Dangerous Games

Perhaps it was boredom; perhaps it was a way of blowing off steam, but adolescents play some pretty dangerous games. This week, I treated two teens for injuries sustained by these games.

The first game was called "Knuckles". Forgive me if I get the rules of this game incorrect, but from what I understand is that teens challenge each other to a game of ramming their fists (knuckles) into a variety of objects, such as walls, doors, road signs, each other, etc.

One of my first patients in the morning was a 16 year old girl (yes, a girl!) holding her right hand. She had some tenderness of the fifth metacarpal -- the bone of the hand directly below the 5th or little finger. This was most likely a common hand fracture, often referred to as a Boxer's Fracture.

A quick trip to the x-ray revealed that she indeed had a 5th metacarpal fracture. It wasn't a bad fracture, but she will need a special cast on her hand for a month or so. A month in a cast should be plenty of time for her to ponder this decision to slam her knuckles into a stop sign on the way home from school. I am not sure how this game is won, but if getting a fracture is considered a point, then maybe she is a winner.

The second patient was brought in with some additional hand injury, mostly just pain and bruising. This was a result of a game called "Quarters". The mother was initially horrified by thinking her 14 year old was playing a drinking game of the same name in which a quarter is bounced into a shot glass. If you miss, you have to drink the shot of alcohol. Fortunately, it wasn't this game.

I know even less about this new quarters game, but apparently it involves the spinning of a quarter on the table. If this spinning quarter stops near your hand, you are awarded with having a quarter flicked into your knuckles. There was no need to x-ray this one. The treatment is simple: Stop doing that! We never played this game when I was a kid; we never had quarters!

This same patient freely shared another game called "Pong". In this game, you volley the ping-pong ball until you miss. If you do miss, then your opponent can hit a ping-pong ball as fast as they can at any part of your body you do not cover. Girls will cover their faces and end up getting a series of round, red welts on their chest and abdomen. Boys, naturally, will cover their groin, not wanting to get receive a line-drive in this area. They will likely end up with red welts on their face.

These are the only three games that I know of at this point, but I would welcome posting from other parents or teens on more of them.

Now, before you start becoming judgmental about teenage behavior, try and remember what YOU did at that age. When I think back on some of the dangerous games that we invented, I am surprised that I made it to adulthood unscathed.

We played Knuckle Poker. If you lost, the winner of the hand was allowed to hit your knuckles with the edge of the deck of cards. Not only was it painful and caused your knuckles to bleed, it encouraged cheating. A variation of this game involved slapping your tender forearm with two saliva-wet fingers. That, of course, stung like a bee and was on the unsanitary side.

The worst of the poker variation was in college, where I played (once) a game of Water Poker. The losers of the hand must drink a small Dixie cup of water…just plain 'ol water. Over the course of an evening, the unlucky ones developed some profound electrolyte imbalances, became dizzy, disoriented, and appeared intoxicated (water intoxication). You would think that future medical professionals would have known better, but in our defense, we did not have that class yet.

Later on, water was replaced by beer or Jack Daniels -- a game that I did not play. I have never been a fan of alcohol and I certainly am not a fan of being drunk. I only experienced alcohol intoxication ONCE in my college years from a drinking challenge (I needed the money, and it wasn't time to sell a pint to the Blood Bank) and vowed never to do that again.

To this day, I do not drink alcohol in any form. People who do not know me think I am either a Mormon (we do have five kids) or a recovered alcoholic! Apparently, it is not socially acceptable NOT to partake in a glass of wine without a detailed explanation.

And, yes, there were other dangerous games, like the various versions of Chicken. Not wanted to be painfully labeled as a coward or chicken, kids will try just about anything. We shot BB guns at each other, threw kitchen matches, threw darts into the air and tried to catch them on a piece cardboard.

We were also constantly challenged to eat various things, from horse manure to hot chili peppers. Not wanted to be a chicken, I would swing on a vine over a 50 foot drop into the canyon below, or sit in the Devil's Seat at Wolf Rocks -- a natural depression in a rock that hung out over a precarious drop off of several hundred feet. Does this sound like a popular television reality series?

I can't say that I was ever Triple-Dog Dared to do these things. I did them thoughtlessly and willingly; just the way kids are supposed to act. My mother knew nothing about any of these things that we did. Just as long as I came home by dark and did not require obvious medical attention, she was totally oblivious to our acts of adolescent stupidity. And, I lived to blog about it.

Related Topics: Media Messages Harm Teen, Child Health, 10 Perks for Teens Who Exercise

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Spinach and E.coli - What next?

Don't take my spinach away. I love spinach. Popeye loves spinach. Kids are often not thrilled about it, but it is an excellent source of iron and other important nutrients. I went to my favorite salad bar the day of the nationwide recall of the contaminated raw spinach (before hearing the news) and wolfed down an impressive share of this tasty vegetable. On the way back to work, I heard about the recall on the car radio. E.coli happens.

E.coli is not an Internet cola drink, but a common type of bacteria that resides in all of us. E.coli is an important intestinal bacteria that helps us process our foods. As long as it remains in our intestines, it poses no harm, but when it ventures out into the world, crap happens.

There are various subtypes of E.coli; some are basically harmless. Some can kill you. As a matter of fact, there has been one reported death related to the spinach contamination, as well as hundreds that became ill with an array of intestinal symptoms, such as vomiting and explosive diarrhea. Many people required intravenous fluids to maintain hydration; others spent a great deal of time in the bathroom reading magazines, or for the technologically advantaged, using a laptop computer to search the Net about this outbreak. No, this is not called a craptop computer.

E.coli often makes it into our meat supply; primarily ground beef. It is rare that a restaurant will ask you how you would like your burger. They automatically cook it well done now. Fast-food establishments that were hit by lawsuits years ago when patrons were served E.coli-contaminated beef have made some serious adjustments in the kitchen. The teenage cooks are now using gloves; and those burgers are cooked to a temperature that would kill anything.

I have spent a great deal of time in the Central Valley of California where there are beautiful spinach fields as far as the eye can see. I am always impressed since I have never been able to grow spinach in my own garden, and yet there are acres and acres flourishing a few hours south of where I live. I have often been tempted to shovel a truck load of that soil in the back of my pickup and speed away.

Those fields are also filled with migrant workers picking the spinach and loading up those crates on trucks. There may not be a building in sight, so where do these workers relieve themselves? Organic farms use organic fertilizer. Need I say more? Granted, most of the fertilizers come from liquified, composted cow manure. The Central Valley is also blessed with some HUGE feed lots that you can smell from miles away, so there is a ready supply. Cow poop also has E.coli, folks.

The spinach is then quickly transported to the packing plants, where it is washed (sort of), unappetizing leaves removed, and then bagged. Within a day, sometimes hours, it can be sitting on the shelves at your local grocery store. This is a very impressive operation, and in most cases, the process is flawless. But, crap happens.

Was the washing water contaminated? How about the hands of the human spinach sorters? There are numerous steps where contamination can happen. I am sure that this recall cost companies MILLIONS, and it will likely take millions more to reduce the chances it will happen again. Unfortunately, it will happen again.

All of the mothers in my practice freaked out and chucked out all of their jarred spinach baby food. This was probably not necessary, since the heat involved in the processing of baby food will kill E.coli and other bacterial contaminants.

My wife made lasagna last night loaded with spinach (from frozen). I trusted that the oven destroyed any rogue E.coli. I have been to restaurants three more times since the recall and certainly miss spinach on sandwiches and salads, but I am not going to take any chances. As you know, I am suspicious of restaurant cleanliness anyway.

When fresh bagged spinach returns, I will most definitely wash the crap out of it before eating it again.

Related Topics: Foods to Avoid When You're Pregnant, WebMD Video: Grill Meat Safely


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Lice: Not So Nice

Within a few weeks of the beginning of school, medical providers around the country start seeing the return of head lice, not unlike the Swallows returning to Mission San Juan Capistrano. I have no idea where head lice go for summer vacation, but we sure see these unwelcome guests in the fall of each year. I like to call our local variety "California Scalp Crickets".

Lice affect up to 9 million children (who's counting?) per year. I briefly addressed this topic in a past Blog, but I feel it deserves a bit more attention.

The misconceptions about head lice are truly amazing! Here are some fast facts:

• Head lice are true HUMAN parasites; you do not get them from the dog; even a dog of dubious character.
• Head lice do not fly or jump; but they will scurry from one head to the next if those heads are touching together long enough, or they can be transferred by combs, brushes, and hats.
• Unlike ticks, head lice do not carry diseases. They are just looking for a comfortable place to reside and to suck some of your extra blood. They don't eat very much, but you certainly don't want to be their restaurant.

The diagnosis of head lice in my office often receives the same horrified reaction if I told someone that had a venereal disease -- total shock and denial. Oh my God, we will have to move.

Head lice are light-shy, so they may be difficult to see crawling around on the scalp, especially in dark, thick hair. Although lice can live off of the scalp for up to 55 hours, it would be unusual to contract them in this manner. Adult lice live about a month. During this period, the females will lay about ten eggs per day. These eggs will hatch in 10-15 days, and a new and rapidly-renewable generation of sexually-active lice. Seeing live lice is a sure sign of an active infestation, but finding the sesame seed-sized eggs, or nits, are usually the first thing we see.

Hair grows an average of 1/2 inch per month. Since lice hatch in two weeks, any nit that is found more than a 1/4 inch (two week hair growth) from the scalp is most likely already hatched.

I remember finding lice on a little pre-schooler during a routine exam, but I failed to inform my nurse. After administering her needed vaccines, I saw my nurse hugging and stroking the hair of the crying child. After I told her about the lice, my nurse went into an instant panic and headed for our clinic pharmacy for some Nix. The rest of the day, she walked around with treated, wet hair; periodically glaring at me with a look that only a scorned woman can usually achieve.

Faced with exclusion from school, parents are desperately seeking an instant cure. It is not going to happen. Although children can return to school immediately after a successful treatment with an approved pediculicide (the medical name for chemicals that eradicate lice and their eggs/nits), many schools have an illogical, if not punitive, "no nit" policy. That is the origin of the term, "nit-picky".

The American Academy of Pediatrics and the National Association of School Nurses concur that no child who has been effectively treated should be excluded from school.

Lice lay eggs on the base of the hair using a type of biological glue that is basically impervious to chemicals. People have used everything from mayonnaise to hot vinegar, to the dangerous practice of using motor oil or gasoline to remove the adherent nits, to no avail. When all of these folk remedies fail, it will eventually come down to picking or combing them out the non-viable nits, one at a time. Or, hire a trained baboon to do it for you.

Only one of our five children ever brought home head lice, but while doing volunteer work with homeless children, it was a daily occurrence.

Head lice do not recognize or respect socioeconomic classes; they are equal opportunity parasites. I must admit that I have some perverse pleasure in informing a snooty, affluent mother that her child has head lice. This sort of makes all of us a bit more equal. After my daughter's case, I offered to go to the school for free head checks (so she wouldn't get them back), but was told this was against school policy.

WebMD has some nice resources for head lice, so I am not going to go into specific details of treatment, but I would like to offer this precaution: Do not over-treat.

Carefully follow the recommended directions on the pediculicide of choice; and only use safe and approved methods. Lindane (Kwell), once used exclusively in this country for head lice treatment is banned in California. Not only did the cooties develop a resistance to this dangerous insecticide, it had a nasty habit of causing seizures in children. It also can contaminate water sources -- a single treatment can pollute six million gallons of water; the equivalent of 300 swimming pools. In August, the federal government banned lindane as a pesticide, but it is still approved in some states and countries as a medication.

The vast majority of head lice medications are safe, even the ones that contain malathion -- an insecticide that California uses quite often to spray for mosquitoes that carry West Nile Virus, or the dreaded Mediterranean Fruit Fly. There is even a new treatment method (Nuvo) designed to suffocate, rather than poison, these little lousy critters.

I know that many of you will be calling your kids in a few minutes for a home head check, so I will not banter on.

Happy hunting.

Related Topics: When to Keep Junior Home from Day Care, Lice First Aid and Treatment

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Sticks and Stones will Break Their Bones

... (But, so will monkey bars)

The day after any long holiday weekend is always a busy time in medical practices. Sick and injured people tend to wait for the office to open on Tuesday, instead of going to a crowded emergency room or urgent care facility. As soon as our phones were turned on Tuesday morning after Labor Day Weekend it never stopped ringing.

In our practice, we have at least six individuals, sometimes more, assigned to our busy phones. On a typical, ten-provider day in our practice, we may see 300 patients and handle a few hundred phone calls asking advice or requesting medication refills. To make matters even more chaotic, we instituted an open access policy earlier this year -- any patient that requests to be seen today will be seen today. The patients love it; the providers are less enthusiastic thus far.

In addition to my responsibilities with WebMD, I work three 12-13 hour shifts (my choice) per week, so I tend to get more same-day, urgent care visits, such as injuries or lacerations.

Yesterday was a bumper day for injured children; I saw six children that experienced the awesome effects of gravity -- three fractures and three lacerations. One little girl (see picture), broke both forearm bones in both arms. She gave me permission to post her picture.

The last time that I treated a double-double arm fracture was my son, Ben, who recently broke his arm again at my youngest son's wedding. This little girl is adapting to her limited mobility just fine and is proud of her choice of a pink and purple cast. The other two children were victims of our friend, and the friend of all successful pediatric orthopedists, the playground monkey bars.



Children are risk-takers. The older an individual becomes, the more likely they will exercise caution due to their experience of childhood. I remember a sled-riding expedition many years ago where we took along one of our kid's friends -- a boy that had never gone sled-riding before. When we arrived at our favorite sledding spot, we were amazed on how quickly he learned. He was really catching air -- flying through air like an experienced Olympic ski jumper. When we commented to the other kids about how well he was doing, the response was, "Well, he doesn't know what will happen if he crashes."

Children seek out hazards. If they don't exist, they will create them. An example was our sliding board into the pool. I bought it through the newspaper (perhaps from a former owner with more sense), and had it installed when the kids were at school. They were having a great time when I suddenly took notice of some unusual cheering-on. When I looked out of my window, I spied our oldest son (Incidentally, the one that made the comment above) sitting in a lawn chair precariously balanced at the top of this ten foot water slide, preparing for his Evel Knievel stunt debut. Apparently, after twenty minutes of sliding down the slide, it wasn't dangerous enough.

In my clinic, I see the same with skateboards and scooters. Give a kid a new skateboard and he will create a dangerous ramp within the hour.

I did my share of crazy, mindless acts as a child, too. Too lazy to walk down the stairs, I would jump out of my attic bedroom into a snow drift. With found objects, we would create any number of vehicles to sail down our step hill.

Before the era of helmet use, three of us, clutching to one PeeWee Herman-type bicycle once slammed into the side of a moving car, safely sailing over it and landing in some hedge (laughing, of course). My friend, Terry and I, threw darts at each other, protected only by our homemade cardboard shields. We stopped after one of the darts stuck in Terry's forehead.

My mother was oblivious and never once gave the "You'll put your eye out"speech. Her clever method of behavior modification was to just let us get hurt. Granted, children are inherently experiential...those that survive, of course.

Related Topics: Pool & Spa Hazards, Make Your Backyard Safe


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Feeling Helpless

This morning I received a frantic call from my sister-in-law. She was following the ambulance containing my brother. Apparently, while working on the computer this AM, he suffered some severe pressure in his head/sinus area, became profoundly dizzy, became weak and white as a sheet, nauseated, vomited, and had disequilibrium.

Yesterday, while working in the yard, he had some left arm pain, but it went away. My brother is not a person who tends to panic, but when he told his wife to call 911, it justifiably frightened her. And, it terribly frightens me.

As a write this, I am feeling helpless and my brother is lying on a gurney 3000 miles away. I am trying to stay busy waiting for a phone call to update me on his condition. The differential diagnoses are running madly through my brain.

Did he have a sudden cardiac event? A gastrointestinal or intracranial bleed? Or, another one of those mysterious vertigo events that are addressed weekly on the WebMD Ear Disorders Board? As a matter of fact, about five years ago, I, too, had a sudden vertigo event which left me with daily tinnitus. I did have problems with equilibrium for a while, but did not have the same symptoms that my brother is experiencing today.

Several years ago, my wife and I returned a day early from a camping trip (too cold!). Our house-sitting son told me to call my friend, John. Apparently his son was ill. I took a shower and unpacked the car and then gave him a call. It was not his son that was ill, but rather John himself.

When I called, he was heading for the bedroom to go to sleep. He told me that he was so profoundly weak, that he could barely stand without passing out. He had called his own doctor who diagnosed him over the phone with the "flu", since he also had diarrhea. Without missing a beat, I told him to hold on to something and stand up now.

As he stood, I heard him rapidly breathing, and then collapse back on the couch. "Put your wife on the phone", I asked. "Call 911...right now. No questions. John is having orthostatic symptoms (his blood pressure was bottoming out when he stands). I suspect he is having a gastrointestinal bleed." I knew he popped ibuprofen like it was candy due to chronic leg and back pain.

I am not always right, but I was correct in this case. His hemoglobin was so profoundly low that he was close to having a cardiac arrest. Emergency surgery found and sealed the eroded artery that was pumping away in his damaged stomach. Today he is just fine. Some years after this scary event, he did have an unrelated quadruple coronary bypass. Again, I felt helpless.

Now, back to my brother... He has been procrastinating about retirement for years, so he continues to work. He drives over 60,000 miles a year for his stressful job. He has invested wisely and has enough resources to retire. Everyone tells him to do it, and he keeps saying, "One more year".

The older we become, the older our friends and family members become as well. Although age alone will eventually take its toll on all of us, it is these sudden health events that shake our formerly-healthy world and drive us to make decisions. I love my brother dearly and hope that the events of today will come out favorably so someday we can be two, vertiginous, hard-of-hearing old men, sitting in our rocking chairs enjoying our retirement for years and years to come.

I know he will be just fine, but right now, I just feel helpless.

Related Topics: First Aid & Emergencies, Symptom Checker

Technorati Tags: health emergency, family

Sexual Abuse by Medical Professionals

Sexual abuse stories make headlines, especially when they involve the clergy and medical professionals. Doctors and other health care professionals who are accused of violating their oath and patient trust, who may have crossed over that thin line, tend to lose their licenses; and many even go to jail.

Some, unfortunately, get away with overt sexual impropriety for years. Some are never caught or even accused. Some are even doing it today. It may have even happened to you.

This story happened to a very good friend of mine. While I trust my friend and gave testimony in court on his character, there are always those lingering doubts. Did he violate this trust behind the closed doors of an examination room?

Perhaps the only people who know the real truth are the two people that were actually there. One went to jail and lost everything...professional license, family, and savings account. The other bought a new house and car with the malpractice settlement. If he truly did the things he was accused of, then justice was served. If he was the victim of false accusations, then that person is going to have a lot of explaining to do in front of God someday.

The medical encounter is a very sacred relationship. Patients not only bare their bodies, but they bare their souls. It is a privilege to care for others, but it is also an awesome responsibility.

After my friend went to jail, I was so demoralized that I decided to leave the practice of medicine and go back to full-time medical education. This event changed me as well. I have returned to clinical practice again, after several years as a university professor, partly because I grew weary of whiny 30-year-old masters students, but mostly because I really missed clinical practice. I don't mind the whining of two-year olds.

Patients can misinterpret examination components if the medical provider does not explain what they are doing, and why. For instance, a breast examination includes expressing the nipple for discharge or blood. If you don't tell the patient you are going to squeeze their nipple (and why), you could be in big trouble.

In my recent Blog about "patients as sheep", Carolyn wrote about her experience with her endocrinologist. He insisted that she be disrobed above the waist, in a paper gown open in the front, for a thyroid exam (neck). She also felt uncomfortable with the doctor's intimate demeanor. She refused to disrobe on a subsequent visit.

Disrobing for a thyroid exam is not necessary. Carolyn listened to that sixth sense that women possess when situations are not what they should be. She stood up to this medical icon. Although she may not know it, but Carolyn may have changed the way this endocrinologist treats women in the future. She did not misinterpret those signals.

My friend was accused of being sexually inappropriate during a seemingly-simple back examination for a work-related injury. I won't delve into the complex accusations of this case, but the judge (not a jury trial) felt that my friend did cross over the line, and used his professional status to intimidate a patient for his own sexual needs.

My friend felt that he was just being thorough, and that he was set up in some elaborate malpractice insurance scheme for money? The real answers may never be known. In my heart, I felt he was innocent, but I also know that he made some terrible mistakes in judgment. It was his word against the patient, since he performed an intimate exam without a nurse being present to chaperone.

He was sentenced to 7 years in prison. The patient (and her husband) was subsequently awarded hundreds of thousands of dollars in the civil suit.

He has since completed his prison time and now works as a janitor at a bank. While in prison, he developed prostate cancer. He has gone on with his life, but a very different life than he imagined...a life that changed during one twenty-minute appointment. He will never don that white coat again.

A PA friend, now an attorney, explained it to me this way: You are alone in an elevator with a woman. Just before the elevator door opens to a crowded lobby, she rips open her blouse, smears her make-up, and dishevels her hair. The door opens and she is screaming, pointing an accusatory finger at you. Assuming that there is not a surveillance camera in the elevator, you are going to have a difficult time defending an attempted rape charge.

Could this same scenario happen in an examination room? You bet.

Patients have certainly been victimized by their doctors, and I suspect there have been many doctors who have been victimized by their patients. The problem with human medicine is that both parties are human. Some are good; some are bad.

I used to appropriately hug my adult patients without thinking, like the ones that just received some bad medical news. Hugs can heal as well as drugs. The last adult person that I hugged in an examination room was a crying man with his two-year old daughter. His wife, the child's mother, was just killed a few days before. She was struck in a crosswalk by a guy driving too fast while talking on a cell phone.

Working in pediatrics, I receive and give a lot of kid hugs. The pediatric examination room is a safe venue since children are always accompanied by parents, grandparents, and siblings. The only real risk of kid hugs that I experience is the infectious disease transmission. I truly love my job and I can't imagine what it would be like to be falsely accused of sexual impropriety, or to lose my license to practice medicine.

I don't know if my friend was guilty or not. He is my friend, so I will just hug him anyway.

Related Topics: WebMD Video: Healing the Doctor-Patient Relationship, Malpractice Suits: Frivolous or Real?

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Healing Power of Laughter

Working primarily with children, I have a fun time at work. Of course, when I worked in family practice - ages, cradle to grave - I still had fun. If you can make a child (or the parents) laugh, you can ease pain and a considerable amount of anxiety.

Before I walk into the examination room, I review the chart. Among other important tasks, I have to first determine if I have seen this patient before. We see so many patients that it is easy to forget the details of a prior visit. If I sutured up a head laceration on a little boy at a prior visit that is seeing me today for a cough, I am certainly going to mention that cut. What was a routine, uneventful visit for me was a very important day in this child's life. The child and the parents love that I "remembered".

I usually write superfluous things in sidebar of the chart note, such as getting a new puppy or going to Disneyland.

At the next visit, I will ask about the puppy (even by name if I wrote it down), or what was their favorite ride at Disneyland. This sets the stage for a very productive visit, and I am credited for having a fantastic memory (which I do not). Routinely, depending on the age of my patient, I greet the child first. I then ask the child to introduce the other people in the room. (The female adult person in the room may not be the parent.)

One day, I asked a little five year old to introduce the woman sitting in the chair that I assumed to be the mother.

"That's my Mom", he said.

"What is her other name?"

A blank stare and silence followed. "Don't you know my name?", the mother asked.  "What does Daddy call me?"

"Babe?", he responded.

I am speaking at the upcoming California Academy of Physician Assistants annual conference this month in Palm Springs. In addition to a session on pediatric otalgia (ear pain), I am also participating in a "Two slides; Two Minutes" session in which the presenters have only two minutes (and two slides) to make clinical point, or to give a clinical pearl. Mine will be "Bird hunting".

Whenever I look in a reluctant child's ear, I tell them I am looking for little birds. Once I have their attention, I will gently look inside their ears with an otoscope while making little chirping noises. Not only does this hold their attention long enough for me to have a thorough examination, it tells me they can hear.

If I have to clean out some obstructive earwax, I tell them it is a bird's nest! Or, bird poop...

Finding age-appropriate humor is very important. For the little people, I often look at the chart with a puzzled look and say, "So you are seeing me today for stinky feet?"

That either will get a giggle or they will agree that their feet stink. Some will even lift up their feet, smell them, to see if it is true. Or, in some cases, put them to my nose for the test. A three or five year old is easy to amuse, but a spiked-hair, heavily-pierced, Gothic teenager is a different species all together. A particularly hostile teenager boy was answering my questions with a loud, obnoxious "NO" to everything I asked.

"Do you smoke?" "NO!"

"Do you drink alcohol?"  "NO!"

"Do you take any drugs?" "NO!"

"Do you have sex?" "NO, I mean...YEAH!"

"Are you alone when you have sex?" I made him laugh. That broke the ice and we had a very productive visit after that. I stopped asking teenagers if they were "sexually-active" when a adolescent girl once responded, "What do you mean? Do I, like, move around a lot?"

As well as dole out stickers and sugar-free lollypops, I do a few magic tricks. If a child is on their best behavior, I will do a little trick for them at the end of the visit. One involves a lit thumb (this is a flesh-colored, latex thumb with an LED light that I slip over my own thumb). I will hold it to their ears and it will magically light up. I can then move it to my own ear and transfer the light. I can then pull it out of my other ear.

I also have a magic bag (with a hidden pocket) that can transform a Barbie sticker to a Spiderman sticker (or vice versa depending on the sex) instantly. It also works for changing favors of those lollypops. I can also make a variety of balloon animals, Ninja swords, and hats.

My wife gave me a balloon-twisting class for my birthday years ago, and it comes in very handy from time to time. Although I have this lingering fear that someone is going to choke on one of my deflated balloons and sue me, my balloon mentor, Bosco the Clown, assures me that it is not very likely. He estimates that he has made a million balloon animals in his long and exciting career and has not killed a child yet. I even invented my own adult-version of an anatomically-correct "wiener dog". that I will make for an appropriate adult. I will let your imagination figure this one out.

Several years ago, my PA wife and I were on a medical mission in Jamaica. I brought a huge bag of long balloons to make each one of the kids a balloon animal or a big balloon hat.  After a full day of seeing patients in a hot, humid building with chickens walking around, there were several older woman waiting around to talk to me. Wondering what cultural faux pas I had committed, I found out that they wanted me to make them balloon hats to wear at the political rally that night.  I can tell that I was very proud to see several of my Carmen Miranda balloon hats prominently displayed during the event.

I had the privilege of meeting the clown/doctor Patch Adams several years ago. He was once chastised by one of his patients for not being serious enough. Patch said that she can have a choice: He can be a stern, serious, get-down-to-business doctor, or a "silly doctor".

In the end, the patient prefered the silly doctor...the one that made her laugh.

"The arrival of a good clown exercises more beneficial influence upon the health of a town than twenty asses laden with drugs."

- Dr. Thomas Sydenham, 17th Century Physician

Related Topics: Include Dads in Kids' Doctor Visits, Choosing A Doctor

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