In case you hadn't noticed when I write, I write from the heart. This week, my heart is with the recent tornado victims. I'm sure you feel the same.
I'd like to talk about emergency preparedness. We all need to address this issue. We need to take personal responsibility for our homes and our families. We need to make sure we have the necessary supplies in the appropriate place or places.
The first question that arises is what constitutes an emergency preparedness kit? The best information I found was at www.ready.gov/america/getakit/index.html. This website gives a ton of information in list form, and is very readable. The ready.gov list is easy for all of us to accomplish. The thing that is striking about the ready.gov list is that it talks about having 3 days worth of food and water. The American Red Cross website says that, also. Emergency crews may get to you in a couple of hours, or it may take 2-3 days. The second question is do you have a specific place in your house that is your "emergency area?" You need a place to store these things in advance. This place should be close to where you take cover.
I'm not going to go through the list on ready.gov. Instead, let me talk about your children. Preschool and school aged children can help by making their own emergency box. All it takes is a shoe box and a little forethought. Let them help. They should each have their own box. It should contain a couple of favorite photos of the family. These are fun to look at while waiting for an "all clear," and can be helpful to emergency crews if family members get seperated. Let them each have their own flashlight. Yes, they will play with them and annoy you. However, if you live through a major disaster, you'll get over it! Pack extra batteries. Let them add some favorite non-perishable foods. The quantity of these is not meant to last 3 days. It is meant to get you through a 2-3 hour tornado warning. After all, it's just a shoe box. These boxes need to be packed and repacked once a year. This means photos should be updated annually and the food really does need to be non-perishable. At the same time you pack the shoe boxes, pick out a spare change of clothing to pack in your emergency area.
Teens and preteens will be happy with the same kind of box with some minor changes. Allow them to pack some old cartridges from a favorite handheld game. Consider headphones and iPods. They can contribute greatly to family harmony in a small space.
I have some miscellaneous items I would like to add to the list. Remember, that you have to stay calm and informed. Make sure your emergency area has extra batteries, playing cards, books and board games. I recommend a television as a way to monitor the emergency, over radio. Some people disagree, others use both. I also suggest packing plastic baggies with zipper closures. They come in handy if everything starts to get wet. Keep several sizes handy. Kansas City suggests shoes and whistles for when it is over, http://sms.mx/CPd6y0.
If you are like most families, you have multiple cell phones. In an emergency situation, turn all but one phone off to conserve battery power. Keep the other(s) on chargers as long as power is available. As power goes out in one phone, turn on the next phone. This improves your chances of having phone power until emergency crews can reach you.
Emergencies happen. While we can't be prepared for each and every one, let us plan for the ones we can anticipate. Involve your children. This will make it more like a game and reduce their anxiety. Have a specific emergency area in your house with supplies there all the time. All you will have to do is add loved ones. Talk about this as a family and consider having drills. Then, when an emergency happens, I hope this will make it easier on everyone.
Dr Nan N
House Call Pediatrician
State of the art care for your child in your home.
http://FiresidePediatrics.com
http://PersonalMedicine.com
Wednesday, May 25, 2011
Wednesday, May 18, 2011
New Acetaminophen Dosing
New Acetaminophen Dosing, One Physician's Response
In the past few weeks, many changes have burst onto the front page concerning acetaminophen, the most commonly used over the counter medication for children. Infant drops are going bye-bye, yet dosing information for children under age 2 will be made more available for combination medications containing acetaminophen. Isn't this a mixed message? What are we to make of all this?
I think it is only fair for me to tell you what I make of all this. I cannot comment on what others are making it. I come to you as a physician and a mother.
Acetaminophen is one of the most useful and widely used medications in the US, and possibly worldwide. It is used for fever, pain and even for prevention of both. It is also the most common medication found in accidental ingestions. That's the medical term for poisoning. That's when your toddler, child or teen gets into the medication without your knowledge or permission. It also includes those times when a parent or grandparent accidentally or unknowingly gives a higher dose than what is indicated. If these overdoses are suspected immediately, they can be diagnosed by a series of timed blood tests and treated with medication. Unfortunately, this is not always the case. I will spare you the details, but this can result in a painful death by liver failure that can take several days. It's heartbreaking.
Acetaminophen is marketed in several different strengths. Tablets come in different strengths, as do liquid preparations. Dosing information for children under 2 years of age has not been available on the packaging. For Pediatricians and Family Practicioners, this has meant a lot of after hours phone calls for dosing information. The proactive physician will make this kind of dosing information available to parents before they need it. I have always given this to parents at the 2 month visit, and geared it toward the child's weight. I also discussed this in one of my first blogs. However, multiple preparations in multiple strengths definately causes confusion. Getting rid of the most concentrated strength will certainly increase safety. Even with this move, doses will need to be based on a child's weight, not on their age.
This means parents will need to know their child's weight at all times. Many of us don't do that. We don't weigh our children on a regular basis. We certainly don't weigh them when they are sick and miserable. Some of us don't have scales in our homes. I recommend two things. The first is that you check with your provider to see if they have a patient portal to your child's medical record. This is a way to access parts of the electronic medical record over the internet. The part that includes your child's weight, height and other vital signs is universally accessible in participating hospitals and clinics. Unfortunately, it is only as accurate as your child's most recent visit. Therefore, you should also consider getting a good set of home scales so that you can weigh your child at home when they are sick.
I am not a fan of over the counter cold medications. They don't work well in children, and they are fraught with side effects. This leads me to the combination medications with acetaminophen. Most of them are "cold" medications. Having dosing information available for children under age 2 years is convenient, because that means fewer phone calls to the physician in the middle of the night. However, it also means that more parents will be giving their children and toddlers medications that I don't think they should have. I think it is going to be difficult for the FDA to do this without sending a mixed message. It is just as unwise for the FDA to be giving mixed messages to parents and grandparents as it is for us, as parents, to give mixed messages to our teenagers. We need to push them to make a completely responsible decision.
Furthermore, if we are going to talk about the safety of acetaminophen, let us not forget the teens. This is still a favorite medication to use in suicide and suicide attempts. While I admit that legislature can to little to address this, all this media attention could be a springboard for conversations. Let's start talking about teens and their use of acetaminophen. Let's talk about their use of over the counter medications in general.
There is a lot of new information out there. A spotlight has been thrown on acetaminophen. I think that is a good thing. I'm not sure it is enough. I have mixed feelings about the withdrawal of acetaminophen infant drops from the market, but I think it is the right thing to do. I am not certain that it is right to post dosing information for children under age 2 for combination medications containing acetaminophen. I also think the conversation needs to move forward concerning the different strengths of tablets. Finally, keep this, and all medications, out of the reach of children and teens. Perhaps that should be the topic of my next blog.
Secure your health. Start at home.
twitter: @DrNanN
personalmedicine.com
youtube: personalmedicineTV
In the past few weeks, many changes have burst onto the front page concerning acetaminophen, the most commonly used over the counter medication for children. Infant drops are going bye-bye, yet dosing information for children under age 2 will be made more available for combination medications containing acetaminophen. Isn't this a mixed message? What are we to make of all this?
I think it is only fair for me to tell you what I make of all this. I cannot comment on what others are making it. I come to you as a physician and a mother.
Acetaminophen is one of the most useful and widely used medications in the US, and possibly worldwide. It is used for fever, pain and even for prevention of both. It is also the most common medication found in accidental ingestions. That's the medical term for poisoning. That's when your toddler, child or teen gets into the medication without your knowledge or permission. It also includes those times when a parent or grandparent accidentally or unknowingly gives a higher dose than what is indicated. If these overdoses are suspected immediately, they can be diagnosed by a series of timed blood tests and treated with medication. Unfortunately, this is not always the case. I will spare you the details, but this can result in a painful death by liver failure that can take several days. It's heartbreaking.
Acetaminophen is marketed in several different strengths. Tablets come in different strengths, as do liquid preparations. Dosing information for children under 2 years of age has not been available on the packaging. For Pediatricians and Family Practicioners, this has meant a lot of after hours phone calls for dosing information. The proactive physician will make this kind of dosing information available to parents before they need it. I have always given this to parents at the 2 month visit, and geared it toward the child's weight. I also discussed this in one of my first blogs. However, multiple preparations in multiple strengths definately causes confusion. Getting rid of the most concentrated strength will certainly increase safety. Even with this move, doses will need to be based on a child's weight, not on their age.
This means parents will need to know their child's weight at all times. Many of us don't do that. We don't weigh our children on a regular basis. We certainly don't weigh them when they are sick and miserable. Some of us don't have scales in our homes. I recommend two things. The first is that you check with your provider to see if they have a patient portal to your child's medical record. This is a way to access parts of the electronic medical record over the internet. The part that includes your child's weight, height and other vital signs is universally accessible in participating hospitals and clinics. Unfortunately, it is only as accurate as your child's most recent visit. Therefore, you should also consider getting a good set of home scales so that you can weigh your child at home when they are sick.
I am not a fan of over the counter cold medications. They don't work well in children, and they are fraught with side effects. This leads me to the combination medications with acetaminophen. Most of them are "cold" medications. Having dosing information available for children under age 2 years is convenient, because that means fewer phone calls to the physician in the middle of the night. However, it also means that more parents will be giving their children and toddlers medications that I don't think they should have. I think it is going to be difficult for the FDA to do this without sending a mixed message. It is just as unwise for the FDA to be giving mixed messages to parents and grandparents as it is for us, as parents, to give mixed messages to our teenagers. We need to push them to make a completely responsible decision.
Furthermore, if we are going to talk about the safety of acetaminophen, let us not forget the teens. This is still a favorite medication to use in suicide and suicide attempts. While I admit that legislature can to little to address this, all this media attention could be a springboard for conversations. Let's start talking about teens and their use of acetaminophen. Let's talk about their use of over the counter medications in general.
There is a lot of new information out there. A spotlight has been thrown on acetaminophen. I think that is a good thing. I'm not sure it is enough. I have mixed feelings about the withdrawal of acetaminophen infant drops from the market, but I think it is the right thing to do. I am not certain that it is right to post dosing information for children under age 2 for combination medications containing acetaminophen. I also think the conversation needs to move forward concerning the different strengths of tablets. Finally, keep this, and all medications, out of the reach of children and teens. Perhaps that should be the topic of my next blog.
Secure your health. Start at home.
twitter: @DrNanN
personalmedicine.com
youtube: personalmedicineTV
Tuesday, May 10, 2011
Staying Hydrated
Hey, it's hot out there!
It's gone from high temperatures in the low 70's to highs in the low 90's overnight, pretty much skipping the 80's altogether. It may be different where you are, but this is life in the midwest. We have three and one half seasons a year. (We only get half a spring).
Now that it has suddenly become hot, let's talk about staying hydrated and keeping our kids hydrated. Adults need eight to ten 8-oz glasses of water a day. They need more if they are very active (strenuous exercise for more than 30 minutes). I know this has been contested in the lay literature, but I still stand by this. Your intestinal tract will work better, your skin will stay more hydrated and you hair will shine. More importantly, you will feel better.
In addition to water, you may want other fluids. I recommend 100% juice, not juice drink or juice mix, even for adults. I would avoid beverages with added sugar-it simply isn't needed. This includes sucrose, fructose, and high fructose corn syrup. Green tea and coffee are said to have health advantages. However, for every caffeinated beverage you drink, you need another 8 oz of water! For a 3-cup a day coffee drinker, like myself, who works out hard an hour a day (5-6 days a week) that's a lot of water.
This same advice about additional fluids applies to your children. They need adequate amounts of water, which I will discuss in a moment. They should get juice that is always 100% juice. Four ounces a day is plenty. More than that blunts their appetite for solid foods. Avoid giving them beverages with added sugar, fructose or high fructose corn syrup.
The hard part of this blog is talking about how much water to give your children. There are very few published guidelines. The ones I could find all deal with children who are already dehydrated. This is what we are trying to avoid. Furthermore, the amount has to change as they grow. Therefore, you should know that much of the following information is my opinion, based on my experience and expertise.
Let's start with infants. Breastfed infants do not need additional water. However, mother needs to make sure she stays well hydrated. Bottlefed infants should start getting water at 1-2 months of age. Start with 2-4 oz a day and work up to 4-6 oz a day. Constipated infants may benefit from 8 oz a day. There is seldom any need to go above that amount in children less than 6 months old. In hot weather, it is better to shelter these children from the heat, than to increase their water intake. This is because their kidneys may not handle the increase in water the same as an adult, and their electrolytes may become unbalanced. This can result in hospitalization.
As they get older, things start to change. At 6-12 months of age, 8-16 oz of water a day seems to work for most children. If your infant is constipated, try increasing their water intake more toward 16 oz a day and see if that doesn't help. At 12-24 months of age, 16-24 oz a day works well for most children. By age 4, I start talking directly to the children about their water intake. I teach them that they need 1 (8 oz) glass of water for every year they are old. That means 4 glasses for a 4 year old, 5 glasses for a 5 year old, etc, all the way up to 8-10 years of age. This makes it very simple and easy to remember. It also works extremely well to maintain good health.
In those wonderful preteen and teen years we discuss the transition to adult recommendations. This includes a discussion of caffeine and increasing water intake to compensate for that. I will allow teens to drink 8 oz of juice a day, simply because many of them are drinking 3-4 8 oz glasses of juice drink already. Cutting back to a single glass of 100% juice is a much healthier choice.
Despite all this, it may be difficult to keep up with the hot weather. How do you know if you child needs more fluids? The early signs of mild dehydration are subtle. They are fatigue and irritability. Older children may exhibit confusion. If you see these things, get your child to a cool environment and get them to drink some fluids. Water is preferable. Most of us get plenty of electrolytes in our diet. However, if they have been extremely active, such as participating in competitive sports for more than 30 minutes without a break, consider an electrolyte drink. If your child does not improve in 15-30 minutes, contact your healthcare provider.
Dr Nan N
House Call Pediatrician, Overland Park, KS
State of the art care for your child in your home.
http://FiresidePediatrics.com
http://PersonalMedicine.com
It's gone from high temperatures in the low 70's to highs in the low 90's overnight, pretty much skipping the 80's altogether. It may be different where you are, but this is life in the midwest. We have three and one half seasons a year. (We only get half a spring).
Now that it has suddenly become hot, let's talk about staying hydrated and keeping our kids hydrated. Adults need eight to ten 8-oz glasses of water a day. They need more if they are very active (strenuous exercise for more than 30 minutes). I know this has been contested in the lay literature, but I still stand by this. Your intestinal tract will work better, your skin will stay more hydrated and you hair will shine. More importantly, you will feel better.
In addition to water, you may want other fluids. I recommend 100% juice, not juice drink or juice mix, even for adults. I would avoid beverages with added sugar-it simply isn't needed. This includes sucrose, fructose, and high fructose corn syrup. Green tea and coffee are said to have health advantages. However, for every caffeinated beverage you drink, you need another 8 oz of water! For a 3-cup a day coffee drinker, like myself, who works out hard an hour a day (5-6 days a week) that's a lot of water.
This same advice about additional fluids applies to your children. They need adequate amounts of water, which I will discuss in a moment. They should get juice that is always 100% juice. Four ounces a day is plenty. More than that blunts their appetite for solid foods. Avoid giving them beverages with added sugar, fructose or high fructose corn syrup.
The hard part of this blog is talking about how much water to give your children. There are very few published guidelines. The ones I could find all deal with children who are already dehydrated. This is what we are trying to avoid. Furthermore, the amount has to change as they grow. Therefore, you should know that much of the following information is my opinion, based on my experience and expertise.
Let's start with infants. Breastfed infants do not need additional water. However, mother needs to make sure she stays well hydrated. Bottlefed infants should start getting water at 1-2 months of age. Start with 2-4 oz a day and work up to 4-6 oz a day. Constipated infants may benefit from 8 oz a day. There is seldom any need to go above that amount in children less than 6 months old. In hot weather, it is better to shelter these children from the heat, than to increase their water intake. This is because their kidneys may not handle the increase in water the same as an adult, and their electrolytes may become unbalanced. This can result in hospitalization.
As they get older, things start to change. At 6-12 months of age, 8-16 oz of water a day seems to work for most children. If your infant is constipated, try increasing their water intake more toward 16 oz a day and see if that doesn't help. At 12-24 months of age, 16-24 oz a day works well for most children. By age 4, I start talking directly to the children about their water intake. I teach them that they need 1 (8 oz) glass of water for every year they are old. That means 4 glasses for a 4 year old, 5 glasses for a 5 year old, etc, all the way up to 8-10 years of age. This makes it very simple and easy to remember. It also works extremely well to maintain good health.
In those wonderful preteen and teen years we discuss the transition to adult recommendations. This includes a discussion of caffeine and increasing water intake to compensate for that. I will allow teens to drink 8 oz of juice a day, simply because many of them are drinking 3-4 8 oz glasses of juice drink already. Cutting back to a single glass of 100% juice is a much healthier choice.
Despite all this, it may be difficult to keep up with the hot weather. How do you know if you child needs more fluids? The early signs of mild dehydration are subtle. They are fatigue and irritability. Older children may exhibit confusion. If you see these things, get your child to a cool environment and get them to drink some fluids. Water is preferable. Most of us get plenty of electrolytes in our diet. However, if they have been extremely active, such as participating in competitive sports for more than 30 minutes without a break, consider an electrolyte drink. If your child does not improve in 15-30 minutes, contact your healthcare provider.
Dr Nan N
House Call Pediatrician, Overland Park, KS
State of the art care for your child in your home.
http://FiresidePediatrics.com
http://PersonalMedicine.com
Wednesday, May 4, 2011
Bicycle Safety
May is National Bicycle Safety month. It's time to get those bikes out of the garage, clean them up and get ready to ride!
It's also time to review bicycle safety with the entire family. Bicycle safety, like so many things, starts at home. It is an ideal family activity-the safety as much as the riding. It is an excellent way to grow together.
As you clean your bicycles, teach your children to check them for damage. Damaged parts should be repaired or replaced before you start riding. If your children or teens will be riding at night, be sure the lights work. Check horns and bells as well.
Check your helmets at the same time. Helmets that get worn frequently, will get worn out. Check the straps and the fit. The helmet should fit snugly. If it moves on your child's head without moving their scalp, it is too loose. Also, it should sit perfectly horizontally on the head, and not at a jaunty angle. Remember, it's purpose is safety, not looks. Most importantly of all, if a helmet has been in an accident, it should be replaced. I encourage all of my clients to wear helmets. If parents wear a helmet as well, they set an excellent example.
Dress appropriately when you ride. This means avoid clothing that is loose enough to get caught in the spokes or chain, such as skirts or wide pants. To protect your toes, wear close-toed shoes or boots, not flip-flops. (I've seen some ugly toe injuries in the last couple of years). If your shoes have laces, make sure they are tied. Also, teach your children to wear reflective clothing if they ride at night or near dusk.
Review the Rules of the Road with the entire family. Remind everyone that cyclists have to ride on the same side of the road as cars, and in the same direction. Stay in bike lanes whenever possible. If driving beside parked cars, be aware that someone may open a car door into your cycle. Stop at all stop signs (always) and at traffic lights (when it is appropriate). Obey speed limits. Watch for cars, because they will not be watching for you.
Then, of course, my best advice is this: go out and enjoy yourself!
Dr Nan N
House Call Pediatrician, Overland Park, KS
State of the art care for your child in your home
http://FiresidePediatrics.com
http://PersonalMedicine.com
It's also time to review bicycle safety with the entire family. Bicycle safety, like so many things, starts at home. It is an ideal family activity-the safety as much as the riding. It is an excellent way to grow together.
As you clean your bicycles, teach your children to check them for damage. Damaged parts should be repaired or replaced before you start riding. If your children or teens will be riding at night, be sure the lights work. Check horns and bells as well.
Check your helmets at the same time. Helmets that get worn frequently, will get worn out. Check the straps and the fit. The helmet should fit snugly. If it moves on your child's head without moving their scalp, it is too loose. Also, it should sit perfectly horizontally on the head, and not at a jaunty angle. Remember, it's purpose is safety, not looks. Most importantly of all, if a helmet has been in an accident, it should be replaced. I encourage all of my clients to wear helmets. If parents wear a helmet as well, they set an excellent example.
Dress appropriately when you ride. This means avoid clothing that is loose enough to get caught in the spokes or chain, such as skirts or wide pants. To protect your toes, wear close-toed shoes or boots, not flip-flops. (I've seen some ugly toe injuries in the last couple of years). If your shoes have laces, make sure they are tied. Also, teach your children to wear reflective clothing if they ride at night or near dusk.
Review the Rules of the Road with the entire family. Remind everyone that cyclists have to ride on the same side of the road as cars, and in the same direction. Stay in bike lanes whenever possible. If driving beside parked cars, be aware that someone may open a car door into your cycle. Stop at all stop signs (always) and at traffic lights (when it is appropriate). Obey speed limits. Watch for cars, because they will not be watching for you.
Then, of course, my best advice is this: go out and enjoy yourself!
Dr Nan N
House Call Pediatrician, Overland Park, KS
State of the art care for your child in your home
http://FiresidePediatrics.com
http://PersonalMedicine.com
Tuesday, April 26, 2011
Your Medical Records
They're Your Medical Records-Why Can't You Have Them?
This past week, I got a reminder that I am always a consumer of healthcare, and only sometimes a physician. I needed a copy of my immunization records. That sounds easy enough. As a provider, I know that this is the simplest part of the record to copy and forward. I also knew that I would have to jump through the same hoops as anyone else.
I called and was directed to the website to download the correct form. I did that. Fifteen minutes later, I was calling back, because I couldn't find the number to fax back the signed form. During that call, I pointed out that some of my immunization information might be in my employee file in Occupational Health, rather than my patient file. They assured me that they would check both. In less than 30 minutes, I was receiving my records back by fax.
I will admit that this is where it differs from most people. I only got my records by fax, because I was in a physician's office. A clinic or hospital will not fax records to an individual. Some will not fax them to a school. Some will fax them to an employer, others will only do so under special circumstances. Everyone else has to wait for snail mail. Okay, you say. That should only take 7-10 business days. Right. It should. Usually, though, it takes 2 months. It doesn't matter if you are having records sent across the country or 2 blocks down the street. It still takes 2 months. If you are asking for your complete medical record, it can take much longer.
What if I didn't have a fax machine, or a personal computer? Then, I would have to find the time to drive in to the office and fill out the release form. If you have moved out of the area, they can mail you the form. That is a 7-10 day delay each direction. This is very frustrating, especially if you are dealing with a deadline. People have asked me if this is an intentional stall technique designed to keep people from asking for their medical records. I don't think so. If it is, it isn't very effective.
As a pediatrician, most of my dealings with forwarding records are quite simple. Parents want immunization records, school physical forms and camp forms. Most of the time these are handed to the family at the child's well visit. Sometimes, however, forms get lost after that. Some parents have to have 3 physical forms completed for each child, each year. Yes, they lose them. Other times, I have seen schools or daycares lose forms for an entire class. It happens. We deal with it. However, there is no denying that such things put stress on the physicians and office staff involved.
I asked a few other people about difficulties getting medical records. I was overwhelmed with the horror stories that were forwarded to me. Stories of people whose records were delayed because of concerns about litigation. Stories of prolonged waits to get records transferred after a move. Stories of physicians not knowing where to look in the charts for outside records(http://chilmarkresearch.com/2011/03/04/a-tale-of-two-medical-records/). Stories of charts being "wrecked," or someone tampering with them, to hide information (http://www.usatoday.com/news/health/2008-04-29-medical-records_N.htm#). Exhorbitant fees charged by the page for copying and forwarding of records.
You have a right to your medical records. Hospitals and clinics have the right to charge a fee to offset the costs of copying and forwarding these records, but there is currently no industry standard for those fees. Hospitals can delay giving you the records under a few select circumstances. However, they should make every effort to get the records to you as quickly as possible. Especially, if it involves the transfer of care of a patient.
Shouldn't electronic medical records (EMRs) be making this easier? I've been using EMRs for almost 10 years. They have done some wonderful things. If a clinic has multiple locations, the same chart is available in all of those locations on the same day. Providers can now type (or use voice-to-text) a note into the chart and have it available the same day the patient is seen. Allergy information is available from the moment a client checks in until they fill their prescription at the pharmacy. Prescriptions are sent digitally, with no misinterpretation due to handwriting.
So, why can't you get your records? Well, a lot of people are working on this. The first part is to make sure the chart is up to date. You may have heard of a government initiative called Meaningful Use. One part of Meaningful Use wants to see providers complete patient notes within 72 hours of a visit. (I work with physicians who complete most of their notes the same day). The second part is accessibility. Some places allow the client (read patient) to access their EMR through a secure portal and view their information. However, most of these are "read only." At Personal Medicine, the patient owns the record and can access it at any time and print or download whatever they need, through their secure portal. Other places are looking at CCRs, Continuity of Care Records or CCDs, Continuity of Care Documents. These can be used to download your entire record to a SIM card or a MicroSD drive.
Talk to your healthcare provider. Let him or her know that you want more. You want accessibility and portability. You want a portal where you can view your records at any time. Better yet, you want to be able to print your records through that portal. Talk loud and talk often. Your voice can and will make a difference.
Oh, yeah. My immunization records are missing several pieces of information that should be there. Like my last 2 doses of influenza, and proof that I had measles, mumps, rubeola and varicella as a child.
I have emailed my Primary Care Physician and asked for a CCD. I'm still waiting to hear back. Next, I'll try visiting him in person.
Dr Nan N
House Call Pediatrician, Overland Park, KS
State of the art care for your child in your home
http://FiresidePediatrics.com
http://PersonalMedicine.com
This past week, I got a reminder that I am always a consumer of healthcare, and only sometimes a physician. I needed a copy of my immunization records. That sounds easy enough. As a provider, I know that this is the simplest part of the record to copy and forward. I also knew that I would have to jump through the same hoops as anyone else.
I called and was directed to the website to download the correct form. I did that. Fifteen minutes later, I was calling back, because I couldn't find the number to fax back the signed form. During that call, I pointed out that some of my immunization information might be in my employee file in Occupational Health, rather than my patient file. They assured me that they would check both. In less than 30 minutes, I was receiving my records back by fax.
I will admit that this is where it differs from most people. I only got my records by fax, because I was in a physician's office. A clinic or hospital will not fax records to an individual. Some will not fax them to a school. Some will fax them to an employer, others will only do so under special circumstances. Everyone else has to wait for snail mail. Okay, you say. That should only take 7-10 business days. Right. It should. Usually, though, it takes 2 months. It doesn't matter if you are having records sent across the country or 2 blocks down the street. It still takes 2 months. If you are asking for your complete medical record, it can take much longer.
What if I didn't have a fax machine, or a personal computer? Then, I would have to find the time to drive in to the office and fill out the release form. If you have moved out of the area, they can mail you the form. That is a 7-10 day delay each direction. This is very frustrating, especially if you are dealing with a deadline. People have asked me if this is an intentional stall technique designed to keep people from asking for their medical records. I don't think so. If it is, it isn't very effective.
As a pediatrician, most of my dealings with forwarding records are quite simple. Parents want immunization records, school physical forms and camp forms. Most of the time these are handed to the family at the child's well visit. Sometimes, however, forms get lost after that. Some parents have to have 3 physical forms completed for each child, each year. Yes, they lose them. Other times, I have seen schools or daycares lose forms for an entire class. It happens. We deal with it. However, there is no denying that such things put stress on the physicians and office staff involved.
I asked a few other people about difficulties getting medical records. I was overwhelmed with the horror stories that were forwarded to me. Stories of people whose records were delayed because of concerns about litigation. Stories of prolonged waits to get records transferred after a move. Stories of physicians not knowing where to look in the charts for outside records(http://chilmarkresearch.com/2011/03/04/a-tale-of-two-medical-records/). Stories of charts being "wrecked," or someone tampering with them, to hide information (http://www.usatoday.com/news/health/2008-04-29-medical-records_N.htm#). Exhorbitant fees charged by the page for copying and forwarding of records.
You have a right to your medical records. Hospitals and clinics have the right to charge a fee to offset the costs of copying and forwarding these records, but there is currently no industry standard for those fees. Hospitals can delay giving you the records under a few select circumstances. However, they should make every effort to get the records to you as quickly as possible. Especially, if it involves the transfer of care of a patient.
Shouldn't electronic medical records (EMRs) be making this easier? I've been using EMRs for almost 10 years. They have done some wonderful things. If a clinic has multiple locations, the same chart is available in all of those locations on the same day. Providers can now type (or use voice-to-text) a note into the chart and have it available the same day the patient is seen. Allergy information is available from the moment a client checks in until they fill their prescription at the pharmacy. Prescriptions are sent digitally, with no misinterpretation due to handwriting.
So, why can't you get your records? Well, a lot of people are working on this. The first part is to make sure the chart is up to date. You may have heard of a government initiative called Meaningful Use. One part of Meaningful Use wants to see providers complete patient notes within 72 hours of a visit. (I work with physicians who complete most of their notes the same day). The second part is accessibility. Some places allow the client (read patient) to access their EMR through a secure portal and view their information. However, most of these are "read only." At Personal Medicine, the patient owns the record and can access it at any time and print or download whatever they need, through their secure portal. Other places are looking at CCRs, Continuity of Care Records or CCDs, Continuity of Care Documents. These can be used to download your entire record to a SIM card or a MicroSD drive.
Talk to your healthcare provider. Let him or her know that you want more. You want accessibility and portability. You want a portal where you can view your records at any time. Better yet, you want to be able to print your records through that portal. Talk loud and talk often. Your voice can and will make a difference.
Oh, yeah. My immunization records are missing several pieces of information that should be there. Like my last 2 doses of influenza, and proof that I had measles, mumps, rubeola and varicella as a child.
I have emailed my Primary Care Physician and asked for a CCD. I'm still waiting to hear back. Next, I'll try visiting him in person.
Dr Nan N
House Call Pediatrician, Overland Park, KS
State of the art care for your child in your home
http://FiresidePediatrics.com
http://PersonalMedicine.com
Tuesday, April 19, 2011
Getting More Fruits and Vegetables in Your Diet
For years, I have been telling people to get 5-9 servings of fruits and vegetables in their diet every day. This past week, I saw someone post a new recommendation that stated we should get 10 servings of fruits and veggies a day. I haven't been able to confirm that. It doesn't make much difference, if most of us are only getting 3-4 servings a day. Many studies have shown that most Americans get only 3-4 servings of fruits and vegetables a day, with most of those being fruits. The recommendation I can find is that we should be getting 5-9 servings a day, with at least 3 servings being vegetables.
I'm not writing today to argue about the details of the recommendation. So, why am I writing? Because most of us aren't getting enough of the healthy cancer-fighting, heart disease-preventing vitamins and antioxidants that are found in fruits and vegetables. If you have family members in this situation, I would like to help. I am going to suggest several things that have worked for a number of people I know. Choose a couple and work them into your daily routine. Once you have done them for several weeks and they become habits, add a couple more.
First, let us talk about what constitutes a serving. A serving of fruit is either a piece, or 1/2 cup for fresh fruit, or 1/4 cup for dried fruit. Let me explain that. An orange is a serving. A medium apple is a serving. A watermelon is not a serving, but 1/2 cup of watermelon is. A grape is not a serving, but 1/2 cup of grapes is. For some reason, a banana is 2 servings. For vegetables, 1/2 cup is a serving for most vegetables with the exception of leafy green ones. It takes 1 cup of leafy greens to make a serving. They should be measured before any cooking, and do not press them down into the measuring cup.
I can already hear someone asking, "Do I really have to measure all this?" Um, yeah. I really don't know any way around that. Until you can accurately eyeball 1 cup and 1/2 cup as well as my great-grandmother, then yes. I suggest you buy several sets of measuring cups. Use them as serving spoons. Keep them handy when preparing food. For my little family of 2, we have 3 sets. It's not quite enough.
Now that you're prepared and have all the right tools, let's get started. It starts with breakfast. Try to get 2 servings of fruits and veggies worked into breakfast. Vegetables are easily added to omelets. Onions, tomatoes and mushrooms can also be put on breakfast sandwiches, English muffins and bagels. I can see getting 1-2 servings of vegetables in an omelet, but getting an entire serving of vegetables on a single breakfast sandwich may be more difficult. You may have to put half the serving on the sandwich and serve the other half as a side dish.
For many people, fruit is easier to eat at breakfast than vegetables. I recommend you use juice for only one serving of fruit (or vegetable) a day, as it is low in fiber. The exception to this is if you are using a juicer, as this retains much more of the fiber. Of course, whole, fresh fruit has all of the fiber and never any added sugar. Use whole, fresh fruit liberally throughout the day. Fruit smoothies are simple and quick and can be a complete breakfast. I suggest you use fresh or frozen fruit whenever possible. Smoothies need a little bit of liquid. Add milk or yogurt, rather than ice cream. For those who cannot have dairy, you can use soy milk, rice milk or almond milk. Smoothies are low in protein. You can add protein powder, or have 1/4 cup dry roasted nuts along with the smoothie (not in it) for a complete meal. Smoothies can be prepared in advance and kept in a thermos for an afternoon snack. Fruit can also be added to hot or cold cereals. For me, a typical breakfast is steel cut oatmeal with 1-2 cups of fresh berries and a little artificial sweetener.
Then there is snack time. For those of you who are home schooling, you have a bit more control over your children's snacks than children in the public or private school systems. However, parents can group together and put pressure on schools to change what is available at snack times. It is already working across the nation to get carbonated beverages out of schools. Snacks should be a fruit or vegetable paired with a source of protein. Simple things are a 1/4 cup of dried fruit mixed with 1/4 cup of nuts. My favorite is 1/4 cup of craisins with 1/4 cup of lightly salted, dry roasted peanuts. (I make several in advance and put them in sandwich-sized baggies). Another example would be an apple or pear and an ounce of cheese in cubes or slices. For those with dairy allergies, try substituting peanut or almond butter. For children allergic to both, apple with deli slices of ham is delicious. Pairing a protein source with your carbohydrate will keep hunger away longer and limits swings in blood sugar.
Lunchtime comes around and we haven't had much in the way of vegetables. This is an opportunity to change that. Swing the balance back with vegetable sticks. Carrots, celery, bell peppers, jicama, sugar peas, even raw sweet potatoes are good choices. Use your imagination. Try to avoid dipping vegetables in cheese or salad dressing, as these are high-fat choices. Choose instead hummus, nut butters, or go without dip. However, if ranch dressing is the only way you can keep your child from trading away his veggies at lunchtime, then measure out one serving. Serving sizes are on the bottle.
After school is another snack time and another opportunity to get a fruit or vegetable into everyone. Don't miss out on this. You can look at what they have already eaten during the day, as well as looking ahead to dinner plans and choose accordingly. Okay. Face it. Most of us aren't that organized. Make sure you have choices available for afterschool that include fruits and vegetables. Build on what we've already discussed.
Dinner comes along and most of us have not yet had 3 servings of vegetables for the day. We might have had 3-4 fruits and 1 vegetable, if we have been working at it. This means that most of the time, dinner plans need to include 2 servings of vegetables. If you opt for a large dinner salad, you can easily get 2-3 servings of vegetables into a single meal. If you only fix one vegetable at dinner, place 1 cup on everyone's plate. It's an easy fix. Of course, if you do that with 2 vegetables and they only eat one, you still win.
Have you reached your totals? Are we at 5-9 fruits and vegetables for the day? We should have had our 3 servings of vegetables. If you aren't sure about the total count, then go ahead and add a fruit to dessert. This takes the focus off of sugar in your dessert.
I hear it. Someone is grumbling about the cost. "All these fruits and vegetables are more expensive." More expensive than what? I could go on for hours about how you will be saving on healthcare costs in the long run, but I won't. I will say that it helps to buy what is in season. More importantly, studies have been done that show diets rich in fruits and vegetables are less expensive than diets rich in junk food. Those studies show that if you Change your buying power from junk food to fresh produce, you actually save money. The problem is that you cannot buy both. You have to decide what is important. I can't do it for you.
One word of caution: this is a lot of fiber. If this is a big change in someone's diet, it can cause some gastrointestinal discomfort. It needs to be paired with an appropriate intake of water! You need to be getting 64-80 ounces of water a day. If not, the fiber can sit in the gastrointestinal tract and cause pain. In rare cases, it can cause obstruction. Please, do not use this as an excuse to avoid fruits and vegetables, just drink the water. You can do it.
Dr Nan N
House Call Pediatrician, Overland Park, KS
State of the art care for your child in your home.
http://FiresidePediatrics.com
http://PersonalMedicine.com
I'm not writing today to argue about the details of the recommendation. So, why am I writing? Because most of us aren't getting enough of the healthy cancer-fighting, heart disease-preventing vitamins and antioxidants that are found in fruits and vegetables. If you have family members in this situation, I would like to help. I am going to suggest several things that have worked for a number of people I know. Choose a couple and work them into your daily routine. Once you have done them for several weeks and they become habits, add a couple more.
First, let us talk about what constitutes a serving. A serving of fruit is either a piece, or 1/2 cup for fresh fruit, or 1/4 cup for dried fruit. Let me explain that. An orange is a serving. A medium apple is a serving. A watermelon is not a serving, but 1/2 cup of watermelon is. A grape is not a serving, but 1/2 cup of grapes is. For some reason, a banana is 2 servings. For vegetables, 1/2 cup is a serving for most vegetables with the exception of leafy green ones. It takes 1 cup of leafy greens to make a serving. They should be measured before any cooking, and do not press them down into the measuring cup.
I can already hear someone asking, "Do I really have to measure all this?" Um, yeah. I really don't know any way around that. Until you can accurately eyeball 1 cup and 1/2 cup as well as my great-grandmother, then yes. I suggest you buy several sets of measuring cups. Use them as serving spoons. Keep them handy when preparing food. For my little family of 2, we have 3 sets. It's not quite enough.
Now that you're prepared and have all the right tools, let's get started. It starts with breakfast. Try to get 2 servings of fruits and veggies worked into breakfast. Vegetables are easily added to omelets. Onions, tomatoes and mushrooms can also be put on breakfast sandwiches, English muffins and bagels. I can see getting 1-2 servings of vegetables in an omelet, but getting an entire serving of vegetables on a single breakfast sandwich may be more difficult. You may have to put half the serving on the sandwich and serve the other half as a side dish.
For many people, fruit is easier to eat at breakfast than vegetables. I recommend you use juice for only one serving of fruit (or vegetable) a day, as it is low in fiber. The exception to this is if you are using a juicer, as this retains much more of the fiber. Of course, whole, fresh fruit has all of the fiber and never any added sugar. Use whole, fresh fruit liberally throughout the day. Fruit smoothies are simple and quick and can be a complete breakfast. I suggest you use fresh or frozen fruit whenever possible. Smoothies need a little bit of liquid. Add milk or yogurt, rather than ice cream. For those who cannot have dairy, you can use soy milk, rice milk or almond milk. Smoothies are low in protein. You can add protein powder, or have 1/4 cup dry roasted nuts along with the smoothie (not in it) for a complete meal. Smoothies can be prepared in advance and kept in a thermos for an afternoon snack. Fruit can also be added to hot or cold cereals. For me, a typical breakfast is steel cut oatmeal with 1-2 cups of fresh berries and a little artificial sweetener.
Then there is snack time. For those of you who are home schooling, you have a bit more control over your children's snacks than children in the public or private school systems. However, parents can group together and put pressure on schools to change what is available at snack times. It is already working across the nation to get carbonated beverages out of schools. Snacks should be a fruit or vegetable paired with a source of protein. Simple things are a 1/4 cup of dried fruit mixed with 1/4 cup of nuts. My favorite is 1/4 cup of craisins with 1/4 cup of lightly salted, dry roasted peanuts. (I make several in advance and put them in sandwich-sized baggies). Another example would be an apple or pear and an ounce of cheese in cubes or slices. For those with dairy allergies, try substituting peanut or almond butter. For children allergic to both, apple with deli slices of ham is delicious. Pairing a protein source with your carbohydrate will keep hunger away longer and limits swings in blood sugar.
Lunchtime comes around and we haven't had much in the way of vegetables. This is an opportunity to change that. Swing the balance back with vegetable sticks. Carrots, celery, bell peppers, jicama, sugar peas, even raw sweet potatoes are good choices. Use your imagination. Try to avoid dipping vegetables in cheese or salad dressing, as these are high-fat choices. Choose instead hummus, nut butters, or go without dip. However, if ranch dressing is the only way you can keep your child from trading away his veggies at lunchtime, then measure out one serving. Serving sizes are on the bottle.
After school is another snack time and another opportunity to get a fruit or vegetable into everyone. Don't miss out on this. You can look at what they have already eaten during the day, as well as looking ahead to dinner plans and choose accordingly. Okay. Face it. Most of us aren't that organized. Make sure you have choices available for afterschool that include fruits and vegetables. Build on what we've already discussed.
Dinner comes along and most of us have not yet had 3 servings of vegetables for the day. We might have had 3-4 fruits and 1 vegetable, if we have been working at it. This means that most of the time, dinner plans need to include 2 servings of vegetables. If you opt for a large dinner salad, you can easily get 2-3 servings of vegetables into a single meal. If you only fix one vegetable at dinner, place 1 cup on everyone's plate. It's an easy fix. Of course, if you do that with 2 vegetables and they only eat one, you still win.
Have you reached your totals? Are we at 5-9 fruits and vegetables for the day? We should have had our 3 servings of vegetables. If you aren't sure about the total count, then go ahead and add a fruit to dessert. This takes the focus off of sugar in your dessert.
I hear it. Someone is grumbling about the cost. "All these fruits and vegetables are more expensive." More expensive than what? I could go on for hours about how you will be saving on healthcare costs in the long run, but I won't. I will say that it helps to buy what is in season. More importantly, studies have been done that show diets rich in fruits and vegetables are less expensive than diets rich in junk food. Those studies show that if you Change your buying power from junk food to fresh produce, you actually save money. The problem is that you cannot buy both. You have to decide what is important. I can't do it for you.
One word of caution: this is a lot of fiber. If this is a big change in someone's diet, it can cause some gastrointestinal discomfort. It needs to be paired with an appropriate intake of water! You need to be getting 64-80 ounces of water a day. If not, the fiber can sit in the gastrointestinal tract and cause pain. In rare cases, it can cause obstruction. Please, do not use this as an excuse to avoid fruits and vegetables, just drink the water. You can do it.
Dr Nan N
House Call Pediatrician, Overland Park, KS
State of the art care for your child in your home.
http://FiresidePediatrics.com
http://PersonalMedicine.com
Tuesday, April 12, 2011
Ceruminosis
Ceruminosis is an interesting word. I like the way it rolls off my tongue. I don't like the way it blocks my ears. Ceruminosis is excessive wax blocking the ears. In some children it comes out of their ears in chunks. In others, it sets up in the ear canal like concrete. Parents sometimes feel it is an arch enemy that must be battled relentlessly until it is completely banished.
That might be a bit harsh.
Ear wax, or cerumen, is present for a purpose. It protects the inside of the ear canal from dryness, dust and other airborne particles. It is important that some ear wax be present at all times. Without wax our ears would itch all the time and even the tiniest dust particle would cause intense pain.
Small, young children seem to have more ear wax than older children. I don't know if that is really true, or if it is just that their ear canals are smaller. This would make the same amount of ear wax appear larger. Either way, parents of small children notice ear wax coming out of their children's ears more so than parents of older children. Please, resist the urge to remove this wax with paper clips, bobby pins or pen caps. These objects may damage the inside of the ear canal, and can even cause permanent hearing loss.
Cotton swabs, such as Q-tips, can actually push wax further back into the ear canal. Yes, a certain amount of wax will be visible on the head of the cotton swab. However, a larger amount tends to be pushed down into the ear canal, creating a firm, large "rock" of wax. These can be very difficult to remove.
So, what's a parent to do? First of all, don't panic. Remember that the wax is supposed to be present. Don't try to remove it. Don't consider it a problem, unless a healthcare provider comments that it is a large amount, or your child complains of pain or decreased hearing. If these things occur, there are several over the counter drops designed to dissolve the wax. These drops melt or dissolve the excess wax, allowing the hairs in the ear to move it out of the ear. Usually, you don't even see the wax leave, as it is moved out in a very thin film. This is a painless procedure, and does not require the ears to be rinsed afterward.
People who have very dry skin will also have dry ear wax. Their ear wax is flaky. These individuals can benefit from oil being placed in the ears on a regular basis, such as once a week. Good choices are Sweet oil or Baby oil. Some people like to warm the oil. If you choose to do this, then I recommend you drip the oil into the ear directly off your fingertip, so that you can be certain it isn't too warm. For small children with excessive amounts of wax, Sweet oil or Baby oil can be used nightly for a week (not warmed, for safety reasons). Have your healthcare provider check the amount of wax in the ears at the beginning and the end of this week. Sometimes, you will need to repeat for another week.
Of course before putting any oil, or anything else, in anyone's ears, it is best to have a healthcare provider check the ears to make sure there isn't some other problem, such as an infection.
Dr Nan N
House Call Pediatrician, Overland Park, KS
State of the art care for your child in your home
http://FiresidePediatrics.com
http://PersonalMedicine.com
That might be a bit harsh.
Ear wax, or cerumen, is present for a purpose. It protects the inside of the ear canal from dryness, dust and other airborne particles. It is important that some ear wax be present at all times. Without wax our ears would itch all the time and even the tiniest dust particle would cause intense pain.
Small, young children seem to have more ear wax than older children. I don't know if that is really true, or if it is just that their ear canals are smaller. This would make the same amount of ear wax appear larger. Either way, parents of small children notice ear wax coming out of their children's ears more so than parents of older children. Please, resist the urge to remove this wax with paper clips, bobby pins or pen caps. These objects may damage the inside of the ear canal, and can even cause permanent hearing loss.
Cotton swabs, such as Q-tips, can actually push wax further back into the ear canal. Yes, a certain amount of wax will be visible on the head of the cotton swab. However, a larger amount tends to be pushed down into the ear canal, creating a firm, large "rock" of wax. These can be very difficult to remove.
So, what's a parent to do? First of all, don't panic. Remember that the wax is supposed to be present. Don't try to remove it. Don't consider it a problem, unless a healthcare provider comments that it is a large amount, or your child complains of pain or decreased hearing. If these things occur, there are several over the counter drops designed to dissolve the wax. These drops melt or dissolve the excess wax, allowing the hairs in the ear to move it out of the ear. Usually, you don't even see the wax leave, as it is moved out in a very thin film. This is a painless procedure, and does not require the ears to be rinsed afterward.
People who have very dry skin will also have dry ear wax. Their ear wax is flaky. These individuals can benefit from oil being placed in the ears on a regular basis, such as once a week. Good choices are Sweet oil or Baby oil. Some people like to warm the oil. If you choose to do this, then I recommend you drip the oil into the ear directly off your fingertip, so that you can be certain it isn't too warm. For small children with excessive amounts of wax, Sweet oil or Baby oil can be used nightly for a week (not warmed, for safety reasons). Have your healthcare provider check the amount of wax in the ears at the beginning and the end of this week. Sometimes, you will need to repeat for another week.
Of course before putting any oil, or anything else, in anyone's ears, it is best to have a healthcare provider check the ears to make sure there isn't some other problem, such as an infection.
Dr Nan N
House Call Pediatrician, Overland Park, KS
State of the art care for your child in your home
http://FiresidePediatrics.com
http://PersonalMedicine.com
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