The Worst Internet Service Ever

Six years ago, I moved to a rural area in the Sierra Foothills. I look out on a beautiful view of the valley and snow-capped mountains. I share my property with deer, rabbits, squirrels, hawks, bats, coyotes, turkeys, and a rare visit by a mountain lion, bobcat, and bear. My precious leisure hours are always outside, tending the garden, trimming trees, or expanding my irrigation system. It sounds wonderful, but there is a flip side. I have the worst Internet service ever. I won't tell you the name, but it rhymes with Mirth Net.

I couldn't believe that this area does not have DSL or cable. The phone lines are not fiber optic. For a while, I installed a second phone line and went back to dial-up, equivalent to going back to the Stone Age. Dial-up was just a bit faster than writing a letter and mailing it. Actually, we did have a cable of sorts, but the signal was so weak at the end of the line, that I could not even get clear local television channels. After paying to lay a new cable line, I was still unable to get a decent TV signal. When they offered to provide my Internet service, I just laughed.

I live at the 2600 foot level and can actually see the flashing lights of many radio, cell phone and communication towers in the distance, but yet I can't get more than an inconsistent bar or two on my cell phone, so a wireless Internet was out.

So, I was left with satellite. It was expensive and required a two-year contract. They would not guarantee a consistent signal, which may be affected by the weather. I thought satellites were ABOVE the weather. With little or no options other than going to the local library or a small village in Mexico (both of which had better Internet service), I agreed to the satellite system. When it works, it works "okay", but in the last eight months, I only get an inconsistent and weak signal very early in the morning and in the middle of the night. I am guessing that there are two subscribers, and only one of us can use it at a time.

When I call the tech support, my blood pressure boils. I almost had a stroke today. I spent the usual two hours on the phone; about 15 minutes navigating their automatic voice commands (which rarely apply), another 15 or more minutes on hold listening to their ads about how wonderful they are, and about an hour and a half dealing with heavily-accented man from India named Jeff (this is what he told me!). I guess that with the out-sourcing of technical support to India, they pick an American-sounding name to try and fool us into thinking that they are really in Denver. My hearing is not very good, and when you are trying to understand someone with a very heavy foreign accent, I had to constantly ask him to repeat what he just said. This, of course, added to my frustration.

Having called this tech line many times in the past, I know their dance. Because I did not hang up while on hold, or have a nervous breakdown listening to their cheesy music or advertisements, I was now forced to deal with incompetence. They announced that my call would be recorded for training purposes. Yes, that's right...training. One time when I called, there was a party going on in the background. When I asked about the background cheering, I was told someone was getting an award for doing a good job. Apparently, Jeff wasn't invited to the party.

He asked me if my computer was plugged in. He then asked me if my satellite modem was turned on. Don't you love it? After I assured him that I was not a two-year-old and born without a brain, we proceeded. He asked me if we were experiencing bad weather. We were not. I could tell this disappointed him. In the past, they have blamed rain, wind, hot weather, sun spots, and a storm in New Jersey (I have yet to know the relationship to my problem in California). I suspect he would blame mosquitoes, dirt on my satellite dish, blowing leaves, or fly-by birds, if he could.

He then took me through an endless series of tests to determine why I do not have service. During his test, I lost the signal again. He told me to log on to another site. When I informed him that I could not log onto another site since I presently do not have Internet service, he said he would need to talk to his supervisor. More music. More ads. More time elapsed. Then, a dial tone. I guess if you can't solve the problem, you just hang up.

I called back and the dance started over again. After another half-hour, I talked to a guy who claimed his name was Dave. He sounded suspiciously like Jeff, and was apparently reading from the same instruction book. I asked to be transferred to someone that could cancel my service. Dave (or Jeff) was very upset about this request. After I vented my story, he happily transferred my call to somewhere. Another, dial tone. I can't even cancel my service!

Has the world gone crazy or is it me? I try to be a patient and courteous man, but I was teetering on the edge of insanity. I imagined Jeff and Dave given each other the high-five. I have a fantasy about using my frequent-flyer miles and go to India and kick the living chutney out them.

As I type, I have lost my Internet signal about a dozen times. It has taken me about an hour to post ONE message on the ENT board. I will have to go to work early tomorrow and post from my office, or pack up my laptop and go to the library. I usually just sit in my car outside and use the wireless signal so I don't have to wait in line behind the guys secretly downloading porno.

Maybe I should move.

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Technorati Tags: stress, internet service

Southern California Fires, Part 2

Staff Photo

As I write this Blog at 5 AM, we are in the midst of the largest, mass evacuation in California history. Thousands of homes have burned and many more are likely to burn down today. Freeways are closed due to smoke. Evacuation centers are busy.

Sitting in her car, heading north after her father's funeral, my wife has joined this massive exodus. She phoned me a few minutes ago to say that Interstate 5 was closed, and she has been directed to an alternate route north to Los Angeles. I did not speak to her very long since the cell phone system is being overrun and emergency personnel need those airways.

When disasters of this magnitude occur, the medical systems are also overrun. My son is an ER nurse in San Diego and has been working overtime caring for hundreds of people, many that have pre-existing respiratory problems such as asthma. Recently, fires in Northern California caused me to cough for a few weeks. I ended up with pneumonia, if you can believe it. I am still coughing.

Sharing the national news with the catastrophic fire is the fact that Marie Osmond fainted on Dancing with Stars. Now, she is blaming it on the smoke from LA fires. Personally, I think it was more of a combination of crash dieting (she has put on a bit of weight after having all of those children), anxiety (afraid she would fall on national TV while dancing), and a hyperventilation. If you see her puffing away after her performance, you can see her breathing very, very hard. When you blow off that much carbon dioxide, you are going to end up on the floor - which she did.

Los Angeles has some notorious brown air anyway. Added to the smoke in this valley is going to cause some serious respiratory difficulties for thousands of people. San Diego's air is a bit better as long as the wind is blowing off of the ocean. Right now, there is a dry, desert wind, blowing from the East. According to the national weather reports, conditions may be improving, but it is going to take days and days before these fires are contained.

Most asthmatics have the foresight to bring their medications, but in the chaos of a quick evacuation where you may be collecting irreplaceable family heirlooms, beloved pets, and some clothes, it would not surprise me to have pharmacies being inundated by refill requests.

I am clearly worried about my wife. Writing this blog is helping me cope with this anxiety. I have to work today, but I would rather be helping out at a shelter someplace if I could get there. Right now, Southern California does not need any more people heading south. My wife is supposed to call me every hour to let me know how she is progressing. Fortunately, she is calmer in traffic than I am. I go nuts sitting in bumper-to-bumper traffic. I just want her home so she can decompress and quietly cry over the death of her father. She needs the sanctity of her home. She needs to pet her dogs (Canine Antidepressants). And, she needs some hugs, which I will provide.

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Technorati Tags: California fires, wildfires, grief, smoke, health

Southern California Fires

Staff Photo

My wife has been in San Diego for the last week to be with her father. He passed away a few days ago, so she has been dealing with those emotional, but important, issues surrounding the death of a loved one. She has been helping to orchestrate his final wishes. Bill had a "death box" with his will, important papers, receipts for burial arrangements, etc. He even took the time to paint the box black and write in big letters - The Death Box. As macabre as the name sounds, many elderly people have the foresight to do this. It makes it so much easier than digging through mounds of accumulated papers and disorganized files. At 91 years old, Bill knew that he would be dying at some point. He created this box years ago, and sadly, it had to be opened this week.

In the midst of this tearful time for our family, there are other reasons to cry. Within view of my father-in-law's home, she can see at least two of the fires that are now devastating the San Diego area. Smoke is everywhere. Up to a half million people may require evacuation and shelter. So far, only one life has been lost due to the fires, but hundreds and hundreds of homes filled with treasures and memories have already been destroyed. At this point, no one has announced a cause, but many are caused by human error; or as I like to call it - blatant stupidity.

California appears to have some of the worst fires in the nation. After I bought my first home tucked away in the hills of Marin county in the early '70s, we nearly had a fire destroy our home. Started by some children starting a campfire, it destroyed a dozen homes. While it was burning rapidly toward our home, my former wife called our insurance company to increase our policy! We had just completed some expensive home improvements and had not adjusted our policy. Fortunately, our home was spared.

Less than a decade ago, the Oakland Hills went up in smoke. The fire was so hot and so devastating that only ashes remained of people's lives. A friend of mine lost everything, including her beloved dog. As she walked through the remains of her stately home, the only thing she found was a diamond from her grandmother's wedding ring. The fire-proof box that it was in did not prove to be fire-proof. The gold setting had melted away, but a tiny black stone remained. When polished, this family gem was the only thing that survived.

Last year, I posted a blog about my fire-happy, weekend neighbor who likes to light campfires and torches in the middle of a bone-dry summer on his undeveloped lot. This idiot now has a huge pile of branches and leaves covered with a tarp, waiting for the "okay" from the Fire District to announce a Burn Day. Burn Days are important in our area since it does eliminate dry fuel that could lead to a devastating fire, but homeowners must be absolutely diligent when doing so. This neighbor does not have electricity or water. I guess he thinks he can beat out a fire that gets out of control with a shovel. I must keep a constant watch when the moron is around. I have the number for the Fire District on speed-dial.

Hopefully, my wife will be able to drive home today. I have been watching the news carefully to make sure there is a safe route, free from the many rapidly-changing wild fires, hurricane-force winds, and choking smoke. Right now, she is safe and the fires are burning in a different direction. She has options to stay with family if conditions are not safe to drive.

My heart goes out to all of those people who have lost their homes and their possessions; to those that are sleeping on a mat in at Qualcom Stadium (home to the NFL San Diego Chargers), to those in parking lots caring for their pets, and to the thousands of fire-fighters who risk their lives. I pray that the winds will abate and the fires will be out soon; and that further lives will be spared.

Southern California Fires, Part 2

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Technorati Tags: end of life, California fires, wildfires

Now, It May Be ONLY Chicken Soup

A week after the FDA recommended a ban on virtually all cold medicines used for infants and children under the age of two, a new panel recommended a broadening of this ban to include all children under the age of six; perhaps even as old as twelve. Very soon, we may be all slurping chicken soup; or smearing Vicks VapoRub on our chests. I bet the herbalists and naturalists are drooling right now, hoping to fill in this pharmaceutical vacuum with equally-as-ineffective vitamin and herbal concoctions.

Medical providers and consumers have been using decongestants, antihistamines, antitussives, and expectorants for as long as I can remember. I can't imagine that the FDA will dump them all.

A few years ago, PPA (phenylpropanolamine) was pulled from the market. PPA was in both cold medications and was the main ingredient of over-the-counter diet pills. A side effect of PPA is a loss of appetite. Not long ago, pseudoephedrine (Sudafed) came under attack as a drug of abuse since it is used as a base in the manufacturing of methamphetamine (crank). Phenylephrine, another decongestant and a common ingredient in nasal sprays, soon appeared in more oral cold medications. There are many, many prescription medications that contain decongestants.

Antihistamines are a mainstay of allergy management since they help dry up a watery nose and control itching. The most common antihistamine is diphenhydramine (Benadryl), followed by chlorpheniramine and a few others. This class of antihistamines can cause profound sleepiness. As you might expect, this side effect was capitalized by using it in over-the-counter sleep aids. Loratadine (Claritin) has an advantage of being non-sedative and has a once-daily dose. There are numerous prescriptions that contain antihistamines.

Antitussives are cough suppressants. Since some scientific studies have proven them to be worthless as well, they may also be heading for the dumpster. DM (dextromethorphan) is a potential drug of abuse among teenagers seeking an over-the-counter high (or low). Codeine, still used as an effective pain medication, has been challenged as a cough suppressant. Many antitussives also contain expectorants -- basically, a drug that causes you to cough. I guess it makes a lot of sense to have a medicine that makes you cough, combined with one that stops a cough...sort of like taking Kaopectate with Milk of magnesia. Milk of magnesia is a potent laxative, of course. I used to jokingly tell patients to use it as a cough suppressant. How would that work? They asked. You would be afraid to cough!

So, what do we have left? There is always water -- they can't take that away! By drinking plenty of water, the viscosity of mucous will be thinner; thinner mucous is easier to expectorate or swallow. If you put water in a humidifier or steam vaporizer, you will help humidify the air you breathe and this will facilitate drainage. If you mix water with a little salt, you have saline. Saline nasal sprays will also help loosen and thin mucous.

For a drippy nose, we still have tissues. For children, we have shirt sleeves and hands. For those environmentalists who do not want to use paper, we have cotton handkerchiefs. Of course, handkerchiefs will eventually need to be washed. The real purists may have to blow their noses on a leaf or something, or master the fine art of firing snot rockets!

For coughing, we will have earplugs so the non-coughing people will not hear us. We can suck on cough lozenges, unless they contain too much sugar or non-calorie sweeteners. Sorbitol, a non-calorie sweetener, can cause diarrhea or excess intestinal gas. This, of course, is another incentive not to cough, and an advantage of not being able to smell.

In crowded Japan, people voluntarily wear surgical masks when they have a cold. I suspect you will see Americans adapting this practice. Have you have coughed or had a dripping nose while wearing a surgical mask? I have, and it isn't a pleasant experience.

Finally, we are back to chicken soup, assuming you are not a vegetarian. I guess vegetarians are on their own. Improperly handled or cooked chicken can contain salmonella -- a bacterium that causes severe diarrhea; again, diarrhea being a potent antitussive. Chicken soup can be high in salt, so the hypertensives may need to be warned.

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Technorati Tags: cold, cough, medication, FDA, health, wellness, pediatrics

A Life Celebrated - Bill Horn

Bill is over 91 years old, or as we like to say in pediatrics, 1,100 months old. He is an insulin-dependent diabetic that recently underwent his second partial foot amputation -- a common complication. He has prostate cancer, an enlarged/weakened heart causing congestive failure, dangerously low blood pressure, kidney failure, and wound infection caused by the worst bacteria ever -- MRSA (Methicillin-Resistant Staph Aureus).

Bill has also been 99.9% deaf for many years. He could probably hear a siren if held to his ear, but basically, he now lives in a world that is silent, although Bill is far from silent himself. He has vocally refused all life-prolonging efforts, including resuscitation. Bill is my father-in-law and he is dying.

As I write this Blog, my wife is at his bedside. At my suggestion, she is using a large white-board to communicate with him. His brain is functioning wonderfully and he often forgets that he talks very loud. Although his body is rapidly failing him, he does not hesitate to say what he thinks -- another privilege of age. One of the first things he said to my wife was, "I would really like to die, but I don't know how." The second thing he said was that he wanted some vanilla soft-serve ice cream from Fosters Freeze, something he has not eaten in years because of his diabetes.

Before the ravages of age and disease took their toll, Bill was a vibrant and active man. He played golf twice a week and enjoyed playing cards at the Indian Casino. Unlike many recreational gamblers, Bill did win a new Ford Mustang a few years ago at the Casino. He took the cash value of the car instead, hoping to take a cruise. He never did make that cruise. I suspect the Casino eventually ended up with most of the cash again.

Bill loved his garden and fruit trees. On his little hillside home, he grew an impressive amount of produce, including grapes, kiwis, oranges, tomatoes, beans, and even a few stalks of corn. Many years ago, we bought him a pair of canaries. He loved his birds so much, that he built them an outside aviary, bought several more pairs, and continued to raise them successfully until a big, black snake ate every one of the birds one night.

Bill ate a very modest and often odd diet. His current Chinese wife would feed him just about anything made with leftover restaurant food, and he would just eat it. Bill secretly loved good 'ol fashioned American meat loaf, beef stew, and an occasional steak. Even with his poorly-fitting dentures, Bill was able to wolf down a good man-meal when he visited with us.

Bill is a WWII Navy veteran. Recruited out of UC Berkeley after Pearl Harbor where he finished his civil engineering degree, Bill became a hard-hat salvage diver and successfully brought up many sunken US warships so they could be used again in the war effort. After the war, he took a job with the California Department of Water Resources. When he retired, he was the Director. Under Bill's leadership, the peripheral canal that provides water to the Central Valley, allows many of us to be eating lettuce today. Without the Department's efforts to construct the Folsom Dam, I would not easily have electricity in my rural home and people in the Sacramento valley would always be in fear of a flood.

Bill loved the outdoors. As Water Resources Director, he would always assign himself to the annual Sierra snow measurement team. They would load up their pack horses and supplies and head off into the mountains to measure the water content of the winter snow. He admitted to me that others could have done this job, but he liked to camp out in the winter. Everyone deserves to take a break from their desks. What the Department now does with a room of computers, these post-war civil engineers did with a pencil and a slide rule. The work that he accomplished in those days is still honored and respected. Bill even co-authored a book on dealing with natural disasters. He was now facing his own natural crisis --one that he predicted but cannot be overcome.

When his children were young, Bill was a Boy Scout Leader. With this knowledge of hidden Sierra lakes, we have many pictures of my wife and her brothers holding strings of huge trout, swimming with the kids in cold mountain streams, or making s'mores over an open camp fire.

Bill and his first wife, Betsy, had five children, including one daughter that is my wife. Two sons have died, another son, born with severe mental retardation from PKU (a now detectable and treatable genetic disorder) lives in a Sacramento area care home. His son, John, also at his side today, lives in San Francisco. After Betsy's unexpected death when my wife was in her 20's, he retreated from the world and his family for many years, working civil engineering jobs in the Philippines and Korea. He traveled alone to exotic places like Morocco and Egypt. Several years later, he remarried a Chinese woman living in the Philippines. Oi Mie has remained his wife for the last 25 or more years.

Bill has been retired longer than anyone that I know. He has been receiving his State Pension for over 35 years; longer than he worked for the State. He was always puzzled by the fact that my wife and I still worked. Actually, he was puzzled by anyone who works at or beyond retirement age. Bill really enjoyed his retirement years, but traveling North America in his motor home until it was no longer safe for him to drive anymore.

Bill is not afraid to die. At 91 and dealing with health problems, he has been expecting it for years. His excellent genetics have protected him. He has two elderly sisters, also with diabetes, that are doing well. Jean lives in the Washington, DC area; and Betty in Napa, CA. On those very rare occasions when they are all together, it is a wonderful to hear their childhood stories and share their joy.

My wife just called a few minutes ago, and Bill has peacefully passed away.

Even wonderful lives must end, but the re-told memories of a life celebrated will live on forever. He was an ordinary man who lived a long and extraordinary life, and we will miss him.

I suspect there were several empty ice cream containers on his bedside table.

A Pediatric Halloween and Silly Medical Visits

Next to Christmas, Halloween is probably the best season for decoration in a pediatric office. I have not been to work for about a week because of a medical conference, but I suspect when I return tomorrow, there will be fake cob webs, pumpkins, and friendly-looking ghosts all over the place.

Every year, the staff will dress up for the kids (picture from last year). The children are absolutely thrilled to have their temperature taken by a pirate, or get weighed in by a dinosaur. Even some of the medical staff will dress up. Personally, I have not. It is not that I don't appreciate the fun that is involved; I just find it difficult to address sensitive health issues, say, dressed as a rabbit or something.

Speaking of rabbits; one doctor does dress up as a six foot rabbit for Halloween. He once entered the room to do a football physical exam on a 17 year old. When a big rabbit asks you to "turn your head and cough," you had better hop to it.

I did dress up when I was speaking at a conference a few years ago. The topic was fever in children, so I decided that I would dress up like the Devil, complete with a full red outfit, cape, pitchfork, and a long, pointy tail. I made my entrance into the lecture hall with the music of Peggy Lee singing, Fever. I approached the podium, took out two red candles and lit them (with a small ring device hidden in my hand). I taped a laser pointer to the pitchfork and used it as a pointer. I finished by firing off an 8 foot blast of fire from a hidden fire cannon filled with flash paper. The audience loved it. The local fire marshal did not. I am not sure how the local religious community viewed it, since this conference was in Salt Lake City, in the shadow of the Mormon Temple. Personally, I think the Mormons would have approved.

Not all parents appreciate this wonderful holiday for kids. They see witches and ghouls as satanic and evil. Perhaps, they are, but not in the context of holiday fun. Some of the local churches have their own Harvest Festival (renamed, of course) and allow children to dress up in tasteful outfits. It is not really appropriate to go to a church function with an eyeball dangling from your face and a knife stuck in your head. Still, every year, we do get a few complaints from the religious crowd.

We give out sugar-free candy (lollipops) to the children if the parents permit. If not, we give them a sticker. Our group literally spends thousands of dollars every year on suckers and stickers. Of course, this is just the cost of doing business when your customers are children.

Last week, I saw a very nice family of Orthodox Jews; Dad and two cute little boys. At the end of the visit, I offered the boys a lollipop. The father refused, unless they were kosher. Guess what? They were! On the wrapping of the lollipop was the kosher symbol. The boys were thrilled, and so was I. After a medical visit, there is nothing like a little treat to make your day.

I think we should start giving treats to our adult patients. I wonder how they would react if I offered them an adult treat? Care for a pack of sugar-free gum? Or, give them a sticker that says, " I had my prostate checked today! Have you?"

Medical offices are scary places for everyone. Even when I see my own medical provider, I get a little anxious. Medical providers have an obligation to make their patients RELAX during the visit, and leave on a positive note. It doesn't cost any more for a friendly medical visit than one of those ritualistic, stern visits by some doctor that doesn't even give you eye contact. If a medical provider cannot be friendly and personable, they should go into radiology or pathology.

I keep a few magic tricks in my office drawer. I have a thumb that lights up, and a magician's bag that has a hidden compartment. I can change a girl sticker to a boy sticker with the wave of a hand!

Patch Adams, a family practice physician/clown, made his patients laugh by wearing a red, rubber nose. So that someone would not be offended by his demeanor, he would always ask, "Do you want a serious medical visit today, or a silly one?" Most people would pick the silly one.

We often take life too seriously. Take time to lighten up and be silly once in a while. Wear a red, rubber nose into your next board meeting or IRS audit. You could make someone smile; someone who desperately needs it.

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Technorati Tags: humor, laughter, medicine, Halloween, pediatrics

Embarrassing Medical Moments, Part I

After over three decades of patient care, I had more than one occasion where my foot made it into my mouth. Medical providers, although they like to pretend they are a different species from their patients, often make embarrassing mistakes. Now, I am not talking about a surgeon removing the wrong arm or something. I am talking about stupid things we might say.

Please don't use baby-talk when you interact with your baby.

A few years ago, I entered the examination room only to see a mother happily playing with her baby.

"Eees a coot 'lil boy. Looka es cootie toes. Mama tickle em? Es wanna a ba-wa?"

Huh? After a few minutes of this baby-babble, I thought I should say something. When babies hear baby-talk, they are more likely to imitate baby talk when they start to speak.

"You should not use baby-talk. It would be better for you to speak more clearly."

She responded with a puzzled look. "I no speeka baby-talk. I speeka good." Of course, I was not aware that the mother had a speech impediment.

Oh, I am so sorry. The last patient must have put a dirty diaper in the trash.

My wife, also a PA, entered a particularly stinky exam room. Immediately, she assumed that the previous patients, a new father with his two-year old, probably put a poopy diaper in the trash - a big no-no in medical office. Moms never do this; fathers on the other hand, do it all of the time.

She put on some gloves and began digging in the trash to find the offending diaper. After a few minutes, the embarrassed patient admitted to passing some unintended gas (She farted just before my wife came in).

Weren't you in jail?

I love teasing little children. One day, I saw a cute little guy, about four years old, peaking over the front desk in our waiting room. All I could see was his little hands and the top part of his head over the counter.

"Hey, I know you. I thought you were in jail."

He responded loudly, "No, I wasn't in jail. But, my Daddy is!"

The entire waiting room stopped reading their magazines and looked up.

You think I'm crazy?

We have quite a few deaf patients in our practice. Over the years, I have picked up a few American Sign Language signs that I will use. However, I found it is not good to try and make up my own.

While taking a particular difficult medical history (without a sign interpreter), I found myself talking louder, and of course, using some animated signs of my own.

I wanted to ask her if she was feeling dizzy, so as I enunciated the words (so she could read my lips in spite of my mustache), I used my index finger to create a series of circles around my ear. Apparently, that does not mean "dizzy".

"You think I'm crazy?" she responded.

In telling some of these embarrassing stories, one of our nurses told me one of hers.

You could use an extra hand.

She was a labor and delivery nurse in a large hospital. A woman had given birth to a set of triplets and was holding two of them. This nurse was holding the third baby. When the mother indicated she would like to hold all three, the nurse responded, "You could certainly use an extra hand."

The mother froze about the same time this nurse noted that she only had one hand.

The reason why I called this Blog, "Embarrassing Medical Moments, Part I" is because I am going to remember more of these special moments. And, I would like to hear some of yours, so please share your stories.

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Technorati Tags: medicine, embarrassment, humor

Infant Cold Medicine Recall: It's Back to Chicken Soup

With the recent withdrawal of dozens of over-the-counter cold medicines for infants, my life may become a bit easier. Or, will it? The medical profession has always been well aware of the limited value of cold medications, and of course, the hazards of using them inappropriately, such as an accidental overdose. The biggest advantage of some of those medications was that it bought us time while nature orchestrated the cure. Parents desperately want to do something. Did I use them with young patients? Yes. Did I experience any problems with them? No.

Colds are going to last a week if you aggressively treat them; and about seven days* if you leave them alone. (*Symptoms can last longer in infants). For the first six months of life, nature has provided infants with some borrowed immunity. The umbilical blood supply provides babies with a healthy dose of Mom's circulating immunities. Breastfeeding can add to the immune response. However, when the baby turns six months old or so, the maternal immunity fades and the baby will have to start fighting them off themselves. Nature has provided about 200 or so different strains of colds to help jump start an infant's immune system. By getting little colds, babies will be better able to fight off other, more serious, infections. Nature provides an ample supply of human viruses and people provide the transport system so we can freely share them.

New parents are not prepared for snotty noses, coughing, and fever, especially in an infant. As a matter of fact, ANY fever tends to freak out novice Moms and Dads. Fever is the body's most primitive immune response and need not be feared. It should be viewed as an expected and welcomed response. When your body raises its temperature, viruses find it more difficult to replicate. If we keep loading kids up with acetaminophen (Tylenol) or ibuprofen (Advil, Motrin), we are really defeating this beneficial fever response. If the kids are handling the fever well, it is often better to leave them alone. However, is perfectly fine to treat misery. Colds can cause body aches and headaches and babies do not understand discomfort. It is okay to treat for comfort, but don't let the thermometer tell you what to do.

Except in very rare occasions, fever is not dangerous and will not cause brain damage (at least in kids). Inexperienced parents, on the other hand, seem to get brain damage when their child becomes ill. If a parent has one child, they can only tolerate about 100 degrees of fever (the normal rectal temperature is 99.6!). If they have two children, they can handle about 101; three children, about 103. After four children, a feverish kid would need to have smoke coming off of them, before parents would panic.

Parents prepare for MONTHS in childbirth classes, but very few are prepared for the dozens of colds and other childhood maladies are just around the corner. Babies that are placed in day-care at this early age are being subjected to an unbelievable array of infectious organisms, transported baby-to-baby, or from child care provider to baby by hands and respiratory droplets. It only takes a few days in a busy day care for an infant to get their first cold. I guess since colds are really beneficial, day-care providers may want to start charging for this extra service.

Colds will occur with or without these recalled medications. Children will get better, with or without these recalled medications. Yes, they may be a more stuffy, and you will need to use some saline nasal spray and the feared, nose-sucker (nasal aspirator), but they will get better. Children may cough a bit more, but coughing helps clear a mucous-filled airway. You may have to get out that cool mist humidifier again.

And, finally, you may need to make some homemade chicken soup, often called Jewish Penicillin. If you can't, there is always Campbell's. Chicken soup not only hydrates and warms those mucous membranes; it tastes great, and will give you something to do while nature orchestrates that cure.

My fear is that a return to chicken soup may work so well, that if (or when) these recalled medications return to market (they were a several billion dollar a year business), that we will start seeing new Triaminic with Chicken Broth, Dimetapp Chicken Plus, or PediaCare chewable chicken soup tablets.

Moser's WebMD Decongestant Chicken Soup

Put one cut-up chicken in 8 cups boiling water (easy, huh!). Cook until chicken is falling off of the bones. Removed cooked chicken and allow it to cool. Remove all of the bones and chicken skin; cut or shred chicken meat into small pieces and return it to the chicken broth.

In a separate skillet, add some olive oil and sautè about two chopped onions, some diced carrots, a few stalks of chopped celery, and a few cloves of chopped garlic (substitute garlic powder if you are lazy or sleep-deprived). After they're cooked, add to the chicken broth.

Now, add some fresh thyme (about 3/4 tsp) or about a 1/2 tsp of dried thyme, two bay leaves, a sprig of fresh rosemary (that you really should have growing outside; or a little dried rosemary if you don't), and a little salt and pepper.

Simmer slowly for about an hour, or until you can't stand it anymore. Taste it. If it is a little weak in flavor, add some chicken bouillon or two cans of prepared chicken broth. Although this may shock the homemade chicken soup purists, it does boost the flavor. Add the fresh, chopped parsley just before serving.

Variations: Pour chicken soup over cooked noodles, or cooked rice. A little soy sauce and fresh ginger will give you that wonderful Asian flavor.

Warning: May cause nose to freely run. Have plenty of tissues available. Will not cause hyperactivity.

Related Topics:

• Fact Sheet: Flu and Colds in Children
• 10 Questions About the Common Cold

Technorati Tags: colds, children, recalled medication, chicken soup, health and wellness

Green Mucous -- What It Is and What It's SNOT

Editor's Note: This post, originally published on 12/1/05, has been updated to reflect today's withdrawal of all over-the-counter children's cold medications by the manufacturers.

Snot. noun. Middle English from gesnot. 1. Vulgar term for nasal mucous; phlegm. 2. A person regarded as annoying, arrogant, or impertinent (not your medical provider). Booger. Dried snot.

Yes, it's not easy to be green, especially if you are mucous in a kid. Why? Because a vast array of parents think that green mucous requires antibiotics. Green = Bad. Clear = Not bad yet.

Viral infections (colds) can cause a variety of mucous color changes in children...green, yellow, orange, brown, and of course, my favorite the multicolored. For the diligent mucous-watcher, these colors are very significant.

After sitting in a congested nasal passage all night, mucous becomes stagnant....just like a green pond. Bacteria love warm, dark, moist areas, so this is where they like to live. But, just because there is bacteria in the mucous, does not mean antibiotics are necessary. The purpose of mucous is to moisturize the air we breathe, and to trap those floating particles inhe air. It is suppose to drain...either out of our noses, or naturally, down the back of our throats.

"Green Nose in the Morning is No Cause for Warning". However, if a child has consistently green mucous from BOTH sides of the nose for over ten days, then your medical provider may take it more seriously. (Note: Green, smelly mucous from only ONE side of the nose of a child is likely to be a retained foreign body...usually food. And, you thought they ate those peas!)

Simple colds last a week if you treat them, and about seven days if you leave them alone; however, the nasal drainage can persists for weeks in children. This time of year, children tend to get exposed to "back to back" viral infections that run together and appear as one, prolonged cold. Children have a lower level of hygiene than other creatures on this planet, and germs are the most common thing they share. Day-care kids are like Velcro when it comes to viral infections. Since children get 6-9 viral infections per year, mostly in the fall/winter months, and colds can "run together"...then don't be surprised if your outgoing, day-care toddler has a runny nose from October to March.

Is there anything you can do about this? No. Well, actually yes.

1. Use saline nose sprays. They keep the mucous thin so it drains, and the nasal mucosa moist so it can do a better job in the dry, household air that we breathe. Cool mist humidifiers are also very helpful in the bedroom.

2. Encourage fluids. Hydrations helps to thin mucous.

3. Antibiotics do NOT work for viral infections. Ever. They don't prevent kids from getting sicker. Let your medical provider decide (without the begging, pleading, and coercion that often occurs). Antibiotics only work for secondary bacterial infections, like middle ear infections, sinus infection, Strep, etc.)

4. Be patient. Colds are inevitable. Cold are even considered biologically beneficial. What??? Cold are beneficial? You bet. Simple viral colds help jump start our immune system to make us more resistant to worse infections.

Hang in there, folks...

Related Topics:

• Cold & Flu Culprits
• Natural Remedies: What Works

Technorati Tags: drug recall, cold, flu, pediatrics

Feeling Like a Dinosaur

I just returned from a four-day medical conference of the California Academy of Physician Assistants (CAPA) in Palm Springs. I had the pleasure of giving two lectures this year, both on Adolescent Medicine. There were 800 registered attendees, which was quite a change since this organization began 33 years ago. I know. I was there in the beginning. I was the founding father and first member of this organization.

Those who have been in clinical practice for over 25 years are affectionately termed the "Dinos". Since this is my 34th year of clinical practice, I am a bit more Jurassic than most. Although I am certainly not the oldest PA, as I looked out upon the audience of young faces, I felt old.

I was there to give a lecture about adolescent medicine. Thirty-eight years ago, I was an adolescent starting a very intensive medical program. Not only do I work with children and adolescents, I even have an adolescent granddaughter. Yep, I felt old.

All of the Dinos had little dinosaurs on their name badges, like we wouldn't have figured that out for ourselves. The Dinos tend to hang out together talking about the old days, or how it used to be. We watch the younger clinicians and students at receptions, and then check our watches to see if it is time for bed. Although I am only 56-years-old and can't really get a true senior discount anywhere, I still felt old.

You don't feel that old when you hang out with older folks. My older brother is retiring this year. Many of my friends have retired and still more have informed me that they will retire soon. I estimate that I still have another 9-10 years before I take down the shingle. My retired friends laugh as they head out to the golf course. For the next decade, I will have to live vicariously through them.

I met some friends for dinner. We went out to a nice restaurant at 5 o'clock - when old people eat. We were the Early Birders. We sat in our booths, eating old people food, looking around at other older people eating and/or taking their medicines. We had a great time. And, yes, we talked about the old days. My friends talked about where they were going to live when they retire (soon). We talked about food and cooking. We talked about traveling. We talked about our various health problems (I call this the "organ recital"). And, sadly, we talked about friends that have died.

Before I started my first teen lecture, I asked how many in the audience were under the age of 38. Over half of the hands rose. As the man behind the podium, I had been in clinical practice longer than most of the audience has been alive. I think next year, I will have to start giving lectures to geriatric conferences, filled with active seniors younger than myself.

Getting older is not for sissies, but it is a state of mind. If you act old, you feel old. If you let yourself decompose, you will fall apart. If you think younger, stay active, and stay away from mirrors, you may feel younger.

The real dinosaurs are extinct; older people are not. We may hang out with a different, white-haired crowd, or eat dinner at 5 PM. We may see our friends suffering from the ravages of time, or we may see vacancies at a table where we all once laughed and shared war stories. Year by year, time will take some of our friends away, but their memories will thrive in the aging hearts and minds of those of us who managed to survive another year.

I really look forward to seeing my Dino friends. We share a common history. If you ever want a real history lesson, be sure to ask someone that lived it. And, please, ask them before it is too late.

How many of us regret not spending more time with our grandparents? Or, wished they had written down all of those precious stories? Every day, entire languages are dying because there is no one left to speak them. Every day, a precious family story is lost because there is no one around to hear it, or no one took the time to write it down.

Yes, I feel old and it is not even my birthday. However, I am grateful that I woke up this morning, played with my dogs, watched the news, and looked out on a beautiful, fall day. I sat down at my computer and wrote a blog entry (although I couldn't post it right away because I have such a crappy satellite ISP!). My wife is in the next room making Halloween costumes for the grandkids. One costume is for our 14 year old granddaughter. This is the last year she will Trick or Treat with the kids. She is getting too old.

Myself? I don't have to work at the clinic today, so I think I will pretend, if only for a day, that I am retired.

Related Topics:

• WebMD Video: Adolescent Specialists
• Baby Boomers: A New Way to Grow Old

Technorati Tags: retirement, healthy aging, teen health, adolescent medicine, health and wellness

Did I Say That Out LOUD?

I have a good time with my medical practice. I like to think that I always appear happy and friendly when I greet patients. I like to joke with the kids and even tease them a bit. A smile or a laugh goes a long way in "setting the stage" and making people relax. I encourage standing parents to sit down, and I sit down. If I have not met them before, I introduce myself and try to find out more about them as people. I clearly think that I portray myself as someone who likes what they do.

One of the more stressful times, especially for children, is when they must have a painful procedure or surgery. You can see it in their faces when you walk into the rooms. Before any needles or scalpels make their debut, it is important to help them relax in a friendly, non-threatening environment.

"I see by your chart that I am seeing you today for stinky feet. Can you tell me about it?" There is nothing like a comment about smelly feet, or boogers, or farting that will get a young child giggling...and relaxing.

When I examine little tummies, I am always guessing what is in there.

"I feel Cheerios...and a cookie...and, what is that? A frog?"

Over the years, I have discovered that you can please some of the people, some of the time, but you can't please a stern-faced ICU nurse on disability for fibromyalgia who starts the conversation by complaining about the care of a previous medical provider. If medicine is part performance art, this was clearly a tough room. My job to win over the patient (and the parent) was going to be difficult.

I was seeing her 14 year old son for a minor surgical procedure. He was frightened. His mother was insisting on giving him a Vicodin - a potent narcotic pain medication before I started the procedure. This created even more anxiety for the teen, who now believed this was going to be the Mother of All Painful Procedures!

"How are things at school?" I asked. Before he had a chance to answer, his over-bearing mother jumped in and informed me that he was a superstar on the school's debate team.

"Wonderful," I responded. "So, you are sort of...the Master Debater!"

I thought I came up with a good one. Granted, it was a little naughty pun, but he laughed...and relaxed. Although I was not watching the mother's reaction, she was apparently not as amused by my clever retort. Of course, she did not say anything...until the next day when she filed a complaint. She did not call me, or send me a letter. She went above my head to clinic supervisors. I guess I would apologize, if I had the opportunity. I am a bit hurt by her back-stabbing way of filing a complaint. I had intended no harm by my comment. She, on the other hand, intends to harm me in any way she can.

Men, even young men, tend to have borderline-sick senses of humor. We do joke about sexual things. Women (and mothers) often do not share our inside humor. His mother clearly did not appreciate the fine art of men humor.

In retrospect, I misread the room. Although my care of her child was flawless, I am sure I will be forever on her proverbial Fecal List for my off-color Master Debater comment. I provided her with even more fodder when she complains about medical care in the future.

I suspect I will not have the professional pleasure of seeing her or her teenage son again. Perhaps, that will be better for all of us. I am busy enough taking care of people that actually like me.

Incidentally, the teenager did not feel one iota of pain during the procedure. Perhaps, he was thinking about something else...

Related Topics:

• How to Choose a Doctor
• Patients School Doctors in Manners

Technorati Tags: medicine, teens, health and wellness