Too hot to fly?

Is this flight attendant dressed appropriately to go to work? Apparently not, according to Southwest Airlines. Kyla Ebbert took her case to the court of public opinion by making an exclusive *cough* appearance on the Today show. (MSNBC)

It was a lot more clothing than the 23-year-old college student wears on her job as a Hooters waitress. Her mother, Michele Ebbert, said she would have told her daughter if the outfit was inappropriate.

“But her outfit is fine, Michele Ebbert told TODAY co-host Matt Lauer. “She looks like every other college girl in San Diego.”

Not according to a Southwest employee identified only as “Keith,” who approached Ebbert after she had taken her seat on the plane and was listening to the flight attendants go through their pre-departure routine.

“He told me, ‘I’m sorry, but you’re going to have to take a later flight. You’re dressed inappropriately. This is a family airline. You’re dressed too provocative to fly on this flight,’ ” she told Lauer.

This is too funny for me. A "family airline?" The term family is used in so many contexts that even I don't know what it means anymore. But, you be the judge. I know employers can interpret their company policies however they want. But, for what this person was allegedly wearing above to be a flight attendant? C'mon, gimme a break....

Listen Live Today @ 4pm

Doctor Anonymous Live! Sept 6th (today!) from 4-4:30pm Eastern Time

I usually try to rehearse for the show with a kind of "test" podcast. But, with my busy schedule this week, I haven't had time to do that. So, this will definitely be a fun show today!

You can also participate in the show! That's one of the fun things about this. I'm going to be logged into google talk before the show. So, if you'd like to say hi before/during the show, you can find me there. You can also send me an e-mail or leave a comment here. Finally, the fun part is that you can call into the show. Just click here for the number.

Can't listen live? Well, that's ok. One of the cool things about BlogTalkRadio is that they record their shows so that you can listen to them later. Starting at about 5pm eastern time, you can click here and listen to the recorded show.

It's just a few hours away now. I hope that you'll be able to join me - either live or listening on the archives. What am I going to talk about? Who knows? You'll have to tune in to find out. I'm just a blogaholic, you know....

Update: Thanks to Cathy for the plug for today's show!

Update 2 (3:15pm): My internet connection just came back after being off for 30 minutes. Hopefully that won't happen again. If it does, then there may be no show for today. Cross your fingers for me!

Update 3 (4:18pm): I give up! My internet has kicked me off about five times in the last 18 minutes. Thanks to all of you who tuned in today to the show. But, for whatever reason, I don't think it was meant to happen today. I'll try again soon for another show.....

Suicides rise as SSRI use falls

Anyone who takes care of children and adolescents remembers the big bruhaha about the use of antidepressant medications and their association with suicides. This was in the context of a huge drug recall at the time (I don't remember which one) and the FDA getting politically killed in the press for (at the time) not being able to protect America's children. (image credit)

Now, we're starting to see the unintended consequences of the black box FDA warning that was placed on these SSRI medications. According to this article from today's Washington Post, as use of the SSRI medications decreased, there was actually and INCREASE in suicides in children.

From 2003 to 2004, the suicide rate among Americans younger than 19 rose 14 percent, the most dramatic one-year change since the government started collecting suicide statistics in 1979, the study found. The rise followed a sharp decrease in the prescribing of antidepressants such as Prozac, Zoloft and Paxil after parents and physicians were confronted by a barrage of warnings from the Food and Drug Administration and international agencies.

The data suggest that for every 20 percent decline in antidepressant use among patients of all ages in the United States, an additional 3,040 suicides per year would occur, said Robert Gibbons, a professor of biostatistics and psychiatry at the University of Illinois at Chicago, who did the study. About 32,000 Americans commit suicide each year.

Now, I admit that I'm not the smartest dude, but even I can connect the dots here. Many docs are afraid to prescribe these SSRI meds, especially to adolescents, because of the huge black box warning - which basically tells docs that they are taking their legal life into their own hands if they prescribe this drug.

Now, some out there are not willing to admit this association. In fact, there are some out there who are aiming the blame at another set of medications as the cause of the increase in suicides.

David Healy, a British psychiatrist who has been critical of the drugs, disagrees. He said that the increase in suicides was more likely caused by the growing use of antipsychotic drugs among children rather than a decline in antidepressant use. "I would be absolutely certain that the increase is not because kids are not being treated," he said. "They may not be getting SSRIs, but they are getting psychotropics."

Of course these kids are not being treated. People like this are making docs think twice about using the best medications (in my opinion) for children and adolesents. I'll be curious to see other reactions to these findings.

Update: Roy from My Three Shrinks just posted on this topic.

Resident work hours

Resident work hours is a buzz phrase used in medical education. About two years following the completion of my residency, there were new rules implemented to try to limit the hours worked my interns/residents. (image credit)

The theory behind this was that interns/residents would not be as tired and would make less mistakes. And, less mistakes would mean less patient deaths (less mortality).

Data just published from the University of Pennsylvania state that since the implementation of resident work hours, mortality rates have not decreased as expected. (WebMD)

The findings "reinforce the impression that there is still not clear evidence for an effect of duty hour reforms on [patient] mortality," suggests an editorial in The Journal of the American Medical Association by David O. Meltzer, MD, PhD, and Vineet M. Arora, MD, of the University of Chicago.

Now, I wouldn't consider myself "old school," but (cue old guy accent) when I was in residency, we didn't have these resident work hour rules. We were on duty until the work was done.

I know that I probably have talked about this before on the blog, but working all those hours during residency really got me ready for my practice now. To be honest, I think I'm working more hours now than I did in residency.

Not only did I learn about clinical issues and diseases in residency, I learned how to try to balance life at work and life at home. I learned how to try to function on less hours of sleep. And, most important, I learned my limitations when I was feeling fatigued.

I could be wrong, but I think these residents being trained today are being sheltered too much and not getting a true taste of what life will be following residency. When they get in the real world, they're going to learn very quickly that there are no work hour rules.

I feel that the American health care system will not feel the real impact of these resident work hour changes for many years. What kind of American medical workforce will have been created with these rules in place? I guess we'll just have to see.

Avoid the popcorn!

I remember when mom and dad got their first microwave oven. I think I was eight years old. When I asked mom what this thing could do, the very first thing she did was put a bag of microwave popcorn in there and turned it on. I was hypnotized by watching and hearing the kernels pop. (image credit)

Now, according to this article from the AP, it is being learned that frequent use of microwave popcorn could put you at risk for a type of lung disease called "popcorn lung."

[A patient] described progressively worsening respiratory symptoms of coughing and shortness of breath. Tests found his ability to exhale was deteriorating, [Dr. Cecile] Rose [pulmonary specialist] said, although his condition seemed to stabilize after he quit using microwave popcorn.

The article goes on to say that more study and research needs to be done to confirm these findings. But, can you imagine the implications if a definite connection is made? This is really making me think twice. Maybe I should opt more for milk duds rather than popcorn while watching my fave DVDs.

iPhone price drops

In San Francisco today, Steve Jobs introduced new models of iPods - Yay! To me, they look cool and I can't wait to head up to my nearest Apple store to check them out.

In a surprise move at the end of his presentation, Jobs also announced a $200 price drop in the iPhone. So, there is no more excuse for you out there on the fence thinking about getting this nifty device. Now, there is some considerable whining out there in some areas of Apple nation. There's this post: "Apple screwed you: So now what?"

Some people out there who stood in line in late June for this thing are talking about how to get refunds. "The early adopter tax" one person is calling it. All I have to say is this: Stop the whining!

Just admit that you had an urge to get the hottest piece of tech out there and told yourself you had to have it. I bought mine about a month ago and I don't think Apple screwed me with the price. If I thought it was too expensive then, I just wouldn't have bought the thing. Gimme a break!

Dr. A Live Tomorrow!

I'm happy to announce that I've been able to work out in my schedule the time for the next Dr. A show. It will be Thursday, September 6th, 2007 at 4pm Eastern Time.

I was pleasantly surprised how many people listened live and listened on the archives. Thanks so much for your support of the show. (image credit)

The official/unofficial title of this week's show is "The Doctor Anonymous Challenge." Hmmm.... What could that be? I'm not going to explain it at all before the show on Thursday.

The possibilities are endless and I'll let all of you speculate on what it could be. What I can tell you is that I think it will be fun and a unique way for you to participate in the show.

So, write it in your calendar, or put the date and time in your PDA. Me? It's already in my trusty iPhone so that I don't forget.

What? You haven't checked out the first show yet? (Thanks SeaSpray for the review!) Well, just check out this link or simply hit the play button in my sidebar below the BlogTalkRadio button. And, enjoy! See you tomorrow.....

TV linked to ADD?

You're probably aware of the links that have been made between television (image credit) and a sedentary lifestyle, obesity, and diabetes. Now, there is new data stating that children who watch 2-3 hours of TV a day - early in life - may lead to attention problems later in life. (Reuters)

The link was established by a long-term study of the habits and behaviors of more than 1,000 children born in Dunedin, New Zealand, between April 1972 and March 1973.

The children aged 5 to 11 watched an average of 2.05 hours of weekday television. From age 13 to 15, time spent in front of the tube rose to an average of 3.1 hours a day.

"Those who watched more than two hours, and particularly those who watched more than three hours, of television per day during childhood had above-average symptoms of attention problems in adolescence," Carl Landhuis of the University of Otago in Dunedin wrote in his report, published in the journal Pediatrics.

Personally, I find this study interesting because I was born around the time frame in which this study was done. Can I draw any conclusions to my own life or the lives of my peers growing up? Hmmmmmm.....

Now, I do admit that I probably watched the same amount of television at the study participants (does video game playing count in that number?). Here is one of the theories reviewed in the article for this association.

One was that the rapid scene changes common to many TV programs may overstimulate the developing brain of a young child, and could make reality seem boring by comparison.

"Hence, children who watch a lot of television may become less tolerant of slower-paced and more mundane tasks, such as school work," [Landhuis] wrote.

It was also possible that TV viewing may supplant other activities that promote concentration, such as reading, games, sports and play, [Landhuis] said. The lack of participation inherent in TV watching might also condition children when it comes to other activities.

The study was not proof that TV viewing causes attention problems, Landhuis said, because it may be that children prone to attention problems may be drawn to watching television.

Attention deficit disorder (ADD) is so multifactorial, it's very difficult to pin one thing down as THE cause. However, I do admit that sometimes I "become less tolerant of slower-paced and more mundane tasks." Maybe I should watch less television and, say, blog more. What you do think?

Flu Shots: Kudos to Sanofi Pasteur

As many of you know who regularly read this blog, my pulse rises a little bit when talking about flu shots. (image credit) I admit that I directed much of this frustration at the companies who produce the flu shots. Check out my posts - Flu Shot Rant and Flu Shot Rant: Part Deux.

Someone in my office mentioned flu shots last week. As my almost started another rant right there in the office, my staff told me that we just received our first partial shipment of flu shots from Sanofi Pasteur. Hmmmm.... That's interesting.

As I did some investigating on this, I found this news story from the AP and I also found a press release from about three weeks ago.

Swiftwater, PA. - Sanofi Pasteur, the vaccines division of Sanofi-Aventis SA, has started shipping the first of about 50 million doses of flu vaccine it expects to produce this season.

The first doses are being shipped to the Centers for Disease Control and Prevention to support the Vaccines For Children program and to private doctors and other health care providers.

Sanofi Pasteur makes about half the worldwide supply of influenza vaccine and more than 40 percent of the U.S. supply, the company said in a statement.

The distribution, sent to providers in partial shipments, is scheduled to continue through the end of October. Influenza rates typically peak in February, according to CDC data.

So, I'm going to give credit where credit is due. Of course, there was very little press at the time. News is only made when the flu shots are late as they have been the past few years. However, congratulations to Sanofi Pasteur for being ahead of the curve this year.

Here are the big questions that my office is now asking: When should we announce to our patients that we have some flu shots? What date should be pick to give out the flu shots? What happens when our patients find out when we have some flu shots?

As stated by the Centers for Disease Control, an influenza season may extend as far as the late spring. So, theoretically, someone could get the flu shot too early and not be protected for a possible late influenza epidemic.

Of course, when our office begins giving the flu shot will be determined by market forces. This means that when some of the supermarkets and other retailers start giving out their shots, that's definitely when our office will be getting the phone calls.

But, getting back to my point, I'm glad that we received a partial supply in August. If your office ordered flu shots this year, have you received a partial shipment yet?

Parents blamed for pre-school stress

In many communities across the United States, the first day of school is usually the day after the Labor Day weekend. (image credit) As (some) parents rejoice and (some) kids dread the start of another school year, there is new research data being released stating that parents cause kids more stress when starting school.

Before all the parents who read my blog start to throw things at me, I'm just reporting a news story here (smile). This study is from the UK and courtesy of icWales. The study looked at kids who are starting school for the first time.

Scientists measured the levels of the stress hormone cortisol in children two weeks after they had started primary school and then again six months later. They also took cortisol measurements three to six months before the children started school to provide baseline levels for comparison.

The researchers said they were surprised to find that, far from providing a baseline, children’s cortisol levels were already high several months before the start of the school term.

High rates of the hormone can even make children more susceptible to colds and other minor illnesses.

Dr Julie Turner-Cobb, from Bath University, who led the research, said, “This suggests that stress levels in anticipation of starting school begin to rise much earlier than we expected.”

Dr Turner-Cobb said it was unclear why pre-school children would become anxious so far in advance, but suggested that parents were getting stressed about their children starting school and were passing those fears onto their children.

The article goes on to talk about how things were easier when they had an older sibling who already went through the "starting school" process. The article also talks about how the first day of school can also be tough on parents.

Now, it doesn't take a rocket scientist to make some of these assumptions. But, I thought the cortisol data was interesting. Any thoughts out there on the stress level of kids and parents when it comes to the first day of school?