It's that time of year again! Time to renew or change your health insurance / benefits. (You thought I was going to say that it was time for the holidays!) I know this is a boring topic but it is important so let's spend a few minutes on it.
The most important thing for you to do when you sign up for your health insurance policy is to read and understand it. If your company has a presentation about benefits then go to it. If not then ask your human resources department / manager about it. This is important so that you don't get any unexpected bills or surprises when you need medical care.
There are many many variations on health insurance today and we can't answer your question if you ask what your insurance covers. We try to practice cost effective medicine for everyone regardless of their health insurance.
With the new Affordable Care Act (Obamacare) all well care is covered without a copay or deductible. (There are still a few insurance companies that this doesn't apply to but they are becoming less common). If an illness or problem is found at a well check then the insurance company will then charge a copay.
So... please read your benefits before you need to use them!
Wednesday, November 21, 2012
Tuesday, September 25, 2012
ER Visits Waiting to Happen
Young children keep parents busy chasing them around. Unfortunately there are many household hazards that don't occur to parents until they are sitting in the ER so I thought I would take some time to review some of the ones that we see.
1. Counters. We frequently see injuries from when kids fall off counters (and beds and couches.) Many times parents put their car seat or bumbo seat on the counter and don't realize that the child can scoot or get themselves out of the seat. One of my favorite sayings is "You can't fall off the floor!"
2. Cords. Everyone knows the dangers of outlet plugs but what about the cords. I see patients that find a cord dangling off the counter and then pull the attached object down on themselves. Irons, electric frying pans, curling irons are all dangerous. Keep the cords out of reach after unplugging an appliance.
3. Coffee Tables. Many young kids fall off the couch and land on the coffee table. They hit their head on one of the corners and end up getting stitches. You might want to consider putting the coffee table away or against a wall until the jumping on the couch phase has passed.
4. Buckets. Young children have large heads which make them top heavy. It makes it easy for them to fall into a bucket of water and then drown. Keep your buckets empty. When my kids were young I would wait until they were asleep for me to mop or iron.
5. Bookcases. Many children think that they are monkeys and like to climb. Things like bookcases and large heavy TVs can be pulled over and then they crush the child. Consider anchoring furniture that can tip to the wall.
6. Bunk beds. It recommended that kids not use bunk beds until about age 6. I repeatedly see young children who fall off the top bunk.
1. Counters. We frequently see injuries from when kids fall off counters (and beds and couches.) Many times parents put their car seat or bumbo seat on the counter and don't realize that the child can scoot or get themselves out of the seat. One of my favorite sayings is "You can't fall off the floor!"
2. Cords. Everyone knows the dangers of outlet plugs but what about the cords. I see patients that find a cord dangling off the counter and then pull the attached object down on themselves. Irons, electric frying pans, curling irons are all dangerous. Keep the cords out of reach after unplugging an appliance.
3. Coffee Tables. Many young kids fall off the couch and land on the coffee table. They hit their head on one of the corners and end up getting stitches. You might want to consider putting the coffee table away or against a wall until the jumping on the couch phase has passed.
4. Buckets. Young children have large heads which make them top heavy. It makes it easy for them to fall into a bucket of water and then drown. Keep your buckets empty. When my kids were young I would wait until they were asleep for me to mop or iron.
5. Bookcases. Many children think that they are monkeys and like to climb. Things like bookcases and large heavy TVs can be pulled over and then they crush the child. Consider anchoring furniture that can tip to the wall.
6. Bunk beds. It recommended that kids not use bunk beds until about age 6. I repeatedly see young children who fall off the top bunk.
Tuesday, September 4, 2012
What I Would Have Kept the Same
In my last post I talked about what I would have done differently when raising my kids. Now I will talk about what I would repeat if doing it again.
1. Reading. I started reading to my kids when they were babies and continued until they were in junior high. It helped them succeed in school as well as fostered a love of reading. We also have great memories of the times spent together. For example the time we read Harry Potter while camping in the pouring rain or the book I refused to read again after reading it 4 times. (The Wizard of Oz)
2. Outside activities. No one in my family has any athletic talent but we have always enjoyed doing things outside. When the kids were young we spent a lot of time at the park and playground. We also played a lot of ball. (I got my exercise chasing them all!) As they got older we progressed to swimming and bike riding. Now we will hike, camp, play disc golf or do yoga together. Next up parasailing!
3. Limited junk food. I have always kept little junk food in the house. No one ever seemed to miss the chips and soda. Then when we would have them in the house they would go uneaten in the pantry because my kids were so used to them not being around. I also would give small servings of things not as good for you. My kids got used to it and never asked for more and now, when serving themselves they do the same.
4. Consequences. I encouraged my kids to become responsible by letting them feel the consequences of their actions. If they returned library books late then they paid they fine. If they lost their lunch box then they had to look for it in the lost and found. If not found then they had to brown bag it or use an old lunch box.
5. Time. I have always made time to do things with my kids. Whenever they asked me to play with them I would. There was no reason the dishes and chores couldn't wait.
1. Reading. I started reading to my kids when they were babies and continued until they were in junior high. It helped them succeed in school as well as fostered a love of reading. We also have great memories of the times spent together. For example the time we read Harry Potter while camping in the pouring rain or the book I refused to read again after reading it 4 times. (The Wizard of Oz)
2. Outside activities. No one in my family has any athletic talent but we have always enjoyed doing things outside. When the kids were young we spent a lot of time at the park and playground. We also played a lot of ball. (I got my exercise chasing them all!) As they got older we progressed to swimming and bike riding. Now we will hike, camp, play disc golf or do yoga together. Next up parasailing!
3. Limited junk food. I have always kept little junk food in the house. No one ever seemed to miss the chips and soda. Then when we would have them in the house they would go uneaten in the pantry because my kids were so used to them not being around. I also would give small servings of things not as good for you. My kids got used to it and never asked for more and now, when serving themselves they do the same.
4. Consequences. I encouraged my kids to become responsible by letting them feel the consequences of their actions. If they returned library books late then they paid they fine. If they lost their lunch box then they had to look for it in the lost and found. If not found then they had to brown bag it or use an old lunch box.
5. Time. I have always made time to do things with my kids. Whenever they asked me to play with them I would. There was no reason the dishes and chores couldn't wait.
Thursday, August 23, 2012
What I Would Have Done Differently
Now that my kids are mostly grown I look back over the years and think about what I would have done differently.
1. Sleep. Most of us make mistakes on the first child and then do better with the second. I was no different. If I had to do it all over again I would not have jumped up and picked up my son evey time he fussed or made a noise at night. I would also have started teaching him to put himself to sleep about 3-4 months of age instead of relying on being rocked to sleep. (My second child was a better sleeper due to these lessons I learned the hard way.)
2. Food. If I had a chance to do it over again I would give more fruits and veggies, less processed food and less fast food. This is a continual work in process.
3. Teeth brushing. When my son was in high school he had braces on for 4 years. The orthodontist lectured him again and again about brushing his teeth. I nagged for awhile and eventually gave up. Well, the orthdontist was right and he ended up with spots on his teeth because he didn't brush well. If I had to do it again I would have tried harder to get him to take care of his teeth. (Now I'm making him pay his dental bills. If that's not motivation I don't know what is!)
4. Junk. A couple of years ago my family cleaned out the kid's bedrooms when my son moved out. I could not believe the amount of junk that had amassed over the years! Some things were beloved toys but others were things that had been barely played with. If I had to do it again I would have tried to buy less stuff. I also would have been more adamant about throwing away or not bringing home the things like Happy Meal toys or freebies from things like school carnivals.
5. Live in the moment. If I had a chance to do it all over again I would have enjoyed my kids more and stressed less about the little things. As we all know time passes quickly and they are grown and gone before we know it.
Next up will be what I wouldn't have changed about raising my kids.
1. Sleep. Most of us make mistakes on the first child and then do better with the second. I was no different. If I had to do it all over again I would not have jumped up and picked up my son evey time he fussed or made a noise at night. I would also have started teaching him to put himself to sleep about 3-4 months of age instead of relying on being rocked to sleep. (My second child was a better sleeper due to these lessons I learned the hard way.)
2. Food. If I had a chance to do it over again I would give more fruits and veggies, less processed food and less fast food. This is a continual work in process.
3. Teeth brushing. When my son was in high school he had braces on for 4 years. The orthodontist lectured him again and again about brushing his teeth. I nagged for awhile and eventually gave up. Well, the orthdontist was right and he ended up with spots on his teeth because he didn't brush well. If I had to do it again I would have tried harder to get him to take care of his teeth. (Now I'm making him pay his dental bills. If that's not motivation I don't know what is!)
4. Junk. A couple of years ago my family cleaned out the kid's bedrooms when my son moved out. I could not believe the amount of junk that had amassed over the years! Some things were beloved toys but others were things that had been barely played with. If I had to do it again I would have tried to buy less stuff. I also would have been more adamant about throwing away or not bringing home the things like Happy Meal toys or freebies from things like school carnivals.
5. Live in the moment. If I had a chance to do it all over again I would have enjoyed my kids more and stressed less about the little things. As we all know time passes quickly and they are grown and gone before we know it.
Next up will be what I wouldn't have changed about raising my kids.
Tuesday, August 21, 2012
Teen Driver Safety, the Obvious and Not So Obvious
My family has been living teen driver safety over the past 2 months. We enrolled our youngest (just turned 16) in driver training over the summer. The training included classes for her as well as one for the parents. A lot of time was spent in class talking about drinking and driving, texting and driving, and distracted driving (other teens in car). Ironically, two weeks ago my husband and son were hit by a distracted teenage driver. It was after school and the teen had a friend in the car and they ran a red light and hit my family and then ran into two other cars. Thankfully there were no life threatening injuries but my son's car was totaled. The teen was sad and apologetic but it was a painful and expensive way to learn a lesson. So, here's the obvious lesson, talk to your teen repeatedly about these issues. Car accidents are the leading cause of death and disability in teens.
Onto the not so obvious lesson. Last night our son dropped his sister off at dance. As she was getting out of the car he started to pull away before she was completely out of the car. Thankfully she was fine. In thinking back I see about 1-2 injuries a year in a teen when getting in or out of a car. It is always a teen driver (most often an older brother!) It never occurred to me to discuss passenger safety with my kids but clearly this is a unaddressed topic.
Onto the not so obvious lesson. Last night our son dropped his sister off at dance. As she was getting out of the car he started to pull away before she was completely out of the car. Thankfully she was fine. In thinking back I see about 1-2 injuries a year in a teen when getting in or out of a car. It is always a teen driver (most often an older brother!) It never occurred to me to discuss passenger safety with my kids but clearly this is a unaddressed topic.
Monday, July 23, 2012
FAQs
I thought I would answer some of the more commonly asked questions about our practice.
1. Until what age do you see kids / teens? We take care of patients until they graduate from high school -- so about age 18-19. At that time we will do their last physical before they go to college and will see them for a few months if they are sick and urgently need to be seen.
2. Why do you recommend a yearly well child check / physical / check-up? Preventative care is important to us. Healthy habits start young and we would much rather try to prevent things like heart disease and diabetes than treat them later in life. At your child's well check we will review their growth and development. We will review their habits and make recommendations. We also we check things that we don't check when you come in for an illness such as scoliosis, hernias, or vision problems.
3. What hospital / ER do you recommend? We recommend a children's hospital such as Cardon Children's (Banner Desert) or Phoenix Children's.
4. What urgent care do you recommend? We do not like urgent care. We feel we provide better care for your child and that is why we get you in the same day that you call when your child is sick. If you absolutely have to go to urgent care we recommend a pediatric one such as Cornerstone or Good Night Pediatrics.
5. Why do you ask about health problems in me or my parents? A detailed family history is important to see what your child is at risk for. As I said in my answer in number 2 we would much rather prevent problems than treat them later!
6. Why do you ask about smoking and pets at home? Things that your child is exposed to can effect their health. Such as smoking exposure increases their risk of asthma, ear infections, and pneumonia. Reptiles at home can be carriers for salmonella. Knowing what is at home helps us better treat your child.
7. I need a copy of my child's immunization record how do I get it? The easiest way is to bring in your child's blue shot card and we will update it. Don't have one -- then ask and we will make you one. Another way is to go online and view your child's patient summary from their visits. Any shots from the last two years will be listed in it. We are gradually working to put all the old shots in it as well. (we have to do it manually so it is slow going!)
8. Do you report to ASIIS? ASIIS is Arizona's online immunization database (don't ask me what the letters stand for). By law we have to report all immunizations given to it.
9. If my child has a health problem after hours what do I do? Call us! Call the office number and you will get the answering service. They will take a message and have a triage nurse call you back. If you have a problem that can't wait for a call back then you need to call 911. Don't forget we are open Saturday mornings for well and sick appointments.
1. Until what age do you see kids / teens? We take care of patients until they graduate from high school -- so about age 18-19. At that time we will do their last physical before they go to college and will see them for a few months if they are sick and urgently need to be seen.
2. Why do you recommend a yearly well child check / physical / check-up? Preventative care is important to us. Healthy habits start young and we would much rather try to prevent things like heart disease and diabetes than treat them later in life. At your child's well check we will review their growth and development. We will review their habits and make recommendations. We also we check things that we don't check when you come in for an illness such as scoliosis, hernias, or vision problems.
3. What hospital / ER do you recommend? We recommend a children's hospital such as Cardon Children's (Banner Desert) or Phoenix Children's.
4. What urgent care do you recommend? We do not like urgent care. We feel we provide better care for your child and that is why we get you in the same day that you call when your child is sick. If you absolutely have to go to urgent care we recommend a pediatric one such as Cornerstone or Good Night Pediatrics.
5. Why do you ask about health problems in me or my parents? A detailed family history is important to see what your child is at risk for. As I said in my answer in number 2 we would much rather prevent problems than treat them later!
6. Why do you ask about smoking and pets at home? Things that your child is exposed to can effect their health. Such as smoking exposure increases their risk of asthma, ear infections, and pneumonia. Reptiles at home can be carriers for salmonella. Knowing what is at home helps us better treat your child.
7. I need a copy of my child's immunization record how do I get it? The easiest way is to bring in your child's blue shot card and we will update it. Don't have one -- then ask and we will make you one. Another way is to go online and view your child's patient summary from their visits. Any shots from the last two years will be listed in it. We are gradually working to put all the old shots in it as well. (we have to do it manually so it is slow going!)
8. Do you report to ASIIS? ASIIS is Arizona's online immunization database (don't ask me what the letters stand for). By law we have to report all immunizations given to it.
9. If my child has a health problem after hours what do I do? Call us! Call the office number and you will get the answering service. They will take a message and have a triage nurse call you back. If you have a problem that can't wait for a call back then you need to call 911. Don't forget we are open Saturday mornings for well and sick appointments.
Monday, May 21, 2012
Two Great Trends
Since I have focused on some negative trends I thought I would now change things up and talk about the positive. I have been a doctor for 18 years and in private practice for 15 years and have seen some wonderful improvements.
First of all I now see less illness, fewer ear infections, and less hospitalizations. This improvement is due to vaccines. Chicken pox has been almost eliminated due to the vaccine. Not only are there fewer office visits and hospitalizations due to chicken pox but I also see few cases of shingles. Next came the release of the pneumococcal vaccine. It is to prevent serious infections such as meningitis and sepsis. A pleasant byproduct of this vaccine has been a decrease in ear infections. Fewer of my patients need to get ear tubes and it is rare for my patients to need more than 1 course of antibiotics to get rid of an ear infection. Next came the rotavirus vaccine. Rotavirus is a nasty vomiting and diarrhea illness. I still see patients with vomiting and diarrhea but the illnesses are much milder than rotavirus so there are fewer office and ER visits and hospitalizations for dehydration. Most importantly these vaccines have led to fewer pediatric deaths. Now that's a trend I like!
The next trend I have noticed is a greater understanding and acceptance by parents that viral illnesses are not cured by antibiotics. I get less arguments and I even have people ask me if the antibiotic is really necessary when I do need to prescribe it! Decreased antibiotic use is good because it leads to less resistant bacteria, fewer side effects, and less cost to the parents. Now if we can only get the rest of the medical community (urgent care!) on board.
First of all I now see less illness, fewer ear infections, and less hospitalizations. This improvement is due to vaccines. Chicken pox has been almost eliminated due to the vaccine. Not only are there fewer office visits and hospitalizations due to chicken pox but I also see few cases of shingles. Next came the release of the pneumococcal vaccine. It is to prevent serious infections such as meningitis and sepsis. A pleasant byproduct of this vaccine has been a decrease in ear infections. Fewer of my patients need to get ear tubes and it is rare for my patients to need more than 1 course of antibiotics to get rid of an ear infection. Next came the rotavirus vaccine. Rotavirus is a nasty vomiting and diarrhea illness. I still see patients with vomiting and diarrhea but the illnesses are much milder than rotavirus so there are fewer office and ER visits and hospitalizations for dehydration. Most importantly these vaccines have led to fewer pediatric deaths. Now that's a trend I like!
The next trend I have noticed is a greater understanding and acceptance by parents that viral illnesses are not cured by antibiotics. I get less arguments and I even have people ask me if the antibiotic is really necessary when I do need to prescribe it! Decreased antibiotic use is good because it leads to less resistant bacteria, fewer side effects, and less cost to the parents. Now if we can only get the rest of the medical community (urgent care!) on board.
Tuesday, May 15, 2012
Two More Trends
Since I wrote my last blog column I have realized two other trends I have seen recently.
I have seen a resurgence in babies and toddlers wearing necklaces. In particular many are wearing "teething neckleaces." These amber colored necklaces are supposed to help with the pain of teething. There is no scientific evidence that it helps. The reason we don't recommend necklaces for babies and toddlers is that they are at risk of catching the necklace on something and strangling themselves. Have you noticed that kid's hoodies no longer have ties for the hood? The reason is because kids were getting them caught on things and getting hurt.
So what to do... For teething we recommend giving your child a wet wash cloth or cold teething ring to chew on. I have seen on the internet that they do make teething necklaces that mom can wear that the child can chew on while in her arms. (They are actually quite stylish!) If you want your young child to wear jewelry we recommend either a bracelet or pinning a charm to their shirt.
The other trend I have noticed are children and teens drinking Muscle Milk. Sometimes they are drinking it because doesn't like regular milk or sometimes they are drinking it to gain weight. Muscle Milk is a protein supplement. It is not approved by the FDA and is like other things you might buy at the vitamin store. It is not milk (the name is misleading.)
What do we recommend instead -- a healthy diet!! (you saw that coming didn't you?!) For the child that won't drink milk we would suggest yoghurt or soy milk. For the child looking to gain weight we would recommend Carnation Instant Breakfast, Boost, or Pediasure/Ensure. Also to gain weight they could eat larger portions of healthy foods such as whole grains, fruits and veggies and lean meats. Most of us (including athletes) get more than enough protein in our diets and don't need a protein supplement.
I have seen a resurgence in babies and toddlers wearing necklaces. In particular many are wearing "teething neckleaces." These amber colored necklaces are supposed to help with the pain of teething. There is no scientific evidence that it helps. The reason we don't recommend necklaces for babies and toddlers is that they are at risk of catching the necklace on something and strangling themselves. Have you noticed that kid's hoodies no longer have ties for the hood? The reason is because kids were getting them caught on things and getting hurt.
So what to do... For teething we recommend giving your child a wet wash cloth or cold teething ring to chew on. I have seen on the internet that they do make teething necklaces that mom can wear that the child can chew on while in her arms. (They are actually quite stylish!) If you want your young child to wear jewelry we recommend either a bracelet or pinning a charm to their shirt.
The other trend I have noticed are children and teens drinking Muscle Milk. Sometimes they are drinking it because doesn't like regular milk or sometimes they are drinking it to gain weight. Muscle Milk is a protein supplement. It is not approved by the FDA and is like other things you might buy at the vitamin store. It is not milk (the name is misleading.)
What do we recommend instead -- a healthy diet!! (you saw that coming didn't you?!) For the child that won't drink milk we would suggest yoghurt or soy milk. For the child looking to gain weight we would recommend Carnation Instant Breakfast, Boost, or Pediasure/Ensure. Also to gain weight they could eat larger portions of healthy foods such as whole grains, fruits and veggies and lean meats. Most of us (including athletes) get more than enough protein in our diets and don't need a protein supplement.
Tuesday, May 1, 2012
Two (Disturbing) Trends
I commonly notice societal trends since I talk with so many people on a daily basis. Here are two trends that I have recently noticed and find alarming.
The first trend I have noticed is that parents are routinely giving toddlers iced tea to drink. Now you may ask what is wrong with that, isn't tea supposed to be good for you? Well, tea is good for you but there can be ingredients in it that aren't. Caffeine is in most tea (more in black than green). Why would you want to make your child more hyper and make it difficult for them to sleep? Also if you drink caffeine regularly and then don't for a day or so you can get headaches and not feel well. (aka cranky child!) The other ingredient that isn't good for you is sugar. If you buy a sweetened tea or add sugar then it can be just like drinking a soda. So, what is ok? I would suggest brewing your own tea using decaffeinated tea bags and then do not add sugar to it. Or, if you are lazy like me I would just give your child a glass of water to drink instead.
The second trend was brought to my attention by my teenage daughter. She tells me that teens are using tanning salons and lying out in the sun. I thought that this had decreased over the years with education about the dangers of the sun but I having been checking with my patients and my daughter is right. So, it is time to start talking with our teens about the dangers of the sun. They don't care about skin cancer so instead I would tell them that the sun causes wrinkles and will make them ugly. Take them shopping for sunscreen to see if you can find a type that they like and are likely to use. Encourage them to put it on daily.
The first trend I have noticed is that parents are routinely giving toddlers iced tea to drink. Now you may ask what is wrong with that, isn't tea supposed to be good for you? Well, tea is good for you but there can be ingredients in it that aren't. Caffeine is in most tea (more in black than green). Why would you want to make your child more hyper and make it difficult for them to sleep? Also if you drink caffeine regularly and then don't for a day or so you can get headaches and not feel well. (aka cranky child!) The other ingredient that isn't good for you is sugar. If you buy a sweetened tea or add sugar then it can be just like drinking a soda. So, what is ok? I would suggest brewing your own tea using decaffeinated tea bags and then do not add sugar to it. Or, if you are lazy like me I would just give your child a glass of water to drink instead.
The second trend was brought to my attention by my teenage daughter. She tells me that teens are using tanning salons and lying out in the sun. I thought that this had decreased over the years with education about the dangers of the sun but I having been checking with my patients and my daughter is right. So, it is time to start talking with our teens about the dangers of the sun. They don't care about skin cancer so instead I would tell them that the sun causes wrinkles and will make them ugly. Take them shopping for sunscreen to see if you can find a type that they like and are likely to use. Encourage them to put it on daily.
Tuesday, April 10, 2012
Talking to Your Child About Drugs
Did you know that the most effective way to help protect your child from drugs and alcohol is to talk to them about it?
Awhile ago I wrote a blog post about having "the talk" with your child. Today we are going to tackle talking about drugs and alcohol with your child. Quite frankly there are many similarities about how to approach these subjects.
First of all, this should be an ongoing discussion as opposed to having one big talk with him. I would start when your child is young before they go to kindergarten. I commonly have young children tell me that it is "yukky" that Grandpa smokes or that it is bad for them. These kids are clearly getting the message at an early age.
Second adjust what you say to your child's developmental level. A young child just needs to hear that it is bad while a preteen/teen may benefit from hearing a more specific story (such as relating about how somone you know was hurt or killed by a drunk driver.)
Third, find teachable moments. When you see things in the media or news about drugs or alcohol ask your child what they think. Good times to talk with them are when you are driving in the car together or walking the dog.
Fourth, discuss scenarios with your older child and teen. Ask them what they would do and give them alternate suggestions as well. For example, what would they do if someone offered them a joint at a party. Some things they might say include "Nah, I"m not into that," "No thanks, I"m in sports and I don't want to risk it," or "My parents would kill me."
Fifth, remember that actions speak louder than words. Think about what message you send when you say that you have had a bad day and "need a drink."
Overall the message to all kids needs to be clear that you do not want them to use drugs, alcohol, or tobacco.
Here is a good resource for further information.
www.drugfreeaz.org
Awhile ago I wrote a blog post about having "the talk" with your child. Today we are going to tackle talking about drugs and alcohol with your child. Quite frankly there are many similarities about how to approach these subjects.
First of all, this should be an ongoing discussion as opposed to having one big talk with him. I would start when your child is young before they go to kindergarten. I commonly have young children tell me that it is "yukky" that Grandpa smokes or that it is bad for them. These kids are clearly getting the message at an early age.
Second adjust what you say to your child's developmental level. A young child just needs to hear that it is bad while a preteen/teen may benefit from hearing a more specific story (such as relating about how somone you know was hurt or killed by a drunk driver.)
Third, find teachable moments. When you see things in the media or news about drugs or alcohol ask your child what they think. Good times to talk with them are when you are driving in the car together or walking the dog.
Fourth, discuss scenarios with your older child and teen. Ask them what they would do and give them alternate suggestions as well. For example, what would they do if someone offered them a joint at a party. Some things they might say include "Nah, I"m not into that," "No thanks, I"m in sports and I don't want to risk it," or "My parents would kill me."
Fifth, remember that actions speak louder than words. Think about what message you send when you say that you have had a bad day and "need a drink."
Overall the message to all kids needs to be clear that you do not want them to use drugs, alcohol, or tobacco.
Here is a good resource for further information.
www.drugfreeaz.org
Tuesday, March 27, 2012
MIsconceptions #4 Acne
There are many myths about acne. I commonly hear parents blame the teen because they eat too much chocolate or fatty food. I also hear that if only the teen would wash better the acne wouldn't happen.
So let's review why acne happens. First of all it is the parent's fault not the teens. Acne is hereditary. What is inherited is the tendency to make extra skin cells (follicular epidermal hyperproliferation) that then leads to plugging of the follicles. Also contributing to acne are hormones that increase sebum production and bacteria.
What can you do to help acne? First off I recommend a mild soap such as Dove or Cetaphil. Wash the face gently two times a day. Pat the face dry. Harsh soaps and scrubbing are not recommended. Next I would recommend applying a cream with 5% benzoyl peroxide in it to the parts of the face that break out. (Benzoyl peroxide is awesome! Not only is it over the counter but it is an anti-inflammatory, anti-bacterial and it decreases sebum and causes desquamation.) Your teen does not need to use a lot of cream, just a little on the parts of the face that break out. The most common side effect is drying of the skin.
All acne therapy (benzoyl peroxide and prescriptions) takes about two months of daily use before results are noticeable. Treatment helps prevent future break outs. There is nothing to put on a pimple to make it go away faster once you have it. It is difficult for teens to use something daily when results aren't visible immediately. Encourage your teen to stick with it!
If this is not helping or if you have concerns about your teen's acne please make an appointment.
So let's review why acne happens. First of all it is the parent's fault not the teens. Acne is hereditary. What is inherited is the tendency to make extra skin cells (follicular epidermal hyperproliferation) that then leads to plugging of the follicles. Also contributing to acne are hormones that increase sebum production and bacteria.
What can you do to help acne? First off I recommend a mild soap such as Dove or Cetaphil. Wash the face gently two times a day. Pat the face dry. Harsh soaps and scrubbing are not recommended. Next I would recommend applying a cream with 5% benzoyl peroxide in it to the parts of the face that break out. (Benzoyl peroxide is awesome! Not only is it over the counter but it is an anti-inflammatory, anti-bacterial and it decreases sebum and causes desquamation.) Your teen does not need to use a lot of cream, just a little on the parts of the face that break out. The most common side effect is drying of the skin.
All acne therapy (benzoyl peroxide and prescriptions) takes about two months of daily use before results are noticeable. Treatment helps prevent future break outs. There is nothing to put on a pimple to make it go away faster once you have it. It is difficult for teens to use something daily when results aren't visible immediately. Encourage your teen to stick with it!
If this is not helping or if you have concerns about your teen's acne please make an appointment.
Tuesday, March 6, 2012
Misconceptions #3 Illness and Fever
Every day I hear many myths about illness that have been perpetuated for years. To start off let me just say that most illness is caused by germs that you catch from other people. It is not allergies, the wind, cold weather, going outside with wet hair, or not wearing a coat or shoes. Let's take the other myths one by one.
1. It is all right to take a bath and drink cold liquids when sick. It doesn't make you worse.
2. Fever doesn't hurt you. It is a natural process that helps your body to fight infection. The higher the fever the worse you feel but it is not dangerous. The reason we recommend acetaminophen or ibuprofen for fever is not bring your child's fever down but to make them more comfortable.
3. A fever is a temperature of 100.4 (38.0 celcius) or higher. Your body temperature ranges from 97.0-100.3 naturally.
4. It is all right not to eat when you are sick. If your child is not hungry or vomiting then don't make them eat -- they might just vomit! Fluids are important though but it is all right not to eat for several days when you are sick.
5. It is also all right to go outside when you are sick and it is fine to let your children play if they feel well enough. If your child is sick they should not be going to public places like day care, school, the store or play areas because then they get others sick.
That sums it up for illness. Next blog with be on the myths associated with acne.
1. It is all right to take a bath and drink cold liquids when sick. It doesn't make you worse.
2. Fever doesn't hurt you. It is a natural process that helps your body to fight infection. The higher the fever the worse you feel but it is not dangerous. The reason we recommend acetaminophen or ibuprofen for fever is not bring your child's fever down but to make them more comfortable.
3. A fever is a temperature of 100.4 (38.0 celcius) or higher. Your body temperature ranges from 97.0-100.3 naturally.
4. It is all right not to eat when you are sick. If your child is not hungry or vomiting then don't make them eat -- they might just vomit! Fluids are important though but it is all right not to eat for several days when you are sick.
5. It is also all right to go outside when you are sick and it is fine to let your children play if they feel well enough. If your child is sick they should not be going to public places like day care, school, the store or play areas because then they get others sick.
That sums it up for illness. Next blog with be on the myths associated with acne.
Tuesday, February 28, 2012
Misconceptions #2 When to Start Healthy Eating
On to my second post on misconceptions I hear from parents in the office. Today we are going to talk about healthy eating in kids. There are two common ones I hear. "He is very active so it's all right if he eats a lot of junk food." And "He is just a kid so I don't worry about what he eats."
So, let's review the reasons about why kids need to eat healthy from birth.
1. To promote good growth and development.
2. To prevent chronic illnesses later in life. Heart disease, high cholesterol, diabetes, and other chronic illnesses don't just suddenly start when you are old. The changes in your body start when you are young but they are not noticeable at that time.
3. To start healthy habits at a young age. Just like with the teeth brushing one doesn't just magically start having good habits later in life. If your child grows up eating junk food then that is what they will eat as an adult. If your child is used to sitting down at family meal times and eating fruits and veggies then they are more likely to as an adult. (and as a bonus they will also teach their kids healthy habits!)
Now about exercise -- you cannot cancel out junk food with exercise! Everyone needs to exercise regardless of their weight, what they eat, or health status. Why? For the same reasons as why the need to eat healthy!
Next up misconceptions about illness and fever.
So, let's review the reasons about why kids need to eat healthy from birth.
1. To promote good growth and development.
2. To prevent chronic illnesses later in life. Heart disease, high cholesterol, diabetes, and other chronic illnesses don't just suddenly start when you are old. The changes in your body start when you are young but they are not noticeable at that time.
3. To start healthy habits at a young age. Just like with the teeth brushing one doesn't just magically start having good habits later in life. If your child grows up eating junk food then that is what they will eat as an adult. If your child is used to sitting down at family meal times and eating fruits and veggies then they are more likely to as an adult. (and as a bonus they will also teach their kids healthy habits!)
Now about exercise -- you cannot cancel out junk food with exercise! Everyone needs to exercise regardless of their weight, what they eat, or health status. Why? For the same reasons as why the need to eat healthy!
Next up misconceptions about illness and fever.
Tuesday, February 21, 2012
Misconceptions #1 Baby Teeth
I commonly find that parents have outdated information or misconceptions and so I thought I would start a series of posts addressing some of the more common ones that I hear.
First off we are going to talk about baby teeth. I find that some parents think that since baby teeth fall out there is no need to take care of them. Baby teeth are actually quite important so we are going to discuss some reasons why.
1. Some baby teeth won't fall out until age 12-13. That's a long time to have teeth that are not cared for.
2. Cavities hurt and can lead to serious infections such as abscesses. If your child's mouth hurts he will be fussy, not sleep well, do poorly in school, and won't eat very well.
3. Good habits start early. Is your child suddenly going to start brushing and flossing when his permanent teeth come in? Probably not. It is best to start good dental habits when young so that they are part of the daily routine for your child's lifetime.
4. Dental work is expensive. I commonly find parents (with dental insurance) that have to spend hundreds to thousands of dollars to fix their child's teeth.
So, how to protect your child's teeth? Start brushing them as soon as they come in. Help your child with their brushing until they are doing a good job (commonly about age 5). Visit a dentist regularly. Avoid sugary chewy foods such as fruit snacks, roll ups and candies. Avoid drinks with sugar in them such as juice, soda, lemonade, and sports drinks. Lastly don't let your child graze all day long or carry a cup around with them.
Myth busted! Next up, the idea that kids don't have to watch what they eat because they are kids.
First off we are going to talk about baby teeth. I find that some parents think that since baby teeth fall out there is no need to take care of them. Baby teeth are actually quite important so we are going to discuss some reasons why.
1. Some baby teeth won't fall out until age 12-13. That's a long time to have teeth that are not cared for.
2. Cavities hurt and can lead to serious infections such as abscesses. If your child's mouth hurts he will be fussy, not sleep well, do poorly in school, and won't eat very well.
3. Good habits start early. Is your child suddenly going to start brushing and flossing when his permanent teeth come in? Probably not. It is best to start good dental habits when young so that they are part of the daily routine for your child's lifetime.
4. Dental work is expensive. I commonly find parents (with dental insurance) that have to spend hundreds to thousands of dollars to fix their child's teeth.
So, how to protect your child's teeth? Start brushing them as soon as they come in. Help your child with their brushing until they are doing a good job (commonly about age 5). Visit a dentist regularly. Avoid sugary chewy foods such as fruit snacks, roll ups and candies. Avoid drinks with sugar in them such as juice, soda, lemonade, and sports drinks. Lastly don't let your child graze all day long or carry a cup around with them.
Myth busted! Next up, the idea that kids don't have to watch what they eat because they are kids.
Tuesday, January 31, 2012
SOAP (Organization of a Doctor Visit)
I recently had a college student observe me in the office because she wants to be a pediatrician. I spent a few minutes explaining to her how a visit is organized so I thought I would also share that information with you. One of the first things a medical student learns about seeing patients and charting is "SOAP" This stands for Subjective, Objective, Assessment, and Plan. This is the order in which the visit and the charting is done.
Subjective means the information that we get from the patient. This includes history of the present illness, past medical history, family history, medications, allergies, etc. Some of this we ask every visit and some of it we review in the chart before coming into the room. It is very helpful if you voice all of your concerns and problems at this point in the visit.
Next is the objective part of the visit. This means the physical exam as well as vitals signs such as weight, temperature, blood pressure, etc.
For the next step, assessment, the doctor takes the information that she gathered in the first two steps to come up with a differential or list of what things the patient might have. Sometimes this is very easy, for example a bulging red ear drum means you have an ear infection or sometimes there are several possibilities of what you might have. I sometimes don't say a lot when I am examining a patient because I want to collect all the information and then I think while I am washing my hands before I sit down to talk with you.
The last step is the plan. Together the doctor and patient discuss treatment recommendations.
Since September the assessment and plan for all of your child's visits are available for you to view online (securely of course). The front desk has the directions on how to access this information for you.
Subjective means the information that we get from the patient. This includes history of the present illness, past medical history, family history, medications, allergies, etc. Some of this we ask every visit and some of it we review in the chart before coming into the room. It is very helpful if you voice all of your concerns and problems at this point in the visit.
Next is the objective part of the visit. This means the physical exam as well as vitals signs such as weight, temperature, blood pressure, etc.
For the next step, assessment, the doctor takes the information that she gathered in the first two steps to come up with a differential or list of what things the patient might have. Sometimes this is very easy, for example a bulging red ear drum means you have an ear infection or sometimes there are several possibilities of what you might have. I sometimes don't say a lot when I am examining a patient because I want to collect all the information and then I think while I am washing my hands before I sit down to talk with you.
The last step is the plan. Together the doctor and patient discuss treatment recommendations.
Since September the assessment and plan for all of your child's visits are available for you to view online (securely of course). The front desk has the directions on how to access this information for you.
Friday, January 20, 2012
Frost the Cupcake (Sunscreen)
I know that sunscreen is not a very popular topic in the winter time but sunscreen is important year round. I recently attended a continuing education conference where I heard a dermatologist (Dr. Wagner) speak on this subject so I thought I would share some of it with you.
I'm sure I don't need to tell you about why sun protection is important. Skin cancer, wrinkles... who wants them? (By the way teens don't care about skin cancer so they are more likely to protect their skin if they think that the sun will make them ugly!)
It is best to get in the habit of applying sunscreen every morning. Make it part of your morning routine such as brushing your teeth. Then if you are going to be in the sun such as going to the pool or park reapply the sunscreen 20-30 minutes beforehand and every two hours after that. Dr. Wagner related applying sunscreen to "frosting a cupcake." You want to apply a lot and to not miss any part of the cupcake, er, skin. It is safe to use sunscreen on babies less than 6 months of age.
So, what sunscreen to buy? Dr. Wagner recommends a sunscreen with the SPF of 30. There is little benefit to the higher SPF sunscreens and as the SPF increases there are increased chemicals in the product. You also want to pick a sunscreen that is waterproof and protects agains UVA and UVB (aka broad spectrum). Some of the best ingredients include mexoryl and zinc oxide. Also if possible get a sunscreen that is perfume free.
Let's not wait until summer. Let's start frosting the cupcake now!
I'm sure I don't need to tell you about why sun protection is important. Skin cancer, wrinkles... who wants them? (By the way teens don't care about skin cancer so they are more likely to protect their skin if they think that the sun will make them ugly!)
It is best to get in the habit of applying sunscreen every morning. Make it part of your morning routine such as brushing your teeth. Then if you are going to be in the sun such as going to the pool or park reapply the sunscreen 20-30 minutes beforehand and every two hours after that. Dr. Wagner related applying sunscreen to "frosting a cupcake." You want to apply a lot and to not miss any part of the cupcake, er, skin. It is safe to use sunscreen on babies less than 6 months of age.
So, what sunscreen to buy? Dr. Wagner recommends a sunscreen with the SPF of 30. There is little benefit to the higher SPF sunscreens and as the SPF increases there are increased chemicals in the product. You also want to pick a sunscreen that is waterproof and protects agains UVA and UVB (aka broad spectrum). Some of the best ingredients include mexoryl and zinc oxide. Also if possible get a sunscreen that is perfume free.
Let's not wait until summer. Let's start frosting the cupcake now!
Friday, January 13, 2012
What ER Do I Take My Child To?
You think your child broke their arm or that they might have appendicitis so what do you do? First of all, give our office a call. Sometimes we can help avoid an ER visit. Then if you need an ER we recommend a children's hospital such as Phoenix Children's Hospital or Cardon Children's Medical Center.
So, why a children's hospital. I know that there is probably another hospital closer to your house or one that advertises shorter wait times but we strongly urge you to go to a children's hospital. At a children's hospital you will get a doctor and staff that specializes in pediatrics. Children are not just small adults and they have different problems and different needs. I commonly see my patients receive unnecessary tests or medications from "adult" ERs.
Another reason to go to a children's hospital is for the specialists. For example, if your child might have appendicitis the results of tests such as ultasound or CT can be dependent on the tech or radiologist's experience with children. Then if your child needs surgery they will have to be transferred to a children's hospital for the surgery and admission.
Lastly, I would go to a children's hospital for the Child Life specialists. These therapists help make your child's stay less stressful and painful.
So, why a children's hospital. I know that there is probably another hospital closer to your house or one that advertises shorter wait times but we strongly urge you to go to a children's hospital. At a children's hospital you will get a doctor and staff that specializes in pediatrics. Children are not just small adults and they have different problems and different needs. I commonly see my patients receive unnecessary tests or medications from "adult" ERs.
Another reason to go to a children's hospital is for the specialists. For example, if your child might have appendicitis the results of tests such as ultasound or CT can be dependent on the tech or radiologist's experience with children. Then if your child needs surgery they will have to be transferred to a children's hospital for the surgery and admission.
Lastly, I would go to a children's hospital for the Child Life specialists. These therapists help make your child's stay less stressful and painful.
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