family practice issues and general life events

Archive for the ‘Family’ Category

Obesity epidemic and school lunch standards

About 5 days ago, the USDA set guidelines for healthier school meals.  As a physician, I should get totally excited about that, but upon hearing the full story, I think my reaction is more of a what?  As the obesity epidemic reaches dramatic proportions, our children are not left out.  According to the American Academy of Children and Adolescent Psychiatry 16- 33% of children are obese.  This is a startling statistic but based on my patient population, I would estimate the number is closer to the 33% rather than the 16%.  But then again, I live in southeastern Oklahoma, and see a patient population of 45% Medicaid.  That is their primary insurance, it does not include those who qualify for Medicaid as a secondary insurance.  During medical school, I never imagined that I would be consulted by parents regarding their underweight child, only to determine he is the only one in the family that is on the growth chart and of a normal weight with respect to his height.  Or the number of children dragged in by their parents sure that their child has a thyroid problem, because it could not be that the only exercise the child gets is to get up off the couch to go to the bathroom between commercials, or that a large pizza is considered a serving size for them.  So I understand that obesity is a problem in our youth.  And I would applaud any efforts to help curb it, should those efforts actually make sense.

This is not an argument for whether I want to subsidize school lunches, food stamps or other government agencies.  These programs are in place, and for the moment, if we are to continue with them at least let their policies make sense.

Per the report found in Reuters  “The guidelines double the amounts of fruits and vegetables in school lunches and boost offerings of whole grain-rich foods. The new standards set maximums for calories and cut sodium and trans fat, a contributor to high cholesterol levels.”  And while I fully understand that, and the attempts to offer only fat-free or low-fat milk, and assure that proper portion sizes are given to children, I doubt that this is even possible to enforce much less implement.

My experience with cafeteria workers is that few if any realize what a proper serving size for an adult, much less a child.  I spend quite a bit counseling patients that serving sizes are roughly the size of their hand (since it is much easier to grasp and compare than carrying around a scale).  And currently, I have heard of schools allowing 2nd and 3rd servings to children.  With few exceptions there is not a child that ever needs a third tray of food.  (Those rare exceptions of underweight and active children this applies to the population that are not at that end of the spectrum)

Not to mention, the black market aspects that could foreseeable pop up.  Who is going to keep kids from bringing food from home?  I know it is being attempted in Chicago, but I remember sneaking brownies and gum into the classroom, where we weren’t allowed to eat as a child.  How are you going to determine if this is food from home, or from the cafeteria itself.

And the biggest reason that this will not work, the original proposal was blocked because potatoes were not initially allowed as a vegetable.  And pizza was also not allowed as a vegetable.  I like french fries and pizza as much as the next person, but let’s be real, health food they are not.  When the food manufacturers selling the food are allowed to dictate what constitutes health foods and what does not, there is a problem.  What child is going to pick an apple over french fries?  Will the school lunch still be able to meet the nutritional standards?  How precisely would those two be considered nutritional equivalents?

As a physician, I spend a lot of time talking to new diabetics and obese patients about their diets, and well pasta and potatoes appear to be the biggest contributors to the caloric intake.  It is what they learned from the USDA and their food pyramid.  The very same organization setting these standards.   The same organization which allowed the lobbyists to dictate the new standards.  And at what cost?

While I agree we have to start somewhere with educating the public and attempting to change the dietary habits of children before the suffer the health effects of obesity, including early onset Type 2 diabetes, hypertension, and high cholesterol, I don’t see this actually being effective.  Substituting whole wheat for white flour in pizza and spaghetti, while it looks like a wonderful idea on paper, may instead be thrown away in favor of other offering either by the school, or an entrepreneurial student.  And while I am in full support of the potential economic lesson this might lead to, it most likely will do little to help.  Nationwide standards have not helped to improve our education system, and without getting input from local officials and parents, I doubt that this will be much different.

Had change been truly desired in the school lunch program, input would have come from the parents, teachers, physicians, dietitians rather than the food industry who would have seen their potential profits cut.  The making of a pizza a vegetable merely because of its tomato paste (which is incorrect, since most use sauce which has a lesser concentration of tomatoes and tastes better) shows just what kind of answers we get from Washington.


Give the gift of health

As Christmas approaches I think about the one thing we should all attempt to give our children- and that is the gift of health.  This does not pertain to those poor children with diagnosis such as cancer, chronic illnesses, or other disease states that have nothing to do with habits that you can control.  Instead this focuses on the rest of the population who can do something to help prevent medical conditions.

Childhood obesity is on the rise.  Mostly due to the readily available fast food culture and the decrease in the physical activity of society overall.  This is not a condemnation of McDonald’s.  I believe in the free market, and if the free market demanded salads and low calorie alternatives, McDonald’s would have one answer within a week and possibly a whole new menu within six months.  But the public does not demand it, so there is no change.

No the answer lies on the parent.  I know, easy scape goat.  But who is ultimately responsible for teaching the child, mom and dad.  And most eating habits are learned at an early age, before the child even enters school.  There is nothing built into the child that makes it demand McDonald’s before it can walk or talk.  In fact, if you never take it to McDonald’s requests for it are limited.  Sure they might see commercials on television, but if you limit the amount of television they watch, there would not be a request.  You may substitute any other fast food establishment you desire in for McDonald’s the story is all the same.

In the parents’ defense, in many poorer areas processed and fast food is cheaper and easier to obtain than fresh fruits and vegetables.  It can be done, it only takes more effort.  And lately I am finding that most parents of obese children that I see, know nothing about serving sizes, how many servings a day or the differences between good calories and bad calories.  Somewhere along the line, this information was lost.  Frequently the parent of a 14 year old tells me how much the child has eaten, and seems surprised when I tell them that is too much food.  And in reality, trying to teach a 14 year old good eating habits (or anything else for that matter) is like hitting your head against a brick wall.  It doesn’t do much good and you end up with a headache.

I like to use the hand as a guide for serving size.  While not exact it is a lot more understandable than gram, ounce or other measuring device.  A hand is always accessible.  Smaller hands, smaller serving sizes

The other thing lost, and probably the bigger problem, is exercise.  While XBOX 360 and Wii have created games that help increase the movements with video games, they do not fully replace the playing baseball in the street, riding your bike until dark, or just having fun playing games with one’s friends.  This I am not faulting parents for not letting your kids out by themselves.  I don’t either.  But unfortunately this fun running without a care has disappeared thus eliminating the burning of calories.  In fact it has probably been replaced in many instances with a bag of Cheetos in front of the television, so not only are we not burning calories we are now increasing the amount we are not burning.

Additionally, parents are under the impression that large amounts of juice is good for the child.  First of all if it is not 100% juice, you might as well give the child a coke.  Secondly, no child needs more that 2 glasses of juice (8 ounces) a day, the rest is just empty calories.  Milk should be limited to 3 glasses (24 ounces total) daily.  Water should make up the rest.  And neither children nor adults need any of the sports drinks unless they are actively pursing a sporting activity.  If you are running a race, ok have a gatorade or a G2.  Sitting on your couch – well you don’t need that 240 calories, you have not lost enough carbohydrates to justify drinking any sports drink.

And I don’t care how hyper your 2 year old is, Mountain Dew is not the same as Ritalin (just because they both are technically stimulants).  You can’t diagnose ADHD that young, current accepted age is 6 with some more recent studies saying 4.  However, they are not the same thing.  Not unless you are hiding the Ritalin in a Cocoa Puff anyway.

Additionally, stop giving coca cola in a baby bottle.  First of all, if they are still drinking out of a bottle there is NO good reason for a Coke.  Talking to the dentists around here it is a toss up between coke in a bottle or putting the two year old to bed with a bottle of juice as being the biggest culprits for tooth decay at a young age.   And unfortunately the earlier we teach these habits, the more ingrained they become

This blog is not anti- any of these foods.  I like the occasional trip to McDonalds, and having pizza delivered when you don’t feel like cooking are nice conveniences.  Additionally, one of the biggest motivators for children is to be like their parents.  So you as a parent need to practice good health.  Eat healthy, with junk food in moderation.  Eat what a serving size is.  Drink plenty of water.  Drink alcohol only in moderation.  Exercise. Find some activity you enjoy doing.  Do it as a family if you can.  Or just find something that you love for exercise and encourage your child to do so.  Don’t smoke, or if you do quit.  Tobacco use in parents is the greatest risk factor for teen to start smoking.  All of these are things that you can do to help encourage a healthy lifestyle in your children.

Please don’t expect the government to help.  Their help has included concepts such as the food pyramid of the 1980’s which many of us grew up with, found later to be flawed and possibly lead to obesity, corn subsidies which has led to an increase in the cost of lean meats, and makes it so that fast food outlets and food manufacturers have cheap, unhealthy products to sell at a cheap cost.  Schools don’t have the time, and from the words of many of my parents their meal options could not be counted as healthy.  And as I was told by one parent, her son was allowed to go back for thirds in the free lunch program at school.  Even overeating healthy foods can lead to obesity when coupled by lack of exercise.  So the answer goes back to the parents.  IT both starts and ends at home.  Please give you child the gift of health, and help change the trend of childhood obesity.  Don’t make me have to talk to another child and explain why their eating habits are killing them.



Testing oneself

This morning, I am focusing on getting myself ready to test for my black belt in Tae Kwon Do.  It has been a long time coming.  Do I have to do it?  Well that is a loaded question- Yes and No.  No I don’t have to do it.  There is no one forcing me to do so.  If I don’t test, nothing bad will happen to me, I won’t lose my house, my family, my job.  But in some ways I do have to test

Here is why- and part of the reason it has been a long time coming.  I started Tae Kwon Do about 3 and a half years ago- give or take six months, sometimes things in my memory get mixed together regarding time.  Any way I moved normally from white to orange, yellow, camo, green, purple, blue, brown, red and red black recommend.  No big deal.  For me, my husband tore his ACL shortly before testing for red and red-black but that cannot be my excuse.  Well I decided not to test on my first chance, was it a mistake?  I don’t know, I didn’t know what the next 6 to 12 months lay ahead.  I just wanted a little more than two months to prepare, so I made the choice.

However, summer came along, things got busy with the kids, and finances got back at work.  In other words, life got in the way.  I had a son with a broken leg- who still tested, a husband limping around refusing to admit he did anything to his knee, and only after someone else made him an appointment did he finally see a surgeon.  Was told that he not only needed surgery, it should be sooner than later, so he chose about 3 months from then.  (Doctors are terrible patients, though in his defense schedules are made 3 months in advance, so there is that)  Ok, so with balancing life, I got busy.  Missed testing opportunity number 2.  And most of the six months between opportunity one and two.

So January comes, hubby has surgery.  So I have to take care of him, his patients, my patients, hospital, kids, … for about 2 weeks.  Then I am back to normal, my patients and kids.  Maybe valid excuses, but excuses, none the less.  And then there is an explosion on the business end.  (Not an actual explosion, but one of patients due to physician leaving town.)  So my thoughts of maybe this testing turn to …well, maybe not, maybe next time, I am just not ready yet.  May comes and goes.

Now we are 6 months later.  Life is still going.  Life will continue to go.  Work is good, though turned over an entire office, gave my first lecture at a national convention, two kids science fair projects, wiped the tears of my oldest when he missed breaking the board at the last test.  And up until last weekend, I was still on maybe and I will try.  However, Sunday night I realized that I have to test.  Time will continue to pass, and there will always be excuses.  And how can I expect my kids to put forth the effort and try, if I don’t get back in the game. And my oldest told me he believes in me and that it is only important that I do my best.

So today, I will go and give it my all.  Because if I don’t test, I am more afraid that I never will.  And that is what life is about testing oneself, improving oneself.  I just have to have faith that I know it, and give it all that I have got.  Wish me luck

Back to School Back Pain

As we approach Labor Day, I think it is slightly odd that it is thought of as the end of summer.  Why?  Because my children have been back in school for three weeks already, and growing up, I don’t remember once that I ever started after Labor Day.  And the other side of the argument is that it is still over 100 degrees here, which if that doesn’t scream summer, I don’t know what does.  However, Labor Day is thought of as the official end of summer, and with that comes the start of the school year, and more complaints of back pain.


Why is there more back pain during the school year?  It is not due to sports or an increase in physical activity.  Instead it is due to what they are carrying on their back.  Usually around 20-30% of their body weight in books/school supplies.  I remember my high school days, my back pack could easily be 40 pounds.  Why?  Because there was not enough time to go to my locker between classes, and so I took all of my books to every class, and most of them home and back with me, only stopping by my locker in the morning, lunch and right before I left to go home.  From what I see, this trend continues today.


A few years ago, some of the companies came out with wheeled backpacks which seemed like great ideas, except they were bigger than the traditional backpack, took up too much room, so the schools banned them.  So while they helped with the child’s physical well being, there just was not room for them in the schools.


I don’t think that the schools are trying to punish the children.  In fact, I think they are trying to come up with some reasonable solutions.  The local middle school is sending a set of books home, that stay at home, and one that stays at school in an attempt to decrease the load on their back.  (Though they may not have much of a choice, since they removed lockers from the school)  Other schools are issuing laptops to the students, in an attempt to decrease the costs of textbooks.  I don’t know if this will decrease the load on the kids backs or increase the costs to taxpayers and parents.  Only time will tell.


However, if there is no way to avoid the backpack on your child, there are a few guidelines that should be kept.  The back pack should weigh no more than 10% of the child’s weight.  A 100 pound child should only carry a 10 pound backpack, and a 60 pound child a 6 pound back pack.  Perform stretching exercises to help strengthen the back, and help to get the strain out of those back muscles.  Occasional use of ibuprofen is fine permitting the child does not have stomach or kidney problems, but if it becomes a daily need, consult your child’s physician.  Sometimes other modalities will need to be done such as physical or occupational therapy to deal with the pain.  Rarely is there a need for xrays, but it is a possibility.  Keep the child at a healthy weight for their height.  One of the biggest causes of back and joint pain is being overweight.  When coupled with a back pack that is too heavy, that is a case of injury and pain just waiting to happen.


If a backpack must be used, make sure it is used as intended, using both shoulder straps, and is for their size of body.  A backpack that is too big or too small can aggravate the problem.  And an overlooked, but common aggravating problem is poor posture, especially in the female who grew before the rest of her class.  Make sure that your child and teen practices good posture.  All of these will help reduce the stress caused by carrying a backpack.

Regular check ups

Sorry about the length of time between posts, but returning to real life seems to have gotten in the way.  It is funny how returning to vacation always does that to you.


Today I wish to address the importance of regular check ups.  Check ups are an easy thing to overlook, and once all of the vaccinations are complete, parents tend to focus more on sick visits and such.  However, regular check ups, about once a year for children over two, are in fact an important need in a child’s life.  It is through check ups that developmental delays are addressed.  For example if you only bring your child in for strep throat, which is usually a shorter work in visits, a delay in speech or other aspects might be missed.  And in the case of speech, the earlier the intervention, the better the end result might be.


Additionally, important tests such as lead levels, and blood counts can be drawn at routine visits to make sure that the child is not anemic, or have to be treated for too much lead which can lead to development problems in brain development.  Lead level tests are especially important for those living in old houses that might have lead based paint, which could be covered up by newer paint or still there.  And in recent years, toys from China keep being recalled due to lead based paint in them.  These make no one immune from the need for lead testing.  Current recommendations are for lead tests to be done at 12 and 24 months and when exposure is suspected.


For those with healthy children, not needing vaccinations, health check ups are also important.  It is at these, that time is allowed in the schedule for questions that parents might have, and to discuss important landmarks.  Sometimes the questions are simple, like child number one was already walking at this age, why isn’t he?  Sometimes they are more complicated, and might need further work up and discussion.  Additionally, it is even more important today with the rapid increase in childhood obesity.  Early intervention can help to prevent the diagnosis of Type 2 Diabetes in children, and discussion of appropriate food intake is always important.  While juice is often marketed on the television as a healthy alternative to soda, many juices out there have just as much if not more sugar than soda, and in any case should be limited to two servings a day.


The older child has issues such as puberty, diet fads, drug and alcohol usage.  All that should be address, as well as STD prevention.  These are important to have before the child is sexually active.  I can’t tell you how many times, I have had these conversations with teenagers which have no idea, what STDs are nor what they can cause in the long term.  And many times, parents are shocked to find out that their child is sexually active.  So it is important to address all of these issues before they are a problem


Anyway, children in all stages of development need to have routine checkups  If only to prevent potential future problems.  In most cases it is easier to prevent the disease from happening, than to treat it later


Why you should not get to the Vancouver Airport 5 hours early

While this seems like a no-brained, that is what I am doing right now. Though in my defense it was not entirely by choice. Actually we just got off of a cruise and when I was arranging airfare, I was told by the cruise ship to make sure the flight was after noon. Great easy enough. So I booked a direct flight to DFW for 2:25, not realizing there was a 12:15.

Anyway, apparently you cannot even check in for you flight at Vancouver until you are within 3 hours of your flight. So we are not even at the gate, we have a huge pile of luggage that we would have to lug everywhere, and therefore we are stuck here.



Anyway, you might ask “Well, why did you get to the airport early?”. Well, you disembark a cruise ship pretty much when they tell you to. So we cleared customs, collected our bags, and boarded the shuttle bus to the airport. Upon arriving we were told that we cannot check in until 3 hours before departure time. So we are here, stuck, waiting.



Yesterday, we had a marathon day at Victoria, on Vancouver Island.  We boarded a coach outside our hotel and drove about 45 minutes to catch a ferry.  The views from the ferry were outstanding.  My children didn’t appreciate the wind from the boat, and argued that they were going to “freeze to death”  While on the ferry, I caught a glimpse of a newspaper, asking if summer was ever going to come.  I found it quite funny, since I had just escaped 106 degree heat in Oklahoma, and was quite enjoying the 60 degree weather.  But apparently it was a big deal, since their averages put the temperature in the 80s.  This seemed quite the theme throughout the day with the Canadians apologizing for the weather and the rain we experienced yesterday.


After landing on Vancouver Island, our driver drove us to the city of Victoria and dropped us off.  We visited the narrowest street in the world, and unfortunately I cannot remember its name.  It is something like RanTan.  It opened up into the China Town in Victoria.  Apparently, Victoria and Vancouver are about 25% Chinese, which I never knew until this trip.


We made our way through the town stopping at a farmer’s market.  My oldest wanted some chocolate covered strawberries so we bought a bowl.  Then my youngest tried one and told me that he did not like the red stuff (strawberry) but the chocolate was good.  So after he ate off the chocolate on his two strawberries, my oldest at the strawberry.  AT least they know how to share.


After finding a pub which served something my youngest would eat (pizza), and enjoying the first half of the US-Japan world cup final.  (If anyone can tell me who won, that would be lovely) we wandered down toward the Royal BC Museum.  IF you are ever in Victoria, this is a place that is definitely worth the look.  We had free tickets to choose on of several choices, and because the driver had mentioned the Wooly Mammoth, that was the choice we made.  However, I would recommend doing it at a much more leisurely pace than we did.  My oldest convinced that we were going to miss the bus, did what we call “Trevor speed” through the museum.  However, I think based on previous trips to zoos and museums, time constraint were not what motivated him.  The natural history and land exhibits are well done.  The loved they microscopes to look at the fossils and various bugs.


After racing through the museum, we went out to take picutes of the Parliament building, and the flowers.  All the while, my son is still concerned that we are going to miss our bus, despite it being about 45 minutes before its arrival right across the street from us.  Finally, after getting more pictures of the area, when the clock tower went off at 3, we went to the meeting point to wait until the coach arrived at 315.


The coach then drove us to the Bouchart Gardens.  This is a spectacular set of gardens that has something for everyone.  (Assuming you don’t hate gardens).  There is the sunken gardens which is a spectacle of colors and water, and the Japanese Garden, the Rose Garden and the Italian Garden.  My son’s favorite was the Japanese Garden, probably because it was more peaceful and sedating.


After that the marathon day was almost over.  (Well if you count a 30 minute coach ride to the ferry for a 2 1/2 hour boat ride followed by a 40 mine coach ride almost over).  So we got on the ferry which was much more crowded and loud then earlier.  WE were not able to find a seat, so we ended up sitting on the floor in the play area.   This rude little boy took my phone away from my youngest who was playing angry birds, so I took it away from him.  Sorry, not about to allow some strange kid to play with my phone.  Later he came back and walked up to my youngest, told him that he smelled and that he needed to go away.  We told the child that he was rude and since we had been sitting over here maybe he should go away.  Shortly there after we went outside to enjoy the view and to take my son out of the situation.  Finally it was time to board our coach and head to the hotel.  To go to bed, and to get some rest for tomorrow

Tag Cloud