Holy Cholesterol Batman! Screening isn’t enough! July 7, 2008

Who knew you’d get two, count em TWO, blogs in one day!  After I finished my earlier entry, I was reading the papers online and discovered that the AAP is recommending that all children over the age of 10 and children between the ages of 2 and 10 with risk factors for high cholesterol get fasting lipid screening tests done to assess total cholesterol, LDL (the bad cholesterol), HDL (the good cholesterol) and triglycerides.  Risk factors for early screening are being overweight (>85th %ile for BMI), having diabetes or high blood pressure, having a family history of high cholesterol, having a male relative with a heart attack before age 55 or a female relative with a heart attack before age 65. 

To determine your child’s BMI you can use this handy calculator and then use the graph to find your child’s percentile.  http://www.cdh.org/ClinicalServices.aspx?id=9523  In my EMR, BMI and percentiles are automatically calculated so you will know at your child’s check up if this is an issue.

What this means for your child is that my nurse will be drawing (through a vein rather than a finger poke) a sample of blood at the check up if your child has been fasting overnight and I will send it off to the lab.  If your child has an appointment too late in the day to do a fasting sample at the check up, you can either take a request to the lab and have them draw the sample any morning, or return to my office for a lab draw early in the morning.  After sending the blood off, I get results in a day or so and will notify you by email of the results.  If the labs are abnormal, I will also send the dietary and exercise changes that are recommended and I will encourage you to implement them for a six month period after which we will do the lipid panel again.  If things haven’t improved significantly, then we will discuss the pros and cons of lipid lowering medications for your child.  If your child’s labs are normal, we will repeat the levels in 3-5 years.

Its a lot to chew on but it emphasizes the importance of doing what we can to keep our kids at the lowest risk.  70% of children have some degree of atherosclerosis by age 20 and although the serious complications of high cholesterol may take decades to present themselves, the eating and activity habits we encourage in our children often last a lifetime.  The dietary recommendations to treat high cholesterol include eating more fruits and veggies, whole grains and lean meats while still consuming skim milk and low fat cheese/yogurt for calcium and protein and keeping saturated fats at less than 7%.  Not a bad plan for any of us!  Also regular activities as simple as a 30 minute bike ride or brisk walk 4 days a week will lower cholesterol too.  Prevention is always better than intervention and certainly more desirable than medications so load up your plate with the fruits and veggies of the season before you walk to the park in the evening to play!

Eat, love and play and each day will be your best!

Molly O’Shea, MD  Birmingham Pediatrics + Wellness Center

www.birminghampediatrics.com

Everything in Texas IS Bigger July 7, 2008

This morning began the week of training in Austin for e-MDs my electronic medical record http://www.e-mds.com/.   I had been excited about it before but when Pat and I sat in our training session today (all day) I really knew I had made the right choice.  It is incredibly easy to use, has a ton of patient education info already built in, can generate any form for school or camp I could ever want, and allows me to track my time much better.  It is bigger and better than I had hoped!  I will be able to fine tune my appointment plan and that is a big bonus.  Prescriptions are incredibly easy, lab and xray orders are generated (no more script pad writing), and even responding to emails is a breeze.  I feel confident in using it already and look forward to learning how to customize the templates tomorrow.  Pat really likes it too.  We have a group of seven of us in this training session (well I guess not EVERYTHING is bigger in Texas) and we are all at different interests and skill levels with EMR use.  One woman is a computer engineer and asks great questions (or at least they seem great since I can’t even understand half the words in them) and others are true novices.  I am thrilled with my choice!

Being in Texas in July has been pleasantly comfortable so far.  Pat and I had lunch outside at a great little restaurant and ate ourselves silly (after all that activity with our fingers and wrists on the computer we needed it).  For dinner, another trainee, Heidi joined us and we went to one of the most amazing and beautiful places I have ever been for dinner.  The are is called The Oasis and you drive up winding roads reminscent of Northern California or Italy to get to this gorgeous restaurant.  As we were dining outside, the sun was starting to set over the lake and the greenery of the trees and beauty of the vista were better than any food could ever have been.  The above photos were all taken at the Oasis.  Pat and I are in the picture on the far right and Pat and Heidi are in the one in the middle.  Seeing myself in a photo makes me hope that everything is bigger in Texas and that I will go back to my normal size when I return to Michigan!  Of course that would require fewer fresh tortilla chips and forgoing a cosmo….hmmm maybe bigger is better!

Did I mention my hotel is right next to a Hooters?  See what I mean? 

Eat, love and play and each day will be your best!

Molly O’Shea, MD  Birmingham Pediatrics + Wellness Center

www.birminghampediatrics.com

The Walls are In!!!! And I have a winner! July 7, 2008

The walls are in!  Woo Hoo!  The sound proofing insulation is going in tomorrow and then the other side of the walls will be done!  Amazing!  Mark (below, left) has worked his butt off (and he didn’t have much butt to start with) and my architect/builder Frank (below, right) is really coming through! 

We spent an hour or so at the space going through each room and making sure things were right and also spent some time mapping out the placement of the reception desk.  ‘Reception desk?’ you say.  That’s right I have gotten the reception desk problem solved and Kevin O’Shea has won a free home visit!  I must admit when I told him he had won, I discovered he was not only unimpressed (he gets home visits all the time) but apparently doesn’t even read my blog!  He had no idea he was in the running!  SURPRISE!  We mapped out the placement since the electrician has to drill through the floor tomorrow to bring electrical to the area.  There are a few more photos on the build out page (the last few for a week since I am in Austin).

Promptly at 445, Pat Demorest and her husband Mark arrived to pick me up to head to the airport for Austin.  I loved the ride there, sitting in the back of Mark’s luxurious car, as we chatted about Mark’s work a bit (he’s a lawyer who also struck out on his own and has never looked back) and how similar we are in our approach to work.  We were discussing how it actually is a bit more stressful to be away on vacation and not have access to our clients/patients.  We know all sorts of stuff is happening and since we are both kinda anal, we want to be in the mix.   Now I am not trying to encourage all of you to wait until I am on vacation to have your kids get sick or get arrested or get into Harvard and need to share this info with me, but know that if there is a real need, I don’t mind still being in touch when I am away.  Mark is the same way.  Pat will be a good fit for me then since they have been married for a long time, have 5 grown children and still like each other!

On the flight to Austin, while I was STARVING TO DEATH since NWA no longer serves ANYTHING on the flight, I chose the paint colors for the various areas in the office.  Remember, the floor is Java colored wood and the ceiling is boring biege as are the cabinets.  The counter tops are a granite look alike with dark browns, some greens and blues and pinkish beiges.  I have always liked color so for the reception area, the Wellness Center will be in ‘Asparagus’ or ‘Lime Green’ and the other walls will be in ’Lazy Daizy’ yellow.  In the hallways throughout the office, blues will reign in three hues.  The main hallways will be in the lightest shade (‘Touch of Blue’) and the alcoves with the scales will be slightly darker (‘Viva la Blue’) and the alcoves with the sinks will be in an ocean blue (‘Overcast’).  The exam rooms, billing center, kitchen and extra office will be in one of three colors: ‘Lazy Dazy’ yellow, ‘Sand Fossil’ a brownish taupe, and ‘Italian Fresco’ which is a light pink.  The lab will be in the ‘Overcast’ blue as will my exercise room and shower, and my brother’s office and my own will be in ‘Viva la Blue’.  I am getting REALLY excited!

But now it 1130 Austin time and I have EMR training tomorrow….at 8 am.  Soooo as excited as I am, it is time for sleep.

Eat, love and play and each day will be your best!

Molly O’Shea, MD  Birmingham Pediatrics + Wellness Center

www.birminghampediatrics.com