do we strive for understanding in every area of geopolitics, history, medicine, science, language, art, religion,and culture? Yes to all, with a caveat. Balance is the key. For some, the ostrich method will work. I'm amazed at the amount of peace I have when I'm not bombarded by news all the time. I feel no withdrawal symptoms. However, some may not be so lucky. Others, myself again included, are content to leave interpretation up to others, at least most of the time. The more personal a subject becomes, the less I'm willing to delegate the responsibility, but it makes sense to me to let experts collate and review and present the information in a form I can digest. Sort of like having a cake made for me vs. having to make it myself. And to do one's own study, to go deeper into a subject or area, to become an expert or at least more informed than the average citizen, is gratifying in certain instances where the topic is of special interest or concern.
it is unlikely that we will stop the overflow of information that comes our way. it will probably only come faster. we must learn how to deal with it, using common sense and balance.
that's enough information for now.