Constipation – PediaCast 017
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Announcer 1: This is PediaCast.
Announcer 2: You're listening to the Tripod Network. What's on?
[Music]
0:00:27.4
Announcer 1: Hello! Moms, dads, grandmoms, grandpas, aunts, uncles, and anyone else who looks after kids. Welcome to this week's episode of PediaCast. A pediatric broadcast for parents. And now direct from Birdhouse Studios, here's your host Dr. Mike Patrick Jr.
0:00:43.8
Dr. Mike Patrick: Hi, everyone and welcome to PediaCast. The pediatric podcast for parents. This is Dr. Mike coming to you from Birdhouse Studio and I'd like to welcome everybody to the program this week. We're going to have another short episode, the follow up, this part two on poop. OK it's all about the poop and that's because one of the most popular search terms. In fact the most popular search term for people coming to PediaCast to the search engines is poop. Boy, I'm just so honored about that. So, this is going to be part two and we're going to talk about constipation and encopresis. Encopresis is just a fancy name for having accidents in your pants with poop, and it’s usually associated with constipation issues. So, we're going to talk about that, coming up here in just a few minutes.
0:01:29.2
I would like to remind you that next week we are going to do an entire episode just based on your questions. So if you have a question that you would like to ask, all you have to do is go to the website at PediaCast.org and click on the contact link and you can get to me that way. You can also e-mail me at mike@pediacast.org or you can call our Skype line at 347-404-KIDS. And next week we're going to get to just as many of your questions as we can.
Now I do want to let everybody know, strep throat, this is the time of the year that we start to see it, and in our neck of the woods, boy we are really starting to have a lot of cases of it that we're seeing in the in the office. Now, keep in mind that I do practice in a fairly large group and there are six doctors in the group altogether. Although, one's on vacation right now. So, on Friday there were five doctors there. And during the course of the day on Friday, the five of us did over 70 throat swabs for strep and over half of them were positive. So, we are just being in and dated with strep throat right now.
0:01:29.2
And it did make me think about telling you this, you want to make sure that if your child does have a sore throat that you make an appointment with your doctor. Because the only sure way to tell the difference between strep throat and a virus is with a throat swab. You know if it's strep, then you're going to need an antibiotic to reduce the risk of rheumatic fever. Also the antibiotic decreases the length of the period of time that your child's contagious and it may shorten the duration of the illness by a day or two. But if it's a virus, remember you don't want an antibiotic because antibiotics do not kill viruses. What they will do is kill off your good, protective bacteria leaving room for resistant and dangerous bacteria grow. And since you can't tell if the kid with a sore throat has strep by the way it looks, you really do need to go in and see your doctor so that they can do a throat swab. OK
0:03:31.2
[Cellphone Ringing]
You know what that means. OK, I am on call and it's Sunday night and it's pretty late you know. It's like after midnight, just after midnight. Since this was only going to be, you know, about a 20 minute show, I was hoping that I'd be able to get through it without interruption. But you know work calls, so I will be back in just a second.
0:04:05.5
OK I'm back. Sorry about that. For those of you who have listened the PediaCast, the last couple episodes. You know that I've been talking a bit about laundry and how manic mommy guilt, oh you know I like that phrase, manic mommy guilt. That definitely describes it. Anyway, how Erin and Kristen over at Manic Mommies basically guilted me into folding laundry and this led to my wife requesting more help with the wash, which is a result that I hadn't actually considered happened. Now I know this whole laundry issue is getting really old and I had planned on dropping it already. Really I had. I mean I wasn't going to mention it again at all. But then I received a voicemail. Let's take a listen.
0:04:49.9
Mrs. Patrick: Hi. I just wanted to leave some feedback on Episode 16 of PediaCast. This is your wife speaking. And I just wanted to let you know that I really appreciate you helping out with the laundry. It's very helpful. To further clarify our load demand meter or Energy Sentry, really the only time that we can do laundry is on the weekends or after 9:00 pm every night. So because of that, it really restricts the time that I can do the laundry. And since I've been spending just about every waking weekend moment at the theatre with Nick, and it's really hard to get laundry done during the week. So I really appreciate you chipping in, in doing a little laundry. It's really, really helpful so we all have clean underwear to wear during the week. Now if you remember, shortly after we were married, I asked you to put in a load of laundry you stuck a pair of red shorts in the white load and we wore pink socks and pink underwear for a long time. And I think it was about fourteen and a half years until I asked you to do laundry again. So, I hate to remind you of that 'cause you may actually try that again, but just remember if you try that again, you'll have pink underwear to go with your pink flannel line jeans. So, anyway I just wanted to give you some feedback. I love the show. You're doing a great job and I love you and thanks for helping out around the house. And thank you Kristen at Manic Mommies and Erin for talking about getting your husbands to help out around the house, because without you guys, I'd be doing my own laundry. So, talk to you later. Bye.
0:06:39.7
Dr. Mike Patrick: Unbelievable. I mean first, I did not stick a pair of red shorts in the laundry. I don't know how they got there. They just fell in. Second, that was fourteen years ago. Fourteen years, talk about not letting you forget something. And third, 20 little e-mail messages everyday aren't enough. Now she has to make comments on my voice line. See what I have to put up with here, folks? No, I'm just teasing. You know the thing is I'm actually glad she did that, because I've been really wanting to try to get her on the program.
0:07:16.5
Karen is a nurse by training. Before we had kids, she worked for several years in a surgical infant intensive care unit at Columbus Children's Hospital. And then after we had our daughter, she went to work at a pediatrician's office as a nurse and she worked there for several years. And now we home school both of our kids and she does most of the work with that. And she's really amazing and has a lot to offer in terms of advice. Particularly with managing kids and behaviour and that sort of thing, cause we have two really well-behaved kids. And I really think that she's played a huge role with that. So if you're interested in hearing more from her, give me an e-mail and then I'll forward them on to her because she's been very reluctant to come on the program. But I think that she could answer a lot of parent's questions just as well as I can. Particularly when it comes to sort of more than nuts and bolts being a mom at home and some of the situations that you might come up upon, with some advice on how to handle those. So if you think that would add something to the program, just give me an e-mail and I'll forward it on to her and if enough of you write in, then maybe she'll change her mind about coming on to the program.
0:08:34.9
I do want to remind you that the information presented in PediaCast is for educational purposes only. We do not diagnose medical conditions or formulate treatment plans for specific individuals. If you have a concern about your child's health, call your doctor and arrange for a face to face interview and hands on physical examination. Also your use of this audio program is subject to the PediaCast Terms of Use Agreement which you can find at PediaCast.org
0:09:01.5
All right, so without further adieu let's get right on in to our topic this week. Oh by the way, after we're done talking about constipation, I do have a segment on Grey's Anatomy. I have a little bit of a problem with the show. I like the show, don't get me wrong. But I do have some things that I think could make the show even better. So if you're a Grey's Anatomy fan, hangout after we get done with our little constipation talk here and we'll talk a little bit about Grey's Anatomy.
OK. So, what is constipation? Well constipation, the key here is really what is the definition of it, because the parents' definition of constipation is often different than what the pediatricians' definition is. From a parents' point of view constipation is usually thought of a sort of a hard formed poop that's difficult to pass and it may happen infrequently. Whereas from our point of view as a pediatrician, constipation is basically just having too much poop hanging out in the intestines.
0:10:03.7
So you can have a kid who has a soft, regular bowel movement everyday, but if they're not getting it all out, you know it starts to back up. And in the office I kid of explain like this, let's say your son or daughter sits on the toilet once a day and gets out a good sized turd. OK, again you know I just love my job. I get to use potty talk and it's still considered clean. So everybody's happy, you know the kid's going once a day and they're getting out quite a bit of poop. But what if your son or daughter had sat there longer and had been able to get out two more turds, if they don't get those out, even though they had a nice healthy bowel movement, they're backed up with two turds, right? And let's say that happens everyday for six weeks, so everyday for six weeks your kids go into the bathroom having a good sized stool, but they're constipated, because they could have gotten out more and over time it starts to back up.
0:11:04.2
So, what kind of symptoms do you see with constipation? Well the most common one is going to be frequent mild belly aches over a long period of time. And these belly ached tend to be worst during and after meals. And the reason for that is because one of the body's responses to you eating is your intestines starts to squeeze, to push things through and down to make room for the new food that's coming. If you're bowels are basically full of poop, then your intestine is squeezing on the stool that's in there but it's not moving very well, and that can cause severe cramping. It can cause mild belly aches and then when it's really bad it can cause severe cramping. In fact sometimes the cramping associated with constipation can be so severe that it's easy to mistake it for a possible appendicitis. And there's plenty of kids out there who get urine to look for a kidney stone, they get blood work to see if they have a high white blood cell count which would go along with appendicitis. And they may even get a CT scan of their abdomen because you're so worried that it could be appendicitis. But here it's just severe cramping from the constipation. And some kids will even vomit with it as well.
0:12:14.3
So frequent, mild belly aches over a long period of time especially when they're worst during and after meals, that can be constipation. Of course there's other things that could cause that as well, but constipation is one of the main things and severe cramping is possible too. Another common symptom is actually, one you may not think about but I do because we see it quite a bit. And that is urinary frequency and day time accidents with pee. Now if you think about it, if your intestines are full of poop and the swollen intestine it's full of stool is pushing on the bladder, the bladder's kind of trigger happy. When it gets pushed on it squeezes or spasms and then that results in urgency on the part of the child. So all of a sudden they feel like, oh I have to go pee really bad. But the bladder wasn't really full, this just happened because the intestines were pushing on the bladder. And so they go to the bathroom and they pee but only a little because their bladder wasn't very full and then this happens frequently.
0:13:15.8
So if you have a kid who is, seems like they have to pee every half hour and only a little bit comes out each time, then one of the things that could that is constipation, even if they have a nice big bowel movement everyday. Because again remember, if they get one out but they could have gotten three out, it's going back up and they can still be constipated. Diabetes can also cause frequent urination. Although a lot of times then their bladder really does fill up, so they pee frequently and they urinate quite a bit. But when you have a kid who is going to the bathroom with pee frequently during the day, certainly checking it for sugar in the urine is an important part of the work up. So again we're just talking about the stuff for informational purposes. If your child has any of these symptoms, you want to go and see your doctor.
0:14:02.2
Another possible symptom with constipation is urinary tract infections especially in girls. And this is because in girls, skin and stool bacteria often make their way into the bladder because the urethra is so short. So it's really easy for skin bacteria to get up into the bladder. But they don't get urinary tract infections because the active peeing basically flushes the bacteria out. But if you have a situation where the intestines are pushing on the bladder and the bladder squeezes, when you pee that way, often times you don't empty the bladder completely. And the reason is that when your bladder fills with urine, it basically becomes full and stretched. And then when you pee it basically pushes down and you're able to get all the urine out. But if the bladder didn't have a chance to stretch all the way, then when it does clamp down and the urine comes out, not all of it may come out. So what you end up doing is having, even though you're peeing frequently in small amounts, you end up with some urine that’s just staying up in the bladder. And so you're not really flushing the bacteria out. So you have this constant residual of urine in the bladder. And then the bacteria that have gotten up there are able to stay and reproduce and then that can lead to urinary tract infections. So constipation can lead to frequent urination and urinary tract infections especially in girls.
0:15:35.0
The next very common symptom of constipation, this is going to really freak you out OK? Diarrhea, I'm serious. Constipation can easily lead to diarrhea. How in the world does this happen? And a lot of parents have trouble understanding this and it kind of look like you like where did you go to medical school? How is it possible? Keep following me here and you'll see that it actually makes sense. If the intestines are so full of stool that there's little room to make new poop, then the liquid products of digestion that make their way to the large intestine have no room to form a proper turd. There's no room, so that liquid waste slides around the massive stool that's in the intestine and then it exits the body as liquid waste which is diarrhea. So a child who is severely constipated often times will have quite loose bowel movements.
0:16:37.9
In the earlier stages of constipation often times it is hard irregular bowel movements, like parents think about when use the word constipation. But usually it will progress to the point where its a liquidy stool. Now this is where encopresis steps in. And basically encopresis is having bowel movement accidents in the pants in a kid who is previously potty trained. And you can see how this happens if this liquid loose stuff that can't form into a proper turd comes slipping out. Over time, kids sort to lose the awareness and the signal cues that this stuff is coming and it just slips out into their pants. And that's how the encopresis comes about. And often times, the vast majority of time when you get rid of the constipation, then the leakage, you'll have the enough room to make proper bowel movements and you will not have this liquid stuff that's slipping out in the pants. They key to preventing the encopresis and the loose stool with constipation is to keep things moving through the intestine. OK before we talk about how you treat it; let's look at what causes the bowels to get backed up with stool in the first place.
0:17:54.2
I think probably one of the biggest things is going to be heredity. Constipation definitely runs in the families. And it usually takes people asking about it before you figure this out. Because let's face it, you go to a family reunion, people are hanging around the table talking about their constipation and what they take for it. But if you start asking around if constipation does run, and you have that problem with your kids, if you did ask a lot of your relatives you would find that it's very common in the family. So some guts just tend to develop constipation more easily than others. So if you take someone who's prone to this and you give them a diet that's sort of lacking in fiber and lacking in the type of sugars and fruits that don't break down very easily, and we talked about this a little bit when we talked about baby poop. If you have a kid who's not eating a lot of fruit, they're not eating a lot of high-fiber bulk kind of foods, then that's going to make it more likely that they'll get constipated.
0:18:57.6
The other issue then if you into account their diet, the hereditary component of it and then you add in to the fact that they hold their bowel movements for whatever reason. And there could be several reasons why they hold it and don't really want to go. One could be pain, if they're having large, infrequent bowel movements that are difficult to pass sort of in the earlier stages of constipation, they learn that it hurts to poop and they hold it. And you know if you hold it long enough, the feeling goes away and then they're able to avoid going to the bathroom and having this pain.
0:19:34.5
Another reason for holding it is just basically not wanting to go in a public bathroom and we find this very frequently in school kids where they'll have to go to the bathroom, but when they feel urge to have a bowel movement there at school and they don't want to disrupt the class, they don't want to make a scene by going up to the teacher and having to leave and then they're gone for a long time. And everybody knows they were gone too long to pee. So you know it's sort of embarrassing or they just don't like going in this public place and no one's there to help them wipe, especially if it's a young elementary school age. 'Cause we all know five and six year olds still want you to wipe their butt and sometimes older. So anyway, holding it back at school is another reason ‘cause then by the time they get home, they don't have to go anymore and they kind of forget about it. And then it's the next day at school when they feel like to go again, and next thing you know they've gone four or five days and haven't had a bowel movement at all and things are starting to back up.
0:20:30.1
In the younger kids who are more like preschool age, a lot of times they get so busy playing, that basically the same thing happens. Except now instead of it being that they are afraid of the pain or they are afraid to go on a public bathroom, they just are afraid to stop playing. Not really afraid, but you know what I'm saying. They're having fun playing. They don't want to interrupt what they're doing and so they hold it and the feeling goes away and they keep on playing.
So if you take a combination of all these things, holding it back, not wanting to go, the heredity of it, and a diet that is lacking in fiber and fruits, then this basically is the combination that causes most cases of functional constipation.
0:21:11.2
If your child does have constipation issues, it is important to see your doctor because there are some serious conditions that can show up as constipation. I'm going to talk very briefly about two of those. One would be a tethered spinal cord. This is not very common but it is one of the things you have to think about in a kid who has chronic constipation problems. And what a tethered spinal cord is, is it's a developmental issue where the end of the spinal cord is sort of trapped at the very bottom, so that as a kid grows the spinal cord actually starts to get stretched. And this is one reasons that doctors during a physical exam in babies look at the lower back in the middle and you're looking for dimples or pits that seem deep or if they have any hemangiomas which is a little scattering of red dots in that area. Those are all things that can be associated with a tethered cord and there are some studies that can be done through radiology type studies to look to see if a child has that.
0:22:15.1
So if you have a kid who has constipation issues, it is a good idea just to look at their lower back and if there's any dimpling or pits or red speckled marks or birthmarks in the middle of the lower back, make sure you let your doctor know about that. 'Cause it may be worthwhile to do an MRI which is the best way to see a tethered cord. And again those are unusual. That is usually not the cause of constipation but it's something that needs to be considered.
Another one is Hirschsprung's disease. And this one is, most muscles are relaxed in their normal state and then when you consciously move the muscle you make it contract. The opposite is true for the muscle that is in the anus. So normally it's closed and then you have to sort of concentrate to make it relax. That involves nerve input and in Hirschsprung's disease, kids are born with the anal sphincter that valved the anus, it will not relax very easily because the nerves don't go to it properly and then that can cause constipation. This is usually diagnosed in infancy, and again this is another reason why your doctor needs to examine a child who's constipated to make sure that that's not happening.
0:23:31.3
But it most cases constipation is just functional. It's not related to any of these rare conditions.
Let's say you see your doctor for constipation and they do the history and physical, they do rectal exam, the tone is normal the rest of the exam is normal, perhaps they get an abdominal film and it shows that the intestine is full of poop. Although, you don't have to do that to diagnose it. But sometimes if there's a question in your mind, that may be helpful. Or you might get an abdominal CAT scan or an MRI. Abdominal CAT scan, if you're worried of appendicitis, if it's severe cramping. Also that can show kidney stones which again, these are unusual things that will cause belly aches in kids, but things that your doctors is going to be thinking about in wanting to rule out.
0:24:18.3
Let's say that after the work up, they decide yeap it's functional constipation. Just run of the mill constipation. What do you do about it? Well the first treatment if a kid will tolerate it, is to change their diet. Now most of the time this doesn't work. And it doesn't work because it's hard to change a kid's diet. But if you can, if your kid will increase the amount of fiber that they eat, often times that will take care of it. A big bowl of Raisin Bran every morning would really help lots of constipated kids. But the key is to try to get your kids to eat a big bowl of Raisin Bran in the morning. It's difficult to do. The Metamucils and FiberCons and those kinds of things, those work well for adults and probably they're fine for older kids as well. I wouldn't recommend Metamucil for little kids because you got to gulp that stuff down or it starts to clump up. It's just so quickly, it doesn't stay mixed in very long and then there have been some instances where kids have choked on that clumped material because they didn't drink it down fast enough.
0:25:21.2
Those kinds of fiber supplements don't usually work very well. I find Raisin Bran works really well in a lot of kids, but again the key is to try to get them to eat it. Another thing you can do is increase fruits and fruit juices. Prune juice is probably the best and it's because it has sugars in it that are not broken down very easily in the intestine. Those sugars make their way down to the large intestine and then by osmosis water goes into the bowel and acts as a stool softener. Apple juice does the same thing although it's not quite as strong as prune juice. White grape juice does not work very well. The sugars that are in white grape juice tend to digest pretty easily and get absorbed so that does not help with constipation nearly as much as prune juice and the apple juice.
0:26:08.5
In terms of the hereditary component of it, nothing you can do to treat that, just have to be aware that you're going to be more to constipation if that runs in your family.
Then the issues with holding it back because they're afraid to go or because of school, those kind of things. For the school issue, what you can do is have your child sit on the toilet for five or ten minutes before they go to school every morning and just sort of push. But if they don't go, that's fine. And then have them do it again as soon as they get home from school. And eventually what'll start to happen is that they'll go at that time. And even though they didn't have to go initially, if they can get their body used to trying at that time, once they are able to go, a lot of times they can then get themselves in to a pattern of going at the same time everyday. A lot of moms and dads out there all know what I'm talking about. They may not have the feeling that they have to go but you want to have them sit on the toilet and just try. And eventually they'll have a time when they do go and if they get on a pattern where they're used to sitting down and trying at a certain time, they may be able to sort of train their bowels when they're going to go the bathroom and then they can avoid going at school, if that's something that they don't want to do.
0:27:26.0
It's a little bit more difficult to get younger kids who are playing and don't want to interrupt what they're doing to go. And one thing I find that helps with that is a sort of a sticker chart system. And when we get into some more behavioral episodes and topics, then we'll talk more about this. Just in a nutshell, what you could do is to tell a younger kid who you're having some trouble with them going to the bathroom is to say, "look, if you sit on the toilet for five or ten minutes, you don't have to go, but you just have to sit there and try," at a certain time of the day, "then when you're done sitting there then you can put a sticker on your sticker chart." So it's something fun that they get to do something because they sat there. It's bribery, it's what it is but that's OK. My wife and I used to joke when our kids were toddlers. Our lives were basically, lives, bribes, and threats. This goes into the bribe category.
0:28:24.0
Then what you can do is once you got them to the point where they associate getting to put a sticker on their little start with sitting on the toilet. Then you can make it a little more difficult and say "OK now, you're not going to get the sticker on unless you actually go. So you still have to sit on the toilet a couple of times a day but if you don't go, that's fine. But when you do go, you get to put a sticker on the sticker chart." And then you could start to make up a system where, you have to do something that they can obtain pretty easily in the beginning so that they can see the association. So you could say, "Look, when you get three stickers, then we'll go to the little park that's down the block and you can swing or slide." I'm just using that as an example. It might be a bowl of their favourite ice cream or it might be getting to go to a toy store and picking up something little or going Chuck E. Cheese or something that they can look forward to. And then after they've done three of those, the next time say, "OK now you got to get five stickers, then we're going to have to get ten stickers. When you get ten stickers, then we're going to do this." So you build it up with they have to get sort of longer and longer in terms of how many stickers they've earned before they get the reward. And it has to be a reward that they'll really enjoy. So those are the kind of behavioral modification stuff that you can do to try to encourage them to go to the bathroom.
0:29:47.5
All right, so let's say now that's working. 'Cause it's often the case. A lot of kids, they get backed up and you got to keep them going regularly and even the best efforts of diet and bowel training and behavioral modification stuff just isn't working. Then what you have to do is resort to some medical treatment. Now again this is in consultation with your doctor and I'll just tell you how I handle this. If you have a kid who's really constipated, and we're talking especially if they have encopresis and the liquidy stool, if it's got to that point. A lot of times the thing that you're going to have to do is clean them out from below. And that includes either doing enemas or suppositories. And there's prescription ones that can be used. Always consult your doctor first with this because there are some enemas that can be dangerous for some kids. And you really want your doctor's advice when you're doing this.
0:30:38.3
Personally I like to try suppositories first, but you know I'm just not an enema guy, I don't know. That's like the last resort. You know what I'm saying? Those are some things you can do to try to clean things out from below. But then what's going to be most important is to keep them regular by giving them stool softener by mouth to help keep things going. And the couple popular ones are Lactulose and Miralax. Basically what these types of medicines do, is they provide particles that don't get broken down by the gut very well or absorbed. So they get down to the large intestine. The large intestine, the inner lining of it is a semi-permeable membrane, if you remember from high school science class, so water is going to move from where there's less particles to where there's more particles. And if you get a whole bunch of undigested particles that get down to the last intestine, your body naturally is going to have water go into the stool and loosen it up.
0:31:37.9
These are really non-addicting stool softeners. The older medicines like the old Ex Lax, they actually had a component in those that worked on the muscle and the intestine to help move things through a little bit faster. And those could become addicting. But the stool softeners that simply increase the water component in the stool are not addicting and they're very safe to use even over a long period of time. When I say over a long period of time, this is probably the biggest issue with treating constipation. This is the problem that I see far more often than any other thing. And that is that you have a kid who's having either hard infrequent bowel movements or they're having liquidy stool or they're having encopresis. And what happens is you start them on these medicines and things get better. And it's human nature when things are better, you think does my kid really need this anymore? So at some point you start slacking off on giving it to him and then there's no bad result.
0:32:40.2
You were giving him; let's say the Miralax which is a powder. You scoop it, put it in some liquid; water, milk, juice whatever and you stop doing that for a few days and they don't have a problem. The constipation doesn't come back, there's no more of the accidents, there's no encopresis. And so you get this false sense of security that your kid doesn't need these medicines anymore. And everything usually does go fine because it usually takes about four to six weeks before the bowel fills back up again and then you're right back to square one. Really in my opinion, you're better off just continuing for a long period of time, rather than doing it until they're better and then you do it for a couple of months, then you stop it then things are fine for six weeks and now you're having accidents again. I think you're better off just keeping them on it over the long haul.
0:33:31.0
How long do you have to do it? Well you know constipation, it's really for most kids, it's a lifelong problem and kids who have constipation issues are probably going to turn into teenagers who have constipation issues and then turn into adults who have the same problem. That doesn't necessarily mean that they'll need the medicine for their whole life. Once they get to the age where they can change their diet, a lot of times they'll be able to control it that way. So if you have a toddler who is on Miralax, by the time they get to be nine or ten years old, they might be able to eat big bowl of Raisin Bran every morning. And by that time they're going to be able to gulp down the Metamucil and not choke on it. So as they get older sometimes you can sort of start to switch over to more of a dietary treatment, but then sometimes you can't and you have to leave them on to these medicines even longer. But like I said they generally are very safe to use and not really addicting to the bowel like the older medicines that we used to use were.
0:34:32.0
Probably the number one prescribed stool oftener that's out there right now is probably Miralax. And I'm sure there are a lot of parents listening to this podcast whose kids are taking that. It is a good medicine, been around for a long time, very safe to use over a long period time. I'm in a unique place because we're close to Columbus Children's Hospital, Dayton Children's, Cincinnati Children’s, a lot of children's hospitals in Ohio. Akron has one, Youngstown has one, Cleveland has one, Toledo has one. So there's a lot of children's hospitals. Where I am, when we have to refer to a GI specialist to mostly Dayton or Columbus and then also sometimes to Cincinnati. And I know the GI specialist there use Miralax quite a bit.
0:35:21.2
So hopefully that answered most of the questions about constipation and encopresis. But if there's something that we didn't cover or there's something that's on your mind, feel free to contact me through PediaCast.org. You can use the Contact Page. You can e-mail me at mike@pediacast.org or again use the Skype line and we'll have that number again in the show notes. And also I listened to Podcast 411 with Rob. And he makes a good point, I probably should start to put that phone number in my title in my Meditags and I think I'll start doing that. That's a great idea. Hadn't really thought about it before.
All right, well we're going to move on into a different arena so to speak here, and I want to talk abut a little bit about Grey's Anatomy. And we'll get into that in just a second.
0:36:12.7
Announcer 3: Hey. This is Craig Patchett from the What's On podcast and you're listening to my favourite Tripod Network show PediaCast. I'm here at the fabulous Tripod Lounge after recording the latest edition of What's On, where I showcase highlights from the outstanding shows that make up the Tripod Network. And I have to tell you that it's always a thrill to play a clip from PediaCast. So join me at WhatsOnpodcast.com for the best of the best and show your support for great shows like this. By the way, I hope this promo ends the rumors once and for all that I'm too busy to focus on each individual show. That's entirely not true and I'm personally insulted by the accusation. Now back to your host or hosts, Dr. Mike.
0:37:02.6
[Music]
Dr. Mike Patrick: All right. So what is my deal with Grey's Anatomy? First I want to say that I don't watch a lot of network television. There's just a very small handful of shows that my wife and I watch and Grey's Anatomy is one of them. Grey's Anatomy and Lost are probably my two favourite shows that are on TV. But Grey's Anatomy, basically in my opinion, there's two parts to a good medical show. You got your personal drama, and then you've got the medical sort of component of it. And probably the series in recent times that sort of mixed the two of those in a very realistic in such a way that you really felt a part of the show was probably the early seasons of ER.
0:38:18.5
Back when Dr. Greene was there and George Clooney's character; I just can't remember his name on the top of my head. But you know who I'm talking about back then. The medical part of ER is always been fantastic, very realistic. And the personal drama, maybe in ER it was a little bit over the edge. I mean it was always big time topics such as life threatening cancers and HIV and these kind of things. But the medical part of it was definitely very realistic.
0:38:49.4
Grey's Anatomy, I find the personal drama and the interrelationships between the characters is really very realistic. Having gone to medical school and been involved in, not a surgical residency but even in pediatrics, you certainly interact with folks from all different sorts of residence and they really do have the whole surgeon temperament down. The sort of interpersonal relationships that happen in the show are very real, I think.
The medical aspect of Grey's Anatomy though is just as extremely lacking and I think the fall of this lies on the medical consultants that they use. And for the most part, I'm talking about little things that would be inexpensive to fix, but I think would just make the show so much better if you could sort of put the interpersonal relationships in the setting of a realistic medical backdrop. It really would just turn it from a good show into a great show.
0:39:56.0
They did win one Emmy last year for their casting and certainly they got a great group of characters there. I think their casting is just excellent. They play off one another very well. But I think in order for it to get an Emmy for like Best Television Drama, they just are going to have to make the medical part of it more realistic. 'Cause there are lot of doctors and nurses out there and people involved in the medical field in one way or another, they notice these things.
0:40:27.8
Let me just give you a couple examples from these past week. And then what I'm going to do is each week as I see something on Grey's Anatomy that's glaring, we'll just to take a quick second to talk about it and hopefully we'll get someone's attention at some point. Again I think the medical consultants are really the ones who are at fault here. I mean they probably just rubber stamped the scripts. And they really need to make their voices heard because a lot of these things could be fixed very easily and not cost a lot of money and not take away from the story line either.
0:40:56.3
So from this last week there was an emergency C-section with a woman who had a double uterus and they were being very careful 'cause the babies had different fathers and they were conceived at different times. And one of them was close to being term the other one wasn't quite done yet. And the emergency C-section was just for one of the babies and they didn't want to disrupt the other uterus. So they did this emergency C-section procedure and Alex was in the room and they had to hold one of the uteruses still while they got the baby that was further long out.
Well this mom, she's laying there opened up with two uteruses, this is a complicated surgery and they show her out. Her eyes are closed and she's got a silly nasal cannula in. You know in her nose that little prongs? What's with that? This mom would have been intubated. There's no question, she would have a breathing tube down her throat and she would have been out with general anesthesia.
0:41:57.7
If I'm wrong with that, if there's an obstetrician out there that would do a double uterus, this is surgery where they're taking one baby out and leaving one baby in. This is complicated stuff. And if you ask me, mom would have been intubated. You know, how hard is it to put a tube in her mouth than sieve a nasal cannula in her nose? But to me, it ruined the scene. I'm watching this lady on the operating table with a nasal cannula and then I'm thinking "put a tube down her throat."
0:42:29.4
Now the other thing is the baby that was left behind so to speak in this scene, started to have distress of its own and was dropping its heart rate. And then Alex started talking to the baby and then everything was fine. That's just craziness. I mean that is just craziness. Babies drop their heart rates for a reason, not just because they're being moved around a little bit or because they're upset. If you think about it there are pregnant women go jogging, they ride bikes, they're in cars. I mean babies get jostled around inside mom. You know what would make a baby drop their heart rate is if it had a compromise in its oxygenation or blood supply through the placenta. Now that would make a baby start to have a problem and talking to the baby is not going to correct on oxygenation or a blood flow issue.
0:43:22.8
But what they could have done, because I do think that Alex talking to the baby was an important part of the plot and character development, what they could have done is just in the background had whatever was really making the baby better. They could say increase the amount of oxygen that the mom's getting or they could have had some sort of manipulation of the uterus because the baby was like compressing the cord. They could have done something in the background so that the audience could see that's what really did it. That's what really made the baby get better but Alex was still showing his sensitive side by talking to the baby. But to insinuate that Alex talking to the baby is what made the baby come out of its little fetal distress episode, I just had to roll my eyes.
0:44:16.7
And the only reason I bring this up is 'cause every week, there's like two or three little things that are just so unrealistic from the medical aspect of it. And I know for most people out there who are watching it, you are watching it for the interpersonal relationships and the whole drama of it, and that’s fine. It's a great show because of that but it would be so much better if all of that interpersonal stuff was in the setting of realistic medical conditions so to speak.
So if anyone out there knows any one of the production staff and they need a better medical consultant for Grey's Anatomy, I am available and all they have to do is e-mail me at mike@pediacast.org and I'd be happy to glance over the scripts and tell you what you need to do.
0:45:03.3
All right, I think we need to wrap this show up. I said 20 minutes and I know I'm well passed that but you know you get me talking and I just have trouble shutting up. All right, well we won't play any music this week though. So I'd like to thank all my listeners. We really had a lot of e-mail this last week with the questions for next week's episode. And I've also just had some really nice comments about the program. And I just thank all of you for taking the time out of your day to listen. I hope you're getting something out of PediaCast, both information and a little entertainment as well. I'd also like to thank all of the new listeners that are here. And if you do go back and listen to some of the past episodes PediaCast, just bear with me that there is a learning curb to all this. So some of the earlier ones weren't quite, not that these are necessarily great, but they were worse quite in the beginning. So you have to just sort of put up with me there.
0:45:56.8
I'd also like to thank my family; Karen, Katie and Nick for allowing me to do this and giving me the time that I need to put together a podcast with the kind of frequency that I've been doing. So thanks go out to them. Also I'd like to thank Vladstudio.com for letting us use artwork on the website, that's appreciated. And once again remember you can submit a question or comment. You can view the show note, sign up for a newsletter, and read the blog. All of those things at PediaCast.org. And if you like PediaCast, please tell spread the word by telling your friends, relatives, and neighbors about our program. You can download free promotional materials on the poster page of our website. And of course reviews in iTunes are also most helpful, also votes at Podcast Alley and Podcast Pickle are also appreciated as well.
0:46:46.0
So until next time. And next time by the way, will be diarrhea and loose stool, especially in toddlers, they get this sort of constant loose stool syndromes that we see pretty frequently. That's what we're going to talk about on our next short episode and then next week we'll do the longer listener mail kind of stuff. So until next time, this is Dr. Mike saying, "stay safe, stay healthy, and stay involved with your kids." So long everybody.
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0:47:34.8
Announcer 2: The Tripod Network. What's On.
