tag:blogger.com,1999:blog-106825434973779887.comments2023-12-19T06:00:35.880-06:00Quest for HealthKristen Stuppy, MDhttp://www.blogger.com/profile/10332172268371143329noreply@blogger.comBlogger26125tag:blogger.com,1999:blog-106825434973779887.post-67651239555956855522013-04-28T20:20:15.810-05:002013-04-28T20:20:15.810-05:00I am never really clear in who manufactures any dr...I am never really clear in who manufactures any drug. I never really cared until I started reading about this topic. All the news about docs being bought by a fancy dinner never factored in those like me who don't bother to learn the companies! <br /><br />I love and follow your blog. I share it on my office Facebook page and the AAP's SOAPM unofficial Facebook page often.<br /><br />Thanks for commenting!<br /> Kristen Stuppy, MDhttps://www.blogger.com/profile/10332172268371143329noreply@blogger.comtag:blogger.com,1999:blog-106825434973779887.post-66726851475311841832013-04-28T16:24:59.709-05:002013-04-28T16:24:59.709-05:00It's a very confusing mess. Concerta originall...It's a very confusing mess. Concerta originally was sold by Janssen (formally, Ortho-McNeil-Janssen, a division of Johnson and Johnson), and they were licensed by Watson to manufacture Watson's own "generic"-- including the OROS delivery system.<br /><br />http://pediatricinsider.wordpress.com/2011/06/25/pharma-weasel-games-tales-of-concerta-and-auralgan<br /><br />Now, as you've pointed out, other "generics" of methylphenidate ER are available at those odd dosing intervals once exclusive to Concerta and Generic Concerta (18,27,36,54 mg).<br /><br />In the past, the Methylphenidate ER generics were either knockoffs of Ritalin LA or Metadate CD, both of which have the bead time release style that these Concerta knock-offs you're describing have. Even Ritalin LA and Metadate CD weren't interchangeable at the same milligrams-- Ritalin front-loaded more of the dose.<br /><br />We need better transparency and labeling of these products, that's for sure!Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-106825434973779887.post-57193917602967011522013-04-25T06:54:53.348-05:002013-04-25T06:54:53.348-05:00Thanks! If you have any topics you'd like to s...Thanks! If you have any topics you'd like to see covered, let me know!Kristen Stuppy, MDhttps://www.blogger.com/profile/10332172268371143329noreply@blogger.comtag:blogger.com,1999:blog-106825434973779887.post-637515892527201932013-01-27T21:08:55.361-06:002013-01-27T21:08:55.361-06:00Thanks, Brandon! I hope people read it and see why...Thanks, Brandon! I hope people read it and see why the exam changes and sometimes needs to be repeated. Thanks for sharing it!Kristen Stuppy, MDhttps://www.blogger.com/profile/10332172268371143329noreply@blogger.comtag:blogger.com,1999:blog-106825434973779887.post-14583967328272167712013-01-27T19:45:02.445-06:002013-01-27T19:45:02.445-06:00This is such an insightful blog post for parents. ...This is such an insightful blog post for parents. Thank you for taking the time to write it and sharing it. Anonymoushttps://www.blogger.com/profile/18425333144820235642noreply@blogger.comtag:blogger.com,1999:blog-106825434973779887.post-66649033582549001612012-12-27T20:21:34.243-06:002012-12-27T20:21:34.243-06:00Coats or any other thick clothing that puts distan...Coats or any other thick clothing that puts distance between the child and the seat or seatbelt are not recommended. Straps cannot be tightened enough with bulky clothing. It makes it easier to always have a similar thickness of clothes because you don't need to readjust straps depending on the weather. Be sure to allow air circulation if you have a cover for infants so they don't overheat. For older kids in boosters, they will be safer and more comfortable without a coat too. A blanket will keep kids warm and allow them to remove it easily if the car warms up so they don't fuss from being overheated. Or they could put their coat on backwards over the belt (where the hood would be over the face if pulled up). Just because a lot of people put coats on in the car doesn't make it safe. Most just don't know the benefits to taking it off. That's why I try to educate!Kristen Stuppy, MDhttps://www.blogger.com/profile/10332172268371143329noreply@blogger.comtag:blogger.com,1999:blog-106825434973779887.post-33496202078608917582012-12-27T17:10:47.440-06:002012-12-27T17:10:47.440-06:00Dr. Stuppy, thanks for this post. Those are some g...Dr. Stuppy, thanks for this post. Those are some good posts for me to review. Can you clarify about coats and carseats now that it is cold? I feel like I have heard you aren't supposed to do it. Obviously that's a lot of work for me, but it's worth it if coats under the straps are unsafe. But I feel like people act like I am one of "those" parents for doing it and almost every other kid I see has a coat on under the straps. Is it okay for a winter coat to be on in a five-point harness? Does it matter what age the child is? What about when the child graduates to a booster? Is it okay then? Thanks!Meghanhttps://www.blogger.com/profile/00197288481664480457noreply@blogger.comtag:blogger.com,1999:blog-106825434973779887.post-75485628013749109242012-12-06T11:22:13.765-06:002012-12-06T11:22:13.765-06:00http://insurancelib.blogspot.com/2012/11/top-tips-...http://insurancelib.blogspot.com/2012/11/top-tips-for-get-cheap-life-insurance.html<br />The Top Tips for get cheap life insurance is:<br />You must teach yourself types life insurance policies of different and learn its advantages are well and in addition to that you must make the effort also to know policies of insurance companies on the diverse life, before the start to get insurance on the cheap you know what already well. Anonymoushttps://www.blogger.com/profile/18130012669900944692noreply@blogger.comtag:blogger.com,1999:blog-106825434973779887.post-46248643775742351272012-10-09T08:54:36.025-05:002012-10-09T08:54:36.025-05:00Just one update to this: It is now recommended to ...Just one update to this: It is now recommended to do a well visit at 30 months, then 3 years, and then yearly following. Kristen Stuppy, MDhttps://www.blogger.com/profile/10332172268371143329noreply@blogger.comtag:blogger.com,1999:blog-106825434973779887.post-72537354518604748202012-10-08T08:18:06.816-05:002012-10-08T08:18:06.816-05:00William: Yes, Amoxil (amoxicillin) is a great anti...William: Yes, Amoxil (amoxicillin) is a great antibiotic for many infections. Unfortunately the dosing requirement has increased over the years (25mg/kg/day has increased to 90-100mg/kg/day) for some infections due to bacterial resistance. Fortunately Strep throat still responds well to amoxicillin. There are some interesting studies that the other "normal" bacteria in your throat can block and protect the strep against it though. Not the typical bacterial resistance, but when appropriate doses of amoxicillin don't work, it isn't that the Strep germs are resistant, it is that the germs have friends protecting them!Kristen Stuppy, MDhttps://www.blogger.com/profile/10332172268371143329noreply@blogger.comtag:blogger.com,1999:blog-106825434973779887.post-25688183625596118562012-10-08T05:34:20.267-05:002012-10-08T05:34:20.267-05:00I have being researching about bacterial infection...I have being researching about bacterial infections and reading your blog, I found your post very helpful. <a href="http://www.canadiandrugsaver.com/antibiotics/amoxil_288.html" rel="nofollow">Amoxil</a> can be used to treat infections caused by bacteria such as pneumonia, ear infection and bladder infection.williamsmarkseohttps://www.blogger.com/profile/14904212911961735296noreply@blogger.comtag:blogger.com,1999:blog-106825434973779887.post-91331237386619975112012-08-19T07:48:51.011-05:002012-08-19T07:48:51.011-05:00Thank you for sharing your 4 M-Powered Parenting S...Thank you for sharing your 4 M-Powered Parenting Styles. It sounds very similar to what I recommend to parents. Always easier to say than do, but no one said parenting would be easy. Rewarding, wonderful, and more positives than negatives, but not easy!Kristen Stuppy, MDhttps://www.blogger.com/profile/10332172268371143329noreply@blogger.comtag:blogger.com,1999:blog-106825434973779887.post-90916501530692661162012-08-18T22:55:23.523-05:002012-08-18T22:55:23.523-05:00I love your tips and completely agree and use them...I love your tips and completely agree and use them myself! I shuffle through the above list of powerful and helpful options when my anger starts to bubble up so I don't 'lose it'. I've coined 4 "M-POWERED PARENTING STYLES" which encompass many of your tips and help me work through the options. My parenting styles include 1) BRAINY PARENTING--thinking it through and finding the source of my anger so I can take steps to change it; 2) DISCIPLINED PARENTING--where I will also take a Time Out for myself until my 'dark cloud' has passed, 3) HEARTFELT PARENTING--acknowledging my negative feelings to myself, talking about them with my kids, and, if needed, saying I'm sorry if I reacted harshly; and 4) PLAYFUL PARENTING--so if all else fails, I will resort to silly voices, characters, games, instant songs, etc. to lighten the mood and help us all escape the grouchiness and anger. <br /><br />While anger is an accepted and natural part of our human experience, it sure feels better to have a handle on it, rather than letting it take over. Great advice for your readers!!<br /><br />Best,<br />Dr. Michelle<br />Your Concierge Child Psychologist<br />mpoweredparenting.comDr. Michelle Macroriehttps://www.blogger.com/profile/01226143502362821229noreply@blogger.comtag:blogger.com,1999:blog-106825434973779887.post-54623435269630141392012-07-22T07:39:45.599-05:002012-07-22T07:39:45.599-05:00Tom:
Thanks for the Costco suggestion. I might t...Tom: <br /><br />Thanks for the Costco suggestion. I might try it, but it still leaves my general problem: how can consumers make smart healthcare choices when there are so many inherent problems?<br />1. Generic medications should ALWAYS be Tier 1 copays. If insurance companies can decide to charge more for generic, how can physicians attempt to keep health care costs low? We can't know everyone's formulary, and most patients don't come in knowing it either. And with many companies changing health insurance companies yearly, patients shouldn't have to change medicines with each new policy. If they are doing well on a generic medication, it should not be cost prohibitive to continue it.<br />2. The "preferred" pharmacy should be the least expensive. If I hadn't forgotten to check my preferred pharmacy first, I would have presumed the $15 was the cheapest because it was a preferred pharmacy and would have never even attempted an out of network pharmacy. The system of having formularies with variously priced drugs divided among Tiers should allow the consumer to know how much they will pay. Maybe the preferred pharmacies could offer a discount, but the copay listed for each Tier should be the maximum charge. In this example I had a $5 difference with one of the generics at 2 different pharmacies, the most expensive being the "preferred" pharmacy. What about other medicines? What about other pharmacies? Where is my best deal? <br />3. The system needs to be more open on pricing. I mention above that I could call pharmacies to try to get pricing, but I know they will say the can't tell me until the run it across. Each insurance contract has different pricing, so my $4 script becomes $10 with a different company. My $10 script becomes $75. The pharmacist really can't know how much the price tag will be until they submit it to the insurance company. I can't turn in scripts everywhere to cost compare, which forces me to make uneducated decisions with my money and healthcare.<br />4. This system overall increases the cost of health care. People don't realize how much work goes into a simple phone call to the doctor's office. At a minimum 3 people are typically involved, and all are being paid to do work that is not reimbursed directly. (I understand there is a cost of doing business, but hear me out here.) The receptionist takes the call and starts a phone call report in the medical record. A nurse checks the message, looks at the chart to see what has been previously documented and if she can handle the call herself or if she needs to talk with the physician first. If it is a timely topic and she needs to clear it with the doc, that means interrupting the doc between patients (translate: each interruption increases the waiting time for people in the office, which decreases patient satisfaction and might hurt business overall). In this situation, the nurse will have to not only call the parent to call a script, but she will also have to call the pharmacy. This is quite a bit of time for a prescription that was already written and addressed by the doc at the time of the visit. Now the doc must review the phone call and sign off on it. All of this time for one simple phone request adds up at the end of the day. This could be a whole separate blog!Kristen Stuppy, MDhttps://www.blogger.com/profile/10332172268371143329noreply@blogger.comtag:blogger.com,1999:blog-106825434973779887.post-8341276978148959312012-07-21T22:44:25.117-05:002012-07-21T22:44:25.117-05:00Try Costco. You don't have to be a member to ...Try Costco. You don't have to be a member to use their pharmacy. We have been on a really bad insurance plan, and we found that Costco's internal plan (which you DO have to be a member to use) was actually better than prescription insurance plan. (The Costco plan didn't cost anything additional to members.) It cut the out of pocket cost of some of our basic prescriptions by half.<br /><br />Pharmacies won't come out and freely tell you that "you could save a lot by doing this..." But, they will answer questions when you question the costs of the drugs.Tomhttps://www.blogger.com/profile/18321982476034093776noreply@blogger.comtag:blogger.com,1999:blog-106825434973779887.post-86060254307141954862012-06-05T10:45:05.195-05:002012-06-05T10:45:05.195-05:00Meghan: Good question! You are correct that if he ...Meghan: Good question! You are correct that if he is too young to understand, Time Out will not be effective. Toddlers develop at different ages, but around age 2 years is when most kids can understand the concept. They need to be able to follow short directions or commands. If he doesn't understand simple commands (such as "bring me your shoes") he will have a hard time understanding "sit in time out". When he starts to get the idea of short commands, you can start with practicing when he is happy and not in trouble. When he seems to get the concept during practice sessions you can start using it for discipline. Before that, re-direction works well!Kristen Stuppy, MDhttps://www.blogger.com/profile/10332172268371143329noreply@blogger.comtag:blogger.com,1999:blog-106825434973779887.post-60405864219830601122012-06-05T09:43:46.841-05:002012-06-05T09:43:46.841-05:00What age is appropriate to start time out? We have...What age is appropriate to start time out? We have a young toddler and do struggle with certain behaviors. Some have suggested timeout to us, but I don't feel confident he would understand it as a consequence. I have also never seen him sit anywhere for more than a couple seconds without being either strapped in or held. Does that mean he's not ready? How do you know your child is old enough to understand the concept of timeout?Meghanhttps://www.blogger.com/profile/00197288481664480457noreply@blogger.comtag:blogger.com,1999:blog-106825434973779887.post-6883244804882717452012-02-11T07:51:09.509-06:002012-02-11T07:51:09.509-06:00Dr Newland:
Thank you for your educational comme...Dr Newland: <br /><br />Thank you for your educational comment. I have been talking about this concept since I learned it in my residency training and do not have any current research since it was so long ago. I fully believe in using evidence based medicine, but have never seen anything to contradict this previously. I do love medicine because we continually learn new things. <br /><br />I continue to think that parents don't need to run right in to a walk in clinic or ER to treat the sore throat, since delay of a day or two should not impact complication risks. If that were the case, I suspect we should be putting all children on antibiotics until the culture is negative. (Clarification to patients: this is NOT recommended in most cases!) I see the highest number of false negative rapid strep tests (negative in the office, positive culture) in the first 24 hours of illness. (This is from personal observation in my office over the years, but would love to see real data on this if anyone knows it.) <br /><br />The biggest reason for this blog was to reassure parents that it is okay (and in my opinion preferable) to wait to go to their medical home for evaluation and treatment. They often ask for antibiotics when the rapid test is negative, and I want them to be reassured that the culture is the "gold standard" and waiting to see if it is positive is not a bad thing. Historically this is the situation in which I most commonly use the argument that having the Strep for a couple days is a good thing and with a negative rapid test it is most likely that the child has a virus and antibiotics are not helpful for viral infections. I also use this information when parents are distressed at 11pm because their child has a sore throat and they feel guilty that they don't want to pay a higher co pay or wake all the kids for a trip to the ER/UC, but want to do what's best for their child. I want them to know that not only is it acceptable, but preferable to do symptomatic care overnight or while awaiting the culture results. I will change my tune with the information you provided unless I find more facts-- though I still support waiting for all the other reasons! <br /><br />What are the other reasons? I have seen many kids inappropriately treated for "Strep" with standard dosing of azithromycin (not 12mg/kg/day and no history of penicillin allergy). I have seen kids tested (and treated) for Strep who present with typical URI symptoms (increasing the likelihood of false positive testing as you alluded to above). I have even seen kids treated for sore throat without any testing because "it looks like Strep". <br /><br />The stimulus for this quick blog was to get parents thinking about how to best utilize healthcare. I still think going to the medical home is best since there are so many reasons for this, and unless there is difficulty breathing, dehydration, or other emergent needs, using the PCP office is preferable. I do appreciate your comments and will look into this further because I want to practice evidence based medicine, and unless past information is contradicted, I continue to use it. I wonder where my attendings learned this information... anyone out there have any references?<br /><br />DrSKristen Stuppy, MDhttps://www.blogger.com/profile/10332172268371143329noreply@blogger.comtag:blogger.com,1999:blog-106825434973779887.post-4765978071809039122012-02-10T22:01:45.602-06:002012-02-10T22:01:45.602-06:00Good Evening Dr. Stuppy,
This is a very interesti...Good Evening Dr. Stuppy,<br /><br />This is a very interesting post. As a pediatric infectious diseases physician I have had the chance of treating and consulting in the outpatient clinic on many cases of recurrent tonsillitis. I'm not aware of delaying treatment being a solution to preventing recurrent tonsillitis. Do you have a reference that demonstrates this? <br /><br /> I think the immunology that you discuss likely does not work for group A strep. In fact, there are over 100 different Group A streptococcus serotypes based on the M protein of this bacteria. I know there has been attempts to develop a vaccine with the attempt to create antibodies and possibly memory T cells that would help prevent group A streptococcus infections, however these vaccines have yet to be successful. I speculate this is likely due to the large number of serotypes with the potential of causing an infection. <br /><br />I think one of the most important points regarding group A streptococcus pharyngitis, aka Strep Throat, is to use the test when it should be used. Many times rapid group A streptococcus cultures will be done when pharyngitis is not present and a stomach ache is without fever. This is not Strep throat or Strep pharyngitis as there is no pharyngitis. Group A streptococcus can live happily in the back of someone's throat without causing infections. The classic signs and symptoms of Strep throat are fever > 100.4, tender anterior cervical node, tonsillar swelling or exudate, and absence of respiratory symptoms such as cough. Additionally, group A strep pharyngitis is unlikely to occur in children less than 3 years of age unless a family member has recently had the infection. Here is an interesting paper from JAMA looking at these symptoms with the modified Centor scoring system: http://jama.ama-assn.org/content/291/13/1587.full.pdf+html.<br /><br />Finally, the main reason to treat group A Streptococcus is to prevent the complications such as rheumatic fever and post-streptococcal kidney disease or arthritis. While treatment might decrease the duration of infection by a day it is the prevention of these complications that is important. In regards to the time period in which treatment needs to be initiated to prevent these complications, I am not aware of any data suggesting what that window exactly is. <br /><br />Thanks for the opportunity to comment on this blog. I look forward to further discussions involving such great infectious diseases topics. <br /><br />Jason<br /><br />Jason Newland, MD<br />Pediatric Infectious Diseases Physician<br />Children's Mercy Hospitals & Clinics<br />Kansas City, MOJasonGNewlandhttps://www.blogger.com/profile/17350759904147450656noreply@blogger.comtag:blogger.com,1999:blog-106825434973779887.post-71734235347808940292012-01-07T09:03:28.360-06:002012-01-07T09:03:28.360-06:00Gee, thanks! Question: Do you see the green screen...Gee, thanks! Question: Do you see the green screen or the new screen with the flowers to the right? I get different versions when I open this page now. ????Kristen Stuppy, MDhttps://www.blogger.com/profile/10332172268371143329noreply@blogger.comtag:blogger.com,1999:blog-106825434973779887.post-13018738782178486602012-01-06T23:53:32.746-06:002012-01-06T23:53:32.746-06:00Dr. Stuppy you rock! We love the Facebook posts an...Dr. Stuppy you rock! We love the Facebook posts and blogs. Keep them coming!suz83https://www.blogger.com/profile/01654823403279197405noreply@blogger.comtag:blogger.com,1999:blog-106825434973779887.post-30487879123941181662011-10-11T21:18:46.000-05:002011-10-11T21:18:46.000-05:00Karen: I agree. There are many unsweetened cocon...Karen: I agree. There are many unsweetened coconut milks with fewer calories (but they vary widely). This just shows how important it is to read the label! DrSKristen Stuppy, MDhttps://www.blogger.com/profile/10332172268371143329noreply@blogger.comtag:blogger.com,1999:blog-106825434973779887.post-37521665149515727812011-10-11T21:01:31.760-05:002011-10-11T21:01:31.760-05:00This chart shows the nutrition info for canned coc...This chart shows the nutrition info for canned coconut milk that you would use in sauces, not the coconut milk that is sold in a cartoon by the soy milk. The stats for that are 5g of fat and only 80 calories.Karenhttps://www.blogger.com/profile/13548453495667638203noreply@blogger.comtag:blogger.com,1999:blog-106825434973779887.post-13812706026835480132011-10-11T20:26:19.895-05:002011-10-11T20:26:19.895-05:00Insurance is a frustrating subject from all points...Insurance is a frustrating subject from all points of view. It is so difficult to understand and even more difficult to try to explain! I'm glad you found this useful! DrSKristen Stuppy, MDhttps://www.blogger.com/profile/10332172268371143329noreply@blogger.comtag:blogger.com,1999:blog-106825434973779887.post-66251933169132819232011-10-11T20:07:25.451-05:002011-10-11T20:07:25.451-05:00This was a really useful article. Thanks for takin...This was a really useful article. Thanks for taking the time to write it. It's easy to only see things from our own point of view, so hearing about your issues and concerns as pediatricians can only be beneficial for everyonelucyannehttps://www.blogger.com/profile/13538147838701264079noreply@blogger.com