Wednesday, November 30, 2011

Tell the Grandparents You Know About Pertussis

Here's a heads-up about a subject that pediatricians are more aware of than many internists and other clinicians who care for older kids and adults.   Pertussis, or whooping cough, caused by the bacterium Bordetella pertussis, remains a serious cause of illness and even a threat to life to young infants.  Although most people have had immunizations against pertussis during childhood, their immunity or ability to fight the infection can wane with age. 

It is now recommended that a single dose of Adacel, the vaccine against tetanus which is combined with pertussis (it works better this way) be given to "all adults 65 years of age and older who have or are likely to have contact with an infant aged younger than 12 months." according to the November 2011 Infectious Diseases in Children newsletter.  This includes pediatricians who refuse to retire, grandparents who have contact with their childrens' children, and day care workers who may unwittingly expose babies to whooping cough.

In older children and adults, pertussis is usually an annoying and sometimes prolonged illness. But in very young children it can cause pneumonia and even sudden death. If you would like to actually hear the sound of the whoop click here. Here is a quote from my own mother's memoir about having whooping cough during a tornado in South Dakota:
In 1929 when I was one year old, I had whooping cough, and a tornado came to our farm.  Since I was very sick (they said I would whoop so much, Pop would hold me upside down to hopefully catch my breath), my folks did not want to take me out into the stormy weather in order to get to "the cave" for shelter.The cave was a storm cellar underground about 50 feet away from the house..... we would seek safety there, even in the middle of the night, when "the weather looked bad".  And so, the family descended to the "cellar" under the house itself. I remember none of this, of course, but heard, stories of "The Storm" as I was growing up and we played "house" with the broken dishes and pots and pans in (my grandmother's) grove of trees across the road. These fragments blew out of our house and ended in those trees.
And I feel respect and wonder at how my parents survived after sitting down there in the cellar, hearing the banging of boards and crashing of glass, (and holding a sick baby).
Dramatic, right?  Any respiratory distress, even in an adult, can be frightening.  Fortunately this degree of disease is preventable.  So, if you have friends, relatives, housekeepers, or caregivers who may be in contact with infants who are not yet fully protected through immunizations until about a year of age, encourage them to get the Adacel vaccine to protect themselves (from tetanus and pertussis) but mostly to protect the young ones in their midst.

Monday, November 21, 2011

The end of an era for me

 As 2011 draws to a close so will ten years in private practice.  As of January 1, 2012 I will no longer be with BridgeSpan Medicine in White Plains.  And I will no longer be practicing primary care for teens and young adults in Westchester.

I will be working as one of the doctors on the multi-disciplinary team of clinicians in the student health center at Barnard College in New York City.  I will be available to undergraduates for primary care, consultation and referral.  I will work side-by-side with nurse practitioners and mental health providers.  And I look forward to participating in mentoring and working with  Adolescent Medicine fellows in training.

My current patients have many options.  They can continue their primary care at BridgeSpan Medicine with Dr Brooke Balchan and her associates from Westchester Park Pediatrics, Drs. Avvocato, Ross, Wurzel and Eisenberg.  And they will be able to access specialty care via a network of fine practitioners throughout the metropolitan area.

In many ways this job is a natural progression for me from being a general pediatrician over 25 years ago when I grew somewhat expert at infants and pre-schoolers as I raised my own tots.   As they grew I was lucky enough to immerse myself in the issues of elementary school, special needs children and parenting.   Over the past fifteen years, my focus has shifted to adolescents and the concern of raising responsible, content people in our culture and how pursuing those goals can affect their health-and that of their parents.    Now as my own children are of college age and beyond, I am called to play a role in the health and well-being of  emerging adults. And how thrilling that is.  I have long thought a job in college health would be a dream for me, and now is the time.

Of course no decision like this comes lightly.  I have struggled for the past decade with the compromises I have had to make with our health care system as it has tried to grow up.  But it is a disabled patient with many handicaps and has lost its way.   As the mammoth insurance industry, unregulated and driven by bureaucracy and profit, has become the conductor of this cacaphonous symphony, the players have lost their music, lost the tune, and are struggling to play in harmony.  I am choosing to move to a smaller quartet, where I can still hear the voices of those next to me and play the classical music of healing that I was trained to deliver.

Many of my patients move in a space in my psyche in much the same way my own children do and I will miss them very much.  Parents I have come to know through tears and laughter will also be sorely missed.  And my colleagues, especially those in the mental health and education arenas, who have taught me so much about doctoring and caring, will be missed as I carry their lessons forward with me.

image from via Google

Tuesday, November 15, 2011

Dinner Table Conversation about Sex

Have fun at dinner tonight with your teens and see if they can guess the right answers on the following questions about teenage sex.*   All data comes from the recent survey from the Centers for Disease Control and their Vital and Health Statistics Report from October 2011:

*Among females ages 18-24 who had their first sexual experience (here defined as intercourse) before age 20, how many of them really wanted it to happen then?  (Answer 41%)

*What percent of boys who had sex before age 20 "really wanted it to happen at the time? (Answer 63%)

This in itself could generate some interesting discussion but if that's not enough to get you to dessert, try these:

*What percent of teen females and males had their first intercourse with someone  "they were going steady with?" (Answer for females: 70% and for males: 56%)

*What percent of females ages 15-19 use a form of contraception at first intercourse? (Answer: 78%)

*Is having an older partner at first intercourse associated with a greater or lesser likelihood of using protection at first intercourse? (Answer: lower likelihood) Be sure to talk about pressure from the Big Boys and Girls.

*What percent of females use non-pill hormonal contraception at first intercourse? (Answer: 6%)  These methods include vaginal rings, injectable and implantable hormones, and emergency contraception....all worth discussing or looking up)

*What percent of never-married teens (15-19) have had intercourse at least once? (Answer 43%)

These are interesting data and are getting a lot of play in the media.  I would point out however, from my reading today of the original document that no questions were asked about non-heterosexual experience and the rather narrow focus on intercourse as an "endpoint" begs the question of what we have discussed elsewhere about the increases in oral sex among both heterosexual and non-heterosexual teens with all the incumbent risks.

*Remind them that you are not fishing around for personal information merely wondering what they think of the data.  Right, Mom.

image from via google

Thursday, November 10, 2011

What should we do?

 Recently a patient asked me what I thought about the Occupy Wall Street movement.  I mumbled something about how I admired the courage to speak out against injustice and inequity but how I worried that their message was being dissipated by a motley group of folks without a clear goal.

I soon realized that was a cop-out.  What movement is well formed from its outset?  What change is brought about in a tidy fashion?  I soon wished I had said something different.

Then at a recent prayer service at my synagogue, Larchmont Temple, I read the following in the siddur, or prayerbook, written by Rabbi Sydney Chayet, a professor of history and a poet:

We oughtn't pray for what we've never known,
and humanity has never known:
unbroken peace,
unmixed blessing.
Better to pray for pity,
for indignation, 
the will to see and touch,
the power to do good and make new.

What Occupy Wall Street might represent for many is in fact this holy indignation, this drive for improvement and for a more moral and meaningful life.  We should be proud and pray for more people like these who are agitated  and discontent and are asking us to look for better ways to make our socity anew. Stepping out of our comfort zones and into a place that is uncertain, but certain in its pursuit of justice and fairness, is a healthy thing.  I would encourage my patient, my children and my friends to go find out what they have to say and what can be carried back home, to school and to the workplace.

image from via

Sunday, November 6, 2011

“Dad, what kind of work do you do?”

As I gather a family history from a new adolescent patient and parents, I usually pause for an entertaining interlude to ask the teenager how old her parents are. Usually she will smile while the parent coyly looks away and the child guesses, often within two or three years of the correct number. After that I inquire about what kind of work her parents do. If mother is a “stay at home mom”, the way in which this is described by her children can be most interesting. Responses have ranged from “she doesn’t do anything” to “she makes sure we are all ok.” Fathers are frequently more complicated and often require a mother’s help to explain.

Recently a sixteen year old answered that her father was in “venture capital” and when I asked what that means to her, she said:”I don’t know.” Nor did the mother know. “We love and respect him,” she said, “but we can’t really explain what he does.” Even when pressed I could not elicit the vocabulary that might explain what his work involves.

So this got me to thinking about Occupy Wall Street, the dissatisfaction so many feel with our “system” and the disillusionment of many youth about their own prospects for success in the current economy and structure of our country. The sense that they have lost control over their destinies leads to the notion that finance and banking are the only means to become truly successful (unless of course they have gifts in the athletic department.) But maybe they don’t even know what bankers and financiers really do all day.

It strikes me that if one cannot share the nature of work with family and talk about the joys, frustrations, pleasures, and pitfalls of one’s job, then there is a badly missed opportunity for teaching our children about making choices and self definition. Not to mention the value to a parent of the intense scrutiny of a smart adolescent who is exploring the world in a moral, political, economic and social sense. As Anderson Cooper calls it: “keeping them honest.”

Here are some questions to start off a discussion* aimed at understanding the world of adult work and the complex decisions that go into choosing a career, seeking and responding to a “calling” and keeping values on track as one prepares for the future:

What is your kind of work called?

What do you actually DO all day?

What do you like about your job?

How did you get started in your work? Why did you choose it? DID you actually choose it?

Do you wish you could do something else? Why don’t you?

What is important to you about your work?

Is it important to make a lot of money?

Do you think the world is a better place because of your work?

What are your hopes for me and my work life?

*clearly these questions are not just for fathers, but can be valuable for any working person, professional or even grandparent

image from