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Book Review: Colic Solved
Have you ever been seated next to a screaming infant in an airplane? If so, you know that even short flights can feel like an eternity. But the question is: why is the baby so miserable? Is there something that can be done to ease their discomfort?
According to pediatric gastroenterologist Dr. Bryan Vartabedian, the answer is a resounding “Yes!” In his new book, Colic Solved Dr. Vartabedian (or “Doctor_V” as he is known on Twitter) describes why unexplained fussiness may often be caused by gastroesophageal reflux disease. Doctor V explains that “colic” is an old-fashioned term to describe the behavior of uncomfortable babies. Colic is not a medical diagnosis anymore than “crying” is… and fortunately the underlying cause of “colic” has been discovered so that it can also be treated.
I met Doctor V at a conference in Albuquerque, New Mexico a couple of months ago. Before our introduction I had no idea that he spent all of his clinical time examining and treating screaming babies – but once that fact was revealed, I understood immediately that he was the right guy for the job. Doctor V is a tolerant, affable man with a tremendous sense of humor and a voice made for radio. He is not easily flustered and has a genuine curiosity about others and their life stories. In fact, there’s something soothing about Doctor V – something that makes you feel that everything’s going to be ok.
And so it’s no surprise that Colic Solved is a written expression of Doctor V’s winsome personality. Every chapter is filled with empathy and reassurance, yet with a clear path forward for teasing out the real cause of a baby’s misery. In most cases, “colic” is actually caused by milk protein allergy or infant reflux (a painful burning sensation caused by regurgitating stomach acid). Doctor V carefully explains how to tell the difference, and what to do about it. Interspersed are amusing vignettes called “Tales From The Crib” in which parents with difficult-to-soothe babies navigate their way towards a resolution.
But best of all, Doctor V does not hesitate to do some good old fashioned myth-busting when it comes to exaggerated claims not based on scientific evidence. Infant formula makers, baby bottle makers, and baby product manufacturers are notorious enablers of magical thinking – moms and dads purchase all kinds of products in a desperate attempt to soothe their babies. Unfortunately, most of these solutions do not treat the root cause of the problem – though businesses thrive on colic cures for desperate parents.
Here’s an excerpt of Doctor V’s exposé of a common soy formula myth (p. 117):
Soy Formula – Do You Feel Lucky?
One of the first impulses for parents with a screaming baby is to reach for soy formula. It sounds all natural and easy to digest. But the role of soy formula in the milk-allergic baby is very misunderstood…
The real problem with soy formula comes with the belief that it’s a reasonable cure for the allergic baby. But up to 50% of babies who are allergic to cow’s milk will react to soy protein in a similar way, so if you or your pediatrician chooses to treat your allergic baby with soy formula, you should consider it a gamble…
Colic Solved is a gem of a book. It’s witty, wise, and well written – a must-read for any parent of a chronically fussy baby. I also think that pediatricians and family physicians should strongly consider prescribing this book to parents of unhappy infants. There’s probably no better way to solve colic once and for all.
5 Things Every MD Should Know Before Using Twitter
Let’s face it, Twitter isn’t that hard to figure out. The interface is intuitive and a little time on the application makes its basic function pretty obvious. But there are a couple of things that medical newbie’s might keep in mind before taking the leap on to Twitter. While I didn’t find myself in any kind of trouble, I had to figure a few things out on my own.
1. Follow and listen. Twitter is as much about listening as it is about talking. The best thing you can do to see how doctors are using microblogging to advance their platforms, practices and passions is look and listen. Pick a group of doctors (look at my follow list for some ideas) and follow them for a couple of weeks to see exactly what they do and how they interact with others. Don’t reinvent the wheel.
2. Goof around now, but ultimately think how you want to use it. You likely won’t have any idea about how to use Twitter when you first jump in. And that’s okay. You can’t understand it’s power until you reach a sweet spot of followers and cultivate relationships that have some history and meaning (in Twitter terms, of course). Ultimately you do want to think about connecting with those who will put you where you want to be – whether it’s just raising your profile as an author or specifically drawing patients for lapband surgery, or whatever. But also keep in mind that you may start by goofing off and never stop … like me.
3. You can follow whoever you darn well please. The world is full of self-ordained social media experts who spend their days working to make you feel like you don’t follow enough people. If you’re a physician with a real job you’re too busy to follow 30,000 people. Keep your eye on the ball and think about the network you want to develop. Whatever you do, don’t believe the nonsense that it’s ‘bad etiquette’ to not follow someone who follows you.
4. Your patients and your hospital are listening. Social media is interesting. While we type in the privacy of our boxer shorts, the world reads what we write. And that includes your patients. While my grandmother used to tell me before going out, ‘don’t do anything you wouldn’t do in front of the Virgin Mary, I’m telling you, don’t Tweet anything you wouldn’t want your patients to see. You represent your personal brand, practice, and profession with that very first tweet. Keep in mind that some hospitals have social media/blogging policies. You might look into this before taking the plunge. If you keep your hospital/institution off your bio, commit to never discuss anything relating to patients and always vow to be a really nice guy you should be good.
5. What happens on Twitter stays on Twitter. Remember that everything you type will remain etched in the infosphere for eternity. This can be retrieved by future employers, partners, soon-to-be-ex-spouses or anyone else interested in seeing or exploiting what you’re really about. Exercise intelligent transparency. Be smart and use your frontal lobe before hitting ‘update’.
I was interviewed by the AMA News last week on doctors and Twitter and that’s what got me thinkin’ about this post. I get a charge out of helping doctors recognize the power of connecting beyond their immediate environment. I hope this helps.
*This blog post was originally published at 33 Charts*
Raw Milk: Got Diarrhea?
By Dr. John Snyder of the Science Based Medicine Blog
I recently saw a 14 year old girl in my office with a 2 day history of severe abdominal cramps, bloody diarrhea, and fever. Her mother had similar symptoms as did several other members of her household and some family friends. After considerable discomfort, everyone recovered within a few days. The child’s stool culture grew a bacterium called Campylobacter.
Campylobacter is a nasty little pathogen which causes illness like that seen in my patient, but can also cause more severe disease. It is found commonly in both wild and domestic animals. But where did all these friends and family members get their campylobacter infections? Why, from their friendly farmer, of course!
My patient’s family and friends had taken a weekend pilgrimage to a family-run farm in Buck’s County, Pennsylvania. They saw farm animals and a working farm. And they all drank raw milk. Why raw milk? Because, as they were told and led to believe, raw milk is better. Better tasting and better for you.
In 1862, the french chemist Louis Pasteur discovered that heating wine to just below its boiling point could prevent spoilage. Now this process (known as pasteurization) is used to reduce the number of dangerous infectious organisms in many products, prolonging shelf life and preventing serious illness and death. But a growing trend toward more natural foods and eating habits has led to an interest in unpasteurized foods such as milk and cheese. In addition to superior taste, many claim that raw milk products provide health benefits not found in the adulterated versions. Claims made about the “good bacteria” (like Lactobacillus) conquering the “bad” bacteria (like Campylobacter, Salmonella, and E. coli) in raw milk are pure fantasy. Some even claim that the drinking of mass-produced, pasteurized milk has resulted in an increase in allergies, heart disease, cancer, and a variety of other diseases. Again, this lacks any scientific credibility.
With this growing interest in unpasteurized dairy products has come an increase in the rate of food-born infections. The federal government developed the Grade ‘A’ Pasteurized Milk Ordinance in 1924, providing a set of guidelines for the safe processing and handling of milk products. Although all 50 states have voluntarily adopted these guidelines, the FDA has no oversight jurisdiction. It is up to individual states to determine their own safety protocols and enforcement strategies. While selling raw milk is currently illegal in 26 states, those with a will have found a way to skirt the law to get their fix of the real deal.
My patient was a victim of a recent outbreak in Pennsylvania, but similar outbreaks of infectious disease due to unpasteurized milk products are a recurring headache for public health officials. Between 1973 and 1993 there was an average of 2.3 milk born disease outbreaks per year. That number increased to 5.2 per year between 1993 and 2006. Whatever the numbers are, there is no question that the increasing consumption of raw milk is a genuine threat to public health.
The health claims made for raw milk, and against its pasteurized cousin, are being heavily pushed by a small but passionate contingent one might refer to as “food guardians.” These are people who espouse a return to the good old agrarian days of wholesome, farm-raised foods, free from man-made chemicals and mass-market processing. Some of these ideals are highly respectable and healthful responses to the ways in which society has dealt with the need to push products to a mass market at profit. For example, the use of pesticides, animal hormones and antibiotics, and farm run-off can have deleterious environmental and human health consequences. However, many of the health claims that are made about products like raw milk are not supported by scientific evidence, and lack scientific plausibility. Despite this lack of evidence, however, the allure of raw milk products is clearly on the rise.
Beyond the obvious public health consequences of this trend lies the problem of an increasing public credulousness when it comes to pseudoscientific claims. This is similar to the trend we are seeing regarding concerns about the dangers of vaccines and excessive fears concerning certain potential environmental hazards.
Unscientific and outright fraudulent claims about the health benefits (as well as the hidden dangers) of a variety of foods is on the rise. And bogus or unsupported nutrition claims are big business. From the immune boosting and weight loss powers of the acai berry, to the cancer protective effects of vitamins, nutrition pseudoscience is all the rage. While raw milk will never have quite the celebrity cache of these “super foods”, it is promoted with the same lofty yet empty claims, and provides the added bonus of infectious diarrhea.
On a recent visit to a local high-end wine shop, I came face-to-face with the ease with which people fall prey to the marketing of food pseudoscience. A woman was examining a bottle of wine when the store keeper approached to offer help. She told her a little about the wine and then said, “And all of their wines are biodynamic.” To this, the shopper exclaimed “Oh wow, that’s great.” She bought the wine, likely without having a clue what the term “biodynamic” even means. Biodynamic farming is a mixture of Gaia-like principles (the earth is a living organism) and organic practices, with a smattering of mysticism, alchemy, and astrology. In essence, a smorgasbord of pseudoscientific farming practices perfect for the current culture of armchair environmentalism and the new found heal-thy-self mantra of the well-to-do. While the motivating factors and socioeconomic status may differ between those drinking biodynamic wine and those drinking raw milk, both are relying on false beliefs and unsupported claims in making their choices to consume these products.
As a lover of cheese, I appreciate that there are those whose refined palates favor the delicacy of unpasteurized, aged cheeses so prevalent in other countries. But to stretch this taste preference to include health benefits unsupported by science and even common sense is not just misguided, it can be dangerous. Dangerous because it increases the risk of infectious disease, but also because it perpetuates a credulous perspective that adds to the ongoing erosion of our appreciation and acceptance of science.
*This blog post was originally published at Science-Based Medicine*
Why You’re More Likely To Die On Saturdays and Sundays
Patients don’t choose the days they get sick.
There are several studies, specifically dealing with heart attacks, showing that the mortality rate increases when a patient visits the hospital during the weekend.
It appears that the same goes for upper GI bleeding. MedPage Today discusses a recent study showing that “patients with nonvariceal upper gastrointestinal hemorrhage had a 22% increased mortality risk on weekends, and those with peptic ulcer-related hemorrhage had an 8% higher risk.”
Staffing issues, leading to delayed endoscopies, appear to be chief culprit. Minutes count in cases of GI bleeding, so the delay is a likely explanation for the higher mortality rates.
Especially in community hospitals, doctors often cover for one another, and in general, there are less physicians available. Short of having more doctors on call, a prospect that faces long odds as hospitals are loathe to pay specialists for additional call, I’m not sure what can be done to rectify this statistic.
One suggestion is to have so-called “bleed teams,” where staff can be quickly mobilized to respond solely to acute GI bleeds. But again, this likely would require more staff, and it’s dubious that hospitals are willing to bear the additional cost.
**This post was originally published at KevinMD.com**
