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confessions and contemplations of a working mommy....

Summer is here!

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By doccarrie · June 25, 2010 · 0 Comments ·


Summer is officially here so let the fun begin!  So, lets start our summer safety review and discuss...

SUNSCREEN

The dangers of sun exposure are well known to us now (sunburn, skin cancer) and protecting your children from sunburn should be a summer priority.  The good thing is that most kids are so used to applying sunscreen and if you start early enough, they will not usually protest (ha!).  So, what should you look for in a sunscreen?

Use some of the following tips to pick your favorite for the season...

1.  BROAD SPECTRUM. Make sure it covers both UVA and UVB rays.

2.  SPF.  SPF is the amount of UV radiation required to cause sunburn on skin with the sunscreen on, relative to the amount required without the sunscreen. So, wearing a sunscreen with SPF 30, your skin will not burn until it has been exposed to 30 times the amount of sun that would normally cause it to burn.

So is a higher number better?  And what number should I buy?

For kids, buy a sunscreen that has AT LEAST an SPF of 30.  If you buy higher, that is fine, but don't pay more for it because it probably will protect the same as 30, which blocks about 97% of UVB rays.

3.  APPLICATION.  Turns out that the way you apply sunscreen is probably more important that the brand you buy or the type (gel, lotion, spray etc.). So, buy whatever type you find to be the easiest to put on. It is probably best to stock the cupboard with a spray and a lotion for different circumstances, and go with a stick or a lotion for the face.


DON'T FORGET!: IT TAKES TIME FOR THE SUNSCREEN TO WORK! Apply about 30 minutes before sun exposure. Try not to apply and then let your child run outside because it will leave them unprotected.

HOW MUCH?

A good rule of thumb is a HANDFUL…the size of their hand. And as they get bigger their hands will grow too!

HOW OFTEN?

In general, you need to reapply every 2 hours, possibly sooner depending on the type of sunscreen and activity. If you buy a waterproof type, it may stay on longer and rub off in the water, but 2 hours is the MAX.

Remember, you are applying sunscreen NOT sunblock, so watch carefully and reapply early and often. Also keep in mind that the strongest sun is from 10 am to 4 pm, so add extra protection at these times.

What is in my cupboard this season?


So far, this is my spray of choice for the kids. The kids variety goes on oily and makes a mess, but this one is dry and easy to apply. LOVE IT!

 


This is my lotion of choice, but it is hard to find this year. It is a lotion but goes on without much need to rub in, kind of like a thin gel. If you can find it, BUY IT…oh, and send me some!

(PS…I wish I had a financial stake in Banana Boat, but unfortunately, I do not, so these are my unbiased recs.)

Filed in: mommyhood, Medical

Learning can be fun... (for me, at least) Part Deux...

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By doccarrie · June 6, 2010 · 0 Comments ·

So, to continue...This is part 2, click here to read PART 1

6.  My baby won't stop coughing! For you mommies out there, this is for you.  As you know, many cough medications for children have recently been labeled as unsafe for young children.  What is a sleepy mommy to do when their child is up coughing all night?

Turns out that HONEY was actually MORE EFFECTIVE than dextromethorphan (DM, the active ingredient in most cough syrups) in clinical studies. Honey soothes the throat and actually has anti-microbial properties.

[You may have heard not to give honey to kids under 1 year due to concern about botulism, this is probably not a worry today but just to be safe, do not use honey in kids <1 year of age] .

7.  Strong bones are a good thing.  Bones get weaker over time and calcium & vitamin D will help you keep your bones strong as you age.  Vitamin D is a hot topic because we are in an epidemic of deficiency.   So, have your vitamin D level checked.  The goal level is 35-40.  Most adults who are not deficient should be taking 800-1000 IU of vitamin D per day.  You may need more to get your level up to normal first.  So start now.  And as with anything else, don't go crazy and start taking mega-doses of vitamin D.  That's not good either.

8.  Pooping is important.  And we all need fiber.  How should you get it?  There are a million brands of fiber, so which is best?  Turns out the stuff on the store shelves as you may have guessed is not as good as getting fiber through foods.  You should be trying to get about 20-30 grams of SOLUBLE fiber per day.  Metamucil, fibercon etc. is INSOLUBLE fiber and one dose contains about 3 grams of fiber.  So, try taking that 10x per day.  OR, you can eat about 1/3 cup of ALL BRAN per day to get 20 grams of fiber and improve your stools, your weight, your cholesterol, your blood pressure etc.  I'm going with the latter.

9.  Fish oil, all the rage.

Should you take it?  Answer...Maybe.  Just like anything else in medicine, it depends on who you are and your risk factors.  Fish oil has many beneficial cardiovascular effects and can even help with back pain or muscle pain.  But, it can cause GI issues and thin the blood. So if that is a problem for you, try to avoid supplementing.

What kind?  Turns out Costco brand is just as good as the more expensive varieties.  Love that place.

How much?  Again, depends.  If you are healthy, try getting it naturally in fish about 2x/week.  If you have heart disease or high triglycerides, you may want to try higher doses if that is safe for you (2-4 grams/day, check with your doctor).

10.  Don't miss the forest through the trees.  The last and most important lesson. Focus on what is important.  Evaluate your cardiovascular risk factors and modify them if you want to live longer and be healthier.  Don't worry about how much or what type of vitamin E is best if your cholesterol is out of whack and if you are 100 pounds overweight.  The only vitamin E that will cure that is EXERCISE.

If you do the following 10 things you will have a 70% chance of living to age 85 without mental and physical disability.

  • DON'T smoke
  • Lower your LDL cholesterol to <100
  • Normalize your blood pressure and your blood sugar
  • Have a normal waist circumfrence and minimize belly fat
  • Lower your stress and normalize your mental health
  • Eat 1 serving of fruit/veggies per day
  • Drink MODERATE amounts of alcohol
  • Exercise on average 30 minutes per day
  • Eat a diet high in fish oils and fiber and low in salt

 

Can you do this?  Less than 3% of Americans do....I challenge you to try!  Become familar with the REYNOLDS RISK SCORE.  It is a calculation of your risk of heart disease or stroke.  WIth a little help and some numbers from your doctor, you can calculate this risk for yourself.  And then, if needed you can work on modifying your risk factors.

So here's to 100!  Sounds exhausting...

Filed in: Medical

Learning can be fun... (for me, at least)...Part 1

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By doccarrie · June 4, 2010 · 0 Comments ·

Today I went to a Women's Health Conference and heard an amazing speaker.  His name was Dr. Mark Moyad and he works in the field of Alternative Medicine at The University of Michigan. He addressed MANY different questions about diets, dietary supplement and alternative therapies.  His talk was funny, informative, and frankly, he was one of the best speakers I have ever heard.  I was so excited about what I learned that I couldn't wait to share it with all of you.  So below are some of the highlights, a top 10 if you will.  Divided by 2 so you are not overwhelmed.  His ideas, interpreted by me.  So here goes starting with the first 5, check back tommorow for part deux.

1.  LESS IS MORE.  Supplements can lead to toxicites and just like anything else, too much of a good thing is bad.  So, look at your diet.  Look at your vitamins.  Figure out what you are eating and what you are missing before you beging supplementing.  Talk to your doctor before starting a vitamin with more than 100% of any of the ingredients. Too much may lead to toxicities which have real consequences (ie. too much selenium can cause diabetes, too much vitamin E can thin your blood).

Of interest, Dr. Moyad's vitamin of choice for himself?  A children's multi-vitamin.  Because it does not exceed the RDA of any one ingredient.

2. This industry is a business.   A BIG business.  Americans spend 22 BILLION (with a B) on dietary supplements yearly and another 13 Billon on other alternative therapies.  So if you don't think that they are trying to sell you something...think again.

3.  Where is the oversight? Alternative therapies, supplements etc. are not subject to the same scrutiny under the FDA as our pharmaceuticals. They can, and do, make claims that are unsubstantiated.  The best way to evaluate ANY drug is to test it against a placebo (or sugar pill).  WHY?  Because there IS a mind body connection that does crazy things and some of their results may be merely a placebo effect.  Some examples he sited...

  • 25% of patients with Erectile Dysfunction will improve with sugar pill
  • Sugar pill results in a net weight loss of 6 pounds in clinical studies
  • 42% of patients with hair loss, yes, hair loss, respond to placebo

 

So, buyer beware!  You may benefit from these products, but you may also benefit just by believing that they are actually working.

4.  Its all about the heart.  Cardiovascular disease has been the #1 killer of men and women for the last 108 out of 109 years (only outmatched one year by the INFLUENZA EPIDEMIC).  So, we NEED to focus on cardiovascular health.  And luckily, what is heart healthy tends to make brains healthy, joints healthy, skin healthy, breasts healthy...etc.  So if you want to pick one "diet", think about a heart healthy one like the DASH diet.

And, as it turns out, all supplements and drugs for that matter also need to be either heart healthy or "heart neutral" to be beneficial.  If they are not, you will hear about it.  Every night on the news.  This is our number one killer and if a supplement or drug messes with the heart, it will increase deaths and will then have black box warnings or be pulled from the market.  Case in point, Vioxx.

5.  A MIRACLE DRUG? Would you be willing to take the following PILL if it were free and had NO side effects?  Here's what it does...

  • Reduces premature death by 30-50%
  • Reduces heart disease and osteoporosis by 40-50%
  • Reduces stroke, type 2 diabetes and colon cancer by 30-50%
  • Reduces breast cancer by 20-30%
  • Reduces depression by 50%, better than ANY anti-depressant...

 

So, would you take it?  I'm in....

Oh, by the way, this is available TODAY.  Its just not a pill.  It's EXERCISE! So go for it!

That is part one of two.  Stay tuned for part 2 to learn more about living healthy.  Will this be you?

 

Filed in: Medical

Why should I care about Primary Care?

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By doccarrie · March 1, 2010 · 0 Comments ·

Do you take your kids to the doctor? "Yes.  I don't miss a visit.  I'm proud that my kids are up to date with their shots."

Do you take yourself to the doctor? "I'm healthy...why do I need a doctor?" (PS I don't have time and I don't have a doctor).

We look out for everyone's best interests.  We try to keep ourselves healthy.  We try to keep our kids healthy.  We mostly play by the rules.  But when everything is always fine, why should I see my doctor every year?  And what kind of doctor should I call "my doctor?"

Lets start with the players in Primary Care...

1.  Internists. Considered "specialists in adult health care".  Able to care for the simplest or most complex of medical diagnoses. Training is a mix between inpatient and outpatient care.  Internists may also see their patients in the hospital.  May sub specialize into various fields such as cardiology, gastroenterology etc.

2.  Family Practitioners Primary care physicians that provide care for patients of all ages.  Training for board certified family physicians is 3 years after graduation from medical school and tends to focus on the outpatient setting.  Includes obstetrical training.

3.  Pediatricians.   Specializing in health care for children.  Usually will provide care for patients up to the age of 18.

4.  Internal Medicine/Pediatrics.   (FYI, this is me.) Considered specialists in adults and specialists in children with the equivalent board certification of an Internist and Pediatrician.  Residency training after medical school is 4 years and training and certification allows us to provide the most specialized care for patients of all ages, newborn through geriatric.  Both inpatient and outpatient trained.  May also sub specialize if desired in any of the pediatric or adult domains.

So who should you consider "your doctor"?

Well, picking a doctor is intensely personal.  Referrals from reliable sources are important to start, but ultimately, you must be able to trust, connect and rely on this person.  This person is going to be your window to the health care system.  Below I have listed some things to pay attention to when selecting your doctor.

1.  They take your insurance.  If they don't, you'll fork over a pretty penny.

2.  Find out what hospitals they are affiliated with and make sure you are comfortable at that institution.  This is important because that will be the place that your doctor will send you for tests, for admission (if needed) and the doctor will usually choose their sub specialists from that hospital.  PS.  hospitals should not be chosen based on how pretty they are or how good the food is.  Remember if you are sick, the only thing that matters is the best medical care.

3.  Office issues.  Are the office staff personable and understanding?  Does the office seem to function well?  Do they take same day appointments for sick patients?  Do they have weekend or evening hours?

4.  Does your doctor make rounds at the hospital or do they use a hospitalist?  Which would you prefer?

5.  Do you feel comfortable talking with this doctor?  Do they listen to your concerns?  Do you feel like they answer your questions without rushing?  How will they communicate results to you?  What is the best way to reach the doctor if there is an emergency?  Who will cover for the doctor if they are unavailable?

There are many changes to come in health care.  But the foundation of good coordinated health care will remain with the the primary care physician.  So find one.  And see them at least once a year so they can get to know you and so you have someone to call if something goes wrong.

A new concept in medicine which is emerging is called the PATIENT CENTERED MEDICAL HOME. I could try to explain this, but this EXCELLENT VIDEO does a better job that I could ever do.  Hopefully, your doctor will start participating and you will soon see positive changes.

So, what are you waiting for....call and make an appointment!

 

 

 

Filed in: Medical
Tagged with: OnSugar March Giveaway

What do I need to know about my cervix and why?

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By doccarrie · February 27, 2010 · 0 Comments ·

Strange title.  I know.  But maybe you'll just read on.

Your friendly cervix is the end of your vagina and the beginning of your uterus.  You probably remember the doctor talking about your cervix dilating if you've had a baby.  This is where most women's knowledge ends.

But, I believe that you should know much more about your cervix.  You should know about it because it is yours.  You should know about because you need to care for it.  You should know about because a small but evil virus can attack it (HPV).  And change it into cancer.  But not if you don't let it.  And now, you can protect your daughters from these evil invaders.

So, a random zoologist, Dr. Papanicolaou (no, I am not making this up) invented the pap smear in 1941.  And now you have to have one.  Maybe every year. Thats all for the history, here's the rest...

The pap smear is only part of your annual gynecological exam (another post).  The pap smear is the part of the exam after the speculum is inserted when the doctor takes 2 brushes to collect cells from the outside of your cervix.  These brushes are then dipped into a liquid based solution and sent to a [strange] doctor that stares into a microscope all day (aka pathologist).  This doctor then interprets the results.  He is looking for changes in the cells caused by the evil invaders (HPV) that can be minor (pre-cancerous), kind of a big deal, or an uber big deal (cancer, rare, not funny but trying to keep this light-hearted).

So, lets delve a bit deeper into HPV.  HPV stands for Human Papilloma Virus.  Not many can pronounce that and no one can remember it so we'll refer to them as the EVIL INVADERS.   The evil invaders are everywhere and there are many different types.  You get them from sex.  (that's right  CERVICAL CANCER is A SEXUALLY TRANSMITTED DISEASE).  Some are very evil (high risk) and some are sort of evil (low risk).  They cause genital warts and cervical cancer.  And as with many other things, men get off scott free.  No symptoms.  They don't usually even know its there (unless they get genital warts and freak out).  But they pass it to us.  And we have to deal with it.  Thanks a lot.

The evil invaders are so common that almost 75-80% of all sexually active women will have an infection by the age of 50.  Thats right, more than 3/4 of you.  So thats you, you, and you but not you.  You get the point.  Its common.

Your body will do 1 of 3 things with this infection.

1.  You will be exposed but your cells will not allow the invaders to penetrate.  Good job cells.

2.  You will be exposed, and your cells will lose in the first line of defense and the evil invaders will get in.  Then your reserve troops (aka immune system) will launch an all out war and win.  Kicking the evil invaders to the curb.  Adios muchachos.

3.  You will be exposed, lose all battles and have what is called a persistent HPV infection.  This is the bad one.

So, the war takes a long time and the evil invaders are pretty stealth and can evade the immune system by being sneaky.  You may have had some sexual indiscretions in college (don't remind me) and everything was fine, then all the sudden, boom, abnormal pap.  That is common.  It can take up to 7 years to see changes from HPV.  That is why you need a yearly exam.  Even after you're with the love of your life.

So, how is the pap interpreted by this men with the microscope (the pathologist)?

Here are the options.

1.  NORMAL.  Awesome.  Thanks for everything, see you next year (frequency of paps to be discussed later)

2.  ASCUS.  Stands for ATYPICAL SQUAMOUS CELLS OF UNDETERMINED SIGNIFICANCE.  I know.  This is absolutely the MOST ridiculous name ever.  But I didn't make it up.  It means cells don't look exactly normal, but they don't look exactly abnormal either.

If you have this, most doctors will do another test called the HPV test.  This will then tell you if you have the high risk or low risk types of HPV.  If you have the high risk type of HPV, most likely you will need a more specialized test called COLPOSCOPY (later).  If you have the low risk types, you may just need a repeat pap smear in 6-12 months.

(NOTE:  these guidelines may not apply to adolescents <20 because they have an easier time clearing HPV infections)

3.  LSIL.  Stands for LOW GRADE SQUAMOUS INTRAEPITHELIAL LESION. Also ridiculous.  Means the cells may be abnormal and you likely have the 2nd form of HPV where your cells were invaded but your immune system is working on kicking the evil invaders to the curb.  Because 15% of women with this result can develop precancerous changes, a colposcopy is needed.

4.  HSIL.  HIGH GRADE SQUAMOUS INTRAEPITHELIAL LESION.  Advanced changes in the cells consistent with persistent infection.  Needs to be followed closely.  Needs colposcopy.  Changes could be cancerous.  Yuck.

So...just a tad about COLPOSCOPY and this torture lesson will be over.  This is a specialized type of pelvic exam where the doctor looks at your cervix up close with a microscope.  A special solution is placed on the cervix to highlight the abnormal areas and biopies (pieces of tissue) are taken.  These are sent to the pathologist to be looked at under the microscope to see if there are pre-cancerous or cancerous cells.

You may have found this to be more information than you wanted to know, but knowledge is power.  An informed patient is well armed.

Stay tuned...now that you are EVIL INVADER (HPV) experts, we need to discuss GARDISIL, the EVIL INVADER VACCINE.  YAY!

What do you know about the immunizations your child gets?

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By doccarrie · February 26, 2010 · 0 Comments ·


This is the start of a series of posts about immunizations. The picture above is helpful to many parents to make sense of the "alphabet soup" of immunizations that are given to our children.  After talking to many parents about immunizations, it is obvious to me that the topic brings up strong feelings.  You may be "pro vaccine".  You may be "anti-vaccine".  You may want to take it slow.  You may follow the recommended schedule.  Hopefully you don't not do it at all.  (kind of sounds like I'm talking about sex....but, I'm not!)  So, instead of  getting into the discussion of whether or not to immunize, what do you know about the vaccinations that your child gets and what DISEASES they protect against?

It would not surprise me to hear that more people will know what vaccine has had UNSUBSTANTIATED claims of causing autism (just to stress, NOT TRUE) than about the diseases that we are protecting our children against.  Please see attached materials to evaluate the mountain of evidence that goes against these claims.  Nevertheless, in our society, those who yell the loudest get the most attention, and a certain playboy playmate has done significant damage to the pro vaccine movement.

So lets start with....DTaP, the diptheria, tetanus and pertussis vaccine.

This vaccine is given 5 times at ages 2, 4, 6, 15-18 months and then again as a pre kindergarden booster.

DIPTHERIA.

Comes from the Latin word "leather" which refers to the tough membrane that is formed in the back of throat with this infection.  Diptheria causes a significant and severe upper respiratory infection characterized by fever, sore throat and enlarged lymph nodes in the neck.  The more serious infections with diptheria can cause stridor, which is a scary noise coming from the upper airway caused by a blockage which can lead to inability to breathe.  Thankfully the disease is rare in the US due to immunization practices, but in other countries, mortality (death) in children can be as high as 7%.

TETANUS.

This one many of you have heard of.  This is a nervous system disorder caused by a bacteria that can cause severe muscle spasm (classically spasm of the muscle that helps us chew, called lockjaw).  You can contract tetanus through any type of cut or puncture wound, and it is more common to contract the disease if the object which penetrated the skin was dirty (with soil or manuer) or rusted.  Once the bacteria is in the body, it can release a toxin that can cause spasm of all your muscles which can be fatal.   Here is a video of a child with tetanus, only inserted for those that need a visual so viewer beware. Yuck.

PERTUSSIS.

AKA whooping cough.  This one matters.  It is on the rise due to the largely unvaccinated population and high rates of infectivity.  Though most people are immunized as children, the immunization wears off over time and adolescents  and adults are susceptible to this highly infectious bacteria.  Because these people care for only partially immunized babies, the disease can be spread to young children as well.

Pertussis usually starts similarly to the common cold with a runny nose and mild cough (catarrhal stage).  It then progresses to a severe cough stage (paroxysmal stage).  This is characterized by a long series of coughs with gagging and then occasional vomiting.  The classic "whoop" is caused by breathing in during one of the coughing "attacks".  This video is a classic presentation of pertussis.  The most severe or fatal forms of disease happens in the youngest children (newborn-6 months) if they are partially immunized or not immunized at all.  So actually, the best way to protect your children is to protect YOURSELF.  Most children acquire this from their household contacts (siblings and parents).  The bad news is by the time you know you have it, antibiotics don't work, they only decrease the rate of infection in others.

So how do you get immunized?...EASY.  See your doctor.  Ask for a shot call TdaP or Adacel (adult tetanus and pertussis vaccine).  Its a one time deal.  You may just save yourself or your child from a scary cold and cough, visits to the doctor, missed days of work or worse.

I will write more on this topic, but the best website for information on immunizations is www.immunize.org.  Another comprehensive source from the American Academy of Pediatrics is linked here.

 

How well do you know...YOURSELF?

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By doccarrie · February 8, 2010 · 0 Comments ·

So this is not an exsitential post about knowing how you handle certain situations, what type of mother you are, etc...but rather this is something much more concrete.  I spend much of my working days talking to women of all ages and have come to realize that we do NOT know ourselves well.  At least our female anatomy.

You may say...I'm enjoying my coffee, why do I care?

Because we are the windows through which our daughters see the world.  We are responsible for educating them about their bodies.  We are their best role models.  We will determine how they view themselves, their sexuality and our actions contribute to their self confidence.  By teaching our daughters about their bodies, they will know that they are in control of it.  And then, hopefully, they will make more responsible desicions.

So enough of the heavy stuff...Lets see how much you know.  Below you will see a labeled diagram.  Take the quiz. Get an 'A'.  The grading system is as follows:

90-100%: Great job, you are ready to teach your kids one day (uggghhh...)

75-90%:  Study the diagram, look in the mirror.  Keep reading my blog. Repeat quiz if necessary.

<75%: Consider getting a book and commit to familiarizing yourself with ... yourself...you won't regret it.  Posts to follow about good resources for all women and information about why this is important, so keep reading.  Repeat the quiz until you get it right.

I would love to know if anyone finds this interesting....so PLEASE comment.  I'd be happy to know that all this work was helpful to someone out there.

PS...if you can't read the letters...they start at A on the left and go down thru G (the last one on the left you can skip).  H through O is on the right.

 



 

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