Insurance, Constipation, and Circumcision – PediaCast 021

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Topics

• Medical Insurance
• Constipation
• Circumcision

Transcription

Announcer: This is PediaCast.

You're listening to the tripod network. What's on?

[Music]

Announcer: Hello moms, dads, grand moms, grandpas, aunts and uncles and anyone else who looks after kids. Welcome to this week's episode of PediaCast, the pediatric podcast for parents. And now, direct from Bird House Studios here's your host, Dr. Mike Patrick Jr.

0:00:43

Dr. Mike Patrick: Hi everyone this is Dr. Mike coming to you from Bird House Studio and I'd like to welcome everyone to the program this week. It's episode number 21 and we're going to be talking about medical insurance, also have some comments on constipation and Encopresis to share with you. And then we're going to wrap things up and talk about circumcision at the end of the program. I'd like to remind you that if you would like to ask a question on PediaCast, all you have to do is go to the website at pediacast.org and click on the contact link and you can ask your question that way. Also you can also email me at mike@pediacast.org or you can call the Skype line at 347404KIDS, that's 34740 K-I-D-S. Now a little disclaimer right here at the beginning, if you've been following along PediaCast last couple of episodes you know that I've recorded 3 or 4 episodes and sort of a, what do I want to say, a marathon kind of night here. I'm just getting, through all of the questions and trying to get all of the answers and going to get caught up plus I'm going to be on vacation for a couple of weeks.

0:0:53

And I wanted to have material for everybody but I do have a cold. I got a scratchy throat, so I'm going to be clearing my throat. I might pause for some sips of a diet coke but I really don't have time to do post production for a couple of episodes here because of this trip that's coming up and my own procrastination. I'm sure that you can understand that so just bare with me please. And I promise that once we get into middle, the late December, I'll be back, do them every week and I won't have to, you won't have to put up on post production things.

0:02:32

Before we get started, I do want to mention one thing, as listening to a red boy podcast. Red boy is one of the great tripod network shows and if you want to find their show you can go to trypodnetwork.com, try is with a Y and click on the link that shows all the shows that you can get to the Red Boy Podcast that way. It's a great podcast and my wife emailed them and they were kind enough to read the email on their podcast.

0:03:04

And she mentioned that we've been on 8 Disney cruises, now I just want to point out here to everyone, very quickly, in case any of you heard that. We are not rich snobs you know pediatricians like you know we're like the bottom feeders in the medical world you know what I'm saying. We don't make a ton of money and you know our malpractice insurance is high and my medical school loans are out of this world, still a lot of money to pay back.

0:03:35

And so I mentioned these things because you know they hear oh they've been on 8 cruises I mean and it sounds like you know we're snobs but trust me folks we're on a budget just like everybody else. You have to realize first of all these 8 cruises were over several years you know and it's not like we're taking 8 cruises in the last 2 years. Disney cruise lines has been around for a little while now and also they are not all 1 week cruises you know there are some 3 days, once in there, there's some 4-day cruises. Yeah there are a couple of weeks once and there's other 10-day one.

0:04:08

But look folks, you know we also conserve our money in other places and save just like everybody else does so I don't know sounds like a snobbish I can't believe I've been actually on 8 cruises but you know the food is just wonderful. So anyways, I felt the need to talk about that in case everybody is over listening to Red Boy and they think oh my goodness 8 cruises? The other thing you have to keep in mind is that I do write a weekly column on the Dis board which is at wdwd.info.com. WDWD as in Walt Disney World info.com. It's the largest online community of Disney fanatics you could say. Big bulletin board, they also have the largest unofficial guide to Disney that's online.

0:05:05

Pretty big site and I write a weekly column on there called Mouse Matters so we go to Disney a lot. In fact, just listening to this podcast at Disney world at the, you know because I'm doing this before we leave. But we own a little Disney on vacation and some club so we do spend a little some time there but you know the way I look at it they're business trips. You know I need material for the column so we got to go to the park. You got to try the restaurants, and you got to know the ins and outs of the cruise line so that I can be a realistic columnist.

0:05:40

Okay I'm sorry I know I'm going on and on over this. We only take vacations a couple of times a year. So anyway we're not snobs really, we're on a budget and pediatricians don't make a ton on a money trust me. Okay, so let's go ahead and move on to the program. I 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.

0:06:21

Okay our first question is really I guess is more of a comment and I'm going to make some comments based on this. Hi Dr. Mike, this is from Megan. This is technically not a medical question but at the same time it's one of the most important issues in medicine. I would love to hear you comments about health insurance, specifically how to find insurance a middle income family can afford. My husband and I recently switched roles. He was a stay at home parent-free for a year and now a I am back home with the kids. Insurance became a big problem because his new company did not allow him to have company insurance for 6 months. We considered cobra but on one income in Orange County California it was not possible to make mortgage and pay for cobra insurance. We did finally find coverage for our kids but it wasn't easy and it took a lot of research to find something even close to affordable to the pre-existing conditions. I still haven't found coverage for my husband and I. I know this isn't your area of expertise so maybe this would make a good topic for an interview episode instead of the question show. Thanks, Megan.

0:07:29

Well thanks for your comments and questions Megan. It is a good question for the interview, an interview episode that I do have planned coming up but it's going to be several weeks. I can go ahead and share my comments with you or my feelings on this. You know this is really tough thing because medical care has become just so expensive. There are so many factors involved with this. It's not a simple thing at all. So when you look at this how can we make health care more affordable? It's really a political issue and it is something that it's going to take a lot of cooperation and compromise and people come in together to figure this thing out.

0:08:18

One of the problems that you run into is it is expensive to practice medicine when you are forced to practice defensive medicine and the attorneys and the malpractice law suits that are out there are really one of the major issues in terms of increasing the cost of medicine. Now I am not saying that that is wrong because if you have a kid who has a disease that was found early and treated because the doctor did not think that that disease was happening but because he was practicing defensive medicine and you know the back of his mind he's thinking, Oh I better check or else I'm going to be sued if I don't and you find something. Well for that parent there's no question the world that all these law suits and the fear of being sued made a difference for your child.

0:09:18
And I don't think that if you've experienced that that you're going to be very open to less litigation and more protection in terms of the legal field. So on the other hand, there is just you know millions and millions and millions of dollars wasted every year and tests that are done unnecessarily where you know it was sort of a really farfetched problem, not problem but well I'm really may have to edit this one. You know the chances that whatever you're thinking is happening which is so slim but you win ahead and did it. And even though deep down you knew that that tests was going to be negative, or that MRI or that EEG, or the consult you know to the third surgeon whatever it is. You know as a doctor you know what the answers going to be. You'll be extremely surprised or something that came up on it.

0:10:30

And if you allowed doctors to use their judgment and they didn't have fear that their judgment was going to be wrong even if it is a tiny bit wrong you would cut the cost of medicine way, way down. Now the problem with that is if you cut the cost of medicine way, way down and these companies are not making the money out of the tests that they've developed then they don't have the capital to develop new tests and this comes in the play too with a lot of pharmaceutical companies. You know these drugs just seem so expensive and yet they use the money for the current drugs to help support the research for future drugs.

0:11:15

Now obviously there's waste in the system although I think that's becoming less so you used to be pharmaceutical company would wind and dine doctors and take them you know to football games and sporting events and vacations then none of that really happens anymore. In fact it's rare to see an ink pen in our office with a drug name on it anymore. I mean yeah they're there but for the most part drug reps who come into really good educational presentations and yeah they bring lunch with them and we do it over lunch but that's because there's really not a lot of time otherwise during the day to do it.

0:11:52

We're seeing patients from early morning until very late in the afternoon or early evening. So I think that that is being addressed and there's less waste there. Obviously there's going to be suits you know higher from the company whose income you know is way more than it needs to be. But on the other hand, you know these guys who get the high amount of money, they are doing a lot of work to get their name out there and the advertiser drug, and so that they could sold more and then selling that drug more gives them more capital to be able to make new drugs.

0:12:28

So you know, with all of these things you could pick a side for and against really make a compelling argument you know I can make an argument for why the malpractice needs to decrease and I can you know, the claims and the law suits that are out there and then there's so much defensive medicine practice. Because of that they could argue that way and they could also argue it from the lawyer's perspective and there is something to be said for keeping doctors on their toes. And if again if you're a parent who had a kid who you know, basically their life was saved because the doctor is practicing the defense of medicine then for you it's definitely worth it.

0:13:10

Now with all this talk, I do know with the new congress that's going to be coming again there's more lot of democrats obviously in the congress. And Hilary, I know she said something about you know, we're not done talking about this health care issue and wow national health care plan and coverage sounds like a great idea and would definitely free people up from having to work. Because, just because of health insurance you know, we go fishing up in Canada for Salmon every year. I go up there every year with my father in law and my brother in law.

0:13:46

And so we spend some time up in Canada and talk the folks up there and the guy who does the fishing charters on Lake Ontario grant great guy fishing Niagara, it's the name of the business Sport Fishing Niagara. If you ever interested in going Salmon fishing on Lake Ontario he's a wonderful guy. But anyway you know, he's a talked very bluntly about the health care situation in Canada that is really, you know there's waiting list to get in for surgeries, there are medicines that they can't get a hold of.

0:14:17

He knows people who come to the United States for their medical care and don't even use the free medical care that they have in Canada and actually from some things I've heard that the system is on the verge of collapse. So you know I think there's going to be lessons here for good people to go in to medicine if doctor's salaries are majorly cut because of a national health care plan. And then you've got some people who are proponents of having a national health care plan that covers children and not adults but I can tell you there'll be a lot less people going in to pediatrics if the paychecks are dependent upon the government where in the adult medicine they're not.

0:14:58

And so you're going to have people who are, you're not just going to have this quality of people who are going into it. It's really not an easy thing and I know I wish I had the answers but I don't. I think again it's going to take a lot of people coming together from both political parties and compromise, and the lawyers are going to have to help out. You know some people have proposed for the malpractice thing to have instead of a jury decide have a group of legal experts and physicians and maybe have a lay people on these panels that would decide malpractice which is some other countries handle it. Where you do, it's not just a jury where or just playing the motions coming but it's actually a group of qualified individuals from the legal field, from the medical field.

0:15:50

And then just from the patient and parent perspective who get their brains together to decide what kind of restitution should be made rather than in the jury because you do get this multimillion dollar claims just are/or judgments that are just outrageous for what happened. You know if a baseball player bats or gets a hit of the third of the time, it's wonderful but you know doctor makes a one mistake out of you know, one thousand patients in counters and it's your kid and you know you just think this doctor is terrible. And you just you hate him, and you want to sue him and you want as much money as you could get because of the damage onto your child.

0:16:38

And as a parent talking I can understand that but from the doctor's point of view you know you won't make mistake out of a thousand patient visits and your name's mud. It's just you know it's really, it's sad a lot of it is because of our expectations and with the legal field so alright I know I kind of went on and on there and I apologize or maybe well I have a good interview episode and discuss that at some point in the future.

0:17:07

Okay, moving on let me take a sip of diet coke here real quick with my whistle. Okay again better post production coming up here soon. And the question no. 2 or comment number 2. This is in relation to the one that we talked about constipation and I talked about motivating kids to go to sit on the toilet and we talked about sticker charts. This comes from Brenda. She says the sticker chart may work for some children but some children refused to be motivated. That is true.

0:17:41

Our pediatrician put our son into Miralax which he took for over a year without much improvement if any. We took him into psychologist to see if there were issues to which we were oblivious to find nothing other than perhaps a strong-willed child. We discovered after my husband tried to use Miralax to encourage or soften a bowel movement after he had hernia surgery that caused some GI distrust and pain, and this made us wonder if our son was having the same discomfort. After one really rough weekend with several suppositories and minimal success, our pediatrician referred us to a pediatric GI specialist at Riley Hospital in the Annapolis.

0:18:23

The specialist found nothing in his initial evaluation that would suggest medical issues. He also couldn't believe our treatment had never included mineral oil. He started my son at that time 4 and a half on mineral oil explaining that there would be oily discharge in his under pants for a few weeks. The oil would prevent the child from holding a bowel movement. The therapy also had you putting the child's stool, the stool after every meal for 5 minutes. The treatment goes half a bowel movement at the same time every day. Our pediatrician also suggested having our son blow while he was trying to have LBM. It didn't matter what he was blowing but that it is impossible to tighten his muscle and blow out. Again, I love my job. Balloons work best although I used a blow-out toy to get at a birthday party. And also blowing Dixie cups off of the book and blowing bubbles. Needless to say within a couple of weeks we were in poop heaven, and haven't had issues since. Keep up the podcast I enjoy listening, Brenda.

0:19:29

Well thanks for your comment Brenda. You know it is true that from Mira lax there are some kids who can and some folks who can have discomfort and cramping when they have it especially if they're really bad up and have a lot of stool and you're adding water and their loosening up those bowel movements you can't just get some cramping. Once you get the GI tire cleared out and you're on a maintenance to also the Miralax to just you know small amount daily just to keep things going usually those cramps go away. We used to use a lot more mineral oil and I still do use it from time to time when we talked about constipation I did sort of ignore it.

0:20:06

I guess that's because of you know and again you get that oily discharge in the under pants for a few weeks. That's kind of an obstacle for a lot of people to using it. But you do make a good point that for some kids that does work really well in terms of getting them trained back. So I appreciate your comments Brenda. Thank you very much! And for folks out there who are dealing with constipation if you've tried Miralax, and you've tried some other things and things aren't working out you might want to suggest to your doctor, hey what about that mineral oil. It's a little old fashion but there's definitely a place for it.

0:20:41

Okay in keeping with our constipation and Encopresis theme here, I want to move on to Adina from Boston. She says Hi Dr. Mike, I heard about your show from the Manic Mommies, thanks Erin and Kristin, appreciate it. I've been enjoying the past few episodes. Poop is a topic. We spent a lot of time thinking about in our house as our 7-year old son has Encopresis I really appreciate your calm and humorous approach to discussing this stressful issue.

0:21:12

I think it's especially important for your listeners to know that kids may need to be on stool softeners for about a long time she stated since constipation Encopresis tend to be long term problems and usually are resolved in a short period of time. Also I think it would be useful to tell people that there's a spectrum of severity of Encopresis from kids that have an occasional toiling to kids who are really afraid to poop due to experience with pain. And some who actually don't even know how to poop in the toilet also to remind people that there is help available for super severe cases.

0:21:48

For example, at Children's hospital in Boston, there is a potty school program that helps kids understand what is going on with their body and simultaneously helps the parents with the behavioral plan. I'm sure other children's hospitals have similar programs. You know actually I don't think that children's hospitals in my area have that kind of program. I think that's a great idea though.

0:22:12

So if anybody out there is listening from Columbus Children's Hospital, Dayton Children's Hospital, Cincinnati Children's Hospital, you know the Ohio children's hospitals. Hey guys Boston has a potty school, you may need to get on the ball here and to find out what that is all about because that sounds a great idea. My having a trouble getting insurance to pay for it and parents, a lot of times don't like this show up money but hey maybe get a grant or something or get a program that started.

0:22:40

I think it's a great idea. I'm sorry Adina goes to say there's a useful discussion board at www.aboutencopresis.com and put a link to that to the show notes. She goes on to say we've been dealing with this issue for 3 or 4 years now. And it really takes a lot of patience. It is a constant struggle to get our son to use the potty appropriately and it is a daily issue for us. Even though he was doing better than he was before parents need to know that this can be a stressful family issue and that they can find help on the internet and in medical and psychological settings. Thanks for listening and great job with your show, Adina.

0:23:20

Well thanks Adina for your comments. I'm sure a lot of parents really appreciated hearing that. When one parent who's dealing with this and hears about it from another parent that's called a support group. Hey we got a support group going on here in PediaCast. It's important. It's important to know that you're not the only one dealing with these things.

0:23:37

And so I really appreciate you writing in Adina and thanks for telling us about the potty school and about that website, really do appreciate it.
Okay moving on to our last, oh no way I have one more comment and then we will get into the circumcisions. This is from Jennifer, I'm sorry Jennifer from Shula Montana and she says, Dear Dr. Mike, I have recently found PediaCast and wanted to let you know how much I enjoy your program. Oh thanks Jennifer! It's a very informative, entertaining, I try, and at times humorous. I especially like your no nonsense approach to the issues.

0:24:13

I am a pediatric physical therapist and mom of three and I was definitely hooked after listening to the immunization and autism show. I appreciated your induct discussion of the chemistry and research studies on the subject. Last week, I was preparing to write a comment to ask you to discuss constipation and lone and behold there was a poop episode waiting for me in my inbox. I usually listen to the episodes while working out and it makes the time fly. Thanks again for the great podcast, Jennifer.

0:24:44

Well thank you Jennifer for your nice comments. We really appreciate it. Alright moving on to circumcisions, Laura from Taunton, Massachusetts. All the folks from Massachusetts I'm sure know how to pronounce it. Dear Dr. Mike, I know how much you love controversial topics so I'm not sure if you'd address this one but I'd love to hear how you advice parents on circumcision. We spoke to our pediatrician and did our own research and decided not to circumcise our now 7-month old son.

0:25:17

I'm finding that I'm getting a lot of criticism from family and some friends after the fact. Even though it's not your penis you're talking though about, oh boy. That was my comment by the way. I understand that this is a personal decision for each family. And I don't condemn those who make a different decision but I'd love to hear your take review on the topic. You always present such objective and informative reviews. Thanks for considering my question and many thanks for the wonderful show. Keep up the great work! Your info has made a difference in my ability to feel like an informed parent. I'm very grateful, Laura.

0:25:5

Thanks Laura for your comments and that's what PediaCast was all about is trying to make parents informed by explaining things and I really do appreciate it. In terms of circumcision you know it depends where you go. You know, where I practice I'd say probably 85 to 90% of kids boys are circumcised and probably 10-15% are not.

0:26:19

When you go into areas where there is a bigger diversity in terms of cultural backgrounds. You find it becoming more of a 50-50 kind of mix. So you know I'm sure in the Boston area route in Los Angeles, Chicago, New York City it's going to be lot fewer boys are circumcised. I do find that this usually follows sort of a family pattern you know if dad's circumcised, it's a lot more likely that his sons are going to be circumcised because he wants his kids to be like him.
And parents you know where dads aren't circumcised they're more likely to not want to circumcise their kids so that their kids going to be like dad. And so it tends to follow family patterns and then those family patterns tend to follow cultural patterns. But what about the medical perspective, well from the medical standpoint circumcisions are not necessary.

0:27:12

There is no medical reason to do a circumcision as long as proper care is taught and taken in terms of the uncircumcised penis. So once boys go to puberty and the fore skins starts to be able to separate completely and be pulled back they really need to be shown how to pull it back and to clean properly. Because if you don't clean it and take care of it in the proper fashion, you can have increase risk of infection and also increase in risk of sexually transmitted diseases and increase risk of certain cancers as well.

0:27:57

So definitely, if you don't circumcise your child you want to make sure that from a young age they would learn how to take care of it appropriately. In infants and young children really there's not a lot of care you need to do you just basically you know, let them pee. If you see any discharge coming from the tip, you want to let your doctor know because they can't get infections in there but they're pretty unusual in the younger kids. Also if you have a younger kid and the fore skin does get pulled back and then it's not able to go back over the head of the penis that can cause a problem where the fore skin of the penis itself and then cut off the blood supply to the penis. If the kids pulled back and stuck and so that something you want to seek medical attention for right away if that sort of thing were to happen.

0:28:48

So you don't have to pull it back and clean it and little babies or in younger children but once you've ended teenage years after puberty you do want to make a habit of pulling things and pull it back and cleaning it out. It is a personal decision and I think that if you got a lot of criticism from your family and friends, I would say don't worry about my kids' penis, worry about your own. Because it's a personal decision and it's none of their business. Really, you know it just amazes me that they're really criticizing you whether you got your kids circumcised or not. It's your kid. they have their own kids, and they can decide for them, oh my goodness.

0:29:28

Okay so thanks for your question Laura, really appreciate it. And my voice is getting froggy because I'm fighting this cold and I know it seems like this cold is going on weeks but you got to remember I'm doing a few episodes in one night because of Disney trip, not another cruise. Just a trip to Disney and we're actually taking grandparents with us.

0:29:48

So in fact we're going to be down there 2 weeks and one set of grandparents. My wife's parents are going to be there for the first week and then my dad and his wife are going to be there on the 2nd week. So you know, if you want to call out a vacation, I don't know maybe a more of a vacation coming home. No I'm just teasing, really I am. I get myself into trouble.

0:30:09

Okay, I'd like to thank everybody for listening and all the listeners out there, old and new, appreciate your support. Thanks to my family for letting me do this crazy project vladstudio.com. Vlad is a wonderful ration artist. I would like to thank him for allowing me to use his artwork on the website at pediacast.org and you can see his other artwork at vladstudio.com. Remember you can submit a question or comment, view the show notes, sign up for a news letter and read my blog at pediacast.org.

0:30:40

And also when you go to pediacast.org, if you go to the blog and you notice that I have a really low number of subscribers. I think as I'm recording I think it's like fourteen and something really like low. So if you haven't subscribed to the blog through a feed, you can do that through my Yahoo or Google, really any news aggregator or news reader. You can subscribe and then you'll be counted in that number.

0:31:11

If you just go to the website itself and look at the blog page and read it that way, you are not counted as one of the readers and of course again as I mentioned last week, the account numbers are important in terms of securing a sponsorship for podcast which we are trying to do so that we can do this more often and be able to make a bit of a living off of these things because they just take up a lot of time to put up these things together.

0:31:39

So if you subscribe through a feed with a blog and the same thing with the show, if you're just coming to the website listening at your computer, that's fine. But if you could subscribe through a feed and listen through iTunes which is free software for you to do download and it's got a great podcast directory so that you can find another wonderful podcast as well.

0:32:00

PediaCast is in the kids and family section there so make sure that you can subscribe through a feed so that we can get our numbers up. If you like PediaCast please spread the word by telling your friends, relatives and neighbors about our program. You can download the free promotional materials on the poster page of our website and of course reviews and iTunes are also most helpful.

0:32:22

So until next time, this is Dr. Mike, with the froggy voice and stay safe, stay healthy, get your Christmas shopping done and stay involved with your kids. So on everybody.

[Music]

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