Wednesday, February 18, 2009

What are growing pains?

I remember in residency, when seeing a child for a knee pain or limp and the evaluation was normal, I would usually say "growing pains". The moms and dads would already have heard about the diagnosis but would be at ease when I would agree. I would compare this to seeing a 40 year old male that comes in for left sided chest pain and I clear him of heart disease then say its just "stress". To throw all the potential diagnosis under one obscure title of stress is not acceptable to an intelligent educated american. Same thing with the diagnosis of growing pains. In the case of my nephew who is 6, his doctor said the limping he was suffering from is probably just that. This is probably true but I think an educated parent would like to know a more specific diagnosis. When the knees are painful, we worry about the patella. Sometimes worry about Osgood Schlatter Disease where the thigh muscles (quads) stay tight and the thigh bone (femur) gets longer. This would make the muscle pull at it's insertion points on the knee with more force causing a lump to form.




In some cases, knee pain and a limp at my nephews age could be something worse like Perthes Disease (or at a later age, a SCFE). Both of these are not common but since the results are bad, they have to be considered if limping doesn't go away or gets worse. Little James just started baseball 6 weeks ago which makes me feel better that we have a reason for the pain but I will probably be getting an xrays later. (Don't like the radiation exposure but I'll watch him closely and did ask my cousin to video tape his training next time.)

As my patients know, history is 80% of the diagnosis and I think baseball will be the reason for the pain (overtraining). The Saguil Approach is to start with a working diagnosis, evaluate for abnormality, watch the training pattern, surface and shoe type, consider an xray, rule out groin issues and consider 1-2 weeks off to see the results. I suggested that if it is due to baseball practice, try childrens motrin/advil three times a day the day of and the day after practice. Pain that breaks through that conservative treatment will mean we have a bigger issue to be investigated faster.

To note, if there is no limp and just complaints, may consider "secondary issues" like he doesn't like the sport or the coach, or worse, there's a bully around.

Thursday, February 5, 2009

Does a normal Cholesterol level mean I have no problems with my heart?

Usually in the ER, patients will come in with a high blood pressure reading, slightly overweight and a history of smoking. After I comment about please rechecking this with the primary care doctor, the defensive answer is I just had a normal physical and normal cholesterol level. Ooohhh my gosh! I think it is the fault of the medical community in giving false hope that chasing a number keeps people healthy. I admit, with the short time we have to discuss, evaluate and treat symptoms in my exam room, it is easier to give a temporary "bandaid" to an effect of the disease and not the cause of it. Perhaps in the next decade, we can have doctors that fix things fast but medical advisors that guide people to make life changes.

Focusing on heart health, cholesterol is a good parameter to check in blood testing at the office once or twice a year but healthy lifestyles and habits will make permanent changes so that you may not have to ever check another blood test ever! (My doc friends are going to hunt me) This is what I believe and I walk the walk, I am a protector of life; family, friends and patients. If people are giving out poor medical or dental advise, I work to educate the patient on other options, natural healing and healthier living. I believe we doctors are giving a false sense of security to people when just controlling cholesterol levels and not making suggestions for life change. The reasons for bad health are multifactorial; can't change the world with one visit. Sometimes it just takes proper planning over the course of time. Building a practice from scratch seemed harder than moving a mountain. Now that I have utilized those around me who have the same passion for helping others, the task at hand seems so easy. (We could have opened a clinic right down the street from the old place, with less overhead and more life breath coming from the physical location never seen before!) This reflects one of my beliefs that when the world is viewed with reservation and contempt, a "black and white" picture will be seen. When viewed with love, faith and energy the colors will be infinite.

Just don't believe maintaining a normal cholesterol level will keep you free of disease. Strive to improve your health, diet and mind even with normal tests. Push the envelope with what you can perform with your body and mind, find a good doctor, dentist, trainer, therapist and life partner. Together we can change the world! There will always be bad economies, bad debt, bad medicine and bad people around but when we all lock elbows together, our concepts and faith are indestructible.

Check out this blog for other things to do in getting that heart healthy;
http://saguilapproach.blogspot.com/