Daddy can bounce and play,
While he sleeps four hours a day,
He brushes the flies away,
But Daddy ain’t got no milk.

Daddy can sing you a lullaby,
Nonsense he makes up on the fly,
He marvels at the beauty in your eyes,
But Daddy ain’t got no milk.
Daddy ain’t got no milk.

With hopes and dreams that soar,
For happiness, health and more,
He watches you breathe from the door,
He’s so tired he’d sleep on the floor,
Chasing windmills and imagined wars,
Sniffing out dangers like a wild boar,
But Daddy ain’t got no milk.
Daddy ain’t got no milk.
Your Daddy ain’t got no milk.

A fever in an infant can be the first sign of an illness. While a rise in body temperature above 100.4 degrees Fahrenheit is part of a healthy immune system response, it does signal potential danger and need for further evaluation. Since a reading may lead to a call or visit to the child’s doctor or emergency room, accuracy is key. What is the best type of infant thermometer?

A digital rectal thermometer.

This is according to such authorities as the American Academy of Pediatrics, Consumer Reports, and the American Academy of Family Physicians.

The definition of a fever is important as well. According to the AAFP:

A normal temperature is about 98.6°F (37°C) when taken orally (in your child’s mouth) and 99.6°F (37.5°C) when taken rectally (in your child’s bottom). Many doctors define a fever as an oral temperature above 99.5°F (37.5°C) or a rectal temperature above 100.4°F (38°C).

Fever in infants less than 4 weeks old can be an emergency, and most likely will require the baby to be hospitalized for evaluation and treatment. Fevers in babies 4 weeks to 3 months old are also considered an emergency requiring prompt medical attention. Always call your doctor for advice regarding fever.

The old-fashioned mercury thermometer has been phased out due to potential toxicity if the thermometer breaks and leaks mercury.

Consumer Reports recommends purchasing a rectal thermometer that can also be used orally as the child gets older, perhaps above age 3.

Expensive thermometers are not necessarily any better, but brands such as Omron have passed muster. Consumer Reports also lists BD Digital, Bebe Sounds, Safety 1st, Summer Infant, The First Years, and Vicks.

Be patient. Thermometers advertising instant reads sound great, but a reading in 20-60 seconds is sufficient and perhaps more precise.

Given the greater precison of rectal thermometers, my office has begun an ambitious initiative to check the temperatures of all our adult patients using the rectal technique as well. So far the response has been mixed. Some patients refuse the more painstaking measurements, while others seem to easily dismiss the added indignity as “just more of the same” they’ve come to expect from American healthcare. Just kidding.

But there’s no kidding about rectal thermometers being the best type for infants.
Happy Mother’s Day, and thanks for enduring all the unpleasantries, Mom.

Among the many dangers we face in our daily lives, from the hostile drivers who tailgate on our morning commutes, to the box of fried bread and sugar donuts bought in to the office, to the kid coughing on us with a 103 fever and influenza… it may seem alarmist to point out one more potential risk normally found in our own pockets. But the common cell phone, and the low level of radiation it emits, are increasingly subjects of debate. Depending on who you listen to, the cell phone is either a modern necessity beyond reproach, or a clear and present danger to which minimizing your exposure is worth the selectively Amish effort.

I picked up a copy of Devra Davis, P.h.D, M.P.H, new book entitled Disconnect. She purports to tell the truth about the cell phone radiation and what the industry has done to hide it, and to provide a few means of protecting yourself against the possible adverse effects of prolonged microwave radiation exposure. I have not fully read the book yet, but I have found it fascinating so far. As a family physician I believe in the value of preventative measures for health, but I am also aware of the paralyzing effect that excessive paranoia can have on our lives. I use a cell phone, but only minimally.

She centers her argument upon the central disconnect between the emerging science of cell phone radiation on human physiology, and the assumption that just because cell phones are omnipresent they must be safe. U.S. cell phone standards were set almost 30 years ago prior to the era of handheld wireless technology, and presumed that an average call would last 6 minutes. Dr. Davis makes the following points:

– At least one study has conclusively proven that cell phone radiation can unravel DNA.   [Another recent study showed that cell phone radiation affects the metabolic activity of brain tissue, as proven by PET scans]
– Studies funded by the cell phone industry find dangers with cell phone radiation at only half the rate that independently funded studies do, signaling a conflict of interest in scientific results.
– Men who do not use cell phones have “healthier” sperm than men who use phones for 2-4 hours a day.
– In one experiment, rats that had mastered getting out of a tank without drowning got lost and swam in circles after being exposed to cell phone radiation for an hour.
– Other nations are already acting on emerging epidemiologic concerns. France is banning the sale of phones for its children, and Russia, the UK, Canada, Belgium, Israel, Finland, Germany, and India have all discouraged the use of cell phones by children. There is no mention of what North Korea or the Sudan are doing.
– The Israeli Dental Association has reported a dramatic rise in a type of rare cheek cancer in young adults under 20.
– Lloyds of London, the oldest insurance company still active in the world, refuses to insure cell phone manufacturers against health-related claims, as do a number of other major firms.
– There are stories of scientists who raised concerns about the long term impact of cell phones on health who were defunded or chased out of research altogether.

The quality of this evidence is often inferential and anecdotal, but it is still worth consideration.  Dr. Devra Davis uses cell phones herself, which adds some credibility to her arguments since efficient life without wireless communication is just not practicable. She does make the point that we need to demand safer cell phones with higher safety standards, and offers these unproven but intuitive measures to possibly decrease the risks of cell phone radiation:

– Use a speaker, hands-free device, or even an earphone to distance the cell phone transmitter from the body and head. Radiation intensity decreases exponentially with distance.
– Try not to carry a cell phone on the body, as the phone still emits radiation when not in active use as it searches for towers, pushes notifications, etc.
– Beware of weak signals and standby mode when the signal strength is blocked, as radiation emission increases while the phone works harder to establish contact
– Keep cell phones away from children, as studies consistently show that their growing brains and skulls are more vulnerable to the effects of cell phone radiation. [I also think the younger generation as a whole is learning that communicating in a multitasking-simultaneously-oral-and-texted-polyconversation is socially acceptable]
– Don’t leave the cell phone on your nightstand. 75 years of low level radiation emission next to your head sounds like a bad idea to me, too.
– [I would add that I try to keep conversations on cell phones brief, and text when simple communication is all that’s needed]

I’m sure that cell phone radiation paranoia deserves it’s share of tempered reasoning.  Realistic comparison to the relative risks of everything else in our often toxic environments shows that cell phone worry is not worth obsession. As I open my window to get some fresh air I’ll be sucking in nanoparticulates, and the stress of my day job will causing dysfunctional amounts of cortisol and adrenaline to be released. But I still think minimizing risks where prudent and possible it worth the fight, and I’ll be reading the rest of her book when I can.

Coincidentally the New York Times Magazine has an article about cell phones and brain cancer today.

 

We are living incarnations of a love that preceded us.

Vibrant, with ailing petals that should fall.

A knot in the throat, a conjuring of another’s quintessence,
as music brightens the void.

As we love others perhaps we can feel the face
of eternity shining down upon us.

If we could but hold on to love,
to be mindful of its primacy,
we might never grow dim again.

Hosting Grand Rounds is a rewarding experience in that it compels you to read through a wonderfully diverse, informative, and insightful collection of thoughts from around the health care world.

Here are some highlights from the past week, and thanks to all who contributed. Enjoy, and read as many as you can:

Dr. Val shares a book review that she published on Scientific American’s website about “Tabloid Medicine: How The Internet Is Being Used to Hijack Medical Science for Fear and Profit.” In this important book Robert Goldberg, PhD, explains why the Internet is a double-edged sword when it comes to health information, empowering some to better decisions, while misleading others into dangerous ideologies such as the anti-vaccine movement. A must-read post and book!

Shrink Rap discloses a story about a psychiatrist who is distraught about an on-line review that he believes was posted by a patient still under his care, and explores the ethics and credibility of such a dilemma.

Future Docs presents a cogent argument for why you should want a medical student to be involved in your care.  Apparently people are now suing medical students along with doctors. Has it really come to this?

Maria from In White Ink reflects on the sacred spaces that are opened by a hospital key card, and reminds us of the privilege that comes with being invited into the private world of a sick patient.  She is a most eloquent and thoughtful physician-writer.

Dr. Pullen delves into the recent admission by Lady Gaga that she tested borderline positive for Lupus, and suspects the uncertainties surrounding the ANA test are to blame for a common predicament.

Enabling Healthy Decisions debates the relative merits of multi-tasking versus focused thinking, and advocates for the old-fashioned focused thinking which engages the hippocampus and allows us to apply knowledge.

Medical Lessons asserts the importance of the salutation “doctor” for some patients, including the star of The King’s Speech, and reminds us of the respect conveyed by using formal names.

Clinical Cases and Images marvels at a report of a heart that has endured 67 stents and 28 coronary angiograms. The cost, cumulative radiation, and logistics are unreal.

Suture for a Living highlights research into a new breast cancer oncogene, ZNF703. Hopefully practical applications will include targeted therapy similar to Herceptin.

Onc RN shares a lovely poem of sorts about hope, and the sobering work of a would-be healer.

ACP Internist asks whether everyone taking a statin drug really needs to in light of news that up to 25% of adults are now taking these medicines.

ACP Hospitalist highlights new research showing that bacterial contamination of physicians’ newly laundered uniforms occurs within three hours of putting them on, making them no more or less dirty than the traditional white coats.

Nuts for Healthcare considers the future of pharma and concludes that the drug development paradigm favors drugs with high prices that are supported by proven better outcomes.

Health Blawg outlines two large fines announced last week by HHS in cases against HIPAA violators.

Mind the Gap laments that more is not done to prevent the falls of the elderly, as recently experienced by his own mother.  A commenter points towards a helpful CDC tip sheet for those looking to take responsibility.

Emmy asks some important questions about the nature of breast cancer and its causative factors.

BJC Health shows how a stressful time in his life created symptoms reminiscent of a condition he frequently diagnoses and treats – fibromyalgia.

Jill of All Trades rehashes a discussion that is all too common with a patient who does not see the irony between cause and effect.

Insureblog revels in the good news that a daily cocktail or glass of wine may help ward of dementia.

Health Business Blog interviews an expert at the University of Rochester about the NIH’s planned drug development center.

Hanging by a Stethoscope reveals a phenomenon in the Filippino health care system in which patients often seek medical certificates excusing work absences, instead of seeking treatment, per se.

Healthline explains a new head lice treatment for adults and children.

Pam Ressler offers an interview she gave about her research in narrative medicine, blogging, and social media in health care.

The Happy Hospitalist points out that white males seem to face longer odds for admission to medical school.

Allergy notes reviews some salient points about chronic spontaneous urticaria.

~

This concludes Grand Rounds for March 1st, 2011.  I’d like to thank all the contributors who shared some excellent writings this week, and would like to encourage those who write about health and medical topics to keep Grand Rounds going.  Your contributions, readership, and inspiration help forge a community.

Next week’s Grand Rounds will be at Dr. Pullen’s site, so head on over soon.

Thank you!

After the computer known as Watson easily dispatched of the best two human Jeopardy contestants in history, IBM announced that one of the first applications of their artificial intelligence technology would be in the medical field. We should soon expect virtual physician assistants in the exam room. At least one of my friends even speculated that the days of human doctors are numbered.

Is it possible that machines will replace humans in the doctor-patient relationship? I doubt it. According to a study done by the Mayo Clinic in 2006, the most important characteristics patients feel a good doctor must possess are entirely human. According to the study, the ideal physician is confident, empathetic, humane, personal, forthright, respectful, and thorough. Watson may have proved his cognitive superiority, but can a computer ever be taught these human attributes needed to negotiate through patient fear, anxiety, and confusion? Could such a computer ever come across as sincere?

Here’s an artist’s conception (read: farce) of how such an application in the examining room might play out. I’m afraid some major calibrations might be needed to substitute artificial intelligence for an “ideal” physician. What do you think?

 

To watch this Oscar-nominated cartoon on a full screen, follow this link:
http://www.xtranormal.com/watch/11199353

Grand Rounds will be held here next Tuesday! Please send me a link and brief description of any good medical blogging from this week you would like highlighted- either written by you or another medical blogger you read.  Please send by Sunday night, February 27th.

Selfishly I’d like to read some posts that discuss current events going on right now, and reflective, creative pieces… but all are welcome!
Email:
drcharles.examining
(at gmail.com)