Tuesday, January 31, 2012

Choosing a Doctor: Tips for Young Adults


As teens age up and move into a world independent from their parents,  one of their new responsibilities is to engage in the process of choosing a doctor. For some teens this process begins early (even by age 10) and for others, not until young adulthood.   In some environments---small towns, colleges, or certain work situations—there may be very little choice about who someone chooses.  In other cases, insurance plans and the inability to access care outside of one’s plan may be limiting.  Some lucky people can affordably have completely free choice about whom they choose to care for them.
 Pediatricians have been heard to say that treating younger kids is sometimes more closely related to veterinary medicine than not. But as teens and young adults can participate much more in their care.

In the next several blog posts, I will lay out some  guidelines for teens and young adults on how to choose a good provider. The relationship with a doctor is important but the doctor also must have the education, training and ongoing commitment necessary to make good decisions when a “disaster” or other scary event takes place.  In the end, if the relationship and chemistry with the provider are not strong and positive, it might not be the right fit no matter how much vetting is done ahead of time.

Why do people need a primary health care provider, sometimes called a PCP?  Checking in on a regular basis is important to catch problems before they arise.   It’s also an opportunity for the PCP to find out  how the patient is doing in a global sense. In medicine for teens and young adults, the idea is to have a “physical” as well as a “mental.” Checking in about sex, alcohol, smoking, relationships, nutrition, and other health habits is just as important (if not more so) than getting a blood pressure taken or lab tests done. A good relationship with a PCP ensures that if a specialist for a particular problem is ever needed,  a  good referral will be made to someone whom the PCP not only trusts but can work with.
Stay tuned for more hints on learning how to take care of yourself after age 18. 

Friday, January 13, 2012

Thinly Minted

This is Taylor.  She recently posted a video of herself on YouTube (and it quickly went everywhere, sent to me by many readers, friends and family) decrying the Girl Scouts because the organization failed to notify her and her family of the fact that transgendered girls are allowed to be members of Girls Scout troops.  Because of her outrage, she is calling for a boycot of the annual cookie sale.

The ludicrous quality of this girls complaint seems to have registered on her, her family and probably her lawyer since her video has "gone private" as of today, meaning you have missed an opportunity to appreciate it.

I encourage readers to see Lisa Belkin's blogpost today Girls Scout Video: What were her parents thinking? where she lays blame squarely on the parents for raising an intolerant, pugnacious, offensive and "sanctimonious" daughter.

I for one, cannot wait for my neighborhood Brownies to peddle their cookies.  I might even buy a box of Samoas which I have always boycotted for their lousy taste.









Tuesday, January 10, 2012

Helping Fat People


This is not funny
When I was a rookie fellow in adolescent medicine in the Bronx in the 1980's, I was assigned a new patient, a "morbidly obese" fifteen year old who weighed over 200 pounds at about 5'2".  He moved with difficulty and he smelled even from across the room.   My assignment was to engage him in a program of weight management through diet and exercise.  He lived close to the hospital so we had weekly appointments.   After a few months of watching his weight increase, I decided to alter my therapeutic goals for him.  The purpose for our visits became simply managing his hygiene.  He and I bonded and he started to groom himself in a more age appropriate way.  I did nothing for his weight.

So now, I wonder if he is still alive, almost 30 years later.  I wonder if he suffered a heart attack or stroke, if he has diabetes, if he can walk at all or if he smells bad again.   If he's alive I  wonder if he was ever offered surgery to help manage his weight.

Nowadays, this young man would be evaluated for many problems beyond the not insignificant social ostracism he was experiencing.   With a BMI exceeding 35 he would be worked up for metabolic syndrome.  Experts disagree on what the components are, but they are some combination of large abdominal girth, elevated triglycerides, blood pressure, and fasting blood sugar.  He would also be evaluated for sleep apnea, gallbladder disease, Type II diabetes, thyroid disease and substance abuse. 

Current insurance companies might require my patient to undergo six months of medically supervised diet and weight managment.  Nowadays, if he continued to gain weight he might be a candidate for weight loss surgery. A recent article in the New York Times profiled a young woman with marginal success after laparoscopic adjustable gastric banding, the simplest and possibly safest of the procedures available to obese teens.  Her story underscores the continued efforts required by a multi-disciplinary team to promote the life-long lifestyle changes required to be successful at keeping the weight off. 

Many US childrens' hospitals are currently participating in a multi-center study of the efficacy and safety of "lap-band" surgery in adolescents.  Here is a quote from the website of the New York-Presbyterian Children's Hospital:

Our investigations evaluate the safety and success rates of laparoscopic adjustable gastric banding surgery in treating adolescents who are obese. There is substantial evidence worldwide that attests to the safety and efficacy of laparoscopic gastric banding, and we are now documenting its role in the adolescent population.

In addition to evaluating the general body changes that occur in the months and years following adjustable gastric banding, we also study the metabolic effects of banding in growing teens. It is our hypothesis that gradual, steady weight loss will not result in nutritional deficiencies, but rather will result in long-term and sustainable weight reduction.
In spite of this progress and the mounting number of success stories, most primary care providers, pediatricians and family medicine doctors, are reluctant to refer patients.  Susan Woolford and her colleagues at the University of Michigan studied hundreds of such primary care providers and concluded that "some severely obese adolescents may desire and potentially benefit from bariatric surgery, but referral for the procedure may depend heavily on the attitudes of their primary care physicians."

With one in three US gradeschool  children overweight, and epidemic numbers of adults with complications of obesity looming, it behooves all of us to look at all the many ways available to tackle this problem.  For some who are beyond a certain BMI, surgery is a life-saving option that deserves exploration.
image from creativeminorityreport.com via Googleimages








Friday, January 6, 2012

Mamaroneck Tigers Hit New Hampshire Primary


 I just heard about an extraordinary opportunity for local Westchester kids from the Mamaroneck High School.   Sixty four lucky students are off to the races!

The New Hampshire primary races that is.  Under the guidance of the AP Government and Politics teacher, Joe Liberti, they are going to be helping to get out the vote for three days this weekend.  Regardless of their own political persuasions or uncertainties, they will stretch their thinking and experience civic duty first hand.  

Activities include meeting with the director of field operations for Newt Gingrich and attending a panel discussion sponsored by Politico.  Best of all, those of us here at home will be able to share in the adventure because they will be creating a ten minute video of their experience.

As parents, caregivers and educators we are always looking for ways to foster competence, character, contribution, and connection (four of the Seven C's crucial to resilience in our kids and ourselves-best described in Ken Ginsburg's book, A Parent's Guide to Building Resilience in Children and Teens).  I am hard pressed to think of a better way to do this.  I hope these students will come back with momentum and energy to rally local residents across the community to debate, discuss and ultimately vote.

For a more complete announcement of this and other interesting, progressive educational opportunities at Mamaroneck, click here.

image courtesy of crazyman7.narod.ru via googleimages