For this week’s episode of CBS Doc Dot Com, I went back to camp. OK, it wasn’t my camp – Camp Algonquin in Argyle, New York – now defunct, where I spent many an idyllic summer growing up. It was Camp Shane in Ferndale, New York, listed on their website as “The original, longest running weight loss camp in the world” at 41 years and counting.
This is a tough time to be overweight or obese. Last week the Centers for Disease Control announced that obesity-related diseases account for 147 billion dollars in medical costs every year in the United States.
About a quarter of Americans are obese and two thirds are either obese or overweight. Over the past twenty years, obesity in teenagers has increased from 5 percent to almost 18 percent. Obese children and adolescents are more likely to become obese adults. Which brings us back to Camp Shane.
I spent an hour talking to about a dozen kids ranging from ages 11 to 17 who had been gathered into a group by Camp owner David Ettenberg and his wife, Zipora. They came in all shapes and sizes but shared a common sentiment – they felt safe at camp, surrounded by people who accepted them for who they were. It brought tears to my eyes to hear how supportive they were of each other, how open they were about their emotions and fears.
In school other kids often mocked them. There’s no way that would be tolerated at camp – not just by the staff but, more importantly, by the campers. “We’re all in this together,” one boy offered. A girl added, “It’s a safe zone for us.” A teenage girl said “You can wear a bikini without being made fun of.” I asked, “What would happen if you wore a bikini at home?” She answered, “You’d most likely get made fun of and like pushed in a pool. Ah ha, you’re fat.”
A boy told me that kids at his school would ask him, “‘Why are you so massive?’ And like usually I’d just laugh it off but sometimes it does get a little annoying. I’m like, how long until I get back to camp?”
The kids all said they had lost varying amounts of weight at camp through portion control and exercise, a program supervised by pediatrician Dr. Joanna Dolgoff. The challenge has been trying to stay on track once they leave camp and return home.
If they can do it at camp, they can do it at home. But not without the support of parents and schools who have been educated about how to help their children make healthy choices. My good friend, Dr. Mehmet Oz, has launched a wonderful organization called HealthCorps “to help stem the crisis of child obesity through school-based health education and mentoring, as well as community events and outreach to underserved populations.” Click here to see the HealthCorps website.
Click here to see this week’s CBS Doc Dot Com about my trip to Camp Shane.
The Happy Hospitalist, generally an excellent blogger, wrote yesterday about how salaried docs must be delivering better care than those greedy FFS docs, because the Cleveland Clinic does a terrific job with docs on a salary. I suspect their excellent outcomes have nothing to do with reimbursement model and a lot more to do with systems and a strong gatekeeper model.
He totally missed the elephant in the room in the Big Group Clinic model: who gets the money for doing the work.
He cites as an example a GI doc who left the Clinic for independent practice and quadrupled his income. Let’s say he’s working as hard as he did in the Clinic; is he billing more than the Clinic did? I doubt the Clinic wasn’t billing the usual amount for the work, so 3/4 of this docs’ billing went where?
I suspect it went into the overhead of the Clinic. This isn’t a knock on them, it works for their group, so fine. Other groups do essentially the same thing. It’s legal and morally defensible, and some docs don’t mind being salaried.
Salaried docs in a big Multispecialty Clinic have different incomes, but not as radically disparate as the non-clinic model. As a way to somewhat equalize RVRBS issues it works (I wouldn’t want to be in the room when salaries come up, though).
What salaries do not do is get docs to work harder, see more patients. Some docs are very dedicated, motivated people who would work for rent and grocery money. Others on a salary would do the minimum: if every patient is more work and more liability without more pay, well, why work more/harder? As an incentive to produce nothing beats getting paid for it.
(This isn’t an endorsement of excessive or un-necessary procedures; there are greedy jerks in all professions).
Also, a happy side effect of getting paid for what you do rather than for having a pulse is those who work hard resent those that don’t (but who would make the same on salary) a whole lot less. Way less inter-group stress.
Salaries aren’t all bad, but they’re not the Key to Great Healthcare.
Discolsure: I’ve worked ED’s both ways, and much prefer fee for service.
*This blog post was originally published at GruntDoc*
Granted I am not generally asked about nipple pain in pregnant women. Those questions tend to go to folk like TBTAM or ER’s Mom.
The article describes a case report of a 25 yo woman in her 2nd trimester with “frequentepisodes of extreme bilateral nipple pain. A typical episodelasted between 5 and 15 minutes and was so painful as to bringher to tears.”
The article discusses Raynaud’s phenomenon of the nipple and share these photos (credit) taken with a camera phone with us. The text with the photo:
Vasospasm of the arterioles manifesting as pallor (left), followed by cyanosis, and then erythema (centre). The right hand image shows the normal, asymptomatic, status.
As with Raynaud’s of the hand (which I am more familiar with), the phenomenon tends to occur when the ambienttemperature drops below a certain threshold that is specificto each individual. Exposure to cold should be avoided, as is avoidance of caffeine, nasal vasoconstrictors,and tobacco.
Additional treatment for Raynaud’s of the nipple:
Women with persistent pain require immediate relief to continuebreastfeeding successfully. Recommended treatment is 30 mg nifedipineof sustained-release once-daily formulation, and most womenrespond within two weeks.
REFERENCE
An Underdiagnosed Cause of Nipple Pain Presented on a Camera Phone; BMJ 2009;339:b2553; O L Holmen, B Backe
Vasospasm of the Nipple–a manifestation of Raynaud’s phenomenon: case reports; BMJ 1997 314: 644; Laureen Lawlor-Smith and Carolyn Lawlor-Smith
I sat with non-medical friends last night and the discussion turned to “health”, as it often does. One guy related the terrible story of a woman who went to her doctor with a certain pain which turned out to be cancer that had spread and she died within a week. The inevitable question; “How do you detect early cancer, so you can catch it and cure it?”
The answer I gave was less than satisfactory for my friends. In fact, they were a bit incredulous with the answer.
All cancer is genetic, in that it is caused by genes that change. Only a few types are inherited. Most cancers come from random mutations that develop in body cells during one’s lifetime – either as a mistake when cells are going through cell division or in response to injuries from environmental agents such as radiation or chemicals.
Different types of cancer show up differently in the body. We have screening tests for some types of cancer. We can detect early breast cancer with mammography. We detect early colon cancer with colonoscopy and hemocult stool tests. We do screening for cervical cancer with pap smears. Early prostate cancer can be detected with PSA, but it is not very specific. Skin cancers can be found early with visualization and biopsy.
What about brain cancer, testicular cancer, leukemia, sarcoma, lung cancer, ovarian cancer and a number of other less common malignancies? We have no screening tests for these diseases. Perhaps we will discover some gene test or imaging test or breath test in the future, but right now, a person would need to have symptoms that would point to the disease.
This is a scary thought for people…especially those who try to live healthy lives.
It is the randomness of life that has always made us feel vulnerable to things we cannot control.
I have not posted a blog in a week because we were on vacation and truly wanted to be on vacation and not be tied to doing any “work.”
We went to north Georgia for a few days then up to the mountains in western North Carolina. How gorgeous! It was so nice to escape the humidity of Florida for a week!
I had an observation on my vacation that I thought I would share. I have talked in previous blogs about mindless eating and how we multi-task while we are eating. When we are not conscious of what we are eating, we don’t fully enjoy it. In addition, we eat more than we realize.
I observed this phenomenon in my little boy who just turned 2 years old. We were in the car a lot for hours on end, so snacking and fast food were part of the trip. Also, because he is 2 and difficult to entertain in a car, we had the DVD player set up for him to watch his favorite Elmo, Clifford, and Thomas the Tank Engine videos.
It was quite amazing that whenever he was glued to the TV, he ate whatever snacks or meals in his carseat without even looking down. He just picked up a piece and put it in his mouth. And he would ask for more. Whenever he was not glued to the TV, he wasn’t asking for food or eating as much. Hmmm…..very interesting.
From now on I am going to be very careful about two things. First, how much TV he is watching. He normally doesn’t watch much but on this trip he got very spoiled with watching his DVD’s and I am afraid it will lead to more asking to watch now that we are home. Second, I am going to only let him snack when he is fully conscious of what he is doing. No food in front of the TV so that he can be very conscious about what and how much he is putting into his mouth.
As a fairly new (2 years) parent, I am still learning these lessons first hand on how to feed children. I just had to share my story because our children learn habits, both good and bad, at a very young age!
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