Friday, February 26, 2010

How Social Media Can Help Doctors Stay Up-to-Date

Physicians, like many other professionals, have continuing education requirements. We are exposed to the newest research and advances while in training, but after we pass our board exams and enter practice, the onus is on us to maintain our knowledge to current standards. Without regular reading and attendance at medical conferences, you can easily get left behind as medicine advances.

I am currently attending the Annual Meeting of the American Academy of Allergy, Asthma & Immunology in New Orleans. It is always a wonderful meeting, full of new information to bring home to my patients. I will be periodically tweeting medical information that I believe may be of interest to my readers: http://twitter.com/allergistmommy

Other colleagues will be doing the same- Matthew Bowdish, M.D. is an allergist who has shared information from past allergy conferences, and will be tweeting at http://twitter.com/matthewbowdish (His tweets from the Western Allergy Society meeting were great, and I'm sure those from AAAAI will be just as informative!)

Ves Dimov, M.D. is an allergy fellow and prolific tweeter, whose updates educate both physicians and patients on the science of allergy: http://twitter.com/allergy

Amazing how technology helps us share information so widely and quickly!

In a seminar earlier today, I shared with colleagues how I believe that using social media tools has made me a better physician. Because I have access to so much information, I read more, and learn more, than I could without these connections. Because I hear first-hand what patients/parents care about, I know what to spend time discussing during visits, and what to write about. So thanks, Twitter, Facebook, Blogger! You're an integral part of this physician's continuing medical education!

Wednesday, February 24, 2010

The Allergist Mommy Confessions

Confession #1: I am still co-sleeping with Son #2. Why is an 18 month old in charge of my bed? I blame absence of any set routine. Because I parent my kids with the help of their grandmothers during the week while DH is out-of-town for work, the boys have 3 households, and 3 separate beds each. While this has fostered a great deal of flexibility and adaptability in my sons, it has also made it difficult to establish bedtime consistency. Hence, Son #2 wedges himself quite comfortably between DH and me in the middle of the night (even on weekends, when he easily could be in his crib). This is also why the odds of a Child #3 coming along any time soon are remarkably slim.

Confession #2: I no longer enjoy nursing, and am desperately trying to wean. I feel guilty admitting this, because I am such an ardent proponent of breastfeeding. However, partly due to Confession #1, and partly due to my own inability to suffer my child's noctural complaints, I have enabled Son #2 in his quest to remain eternally latched. He should have been sleeping through the night long ago, and it's really hard to blame this one on anyone but myself. As my husband reminds me every time I complain about this, I am too soft.

Confession #3: I really want a mommy-cation. I want to sleep through the night. I want to eat at a restaurant that has cloth napkins. I want to take a 30 minute shower. I want to get my nails done and actually let them dry fully before leaving the salon.

Confession #4: I'm skipping town. Hopping on a plane to the Big Easy (OK, fine- it's a medical conference, but that's as close as the Allergist Mommy is going to get to a real vacation right now). Leaving the kids with their loving father and grandparents for a few nights. Maybe, magically, miraculously, Son#2 will be sleeping all night in his own bed when I return. Or maybe not. Whatever- at least my nails will look good.

Monday, February 22, 2010

2010-11 Influenza Vaccine Will Include H1N1 Virus

The Health Organization Committee that determines the composition of the yearly influenza vaccine met last week, and has decided to include H1N1 in the 2010-11 vaccine.

It is recommended that the following viruses be used for influenza vaccines in the 2010-
2011 influenza season (northern hemisphere):
– an A/California/7/2009 (H1N1)-like virus;
– an A/Perth/16/2009 (H3N2)-like virus;#
– a B/Brisbane/60/2008-like virus.

For the full report, please go to: http://www.who.int/csr/disease/influenza/201002_Recommendation.pdf

This was anticipated, but there was a chance that the H1N1 would still be separated into an additional injection, so I am pleased that my patients will only need a single dose of vaccine to get coverage for both seasonal and H1N1 influenza this coming year. Interestingly, the strain of H1N1 is the same as in the 2009-10 H1N1 vaccine- so it may actually serve as a booster dose for patients who received the vaccine this past season.

Friday, February 19, 2010

The Doctor Will See You... Sooner Than You Thought? Why Asthma Patients Need Frequent Follow-Up.

At the end of every patient visit, I let my patients know when I would like to see them again. For some patients, the visits are infrequent- once a year for a well-controlled patient with nasal allergies. However, for asthmatics, I recommend more frequent visits.

Lately, I've begun noticing that my chronic asthma patients occasionally look at me sideways when I tell them that I expect to follow-up with them every 3-4 months to document asthma control and adjust medications. There have been a few disgruntled phone calls after a patient learns that only 3 months worth of refills have been submitted to the pharmacy, instead of the standard 6-12 month supply. It has occurred to me that my patients are not alone in their confusion as to why their physician can not bear to be apart from them for more than 12 weeks at a time, so let me explain myself:

1. I am not secretly in love with you.
2. I am not trying to get paid for shooting the breeze with you quarterly.
3. I am not in cahoots with big pharma, or trying out new drugs on you. (If there's a new drug, I'll try it out on myself first, thank you very much.)

The real reason, albeit dull, is an important one. CONTROL.

No, not my inane need to control every aspect of your life (although my hubby and kids might tell you otherwise).

I'm on an endless search for asthma control. It is unacceptable to me to have my patients walking around puffing on their rescue inhalers (>2x/week) when what they really need is a more optimal dose of controller medicine. It is equally unacceptable to have my patients walking around symptom-free on higher-dose controller medicine, when a lower amount of medication might adequately control their disease.

So, how do I decide how often is often enough, when it comes to asthma follow-up?

Inhaled corticosteroids, when taken regularly as prescribed, generally take around 2 weeks to begin exerting their beneficial effects, but take around 6 weeks to reach maximal efficacy. So, after changing a patient's asthma controller medicine dose or regimen, I will wait at least 6 weeks before deciding if the new dose is working adequately. If it is working well, I will continue the dose for at least 3 months before attempting to decrease the dose, per asthma guidelines published in 2007 by the National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health. But, I always attempt to decrease, as long as the patient has done well for the past 3 months. Asthma severity is fluid, and changes over time. Just because a patient required a certain dose in January 2005, doesn't mean that they should be on the same dose in August of 2010. It is my responsibility as an asthma specialist to keep pushing the dose of medication as low as tolerated.

To find a dose that works and just keep it there for years on end without trying to limit cumulative medication dosage is just laziness, in my opinion.

In light of the recent FDA recommendations regarding long-acting beta agonist medications in asthma, it seems even more important to keep pushing these doses down. Read more: http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm200923.htm

So when your doctor asks to see you sooner that you anticipated, don't worry that you're the object of an inappropriate crush- she may actually have your best health in mind.

Wednesday, February 10, 2010

Chasing Rainbows- Or, How Even Crappy Days Have Silver Linings

Son #1 woke up three times overnight and ended up in Grandma's bed after he decided that me marching him back to his own room was no longer acceptable. (Grandma's are softies.)

Son #2 was actually sleeping soundly for the first time in weeks, until the earthquake woke us up. Earthquake? Yes, earthquake. (Thank goodness our cities are built on a thick layer of bedrock, and that our municipalities enforce building codes.)

I woke up to a foot of snow covering my car, and my windshield wipers were frozen to my windshield. Yipee.

So, the thought of trudging to work on a day when the majority of patients will choose to stay home was less than enticing.

However, as I was driving along, the wheels of all the cars in front of me on the highway aerosolized the slush on the road. It's a strikingly clear and sunny day, and when the sunlight hit the airborne slush droplets, it had the magical effect of creating small rainbows between me and my fellow commuters. From slushy mess to beatiful refraction- if that's not making lemonade from lemons, I don't know what is.

Sunny day, will probably have plenty of time to finish my stack of paperwork today, chased rainbows this morning... things could be worse. :)

Tuesday, February 9, 2010

Happy Birthday to the Allergist Mommy Blog!

Time flies- it's been a whole year since the first Allergist Mommy blog post!

In that time, I've enjoyed sharing my perspective on the latest developments in pediatric allergy. It's nice to have an audience other than my husband for my musings. I haven't asked, but I think he also appreciates that I have redirected my educational efforts away from him. :)

In the past year, you've learned how (against the odds) Son #1 outgrew his peanut allergy. You've read about Son #2's eczema and developing asthma. You've seen how underneath the cool exterior, physicians are parents too. We worry about our kids the same way our patient's parents do. And we make the same mistakes that everyone does.

That said, I hope I've also shed some light on the fact that while we certainly don't have all the answers, physicians can help shed some light on the mystery that is modern medicine, and be valuable guides to help parents and children navigate the challenges of allergies and asthma.

Thanks for reading- here's to another great year ahead!

Wednesday, February 3, 2010

Dry Winter Air Means Itchy Flaky Cranky Kids- Here's What You Can Do!

It's that time of year- the heat is on indoors, and the humidity in our homes takes a nosedive. Kids (especially those with a history of eczema) start getting itchy, scaly, cracked skin. Ouch! We all want to minimize the amount of medication we apply to our children's bodies, so try these these quick tips first:

1. lukewarm baths/showers, no greater than 10 minutes
2. pat (don't rub) dry with a towel that is free of fabric softener
3. immediately apply an emollient - a ceramide-containing cream all over the body in the AM (Cera/ve, Mimyx, Atopiclair are all good choices), and don't skimp on the petroleum jelly at bedtime (who cares of they're a little slippery?)
4. keep the ambient humidity in your home between 40-50%
5. turn down the heat!

For most cases of dry winter skin, the above is enough to keep a bad eczema flare at bay. However, if your child's skin does flare up, don't be afraid to use the topical anti-inflammatory ointments (they work better than creams or lotions) aggressively for a short period of time. As the condition of the skin improves, you'll be able to back off on the frequency of application.

Below is the text of the dry skin care regimen I suggest for my patients:


Dry Skin / Eczema Care Instructions

Cleansing:

Bathe/shower with warm water (never hot!) for no longer than 10 minutes 1-2 times daily. Apply soap to the following areas only: folds of neck, underarms, groin, buttocks, palms, and soles.

The following cleansers are mild enough for daily use:
  • Aveeno Skin Relief Fragrance Free Body Wash
  • Basis Sensitive Skin Bar
  • Cetaphil Gentle Cleansing Bar
  • Dove Sensitive Skin Beauty Body Wash
  • Dove Sensitive Skin Unscented Beauty Bar
  • Vanicream Cleansing Bar

Moisturizing:

After bathing, pat (don’t rub) with a towel until the skin is mostly dry. Apply generous amount of moisturizer/emollient to skin immediately after drying, and rub until no longer visible. Avoid most lotions, which contain mostly water, and are not effective at locking moisture into the skin. The simplest and least expensive emollient is simply petroleum jelly. Other effective OTC options include: Cera/ve cream, Vanicream, Eucerin cream, Aquaphor, and Aveeno Cream.

Topical Medications:

Once moisturizer/emollient is absorbed into skin, apply topical anti-inflammatory medication to affected areas only. See instructions below:

Acute flare of eczema: TBD by physician
Resolving eczema patches: TBD by physician
Maintenance for areas prone to flares: TBD by physician


Laundry:

Cotton clothing is best for sensitive skin. Use dye-free, fragrance-free detergent, such as ALL Free and Clear. Use hot water and a second rinse cycle to ensure that all detergent is washed out of your clothing. Avoid fabric softener, especially dryer sheets.

Monday, February 1, 2010

My Valentine's Day Party Saga- Or, Why it Never Pays to Think Ahead

I was so proud of myself. I had a little extra time on my hands (don't ask me where it came from, because I can't imagine I'll ever find it again), so I decided I would take a trip to the store and buy all the supplies I needed to make cute peanut/treenut-free Valentine's Day goodie bags for Son #1's preschool class.

I dutifully purchased stickers, little plastic baggies, pencils, and individually wrapped/labelled candies for distribution to the little cuties.

I sat and patiently assembled all the bags for him and his 13 classmates, and even made an extra couple of bags, just in case.

Last night, I read the newsletter from his classroom: "If your child will be bringing Valentines in for our party on the 12th, please make sure to bring for everyone, so we don't have any hurt feelings." Excellent point- I couldn't agree more. (hence the extra few bags!)

The newsletter continued: "We have 22 students." WHAT??!?! 22?! Ahem- where did these extra 8 children magically come from? Were you running an enrollment special in January?

Sheesh. Serves me right for pretending to be super-mom. I'm done with thinking ahead- I'm going back to being procrasti-mom, thank you very much. And, apparently, I'm also headed back to the store...