Pediatrics
kkrisberg | March 25, 2017Yesterday, House Republicans failed to find enough votes to pass their Affordable Care Act replacement. It was a very good day for the millions of Americans projected to lose their coverage under the GOP plan. But let’s be clear: Obamacare is not safe.
In a last-ditch effort to round up more votes, House Speaker Paul Ryan, R-Wis., proposed an amendment that would have, beginning in 2018, allowed states to determine the kinds of essential health benefits required in insurance plans purchased with tax credits. Under Obama’s health care law, insurance plans sold via the federal health care…
oracknows | June 3, 2016After over 11 years at this blogging thing, I periodically start to fear that I’m becoming jaded. In particular, after following the infiltration of quackery in the form of “complementary and alternative medicine” (CAM), now more commonly known as “integrative medicine,” because it integrates CAM with evidence-based medicine. Of course, in reality, what “integrative medicine” really does is to integrate prescientific, pseudoscientific, and antiscientific quackery with real medicine, and that’s what I mean. I thought I had seen it all in academic medical centers and medical schools: the faith…
kkrisberg | March 11, 2016Poverty and poor health often go hand-in-hand. However, the effects of poverty may be especially profound for children, who are moving through critical developmental and educational phases in their young lives. Knowing that this social determinant of health can lead to a lifelong struggle with poor health and disease, the American Academy of Pediatrics is now calling on pediatricians to screen their young patients for poverty.
Connecting low-income patients with social services and assistance is not necessarily new for many health care providers, but the fact that the nation’s leading…
oracknows | January 25, 2015
It's no secret to my regular readers that it's highly unlikely that I'll ever be getting a job at the Cleveland Clinic Foundation (CCF) any time soon. After all, I've written posts about the CCF in which I've criticized its promotion of reiki, its establishment of a traditional Chinese medicine (TCM) herbal medicine clinic, complete with a naturopath running it, and its recent embrace of the founder of "functional medicine" (not to mention collaborator with antivaccine activist Robert F. Kennedy, Jr.) Dr. Mark Hyman. A quick Google would reveal me as the author of such criticisms. Such is…
oracknows | August 4, 2014
As prolific as I am, I have actually slowed down. Long time readers know this, as I used to have a post up seven days a week and sometimes two or more in a day. These days, I’ve made it a rule that I don’t post on weekends (except if something really catches my eye and I can’t control the blogging itch until Monday), and I almost never post more than once a day on weekdays. Heck, of late I’ve even been known to miss a weekday every now and then without even recycling posts from my not-so-super-secret other blog. It’s good, as I was a bit insane back then.
What I’m talking about is an…
oracknows | February 27, 2013Thanks to a winter storm that dumped a heapin' helpin' of heavy wet snow on us last night, we lost power before this post even got going. However, I did have a bit of time this morning to finish it up as a quickie (by my standards) before my laptop battery indicator started expressing its displeasure. Since it's a topic that doesn't really necessitate a long post anyway, it's a perfect fit for today, and I'll just put off what I was going to write about today until tomorrow. Or the day after if nothing else comes up between now and then that interests me more. You see, the power company is…
Furious Seasons: Researcher who claimed 3-year-olds get depressed may have undisclosed industry ties
ddobbs | August 31, 2009If nothing else, this points out the need to clarify what "past 5 years" means in declaring history of possible conflicts of interest. 5 years before publication -- or research and writing? Presumably there's a difference, if we're specifyng a time frame anyway
signout | May 12, 2008"What I want you to do," I said, "is breathe in deep, then blow it all out like you're blowing out birthday candles."
He focused his eyes in concentration and blinked a few times, then did as I'd said, aiming for the finger I held in front of him.
I listened to his back with my stethoscope. "Again," I said. "Again. Again. Good job! Again."
His mother sat forward in her seat and breathed in sync with her boy, her face softened from the suspicious glare she'd trained on me a moment before. After I'd listened to every part of the kid's chest, I put my hand up for a high five, which he gave me…
signout | February 23, 2008It's been a while.
I've been in a demoralizing, soul-sucking stretch of rotations for about two months. Suddenly, sleep has become more of a priority than ever before, and documenting the details of my crappy life seems less important and ultimately, less useful than ever. Still, you people seem to want to taste of every plateful of shit that's placed in front of me.
One of the more recent combo platters was served a few weeks ago, when I was on a pediatric emergency room rotation. My first night on, I saw a clinic patient of mine who had been sent into the emergency room by one of our…
signout | January 8, 2008I switched on the boob tube the other day while folding laundry and somehow ended up watching children's television. (What? It happens.)
On Nickelodeon (motto: "Entertaining stoned adults since, I dunno, 1982?") I caught the tail end of a show called "Yo Gabba Gabba." Per the description on the Nick, Jr. website, this is an educational show directed at children 1 year old and up. Per me, it is freaking awesome. In the fifteen minutes I watched, I was urged to try new foods, not eat off the floor, and dancy dance--with Leslie Hall. Leslie Hall, people!
Well-intentioned and spectacularly hip,…
signout | September 22, 2007Much as activism kind of annoys me--I blame my polite mother--I am fairly solidly behind the woman who's fighting facebook for banning pictures of her breastfeeding. Breastfeeding is really good for babies,* and I'm all for making it as easy for moms to do as possible. That might mean overcoming our discomfort at viewing the breasts of women we don't know.
In the U.S., it's normative to find female breasts sexay. I'm not sure why; they have a pretty clear function, and it's not reproductive. Lots of people in this culture get a little shifty-eyed around breastfeeding mothers, and although…
signout | May 10, 2007I was recently asked by Blog, MD to weigh in on how I'd spend the $456 billion that has so far been spent on the U.S. military effort in Iraq if, by some terrible error, I were made Queen of the World. This is a difficult question for me because the only items of whose cost I am sure these days are grocery store sushi and sturdy shoes. And while it would be kind of awesome to buy enough spicy tuna rolls to last me until I'm too old to chew anything but the wasabi, that wouldn't exactly benefit humanity.
So.
If it were up to me, I'd spend this wad of cash entirely on education. I'm no expert…
signout | April 16, 2007It was a pretty simple story: their 3-year old had had fever and lethargy for three days. She was fussier than usual, but consolable. On the second day of the fever, her cautious doctor had done some blood tests and an x-ray, and although neither confirmed a bacterial infection, he'd started antibiotics. The medicine hadn't helped her much, and now they were in the emergency room on Easter Sunday, both furrowing their brows as I looked in her eyes, her mouth, her ears.
They were worried, but not worry-crazed, and they seemed cool--like the kind of people I'd sit down with for a beer. We…
signout | March 24, 2007The first phone call came about a month ago, on a day I wasn't in clinic. The phone nurse had left me a message: Rosie's mother wants to know why she keeps turning in circles."
I had never met the 10-year-old Rosie, but looking through her old records, I found that she has a non-specific kind of global developmental delay--something we used to call MRCP, for "mentally retarded/cerebral palsy." I also found that this wasn't the first time her mother had called with concerns about Rosie's circles--over the last five years, there had been at least as many calls with the same question, and Rosie…
signout | January 13, 2007I just finished a rotation in pediatric hematology and oncology, where almost all of the kids I was taking care of had cancer. Most had leukemia or lymphoma with prognoses that were varying degrees of good. A few had other, highly curable solid tumors. Only one kid--a boy I've written about here twice before--had a bad cancer. But boy, was it bad.
His tumor, called a neuroblastoma, is a cancer of the sympathetic nervous system. Its prognosis can vary significantly with the age of the patient it affects and with characteristics of the tumor itself. This boy's problems had started at the age of…
signout | December 25, 2006I'm an M.O.T., so for me, Christmas, meh. It's just kind of another day. I'm neither especially cranky about having to work nights through the holiday, nor is my heart filled with the dazzling light of yuletide joy.
But last night, a colleague reminded me of something that brought home the true meaning of Christmas: today, I am exactly halfway through my intern year.
Hallelujah!
We even had our own Christmas miracle: we got a kid with a huge neuroblastoma in his liver down to the CT scanner at 2 a.m....and he wasn't bleeding into the tumor. (The real miracle is the first part.)
Huzzah! I…
signout | October 15, 2006When I started medical school, I was not into kids. It was partly a matter of principle--I didn't want to do what everyone else was doing, and everyone else was loving kids, so it became my business to not like kids. Another part of my distaste was the spectacular humorlessness of so many people in pediatrics, their overall trend toward an inauthentic kind of hokey-jokey smileyness and their tendency to stare blank-eyed and confused at sarcasm. I was also rubbed wrong by the unspoken ethic--and not just in medicine--that kids deserve more care, more love, more forgiveness, more everything,…
signout | July 27, 2006As a brittle, childless spinster, I don't have child-rearing experiences of my own to draw on. Yet every day in clinic, I make reassuring eye contact with haggard looking, applesauce-spattered people, and explain to them how to raise their children. I have no data to back me up-only snippets I've overheard from people who actually know what they're doing.
This is not evidence-based medicine. This is fraud. As someone who has never had the pleasure of ignoring a breath-holding spell or a tantrum, I feel like a total jackass telling parents to do it. But what's odd is that when I speak as if I…