Sun-Proofing Your Child's Skin: Dr. JJ's guest blog as seen on Huffington Post

This month marks the beginning of beach vacations, pool parties and outdoor BBQs, which means it's a crucial time to keep your child's skin protected from the sun's harmful UV rays. May's National Skin Cancer Awareness Month reminds us all to practice sun safety -- not just during the year's hottest months, but year round. A parent has good reason to engage in sun protection early on: One blistering sunburn from unprotected sun exposure as a child can possibly double the risk of melanoma (the most serious form of skin cancer) later in life. And one in 55 people will be diagnosed with melanoma during their lifetime, according to The Skin Cancer Foundation.

In spite of these sobering statistics, most of us -- more than 66 percent -- don't use sun protection regularly. But if we help the youngest members of the family start off on the right track, and as parents we begin to practice what we preach, our children will be more likely to make a habit out of protecting themselves.

To find out how, click here to read more from Dr. JJ's guest blog on Huffington Post.

Diary of a Doc: Dr. JJ -- 1149 Days and Counting

So my son, Max, is home from college in all is glory -- 3 stuffed duffle bags (gotta give him credit...at least he did his laundry before coming home. His clothes were wrinkled, but CLEAN!), 1 backpack, 1 computer case...aching for a haircut and an In N' Out burger. It took almost a whole school year for Bruce and I to get into some sort of established rhythm and routine with the nest being mostly empty, and Max's return has thrown a wrench (quite happily I might add) into daily life. He has taken up temporary squatting rights on the sofa, as his bed is still sandwiched between our office desks and the wall (I am none too happy that my home office is still not ready), a bookcase is serving as his closet in the dining room, and the refrigerator is suddenly much emptier as Max returns to home cooking. I learned yesterday while shopping in the market with him that A1 Steak Sauce is his savior at school -- drowning out all unsavory tastes and rescuing the hopelessly boring food served in the dining hall (at University of Michigan)...ugh! We'll have none of that this summer. Already the energy in the house is different, as a smattering of his local friends are starting to stop by (eyeing him jealously as their school terms aren't over for another month) to eat, visit and reconnect. I give Max credit in that the first day after arrival , after getting a decent haircut , he was on the move looking for a summer job (or two). He wants to get his feet wet in law or entertainment, and also wants to make a little $$, whether babysitting, working in the mall, tutoring or whatever...
He is pretty motivated without a kickstart from us! Some things haven't changed, however -- the smell of the young man pervades the household (those feet! Ugh!), the tabletops now littered with the detritus of a good snack, and the reality that mom gets a few extra bear hugs a day. I am in heaven (when I'm not cooking!).

Diary of a Doc: Dr. Diane -- Reflections on Becoming an MD and a Mom

I often get asked "How do you do it? Being a mom of 2, pediatrician and co-founder of MD MOMS?". I find myself wondering why the question was posed, as it suggests that I'm managing an insurmountable feat of some kind. I'd imagine I'm not all that different from most career moms out there. It comes from the delicate, not always controllable, but somehow effective balancing act of just doing the best I can, in roles that really fuse together and become one. A role that is shaped by life but one that I hope would be an adequate model for my kids to observe and learn from.

Having fled Vietnam during the height of the war at the age of 10 and immigrating to the US, I've experienced what it means to start anew in a very different land and culture. I have memories of a more privileged life in Vietnam, with nannies, tutors and chauffeurs. Yet my more intense recollections were of my efforts to assimilate into being a 5th grader in America. I learned that my pajamas are not to be worn at school, that holding my sister's hands while we walked home from school was seen as 'too intimate', and that you can actually refer to your teachers by their first name without any reprimand. It wasn't always easy, but we worked hard
to assimilate and excel.
As life went on, I began to recognize that my motivation stems from observing my parents' sacrifices to rebuild their lives from scratch for the benefit of their children. Therefore, I strived to take advantage of every blessed opportunity afforded to me by excelling in academics. I entered UC Davis medical school after attending UCSD and graduated from my pediatrics residency without any breaks for travel or real work/life experiences.
I got married after internship and became pregnant at around the second year of residency, and by the time I joined my first pediatric practice, I was a mother with 2 kids under the age of 4 (gulp).

It's often said that having children makes you a better pediatrician. While I think that is certainly true, personally, I feel that my experiences in my practice have taught me to be a better mom. As I struggle with a tragic diagnosis, or a difficult situation, I've become better at putting life into perspective and have tried to "not sweat the small stuff" at home. Through my children's young years, I worked full time, but as they have grown beyond after-school care, I've cut back my hours at the office. My husband is a physician also, so the whirlwind of both medical schedules and the academic schedules of 2 children left us with a short window of quality time in the evenings (often filled with homework) certainly not conducive to a relaxing bedtime routine!
Now my hours at the office coincide with their school time, and I'm a ready presence for them when they return from school. Oftentimes, homework time is a perfect time for me to work on my homework: MD Moms projects.

I wouldn't go so far as to say that life is easy, but I know first hand that it could be a lot tougher! Though my children are far removed from the first generation immigrant experience, I hope that they will strive to do the best they can with whatever life floats their way. And if they ever do find themselves having challenges with multitasking, I will remind them to do what I do and "not sweat the small stuff"!

Happy Mother's Day to all of you!!

Diary of a Doc: Dr. JJ -- On Being an MD Mom and Striking the Balance Between the Two

While perusing one of our favorite sections of the NY Times, the Well blog, we were understandably drawn to an entry called "Doctoring and Mothering", along with a moving companion article by Dr. Pauline Chen, "Bringing Out the Mother in All of Us". It gave us a moment to reflect on our own lives, as women, MDs, moms and, of course, as the MD Moms. We can certainly all relate to the challenge of striking that perfect work/life balance, and we'd without a doubt be zillionaires if we had the magic formula.
At the end of her blog, Tara Parker-Pope posed these questions to her readers, "Are you a doctor juggling the challenges of patient care and family care? Is the balancing act faced by doctors any different than what every working parent experiences?"
Here, Dr. JJ weighs in with her very personal perspective:

My opportunity to become physician, wife and mother all occurred within such a narrow window I didn’t think twice. I entered med school at age 30, married later that year, and delivered my son 9 months before graduation. During residency at CHLA my little guy was our class mascot - an ever present cherub brought to visit by his dad (the defacto mother as well), and discovering McDonalds (on campus in the hospital) a bit too early in his life.
The reality of what impact my training and lifestyle had on my young son came one day, when I picked him up from pre-school. I was dressed in my usual sweats (never wore scrubs outside of the hospital). His teacher laughingly remarked what an imagination my son had when asked what his mother did for a living. He replied “She’s the doctor at McDonald’s!” She thought he was just imaginative - I set her straight.
I knew from the get-go that both pediatric medicine and raising a child would dovetail nicely, but would require sacrificing time away from home. For us the quality of the time remaining together certainly overshadowed the quantity. I was always of the mindset that to be a great physician meant working fulltime and being there for my patients unconditionally. For me a doctor-patient relationship is strained when the doctor is not a present force the majority of the time. The learning curve for the physician is also diminished when the responsibility for the patient is handed over to others.
My husband worked from home in order to care for our son, and it was clear that I had to be the breadwinner for us to successfully manage our obligations. In the early stages of building my practice I made the conscious choice to NOT work part-time, to NOT ask for time off for small events (and saved my requests for the times that really mattered) , despite the glares from my part-time female colleagues. Was I any less a mother? I don’t think so. Did I become a better physician as a result? Yes. Was it worth it? Definitely.
With one child, certainly, this “balance” is more manageable. What challenged us greatly was the addition of parenting my mom for 5 years, as she had developed Alzheimer’s at an early age. Our best-laid plans cracked and the challenge of parenting/care-giving became too much as my mom’s dementia worsened and her health declined. Our marriage became strained as my mother’s needs grew, and there weren’t enough hours in the day to really tend to everyone’s needs. We moved mom into an assisted living facility which helped restore balance at home, but certainly made it impossible to consider cutting back hours and spending more time at home during my son’s middle school/high school years.
I wanted so desperately to process this stage of his life and make sure I had done enough to prepare him to be an intact, emotional responsible young adult. I started writing about him, his successes, failures, accomplishments, looked at his learning curve, his friendships, his insights. By the time he graduated I was convinced that his dad and I had really done a reasonably good job of preparing him for real life, despite the topsy turvy nature of our family life.
Now my darling son is 18, having finished his freshman year of college. I am still plugging away, and although I have missed many, many of his daily feats and events through the years, his dad has always been there. We have a very special bond despite the time away from home. He has a very happy mom, as I have been able to achieve my dream of being a pediatrician (albeit later than planned), having a tremendous kid, and an intact marriage. It certainly hasn’t been easy, but I would do it again!
Happy Mother’s Day to all of you women docs out there! You rock! ..And roll with the punches!

Swine Flu (H1N1): Part 2 - Q&A and FAQs

With the second swine flu-related death in the U.S. (first of a U.S. citizen) occurring yesterday, we decided it was a perfect opportunity to post Part 2 of our swine flu update. We chatted with Tara Mandy, publisher of StollerTraffic.com, an online resource and weekly e-newsletter for city moms with kids under 3. Tara came to us for some tips and perspective (OK...and to help talk her and her readers off the ledge) and we were, of course, happy to oblige!
Here, we answer some of her and her readers' most pressing questions:

Are babies and toddlers more or less susceptible to Swine Flu (H1N1)?
Babies and toddlers who are below school aged, are less likely to be exposed to social situations, which would then expose them to swine flu. However, if infants and toddlers do become infected with Influenza, they are more likely to have a more severe or prolonged illness which can be associated with more complications.

Are there special considerations for pregnant women?
Pregnant women are deemed to be in the high-risk group, if again, we take our experiences from past influenza pandemics. They should take precautions to reduce their risks of contracting swine flu. These actions include frequent hand washing, covering coughs, avoiding contact with ill people and reducing unnecessary social activities in crowded settings. If a pregnant woman has swine flu, she can be treated with antiviral therapy, though these drugs have not been formally tested for use in pregnancy. Past experiences with Tamiflu and Relenza have shown them to be safe and effective in pregnancy with no observed ill effects seen in their newborns.

When should you call your pediatrician?
If your child has a sudden onset of fever along with a sore throat, cough, headache or body aches, call your pediatrician. Reports seem to indicate that the swine flu presents with an acute onset of high fever, and a rapid progression of the other symptoms. If you bring your child within a day or two of fever onset, anti-viral therapy is more likely to be effective. Most health care providers are equipped to diagnose flu in their offices. If your doctor suspects your child has influenza, he/she may perform a wash of your child's nasal secretions and submit it to your local public health department for analysis by the CDC.

When should you NOT call your pediatrician?
If you basically feel like you have the common cold or stomach flu virus -- both are common at this time of year. Do not call your doctor to obtain anti-viral therapy "just in case". This important therapy is reserved for those truly in need. Do not call your doctor if your child has NO symptoms and you have NOT travelled to a high risk area or had contact with a person suspected of having H1N1 (swine) flu.

What are Tamiflu and Relenza?
Tamiflu (oseltamivir) and Relenza (Zanmivir) are both FDA approved anti-flu antivirals that have been used to treat Influenza in the past and are deemed to be effective against the current swine influenza A virus (H1N1). They work best if started within 48 hours from the onset of flu symptoms.

What's the difference between the two?
Tamiflu is approved for treatment in patients 1 year of age or older. It is available in liquid or pill form and should be taken twice a day for 5 days for active flu. During pandemic conditions, there are dosage recommendations extending down to 3 months of age.
Relenza is for treatment of patients who are 7 years or older. It is also for preventative treatment for patients 5 years or older. It is taken twice a day for 5 days and inhaled directly into the lungs.

Are Tamiful and Relenza "okay" for babies/toddlers? Nursing moms? Pregnant women?
FDA approval of these antivirals are as per the ages described above. However during epidemics, Tamiflu can be used for children down to 3 months of age under the Emergency Use Authorization clause (EUA). Nursing moms and pregnant women can be treated with both Tamiflu and Relenza.

Is there a shortage of either one?
The U.S. Government has a stockpile of these antivirals, but judicious use of these medications is recommended, and we don't want to risk developing viral resistance to the drugs. That means that these medications should not be used daily "just in case" for prevention. They are to be used only in the vent of H1N1 illness and for household contacts of flu victims.

What are the downsides of taking Tamiflu or Relenza as a preventative?
Taking either drug in a preventative regimen is indicated only under certain specific circumstances. Essentially, these medications are recommended for the very young, or very old or those with chronic underlying illnesses who have been exposed to suspected or confirmed swine flu. These include household contacts, school contact or travel contacts to high-risk areas.
Tamiflu has side effects that may include nausea, vomiting, abdominal pain, seizures or behavior changes.
Relenza may cause breathing problems, especially in patients with underlying lung disease or asthma. It may also cause seizures, confusion or abnormal behavior.

Are there any other preventative measures worth considering?
Definitely. Here are some practical tips (mentioned in our previous swine flu post, but worth reiterating):

• Avoid who are ill and thrive with those who are well
• STAY HOME IF SICK and don't return to work, school or daycare until well and fever free for at least 24 hours
• WASH HANDS WASH HANDS WASH HANDS when coming in from school, outside or work and before putting anything in your mouth
• If you are coughing, cough into your sleeve or tissue. Wash hands frequently throughout the day.
  
• Don't share food or drinks with others. Secretion exchange is a common route of infection.
  
• Don't ask for trouble by traveling to high risk areas
• Call your pediatrician if your child has true flu symptoms so that they can diagnose and treat early (within 24-36 hours of onset of fever). True flu symptoms include fever (usually over 101-103), chills, headache, sore throat, runny eyes and nose, cough and aches. Influenza A symptoms tend to hit a bit harder, so symptoms recognition is usually obvious
• When new strains of flu emerge, such as H1N1, it takes 4-6 months to develop an appropriate vaccine to cover that strain. Already efforts are in place to develop a vaccine against H1N1, in addition to other new strains of influenza that have attacked worldwide.

Again, we can't emphasize enough the power of STAYING HOME IF YOU ARE ILL, so that the freedom to move about and attend schools, events, travel and activities of daily living is maintained for those who are healthy.

Should I keep my baby/toddler under any sort of quarantine if I live in a city where swine flu has been confirmed?
It's always easier to prevent illness than to diagnose and treat it, however, it is reasonable to move about your community and do the things you need to do if you have reasonable control over whom you come in contact with. For example, a day long jaunt to a large indoor play place may not be advised if you have H1N1 in your community. But a birthday party in your home attended by healthy, asymptomatic children is reasonable. This is the time when communities need to work together to preserve public health, so keep attuned to the advisories delivered by your local health departments.

While we would advise against unnecessary crowded or social contacts, obviously if you live in a densely populated urban area like New York City, staying locked in your home and not using public transportation is not always practical.

The most critical advice we can offer as pediatricians is that we all do our part to stay healthy and prevent unnecessary spread of germs. This means STAY HOME if you feel sick and wash your hands (and your children's' hands)...A LOT...especially after you come in from the outdoors or a social situation.

We must remember that the total number of cases of confirmed swine flu in the US really amounts to a relative handful (as of 5/6, 642 cases nationwide), and that with the support of our medical and public health communities, we are equipped to handle this situation. We must also keep in perspective that the case described in the US have been mild to moderate in severity (aside from the tragic exceptions in the case of 2 recent deaths in Texas), and that local communities affected are reacting appropriately and outcomes have been good so far.

Any thoughts or insight you can provide to help explain the 2 recent deaths (and help calm any panic)?
Very young children and the elderly are more at risk for dying to getting really sick from the flu. Approximately 36,000 Americans die every year form the influenza virus. Of this number, in 2007-2008, 83 were children. So deaths in this age group represent a minority, albeit a tragic one. While we would never ever want to minimize the grief that the families of these families are experiencing, 2 deaths from swine flu, relative to the total average number of deaths from flu every year, is not a cause for public panic.

Our recommendation is that we use this tragedy as an opportunity to reemphasize to parents the critical importance of vaccinating your kids from influenza every year* (hence this year's recommendation from the AAP that ALL children between the ages of 6mo and 18yrs be vaccinated with the flu vaccine!).
*Important note: this vaccine does not protect against this particular strain, however the medical community is working quickly on developing a specific swine flu vaccine.

Like we said, remember that flu from Influenza claims the lives of 36,000 Americans yearly (most often in the elderly and very young) and infects millions of Americans every winter -- and the great majority survive and thrive.
We said it in our last post (so forgive the redundancy) but we'll say it again: It is still too early to tell how severe this now prolonged flu season will be, but remember that summer is coming, and the flu virus tends to want with warm weather. Keeping this in mind, we anticipate a short outbreak, with the help of Mother Nature. Some of the hysteria thankfully seems to have waned a bit, but we still want to emphasize that we all use common sense, be sensible, stay calm, and WASH your hands!